In courts and in clinics , doctors and lawyers combine their power to keep people on the right side of health .
ON AN EARLY SUMMER MORNING in Lower South Providence , community health worker Anthony Thigpen stands in the parking lot of the Lifespan Center for Primary Care while a stocky , agitated man with tattoos and a muscle T strides back and forth in front of him . “ What ’ s goin ’ on , Teddy ?” Thigpen says in a warm , low voice .
“ Talk to me .”
Theodore “ Teddy ” Wright , one week into probation , says that he was explaining to his girlfriend Paula ’ s landlord that he had tried to fix the broken windows in her apartment — where , by the way , the shower doesn ’ t work , either — but they had a misunderstanding and the landlord hung up on him , and that just doesn ’ t sit right .
Paula , a petite woman in leggings , paces nearby . She wants to break the lease . He wants a showdown with the landlord . For Thigpen , keeping Paula housed and Wright out of trouble are paramount .
“ Here ’ s how we ’ re going to move forward peacefully ,” he says quietly . Over the next 10 minutes tempers cool , fists are bumped , a plan is put in place . Thigpen heads for his SUV , ready for his next call . “ Hey , Anthony !” Wright calls out across the parked cars . “ Much love and respect .” “ Love you too , brother ,” Thigpen says .
RETURN ON INVESTMENT
The Center for Primary Care serves as the outpatient site of The Warren Alpert Medical School ’ s internal medicine residency program . On Wednesdays , it ’ s also home to the Transitions Clinic , where people leaving prison , most of whom receive Medicaid , can get comprehensive support that extends well beyond primary care .
Established in 2018 , the clinic ’ s three community health workers stand ready to help clients secure necessities like food , clothing , and even shelter ; connect them with social services ; facilitate their relationships with family members ; provide transportation ; and visit and advocate for them if they become hospitalized . Like his fellow CHWs , Thigpen , 42 , knows all about the challenges of re-entry . In his 20s , he served eight years in federal prison .
The holistic approach to health care that the CHWs make possible is at the heart of the clinic ’ s mission . Over the past two decades , physicians and public health experts have come to understand the importance of the social determinants of health — the conditions under which we live , learn , work , play , and age — as well as the structural ones — the often racist economic and social policies that perpetuate inequity . Indeed , research shows that 60 percent of our health is affected by these determinants .
Many justice-involved individuals are doubly affected by these facts : not only is engagement with the criminal legal system often a result of social determinants of health , it is also a cause of poorer health outcomes . The Center for Primary Care reports that 40 percent of its patients have a history of incarceration , and 46 percent have a family member with a history of incarceration .
Sarah Martino , deputy director of the Center for Health and Justice Transformation at The Miriam Hospital , knew of the Transitions Clinic model ( there is a national network of them ) and had been trying to start one in Rhode Island . Working with colleagues , she obtained a seed grant to plan the clinic in 2016 . Eventually , through a combination of funding sources , including a contract with the Rhode Island Department of Corrections , they were able to cover the salaries of a medical discharge planner and community health workers . Lifespan gave them a home in the CPC , and the Division of General Internal Medicine granted the physicians ’ time .
Then , Martino says , “ the world just gifted me Rahul .”
THE MOMENT OF RELEASE
Rahul Vanjani , MD , an assistant professor of medicine , joined the Medical School faculty after working at the Rikers Island jail complex in New York City and San Quentin State Prison in California . To him , the carceral system has been the “ missing piece ” in the biomedical community ’ s growing interest in addressing social determinants of health . Prisoners suffer from chronic and communicable diseases , mental illness , and substance use disorders at higher rates than those
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