The Fortune News: Care Management

THE FORTUNE NEWS VOLUME LII • FEBRUARY 2020

CARE MANAGEMENT

REBUILDING LIVES THROUGH ACCESS TO HEALTHCARE AND TREATMENT The Fortune Society

BUILDING PEOPLE, NOT PRISONS

THE FORTUNE NEWS EDITOR-IN-CHIEF Stephanie Geier DESIGNER Emerson Soto

The Fortune News is a publication from The Fortune Society, printed twice a year to inform the public of the work and impact of Fortune’s reentry services and advocacy efforts. @2020 The Fortune Society, Inc. All Rights Reserved

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VOLUME LII · FEBRUARY 2020

THE FORTUNE NEWS TABLE OF CONTENTS

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OUR MISSION Learn About Our Mission, Programs, and Services

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NAVIGATING THE HEALTHCARE SYSTEM DURING REENTRY

EYE ON FORTUNE Key Events in 2019

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FACES OF FORTUNE Staff and Participant Experiences

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A GUIDE TO MEDICAL CARE DURING INCARCERATION AND AFTER RELEASE

LETTERS TO THE EDITOR Letters from Individuals Who Are Currently or Formerly Incarcerated THE CARE MANAGEMENT UNIT The Fortune Society’s Own “Heathcare Concierge”

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TRUST AND LAUGHTER Key Junctures For Change

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Q&A WITH DR. JONATHAN GIFTOS Preventing Opioid Relapse and Overdose

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FINDING HEALTH SERVICES AND SUPPORT AT THE COMING HOME PROGRAM

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BEING RESPONSIBLE FOR YOUR HEALTH: CHARLES’S STORY

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ACCESSING SUBSTANCE USE TREATMENT AFTER INCARCERATION

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THERAPY A Powerful Way To Cope With The Stressors Of Coming Home

VOLUME LII • FEBRUARY 2020

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OUR MISSION

PROGRAMS & SERVICES

The Fortune Society’s mission is to support successful reentry from incarceration and promote alternatives to incarceration, thus strengthening the fabric of our communities.

Alternatives to Incarceration (ATI)

We do this by:

Our ATI program reduces the prison and jail population, helps hundreds of individuals receive holistic, supportive services, and saves taxpayers millions of dollars that would otherwise have been spent on incarceration.

Believing in the power of individuals to change;

Benefits Access

Building lives through service programs shaped by the needs and experiences of our participants; and

Our Benefits Access program helps participants achieve economic mobility by coordinating access to public benefits available to individuals and families with low incomes, including the Supplemental Nutrition Assistance Program (SNAP), Medicaid, Social Security Disability Insurance, and other forms of public assistance.

Changing minds through education and advocacy to promote the creation of a fair, humane, and truly rehabilitative correctional system.

Creative Arts Our Creative Arts program supports the educational, emotional, and cultural development of individuals impacted by the justice system through creative writing, storytelling, music, theater, and visual arts.

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Education

Housing

Our Education program empowers students to achieve personal and professional goals, such as acquiring basic literacy skills, earning a High School Equivalency diploma, attending college, or preparing for employment.

Our Housing program assists individuals with justice involvement and their families experiencing homelessness in building better futures through supportive and affordable housing. The program provides low-threshold access to emergency, transitional, and permanent housing in our congregate buildings: The Fortune Academy (“the Castle”) and Castle Gardens, along with our Scatter-Site housing program.

Employment Services Our Employment Services program is designed to equip job seekers with justice involvement with the skills necessary to obtain employment and thrive in the workplace. The program offers job readiness, transitional work, and sector-based skills trainings in Environmental Remediation, Green Building Maintenance, Culinary Arts, CDL Class B, Social Services 101, and OSHA 30/ Flaggers. We also offer job placement assistance and retention services.

Mental Health Treatment Our participants have access to a full spectrum of services through our NYS Office of Mental Health (OMH)-licensed Better Living Center (BLC), which serves individuals with mental health needs and histories of justice involvement.

Family Services

Prepare For Release

Our Family Services program works to unite participants with their loved ones by facilitating healthy parentchild activities, parenting and Healthy Relationships workshops, and referrals to legal services for custody, visitation, and child support commitments.

Our Individualized Corrections Achievement Network (I-CAN) program provides skill-building and discharge preparation services to eligible individuals during their incarceration at NYC Department of Corrections (DOC) jails and offers continuing reentry support following their release.

Food And Nutrition Our Food and Nutrition program offers nutrition counseling and education, cooking demonstrations, and produce giveaways. Our meal program serves over 50,000 meals annually in addition to the 20,000 pounds of fresh, locally grown produce we distribute to participants through partnerships with local farms.

Treatment Services Our New York State Office of Alcoholism and Substance Abuse Services (OASAS)-licensed outpatient substance use treatment clinic empowers people with substance use histories to heal and recover from addiction and the trauma of incarceration.

Health Services Our Health Services program connects individuals with justice involvement and chronic conditions to quality healthcare and social services. We also provide individuals living with HIV/AIDS and opioid use issues with vital discharge planning, case management, health education, and connection to quality, community-based treatment and care.

THE DAVID ROTHENBERG CENTER FOR PUBLIC POLICY In honor of our founder’s tireless efforts to promote the rights and fair treatment of people with legal system involvement, Fortune launched The David Rothenberg Center for Public Policy (DRCPP) in 2007. DRCPP works to build equitable legal systems, advance alternative approaches to justice, change counterproductive laws, expand effective program models, and shift public perception.

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NAVIGATING THE HEALTHCARE SYSTEM DURING REENTRY

BY ASHANTY REECE Care Navigator The Fortune Society

When I meet with new clients at The Fortune Society as a Care Navigator, I introduce The Care Management Unit’s (CMU) services as a resource to help them navigate their healthcare.

CMU promotes “preventative care,” medical services to prevent illnesses, diseases, and any other medical emergency. This is done by connecting clients to medical professionals who will help them manage their medical diagnosis and avoid any severe medical conditions leading to the emergency room or hospitalization.

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My responsibilities as Care Navigator closely align with the definition of “navigation”—finding and following a path through a difficult place, and dealing effectively with a complicated situation. For most of CMU’s clients, learning how to get professional medical care can be just that—difficult and complicated. This is where the CMU team steps in to help.

