Perspective Chapter: Racial Equity and Community Reintegration and Support in Pennsylvania

Abstract

The Racial Equity and Policy Framework provides theoretical guidance on understanding the impact of race on the experiences of individuals with substance use disorder, former incarceration, and mental health needs community integration and several key resources available to support them in the state of Pennsylvania. This work is part of a broader project and commitment to study of racial equity and community integration to understand the availability of resources and needs of constituents in the state. The Racial Equity and Policy Framework helps to contribute to discussions on the integration of race and equity, and the lack thereof, in the service of constituents, and to identify where there is a need to raise questions. The chapter concludes with recommendations for policy and practice.

1. Introduction

This book chapter focuses on perspectives about the role of racial equity and community support and reintegration in Pennsylvania. A health-focused racial equity based framework [1] provides theoretical guidance on observations of current literature and published reports on issues that impact policies and practices on the experiences of individuals with substance use disorder, former incarceration experiences, and mental health needs. These perspectives are supported by my professional reflections of work in community reintegration programs and as a resident of the state of Pennsylvania in review of publications about the need for racial equity. In this chapter community reintegration is identified as an intervention and solution to providing support in local communities for Pennsylvania residents with substance use disorder, former incarceration, and mental health needs. Community reintegration involves governmental infrastructure to provide resources to help constituents access a variety of services and navigate systems of support at the federal, state and local levels. Publications about state and local resources provide important knowledge on the characteristics of racial equity and community reintegration. This includes state and local level reports and action plans that currently influence the daily lives of constituents.

A significant issue in community support is the viability of racial equity of community support reintegration of individuals who experience trauma related to: drug addiction and abuse, a former incarcerated status, and a history of mental health issues and institutionalization in the state of Pennsylvania. This project will focus on increasing awareness of racial equity in their leadership in community development in Pennsylvania within these three main topic areas and discuss best practices in their work that improve the circumstances of individuals within their communities.

The goal of this theoretical work is two-fold: to contribute to discussions on the importance of racial equity and community support and reintegration within the state, thereby increasing awareness of racial equity within the Department of Human Services. Additionally this work serves to increase awareness about the importance of racial equity in leadership specific to community support and reintegration programs and efforts within Pennsylvania.

The questions guiding this study include: In what ways has the Pennsylvania Department of Human Services advanced racial equity in the leadership of community development? In what ways is racial equity evident in community reintegration and support efforts in the state of Pennsylvania? This chapter addresses work within the Department of Human Services currently focused on the advancement of racial equity through collaboration and supportive dialogue, research, and resources on the importance of increasing awareness and representation of voices and experiences from various racial and cultural backgrounds. Furthermore, the specific focus on racial equity in the leadership of community support and integration allows for participation in this discussion from leaders of various programs and efforts within the state. This work serves to raise awareness about the vital importance of community support and integration for individuals faced with drug addiction, the challenges associated with the former status of incarceration, and the effects of institutionalization for those experiencing mental health crises. In addition to pool publications, this work intends to discuss community support and reintegration programs throughout the state, in both urban and rural areas in an effort to partner in collaboration with other practitioners, scholars, advocates, and activists within the state to identify best practices for community development.

2. Racial equity and policy [REAP] as a theoretical framework

In choosing a theoretical framework to examine the topics for this chapter it is important to consider the broader context of influence on racial equity and leadership. Several states have enacted legislation to ban the study of race and use critical race theory in education. While Pennsylvania has been involved in discussions on racial equity and leadership, to include a report referenced in this chapter, consideration of legislative bans on the use of race is necessary as an act of advocacy to ensure active use of racial equity principles. The Racial Equity and Policy Framework, REAP [1], is a tool for facilitating engagement with insights of policy processes to understand ideas, events, networks, and contexts shaped by institutions and actors. As a health-equity based framework, REAP is wide-reaching in scope and appropriate for the topics in this chapter as each one is relevant to issues of health and wellness and many others issues disproportionately affecting socially, culturally, and economically diverse communities [1]. Thus, for the purpose of this chapter select issues addressed in the framework help to inform what is known about drug addiction, incarceration, and mental health disparities in Pennsylvania.

For instance, in the discussion on drug addiction the impact of the open air drug market on the community is widely debated with particular emphasis on activities in the Kensington area of Philadelphia. To further understand the need for racial equity I ask readers to consider: In what ways is racial equity considered for the purpose of community support and reintegration? Additionally, for those in the community that are formerly incarcerated, how is racial equity considered in community support and reintegration initiatives? In consideration of the mental health issues associated with drug addiction and incarceration, in what ways is racial equity considered in the advocacy for those seeking treatment in Pennsylvania? Though there are a myriad of programs and initiatives that focus on these issues throughout the state, the goal of this chapter is not meant to be an exhaustive study, rather a chance to highlight some of these issues to contribute to the broader discussions on racial equity and community support. Perspectives in this chapter can be considered in broader discussions on racial equity and community integration.

