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At the heart of every policy change, every system overhaul, and every reform initiative are the lives of real people. There are the individuals who drive the systemic change forward and the individuals whose lives are fundamentally altered by its implementation.

Criminal justice reform is no different. As part of its national work to reduce jail populations across America since 2015, the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge (SJC) has affected people’s lives in real ways. By reducing reliance on jails, SJC makes it easier for people to be an active part of their families’ lives, work and go to school, all of which contribute to building safer communities and a more just society.

One area where the criminal justice system has lagged is in the health outcomes of incarcerated people. As part of broader efforts to address health system inequities, there is new focus on supporting the health needs of people who are transitioning from incarceration back into the community. Until now, the health care system for people who are incarcerated has been fragmented and inadequate. Many individuals struggled with the abrupt loss of Medicaid benefits during incarceration, leading to gaps in critical medical and behavioral health care at release from jail. These gaps often result in worsening health conditions, increased risk of death upon release (especially from overdose), difficulties securing employment and housing, and a higher risk of re-incarceration. The absence of coordinated care and support systems perpetuated cycles of instability and repeated contact with the criminal justice system.

Increasingly, states are leading efforts to use Medicaid to build continuity of care at release, and California is the first state in the nation to do so. California made history in January 2023 as the first state to receive approval from the federal Centers for Medicare and Medicaid Services (CMS) for a Medicaid Reentry Section 1115 Demonstration Opportunity. Ten additional states have recently been approved by CMS to implement their own, similar waivers and thirteen states have also proposed waivers. California’s efforts, the California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved Initiative, aim to ensure that people transitioning from incarceration back into the community receive continuous medical and behavioral health care. As of October 1, 2024, the first three California counties have gone live to provide prerelease services and behavioral health links. This marks a significant leap in addressing the complex health needs of individuals reentering the community, fostering unprecedented collaboration between criminal justice and healthcare systems.

But what does this change mean for real people, both individuals with lived criminal justice experience and the practitioners dedicated to their care?

“When medical benefits are hooked up, it can save lives,” said Joe Calderon, Manager of Recruiting and Training with reentry program Urban Alchemy, and a person with lived experience of incarceration, in San Francisco. “We’re talking about people who historically aren’t trustful of systems and who haven’t had access to medical [services]. When we have a program using community health workers, we’re able to bridge the biases that prevent people getting access to care.”

For individuals leaving incarceration, this change can be considerably life-altering. The CalAIM Justice Involved initiative intends to transform the reentry experience, moving from a fragmented and often inadequate system to one that prioritizes continuous care and support. Historically, individuals faced numerous challenges upon reentry. “We need to make the correct connections with the system. The CalAIM benefit being there is important, but we also need organizations to help build relationships so that people can show up for care,” Joe noted.

Under the new waiver, the landscape will change. Medicaid benefits will now become active prior to a person’s release, improving sustained access to necessary medications and medical supplies. Individuals will be provided with transitional care plans, including pre-release services and connections to community-based providers. The availability of support systems, such as case managers and continuity of access to health and behavioral health care, and housing assistance, aids individuals in rebuilding their lives. By enhancing the continuity of care during the critical transition back to the community, this initiative will not only improve health outcomes but also offer hope for breaking the cycle of incarceration.

“When it comes to medical benefits, the honey might be there to be accessed, but we need to help people get into the honeypot,” Joe acknowledged. “There are a lot of competing priorities around reentry and medical matters, and medical often gets forgotten.”

Others are more skeptical about the program and want to make sure that those implementing it avoid perpetuating inequities and acknowledge the system’s history of harm and broken trust.

“As a formerly incarcerated person, I know what it’s like to transition back into the community,” said Aminah Elster, CEO of Proximate Strategies Consulting. “For some people, I think CalAIM might be beneficial, but it’s only a small subset of those incarcerated. It only covers the last 90 days of incarceration.”

Earl Simms, CEO of Restorative Community Solutions and a person with lived carceral experience, has been involved in some of the discussions about CalAIM over recent months.  He has concerns about the system’s ability to build the trust needed to successfully implement these changes. “I think the continuity of care idea is amazing,” he said. “But we need to be careful not to be too excited about this program because we need to have trusted, credible messengers involved in managing the delivery.”

It’s crucial to remember that at its core, this initiative is about people – particularly the people who will experience these transformative changes. The advisory insight from people with lived expertise can make a tangible impact on the efficacy of the innovations practitioners are making. However, to do this, practitioners must make a dedicated effort to consistently seek, incorporate, and uplift these voices at various stages of the implementation process. Earl’s concerns about credible messengers are important to take into consideration. “I’ve not seen the brainstorming around the new program include more voices like mine, I’ve not seen people with lived experience included in thinking about where the gaps might be. It would be good to have an oversight committee including people with lived experience to help us course correct when things go awry.”

