Topic: Reentry

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.

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.