Treatment Plan
Providence Hope and Recovery
Our Treatment Program
We want to build women up and
equip them with the tools for success.
When a woman first comes to our program it is essential to address her critical re-entry needs which would include:
History of abuse, poverty, substance use, family support, dependent children and be ready to assist her with care coverage providers (e.g., Medicaid) and other social supports, and advocacy organizations. An effective reentry plan should be strengths-based, trauma-informed, and individualized.
Pathways:
- Housing providing distance from prior abusive relationships
- Transportation
- Clothing
- Income and employment, often to support children/single-parent households
- Identification (e.g., Social Security card, birth certificate, government ID)
- Education
Mental health care or trauma-related symptomology
- Substance use disorder treatment
- History of sex work/trafficking
- Primary health concerns, including pregnancy, gynecologic health, and weight gain associated with incarceration
- Reproductive health care, prenatal care, and treatment for sexually transmitted diseases
We will provide safe and stable housing which is particularly important for women to ensure their physical and emotional safety immediately following release. Having a secure place to live can minimize the risk of women returning to sex work or relying on unhealthy relationships to meet basic needs. Safe and stable housing should be located away from prior abusive or unhealthy relationships with space for the woman to make her transition back into the community a positive and productive experience. A woman’s criminal history can make it difficult to find appropriate housing, as many communities lack sufficient housing options for people with a criminal conviction. Some communities may have transitional housing or halfway houses for women; however, not all jurisdictions certify or regulate these programs. Housing programs should be vetted to ensure they do not engage in predatory practices, such as requiring significant portions of a woman’s disability check (if she receives disability benefits) or paycheck, or forcing program participants to engage in inappropriate or illegal behaviors or labor (e.g., panhandling, prostitution) to generate income for the program. Employment is crucial for women in meeting their needs.
Address Substance Use Disorders
Substance use disorders (SUDs) are common among incarcerated women.18 Though current national rates of SUDs are higher in men than they are in women, this gap is decreasing. In addition, women’s substance use patterns and outcomes differ from those of men. For example, managing SUDs during pregnancy is a medical concern unique to women; women are also more likely to have a co-occurring mental health diagnosis than men are. Further, women face considerable gender-specific barriers to accessing addiction treatment compared to men, including pregnancy, the need for childcare, and sexual harassment.
Opioid misuse is currently a major concern in the United States, and in recent years there has been an increase in the number of females using opiates. Between 2000 and 2014, the number of deaths due to opioid overdose in the United States increased by 200 percent. The opioid epidemic has impacted the criminal justice system, with a higher rate of opioid use among incarcerated individuals than among the general population. This fact has particularly serious implications for women, who are more likely than men to experience overdose and death related to opioid use after release.
It is important to connect clients with substance use treatment and services during and after incarceration and to support their continued engagement. If women are engaged in substance use treatment programs while incarcerated, efforts should be made to help them continue utilizing these services when they reenter the community. This might include having contact with the same treatment provider post-release, receiving services within 24 to 72 hours after release, and receiving long-term follow-up. A number of treatment approaches have been found to be effective or promising among justice-involved women:
- Medication-assisted treatment (MAT) is an evidence-based practice for treating opioid and alcohol use disorders. MAT is considered a best practice for treating pregnant women.
- A range of cognitive-behavioral therapies show effectiveness—rated between promising and
proven—in reducing substance use disorders. These therapies include motivational interviewing
and contingency management, among others.
- Harm reduction is not a specific treatment but a general approach to substance use intervention.
Harm reduction focuses on reducing the consequences of substance use and recognizing the non-
linear process of recovery during substance use treatment.
Other potential barriers should be addressed for reentering women with substance use disorders. For instance, providing childcare and transportation options can increase participation and retention in substance use treatment programs. Assessing the woman’s relationships with loved ones who are also experiencing substance use disorders is key to understanding who is available in the woman’s network to support recovery and what relationships may need to be considered with caution or severed during the transition back into the community. Understanding the woman’s ability to pay for treatment is also critical.
Women reentering the community may be eligible for Medicaid coverage, particularly if they are mothers with custody of their children. If they are not eligible for Medicaid, it will be important to help women navigate options for obtaining health insurance or conversations with her treatment providers to see if they are able to charge for services using a sliding scale, arrange an achievable payment plan, or provide some other subsidized means for accessing treatment at a manageable rate
Physical and Reproductive Health Care
Incarcerated individuals have higher rates of sexually transmitted diseases (STDs) than non-incarcerated individuals do, and the prevalence of hepatitis C among currently or formerly incarcerated individuals is high. Incarcerated women are at an especially high risk of STDs and HIV, often due to engagement in transactional sex.
Pregnancy should also be addressed during and after incarceration. About 75 percent of women in jails and prisons are of childbearing age. Although a comprehensive national count of incarcerated pregnant women does not exist, estimates indicate that over 3 percent of women entering prisons are pregnant and about 6 to10 percent of women in local jails are pregnant.
Women’s access to health care within jails and prisons varies and is often limited. Many individuals do not receive adequate health care while they are incarcerated, and upon reentry, women often experience additional barriers to quality health care. One study showed that women leaving jail or prison under community corrections supervision were more likely to use the emergency department or experience hospitalization than were men under community corrections supervision and the general population.
This points to the critical need to link women with healthcare coverage or insurance:
- If working with a woman who may qualify for Medicaid, begin the necessary paperwork to initiate or reinstate enrollment in the state Medicaid program prior to her release whenever possible. The paperwork should be started prior to release so that it may be submitted and coverage initiated as promptly as practicable following release.
