Innovations in Reentry Pilot Projects
With current funding from Health Care Services Agency and carried out in partnership with Probation, the Sheriff, and the jail medical provider (CFMG) – we facilitate reentry after incarceration at Santa Rita Jail via transition support pre- and post-release, and overall stabilization and access to a healthier life post-release. HealthyMeasures expands access to stabilizing services to formerly incarcerated individuals utilizing Navigators who facilitate engagement in clinical and wraparound services at Roots and in the community. Over three years, Navigators have delivered 1,548 Navigator visits to 495 unduplicated clients recently released from incarceration. Of these clients, either via diagnosis or self-report, 46.1% indicated the need for behavioral health care services, 18.4% indicated the need for SUD services, and 12.1% indicated a need for both behavioral and SUD services. Of 495 people in the HealthyMeasures program since inception, 23% (111) are women. Another component of our commitment to serve the formerly incarcerated is the Emancipators Initiative, our workforce program that provides ongoing support, training and employment for difficult-to-employ reentry individuals. Initiated in 2011 with support from Alameda County Social Services Agency, we developed the platform in which we train at-risk individuals: our model soap factory. Through ongoing support and a best practices curriculum, Emancipators demonstrate a high level of success in building employability skills, personal accountability and a strong work ethic. We graduate an average of 50 individuals per year from the Emancipators Initiative, with a 96% success rate with respect to long-term stabilization and employment. Roots is well-positioned to build upon this success by incorporating gender-responsive services for reentry women experiencing barriers to enter the workforce.
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: Incarceration
Exploring & Developing Career Ladders in Manufacturing & STEM for Formerly Incarcerated Women
…a flexible and expandable program model for reentry engagement and empowerment which addresses critical barriers and can be replicated by other providers and agencies. This will include delivering a condensed version of the training curriculum and exercises/lesson plans/agendas we developed in our Round 2 Innovations “Reentry Engagement Framework.” We will also document our program model for reentry consumer forums, building upon our experience holding listening sessions and community forums in Round 2 innovations among others. Importantly, we will maintain a specific focus on aligning these activities such that participants meaningfully engage with the CCP-EC, its subcommittees and the CAB.
Core Care Model:
Program:
Themes, Keywords & Tags: Incarceration; Women; Workforce
Exploring & Developing Career Ladders in Manufacturing & STEM for Formerly Incarcerated Women
We have been working directly with the reentry population since our beginnings in 2008, starting as a mobile volunteer operation visiting patients at transitional, reentry housing and substance use facilities. In 2013, we formalized our HealthyMeasures Initiative as a best-practice strategy to serve reentry individuals with chronic medical conditions, establishing a formal relationship with San Quentin Prison Health. In 2014, with support from Alameda County Health Care Services Agency we expanded HealthyMeasures to recruit and train formerly incarcerated individuals who complete their Community Health Worker Certificate at SF City College and provide navigation/intensive case management to recently released individuals.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry
Exploring & Developing Career Ladders in Manufacturing & STEM for Formerly Incarcerated Women
Another component of our commitment to serve the formerly incarcerated is the Emancipators Initiative, our workforce program that provides ongoing support, training and employment for difficult-to-employ reentry individuals. Initiated in 2011 with support from Alameda County Social Services Agency, we developed the platform in which we train at-risk individuals: our model soap factory. Through ongoing support and a best practices curriculum, Emancipators demonstrate a high level of success in building employability skills, personal accountability and a strong work ethic. We graduate an average of 50 individuals per year from the Emancipators Initiative, with a 96% success rate with respect to long-term stabilization and employment. Roots is well-positioned to build upon this success by incorporating gender-responsive services for reentry women experiencing barriers to enter the workforce.
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: Incarceration
Exploring & Developing Career Ladders in Manufacturing & STEM for Formerly Incarcerated Women
Roots fulfills an integral component of its mission, “establishing partnerships to ensure a more efficient continuum of care in Oakland,” not only through direct partnerships, but via participation in collaboratives that facilitate collective impact, share best practices and work towards an intact safety net. Roots has established a strong set of partnerships, including client cross-referrals and access to external resources, identifying organizations and agencies that engage with high risk individuals. Successful implementation of our reentry programming is supported by strong working relationships with the Alameda County Probation Department and its contractor, the Transition Day Reporting Center, both of whom send us direct referrals into our reentry programming. We also work collaboratively with California Forensic Medical Group and the Alameda County Sheriff including Operation My Home Town and Santa Rita Jail. We are also pleased to partner with Because Black is Still Beautiful, another Probation Contractor, to expose women in reentry to higher education as part of their working and professional development. Roots has served as the fiscal sponsor for Because Black is Still Beautiful through the Probation Department’s Community Capacity Fund (CCF), witnessing firsthand the capacity being built for this provider. Based on the goals of the CCF, we consider this subcontract opportunity to be desirable progress of this partnership to support reentry communities.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry; Partners
Exploring & Developing Career Ladders in Manufacturing & STEM for Formerly Incarcerated Women
In an effort to expose reentry women to the pursuit of higher education as part of their working and professional development, Roots will partner with Because Black is Still Beautiful and their Just Say Know program. This is a culturally affirming, gender responsive program designed to promote academic engagement among criminal justice impacted women. It contains two components: (1) educational workshops and (2) educational mentorship and counseling. Two educational learning theories will be utilized throughout the program. The first is the Transformational Learning Theory, founded upon the idea that a listener or participator of an experience/curriculum will develop positive life-changing thoughts based upon what they have heard or experienced. And the second, the Liberation Education Theory, encourages learners to think critically, challenge oppressive social structures in society, and work to change them.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry; Women
Exploring & Developing Career Ladders in Manufacturing & STEM for Formerly Incarcerated Women
HealthyMeasures expands access to stabilizing services to formerly incarcerated individuals utilizing Navigators who facilitate engagement in clinical and wraparound services at Roots and in the community. Over three years, Navigators have delivered 1,548 Navigator visits to 495 unduplicated clients recently released from incarceration. Of these clients, either via diagnosis or self-report, 46.1% indicated the need for behavioral health care services, 18.4% indicated the need for SUD services, and 12.1% indicated a need for both behavioral and SUD services. Of 495 people in the HealthyMeasures program since inception, 23% (111) are women.
Core Care Model:
Program: Healthy Measures
Themes, Keywords & Tags: Reentry
Exploring & Developing Career Ladders in Manufacturing & STEM for Formerly Incarcerated Women
The majority of reentry services nationwide were developed for men; Alameda County has been no exception. However, in 2014 the Alameda County Board of Supervisors-adopted Roadmap to Reentry concluded that a key strategy in reducing recidivism is to “provide gender responsive services and supports to the female target population.”
Roots understands that women are integral to the makeup of our communities and families, thus uplifting our most marginalized mothers, daughters and sisters impacts more than just the individual themselves. The Emancipator program is built to facilitate healing, and address the trauma that comes from separation and support successful reunification. Additionally, the program will strive to provide long term harm reduction techniques as a means to deter women from high risk behavior, promote self-empowerment and prevent recidivism.
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: Reentry
African American Steering Committee for Health & Wellness for Culturally Congruent Services for African Americans
In 2011, we implemented our HealthyMeasures Initiative, a best-practice strategy to facilitate reentry afterincarceration via short-term transition and overallstabilization at our primary care facility. Roots established a formal relationship with San Quentin Prison Health so that inmates could make an appointment to enroll in medical care prior to release, immediately linking them to Roots as their primary medical home upon release to jump-start their transition. In 2013, with support from Alameda County Health Care Services Agency, we expanded HealthyMeasures to provide pre- and post-release services to individuals in/released from Santa Rita Jail, incorporating the training/hiring of Roots Health Navigators – formerly incarcerated community members who become certified healthcare workers and provide wraparound services for reentry individuals, many of whom have chronic health conditions such as diabetes, hypertension, and asthma; and mental health diagnoses, including those associated with exposure to violence, such as PTSD. Currently eight full time Health Navigators provide immediate and ongoing access to clients to ensure effective reintegration into their communities. This work is demonstrating that individualsin transition are more likely to successfully reintegrate when they maintain a trusting relationship with their primary care medical home coupled with mental/behavioral health diagnosis and treatment, and enhanced through culturally and situationally congruentNavigators who work closely with each patient and ensure they receive stabilizers including public benefits programs, employment training/jobs,stable housing, food, family, mental health and addiction counseling, and peer-centered mentoring.
