Harm Reduction in the Context of Interactions with Law Enforcement - Part 1

At the Core of Care

Published: January 22, 2024

SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families, and communities.

I'm Sarah Hexem Hubbard with the Pennsylvania Action Coalition and the Executive Director of the National Nurse-Led Care Consortium. As part of a special collaboration with the Obscured Journalism Initiative we recently hosted a panel discussion to explore law enforcement interactions with the community and how to implement a harm reduction care model. We’re excited to share the panel discussion with you. Our partners at Obscured have put this podcast episode together featuring Part 1 of the discussion.

EMILY: This is Obscured the podcast from Kouvenda Media about critical issues that don't get much attention because they're complex, overshadowed, and unfold largely out of the public eye. On this limited series, From Words to Weapons, we’re focused on survivors of law enforcement trauma. I’m Emly Previti.

STEPHANIE: And I’m Stephanie Marudas. This is part 1 of a panel discussion about harm reduction in the context of interaction with law enforcement and solutions that could promote community well-being and mitigate trust. 

We partnered with the National Nurse-Led Care Consortium and the Pennsylvania Action Coalition to hold the discussion with support from the Independence Public Media Foundation. 

On this episode part one, we're going to hear presentations from each of the panelists.

EMILY:  And then on part two will hear a moderated question-and-answer discussion between the panelists.

The first presentation we’ll hear is from Talitha Smith. Talitha is a nurse navigator with RIvER, which stands for Rethinking Incarceration and Empowering Recovery. It’s a clinic within the Allegheny Health Network’s Center for Inclusion Health, the same clinic we heard about in episode 8 of our series with Talitha’s colleague, Divea Bn. We recommend you check out that episode if you haven't already. 

STEPHANIE: Talitha has long-time experience working with marginalized populations and found her passion in community health after becoming a nurse as a second career. In her work, Talitha actively promotes harm reduction and conducts related education. She also advocates for access to comprehensive quality healthcare for all. In addition to her work at the RIvER clinic, Talitha is an adjunct professor at Carlow University and works as a local travel nurse.

TALITHA: Hello everyone. Good morning my name is Talitha Smith and I arrived here from Pittsburgh, PA. Got to be like, “Go Steelers”. Got to do that shout out so going first is intimidating but I hope I, “understood the assignment” as they say. If not, this is my interpretation, my life and work as I see it. It's my hope I can leave you with valuable knowledge, questions to consider, and goals to work towards. So currently I am a nurse navigator at Allegheny Health Network. I work under the non-profit arm, the Center for Inclusion Health (CIH) directly for the RIvER Clinic. AHN is one of two large health systems in Pittsburgh but AHN is special, not just because I work there but because of the CIH. CIH has services not offered by other health providers and in particular RIvER Clinic. I really don't know if there's another place like us across the country. RIvER stands for rethinking incarceration and empowering recovery. But before I get more into the RIvER I just want to give you a little overview of CIH and if you like more information you can go to AHN.org and search “Center for Inclusion Health”. 

CIH was formed in 2014 as one of the nation's first comprehensive programs of its kind focused on meeting healthcare needs of individuals in underserved or marginalized populations and to reduce costs.The programs are delivered in several ways so we have Crisis Center North which is a partnership and we assist people who are experiencing intimate partner violence with counseling and resources. The Center for Recovery Medicine helps with substance abuse treatment for patients and families. We have homeless healthcare and they provide health care on the streets, in hospitals, shelters, just about anywhere where people have unstable living conditions and we call that “people who sleep rough”. 

The Positive Health Clinic does HIV testing and comprehensive care for people affected by HIV. We also have a mobile unit which goes out and does HIV and Hep C testing. Food insecurity we have a few food banks in different areas and we give out free healthy foods and free nutrition counseling. There is immigrant and refugee division to help people from different cultures to receive care they can understand, no matter what language they speak and this even has families who would like to participate in that. 

And we do transgender healthcare and there's a range of research-backed medical and surgical services to people who are transgender, non-binary, or gender diverse. And lastly, perinatal hope and that provides a safe space for pregnant and postpartum women who have substance use disorder.

So now let's talk about RIvER, my passion. Like I said it's one of a kind in our region and as far as I know probably the country. Our programming is aimed at rapidly, effectively, and compassionately meeting the health needs of individuals following release from incarceration as well as connecting them with social support that can help them get a better fresh start. Our patients receive care regardless of their ability to pay immediately following discharge from jail and when I say immediately I truly mean that. On any given Tuesday you can find myself and my team outside of the jail but soon as the releases come out I'm asking, “Do you have a PCP? Do you have any substance use issues?” and I'm making appointments and setting them up to come to our clinic. 

The reason that this is important is that former present inmates are at a high risk for death after release. Their 12.7 more times likely to die than the average population especially in that first two weeks. The leading causes were drug overdose, cardiovascular disease, homicide, and suicide. 

So how did this all get started? My boss was resident and she did part of that in the jail and she saw how poor the healthcare was. So she teamed up with another internal medicine doctor and they decided they wanted to do something about the statistics. So I'm thankful that AGH also recognized the need because they provide the funding for my clinic. And AGH is also the provider now for the jail. We had a lot of people die at our jail just from basic healthcare needs. You know and a lot of people go in and go through withdrawal with no comfort medicines. So it was really kind of brutal. 

So following getting discharged from the jail, a lot of people lack adequate assistance with assessing and coordinating healthcare and other social services. You know they might not have been taking care of their health before they went to jail and they face challenges advocating for their health needs. The RIvER Clinic seeks to close this gap between incarceration and reentry into normal life. 

So there are a few terms that are big for me and during this presentation, the gap is the first one because that's what I stand in for my patients and their families. While we provide healthcare, we're standing in the gap, my team. So I see this as a religious term but I can't…I think it's perfect for people who are dealing with recovery. People who suffer from use disorders often alienate their families and their families are like, “I'm done with the shenanigans”. And so sometimes you know it takes an outside person to still be there. 

Yesterday, I added this because I visited my nieces in New York and their father suffers from use disorder. And he was like, “Yeah I'm getting out of jail. I'm gonna come work at your restaurant and focus on my sobriety” but he hasn't showed up. 

