4th year Medical Student Warren Alpert Medical School of Brown University
Disclosure(s):
M Catherine Trimbur, MD, MPH: No financial relationships to disclose
Daniel Parra, n/a: No financial relationships to disclose
Key Message : As the prison population ages, an increasing number are released through compassionate or medical parole with complex health needs. Community Health Workers with lived experience are critical in supporting these individuals, addressing legal challenges on release. Their role helps uphold dignity and equity for seriously ill patients.
Abstract: Background Incarcerated populations in the U.S. are aging rapidly and bear a disproportionate burden of serious illness and high mortality rates (I, II). The Transitions Clinic Network (TCN) provides community-based care to people upon reentry, integrating Community Health Workers (CHWs) with lived experience into clinical teams (III). CHWs are increasingly supporting patients with serious illness upon reentry, particularly those released on medical parole or compassionate release. Navigating legal involvement, including community supervision can be challenging for patients and CHWs (IV). This study examines how CHWs and providers screen for and intervene on criminal legal issues and the impact of this work on provider and patient well-being. Methods A cross-sectional survey was conducted across TCN sites. Questions covered screening and intervention practices, types of legal involvement identified, and impact on CHW self-efficacy. Quantitative data were analyzed using chi-square and t-tests; qualitative responses underwent thematic analysis. Results We received 65 responses from CHWs and 4 from non-CHW providers. 62% reported routinely screening patients for active legal challenges. Of these, 72% reported intervening, by writing advocacy letters for court, housing, or employment proceedings or by providing in-person court support. CHWs overwhelmingly reported that this work enhanced their effectiveness: 96% of screeners who intervened said it made them better CHWs. Barriers to screening included lack of training or discomfort with legal systems. Conclusions As palliative care increasingly serves populations with complex social and structural vulnerabilities, addressing ongoing legal involvement is central to providing person-centered care, tending to suffering and restoring dignity. CHWs with lived experience are uniquely positioned to build trust, identify medical-legal barriers, and intervene. This model supports continuity of care for patients with serious illness while reducing CHW burnout and promoting equity in end-of-life care delivery. Findings highlight a promising strategy for expanding palliative-informed, justice-based care across settings.
References: (I) Williams, B. A., Goodwin, J. S., Baillargeon, J., Ahalt, C., & Walter, L. C. (2012). Addressing the aging crisis in U.S. criminal justice healthcare. Journal of the American Geriatrics Society, 60(6), 1150–1156.
(II) Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison — A high risk of death for former inmates. New England Journal of Medicine, 356(2), 157–165.
(III) Wang, E. A., Hong, C. S., Samuels, L., Shavit, S., Sanders, R. (2010). Transitions Clinic: Creating a Community-Based Model of Health Care for Recently Released California Prisoners. Public Health Reports, 125(2), 171–177.
(IV) Lisa B Puglisi, James Bhandary-Alexander. (2024) How Should a Medical-Legal Partnership Address Unique Needs of People With Criminal Legal System Involvement? AMA J Ethics. 26(8):E634-639
Learning Objectives:
Recognize how addressing criminal legal system involvement can reduce suffering and improve continuity of care for seriously ill individuals returning from incarceration.
Discuss the role of Community Health Workers in advancing equitable, person-centered care through trust-building, advocacy, and support for patients navigating structural vulnerability at the end of life.