The implementation of the Medicaid 1115 reentry waiver represents a shift in how we approach health care for justice-involved individuals that recognizes health care as a crucial component of successful reentry. It hinges not just on the policy changes, but on the human connections and systems built to support these changes. Practitioners across criminal justice and healthcare fields, including county health, jail operations, correctional health, and managed care plans, are forging new relationships and developing communication pathways that were previously minimal or non-existent. This collaboration between justice and healthcare practitioners, along with the involvement of individuals with lived expertise, also helps to create a system that is informed by the people they aim to serve. Ultimately, these bridges are building a framework that prioritizes human connection and continuity of care.

For more information on the Medicaid Reentry Section 1115 Demonstration Opportunity, the CalAIM JI initiative and its implementation, we encourage you to read the full papers released by Justice System Partners (JSP) and The Health and Reentry Project (HARP). Together, we can work towards a more just, equitable, and human centered approach to reentry that helps transform lives and communities.

Link to the paper: Implementing the Medicaid Reentry Waiver in California.

–Special thanks to Joe Calderon, Manager of Recruiting and Training with Urban Alchemy, Aminah Elster, CEO of Proximate Strategies Consulting, and Earl Simms, CEO of Restorative Community Solutions.

Since 2015, we’ve worked with the Safety and Justice Challenge in communities across the country to develop, implement, and study tailored strategies to safely reduce jail populations. Now, we’re embarking on a new effort to synthesize that research into the next generation of reform priorities—and better understand how to effectively reduce racial and ethnic disparities.

The Safety and Justice Challenge (SJC), funded by the John D. and Catherine T. MacArthur Foundation, has been commissioning research in communities to answer the question of “what works?” in criminal legal reform across the nation for nearly a decade. From its inception, the SJC has relied heavily on data to develop reform strategies and assess progress toward initiative goals across participating sites. Data are also used to develop research and lessons learned for the larger criminal legal field, as a way to advance fair and effective reform work on a broader scale. The SJC Research Consortium (Consortium), managed by CUNY ISLG, was established in 2019 to develop and carry out research.

Synthesizing Research into New Priorities for Criminal Legal Reform

To honor the upcoming decennial milestone, in 2023 we began leading an entirely new work stream in partnership with the MacArthur Foundation and its affiliates to review and summarize lessons learned from across SJC-funded research projects and initiatives. The goal of this SJC synthesis work is to tap into our unique bird’s eye view to identify issues within the SJC research priorities that inform our work and the field at large.

As part of this new work, we are cataloguing and reviewing all SJC-funded research to better understand this collective knowledge, including important lessons on how to change systems, what impacts reform strategies have on individuals and communities, and how to eliminate racial and ethnic disparities. As the SJC continues to fund work through its various mechanisms, we will add new findings to our synthesized learnings to keep current on what know about achieving a more just and equitable criminal legal system, so that we can use this knowledge to drive our collective work.

The recently published Research Year in-Review offers a preview of the first chapter of our journey. It presents some common themes and preliminary findings related to the Eliminating Racial and Ethnic Disparities research priority area that has guided SJC work. As this work is in its earlier stages, the learnings shared there and summarized here are not inclusive of all research funded by the SJC to date, and findings will continue to be expanded throughout 2024.

Even during preliminary synthesis stages however, several themes emerged:

• Racial and ethnic disparities won’t naturally fall with general reduction in jail populations. Specially targeted efforts are required to achieve this.

• Restrictions on who can participate in programming like diversion and deflection—also known as eligibility criteria— pose significant barriers to services, program buy-in and uptake, and create multiple forms of bias leading to disparate outcomes.

• At the aggregate level, progress on reducing racial and ethnic disparities has not been made as quickly as progress in reducing jail populations, but research has uncovered a myriad of ways that harms have been reduced for BIPOC individuals enmeshed with the criminal legal system.

• Programs with multiple participation/completion requirements can be counterproductive to the goals they are trying to achieve.

• Deflection rates are not always equitable, but do keep individuals out of the criminal legal system—especially those with mental health and substance abuse disorders.

• Diversion programs are showing preliminary, but positive results for the Black juvenile population, and have the potential to reduce disparities for new convictions and new jail admissions.

• Population Review Teams do have the potential to reduce racial and ethnic disparities, but the small number of cases reviewed each year lead to minimal impacts. However, strict eligibility criteria can actually create disparities in terms of who’s cases are selected for review.