He hasn't made the actual plans and my nieces were joking like, “Yeah I'm going to tell them to get dressed. I'm going to come down to Pittsburgh and get them, then I'm not going to show up for three days”. You know, ha ha. You know, that's funny, but it's trauma-based funny, right? So I just know that I was like, “Yeah, girls, this is what I do at work when people can't take it anymore cuz their family members are a mess, I'm right here you know dealing with that mess till they can get theirselves together”. 

So individuals most commonly engage in primary care with us. They have a lot of medical comorbidities, substance use disorder, and we see a lot of hepatitis C and women health issues. 99.9% of the people we serve connect, need to connect with mental health services even if a few times. Even if they don't have a diagnosis. If you use drugs you're going to have some posttraumatic stress. They need to learn to deal with their addictive behaviors and just everyday life sober. We often push to get off drugs, but those drugs have sometimes been masking a lot of pain and hurt and it's heavy once you stop using. So what do you do with that? But like I said I'll be looking for my brother-in-law once I get back to Pittsburgh so he can reconnect with my nieces in a positive manner when he's ready. 

So what does RIvER’s work look like in action? On a daily basis our team is out and about working directly in high incarceration areas. We have two physicians, a community health worker, a health coach, a peer recovery specialist, a social worker, and myself. On Mondays, we have a clinic at a homeless shelter right down from the jail. Tuesdays, like I said we're outside the jail doing follow-up from clinic. 

Wednesdays, we go to a community food kitchen and we sit there, we give out safe smoking kits, wound care kits, toiletries, Narcan, fentanyl and xylazine test strips, condoms, dental dams, lubrication, anything you could think of alcohol wipes, I'm giving out harm reduction. 

Thursday, we go to Roots, which is an outreach center where people could just walk in. They sleep hard, they can do needle exchange there. They get resources like free vet clinics for their pets and legal help and on Friday we have clinic all day. We provide PCP and MOUD. 

So a major part of the work we do includes harm reduction. As I mentioned we give out safe smoking kits, we even created a safe snorting kit. And I can't tell you how grateful my patients were for these things. 

Like you know people's like, “What is this?” and I'm like, “Oh that plastic piece? That's so you put it on the pipe so you don't burn your lips. So you don't share the same pipe with somebody else. So you don't get herpes”. And I can see their brain like, “Y’all really made these kits, liike y’all really giving out chore”. Yes, we are. So those small things, I can see in my patients, they made, they felt like we cared about them, because we do. 

And you know some people would say, “Oh you're helping people smoke crack” but I'm not and I would never. What it comes down to is perception, in my opinion. And so I have to work to change the perception of my patients, communities, law enforcement so that we can see people's humanity and see the importance of harm reduction to preserve health for when they may be ready to begin recovery from addiction. 

So I have a question for everybody just to think about. Now if I ask for a volunteer today to come here like, “Meet me outside and I want you to meet me outside in your underwear”. Everybody would be like, “Oh she's crazy, ain’t nobody going outside in their underwear”. I know it’s cold, so let’s just say it’s 80 degrees would that change your mind? No? Okay, nobody's going outside in their underwear but if I said, “Hey meet me outside. I'm going to take you on vacation we're going to the beach”. Eventually, I'm going to have you outside in your underwear, right? Because you going to be in a swimsuit. A swimsuit is nothing but underwear made out of swim material, right? So safe smoking kits are nothing but healthcare made out of love for humanity. 

My focus is to keep people whole and safe as possible for when they're ready and capable to make better choices. My first job as a community health nurse was at a Christian health center led by a pastor. We had Bible study, we prayed every morning, but guess what we also did? Reached out to the LGBTQIA+ population. 

Dr. Gloucester was big on servant leadership. I'll never forget one Bible study in particular. He said, “when Jesus healed people, he never asked them questions”. He didn't ask them, “what were you doing before this? Who was you hanging with? How did you get like this?” He met them where they were. And that was my start in community health. It wasn't my start in the nonprofit world, but it was my start to look at people without bias, which I thought I did before, but I didn't. 

So like I said, it wasn't my first rodeo at serving. I just learned to serve without bias there. And, working in the service field and knowing how to serve are two different things.

I think a lot of people get jobs, like where I live in non-profits, they're so big, a lot of people work there. You have to have an idea about yourself, who you want to become based on your likes, dislikes, and personality. But as I look back on my career, I've been helping people my whole life. And I remember I had wrote a speech, they asked me what's the most important thing in the world, and I did it on help, because no matter your standing in life, we all need help at some time with something.

And we often have cultural competence training at our jobs now, you learn like you can't give this person the same thing you give this person, right, because of their cultural background. Everybody can't get the same kind of help. Our help has to be culturally competent and drug addiction is a culture.

Um, I help people all over the United States and I've, I've seen, you know, we got a million different cultures and we have to just recognize that, you know, drug addiction is one of them. People's been using drugs since the beginning of time. So, I said all this to say that in my 20 years in the non-profit world, my dedication to mirror what would Jesus do, my life experiences combined, they all brought me to work at RIvER.

And about a month ago, a young man asked me why I did this work. I told him, well, as far as addiction, my auntie overdosed from heroin by herself on the side of the road when I was a toddler. After using heroin since she was about 14. And even though I was a baby when it happened, it still hurts me to this day.

You know, my family will say, “Oh, you look just like your auntie. Oh, you're so smart, like your auntie Willa Mae”. And I always fantasized about meeting her and being with her. And I just wonder, like, if they had Narcan back in the day, would she be alive? You know, if they were doing harm reduction back in the 70s, would somebody have told her, don't use alone when you get that good batch?

You know, maybe I could have got her on Suboxone, and she'd still be alive. You know, we would still have her. So. As far as jail, I've been going to the jail since I was a baby. My mom was taking me to go see my dad in jail. My daughter's father did 12 years. Um, my first love did a bit. My husband's a felon.

And I've been to jail. And I was thinking, like, what was I going to share today? Because I don't talk about that a lot. But I figured today would be good to share it. 

So, that day when I got arrested, the officer pulled me over for a traffic violation, which we often see, right? And he, the system was down because there was a thunderstorm and he told me, “If you call somebody to come get you, I'll let you go home.” And sounds great, right? I didn't have anybody to call to come get me. My mom never had a driver’s license. I have a small family. My sister never had a driver's license. I didn't even know who to call.

