RETURNING CITIZEN LEADERS Community actions to reduce risk of

incarceration, address trauma and

improve community health

CCRMC RETURNING HEALTH PARTNERSHIP

• The project described was supported by Grant Number 1CMS331071-01-00 and 1C1CMS331300-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

• Disclaimer: The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

PRESENTERSArlinda Timmons-Love, ELE

• REMEDY Program Development Team and Group Leader

• West Contra Costa County African American Re-entry Health Conductor CCCounty Health Svc Division Office of The Director Reducing Health Disparities Partnering With Center For Human Department

Michael Changaris, PsyD

• Health Psychologist – CCRMC Health Psychology Groups Program Lead

• Chief Training Officer – Integrated Health Psychology Training Program Partnership Between CCRMC and Wright Institute

• Integrated Pain Psychology Rotation Lead

• Health Psychology Transitions Care Lead

DISCLOSURES

This team has no disclosures related to these materials at this time.

PRESENTATION GOALS

1. Develop a basic framework for for establishing peer leadership

support services and partnerships.

2. Understanding key factors in developing, training and mentoring

peer leaders.

3. Peer leader roles in program development – Growth in program

management skills.

4. Review clinical outcomes in TCN, REMEDY, Peer Partnership

5. Explore lessons learned in the development of peer leaders.

WORKSHOP OVERVIEW

5 Min Introduction: Returning Citizens as Community Leaders

5 Min Video: Experiences in the REMEDY Program

5 Min Discussion: Impact of Video and Peer leadership

15 Min Presentation: Peer leadership development process

10 Min Exercise: Developing Peer Leaders and Programs

10 Min Presentation: Peer leadership program development tools and program outcomes.

10 Min Discussion with Panel

INTRODUCTION: RETURNING CITIZENS AS COMMUNITY LEADERS

Developing Healthy Minds,

Bodies, Spirits, family and

community

BUILDING A SYSTEM OF CARE HELPSOPEN DOORSTO BUILDING A LIFE OF MEANING AN PURPOSE

FINDING THE WAY HOME

SHARING WHAT YOU FOUND

Returning Citizen Leaders

THE REMEDY: REENTRY MAKING EVERYDAY YOURS

Healthy Mind

Healthy Body

Healthy Spirit

Healthy Community

RETURNING PROGRAM THAT PROMOTES HEALTH

REMEDY GroupThe REMEDY group provides health education,

CBT and emotion regulation skills, peer support, coordination with medical team and

health conductor support.

Integrated Transitions ClinicThe integrated transitions clinic model has five components a. trained medical team, b. health

conductor/consumer, c. REMEDY group, d. health psychologist, e. returning leaders

Support ServiceReentry programs need a web of support

services like day programs, job training/skills, education, SUD Tx, Housing, Transportation.

Trained Primary Care ProviderProviders who are committed to returning health can improve health care attendance, medication

adherence and patient health.

Health ConductorsHealth conductors are trained professions who understand needs of a community and play a central role in health, mental health and care

coordination

Health PsychologistHealth psychologist/BHC provide warm handoffs for crisis & health education, referral SUD/MH

services, group Tx and individual Tx

Returning Citizen Leaders

Returning citizens bring with them a wealth of knowledge, experiences and are fertile ground for leadership. Peer leadership is

an act of restorative justice giving back to the community through one’s own growth development and change.

Mental Health &

Returning Leaders• Social Connection: social

• connection improves mental health

• Returning citizens can be isolated with limited

or challenging support networks.

• Opportunities for leadership and exposure to

leaders can increase social connections.

Employment &

Returning Leaders

• Most jobs are found through connections

• Barriers to finding work can lead to giving

up. Mentors help people lean in when things

are difficult

Education &

Returning Leaders• Many returning offenders do not have formal

education and at times a history of

educational challenges.

• The model of peer leaders completing their

GED or are engaging in college/job training

can make what feels impossible possible

Substance Abuse &

Returning Leaders• Many mental health and SUD programs do

not understand the needs/risks of returning

citizens.

• Peer leaders can help program design and

support connectivity between reentry

community and treatment

Returning Leaders Can Impact on Factors Relating to Recidivism

VIDEO: EXPERIENCES IN THE REMEDY PROGRAM

Developing Healthy Minds,

Bodies, Spirits, family and

community

LIVED EXPERIENCE TO LEADERSHIP

Leadership requires significant change and transformation of heart.

The act of being a leader changes one's since of self and one’s beliefs about what one is capable of.

These factors are the heart of cognitive behavioral therapy.

As one’s experience of their skills change, their beliefs change too.

INTRODUCTION - TCN AND REMEDY

REMEDY GROUP STATEMENT: The REMEDY group is a community home for people who are reentering from prison. We believe each of us has strength, wisdom and is worth full respect. Each member of the community is a vital strength. Each of us carry our struggles and together the struggles are lighter. Like iron that sharpens iron we support each other to build our personal health, community strength and group vitality. Through our connection and action we build healthy minds, healthy bodies and healthy spirits.

