Returning to the community after incarceration is a process filled with challenges – finding a job, finding a place to live, reconnecting with the remnants of a former life. For many formerly incarcerated individuals, this return is made even more difficult by chronic health problems like diabetes, kidney disease, or mental illness.
But because there are so many other obstacles to overcome, these individuals are often unable to access the kind of health care that they require and simply go without regular care.
Evan Ashkin, MD, a professor of family medicine at the UNC School of Medicine, has founded the Formerly Incarcerated Transition (FIT) program to help chronically ill former prisoners who have recently been released connect with primary care medical services that they can access regularly.
Ashkin saw the need for a program like FIT while working at Piedmont Health Services’ Prospect Hill Community Health Center, which serves vulnerable populations in the community.
“Patients were coming into the clinic that hadn’t seen a primary care provider for long periods of time, more than two years in some cases,” Ashkin said. “Many had diabetes and other chronic conditions that required regular clinic visits.”
These patients often told a similar story: after being released from prison, they had no health insurance, no access to free care, and no program linking them to medical services in the community. And without supports like these, they had simply gone without care.
“It had never occurred to me that someone with a chronic illness would be released from prison without a way to connect with a provider,” said Ashkin.
Success for formerly incarcerated individuals depends on many factors: access to housing, vocational training, and medical care. Currently, the state of North Carolina has no formal system linking people to medical care upon release from incarceration, and the burden of this absence rests most heavily on the chronically ill.
Continuity of care is especially important for people suffering from chronic diseases such as diabetes, high blood pressure, kidney disease, substance use disorder and mental illness. Receiving regular care for chronic conditions has been shown to reduce hospitalizations and prolong life for the patient. Direct and timely connection to medical care is essential as there is a 12 times higher risk of death in the first two weeks after release from prison. Continuity of care for chronic illness also reduces overall health care costs, which means in most cases it would cost the state less to provide regular primary care visits than it would to provide catastrophic care to those without consistent access to a provider.
Working in partnership with the Durham Criminal Justice Resource Center, the Lincoln Community Health Center, and both the Durham and North Carolina Departments of Health, Ashkin launched the FIT pilot program in Durham based on the national Transitions Clinic Network model.
The Transitions Clinic Network was founded at the University of California, San Francisco to tackle the very same problem Ashkin hopes to solve with FIT – offering health services to those recently released prisoners with chronic health issues.
Transitions Clinic Network also trains formerly incarcerated individuals to become community health workers who are then able to assist others successfully reenter the community by linking them to care and helping them find housing and job training.
This past February, FIT hired one such community health worker, Torrey Green, to begin assisting clients. Torrey – who splits his time between offices in the Durham Health Department and the Durham County Criminal Justice Resource Center – helps those transitioning back into the community navigate the sometimes rocky terrain of health care. He also helps connect individuals to additional resources available in the Durham area.
Not only are FIT clients dealing with one or more chronic conditions, they also often face food, housing, and job insecurity.
“These guys that come into my office face so many hurdles,” Green explained. “What I do, what FIT does, is take one very important thing off their plate.”
Green was raised in a low-income neighborhood in Durham and turned to selling drugs when times were tough. Though never incarcerated, he had a misdemeanor drug charge on his record that made it difficult to get or keep a desk job. A life-long Durham resident, he has watched many in his community cycle through the “revolving door” of incarceration.
Green eventually turned to community work as a way to help others turn their lives around, volunteering with organizations such as Bull City United, an outreach program that reaches out to individuals affected by violence and encourages them to resolve their conflicts peacefully.
“For those working to make FIT happen, this isn’t just a paycheck job,” Torrey said. “It’s people who really care, trying to make a difference.”
The FIT program has privately raised funds for a voucher system: providing former inmates with vouchers that can be used as payment for clinic visits and medications at local care providers, such as Lincoln Community Health Center. FIT reimburses these clinics with program funds for vouchers that have been redeemed.
In May 2017, the FIT program received a $340,000 grant from The Duke Endowment, a private foundation based in Charlotte. With these funds, Ashkin plans to expand the FIT program to Orange County where it will work in partnership with the Orange County Health Department, the Orange County Criminal Justice Resource Office, and Piedmont Health Services.
The North Carolina Department of Public Safety, which runs the prison system, is keen to spread this model even further with help of groups like FIT. The North Carolina Community Health Center Association, under the leadership of CEO Ben Money, is also actively involved in helping to develop the FIT model here in North Carolina.
FIT is just getting started. The problems it tries to help overcome are daunting, but Green and Ashkin nevertheless remain hopeful.
“Every year in North Carolina, more than 20,000 people are released from state prisons and they’re not given any transition help related to health care; no wonder there’s a revolving door,” Green said. FIT bridges the gap between the help formerly incarcerated individual are currently receiving and what they need to be successful.
Providing health care to this especially vulnerable population more effectively is a statewide challenge and Ashkin is hopeful that the FIT program will expand throughout North Carolina. According to Ashkin, providing continuous care for former prisoners is both a moral and an economic responsibility.
“I think we have a societal obligation to help formerly incarcerated people become productive, fulfilled members of the community,” said Ashkin. “But even from a purely economic standpoint, linking people with chronic illness to medical care and preventing serious medical complications is a public health priority.”
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Heather Wilson is a communications specialist in the department of family medicine at UNC.