Office of Minority Health

Reentry is the transition from incarceration – life in prison, jail, or juvenile justice facilities – to life in the community. Each year roughly 600,000 individuals return to our neighborhoods after serving time in federal or state prisons and 11.4 million people cycle through local jails. Nearly everyone who goes to jail and approximately 95 percent of persons in state or federal prison will eventually return home.  Although returning to the community may be inevitable, successful reentry and reintegration are not. Recidivism studies reveal that two out of every three people released from state prison are rearrested for a new offense and about half return to prison within three years. When reentry fails, the social and economic costs are significant – higher crime, more victims, increased family distress, and greater strain on state and municipal budgets.

The effects of incarceration are felt far beyond prison walls and impact health. In addition to pressing needs upon reentry such as housing, employment, and educational opportunities, justice-involved individuals have disproportionately high rates of chronic health conditions, and mental health issues and substance use disorders are common. Youth typically face a host of challenges to making this transition successfully, including receiving the necessary support from their families, peers, and communities; enrolling in an appropriate educational or vocational setting; maintaining a continuity of treatment for psychiatric disabilities or substance use disorders; and transitioning to adulthood and economic independence. Poorer access to health coverage and health care pose significant challenges for returning citizens, can contribute to a worsening of their health status, and are associated with higher rates of recidivism. The health sector, therefore, has an important role to play in supporting formerly incarcerated individuals to address their health needs. Access to health care and improved health status may also lead to improved opportunities for employment, housing, and family support. Furthermore, racial and ethnic minorities are disproportionately represented in the correctional system, and such involvement places a disproportionate negative impact on the health and well-being of these groups and their families. All Americans, including those who are formerly incarcerated and have paid their debt to society, should have the opportunity to reach their full potential for health.

The purpose of this webpage is to provide a consolidated location for available reentry resources for returning citizens and their families, HHS grantees, and other individuals/organizations working to help people leaving the criminal justice system.

Health Care and Coverage

Background: 

• Approximately half of individuals in prison or jail report having had a chronic condition and almost 20 percent report having had an infectious disease.
• More than half of individuals in prison or jail report having a mental health condition, and about half (53 percent of all state prisoners and 45 percent of all federal prisoners) meet the American Psychiatric Association’s Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) criteria for drug dependence.  These rates are significantly higher than the general population.
• After release, there is often even less care in the community. Yet the research is clear: continuity of care is essential if we want to see health and safety benefits.
• Whether it be for substance use disorders, mental illness, infectious or chronic conditions, continuity of care must be a priority, particularly in the first days and weeks after release when the risk of relapse, reoffending, and even death, is most acute. Overdose from opioids, for example, was the leading cause of death for former prisoners, with highest risk present in the first week of release.

Resources:

• Federal Guidance on Health Coverage and Care for Justice-Involved Individuals
• Incarceration and the Marketplace Guidance – This FAQ provides guidance on the definition of “incarcerated,” and “incarceration pending the disposition of charges” for the purposes of eligibility for enrollment in a Qualified Health Plan through the Marketplace. 
• Medicaid State Health Official Letter and FAQ on Medicaid services for individuals transitioning from incarceration to communities  – This guidance updates decades-old policy and clarifies that individuals who are currently on probation, parole or in home confinement are not considered inmates of a public institution. It also extends coverage to Medicaid-eligible individuals living in community halfway houses where they have freedom of movement.
• Medicare Coverage of Items and Services Furnished to Beneficiaries in Custody Under a Penal Authority.  Explains what services Medicare Fee-For-Service Program will pay for individuals who are under arrest, incarcerated, imprisoned, escaped from confinement, under supervised release, on medical furlough, required to reside in mental health  facilities, required to reside in halfway houses, required to live under home detention, or confined completely or partially in any way under a penal statute or rule. 
• CMS Guidance to Surveyors on Federal Requirements for Providing Services to Justice Involved Individuals – Explains the standards for providing care to justice-involved individuals in a variety of health care settings in order to be eligible to receive federal funding.

