You are the executive director of the Center for Health and Justice Transformation at Lifespan. We will get into more detail further in, but to start, please give us an overview of the center.
The Center was founded 18 years ago by Infectious Disease and Addiction Specialist, Dr. Josiah ‘Jody’ Rich and Dr. Scott Allen. Both were treating patients at the Adult Correctional Institutions (ACI) and felt that there were knowledge and care coordination gaps at the intersections of infectious disease, behavioral health disorders, and advocacy for people placed in the margins of society due to social and structural issues, and the criminal legal system. They believed physicians and the medical establishment had an outsized role to play in not only medicine and research, but also leveraging their positions in society to impact policy. Hence, the Center for Health and Justice Transformation, initially called the Center for Prisoner Health and Human Rights, was created.
Who does the center serve?
We are a think and do tank, and our work is based on the social and structural determinants of health, with a focus on the criminal legal system and its impacts on individual and community well-being. We research, collaborate, and co-create solutions with people directly impacted, state agencies, and other nonprofits in the following areas: access to comprehensive care; criminalization of health and social conditions i.e. substance abuse disorder, mental health disorders, and poverty; as well as center the lives and conditions of people racialized as Black and IMPOC ( Indigenous, Multicultural, Person of Color) who are disproportionately and deleteriously affected by both systems.
One core issue is decriminalization. For those who may not be familiar with the concept, what is that?
Race is criminalized in America. Being Black or IMPOC means you will have a greater chance than others to be profiled, undergo surveillance, be arrested, and incarcerated in America. If you have medical conditions such as addiction and/ or a mental health disorder, you are at risk of being arrested and incarcerated more than the general population. If you were born into neighborhoods and communities with high poverty rates, you also have a greater chance of being profiled, arrested, and incarcerated. If your life experiences include these intersecting realities, than research shows that you or your peers will make up 60 -70% of the incarcerated population. These are social, structural, and health conditions, not moral malfeasance. These issues are related to racism and discrimination, not self-determination; these issues are related to poor educational systems; food and medical deserts; overpolicing; gerrymandering and redlining; and other sociopolitical conditions and decision-making. Our goal at the center is to educate and dismantle the ways in which these conditions are weaponized and used to trap people in cycles of incarceration.
Another issue is reentry. Describe that please.
Reentry is most known as people physically being released from jails or prisons and returning to society. Typically, the profile of 60% of reentering people shows a history of poverty, addiction and/ or substance use disorder, or other medical conditions. For the center, reentry is a continuum that starts well before individuals are incarcerated. It includes criminalization, over policing, Procedural Justice issues, sentencing, access to care for health conditions while incarcerated, options for education, skill development and employment, housing, and connections to community services post incarceration, to disrupt future incarceration or recidivism. Our efforts to transform the justice or criminal legal system and health systems are not complete without researching and generating solutions to disrupt these cycles of incarceration.
And a third is Statewide Criminal Justice planning. What does that entail?
For us, that is working via the state’s Criminal Justice Policy Board (Governor-appointed members) to create a comprehensive strategic plan for RI that coordinates data collection efforts across systems; provides interagency opportunities to effectively tackle our biggest criminal legal system challenges; allocates funding in an equitable manner, and properly evaluates the effectiveness of programs. You can find our briefs on this issue at healthandjustice.org under publications.
The challenges facing those you serve are significant. Are you seeing progress?
Progress is slow and complicated and needs to be contextualized. The overall census at the ACI is down, but the recidivism rate is stagnant. Rhode Island has a nearly 48% recidivism rate. Nearly a third of Rhode Islanders have a criminal record. Almost half of the people in our jail and prison have a cooccurring disorder (mental and substance abuse) and we do not have enough community-based treatment programs. And for the providers in this space, they barely break even and are asked to take on more. We have a housing crisis in Rhode island. Access to stable housing is a leading factor in recidivism, relapse, and overall health and well-being. We have state challenges in education and employers continue to discriminate against people with a criminal record. There is more discussion now than at any moment about how to address these issues, but we need to move from talk to better coordinated data collection efforts at all connecting points in our systems; we need to do better in policy and legislation; and our state commitment to doing better needs to be reflected in our state budget.
What about the families of inmates and the previously incarcerated? This includes children, whose lives and futures are directly impacted by their parents.