So by this time, his partner comes and he's angry, you know, just comes off the rip angry like, “Oh, you're playing around. He was being nice to you. I'm going to take you to jail.” And I'm explaining to him, sir, like, I don't have nobody to call. I tried to call my friend. She didn't answer. Like, we were young. We didn't have money to have a car. And the crazy thing about that is, I went to jail, I called my mom. She got her friend's grandson to come get me or something. But guess where I also didn't have a ride to? College. I caught a Greyhound bus to college with a laundry bag of clothes. Because I didn't have anybody to take me.

So for that officer to think that he was giving me something, this great opportunity, he wasn't. Because if I didn't even have a ride to go better my life, how was I going to get a ride, you know, to get out of that situation? So, that just brings me to talk about empathy. You know, I don't even think that cop lived in the city. Did he know anybody like me? You know, could the first cop not continue to show empathy because the second cop was turned up? You know, those are the questions that swirl in my head when I think about that. But, you know, that's dangerous. Downright dangerous, because we've seen what can happen with just a simple traffic stop.

The four attributes of empathy are perspective taking, staying out of judgment, recognizing emotion in another person, and communicating the understanding of another person's emotion. I was definitely crying when I was getting arrested. I was embarrassed because I was too poor to take what seemed a simple way out.

When actually I just lacked the resources, but I just think if they lived in the community, they would have probably understood the resources were lacking. So you know, I know my work is hard. I know the police is. They have a hard job to do, and it's hard to remain free from bias. I have a patient now that's the same age as my daughter. She comes from a great family, and I just want to shake her and be like, “Get yourself together.” 

It's so easy for us to, if a person had a bad life, to say, “Oh, I can understand how they got on drugs, and maybe we'll be more empathetic.” But when I see this girl that came from this, well, I'm like, and I have to stop myself.

So I'm sure, you know, sometimes the police have to stop their self too. But um, you know, even Mother Teresa, when her letters came out, everybody was like, “Oh, she's the icon of giving care. And she was like, this stuff sucks.” So what are us normal, regular people going to do? You know, what can we expect from police officers?

But in addition to working at the RIvER Clinic, I work as a professor at Carlow University. And I just had an assignment for my students to identify a policy that would benefit the population they serve. So, as far as policy, like, I really promote police officers living in the communities that they serve.

Some of us are more naturally empathetic than others, but it is something that can be taught. We have, um, these special neurons in the front of our brain that click when we do an activity, and they also click when we see another person do that activity. So, there is training that can be done to teach people to be more empathetic.

And I'm like, you know, “Why wouldn't police officers want to be empathetic?” But sometimes they got to block it out. When you're always dealing with trauma, you know you can get burned out if anyone of us work in jobs that serve. So, you know, sometimes they have to block that out. But there's learning and there's training where you learn to look at things in a different perspective so you can block it out so it's not too much of a burden for you and you can still be empathetic.

And I don't know what training they get. I think they need it. I think people should volunteer, in different communities, read in fiction books, helps you look at people's lives from a different perspective. So, the best way to gain exposure is to be there. You know, I know there's recruitment problems with police, but an able body and a good worker are two different things. And how can we change how police view harm reduction? They, it has to be perceived as healthcare and critical to keeping people who use drugs alive and as healthy as possible.

We have to help everyone, police, other people, see those people as capable of being healthy. A lot of times when somebody's on drugs, people will say drug addict. They're not just a drug addict. They're a mother, a father, a doctor, a cousin. They're a ball of potential. I got seven personalities. My husband can tell you that. So, I know that people have all of these things inside of us, and if they choose to, when they recover, they are a prayer, answer, a testimony, a role model, a leader, a change maker, and more than any of us could probably even imagine. Thanks. 

EMILY:  Now we’re going to hear a presentation from Chad Bruckner. Chad is a retired police detective. He began his career in the U.S. Army, rising to the rank of staff sergeant and serving overseas.

STEPHANIE: After the military, Chad started a career in policing in Montgomery County, PA. He worked first as a patrol officer and was then promoted to the rank of a detective. He also served as a senior field training officer, a squad leader, an undercover officer, and a coordinator for the Montgomery County drug task force.

EMILY:  Chad retired from the police force in 2021. He now owns and oversees a private investigator firm and is a coach and recovery specialist. Chad reflects on his policing experience in his first book that came out recently, called, “The Holy Trinity of Successful and Healthy Police Organizations: Improving Leadership, Culture and Wellness.”

CHAD: Ooh, I got a ride on the coattails of that. It was awesome. Wow. Um, and thank you for sharing. It's hard. It's hard, still for me, to listen to people's experiences and stories because I think about my experience. I think about where I was as a police officer. I think about the experiences, the situations that we were in and did we do the job the way it should have been done? Or did we go a little heavy handed? Or were we not as empathetic as we could have been? And those are things I think about all day every day. I really do. So I'm pleased to be here with you. I'm Chad Bruckner. I'm representing the LEAP: Law Enforcement Action Partnership.

It's a criminal justice, reimagining reform movement. I'm really happy to be a part of it and give me one second. I'm still processing. Seriously. That was, uh, wow. That was like, That was awesome. Thank you. Empowering. Um, I was almost gonna cry thinking about it because when you talk about the empowerment of people that kind of hits me tremendously.

So, I spent 13 years in law enforcement, Montgomery County, Pennsylvania here. Previous to that, I was in the army for eight years and for 21 years, I served. Went in the army at 17 and for 21 years I served community, served our country, served people. And always as best as I could try to meet them where they're at.

Unfortunately, when you work in systems and organizations like that, you're ripe for getting shot with arrows in the back. And anybody that's ever done advocacy, I think, can attest to when you're sticking up for somebody or fighting for people. If that goes against the popular notion, you know, good luck.

So, but that's why we're here. That's where change is. So I'm happy to be a part of this.

Bear with me here.

Anyway, excuse me. This is a very raw topic for me. Very raw issue. I'm in recovery. And a lot of the stuff that Talitha said is stuff that I can relate to 100%. So bear with me as I just work to process some of the stuff she said. I think harm reduction is some of the most… We're missing the mark so much in law enforcement and the policing profession and societies in general.

I can't tell you how many situations I've been involved in where we use stigmas, biases and judgments to, not meet people where they're at, expect people to meet us where we're at. In that situation with your car and not having a license. And I just, I cringe, I grit my teeth when you're telling that story and it's, you know, what do you do to somebody that doesn't have the resources?

