New study shows linkage facilitation models utilizing peer navigation reduce substance use and increase treatment engagement among women

Findings from the Kentucky JCOIN Clinical Research Center

A recent study from JCOIN’s Kentucky clinical research center found that linkage facilitation interventions that utilized telehealth alone and in combination with peer navigators improved treatment outcomes for justice-involved women with opioid use disorder (OUD) leaving jail.

Two women talking over a café table with a window view.

Linkage facilitation is an approach designed to enhance coordination and connections to services for individuals returning to the community after incarceration. Findings show that individuals who received the interventions were more likely to participate in any type of treatment within the first three months post-release from jail compared to those who received standard care only.

Incarcerated women face complex challenges during reentry, including returning to relationships or household environments where others may be actively using drugs, stress associated with resuming childcare responsibilities or navigating reunification with children, and insufficient access to employment, housing, or financial stability. Most prior studies on medications for opioid use disorder (MOUD) and incarceration have focused on male or mixed-gender samples, leaving critical gaps in understanding how to support women effectively (Clark-Moorman, 2025; Staton et al., 2024).

“This study offers new opportunities for treatment linkages for incarcerated women,” said Dr. Michele Staton, lead author and professor at the University of Kentucky. “Our findings suggest that interventions like peer navigation may support better substance use outcomes during this critical period.”

The Kentucky JCOIN team sought to address this gap by evaluating interventions designed to improve care, coordination, and service delivery by connecting individuals with substance use disorder (SUD) to community-based treatment providers. This process, also called “linkage facilitation,” was a major focus of JCOIN’s 13 multisite clinical trials, which collectively prioritized linkage facilitation strategies to improve treatment continuity and reentry outcomes for individuals.

The Kentucky JCOIN team sought to address this gap by evaluating interventions designed to improve care, coordination, and service delivery by connecting individuals with substance use disorder (SUD) to community-based treatment providers. This process, also called “linkage facilitation,” was a major focus of JCOIN’s 13 multisite clinical trials, which collectively prioritized linkage facilitation strategies to improve treatment continuity and reentry outcomes for individuals.

This study evaluated two telehealth linkage facilitation models compared to standard jail treatment practices (no telehealth and no linkage facilitation), with the goal of advancing connections to services following release from jail and helping to bridge a critical gap in care during reentry. The study included 900 incarcerated women with OUD across nine Kentucky jails who were eligible for release from jail within 7-60 days. Of those, 600 participants were recruited from jails’ general populations and randomly assigned to receive one of the two interventions. Notably, at the time of study implementation, these individuals were not receiving any SUD services during incarceration due to many Kentucky jails only offering SUD treatment programs for men but not for women. The two interventions included:

  • Telehealth-Only Group (n=299): Participants met virtually with a community-based treatment provider before release to complete an assessment, learn about MOUD, and develop a reentry plan for ongoing SUD care. No additional support was provided post-release.
  • Telehealth + Peer Navigation Group (n=301): In addition to receiving the same provider telehealth sessions as the Telehealth-Only Group, these participants also received an additional virtual telehealth session with a Peer Navigator—women who are in long-term recovery, have prior experience with SUD treatment, have a history of justice-system involvement, and are certified peer support specialists—during incarceration. These Peer Navigators provided additional support by helping identify reentry barriers and needed resources to support treatment engagement. Participants in this intervention group also had access to up to 12 weekly phone-based recovery support sessions with the Peer Navigator post-release. These sessions focused on personal goal-setting and practical, strengths-based strategies for recovery, including strategies to maintain recovery/remission, accessing safe housing, financial counseling, job skills, and sober social activities.

The remaining 300 participants (the “treatment-as-usual” group) were recruited from four jails that already provided SUD treatment services for women (a six-month modified therapeutic community program) at the time of study implementation. As part of the “treatment-as-usual” regimen, participants had the option to start naltrexone—one of the FDA-approved MOUDs—before release and receive referrals to community-based treatment for ongoing injections post-release. These individuals did not receive telehealth sessions or linkage facilitation services during the study.

All participants completed follow-up interviews conducted at three months post-release. These asked whether participants engaged in any type of SUD treatment since jail, received any type of prescribed MOUD, and the number of days in which they had used any type of substances. Findings from the study showed limited significant differences between the two intervention groups (Telehealth-only or Telehealth + Peer Navigation). Therefore, the researchers combined these groups into a single “intervention group” when comparing many of the outcomes to the “treatment-as-usual” group.

