Effective Reintegration: Collaboration, Communication, and Continuum of Care
By Rachelle Steinberg
Individuals approaching release from a correctional setting often experience anxiety. Although returning to the community should be a positive event, many men and women reenter the community with little to no supports, including no stable housing, employment, support services, or even basic necessities. Effective planning for one’s release from custody begins on their first day in the correctional setting, as the specific needs of each individual can vary tremendously. It is incumbent upon local Sheriff staff to be thoughtful toward their needs and how best to support them through pre and post release.
The key to successful reentry requires understanding the incarcerated population. Correctional facilities are no longer places of detention used to punish people for their crimes. Jails and prisons across the country are de facto training, school, detox, medical and mental health facilities. Those who are incarcerated have substantial needs and correctional agencies must evolve in how they provide programming, treatment, and education to better serve these needs.
The Suffolk County Sheriff’s Department (“SCSD”), located in the heart of Boston, operates two facilities for male and female, pretrial and sentenced individuals. SCSD is one of only a handful of agencies that houses incarcerated women. In October 2019, SCSD began housing females from Essex, Norfolk, and Plymouth counties.
The population housed at SCSD facilities, and their length of stay in custody, has decreased dramatically in recent years. While individuals may be sentenced to a House of Correction for no more than two and a half years per charge, a majority of those sentenced are in custody for a fraction of that time for many reasons. In the past two decades, courts have been imposing shorter sentences. Those shorter sentences are further reduced because of: time served while on a pretrial status; “good time” credits for participating in education, work, and other programs; and early release by the Massachusetts Parole Board. As a result, the length of time incarcerated individuals have remained in SCSD’s custody has steadily decreased for more than a decade, requiring the SCSD to re-evaluate how it develops and provides programs to those in its care.
A snapshot of SCSD’s current population gives sobering insight into the inherent difficulty of providing comprehensive and complete services to a transient population:
- 71% of the male population is pretrial;
- 79% of the female population is pretrial;
- 55% of the pretrial population is released from custody in less than 30 days;
- 17% of the pretrial population is in custody longer than 90 days;
- 28% of the population is sentenced; and
- Of those sentenced, 41% are released within 90 days (15% released in less than 30 days and another 14% released in less than 60 days).
SCSD has also seen a decline in the number of individuals incarcerated. Although the average daily population continues to decrease, the medical, mental health, and substance use needs of those in custody have severely increased. As a result of prioritizing those needs, the SCSD has steadily increased the number of medical and mental health staff it requires to ensure necessary care while incarcerated and in preparation for reentry.
Assessments and Meeting the Needs of the Population
SCSD and other correctional systems have evolved and are creating new models using evidence-based systems that seek to address the particular needs of incarcerated individuals. Most programs are now designed to be shorter in length, recognizing the limited time the population is engaged in programs. Data about engagement and effectiveness in these programs proves that understanding the population’s needs and providing targeted programming and treatment works. SCSD’s recidivism study shows that individuals who participated in educational, vocational, and intensive reentry and support programs had lower rates of recidivism over three years compared to those who did not. Of the men and women who participated in programming, 46%-47% did not have a new criminal incident compared to the overall percentage of recidivism of 32%.[1]
To find the right treatment and programs to address an individual’s needs, SCSD staff begins the assessment process the moment someone enters the facility. During intake, medical and mental health teams delve into each individual’s health history. This includes, but is not limited to: suicidality, including attempts and hospitalizations; mental health and medical diagnoses; history of trauma; substance use history, including overdoses, residential treatment, and/or hospitalizations; and current prescribed medications and treatments. Additionally, for females, staff assesses current or historical pregnancy, terminations, and all other female health related needs.
Following the intake process, medical and mental health staff create comprehensive treatment plans irrespective of the individual’s possible length of incarceration. For many, this begins with medically managed withdrawal (i.e., detox). These withdrawals can often be complex because incarcerated patients frequently use multiple substances, which may require multiple medical protocols. Another challenge for the medical team is addressing all outstanding medical issues. This process is especially daunting and difficult because the SCSD medical assessment and treatment may be the first medical care the incarcerated person received in years. Those with a mental health diagnosis, a history of mental health related events or trauma are immediately referred to be seen and evaluated by mental health providers. This evaluation assists clinicians, psychiatrists, and the patient in creating a thoughtful care plan which may include medication previously prescribed or a new treatment, one-on-one counseling, and group therapy.
SCSD also works closely with the Massachusetts Department of Mental Health (“DMH”), as about 7% of those in its custody are DMH clients. This partnership enables the mental health team and DMH staff to create a plan pre and post release, which is imperative for this vulnerable population. Many of the men and women in SCSD’s custody self-report a history of trauma requiring programming and treatment that is trauma informed. Although trauma is reported by all populations, women self-report at a rate of over 85%. SCSD collaborates with many community partners that can support those dealing with issues of intimate partner violence, sexual exploitation and trafficking, and other common forms of trauma.
Concurrent with medical and mental health needs, the classification, case management, reentry, and education staff evaluate what individuals will need before and after release. These staff members complete necessary assessments to create an individualized service plan (“ISP”), which become an individual’s program and housing map throughout their incarceration. Staff review the possible length of stay, criminal history, education level, and program needs to complete the plan. The ISP also includes an assessment of whether an individual is an appropriate candidate for transition to the community in a halfway house or home setting while still in SCSD custody and supervision. The possibility of placement in the community pre-release provides individuals the opportunity for a smoother reintegration with increased supports and assistance by SCSD staff.