• Bail reform can reduce disparities by ensuring that more defendants are being Released on Recognizance (ROR) for certain types of cases during the pretrial phase. Additionally, eliminating cash bail reduces the burden of paying bail which typically falls to BIPOC individuals that cannot afford it.

• Black individuals tend to be incarcerated more than any other group for probation violations. Programs that are meant to expedite release for those detailed for violations can have significant impacts on Black individuals.

• Findings on pleas are mixed, but indicate that Black individuals tend to face worse plea outcomes, especially for drug and weapon offenses.

• The role and presence of a defense provider at bond hearings can lead to more equitable outcomes.

For more information about 2023 SJC research published, new projects launched, SJC media mentions, and more detailed information on synthesis work, visit the full 2023 Research Year-in-Review.

CUNY ISLG has launched a new process for soliciting ideas and approaches from SJC Consortium members – an opportunity to submit letters of intent (LOIS) to pitch research projects to the CUNY ISLG Consortium team! CUNY ISLG will now accept LOIs for research proposals from current Consortium members on a rolling basis throughout the calendar year. These LOIs are intended to be short 2-3 page submissions describing research ideas that touch on one more of the SJC priority areas and advance SJC research goals and objectives, particularly around knowledge development. The requirements and guidelines for submitting LOIs as well as information on the review process can be found here.

Criminal legal reformers are increasingly adopting a more holistic conception of safety, one where the goals of reducing crime, violence, and recidivism are necessary but not sufficient. This means extending the parameters of public safety investment beyond the traditional boundaries of the criminal legal system.

A new policy brief from the Center for Justice Innovation makes the case for why investment “upstream” of justice-system involvement—investment in and tailored to communities—is criminal legal reform and promotes community safety.

Los Angeles County, for example, may have quietly rolled out the next generation of criminal legal reform. Ballot Measure J, which was approved by voters in 2020 and is now the Care First Community Investment Spending Plan (CFCI), mandates that at least 10 percent of the county’s locally-generated, unrestricted funds—estimated to be between $360 million and $900 million in the first year alone—go toward direct investment in social services and community-based alternatives to incarceration. In establishing CFCI, the county declared it “time to structurally shift…budget priorities and reimagine Los Angeles County” to “address racial injustice, over-reliance on law enforcement interventions, limited economic opportunity, health disparities, and housing instability.”

If implemented well, CFCI will serve as a vision of community safety as part of a larger push for community justice. This vision runs counter to the status quo in most cities and counties, and it requires deeper investments in community-led programs and preventative services upstream from system-involvement.

Despite the conventional wisdom that contact with the criminal legal system deters crime, research tells a more complicated story. Even fleeting system-involvement can increase a person’s future risk of an arrest. As for longer periods of confinement, a recent meta-analysis of more than a hundred research studies concludes—as a matter of “criminological fact”—that incarceration has “no effect on reoffending or slightly increase[s] it when compared with noncustodial sanctions.”

Researchers have found that the bulk of the needs driving system-involvement include the need for familial support, stable employment, educational opportunities, and strong community ties—all needs most meaningfully addressed within the community.

A recent comprehensive review of evidence-backed strategies for reducing community violence cites a shortlist of effective measures, including improvements to neighborhood environments, efforts to promote anti-violence social norms, and youth engagement programs. These kinds of upstream strategies will not look the same in every community, and there is powerful evidence to support this locally-tailored approach.

A team led by Princeton University sociologist Patrick Sharkey found that “every 10 additional organizations focusing on crime and community life in a city with 100,000 residents leads to a nine percent reduction in the murder rate, a six percent reduction in the violent crime rate, and a four percent reduction in the property crime rate.”

And then there are the cost savings. In New York City, the comptroller calculated that the cost of jailing one person for one year was a staggering $556,539. If you are imagining the good that could be done if those public sums were redirected, consider that it costs less than one-thirteenth of that amount—$42,000—to provide supportive housing with services for the same period. In establishing CFCI, Los Angeles estimated that the almost $400 million it was spending annually to house roughly 900 youth in juvenile facilities could fund a full year’s tuition for more than 30,000 in-state students at the University of California, Los Angeles.

Yet across the country, city and county governments continue to focus on shoring up responses to crime rather than minimizing the need for these responses in the first place. With few exceptions, governments at all levels allocate the lion’s share of their budgets to law enforcement agencies, shouldering them with almost exclusive responsibility for community safety—along with sizeable investments in other “downstream” agencies such as pretrial services and probation departments. Even with compelling research evidence in hand, reformers have struggled to broaden the gaze of governments to include preventative intervention as a credible and effective use of public safety dollars.

