Whittier Street Health Center Post Prison Release Program established February 2003 Current programming is a Case Management and Care Coordination program. Whittier partners with several community based programs to meet the needs of the clients served. Background: Re-entering the community after incarceration can be extremely challenging in any circumstance and especially for people with ongoing health problems including mental health and substance abuse. A comprehensive re-entry plan that includes health care along with other social services can ease the process of re-entry. Partnerships between jails and community based providers can help break the cycle of recidivism by providing vital care to a vulnerable population. This comprehensive and effective re-entry support to meet the health and social support needs gives this population the support needed for a successful re-entry and a healthy and productive life. Whittier Street Health Center is a comprehensive community health center that provides primary care, wellness, education programs and support services to over 25,000 individuals from diverse backgrounds. The communities Whittier serves face significant disparities in health outcomes and negative social and environmental determinants of health. Whittier Street Health Center serves an area which has a higher percentage of African -American men and women who are incarcerated. The catchment area includes Roxbury, Lower Roxbury, South End, South Boston, Jamaica Plain, Dorchester, Mattapan, North End and East Boston. The Center developed an effective Pre and Post Release in 2003 and developed a highly successful Prison to Life model to address the disparities in this population. Through our collaboration with federal, state, county corrections and law enforcement agencies, faith based organizations and other community partners; the Center is able to help former inmates with their successful reentry. The following are some of the issues addressed: Pre-Release issues Challenges with having only a general plan and not an individual plan for individuals in Prison to address the array of Mental Health and substance abuse issues including dual diagnoses. High levels of Hepatitis C. upon release reflecting a need for disease management for the infected population. The Viral load needs to be closely monitored. No rehabilitation, detox, AA/NA to address the chronic cases of substances abuse The type of medications used in the Prison may not be as effective to address some of the Mental Health cases. Post Release issues Mental Health (Depression, PTSD, Anger Management, Relationship issues) Whittier Street Health Center 1290 Tremont Street, Roxbury, MA 02120 Page 1
Substance Abuse (Alcohol, marijuana Opiates, Narcotics & Prescribed medication) Social Services (Birth certificates, Mass ID) Homelessness Unemployment Lack of a Care Plan No Support from family and friends CORI Outcomes and impact of Whittier s Program: 1. Establishing a Medical home for ex-offenders and health Insurance for a transient or homeless population who are highly unstable 2. Lowering the viral loads Hepatitis C. and HIV(medication management ) 3. Creating a HEP C Group (Case management and support) 4. Establishing support for patients with other chronic illnesses such as diabetes, CVD and hypertension 5. Establishing individual and group counseling for mental health and substance abuse (Men s Health Rap group, SOAP Structured Outpatients Addictions program, Narcotics committee, Suboxone, Anger Management groups, Integrated Family Therapy group, etc) 6. Overdose prevention (Narcan training for newly released) 7. Promoting Wellness and Prevention nutrition, acupuncture, physical fitness, life coaching 8. Linking returning citizens to social services see list below Social Services 1. Skills development and linkage to employment 2. Housing 3. Education (GED, Higher Education & Career Development)) 4. Food stamps 5. Case management and navigation 6. Values Training Population Served At Whittier: Male population in 2012 960 Whittier Post Prison Release Intake and assessment for males per year Educate over 1100 men inside of the Prison and 1200 outside of the Prison Link 700 Men to Primary Care from the prisons system per year Case Manage 360 men per year Whittier Street Health Center 1290 Tremont Street, Roxbury, MA 02120 Page 2
Screen over 400 men for (Stds) Sexually transmitted diseases especially GC, RPR, Chlamydia, Hepatitis C and HIV per year Trained 200 men on overdose prevention and the administering of Narcan to save lives Hired ten men as Ambassadors upon completion of the 12 week Men s Health Ambassador program. Female population in 2012: 64% African American 5% Latino/Hispanic 29% Caucasian 2% other 200 Female intake and assessment starting 2/1/12 Educate over 700 women inside and outside the prison (outreach in community) Link 150 women to primary care Case management 150 women Hired former clients as Patient Navigators - 18 women from community and McGrath house Whittier Street Health Center 1290 Tremont Street, Roxbury, MA 02120 Page 3
Whittier Post-Prison Release Collaborative: A Case Management and Care Coordination Program Established in 2003 in consultation with ex-offenders, patients, community leaders, South Bay House of Corrections staff and Rabbi Shapiro South Bay s Chaplain in 2003, and in partnership with several community based organizations. Prison-to-Life Transitions Model Pre-release Consultation Individual Counseling and Peer Group Meetings Transitional, Safe and Affordable Housing Values Training WPPRC Progr am Skills Development and Job Training Referrals and Service Coor dination Accessible Health Care and Human Services Job Placement and Child Care Support Whittier Street Health Center 1290 Tremont Street, Roxbury, MA 02120 Page 4
Pre-Release Consultation The WPPRC members and program staff will work with justice system authorities and community residents to identify and engage men and women who are in the penal system. These individuals will be visited on a bi-weekly basis at least six months prior to their release from the system. The WPPRC Program, its goals, procedures, expectations and benefits will be shared during these visits. A preliminary WPPRC Individual Growth Plan will be developed prior to release for each program candidate. A listing of pre-release expectations will be provided to each candidate and will be reviewed as part of the final selection process. The benefit of this approach lies in the sense of accomplishment, hope and responsibility that comes after the candidate s release from prison and acceptance into a defined and supportive community. Transitional, Safe and Affordable Housing Having a safe, clean and organized place to live is the first step to successful reentry into society. This is a place where morals, values and personal possessions do not need to be compromised. Upon release, WPPRC clients will be assigned to group housing designed to provide the continuous supports and positive environment required for initial separation from the negative elements of the community. This transitional housing will be provided for 9 to 12 months depending on the progress of the individual WPPRC client and the assignment to affordable housing. Once assigned to affordable housing, the WPPRC client will pay for his/her residence and the usual monthly expenses. Skills Development and Job Training Give a man a fish, and he will eat for a day. Teach him to fish, and he will eat for a lifetime. Skills development and job training are essential to employment, self-empowerment and selfsustainability. The WPPRC Program is designed to liberate its clients, as opposed to making them dependent on external supports. (Note: The client designation is not about dependency. To the contrary, it speaks to our sense of family and the expectation of making a contribution Whittier Street Health Center 1290 Tremont Street, Roxbury, MA 02120 Page 5
to newer members and to the greater society.) Skills development and job training will be provided and/or coordinated in a range of technical, vocational and administrative fields. This training is a requirement for participation in the program. Job Placement and Child Care Support In order to achieve the intended objectives of skills development and job training, effective job placement support must be provided to each WPPRC client. Each WPPRC client will receive training in the areas of interview attire and interviewing skills, and will be given assistance in the development of a resume and professional statement of purpose. WPPRC program staff will work with private sector employers, community-based organizations, training school job placement departments, and state government training and education agencies in order to effectively place and assist WPPRC clients upon completion of their basic skills and job preparation training. We also recognize, particularly for single parents, the need for available and affordable childcare services. Childcare service assistance and support will be coordinated as an essential part of the program offering. Whittier Street Health Center 1290 Tremont Street, Roxbury, MA 02120 Page 6