REMEDY – REENTRY MAKING EVERY DAY YOURS VIDEO

PEER LEADERSHIP DEVELOPMENT PROCESS

Addressing health disparities,

reducing barriers and building

community.

INCARCERATION CHANGES THE COMMUNITY FABRIC

Increased family

poverty and associated

health and mental

health risks.

Returning creates

challenges with

adjustment and impact

family wealth.

Disrupted family

relationships impacts a

child’s ability to bond

with returning family

member

Grandparents in

parenting role and

taking care of young

children.

Children w/ incarcerated

parents have > risk of

chronic illness, depression

and beh problems.

Disrupts the family system

and increases risk children

in foster care and need

for multiple health and

mental health services.

RETURNING LEADERS & POST INCARCERATION SYNDROME

1. Institutionalized Personality, 2. Post-Traumatic Stress Disorder, 3. Anti-Social Traits and Action, 4. Sensory Deprivation Syndrome, 5. Substance Use Disorder

Post Incarceration SyndromeRecovery – Returning – Reconnecting – Realizing

“It's just, you, in prison, you learn not to show your

emotions. You don't wanna be weak, you know, you

need to be strong, you need to continue to be strong,

and always strong.”

1. Normalizing challenges can increase

problem solving.

2. Peer leaders creating social connection

and learning the skills to navigate the

social demands post-incarceration.

3. Increased self-care and skills for

developing goals can begin to transform

symptoms of trauma and create a

sustainable & meaningful life.

RETURNING CITIZEN LEADERSHIP

1. Many times we will do for others what we struggle to do for ourselves. Leadership requires valuing oneself, others and one’s community.

2. Leadership challenges people to find within them what is possible and to transform habits, ideas and patterns that have kept people stuck.

3. A returning citizen can become a beacon for others and do some of the work of rebuilding the community fabric that was ruptured through crimes and the impacts of incarceration

RETURNING LEADERSHIP ROLES

Natural Peer SupportPeers in groups or in a program may offer

their number and connect naturally.

MentorsActive training engage with peers in an

ongoing supportive relationship.

Group LeadersReturning leaders have three core roles 1.

group development, 2. facilitation, 3. Group

mentors (Speaking and Sharing).

Program Leadership and StaffOrganizations need people who have lived

experience to help develop programs,

problem solve challenges and support health

in returning community.

Community/Political LeadershipLeadership in local reentry events, sharing

lived experience, speaking to groups,

political leadership.

1

2

3

4

5

PEER LEADERS DEVELOP A NETWORK OF CAREFOR RETURNING CITIZENS

Health &

Wellness Returning

Citizen

Public

Support

Education

Support

Housing

Support

Job Skills

Ed. &

TrainingBuilding a Life of

Meaning &

Purpose

REMEDY GROUP LEADERSHIP TRAINING

Outcome 1 (Metric): Existing Re-entry leader identifies re-entry leader.

Outcome 2 (Process Metric): Peer Leader Training

Outcome 3 (Process Metric): Peer Leader Tool Kit Development

1. Targeted outreach skills

2. Engagement skills

3. Health system navigation & enrollment

skills

4. Identify & develop community

partnership.

5. Review and understand REMEDY

curriculum.

6. Observe/Graduate REMEDY

7. Co-Facilitate REMEDY (w/ obsv).

8. Health education skills

9. Understand transitions clinic

10. Develop collaboration w/ clinic

PCP and medical team.

11. One leadership role (conference)

12. Develop effective boundaries

and leadership skills

1. Reentry leader will develop a factsheet and educational toolkit for returning citizens.

2. Reentry leader will develop an list of services and resources needed by returning citizens (exiting and not existing services)

3. Peer leader identifies community organizations and partners to conduct presentations that address health disparities

New leaders are identified by reentry leaders. The new leader is discussed at case conference and a development plan is

created by REMEDY reentry team.

CODESIGNParticipatory Design

Builds Systems that Meet

Real Human Needs

COMMON BARRIERS TO REENTRY LEADERSHIP

Lack of experience Financial support Tools and skills Leadership

Stigma/Biases Program development support

Lack of organizational

suppot

PEER LEADERSHIP ROLES AND POSSIBLE DEVELOPMENT PROJECTS

Natural Peer Support

Mentorship Project

Group Leaders

Program Leadership

and Staff

Community/Political

Leadership

1. Develop a process for exchange of contacts between members

2. Create a reentry speaker opportunity for new program members

3. Offer community evening event with food to create connections

1. Develop linkages between existing mentorship program and service.

2. Develop peer reentry training process and test w/ 2 leaders

3. Seek funding and agency support for reentry mentorship program

1. Develop team to establish reentry support group and include reentry

leaders in the development.

2. Develop a medical group visit for returning citizens including a training

process for medical providers and structure using feedback reentry leaders.

1. Invite a reentry leader to come and speak at a lunch and learn with

medical staff.