REAP [1] informs on how, where and when to raise critical questions about the challenge to facilitate racial equity as it relates to the disproportionality, decentralization, and voice of the community. For the issues discussed in this chapter there is an emphasis on identifying resources where there are perspectives on structural racism and behavioral responses by individuals who can benefit from improvements in racial equity. The use of major research reports, peer-reviewed articles, and publications from the State of Pennsylvania offer critical insights for understanding the implementation of racial equity strategies.

2.1 Racial and health equity and positionality statement

The Covid 19 Pandemic “exposed a depth of racial injustice entrenched in American social, economic, and political life.” [2]. It also highlighted significant health inequities due to structural racism^.[3]. For the last two decades, and beyond, at the center of community support and reintegration efforts for individuals with substance use disorder, experience with incarceration, and mental health needs are institutions and actors working within structurally racist systems. Interrogating systems of structural racism is critical to facilitating racial and health equity. For example, reports like Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare [3] raise questions about the importance of the availability of support strategies within these systems that facilitate community integration by a healthcare industry that is representative of the constituents it serves. It asserts the importance of an increase in racial equity through the hiring, and retention, of a racially and ethnically diverse workforce. It also suggests the importance of interventions that ensure individuals who are in need of community reintegration support are able to navigate systems that are designed to support them. This involves collaboration across multi-levels of actors that includes health systems where individuals in need of care seek treatment.

This work identifies where racial equity is considered in community reintegration interventions in literature focused on Pennsylvania and efforts to support individuals with substance use disorders, former incarceration experience, and those with mental health needs. This work, Racial Equity and Community Reintegration and Support in Pennsylvania, builds on findings from the Pennsylvania Department of Human Services Racial Equity Report: Leading the Fight for Justice, Equity and Opportunity for All People Report [4] that identifies diversity equity and inclusion, and economic justice as priorities in community development work. According to the report, the Department of Human Services is a large employer in The Commonwealth employing more than 16,000 employees and provides a knowledgeable base for understanding the complexities of public-facing work in these topic areas within communities across the state of Pennsylvania. The report calls for an increase in representation in racial equity to improve service and support of the demands from constituents that represent a wide variety of ethnicities and experiences in the state of Pennsylvania.

2.2 Positionality statement

As a resident of Pennsylvania, I have a particular interest in studying the issue of community reintegration and support. I have witnessed the role of support for community reintegration in substance use disorder and recovery and have seen the importance of interventions and the need for racial equity. For example, in Philadelphia, there are observable situations of disproportionality, decentralization with substance use disorder in what is considered an “open air drug market” [5] where an increase in racial equity in the voices that are heard on this topic has been addressed. Furthermore, understanding the resources available to support the study of the topic of racial equity is critically important to any long term commitment to community reintegration as an intervention.

3. Literature on REAP and community support and reintegration in Pennsylvania

The literature specific to the concept of community support and reintegration in Pennsylvania on the constituents highlighted is sparse. A review of literature on this topic yielded various reports on statistical portraits on substance use disorder, former incarceration, and mental health needs. Additionally, articles on health equity underscore the importance for additional study to understand the experiences of constituents and their need for support. To address the limitations of the book chapter, observations of literature are included on each topic. Additionally, while reports indicate that long-term strategies of care are a priority, more information on the role of community integration is needed.

3.1 Support for substance use disorder in Pennsylvania

Substance use disorder is a priority in racial equity efforts in the state of Pennsylvania Department of Human Services and is addressed in its health equity and economic justice initiatives [4]. A major focus of facilitating these initiatives is access to data on individuals in need of support and identifying efficient community development strategies to administer services. The American Psychological Association defines Substance Use Disorder, also known as SUD as:

“excessive use of a substance, including: alcohol; tobacco; opioids; caffeine; cannabis; hallucinogens; inhalants; sedative, hypnotics, or anxiolytics; stimulants (e.g., amphetamine, cocaine); and more. Various mental health conditions, such as depression, may co-occur along with substance use disorder.” [6]

The Department of Human Services has advanced racial equity through the development of a report focused on the topic of racial equity. The declaration of a commitment is a crucial first step in the advancement of racial equity. The report informs readers on the practices of community development by identifying ways DHS has implemented strategies to improve social services like housing, job readiness and support for childcare. The report acknowledges more work needs to be done to serve the most vulnerable constituents in Pennsylvania and identified the development of racial equity as a priority. According to the Pennsylvania DHS, racial equity in SUC is considered in factors contributing to long-term physical, behavioral, and social determinants across multi-levels of services, supports, and programs with a focus on trends in racial gaps. The Substance Use and Mental Health Services Administration, also known as SAMHSA [7], reports from a national 2021 survey the percentage of individuals aged 12 and older with substance use disorder was highest among young adults aged 18–25 (25.6% or 8.6 million people), followed by adult aged 26 or older (16.1% or 35.5 million people), then by adolescents aged 12–17 (8.5% or 2.2 million people).

