Reentry case workers

Jail-based case workers connect incarcerated individuals to treatment and other community-based services upon release from jail.

Local Examples

Franklin County, MA Franklin County Sheriff's Office

• Clinical reentry services are offered to everyone leaving the jail, including people who were in the jail at the pretrial stage, had served sentences, and had a short stay for probation violations.
• Reentry case workers (RCWs) engage with people upon and after release to provide assistance in navigating reentry and addressing barriers such as transportation and housing. RCWs connect people to wrap-around services in partnership with treatment providers.
• RCWs provide long-term case planning, collaboration with community partners, relationship building, and addressing stigma through empowering clients and educating the community.
• RCWs deliver services that aim to enhance skills, support effective system navigation, and reinforce valid and effective behaviors.
• See also Specialized Jail Personnel.

For more information on this example, see these resources:

• Collaborative Comprehensive Case Plans ("Lead Case Planner: Correctional Agency")
• Program Description: Specialized Jail Personnel - Franklin County, MA

Bernalillo County, NM Intake Receiving Screening, Transition Planning, Resource Reentry Center, Navigators and Boundary Spanning Case Mangers

Intake Receiving Screening

• Upon booking into the Metropolitan Detention Center (MDC), every person completes an Intake Receiving Screening administered by MDC’s medical contractor.
• This screening assesses forevaluates criminogenic risk, prevalence of substance or alcohol use, behavioral health needs, and suicidality.
• Based on the weight of the responses, an automated score is generated that places the person in a particular risk group.
• This grouping assists service providers in MDC and at the Resource Reentry Center to determine the necessary level of care and provide services in a focused way.

Transition Planning

• Clients whose scores indicate higher risk and higher need (score 6-8) and who remain in custody longer than 48 hours meet with a transition planner to conduct a reentry needs assessment and develop a formal transition plan.
• This transition plan identifies and addresses the immediate and long-term needs of the person returning to their community.
• Clients play an active role in developing their transition plan.
• Transition planners maintain contact with and provide support to the client prior to release.
• They work to actively connect clients to support systems in the community that they can then access upon release.
• Without proper transition planning, many of these individuals will return to the same challenges they faced prior to incarceration.

Resource Reentry Center (RRC)

• The RRC opened in 2018 and is open 24 hours a day, 7 days a week.
• Each year, the MDC releases approximately 21,000 individuals. The vast majority of these individuals go through the RRC.
• The RRC is voluntary program designed to provide a safe landing spot for people released from MDC.
• RRC staff are available to connect individuals with resources such as food, transportation, shelter, clothing, case management, medication, counseling or substance use treatment, veteran services, pretrial services, physical and behavioral health care, NARCAN education and training, vocational services, and other services.
• RRC staff also complete transition plans and reentry needs assessments (for those who have not had the opportunity due to short jail stays) and coordinate the warm hand-off to the community.

Navigators and Boundary Spanning Case Managers

• Six community health workers/navigators are housed at the RRC to review transition plans with clients who received these plans at MDC and ensure that clients are aware of and prepared for next steps.
• Boundary spanning case managers also work out of the RRC and the jail (using tele-meetings as needed) to provide case management services to people who have a transition plan and/or are on a list of people who frequently utilize multiple systems. The case managers focus on people who have been diagnosed with a serious mental illness.
• Both navigators and boundary spanning case managers can assist any and all clients coming through the RRC by making referrals, even if they don’t have a transition plan and are not on the “frequent utilizer” list.

Winona County, MN Reentry Assistance Program Plus

• Winona County’s Reentry Assistance Program Plus (WRAP+) utilizes a community connector who serves as the primary case manager for people who are released from the jail.
• The community connector conducts additional risk and needs assessments and coordinates referrals for diagnostic mental health assessments and chemical dependency assessments as needed.

Chester County, PA Chester County Prison

• A cross-systems coordinator is located at the Chester County Prison. Public defenders, attorneys, pretrial staff, and probation and parole staff make referrals to the coordinator, who works primarily with the population who has severe and persistent mental illness.
• The cross-systems coordinator assesses each referred individual’s needs for release to the community and works with stakeholders and community-based providers to develop a comprehensive release plan for individuals who have a serious mental illness.
• The cross-systems coordinator facilitates referrals to community-based providers and follows up with either the providers or individuals themselves upon their release from Chester County Prison.