There are encouraging signs, however. The City of St. Louis recently established an Office of Violence Prevention. In Los Angeles, Mayor Karen Bass has pledged to “hold people who commit crimes accountable,” but also “to take real steps to prevent crime from happening in the first place.” She is investing in the social and economic conditions impacting families via a new Office of Community Safety. In New York City, through a range of initiatives in historically disinvested communities, the Mayor’s Office of Criminal Justice is working to “democratiz[e] public safety while removing systemic barriers that many residents have and continue to face.”

But we must go further. In pursuit of lasting impact, reformers—and their counterparts in government and philanthropy—must swim upstream toward the waters of community-led innovation. Does this approach to reform make the work more complex and less conducive to easy replication? Does it shift considerable power from system actors to community members? Will it change the world for the better? Yes, yes, and yes.

Jails are racialized organizations. Many jails have racialized subcultures, where residents of non-White racial backgrounds face increased segregation, tensions, or violence; limited employment opportunities; and social stigma. Racial disparities in incarceration exacerbate vulnerability to violence, sexual abuse, solitary confinement, and inadequate healthcare. Carceral environments such as jail often manifest racial divisions, with staff frequently exhibiting racial antagonisms, either individually or collectively.

As part of its efforts to lower jail populations across America and address racial disparities in the criminal justice system, the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge recently funded a project examining racial disparities within a county jail. The resulting report presents an approach that can build greater racial equity within jail settings.

The premise of the report is that the lack of racial equity in jails can profoundly impact the conditions of confinement for both residents and staff. The following key themes emerged in the research:

• Staff and incarcerated persons identified that they felt a pervasive sense of unfairness within the organization, and people in minoritized groups felt that there was little accountability for staff racist behavior or misconduct of any kind.
• Staff and incarcerated persons felt that racism is implicitly endorsed and perpetuated. Conversely, some White staff and residents downplayed or overlooked the existence of racism, and attributed any hardships experienced in the jail environment to factors other than race.
• Staff concerns included disparities in promotions and leadership opportunities. Black staff felt that they were often overlooked for promotions. Staff felt that there was a lack of transparency in the process.
• Resident workgroups described a lack of beneficial programs within the jail. Incarcerated women denoted that the programming was designed for men, and that they did not have equal opportunity to participate in programming.
• Healthcare, particularly access to mental health services, was a key stressor for all. Many residents indicated that their medical emergencies were not taken seriously or responded to in a timely manner. Staff would like more mental health counseling made available, as well as a cultural emphasis on staff and incarcerated person wellness.
• Inequities are intersectional. For example, women felt that their hygiene needs were not addressed. Women lacked access to soap, menstrual supplies, and undergarments. The concerns were heightened for Black women. Individuals who did not speak English as their primary language or had other physical or mental disabilities felt that their needs were not met or even considered.

Through workgroups and surveys involving staff and residents, we identified and prioritized 30 interventions that can help jail become more equitable. The following key themes emerged:

• It is essential to balance power in racial equity work, particularly in the context of jails where conditions of confinement are intertwined with power dynamics.
• Both staff and residents want more transparency and accountability. They felt there was a need to develop or appoint an external group to review the jail operations and manage staff complaints and internal affairs investigations.
• Staff requested a clear career pipeline from the jail’s frontline to leadership to allow for job expectations to be more transparent. They requested that all employees receive the support, training, and development needed to be promoted to higher jobs.
• Both staff and residents requested substantial reforms to healthcare. Residents suggested implementing a protocol to respond to sick calls and medical emergencies. Staff felt that there was a stigma against requesting assistance, particularly mental health care, and suggested more confidential programming and supports.

The issues raised during this project require care and attention that are often not fully available to those who manage a chaotic environment such as a jail. Staff and residents raised concerns about the full adoption and sustainability of this effort. Continued support is needed in the implementation of the recommendations, and this underscores the broader implications for the sustainability of this transformative work and its potential for lasting systemic change.

Reentering the community after incarceration is a complicated, lengthy process, made more difficult by system failures and lack of support and services. Many survivors have specific needs, but these are rarely considered in reentry programs. Experts suggest making the process more trauma-informed and centering the needs of survivors.

The National Center for Victims of Crime recently convened a group of experts with lived experience with victimization and incarceration to discuss how to make the reentry process more trauma-informed. We want to extend a special thank you to Tanisha Murden, Rylinda Rhodes, and Jason Witmer for their participation, which was essential to the report they co-authored on the subject, and the recommendations it provides.

