The Road After Prison: Care, Recovery and Safer Communities with Michael Chaple Pt.2
In this second episode, Professor Goodman Sibeko is joined by Michael Chaple to explore the critical first weeks after release and what continuity of care looks like in practice. Michael discusses the challenges people face when returning to the community, including securing housing, healthcare, medication, identification, employment, transport, and social support.
The conversation looks at what distinguishes a genuine warm handover from a referral that exists only on paper, and why coordination between correctional and community providers is essential. Michael also explores the role of stable housing, employment, family support, peer support, and recovery communities in successful reintegration, as well as practical approaches for maintaining continuity of care in settings with limited resources.
Featured Voices
Host – A/Prof. Goodman Sibeko
ISSUP Global Scientific Advisor.
Head of Addiction Psychiatry, University of Cape Town.
LinkedIn: goodmansibeko
Twitter/X: @profgsibeko
Guest – Michael Chaple
Michael Chaple is an internationally recognised expert in correctional behavioural health, implementation science and justice-health systems integration. His work has focused on strengthening substance use and mental health services in correctional settings and improving continuity of care as people return to the community. Learn More>>
Time Stamps
Professor Goodman Sibeko (00:00)
Hello and welcome back to The Road After Prison, Care, Recovery and Safer Communities with Michael Chaple. The first weeks after release can be a period of exceptional vulnerability. A person may be trying to maintain treatment while also securing medication, identification, housing, income, transport, and trusted support. In this episode, we examine what continuity of care really looks like in practice, why relationships between correctional and community services really matter and what can be achieved still where formal treatment resources are limited. Michael, welcome back. Thank you so much for joining us again.
Michael Chaple (00:37)
Thanks for having me, Goodman.
Professor Goodman Sibeko (00:39)
Let's begin with why this transition period is so critical. Why is it that these first few days and weeks after we are such a critical period?
Michael Chaple (00:47)
Yeah, that's a good question. It has been emphasized that the highest concentration of rearrests or technical violations on parole or probation occur immediately upon re-entry, typically due to the acute instability. You talked in your introduction about all the different things people are contending with. Over two-thirds of individuals struggle with relapse into alcohol or drug use within the initial 30 days if support is absent.
Individuals face a drug overdose risk, which is something you'll hear about often, that is substantially higher than the general population, with the problem being that as drug tolerance drops during incarceration, it makes old doses lethal upon release if they just return to what they knew. Chronic illnesses can go untreated without immediate access to medical care. Socioeconomic pressures associated with finding housing or employment, which can be especially difficult with a criminal record, heavily influence early reinvolvement and criminal behavior. Social isolation can be a real problem, and it can occur as ties to family and community are strained and broken. So early access to these supportive services will help set the tone for longer-term recovery, but absent that, the pressure is just significant, as you can imagine.
Professor Goodman Sibeko (01:59)
It's a higher sense of really being thrown to the wolves, isn't it? And so, keeping that in mind, what then does effective continuity of care look like from the perspective of somebody who's leaving custody?
Michael Chaple (02:11)
Effective continuity of care upon release requires addressing all of the potential needs that an individual presents. And I made mention of these in the last, you know, in the last segment, but really, like, we have to look at it from the point of what are the foundational things that they need? ID cards, birth certificates, social security cards, things that they need to access housing, for example, or employment. Without those, they're not even going to be considered.
They need housing, they need stable housing, transportation, health and behavioral health care. So all those things are critical. We have to run the gamut of that. A comprehensive, I'll say the word assessment. It really depends how you operate. But there's importance around insurance activation and Medicaid here in the United States, right? There are waivers available now where you can get Medicaid activated prior to release. That used to not be the case. Medication continuities specifically, right, whether it's for chronic illness, HIV/AIDS, psychiatric care, medications for opioid or alcohol use, those are some immediate needs. And then the referrals to community mental health or substance use treatment providers. So those are like the behavioral health needs on top of all the fundamental needs that need to be met at the point of release for solid continuity of care.