Our formerly incarcerated clients have often only been exposed to healthcare professionals during confinement and some of those encounters were traumatic. The clients shared that sometimes their diagnoses are not thoroughly looked at and the

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medications prescribed often do not resolve the issues. Clients also shared that although healthcare providers do not educate them on their diagnosis or the medications prescribed, they take what is provided to them. They do not question or feel as if they have a voice to do so. This has resulted in the worsening of their mental and physical health, as many have been wrongfully diagnosed or medicated.

Once released, formerly incarcerated individuals have to deal with a healthcare system that can sometimes feel more like the legal system when trying to navigate it alone. Sometimes they face barriers that encourage them

to not face it at all; they’d rather not make too much money, they will not collaboratively to advocate for social deal with complicated insurance qualify for health insurance or it won’t justice reform. eligibility or obtaining documents be affordable for purchase. At times, When I work with clients, I let them necessary to get coverage. After making and scheduling appointments know that they also have a voice when incarceration, they sometimes face is difficult because they do not have it comes to their healthcare. They have coverage restrictions due to their income or a means of transportation to the right to question their providers incarceration status not being updated get there. These are just a few of the and not feel stuck in receiving upon release. Trying to prove they are issues our clients face when trying to treatment they do not feel comfortable no longer incarcerated can prolong the navigate their healthcare. with. At the same time, the process of them obtaining CMU team is there to guide, insurance and often turns “When I work with clients, I let them support, and educate them to the client away from know that they also have a voice work towards breaking the services altogether. mental strain of navigating when it comes to their healthcare.”

During reentry, people the healthcare system.  may shift their priorities, which sometimes do not include My job is to guide them through checking on or improving their health. all of this as a Care Navigator and This can happen for different reasons. advocate for systems change as part For instance, individuals who want to of the Policy Center Collective—a find employment may learn that if they group of 30 Fortune staff working VOLUME LII • FEBRUARY 2020

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EYE ON FORTUNE THE NEW YORK CITY COUNCIL VOTES TO CLOSE RIKERS ISLAND OCTOBER 17, 2019 In a huge step forward for criminal justice reform, on October 17th, the New York City Council voted YES on a plan to close Rikers Island. The plan proposes to shut down Rikers, which has nearly 10,000 beds, by 2026 and replace it with safer and more humane, borough-based facilities. This historic progress was made possible by years of grassroots advocacy from the #CLOSERikers campaign, a movement centering the voices of people with lived experience. They bravely told their stories, shedding light on the inhumane conditions and abuses occurring at Rikers. Fortune was a proud partner in the Close Rikers movement. 

TIE DAY OCTOBER 22, 2019

HOPE AND JUSTICE GALA OCTOBER 29, 2019

When it comes to making first impressions at jobs and interviews, dressing for success can make all the difference. On October 22nd, The Fortune Society’s Alternatives to Incarceration (ATI) program held its annual “Tie Day,” a workshop that teaches formerly incarcerated men how to tie a necktie. The ties were donated from Fortune staff and J. Crew, and participants also had the opportunity to explore college educations and careers. 

The Fortune Society’s annual Hope and Justice Gala was an incredible success! Thanks to the generosity of the 480 attendees and other supporters, it raised nearly $1.7 million.

These resources will allow Fortune to continue to provide vital reentry services to over 8,000 individuals with justice involvement annually and advocate for a fairer and more humane criminal justice system. At the gala, three inspiring advocates were honored: Joshua L. Steiner from Bloomberg L.P., and Fortune’s own Director of Admissions, Nancy Lopez, and Executive Vice President, Stanley Richards. 

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FACES OF FORTUNE

EILEEN KOBRIN

RICHARD LOUIS

DYJUAN TATRO

Did they give a firm handshake?

Have you ever been convicted of a crime? – This is a question that many individuals with justiceinvolvement such as Dr. Richard Louis encounter throughout their lives. Although unavoidable, he responds to it with confidence, thanks to his experience as a client and staff member at Fortune. Here, he learned to address the question openly, and discovered the inner resilience to live on his own terms.

At the age of 19, Dyjuan Tatro was serving a 14-year prison sentence when he came across a transformative opportunity at Eastern Correctional Facility—a program called the Bard Prison Initiative (BPI), which would allow him to pursue a college education in prison. Dyjuan immediately enrolled—a decision that equipped him with a new mindset.

Are they speaking with confidence?

These are just a few questions that Eileen Kobrin, a volunteer at The Fortune Society, asks herself when conducting simulation interviews with clients. Through Fortune’s Mock Interview Project, hundreds of participants have successfully navigated one of the most daunting steps of the employment process: the interview.

“The whole idea is for the clients to develop a rapport with the interviewer…” says Eileen. “We encourage them…to develop some kind of a relationship, to smile.”

The Mock Interview Project is a game-changer because participants learn to develop a story of their skills and build inner confidence—so that when the real interviews come along, they are prepared.

Just as Fortune clients have learned lifelong skills from Eileen, they have also inspired her.

“I stand in awe of these men and women who’ve got everything going against them…” she said. “And yet...

They’re not giving up.” 

At Fortune, Dr. Louis learned to answer the conviction question by highlighting his accomplishments and conveying that his prison sentence does not define him.

Dr. Louis went on to earn a doctorate degree in Education for Organizational Leadership and now works at Broward College as the Associate Dean of Student Affairs, where he established a scholarship for students with incarcerated parents. He continues to live life to the fullest, unashamed of his past mistakes. “…I have the confidence to live in the world on my terms and have the world see me, and not just a conviction,” he said. 

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Now a Board Member at The Fortune Society and Government Affairs Officer at BPI, Dyjuan was recently featured in the PBS documentary College Behind Bars.

“Education...allowed me to…situate myself better in the world,” he said.

Dyjuan majored in math, completed a project on cancer cell proliferation, and took stimulating courses that gave him new ways of thinking.

Today, he advocates for the rights of incarcerated people as a Fortune board member, where he is especially focused on supporting criminal justice policies related to housing and LGBTQ issues.

“I think everything Fortune is doing around housing is amazing...” he said.

“Those are broad policy issues that take time…” 

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LETTERS TO THE EDITOR MEANING OF LIFE: THE CASE FOR ABOLISHING LIFE SENTENCES (THE NEW PRESS, 2018)

By Marc Mauer and Ashley Nellis Review by Christopher Santiago More than 200,000 people are serving life sentences in the United States.