Core Care Model:
Program: Healthy Measures
Themes, Keywords & Tags: Incarceration; Mental Health; Reintegration; Employment; Job Training
African American Steering Committee for Health & Wellness for Culturally Congruent Services for African Americans
A general mistrust of institutions is a common theme among our African American community, and is even more prevalent among the formerly incarcerated or institutionalized. For this priority population, personal safety is often understandably equated with “avoidance of the system.” Many individuals re-entering society, particularly those with mental health diagnoses, prioritize self-protection above all else, which can manifest in a desire to distance onesself from the institutions and systems in which they have experienced trauma, even when the ramifications include damaging effects on personal health. Through HealthyMeasures we have successfully facilitated reentry after incarceration via transition support and overall stabilization for over 500 individuals, with approximately 100 active members at any given time. Over 95% of these individuals have been/are African American, and over 90% African American men. This successful program demonstrates how access to a culturally congruent primary and behavioral care home, along with key stabilizers (public benefits programs, employment training/jobs, stable housing/food), and dedicated, peer-centered mentoring and navigation leads to stability, agency, and improved outcomes. Roots has ensured a culturally responsive, client-centered approach through integration of Roots Health Navigators – peer case managers who are formerly incarcerated, and who complete their Community Health Worker and/or Health Coaching Certificate and provide navigation/intensive case management to recently released individuals.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Reentry
African American Steering Committee for Health & Wellness for Culturally Congruent Services for African Americans
A general mistrust of institutions is a common theme among our African American community, and is even more prevalent among the formerly incarcerated or institutionalized. For this priority population, personal safety is often understandably equated with “avoidance of the system.” Many individuals re-entering society, particularly those with mental health diagnoses, prioritize self-protection above all else, which can manifest in a desire to distance onesself from the institutions and systems in which they have experienced trauma, even when the ramifications include damaging effects on personal health. Through HealthyMeasures we have successfully facilitated reentry after incarceration via transition support and overall stabilization for over 500 individuals, with approximately 100 active members at any given time. Over 95% of these individuals have been/are African American, and over 90% African American men. This successful program demonstrates how access to a culturally congruent primary and behavioral care home, along with key stabilizers (public benefits programs, employment training/jobs, stable housing/food), and dedicated, peer-centered mentoring and navigation leads to stability, agency, and improved outcomes. Roots has ensured a culturally responsive, client-centered approach through integration of Roots Health Navigators – peer case managers who are formerly incarcerated, and who complete their Community Health Worker and/or Health Coaching Certificate and provide navigation/intensive case management to recently released individuals.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Incarceration; Safety; Reentry
African American Steering Committee for Health & Wellness for Culturally Congruent Services for African Americans
Roots’ goal for this work is to extend our culturally-defined, trauma-informed behavioral, health and wraparound services to an increased number of African American reentry individuals with a mental health diagnosis. Our goal is undergirded by Roots’ theory of change, which identifies priority conditions that must be addressed to reach positive, whole health outcomes: chronic disempowerment; lack of positive/pro-social community engagement; few employment opportunities; unstable family relationships; low self-esteem and underdeveloped relationship skills; and attitudes/beliefs that lead to poor decision-making. Roots’ underlying theory of change—whether in the clinical setting, in service navigation, or in workforce development—is that empowering those who have been marginalized with skills that enable them to engage positively with themselves as well as their communities in the context of wraparound services delivered in a safe and therapeutic environment, improves morale and self-efficacy, ensures successful integration/reintegration into society, and reduces the risk of recidivism and institutionalization.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Reentry; Health Trauma; Employment; Workforce Development
ACOCAP
An estimated 12.5% of Alameda County residents lived below 100% of the federal poverty level in 2013, according to the 2009-13 American Community Survey. Our target population lives in cities with some of the highest poverty rates in the county, including Oakland, where 20.5% live below the poverty level, Hayward with 14.4%, San Leandro with 10%, and Union City with 8.4%. AC-OCAP’s 2016-17 Community Action Plan describes income conditions faced by many Oakland families: “27% of Oakland’s residents had an annual income less than $24,999 and 39% of female- headed households with children under 5 years of age had incomes below the poverty level.”2 Staggering racial disparities in child poverty also persist with African Americans at 30%, compared with Whites at 6%.” Similarly, nearly one out of four (24.9%) individuals in Roots’ East Oakland service area live below the poverty; as a result, we are all too familiar with the magnitude of unmet needs compounded by no insurance, little income, and/or job insecurity. More than one in four of our service area residents above the age of 17 lack even a high school diploma. Age-adjusted death rates for diabetes and hypertension are at least 50% higher in our service area than in the state – health conditions that if diagnosed early and managed properly would not lead to premature death. Our service area is also home to the greatest concentration of supervised individuals (probation/parole), and comprises 7 of the top 10 stressor beats in Oakland, indicating higher rates of violent crime. Roots staff and board recognize that as the gap in resources and opportunities continues to grow, our target population will experience disproportionate impact – reinforcing what data and experience tell us: high poverty and unemployment correlate with lower quality of life, shorter life expectancy, lower educational attainment rates and greater exposure to violence and incarceration. Roots clients tell us that their greatest current needs are stable housing; culturally congruent/competent counseling, health care and mental health services; and training that leads to permanent and sustainable employment.
Manufacturing is the fifth largest employment sector in Alameda County, and for 13 of the top 50 county manufacturing jobs, only short-term training is required. Per Made in the East Bay: A Study of Advanced Manufacturing in Alameda County, “By any measure, Alameda’s manufacturing sector is a major contributor to the local economy. High wage jobs provide workers with a livable wage well above the median…An economically healthy and vibrant manufacturing sector is, therefore, very important to the Alameda County economy.” In their manufacturer survey representing >16,000 employees, 74% of employers indicated a need for “new or more effective pre-employment or soft skills training. Work ethics and communication skills, including language deficiencies and poor reading comprehension, are of primary concern, as is basic math and computer skills.”
ref. ACOCAP_RFP_Response.pdf, 2017-2019 – Dan Abrahamson
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: Unemployed; Homeless; Incarceration
ACVPI
In 2011, we implemented our HealthyMeasures Initiative, a best-practice strategy to facilitate reentry after incarceration via short-term transition and overall stabilization at our primary care facility. HealthyMeasures was initially established via a formal relationship with San Quentin Prison Health whereby, prior to release, inmates make an appointment to enroll in medical care and link to Roots as their primary medical home immediately upon release to jump-start their transition. In 2013, with support from Alameda County Health Care Services Agency, we expanded HealthyMeasures to provide pre- and post-release services to individuals in/released from Santa Rita Jail, incorporating the training and hiring of Roots Health Navigators – formerly incarcerated community members who become certified healthcare workers and provide wraparound services for reentry individuals, many of whom have chronic health conditions such as diabetes, hypertension, and asthma; and mental health diagnoses, including those associated with exposure to violence, such as PTSD. Currently eight full time Health Navigators provide immediate and ongoing access to clients to ensure effective reintegration into their communities. This work is demonstrating that individuals in transition are more likely to successfully reintegrate when they maintain a trusting relationship with their primary care medical home coupled with mental/behavioral health diagnosis and treatment, and enhanced through culturally and situationally congruent Navigators who work closely with each patient and ensure they receive stabilizers including public benefits programs, employment training/jobs, stable housing, food, family, mental health and addiction counseling, and peer-centered mentoring.
ref. ACVPI_Roots_Proposal.pdf, November 2016 – Dan Abrahamson
Core Care Model:
Program: IMPACT Eastmont; Healthy Measures
Themes, Keywords & Tags: Unemployed; Homeless; Incarceration
Reentry Engagement Framework Project Proposal for Innovation in Reentry Round 2
The Reentry Engagement Framework (REF) Project will result in recommendations for improved systems and services that reduce recidivism and facilitate better integration into the community. We will expand best reentry practices by involving formerly incarcerated individuals in authentic, ongoing engagement in decision-making with policymakers, as well as evaluation of systems, services and funding for reentry individuals, offering a new tool to help institutions and Community Based Organizations (CBOs) improve responses to reentry needs in partnership with reentry individuals.
Core Care Model:
Program: Reentry Engagement
Themes, Keywords & Tags: Reentry
Reentry Engagement Framework Project Proposal for Innovation in Reentry Round 2
There are few examples in which reentry individuals are successfully and meaningfully engaged to improve the systems that serve them. Given the complex and evolving landscape with respect to reentry, and persistently high rates of recidivism, we have identified a critical need for ongoing participation of formerly incarcerated individuals in the processes that lead to program design and service delivery. Through the REF Project, we aim to develop a framework within which reentry clients, providers and decision-makers alike can inform one another and reinforce successful pathways for successful reentry.
The REF Project can meet the needs of reentry-serving systems and organizations by identifying mechanisms and strategies to ensure ongoing engagement and responsiveness. The recommended framework will allow policymakers, community leaders and CBOs to receive feedback as well as support from formerly incarcerated community members. Such a framework for ongoing engagement is becoming increasingly necessary since the passage of AB109, as the number of reentry community members continues to grow while rates of recidivism remain high.
Despite the need for engaging reentry individuals in the shaping of the programs that serve them, there are few examples of this happening. This is due in part to the fact that leadership development and civic engagement may be challenging while individuals struggle to meet basic needs and overcome barriers to reentry. Yet our extensive experience working with the reentry population convinces us that involving reentry persons in identifying and addressing barriers to their stability – individually and collectively – is an important component of successful reintegration.
Core Care Model:
Program: Reentry Engagement
Themes, Keywords & Tags: Reentry; Needs Statement
Reentry Engagement Framework Project Proposal for Innovation in Reentry Round 2
a) Target population Our experience serving the reentry population teaches us that, given the opportunity and proper support, many reentry individuals are willing and able to engage in a program that provides a safe space for sharing and encourages their voices to be heard. Roots and Timelist will reach out to persons who are on probation and/or recently released from incarceration to present the opportunity to participate in such a program. A minimum of 30 eligible individuals will be selected as REF Project Fellows. These Fellows will engage with the REF Project for a 6-month period. The REF Project Evaluation Team will identify criteria for Fellows before outreach takes place to ensure a diverse cross-section of participants, taking into account age, length/number of sentences, time since release, gender, race, immigration status, and recidivism risk. These criteria are set forth in Roots’ intake tool which also includes validated questions on recidivism risk. Spanish language access will be available.
b) Outreach & Recruitment Flyers describing the project will be circulated within our extensive network of organizations, including East Oakland Building Healthy Communities’ 41 partners and the Roots-founded Community-Rooted Provider Coalition comprising 19 healthcare providers that serve low income residents. We will also conduct project outreach through providers contracted with Alameda County Probation Department, and other reentry-serving employment and housing providers. Potential participants will submit a brief, client-centered application to be considered for a REF Project Fellowship. In addition to ongoing support and leadership development, participants will each receive a $700 stipend and transportation assistance during the fellowship.
Core Care Model:
Program: Reentry Engagement; REF
Themes, Keywords & Tags: Reentry; Evaluation;; Target Population
Reentry Engagement Framework Project Proposal for Innovation in Reentry Round 2
Roots, Timelist and Centerforce are proposing the Reentry Engagement Framework Project as an innovation that will enhance the work and efficacy of agencies and institutions that serve reentry populations. We will involve reentry individuals with key stakeholders through participant focus groups, as well as interviews with agencies, policymakers and CBO leaders to build confidence and self-sufficiency among REF Fellows, and identify both best practices and barriers to access as formerly incarcerated individuals navigate integration into the community.
The project will be coordinated by Roots Empowerment Programs Administrator who will work closely with the Evaluation Team and Program Staff to ensure that project goals and objectives are met. In addition to this Programs Administrator, the Evaluation Team will consist of Roots’ Director of Community Research, Roots’ Data Specialist, and the lead Facilitator Trainer who is formerly incarcerated (Timelist). Our team of six Program Staff includes additional formerly incarcerated staff: 5 community health outreach workers (Roots) and a case manager/lead facilitator (Timelist). The lead Facilitator Trainer will also provide initial training in group facilitation as well as ongoing support to Program Staff, ensuring that they are supported, and that their experiences and findings optimally inform program progress.
REF Project Fellows will attend two focus groups led by our formerly incarcerated facilitators and observe/attend at least one decision-making meeting or interview with a policymaker or key CBO. Using group reflection, participants will share insights about their own experiences, what they are learning from observation and interviews, and what practices are likely to improve successful reintegration. At the close of the project, a final report will be produced and reviewed/approved by participants themselves to ensure it is an accurate reflection of their work together.
