Preventing hospitalization following incarceration

Transitions Clinic promotes health through intensive support as people with chronic illnesses move back into communities from prison 

As Lifespan community health worker Koren Carbuccia drives through South Providence to meet a woman who has repeatedly cycled in and out of prison, she gazes out at the city streets and recounts how she herself once did time in state prison. Frustrated at how hard it was to make ends meet, Carbuccia resorted to dealing drugs to make money.

Yet when Carbuccia was finally released from prison, she found that staying committed to turning her life around was far harder than she anticipated.
“It was a lot of falling and getting up, and falling and getting up again,” she says. 

Now, as she’s on her way to pick up Lisa Vazquez, Carbuccia explains why she’s ideally suited to help clients who have been incarcerated -- “my people,” as she likes to call them.

“The challenges Lisa faces, I understand. I’ve been through them,” says Carbuccia, who found herself living on her own at age 15. “I address them in a positive way. I say, ‘I’m going to show you how to live out in the community. I’m going to show you how to work and live healthy because we are trying to avoid you going back.”

Vazquez, thin in a dark parka, is standing outside her apartment building when Carbuccia pulls up, gets out of the car and greets her with a hug. Once settled in the car, Vazquez, 54, updates Carbuccia on flooding in her apartment, her part-time work painting and her search for a full-time job.  

“These things can all be detrimental to her health,” Carbuccia says.

As Carbuccia drives Vazquez to a routine doctor’s appointment at Rhode Island Hospital’s Center for Primary Care on Chapman Street, their conversation never lets up. 

“I don’t come from an easy life. I spent most of it in prison,” says Vazquez. “These people take the time to hear about everything in your life. They have been on my side ever since I came here.”

Improving health outcomes through peer support

Carbuccia works full-time for the Providence Transitions Clinic, a community program Lifespan launched to meet the complex and myriad needs of individuals transitioning out of incarceration. Left unresolved, these needs – from securing housing and food to accessing primary medical care – can contribute to recurring mental and physical health issues. That, in turn, can result in recidivism as well as costly visits to the emergency department and hospitalizations. 

Sarah Martino, senior project director at The Miriam Hospital’s Center for Prisoner Health and Human Rights, spent several years establishing the clinic in partnership with Lifespan’s Community Health Institute and the Rhode Island Hospital Center for Primary Care.

Facts & Figures

Year established: 2018
Clients assisted: 56
Primary care visits: 262
Avg time from prison release to first primary care visit: 17.4 days 
Referrals: 52% by R.I. Dept. of Corrections; 32% within Lifespan; 16% by community partners
Funding sources: Rhode Island Foundation, R.I. Dept. of Corrections, Damiano Foundation.​

"The Providence Transitions Clinic is part of a network of similar programs across the country that use a peer workforce to address the health and reentry needs of formerly incarcerated adults,” says Martino. “Since the program launched in January 2018, we've served over 70 patients, and have successfully retained the vast majority of those patients in primary care while also connecting them to other much needed services and resources. Over time, this work should improve health outcomes, keep patients out of the hospital, and demonstrate that health care is more than what happens at a clinic or a hospital."

Through a contract with the Rhode Island Department of Corrections, Lifespan provides medical planning for individuals that have more than one chronic health issue, which can include substance abuse.

“We know that those first couple of days after release is the period when the person is at the highest risk of slipping back into substance use or other risky behaviors,” says Carrie Bridges-Feliz, director of the Community Health Institute. “So the community health workers are identifying people in prison who have multiple chronic conditions, introducing themselves and starting to build a relationship with them.”

That way, she says, as soon as they are released, Carbuccia and the Transitions team can facilitate getting them to regular doctor visits at Lifespan Primary Care to manage their health issues. Equally as important, the team can begin to “connect them to all of the community-based resources that they need to stabilize and improve their reentry into the community,” says Bridges-Feliz. “It could be housing, it could be food, it could be access to substance abuse treatment services.” 

That’s how Vazquez, who graduated from the New England Institute of Technology but has been challenged with addiction, homelessness and imprisonment, got paired with Carbuccia, who abandoned her college aspirations for a life of crime on the streets before ultimately turning her life around. 

"What's the use? I'm going to die anyway"

Vazquez, 54, was feeling extremely vulnerable following her most recent release into the community. By then, the days when she earned a degree in broadcasting technology and worked at a local TV station, were well behind her. Anxiety and depression were constant challenges. Addiction too. She had acquired hepatitis C, which was likely to damage her liver one day if left untreated. And she was living in a homeless shelter and unable to find steady work.

“People think you can live like that?” Vazquez says. “I felt like, ‘What’s the use? I’m going to die anyway.’ You end up in the Emergency Department not wanting to live any longer. I felt like I was all alone. You let go of your dreams, your self-worth.”

Most clients are connected to the Transitions Clinic while still incarcerated, but Vazquez began working with Carbuccia during her struggles following her release. The support she gets extends from Carbuccia to a team that includes primary care physician Rahul Vanjani, M.D., a pharmacist, program administrators and other community health workers. Every week, they meet at the Center for Primary Care on Chapman Street to discuss cases, especially the clients visiting the clinic that day.

When Vazquez arrives at the center, Carbuccia accompanies her right into the exam room where they continue to chat while awaiting Dr. Vanjani. Vazquez expresses gratitude for all the support – including the costly medications she was prescribed to cure her hepatitis.

"“I can’t believe you are standing with me right now,” some clients say to her. “We develop a rapport.”

“They basically saved my life. I’m not a broken soul anymore,” she says. “You have to have someone that believes in you.”

 “The world can kick you,” Carbuccia responds, “but you have to kick back.”

Vazquez agrees, saying, “I’ve worked hard to get to where I’m at. I don’t want to throw that away.”

Sometimes Carbuccia picks up Vazquez and takes her to the farmer’s market next to the Cranston Street Armory. That way she can make it easier for Vazquez to buy healthy foods, even offering her vouchers to get plenty of produce for free.  Sometimes they’ll just stop for coffee or something to eat and chat.

“I can’t believe you are standing with me right now,” some clients say to her. “We develop a rapport.”

Carbuccia uses all these opportunities to talk about how she created a new life for herself after prison—“teaching moments,” as she calls them, in which she models how others can advocate for themselves and overcome the disparities she too has had to confront.

 “Some people don’t know where to begin. Some, after 20 years in prison, come home to nothing,” Carbuccia says. I say, ‘Work with me and it’s going to happen.’ When they see me, they say, ‘I can get that job. I can make amends with my children.’ ”

Says Vazquez, “It’s the best thing that ever happened to me in my life.”