That’s more lifers than in any other country, and despite declining crime rates, their number is growing.

In “The Meaning of Life: The Case for Abolishing Life Sentences” (2018), Marc Mauer and Ashley Nellis of The Sentencing Project succeed in drawing from a wide range of sources and plenty of evidence to make their case against life imprisonment. They explain how life sentences conflict with human rights norms, contradict the principles of rehabilitation, contribute to mass incarceration, and result in diminishing returns for public safety as prisoners “age out” of criminal behaviors. Life sentences disproportionately affect vulnerable populations and people of color while having little or no deterrent effect on crime.

The book provides a roadmap for research-based criminal justice reform and policy recommendations at a time when there is bipartisan support for decarceration in America.

To lay the groundwork for a realistic challenge to mass incarceration and to provide a better approach to public safety, the authors write, “sentences in American prisons should be capped at a maximum of twenty years, except in circumstances in which the individual still presents a clear threat to public safety.”

Mauer and Nellis thoroughly debunk the notion that life sentences are an alternative to the death penalty. They show that life imprisonment is a more protracted form of the death penalty with less procedural safeguards and 7

public scrutiny. At the top of the sentencing scale, life sentences exert upward pressure on the severity of all other sentences, resulting in longer prison terms that distort how criminal justice resources are allocated. Aging prisoners cost twice as much as younger prisoners to house and are far less likely to reoffend. If those funds were reallocated to reentry services, education, employment, housing, and substance abuse treatment in underresourced neighborhoods, the book argues, they would produce better outcomes for public safety.

Spread throughout the book are six profiles of lifers written by awardwinning author and former lifer Kerry Myers. It’s hard to read the profiles without pangs of sympathy for these six people. Lifers are condemned to live in hopelessness and despair, with little reason to pursue an education or refrain from violence. But these stories reveal, again and again, that humans have the capacity for positive change and personal transformation.

They deserve a chance at redemption.

“It is long past time to join the rest of the democratic world by scaling down the excessive nature of punishment that has become the hallmark of mass incarceration.” It’s time to end life imprisonment. For more information, visit endlifeimprisonment.org.

Christopher Santiago is serving a lifewithout-parole sentence in the South Carolina Deptartment of Corrections.

Christopher Santiago #304243, F2-136 Kirkland Correctional Institution 4344 Broad River Rd. Columbia, SC 29210 WWW.FORTUNESOCIETY.ORG

I WILL … MORE I will smile more I will listen more I will be more polite I will share more I will be more I will care more I will walk and enjoy more I will Love more I will pray more I will be Happy more I will try more harder I will learn more I will give more I will be kind more I will talk less, not more I will see more I will do more I will laugh more I will dream more I will celebrate our Lord more I will say please, more I will say thank you, more I will teach more I will exercise more I will help more I will clean more I will talk up more I will leave more I will keep better time more I will not, say much more I will believe and trust in Him more Truly God be the Glory Edgar Singleton Indiana State Prison 1 Park Row Michigan City, IN 46360

A GUIDE TO ACCESSING MEDICAL CARE: INSIDE AND OUT

BY MICAELA LINDER Director of Research The Fortune Society

“The following guide provides suggestions for how to navigate some of the challenges you might face trying to access adequate healthcare, both while incarcerated and after release from jail or prison.”

Even though the United States spends $8.1 billion on healthcare in prisons, access to adequate care can still be challenging. People with justice involvement have higher rates of cancer, heart disease, traumatic brain injuries, chronic conditions, and infectious diseases, than people in the general population. Among incarcerated people with persistent medical problems, 12.9% in federal facilities, 20.1% in state facilities, and 68.1% in local jails reported receiving no medical examination since incarceration; and following serious injury, 7.7% of people in federal facilities, 12% of people in state facilities, and 24.7% in jails were not attended to by medical personnel. Additionally, every stage of interacting with the criminal justice system can lead to lapses in access to insurance coverage, medication, and medical records, compromising individuals’ ability to be healthy.

The following guide provides suggestions for how to navigate some of the challenges you might face trying to access adequate healthcare, both while incarcerated and after release from jail or prison.

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CONTINUED: A GUIDE TO MEDICAL CARE MEDICAL CARE IN JAIL OR PRISON PREPARING FOR THE APPOINTMENT DOCUMENTING YOUR SYMPTOMS It can be difficult to get an appointment with a medical provider while inside. Make the most of your appointments by keeping thorough records of your symptoms prior to the appointment. Use the log below as a template for how to track your symptoms. As much as possible, try and write down your symptoms as soon as you notice them. If you are not able to bring paper into your appointment, review your logs prior to the appointment, and write down important dates and symptoms on the back of your appointment docket.

Date

What day did the symptom occur?

Sensation

What did it feel like? Dull, cramping, piercing, sharp, stabbing, throbbing?

Severity

From 1 to 10, what is your level of pain (10 = worst)?

Location

Where on your body is the symptom located? Try and be as specific as possible.

Is it the right side or the left side? Is it the upper or lower portion of a body part? Is it the whole body part, or just part of it?

Duration

Setting

What time did the sensation start and how long did it last?

Where were you when you started to experience a symptom or changes in your symptoms?

What medication did you take and what was the dose? If you have been without a Medication medication you regularly take, document how long you have been without your prescription.

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LISTING YOUR PRIORITIES AND QUESTIONS Make a list of everything you want to discuss in your upcoming appointment to try and ensure you get through as many of your concerns as possible. Writing out your responses to these questions, or going over them with a friend, can help you remember what to cover during your appointment.

• • • • • •

What are the three main reasons you are visiting the doctor?

Do you have any new symptoms you want to discuss?

Do you have any questions from your last visit to the doctor?

Have you experienced any barriers to accessing your medication?

Have you been experiencing any side effects to your medication?

Is there anything difficult or sensitive that you want to talk about with your doctor?

CONNECTING WITH SUPPORT Going to the doctor can be a difficult and demoralizing process for many people. Before you go into an appointment, consider if there is anyone whom you might call on for support. Most people have very few reliable relationships, and this can be even harder when you are dealing with separation caused by incarceration. If you do not have a person to call on, consider whether there is an organization or group that you might want to be in contact with. Try and let someone know, even if this is just in a letter to yourself, how you are feeling about your upcoming appointment, and any support you hope to receive when you are done.