Professor Goodman Sibeko (03:23)
And so, you know, one can speak about a warm handover. You know, we alluded to releasing somebody to the wolves, and now we're talking about all of these really important personal and structural considerations. So in assisting these individuals, what really would you say distinguishes a warm handover from a referral that exists only on paper?
Michael Chaple (03:43)
Yeah, I mean, this is something all of us can relate to. You go to your doctor and you're given a referral to a specialist. Are you given it on a piece of paper where you can't even read your doctor's handwriting and they tell you to call this person and you don't know who they are? And when you call them, they don't know who you are and they ask you who referred you and you go through this mess versus actually being introduced to the provider, right, in a number of ways. And so the opportunity to connect with a health provider prior to release makes the individual feel safe, supported, builds trust, it increases the likelihood that they'll follow through with the referral upon release.
There are plenty of opportunities for community-based treatment providers to do inreach, to go into the facility prior to release, to do assessments, to identify needs, and to introduce themselves to these individuals. They not only build interpersonal connection between the individual and the provider, but can also help to troubleshoot logistical barriers to care upon release, other issues with transportation, competing demands of child care, employment, correction supervision, and that immediate connection to treatment can help to prevent relapse by keeping people engaged and reduce the risk of overdose. This added stability should have a positive impact on successful re-entry.
Professor Goodman Sibeko (04:57)
So, you know, Michael, in addition to this idea, because I think what we're really talking about here is a therapeutic alliance, is creating a space of trust and a space that the individual can rely on to be in their corner. So in addition to this idea, how important would you say are uninterrupted medication, behavioral healthcare, and I think importantly, clear communication between providers as well? And how can that be facilitated?
Michael Chaple (05:24)
Coordination among providers is critical. When you're thinking about re-entry, there are a lot of stakeholders involved. There are a lot of different community-based providers that need to contribute to the process. We talked about all the different domains, right? Housing, employment, justice, treatment. And if you think about that, they're all serving one individual. And to the extent that they're communicating at the least, coordinating to a greater degree, and maybe even if they're lucky, collaborating on the intervention, there's a greater chance for success.
Even if we just think about the relationship, for example, between treatment providers and criminal justice professionals. If we think about being on parole, for example, and having to be in treatment and having a return to use and how that's viewed in parole versus how it's viewed as part of the recovery process and treatment. There needs to be coordination so that everybody's not operating in their own silos and everybody can understand the context of what's happening, when it's happening, and why it's happening. And it goes so much deeper than that. But if you think about even just the sheer challenge of navigating all these resources, if there's no coordination or collaboration amongst providers while you're trying to navigate those resources, they're just gonna send you in circles and drive you right back to where you started.
So it's absolutely critical.
Professor Goodman Sibeko (06:42)
Yeah. So would you argue that this, in order for this to be, you know, successful, you know, you could argue that the providers need to be similarly invested in the outcome of a fully supported, assisted, rehabilitated individual in all spheres?
Michael Chaple (06:58)
Yes, absolutely. I mean, most of the work that we do when we work on re-entry initiatives in communities is getting these providers to the table, getting buy-in from folks maybe who haven't historically been at the table, for example, like a housing authority or something like that. Like, it gets, we're talking about the nuances, you know, of stakeholders in society and getting them all to the table, getting them to buy in, if not equally, you know, to a sufficient extent.
And getting them to understand what the mutual benefits are, you know, for one another to participate and how it benefits the individual and society, you know, in the greater society.
Professor Goodman Sibeko (07:33)
So, Michael, we've, I think we've already alluded to some of these conditions that, you know, influence how someone, you know, what the course of their life looks like post-release. But specifically, because we're focused on recovery, so beyond clinical treatment, are there any specific practical or social conditions which you're aware of that most influence successful reintegration?
