# Presentation: 130790

## Strategies for Working with 	      the Re-Entry Population

**Presented By: Cherie A. Hunter**
**Corrections Transitional Programs                         & Health Services Administrator**

## Learning Objectives

**At the end of the workshop participants will be able to:**
**Identify 3 challenges for working with offenders returning to their families and communities**
**Understand the role that their “Knowledge, Skills and Attitudes”  play in reentry for the offender**
**Increase their awareness about health issue’s such as HIV/AIDS and Hepatitis within the offender population**

## Challenges for Re-entry

*Stigma*
- Effective Family & Community Reunification
- Creating an Effective Reentry Plan

**Notes:**

As we talk about stigma, before we define what it is, I’d like to talk about what it feels like. 

Offer personal anecdote, experience of stigma.

## Have you ever hid something about yourself because you feared being ostracized or excluded?

**Keeping Secrets**

**Notes:**
I’d like to as you to talk about experience when you’ve felt unaccepted and looked down upon.  

ASK ALL -- volunteers ....  (take time).

Follow-up to all:  
Flip chart:  How did you feel?
Flip chart:  What did you want to do?

e.g. Felt judged and scapegoated without the person knowing anything about me.  
Wanted to (and did) disengage.

(Transition – definition of stigma)

## Stigma is defined as “a brand;  mark of disgrace;  stain on character.”

**Stigma is defined as “a brand;  mark of disgrace;  stain on character.”**

**Notes:**
What is stigma?   Here’s what the dictionary says.

## A narrow set of beliefs that damages a broad, diverse group of individuals. As a basis for discrimination, stigma robs people of the opportunity to live, work, and thrive in the community. 

- (Source: The National Stigma Clearinghouse)

## Stigma—Social Disease

- Society determines normal
- Deviation from the “normal” results in a social, collective reaction to
- Isolate
- Correct
- Treat
- Punish
- Stigma is an attempt at social control

**Notes:**
If stigma is a social disease, changing stigma will take social marketing

## Tribal Stigma
Stemming from perceived or real association with a particular group
Associated with ethnicity, gender, race, nationality, or religion

- Stemming from perceived or real association with a particular group
- Associated with ethnicity, gender, race, nationality, or religion

**Types of Stigma**

- (Source: Stigma: Notes on the Management of the Spoiled Identity, Dr. Irving Goffman, 1963)

## Stigma is...

- an attribute that is deeply discrediting
- Stigma can...
- arise when a person
- possesses an attribute
- that makes one
- different from others...
- and a less desirable kind
- Stigma thus...
- reduces that person in our minds from a whole and usual person to a tainted, discounted one

- (Adapted from Erving Goffman, 1963)

**Notes:**
Reactions?

When you Google the word “stigma” more than 23 million hits pop up. Each site has a slightly different definition of stigma, each social science field has its own compelling list of why stigma is so damaging—so why does it still exist and what can be done about it? 

## Stigma

- Perpetuates **prejudicial attitudes** and beliefs
- Reinforces internalized judgments
- Results in **discrimination**

- (Adapted from National Treatment Plan, U.S. DHHS, 2003)

**Notes:**
Examples – if just makes people feel bad, that’s one thing, and that’s bad enough.
But more than that, stigma results in discrimination.  Stigma against people in recovery keeps them from being hired – or from disclosing their recovery status.  
ASK:  Give examples of how people in recovery are or have been discriminated against.  (employment, housing, education, how about even by treatment providers?)
How are people living with HIV discriminated against?
Problem definition: (maybe pre-write on flip chart)
Stigma gets in the way of people’s decisions and actions – and non-actions --, negatively affecting both those in need of treatment and those in recovery. Stigma also affects the family members and friends of these individuals, as well as those who are trying to serve them. 

Ever feel stigmatized by association? Because you work with certain populations?

