Student-Led Program Coordinates Post-Incarceration Health Care
The Miami Med Reentry Care Coordination (MMRCC) program, started in 2020 by University of Miami Miller School of Medicine students, aims to expand its reach in 2023 to people in the community who have been incarcerated and need help establishing health care services.
“MMRCC offers patient navigation services to people who are returning from incarceration. We help participants with things like finding health insurance, connecting with primary care or other medical, dental, or mental health services,” said third-year medical student Julia Telischi, who is one of four Miller School students on the MMRCC’s executive team. “Then, we set some longer-term health goals with them and have regular follow-ups for up to six months, where we meet regularly with participants, track their progress with their goals, and help troubleshoot any issues they might be having navigating the health care system.”
The program benefits both participants and the medical students helping them, according to the student founders, who have since graduated from medical school.
“I believe this project has been a cornerstone to my development as a future provider and leader,” said MMRCC founder and former Miller School student Erin O'Keefe, M.D. ’22.
Kyrra Engle, M.D. ’22, MMRCC co-founder, said that growing the program and helping people transition to a potentially healthier life after incarceration was the most meaningful experience she had in medical school.
“I feel as though I have learned as much, if not more, from my participants as I hope they have from me,” Dr. Engle said.
Telischi was recruited into the MMRCC in her first year of medical school, the program’s pilot year.
“Back then, there were four of us running the program and doing the pilot navigation,” Telischi said. “Today, there are four of us on our executive team. We had five navigators last year, another four that came on in the summer, and we recruited three more this fall. We’re still pretty small, but we’d like to expand.”
The program pairs an individual who has been incarcerated with a patient navigator who has been trained specifically for this population. They meet every two weeks to set health care goals, which the participants take the lead in setting. The navigators, as their titles imply, help participants find their ways through the health care system.
Tapping more medical students to provide patient navigation services for people returning from incarceration is much needed, according to Telischi.
“This is a population that’s very prevalent in Miami-Dade. If you walk through Jackson Hospital wards, you’ll see at least one patient with a corrections officer outside their door at any one time,” she said. “And I think it’s important to get exposure to different populations in medical school. We focus on long-term relationships. That’s why we don’t have each navigator with a ton of patients; we want them to focus on developing a longitudinal relationship with each participant.”
Providing services like MMRCC is vital for the big picture of health care, according to Kathryn M. Nowotny, Ph.D., associate professor in the Department of Sociology at the University of Miami College of Arts and Sciences, director of the Miami Health and Justice Lab, and MMRCC faculty advisor.
“People who are incarcerated in general have much higher rates of health conditions than people in the community,” Dr. Nowotny said. “The ones we think of most often are mental health and substance use issues. But they also often have chronic conditions, things like high blood pressure and diabetes that are not managed.”
Ironically, the criminal justice system has become an important provider of U.S. health care, according to Dr. Nowotny.
“We have an urban poor population that is constantly surveilled by the police, that has high rates of incarceration, that is underinsured, that lives in disinvested neighborhoods. They often only receive care from emergency departments or during periods of incarceration,” Dr. Nowotny said. “Once they’re not incarcerated, there really is no system to help them manage their health conditions. They often go without insurance, particularly because insurance is related to employment. Florida currently has over 1,000 statutes limiting employment and other activities among people who have been incarcerated.”
Helping these people get their health care footing can improve this vulnerable population’s well-being, as well as prepare future physicians to care for an often overlooked but substantial segment of society.
“Over 70 million people have a criminal record; on any given day, two million people are incarcerated; and 50% of Americans have a loved one who has been incarcerated,” Dr. Nowotny said. “But it’s not embedded into our medical training program, so having students exposed to working with this population, teaching them about issues related to the criminal justice system — how the criminal justice system impacts the health of those who are incarcerated, their families, their communities — is incredibly beneficial.”