Ascension's St. John gives the women a medical home
By JULIE MINDA
In spring 2017, prospects looked bleak for Julianne Harman of Tulsa, Okla. In jail awaiting trial on driving under the influence of alcohol and methamphetamine possession charges — and having violated the conditions that had earned her a deferred sentence for a 2011 felony methamphetamine manufacturing charge — she was facing a possible sentence of seven years to life.
Harman jumped at a chance to again defer her sentence by taking part in Women in Recovery, a comprehensive prison diversion and rehabilitation program. She is participating in the program's mental health and addiction counseling and building life skills while living under close supervision. As she approaches a February graduation, she's working at a Subway restaurant and beginning to reestablish contact with her three estranged teenage children and rebuild a relationship with her husband of five years, a man she calls her "fairytale husband."
The program "completely changed my life," said Harman, 39.
She is one of the more than 745 women who, since 2009, have opted for the opportunity to defer their prison sentences for nonviolent felony offenses by participating in the intensive sobriety and support program from the Tulsa-based nonprofit Family & Children's Services.
For the past two years, Tulsa's St. John Health System has provided medical care and prescription medication to Women in Recovery participants at no cost to them. (See below.) According to Annie Smith, St. John director of community health and engagement, St. John aims to assist program participants and their families with navigating the health care system and to provide them with access to a medical home. "In turn, this partnership provides a critical learning opportunity for St. John's health care providers and new physician residents" in care of the vulnerable, said Smith.
According to information from Women in Recovery, Oklahoma has the highest rate of female incarceration in the U.S., with nearly 65 percent of the approximately 3,200 women who are imprisoned, serving sentences for nonviolent drug crimes. Eighty-five percent of Oklahoma's incarcerated women are mothers — there are an estimated 7,000 children affected, 5,000 of them under age 18.
The George Kaiser Family Foundation asked Family & Children's Services to develop programming to address dual drivers of female incarceration: poverty and addiction. The result was Women in Recovery. The foundation is its primary funder.
Clients of the Women in Recovery program from Tulsa, Okla.-based Family & Children's Services learn culinary skills in its job readiness program. Ascension's St. John Health System of Tulsa provides medical care to Women in Recovery's clients.
Courtesy of Family & Children's Services
To be eligible for Women in Recovery, women must be 18 or older, have a substance use disorder and be prison-bound for nonviolent drug offenses or related crimes such as theft. Program staff run background checks, interview candidates and their loved ones and coordinate the process with the court system — all to ensure the women are the right fit for the rigorous program and that they would not pose a threat to society if released. A judge must approve the women's entry into the program, and court officers provide continuing oversight of a woman's progress.
Working the program
Women who are accepted into the Women in Recovery program plead guilty to a felony. The court assigns a status of "pending" to their cases; sentencing is deferred until they complete or drop out of the program.
Women who are in jail are released to live in group housing owned by partners of Women in Recovery. They begin a structured program, where their movements and contacts with the outside world are restricted, according to Rachel Delcour, the program's criminal justice court coordinator. In addition to mental health and addiction counseling, Family & Children's Services provides life skills coaching. Participants gain relationship and parenting skills, and they build job skills.
All participants in the Women in Recovery program in Tulsa, Okla., complete beginning and advanced culinary classes that make them job ready. Courtesy of Family & Children's Services
As they reach program milestones, clients earn increased freedom. They get jobs with the goal of becoming self-sufficient. They begin the steps to reunify and rebuild trust with children and other loved ones, and transition to living independently.
All along, all clients are subject to random drug testing. All participants also are subject to Women in Recovery's rules and regulations, such as travel restrictions and limits on when and how they can interact with their loved ones.
Delcour says all program clients have regular in-person reviews with the judges overseeing their cases. Delcour submits written reports, so the court can keep track of each client's progress and rule violations.
