Employing Former Prisoners as Community Health Workers: Success and Challenges

Returning prisoners have high rates of chronic diseases, mental illness, and substance use. Most prisoners cite the emergency room as their source of care upon release and have little support in navigating the fragmented medical and social services. Prisoners have faced substandard care in the prison medical system leading to mistrust and fear of judgment which are barriers to seeking care. Transitions Clinic (TC) is an innovative program that engages chronically-ill adults into primary care upon release from prison. Specially-trained community health workers (CHWs) with histories of incarceration outreach to recently-released prisoners and guide them through the complex medical system to promote health and stability. CHWs successfully leverage their own incarceration to relate to their patients' struggles and advocate for patients' needs. In return, patients feel at ease which builds rapport and trust improving health outcomes. CHW's bridge the cultural gap between provider and prisoner. They are non-judgmental and provide critical emotional support during the vulnerable state of reentry. While the CHW's prior incarceration is the key component to the program's success, it also brings unique challenges. Like their patients, the CHWs face a stigma of incarceration and distrust from the medical community. Since the CHWs have been incarcerated with some of the patients, they face exclusive ethical dilemmas. Prison cultures and conflicts extend beyond the prison and sometimes leads to patients expecting inappropriate favors or tense encounters. TC has developed many strategies to mitigate these challenges, all of which come from feedback from the CHW's personal and professional experiences.