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DURING THE APPOINTMENT

TESTS

SETTING THE AGENDA WITH THE HEALTHCARE PROVIDER The more information your medical provider has upfront about what topics you want to cover during the visit, the better. Try and pick your top three priorities (or fewer) prior to going into the appointment, and let your provider know what those are as early on in the appointment as possible.

When setting the agenda for the appointment, try and keep your sentences short and to the point. Below are some example statements: • • • •

“I want to cover the results of my blood work and my asthma.”

“I want to talk about the piercing headaches I have been experiencing over the past three months.”

“I would like to discuss the side effects of the medication prescribed to me during our last appointment.”

“I am concerned about the chest pain I have been experiencing.”

ASKING QUESTIONS It can be intimidating to ask questions during a medical appointment. Use the following as a guide for questions you might want to ask, depending on the provider’s level of receptivity to questions.

EXAMINATION • •

What are you looking for during this examination?

What are you listening for by putting the stethoscope to my lungs?

• • • • • •

Why is this test being performed?

Are there any potential side effects?

When can I expect the results?

What will these results tell you about my health?

What are the follow-up steps after we learn the test results?

Will I need a follow-up appointment?

DIAGNOSIS • • • • •

What may have caused this condition?

Is this condition permanent?

How is this condition treated or managed?

What will be the long-term effects on my life?

Are there any symptoms I should look out for, or ask my friends to look out for, that might be a sign that I need immediate care?

MEDICATION • • • • • • • • •

What is the name of the medication?

What does the medication do?

Is this medication addictive?

When and how should I take this medication?

For how long should I take this medication?

What are the potential side effects? If there are side effects, are there any ways we can reduce these?

Will I notice any changes as a result of the medication? If yes, when can I expect to notice these changes?

How effective is this medication?

Is this medication safe to take with the other medication that is prescribed to me?

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CONTINUED: A GUIDE TO ACCESSING MEDICAL CARE MEDICAL RECORDS •

May I have a copy of my medical record for this appointment, including the results of any tests given?

AFTER THE APPOINTMENT DOCUMENTING YOUR APPOINTMENT Keeping your own records of your appointments and tests results can help you see patterns in your health and remember the information a healthcare provider gave you.

You can also use the record as documentation. If you had an appointment that was canceled, or if you were unable to get access to an appointment, be sure to record those dates.

Use the following as a documentation template:

Date

What day was the appointment? Or what day was an appointment scheduled for, but then canceled?

Instructions for family members (or other nonincarcerated people) filling out a form on your behalf: Leave the patient signature line blank, unless you are the legal representative (a court-appointed legal guardian; health care agent appointed by a valid health care proxy) and are signing on behalf of the incarcerated person. If not, mail the completed form to the incarcerated person and ask him/ her to sign the form in front of a facility staff member such as a nurse, doctor, ORC, or correction officer, all of whom can sign as the witness to the incarcerated person’s signature before giving the form to medical staff to be placed in their medical record. A copy of the form should be provided to the incarcerated person.

Access the form at the following link: https://www.health. ny.gov/forms/doh-5032.pdf

MEDICAL CARE AFTER RELEASE PAYING FOR MEDICAL CARE

Provider

What was the name and position of the medical provider?

•

Tests

What tests were performed?

•

What is Medicaid and who is eligible?

•

How do you apply for Medicaid?

•

Results

Were you given any test results? What were the results?

Diagnosis

Did the healthcare provider give you a diagnosis?

Symptoms

Did the provider tell you to monitor any symptoms?

Follow-Up

Are there any follow up steps you need to take?

Concerns

Do you have any issues with the way you were treated?

•

You may be able to apply through the Marketplace. You can find your state marketplace, as well as information on your state’s income threshold for Medicaid eligibility, at this link: https://www.healthcare. gov/marketplace-in-your-state/

For those applying through New York State: •

MAINTAINING YOUR MEDICAL RECORDS If you would like someone outside of the prison to keep an additional copy of your medical records, fill out Department of Health Form 5032(DOH-532): 11

Medicaid is a free health insurance program for people with low income or no income.

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If you are able to apply through the Marketplace: •

Call NY State of Health, The Official Health Plan Marketplace at 1-855-355-5777

•

Apply online at NY State of Health, an organized marketplace also known as Obamacare, designed to help people compare and enroll in health insurance coverage: http://nystateofhealth.ny.gov/

•

If you need help, anyone who is eligible to apply through the Marketplace can do so with a Certified Assistor or Navigator.

Visit https://info.nystateofhealth.ny.gov/ ipanavigatorsitelocations to find one.

•

•

•

If you are unable to apply through the Marketplace: •

Call the New York State Medicaid Helpline: 1-800-541-2831

•

Visit your local Social Services Office: https://www.health.ny.gov/health_care/ medicaid/ldss.htm

For those who must apply through New York City: •

Call the Human Resources Administration (HRA) Medicaid Helpline: 1-888-692-6116

•

Visit an HRA Medicaid office: https:// www1.nyc.gov/site/hra/locations/ medicaid-locations.page

If you do not meet the income threshold for Medicaid: •

You may still be eligible to apply for other healthcare plans through the Marketplace that are partially subsidized by the government.

Visit healthcare.gov for more info.

NAVIGATING CONNECTIONS TO MEDICAL CARE POINT OF REENTRY AND TRANSITION (PORT) LINE •

•

PORTline is a general helpline to assist people recently released from custody in NYC jails with their reentry and transition needs. It is run by the NYC Health + Hospitals Corporation, and can help you get connections to medical care and obtain or fill a prescription, including for Suboxone.

General assistance with reentry and transition can also be obtained through the Correctional Health Services PORTline at (646) 614-1000.

QUESTIONS TO CONSIDER WHEN YOU ARE LOOKING FOR A DOCTOR OR CLINIC • • • • •

Do they accept “walk-in” visits?

Do they accept your health insurance?

Do you have any special concerns and does the doctor have experience treating them?

Is the clinic easy for you to get to?

Are there friends or family members who might have a good doctor you might also want to visit?

