Recovery Finance: Financial Health and Mental Health After Incarceration
Phase: NA
Conditions: Financial Hardship, Mental Health Issue, Substance Use
Sponsor: Yale University

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STUDY PROTOCOL
Social Behavioral Template
Recovery Finance: Financial Health and 
Mental Health After Incarceration
IRB#2000033658
Protocol Version
February 20, 2024
VERSION # 003
Clinical Trials Registration Number (if applicable)
Confidentiality Statement:
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Protocol Number 2000033658
Synopsis
Purpose
This proposal will address financial wellbeing, an often overlooked but important factor 
impacting reentry for justice-involved people with mental health challenges, who are 
disproportionately Black and Latinx. The project will change community level 
determinants by integrating financial capability support (one-on-one
coaching and access to financial tools and services) into existing services and training 
bank and credit union staff to reduce discrimination. It will also support collaborative 
community efforts working towards upstream policy and legal reforms to reduce the 
incidence of those financial challenges.
Objectives
This research project will use Community Based Participatory Research (CBPR) 
methods to achieve the following specific aim:
1) Change community level determinants that impact financial well-being and health of 
the target group by training existing service provider including: i) community-based 
financial capability providers to be able to address financial difficulties of the target 
group; ii) service providers along the criminal justice pathway to be able to provide 
basic financial guidance to target group; iii) financial institution staff to reduce 
discrimination related to financial consequences of justice-involvement and mental 
illness. We will also support community collaborations working for legal/policy reform 
that impacts finances of target group.
2) Use mixed methods to assess impact on community determinants, measuring 
integration of financial capability support into existing services, ability of financial 
coaches to support target group, access to financial products, attitudes, knowledge and 
behavior of bank staff, strength of community collaborations, and progress towards 
changes in laws and policies.
3) We will assess impact on individuals by measuring target mechanisms (financial 
skills, self-efficacy and behavior) hypothesized to mediate the relationship between 
financial capability support and primary outcomes including financial well-being and 
other health determinants (employment, housing, social support, mental health 
supports, and belonging), secondary outcomes (health and recidivism) and mediators 
between primary and secondary outcomes (hope, empowerment, and mastery).
4) Assess the value of integrating peer support into community-based financial 
capability support for the target group by randomizing participants into two groups, 
financial capability support only, or financial capability support plus peer support.
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APPROVEAPPROVEDBBYTHTHEYYALALE 
Study Population
The target population is persons 18 years of age or older who have been released from prison 
24 months ago or less, who have mental health challenges and are interested in receiving 
financial guidance and live in or use services in the city of New Haven. As well financial 
coaches, bank staff, and criminal justice providers who provide services for people released 
from jail or prison.
Number of Participants
This research study plans to enroll 204 people. Participants will be randomized in two arms 
N=102 participants per arm for two arms for a total of N=204.
Study Design
This project will test a community level intervention to address financial difficulties of people who 
are justice-involved, low-income and have mental health challenges, in a setting where this 
population is disproportionately Black and Latinx. The study will assess whether training service 
providers and staff of financial institutions and supporting community collaborations results in 
greater availability of community level services, reduced local structural discrimination and 
increased community resources. An individual component of the intervention will involve a 
randomized control trial of participants receiving FCS with participants randomized to receiving 
additional peer support or not. The mixed-methods assessment will include validated 
quantitative measures, qualitative interviews, focus groups, and participant observation.
Integration of data sources across quantitative or qualitative measures will allow for a 
contextualized understanding of the impact of the Recovery Finance intervention on community 
level determinants of health. CBPR methods will be employed throughout the research to 
provide ongoing feedback about research design and
implementation, study results, and interpretation.
Conceptual model. Our conceptual model posits that people who are justice-involved and have 
mental illness, who are disproportionately Black and Latinx, suffer from structural violence 
associated with poverty, discrimination, racism, including being excluded from financial 
services, and dealing with the financial costs of incarceration, as well as associated social 
determinants of health. This project will intervene at the community level through a continuous 
CBPR process, involving regular community meetings and consultation. Community/societal 
level: Activities at the community level will include: i) Training financial coaches to provide FCS 
to the target group; ii) Training people who provide services along the criminal justice pathway 
to provide basic financial support as part of their ongoing work with the target group; iii) Training 
bank and credit union staff to understand the causes of the financial difficulties faced by the 
target group, and how access to financial services can help to address those difficulties,
and, iv) Supporting community collaborations to address legislative and regulatory policy reform.
We hypothesize that these community level interventions will result in changes in community 
determinants, including greater availability of services (FCS integrated into service system), 
reduced local structural discrimination (less discrimination among financial institution staff), and 
more community resources (greater availability of safe and affordable financial products, more 
effective community collaborations). We also hypothesize that more effective community 
collaborations will impact societal level outcomes through influencing policies and laws, but 
most likely these changes will not have a measurable impact on financial well-being and
distal outcomes during the project period. Individual level: As a result of changes in community
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Study Duration
The research study duration is planned four years after IRB approval, 8/31/2026.
Outcome Variables
This research study proposes to use the following outcome variables:
Convening a Community Advisory Board to identify stakeholders to help in refining, recruitment, 
and study design as part of the CBPR process. Sequential Intercept Mapping will be used to 
identify intercept points at which to intervene to help people with behavioral challenges who are 
justice involved and try to divert them from the system. SIM workshops will be used to identify 
where financial difficulties arise as a person moves through the system. Co-design workshops 
will be used to finalize the design of the project. Implementation of service provider training 
about structural roots of financial challenges.
In Phase II the following outcome measures will be used:
Community Outcomes: Pre and post analysis will be conducted to determine differences 
between pre and post intervention.
Societal Outcomes: Policy and legal reforms resulting from community collaboration will be 
documented from community meetings and activities.
Individual Outcomes: The research will use qualitative interviews (N=18), participant observation 
utilizing ethnographic methods such as Rapid-Assessment Ethnography and quantitative 
interviews. Primary outcomes include financial skills, financial self-efficacy, financial situations, 
financial well-being, employment, housing, social support, sense of belonging, and mental 
health supports. Secondary outcomes include physical health, psychiatric symptoms, substance 
use, and recidivism.
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Locations/Facilities
The research will take place in the city of New Haven community and the offices of the Yale 
University Program for Recovery and Community Health.
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Abbreviations
Abbreviation
Explanation
CBPR
Community Based Participatory 
Research
CAB
Community Advisory Board
SIM
Sequential Intercept mapping
CFBP
Community Financial Protection Bureau
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Glossary of Terms
Glossary
Explanation
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Table of Contents
Preface.....................................................................................................................................2
Synopsis ..................................................................................................................................3
Purpose................................................................................................................................3
Objectives.............................................................................................................................3
Study Population ..................................................................................................................3
Number of Participants.........................................................................................................3
Study Design........................................................................................................................3
Study Duration......................................................................................................................3
Outcome Variables...............................................................................................................3
Locations/Facilities...............................................................................................................3
Abbreviations ...........................................................................................................................4
Glossary of Terms....................................................................................................................5
Protocol Revision History.........................................................................................................9
1
Background.....................................................................................................................10
1.1
Background .............................................................................................................10
1.2
Prior Experience (if applicable)................................................................................10
2
Rationale/Significance ....................................................................................................11
2.1
Rationale and Study Significance ............................................................................11
2.2
Risks........................................................................................................................11
2.3
Anticipated Benefits.................................................................................................11
3
Study Purpose and Objectives........................................................................................12
3.1
Purpose ...................................................................................................................12
3.2
Hypothesis...............................................................................................................12
3.3
Objectives................................................................................................................12
4
Study Design ..................................................................................................................13
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4.1
Study Duration.........................................................................................................15
4.2
Outcome Variables/Endpoints .................................................................................15
4.2.1
Primary Outcome Variables/Endpoints ............................................................15
4.2.2
Secondary and Exploratory Outcome Variables/Endpoints (if applicable)........15
5
Study Participants...........................................................................................................16
5.1
Study Population .....................................................................................................16
5.2
Number of Participants ............................................................................................16
5.3
Eligibility Criteria ......................................................................................................16
5.4
Recruitment Procedures..........................................................................................17
5.5
Consent/Assent Procedures/HIPAA Authorization ..................................................17
6
Study Methods/Procedures.............................................................................................20
6.1
Study Procedures ....................................................................................................20
6.1.1
Data Collection .................................................................................................21
6.2
Method of Assignment/Randomization (if applicable)..............................................21
6.3
Adverse Events Definition and Reporting................................................................21
6.4
Reaction Management ............................................................................................21
6.5
Withdrawal Procedures ...........................................................................................22
6.6
Locations/Facilities ..................................................................................................22
7
Statistical Design ............................................................................................................23
7.1
Sample Size Considerations....................................................................................23
7.2
Planned Analyses....................................................................................................23
7.2.1
Secondary Objective Analyses (if applicable) ..................................................23
7.2.2
Analysis of Subject Characteristics (if applicable) ............................................23
7.2.3
Interim Analysis (if applicable)..........................................................................23
7.3
Data Relevance .......................................................................................................24
7.4
Data Coding.............................................................................................................24
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7.5
Data Analysis Tools.................................................................................................24
7.6
Data Monitoring .......................................................................................................24
7.7
Handling of Missing Data.........................................................................................24
8
Data/Specimen Handling and Record Keeping...............................................................25
8.1
Subject Data Confidentiality.....................................................................................25
8.2
Data Quality Assurance...........................................................................................26
8.3
Data or Specimen Storage/Security ........................................................................26
8.4
Study Records .........................................................................................................26
8.5
Access to Source.....................................................................................................26
8.6
Retention of Records...............................................................................................26
8.7
Data and Safety Monitoring Plan.............................................................................27
9
Study Considerations......................................................................................................28
9.1
Institutional Review Board (IRB) Review.................................................................28
9.2
Research Personnel Training ..................................................................................28
9.3
Study Monitoring......................................................................................................28
9.4
Unanticipated Problems and Protocol Deviations....................................................29
9.5
Study Discontinuation..............................................................................................30
9.6
Study Completion ....................................................................................................30
9.7
Conflict of Interest Management Plan......................................................................30
9.8
Funding Source .......................................................................................................31
9.9
Publication Plan.......................................................................................................31
10
Appendices .................................................................................................................32
11
List of Tables...............................................................................................................33
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Include the IRB approved protocol version number and date for each revision of the protocol. All 
version history should remain in the table and never be deleted. The oldest IRB approved version of 
the protocol should be listed on the top row. The most recent IRB approved version should be listed 
on the bottom row.
Protocol Revision History
Version 
Date
Summary of Substantial Changes
09/11/2022
Initial protocol submission
07/06/2023
Modification to reflect increase in CAB meeting stipend payment
02/20/2024
Modification to reflect the increase of time for eligibility, from 12 months prior to interview 
date out of prison to within 24 months prior to interview out of prison. Also added the 
recruitment flyer. 
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1 Background
1.1
Background
Many individuals who have been incarcerated experience financial difficulties that 
contribute to a vicious circle of recidivism and poverty, particularly among our target group, 
minoritized populations who are already financially disadvantaged. Support for people 
leaving incarceration often includes help finding employment income or connection with 
disability benefits. Such support is crucial, but by itself does on address the multiple 
financial challenges faced by people who have been incarcerated, that by itself does not 
address the multiple financial challenges faced by people who have been incarcerated, 
that contribute to recidivism and perpetuation of poverty, and are also more prevalent 
among minority populations. Those challenges include problem debt, poor credit, and lack 
of effective access to banking services.
Incarceration and debt: People who have been incarcerated have high rates of what 
we term 'problem debt' - unsecured debt, high-cost auto-loan debt, unpaid bills including 
Legal Financial Obligations (LFOs) and personal debt; such debts are higher among 
people of color. Such debts may be relatively small in dollar amounts, but have serious 
negative consequences, including for health. Meanwhile, this group has less wealth- 
enhancing debt, such as mortgages, affordable auto-loan debt, student loan debt and 
business debt, than others; if they have such debts, they are more likely to be in 
arrears. They also have high rates of child support arrears. These financial problems 
often predate criminal justice involvement, particularly among our target group, but are 
made significantly worse when a person is incarcerated, as they are unable to effectively 
manage their finances, pay bills, and make payments on existing debts, resulting in 
