With a rapidly changing policy landscape, states are seeking to build the infrastructure to effectively connect individuals reentering the community from incarceration with health and social services. Policymakers are seeking to engage people with lived experience of incarceration in informing program design and implementing reentry transitions. To inform those efforts, NASHP hosted a cross-policy discussion for states participating in NASHP’s Community Health Worker (CHW) Learning Collaborative and Reentry Learning and Action Network. The meeting brought together state officials from Medicaid, public health, corrections, and other agencies to discuss challenges and best practices for engaging the CHW workforce for programs that support justice-involved individuals. The conversation featured three programs that bring lived expertise to interventions supporting individuals reentering the community from incarceration.
Transitions Clinic Network
Transitions Clinic Network (TCN) is a national nonprofit supporting capacity building and system transformation in primary care health systems to address the complex health needs of people returning from incarceration. Its network of community-based clinics includes 48 sites — in Alabama, Arkansas, California, Connecticut, Louisiana, Massachusetts, Minnesota, New York, North Carolina, Puerto Rico, Rhode Island, Texas, Washington, and Wisconsin — that have implemented the evidence-based program, which embeds CHWs with lived experience of incarceration in primary care teams. The TCN model was developed in collaboration with community-based organizations (CBOs) and impacted community members to address health disparities and improve health and well-being. Under the model, TCN hires and trains formerly incarcerated CHWs, along with primary care teams, to provide culturally competent patient-centered services. CHW services include conducting both in-reach into jail and prison, as well as outreach into communities to support continuity of care. CHWs also assist patients in navigating the health system, including health insurance, medication assistance, or specialty appointments, and social services, such as housing, employment, and education systems. In addition, CHWs provide emotional support, mentorship, and family reunification support, along with individual and system-level education and advocacy. CHWs also provide cultural interpretation for primary care teams.
Evidence shows that TCN programs have contributed to greater engagement with primary care services, reduced emergency department utilization and hospitalizations, and improved health and reentry outcomes for returning community members.
TCN Model Outcomes
A study at the San Francisco TCN site found a 51 percent reduction in overall emergency room utilization in a year compared with patients in standard primary care.
A study at the New Haven TCN site found that the TCN model reduces patients’ preventable hospitalizations by half, shortens hospitalizations by almost one day, and reduces technical violations of parole and probation that results in 25 fewer incarceration days in the first year after release.
A study at the Santa Clara TCN site found that attendance at the first medical appointment following jail release increased from 30 to 70 percent when patients met with a CHW prior to their release.
A study at the New Haven TCN site found that participants had lower criminal justice system costs compared to participants who received standard care, that participants’ Medicaid costs were similar, and that each dollar invested in the program yields $2.55 back to the state.
There are multiple legal, social, and administrative barriers to hiring CHWs with lived experience of incarceration. For example, some state laws prohibit hiring health workers with prior criminal convictions. In addition, employers may be inexperienced in successfully partnering with formerly incarcerated CHWs and may encounter significant administrative burdens related to payment and reimbursement for CHW services. States may evaluate their legal environment and collaborate with experienced community partners as they consider implementing these types of programs. TCN shared opportunities to invest in workforce development for formerly incarcerated CHWs to overcome employment barriers, including via Medicaid, general county funds, and grant opportunities.
Kansas
Through two programs supported by the Kansas Department of Health and Environment (KDHE), communities are engaging CHWs in reentry work and increasing the pipeline of CHWs with lived experience of incarceration. One program embedded a CHW into the Crawford County Jail to support people with behavioral health needs using a portion of Centers for Disease Control and Prevention health disparities and CHW 2109 grant funding. In 2023, the CHW provided 773 services to 112 clients, including running group life skills classes and working one-on-one to help clients navigate housing, transportation, employment, insurance, and other essential reentry service assistance. Of the 112 clients served in 2023, only one client was reincarcerated. Surrounding counties are currently working to replicate a similar program in their local correctional facilities.
The state also supports a CHW core curriculum training in the Topeka Women’s Correctional Facility, with the goal to train CHWs to be hired upon release. Identifying community organizations that would hire previously incarcerated individuals in these roles predated program enrollment and was essential to staff buy-in. Additionally, some women will be working as CHWs while incarcerated to provide preventive care and support medical providers in the prison. Thus far, 15 women have completed the training, with a waiting list of over 40 individuals for the next class. KDHE is currently applying to other grants and working across agencies to identify additional funding streams to support hiring of CHWs and expand the training to other correctional facilities across the state.
Alaska
The Community Justice Worker (CJW) Program was developed as part of a medical-legal partnership initiative led by the Alaska Legal Services Corporation (ALSC), Alaska Pacific University, and Alaska Native Tribal Health Consortium to embed civil legal aid within the state health care delivery system. The project is designed to respond to the disproportionate legal needs of Alaska communities that have significant lack of access to legal providers. Based on statewide community mapping of legal providers, social services, medical and information service providers, the project developed an analogue to the longstanding, village-based Community Health Aide Program (which evolved along with the Community Health Representative program).The CJW Program is supported by a Bar Rule 43.5 waiver, approved by the state Supreme Court, that permits non-lawyer advocates to provide certain legal services when supervised by a legal aid organization.
ALSC provides supervision and trainings modeled after trainings for community health aides/practitioners. The CJW Program recruits qualified non-lawyer volunteers such as paralegals, Tribal legal advocates, Tribal employees, village health aides, or law students to serve Alaskans who are unable to afford or access civil legal help. There are currently over 500 community justice workers who are undergoing or have completed training, located in 47 communities across the state, including many off the road system. CJW placement in remote areas enables ALSC to better match clients with local legal services, as most ALSC attorneys are in urban areas on the road system. CJWs have successfully advocated for individuals in administrative proceedings, drafted letters and other documents, and have provided legal information in court proceedings, ultimately contributing to positive outcomes for clients who may otherwise not have received legal help.
Looking Ahead
As pandemic-related funding is ending, states are developing sustainable financing approaches to maintain and grow access to CHW services and supports that have been so vital to reaching underserved communities. Simultaneously, recent policy changes at the federal and state levels to support justice-involved individuals provide an opportunity to more systematically partner with CHWs with lived experience of incarceration to augment team-based transitions to needed health and social supports that improve health and well-being and reduce recidivism. The models discussed here provide examples of initiatives that states can draw from.
NASHP will continue to convene state officials to learn about innovative strategies and promote best practices used to support their work via the CHW Learning Collaborative and the Reentry Learning and Action Network. Learn more about NASHP’s CHW and Reentry policy work on NASHP’s website.