DURING THE APPOINTMENT It is important for you to be as comfortable as possible during your visits to the doctor, and doctors in the community are often more flexible than doctors on the inside. Below are some options that you might want to use during the appointment, to help make sure that you are getting what you need out of the appointment: • • •

• •

Tell your doctor what you would like to focus on during the appointment.

Tell your doctor what your goals are for your health.

Ask if it is possible for you to shift an item of clothing rather than put on a robe. While this might not always be possible, depending on what the doctor needs to examine, you can always ask.

Ask the doctor to tell you what they are doing and why they are doing it.

End the appointment at any time if you feel uncomfortable.

AFTER THE APPOINTMENT The following questions can help you evaluate if you would like to keep visiting your doctor. Having an open and trusting relationship with your physician can help your health and well-being. If you do not like your doctor, you have the right to find a different one who might be better suited. You are the expert on your health, and you deserve someone who respects you and values your insights.

• • • • • • • •

Did the doctor ask about your health goals?

Did the doctor give you a chance to ask questions?

Did it seem like the doctor was listening to you?

Did the doctor give you enough information about your diagnosis and/or health plan?

Did the doctor work in collaboration with you, or did the doctor just tell you what to do?

Did you feel comfortable with the doctor?

Did the doctor seem like someone you could talk to?

Was the doctor warm and welcoming, or impatient?

Please use this guide as a starting point to work out what works best for you, and please write to us if you have feedback or suggestions: Micaela Linder, 29-76 Northern Blvd., Long Island City, NY 11101. 

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THE CARE MANAGEMENT UNIT – THE FORTUNE SOCIETY’S OWN “HEALTHCARE CONCIERGE” As the number of people in jails and prisons requiring treatment for lifelong illnesses increases, so does the need for reentry services that are sensitive to the needs of people with chronic health problems. In response to this gap in services, The Fortune Society created the Care Management Unit (CMU), which began its work in July 2016.

CMU was made possible by the Affordable Care Act, which gave state governments the authority to create “health homes” for people with Medicaid. Health homes (not to

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be confused with home health) are organizations that bring healthcare and social service providers together to improve patient care. New York State created its own health home program in 2011.

Medicaid health homes work with organizations called “care management agencies” (or CMAs) to provide direct services to individuals on Medicaid who have been identified as having two or more chronic conditions and are high utilizers of the emergency room(s) for their medical needs.

For those returning “home” from

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periods of incarceration, navigating a healthcare system while also trying to adjust to new environments is much more challenging. As such, Fortune created the CMU – a health home concierge, if you will – providing a team to help people reentering the community navigate their medical and mental health needs until they can manage on their own.

The services provided by our Health Home/CMU staff include Medicaid activation/re-activation, Managed Care Organization selection and benefits navigation, referrals to



Our Benefits Access Program connected 301 people with Medicaid in 2019. primary care and specialty providers, connection to medical transportation, and case conferencing with doctors, social workers, and other members of the patient’s care team. Home visits, which for many of our clients take place within the NYC shelters, are also an active part of our daily routine.

However, our work doesn’t stop there.

Once the immediate medical and mental health needs are addressed, and a plan is put into place for ongoing healthcare stabilization, the focus then turns to the social determinants of health (SDOH) needs of those we serve. Non-medical issues like unstable housing, food deficiencies, improper clothing, and lack of social supports can have a significant impact on someone’s long-term health, so our staff works closely with partnering services, both within Fortune and externally, to connect them to the supportive services they need to live healthier lives. For the CMU team, shopping for groceries with clients, assembling shelter care kits, assisting with paperwork related to obtaining ID or changing one’s legal name or gender, and connecting people to 2010e application assistance for supportive housing, are all part of a day’s work.

THE CMU IS EXPANDING Fortune’s Care Management Unit has expanded beyond the traditional Health Home model to serve a number

Nearly 100% of Fortune’s housing clients are connected to primary care. of individuals who would either not qualify for health home services, or who are in need of much more intensive case management.

The CMU recently joined forces with the Health Justice Network (HJN), a program developed in partnership with the NYC Department of Health and Mental Hygiene, the Manhattan District Attorney’s Office, and fellow community-based organizations, to provide direct connections to medical and reentry services, through the help and guidance of Community Healthcare Workers. The program is open to adults who have been released from jail or prison to NYC within the past 12 months. Many of these individuals do not meet the chronic conditions criteria for health home care management but are in need of primary care. By developing a closed loop referral system, HJN is able to track the effectiveness of the services provided, as well as the progress of the individuals referred.

INNOVATIVE CONNECTIONS FOR THOSE WITH THE HIGHEST NEEDS Additionally, this summer the CMU took a huge leap into the world of Recovery Coordination Agency (RCA) work. Through a partnership with Healthfirst, Fortune’s RCA team is implementing an innovative model for connecting Medicaid enrollees with significant mental

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illness, substance use disorders, or both, to intensive community-based supportive services. The funding for this program comes from a NYS grant created in response to the low utilization of services by people who are eligible for a Health and Recovery Plan (HARP). HARPs are a health insurance benefit offered by many Medicaid Managed Care providers to patients with significant histories of a need for behavioral health treatment (i.e. multiple admissions to inpatient substance abuse or mental health treatment). One of the advantages of HARP enrollment is the opportunity to receive Home and Community Based Services, which can include supportive employment, short-term crisis care, programs for patients and their families, and access to networks of certified peers with lived experience of substance use and mental health treatment.

Our predominantly field-based RCA team is focusing specifically on identifying and helping HARP-eligible individuals receive the supportive home and community-based services they’re entitled to. Our team is able to engage, assess, and receive approval from the insurance providers for these services and take the extra step of ensuring that they make it to their initial appointments. We believe that this model will connect more people to services that are crucial to improving their health and well-being. 

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TRUST AND LAUGHTER: KEY JUNCTURES FOR CHANGE Here’s my explanation. People who have been though the prison system, in addition to experiencing the absurd concept of punishment, mostly At a recent gathering among “To create a healing atmosphere, share two emotions before staff at The Fortune Society, our and during incarceration — Executive Vice President Stanley Fortune and similar programs abandonment and betrayal.