2. Support reentry leaders to go to state and national lobbing days.

3. Set up a ban the box initiative with reentry leaders.

1. Training and hire reentry leaders in to program staff positions.

2. Identify core staffing roles for reentry leaders.

3. Ask reentry leader staff from other systems to consult about program.

EXPERIENTIAL EXERCISE: BRAKING DOWN BARRIERS TO DEVELOPING PEER LEADERSHIP

Exploring barriers to developing

peer leadership and how to

support multi-systemic peer

leaders.

EXERCISE FOR DEVELOPING REENTRY PROGRAM IN YOUR COMMUNITY

Instructions

Brake into groups of 4-6 with people who’s programs are close to the same stage of development as yours choose a note taker.

Answer these questions as a group

1. How could peer driven design work in your program?

2. What are ways where reentry peer leaders could support your existing services?

3. Discuss one action you can take towards reentry leadership in your community

PEER LEADERSHIP PROGRAM DEVELOPMENT TOOLS

Developing tools for sustained

change and developing peer

leadership.

LIVED EXPERIENCE AT THE CENTER

TOOLS TO SCALE REENTRY LEADERSHIP PROGRAMS

Logic Models

Logic models are a systematic

way to see the relationship

between resources you have

and desired programmatic

outcomes.

Driver Diagrams

Driver diagrams are a way to

see the relationship between

one’s organizational aim, drivers

of change and change efforts.

Logic Model Driver DiagramPDSA Cycle

Plan-Do-Study-Act (PDSA)

This is a simple tool to try big

ideas in a small way. Real

change is iterative. The idea is

tried and tested and then

retried. Using

REENTRY LEADERSHIP EXAMPLES OF PROGRAM DEVELOPMENT

PDSA Cycle Ramp Up

Example Program Logic Model

Example Driver Diagram

Connecting reentry mentors with existing

groups inside prison (See Handout Example)

Developing mentor training program for

outpatient mental health (See Handout)

Developing system of reentry leadership to

improve health in reentry population

(See Handout Example)

REMEDY TCN PEER LEADERSHIP PROGRAM OUTCOMES

Leaders Completed

Group Training

Number of

Groups Lead

REENTRY Leader

Driven Services

Eight reentry group and community leaders have been trained

in group leadership skills and have engaged in community

leadership projects for reentry community

REENTRY Leaders have engaged in group leadership, outreach

calls, speaking to organizational leaders, speaking to

California assembly, connection with services such as work

training/health care/appointments/education/transportation.

Two reentry groups have been established in two clinics in the

county. Peer leaders have been leaders 52 group sessions

yearly in two sites.

REENTRY LEADER DRIVEN COMMUNITY PROJECTS

REMEDY Reentry leader

connected to goodwill

industries and established

a contract to support

returning group members

to get work training and

access to work.

REMEDY Reentry Leader

created connection with

reentry success center for

REMEDY group members.

The Reentry Success Center

supports returning citizens

and their families to have

financial planning, family

support, legal services,

education and training, and

employment assistance.

REMEDY Reentry Leader

developed a connection

with a homeless shelter

that supports individuals

who are returning to

bring members of the

center to the REMEDY

group and to develop a

REMEDY group in their

shelter.

Recidivism within Contra Costa County 2014-2016

Number of re-incarcerations

# P

atient

s

0

5

10

15

20

25

30

35

40

45

50

0 1 2 3 6 5 13 8

Heal

th O

utco

mes

TCN

Ree

ntry

Clin

ic a

nd R

EMED

Y Gr

oup

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Diabetics A1C <7 (N = 12)

Total Pts A1C <7 (N = 40)

Average SBP <140 (N= 74)

LDL < 160(N = 39)

Total Chol <240 (N = 32)

Transition Clinic Health Metrics 2014-2016 He

alth

Out

com

es T

CN R

eent

ry

Clin

ic a

nd R

EMED

Y Gr

oup

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

% with Diabetes and A1C < 7 % with A1C < 7 % with Average Systolic BP < 140 % with LDL < 160 % with Total Cholesterol < 240

Transition Clinic Patients Summary (2017-Current) %

Heal

th O

utco

mes

TCN

Ree

ntry

Clin

ic a

nd R

EMED

Y Gr

oup

CANCER SCREENING

Breast Cancer Screening

Eligible patients = 9

Percentage of patients with up to date screening = 56%

Cervical Cancer Screening

Eligible patients = 11

Percentage with up to date screening = 64%

Colon Cancer Screening

Eligible patients = 26

Percentage with up to date screening = 54%

Health Outcom

es TCN Reentry

Clinic and REMEDY Group

REMEDY Q&A DISCUSSION CONSUMER ROLE IN PROGRAM DEVELOPMENT

Program development rooted in

real human needs makes

meaningful change in people’s

lives.

• The project described was supported by Grant Number 1CMS331071-01-00 and 1C1CMS331300-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

• Disclaimer: The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

THANK YOU FROM OUR RETURNING HEALTH PARTNERSHIP