arrears and damaged credit scores. Additional debts accumulate to pay for in-prison 
costs. After release, given difficulties finding employment and damaged credit, which 
increases the cost of borrowing, debts can worsen, and credit is further damaged.
Incarceration and credit: People in prison see their credit scores drop by 42-57 points 
on average; lower scores mean significantly higher interest rates, and less access to 
wealth-building debt. People of color have significantly lower credit scores, regardless 
of incarceration. High rates of identity theft among incarcerated people also damage 
credit.
Incarceration and banking: People who have been incarcerated are less likely than 
others to have bank accounts, relying instead on 'Alternative Financial Services' (AFS) 
such as prepaid cards, check-cashers, rent-to-own stores, and pawnshops, costing on 
average $2,400 annually. Our target group is more likely to be unbanked even prior to 
incarceration, due to fees, discrimination, and mistrust; AFS providers are often trusted 
more despite higher costs, in part because those costs are transparent and predictable, 
unlike bank fees. After incarceration, unbanked rates increase further due to lost ID, 
unpaid overdrafts, confusion, and discrimination. Many lenders require borrowers to 
have two years of uninterrupted employment and credit history. People without a bank 
relationship cannot access wealth-building debt and have limited options to build their 
credit, further perpetuating the cycle of poverty.
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Financial difficulties caused by incarceration negatively impact health: Problem 
debt, including from LFOs, lack of savings, and AFS use are associated with negative 
health outcomes including psychological distress, depression, psychosis, suicidality, 
stress and anxiety, and skipping mental health appointments, as well as a range of 
physical health problems. People with mental illness with such financial difficulties face 
barriers to recovery, including stress and anxiety. Low credit scores are associated 
with psychosocial stress and overall negative health.
Incarceration-related financial difficulties affect employment, housing, social 
networks, and sense of belonging: Financial problems related to incarceration 
negatively impact employment and housing outcomes, social network support, and 
feelings of belonging, all of which are important health determinants.
Impact on employment: Discrimination against people with criminal records is a key 
reason for high unemployment, but debt and credit problems may also play a role, 
through background credit checks, wage garnishing that can impact willingness to 
work, and inability to borrow to purchase needed items such as a vehicle.
Impact on housing: People who have been incarcerated are almost ten times more 
likely to be homeless or housing insecure; in addition to discrimination against people 
with criminal records, landlords often deny housing to people with poor credit.
Impact on social networks: People who are in debt, particularly if unemployed or 
unhoused, rely more heavily on social networks already stressed by the loss of income 
and other costs of the person having been incarcerated, resulting in social network 
members themselves facing financial difficulties including debt.
Impact on belonging: Problem debt is associated with shame and feelings of failure. 
credit has become a marker of social belonging and is associated with feelings of social 
membership and self-worth. recently incarcerated people see having a bank account 
as a sign of maturity.
Incarceration-related financial difficulties are associated with criminal justice 
involvement/recidivism: We know income is associated with recidivism, but other 
aspects of finances are also relevant.
Debt, credit, and recidivism: LFO debt is associated with recidivism, and there is a 
mutually reinforcing association between debt and crime. Credit is associated with 
recidivism: people who have been incarcerated are 20% more likely to recidivate if 
their credit was damaged during incarceration.
Employment, housing, social networks, belonging and recidivism: The 
association between debt, credit and recidivism may operate in part, through the impact 
of debt and credit on employment, housing, social networks and belonging, all of which 
are associated with recidivism.
Banking and recidivism: Being banked may impact recidivism via its connection with 
social belonging, as well as credit and debt; without a banking relationship it is 
impossible to access many types of loan and is extremely difficult to build credit.
Health-disparity populations are disproportionately impacted: Black and Latinx 
people with low incomes, and people with mental illness are disproportionally
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incarcerated; and more likely to have financial difficulties, regardless of incarceration. 
Due to structural racism that has historically and continues to impact finances, Black 
and Latinx people have lower incomes, far less wealth (assets, savings), more problem 
debt and or more arrears or default on all types of debt lower credit scores and are more 
likely to be unbanked. People with mental illness also have lower incomes, less wealth, 
more problem debt arrears, worse credit and are more often unbanked than others; this 
project's PI, Dr. Harper has studied this issue extensively.
Covid-related financial benefits and debt relief reduced debt and improved credit for 
many, but racial and ethnic disparities persist and there is evidence that AFS borrowing 
increased. Black and Latinx people who have been incarcerated face greater difficulties 
than others obtaining housing and employment; the same is true for people with mental 
illness; and recidivism rates are higher for both groups.
Strategies exist to address financial difficulties: Financial capability interventions 
can reduce financial difficulties such as those faced by our target group and have been 
shown to positively impact health. Interventions include one-on-one coaching and 
connection to appropriate financial products, integrated into existing services. Some 
efforts have been made to adapt these interventions to meet the needs of this project's 
target group, people who are justice-involved and have mental health challenges, who 
are disproportionately Black and Latinx, but we know too little about how to 
operationalize such interventions effectively, or their impact on health or recidivism 
outcomes for this group. This project will help to rectify this lack of knowledge.
1.2
Prior Experience (if applicable)
Preliminary research, including by PI Harper, suggests that adapted FCS can be 
effective for criminal-justice involved people with mental health challenges: There 
is evidence that people who have mental illness and who have been incarcerated can 
benefit from FCS adapted to their situations, including financial coaching and access 
to and support with bank accounts. Financial guidance can be helpful for people 
who have been incarcerated: People who have been incarcerated have lower levels 
of financial literacy than others. Numerous recommendations have been made to 
include FCS both inside prison and after release, to improve reentry outcomes, 
including help with credit repair. People who are incarcerated are interested in 
receiving help to improve their financial knowledge. A financial literacy program for 
males in a work release program (n=180) improved participants' subjective and 
objective financial knowledge, understanding of banking, and financial attitudes. 
Financial education and credit counseling provided to women in prison (n=300) 
increased financial self-efficacy and self-empowerment, and the ability to identify and 
access financial resources in the community. FCS materials for people with 
incarceration histories have been adapted and or created specifically for this 
population, such as checklists for addressing debt and credit, including by PI Harper
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based on the findings of her study of the financial challenges faced by people with 
mental illness recently released from prison.
Access to bank accounts and other financial products after incarceration is 
possible and can be helpful: People who have been incarcerated are mistrustful of 
banks and afraid of fees and may be afraid of account garnishing if they owe child 
support or other debts, but studies have shown that trusted persons can encourage 
people to make financial decisions, including opening a bank account. While some 
financial institutions refuse to open accounts for persons who are or have been 
incarcerated there is no state or federal law requiring this. Regulations require that a 
person shows ID before opening an account (many in our target group lack ID), but 
have discretion regarding whether or not to accept prison ID. Many of our target group 
are denied accounts due to past unpaid overdrafts, but this too is an organizational level 
policy; financial institutions can open accounts for persons with past unpaid overdrafts, 
unless it arose from fraud. Studies have recommended that financial institutions 
collaborate to address barriers faced by formerly incarcerated people and take steps 
to change the culture and attitudes of bankers. Pennsylvania's State Department of 
Banking and Securities collaborated with the Department of Corrections to provide 
financial guidance and access to accounts for people during and after incarceration. 
We hope to encourage a similar collaboration in Connecticut. Outside mainstream 
banking, fintech companies are developing targeted financial products. In 2021, after 
research revealed the extent to which justice-impacted people are excluded from 
financial services, the Financial Solutions Lab invested in fintech start-ups seeking to 
help this group. These include online bank accounts targeted to the formerly 
incarcerated, small dollar credit building loans, a risk-assessment tool for landlords, 
employers, and lenders to assess the risk of people with criminal records more fairly, 
and debt dispute technology. In short, there are numerous opportunities to improve 
access to bank accounts and other financial products for people both during and after 
incarceration.
PI Harper's work indicates the complex financial difficulties faced by people who have 
mental illness and have been incarcerated, and the potential for tailored F S to address 
those difficulties. See table below:
'Alejandro' had found a job after being released and was planning to buy 
a car to be able to get a better job. However, his credit was extremely 
bad, due to multiple bills that had gone unpaid while he was in prison, 
including child support, utilities, and a large bank overdraft; he said that 
some of the bills were due to identity theft. He tried his best to work on his 
debts and credit but could not make headway. One barrier was the high 
amount of child support that was taken out of his check every month.
Alejandro could have been advised to close all his 
accounts, including freezing his child support, before or 
soon after going into prison. After release, a financial 
coach could have helped him address the identity theft, 
negotiate with creditors, repair his credit, save for a 
deposit, and find an affordable car loan option.
'Jim', a 24-year-old Black man who receives SSI, explained that during 
his last stay in prison his SSI, which was being paid into a bank account, 
was discontinued after 2 months. On release, he was unable to access 
his account as he had lost his ID and could not remember any of his log-in 
or passwords. He is living in transitional housing so has no immediate 
need for money. His SSI has recently been re-instated and continues to 
be paid into his bank account. Jim is extremely anxious that, combined 
with the SSI that was paid into his account while he was in prison, any 
new payments may take his balance over $2,000, which will result in his 
SSI being discontinued.
Jim's discharge plan could have included verification 
that he was able to access his bank account after 
release. On finding that he wasn't able to access it, a 
financial coach could have helped Jack either to use 
his prison ID to access the account, or obtain 
alternative ID.
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'Carlos' explained that he had found out a few months after release that 
phone and utility accounts had been opened in his name while he had 
been incarcerated, and he now owed
$1,000s in arrears. He was struggling to pay current bills for his new 
family and struggled to manage his anger about the identity theft. He also 
said that it was a struggle to manage his current bills, as had never had 
to pay such bills before going to prison, when he had been a successful 
drug dealer and other people had taken care of bills.
Carlos could have been advised to freeze his credit 
soon after being incarcerated, to check his credit score 
regularly while in prison, and received financial 
coaching to help him learn how to pay his bills after 
release.
After many years of repeated incarcerations and traumatic abuse, 
'Theresa' was receiving disability benefits and was beginning to imagine 
a more stable future, including her own apartment. However, she was 
certain that her unpaid utility bills from the past would make that 
impossible, and as a result had decided that imagining having her own 
apartment was unrealistic.
Theresa could work with a financial coach to determine 
whether she had unpaid bills, address any debts, and 
start to build credit to be able to get an apartment one 
day.
'Sandra' had spent so much money paying for phone calls and putting 
money on her boyfriend Jack's books in prison, that she had fallen behind 
on her utility bills and her car payments. When he was released, she was 
resentful at having got into financial difficulties on his behalf, and ended 
the relationship despite, she said, still loving Jack. Without the support he 
had been expecting from Sandra, Jack returned to his old friends, and start 
selling drugs again, and was soon re-incarcerated.
Thankfully, the law has changed such that Sandra 
would no longer have to pay for phone calls, though 
other in-prison expenses are still significant. A financial 
coach could have helped Sandra to plan her finances 
to be able to put money on Jack's books without falling 
behind on other bills, though this depends on Sandra's 
income and other expenses.
Our team has conducted preliminary work on FCS for people with mental 
illness, peopleof color, and peoplewithhistoriesofincarceration: PI Harper has 
done extensive preliminary work relevant to this project's intervention at both the 
individual and community level. Harper directed a NIMH 34 mixed methods study (PI- 
Dr. owe) testing a F S intervention, including training for service providers, one-on- 
one coaching, and access to no-cost savings accounts for low-income people with 
serious mental illness (n=31), 45% of whom had a history of criminal justice  
involvement, and 75% of whom were Black or Latinx. Participants valued the support, 
with half attending coaching sessions regularly. They opened bank accounts, 
improved credit, paid more bills on time, paid more attention tofinances, set financial 
goals,spenttheirmoneymoreresponsiblyandlessimpulsively, felt less vulnerable to 
financial victimization, and felt more confident about managing money. There was 
no improvement in saving regularity, feeling debt burdened, financial stress or overall 
financial situation; barriers included lack of income, disability benefit asset limits, and 
lack of access to fee-free bank accounts. In a qualitative study, Harper explored 
perspectives of people with representative payee experience to identify existing 
and potential fintech tools useful for this population, and recommended ways that 
banks and credit unions can better accommodate people with mental health 
challenges; these recommendations were presented to local financial institutions in a 
White Paper prepared in collaboration with the Yale Law school. Harper was PI of a 
mixed methods study exploring the experiences of debt and financial hardship 
among recently incarcerated people using mental health services and their social 
network members (n=41), 62% of whom were Black or mixed race, and 13% Latinx. 
The study found that incarceration deepens existing problem debt and adds new 
debts from in-prison costs and identity theft which complicate the search for housing, 
employment, and financial stability, leading to further debt, stressing social 
relationships, and reproducing social and economic inequality. Harper conducted a 
scoping review of research on incarceration and debt, with similar findings. Harper 
has also led studies exploring debt among people with serious mental illness, and
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recently incarcerated people with chronic health problems, finding that Black and 
Latinx people are more likely to have debt, number of debts is associated with 
depression, financial stress and poor health and people with serious mental illness 
who have debt are more likely to skip appointments for mental or physical healthcare. 
Harper is currently PI of a mixed methods community Based Participatory Research 
(CBPR) study exploring associations between debt and health of low-income people 
(n=402) in New Haven, the site of this study, including 66% Black or Latinx, 28% people 
with incarceration histories, and 20% people who self-identified as having a disability. 
Pertinent initial findings from this study are that people who are Black or Latinx have 
more debts than others, and that people with more debts are more likely to report 
mental or physical health challenges. In addition, Harper has been involved in training 
relevant to this project, including: i) training social service providers using the Your 
Money Your Goals curriculum, giving them skills to address client financial difficulties; ii) 
training people providing services to justice-involved people in New Haven using the 
same curriculum and the companion-guide focused on justice-involved people; iii) 
training mental health providers using the same curriculum and the companion- guide 
focused on people with disabilities. She is currently o-I of a Veterans Administration 
project, providing recovery-oriented money management training and consultation to 
agencies serving homeless veterans.
Our team has led research showing strong evidence of the value of peer support 
as a bridge between social inequities and optimal health. Our team has been on 
the forefront of developing and evaluating peer interventions since the 1990s, 
demonstrating that those who have "been there" can serve as powerful motivators, role 
models, and educators for others. Peers can effectively engage people who have been 
otherwise difficult to engage, connect them to needed services, while instilling hope, 
and promoting activation and self-care. In our research, peer interventions have been 
associated with moderate to large effect size improvements among persons with 
serious mental illness in: hope, sense of well-being, self-care, and quality of life; drug 
and alcohol use and hospitalizations; and community tenure after hospitalization. Meta- 
analyses and systematic review show that peer-delivered services are generally 
equivalent to usual care conditions for
adults with SMI in regard to traditional 
clinical outcomes (e.g., symptom 
severity), and superior to usual care 
when 
examining 
more 
recovery- 
oriented 
outcomes 
(e.g., 
hope, 
empowerment, 
quality 
of 
life). 
Research by Dr Bellamy with Black 
and Latinx people with Substance- 
Use-Disorder (SUD) indicates that 
Imani, a peer support and community 
health worker (church facilitators) 
driven intervention can impact overall 
wellness    (the    8    dimensions    of
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wellness), including improvements in 
financial health from baseline to 12 
weeks following the intervention (see
figure 1). To date, over 1000 individuals have enrolled in the Imani program across the 
state of T; Imani participants across 7 sites were from diverse backgrounds and 
experiences: 43% female, 22% Latinx, and 61% Black. The majority had experienced 
incarceration (65%), and 14% were on probation parole. Data collected from cohorts 2 
and 3, found 43% of those who began treatment were retained at weeks 12 and 32% 
were retained at week 22181. In addition, we found a significant increase in all 8 scores 
on the Dimensions of Wellness assessment from pre- treatment to week 12 (time p
<.05). This work indicates that peers can be effective in working with people to address 
SDOH and other experiences resulting from structural discrimination.
Our team has conducted research on peers for justice-involved people with 
