Working Together for Women (WTW) is a unique collaboration in which Drexel University's Caring Together clinical program, the Philadelphia Office of Addiction Services, and Mothers in Charge (a community-based violence prevention/reentry support program) have united to address the post-incarceration challenges faced by women with substance use and psychiatric disorders. Over the past 25 years, larger numbers of women have been incarcerated for substance and behavioral related crimes. The American prison system has become the de facto behavioral healthcare system for persons with psychiatric and substance use disorders. In response, WTW provides innovative, comprehensive, and integrated healthcare to prevent relapse and recidivism and bridge gaps between the behavioral health and criminal justice systems. WTW participants receive support services through trained Reentry Peer Specialists (RPS), women stable in their recovery who have been incarcerated and are living healthier lives.
Overwhelmed by the competing demands and service needs associated with reentry and the typically long waits for behavioral treatment services, many women (over 70%) relapse and are re-incarcerated within 5 years without access to services. The availability of RPS, who establish pre-release relationships and serve as positive role models, is critical to WTW success. Prior to release, RPS formally screen women for their reentry needs, and work together to develop mutually agreed upon reentry plans. Behavioral healthcare appointments are scheduled within 48 hours after release and a psychiatric evaluation within 7 days of WTW admission. RPS meet regularly as needed with the women in the community and onsite at WTW to ensure treatment adherence, address scheduling conflicts and secure other needed resources (medical care, housing, health insurance, income). WTW staff keep RPS informed of each woman’s ongoing treatment and service needs via weekly meetings and case manager contacts.
The multiple stressors associated with reentry exacerbate women’s pre-existing behavioral health problems, creating signifcant risk for relapse and reincarceration. RPS are trained in both the initial WTW-developed screening tool and the reentry needs screening tool focused on behavioral health, and serve as hopeful models of recovery. Evidence-based and gender specific, trauma-informed addiction and onsite psychiatric treatment are readily available and integrated with preventive and medical healthcare at a WTW co-located Federally Qualified Health Center (FQHC), creating a medical home for the women. RPS also educate other organizations such as the Department of Public Welfare and Legal Systems on women’s specific behavioral healthcare reentry needs. WTW offers regular professional education programs on the challenges faced by and treatment models available to reentry women to service providers with a focus on reducing stigma and increasing recovery opportunities.
The increase in U.S. incarcerated women has created emotional, health and financial devastation for families, communities, and criminal justice/social service systems. Approximately 80% of these women have had co-existing behavioral health disorders prior to incarceration. Inadequate transition planning can result in a host of negative, costly outcomes, including compromised public safety, overdose, hospitalization, suicide, homelessness, and re-arrest. Pre-release identification of reentry needs with timely connections to supports can be a cost-effective way of reducing substance use, decreasing recidivism and improving the health of WTW women and their families. A 2013 Vera Institute report found that crisis intervention teams (mental health, criminal justice and community partners) help divert persons with mental illness from jail detentions and emergency room visits. Studies of similar programs in other cities show more than $4 million in cost-savings per program after 1 year.
The successful creation of WTW itself, through its clinical, governmental, and community partners, is innovative, as these groups do not typically come together to create a unified system of care with strong internal communications. WTW's development of RPS, based on the successful role of peer specialists in addiction treatment, is a creative and high-touch approach to addressing the complex needs of post-release incarcerated women (e.g., substance use, psychiatric and medical disorders, untreated trauma/domestic violence, disconnection from their children/family, loss of loved ones to violence). WTW creates an integrated and coordinated system of evidence-based treatment, government, community and homebound services for targeted women. The RPS facilitate this system to promote recovery, reduce recidivism, and support family reunification among reentry women and their families, resulting in a valuable model for use in other reentry settings.
With the vision and goal to provide comprehensive reentry services to an extremely vulnerable population and their families, WTW was created two years ago under the leadership and direction of the Philadelphia DBHIDS’ Office of Addiction Services; the Caring Together Program, a 26 year-old dual diagnosis addiction treatment program for Philadelphia women; and Mothers in Charge, a community-based violence prevention and reentry support agency emphasizing services to women. With these leaders, WTW has established expertise and is recognized in greater Philadelphia for service and program innovation. WTW has also engaged multiple service, academic, governmental/legal agencies and criminal justice stakeholders to ensure its success. In October 2015, SAMHSA's positive funding review lauded WTW’s model replication plans and presentations to potential organization adopters, such as addiction/behavioral health, reentry, and community based programs in regions nationwide.
Core financial support for WTW is based on clinical income from the Caring Together program. This income stems primarily from Philadelphia’s Community Behavioral Health (CBH) billing and recovery based services funded through the City’s Behavioral Health Special Initiative (BHSI). This funding will expand in correlation with increasing patient volume. Support for the three RPS and two case managers comes from the SAMHSA reentry grant which was funded for three full years in October 2015; WTW was one of only six reentry programs nationally to receive that level of funding. Both Drexel University’s Office of Insitutional Advancement and Mothers In Charge are committed to identifying and applying for governmental and foundation support to sustain all WTW staff and programs. Masters level Rosemont College students trained in the WTW model of care, as well as WTW and Caring Together program graduates, serve as ambassadors and future clinicians in WTW.
WTW leadership and staff have designed the WTW program with participant input to meet the needs of a specific population. While the current model is targeted towards incarcerated women, many components are replicable to meet the reentry needs of both genders and individuals with other behavioral health issues. As part of the SAMHSA grant, we are quantitatively and qualitatively tracking the success of various program components and use of resources for WTW; evidence-based data will determine which elements should be incorporated into similar programs. We will focus specifically on the RPS, for which we have created job descriptions, training modules and reenty screening tools that can be used in multiple reentry settings. We will document benefits and barriers by surveying and interviewing RPS, participants, stakeholders, and such funding sources as SAMHSA and the Office of Addiction Services.
WTW’s major initial focus has been on recruitment of eligible individuals, which requires significant outreach. WTW leadership and staff have met with multiple stakeholders, engaging prison staff, district attorneys, public defenders, city judges, and probation officers as well as clinical and other service and government agencies (e.g. DHS) and significant disconnects have been identified within the system. For example, agencies are poorly integrated and work in silos, creating additional challenges for women seeking services necessary for successful reentry. This makes the RPS role in connecting women with multi-agency services even more vital. To mitigate those challenges, the RPS plan is to work with 100 new women annually, ensuring their adherence to treatments and appointments and securing needed reentry resources. We will continue our strong quantitative evaluation of WTW, which began with the SAMHSA grant and uses data that is regularly downloaded into the SAMHSA system.