Community health workers right FIT for Formerly Incarcerated Transition program
By Melanie Raskin
Imagine serving your time and, at last, being released from prison. Second chances can be tough if you don’t have housing, a job, or a medical home. It’s even worse if you have a chronic disease, such as diabetes, kidney disease, or mental illness. Former prisoners are falling through the healthcare cracks. NC FIT is working to pull them out with the help of community health workers, public health professionals who work with populations they know well to improve health knowledge and empower people.
The Formerly Incarcerated Transition Program, a partnership of Lincoln Community Health Center, Durham Criminal Justice Resource Center, Durham County Department of Public Health, and NC Department of Public Safety, launched in 2017 to reconnect former offenders to “the real world.”
Community Health Workers are vital to the process, says Program Director and Professor of Family Medicine at UNC-Chapel Hill Dr. Evan Ashkin. They use outreach, education, social support, and advocacy to help clients reenter successfully with a direct link to healthcare and a physician champion willing to show caring support, as well as essential information on transitional housing, vocational rehabilitation, and community college education programs. But FIT CHWs are different from their public health peers in 25 similar clinics across the country. FIT’s CHWs are former prisoners. “Our program is working because our CHWs have walked in our clients’ shoes,” Ashkin points out. “They have been there themselves and faced the same struggles and barriers, so there’s a unique trust and rapport. They are true peer navigators for a population that is highly marginalized and often forgotten.”
So far, two CHWs serving Durham and Orange Counties have arranged for 50 clients to receive primary care services, providing support in the form of transportation to medical appointments, vouchers for clinic co-pays, and help with driver’s licenses. A third CHW was added for Wake County, and two more are joining the program in Mecklinburg County this fall. FIT’s unique approach is paying off: It has reduced use of the ER by program participants and improved health and other outcomes. And there’s the added bonus of providing formerly incarcerated individuals good jobs with benefits as CHWs, and a way to take care of their families and contribute to a community they know well.
Makes economic sense
“We worked with one client who was a diabetic,” Ashkin explained. “When he was released, he may have had one month of meds and was housing insecure. He ended up in a diabetic coma for four days. We got him and now he’s doing great. That one hospitalization cost more than a CHW’s entire salary. If we had gotten the client sooner, we could have saved him pain and suffering, and saved the healthcare system a lot of money.”
“I strongly believe everyone has a right to healthcare,” Ashkin concluded. “Incarceration is the only time a person has a constitutional right to healthcare. That ends after release. These people leave prison with chronic disease and are not eligible for insurance. They can’t even apply for ACA insurance. This is not rocket science. FIT is a completely sound financial argument. There are people who think we are expending public resources on folks who chose to commit a crime. But economically, it makes sense to provide basic primary care services, instead of having someone with kidney failure or diabetes end up at the hospital for long-term, expensive care.”