mental illness: Dr Bellamy's work has also focused specially on the training, 
development, and implementation of Forensic Peer Support (FPS) services. People 
with histories of mental health and SUD challenges returning to the community after 
incarceration face tremendous challenges in successful reentry to community, 
including reconnecting or connecting with mental health and substance abuse 
treatment, finding adequate housing, finding employment, reuniting with family and 
friends, dealing with finances, etc. Recidivism remains high principally because of these 
challenges. FPS can help people connect with their communities, access treatment 
and other supports, and assist with psychological, social, and financial challenges, and 
in so-doing can reduce recidivism substantially. Peer support may help with confidence 
and self-esteem when dealing with financial challenges. In previous research 
conducted by Dr Bellamy and colleagues on the PeerStar forensic peer project for 
people with mental health and SUD challenges returning from jails in rural 
Pennsylvania, all had a mental illness diagnosis. Surprisingly, in the first year after 
release from prison, participants did much better than those in the general US prison 
population in terms of re-incarceration rates (21.7 percent vs 43.4 percent). While 
preliminary findings of this approach, this study reaffirms the idea that forensic peer 
support can help reduce recidivism rates for people diagnosed with a mental illness 
coming out of prison.
Legal, policy and cultural barriers impacting financial capability for justice- 
involved people with mental illness: One-on-one interventions alone cannot 
address financial difficulties and related health problems. Effective financial capability 
programs partner with banks and credit unions to ensure people have access to 
needed financial products, which can entail encouraging those financial institutions to 
change their operational policies. Effective financial capability programs also 
acknowledge and partner to address the broader structural conditions that cause 
financial difficulties through supporting community efforts for legal and policy reform. 
The financial difficulties that we seek to address are rooted in specific community and 
societal level policy decisions. Structural discrimination operates through these financial 
difficulties, with populations that have been marginalized, including people with mental 
illness, most negatively impacted. People who are justice involved are affected by 
policies including fines and fees, bail and legal counsel, and cost of in-prison amenities.
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In Connecticut, the site of this project, people who have been incarcerated are indebted 
to the state though a lien, which can claim up to half of the value of a person's estate, 
inheritance, lawsuit proceeds, or lottery winnings, up to 20 years after their release, as 
payment for the cost of incarceration. People in transitional housing are not eligible for 
the Earned Income Tax Credit (EITC), which has been shown to improve health of 
recipients25. All of these barriers can be addressed through legislative, regulatory, 
and organizational policy reform. Recently, community-based campaigns in 
Connecticut changed laws regarding the cost of prison phone calls, and regarding a 
lien on welfare recipients, similar to the incarceration lien mentioned above.
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2 Rationale/Significance
2.1
Rationale and Study Significance
This project will test a community level intervention to address financial difficulties of 
people who are justice-involved, low-income and have mental health challenges, in a 
setting where this population is disproportionately Black and Latinx. The study will 
assess whether training service providers and staff of financial institutions and 
supporting community collaborations results in greater availability of community level 
services, reduced local structural discrimination and increased community resources. 
An individual component of the intervention will involve a randomized control trial of 
participants receiving F S with participants randomized to receiving additional peer 
support or not. The mixed-methods assessment will include validated quantitative 
measures, qualitative interviews, focus groups, and participant observation. Integration 
of data sources across quantitative or qualitative measures will allow for a 
contextualized understanding of the impact of the recovery Finance intervention on 
community level determinants of health. BP methods will be employed throughout  
the research to provide ongoing feedback about research design and implementation, 
study results, and interpretation. Our study timeline is included in the PHS form.
CBPRITransformative paradigm: The root causes of the target group's financial 
difficulties are understood as forms of structural violence, referring to the ways that 
social, political, and economic systems harm some more than others. Intervention at 
the systems level is needed to effect individual change. In addition to racism, poverty 
and discrimination, the financial marginalization of the target group, exacerbated by 
incarceration, is a form of structural violence. To address this structural violence, our 
BP methods will be informed by a transformative paradigm of research, which pays 
particular attention to issues of power. In keeping with this paradigm, we use a cyclical 
mixed methods approach, involving community not only in defining the problem, 
developing research design, and participating in data collection and analysis, but also 
in considering future research needs, and "tying the data collected to social action".
Conceptual model and target population. Our conceptual model (fig.2) posits that 
people who are justice- involved and have mental illness, who are disproportionately 
Black and Latinx, suffer from structural violence associated with poverty, 
discrimination, racism, including being excluded from financial services, and dealing
Conceptual model and target population. Our conceptual model (fig.2) posits that 
people who are justice- involved and have mental illness, who are disproportionately 
Black and Latinx, suffer from structural violence associated with poverty, 
discrimination, racism, including being excluded from financial services, and dealing
Conceptual model and target population. Our conceptual model (fig.2) posits that 
people who are justice- involved and have mental illness, who are disproportionately 
Black and Latinx, suffer from structural violence associated with poverty, 
discrimination, racism, including being excluded from financial services, and dealing
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Conceptual model and target population. Our conceptual model (fig.2) posits that 
people who are justice- involved and have mental illness, who are disproportionately 
Black and Latinx, suffer from structural violence associated with poverty, 
discrimination, racism, including being excluded from financial services, and dealing 
with the financial costs of incarceration, as well as associated social determinants of 
health. This project will intervene at the community level through a continuous BP 
process, involving regular community meetings and consultation.
Community societal level: Activities at the community level will include: i) Training 
financial coaches to provide F S to the target group; ii) Training people who provide 
services along the criminal justice pathway to include basic financial support as part 
of their ongoing work with the target group; iii) Training bank and credit union staff to 
understand the causes of the target group's financial difficulties, and how access to 
financial services can help to address those difficulties, and; iv) Supporting
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community collaborations to address legislative and regulatory policy reform. We 
hypothesize that these community level interventions will result in changes in 
community determinants, including greater availability of services (F S integrated into 
service system), reduced local structural discrimination (less discrimination among 
financial institution staff), and more community resources (greater availability of safe 
and affordable financial products, more effective community collaborations). We also 
hypothesize that more effective community collaborations will impact societal level 
outcomes through influencing policies and laws, but most likely these changes will 
not have a measurable impact on financial well-being and distal outcomes during the 
project period.
Individual level: As a result of changes in community determinants, we hypothesize 
that the target group will have greater access to F S services that will improve their 
financial situations and financial well-being through identified target mechanisms 
(financial skills, financial self-efficacy, and financial behavior). Less discrimination 
among financial institution staff and more availability of safe and affordable financial 
products will directly affect financial situations and financial well-being. Improved 
financial well-being will directly affect physical health, psychiatric symptoms, 
substance use and recidivism, medicated by mastery self-efficacy, empowerment, 
and hope.
Improved financial well-being will also impact health and recidivism indirectly through 
its effect on employment, housing, social support outcomes, as well as a sense of 
belonging, all of which affect health and recidivism.
We also hypothesize that improved financial well-being will impact health directly 
through identified target mechanisms. We hypothesize the F S intervention plus or 
minus peer support increases primary outcomes through the target mechanisms of 
increased financial skills, financial self-efficacy, and financial behavior.
2.2
Risks
1) Service providers/bank and credit union staff: Focus group participants might 
also experience distress when talking about their training experiences. The 
focus group facilitators are experienced and trained to address such 
situations. In our experience with focus groups, there has never been an 
unmanageable situation of distress experienced by a focus group participant.
2)
Potential risks to study participants may include distress by participating in 
an interview about their lives or discussing their financial health with financial 
coaches and Peer Wellness coaches. This sharing may evoke an array of 
responses, including emotional, psychological, cultural, or racial distress for 
some participants by recalling difficult experiences in their own life. The 
Financial and Peer Wellness coaches are trained and can assist the 
individuals in processing these emotions. The Research Assistant staff who 
will conduct interviews are also trained to address these situations. In our 
experience, such events are very unlikely. If it is the case that a participant 
would like to talk further about their difficult experience and need further 
support, they will be offered resources such as local hotlines, community
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based acute mental health service affiliate organizations in New Haven, 
(e.g., the Yale Department of Psychiatry), in addition to Dr. Elizabeth 
Flanagan who is a licensed clinical psychologist on our research team, and 
the research team’s contact information. These resources will be made 
accessible with each of the Financial and Wellness coaches, and members 
of our research team.
3) A breach of confidentiality is possible, but not likely for all study participants. 
Should a breach be noted, the participant will be informed immediately, along 
with the APIs, and reported to the IRB for review and further direction.
4) The risk level to participants in this study is minimal and the likely impact is low.
We believe, based on our experience, current safeguards, and additional 
safeguards to be put in place as part of this study, that we will be able to avoid 
violations of confidentiality or risk of possible distress to research participants. 
The importance of the knowledge expected to result from this study to our target 
group and to communities and society are substantial and make the risk to 
subjects reasonable.
2.3
Anticipated Benefits
(1) Service providers/bank and credit union staff: We anticipate that 
research participants will benefit by contributing to the ability of their 
organizations to better address the financial difficulties of people with 
incarceration histories and mental health challenges.
(2) Individuals with incarceration histories and mental health challenges: We 
anticipate that research participants will benefit by improving their financial, 
physical, and mental wellness through the intervention. This will further 
contribute to the field of social and criminal justice, mental health, and 
minority health and health disparities science by providing the data 
necessary to further our understanding of evidence-based culturally 
informed treatment options, but more importantly, provide an opportunity to 
impact the individual lives of minoritized people with history of incarceration 
and mental health challenges, systemically.
The risks associated with this study are minimal and we have a reasonable 
plan for addressing any unforeseen events. The potential benefits of this 
study to our study population and to communities and society are substantial. 
Therefore, we think the potential benefits to participants significantly 
outweigh the risks.
This proposed study has the potential to enhance our scientific knowledge 
of considerable significance in understanding strategies to increase access to 
evidenced-based treatments and culturally responsive financial health and 
wellness health for people coming out of prison with mental health 
challenges. We are attempting to understand how to reduce financial 
difficulties faced by justice-involved individuals with mental health challenges 
returning to their communities after incarceration. We hypothesize that the
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24
This proposal will address financial wellbeing, an often overlooked but important factor 
impacting reentry for justice-involved people with mental health challenges, who are 
disproportionately Black and Latinx. The project will change community level determinants 
by integrating financial capability support (one-on-one coaching and access to financial tools 
and services) into existing services and training bank and credit union staff to reduce 
discrimination. It will also support collaborative community efforts working towards upstream 
policy and legal reforms to reduce the incidence of those financial challenges.
We hypothesize that these community level interventions will result in changes in community 
determinants, including greater availability of services (FCS integrated into service system), reduced 
local structural discrimination (less discrimination among financial institution staff), and more 
community resources (greater availability of safe and affordable financial products, more effective 
community collaborations). We also hypothesize that more effective community collaborations will 
impact societal level outcomes through influencing policies and laws, but most likely these changes 
will not have a measurable impact on financial well-being and
distal outcomes during the project period. Individual level: As a result of changes in community 
determinants, we hypothesize that the target group will have greater access to FCS services that will 
improve their financial situations and financial well-being through identified target mechanisms 
(financial skills, financial self-efficacy, and financial behavior). Less discrimination among financial 
institution staff and more availability of safe and affordable financial products will directly affect 
financial situations and financial well-being. Improved financial well-being will directly affect physical 
health, psychiatric symptoms, substance use and recidivism, medicated by mastery/self-efficacy, 
empowerment, and hope. Improved financial well-being will also impact health and recidivism 
indirectly through its effect on employment, housing, social support outcomes, as well as a sense of 
belonging, all of which affect health and recidivism. We also hypothesize that improved financial well- 
being will impact health directly through identified target mechanisms. We hypothesize the FCS 
intervention plus or minus peer support increases primary outcomes through the target mechanisms 
of increased financial skills, financial self-efficacy, and financial behavior.
intervention will affect community-level health determinants including: i) 
more availability of services (integrating financial capability support into the 
existing service environment); ii) less local structural discrimination (by bank 
staff against justice-involved people who have mental illness); iii) more 
community resources (access to safe, affordable financial products, effective 
community collaborations working towards legal/policy reform). Resulting 
individual level outcomes will include improved financial well-being, which 
will improve recidivism and health outcomes directly, and indirectly through 
improving employment and housing outcomes, increasing sense of 
belonging, and strengthening social network and mental health supports.
3 Study Purpose and Objectives
3.1
Purpose
3.2
Hypothesis
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This research project will use Community Based Participatory Research (CBPR) methods to 
achieve the following specific aim:
1) Change community level determinants that impact financial well-being and health of the 
target group by training existing service provider including: i) community-based financial 
capability providers to be able to address financial difficulties of the target group; ii) service 
providers along the criminal justice pathway to be able to provide
basic financial guidance to target group; iii) financial institution staff to reduce discrimination 
related to financial consequences of justice-involvement and mental illness. We will also 
support community collaborations working for legal/policy reform that impacts finances of 
target group.
2) Use mixed methods to assess impact on community determinants, measuring integration 
of financial capability support into existing services, ability of financial coaches to support 
target group, access to financial products, attitudes, knowledge and behavior of bank staff, 
strength of community collaborations, and progress towards changes in laws and policies.
3) We will assess impact on individuals by measuring target mechanisms (financial skills, 
self-efficacy and behavior) hypothesized to mediate the relationship between financial 
capability support and primary outcomes including financial well-being and other health 
determinants (employment, housing, social support, mental health supports, and belonging), 
secondary outcomes (health and recidivism) and mediators between primary and secondary 
outcomes (hope, empowerment, and mastery).
4) Assess the value of integrating peer support into community-based financial capability 
support for the target group by randomizing participants into two groups,
financial capability support only, or financial capability support plus peer support.
3.3
Objectives
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4 Study Design
Phase I Year 1:
Following notice of award, we will convene the Community Advisory Board (CAB) 
and research team to review protocol and finalize preparations. The CAB will meet 
quarterly. We will also identify a broader stakeholder group to participate in refining 
the study design, and help with recruitment, in addition to assessing progress 
towards community level outcomes. We will support this stakeholder group to 
convene at least once annually and will also hold annual public community 
conversations. The stakeholder group will include people with lived experience, 
family and other social network members, and service providers, including financial 
institutions. We will work with our partner, AHS, to identify an NH-FE employee who 
will lead in developing referral pathways for the target group, providing direct 
coaching to interested individuals and supporting other coaches as needed.
Sequential Intercept Mapping to identify intervention points:
The Sequential Intercept Mapping (SIM) model identifies 'intercept points' at which 
to intervene to help people with behavioral health challenges who are justice 
involved and try to divert them from the system. In SIM workshops stakeholders and 
service providers use the model to collaboratively identify the resources that exist at 
each intercept, and the gaps in support and services. We will adapt the SIM method 