- Women with custody upon release of children who are minors should be considered for Medicaid eligibility. If the woman has disabilities and qualifies for Social Security Disability Insurance, check to see if she is automatically eligible for Medicaid coverage as well.
- If working with a woman who may not qualify for Medicaid, federally funded health centers or
community-based centers that charge fees based on a sliding scale may provide affordable services to address a number of different health needs.
The reentry process is an opportunity to provide women with essential healthcare services. Their needs will likely differ depending on a woman’s health conditions or childbearing status. Providing long-acting, reversible contraceptive services to incarcerated women prior to reentry helps them avoid common barriers to contraceptive care in the community. This can allow them to focus on other aspects of reentry without having to worry about an unintended pregnancy. Recommendations for contraceptive services are as follows:
- Offer contraception, in a non-coercive manner, prior to reentry to help women avoid
unintended pregnancies
- Ensure women understand their choice to receive or not receive contraception
- Provide education on contraception methods and services
- Consider long-acting, reversible contraceptives such as intrauterine devices (IUDs) and implants, which can last several years without follow-up
Pregnant women reentering the community might face additional stressors related to reproductive health care.
Recommendations for working with pregnant women during reentry include the following:
- Identify, educate about, and link to agencies providing comprehensive reproductive healthcare services
- Link to substance use disorder treatment; provide education on the safe use of pharmacotherapy for substance use treatment during pregnancy
- Link to mental health treatment, with particular attention paid to anxiety and perinatal depression disorders; provide education on the safe use of pharmacotherapy for mental illness during pregnancy
- Engage client in parent or maternity counseling and classes.
Institutional Culture:
We are aware that the culture associated with incarceration can influence clients’ general functioning during and after incarceration. Jail and prison environments and staff, institutional and community-led programs, security concerns, rigid schedules, and the use of solitary confinement all shape the culture of correctional facilities and can have a lasting impact on a woman’s perceptions of safety, time management, and relationships with authority figures. Some researchers recommend that prison culture be included in a culturally competent framework for addressing reentry and other needs of individuals who have experienced incarceration.
Physical Settings
We are cognitive of and trauma-informed, gender-responsive programs use spaces that are designed to create a warm and inviting physical setting where a woman can feel safe. Ways to ensure that a space is trauma-responsive include the following:
- Keep doors open
- Use adequate lighting
- Offer various seating options, so that women can face the door if preferred
- Offer childcare options when possible
- Provide access to a certified peer specialist.
Strategies to Reestablish Family Relationships:
Women who stay engaged with their families during incarceration generally see more positive outcomes than those who do not, such as increased resiliency among children, reduced family justice involvement, and lowered risk of substance use and other risky behaviors. In some cases, it might not be appropriate for reentering mothers and their children to live together after release. In these situations, the proper agencies should work with the mothers to plan for visits and take steps toward reunification, as appropriate.
Regardless of the living situation, agencies and individuals working with reentering mothers should ensure they are linked with evidence-based parenting classes and family reunification supports. Individuals who work with incarcerated mothers should do the following:
- Ensure mothers have appropriate social support to effectively parent
- Provide legal support regarding child custody concerns
- Engage mothers in family therapy and parenting education, if needed
- Facilitate family reunification upon reentry
Facilitate Payment of Justice System
Fines and Fees
Incarcerated individuals are often required to pay fines and fees related to their crimes, pretrial detention fees, court filing fees, and costs associated with the conviction process (e.g., fingerprinting, public defender fees, and probation or parole fees). Failure to pay fines or restitution, no matter how small in dollar amount, can result in re-incarceration.
Women in particular are at risk for financial instability prior to incarceration and post-release. Regardless of incarceration status, women often have less financial literacy than men have.
Additionally, justice involved women have very high rates of domestic violence exposure, which can affect their access to important financial information (e.g., their partner did not allow them access to this information). Finally, there is evidence that women often engage in criminal behavior that is directly related to generating income (e.g., prostitution or drug offenses). Helping women navigate justice system costs can reduce the likelihood of financially driven recidivism. Family members of incarcerated women might also be financially burdened. In addition to legal fees, family members face costs related to prison phone calls, video or in-person visitations, and commissary purchases. This can be a hardship, especially if a woman’s incarceration led to the loss of a household income. Reentry costs for the family members of incarcerated women can also be significant financial burdens (e.g., sharing or providing housing, covering utility or cell phone expenses, and more).
Several concrete strategies we will use with our previously incarcerated women to manage these debts:
- Ask the debtor to provide information about the fines/fees
- Ask the courts to help develop a repayment plan
- Ask courts to consider waiving fines, fees, and costs for indigent women and families
- Obtain written documentation of the debt
- Help write out a payment plan to provide a sense of control over the repayment process
Individuals who assist women with crime-related debt should also be aware of local initiatives and advocacy groups working to reduce the financial burden and consequences associated with crime-related debt.
Conclusion
As the prevalence of reentry services and programs increases across the United States, it is important that these efforts be shaped to maximize the investment of funds, staff time, and resources and ensure optimal results for women returning to their communities. By comprehensively addressing issues that emerge from a woman’s pathway into the criminal justice system, racial and ethnic disparities, relational approaches, trauma, and substance use disorders, individuals providing reentry services may be confident that their work will positively impact the women they serve along with their children and families.
Providence Hope and Recovery
8 N. Jefferson Street, Roanoke, VA 24016