Formerly Incarcerated Transition Program

Upon release from the state prison system, individuals are frequently without work, without health insurance, and without a medical home. The Formerly Incarcerated Transition (FIT) Program sponsored by UNC Family Medicine aims to connect all formerly incarcerated individuals who have a chronic disease with a primary care provider and a comprehensive reentry plan.

Community Health Worker with Client, photo credit Transitions Clinic Network

For formerly incarcerated individuals, successful reentry into the community depends on many factors, including access to housing, vocational training, and medical care. Currently, the state of North Carolina does not have a formal system to link people to medical care upon release from incarceration. This is especially important for people suffering from chronic diseases, such as diabetes, high blood pressure, kidney disease and mental illness. In fact, within the first 2 weeks of release from prison there is a 12 times higher risk of death for these individuals. 

What is the Formerly Incarcerated Transition Program (FIT)?

The FIT Program is designed to help address this gap in care. The FIT Program broadly collaborates with existing reentry providers across a wide spectrum of support services, primary health care providers  and the NC prison system. FIT program partners include the North Carolina Department of Public Safety (which administers the state prisons), Federally Qualified Health Centers, County Departments of Health,  and local reentry councils. The first FIT Program in the state was started in early 2017 in Durham County with partners including the Lincoln Community Health Center, The Durham County Department of Health and the Durham Criminal Justice Resource Center.  A Community Health Worker (CHW), themselves with a history of incarceration, makes contact with prisoners with chronic disease upon release or prior to release, and develops rapport and helps put together a comprehensive reentry plan. The CHW works directly with the formerly incarcerated individual after release to achieve successful reentry and specifically to facilitate connections with primary medical care, and if needed behavioral health and substance use treatment. The CHW will take them to medical appointments and help assure they have proper follow up and can obtain their medications.

The FIT Program, with support from The Duke Endowment, has been able to expand to Orange County and will begin serving clients in early 2018.

The FIT Program is based on a model developed by the Transitions Clinic Network (TCN) and continues to collaborate with TCN is program development and expansion. Transitions Clinic Network programs have been successful in other parts of the U.S. and have decreased rates of hospitalization and emergency room use.

How is the FIT Program Funded?

Most formerly incarcerated people do not have health insurance upon release. Through private donations the FIT Program provides funding to cover the office visit and medication costs of clients when other support is not available. Office visits at Community Health Centers are $20-$30 and medications cost between $4-$20 per month per medication. Funding for the Community Health Workers has been supported by the NC Department of Public Health, Both the Durham and Orange County Health Departments, and a grant from The Duke Endowment.

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UNC Family Medicine
FIT Program 

Please consider making a donation. Formerly incarcerated people face multiple barriers to care and this program can really make a difference in their lives.

Thank you for your support!