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NC FIT LogoThe North Carolina Formerly Incarcerated Transition (FIT) Program coordinates with existing state and local resources to assist people coming out of incarceration with connections to essential medical services. A specially trained Community Health Worker (CHW), with prior justice system involvement, acts to coordinate services. FIT CHWs connect eligible clients with chronic disease, mental illness, and/or substance use disorder to appropriate health care services and helps put together a comprehensive reentry plan working with local reentry partners. The mission of the FIT Program is to empower community members upon their return from incarceration to become self-sufficient and to reach their health and wellness goals.

The FIT Program of Wake County is based out of the UNC REACH Enhanced Primary Care clinic (formerly UNC WakeBrook Primary Care) at 401 E. Whitaker Mill Road, Suite 2100, Raleigh, NC. Our community partners in Wake County include Advance Community Health, Oak City Cares, and SouthLight.

Who is eligible?

To be eligible to participate in the FIT Program, individuals must meet all of the following criteria:

  • Released from incarceration (jail or prison) within the past two years
  • Experiences a chronic medical condition and/or mental illness
  • Adult resident of/or returning to Wake County
  • Desires to actively participate and work with a FIT CHW

Health Services

  • Establish a primary care medical home
  • Support with obtaining and managing medications
  • Coordinate referrals to mental health/behavioral health services and substance use disorder treatment
  • Link to wellness resources such as nutrition coaching and tobacco free programs, among others

FIT Wellness

FIT Wellness is a unique program in the Wake County FIT Program that focuses on people with severe mental illness (SMI). Funded by a grant from the NC Department of Mental Health, FIT is able to offer continuity Psychiatric care for people with SMI released from state prisons and coming to Wake County. Participants work with a FIT CHW dedicated to this effort that assists them in a comprehensive reentry plan and coordinates their care at UNC REACH Enhanced Primary Care. At this clinic, they see a Psychiatrist that also works in the prison system, and they become established with a primary care provider for medical needs.


For referrals to the FIT Program of Wake County, please email to request the current FIT Program Referral Form and Release of Information. After referral forms are received and reviewed, FIT CHWs will outreach to clients to assess eligibility, medical needs, and interest in the program.