to identify where financial difficulties arise as a person moves through the criminal 
justice system and refine training materials for service providers working across the 
system to help them address those difficulties early on, for example by helping people 
freeze credit, defer student loans, and suspend child support payments.
Co-design workshops:
Building on the SIM results, we will organize a follow-up co-design workshop at 
which the same group will collaboratively finalize the design of the project, including 
identifying appropriate staff to target for training, and refining the content of that 
training. We will build on existing training materials including the Consumer 
Financial Protection Bureau (CFPB) Your Money Your Goals focus on reentry 
Disabilities toolkits, for which Dr. Harper is a trained instructor, Dr. Harper's guide to 
managing incarceration-related debt, and a credit repair toolkit designed for justice- 
involved people. The research team has experience conducting both SIM and co- 
design workshops about similar issues.
Finalize and implement service provider training:
After collectively finalizing training materials we will train two groups of people; a) existing 
coaches working for the New Haven Financial Empowerment Center (NHFEC) to enable 
them to address the financial difficulties faced by the target group, and b)service providers 
currently working with the target population at various points along the criminal justice 
trajectory, including staff of jail diversion and forensic psychiatry programs, pre-sentencing 
programs, public defenders, in-prison counselors, probation and parole officers, and staff 
of transitional housing and reentry programs, to enable them to address common financial
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problems that people may face, and to understand when a referral to financial coaching is 
possible/appropriate; c) bank and credit union staff to understand the causes of the 
financial difficulties faced by the target group, and how access to financial services can 
help to address those difficulties. We will educate staff of financial institutions and 
regulators, including the State Department of Banking and the local FDI representative, 
about the structural roots of the financial challenges faced by people who have been 
incarcerated, to reduce existing discrimination. To accomplish this, we will partner with 
BankOnConnecticut, an existing coalition of banks and regulators, for which PI Harper is 
a steering committee member; All trainings will be offered twice more annually in case of 
staff turnover. Each training will be repeated twice more, in years 2 and 3, to provide 
refresher training to people already trained, and to train any interested newly hired service 
providers/staff. Following the training, we will conduct a series of three annual focus 
groups with people who participated in each of the above trainings (N=60).
Phase II:
Ongoing support for trained service providers:
Service providers who engage with people through the criminal-justice pathway and who 
have been given financial capability training will be invited to participate in twice-yearly 
check-in meetings with NH-FE financial coaches, to discuss their experiences using the 
skills learned from the training and the guidance materials, and to collectively address any 
challenges faced.
Ongoing support for community collaborations:
Through the BP process, we will support community collaborations working on relevant 
legal and policy reform, including preparing policy briefs to share relevant findings from our 
work, such as the health impact of FCS. We do not seek to influence the direction of any 
associated advocacy or to organize any lobbying activities. The laws and policies that may 
be impacted will depend on collective determinations made by involved stakeholders, and on 
changing political circumstances.
FCS for people recently released from jail who have mental health challenges:
Eligible individuals - people over 18 years old, with a self-reported history of mental health 
challenges, released from prison within the last 24 months, living or using services in the 
City of New Haven, and interested in receiving financial guidance - will be recruited from 
transitional housing facilities, a local reentry welcome center, and a mental health clinic 
providing services to justice-involved adults and invited to enroll in our study of FCS at the 
NH-FE . FCS comprises a) one-on-one financial coaching, which entails at-least monthly 
meetings with a financial coach. Initial meetings are in person; subsequent meetings can be 
via zoom, phone or in person; b) support with opening an overdraft-free account. Coaches 
can also help people access other financial products such as free tax preparation (VITA), 
credit builder loans, or online bank accounts, or products recommended by our Justice Tech 
partner.
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Peer support:
Half of our sample, stratified by gender, will be randomized to the 'treatment plus' group, 
and will also be offered one-on-one peer support from a trained Recovery Support 
Specialist. The peer supporter will be trained in forensic peer support and the 8 dimensions 
of wellness to give them additional skills to assist participants in addressing SDOH 
challenges. Dr. Bellamy and peer supporters on this project have served as trainers in 
forensic peer support, wellness coaching around the 8 dimensions, and on peer support 
training and certification. These training technologies are used throughout the country in 
providing training to peer supporters.
Individuals with Incarceration Histories and Mental Health Challenges:
This research study will enroll 204 people (N=204) who have been released from  
jail or prison 24 months ago or less and who have mental health challenges. 
Participants will be randomized in two arms – (N=102 participants in each arm). They 
will be enrolled on a continuous basis starting in month 9 of year 1 until month 4 of 
year 3. We plan to enroll 36 participants in year one, 118 participants in year two, and 
50 participants in year 3. All participants will be enrolled in New Haven, CT county. 
The Peer Wellness Coaches and other research staff members have established 
long-term trusting relationships with people in the New Haven community, which will 
enhance our recruitment efforts. Additional recruitment methods include flyers, word 
of mouth, local media advertisement resources, and social media. Mental Health and 
carceral services such as the Connecticut Mental Health Center (CMHC), halfway 
houses, community supervision programs, and the New Haven Re-entry Center will 
also be approached for the recruitment advertisement. If interested, the potential 
participant will contact the research assistant, and the researcher will answer any 
questions or concerns of the potential participant. If/when they decide to participate 
in the study, the potential participant will be screened for eligibility. The interested 
individual will answer screening to determine eligibility. If eligible and still interested, 
the participant will be invited for an interview for consent and baseline interview. 
Participants will be screened, consented, and complete their baseline assessments, 
after which they will be referred to a meeting with the New Haven Financial 
Empowerment Center (NH-FEC) &CAHS) financial coach, within 30-days of their 
baseline assessment.
Participants will be randomized to two arms: Arm #1 financial capability support = a) one-on- 
one financial coaching, which entails monthly or more frequent meetings with a financial
coach; initial meetings are in person, and subsequent meetings can be via zoom, phone or 
in person, depending on the convenience for the client and b) access to safe and affordable 
financial services, which includes support with managing any existing bank accounts, or 
supporting a person to open a new overdraft-free account. Coaches can also help people to 
access other financial products such as free tax preparation (VITA), credit builder loans, 
online bank accounts, or other products recommended by our Justice Tech partner.
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Arm #2 with peer support = in addition to financial capability support will also be offered one- 
on-one peer support from a trained Recovery Support Specialist…during the period they are 
receiving the intervention. Wellness coaches will provide weekly meetings (30 to 60 minutes 
duration).
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Pre-Screening
<Time Point, 
e.g., Day -30 to 
Day 1>
Phase 1 >
Phase 2>
Arm 1
N = 102
Randomize
Arm 2
N = 102
Visit 2
<Time Point, 
e.g., Day 14 ± 7>
Visit 3
<Time Point, 
e.g., Day 28 ± 7>
Visit 4
<Time Point, 
e.g., Day 42 ± 7>
Visit 5
<Time Point, 
e.g., Day 56 ± 7>
Visit 6
<Time Point,
e.g., Day 365 ± 30>
Administer study intervention Session 1
Final Assessments
<list analyses to be performed 
OR refer to Schedule of 
Activities>
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Post-Intervention assessments 
Qualitative interviews
Administer study intervention Session 3 (if applicable)
Administer study intervention Session 2 (if applicable)
Recruitment 
Baseline Interview N=204
Convene CAB board
CBPR: refine design with community 
Finalize training material
Train providers CJ pathways (N=30), FEC (N=30) 
Anti-discrimination training for bank/credit union staff
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Protocol Number 2000033658
February 20, 2024, Version 003
The research study duration is planned four years after IRB approval, 8/31/2026.
4.1
Study Duration
4.2
Outcome Variables/Endpoints
Outcomes and measures. We have identified measures and sources of data for each 
element in our conceptual model and have mechanisms in place to collect the data at key 
points throughout the study.
Community outcomes and measures: i) FCS built into services system: We will count 
number of people trained, number of people fitting description of target group accessing 
services at the NH-FE , asking about the issue atannual focus groups with service providers, 
at quarterly AB meetings and annual stakeholder and community meetings. ii) Reduced 
discrimination among bank staff regarding mental illness and criminal justice involvement.We 
will count number of people trained, ask at annual focus groups with bank and credit union 
leaders staff if they have noticed different attitudes towards and treatment of target group, 
and ask at quarterly AB meetings and annual stakeholder and community meetings if they 
have noticed different attitudes towards and treatmentof target group; iii) More financial 
products that meet needs of formerly incarcerated people with mental illness.We will track 
product offerings through visiting calling branches, ask about products at annual focus 
groups withbank and credit union leaders staff, and ask at quarterly AB meetings and annual 
stakeholder and community meetings whether people have noticed improved product 
offerings; iv) More community collaborations. We will document community collaborations 
and partnerships working towards policy and legal reform created as a result of the project and 
monitor and document the activities of those partnerships. Due to a lack of a randomized 
trialfor the community level interventions, we plan to conduct a pre-post analysis, e.g., use a 
pair analysis to determine if there are differences between baseline (pre-intervention) and 
during follow-up (post-intervention). We will also consider the use of segmented regression, 
separating the time periods into segments based on keyevents happening (i.e., trainings 
offered) and analyze changes over time. For outcomes for which we are able to obtain 
"control" data (state level data on recidivism), we will employ a difference-in-difference 
approach to help ensure that the impact being observed can be attributed to the intervention 
and not just a temporal trend. Societal outcomes and measures: Any policy legal reforms 
resulting from the improved community collaborationsmay be beyond the scope of this grant, 
given the time such changes take. We will document community meetingsand activities and 
will monitor the progress of any legal or policy reform.
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Protocol Number 2000033658
February 20, 2024, Version 003
Individual outcomes and measures: Based on statistical power analysis (described 
below), we will recruit up to 204 participants. Potential participants will be given study 
information, including a contact number. On calling, they will be screened for eligibility, and 
given study information. If they are interested in participating, a meeting will be arranged at 
which, after obtaining written informed consent, they will be administered the baseline 
interview packet and paid $50 for completing the interview. They will then be referred to the 
NH-FE for FS support peer support. Participants will also complete the interview measure 
packet at 6-month and 12-month follow-up. Financial situation (see measures below) will, for 
people engaged in F S, be measured using the NH-FE existing data monitoring system, 
Financial Empowerment enter Boost Outcome Tool (FE BOT), which we have permission to 
access for study participants. Qualitative component: A sub-sample of 18 participants, 
selected randomly, will be invited to participate in in-depth qualitative interviews at baseline, 
6- month, and 12-months. Interview guides will be developed to probe specific issues 
identified through community and AB meetings; the content of this guide may change over 
time based on the results of ongoing quantitative and qualitative data collection, and in 
discussion with the AB. Interviews will last between 45 minutes to 1 hour,and participants will 
be paid $50. All in-depth interviews will be audio-recorded and transcribed. Participant 
Observation. We will add context to our understanding of the interview data through 
adapted participant observation methods. We will use tools adapted from ethnographic 
methods, such as focused ethnography and apid-Assessment Ethnography to obtain 'thick 
description. For example, we will spend time with participants before and after coaching 
sessions and will take detailed, reflexive notes, though we will not participate in coaching 
sessions. We will spend time in spaces and institutions pertinent to the financial lives of our 
target group, identified through meetings with the advisory board and the BP process, and 
take detailed field notes.
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APPROVED BY THE YALE UNIVERSITY IRB 3/13/2024
Protocol Number 2000033658
February 20, 2024, Version 003
4.2.1
Primary Outcome Variables/Endpoints
Primary outcomes: Target mechanisms to be measured include financial skills, financial 
self- efficacy, and financial behavior. Primary outcomes include financial situation (use of 
financial products, income, current debt, savings, credit score, financial hardship), financial 
well-being, employment, housing, social support, sense of belonging, and mental health 
supports.
Financial capability support (FCS) as part of general service system:
We will measure this outcome by counting number of people trained, number of people fitting 
description of target group accessing services at the NH-FEC, asking about the issue at annual focus 
groups with service providers, and at quarterly CAB meetings and annual stakeholder and community 
meetings.
Discrimination of bank staff:
We will measure this outcome through counting number of people trained, asking at annual focus 
groups with bank and credit union leaders/staff if they have noticed different attitudes towards and 
treatment of target group, and asking at quarterly CAB meetings and annual stakeholder and 
community meetings if they have noticed different attitudes towards and treatment of target group.
Access to safe and affordable financial products:
Indicated by:
Greater availability of existing products and introduction of new products 
Measured by (quantitative):
- Track product offerings at local banks/credit unions though observation and call to local branch 
managers (annual years 1-4)
Measured by (qualitative):
-
Focus group with bank and credit union leaders (annually years 1-4, representatives of 
approx. 10-15 institutions)
-
CAB/CBPR meeting notes (ongoing - CBPR community/stakeholder meetings will be held at 
least annually. CAB meetings will be held quarterly).
Effective community collaboration:
Indicated by:
Partnerships created, meetings held, bills supported Measured by (qualitative):
-
Research team meeting notes (ongoing)
-
CAB/CBPR meeting notes (ongoing - CBPR community/stakeholder meetings will be held at 
least annually. CAB meetings will be held quarterly)
-
Media tracking.
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APPROVED BY THE YALE UNIVERSITY IRB 3/13/2024
Protocol Number 2000033658
February 20, 2024, Version 003
Use of safe and affordable financial products:
From Administrative data from the Financial Empowerment Center Boost Outcome Tool 
(FECBOT) and by self-report (do you currently have a bank account? Does your account 
allow for charging of overdraft fees?).
Debt:
From Administrative data from the Financial Empowerment Center Boost Outcome Tool 
(FECBOT), self-report (please list all the debts you currently owe)and as part of a validated 
measure of financial hardship.
Credit score:
From Administrative data from the Financial Empowerment Center Boost Outcome Tool 
(FECBOT) and by self-report (what is your current credit score - select from range).
Income:
From Administrative data from the Financial Empowerment Center Boost Outcome Tool 
(FECBOT) and in the Lehman (1988) Quality of Life interview
Financial well-being:
1)
A validated measure of financial stress, the Incharge Financial Distress/Financial 
Well-being Scale (IFDFW) Scale
(Prawitz 2006)
2)
A validated financial well-being measure which assesses a person's feelings about 
aspects of their financial situation (CFPB 2017)
Employment:
We will measure employment as well as satisfaction with employment with the Lehman 
(1988) Quality of Life interview, which has established reliability and validity.
Housing:
We will measure housing as well as satisfaction with living situation with the Lehman (1988) 
Quality of Life interview, which has established reliability and validity.
Social support:
We will measure social support using the ISEL-12 scale. This 12-item scale has established 
reliabilty and validity.
Mental health supports:
In our self-reported Service Use measure, participants will be asked about the number of 
visits for outpatient mental health services, self-help groups, peer support, social 
rehabilitation, and supported employment.
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Protocol Number 2000033658
February 20, 2024, Version 003
Secondary outcomes: These include physical health, psychiatric symptoms, substance use 
and recidivism, with mediators including mastery self-efficacy, empowerment and hope.
Recidivism:
Recidivism will be assessed through the public access criminal database called ctlookup.org 
Physical health:
Physical health will be measure by the SF-12. The SF-12 has good internal consistency 
(Cronbach alpha coefficients of 0.72 to 0.89); test retest reliability (r = 0.73-0.86).
Psychiatric symptoms:
The 9-item PHQ-9 will measure depression. Reliability and validity of the tool have indicated 
it has sound psychometric properties. The Beck Anxiety Inventory will be used to assess 
Anxiety.
Wellness:
Overall Wellness will be measured by the 8 Dimensions of Wellness Measure which 
assesses physical, environmental, spiritual, social, emotional, financial, occupational, and 
intellectual wellness (Swarbrick 2012).Wellness goals for each of the 8 dimensions, activities 
engaged in, and an self-assessment of where participants are currently and where they 
would like to be with respect to each of the 8 dimensions will be also logged in the coaching 
measure at peer coaching sessions.
4.2.2
Secondary and Exploratory Outcome Variables/Endpoints (if applicable)
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Protocol Number 2000033658
February 20, 2024, Version 003
36
At least thirty (N=30) financial coaches and criminal justice service providers 
from the New Haven area will participate in training activities during the 
project's first year as part of our partnership with the NH-FEC and local 
organizations providing services to the target group. The training will be 
repeated twice more, in years 2 and 3, to provide refresher training to people 
already trained, and to train any interested newly hired service providers. At 
the end of years 1, 2, and 3, people who received that training will be recruited 
to participate in an online focus group to discuss the intervention (3 focus 
groups over 3 years with 10 participants each) (N=30).

