Quality improvement fund - justice involved - mariposa community health center (MCHC) is the only health center in santa cruz county, arizona, serving over half of county residents (>26,000)

Santa cruz county is a rural county located along the U.S. Border with mexico. The population is predominately hispanic/latino (83%) and 78% of households speak spanish. Approximately 20% of the population lives in poverty, and 14% has no health care coverage. The santa cruz county sheriff's office oversees the adult detention center which has the capacity to hold 372 individuals. Due to the proximity to the border, the area experiences high drug trafficking related crime and apprehension. A majority of incarcerated individuals are faced with a substance use disorder (SUD). Many are hispanic, spanish-speaking individuals with low educational attainment. The detention center contracts with a private healthcare organization to provide primary and behavioral health care services. For individuals with complex behavioral health needs soon to be released, the jail medical provider care coordinator contacts community agencies for support such as for emergency shelter, rehabilitation, or other mental health services. However, this is on a case-by-case basis with no consistent process to identify needs and connect people to reentry services. A more comprehensive system is needed to coordinate access to medical, behavioral, and social services, so that these individuals may reenter the community with a greater opportunity for improved health and social outcomes. To address the needs of individuals soon to be released from incarceration, mariposa will pilot and evaluate innovative strategies that will support individuals' reentry to the community by facilitating access to high quality primary and behavioral health care, as well as to critical health related social services. Through a trauma-informed approach, and in partnership with the adult detention center, a community health outreach worker (CHW) within mariposa's department of community health services will initiate comprehensive reentry planning for incarcerated individuals that will address medical, mental health, substance abuse, housing, employment, and other social needs. This planning process will ensure continuity of care for medical and behavioral health services provided at mariposa, as well as referrals and warm hand offs to outside service providers. The CHW will assist with coordinating appointments, transportation, and address barriers to ensure access to health care. Case management services will include assisting individuals enroll in, and access benefits such as medicaid, medicare, social security, disability, snap, and WIC services. Assistance and referrals will also be made for educational and workforce opportunities. Mariposa is the lead partner for the local santa cruz county overcoming addiction consortium (SOSA) which was initiated in 2019 to address the opioid crises locally. The consortium is comprised of primary and behavioral health care providers, the local shelter, the hospital, law enforcement, the courts, K-12 schools, and the local community college. Recently, a SOSA lived experience committee was formed to provide guidance and feedback to the consortium with regards to the needs of people affected by SUD. The committee represents a wide range of lived experiences including persons who have been incarcerated, who use or have used drugs, who are in recovery, who have received mat services, lgbtq individuals, and persons who are, or have experienced, homelessness. SOSA and the lived experience committee will be key partners in the implementation of this project. Overall, mariposa's reentry support program will strengthen existing partnerships with law enforcement, detention, and the courts to inform and promote the availability of its services, and to promote awareness among individuals soon to be released from jail about services including health education and peer support.