Katie Kramer, M.P.H., M.S.W., is the co-founder and CEO of Corrections, Communities & Families of The Bridging Group in Oakland, CA. For the past 25 years, she has focused on the development, implementation, and evaluation of social service and health programs that serve individuals, families and communities affected by the criminal justice system. Katie also a lead trainer and capacity building provider for Project Start+ (PS+), a behavioral re-entry intervention for people living with HIV returning to the community after incarceration.
We caught up with Katie to learn more about her work and the PS+ intervention.
Tell me about yourself and how you got involved in this work.
My original training was in social work. As a social worker, I worked with children whose parents were in prison. I have worked for over 20 years with people in prison and their families. Supporting people while they are incarcerated, as well as their families is so important, not just for the individual, but for the community as a whole.
We need to work together to change the public perspective. There is a machine of mass media telling us that people who are in prison or jail are bad people. This is not true. People in prison or jail are people, some of whom may have made bad choices and many have been criminalized because of their life circumstances or health status including mental illness, substance use and homelessness. Additionally, as we think about the HIV epidemic, we must focus on all people -- including people in prisons or jails. We can't get to zero if anyone is left behind.
Why is working with people living with HIV returning home from prison or jail important?
People in prison or jail are often forgotten or seen as "off and away." But the reality is that 95% of people in prison and jail are coming back home and into the community. So, from a global public health or safety stance, supporting people in prison and jail helps to make our communities healthier and safer.
More specific to people living with HIV, incarceration may be a time when they get linked into care for the first time or the first time in a long time. It is also a time when people may first learn of their HIV status. After release, when people return to their community, it can be difficult to remain in care and manage HIV treatment. More urgent needs, such as housing, food, or employment can take priority. Working with folks in prison or jail to link them to care and other services upon release can help people stay engaged in care, with no gap in medication management, health care, or other support services.
I'd also like to add that many of the people in prison and jail are under-served and under-resourced. Working with people who are in prison or jail is an important way to connect with people who may not have been able to engage in care in the community previously. It is a unique and important way to form connections and provide support.
What is Project Start+ and why is it unique?
Project Start+ is a tailored re-entry program for people living with HIV returning to the community after incarceration. It was designed specifically for the unique challenges and barriers that people face after incarceration. It is a short-term bridge program, not intended to replace long-term systems of care. Through the program, we work with people two months prior to release and three months post release to do very intensive and unique planning to link them to long-term systems of care. It is a great complimentary program for organizations who are already providing treatment, case management, or patient navigation services.
While Project Start+ has a unique emphasis on linkage to and re-engagement in care, it is packaged within helping people meet their larger other re-entry needs. It's not only about HIV, it's also about housing, food, and employment. If folks don't have a place to stay, food to eat, or don't know how to report to parole, there's no way for them to prioritize or make it to their medical appointment. Project Start+ integrates HIV linkage to care and risk reduction into the larger re-entry needs of people.
Tell us about a time that providing support to someone returning home made all of the difference in their lives.
I worked with a man who was homeless and not accessing care prior to incarceration. When I met with him, we took the time to sit down and connect about his health and other needs. Since he had last been taking medications, there had been advancements, so we could decrease the number of pills he had to take, which had been a challenge for him.
After his release, we linked him to a clinic in San Francisco that has special clinic days for folks who are formerly incarcerated, so he felt much more comfortable and less stigmatized going to this clinic. We went with him to his first medical appointment and helped with small things, like making sure his new medication looked the same as the ones in jail, to provide continuity for him. Through it all, we also linked him to housing services and mental health support. Even with the challenges that he faced after release, he continued to maintain his appointments at the health clinic and take his medications. I think part of his success was because we supported him in finding medical care that was accessible, safe, and comfortable for him.
What are some best practices for organizations when working with people who have been in prison or jail?
Here are a few best practices, in no particular order:
- A core element of Project Start+ is that the same staff person works with a client inside and out of prison or jail. Meeting someone on the inside builds trust; having that same person greet them when they come home is key to the success of Project Start+. So much of the success of an intervention relies on that relationship. Additionally, as much as possible, using a peer or near-peer model for staffing is important. Because of that inside-outside requirement in the staffing, some folks may run into clearance issues. But if the correctional facility will allow it, formerly incarcerated staff members can be a real asset to a program.
- For medical clinics, it is important to truly have a welcoming culture of serving folks who are formerly incarcerated. You can have designated days or appointments specific to people who are formerly incarcerated or their families. For example, an agency in Dallas that implements Project Start+ has designated two appointment slots at their medical clinic every week for people coming home after incarceration. If no one is being released that week, then the clinic will fill slots with other patients. This way, anyone coming home through Project Start+ has a guaranteed appointment within their first week home.
- Project Start+ is intentionally a short-term intensive program intended to bridge people to a long-term system of care. If the Project START+ staff is the only one in a person's life providing support, they are doing the participant a disservice. From day one, staff should help identify what other resources, people, and support is available and link them into the long-term system of support. That said, reincarceration is part of the lives of many people we work with. In the case of reincarceration, people are eligible to participate in Project Start+ again.
- Lastly, Project Start+ is grounded in a harm-reduction framework and incorporates an overdose prevention model. We have seen that right after release is a time with high risk for overdose, so incorporating these strategies into your program can be life-saving.
How do you stay motivated day to day in your work?
I have been working with folks who have been incarcerated for over 25 years and honestly, they are the ones who many times inspire me. It is a community of people who often have been left behind. It's inspiring to be able to help people identify their own strengths and support them in their efforts to turn their lives around.
Looking for CBA to improve your organization's ability to work with currently and formerly incarcerated people, including how to implement Project Start+? Access free technical assistance from The Bridging Group through AIDS United's Getting to Zero program!
Sarah Hashmall is communications manager at AIDS United.
[Note from TheBody.com: This article was originally published by AIDS United on Nov. 1, 2017. We have cross-posted it with their permission.]