• Correctional Health
• CDC Correctional Health - This webpage from the Centers for Disease Control and Prevention links to corrections and public health departments, guidance on the prevention, care, and treatment of infectious disease found in correctional settings, scientific reports on health in corrections, and other health education materials. 
• Public Health Reports Supplemental Issue: The Justice-Involved Population and Health - This journal supplement, funded by the HHS Office of Minority Health, includes articles which examine the health of the justice-involved population and their families, propose policies and interventions to address health needs of the justice-involved population and their families, and assess how population health surveys can provide better information about the justice-involved population and identify opportunities for bridging knowledge gaps on health disparities and health needs of the justice-involved population.   

• Outreach and Enrollment
• Health Care Coverage Options for Incarcerated people- This webpage on healthcare.gov explains all of the available health care coverage options for incarcerated or recently released individuals.  
• Incarcerated and Recently Released Customers Guide- This guide explains eligibility of incarcerated or recently released adults for health care coverage in the Marketplace, Medicaid, and Medicare.  
• Health Care Coverage for Reentering Men: What Difference Can It Make? –  This policy brief from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) provides tips and strategies for community-based organizations interested in helping men leaving the criminal justice system get enrolled in health care coverage.

• Behavioral Health
• Reentry Resources for Individuals, Providers, Communities, and States – Substance Abuse and Mental Health Administration’s (SAMHSA) reentry resources for behavioral health providers & criminal justice practitioners; individuals returning from jails and prisons; communities and local jurisdictions; and state policy makers.
• Guidelines for Successful Transition of People with Mental or Substance Use Disorders from Jail and Prison: Implementation Guide.  This Substance Abuse and Mental Health Administration resource provides actual examples of successful strategies for transitioning people with mental or substance use disorders from correctional settings into the community.  
• SAMHSA Behavioral Health Treatment Locator – Online search tool for treatment facilities in the United States or U.S. territories for substance use and/or mental health problems.
• SAMHSA Criminal and Juvenile Justice Activities – Summarizes SAMHSA efforts related to behavioral health and the justice system.
• GAINS Center for Behavioral Health and Justice Transformation – SAMHSA technical assistance center focusing on expanding access to services for people with mental and/or substance use disorders who come into contact with the justice system.
• Drugs & the Brain Wallet Card – is designed for people who have stopped using drugs while they were detained in the criminal justice system or while receiving inpatient or outpatient treatment. Counselors can customize this tool to help individuals identify triggers that could prompt a drug relapse. It also includes information about resources and helplines.
• The Science of Drug Use: Discussion Points – is intended for judges, counselors, and other professionls who work within structured criminal justice settings. The discussion points offer suggestions for how to talk with teens and young people about drug use, and reinforce the concept that addiction is a brain disease and needs treatment and ongoing attention.
• Easy-to-Read Drug Facts – are brief, printable documents for persons with lower literacy levels. These documents include information about specific drugs, the negative impact of drug use, the nature of addiction, and treatment and recovery.
• Creating a Trauma-Informed System of Care for Formerly Incarcerated Dads – This brief describes how fatherhood programs serving men in reentry can infuse their programming with the principles and elements of a trauma-informed system of care to support fathers and staff who have experienced trauma.

• Other Information on Health Care Coverage
• The Importance of Medicaid Coverage for Criminal Justice Involved Individuals Reentering Their Communities – ASPE policy brief explains why Medicaid and access to the health benefits the program covers can play a key role in improving the health not only of justice involved individuals, but also of their communities.
• Health and Mental Health Services Vital to Successful Re-entry of Previously Incarcerated Individuals – SAMHSA/OMH blog post discusses importance of supporting behavioral health during reentry.
• Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care – HHS Office of Minority Health article in AIMS Public Health examining opportunities through the Affordable Care Act to address health disparities experienced by the reentry population that places them at risk for negative health outcomes and recidivism.

Employment

Background:

• More than 70 million people – roughly one in three Americans of working age – has a criminal record, mostly for relatively minor non-violent offenses, and sometimes from decades in the past.

• Job applicants with a criminal record are 50% less likely than their peers without a record to receive an interview or a job offer, even with identical resumes and qualifications. Additionally, the American Bar Association has chronicled over 26,000 state occupational licensing restrictions for people with criminal records, including over 6,000 restrictions for misdemeanor offenses and nearly 20,000 restrictions that are lifetime or permanent restrictions for a conviction. 

• While research is clear that stable employment is an important predictor of successful reentry, individuals with criminal records face high obstacles obtaining meaningful employment, even if they have paid their debt to society, are unlikely to reoffend, and are qualified for the job for which they are applying.

