A pilot program in New Haven is testing whether providing formerly incarcerated people direct cash assistance results in better health outcomes. Researchers say it’s one of the first interventions for this demographic in the U.S. looking into health impacts.
Within walking distance of the program office on Temple Street, Verneisha Snow, a participant, is searching for the sunniest patch of grass on the New Haven Green. When she finds it, she squats right down and looks up at the almost cloudless sky. She’s thankful, she says, to be back from prison.
“Luckily, I didn't get to do too much time, but I am a woman with a record,” she says. “A lot of us have records, but we want to do better in life. And we're not often given those opportunities. If people look [at] what the past says about us, then they try to jump to conclusions. They try to make us like the bottom of the barrel. I think we should allow people to grow, we should allow people to change.”
Snow is lean and graceful, with braids that frame a chiseled face accentuated by a nose pin. She catches me looking at a dark patch on her cheek — a birthmark perhaps?
“It’s self-mutilation, every single day since sixth grade,” she says, gently touching her scar.
She talks about when her immigrant Dad was deported to Jamaica, and shrugs aside any offer of sympathy. “It’s life,” she says.
Even though her single mom had a job in computer tech support, it wasn’t enough to raise four kids and pay Fairfield County rent. So they moved from Bridgeport to New Haven.
Snow says she survived “sex abuse, the bullying that I used to go through, a lot of deaths, a lot of killings where I am. My mom did a good job at raising respectable kids, so I was able to stay out of trouble. But we were still surrounded — I mean it's like any other inner city — with violence and with, you know, issues. As a woman like myself [Black, gay, inner city], I just always feel kicked down, and I love the world so much. So the days where the world doesn't feel like it loves me back, I take it kind of hard.”
Now 28 years old, she says she’s finally done with dermatillomania — that’s the name for her mental health condition, she recently learned from a doctor at a free clinic.
And it’s not the only thing she’s left behind just this past summer.
“I'm somebody who had substance abuse issues going through all the traumas and stress that I went through, not looking for an excuse,” she says. “I did what I had to do to move over that. So my drug of choice was prescription meds. I was spending nearly $200 a day on these things.”
That too is now behind her, she says.
Snow ended up in the pilot study that gives direct cash assistance to recently incarcerated people in New Haven and Bridgeport, run by the SEICHE Center for Health and Justice, a joint venture between the Yale School of Medicine and Yale Law School.
SEICHE is headed by Dr. Emily Wang, a primary care physician providing health care for the recently incarcerated, and a MacArthur Genius Grant recipient.
Wang says her years as a primary care doctor taking care of people living in deep poverty showed her that health solutions should center around, “What would make a difference? What are the things that we would need to bring to bear so that health outcomes improve once people come home?”
Soon after incarceration, Wang’s research shows, people are at a high risk of hospitalization, a higher risk of cancer mortality, and at high risk of dying.
Dr. Benjamin Howell — also a primary care physician at SEICHE treating people reentering society from prison — is heading the pilot comprising 30 participants with health needs that are, what Howell says, “normal” in this demographic. Conditions range from hypertension and diabetes to chronic obstructive pulmonary disease (COPD), and asthma.
Snow has both asthma and COPD.
The pilot program
Howell says that when Medicaid was expanded in Connecticut, doctors expected to see more primary care utilization and fewer emergency department visits among formerly incarcerated people. But they didn't.
The reason for that, Howell says, is that Medicaid addresses some of the needs, but it doesn't address all the needs of this population.
“It absolutely doesn't address the social and material needs,” he says. “But also it doesn't address the behaviors around how you engage with health care, whether you follow up with the primary care doctor, and how you fit that into your schedule.”
The participants reported an average annual income of $7,500. Twelve reported having no monthly income at all.
“We know that sort of inability to meet your material needs, put a roof over your head, put food on your table are going to have long-standing impacts on your health,” Howell says. “And there’s an opportunity to actually directly intervene on that and we’re hopeful that this type of intervention can really remediate some of those needs.”
The intervention, launched in August, consists of $500 every month for six months, offered to each participant — no strings attached.
“For health outcomes, we will be measuring things like engagement with primary care, use of emergency departments, and hospitalizations in addition to measures of blood pressure, diabetes, and cholesterol management,” Howell says. “We will also assess perceived stress and cognitive effects, like short and long-term planning.”
“As this is a pilot, I think the best we will be able to show is the potential for this type of intervention,” he says. “We hope to use this data to propose a more rigorous, larger evaluation in the near future that can more definitively determine the impact of this type of program.”
SEICHE’s funding for the program comes from private philanthropy via a nonprofit called 4-CT.
Sarah Blanton, CEO at 4-CT, says they’re seeing early qualitative benefits in the Elm City Reentry Pilot. Mental health is a key indicator that researchers are measuring.
Blanton checks in every three months since the program launched in March, inviting participants to share outcomes.
She pulls up her phone and shows a text from one of them.
“I can’t wait to share my progress and positive insights,” Blanton reads. “And then he proceeded to send me photos of him at his new job at Yale New Haven Hospital, and he is also taking night classes at community college.”
Snow’s been using her money to rent a music studio.
Her Spotify page has close to 60,000 monthly listeners and four years ago, the New Haven Independent wrote that the city “has birthed a once-in-a-generation talent in Snowsa,” her rap name.
In Paradise, as with much of her songs, her love for Elm City and the places she grew up shines bright.
Now, Snowsa says she’s in her studio making music every single day.
It's an inviting space with a couch piled with cozy throws, three pet lizards and a frog, and of course, a sound-proof booth with recording equipment.
“It’s really good for my mental health,” she says. “Like it keeps me out of a lot of trouble; doing the right things. And it keeps me going forward.”
Life, she says, is getting back on track.
“I got a scholarship to the University of Bridgeport for people who were formerly incarcerated,’ she says. “Growing up, I never knew I was a smart person. I always thought I was really dumb. I would tell myself that because it's a mindset game, you know.”
She’s enrolled in the university’s undergrad business program and hopes to start her own business one day.
But for now, Snowsa says she’s found a sense of wellbeing.
“I’m very proud of myself,” she says, tearing up. “And I don’t hear that a lot, you know, but I’m proud of myself.”