Richards challenged a group of As a result, individuals with must be cognizant of people’s us, asking “What makes Fortune justice involvement experience backgrounds, and the betrayal special?” an overwhelming lack of trust. and abandonment that Without trust, however, you It’s a fair question posed for creates a lack of trust.” can’t move a train or open a people who dedicate their heart. lives to creating an accepting environment for people coming out Later, a colleague approached me and I reached this assessment without of prison. said, “That was a curious answer to a “empirical evidence” provided by complicated question. Fill me in.” foundation-funded research surveys.

I half-listened to the responses, trying And without reading proactive social to explore my own experiences. When

BY DAVID ROTHENBERG Founder The Fortune Society

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Stanley pointed at me, I responded simply by saying “laughter.”

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science tomes. (Well, I did a great deal of reading, but understanding the partnership between laughter and trust was achieved by on-the-scene experiences).

In 1967, when Fortune was founded, I was “the square”—the civilian amidst men and women whose lives were dramatically different than mine. They were my teachers. I listened, watched, and learned.

When Fortune grew and moved out of our one-room space into a loft with several room dividers and a community meeting room, someone gave us a ping pong table which provided diversion for the folks hanging around.

start to trust. He began to confront the demons and remove the barriers that caused his pain and his acting out.

Toby’s life is just one story – or as one person in academia once charged me, “that’s an anecdote; we have statistics.”

I’ve read the statistics, but I’ve lived the anecdotes.

At Fortune, trust is a primary issue. It is a starting juncture for change. Health and medical care is an intricate part of re-entry—but it can be difficult for formerly incarcerated people to trust medical professionals, considering their past experiences. Staff persons

I met a 17-year-old who was referred to Fortune by his probation officer. Toby was a big young man and very angry. Very. He only spoke to answer a specific question with as few words as possible. I challenged Toby to a game of ping pong. He played—angrily—but he played. He would look through me as if I didn’t exist. I always chattered and made small jokes.

After a bit I became aware of his embarrassed smiles. In time, I earned a few muffled laughs. It took weeks but the laughs prompted some small talk. Toby began to open up. He took classes to earn a G.E.D., hanging out with other motivated young men.

He started having a life.

A year later, at one of Fortune’s Progress Award ceremonies, Toby received a plaque entitling him “the outstanding teenager.”

Toby never looked back. He has had a good career, two daughters, and, he says, a good life.

It was playing ping pong, remembering how to laugh, that allowed him to

believing or caring for self.

In prison, as men and women mature, they often age out of rebellious feelings that led them into cages. In the past, they managed the pain by escaping to drugs or booze.

But even as people mature, trust is difficult to identify because too often in the past, trust was followed by abandonment or betrayal.

When men and women come out of prison – and enter a building where there is laughter – it is a new experience. The atmosphere at Fortune allows people to reclaim their lives, and suggests that they are more than the accumulated negative experiences of their pasts. There are a thousand ingredients that make this transformation possible.

That path is cluttered with their unchallenged demons.

I have come to believe that laughter makes it easier to confront the past and prepare for a meaningful future.

who are sensitive to this assume an important role in helping people with justice involvement access services by identifying and responding to real barriers caused by lack of trust.

To create a healing atmosphere, Fortune and similar programs must be cognizant of people’s backgrounds, and the betrayal and abandonment that creates a lack of trust.

If you listen carefully, you learn that a lack of trust mostly starts early in life—with abandonment and/or betrayal. When such a child becomes a teen, few societal guidelines are respected. They have stopped VOLUME LII • FEBRUARY 2020

P.S. 40 years after Toby left Fortune, he paid us a visit. I invited him to sit in on a group of teenagers in our Alternatives to Incarceration program. Afterwards, he said it had been like being in a time capsule.

“David,” he said, “those young men could have been the guys with me back in the ‘70s. Same anger, same emotions. Only thing different is their music.”

Then he asked, “Was I that angry?” I looked at him. “Of course you were,” I said. “I used to call you the angriest kid in New York City.” And then he laughed. He did comment that there was also laughter in the room.

That matters. Trust me. 

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A Q&A WITH DR. JONATHAN GIFTOS PREVENTING OPIOID RELAPSE AND OVERDOSE What are the most important things for incarcerated people to know about MAT?

DR. JONATHAN GIFTOS Former Clinical Director of Substance Use Treatment for NYC Health + Hospitals, Division of Correctional Health Services at Rikers Island

In response to the prevalence of opioid use disorder among people with justice involvement, jails and prisons are starting to change how they address it. One treatment that has increasingly gained traction is Medication Assisted Treatment (MAT), an intervention becoming known for its affordability, effectiveness, and uniquely holistic approach. Through a combination of medications (i.e. methadone, buprenorphine, and naltrexone), counseling, and behavioral therapy, it not only reduces withdrawal symptoms, but addresses underlying issues driving substance use.

Dr. Jonathan Giftos, former Clinical Director of Substance Use Treatment for NYC Health + Hospitals/ Correctional Health Services, is one expert who has seen MAT’s effectiveness in helping patients with justice involvement avoid opioid relapse and overdose. In the following Q&A, he shares key information about MAT and advice for people who are incarcerated in jails and prisons that offer it.

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Medications such as methadone or buprenorphine (e.g, Suboxone) are effective treatments for opioid use disorder (i.e, opioid addiction: addiction to heroin or prescription pain killers). They have been shown to reduce opioid use and complications such as HIV infection.

Most importantly, these medications reduce risk of death. They can be complemented by other services such as counseling or recovery groups if patients are interested.

The most important thing to know is that these medications are most effective when taken every day (i.e, as maintenance medications), and not when used simply to wean one’s self from opioids (i.e, “detox”). For people in correctional settings, taking methadone or buprenorphine has been associated with an 85% reduction in risk of death from overdose during the first few weeks that one returns to the community.

What advice do you have for each of the following groups of people?

Incarcerated people who do have access to MAT, but are ambivalent about using it Ambivalence is normal for people with addiction. And this is especially true regarding treatments like methadone or buprenorphine. Some may think they are “trading one addiction for another.” I usually tell people that there is a difference between physical dependence — which simply means that you must take a medication daily or you will feel withdrawal symptoms — and addiction, which is the compulsive and often escalating WWW.FORTUNESOCIETY.ORG

use of a substance despite negative consequences. Untreated addiction can lead to people’s lives getting worse. Medication like methadone or buprenorphine often lead to people’s lives improving. They feel better, they can engage other needed health care services, they can save money, and more.