• The impact of having a criminal record is exacerbated among African Americans, who are more likely than whites both to have a criminal record and also to experience racial discrimination in the labor market without a criminal record.

Resources:

• Equal Employment Opportunity Commission Guidance on the Consideration of Arrest and Conviction Records – The Guidance seeks to ensure that criminal background reports obtained by employers about job applicants and employees are not used in a discriminatory way.
• Myth Busters on Employment –The Federal Interagency Reentry Council has published a number of “MythBusters” to clarify federal laws regarding employment, including on these myths:
• MYTH: Businesses and employers have no way to protect themselves from potential property and monetary losses should an individual they hire prove to be dishonest.  (Myth Buster HERE)
• MYTH: People with criminal records are automatically barred from all employment. (Myth Buster HERE)
• MYTH: The Federal Government’s hiring policies prohibit employment of people with criminal records. (Myth Buster HERE)
• MYTH: Employers have no federal income tax advantage by hiring an ex-felon. (Myth Buster HERE)
• MYTH: An employer can get a copy of your criminal history from companies that do background checks without your permission.  (Myth Buster HERE)
• The Federal Bonding Program – The U.S. Department of Labor established the Federal Bonding Program in 1966 to provide Fidelity Bonds that guarantee honesty for “at-risk,” hard-to-place job seekers. The bonds cover the first six months of employment. There is no cost to the job applicant or the employer.
• Work Opportunity Tax Credit (WOTC) -- The WOTC is a Federal tax credit available to employers for hiring individuals from certain target groups who have consistently faced significant barriers to employment. 
• Department of Labor WorkforceGPS Justice Involved/Reentry Adults – A list of resources, webinars and organizations that focus on providing assistance to adults re-entering the workforce
• Department of Labor WorkforceGPS Reentry Employment Opportunities Community -- Practitioner ideas and tools for providing employment assistance, including improving program practices, supporting transitions, strengthening partnerships and ensuring sustainability.

Housing

Background:

• Stable housing is particularly critical for people returning from prison and jail, who face a myriad of challenges while reestablishing themselves in their communities. Yet significant barriers to stable housing for reentering individuals exist.
• Across the country, over 10 percent of persons released from prisons and jails face homelessness upon reentry – a percentage that could be as high as 50 percent in large, urban areas. The lack of stable housing increases the likelihood of contact with the justice system.
• Often, the best case scenario for individuals returning from prison or jail is to live – at least temporarily – with family members. However, even in instances where the family wants to open their doors to their returning relative, barriers may persist.
• For those with family members who live in buildings managed by public housing authorities (PHAs), local PHA policies – or misconceptions about these policies – may prevent them from residing with family members, who fear eviction. Others may not have family members who are willing or able to provide a place to live. Too often, these individuals become homeless.

Resources:

• Myth Busters on Public Housing– MYTH: Individuals who have been convicted of a crime are “banned” from public housing.
• Fair Housing Guidance – Guidance from the U.S. Department of Housing and Urban Development (HUD)explains when barriers to housing for those with criminal records may violate the anti-discrimination provisions of the Fair Housing Act.
• It Starts With Housing – This HUD report highlights innovative practices from Public Housing Authorities that are helping provide people with second chances.

Education

Background:

• In a federal study of people released from state prisons, 94 percent of incarcerated adults identified education as a key reentry need.
• Roughly 37 percent of people in state prisons do not have a high school diploma or GED, and 86 percent lack postsecondary education.
• Education is a core resource for release preparation, and is an evidence-based tool for reducing recidivism among adults and juveniles. The RAND Corporation’s meta-analysis of research on correctional education found that, on average, incarcerated people who participated in correctional education programs were 43 percent less likely to recidivate than their counterparts who did not.
  
  A one dollar investment in prison education translates into four to five dollars of savings in corrections costs during the first three years after release.

• Education is also a critical issue for youth in custody, including youth with disabilities. Of those who were tested, nearly one-third of the individuals in juvenile-justice facilities were diagnosed with learning disabilities, though fewer than 25 percent received special education services and supports to address their needs.

