How Integrated Healthcare and Social Services Can Close Gaps After Incarceration
By Aimee McPhail, Research Associate
The New York City Health Justice Network (NYC HJN) is supporting people returning home from incarceration by providing holistic healthcare and social services. A recent evaluation of the program found evidence that it made a positive impact on reducing future criminal legal system involvement. This evaluation highlights the value of similar reentry programs tailoring their services to address the wide-ranging needs of individuals reintegrating into the community.
Thousands of people in New York City return home from incarceration each year.¹ When they do, they often face an array of challenges, including difficulty finding employment and housing instability.² If left unaddressed, this can undermine successful reentry into the community. This is on top of the fact that incarceration often disrupts health care treatment, making it more difficult for individuals to access and keep track of necessary medical treatment and services.³ People who have been incarcerated often lack a primary care physician upon release, rely on emergency departments for healthcare, lack essential medications, and disproportionately experience mental health issues that interfere with the ability to manage serious medical conditions.⁴ Taken together, individuals with criminal legal system involvement are at a higher risk for poor health outcomes (e.g., chronic illness, substance use disorders, cardiovascular disease) compared to the general population.⁵
Funded through the Criminal Justice Investment Initiative (CJII), a partnership between DANY and CUNY ISLG, the NYC HJN embeds community health workers (CHWs) in primary care and community-based organization (CBO) sites to connect previously incarcerated individuals to primary care and other wraparound services (e.g., employment and housing services).
Local health departments, in partnership with community-based reentry programs, play a crucial role in connecting individuals released from incarceration to the proper healthcare and social service supports necessary for successful reentry –such as primary care, housing, employment, and vocational training. To address key gaps in New York City’s reentry landscape, the Manhattan District Attorney’s Office (DANY) funded the NYC Department of Health and Mental Hygiene⁶ to launch and operate the Health Justice Network (NYC HJN) in Northern Manhattan. Funded through the Criminal Justice Investment Initiative (CJII), a partnership between DANY and CUNY ISLG, the NYC HJN embeds community health workers (CHWs) in primary care and community-based organization (CBO) sites to connect previously incarcerated individuals to primary care and other wraparound services (e.g., employment and housing services). NYC HJN aims to hire CHWs with lived experience of the criminal legal system, whether directly or indirectly (i.e., through a family member or friend), similar to that of potential clients. CHWs provide social emotional support and serve as critical advocates who help clients navigate the healthcare system and wide range of social service organizations often needed during the period of reentry to the community after incarceration.
From March 2019 through December 2023, NYC HJN supported 1,339 people recently released from incarceration—more than half of whom enrolled in the program within three months of being released. This meant connection with health-related services like health insurance, primary care, dental care, mental and behavioral health. It could also mean linkage to social services, including assistance with employment, housing, food security, obtaining vital documents, and legal support.
Through CJII funding, NYU-CUNY Prevention Research Center (PRC) conducted an outcome evaluation of the program. Following an interim evaluation of the program that found a high level of program engagement, the final report findings offer preliminary evidence of NYC HJN’s ability to reduce future criminal legal system involvement among participants. Moreover, the evaluation demonstrates how reentry programs that adopt a holistic approach to supporting individuals released from incarceration may support a more successful transition back into the community.
Read more about how the program helps recently released participants navigate the reentry process.
NYC HJN Participation and Reducing the Number of Rearrests
PRC examined the relationship between NYC HJN program participation and re-involvement in the criminal legal system, specifically focusing on outcomes of rearrest, reconviction, and reincarceration at 6- and 12-months after the program started. Using a sample of 203 NYC HJN clients who enrolled in the program between 2020 and 2022, PRC found that those who enrolled in NYC HJN had fewer rearrests at 6 months compared to similar individuals who did not enroll in the program (see Figure 1) – a trend that was also evident up to 12 months post-program start. When looking at the proportion of NYC HJN clients versus non-clients who had rearrests, the results trended in favor of program clients (68.5 percent did not have a re-arrest, versus only 62.2 percent of the comparison group), though the results were not statistically significant.
Figure 1. Average Number of Re-arrests at 6- and 12- Months Among HJN Clients vs. Non-Clients
Similarly, NYC HJN clients had a marginally significant lower reconviction rate at the 6-month follow up, compared to non-clients (6.4 percent clients reconvicted vs. 11.5 percent non-clients reconvicted). The reconviction rate at the 12-month follow up, however, was not statistically different between these groups (13.3 percent clients reconvicted vs. 17.4 percent non-clients reconvicted). Rates of reincarceration were relatively similar for both NYC HJN clients and non-clients at the 6-month (2.0 percent vs. 2.7 percent reincarcerated, respectively) and 12-month follow up (3.9 percent vs. 4.7 percent reincarcerated).⁷ While some of these outcomes favor NYC HJN program participation and suggest a positive impact on reducing further criminal legal system involvement in the first 6-12 months following enrollment in the program, further research with larger sample sizes may be able to provide evidence of these trends more conclusively.