At least ten (N=10) staff working for banks or credit unions in the New Haven 
area will also participate in training activities during the project's first year as 
part of our partnership with local banks and credit unions through the BankOn 
Connecticut Coalition (run by our partner organization, CAHS). The training will 
be repeated twice more, in years 2 and 3, to provide refresher training to people 
already trained, and to train any interested newly hired staff.

At the start of years 2, 3, and 4, people who participated in the training for 
bank and credit union staff will be recruited for a focus group (3 focus groups 
over 3 years with 10 participants each) (N=30).This research study will enroll 
204 people (N=204) who have been released from jail or prison 24 months 
ago or less and who have mental health challenges
5 Study Participants
5.1
Study Population

At least thirty (N=30) financial coaches and criminal justice service providers 
from the New Haven area will participate in training activities during the project's 
first year as part of our partnership with the NH-FEC and local organizations 
providing services to the target group. The training will be repeated twice more, 
in years 2 and 3, to provide refresher training to people already trained, and to 
train any interested newly hired service providers. At the end of years 1, 2, and 
3, people who received that training will be recruited to participate in an online 
focus group to discuss the intervention (3 focus groups over 3 years with 10 
participants each) (N=30).

At least ten (N=10) staff working for banks or credit unions in the New Haven 
area will also participate in training activities during the project's first year as part 
of our partnership with local banks and credit unions through the BankOn 
Connecticut Coalition (run by our partner organization, CAHS). The training will 
be repeated twice more, in years 2 and 3, to provide refresher training to people 
already trained, and to train any interested newly hired staff. At the start of years 
2, 3, and 4, people who participated in the training for bank and credit union staff 
will be recruited for a focus group (3 focus groups over 3 years with 10 
participants each) (N=30).

This research study will enroll 204 people (N=204) who have been released 
from jail or prison 24 months ago or less and who have mental health 
challenges.
5.2
Number of Participants
APPROVED BY THE YALE UNIVERSITY IRB 3/13/2024

APPROVED BY THE YALE UNIVERSITY IRB 3/13/2024
Protocol Number 2000033658
February 20, 2024, Version 003
5.3
Eligibility Criteria

Participants must be 1) at least 18 years of age; 2) have been released from 
jail or prison 24 months ago or less; 3) self-identify as having mental health 
challenges; 4) living or using services in the City of New Haven and 5) be 
interested in receiving financial guidance.

Ineligibility Criteria for the Financial Health and Mental Health after 
Incarceration intervention: Persons 1) less than 18 years of age; 2) not have 
been released from jail or prison 24 months ago or less; 3) not self-identify as 
having mental health challenges; 4) living or using services in the City of New 
Haven and 5) be interested in receiving financial guidance.