Resources:

• Beyond the Box Resource Guide – This U.S. Department of Education (ED) guide provides information for colleges and universities to help remove barriers that can prevent the estimated 70 million citizens with criminal records from pursuing higher education.
• Reentry and Corrections Education – The Federal Trade Commission’s webpage for justice-involved individuals and staff working with this community provides resources on financial literacy, scams, identity theft, and background checks.
• Guiding Principles for Providing High-Quality Education in Juvenile Justice Secure Care Settings – This guide from the ED and the U.S. Department of Justice identifies promising practices for improving education programs in juvenile justice facilities, as well as areas in which federal legal obligations apply.

Children of Incarcerated Parents

Background:

• On any given day, as many as 2.7 million children – or one in 28 – have a parent in prison or jail. For African-American children, the rate is one in nine.
• More than five million children, or seven percent of all children in the U.S., has had a parent who lived with them go to jail or prison.
• Children of incarcerated parents may face increased risk of homelessness, financial instability, problems at school, and behavioral and mental health conditions, including depression and anxiety.
• Despite the strength and resilience of many children, the shame and stigma associated with incarceration may cause children to feel isolated and may prevent parents from discussing their circumstances with others, causing many justice-involved families to go unidentified and unsupported.

Resources:

• Children of Incarcerated Parents – Federal website with information and resources.
• Tip Sheet for Incarcerated Parents: Planning for a Visit from Your Child/Children– This resource will provide strategies to parents to help them prepare for their child’s visit to make the experience as positive as possible.  It includes information about child development, ways to prepare the child for the visit in order to reduce possible stress and trauma, and suggested family friendly activities.
• Supporting Youth with Incarcerated Parents: For School Staff-This video and discussion guide are designed for school staff who provide direct supports and services to students: teachers, administrators, and support staff (e.g., school social worker, psychologist, guidance counselor, librarian, art teacher, PE teacher, cafeteria worker, custodian, bus driver). School staff contributed to the planning and content and several are featured in the video.
• Supporting Youth with Incarcerated Parents: For Social Workers-This video and discussion guide are designed for social workers who may come in contact with children of incarcerated parents. They are intended for the larger world of social work, including those who work in clinical settings, community and faith based organizations, schools, child welfare, juvenile justice, adult corrections, etc. Professional social workers contributed to the planning and content and several are featured in the video.
• Video Visiting in Corrections: Benefits, Limitations, and Implementation Considerations – This guide is meant to help correctional facilities incorporate a video visitation system as a way to enhance family communication.
• Incarcerated Groups/Reentry – This Administration for Children and Families (ACF) Office of Child Support Enforcement webpage provides a list of resources for parents who are returning to their communities after incarceration.  

Financial Resources

Background:

• Reentering individuals can face financial insecurity. One study that surveyed individuals going through the reentry process found that 62% of respondents reported having legal/financial debt related to the criminal justice system.
• This debt can result from unpaid fines, court fees, treatment fees, law enforcement fees, restitution, and child support. 
• Because of this accumulation of debt, reentering individuals can face challenges establishing credit, opening bank accounts, and saving money.

Resources:

• Your Money, Your Goals: Focus on Reentry – This guide provides information and tools specific to the financial challenges encountered by justice-involved individuals, including tools to help people prioritize and manage their debt, know their rights about background reports, and access and fix their credit reports.

General Resources

• National Reentry Resource Center – The National Reentry Resource Center provides education, training, and technical assistance to states, tribes, territories, local governments, service providers, non-profit organizations, and corrections institutions working on prisoner reentry.
• Roadmap to Reentry – Principles of reform supporting the U.S. Department of Justice’s efforts to ensure that all justice-involved individuals are able to fulfill their potential when they come home, and to support and strengthen reentry programs and resources at the Bureau of Prisons (BOP).  These principles of reform will be implemented throughout BOP, deepening and further institutionalizing the Department’s commitment to reentry. 
• The Federal Interagency Reentry Council: A Record of Progress and a Roadmap for the Future – This report from the Federal Interagency Reentry Council highlights progress to date and maps the road forward.
• Economic Perspectives on Incarceration and the Criminal Justice System – This Council of Economic Advisors report using economic analysis is a lens for understanding the costs, benefits, and consequences of incarceration and other criminal justice policies.
• Juvenile Justice - This page on the federal website youth.gov contains information on the juvenile justice system for individuals working with this population of youth.