Because implementation is outside of the scope of this RFP, Roots has secured a commitment from East Oakland Building Healthy Communities (EOBHC) leadership to explore: (1) ways that the practices outlined at the close of this work could be shared across our communities, and (2) consideration of EOBHC as a potential vehicle to continue this work once the REF Project is completed. In addition, we have been in conversation with The Anti-Recidivism Coalition (ARC) who has also expressed an interest in potential collaboration with us to pilot the recommendations from the six month study. ARC offers a rare example in which reentry individuals not only stabilize their lives and shift their thinking from the prison environment to accepted community norms – they also learn how to advocate for policies that are informed by their direct experience and practice, work with systems, and lead advocacy efforts themselves. See www.antirecidivism.org.
The REF Project is a critical new method for building capacity and competence among reentry organizations and policymakers to achieve higher levels of success for reentry individuals. Unfortunately, reentry individuals face substantial barriers, inadequate resources and limited job and housing prospects. Even with several forward-looking program models, myriad systemic barriers remain to reentry success and Alameda County’s recidivism rate hovers at 59%, according to a report from the California Department of Corrections And Rehabilitation (January 2014).
Roots’ theory of change, which guides its work and this project proposal, is as follows: “Empowering at-risk individuals with skills that enable them to engage positively with themselves as well as their communities in the context of wraparound services delivered in a safe and therapeutic environment will improve morale and self-efficacy, ensure successful reintegration into society, and reduce the risk of recidivism.”
Timelist and Roots both believe that empowering the reentry population is necessary for success. Both organizations actualize this vision not only by serving and training formerly incarcerated community members, but also by ensuring that the staff members delivering reentry services have lived experience of incarceration themselves. We also share an approach to reentry work that emphasizes comprehensive, wraparound services and community building, which is why Timelist refers its reentry clients to Roots’ health services and workforce development programs, and Roots refers its clients to Timelist for various training opportunities.
Core Care Model:
Program: Reentry Engagement
Themes, Keywords & Tags: Reentry; Incarceration; Empowerment; Capacity Building
Reentry Engagement Framework Project Proposal for Innovation in Reentry Round 2
Evaluation is embedded within all project activities – by the Evaluation Team, Program Staff and by REF Project Fellows, who will use assessment, observation and evaluation as they define report outcomes. Success rests on skilled facilitation that builds each individual’s capacity to identify promising practices, analyze access issues, and also evaluate their own and the group’s work over the grant duration. Process evaluation will include assessments about inclusiveness, openness, trust, ability to learn from others, and the impact of participation on reentry success itself.
Qualitative data from transcribed focus groups, interviews as well as participant evaluations will be analyzed, the information sorted and labeled, and emergent themes identified. Interpretation of qualitative data will be performed through listing, diagramming, and connecting categories and emergent themes, and highlighting representative or illustrative statements and quotes. The Evaluation Team will compile all qualitative and quantitative data, and summarize findings. The Evaluation Team and formerly incarcerated Program Staff will review these findings and work together to craft the final recommendations. Review of the final product will be conducted by REF Project Fellows who will edit/add and sign off on the report before it is shared.
Core Care Model:
Program: Reentry Engagement
Themes, Keywords & Tags: Reentry; Evaluation; Data
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
Roots Community Health Center (Roots), with our primary site located in deep East Oakland, is committed to our mission: to address long-standing health inequities by providing culturally competent, comprehensive physical and mental health services; education, employment and training; and wraparound services that build client self-sufficiency and promote community empowerment. Roots addresses social determinants of health disparities that are often not prioritized by traditional medical providers. Our programs and services honor the “roots” of culture, heritage, and tradition; prioritize easy patient/client access; ensure community-aware, responsive programs; and enable long-standing partnerships, resulting in an efficient continuum of care for our clients/patients.
At Roots, services are provided within a safe, trustworthy environment enabling the best possible outcomes for so-called “hard to reach” individuals. By demonstrating competency through humility and a desire to meet individuals “where they’re at” each Roots provider establishes him or herself as someone that individuals can trust and with whom they can share their concerns and develop a therapeutic relationship. Such relationships lay a foundation for increased patient/client engagement, empowered attitudes regarding systems of care, and improved standards of health within underserved communities overall.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry; Mission; About
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
Roots proposes to design and implement a flexible and expandable program model for reentry engagement and empowerment which addresses critical barriers and can be replicated by other providers and agencies. This will include delivering a condensed version of the training curriculum and exercises/lesson plans/agendas we developed in our Round 2 Innovations “Reentry Engagement Framework.” We will also document our program model for reentry consumer forums, building upon our experience holding listening sessions and community forums in Round 2 innovations among others. Importantly, we will maintain a specific focus on aligning these activities such that participants meaningfully engage with the CCP-EC, its subcommittees and the CAB.
Core Care Model:
Program: Healthy Measures
Themes, Keywords & Tags: Reentry
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
We are also achieving great success enrolling “hard to reach” reentry and homeless individuals into Medi-Cal and CalFresh, through a relationship with Social Services Agency, and also have held/currently hold workforce and Probation contracts. Building on our shared commitment to serve the most marginalized across the County with high quality, culturally sensitive services and programs, we welcome the opportunity to offer continued value to county initiatives by participating in this effort to increase overall stability of justice involved individuals.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry; Medi-Cal; CalFresh; Partnerships
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
We have been working directly with the reentry population since our beginnings in 2008, when we started as a mobile volunteer operation visiting patients at transitional/reentry housing and substance use facilities. In 2013, we formalized our HealthyMeasures Initiative as a best-practice strategy to serve reentry individuals with chronic medical conditions, establishing a formal relationship with San Quentin Prison Health. In 2014, with support from Alameda County Health Care Services Agency we expanded HealthyMeasures to recruit and train formerly incarcerated individuals who complete their Community Health Worker Certificate at SF City College and provide navigation/ intensive case management to recently released individuals.
With current funding from Health Care Services Agency and carried out in partnership with Probation, the Sheriff, and the jail medical provider (CFMG) – we facilitate reentry after incarceration at Santa Rita Jail via transition support pre- and post-release, and overall stabilization and access to a healthier life post-release. HealthyMeasures expands access to stabilizing services to formerly incarcerated individuals utilizing Navigators who facilitate engagement in clinical and wraparound services at Roots and in the community. Over three years, Navigators have delivered 1,548 Navigator visits to 495 unduplicated clients recently released from incarceration. Of these clients, either via diagnosis or self-report, 46.1% indicated the need for behavioral health care services, 18.4% indicated the need for SUD services, and 12.1% indicated a need for both behavioral and SUD services. As such, Roots has the expertise required to meet the needs of reentry individuals in crisis, support them to achieve their goals, and recognize their stage of readiness to participate in the civic process.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Reentry; Incarceration
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
Another component of our commitment to serve the formerly incarcerated is our Emancipators Initiative, our workforce program that provides ongoing support, training and employment for the hardest to employ from our community, including reentry individuals. Initiated in 2011 with support from Alameda County Social Services Agency, we developed the platform in which we train at-risk individuals: our model soap factory. Through ongoing support and a best practices curriculum, Emancipators are demonstrating a high level of success in building employability skills, personal accountability and a strong work ethic. We graduate an average of 50 individuals per year from the Emancipators Initiative, and Reentry Emancipators have a 96% success rate with respect to long-term stabilization and employment. As reentry individuals move from crisis states to being secure in their lives, they become the ideal representatives to interface with policymakers on the systems that have impacted them. Roots is well- positioned to identify and support these individuals to build skills and meaningfully engage in public process.
Core Care Model: Navigation
Program: Clean360; Emancipators Initiative
Themes, Keywords & Tags: Reentry; Incarceration
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
In 2016 Roots was awarded a Round 2 Innovations In Reentry Grant from Alameda County Behavioral Health Care Services to create the Reentry Engagement Framework (REF) Reentry Leader Fellowship. This project had the goal to identify ways to improve systems and services that reduce recidivism and facilitate better integration of the formerly incarcerated into the community by seeking direct feedback from these individuals themselves. Roots involved formerly incarcerated individuals in authentic, ongoing engagement in decision making with policymakers and evaluation of systems and services and funding for reentry individuals. The Leader Fellowship engaged systems impacted individuals in leadership development and community advocacy skill building.
We engaged 15 formerly incarcerated individuals over a six month fellowship to explore and identify best practices for stakeholder engagement with reentry populations. Through a structured group process co-facilitated by Roots’ staff impacted by incarceration, fellows participated in leadership development and a series of workshops and meetings, resulting in identification of best practices and co-creation of a training curriculum for formerly incarcerated individuals to engage with stakeholders as advocates regarding best practices and as experts in peer navigation for reentry. Together they attended 32 workshops/meetings; prepared for, observed and made public comment at three Alameda County Board of Supervisors meetings; attended a listening session held by the Chief of Probation; and organized and facilitated two listening sessions sponsored by the Office of Supervisor Wilma Chan, where they engaged with systems leaders and community members on reentry issues.
The major product of this project was the Reentry Engagement Toolkit, a resource guide of best reentry practices designed to help institutions and organizations improve responses to reentry needs in partnership with reentry individuals. The toolkit is intended to assist organizations and agencies considering undertaking the work of reentry engagement, and to serve as a resource to formerly incarcerated individuals engaging in systems change work.
Core Care Model:
Program: Reentry Engagement Framework (REF)
Themes, Keywords & Tags: Reentry; Partnerships
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
We propose to design and implement a flexible and expandable program model for reentry engagement and empowerment which addresses critical barriers and can be replicated by other providers and agencies. This will include delivering a condensed version of the training curriculum and exercises/lesson plans/agendas we developed in our Round 2 Innovations “Reentry Engagement Framework.” We will also document our program model for reentry consumer forums, building upon our experience holding listening sessions and community forums in Round 2 innovations among others. Importantly, we will maintain a specific focus on aligning these activities such that participants meaningfully engage with the CCP-EC, its subcommittees and the CAB.
Formerly incarcerated individuals will be selected to participate in four informational prerequisite workshops including leadership development, civic engagement and storytelling. Once these workshops have been completed, they must pass an assessment and interview (to be developed during the planning phase) in order to gain access to resources designed to support their participation in local public reentry-focused meetings. A feedback mechanism will be designed to ensure engagement and contribution by participants, and a debriefing component will encourage continued participant growth and the development of new skills through the process.
We propose to utilize Roots Empowerment Center, our accessible, user-friendly computer lab and resource center, as the entry point for engaging formerly incarcerated individuals in Community Engagement & Empowerment. We serve over 120 individuals per month in the Empowerment Center, approximately 71% of whom are formerly incarcerated. Roots’ Economic Empowerment Coordinator, who staffs the Empowerment Center, will be trained and well-positioned to educate Empowerment Center consumers on the opportunity presented by this project, and will be responsible for coordinating enrollment into the program. We will also accept referrals from all of our usual partners including Santa Rita Jail, CBOs, Probation, Transition Day Reporting Center, etc.