Service providers/bank and credit union staff participant must be 1) at least
18 years of age and 2). a financial coach or criminal justice service 
providerfrom the New Haven area will participate in training activities during 
the project's first year as part of our partnership with the NH-FEC and local 
organizations providing services to the target group. The financial coaches 
and criminal justice service providers are neither participants nor research 
staff. These are community service providers. They are providing their usual 
services available to anyone.
5.4
Recruitment Procedures
Focus groups with trained service providers: Providers will be contacted using 
contact information shared during the training and asked if they are interested to 
participate in the focus group. Those who are interested will receive a Zoom link for the 
focus group. Prior to beginning the focus group, all participants will receive information 
about the study and the focus group, will have any questions answered, and will give 
verbal consent to participate.
At least ten staff working for banks or credit unions in the New Haven area will also 
participate in training activities during the first phase of the project, as part of our 
partnership with local banks and credit unions through the BankOn Connecticut 
Coalition (run by our partner organization, CAHS). At the start of years 2, 3 and 4, 
people who participated in that training will be recruited for a focus group (3 focus 
groups over 3 years with 5-8 participants each). Similar procedures utilized for the 
financial coaches and criminal justice providers focus groups will be utilized.
Individuals with incarceration histories and mental health challenges:
All participants will be enrolled in New Haven, CT county. The Peer Wellness Coaches 
and other research staff members have established long-term trusting relationships
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Protocol Number 2000033658
February 20, 2024, Version 003
with people in the New Haven community, which will enhance our recruitment efforts. 
Additional recruitment methods include flyers, word of mouth, and local media 
advertisement resources and social media. Mental Health and carceral services such 
as the Connecticut Mental Health Center (CMHC), halfway houses, community 
supervision programs, and the New Haven Reentry Center will also be approached for 
recruitment advertisement. If interested, the potential participant will contact the 
research assistant, and the researcher will answer any questions or concerns of the 
potential participant.
5.5
Consent/Assent Procedures/HIPAA Authorization

Service providers/bank and credit union staff: Six focus groups will be 
conducted with trained financial coaches and criminal justice providers (3 
focus groups with 10 participants each) and bank staff (3 focus groups with 10 
participants each). These focus groups will be conducted after the end of 
training via an audio- video conferencing platform such as Zoom, approved by 
Yale University IRB. Participants are providers and will not receive 
compensation for their participation.

Once a potential participant expresses interest in the proposed research study 
(by contacting the research team), the research assistant will give a detailed 
description of the study, describe what research activities are involved for the 
participant; review confidentiality and privacy, the risks and benefits of their 
participation, the importance of the knowledge gained, remind them that 
participation is voluntary and they may decline/opt-out of the study at any time, 
without consequence. The research assistant will answer any questions or 
concerns of the potential participant—if/when they decide to participate, the 
potential participant will be screened for eligibility. Interested participants will 
answer screening questions which include age; criminal justice involvement 
history, mental health history, and interest in receiving Financial Health 
coaching services. Participants will be screened, consented, and complete 
their baseline assessments within 30-days prior to their first appointment with 
the Financial Coach. If the potential participant meets eligibility criteria, they 
will be offered the option to complete the informed consent process 1) 
remotely using a smartphone 2) remotely using a tablet/personal computer, 
where a research assistant will be available to help the participant, or 3) in- 
person with a research assistant at a mutually agreed upon space in the 
community, or at Dr. Harper’s PRCH research offices located in New Haven. 
Prospective participants choosing a remote option will receive instructions to 
access their assigned study link and unique personal identifier required for 
participation. Members of our research team will be available for those 
requiring any assistance (including literacy, both reading and technological).
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Protocol Number 2000033658
February 20, 2024, Version 003

Online consent: The participant will read an informed consent form on the 
screen, which will provide a detailed description of the study, a description of 
the research activities, format, confidentiality and privacy, risks and benefits, 
voluntary participation, economic considerations, duration, and withdrawal. 
The form will clearly state that participants can withdraw participation at any 
time by closing the browser window, and that they may opt-out of any survey 
questions by selecting an alternative option (e.g., "I do not wish to answer this 
question"). This will not affect payment or result in any consequences. If the 
participant would like to consent for participation, they will do so by scrolling 
down on the consent form screen and actively indicating consent (e.g., click a 
button stating "I consent") if they agree to the terms of participation. The "I 
consent" button will indicate they understand their involvement in this online 
research study, and informed consent will be implied.

In-person consent process: Research assistants will meet prospective 
participants at either 1) mutually agreed upon space in the community or (2) at 
Dr. Harper’s PRCH research offices located in New Haven according to 
participant preference. The consent process will include all steps as described 
above, following established IRB approved procedures.

Following informed consent, the participant will be asked to scroll to the next 
page to complete a demographic face sheet, then navigate through the online 
baseline measures by endorsing each item with their selected response 
(duration approximately 60 minutes). The participant will be able to see their 
progress by viewing a completion bar located on the survey page. Upon 
completion of the baseline assessment, the participant will be asked to enter 
their email address for verification of e-gift card to receive their payment for 
participation in the online study. The participant may also choose to receive 
their payment in the form of a physical gift card or cash. Participants will 
receive a $40 e-gift card (or physical gift card or cash) for their participation.

For the 6-month assessments, participants will be offered an opportunity to 
update any demographic data on the face sheet and complete follow-up 
measures online by endorsing each item with their selected response 
(duration approximately 60 minutes). Upon completion of the 6-month 
assessments, the participant will be asked to enter their email address for 
verification of e-gift card payment for participation in the online study. The 
participant may also choose to receive their payment in the form of a physical 
gift card or cash. Participants will receive a $40 e-gift card (or physical gift 
card or cash) for their participation.

For the 12-month assessments, participants will be offered an opportunity to 
update any demographic data on the face sheet and complete follow-up 
measures online by endorsing each item with their selected response (duration 
approximately 60 minutes). Upon completion of the 12-month assessment, 
the participant will be asked to enter their email address for verification of e- 
gift card payment for participation in the online study. The participant may also
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Protocol Number 2000033658
February 20, 2024, Version 003
choose to receive their payment in the form of a physical gift card or cash. 
Participants will receive a $40 e-gift card (or physical gift card or cash) for their 
participation.

Qualitative interviews will be conducted with 20 consented randomly selected 
participants (duration approximately 60 minutes). These interviews will be 
conducted via an audio-video conferencing platform such as Zoom, approved 
by Yale University IRB or by telephone or in-person with digital-audio 
recording. The participant may also choose to receive their payment in the 
form of a physical gift card, or cash. Participants will receive a $40 e-gift card 
(or physical gift card or cash) for their participation.

Participants will be given an opportunity to refuse digital audio-recording in the 
qualitative interview, but they will not be able to participate in the qualitative 
interview. They will be informed that all interviews are confidential.
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Protocol Number 2000033658
February 20, 2024, Version 003
6 Study Methods/Procedures
6.1
Study Procedures
The data collection for the research will be done via REDCap. Interested participants will 
provide informed consent electronically.
Following informed consent, the participant will be asked to scroll to the next page to 
complete a demographic face sheet, then navigate through the online baseline measures by 
endorsing each item with their selected response (duration approximately 60 minutes). The 
participant will be able to see their progress by viewing a completion bar located on the 
survey page. Upon completion of the baseline assessment, the participant will be asked to 
enter their email address for verification of $40 e-gift card to receive their payment for 
participation in the online study.
For the 6-month assessments, participants will be offered an opportunity to update 
any demographic data on the face sheet and complete follow-up measures online by 
endorsing each item with their selected response (duration approximately 60 
minutes). Upon completion of the 6-month assessments, the participant will be asked 
to enter their email address for verification of e-gift card payment for participation in 
the online study. The participant may also choose to receive their payment in the form 
of a physical gift card or cash. Participants will receive a $40 e-gift card (or physical 
gift card or cash) for their participation.
For the 12-month assessments, participants will be offered an opportunity to update 
any demographic data on the face sheet and complete follow-up measures online by 
endorsing each item with their selected response (duration approximately 60 minutes). 
Upon completion of the 12-month assessment, the participant will be asked to enter 
their email address for verification of e-gift card payment for participation in the online 
study. The participant may also choose to receive their payment in the form of a 
physical gift card or cash. Participants will receive a $40 e-gift card (or physical gift 
card or cash) for their participation.
Qualitative interviews will be conducted with 20 consented randomly selected 
participants (duration approximately 60 minutes). These interviews will be conducted 
via an audio-video conferencing platform such as Zoom, approved by Yale University 
IRB or by telephone or in-person with digital-audio recording. The participant may 
also choose to receive their payment in the form of a physical gift card, or cash. 
Participants will receive a $40 e-gift card (or physical gift card or cash) for their 
participation.
Participants will be given an opportunity to refuse digital audio-recording in the 
qualitative interview, but they will not be able to participate in the qualitative interview. 
They will be informed that all interviews are confidential.
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Protocol Number 2000033658
February 20, 2024, Version 003
Economic Considerations:

Participants will receive $40 cash, e-gift card, or gift card stipend payments for their 
participation in baseline, 6-month, and 12-month interview. (N=204 X $40 
X3=$24,480)

Participants will receive $40 cash, e-gift card, or gift card stipend payments for their 
participation in qualitative interviews. (N=20 X $40 X 2=$1600)

Participants of the CAB will receive a $100 cash, e-gift card, or gift card 
stipend payment for their participation in CAB meetings (N=6 participants X
$100 X 4 meetings per year X 4 years = $9600)

Four community consultants will receive a $1000 stipend payment for their 
participation in community meetings (N=4 X $1000= $4000)
Visit Schedule Table
Pre-screening 
(Pre-consent)
Visit 1
Day 1
Visit 2
Day 14 ±7
Visit 3
Day 28 ±7
Visit 4
Day 42 ±7
Visit 5
Day 56 ±7
Visit 6
Day 365 ±30
Unscheduled 
Visit
EMR Review Eligibility
X
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February 20, 2024, Version 003
Informed Consent
X
Demographics
X
Clinical history
X
X
Height & Weight
X
X
X
Outcome Evaluation
Pain Assessment (Brief
Pain Inventory)
X
X
X
X
Quality of Life 
Questionnaire
X
X
X
X
X
X
Randomization
X
Control & Experimental
Interventions – Occupational 
therapy
X
X
X
X
Adverse Events Reporting
X
X
X
X
X
X
X
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Protocol Number 2000033658
February 20, 2024, Version 003
6.1.1 Data Collection
Data will be collected using the REDCap platform. Following informed consent, the 
participant will be asked to scroll to the next page to complete a demographic face 
sheet, then navigate through the online baseline measures by endorsing each item 
with their selected response (duration approximately 60 minutes). The measure 
packet will include a face sheet with demographic information, service utilization, SF- 
12V2, Quality of Life measure, ASI, ISEL-12, Adult State Hope Scale, Patient 
Activation Measure (PAM), Wellness in 8 Dimensions Inventory, Peer Support 
Service Satisfaction Survey, CMS_AHC HRSN, Patient Health Questionnaire 
(PHQ9), SCL-90 Anxiety Subscale, Peer Support Provider Contact Log, Community 
Connections Index, Empowerment Scale, Financial Distress and Financial Wellbeing 
Scale, Financial Hardship Strain, Financial Skill Scale, The Financial Self-Efficacy 
Scale, Money Mismanagement Client Rated Assessment. The participant will be able 
to see their progress by viewing a completion bar located on the survey page. Upon 
completion of the baseline assessment, the participant will be asked to enter their 
email address for verification of e-gift card to receive their payment for participation 
in the online study. The participant may also choose to receive their payment in the 
form of a physical gift card or cash. Participants will have the option to have these 
interviews administered by the research staff or on their own.
These interviews will be administered at baseline, 6-months, and 12 months.
Participants (N=20) will also offered participate in qualitative interviews, a recorded 
informal conversation regarding their experiences. Questions will be developed with 
the help of the stakeholders CAB and submitted to IRB for approval prior to 
implementation. The qualitative interviews will be digitally audio/video recorded. 
These interviews will take place at the end of the 6-month and 12-month 
assessments.
In addition to the quantitative and qualitative interviews, the researchers will also be 
collecting notes from the CAB meetings, stakeholder meetings, focus groups, and 
peer workers notes and contacts.
6.2
Method of Assignment/Randomization (if applicable)
Randomization will take place at the individual level. Participants will be randomized to 
treatment as usual (regular FCS) or treatment as usual with peer support using a 1:1 allocation 
ratio. The randomization scheme will be generated by the study statistician and given to the 
data manager for implementation using the Research Electronic Data Captures (REDCap’s) 
randomization module to maintain allocation concealment. The randomization will be stratified 
by gender and carried out using random permuted block sizes of 2,4, and 6. Participants will 
be randomly allocated after completion of the baseline assessment.
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February 20, 2024, Version 003
6.3
Adverse Events Definition and Reporting
Dr. Harper (PI) is responsible for oversight of the DSMP and ensuring adherence to 
procedures for identifying, monitoring, and reporting potential adverse events (AEs) at each 
site. AEs will be monitored through frequent communication with recruitment sites and weekly 
team meetings. In accordance with NIH Reported Events policy, Dr. Harper will report all such 
events to the NIH Program Official and other monitoring entities (i.e., IRB, ISM). Non-serious 
adverse events, unrelated serious adverse events, unanticipated problems, and protocol 
violations will be reported annually in the NIH progress report and IRB continuation application 
and discussed at least quarterly with the ISM. Dr. Harper will also notify NIH, in writing, about: 
any suspension or termination of IRB approval (within 3 business days); deaths related to 
study participation (immediately and no later than 5 business days of learning of the death); 
unexpected Serious Adverse Events (SAE) related to study participation (within 10 business 
days of awareness of the SAE); and unanticipated problems involving risks to subjects or 
others (within 10 business days). Any serious or continuing noncompliance will be reported to 
the NIH PO by the Yale University IRB within 10 business days of determination.
As stated in the NIH Reported Events policy, all documentation will contain the 
following elements: “identifying information for the research protocol; the date on which 
the event occurred and the date at which the PI became aware of the event; a detailed 
description of the event and impact on the participant(s); a detailed description of the 
measures taken (including clinical) in response to the event (if any); confirmation that 
the appropriate monitoring entities and regulatory bodies have been notified as needed; 
and a description of any changes to the protocol or other corrective actions that have 
been taken or are proposed in response to the event.”
6.4
Reaction Management
(1) Service providers/bank and credit union staff: Focus group participants might also 
experience distress when talking about their training experiences. The focus group 
facilitators are experienced and trained to address such situations. In our past experience 
with focus groups, there has never been an unmanageable situation of distress experienced 
by a focus group participant.
(2) Individuals with incarceration histories and mental health challenges: Potential risks to 
study participants may include distress by participating in an interview about their lives or 
discussing their financial health with financial coaches and Peer Wellness coaches. This 
sharing may evoke an array of responses, including emotional, psychological, cultural, or 
racial distress for some participants by recalling difficult experiences in their own life. The 
Financial and Peer Wellness coaches are trained and can assist the individuals in 
processing these emotions. The Research Assistant staff who will conduct interviews are 
also trained to address these situations. In our past experience, such events are very 
unlikely. If it is the case that a participant would like to talk further about their difficult
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experience and need further support, they will be offered resources such as local hotlines, 
community based acute mental health service affiliate organizations in New Haven, (e.g., the 
Yale Department of Psychiatry), in addition to Dr. Elizabeth Flanagan who is a licensed 
clinical psychologist on our research team, and the research team’s contact information.
These resources will be made accessible with each of the Financial and Wellness coaches, 
and members of our research team.
6.5
Withdrawal Procedures
Participants who wish to withdraw from the research study may do so by informing the PI or 
research staff. This may be done verbally or in writing.
6.6
Locations/Facilities