People who are being transferred from a correctional facility with MAT access to one without MAT access Some patients may be transferred from a setting with medication access to a setting with more limited medication access. If a patient worries that this may happen to them, they can discuss that concern with health care staff.

There is no one answer in these cases, but coordination and counseling can sometimes help patients feel better about the process.

Incarcerated people who have used MAT and are about to be released.

Additionally, are there any followup steps that those specifically being released from Rikers should take?

All patients who began using medication for opioid use disorder in the jail are offered a community referral. They are also tracked through discharge. The reentry process is very challenging with lots of competing pressures. Additionally, Medicaid may still be suspended due to incarceration, complicating access to medication or services.

Any recently released patient in New York City who has questions about their release plan should call our Point of Reentry & Transition (PORT) line at 646-614-1000 for assistance. 

FINDING HEALTH SERVICES AND SUPPORT AT THE COMING HOME PROGRAM

BY JESUS ROBLES Program Coordinator The Coming Home Program

Successful reentry into society after justice involvement is key to improving the personal and emotional well-being of individuals, as well as reducing social and financial costs to the community and criminal justice system. A crucial part of reentry is access to health services. To promote positive health outcomes and equity, establishing connections and support networks with community partners is essential. One initiative that does so is the Coming Home Program (CHP) at the Morningside Clinic at Mount Sinai St. Luke’s Hospital, which provides medical care, as well as mental health and social services for individuals who are recently released or have a history of incarceration.

CHP staff support network and resource building by creating referral streams with community-based organizations and local government agencies including courts, divisions of probation and parole, federal halfway houses, and reentry taskforces. Since outreach efforts began in November 2018, CHP has built key partnerships that are responsive to the needs of various stakeholders.

Outreach occurs within the individual organizations and across agencies at taskforce meetings and community forums. Every person referred to CHP is connected to a staff member who facilitates early engagement with the patient and sets up a timely appointment with a social worker and primary care physician, often

within days of the referral. Staff members regularly reach out to CHP patients to foster retention for those who have missed appointments or may need more support. CHP patients have access to an extensive array of services, including the Addictions Institute, Health Home, Care Coordination, accompaniments, and support groups addressing anger management, substance use, and others. Patients also provide feedback as stakeholders in Morningside’s Consumer Advisory Board.

In order to address the psychosocial needs of each patient, CHP patients complete a comprehensive assessment which includes mental health and substance use screening. A majority of CHP staff have lived experience in the justice system. The lived experience helps the team better connect with patients while providing care that places the patients’ needs front and center with a high level of understanding. All staff at the VOLUME LII • FEBRUARY 2020

Morningside Clinic have been trained in providing trauma-informed care; the mental health and social work teams have extensive training and experience in providing services to individuals with a substance use disorder and cooccurring mental health disorders.

The Coming Home Program can help you transition back into the community with care, compassion, and understanding. By being part of the program, you will have access to state-of-the art services within the Mount Sinai Health System. Reentry can be difficult, but you do not have to do it alone.

Upon your release you can call either 212-523-6500 / 917-697-8563 or email ComingHome@mountsinai. org to schedule an intake appointment with the Social Worker. If you are working with an organization, you can also ask your case manager to reach out and schedule the appointment. 

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BEING RESPONSIBLE FOR YOUR HEALTH: CHARLES’S STORY Trust yourself. Have patience. Become an information-seeker.

This is advice Charles has for people being released from prison, and they were the tenets he followed during his own reentry in 2018. After 23 years inside, he faced many challenges adjusting to society, one of which was accessing primary healthcare.

Although his journey remains unfinished, Charles is proud of the progress he’s made since he decided to take responsibility for his health at The Fortune Society.

helped him find a primary care doctor.

“When I got my primary care doctor, it was off to the races,” said Charles.

His doctor quickly obtained his medical records, which furthered his SSI application. She also referred him to hand and back specialists, who continue to strengthen his ligaments.

The pain hasn’t gone away—but with professional help, Charles is learning to manage it.

In prison, Charles recalls how medical care can be traumatic, and how “I don’t play with my he faced combative “This is…the first health. I’m trying to guards and medical time I’m actually live as long as I can. professionals. living in society Thus, distrust This is my life, so I’m [as a] productive towards medical citizen,” he said. going to try to take professionals “[Fortune is] the responsibility for it.” among people with kind of hand that I justice involvement needed.” can be difficult to overcome.

After release, Charles had to navigate However, this was not an issue for a confusing bureaucracy to apply for Charles. From the start, he was benefits and access primary care. One determined to receive the care he challenge he faced was obtaining deserved. At doctor’s appointments, copies of his medical records, a he’s clear, truthful, and asks questions. common difficulty after prison, which he needed to apply for Supplemental “I don’t play with my health,” he said.

Security Income (SSI). At the time, he “I’m trying to live as long as I can. also didn’t have a primary care doctor, This is my life, so I’m going to try to who would have quicker access to his take responsibility for it.” medical records.

In order to take responsibility for his He was especially motivated to seek health, however, Charles had to trust care for the chronic pain he continues himself first. to experience due to injuries he endured from physical violence in “I got to trust myself enough first prison. to allow me to trust you…” he said.

“That’s the first thing I learned in But this changed at Fortune. Our Care helping myself.”  Management Unit not only gathered information for his SSI appeal, but 20

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ACCESSING SUBSTANCE USE TREATMENT AFTER INCARCERATION

BY RONNALD HARRIOTTE Transitional Specialist Coordinator The Fortune Society

As a Transitional Specialist Coordinator for The Fortune Society’s Connections to Care (C2C) initiative, I help individuals with opioid use issues make the transition from prison back into the community. At C2C, we engage in advocacy, provide referrals to supportive services, and give muchneeded moral support to individuals struggling with opioid use.

In my work, I’ve witnessed firsthand the gaps in valuable services and information during reentry.

Individuals with a history of substance use being released from custody face unique information gaps.

Here are some of the obstacles, as well as tips for overcoming them: No Health Insurance: People are often released from custody without active health insurance, which they need to receive services from treatment programs for Methadone.

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However, under OASAS guidelines, if a person is released from custody and referred to treatment for methadone, the client is entitled to receive “Courtesy Dosages” until their insurance is active.