Core Care Model: Empowerment
Program: Reentry Engagement Framework (REF)
Themes, Keywords & Tags: Reentry; Incarceration
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
Four workshops led by formerly incarcerated individuals will consist of a condensed version of OUR Project curriculum developed during Innovations Round 2. Topics include leadership development, storytelling and civic engagement. Individuals must complete all four training sessions and pass a post-test and interview before receiving a certificate of completion. Once this certificate is received, the participant will be eligible to receive support from the Community Engagement & Empowerment Development (CEED) Fund for attending public meetings and reporting back.
Core Care Model: Empowerment
Program: Reentry Engagement Framework (REF)
Themes, Keywords & Tags: Reentry; Incarceration, Economic Empowerment
Piloting a Flexible Mechanism for Reentry Engagement in Local Public Process
Funds set aside through this scope of work to provide meals, transportation and stipends to support attendance and participation in approved public meetings. Preparatory Meetings. Required engagement prior to attending the meetings, wherein the prior meeting minutes as well as the upcoming agenda are reviewed. Debrief with Navigator. Following engagement in a public meeting, participants will debrief with their navigator on their personal responses to participation in the meeting, reactions that may have been triggered in the process, and lessons learned to prepare them for the next meeting. Report Back. Elements of report back will be determined in the planning phase, and will likely include the completion of a brief evaluation form. Upon acceptance of this report back, the participant stipend will be provided. Reentry Consumer Forums. An extension of the opportunity to interface with policymakers at local advisory meetings, these forums will provide a safe space for reentry individuals to share their experiences and provide valuable input. Those utilizing the CEED fund will be given the opportunity to plan and present at these forums, and will invite stakeholders, family and community members to attend.
Core Care Model: Empowerment
Program: Reentry Engagement Framework (REF), CEED Fund
Themes, Keywords & Tags: Reentry; Incarceration, Economic Empowerment
On the Frontlines of Communities in the U.S. (FOCUS)
Roots Alliance practices serve traditionally “hard to reach” populations including a large number of low-income African American patients, those re-entering society from prison, and those with substance abuse histories. The HealthSTATS project presents a powerful opportunity to routinize screenings in this high-risk population, establish an accurate baseline, increase the number of patients who are diagnosed early, and provide succinct and comprehensive follow-up care for patients who test positive. Of the Alliance practices, ten have been selected to participate. The HealthSTATS program proposes to expand current testing practice by offering HIV/Hepatitis C testing with routine blood work to all patients 13+ annually regardless of risk factors. Not only is there buy-in from each of the physician leaders at the individual practices, but there is also a strong commitment from Roots Clinic’s entire leadership staff to ensure that HealthSTATS is successful and sustainable across similar clinical sites and beyond. To maintain the highest efficacy of new protocols and accuracy in data, the HealthSTATS program includes a strong professional education component including regular on-site in-services for each clinic and quarterly symposia as well as oversight by a CQI subcommittee. In addition to disseminating our findings to all members of our Alliance, we plan to publish a comprehensive report, including recommendations and best practices, to be widely distributed via our existing relationships with Alameda County Public Health Department and Alameda County Social Services Agency and will seek other opportunities to present this material such as national, regional and local conferences and symposia.
Core Care Model:
Program: HealthSTATS
Themes, Keywords & Tags: Reentry; HIV, Hepatitis C
West Oakland Street Outreach
WAFC, formed in 1968 is led by Bishop Keith Clark, who became pastor in 1993. Incorporated as WAFC in 2011, WAFC has 5 Bay Area campuses with over 1200 members; 2500+ regularly attend Bible Studies and WAFC events. WAFC’s ministry addresses quality of life issues including anger management, conflict resolution, effective communication, self-improvement, literacy, entrepreneurship, tutoring, and dismantling cultural pathology by developing positive male relationships. Roots and WAFC share a commitment to build community health by reducing violence/homicide, and hire staff with street credibility and connections that result in trust for our agencies and services, also demonstrating congruence with OU’s Street Outreach goal to reduce the impacts of exposure to violence or re-victimization through individual and community support.
ref. OU_Narrative_FINAL_1020am.docx West Oakland Street Outreach Proposal, April 2018 – Dan Abrahamson
Core Care Model:
Program: West Oakland’s Word Assembly a Family of Churches (WAFC); Emancipators Initiative; Healthy Measures; Clean360
Themes, Keywords & Tags: Reentry; Anger Management; Conflict Resolution; Effective Communication; Self-Improvement; Literacy; Entrepreneurship; Tutoring
West Oakland Street Outreach
Roots’ HealthyMeasures Initiative is a best-practice strategy to serve reentry individuals with medical conditions. Formal relationships with San Quentin and Santa Rita link inmates to Roots pre-release, jump-starting their transition. We hire and train formerly incarcerated individuals as Health Navigators who enrolled and case managed 312 reentry individuals over the past year, and expanded HealthyMeasures via OU’s Young Adult Intensive Case Management.
ref. OU_Narrative_FINAL_1020am.docx West Oakland Street Outreach Proposal, April 2018 – Dan Abrahamson
Core Care Model: Navigation
Program: West Oakland’s Word Assembly a Family of Churches (WAFC); Emancipators Initiative; Healthy Measures; Clean360
Themes, Keywords & Tags: Reentry; Incarceration
West Oakland Street Outreach
Roots’ East Oakland sites, reentry program, and our North Oakland workforce site have seen increasing numbers of West Oakland residents, which has necessitated expansion of our services to West Oakland. As a result, Roots has deployed mobile services to high-risk and vulnerable West Oakland populations every week for the past year: our outreach bus targets the reentry population, and our mobile clinic targets homeless and substance using populations. WAFC works with hundreds of high-risk West Oakland residents through their programs including Word Academy and Fun Sunday. Twice weekly Brotherhood Gatherings, currently held in East Oakland, will be expanded to West Oakland for the proposed project. Roots and WAFC share OU’s vision to reduce violence in Oakland among youth/young adults, and create a well-integrated violence intervention system that results in healthier communities and long-lasting, positive results for perpetrators and victims of violence.
ref. OU_Narrative_FINAL_1020am.docx West Oakland Street Outreach Proposal, April 2018 – Dan Abrahamson
Core Care Model:
Program: West Oakland’s Word Assembly a Family of Churches (WAFC); Healthy Measures
Themes, Keywords & Tags: Reentry; History; Vision; Workforce
West Oakland Street Outreach
Through Roots’ HealthyMeasures Initiative, Emancipators and Clean360, we have developed a solid curriculum and training methodology based on best practices in working with high risk individuals, prioritizing African American men, many returning to Oakland after incarceration. This work is demonstrating that at-risk individuals are most likely to change their thinking and behavior when they are presented with alternatives during defining life events/transition (incarceration, reentry, post-traumatic injury, involvement in violence or loss of a loved one to violence), and are more likely to successfully integrate into society when they form trusting, healthy relationships.
ref. OU_Narrative_FINAL_1020am.docx West Oakland Street Outreach Proposal, April 2018 – Dan Abrahamson
Core Care Model:
Program: West Oakland’s Word Assembly a Family of Churches (WAFC); Emancipators Initiative; Healthy Measures; Clean360
Themes, Keywords & Tags: Training; Curriculum; Incarceration
West Oakland Street Outreach
Through client-centered, culturally congruent case management we are assisting clients in addressing physical/mental health barriers and legal and psychosocial issues, supporting long-term stabilization. Our experience working with the reentry population has shown that identifying and dismantling barriers to social, emotional, and financial stability, emphasizing healthy relationships and prosocial behavior, is a fundamental first step towards successful integration into society.
ref. OU_Narrative_FINAL_1020am.docx West Oakland Street Outreach Proposal, April 2018 – Dan Abrahamson
Core Care Model:
Program: West Oakland’s Word Assembly a Family of Churches (WAFC)
Themes, Keywords & Tags: Cultural Competency; Reentry
West Oakland Street Outreach
Five to six hundred individuals will be encountered and receive messages of empowerment and alternatives via street outreach, planned community events and memorials. One hundred of the most high-risk of these individuals will be identified, screened for eligibility, and intensely engaged in services and prosocial activities. Of these, ten leaders will be engaged as “Street Navigators” who receive significant stipends and support as they assist in delivering strong messages of non-violence/non-retaliation. Street outreach workers will: engage and maintain connection with participants, including Street Navigators via texts, calls, face-to-face conversations (individually); reach out/recruit high risk individuals to participate in Brotherhood sessions at least weekly (groups); lead one-to-one conversations/follow-up with high risk individuals to encourage/troubleshoot issues of concern (individually); assist in mediation/mediate street conflicts as they emerge in real time (individual and groups); engage with high risk individuals identified as key to violence reduction through face-to-face meetings, texts, phone calls, etc (individually) ; partner with street navigators in shaping personal life plans (small groups); work with high risk individuals to build employability/career plans or apply to SSI (groups); plan and hold outreach events to educate participants, family members, key community members on program resources and goals (groups)
Street Navigators: identify/link highest risk individuals to street outreach workers; work with Street outreach workers in shaping their individual life plans (individually or small groups). Violence Interrupters mediate/reduce likelihood of retaliation through HGH and other sites as needed (individually and group); lead follow-up and home visits for participants resisting or failing to complete program components (individually); provide supervision/structure/follow-up of all staff to meet project goals/activities (individually and groups); provide training/support to all staff regarding team building, conflict reduction/mediation and dealing with individual re-traumatization through project work (groups). The Inside Navigator at Santa Rita Jail will identify high risk West Oakland incarcerated individuals and encourage their participation in project upon release; work with Violence Interrupter to encourage identified high risk individuals that are re-incarcerated to refrain from retaliation/community violence.