You know, I'm giving you this great opportunity. I'm not meeting you where you're at. I'm asking you to come to me. And, you know, what do you do to people that don't have these resources? It's a, it's a tough thing. And, so I come in  from a place of how can we make it better? How can we use harm reduction in the policing space as a performance coach is what I do now.

I'm a small business owner. I have two small companies. One's a private investigation firm and one I own a performance coaching company and I try to work with police officers, coaching them how to be resilient, how to be empowered, how to be more empathetic and come back from adversity and treat people with more respect and really focus on relationships and service.

And it is a challenge because that is really; we have drifted away from that into some respects, to some degree, we have drifted away from service. We have become very transactional. We used to be very relational. I share these stories as somebody that I led my agency into arrests. I was very proactive, led the community in arrests, created an undercover drug unit to, to target our open air drug market that we had at the time, was very successful. We made a lot of arrests. I'm very proud of that because it was rooted in service and keeping the community safe.

So living in this space, I think, to light this at the best of, there's good things and bad things and living right in the middle of it, which is what we're doing in our professions, in our community. It's challenging. And I think if we just understand that there are good things and bad things happening to us every single moment of our job and living in that middle space, filling the gap.

I love how you said that. That's incredible. So my experience, the last couple of years, has taken me left, right, up, down a long journey. And I’d like to share a little bit with you real quick. I was the guy that was making a lot of arrests, making a lot of great relationships, wanting to do the good job, really being noble, being virtuous, got promoted detective in four years, got my master's while I was taking one class at a time while I was being a detective, raising three kids at home. My wife.

Trying to be, you know, working towards being the next chief of police. That was my goal. There became an issue there at the agency I worked with, that merit stopped being something that we attach ourselves to. Service, selfless service. Selfless service was something that we stopped doing. And as a selfless oriented person who cares more about the community than myself, when I started to watch self serving behavior happen inside our own agency, it was such a moral injury to me. 

And I don't know if you guys ever heard that term, moral injury; I'm sure you have in health care and nursing, but it's rather new in my space from the police and military space of PTSD, a form of PTSD. And I think so many of us subconsciously have been exposed to situations. And I can explain mine where when I began to watch the system and organization, it's not just my agency, by the way, it was a policing profession. As I started to watch transactional relationships become more important in relation, to watch taskmaster skills become more important than service. 

There was a gentleman who got released for double homicide from prison. I remember meeting him for coffee. This is towards the end of my career, maybe 2020 during Covid in the height of 2020 or, um, 2019. He asked me to meet him in a coffee shop. Now he looked different than me, and he was a convicted felon and murder. That didn't matter to me. I didn't care about any of that. The guy asked to meet. Sure, you want to meet? You're asking for a meeting and have help? Sure, absolutely. The level of targeting and bullying I got from that, from just members of my own police, you know, hanging out with the enemy, you know, it was crazy.

And I just wrote a book actually three weeks ago, and what I say, and it's really apropos I think to this conversation is, I fought the enemy. I fought a real enemy. And these American citizens, our brothers and sisters, are not the enemy. So we got to figure out a way to get back to bringing our communities together to not give somebody anxiety, or some sort of shame, for not having the resources that wasn't her fault.

I'm sorry. I get a little passionate because this is really a serious topic. I think there's so many good Americans, so many good people living right here in this community, right in this country, that are getting marginalized and shifted upon because they don't fit a certain mold or they don't put in a certain box a certain way.

And it's not right. It's just not right. And I'm proud of all these organizations that are coming and doing this, because I think by connecting and by talking and by listening; I almost thought of excusing myself. At one point doing where you were saying, because I was just, I thought I was going to cry and I don't want to do that.

But I said, you know what, in my head, I got to sit here and listen to this. I got to look her in the eyes. I got to sit and listen to this because I got to learn too. So I'm learning every day and I appreciate that. So as a performance coach, I really advocate for empowerment and I'm doing this in the recovery space for police officers, which I think is really neat.

I actually put a section of my book about harm reduction because I think it is so important. I speak from the police experiences of myself. Um, I'm in recovery. And it's not just from alcohol, it's from mental and emotional health. That's how I describe it. I'm a certified recovery specialist here in Pennsylvania, so I can help people in recovery on the recovery journey as a CRS, as a performance coach, working with first responders and military and some athletes.

Now, I'm realizing that help probably more than anything, empowerment is the fundamental thing. We got to stop telling people, sorry, yeah, you're down. Sorry that happened to you. Yeah, we can say that, we can be empathetic for sure, but how can I help you? How can I walk with you on this? How can we help you get to where you want to go?

I know that happened to you. I'll sit with you as much as you want to talk about that. But at some point we got to move because I know inside you, you have something special and maybe nobody ever told you that. Maybe nobody ever developed you or poured into you or identified you as a future leader. That stinks. But I'm right now telling you today you are that. 

So now we can't go back and say, oh, that happened to me 15 years ago, 20 years ago. I know it did. But today is today. And I think it's great with the harm reduction space. I tell police officers, “I drink a six pack every day.” Okay, how about just drink three drinks tonight? “How's that gonna help me?” It's better than six. It's better than six. “That's ridiculous.” Don't do that to yourself. Let's do one day, today. Drink three beers tonight. “You're telling me to drink three beers.” Are you gonna drink six? “Yeah.” Drink three. And these conversations I'm having, it's an education.

They never heard this kind of conversation, never heard this topic. They think, like I did, there is something wrong with me. I'm broke. And there's a lot of shame that gets rolled into it, and then we start to treat citizens badly. Because I'm ashamed of myself. Of course I'm going to treat a citizen badly.

If I'm not loving myself. So I tell cops, do you love yourself? You know most cops can't answer that question? I said, do you love yourself? Look in the mirror. And I did it to one cop and he goes, I'm not looking in that thing. And I looked, I know somebody that avoided mirrors in 2019 to 2020 because I was so ashamed of myself in my house. I avoided mirrors. I know what that feeling's like. 

And we got to help these cops. I'm doing that now to tell them you're okay. But what's not okay is to take it out on people. What's not okay is not to be a good servant. You got to find another job if you're not going to do that. But if you're going to put the work in and you want to grow and develop to serve people, meet them where they're at, I'll help you do that.

