Editor’s Note: If you’ve ever needed help but weren’t sure where to turn, then you know how important just one trustworthy guide can be. This blog post is part of an occasional series called “Connection, Trust, and Recovery,” by Michele Easter. The series is about how peer supporters can help people who are returning to the community after incarceration. Today’s installment highlights the voice and experience of Eugene Wilson, a Community Health Worker for the Formerly Incarcerated Transitions Clinic in Guilford County. The logo for this series was created by Pitch Story Lab, the student-run creative agency at Duke University.
By Michele Easter
People returning to the community after incarceration are more likely to have a chronic health condition and to face serious challenges to healthcare access, due to lack of insurance, stigma, trouble navigating the legal system, and unmet basic needs such as housing and employment.
To improve the health of returning community members with chronic conditions, programs such as Formerly Incarcerated Transitions (FIT) assist people to participate in healthcare.
A key part of the FIT program is connecting to a Community Health Worker (CHW) who also has lived experience of incarceration. These peer workers not only link people to healthcare and other services, but also support them to engage fully to improve their health and wellbeing.
To learn more about FIT and the kind of help provided by CHWs, I met (virtually) with Eugene Wilson, a CHW at the Guilford County FIT program. Guilford County is one of five North Carolina counties with FIT programs; the others are Durham, Orange, Wake, and Mecklenburg.
FIT programs are located at Federally Qualified Health Centers (FQHCs), county health departments, or community health clinics, all of which improve access to medical care to people with little or no income.
Wilson’s office is located at Triad Adult and Pediatric Medicine, which is an FQHC with five sites across Guilford County. The FIT program is in Greensboro and High Point. There, he helps people complete paperwork establishing their eligibility for FQHC services, and to access that care by making and keeping appointments, providing vouchers or other assistance to help FIT patients cover costs such as co-pays and medication purchases, and encouraging them to stay engaged in meeting their health and life goals.
Because FIT CHWs have lived experience of incarceration, they are a good liaison for people who may otherwise fall through the cracks following release.
How does that lived experience help clients improve their health? Sometimes people avoid healthcare because they fear that service providers will look down on them or treat them disrespectfully.
By contrast, a FIT CHW is a peer who has been through a similar experience so it is easier to build trust and rapport: “We [CHWs] can relate… most people do better when they are able to relate,” Wilson said.
Even though this lived experience is important for trust and relationship-building, it is not “front and center.” Wilson explained the CHW doesn’t need to know about the client’s charges, and the client doesn’t need to know about CHW’s charges.
Wilson described the CHW’s lived experience of incarceration as a unique type of knowledge that serves specific needs: “If I want my car fixed, I go to a mechanic who specializes in my particular car.”
His specialized knowledge helped a client who was displaced and lost all of his possessions when his transitional home caught on fire. While dealing with this overwhelming situation, Wilson reminded him that under the terms of his supervision the parole officer would need to know where he was: “If the P.O. shows up to where you’ve been living, they may think you have absconded.” Wilson encouraged him to contact the officer, not only to update him as to his residence, but also to learn whether the probation officer could assist with the situation. Fortunately, it turned out there were resources and referrals available through the probation officer via the NC Division of Public Safety.
The CHW can also guide clients in navigating new and challenging situations. Someone who has been incarcerated for a long time may lack skills and knowledge that create a barrier to healthcare participation. A CHW is sensitive to this, Wilson said, noting “we’re there every step of the way. What if the person never had to go to pharmacy, do they know where it is, do they know how to present themselves?”
CHWs not only help with skills to “navigate from point A to point B,” but also “people skills and soft skills,” such as how to speak to the pharmacist and how to address problems that may arise, like the medication not being ready when expected.
A FIT CHW can even help people work to meet broader life goals such as employment, an important social determinant of health and successful reentry. Wilson has a background in job skills training and uses that with FIT clients. Having faced similar challenges, he can help others identify goals, believe in themselves, and take action steps.
“You can get a job, you can be successful, here is the blueprint,” Wilson said.
The CHW is person-centered. Empowerment is a key concept within FIT.
“We sit down and have conversations — do you want the help?” Wilson asked. “This is not something anyone can make you do. I do a lot more listening than talking: This is their life and they’re in charge, I empower them to be owners of their own lives.”
The focus is on listening to the client, asking people what their goals are, and helping them to get there. It would be counterproductive for the CHW to impose their views and priorities.
“I want to hear about what they’re passionate about, their dreams, that helps me help them,” Wilson added. He explained that it’s important to start with the person’s concerns – for example, a ‘homeless’ person may prioritize clothes and hygiene over goals related to school or employment. Success in solving one problem may increase confidence in solving the next one.
At the close of our conversation, I asked Wilson if there was anything else about his work that he wanted others to know about.
“Accountability stands out, in my mind,” he replied. “These are men and women who made bad decisions and all are looking for 2nd, 3rd, 8th chance, AND they are the key to our program’s success, and to their own individual success. The people closest to the problem are also closest to the solution.”
I was struck by how Wilson’s definition of accountability is person-centered but also how he was concerned about effects on other people: awareness of one’s present actions and their effects on others, good or bad, is key to gaining the power to create a better future, not only for oneself and for others and the world.
I was grateful for the time Wilson spent with me explaining what he does. I am more convinced than ever of the crucial role of CHWs and peer supporters in helping people overcome barriers to engaging in healthcare and other services that they need and deserve.
The Wilson Center is hosting an expert panel discussion about frontline programs for individuals returning from incarceration and how they can support re-entry with healthcare and peer support. This event will focus on meeting program clients' behavioral health needs and will discuss more about NC FIT. Panelists are Shira Shavit, MD, Executive Director of the Transitions Clinic Network (TCN) out of San Francisco; Joseph Calderon, Senior Community Health Worker with TCN; Evan Ashkin, MD, Director of the North Carolina Formerly Incarcerated Transition (FIT) Program; and Tommy Green, NC FIT Program Lead Community Health Worker (CHW) and the Orange County CHW.
The virtual event will be at 12:30 p.m. August 24. Registration is required: https://bit.ly/Reentryprograms.
Michele Easter is an Assistant Professor in Psychiatry and Behavioral Sciences at Duke University’s School of Medicine. She is also part of the Behavioral Health Core at the Wilson Center for Science and Justice.