Supporting staff will hold award/recognition events to increase confidence/self-esteem of participants; Roots will provide primary health/behavioral care access via our mobile medical van; WAFC will provide memorial services free of charge; and Roots and WAFC provide individual counseling for all staff.
ref. OU_Narrative_FINAL_1020am.docx West Oakland Street Outreach Proposal, April 2018 – Dan Abrahamson
Core Care Model: Navigation; Empowerment
Program: West Oakland’s Word Assembly a Family of Churches (WAFC)
Themes, Keywords & Tags: Incarceration; Behavior
PATH
In 2015, with support from Alameda County Health Care Services Agency, Roots implemented its HealthyMeasures Initiative to provide pre- and post-release care and case management services to individuals with chronic illness who are in/being released from Santa Rita Jail. We incorporated the training and hiring of Navigators, all formerly incarcerated individuals from our service area who become certified healthcare workers with a typical caseload of 25 clients, linking them to wraparound services and primary/behavioral care. All HealthyMeasures patients have chronic health conditions such as diabetes, hypertension or COPD, and many also have mental health diagnoses, including those associated with exposure to violence and trauma, such as PTSD, anxiety and depression. Over 1.5 years, we served 327 patients with a chronic disease, with 844 Navigator case management visits and 704 face-to-face visits with their primary care provider. We also performed approximately 300 Medi-Cal enrollments, pre-/post-release from incarceration; and 85 CalFresh (food stamps) enrollments for this population.
ref. PATH Narr_7_FINAL.docx, April 2018 – Dan Abrahamson
Core Care Model:
Program: Healthy Measures
Themes, Keywords & Tags: Incarceration; Health
Proposition 47 Housing Assistance Support Services
Through our HealthyMeasures Initiative – funded by Health Care Services Agency and carried out in partnership with the Sheriff and jail medical provider (CFMG) – we facilitate reentry after incarceration via transition support (pre- and post-release) and overall stabilization post-release. HealthyMeasures expands access to stabilizing services to formerly incarcerated individuals utilizing a Transition Navigator who forms relationships with inmates pre-release and bridges them post-release to a Roots Health Navigator who facilitates their engagement in clinical and wraparound services at Roots Community Health Center and in the community.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Incarceration; Reentry
Proposition 47 Housing Assistance Support Services
Our Navigators have unique qualifications derived from their shared life experiences that enable them to authentically engage with their clients, helping them overcome mistrust as well as the stigma of seeking care – both medical and behavioral. Roots Health Navigators facilitate improved health care access through service navigation and care coordination, while supporting clients to build their own skills of self-advocacy. This work is demonstrating that individuals in transition are more likely to successfully reintegrate when they maintain a trusting relationship with their primary care medical home coupled with mental/behavioral health diagnosis and treatment and enhanced by stabilizers including public benefits programs, employment training/jobs, stable housing, food, family, mental health and addiction counseling, and peer- centered mentoring.
Over 2.5 years, Navigators have delivered 1,241 Navigator visits to 411 unduplicated clients recently released from incarceration. Of these clients, either via diagnosis or self-report, 49.8% indicated the need for behavioral health care services, 19.7% indicated the need for SUD services, and 12.7% indicated a need for both behavioral and SUD services. Also, upon intake, 51% of HealthyMeasures clients reported living on the street or in their car, 8% in an SRO or substance abuse treatment facility, and another 28% reported “couch surfing.” Only 11% reported renting/owning an apartment/house. Thus, we believe that this funding opportunity represents a significant enhancement to the array of supportive services we currently offer reentry clients who experience a disproportionate incidence of mental illness, substance use disorder and homelessness.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Incarceration; Reentry
Proposition 47 Housing Assistance Support Services
In addition to our expertise working with the focus population(s), Roots possesses the organizational capacity to integrate housing assistance into our programmatic and fiscal processes alike. Roots holds several master contracts which include subcontracts, and provides fiscal sponsorship for four organizations/groups, helping them build their internal capacity, broaden their scope and deepen their impact in their respective communities. We also accommodate approximately 60 individuals per year in stipended apprenticeships and internships, and have offered a multitude of paid opportunities for participation in leadership and constituency-building opportunities. As a result, we have developed protocols for processing payments in a timely manner for individuals and small groups who may not have the capacity or experience with more complex accounting processes.
Core Care Model:
Program:
Themes, Keywords & Tags: Housing; Reentry; Employment
Proposition 47 Housing Assistance Support Services
Roots will implement Prop 47 Housing Assistance Support Services, administering funds to eligible, prioritized justice-involved individuals to assist them in overcoming the barriers of homelessness and housing instability. Housing has always been a top need expressed by the reentry clients we serve, and this need has only continued to increase. We are enthusiastic about the opportunity to be able to help address this necessity, working strategically and thoughtfully to prioritize those for whom we can make the greatest impact.
Core Care Model:
Program:
Themes, Keywords & Tags: Housing; Homeless; Reentry
Proposition 47 Housing Assistance Support Services
We propose to pair this critical Housing Assistance Support to our existing HealthyMeasures Initiative which provides Navigation and Whole Health services to the reentry population. We are encouraged by this opportunity to enhance needed supports for the many formerly incarcerated Oakland residents who are expected to successfully reintegrate into their families and communities. The proposed program joins our expertise as primary care medical home dedicated to serving the target population with our experience developing and executing successful workforce and barrier removal initiatives designed to support the needs of those reentering society after incarceration. Our approach combines physical and behavioral healthcare with complementary wraparound services enhanced by health navigation/case management to access benefits and build linkages to appropriate services; the addition of Housing Assistance support would be a natural complement to this work.
Core Care Model:
Program: Healthy Measures
Themes, Keywords & Tags: Housing; Whole Health; Reentry
Proposition 47 Housing Assistance Support Services
Securing basic needs including food, stable shelter, safe environments, and social connectedness are necessary for effective behavioral/mental health self-management and avoidance of unnecessary health services utilization. Roots Community Health Center has established intake and assessment tools and processes that evaluate social determinants of health, establishing a baseline and enabling ongoing monitoring of the stability of each client. In addition to administering the intake and life assessment tools, Navigators are trained to administer Screening, Brief Intervention, and Referral to Treatment (SBIRT), the Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), and the PHQ-9 depression screening instruments to assist in identifying mental health challenges, substance use disorders and corresponding need for supports. Navigators use results to proactively connect patients with community resources as well as internal or external referrals. Information gleaned from the assessment assists in determining frequency and intensity of services, appropriate assignment of clients to Navigators, and efficient monitoring of client progress. For this scope of work, we will utilize our data systems to correlate baseline status with eligibility requirements, develop prioritization and interventions, and evaluate with respect to health/mental health and housing outcomes in an effort to achieve the greatest impact.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Housing; Reentry; Employment; Substance Abuse; Food Access; Whole Health
Mental Health Prevention & Early Intervention (PEI) Services in Sobrante Park
Roots collaborates across the city and county with the Mayor’s Safety Impact Table (which is focusing on projects in East Oakland), the Justice Reinvestment Coalition, the Racial Equity Task Force, and the African American Steering Committee for Health and Wellness. Roots staff are active participants in several East Oakland place-based initiatives, including Violence Prevention Initiatives for Eastmont and Sobrante Park, as well as initiatives overseen by the Alameda County Public Health Department including Oral Health, Educational Care Coaching, tobacco policy advocacy and cessation, and diabetes education. Roots also provide significant direct service in the area via our Health Care Services Agency-funded street medicine/mobile clinic, and Hepatitis C treatment program (at the 105th and Pearmain needle exchange). Roots also performs housing assessments on the streets of East Oakland through our relationship with the City and County via the newly-launched Coordinated Entry System.
Core Care Model:
Program:
Themes, Keywords & Tags: Housing; Reentry; Hepatitis C; Partnerships
Sobrante Park Narrative
Roots is a nationally recognized leader in addressing entrenched barriers to economic opportunity for East Oakland’s impoverished and hard-to-employ residents. We know how to positively influence behavior. We begin by empowering individuals. We get them to understand that they have choices, and to exercise those choices, including the manner in which they receive health services. And we strengthen partner organizations in this field by providing them with fiscal sponsorship, incubation, technical assistance and capacity building. More specifically, and by design, Roots’ clinics are training grounds for Oaklanders who aim to serve their home community as health professionals. Roots trains more than 60 individuals annually in healthcare professions ranging from community health outreach worker to nurse to physician. Roots launched its Emancipators Initiative in 2012 to provide on-the-job training in light manufacturing and then link graduates to permanent employment. The success of the Emancipators Initiative (begun as a workforce pilot with Alameda County Social Services Agency for persons on General Assistance) led to the creation of Roots’ social enterprise, Clean360 (www.clean360.org), in which at-risk individuals study and work in our model soap factory, learning how to produce, market, sell and ship small batch, handcrafted soaps, for which they receive stipends, barrier removal assistance, and ongoing support.
ref. RFP#HCSA-900218_Sobrante Park_narrative.pdf, March 2018 – Dan Abrahamson
Core Care Model: Empowerment
Program: Emancipators Initiative
Themes, Keywords & Tags: Reentry; Whole Health; Employment; Clean360
Sobrante Park Narrative
Roots also operates an Empowerment Center – a drop-in site where community members receive assistance with resume development, skills trainings, job search and employment. We host hiring and financial literacy events, connect job seekers with our Better Dressed for Success closet and cultivate relationships with a wide array of employers, like Tesla, who are ready to hire our clients.
ref. RFP#HCSA-900218_Sobrante Park_narrative.pdf, March 2018 – Dan Abrahamson
Core Care Model: Empowerment
Program: Empowerment Center
Themes, Keywords & Tags: Reentry; Whole Health; Employment
Sobrante Park Narrative
Navigators use results of the intake and assessment process to proactively connect patients with internal as well as external resources. Information gleaned from the assessment helps Navigators determine the appropriate frequency and intensity of services, choose which clients to pair with which Navigators, and how best to monitor client progress. We utilize our data systems to correlate baseline status with service eligibility requirements, develop prioritization and interventions, and evaluate health/mental health and housing outcomes to assess (and improve) our impact.
Roots Navigators offer a wide array of services, including: case management, service navigation, Medi-Cal enrollment/renewal, CalFRESH (food stamp) enrollment/renewal, screening for and connection to onsite legal services including record clearing remedies, and distribution of essentials and basic supplies, such as bus passes, diapers (adult and child), car seats, and hygiene kits. Our Empowerment Center, co-located with our East Oakland clinic, includes a computer lab for resume development, job search and housing search, and onsite hiring events hosting a broad range of employers. Roots will soon launch a food pantry in collaboration with the Alameda County Community Food Bank to address high levels of food insecurity encountered by our clients. We propose adding the Time Banking platform to our economic empowerment services to promote meaningful engagement, and to earn social capital and time-based currency as ways to achieve economic stability. While we understand that employment opportunities for adults are not within the scope of this RFP, we consider poverty to be a profound barrier to wellness for our community. Therefore, we will help clients who could benefit from apprenticeships – to be provided in-kind. Participants will earn stipends as well as credit in the time bank, while developing meaningful skills in light manufacturing, outreach, health administration, and retail/customer service at our Roots and Clean360 sites.
ref. RFP#HCSA-900218_Sobrante Park_narrative.pdf, March 2018 – Dan Abrahamson
Core Care Model: Navigation
Program: Empowerment Center, Healthy Measures
Themes, Keywords & Tags: Reentry; Housing; Clean360
Healthy Measures: Health Care Connection Services for Formerly Incarcerated
Since 2011, Roots Community Health Center, located in East Oakland, has been dedicated to meeting the needs of low-income, underserved individuals and families who experience the multigenerational impacts of poverty, violence, and incarceration. While Roots established itself as a primary care medical home for all underserved patients, leadership shared a specific mission to provide comprehensive care to African American men, many of whom have never engaged meaningfully in medical care as a result of the many barriers to public benefits and services programs that existed. Our patients are a high health need population, the majority of whom live with chronic illnesses and also suffer from trauma-related behavioral health conditions including substance abuse disorders and the mental health impacts of institutionalization. Roots staff and clinicians are trained to provide culturally-competent, trauma-informed care that addresses the symptoms as well as the causes of trauma, making us ideal candidates to serve newly-released, chronically ill patients.