Key findings include:

  • Treatment engagement post-release: Participants who received either intervention were more likely to engage in any form of SUD treatment within three months of release (49.1%) compared to the “treatment-as-usual” group (35.1%).
  • Intervention Effects: Participants in the Telehealth + Peer Navigation group had 2.4 times greater odds of engaging in SUD treatment compared to the treatment-as-usual group.
  • Peer Navigator Contact: Completion of more sessions with a Peer Navigator correlated with significantly fewer days of substance use, including opioid use specifically, during post-release.
  • Community Supervision: Women under community supervision (probation or parole) were more likely to enter both SUD treatment and MOUD treatment post-release compared to women who were not under supervision, regardless of the intervention group.
  • Predictors of Engagement: Prior experiences with MOUD and other forms of SUD treatment were associated with increased odds of treatment participation after incarceration across all study arms.

Why Linkage Facilitation?

Linkage facilitation refers to efforts to connect individuals with community-based services and support, including addiction treatment, medical appointments, housing, transportation support, and other needs (Hogue et al., 2024). Facilitated linkages to these types of services can be especially critical for justice-involved individuals returning to the community to support successful reentry outcomes (Satcher et al., 2024). JCOIN identified linkage facilitation as a key research priority to strengthen treatment continuity and reduce overdose risk during reentry.

This summary highlights select findings from the 2025 publication, Outcomes Following Two Models of Treatment Linkage Facilitation for Women with a History of OUD Following Jail Release, authored by Dr. Michele Staton, Dr. Martha Tillson, Douglas Terrill, Dr. Carrie Oser, Dr. Carl Leukefeld, Dr. Laura Fanucchi, Dr. Kathryn McCollister, Dr. Megan F. Dickson, Erin Winston, Jaxin Annett, and Dr. J. Matthew Webster, and published in the Journal of Substance Use and Addiction Treatment.

To read the full study, visit:https://doi.org/10.1016/j.josat.2025.209702

The Article

Staton, M., Tillson, M., Terrill, D., Oser, C., Leukefeld, C., Fanucchi, L., McCollister, K., Dickson, M. F., Winston, E., Annett, J., & Webster, J. M. (2025). Outcomes following two models of treatment linkage facilitation for women with a history of OUD following jail release. Journal of substance use and addiction treatment,174, 209702. https://doi.org/10.1016/j.josat.2025.209702

References

Clark-Moorman, K. (2025, January). Formerly incarcerated women and reentry: Updated trends, challenges, and recommendations for research and policy. National Institute of Justice. https://www.ojp.gov/pdffiles1/nij/310062.pdf

Hogue, A., Satcher, M. F., Drazdowski, T. K., Hagaman, A., Hibbard, P. F., Sheidow, A. J., Coetzer-Liversage, A., Mitchell, S. G., Watson, D. P., Wilson, K. J., Muench, F., Fishman, M., Wenzel, K., de Martell, S. C., & Stein, L. A. R. (2024). Linkage facilitation services for opioid use disorder: Taxonomy of facilitation practitioners, goals, and activities. Journal of substance use and addiction treatment, 157, 209217. https://doi.org/10.1016/j.josat.2023.209217

Satcher, M. F., Belenko, S., Coetzer-Liversage, A., Wilson, K. J., McCart, M. R., Drazdowski, T. K., Fallin-Bennett, A., Zaller, N., Schultheis, A. M., Hogue, A., Vest, N., Sheidow, A. J., Del Pozo, B., Watson, D. P., Hibbard, P. F., Stevens, R., & Stein, L. A. R. (2024). Linkage facilitation for opioid use disorder in criminal legal system contexts: a primer for researchers, clinicians, and legal practitioners. Health & justice, 12(1), 36. https://doi.org/10.1186/s40352-024-00291-8

Staton, M., Tillson, M., Levi, M. M., Webster, M., Oser, C., & Leukefeld, C. (2024). Screening Incarcerated Women for Opioid Use Disorder. Journal of drug issues, 54(1), 57–73. https://doi.org/10.1177/00220426231151595