City of New Haven

Connecticut Mental Health Center

Yale University Program for Recovery and Community Health
7 Statistical Design
7.1
Sample Size Considerations
The primary outcome of interest is financial well-being. The primary hypothesis is that 
participants randomized to receive financial coaching plus peer support will have better 
financial well-being at 6-months compared to those who do not receive peer support. Based 
on prior research with low-income populations using financial well-being measures106, 124, 208, 
we expect to be observed a standardized effect size of 0.5. With 90% power and a two-sided 
type I error rate of 0.05, using a two-sample t-test (conservative), we will need 86 
participants per arm (172 total) to detect the 0.5 standardized effect size. To account for a 
15% missing data rate at the 6-month time point, we plan to randomize 204 participants (102 
per group). For secondary outcomes at 6- and 12-months (e.g., employment, sense of 
belonging, social support, housing), we hypothesize that those receiving financial coaching 
plus peer support will perform better. Based on an effective sample size of 172 (at 6-months) 
and assuming an additional 10% missing data at 12-months (n=154), assuming a two-sided 
type I error rate of 0.01 (conservative to account for multiple testing), we will have 80% 
power to detect standardized effect sizes 0.53 and 0.56 for 6- and 12-months, respectively, 
for continuous outcomes, and absolute differences ranging from 23%-26% and 25%-27% for
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6- and 12-months, respectively, for binary outcomes, for baseline rates in the treatment as 
usual group ranging from 20%-50%.
7.2
Planned Analyses
Analysis: All analyses will be performed according to intent-to-treat with an overall type I error 
rate of 5% (two- sided) using SAS ( ary, N ) and ( Project). All analyses will follow the  
design and account for stratificationby gender. Parametric distributional assumptions (e.g., 
normality) will be checked and other distributions will be considered prior to transformations 
and non-parametric methods. Baseline descriptive statistics (e.g., means, standard 
deviations, frequencies, proportions) will be presented overall and by treatment group. No 
inferential statistics will be presented. Baseline variables that appear to be different between 
the two treatment groups willbe adjusted for in sensitivity analyses. Linear mixed models 
utilizing all data (baseline, 6- and 12-month) adjusting for gender will be used to analyze   
the primary outcome. We will test the time by treatment groupinteraction term at the 10% 
level of significance. If this term is significant, we will utilize a contrast term at 6-months to 
test the primary hypothesis. If this term is not significant, we will use the time-averaged 
treatmentdifference to test the primary hypothesis. Generalized linear mixed models (e.g., log 
link for binary outcomes; identity link for continuous outcomes) adjusting gender will be used 
to analyze secondary outcomes. Like the primary outcome, we will test for treatment by time 
interactions at the 0.10 level. If significant we will use contrast at 6- and 12-months to assess 
for differences; if there is no interaction, then a time-averaged approach will be utilized, and 
we will have more power to detect the proposed effect sizes. To control for false discovery 
forsecondary outcomes, we will use the Benjamini and Hochberg method224. We will make 
attempts to limit theamount of missing data through stipend payments to participants, but we 
expect that we will encounter missingdata. We will employ mixed models approaches, which 
utilize all available data and assume missing at random.We plan to assess the robustness of 
our results under a missing not a random assumption using pattern mixture models. We will 
also consider utilizing inverse probability weighting to account for missing data, if necessary. 
Exploratory analyses will focus on mediation analyses and explore tests of both the direct 
effect of treatment on the mediator and the indirect effect as well as the mediated effects of 
factors in between primary and secondaryoutcomes as predicted in the model (see Figure 
2)225.
Qualitative data analysis: Transcriptions and field-notes will be analyzed and interpreted 
using qualitative thematic analysis procedures in which coding and sub-coding categories are 
derived iteratively from transcribeddata, integrating inductive and deductive approaches226, 227. 
We will then integrate qualitative and quantitative findings to help us best understand the lived 
experience of financial difficulties related to incarceration for the target group, and the impact 
of the intervention on those difficulties. One way we will do this is by synthesizing the data to 
build participant profiles that identify constellations of demographic characteristics, 
incarceration histories and financial difficulties most associated with both improved financial 
well-being, and with lack of such improvement. We will do this by identifying the above 
associations using the quantitative analyses and using the qualitative data to probe more 
deeply into how those associations are experienced in people's lives.
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Explain how data will be analyzed to evaluate the secondary study objectives, if applicable.
Specify descriptive analysis to define subject population(s).
7.3
All analyses will be performed according to intent-to-treat with an overall type I 
error rate of 5% (two- sided) using SAS (Cary, NC) and R (R Project). All 
analyses will follow the design and account for stratification by inmate status. 
Parametric distributional assumptions (e.g., normality) will be checked and other 
distributions will be considered prior to transformations and non-parametric 
methods. Baseline descriptive statistics (e.g., means, standard deviations, 
frequencies, proportions) will be presented overall and by treatment group. No 
inferential statistics will be presented. Baseline variables that appear to be 
different between the two treatment groups will be adjusted for in sensitivity 
analyses. Linear mixed models utilizing all data (baseline, 6- and 12- month) 
adjusting for inmate status will be used to analyze the primary outcome. We will 
test the time by treatment group interaction term at the 10% level of significance. 
If this term is significant, we will utilize a contrast term at 6-months to test the 
primary hypothesis. If this term is not significant, we will use the time-averaged 
treatment difference to test the primary hypothesis. Generalized linear mixed 
models (e.g., log link for binary outcomes; identity link for continuous 
outcomes) adjusting for inmate status will be used to analyze secondary 
outcomes. Like the primary outcome, we will test for treatment by time 
interactions at the 0.10 level. If significant we will use contrast at 6- and 12- 
months to assess for differences; if there is no interaction, then a time-averaged 
approach will be utilized, and we will have more power to detect the proposed 
effect sizes. To control for false discovery for secondary outcomes, we will use 
the Benjamini and Hochberg method. We will make attempts to limit the amount 
of missing data through stipend payments to participants, but we expect that we 
will encounter missing data. We will employ mixed models approaches, which 
utilize all available data and assume missing at random. We plan to assess the 
robustness of our results under a missing not a random assumption using pattern 
mixture models. We will also consider utilizing inverse probability weighting to 
account for missing data, if necessary. Exploratory analyses will focus on 
mediation analyses and explore tests of both the direct effect of treatment on 
the mediator and the indirect effect as well as the mediated effects of factors in 
between primary and secondary outcomes as predicted in the model.
7.3.1
Secondary Objective Analyses (if applicable)
7.3.2
Analysis of Subject Characteristics (if applicable)
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If an interim analysis will be done, explain the rationale, timing, and impact to the study. Include any 
stopping rules that would determine if the study should be discontinued.
To accomplish our aims, we have designed two components of the Financial Health and 
Mental Health after Incarceration research project, involving data collection from human 
subjects: (1) Enrollment and data collection of participants in the intervention (n=204), 
including randomization of participants who will receive regular financial capability support,
(2) training of existing coaches working for the New Haven Financial Empowerment Center 
(NHFEC) and training for service providers currently working with the target population at 
various points along the criminal justice trajectory, including staff of jail diversion and forensic 
psychiatry programs, pre-sentencing programs, public defenders, in-prison counselors, 
probation and parole officers, and staff of transitional housing and reentry programs, to 
enable them to address common financial problems that people may face, and to understand 
when a referral to financial coaching is possible/appropriate. We will then conduct a series 
of four focus groups with the trained providers (n=40).
We will utilize a parallel-group design for the randomized control trial (RCT). Randomization 
will take place at the individual level. Participants will be randomized to treatment as usual 
(regular financial capability support) or treatment as usual with peer support using a 1:1 
allocation ratio. The randomization scheme will be generated by the study statistician and 
given to the data manager for implementation using the Research Electronic Data Capture 
(REDCap) randomization module to maintain allocation concealment. The randomization will 
be stratified by gender community supervision status and carried out using random 
permuted block sizes of 2,4, and 6. Participants will be randomly allocated after completion 
of the baseline assessment.
Yes, all analyses will be performed according to intent-to-treat with an overall type I error rate 
of 5% (two-sided) using SAS software.
7.3.3
Interim Analysis (if applicable)
7.4
Data Relevance
7.5
Data Coding
All collected participant data will be assigned a code via REDCap. Access to the link 
between participant and code will only be available to the research team.
7.6
Data Analysis Tools
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We will make attempts to limit the amount of missing data through stipend payments to 
participants, but we expect that we will encounter missing data. We will employ mixed 
models approaches, which utilize all available data and assume missing at random. We plan 
to assess the robustness of our results under a missing not a random assumption using 
pattern mixture models. We will also consider utilizing inverse probability weighting to 
account for missing data, if necessary.
7.7
Data Monitoring
Dr. Harper (MPI) is responsible for monitoring all study activities on a day-to-day basis. Dr. 
Harper will hold weekly research team meetings and discuss protocol and implementation 
issues, review adverse events, and discuss preliminary or incidental findings. We will also 
meet quarterly with our Advisory Council and ISM. Data analysis will be ongoing throughout 
the research period. Trial stopping rules include a greater than expected morbidity or 
mortality rate, patterns of unanticipated negative findings associated with the intervention, or 
interference/hindering of the administration of routine medical and behavioral health care that 
cannot be resolved by an NIH-approved protocol or DSMP change.
7.8
Handling of Missing Data
8 Data/Specimen Handling and Record 
Keeping
8.1
Subject Data Confidentiality
Participant confidentiality and privacy is strictly held in confidence by the participating 
investigators, their staff, and the sponsor(s)/funding agency. Therefore, the study protocol, 
documentation, data, and all other information generated will be held in strict confidence.
All research activities will be conducted in as private a setting as possible.
Representatives of the Institutional Review Board (IRB), regulatory agencies or study 
sponsor/funding agency may inspect all documents and records required to be maintained 
by the investigator for the participants in this study. The study site will permit access to such 
records.
The study participant's contact information will be securely stored at each study site for 
internal use during the study. At the end of the study, all records will continue to be kept in a 
secure location for as long a period as dictated by the reviewing IRB, Institutional policies, 
regulatory, or sponsor/funding agency requirements.
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Study participant research data, which is for purposes of statistical analysis and scientific 
reporting, will be transmitted to and stored at the Yale University Program for Recovery and 
Community Health. This will not include the participant's contact or identifying information. 
Rather, individual participants and their research data will be identified by a unique study 
identification number. The study data entry and study management systems used will be 
secured and password protected. At the end of the study, all study databases will be de- 
identified and archived at the Yale University Program for Recovery and Community Health.
8.2
Data Quality Assurance
Although Dr. Harper assumes primary and ultimate responsibility for monitoring protocol 
implementation, safety, and adherence to the DSMP, she will be aided by our program’s 
internal safety officer (Kimberly Blackman) and the Project Manager. Together, they will 
ensure that procedures are streamlined for the identification and reporting of adverse and 
unexpected events across recruitment sites. Dr. Harper and Ms. Blackman are responsible 
for all quality assurance measures for subject recruitment, enrollment, enrollment targets, and 
for the validity and integrity of the data in compliance with Good Clinical Practice (GCP) and 
applicable regulatory requirements.
8.3
Data or Specimen Storage/Security
All electronic data collected will be via REDCap. In the case, we use paper and pen data, 
the data will be rendered de-identified and kept in a secure locked cabinet, in a secure 
office.
8.4
Study Records
Research materials and data will be obtained from quantitative assessments online via 
RedCap (a secure platform approved by the Yale University IRB). If necessary, these 
assessments can be provided by pen and paper, and transferred into RedCap by research 
assistants, if some participants with limited technological literacy request support. Qualitative 
interview data will be obtained via video-audio conference using a HIPPA compliant platform 
(approved by Yale University IRB) or by telephone or in-person interviews digitally audio 
recorded. Focus groups with facilitators will be recorded, and the audio files will be 
transcribed for qualitative analysis.
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How research material, data, and records will be obtained
Research materials and data will be obtained from quantitative assessments online via 
RedCap (a secure platform approved by the Yale University IRB). If necessary, these 
assessments can be provided by pen and paper, and transferred into RedCap by research 
assistants, if some participants with limited technological literacy request support. Qualitative 
interview data will be obtained via video-audio conference using a HIPPA compliant platform 
(approved by Yale University IRB) or by telephone or in-person interviews digitally audio- 
recorded. Focus-groups with facilitators will be recorded and the audio files will be 
transcribed for qualitative analysis.
Whether any private identifiable information will be collected in the proposed research 
project
Private identifiable information will be collected in the proposed research study. Personal 
health information will include contact information (e.g., name, address, phone number, 
email address, date of birth), personal responses to assessments during the study, criminal 
justice involvement history, and personal responses to qualitative questions about 
experiences and histories with the criminal justice and mental health system, when relevant.
8.5
Access to Source
8.6
Retention of Records
De-identified data will be kept indefinitely.
8.7
Data and Safety Monitoring Plan
We have designed our Data Safety and Monitoring Plan (DSMP) with careful 
consideration of the relative risks to all participants and the nature of the trial. Although 
our research study and intervention itself poses “no greater than minimal risk”, it does 
involve participants who use substances. Thus, in accordance with NIH guidelines 
and federal regulations for conducting research involving persons who with criminal 
justice involvement, we have put additional monitoring and protections in place to 
promptly identify and respond to adverse events. This includes the identification of an 
Independent Safety Monitor (ISM)—Dr. Madelon Baranowski, a Professor in the 
Department of Psychiatry, Yale School of Medicine, and Director of the Division of 
Law and Psychiatry at the Connecticut Mental Health Center —who will provide 
additional oversight of all research activities, as deemed necessary by NIH. The ISM 
will advise Dr. Harper and NIH of any safety concerns, review adverse events, and 
make recommendations to the study team on design and implementation issues.
Once finalized and approved by NIH and the Yale IRB, this DSMP will not be
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modified without prior review and approval from NIH. If the benefit-risk analysis 
changes, we will work closely with the NIH Program Officer to modify our clinical 
protocols and DSMP accordingly.
A summary of our research protocol, including a description of participants, sites, 
measures, sample size, sources of data, inclusion/exclusion criteria, foreseeable 
risks, consent procedures, protections of privacy, and data security procedures can 
be found in the Protection of Human Subjects Section and the Research Strategy.
Trial Safety. Events that would preclude a participant from continuing the intervention 
include discontinuation or withdrawal from the research study by the participant; 
aggressive or threatening behavior toward research staff; a Serious Adverse Event 
(SAE) that is related to the intervention itself; or other events or circumstances about 
which we are advised by the ISM, IRB, or NIH that participation in the study should 
be terminated.
The Yale University Policy on Conflict of Interest requires that assessment and disclosure of 
conflict of interest occur on an annual basis or as a new conflict of interest emerges. Potential 
conflicts of interest identified among any member of the research team or the ISM will be 
immediately reported to the Yale Conflict of Interest Committee who will advise on methods 
of resolving the conflict, including, if need be, removal from the grant. We will ensure 
compliance with the DSMP at the recruitment sites by working closely with facilitators to 
ensure that all are familiar with, and upholding, the DSMP. Reporting of adverse events, 
incidental findings, and other relevant study information will be shared across recruitment 
sites.
9 Study Considerations
9.1
Institutional Review Board (IRB) Review
The protocol will be submitted to the IRB for review and approval. Approval of the protocol 
must be obtained before initiating any research activity. Any change to the protocol will 
require an approved IRB amendment before implementation. The IRB will have final 
determination whether informed consent and HIPAA authorization are required.
Study closure will be submitted to the IRB after all research activities have been completed.
Other study events (e.g. data breaches, protocol deviations) will be submitted per Yale 
policies.
9.2
Research Personnel Training
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Researchers assisting with the conduct of research activities are certified in CITI Human 
Subjects Protective Training and HIPPA guidelines to ensure study adherence to study 
procedures and their responsibility to carry out the protocol.
9.3
Study Monitoring
Although Dr. Harper assumes primary and ultimate responsibility for monitoring protocol 
implementation, safety, and adherence to the DSMP, she will be aided by our program’s 
internal safety officer (Kimberly Blackman) and the Project Manager (Dr. Flanagan, also co- 
investigator). Together, they will ensure that procedures are streamlined for the identification 
and reporting of adverse and unexpected events across recruitment sites. Dr. Harper and 
Ms. Blackman are responsible for all quality assurance measures for subject recruitment, 
enrollment, enrollment targets, and for the validity and integrity of the data in compliance 
with Good Clinical Practice (GCP) and applicable regulatory requirements. Dr. Flanagan is 
responsible for interim, annual, and final analyses of program components, targets, and 
outcomes. As noted above, we have also identified an independent, external ISM (Dr.
Baranowski) who can provide additional guidance and oversight of the DSMP and research 
protocols.
9.4
Unanticipated Problems and Protocol Deviations
A protocol deviation is any noncompliance with the protocol. The noncompliance may be 
either on the part of the participant, the investigator, or the study site staff. As a result of 
deviations, corrective actions are to be developed by the site and implemented promptly.
It is the responsibility of the site investigator to identify and report deviations within <specify 
number> working days of identification of the protocol deviation. All deviations must be 
addressed in study source documents, reported to the study sponsor, and the reviewing 
Institutional Review Board (IRB) per their policies.
Unanticipated problems involving risks to participants or others include, in general, any 
incident, experience, or outcome that meets all of the following criteria:

Unexpected in terms of nature, severity, or frequency given (a) the research 
procedures that are described in the protocol-related documents, such as the 
Institutional Review Board (IRB)-approved research protocol and informed consent 
document; and (b) the characteristics of the participant population being studied;

Related or possibly related to participation in the research ("possibly related" means 
there is a reasonable possibility that the incident, experience, or outcome may have 
been caused by the procedures involved in the research); and
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
Suggests that the research places participants or others at a greater risk of harm 
(including physical, psychological, economic, or social harm) than was previously 
known or recognized.
If the study team becomes aware of an unanticipated problem (e.g. data breach, protocol 
deviation), the event will be reported to the IRB by IRES platform.
The UP report will include the following information:
Protocol identifying information: protocol title and number, PI's name, and the IRB project 
number;

A detailed description of the event, incident, experience, or outcome;

An explanation of the basis for determining that the event, incident, experience, or 
outcome represents an UP;

A description of any changes to the protocol or other corrective actions that have 
been taken or are proposed in response to the UP.
To satisfy the requirement for prompt reporting, UPs will be reported using the following 
timeline:

UPs will be reported to the IRB within 72 hours of the investigator becoming aware of 
the event.
9.5
Study Discontinuation
Events that would preclude a participant from continuing the intervention include 
discontinuation or withdrawal from the research study by the participant; aggressive or 
threatening behavior toward research staff; a Serious Adverse Event (SAE) that is related to 
the intervention itself; or other events or circumstances about which we are advised by the 
ISM, IRB, or NIH that participation in the study should be terminated
9.6
Study Completion
The completion date is estimated to be four years from IRB approval.
9.7
Conflict of Interest Management Plan
The Yale University Policy on Conflict of Interest requires that assessment and 
disclosure of conflict of interest occur on an annual basis or as a new conflict of 
interest emerges. Potential conflicts of interest identified among any member of the 
research team or the ISM will be immediately reported to the Yale Conflict of Interest
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Committee who will advise on methods of resolving the conflict, including, if need be, 
removal from the grant. We will ensure compliance with the DSMP at the recruitment 
sites by working closely with facilitators to ensure that all are familiar with, and 
upholding, the DSMP. Reporting of adverse events, incidental findings, and other 
relevant study information will be shared across recruitment sites.
9.8
Funding Source
National Institute of Health (NIH)
9.9
Publication Plan
We will ensure that the clinical trial conducted under this award is registered and 
study results are submitted to ClinicalTrials.gov as outlined in the NIH Policy on the 
Dissemination of NIH-Funded Clinical Trial Information policy and according to 
timelines stated in the policy. Informed consent documents for the pilot clinical trial 
will include a specific statement regarding posting of clinical trial information at 
ClinicalTrials.gov. Yale University has an internal policy in place to ensure that 
clinical trials registration and results reporting occur in compliance with policy 
requirements.
Access to databases generated under the project will be available for educational, 
research and non-profit purposes. Such access will be provided using web-based 
applications, as appropriate, to avoid or minimize associated costs. Publication of 
data shall occur during the term of the project, if appropriate, or at the end of the 
project, consistent with normal scientific practices. Research data which documents, 
supports and validates research findings will be made available after the main 
findings from the final research data set have been accepted for publication. Such 
research data will be redacted to prevent the disclosure of personal identifiers. All 
data obtained from participants will also be shared via the National Database for 
Clinical Trials related to Mental Illness (NDCT). In enrolling participants, necessary 
information will be obtained to generate a Global Unique Identifier (GUID). The 
necessary strategies to develop the GUID will be achieved with the tools available at 
the NDCT website. Raw data will be submitted every 6 months until the end of the 
grant. Plain language text will be added to the consent form to inform participants 
and obtain their consent to share data with NDCT.
The plan allows us to disseminate findings to participants, communities, banks, 
DOC, DMHAS, churches other stakeholders, staff at local mental health authorities, 
community members, researchers, and other community agencies. The advisory 
and CBPR team will assist with targeting our dissemination efforts and will be 
involved in sharing the information in the community, to organizations and banks, 
and at conferences targeted to researchers, providers, community leaders, and for 
people with histories of incarceration. A preliminary dissemination plan involves the 
following:

Provide reports to NIH to share successes and challenges.
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
Share findings with the participants and other service users. Oftentimes, 
individuals are involved in research studies sponsored by Yale and other 
institutions and never get to hear about the findings. We will translate the 
report in a more “accessible” language so that non-researchers can 
understand the reports. Hearing from fellow CBPR and advisory team 
members throughout the project will also keep us accountable to the 
purpose of the project, which is ultimately to better support individuals. We 
plan to have dissemination report presentations at 4 points during the study 
particularly to share the information as part of the CBPR process.

Share findings with NIH, SAMHSA, CMS, CDC, DOC, Banking 
Institutions, and other national organizations that will be interested in 
these findings.

Share the findings with experts throughout so that they are aware of 
the process and to learn about the challenges and successes.

Share findings with DMHAS, our state mental health authority, and 
providers in the National Association of State Mental Health 
Program Directors (NASMHPD), DOC, so they have access to this 
timely information.

Share study findings and replication tools.
10 Appendices
Appendix #
Title
Section
Topic
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11 List of Tables
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