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: Incarceration; Partnerships; Mental Illness; Reentry
Healthy Measures: Health Care Connection Services for Formerly Incarcerated
Roots also operates its Emancipator’s Initiative, which is designed to facilitate a short-term transition and to provide overall stabilization for men re-entering society after incarceration. This program best reflects Roots philosophy that individuals in transition not only need a primary care medical home, they also require other essential stabilizers: public benefits programs, employment training/jobs, stable housing, food, family, mental health and addiction counseling, and dedicated mentoring. Our experience working with this population has shown that identifying and dismantling barriers to social, emotional, and financial stability is a fundamental first step in an expeditious transition. As such, the program assists participants in addressing legal barriers, such as criminal history, probation and parole status, child support orders, child custody matters, IRS liens/levies, restitution orders, and DMV issues; psychosocial/health barriers, including physical health, mental health, substance abuse, family/support system, counseling needs, and access to housing, food, clothing, and healthcare services; and competency barriers, such as math, reading, communication, and basic computer skills. Emancipators also provides on-the-job training in light manufacturing and offers participants the opportunity to pursue entrepreneurship. Participants are trained in soap manufacturing as well as marketing and merchandizing and coached in sales and business strategies and linked to long-term employment opportunities. In order to address the ongoing medical needs of its participants, Emancipators provides paid time off for medical visits and integrates self-care strategies related to physical and mental health concerns into the program’s curriculum. At Roots, participants have access to primary care and services for chronic conditions, such as diabetes, hypertension, etc, and may also utilize patient educational and group support opportunities at the clinic. As fostering patient empowerment is one of Roots’ core values, reentry patients learn to utilize effective tools for self-advocacy regarding personal health needs and to develop strategies for navigating the medical system, which is a key component of barrier removal for this population in particular.
Core Care Model: Navigation
Program: Emancipators Initiative
Themes, Keywords & Tags: Reentry; Medical Care; Mental Health; Substance Abuse
Healthy Measures: Health Care Connection Services for Formerly Incarcerated
Roots Community Health Center focuses on the health of its patients and the entire community. We believe a healthy community requires access to basic services, economic vitality, and community empowerment. Community empowerment requires that its people have the ability to speak on their own behalf and provide their own direction. As such, Roots has enabled community empowerment and patient-engagement–a critical component of community empowerment–by staffing the clinic with members of our immediate East Oakland community. Thus, Roots operates with the belief that the most effective way to care for our patients is to provide medical and support services that are truly congruent with their needs. Building a clinical team whose majority is composed of community members ensures the provision of culturally-competent medical care and empowerment for our community as a whole. In this manner, Roots enacts its mission to heal the community from within. Building on our mission and current practices, and drawing from our successful workforce program for reentry men (Roots Emancipators Initiative) integrating health navigators who have a history of incarceration is an intuitive next step in the expansion of our current service delivery model. Further, because Roots leadership has demonstrated expertise in training and hiring reentry individuals, we are certain that our HealthyMeasures health navigators will be well-supported and warmly-welcomed at Roots.
Core Care Model: Navigation
Program: Emancipators Initiative; Healthy Measures
Themes, Keywords & Tags: Employment; Reentry
Healthy Measures: Health Care Connection Services for Formerly Incarcerated
Distinct from our collaborative partnership with Centerforce will be a newly-forged, contractual relationship with Transitions Clinic, located in San Francisco. Transitions Clinic is an innovative clinic that establishes a medical home for individuals with chronic diseases recently released from prison. Their unique model provides timely patient-centered medical services for these individuals and their families. Transitions Clinic caters to individuals recently released from prison and assists them in successful and healthy re-integration into their lives and communities. Because Transitions and Roots share a similar mission to provide culturally-appropriate medical care to previously incarcerated patients, Roots visited the clinic in 2013. As a result of this meeting, Transitions offered Roots a scholarship to San Francisco City College for the Post Prison Health Worker program and also connected Roots with the San Quentin discharge planner after which time Roots established an ongoing and successful relationship with the prison.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Reentry; Incarceration; Partnerships
East Oakland Building Healthy Communities
In 2012, Roots implemented its Emancipators workforce initiative which gave rise to the design and implementation of our social enterprise, Clean360 where we train individuals who have been marginalized from the workforce in our model soap factory. This social enterprise model is a community development strategy that serves to train and employ increasing numbers of individuals who have been excluded from the workforce, while reinvesting revenue into the community. We recently opened our third retail location in East Oakland, where community members are demonstrating their support of our investment in East Oakland by making this our most successful retail location to date, despite its location in the highest poverty neighborhood. Roots and Clean360 are employing increasing numbers of East Oakland residents, fiscally sponsoring community groups and smaller non-profits, and supporting entrepreneurs and incubating small businesses, all as part of our mission to reduce poverty and dependency in our community, by promoting self-sufficiency and community empowerment.
Core Care Model: Navigation
Program: Emancipators Initiative
Themes, Keywords & Tags: Reentry; Workforce; Clean360
East Oakland Building Healthy Communities
Because economic and employment barriers are primary deterrents to whole health, Roots strengthened our job training/employment programming through the launch of the Emancipators Initiative, providing on-the-job training in light manufacturing; barrier removal and “soft skills” training; and upon individual readiness, linkage to permanent employment. Roots’ Emancipators Initiative began as a workforce pilot with Alameda County Social Services Agency to transition individuals off of General Assistance, and led to the design and implementation of our social enterprise, Clean360 (www.clean360.org), in which we train at-risk individuals in our model soap factory. Emancipators learn how to make small batch, handcrafted soaps while they receive paid on-the-job training, barrier removal assistance, and ongoing support. Our social enterprise is a vehicle for individual empowerment and a critical component of the program’s own sustainability model, as all revenue generated goes directly to fund more jobs. Through paid, on-the-job training and comprehensive support to individuals with significant barriers to employment, Clean360 has graduated 34 soap-makers to date with a 97% success rate for stabilization and long-term employment.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry; Employment; Clean360
Service Area Competition
Roots has admitting privileges via transfer agreements in place with Alameda County Medical Center and Sutter East Bay Hospitals DBA Alta Bates Summit Medical Center, both located in the service area. These agreements facilitate continuity of care and the timely transfer of patients and their records between Roots and the hospital. Roots and the hospitals utilize mutually agreed upon transfer and referral forms that provide the necessary medical and administrative information that enables continuing care to the patient. The transfer and referral forms include information such as current medical findings, diagnoses, a brief summary of treatment followed by the transferring institution, nursing and dietary information, ambulation status, and other pertinent administrative and social information. Roots Community Health Center is also an important link to a primary care medical home for men released to the East Bay through an existing relationship with San Quentin State Prison Health, with whom Roots has a memorandum of understanding (MOU). Through this MOU, inmates are able to make an appointment to sign up for benefits and medical care prior to release, so that upon release, they are immediately linked to a culturally competent primary medical home as they navigate the transition. Virtually all of these patients suffer from chronic illnesses, including mental health disorders. Through this MOU, San Quentin Prison Health sends complete patient medical records to Roots in advance of the patient’s first appointment, ensuring continuity of care without the lapse in monitoring and treatment that is typical among the re-entry population. At Roots, re-entry patients receive culturally competent, trauma-aware services which support acute medical needs, and long-term stabilization and engagement in primary care.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry; Partnerships; Hospitals
AB 109 Reentry & SSI Advocacy Population Case & Case Management Services
Early on, we implemented our HealthyMeasures Initiative, facilitating reentry after incarceration via short-term transition and overall stabilization at our primary care facility. This work is demonstrating that individuals in transition are more likely to successfully reintegrate when they maintain a trusting relationship with their primary care medical home coupled with mental/behavioral health diagnosis and treatment, and enhanced by stabilizers including public benefits programs, employment training/jobs, stable housing, food, family, mental health and addiction counseling, and peer-centered mentoring. We have added value by employing peer case managers (Roots Health Navigators), all of whom are formerly incarcerated, and who complete their Community Health Worker Certificate at SF City College and provide navigation/intensive case management to reentry clients. Through client-centered, culturally congruent case management we are assisting clients in addressing physical/mental health barriers and legal and psychosocial issues, supporting long-term stabilization.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Reentry; Housing; Mental Health
AB 109 Reentry & SSI Advocacy Population Case & Case Management Services
Our HealthyMeasures Initiative is particularly effective as clients navigate major life transitions, including reentry to the community after incarceration. This model has reliably been shown to improve mental and physical health outcomes in clients with mental illness. In our proposed program, we will adapt our model to accommodate case management time-limitations and targeting of the reentry population with SMI, which will allow us to provide services to a larger number of SMI individuals reentering the community. The focus of our case and care management in this adapted Behavioral Case Management Model will be to provide individuals with continuity of care from jail to the community, enrolling them in benefits and services for which they qualify, and facilitating linkages to stabilizing resources and long-term care. Case and care management will occur within the context of the patient-centered health home, which we anticipate – as in our current program – clients will continue to access following graduation from case management. This feature provides a foundation of stability and continuity of care, counteracting anticipated self-doubt and institutional mistrust exhibited by reentry individuals.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Reentry; Housing; Mental Health
AB 109 Reentry & SSI Advocacy Population Case & Case Management Services
Mitigating challenges through cultural and community competence. Roots leadership agrees that in order for this population to meaningfully engage in ongoing primary, preventative and mental health care, their initial experiences upon entering the medical system must build trust and create a partnership between client and staff to overcome the multitude of barriers that exist. Engaging these patients on the ground-level when they enter the system is crucial to ensuring ongoing care. Thus we have built on our early work to bring vitally needed tools for health and stabilization to men reentering society from prison and those with substance abuse and mental health issues, through implementation of HealthyMeasures Initiative, a strong case/care management model staffed by a team that includes Roots Health Navigators (RHNs: peers who have all been incarcerated) who play a lead role in building trusting relationships and individualized plans with patients/clients, while ensuring they feel safe, comfortable and supported by our team. Clients often contact their RHN and drop by Roots to check in, even without an appointment; we believe that this level of engagement is due in part to our selection, training and support of RHNs with shared experiences and a true connection to community. RHNs build trust that facilitates their ability to obtain detailed information from clients including family contact information, where they hang out, and what they do when they are under stress. RHNs take an assertive approach to staying connected, via home visits and active outreach, especially during times of crisis. We frequently receive information from others involved in clients’ lives, such as probation officers, service providers and family members. And while these individuals/organizations understand our duty to protect client privacy, they are often moved to share information with us that assists in client care.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Reentry; Housing; Mental Health
AB 109 Reentry & SSI Advocacy Population Case & Case Management Services
We see patient empowerment as another critical tool in establishing trusting relationships with reentry patients, but particularly those diagnosed with SMI. Our RHNs and clinical team promote the use of self-advocacy tools regarding physical and mental health needs as well as partnering in the development of strategies to navigate the healthcare system. Roots integrates successful strategies for outreach, healthcare enrollment and linkage to care utilizing an empowerment approach which emphasizes that “knowledge is power” and that everyone, regardless of beliefs about or access to the medical care system, has the “right to know” his or her health status and self-manage their conditions with confidence. This approach to patient engagement through self-empowerment has resonated with hard-to-reach, marginalized and chronically disempowered populations, because they often recognize that they don’t know their health status and/or have questions about past diagnoses, and respond positively to the element of choice our approach offers them. For our reentry patient panel receiving case management from our RHNs, this approach serves as a platform upon which to build skills in self-management and self-advocacy. Through motivational interviewing and self-assessment, patients set goals in key areas of life, and create a plan against which their progress is measured. Patients report feeling increased control over their lives and medical conditions – a key component to overall stabilization during the reentry period in particular. Our physicians report that patients who have received this case and care management are more organized and become active participants in their own care, leading to improved patient-provider communication and adherence to treatment. Additionally, we are noticing that developing skills of self-efficacy and service navigation in the primary care medical home translates well into other areas of life. As such, Roots’ clinical setting provides a safe haven within which patients/clients are supported and empowered to build the skills of self-advocacy required to successfully navigate systems and engage positively with other providers, family, and community.