## How is stigma like addiction?

- Passed from generation to generation
- We don’t always know we have it
- Logic and information don’t defeat it
- Hurts everyone
- Attacks wholeness & dignity (reduces)
- Divides us from others
-    and from ourselves
- Robs us of hope

**Notes:**
- Generation to generation – American History X.
- Don’t always know we have it.  Like stereotypes, Malcolm Gladwell’s “Blink.” Not me!
Logic and information – think about political discussions. These topics hit people in the gut. Stigma is about internalized feelings. (Nor is fighting addiction about logic and information – it’s a bio-psycho-social disease)

Hurts everyone. Family, community illness, public health

- Robs us of hope.  Layer after layer ... builds up, eventually many give up, lose hope.

## Stigmatized Groups

- Recovering persons
- Persons with substance use disorders
- HIV positive persons
- Racial identity
- Sexual identity

- Gender
- Age group
- Homeless
- Survivor of abuse
- Offender or ex-offender
- Low income
- Other?

**Notes:**
What other groups of people are stigmatized?
Quick group exercise -- 
On your own, pick 1 or 2 groups you think may be strongly represented among the people you serve.  What steps have you taken to better understand the effects of stigma on these individuals?  What are other steps you can take to better understand the complexity of these experiences?  Is anyone willing to share their thoughts on this?

## Stigma Perpetuated

- Language
- central to stigmatizing behavior
- Jokes
- Cartoons
- Generalizations
- Labels
- Media

**Notes:**
Types of drugs and their association with a high or low social status and can serve as a basis for generalized stigma.  For example, cocaine is typically a more  expensive drug to purchase, is perceived to be more closely associated to the wealthy and therefore less stigmatized than heroin which is often associated with squalid surroundings, and ‘buys’ financed by muggings and robbery. 

## The Stigma of Addiction

**Experience of Addiction**

**Pain**

**Ambivalence**

**Difference**

**Notes:**
At the center of stigma are feelings of isolation and shame.
What the individual experiences are disapproval and discrimination.
Stigma is perpetuated by fear and myths.   
ASK:  What kinds of fears and myths are out there that perpetuate stigma?
Myth:  Once an addict, always an addict.
Fear:  Person in recovery is not reliable or trustworthy

Transition -- SO WHAT CAN WE DO TO CHANGE THESE MYTHS AND ADDRESS THESE FEARS?  We need to begin to change societal norms.

## Stigma at All Levels

- Macro level
- Strong influence on policy
- Community level
- Response of community agencies to the stigmatized group and their families
- Individual level
- Profound changes in the individual’s identity
- Changes the way they are perceived by others

**Notes:**
Policy—in terms of substance use—criminalization of drug users, and the types of treatment that is available (methadone); in terms of HIV—funding that is available for treatment, availability of treatment and the government’s response to the epidemic

Individual stigma can become almost like a self-fulfilling prophecy

## 		  Exercise

## Re-Entry and HIV

## Every hour, two young Americans between the ages of 13 and 24 are infected with HIV

## AIDS is among the top three causes of death for African American women between 15 and 44 years of age.  And men between 35 and 44 of age in the United States.

## Women are 8 times more likely than men to contract HIV from one act of intercourse

## African American women between 15 and 44 years of age are the fastest growing group to get HIV infection

## HIV and Re-Entry

- Most reentering males never admit to at risk sexual behavior during incarceration.
- Most wives and/or girlfriends do not require HIV testing of their mate upon return.

## HIV – How it is seen by others

**The person with the disease is perceived as being responsible for having it**
**The disease is viewed as fatal or degenerative**
**The condition is viewed as contagious**
**The condition produces visible physical changes others view as unpleasant **
**Presents barrier to prevention and treatment**

- (Source: HIV/AIDS Stigma: Theory, Reality
- and Response, HRSA 2004)

**Notes:**
Research done on stigma associated with HIV indicates that it is widespread. 

Some argue that the stigma associated with the disease of HIV has prohibited a stronger public and government response to the disease of HIV and to its prevention and treatment. 

