For People Who Have Been Incarcerated, A New Approach to Rebuilding

Their clients have been incarcerated, sometimes for decades. They need to find jobs and housing – and quickly. Some are trying to regain custody of their children. And many have mental health issues, ranging from mild depression to more severe schizophrenia.

In California’s East Bay, Roots Community Health Center, a community clinic and partner of Direct Relief, is working to care for precisely these individuals through two, year-long tailored programs.

One, Nia Care, is intended for clients with mild to moderate mental health symptoms. The other, Afiya Care, works with people who have moderate to severe symptoms. Both programs combine the work of a behavioral health care provider with that of a care navigator – someone who can connect clients to food, housing, employment, transportation, and other resources.

“You might see the therapist in the morning and then see the navigator right afterward,” said Shanice Smith, who is the clinical services manager for behavioral health at Roots. She explained that the experience of being incarcerated is itself traumatic for many people and that the process of rebuilding a life involves navigating a complex and difficult system.

Roots is a state-licensed community clinic, which means that it provides primary and preventative health services to a largely underserved population. But Roots doesn’t stop there: From a street medicine clinic to an apprenticeship and internship program, they run a series of initiatives designed to meet the complex needs of their patient population.

“It’s beyond a clinic, and I want people to know that,” Smith said.

A new approach

Even before Nia Care and Afiya Care, Roots worked to connect people who had been incarcerated to legal and other services. So when Alameda County needed partners to help provide mental health and navigation services to patients, Roots’ CEO, Dr. Noha Aboelata, jumped at the chance.

“We were already doing that work, so it wasn’t anything new,” Smith explained.

The goal of both programs is first to meet clients’ basic needs – helping them find food, housing, and clothing, and working to stabilize any acute mental health issues. Gradually, clients gain stability and self-sufficiency. Their mental health improves, they secure employment and permanent housing, and they grow increasingly confident as they rebuild.

Today, Nia Care works with approximately 70 people each year; Afiya Care will reach about 40.

Many patients are referred to the programs through probation officers, the county, and other nonprofits. But anyone who has a history with the justice system can walk in and be assessed by a navigator, who will refer them to a behavioral health provider and begin connecting them to services.

Navigating the system

Navigators are “the biggest workforce at roots,” Smith said. “They’re on the frontlines…you might see your navigator every single day.”

For the Nia Care and Afiya Care programs, Roots focuses on navigators who have relevant lived experience.

“I know what the struggle is. I know what they’re up against, and everything in me is to let them know, ‘You can do this,’” said Kisha Williams.

Williams has been incarcerated in the past and went through both Nia Care and Roots’ Emancipators Apprenticeship program, which helps people prepare for employment. She’s now a certified community health worker. She explained that her experience helps her understand and empathize with clients’ perspectives.

“I can relate to a lot of the trauma that comes from being incarcerated,” she said. “I have a passion for [this population]. It’s rewarding after I know I’ve made a difference.”

Working with clients means helping them meet their own unique goals. “They’ll tell you what it is that they need,” whether that’s housing, treatment for a substance use disorder, help to regain custody of children or employment, Williams said. “The best way to meet a client is with empathy.”

Some of it is a “waiting game,” particularly for housing – which is in short supply in the Bay Area. Getting people trained and prepared for employment is also time-consuming.

But much of it is also about mindset – a lesson Williams said she learned from the Nia Care program. When people have a history of incarceration, she explained, they frequently feel that “’I’ve been in jail, and now my life is over.’”

The best way to overcome that is to support clients – and help them find opportunities. “When they get that job interview or get that job, their mindset changes…they get to look at things in a positive way,” Williams said. “I’m helping them to break down the barriers that they think prohibit them from being successful.”

Williams gave the example of a client who went through the Emancipators Apprenticeship program and found stable housing and a permanent job. He’s even planning to go back to school. “He’s a person now who can smile…He’s living his best life,” she said.

Developing strengths

Behavioral health services are an indispensable part of both programs, and can help clients navigate a frustrating system.

Smith gave the hypothetical example of a mother trying to regain custody of her children. Many of the women who participate in the programs “either don’t have [visitation] rights or the time that they do have is supervised,” she explains. A client struggling with anxiety, anger, or past trauma may have trouble dealing with the situation.

A therapist would help that mother “start putting names to these feelings,” Smith said, and work with her to reframe thoughts that “aren’t contributing to you getting your kids back.”

These techniques might involve everything from deep breathing to role-playing to motivational interviewing. Therapists also work with a psychiatrist and primary care providers, who make sure clients are on an appropriate medication regimen.

Social worker Monika Scott, the lead clinician for the Afiya Care program, said she always begins by “getting a really good story…just allow them that space.” Clients may have post-traumatic stress or auditory or visual hallucinations that need addressing.

But what’s most important are the client’s priorities. “I really feel that I’m there to partner with them on whatever their goals are,” Scott said, whether that’s reducing anger or improving self-esteem.

Whatever the goals, Scott said she focuses on clients’ individual strengths. “Everyone has strengths, and…some of the things they have overcome, they have taught me invaluable lessons,” she said.

Many of Scott’s clients are highly concerned about returning to their lives after a long period of incarceration. “How many people have been locked away for ridiculous charges, and spent the majority of their life in prison?” she asked. “I want to help people navigate that and get around that.”

Alison Powe, a behavioral health clinician for Nia Care, explained that awareness of the role incarceration plays is essential. “We really have to be mindful of them being locked up for so long,” she said. Even activities like going to the grocery store can feel overwhelming.

The goal of the programs is to help clients become self-sufficient within a year. However, some patients elect to continue their behavioral health services – along with their regular health care – at Roots.

“The door is always open,” Scott said.

Direct Relief has supported Roots Community Health Center, a member of the National Association of Free and Charitable Clinics, with more than $200,000 in medical material and cash support since 2015.