Core Care Model: Empowerment
Program:
Themes, Keywords & Tags: Reentry; Advocacy; Engagement
AB 109 Reentry & SSI Advocacy Population Case & Case Management Services
Recently released individuals with a chronic medical illness are eligible to receive individual case management with a RHN (Peer Navigator) through Our HealthyMeasures Initiative. Over 50 individuals are currently being case managed through this initiative, with a projected caseload of 90 individuals by the end of this year. The proposed program represents an expansion of our HealthyMeasures Initiative, which is supported by funding from the Alameda County Health Care Services Agency and is designed to assist successful community reentry by formerly incarcerated individuals who have chronic physical and/or mental illness. Roots has successfully integrated into our care team RHNs, all with a shared history of incarceration, who serve as ombudsmen and provide support and advocacy to men and women navigating their reentry process after incarceration. RHNs are assigned their own panel of re-entry clients, enrolling them into public benefits, assisting them with barrier removal and with navigation of all bureaucratic processes, securing housing, attending appointments, establishing medical care as needed, coordinating family meetings, and linking individuals to social services.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Incarceration; Illness
AB 109 Reentry & SSI Advocacy Population Case & Case Management Services
Roots receives client referrals from San Quentin, Corizon at Santa Rita Jail, Alameda County Probation, and the Transition Day Reporting Center. Roots and Corizon work together to promote the HealthyMeasures Initiative at Santa Rita, identify inmates nearing their release date, and link them directly to Roots, resulting in a seamless, positive hand-off from incarceration to reentry. As our visibility has increased in the jail, clients have directly requested linkage to Roots, through letters to our RHNs, or direct requests to Criminal Justice Mental Health and Corizon staff.
Core Care Model: Navigation
Program: Healthy Measures
Themes, Keywords & Tags: Reentry; Partnerships
The Healthier California Fund
Because economic and employment barriers are primary deterrents to whole health, Roots strengthened our job training/employment programming through the launch of the Emancipators Initiative, providing on-the-job training in light manufacturing; barrier removal and “soft skills” training; and upon individual readiness, linkage to permanent employment. Roots’ Emancipators Initiative began as a workforce pilot with Alameda County Social Services Agency to transition individuals off of General Assistance, and led to the design and implementation of our social enterprise, Clean360 (www.clean360.org), in which we train at-risk individuals in our model soap factory. Emancipators learn how to make small batch, handcrafted soaps while they receive paid on-the-job training, barrier removal assistance, and ongoing support. Our social enterprise is a vehicle for individual empowerment and a critical component of the program’s own sustainability model, as all revenue generated goes directly to fund more jobs.
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: Reentry; Employment; Clean360
CCF Phase II
In addition to being a state-licensed community clinic providing primary and behavioral health care services, we also provide training, internships and employment for formerly incarcerated individuals to become Community Health Workers who, in turn, support recently released individuals with chronic conditions; we have implemented Intensive Case Management for reentry clients; we provide Transition Management inside Santa Rita Jail; we designed and implemented a Workforce Development social enterprise – Clean360; we implemented Targeted Case Management with Roots Health Navigators, leveraging local (county) investments to draw down federal funds for reinvestment into our programs; and we continuously expanded Barrier Removal (DMV, Child Support, etc.) services for reentry clients.
Core Care Model: Navigation
Program:
Themes, Keywords & Tags: Reentry
CCF Phase II
As part of our mission to reduce health disparities in high-need patients by implementing a health care model that responds to the needs of the whole person, we launched the Emancipators Initiative – our workforce program with a training curriculum incorporating best practices that provides ongoing support and employment for the hardest to employ from our community, including reentry individuals. With support from Alameda County Social Services, and significant resource allocation from Roots, we designed and implemented a social enterprise, Clean360 (www.clean360.org) as the platform in which we train at-risk individuals in our model soap factory. Emancipators are demonstrating a high level of success in building employability skills, personal accountability and a strong work ethic. In the past two years, 32 participants completed the program – 30 of them reentry individuals. Reentry Emancipators have a 94% success rate with respect to long-term stabilization and employment, and under a 3% recidivism rate.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry; Clean360
Systems for Action: Systems & Services Research to Build a Culture of Health
Employment is one of the basic determinants of health, and influences the ability to obtain other determinants, such as food, and shelter. In East Oakland, there is a growing gap in resources for Oakland’s reentry residents. Many men lack basic skills to gain employment, and those with criminal records face even more barriers to employment. For the majority of employers, the cost of doing business is “high enough”, and they prefer not to take risks/incur costs by employing the “difficult to employ”. While there have been some promising programs that focus on formerly incarcerated individuals, including those addressing employment needs (Bloom et al., 2007; Bushway et al., 2012; Duwe, 2015; Newton et al., 2016) and providing wraparound housing services (Lutze et al., 2014), there are few cohesive programs that combine health and employment services, and provide “standard” outcomes with generalizable programmatic evaluations from which to learn best practices. Additionally, most employment and/or reentry programs do not have a sustainability model built into them.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry; Workforce; Employment; Homelessness
Systems for Action: Systems & Services Research to Build a Culture of Health
Roots clients have identified the need for workforce training and employment, as essential to their mental and physical health. However many inthis population, especially the formerly incarcerated,are in a cycle of poverty, poor education, drug abuse, and incarceration. After incarceration, community members often find themselves unprepared for (lack of education), and unable to obtain employment (jail record). Roots has twodifferent employment programs: the community health care worker program and Emancipators(see above), which uses the community health care workers tohelp individuals navigate workforce training, inclusive of obtaining employment, including at Roots’ sponsored manufacturing program. We hypothesize that participants in workforce training will have higher health status,including reduced measures of activity limited days and improved measures of self-rated health, self-efficacy and self-esteem, which will only be maintained with employment.
Core Care Model:
Program:
Themes, Keywords & Tags: Reentry; Workforce Training; Employment
Global Giving
Workforce Development. At the same time, Roots expanded our whole health model by launching our soap-making factory, Clean360 to train and employ low-income and majority formerly incarcerated African American community residents who participate in workforce development through the Emancipators Initiative. The Emancipators Initiative offers Roots apprentices a comprehensive workforce curriculum and paid, on-the-job training with whole-person support so that they are able to meet basic needs while gaining work experience at Clean360 or in partner employment settings. Over 30 months, 44 participants have graduated from the program, and 41 have successfully reintegrated into Oakland neighborhoods: 30 are in long-term, stable employment; 7 are in temporary employment; 4 are in school full time; 2 are in substance use rehabilitation programs; and only 1 has returned to prison. All participants are current on child support, restitution and probation/parole terms.
ref. GG_accepted
Core Care Model:
Program:
Themes, Keywords & Tags: Workforce Development; Reentry; Employment; Whole Health
IRUSA Narrative
A grant from IRUSA will help Roots Community Health Center expand our Emancipators Initiative – Roots’ workforce training program based in our Clean360 social enterprise – to serve more individuals and include a critical focus on achieving housing stability for a minimum of 40 hard-to-employ, unstably housed Oakland residents in 2018. The proposed expansion will directly address housing stability via: a thorough assessment of housing status and needs, the provision of transitional housing when indicated, and substantial move-in support. This pilot will demonstrate that transitional housing, coupled with workforce training, provide key life stabilizers that challenge injustice and poverty, offering hope and a path to self-sustainability for those living on the margins of society.
ref. IRUSA Narrative
Core Care Model: Empowerment
Program: Whole Health & Empowerment Project
Themes, Keywords & Tags: Whole Health; Workforce Development; Reentry; Employment; Clean360
Emancipators Initiative: Education, Empowerment, Enterprise
Roots Community Health Center, located in East Oakland, appreciates the opportunity to submit this proposal for our Emancipators Initiative. The Emancipators Initiative is Roots’ workforce program that provides ongoing support, training and employment for the hardest to employ from our community, including reentry individuals. Over the past year, with support from Alameda County Social Services, Roots piloted the Emancipators Initiative with 19 participants, demonstrating a high level of success in building employability skills, personal accountability and a strong work ethic that has led to long-term employment. In 2016, our goal is to raise funding that will help us train and employ a minimum of 24 traditionally difficult-to-employ individuals, including those with criminal records.
The Emancipators Initiative was designed to expand our impact as part of Roots’ mission to address long-standing health inequities by providing culturally competent, comprehensive healthcare, mental health, and wraparound services that emphasize patient/client self-sufficiency and community empowerment. Roots implements its programs and services while honoring the “roots” of culture, heritage, and tradition by providing unprecedented access to services; by remaining community-aware and community-responsive; and by establishing partnerships to ensure a more efficient continuum of care in Oakland.