Clients graduate from the program when they are maintaining sobriety, are employed full-time and have a place to live that does not pose a risk of temptation to relapse. For most clients, this is about 18 months into the program. All graduates can access all of Women in Recovery's services indefinitely, through aftercare.
Those who graduate from Women in Recovery can go before a judge and ask to have their convictions expunged. Judges consider their progress and performance in the program.
Women in Recovery client Julianne Harman, at left, meets with Dr. Erin Morgan, a family medicine specialist with St. John Clinic — Family Medical Care in Tulsa. Courtesy of St. John Health System
To date, nearly 400 clients have graduated from the program, while about 180 women were terminated from the program, with most of those women sent to prison by their judge. There are 168 current participants. Over Women in Recovery's nine-year history, graduates have a recidivism rate of just 6.7 percent.
Mimi Tarrasch, executive senior director of Women in Recovery, said the program is a springboard to a better life.
Three-fourths of the women in the program are mothers, but jail and life circumstances have separated most of them from their kids. Nearly 90 percent of these women reestablish or maintain contact with their children through the program, which also provides services to their children. The program estimates it has impacted the lives of more than 1,500 children.
Harman said she has worked through much of her life trauma in Women in Recovery therapy sessions. She's also gaining control of multiple medical issues with the help of St. John clinicians. Harman said she's had lifelong medical problems and that as an adult, she developed a dependence on prescription pain medication. By 2011, she was also dependent on alcohol and methamphetamine.
When she was deep in her addictions, she'd avoided the medical system. Dianne Hughes, Women in Recovery director of self-sufficiency, said such reticence is common among people with substance use disorder. Now, though, Harman is receiving medical treatment from St. John and takes nonaddictive prescriptions for seizures and other conditions. She's being treated by a neurologist for her seizure disorder.
She said St. John physicians have treated her better than any other doctor ever has. "They go above and beyond."
St. John gives a medical home to Women in Recovery participants
Women with a long history of substance abuse have put their health at risk. In addition to direct damage done by drug abuse, the life chaos that can accompany addiction can make them inattentive to the need to address acute health needs and to keep chronic conditions in check. Accordingly the women's health can quickly spiral downard. Women who are abusing substances may fear the judgement of health care providers and stay away from doctors. Living in poverty and being uninsured or underinsured are also significant barriers to health care access.
According to Mimi Tarrasch, just
5 percent of the participants in Women in Recovery, a prison-diversion program in Tulsa County, Okla., are insured when they enter the program. Tarrasch, executive senior director of Women in Recovery, said few women enter the addiction recovery and social rehabilitation program with any financial resources to speak of. They may not know how to access medical care, or how they'll pay for it if they were to manage to get care.
Dianne Hughes, Women in Recovery director of self-sufficiency, said unaddressed chronic conditions are very common among program clients.
As the medical provider for the Women in Recovery program, Tulsa's St. John Health System has eliminated some of these hurdles to health care access and is working on lowering others. Annie Smith directs community health and engagement for St. John. She said for Women in Recovery participants, the experiences of mental health conditions, addiction, poverty, trauma and medical issues are often closely intertwined and at times can seem insurmountable. And often, all such concerns must be addressed for the individual to be able to start on a new course toward health, well-being and stability.
Through St. John's Medical Access Program, St. John Clinic — Family Medical Care provides Women in Recovery participants with a primary care medical home and specialty medical care from other St. John clinicians. The Medical Access Program pays providers a Medicare rate for care provided to Women in Recovery participants.
St. John can screen Women in Recovery clients for Medicaid eligibility and help them apply for health insurance, an important component to their long-term well-being and success.
St. John's Dispensary of Hope prescription drug assistance program provides Women in Recovery participants with medication at no cost to them.
Smith said that by providing the continuity of a medical home, St. John is setting the stage for the women to develop a trusting relationship with their health care providers as they become more comfortable with the health care system and with self-care. Tarrasch said with the women's health stabilized, hospital readmission rates have decreased for those who had required inpatient care.
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