But you have to do it yourself. It's a choice. It's an action. I will meet you there and I'll help you get there, but you got to do all the hard work and heavy lifting, but I will be there to give you real feedback, honest, caring feedback, direct feedback, so you can make the change you need to make and keep going.

This is a road that it's new. It's very new for law enforcement. There is a lot of blowback in the coaching space and the mentors space and in the therapy space. I have four therapists and I tell cops I have four therapists: psychiatrist, psychologist, an E.M.D.R. therapist, and a trauma-protocol therapist. And they all do different modalities.

They all do different therapies to help me succeed, help me grow, to help me stay in the fight because that's the most important thing for me. And I want to share with these cops that the citizens need you to stay in the fight. We need law and order. But what we don't need is chaos. What we don't need is targeting people.

What we don't need is a lack of understanding where people have come from and what they've experienced. And that's what's happening. One of four police officers have childhood adverse experiences in their life. And I put this in my book because I think we should be talking about this. I think this affects a lot of us.

Those childhood experiences are adverse experiences. We bring them into our adult life if we don't deal with them, if we don't heal them. That is baggage and it's okay, but that is baggage if we don't acknowledge it and be self aware and fix it. We could be dealing with unhealthy perspectives, which a lot of police officers can bring, solely from stuff they've been through in their own personal life.

And we start to work through that with them and understand the childhood abuse, growing up low income, poverty, domestic violence, alcoholism or drug abuse. A lot of cops have seen this stuff as children. And it's why we choose these service professions, probably like health care. My sister's a nurse and I'm so proud of her.

And growing up low income like we did, you know, I think, I never asked her about this, but I think she and we all charted a course to help people and serve people where we're at in our own different ways. And harm reduction is such a powerful thing that we can help police officers to stop the shame.

I leave a chapter in my book called Shame, solely because I think we're not able to make the change as quickly as we need to make, as much as we need to make. Because we've got to start from inside. We've got to start from helping the officers heal their personal shame. We have a leadership crisis in this profession.

No doubt about that. We don't have nearly as good executives leading our police departments. And everything flows through our culture. Everything flows through the leadership and the culture. So, in my book I reference, if you want to have an empathetic police department, it's very simple what to do. Hire an empathetic chief.

And give him or her two or three years. And watch what happens. That's it. But that is not an attractive quality. What we like is we like SWAT officers. We like people who lead the department in arrests. Those are metrics that we can get behind. So I think we need to start changing the community narrative.

We need to stop having our communities ask for those kinds of leaders. Not to say those experiences are valuable. They're tremendously valuable. We're gonna need to tap into that if we need it. But SWAT calls are part time. Unless you're in Philadelphia, you have a full time SWAT unit, in the surrounding counties it's not a full time SWAT unit. So you might get one call a month, two calls a month. So that's a very small part of your job. 

What are you doing in that other majority part of your job? And we have to help leaders or stakeholders, elected officials start making better decisions who they hire as chief. We have to start leading with empathy, with care, with heart.

Influence and leadership is a tremendous, tremendously powerful thing. If we want to start good cultures and mitigate harm reduction, we need to start looking at the leadership running our police department. We need to start looking at how we influence our officers, how we train, how we mentor. What about when the officers are going through a tough time at home?

Are we meeting them where they're at and helping them through it? Because all that has a derivative effect on how they interact with the community.

Okay, I think I'm done for now. I'm very passionate. I'm sorry, and I can keep going, so thank you.

STEPHANIE: And the final presentation we’re going to hear is from Laurie Corbin. Laurie is Managing Director for Community Engagement at Public Health Management Corporation, or PHMC. She oversees a range of programs that provide social services, prevention, intervention, treatment, and education to at-risk individuals and their families.

EMILY:  Laurie explains how these programs focus on diversion from incarceration and advanced release from incarceration, treatment readiness, and recovery support for people who are justice involved. She also oversees several social services programs that provide outreach to people experiencing homelessness and individuals living with HIV and AIDS.

LAURIE: Good morning everyone. Happy to be here today, and I'm also a little bit under the weather, so please excuse me. I am Managing Director for Community Engagement at Public Health Management Corporation, actually the facility that we're in right now is one of our community based locations.

We do a wide range of services that really we build to create and sustain healthier communities. And so we really work with a range of populations and programs and services for most populations, I would say with, except the senior citizen population specifically. So again, I have worked for the organization for more than 13 years. I'm a social worker by training, and have had the privilege over the last 13 years to be in the position to lead our continuum of criminal justice programs that serve a range of individuals.

In my larger role as Managing Director for Community Engagement, I actually oversee a continuum of programs that really serve most of our most vulnerable individuals in the community. I always say I have three buckets of work. One is the criminal justice programs. Second, we do a range of services for individuals who are experiencing homelessness. And that includes, you know, working with the individuals in the shelter. We also do permanent supportive housing. We actually have a housing program probably five minutes away, for anybody's local at 47th and Wollaston Avenue. HelpUSA that we partner with. And we do a lot of rental assistance and utility assistance for individuals to stay in their housing.

Because again, one thing sometimes people don't realize in the housing services realm, one of the things you want to do is prevention. You really want to prevent people from becoming homeless. There are things that you can put into place that sometimes people just need help with rent or help with other resources to maintain that household.

And then the third bucket I talk about is that I run a recovery support center in North Philadelphia. We talk about harm reduction. It's actually been in place, or that program's been around since 1997-1998. But it was established for harm reduction and a place in the community where we serve people who do not have to be abstinent from substance use and most have mental health challenges. 

The only thing we ask is that you not use right before you come into the program, because we also want this to be a safe space for everyone. Because we know that harm reduction does work. And the goal with that particular program is we want you to come, we want to support you, you can get a hot meal, you can attend groups, we do, you know, life skills, we'll connect you to services. But on that day that you are ready, that I want to do something different than how I've been living my life and I may want to go into treatment, we will hand walk you into treatment.

So again, you know, harm reduction really is at the core of the work that I do. My staff will sometimes talk about how passionate I am about the work, because I really do believe in what we're doing and how we're doing it. I forget which one of the two panelists really talked about, you know, substance users or some people with use disorders are really looked down upon in our community.