Roots Community Health Center implemented the Emancipators Initiative as part of a public-private partnership to provide new opportunities for General Assistance (welfare) recipients, many of whom have been recently released from incarceration. In the first months of implementation, we forged a social enterprise, Clean360 (www.clean360.org), as the platform in which we train at-risk individuals in our model soap factory. In our first year, 19 participants completed the program – 18 of them reentry individuals – with 11 employed in outside businesses and six employed through Roots. Of note, four Emancipators have gone on to further their education in the Health and Human Services professions, obtaining their Community Health Worker and Health Coaching Certifications.
In just one short year, the Emancipators Initiative has evolved into an effective program for job creation, barrier removal and long-term alternatives to incarceration. By preventing recidivism and eliminating reliance upon public benefits, the Emancipators Initiative is not only transforming individual lives and families, but is resulting in measurable cost savings to city and county systems.
ref. REI_AASC_funding request_6 month Emancipators Initiative: Education, Empowerment, Enterprise
Core Care Model: Empowerment
Program: Emancipators Initiative
Themes, Keywords & Tags: Emancipators; About; Reentry; Employment; Barrier Removal
Empowerment Pathways
Through the Empowerment Pathways Program, we will collaborate with Timelist, located in Union City; Building Opportunities for Self-Sufficiency (BOSS), located in Oakland, Berkeley and Hayward; and Preventive Care Pathways in Oakland to increase the numbers of Alameda County reentry individuals who pursue/consider pursuing education, and reduce recidivism among the clients who are placed in educational services. Roots and Timelist will serve as the primary points of entry and ongoing support for all clients; all four agencies will provide experiential opportunities for clients in a supportive, non-judgmental environment.
ref. Roots Education Proposal_FINAL_4142016 EMPOWERMENT PATHWAYS PROGRAM
Core Care Model: Empowerment
Program: Empowerment Pathways
Themes, Keywords & Tags: Partnerships; Recidivism; Reentry; Education
Empowerment Pathways
Roots, Timelist, BOSS and Preventive Care Pathways share successful track records in providing education services/links and transitional employment to reentry individuals from across Alameda County. Our combined expertise and our commitment to the reentry population ensures success in implementation of the Empowerment Pathways Program. In 2013, Roots implemented our HealthyMeasures Initiative as a best-practice strategy to serve reentry individuals with chronic medical conditions, establishing a formal relationship with San Quentin Prison Health. Inmates made an appointment to enroll in medical care prior to release, so that they were immediately linked to Roots as their primary medical home upon release to jump-start their transition. In 2014, we expanded HealthyMeasures to recruit and train formerly incarcerated individuals who complete their Community Health Worker Certificate at SF City College and provide navigation/intensive case management to recently released individuals. Over the past 12 months, Roots Health Navigators have provided case management services to 426 recently released Oakland residents, over 80% from East Oakland. They develop strong, positive relationships with their clients as they work towards stabilization via enrollment in Medi-Cal/CalFresh; assistance with DMV barriers; shelter/housing; clothing; job-seeking support; education linkages; enrollment in substance abuse facility/sober living; attending to medical/behavioral needs; ongoing mentoring and building healthy relationships with peers and family. Our external evaluation for this work is done by Yale University through which we have obtained IRB approval.
Building on our commitment to serve the formerly incarcerated, in 2011, with support from Alameda County Social Services, Roots launched Emancipators Initiative – our workforce program that provides ongoing support, training and employment for the hardest to employ from our community, including reentry individuals. In the first months of implementation, we forged a social enterprise, Clean360 (www.clean360.org), as the platform in which we train at-risk individuals in our model soap factory. Through ongoing support and a best practices curriculum, Emancipators are demonstrating a high level of success in building employability skills, personal accountability and a strong work ethic. In the past two years, 26 participants completed the program – 25 of them reentry individuals. Reentry Emancipators have a 96% success rate at long-term stabilization and employment.
Roots’ underlying theory of change—whether guiding the Emancipators Initiative, in the clinical setting, or in in service navigation—is as follows: “Empowering formerly incarcerated and otherwise marginalized individuals with skills that enable them to engage positively with themselves as well as their communities in the context of wraparound services delivered in a safe and therapeutic environment will improve morale and self-efficacy, ensure successful reintegration into society, and reduce the risk of recidivism.” Timelist shares a vision in which empowerment of the formerly incarcerated is central. Their staff has a diverse educational background that includes hiring formerly incarcerated individuals who served long prison sentences as reentry coaches; they have been serving the prison/jail population for over 10 years.
BOSS is an award-winning county-wide organization that helps people who are facing deep poverty and multiple special needs. BOSS works one-on-one with each family and each individual to help them achieve stable income, permanent affordable housing, and lasting wellness. Services include emergency shelters, transitional houses, education and employment programs, family and child development services, health and mental health care programs, leadership development and organizing initiatives, re- entry initiatives, and more.
ref. Roots Education Proposal_FINAL_4142016 EMPOWERMENT PATHWAYS PROGRAM
Core Care Model: Empowerment
Program: Empowerment Pathways
Themes, Keywords & Tags: Partnerships; Recidivism; Reentry; Education; BOSS; Timelist; Preventative Care
Community Recidivism Reduction Services
Recognizing the acute need for effective, culturally-congruent and trauma- aware re-entry services in Oakland that meet individuals’ transitional needs, Roots developed its HealthyMeasures Initiative designed to facilitate short-term transition and provide overall stabilization for men and women re-entering society after incarceration. This program best reflects Roots’ philosophy that individuals in transition require multiple essential stabilizers and wraparound services: access to public benefits programs, employment training/jobs, stable housing, food, family, mental health and addiction counseling, as well as dedicated mentoring, all of which can – and should – be delivered in the context of the primary care medical home. Our experience working with this population has shown that identifying and dismantling barriers to social, emotional, and financial stability is a fundamental first step in an expeditious transition. As such, the program assists participants in addressing multitude of issues including:
- Legal barriers such as: criminal history, probation and parole status, child support orders, child custody matters, IRS liens/levies, restitution orders, and DMV issues.
- Psychosocial/health barriers including: physical health, mental health, substance abuse, lack of connection to family/support system, counseling needs, poor access to housing, food, and clothing.
- Competency barriers such as: math, reading, communication, and basic computer skills.
Since 2013, Roots has been an important direct link to a primary care medical home for individuals released to the East Bay from San Quentin through an existing Memorandum of Understanding (MOU) with San Quentin Prison Health. Through this MOU, inmates are able to make an appointment to sign up for benefits and medical care prior to release. As such, upon release, they are immediately linked to a culturally competent primary medical home as they navigate the transition. Almost all of these patients suffer from chronic illnesses, including mental health disorders, and need additional support services upon release, such as housing, employment training, and counseling. At Roots, re-entry patients receive culturally competent, trauma-aware services that support acute medical needs and long-term stabilization. Because individuals who have experienced chronic and/or long-term incarceration are likely to require support services immediately post-release, and due to the fact that the two-week period after release is critical, swift and efficacious linkage to a primary care medical home that offers wraparound services is a fundamental component of their stabilization.
ref. Roots Response Packet_RFPLLN901387_07292015_Submitted Community Recidivism Reduction Services
Core Care Model:
Program: Healthy Measures
Themes, Keywords & Tags: Barrier Removal; Reentry
The Emancipators Initiative
The Emancipators Initiative of Roots Community Health Center brings employment opportunities to reentry and high risk Oakland residents, especially African American men, who are most vulnerable to negative social determinants of health, including violence/crime and unemployment. Full implementation of the Emancipators Initiative will result in service navigation and barrier removal for at least 30 individuals annually; of these, 25 participants will remove legal, psychosocial, competency, and health barriers to employment while they gain a living wage and stable employment, until they are ready to graduate into permanent, long-term sustainable employment.
The Emancipators Initiative is Roots’ workforce program that provides ongoing support, training and employment for the hardest to employ from our community, including individuals re-entering our community from correctional institutions. In the past year, with support from Alameda County Social Services, Roots piloted the Emancipators Initiative with 19 participants, demonstrating a high level of success in building employability skills, personal accountability and a strong work ethic that has led to long-term employment. The Emancipators Initiative was designed to expand our impact as part of Roots’ mission to address long-standing health inequities by providing culturally competent, omprehensive healthcare, mental health, and wraparound services that emphasize patient/client self-sufficiency and community empowerment. Roots implements its programs and services while honoring the “roots” of culture, heritage, and tradition by providing unprecedented access to services; by remaining community-aware and community-responsive; and by establishing partnerships to ensure a more efficient continuum of care in Oakland.
Roots Community Health Center piloted the Emancipators Initiative as part of a public-private partnership to provide new opportunities for General Assistance recipients, many of whom were recently released from incarceration. In the first months of implementation, we forged a social enterprise, Clean360 (www.clean360.org), as the platform in which we train at-risk individuals in our model soap factory. In the past year, 19 participants completed the program – 18 of them reentry individuals – with twelve employed in outside businesses and five employed through Roots. Of note, four Emancipators have gone on to further their education in the Health and Human Services professions, obtaining their Community Health Worker and Health Coaching Certifications.
ref. Roots_Emancipators_General Proposal_2016 The Emancipators Initiative, 2016
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: Emancipators; Workforce; Reentry
The Emancipators Initiative
Roots is setting a new standard in Alameda County in implementation of a precedent-setting program that tackles these challenges through training and employment, including at our own social enterprise, Clean360. We build basic skills and provide on-the-job training, removing as many barriers to long-term stabilization as possible; develop relationships with outside employers willing to hire job-ready candidates despite criminal record history; and have launched a sustainable social enterprise that results in stable employment opportunities.
Clean360 is the business platform for this work. Emancipators participants receive hands-on training as they learn how to make small batch, handcrafted soaps from the finest ingredients in its workshop and retail location in Oakland’s Uptown neighborhood. Clean360 was created by Roots leadership to demonstrate a productive, sustainable business model, so that increasing numbers of people could be employed without relying solely on outside funding. We knew the product had to be something healthy and natural, something that everyone needs, and something that makes people feel good. And so the idea for producing soap was born.
One hundred percent of the proceeds from the sales of Clean360 soap are used to grow and sustain the program. Through Clean360, the Emancipators Initiative is a source of hope and opportunity for those who have been disconnected from the workforce for an extended period of time, have experienced significant barriers to employment, and may not have basic job readiness skills.
ref. Roots_Emancipators_General Proposal_2016 The Emancipators Initiative, 2016
Core Care Model:
Program: Emancipators Initiative
Themes, Keywords & Tags: Emancipators; Workforce; Reentry; Workforce; Employment; Clean360