In applying the REAP [2] Framework to the issue of disproportionality in substance use disorder in Pennsylvania there are several priorities for increasing racial equity and community integration support. First and foremost, there is a need for racial equity within the leadership of DHS. Disproportionality typically refers to the way resources are allocated thus it is important to note that when there is a lack of racially equitable leadership this influences the decision-making about resources. While the report indicates there is ongoing work to consider how to improve and increase racial equity in leadership, in future work, there should be consideration for the ways strategies for community reintegration are included in the development of leadership. Second, disproportionality affects Black and Brown communities who are in need of support for substance use disorder more than their white counterparts. In response to this disparity, there is a commitment to infrastructure to support activities that can facilitate community integration. This includes initiatives that focus on health equity. These initiatives do not specifically address substance use disorder, though issues like increasing employment and training/skills development programs, and legal aid that helps individuals stay in their homes, thus, helping them to remain in the community.

In terms of decentralization, the case example of Kensington where there is a specific strategy to implement policies specific to substance use disorder, particularly in open-air drug markets as noted in the 2021 Executive Order 1–24 Declaring a Public Safety Emergency and Action Plan [8]. There have been commitments to support racial equity leadership to facilitate these initiatives that involve community feedback and welcomes the voice of the community. Pennsylvania DHS is committed to facilitating discussions with constituencies across the state to support a commitment to diversity, equity, inclusion and anti-racism. Open and honest dialogue about the experiences of individuals with substance use disorder must include activities that foster community integration.

3.2 Support for the incarcerated and formerly incarcerated

The Pennsylvania Department of Human Services advances racial equity by addressing several community integration activities that support individuals who have been formerly incarcerated. In particular, its focus on economic justice addresses food and housing insecurities and is supportive of the needs of individuals who have been formerly incarcerated. The PA DHS report does not specifically address formerly incarcerated populations, though its work to identify the needs of the homeless, those in need of housing aid and access to social services, and education are areas where individuals participating in state/city-wide reentry programs could be most vulnerable and this work continues to both inform and represent practices of community development. More research is needed to fully understand how the work of economic justice contributes to efforts of community reintegration.

The disproportionality of formerly incarcerated persons reveals glaring inequities in needs for employment and challenges with joblessness. The Prison Policy Initiative [9] citing data by the Bureau of Justice Statistics, reports that in 2010, nationwide, more than 50,000 people were released from prison. Yet, from this number:

“a staggering 33% found no employment at all over four years post-release, and at any given time, no more than 40% of the cohort was employed. People who did find jobs struggled, too: Formerly incarcerated people in the sample had an average of 3.4 jobs throughout the four-year study period, suggesting that they were landing jobs that didn’t offer security or upward mobility.” [9]

The work of economic justice in Pennsylvania considers the roles of multiple programs doing work to support the needs of this population. Identifying the ways to collect data on the impact of the programs continues to be a huge challenge. It is important to note the work of community integration as a way to help formerly incarcerated persons navigate access to services is vital to their overall success. Work to support the formerly incarcerated in Pennsylvania remains a concern with efforts to address the challenges this population faces on several levels. First, there is a state-wide acknowledgment of racial inequity and the racial violence that ensues as a result. PA DHS acknowledges “historically undervalued and underserved communities” [4] as a priority and is committed to broadening discussions about their needs and the resources available to help them. Second, there is a similar focus available in local city government in the state. Included in the 100 Day Action Plan [5] Initiatives for The City of Philadelphia, an intergovernmental task force serves to decentralize power to work collaboratively on issues affecting the formerly incarcerated within the community. For formerly incarcerated communities to thrive, a plan for community reintegration can make a positive impact on long-term success for increasing racial equity.

Both at the state and local levels the opportunity to include the voices of the community is an active strategy within the commitment for racial equity. The PA DHS report weighs heavily on this work as it is touted as the largest employer in the state with responsibilities that touch the daily lives of constituents. The report asserts the role of empowerment as an important practice in collaboration with the community. The work of this chapter asserts that practices and policies must also prioritize specific actions for community integration for long-term support of racial equity initiatives.

3.3 Support for individuals with mental health needs

The Department of Human Services in Pennsylvania has advanced Racial equity work in community support and reintegration of individuals with mental health needs as a key priority. Specifically, there is a health equity focus on the racial disparities of newborns in addition to the mortality rates of women giving birth with Black women dying in childbirth at rates three times higher than white women. And, Black newborns being 13 less likely to receive vital well-child medical care as noted in the PA DHS report. The mental health needs and trauma involved with the experiences are far-reaching with serious implications for ongoing racial equity work.

