title: Finding the loopholes: a cross-sectional qualitative study of systemic barriers to treatment access for women drug court participants.
abstract: BACKGROUND
  Therapeutic diversion courts seek to address justice-involved participants' underlying problems leading to their legal system involvement, including substance use disorder, psychiatric illness, and intimate partner violence. The courts have not addressed systemic hurdles, which can contribute to a cycle of substance use disorder and recidivism, which in turn hinder health and wellness. The study purpose is to explore the systemic issues faced by women participants in drug treatment court from multiple perspectives to understand how these issues may relate to health and wellness in their lives.
  
  
  METHODS
  Qualitative thematic framework analysis of five separate focus groups consisting of female drug treatment court participants, community providers, and court staff (n= 25). Themes were mapped across the socio-ecological framework and contextualized according to social determinants of health.
  
  
  RESULTS
  Numerous systemic factors impacted women's access to treatment. Laws and legal policies (governance) excluded those who could potentially have benefitted from therapeutic court and did not allow consideration of parenting issues. Macroeconomic policies limit housing options for those with convictions. Social policies limited transportation, education, and employment options. Public policies limited healthcare and social protection and ability to access available resources. Culture and societal values, including stigma, limited treatment options.
  
  
  CONCLUSIONS
  By understanding the social determinant of health for women in drug treatment court and stakeholder's perceptions, the legal system can implement public policy to better address the health needs of women drug court participants.
authors.affiliation: University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd. Rochester NY 14642, USA ; University of Rochester School of Medicine, Women's Initiative Supporting Health Center for Community Health, 300 Crittenden Blvd. Rochester, NY 14642, USA.
authors.forename: Diane S
authors.initials: DS
authors.lastname: Morse
authors.affiliation: University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd. Rochester NY 14642, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Silverstein
authors.affiliation: University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd. Rochester NY 14642, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Thomas
authors.affiliation: University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd. Rochester NY 14642, USA.
authors.forename: Precious
authors.initials: P
authors.lastname: Bedel
authors.affiliation: University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd. Rochester NY 14642, USA ; University of Rochester School of Medicine, LIVV and Susan B. Anthony Center for Women's Leadership, 300 Crittenden Blvd. Rochester, NY 14642, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cerulli
keywords: And socio ecological model; Drug treatment court; Justice-involved women; Social determinants of health