Well, I work with people who have behavioral health or substance use concerns and those who are involved with the criminal justice system. Okay. You know, a great way to sometimes start a dinner conversation with folks. People will say, oh, you work with those people, and it's like, oh, no, those people are like your brother or sister or your family member, because let's be honest about it, we all know somebody who's been involved with the criminal justice system, and we all know somebody who has an addiction issue, and we may not have called it addiction. 

You know, as a little girl, I had an aunt who was an alcoholic. She was a functional alcoholic, you know, worked Monday through Friday. Friday and Saturday she drank, Sunday got herself together and worked every day, but she was an alcoholic. Okay, we all have that, we don't talk about it though, we don't talk about it in families because there's shame and there's blame that goes along with it.

And so I think again when we talk about harm reduction we really need to talk about how we keep people safe. Because when we're keeping individuals safe, we keep our communities safe, we keep our children safe, and then safety also allows people to then really deal with a lot of their experiences including the traumas that they've had throughout their lifetime.

So what I want to talk to you a little bit about this morning is some of the work that I do in the criminal justice realm in Philadelphia, provide some information about some innovative and promising practices which are occurring locally within our behavioral health system, as well as our police department, and then some national models to think about at the both local and national level.

And so the original program that I began working in 13 years ago is called the Forensic Intensive Recovery Program, otherwise known as FIR, F I R. It's one of the oldest prison deferral programs in the country. It's been in place since 1993. What's really neat about this program, it is a collaboration, and when I do real formal presentations, there is a slide that is pieces of a puzzle, and it really shows all of the collaborating agencies that have worked over the years to really support people who unfortunately get involved with, you know, some type of activity that causes them to get incarcerated.

But the goal is really to get people out of jail as quickly as possible or divert them from jail. Get them connected to behavioral health services. And then we also provide case management services. Again, this came about 30 years ago. Prison overcrowding. You know, the city was actually under both a state and federal consent decree, like, you have to reduce your prison population.

So in the wisdom of city leadership bringing together, you know, parties from the behavioral health system, law enforcement, the community, legislative officials, you named the bodies as well as non-profits, treatment providers, and said, we need to come up with a model of how we can get people out of incarceration and connected to the services. 

And that's how the program really started. Started with serving about 250 individuals in 8 treatment programs 30 years ago. Right now we're serving several thousand people a year. We have a network of over 80 service providers that provide behavioral health services to individuals.

Our work is that we actually do, behavioral health assessments behind the walls of the Philadelphia, Department of Prisons. Prior to the pandemic, my staff were going actually in doing face to face visits. We are doing those by way of Zoom. I will almost guarantee you we're probably, if one, if not the only place in the country that's probably doing that type of work by way of the Zoom platform.

And we transitioned to that pretty quickly, you know, everything shut down in March of 2020. First we started doing telephone by May and then by July we were doing Zoom calls. And so we're doing this interviews with individuals, we get some background, we find it out. And, and the referrals come to us through, the public defender's office.

They identify individuals according to the types of crimes that they commit. And we work with, nonviolent felony offenders. What kind of, crimes they have committed, and really, you know, determine whether they have a behavioral health concern that may be beneficial through the program. We do an assessment.

We determine, you know, the level of behavioral health concern. Our focus is primarily substance use disorders, but we actually partner with the behavioral, the Department of Behavioral Health if we have somebody who strictly has a mental health disorder. You said earlier that. Or I think, again, I forget who said it, that you really can't tease the two apart because again, they're very, you know, enmeshed with each other.

However, we talk about primary diagnosis being really substance use disorder. We make a determination of what level of treatment that person should receive. Is it outpatient? Is it inpatient? Is it, intensive outpatient? Do they need housing? Recovery housing? Again, a lot of people languish in jails because they don't have anywhere to go.

And so, you know, and what's going to be good for recovery support for them. Because that's really key. Because when you come back into the community, you want to be in, you know, and it's, and our communities are really damaged in so many ways, but you really want some supports around you to help your recovery to be successful.

I should also say. As a practice, I actually ran a drug treatment program for about seven years for, women and children. So I also know the impact of treatment and how people can really change their lives, and the impact on their children, especially when I run into, clients who 30 years later are, like, first of all, I don't recognize, secondly, their kids are doing phenomenal things and that's the perspective I bring to my work

 We also make sure that they have insurance to pay for the treatment upon release, and that they know specifically where they're going.

So therefore, when they're released from, jail, actually the sheriff's transport them to their treatment program. And, or the recovery house. So again, it's a direct link, because we know people fall through the cracks, given the opportunity, you know, unfortunately, we've lost people to overdose primarily coming out of jail, because again, that's when people are at highest risk.

Or overdosing is once they've been incarcerated because they don't have the drugs in their system, and unfortunately, we have had people who pass away from that, but we get them connected to services right away, and then I have a team of case managers who provide support to those individuals once they're back in the community.

 Again, and it's their plan for their life. You know, we like to have control over our lives. We don't want people necessarily telling us what to do, how to do it, where to do it. A lot of the folks that we work with, that's all they've experienced in their lives, you know, from a very young age.

And it's really hard sometimes to engage folks like, you know, like how, you know, this is your recovery plan. We want to work this with you, what are your short term dreams, what are your long term dreams? And we're talking about it as goals and dreams because we want people to have those goals and dreams because we know we all need those things in order, and we've needed those things to get where we're at, at whatever point in our life that we're at.

And so we're actually trying to instill those things into the individuals we work with once they are released from incarceration. The other thing about, um, I would say about the individuals that we're working with who are in incarceration, many of whom are, opioid users, unfortunately, the Philadelphia Department of Prisons does have a robust, medication assisted treatment program.

And so, many of our individuals, even if they were not inducted on MAT prior to incarceration, they do get inducted while they're behind the walls. And we make sure that we get them connected to treatment services that will continue that upon release from incarceration. But Talithia talked about the healthcare needs of individuals as well, really sick.

 Sometimes I'm wondering, like, I don't even know how these people did crimes. Because, you The love, the acuity that they're showing, and some of it, unfortunately, I think also gets exacerbated by being incarcerated, which is also another form of trauma, um, that people don't really think about, but it's, it's, you know, if anybody has gone to jail, as I always say, on the just visiting side, you know, it's a little stirring.

I go to jail, I, you know, I've gone to meetings, you know, I've been blessed, I've never been incarcerated, but it doesn't mean, you know, but I've just been blessed in that way, that has just not been my experience. However, even visiting, you know, a correctional institution, it's it.

