What We Will Do:

Using a three-tiered approach, partners will:

• Establish and expand the Guilford County Formerly Incarcerated Transition (FIT) program,
• Facilitate a “Linkage” to medical and behavioral health care as well assist with other social and community needs and  
• Support the Post-Overdose Response Team’s ongoing work to reduce overdose deaths and increase access to harm reduction strategies and treatment options.

Who Is Involved:

Triad Adult and Pediatric Medicine (TAPM)

UNC Family Medicine

Guilford County Department of Health and Human Services, Division of Public Health (GCDHHS)

Guilford County Solution to the Opioid Problem (GCSTOP) 

Guilford County Emergency Medical Services (EMS)

When this Takes Place:

These efforts are ongoing.

How We Will Do it:

The Guilford County Formerly Incarcerated Transition (FIT) program connects justice-involved persons (JIP) with chronic medical conditions, mental illness and/or substance use disorder to patient-centered primary care. Administered by Triad Adult and Pediatric Medicine, the program utilizes a specially trained community health worker to build trust and act as a peer navigator for reentry with a special focus on opioid use disorder (OUD). During the intake and new patient process, the community health worker determines many of the essential needs of the participants and will “link” the participants with additional insurance, medication assistance and medically related services. This program improves the well-being and health of people who have been recently released and improve their chances of successful reentry into the community. UNC Family Medicine, which partners with the North Carolina Department of Public Safety, the North Carolina Community Health Center Association and others, provides consultation to the Guilford County FIT program and trains providers. Guilford County Department of Health and Human Services, Division of Public Health receives NC Department of Health and Human Service grant funds and subcontracts to TAPM to provide these services in Guilford County. 

Guilford County Solution to the Opioid Problem (GCSTOP) and Guilford County EMS's Post-Overdose Response Team work together to prevent repeat overdoses and to counsel persistent users to enter treatment or adopt evidence-based harm reduction practices. GCSTOP provides a staff person to the Post-Overdose Response Team. GCSTOP also provides syringe exchange, harm-reduction training and education to the community about overdose response. This effort began with special appropriation funding from the state to Guilford County’s EMS to address the increasing number of opioid overdoses and opioid related deaths. The GCSTOP program is housed in within the Department of Social Work at the University of North Carolina at Greensboro. In addition to providing counseling on treament options, team members can assist in linking individuals with a medical home and treatment. Guilford County Department of Health and Human Services, Division of Public Health receives NCDHHS grant funds and subcontracts to GCSTOP and Guilford County EMS to provide these services in Guilford County.