Key Takeaway 1: Every person is different and has different needs related to their past trauma. 

Trauma can result from exposure to emotionally disturbing or life-threatening incidents that have lasting effects on a person’s functioning and well-being. According to the Centers for Disease Control and Prevention, up to 60 percent of adults experienced traumatic events during childhood, while incarcerated individuals report an average of at least five traumatic childhood experiences. The environment to which people are exposed while incarcerated is also inherently traumatizing, with appalling conditions like overcrowding, solitary confinement, and exposure to violence. These factors can contribute to a post-incarceration syndrome like post-traumatic stress disorder (PTSD), making it difficult for formerly incarcerated individuals to meet their basic survival needs.

Trauma can also lead to negative outcomes as people reenter society after incarceration, such as technical parole violations resulting in a return to jail or difficulty adjusting to work and social situations. This all highlights the need for trauma-informed reentry services to support individuals in healing and successfully integrating back into society. When people who have been incarcerated have unaddressed trauma, they may experience a range of serious negative outcomes. Meanwhile, trauma-informed reentry services allow people to make mistakes and be imperfect.

Key Takeaway 2: Centering families and children with wraparound support 

Family connections are crucial for successful reentry post-incarceration. They provide emotional, psychological, and practical support while minimizing the negative impact of parental incarceration on children. Support from family members aids in community reintegration, reduces recidivism, and acts as a primary source of financial and emotional assistance. Increased visitation, especially close to an individual’s release, has been shown to delay recidivism.

However, families dealing with incarceration face various challenges like separation, economic strains, and social stigma, which can adversely affect children’s outcomes in the long run. Positive family backing during reentry is essential, though it can strain families emotionally, socially, and financially. Inclusive case management involving family, friends, mentors, and others in the reentry planning process can help in maintaining vital connections. Peer support from individuals with similar experiences can aid in family reunification, offering guidance and emotional support to both the formerly incarcerated individual and their family. This support system encourages openness about fears and concerns while serving as a beacon of hope for successful recovery post-release.

Key Takeaway 3: Lower barriers to services and consider locating them in the same place.

It is challenging for people leaving incarceration to stabilize their lives on the outside. While some communities have resources for reentry assistance, these resources are often disconnected and do not provide efficient support. Some organizations prioritize outcomes over building relationships, which may result in re-traumatization. Reentry centers offer support for various needs including housing, employment, transportation, substance use and mental health treatment, and medical care. The effectiveness of these services is heightened when provided by individuals who have successfully reintegrated into society themselves. These individuals understand the daily challenges of reentry, which is crucial in cases where the community has changed since the individual’s incarceration. Some community members may not be supportive, making it vital for the reentering individuals to have access to peers who understand both the internal and external challenges they face. Supportive peers not only alleviate feelings of isolation but also serve as role models, showcasing the possibility of success beyond past mistakes.

Key Takeaway 4: Infuse knowledge of trauma and how it manifests into every step of reentry.

Training for reentry providers is essential to effectively work with clients affected by trauma. This training should cover the impact of trauma on clients, vicarious trauma on providers, trauma-informed care principles, and specific trauma-informed skills like de-escalation. Ongoing coaching or supervision can further support providers in mastering new trauma-informed skills.

Additionally, service providers should recognize the importance of positive reinforcement in building trust and encouraging success for individuals reentering society. People who are incarcerated often experience trauma, but they also demonstrate resilience. Reentry providers can support them by using case planning and service referrals based on factors that promote healing and resilience. These strategies can include social support, stable employment or school connections, coping skills, and spirituality. Referrals to trauma-specific treatments are crucial for clients with conditions like PTSD or post-incarceration syndrome.

Key Takeaway 5: Implement healing practices into all reentry plans. 

The purpose of restorative reentry processes is to aid people in a successful transition home by repairing harm to the extent possible. This aids people returning from incarceration to rebuild support, ultimately reducing recidivism and trauma. Restorative justice can use a trauma-informed approach by recognizing the impact of trauma on both the victim and the person who perpetrated the crime and addressing those effects in the process of restoring harm and repairing relationships. By focusing on the traumatic impact, preventive strategies can be formulated. A trauma-informed restorative justice process involves understanding the prevalence of trauma, recognizing signs and symptoms, responding with empathy and support, and taking steps to avoid re-traumatization.

Highlighting Promising Programs

The report links readers to six trauma-informed reentry programs showing promise across America. While we recognize that implementing these best practices may be a lengthy process, it is well worth the effort. The promising programs we highlight show that integrating trauma-informed approaches will create more sustainable and successful reentry programs, nationwide.