Increased Access and Linkages to Appropriate Healthcare and Social Services are Essential for Navigating Reentry across Social Groups
NYC HJN’s innovative initiative facilitates community reentry through client-centered programming. It has successfully engaged individuals of different ages, identities, and experiences who have recently been released from incarceration. Around one quarter (28.2 percent) of clients were aged 35 or younger, while 71.8 percent were 36 years of age or older. Nearly all were male (92.7 percent), and most identified as Black (52.1 percent) or Latine (27.3 percent), broadly reflecting the New York State incarcerated population.⁸ Upon enrolling, two-thirds of clients had only a high school diploma or equivalent or less (67.9 percent), and the vast majority were unemployed (80.3 percent). A majority of clients (60.6 percent) were most recently released from city jails, while 39.4 percent percent were most recently released from state prisons.
A key aspect of this type of support are CHWs integrated at primary care clinics and CBOs, as their lived experience and shared language of the healthcare and criminal legal system allow them to build trust with those released from incarceration.
The evaluation findings from NYC HJN's approach underscore the importance of connecting people with various backgrounds to appropriate reentry services, as well as demonstrate the potential for such programs to help avoid future involvement with the criminal legal system. A key aspect of this type of support are CHWs integrated at primary care clinics and CBOs, as their lived experience and shared language of the healthcare and criminal legal system allow them to build trust with those released from incarceration. These skills, in combination with training for CHWs on providing trauma-informed care⁹ and teaching social resilience,¹⁰ can better assist clients in navigating reentry services.
Furthermore, navigating reentry may look different depending on specific factors such as age, gender, race/ethnicity, and specific mental health or healthcare needs. For example, NYC HJN clients 35 years of age or younger, compared to older clients, had higher rates of rearrest. These findings are consistent with broader research showing a decline in criminal behavior as people mature from youth into adulthood, but also indicate the potential utility of programming focused on needs based on age. In addition, clients released from jail, as opposed to those released from prison, had higher rates of rearrest. Although incarceration in jail disrupts one’s life just as prison does, reentry support is typically more limited for those returning to the community from jail, in part due to the likelihood of shorter durations of incarceration in jails. Therefore, it is important for reentry programs to take these diverse needs into account and tailor programming accordingly.
About the Program and Evaluation
NYC HJN continues to provide individuals returning from incarceration with the necessary supports and services to ensure the process of reentering the community is made less challenging.
This blog accompanies NYU-CUNY PRC’s outcome evaluation report of NYC HJN focusing on NYC HJN’s impact on clients’ recidivism outcomes (i.e., arrest, conviction, and reincarceration). A concurrent evaluation assesses the effects of NYC HJN on health outcomes, with preliminary findings of that evaluation (not yet published) showing positive results.
ABOUT THE CRIMINAL JUSTICE INVESTMENT INITIATIVE
The Manhattan District Attorney’s Criminal Justice Investment Initiative (CJII) focuses on three investment areas—crime prevention, diversion and reentry, and supports for survivors of crime. HJN is part of the CJII’s investments in diversion and reentry.
The CUNY Institute for State and Local Governance manages and provides technical assistance to CJII contractors, and conducts oversight and performance measurement throughout the lifetime of the initiative.
Footnotes
NYC Open Data. Inmate Discharges. Updated June 1, 2023. Accessed June 2, 2023. https://data.cityofnewyork.us/Public-Safety/Inmate-Discharges/94ri-3ium.
Phillips, L. A., & Spencer, W. M. (2013). The challenges of reentry from prison to society. Journal of Current Issues in Crime, Law & Law Enforcement, 6(2).
Feingold, Z. R. (2021). The stigma of incarceration experience: A systematic review. Psychology, Public Policy, and Law, 27(4), 550–569.
Wildeman, C., & Wang, E. A. (2017). Mass incarceration, public health, and widening inequality in the USA. The Lancet, 389(10077), 1464-1474.
Latham-Mintus, K., Deck, M. M., & Nelson, E. (2023). Aging with incarceration histories: An intersectional examination of incarceration and health outcomes among older adults. The Journals of Gerontology: Series B, 78(5), 853-865.
With the Fund for Public Health in New York City as the fiscal conduit
Please note that case processing time tends to be long in New York City, reducing the ability to observe reconviction and reincarceration within 12 months more broadly.
Profile of Under Custody Population as of January 1, 2021. NYS Corrections and Community Supervision.
Trauma-informed care refers to an approach that aims to engage people with histories of trauma, recognize the presence of trauma symptoms, and acknowledge the role that trauma has played in their lives.
An approach to individual self-regulation, health and resilience that trains and empowers providers to deploy tangible self-regulation and behavioral modification skills in response to the specific physical and emotional symptoms triggered by trauma and stress.
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