A primary goal for many in corrections is to ensure the men and women in custody return to society in better condition than when they left. With this goal in mind, correctional agencies need to provide programs, education, and treatment that meet the needs of those in their custody. SCSD offers an array of evidenced-based programs, substance use treatment, and educational opportunities from special education, GED and HiSET preparation and testing, and a number of holistic programs, such as yoga and meditation. “There is substantial and growing evidence of the many benefits of higher education in prison: reducing recidivism, improving facility safety, enhancing the self-efficacy of incarcerated people, potential interruption of intergenerational cycles related to poverty and education attainment and the ability to boost students’ employability.”[2] A few of SCSD’s vocational offerings are culinary arts, gardening, and a builder’s program. Some vocational programs provide the opportunity to obtain valuable certifications, such as the OSHA 30 and ServSafe certifications. Programs that offer transferable skills, along with employment referral assistance, allow men and women the ability to work once in community.
A thoughtful reentry and discharge plan should include referrals to community agencies to assist with job assistance and/or training; social service supports; and medical, mental health, and substance use continuum of care appointments. Staff work with each individual to determine their needs and the area in which they will be living upon release for a plan to obtain housing, appointments, and connections to other resources.
Hurdles for Those Awaiting Trial
Another major barrier in reentry planning is that a majority of those in county correctional facilities throughout the Commonwealth are awaiting trial, which leaves staff and discharge planners with no ability to predict release dates. In Massachusetts, of the 16,000 individuals incarcerated, over half, are being held in county correctional facilities.[3] In Suffolk County, over 70% of the average daily-incarcerated population is awaiting trial (also known as “pretrial detainees”). Without knowing if a pretrial detainee will be held for days, weeks, or months, it is difficult for correctional staff to provide effective treatment, programs, and reentry plans as well as post-release referrals and services. Without a discharge date, there is limited ability to ensure health insurance coverage or to make medical, mental health, and/or treatment appointments in the community. Staff do their best to work with the courts, probation, defense attorneys, and other community agencies to prepare a release plan for pretrial detainees. However, it is almost impossible to create concrete plans when a release date is unknown.
Transitioning into the Community
One of the most difficult challenges resulting in homelessness, displacement, and a lack of access to resources is housing. During the intake process, approximately 10% of the population report being homeless or unhoused prior to their arrest. This number is lower than the reality, because many who meet the definition of homeless do not self-identify as homeless. Individuals believe they can return to where they were living or will stay with friends. However, where they were living before is often not optimal or even an option where other residents have open legal issues or the housing is not otherwise appropriate.
Another common challenge occurs because many of those in custody do not have any form of identification. Identification is required to access most community resources. The SCSD and other correctional institutions are collaborating with the Registry of Motor Vehicles to ensure most individuals receive some form of acceptable identification upon their release.
It is also difficult to provide continuous care to address medical and mental health treatment because MassHealth coverage ends when an individual enters any custody status. MassHealth requires a release date before resuming coverage. Where a release date is difficult to obtain for pretrial detainees, discharge planners cannot enroll or re-enroll individuals before their release. Without insurance coverage upon release, an individual may miss key medical appointments and medication and be excluded from housing at residential treatment programs.
SCSD also provides care and a variety or programming to the many incarcerated individuals with substance use disorder. Statistical data shows that people released from jail or prison are 120 times more likely to overdose on opioids than the general population in Massachusetts. County correctional facilities and the Department of Correction, offer all three forms of Medicated Assisted Treatment (MAT) for Opioid Use Disorder (OUD),[4] which is considered the “gold standard of care” by the medical community and U.S. Surgeon General.[5] For many diagnosed with OUD, being able to access multiple treatment options is important. SCSD offers groups, one-on-one counseling, as well as MAT. Although SCSD is currently in the process of compiling the measurable data, we know that providing MAT in correctional settings as part of one’s reentry process reduces potential overdoses upon release and reduces recidivism.
Conclusion
Collaboration, communication, and the continuum of care are paramount to successful reentry. The SCSD prides itself on its various collaborations with justice partners, the courts, probation, parole as well as many social service and support agencies throughout the Commonwealth. Open lines of communication with the courts, specialty courts, probation, and defense attorneys is immensely helpful for reentry planning, especially for those being held pretrial. Having a sense of when an individual is leaving and establishing possible home and program plans allows staff to get all systems in place, such as appointments and prescriptions. Bringing community partners into the facilities to meet with the men and women as part of their reentry preparation is also a priority because it fosters relationships with the clients, permits the plan for a warm handoff on the day of release, and increases the likelihood that they will show up to the organization post-release. These men and women cannot succeed without partnerships between corrections, justice and legal entities, service agencies, and most importantly the community’s willingness to welcome them back and offer them support and another chance.
Rachelle Steinberg is an Assistant Superintendent at the Suffolk County Sheriff’s Department. She focuses on contracts and operations overseeing medical and mental health services, substance use, reentry, and women’s programming. She is the Department’s Trial Court liaison.
[1]Jonathan Jones & Benjamin Forman, Reducing Recidivism in Massachusetts with a Comprehensive Reentry Strategy, MassINC Policy Brief (Jan. 2016).
[2]Commission Urges New England States to Prioritize Prison Education, Commonwealth Magazine (June 16, 2023).
[3]Leah Wang, Punishment Beyond Prisons 2023: Incarceration and supervision by state, Prison Policy Initiative (May 2023).
[4]Improving Release Process and Treatment Continuity for Incarcerated People May Help Reduce Opioid Overdoses, Tufts University School of Medicine (Aug. 11, 2022).
[5]Linda Richmond, Surgeon General’s Report on Opioids Emphasizes ‘Gold Standard’ Treatment, Psychiatric News (Oct. 12, 2018).