## HIV Implications for Prevention

- Avoidance of HIV testing and/or treatment
- Increased stress from hiding the condition
- Anxiety, depression, and guilt
- Loss of support and social isolation

- Emotional or physical violence
- Healthcare provider relationships decline
- Discrimination in housing, employment, or public accommodations

- (NAPWA Facts At-A-Glance:
- HIV/AIDS Stigma and Discrimination)

**Notes:**
Fear of stigma can be a prohibiting factor for persons at risk of HIV in getting tested or who test positive for the disease in seeking treatment. 

Stress, anxiety, and depression can exacerbate physical complications 

## Reunification!!!Why should you understand your target population? 

**Why should you understand their ****Family & Community****? **

**What role **_**does**_** prevention play?**

**Notes:**
Ask participants to respond to these questions.  Write their responses on the flip chart. (5-7 minutes)

## Environmental Prevention Strategies

- Many returning to the community from incarceration return to the environment in which they became criminally involved
- To change individual behavior—the environment may have to change

**Notes:**
It is not just about “treating” the individual’s substance use, but about changing the environment to one that supports recovery, that supports education efforts around preventing the spread of HIV/AIDS and hepatitis, eliminating the temptations to use (i.e., accessibility of alcohol and other illicit drugs), supportive housing and services, child care, employment opportunities, etc. 

ASK participants to discuss ways in which their strategic plan will help change the environment. Write their responses on the flip chart. (3-4 minutes)

## Applying Prevention to the Reentering Population for Reunification

- The role of prevention is to create healthy communities in which people have a quality of life:
- Healthy environments at work and in school
- Supportive communities and neighborhoods
- Connections with families and friends
- Drug and crime-free
- These same principles can be applied to communities with high rates of return from correctional facilities

- (Source: http://preventionplatform.samhsa.gov)

## Prevention Practice

- Traditional prevention strategies focus on delaying the onset of substance use
- However, primary prevention theories can apply when preventing relapse or the transmission of AIDS/HIV and Hepatitis
- Eliminating risk factors
- Enhancing protective factors
- Changing the environment

## “Identifying Capitol to Create a Reentry Plan”

## What is “Capital”?

- Resources that can be accumulated over time
- Physical capital: housing, food, healthcare etc.
- Cultural Capital: education, skills
- Social Capital
- Direct support for reentry, e.g. support group
- Other social capital such as employment , and family connections

## Creating a Re-entry Plan for Clients

- Be aware of your own attitudes and biases
- Understand the psychological roots of stigma
- Know your audience’s knowledge, attitudes, and beliefs
- Be respectful, listen, and respond to what you hear

- (Source: Great Lakes ATTC)

## Creating a Re-entry Plan for Clients

- Identify and understand different audience segments
- Learn what people care about, how they define problems
- Portray payoffs of change
- Make change attractive
- Zero in on specific themes

- (Source: Changing the Conversation* *CSAT, 2000)

##                 Remember To:

- Respect

- Empower

- Include

**Notes:**
ASK: what other strategies exist to combat stigma?

Education: presentations, training for community members and key stakeholders in the community; disseminate pamphlets and other information 

Integration: create opportunities within the community to bring stigmatized populations into contact with members of the community

Social/support networks: providing opportunities for individuals that are a part of stigmatized populations can help alleviate the isolation and other emotional side effects of stigma. Individual and group counseling can also help. 

In combination with a social marketing strategy, grass  roots advocacy can go a long way in destigmatization—it gets people involved at all levels of social marketing and raises public awareness of the condition that results in the stigma.

Treatment and care for HIV: changing the image of HIV from an incurable fatal disease to a manageable disease that requires provision of care. Provision of recovery support services for those with substance use disorders helps in promoting long term recovery. 

Change language—pay close attention to the language that is used in the communities, encourage non-stigmatizing language; encourage inclusion in language (not those people but persons living with HIV; a person with a substance use disorder not addict).  Assess language used in all aspects of community life-from agencies and staff to policy makers to business leaders.

- EXERCISE!!!!!
- Creating a Plan using Reentry Capitol

## Questions?