It can be traumatizing that, but just imagine if you're living there, just imagine some of the living conditions that people have. And so what we see is that we may interview somebody within their first month, six weeks of being incarcerated. They may not get out of jail for months later. 'cause again, and for people to get out of jail and get.

It has to be signed off by, the judge, and the judge has to be in agreement, and the client has to be in agreement as well. But it may be 11 or 12 months later, we get calls from our treatment program saying, Oh, we didn't know Laurie had her, you know, head falling off. We didn't know Laurie had this severe, you know, diabetic problem.

We didn't know either. When we interviewed Laurie, you know, back in August, you know, she didn't present with any health concerns. A lot of these things have come to light during the time of being incarcerated. So, that's one of the things that we will work with our individuals with once they come out of jail.

We'll get them connected to healthcare services. PHMC actually has six federally qualified health clinics, including at this location. , I'm doing a commercial announcement here. Uh, IOP remunerations, I didn't do so. Um, and so we, we connect them to services in the community. Many people don't have a primary care provider.

They're usually using an emergency room. That is their care provider. And so we really want to instill in folks like, hey, well, you know, making this connection, it's really important. You're important. You are important. When I have the opportunity to speak to individuals, there's a program that, you know, that , the feds, local government, state government [00:48:00] does when individuals are coming back into a certain police district in Philadelphia that, and these individuals are high risk for reincarceration, I have the opportunity to talk about our programs and services.

And the one thing I talk about is don't be afraid to ask for help. Talithia talked about that because people are really scared about asking for help. And then I said, and it's usually, you know, no bias here, but it's just sort of what we know the data to be. Primarily men, and men do not take care of their health in the same way.

We see healthcare providers in the same way as women may, you know, I preface this by saying, you know, it's important for you to take care of your health in order to take care of your family and you want to be here for your family, but you also have to care enough about yourself because many of our individuals, they just don't, you know, it goes back to, you know, a lot of, I don't want to say a lot, a lot of individuals that we work with in these programs don't care about ourselves.

A lot of ourselves, we don't care about ourselves, you know, and then so again, and then that's due to the trauma that we've experienced. the way that we've grown up, you know, and again, you know, how, you know, and, and just having the resources or accessing, you know, healthcare in the community is not always accessible and bad experiences.

That's just another whole presentation that we could talk about, and just around sort of, you know, the challenges with that and why people do not. access, health care services. But in our work with our individuals who are coming out of prison, we really want to do it in a holistic way because we really want to support them.

And really, you know, we also will link people to very specialized services, to address the issues of trauma, many of which develop in, childhood. I'm glad that, you know, um, the ACEs was talked about, the adverse childhood. Exposure that all of us have had some type of adverse exposure as a child.

It just depends on where you fall out on the scale. And many of the folks that we work with fall on the very high side of the scale, and and and I would offer that many of our police officers are also going to fall on that higher side of the scale as well, and it's not just, you know, it's just not really been assessed and acknowledged in that way, and I think that's something else that we need to look at as we're talking about this work and sort of reducing harm to individuals who are involved in the, criminal justice system.

I want to talk about one particular program that I just love, and my staff hate when I say this, because they hate when I pick out one program over another. And it's a newer program, it's called the Accelerator Misdemeanor Program. All of our programs have really complicated names. We refer to it as AMP Court.

And it's one of the things that really is nice about this program, it is a neighborhood based court program. That actually the court hearings happen in police districts. Really cool concept, actually for anybody who's looking for Philadelphia. , Seth Williams, who was our DA before he fell from grace and ended up being incarcerated, really actually taught, really helped to implement this model.

And I think, again, it was a way of, looking at individuals who were having quality of life crime. Now, coming through the Regular Trial System, getting connected with social services supports behavioral health assessments linked to services, with the goal of, you're gone be in the program for a relatively short period of time, we're going to assess to see what kind of supports that we can provide to you, get you linked to those supports.

Once you've demonstrated, for example, you know, Laurie gets assessed and needs to go in and substitute treatment. Once, which we will, people now, originally how we set it up, it took a little bit longer, but right now, we can do same day, next day, within the week, get you an appointment. We've actually walked people to appointments.

If, once you, you know, demonstrate that you're going on a regular basis. Your case can be dropped in a relatively short period of time, so you may end up being involved with the court system for two months versus many years, which is what happens with many of the individuals that we work with. Again, it's a collaborative effort between the court system, the district attorney's office, the public defender.

We are the social service, social service behavioral, health provider. I go out to those court hearings, post COVID. We are happening, it's happening at the 24th and 25th police district. Near, and it serves a lot of individuals who are from the Kensington area, which you know, again, we know, which is a very high drug use area.

 It is incredible to sit in that courtroom and just to, number one, hear, you know, first of all, how people get involved with the criminal justice system, but also,

The brokenness that people present with, but also to see over time how with the support of really engaged judge who will talk with those individuals on a one on one basis, empathetic, very empathetic, will share themselves a little bit about themselves. We really say like, I, you know, I really want you to do well, like you're 60 some years old.

You know, you know, like we've lived a long time, you know, we, we, you know, really want to help you. to do better. You know, you've got a couple kids. What does that look like? I remember one hearing, Liz was the last person in court, and it was only court staff. It was my team. It was the judge. We always have a sheriff in the room.

We'll have police, you know, coming in and out. Literally, you could hear a pin drop, but the level of emotion, with this individual who literally just broke down and just said, I need help, but I really want to thank you for the opportunity, because it's the opportunity. It's an opportunity to do something different, and I think it's a model, it is a model where the judges Who sit that court will advocate for this program in a way I've never seen judges advocate for a program because they can see the impact that makes a difference in people's lives.

And on the, on the, and the big carrot on the, , for the ending, for people who are successful in this program, they can apply to eventually get their records at sponge. And one of the things that was keeping people in the program pre pandemic was the ability to pay court's fines and costs, and there's now money from the managing director's office.

to actually do that. That's one of the things that keep people, caught up in the criminal justice system, the ability to pay court sponsored costs. That's another whole session that we can talk about. So that's a really, interesting program , and again, right now we're doing it at the 24th and 25th Police District, and then we do one day of court at the Criminal Justice Center here in Philadelphia.

