A: You’re not alone - many facilities face challenges maintaining communication with community-based treatment providers. Continuity of care is critical for reducing relapse and recidivism, but it often requires proactive coordination. Here are some strategies that have worked for other RSAT programs.
1. Establish formal partnerships or MOUs
Some jails and prisons create formal agreements with local treatment providers, outlining roles and responsibilities for pre-release planning and post-release engagement. These agreements can include protocols for sharing information (within HIPAA limits), coordinating medication access, and warm hand-offs.
2. Use dedicated reentry or discharge planning staff
Having a staff member—often a counselor, case manager, or reentry specialist—responsible for discharge planning can improve follow-through. This person can schedule appointments, secure transportation, and communicate directly with community providers in advance of release.
3. Invite providers into the facility
When possible, bring community treatment providers into the RSAT program to meet participants before release. This helps build rapport and trust, increases the chance that the participant will follow through with care, and gives providers a better understanding of the RSAT population.
4. Create participant “release packets”
These packets often include copies of assessments, treatment summaries, medication lists, and provider referrals. They help participants advocate for themselves and support community providers in continuing care without needing to start from scratch.
5. Use peer support or recovery coaches
Some RSAT programs partner with peer support organizations to provide navigation services or recovery coaching during and after incarceration. Peers can help participants attend initial appointments, stay engaged, and access recovery support in the community.
If you haven’t already, check out the Promising Practices Guidelines for RSAT Programs on the RSAT-TTA website. The guidelines include a section on continuity of care, with examples from jails and prisons that have successfully implemented these practices.
You can also reach out to the RSAT-TTA team directly if you’d like help identifying community resources, developing local partnerships, or designing a reentry protocol that works within your facility’s capacity.