Data and Statistics

• Reentry Trends in the US – Data from a Department of Justice Bureau of Justice Statistics recidivism study.
• National Reentry Resource Center Facts and Trends – Data compiled by the National Reentry Resource Center.

Data and Statistics

Bureau of Justice – Reentry Trends in the US
National Resource Reentry Center

Reentry Programs

OMH HIV/AIDS Health Improvement for the Reentry Population (HIRE)
Federal Funding and Services for Prisoner Reentry
Federal Bureau of Prisons Reentry Programs
Residential Reentry Centers
Reentry Programs by State
Mercy Corps Northwest-ROAR
Reentry Programs for Women Inmates
Ex-Prisoner Reentry Pilot Project
National H.I.R.E Network

Resources for Justice Involved Individuals

Children of Incarcerated Parents
Tips for incarcerated parents
Tips for correctional staff
Tips for mentors
Tips for teachers
www.benefits.gov
National Resource Center for Children and Families of the Incarcerated

Nonprofit Organizations

National Coalition of Community-Based Correctional and Community Reentry Service Organizations (National Network of Prison Nonprofits)
Justice Center –The Council of State Governments National Reentry Resource Center

Technical Assistance

Incarceration & Reentry
Health Care Coverage for Reentering Men
The Importance of Medicaid Coverage for Criminal Justice Involved Individuals Reentering Their Communities
Office of the Assistant Secretary for Planning and Evaluation

Roadmap to Reentry
The Department of Justice (DOJ)

Reentry Resources for Individuals, Providers, Communities and States
SAMHSA

Findings on Best Practices of Community Reentry Programs for Previously Incarcerated Persons (2007)
Eisenhower Foundation

Building Knowledge about Successful Prisoner Reentry Strategies (2013)
Manpower Demonstration Research Corporation

Implementing a Reentry Program According to Best Practices (2007)
Massachusetts Executive Office of Public Safety

Leading Best Practices in US Prisoner Reentry Employment Programs
SAFER Foundation

Mentoring Ex-Prisoners: A Guide for Prisoner Reentry Programs (2007)
Department of Labor

Office of Minority Health

Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care AIMS Public Health , 2014, 1(2): 76-83. doi: 10.3934/publichealth.2014.2.76 Lacreisha Ejike-King, Rashida Dorsey U.S. Department of Health and Human Services, Office of Minority Health

Office of Minority Health Resource Center
Select articles on reentry in minority populations from the OMH Resource Center.

SAMHSA- Substance Abuse and Mental Health Services Administration
GAINS Center for Behavioral Health and Justice Transformation.
SAMHSA’s Efforts on Criminal and Juvenile Justice Issues

Justice Center-The Council of State Governments
National Reentry Resource Center
Integrated Reentry and Employment Strategies: Reducing Recidivism and Promoting Job Readiness

National Institute of Justice Publications and Videos

Consequences of a Prison Record for Employment: How Do Race, Ethnicity & Gender Factor In?
NCJ 245440, February 2014, Recorded Seminar, by Scott Decker (11 pages)
Detail | HTML (Transcript) | VIDEO (01:11:29)

Second Chance Act: What Have We Learned About Reentry Programs So Far?
Interview With Ron D'Amico
NCJ 243010, June 2013, Remarks/Interview, by Ron D'Amico (1 pages)
Detail | HTML (Transcript) | VIDEO (00:07:45)

'Cultural Shift' Is Among Findings of Second Chance Act Evaluation
NCJ 244147, December 2013, NIJ Journal, by Nancy Ritter (7 pages)

Improving Access to Services for Female Offenders Returning to the Community
NCJ 237725, March 2012, NIJ Journal, by Marie Garcia, Nancy Ritter (6 pages)

In Search of a Job: Criminal Records as Barriers to Employment
NCJ 238488, June 2012, NIJ Journal, by Amy L. Solomon (10 pages)

National Institute of Justice Grant Reports:

Childhood Trauma and Its Effects: Implication for the Police (2015)

Investigating Prisoner Reentry: The Impact of Conviction Status on the Employment Prospects of Young Men (2009)

Reentry: Dynamic Risk Assessment

The Effectiveness of Prisoner Reentry Services as Crime Control: The Fortune Society

For more resources on reentry, including customized funding and literature searches, contact the OMH Resource Center at info@minorityhealth.hhs.gov or 800-444-6472.