This disproportionality warrants a strong focus on policies and practices that facilitate the implementation of community integration strategies. Decentralization of the mental health needs for the constituents of the state are specifically addressed both at the state and local level in consideration of long-term racial equity needs. In Philadelphia, an intragovernmental seeks options for funding sources that can help to provide services for the most vulnerable citizens in need of mental health care. As this work continues it will be important to see how community integration is considered and implemented as a long-term priority of racial equity.

The voices of the community are priorities at the state and local levels in terms of resources reviewed on individuals with mental health needs. In reviewing this information more knowledge about the ways both the state and local governments will work together will serve to help amplify racial and cultural perspectives to understand the priorities and nuances of racial equity in the state.

4. Discussion

First and foremost it is important to note that community support and reintegration efforts are a work of progress in the State of Pennsylvania. A limitation of this chapter is its emphasis on the City of Philadelphia as a major contributor to The State and its economy. The City of Philadelphia 100-day Action Plan and Executive Order presented in this chapter illustrate examples of confronting challenges to racial equity and providing solutions to improve economic justice for its constituents. The intergovernmental approach to these efforts underscores Philadelphia as a major contributor to the state-level work on racial equity. Observations on services that facilitate community support and reintegration should be considered as guidance and not generalized to other cities and municipalities within The State. There are a few highlights to consider related to perspectives on racial equity and community support and reintegration as addressed in the resources considered thus far. First, the Pennsylvania Department of Human Services is a major contributor in the development of racial equity within The State.

While there is a focus on actions that align with REAP [2] collection of data remains a huge challenge in identifying the needs of constituents and priorities for racial equity and community support. Identifying opportunities that facilitate consistent data collection can help to streamline efforts. This includes collaborative use of data between state and local governments. Second, the concept of community integration may have not been fully actualized at the state and local levels, yet characteristics might exist. It is important to identify where progress is being made to build towards more complete and sustainable community reintegration plans. This involves explicit discussion of community integration strategies and implementation plans. Third, funding sources are needed to fully make racial equity and community integration a commitment to governmental infrastructure. Community integration needs to be included in any long-term racial equity plans.

The REAP [2] Framework helped to identify where racial equity and community integration existed and opportunities for further development. This framework can also be helpful in determining the needs for evaluation of ongoing racial equity and community integration efforts. For example, disproportionality, decentralization, and voice can be considered in how strategies for racial equity can be considered in defining community reintegration within an intragovernmental framework where discussion of community integration focuses on key principles across a variety of communities and contexts across the state. The process of how to include the voices of the community and when and where those voices are heard is vitally important to the success of racial equity and community integration. First-hand accounts and testimonials of experiences where racial and cultural perspectives highlight nuances of progress can help to identify where there is need for additional support.

5. Conclusion

The Pennsylvania Department of Human Services continues to make significant strides in the development racial equity work yet there continues to be more work to do to actualize concepts within the REAP Framework. There is evidence of community support and reintegration in Pennsylvania through efforts of economic justice, yet more work must be achieved to broaden this work within The State and in the application of initiatives with the most vulnerable constituents. As suggested in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care [10], an example like The City of Philadelphia is where challenges to economic justice are being confronted and new changes and perspectives can contribute to long-term positive effects of racial equity and economic justice.

Racial equity is a priority in communities where there are significant racial disparities and initiatives designed to improve experiences for constituents that are often most vulnerable [11]. The brief discussion in this chapter is focused on highlighting a few key areas where racial equity and community and community integration converge. There is more work that is needed to actualize racial equity. Racial equity is a practice/policy that needs to be prioritized within governmental infrastructure and this may involve highlighting the important work that has been, and is currently being done that may not be reported. Future work should consider ways to identify practitioners, scholars, advocates, and activists who are leaders in racial equity in a variety of disciplines and communities of practice to advance knowledge on its impact in community support and reintegration within The State.

Future work should emphasize the role relationship-building with key leadership within DHS along with identifying racial equity leaders. In addition, in collaboration with DHS, I will identify practitioners, scholars, advocates and activists who are leaders in community support reintegration programs and efforts within Pennsylvania with a focus on both urban and rural areas. There will be an emphasis on collaboration with leaders to address racial equity in counties where there is a lack of diverse leadership. As a resident of Philadelphia, I will continue to study the issue of community support and reintegration. I have personally witnessed the role of programmatic support of community support and reintegration in the process of drug addiction and recovery and look to increase knowledge in this area. I will work with identified leadership to develop a draft report that identifies their work priorities and initiatives focused on racial equity and key resources used. I intend to review this report with key leadership and constituents and to review the feedback to be informed for a series of focus groups and site visits to community support reintegration programs. There will be preparation for the discussion of best practices in the next phase of the project to include a series of podcast interviews with racial equity leaders of community support and reintegration programs and efforts.