I'm going to switch a little bit and talk about, a few of the initiatives that are run by the Department of Behavioral Health and Intellectual Disabilities here in the City of Philadelphia. I would be remiss if I didn't say that my programs get funding and have a very close relab collaborative relationship with, DBHIDS, , and their team in doing the work that we do.

So they really have looked at, through their Behavioral Health and Justice Division, looked at police. programs, sorry, police based initiatives that provide supports and strategic opportunities to divert individuals from the justice system in Philadelphia by working in partnership with the police department and then with the managing director's office and the managing director's office of criminal justice programs.

The first is the Crisis Intervention Training for Police Officers, and you talked about training for police officers. And again, it's a national model. It's been, , it's been implemented for quite a number of years here in Philadelphia, and there are cohorts of, police, officers who go through the training.

And the goal is really around violence prevention, de escalation, and community collaboration. Those are three key things. You know, one of the things that I always talk to my team members around is one of those skill sets that we try to build up in, in the folks who are doing direct service work, or even, even for myself at my level, is how you de escalate situations.

So some of the, you know, harm reduction also is related to de escalation. You know, some of the, of the, the encounters potentially between police and community members could be reduced. If police officers really hit the skill set in order to deescalate incidents versus sort of egging it on, you know, for lack of a better word, you know, you can see where sort of, you can see where things are kind of getting out of control versus like, you know, lowering your voice and, you know, there's ways to engage people to de escalate situations and I think that's a really important piece.

And then the other, you know, violence prevention again as related to like how do we reduce the level of violence in the community, violence that's, you know, sometimes, you know, it's a combination of factors, it's between the police and the community and things of that nature and how do we look at sort of that intertwining there.

And then community collaboration. You know, again, having, police living in the community, I think, you know, again, I think that's a really important, thing for us to really think about, you know, where, you know, they are embedded in the community, they live in the community, people know them as people.

know people as people. Is that relational? piece that's really important, and I agree, we, we don't have relational pieces going on in our larger society. , and I just think, you know, what's happening, you know, in our police departments, I think what's happening in our communities, it's just a mirror of sort of some of the larger dysfunction that's happening in our, in our larger communities, and I think we really need to talk about what those relationships should look like, and how do we build that going forward.

So, again, that's something that, you know, the, the, one of the initiatives that DBH is working in, working on. The other one is a 911 triage system. Again, for any of those who are local, people may remember several years ago, I believe it was 2020 or 2021, sorry I'm losing track of time here, Walter Wallace was the individual who lived in southwest Philadelphia, not too far from here, who was having a mental health crisis.

Family called for help, there was engagement with the police, and unfortunately Mr. Wallace was killed. You know, you know, there's, there's a couple, there's so much, you know, wrapped up in this, but with that being said, you know, the city really has taken it upon themselves to really look at how dispatched and who are the appropriate people to be dispatched.

Is it the police that you're dispatching or are you dispatching a behavioral health worker and somebody from a mobile crisis team, which we now have more of, to go on the scene to kind of assess what's going on? Because in many instances, you know, this person was getting treatment, actually. This person was.

I mean, had a diagnosis of mental health disorder, had been receiving treatment. Family just did not know quite how to handle the situation, which is why they called the police. Again, you know, this is the other piece of it, that how do we put supports in harm reduction? How do we get supports into the hands of family members and community to help, help also?

Because it's really scary when somebody is really in a mental health crisis. I remember being new as a treatment, director. And, you know, the residential program that I ran, where this mother lawyer decompensated in front of my eyes. You know, all the, and, and very scary experience. So and I was a trained professional.

So a lot of, if you're, you know, if you're just a family member and this is my child and this is my brother, this is my sister, how do I handle those things? So again, they're looking at, again, you know, co locating behavioral health worker along with an I 1 1 dispatch, assessing the situation and sending out the appropriate team.

It's still in the early stages, I think there's still work to be done in that area, but I really, and it's based on some of the, there's models across the country where this has already been existing for quite some time, and so again, you know, it's good to see, but we just need to see more of this, um, more robustly happen, and really also then to begin to also inform the community about what also is happening as well.

 So then a couple of national initiatives, and Philadelphia is doing some work in it. One is the Stepping Up Initiative, and it's a national, program. to reduce the number of individuals with mental illness being incarcerated there's 500 counties nationally that are being involved in this program.

And it's just a number of different initiatives. Like, what are ways that we just don't incarcerate people who have a mental health concern? You know, talking with the Chief Medical Officer, of the Philadelphia Department of Prisons, he will tell you, we run the largest mental health hospital on the prisons, than in Philadelphia.

We don't have an institution in the city itself. That handles the number of people who have mental health disorders, that we do at the prison. Something wrong with that. I mean, again, I think that just goes back to a larger issue that we have our priorities really messed up in terms of our society as a, as a country.

Kind of piggyback, the last thing I want to talk about is piggybacking on my comment a minute ago about how do we help community members. How many people have heard of Mental Health First Aid? Okay, well if you haven't heard about it, I would really recommend that everybody be trained in mental health first aid.

It really helps people, it's a skills based training that teaches people, um, how to understand it. It's how to identify, understand, and respond to signs and symptoms of mental health and substance use challenges. And this can be help support with your peers, your co-workers, your friends, um, all of my teams go through it.

I've been trained in it. Just like everybody, you know, a lot of us are trained in how to do first aid. This is on the mental health side. This is a tool because, again, it's really scary when someone is having a mental health crisis. It's really scary. And somebody may be withdrawing from, a high on opioids and what do I do and how do I do and how do I help.

This is something that we as community members. can do. Because again, it's going to take the larger community in order to address, these issues and, to, to move forward harm reduction. Now, the last things I would like to say is that we've talked about trauma and the impact of trauma, throughout all of our panel presentations.

I just want to emphasize, you know, we've talked about our, individuals, participants, clients, community members really being impacted. Want to emphasize again around also our law enforcement also, , impacted as well. That was spoken about earlier. I was at a presentation within the last year or so, there's a researcher who's really talked about how the brain, functioning of police officers change within three years of them being in a police force.

And I think that's something that we really need to think about, like, you know, because again, the stressors and the trauma and how do we, , help them, you know, in ways. There has to be, you know, we, you know, again, we, we need law enforcement, but we need a different law enforcement and how do we support people who are working in some of the most stressful work that you can work in.

I'll leave it at that. Thank you.