Michael Chaple (07:56)
So many have argued, and I can say that I disagree that secure and stable housing is the most critical factor upon release. You know, traditional treatment-first models have required people to graduate through temporary housing and then meet sobriety rules, strict sobriety rules, before earning more permanent housing solutions. And this can be a significant barrier to long-term stability as recovery is a process that doesn't always entail abstinence or sobriety.
So, in the event of return to use, housing supports can be revoked, which can create barriers to recovery. So, in contrast, there's a housing-first model, which many people may have heard of, it's low-barrier access to permanent housing. So it does not require them to prove that they are sober or in treatment. And this is based on the belief that it's easier to address health and personal goals from a safe, stable place to live, right? It makes sense.
So that's one thing I'd like to emphasize. Also, employment obviously is critical to the ability to live independently as it relates to housing. Some options may initially be subsidized to support individuals in the re-entry period. But longer term, they must have the ability to afford their living space. Similarly, employment offers the financial stability necessary to meet basic survival needs for the individuals and sometimes the families they're supporting. Beyond that, employment that is meaningful supports a pro-social routine and contributes to personal growth by helping to build self-esteem, self-efficacy, and a connection to their community. So it's really critical. People need to feel a purpose.
And then of course, family support and social connection are critical. First, family and friends can help support basic needs, right? Could help provide options regarding housing, food, clothing, transportation, childcare, etc. But they also provide critical emotional support and a sense of psychological safety, right, that help builds resilience. But of course, this is, you know, largely dependent on the nature of prior relationships. Some families and those relationships are problematic. But the point is that there are these many other domains, if you will, that need to be addressed if we think about, you know, beyond treatment, that need to be taken care of for the individual to really have any shot at success. So it's a lot of work to do.
Another thing to consider is that when we think about the model for re-entry planning, and we talked about the importance of, you know, planning in advance, is that there needs to be some, you know, dedicated responsibilities given within these facilities in terms of re-entry case management, re-entry planning. We've seen that come in a various amount of ways. Sometimes the investment by the prison, the jail is not significant. But if you're starting earlier and you're identifying these needs and you're working forward, you know, you really have to be able to assign those roles and responsibilities to someone that's going to carry them through on a routine basis for the sake of organization.
Another way that I've seen it go about is when you have specific needs in terms of re-entry planning, like let's say behavioral health assessment, you might reach out to community partners, arrange for them to come in and do some of that work, reach in, right? What we call often reach in, where they can come in and do some of that work and contribute. And they may not even want to get paid for it. They may just do it for the referrals, right? There's a little something for them to gain. So you could also collaborate with your community partners to come into the facility and assist with re-entry planning with a dedicated staff member who coordinates all that and oversees the process from, you know, at least a thirty-thousand-foot view. So that's something else to consider.
Professor Goodman Sibeko (11:18)
Really an important consideration for sustainability and scalability, isn't it?
Michael Chaple (11:22)
Yes, yes. I mean, it has to be. It's a significant role and it can't just be, you know, it can't just be a minor investment. You have to understand that there needs to be stability with this role.
Professor Goodman Sibeko (11:34)
And, you know, really when you think about those family relationships and that social connectivity, these are folks who might have been affected negatively by some of the experience or who might in fact have contributed to how the person developed and then ended up, you know, with that sort of behavior. With that in mind, what sort of distinctive contribution would you say peer support and recovery communities can make in this context?
Michael Chaple (11:58)
Yeah, peer support is crucial and it's growing. The recognition of its importance is growing. I think there's a lot of work to be done to understand how to effectively apply and utilize it. But in theory, it plays a crucial role in re-entry, both in terms of the value of lived experience as it pertains to recovery from substance use and/or mental health, right? Behavioral health recovery, but also lived experience with legal system involvement.
And we're increasingly seeing an emergence in something that we call, or some people here call, forensic peers, meaning that they're peers who have lived experience in the legal system. Peers are viewed as credible messengers that help to enhance engagement, right? It's relating to somebody who's been through something that you've been through. They help to enhance engagement, navigate practical needs, such as the complex requirements for parole and treatment services. They link to resources.