There are high percentages of children with a family member or caretaker either currently incarcerated or have previously experienced incarceration in Rhode Island. This can affect a child in multiple areas including education, health, future employment, and increases the risk of that child being incarcerated. Parents and caretakers also experience depression and higher rates of reincarnation because of separation. All of this is a correlating factor in a phenomenon called social disorganization. We see this in Rhode Island and nationally. And when families and communities experience this, we are all impacted.
What can the public do to support the center’s mission?
Change is not a spectator sport so people can join our advisory board and/or donate to the center and other organizations that serve the community. People can also choose to offer grace and kindness to people who are incarcerated or reentering as data shows they’re our neighbors and friends. Lastly, please talk to your local elected officials and demand they do better. We can all do better on these issues no matter how big or small and there are many examples to pull from in our region, nationally and internationally.
Tell us about the center’s organizational structure. It’s a unit of Lifespan, the state’s largest healthcare system, correct?
Yes. We started the center at the Miriam Hospital and we are now based at Rhode Island Hospital. It’s rare for a health system to be home to a center like us. We appreciate the partnership and support over the years and continue to look for ways to scale our work as our funding is entirely made up of grants and donations.
And there is also a partnership with Brown University. You are an associate professor at Brown’s School of Public Health, for example. And Dr. Josiah Rich, co-founder and Chief Medical Advisor, is a professor of Medicine and Epidemiology at Brown. How do these associations help the center?
We serve as a catalyst for connecting research and community together to explore issues and use data and research to build knowledge and develop solutions.
Give us some of your background, including education and previous positions that led you to the center.
I attended local schools in Rhode Island. Shout out to Baldwin Elementary, St. Mary’s, and Shea High. From there, I went to the University of Rhode Island and was on my way to law school in Boston when I received a full ride and research assistantship to Penn State. I’ve spent the bulk of my professional career in Pennsylvania, starting in small non-profits, then moving to local and state leadership roles. I worked heavily in government systems, with service providers and community based organizations, and on national efforts in behavioral health, education, and justice. My last role in Pennsylvania was as an appointed Secretary of Pardons managing, the clemency process, and public hearings for the state. I also created a boutique consulting agency and came back to Rhode Island in 2018.
Did you have any mentors?
I’ve had really great people in my life shine a light on me and teach me so many invaluable lessons by their example. I’m pleased to offer eternal flowers to: Carolyn Sovet who decided I was a leader before I did, and offered me the greatest of student leadership opportunities as an undergrad at URI. A big shout out to Professor Alfred Killilea, for his boundless belief in me and the warmest heart and kindest soul I’ve ever encountered. His courses shifted my college experience in immeasurable ways. To Rebecca Shaver who offered me my first leadership position at 24 years old, and showed me there were many forms leadership can take, including kindness. Next are Pat Gadsden, Faye Fisher, Ruby Doub, and Leila Leite — women in Pennsylvania who provided support and friendship when I needed it the most as a young black woman in a big systems leadership roles. Presently, Dr. Jody Rich is my sounding board, colleague, friend, and mentor who believes deeply in my abilities and assures me that there is little I can’t accomplish. I’m eternally grateful to all of them, and pay it forward serving as a mentor to others.
We read this quote from you on the center website: “A fire ignited inside of me many moons ago as little black girl around the cause of injustice. The more I lived and the more I read, the more I realized I had little choice in the matter. I dared to dream then that change was possible, and still maintain a stronghold around this notion.” Can you elaborate?
My comments were based in the inequities, racism, and discrimination I saw my parents face as immigrants in this country as well as my own experiences as a child. I was too young to place a name to those experiences at the time, but my stepfather began to answer my questions and educate me. While young , my naivete abated as I’d hear from my peers about feeling profiled by police, unfair treatment in the classroom, and witnessing special education classes, detention classes, and suspensions disproportionately impact Black and brown students. Then, I had a seminal experience of being harassed and pepper-sprayed by police at just 15 and vowed to work to end injustice. I knew then that if my existence felt like a threat, then there was never going to be feelings of safety nor peace for people who look like me. Years later in college, I completed a training and educational experience with the Rhode Island Public Defender’s Office and have continued the path of social justice, health equity, policy, and community engagement in many forms over the past 20 years.
