Social Determinants of Reintegration and Continuity of Care among Justice-Involved Youth with Substance Use Disorders: A Metasynthesis

CONTINUITY OF CARE AND SOCIAL DETERMINANTS OF REINTEGRATION AMONG JUSTICE-INVOLVED YOUTH WITH SUBSTANCE USE DISORDERS: A QUALITATIVE EVIDENCE SYNTHESIS Abstract Background: Reintegration among justice-involved youth with substance use disorders (SUD) remains a persistent public health and drug policy challenge, with high rates of relapse and recidivism linked to fragmented service systems and disrupted care transitions. Existing evidence has largely emphasized program effectiveness, with limited attention to system-level determinants shaping reintegration outcomes. Objective: This qualitative evidence synthesis (QES) examines how continuity of care and social determinants of health (SDOH) influence reintegration and aftercare outcomes among justice-involved youth with SUD, situated within international rehabilitative frameworks. Methods: Guided by the Cochrane Qualitative and Implementation Methods Group framework and reported in accordance with PRISMA 2020, qualitative findings were synthesized using the Joanna Briggs Institute meta-aggregative approach (JBI-QARI). Eight studies (n=217 participants) were included from 3,231 records across PubMed, PsycINFO, EBSCOhost, MEDLINE, ProQuest, and ScienceDirect (2012–2022). Studies spanned North America, Europe, Africa, and Southeast Asia, reinforcing the international scope and policy relevance of findings. Results: Reintegration trajectories were shaped by access to core social determinants, including housing, education, healthcare, and employment. Continuity of care emerged as the central integrative mechanism linking custodial treatment to community-based recovery, particularly during high-risk transitions. Fragmented aftercare and service discontinuities were consistently associated with relapse, disengagement, and recurrent justice system contact, whereas family engagement and cross-sector coordination enabled sustained reintegration. Conclusion: Reintegration is a system-level process mediated by structural conditions rather than individual-level factors alone. Policies that fail to embed social determinants within integrated, cross-sectoral systems and advance a continuity of care risk perpetuating cycles of relapse and re-incarceration. Keywords: continuity of care, social determinants of health, juvenile justice, substance use disorders, health equity, aftercare Competing Interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding Sources: This research project received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authorship Declaration (CRediT): All authors hereby affirm that each has made a substantial contribution to this work, has reviewed and approved the final version of the manuscript, and consents to its submission. The authors further declare that this work is original, has not been previously published, and is not under consideration for publication elsewhere. Dr. Mejia ([e-mail]; [phone]) serves as the corresponding author and assumes responsibility for all communications. JUT: Conceptualization, Validation, Formal analysis, Data curation, Writing – original draft/final, Visualization NBP: Conceptualization, Methodology, Validation, Investigation, Data curation, Writing – review & editing PGM: Methodology, Formal analysis, Data curation, Visualization; Supervision, Project administration RBH: Conceptualization, Software, Investigation, Writing – review & editing