So they sort of sometimes have a loose case management function like housing and jobs. They assist with coping strategies. They do a lot of different things. The relatable guidance provided by peers really helps to reduce the sense of isolation and build hope towards recovery. You've been where I am and look at where you are now. And whether it's treatment, whether it's legal system involvement, whether it's both, peers have been increasingly recognized as critical to the effort, not only for the roles they play, just for what they represent in the process.
Professor Goodman Sibeko (13:18)
It sounds, Michael, to me like we're really talking that the general theme is a theme of creating access to belonging, isn't it? All across from services and to social belonging and ability to contribute and function. Now, a lot of settings might be working with limited resources, you know, and so many countries and communities will have limited treatment capacity. We already know that already the mental health field is already, you know, has a scourge of reduced resources. So where should practitioners begin with an ideal continuum of care where there's restrictions?
Michael Chaple (13:51)
Yeah. Yeah. So I mean, I often hear this question here in the United States as it pertains to, for example, rural areas compared to urban areas, right? We have fewer resources, just as a point of comparison. You know, the simple answer is always just do the best that you can with what you have, right? You can't create models that you can't fund that include services that you don't have access to.
Right. You have to do the best with what you have and be able to do a comprehensive assessment of that and figure out how you can best piece it together. But being more specific, resource-limited communities need to be creative in prioritizing and assigning tasks. Right. Knowing that you might have access to certain specialty care resources, you can shift tasks to other community health workers and things like that. This can save money, reduce wait times, build trust.
Telehealth technology in certain areas has been a big difference maker. Obviously, infrastructure matters where you are. Do you have that kind of infrastructure? But using telehealth to bring treatment to the individual through remote counseling, medication management has greatly improved access to care in resource-challenged areas.
Increased coordination with primary care could be critical, right? If you don't have behavioral health, most areas do have primary care. And so figuring out how you can leverage primary care, who will differ in terms of their preparedness to deal with substance use, but at least making that assessment and having that conversation. This might include something like training a primary care provider to offer basic buprenorphine treatment, embedding peer recovery coaches in local emergency rooms and clinics to make connections and drive referrals, right?
And then also increasing outreach efforts is an effective way to engage individuals. Now outreach can cost money, it depends on how you do it. But sometimes in resource-starved areas, it's better to go to them than expect them to come to you. And so this includes deploying mobile health units as a primary way of engaging patients, partnering with community centers, distributing harm reduction supplies.
And then you also might also have to think about operational adjustments, right? For example, dispensing larger supplies of medications to reduce clinic visits, conduct group sessions rather than individual sessions, implement more flexible scheduling, so on and so forth. So rather than get into the weeds, there are changes that can be made, but again, you can't create a program that you can't create.
Professor Goodman Sibeko (16:17)
That's fantastic, Michael. So you've really helped us think through some of the structural, individual, intersectoral considerations that need to be in place to enable recovery from incarceration to post-release. So thank you so much for that, Michael. You've shown us that continuity is not simply a referral made before release. It's a coordinated bridge that's built through relationships, practical preparation, medication and treatment continuity, and support for really the realities of daily life.
And in the next episode, episode three, we'll widen the lens from the individual transition plans to the systems around them. And we'll explore fragmentation, cross-section, cross-sector partnerships, implementation science, and how jurisdictions need to strengthen coordination without necessarily continually adding disconnected programs. Join us for that.
Thank you for spending this time with us. We hope you enjoy that as much as we do. Be sure to hop on over to our website, isop.net, where you'll find information on how to sign up for free membership. Take care and catch you on the next one.
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The ISSUP Exchange podcast series explores the evolution of responses to the challenges of substance use—from research and training to ethics, quality standards and evidence-based practice. We connect the dots so you can see the big picture.
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