No Identification: Individuals are often released from custody without New York State-issued ID, which can deter them from following up with treatment.

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Under OASAS guidelines, if a person appears at a treatment facility with a valid referral, but has no ID, his referral should be accepted and he or she should be administered a “Courtesy Dosage.”

Stigma: As individuals attempt to access treatment, they will often choose not to follow through out of fear about how some people will view them, treat them, or respond to their requests.

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It is your right to seek and receive treatment. You are entitled to receive treatment without negative

responses or judgment. In fact, the treatment you receive should be encouraging and propel you forward.

Information is the key to a healthy community.

Information is the key to healthy prisons. Granted, the information included in this article only pertains to those detained and preparing to be released in New York. If you are preparing for reentry and are being referred to a Methadone Maintenance Treatment Program (MMTP), be sure to follow up with your counselor prior to release to ensure you will have an active referral.

Everyday, compassion and empathy are reflected in the staff who help C2C clients. In an evaluation report, one former C2C participant said the following about his Transitional Specialist: “He calls me at least three times a week just to make sure that I am focused and I’m still continuing to stay on the right path...I don’t have regular friends that do that, and he does.”

Surround yourself with people who will contribute to your sobriety in a constructive way, and your path to sustained recovery will be easier and more successful.

If you are in New York and have questions regarding your rights to treatment, contact the Office of Addiction Services and Supports (OASAS): (518) 473-3460. 1450 Western Ave., Albany, NY 12203.

If you will be released in the near future and you are interested in our services, you can also write or call C2C with questions: Ronnald Harriotte Transitional Specialist Coordinator The Fortune Society 625 West 140th Street New York, NY 10031 646-937-5351 (Direct Line). 

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THERAPY: A WAY TO COPE WITH THE STRESSORS OF COMING HOME

BY MAGGIE GREENE Program Director, Better Living Center The Fortune Society

On October 29th, 2019, The Fortune Society held its annual Hope and Justice Gala, where justice involved people gave speeches about their journeys returning home from prison and celebrated their achievements.

There were many successes shared – people finding employment, completing internships, participating in Fortune’s transitional housing, and other important gains. The annual gala is a celebration of all the hard work that occurs within Fortune’s walls. However, coming home may not always feel like an easy path

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worth celebrating. Adjusting to the community after incarceration is fraught with many stressors, including accessing safe housing, reconnecting with family and friends, finding employment, and maintaining physical and mental health. Being in prison changes a person’s thoughts, emotions, and behaviors. Take a look at how you’re eating – do you attempt to eat your food as fast as possible?

Do you often avoid the cafeteria due to the crowd? Do you eat with your food covered by one arm? A task that many people do not do mindfully – eating –

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can become different inside the prison walls due to learned behaviors.

All of these behaviors may be signs of Adjustment Disorder, a clinically treatable mental health diagnosis that impacts 11 – 18% of people with any clinical psychiatric disorder.

Adjustment Disorder is found in all age groups and all cultures, and is essentially the development of emotional or behavioral symptoms in response to a stressor. Coming home, you may experience feelings of hopelessness, nervousness, or other negative emotions or behaviors.

INTERESTED IN ATTENDING THERAPY? HERE ARE SOME TIPS:

If you do, you may want to consider enrolling in therapy—a powerful way to help with the stressor of coming home.

our mental pain in the same way they remember our physical pain. Do you know anyone who has ever broken their arm and says that it still tingles in the cold weather? Traumas often impact our bodies as well; when discussing a painful memory, your head may begin to hurt. Our bodies remember our mental pain like physical pain.

Therapy can be the first step in managing your mental health for life. However, it does not mean that you will be in therapy for life. The skills and self-knowledge you gain in therapy can stay with you long after “Therapy can be the first Additionally, you stop attending there is stigma step in managing your sessions. Therapy associated with mental health for life.” is essential in mental health. helping to recover However, this and readjust back. Typically, a client is a negative stereotype that is not comes weekly for individual therapy rooted in the reality of what therapy for a period of time, which can then entails and who seeks mental health be decreased to biweekly or monthly help. If you find yourself having depending on the progress. difficulty after coming home, you owe it to yourself to focus on your Therapy is different from talking to mental health and have therapy be a a friend. A therapist creates a nonpart of your coming home journey. judgmental, safe space for you to Therapy can help shape you to be the discuss successes and challenges best version of yourself – a version in your life. Everyone’s life story that may one day be celebrated at is different, so therapists create an Fortune’s annual gala. individualized treatment plan that focuses on strengths. The therapist If you are seeking mental health can teach positive coping skills to help treatment after release, you are navigate the stressor of coming home. welcome to come to our New York State Office of Mental HealthHowever, going to therapy, and licensed Better Living Center making the decision to start it, is hard (BLC), which offers services to work. The choice to heal may require individuals with mental health needs discussion of past wounds and traumas and histories of justice involvement.  that impact us. Our bodies remember

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Accessing therapy inside: If you live in New York State, discharge planners in any state prison have a legal obligation to provide you with referrals for mental health treatment. A referral from a jail or a prison is seen as a priority by mental health clinics, and this may be the fastest way for you to receive an appointment. The first appointment in a mental health clinic may be an assessment screening where an intake coordinator gathers your demographic information, explains your rights as an outpatient client and administers some surveys. Then, you may meet with a licensed provider for the comprehensive psychosocial, which will require asking questions about your life story.

Your first session: Nothing is offlimits in therapy, although it may be hard to discuss at the first session!

As staff, we try to create a place of comfort for you to begin to share your story, thoughts, and emotions.

Depending on the setting, you may participate in individual, group, family, and couple’s therapy. You may also be required to see a psychiatric provider to complete a psychiatric evaluation.

After your initial sessions: If you tried a therapist, and he or she didn’t seem like a good fit, don’t give up on the therapeutic process!

There are many different types of therapy. A therapist may be trained in a type of therapy that just doesn’t work for you—and that’s ok! You can always ask for a referral to a different provider. Don’t let disliking an individual therapist stop you from taking part in therapy overall.

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QUESTION FOR OUR READERS

HOUSING

What policies and perspectives are needed to end housing discrimination against people with criminal records?

Send responses to info@fortunesociety.org or mail them to the mailing address above.