Peer education program key in harm reduction, disease prevention
One of the core elements of public health is “meeting people where they are.”
It’s a doctrine that aims to acknowledge disparities and lived experiences to build bridges that will help a person receive the health care they need. It can refer to a physical place as well, however, and for people in congregate settings, the risk of transmitting disease is heightened by proximity.
The threat of widespread illness can be even greater for the nearly 23,000 people currently incarcerated in the Indiana Department of Correction (IDOC).
People like Deborah Nichols and Erika Chapman are working to change that by bringing a health education training program directly to incarcerated individuals, meeting them where they are and helping reduce the risk of disease transmission. Chapman, HIV/STD, and Viral Hepatitis Division Harm Reduction Program manager, and Nichols, former Indiana Department of Health (IDOH) deputy Surveillance Program director, are part of the Indiana Peer Education Program (INPEP). And they’re working to start incarcerated people off on a journey they hope will improve public health and allow peer educators to find a new purpose.
INPEP beginnings
Nichols, who spent nearly seven years with IDOH, said the genesis of INPEP dates to 2018. At that time, one of her colleagues attended the National Hepatitis in Corrections Conference and learned about the New Mexico Peer Education Project (NMPEP), which makes use of Extension for Community Health Outcomes (Project ECHO). According to the Richard M. Fairbanks School of Public Health, ECHO is “a movement to connect local primary care teams with inter-disciplinary specialist teams to spread knowledge and amplify local capacity to provide best practice care for complex chronic health conditions.”
It didn’t take long for Nichols to envision how such a program could help public health efforts in the Hoosier State.
“She told me about it, and I was like, ‘This is amazing. We have to do this.”
Nichols crafted an hour-long speech extolling the virtues of ECHO that she planned to present to officials and potential program partners to convince them to consider adopting the program, but as it turned out she didn’t need nearly that long to persuade anyone. Within minutes, the program had been given the go-ahead and movement was made to implement peer-led public health training into IDOC facilities.
Nichols was able to obtain initial funding from the Centers for Disease Control and Prevention (CDC) and partnered with Step-Up and the Richard M. Fairbanks School of Public Health ECHO Center to get INPEP off the ground.
Lived experiences
The key element of INPEP is that is driven by people who are incarcerated. Staff from IDOH, Step-Up, and the Fairbanks school’s ECHO Center partner to deliver a 40-hour training class for as many as 20 INPEP educators. The peer educators learn about hygiene, harm reduction, substance use disorders, how to teach adult learners, motivational interviewing, how certain diseases are spread (with a large focus on hepatitis C), risky behaviors that can lead to illness, and more. Once they graduate the course, the peers are certified to teach 10-hour workshops centered on what they’ve learned with other incarcerated people. In that way, this important information comes directly from peer educators who have many of the same lived experiences as the students.
Chapman believes this is a strength of the program as it allows information sharing among people with specific knowledge of day-to-day life at a given correctional facility.
Beyond sharing lived experiences, however, Chapman believes INPEP helps incarcerated individuals be seen as people first.
Photo caption: The Indiana Peer Education Program (INPEP) has trained more than 160 per educators across several Indiana Department of Correction facilities. Participants learn about infectious diseases, mental illness and other health topics they can share information about with other incarcerated people.
Positive reviews
Chapman explained that there are four core elements to INPEP. The mandatory 40-hour training for peer educators is the foundation and is followed by 10-hour workshops peer educators provide to their prison communities. There is also a monthly virtual meeting of all peer educators and peer-to-peer case-based learning. The final piece is a monthly site visit each of the IDOC facilities by INPEP Hub Team members.
“It’s very labor-intensive and time-intensive but invaluable for public health,” she said.
Though it takes effort, intention, and time, Chapman, Nichols and others with partnering organizations have brought the program to dozens of peer educators and people living in incarceration and it’s earning rave reviews from some of the people helping make a difference in the cell block.
"ECHO is life changing for these guys, as well as for us,” said one peer educator who asked to be identified only by his first name, Ronnie. “ECHO is change for the good, a light for darkness that is going on in addiction, mental health, sexually transmitted diseases, and other health risks. ECHO is a cure for the lost souls of not caring. Because where people don't care, ECHO cares."
As of late May, people like Ronnie have helped bring INPEP to approximately 2,500 Indiana DOC inmates via the 10-hour workshops. Throughout the seven DOC facilities offering INPEP, 163 peer educators have been trained.
Ongoing partnership
Nichols, who departed IDOH in late May for a new role as an epidemiologist for IDOC, was instrumental in getting the program off the ground, but she’s worked in tandem with Chapman to help INPEP become a staple in Indiana correctional institutions, with the hope of one day having that program available in every facility.
Nichols believes this new opportunity will help her further her work in public health. Despite beginning work for a different state agency, she and Chapman will remain connected through their roles with INPEP.
“One of the things the peers in the program say a lot is, ‘I want to be part of the solution, not part of the problem,’ and with me it’s the exact same thing: I want to be part of the solution,” Nichols said.
Nichols and Chapman both cited the people-first aspect of the program as one of its most appealing tenets. They said that in most instances, the words “offender” or “prisoner” are not part of the INPEP lexicon. The people being served as just that: people.
“These are our fellow human beings,” said Chapman. “They may have made different choices along their path, but they’re human beings and they have dignity and worth.”
Treating people as such nets the best results, Chapman and Nichols believe.
“Meeting someone where they are – at a difficult moment or stage of their life… that can give value and purpose to people,” said Chapman.
Building a legacy
Nichols noted that Indiana is only the second state in the nation to offer this type of public health program to incarcerated individuals. She believes this is a key element as the peer educators will carry what they’ve learned with them when they leave behind the prison walls. And those who learned about disease transmission and other topics from their fellow inmates will also one day leave the facility with some important tools for staying well.
“What we see is that they tell their families, they share this information with their friends,” said Nichols.
Topics have remained timely with COVID-19, hepatitis, and legionella among the subjects presented through the program.
In that vein, INPEP is the rare case where an epidemiologist might hope to see something take on the role of a contagion, passing from person to person, but in this way helping keep people healthy instead of causing illness.
The program is also a source of pride for those who complete it. Graduation ceremonies have been attended by deputy wardens, fellow incarcerated individuals, administrators, corrections officers and others, forming a motley crew of supporters. The presence of so many also shows how the program is reaching more than just its intended audience.
Chapman and Nichols are optimistic about where INPEP will go in the future. Nichols noted there are “a lot of states interested” in following New Mexico’s and Indiana’s lead. Both program leaders said they plan to adapt as the program grows, though its core strength of reaching out to a uniquely vulnerable population will remain.
And so will the optimism.
“There is always the potential for people to do good things,” said Chapman. “I see this as a way to give dignity to people, to give them something that helps them keep going.”
Story by Brent Brown, Indiana Department of Health