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RCORP - Rural Center of Excellence on SUD Prevention

First Day Forward Program: An Overview

NE Kentucky Substance Use Response Coalition logo

Created through a Rural Communities Opioid Response Program (RCORP)-Implementation grant, First Day Forward (FDF) is a jail reintegration program that aims to connect individuals to resources, both during incarceration and after their release. This project by St. Claire HealthCare, a member of the Northeast Kentucky Substance Use Response Coalition, strives to give those with substance use disorder (SUD) a true “First Day Forward” as they re-enter the community.

the first day forward initiative really

grew out of the inmate interviews that

we have done in gosh i guess at this

point in six jails across northeastern

kentucky where we

sat down with individuals that had been

arrested on drug related charges uh had

a self-identified

substance use disorder

and were willing to be interviewed about

what had led them to their current

situation uh what program it was

available to them in the jail and what

programming we could put together as a


upon their release so that's led us to

do some brainstorming we came up with

the idea for a program and one of dr

maclean's colleagues uh wendy fletcher

was actually the person who coined the

phrase first day forward that

really targeting

education to inmates father still

incarcerated but really focused on that

first day of release first day forward

uh takes these peer support individuals

from across our region links them with


inmates does a month to three months of

engagement while they're still


picks them up from the jail at the day

of their release gives them uh whatever

necessities they might need at that


during their incarceration we've been

working with them to make sure where you

go in upon release do you

need uh

any kind of treatment linkages upon the

point of your release what are you

thinking in terms of employment so we're

working with them on all those types of

activities uh to make sure that uh that

they have a a chance i mean that that's

all these individuals want and need is a

chance to

to get a the right path toward recovery

upon their release so so firstly forward

we're currently uh providing that

service in three counties within our

region we've had phenomenal success uh

just recently one of our the first

inmates that we engaged with uh had

gotten released and uh had gone through

uh the the year of um sobriety and then

went and got the training to become a

pure uh support uh individual himself so

that is as big of a success story as you

can possibly have somebody who was in

jail that we connected with them and now

they are doing what we want to have

others in the region do tell their story

and and be an inspiration to others

the incarcerated population is

considered very vulnerable and high risk

from a addiction or moud standpoint

when they go into jail if they've been

utilizing or using illicit drugs


they have developed a tolerance to it so

their tolerance is very very high

during incarceration

they go through the withdrawal

that tolerance is gone they get out

they have a high high risk of

sudden death from overdose that's the

number one cause of death within the

first two to four weeks of release for


because they don't understand

the risk of going and using

in addition

now that we have the fentanyl

on board and being laced in the heroin

that also increases

the risk of death to these patients who



incarcerated and now released by without


education or knowledge and so

part of hopefully the first day forward

is some of that education

regarding the tolerance



to the heroin going in and then the lack

of tolerance coming out and the

increased risk

employment is so key to this i mean you

can have various other things in place

but if these individuals upon release

can't find a job

then the chance of them relapsing being

right back in that same situation are

much higher so we've done a lot of

programming within our region to try to

put things into place to to change the


that so many individuals unfortunately

still have


individuals who who even even if it was

in their past there's still so much

stigma out of people that that ever


prescription medications or abused

illicit drugs so we're currently doing

employment forums across the region

where we have

uh peer support specialists that are

doing presentations to employers across

the region telling their story about how

they once were

addicted now they're in recovery and

that there are numerous other

individuals like them across the region

that uh that can be very good employees

uh for uh those employers across the

region and can really be a new source of

employment and uh and workforce

development within the region


FDF began with a focus on three counties in northeastern Kentucky: Clark (started September 2020), Mason (started September 2021), and Powell (starting September 2022). Through a second RCORP-Implementation grant, FDF was initiated in the Montgomery County Regional Jail in September 2021 as well. Peer support specialists are screening individuals for program criteria including anticipated release to one of these counties, self-identified SUD, and willingness to participate.

When candidates are accepted into the program, peer support specialists immediately begin working with them. They provide cognitive life skills education and work with participants on their personalized pre-release and post-release case plans. Peers can help with a range of other steps, including expungement information, social security card applications, birth certificate requisition forms, applications for medical cards, naloxone training, local resource guides, employment opportunities, and treatment options. Ideally, peers begin meeting with individuals a month before their release.

After release, the participant’s post-release case plan begins. The peer provides a safe ride from the corrections facility directly to the community or to a treatment center and makes sure the participant’s basic needs are met. The peer connects the individual to community resources such as housing, employment opportunities, self-help meetings, medications for opioid use disorder (MOUD) treatment if desired, primary care, and case management. The peer is also available to attend doctors’ visits and NA/AA meetings and appointments to apply for Medicaid, an identification card, Supplemental Nutrition Assistance Program, etc.

For the first 30 days after release, the participant has weekly face-to-face contact with the peer. Days 31 through 60, that face-to-face contact occurs biweekly. Days 61-120, the participant has monthly phone calls with the peer that continue for the duration of the grant project. 

As of September, FDF had begun serving 45 participants, both male and female, in Clark County. At this time, most participants are still incarcerated. Eight have been released into an SUD residential treatment facility.

FDF’s new RCORP grant from the Health Resources and Services Administration is supporting provision of pre-release naltrexone injections to those who are interested in this treatment. Pre-release naltrexone suppresses cravings for opioids that can lead to relapse and overdose for individuals whose tolerance has been reduced during incarceration. The new grant allows First Day Forward to expand to Montgomery County and to provide pre-release naltrexone injections for the Rowan County jail’s reentry program.

Below are testimonials from three participants in the program:

The benefits of the FDF program have been amazing for me personally. I can now see what makes me tick and what leads me to think that I can use. It's all excuses. I have to work on myself and figure out why I turn to use before I can live a better life. The reason I ended up with a record is because I would rob anyone to make myself feel “well.” This is true for most people like me. When it comes to my anger, I have learned I use it as an excuse because I can't let go of my trauma. Until I get to the root of my past, I will continue to make the same mistakes. This program helped me to realize all of this. It's refreshing to finally have something that helps me understand where I went wrong.

—Donnie, FDF participant, Clark County

First Day Forward was really beneficial for my recovery. It helped me connect to the recovery community within Clark County and the resources I needed to attain long term recovery. If it wasn’t for this wonderful program I would have gone back to using drugs/alcohol. This would have ultimately led to death or jail. I am forever grateful for this program and encourage all who can to participate. I have been moving forward since the first day of my release! 

—Brandon, FDF participant, Clark County

My name is Casey, I am a 35-year-old heroin addict from Winchester, KY. My clean date is 11/05/20. I am a client of ART [Achieving Recovery Together] and in a program called First Day Forward. … this is how it helped save my life.

I can remember sitting in jail as a result of my addiction feeling hopeless, alone, and totally lost. Having zero ties to anyone in recovery or any support to help me stay clean outside of jail. I heard about a program called First Day Forward that ART had just started and all I knew is that it was for addicts like me. So I signed up. I am so grateful for that decision because I know it’s a big part of why I am still clean today. 

First Day Forward gave me hope and the support I truly needed. They helped me start my recovery from inside the jail. The program helped me with so many things from finding me a bed at a treatment center, driving me from jail to the treatment center. They bought me clothes, hygiene items, helped me get my birth certificate, social security card, just so many things, … but most of all they gave me hope and support. They helped love me back to life and gave me the strength in knowing I wasn’t alone anymore. It’s a group of people just like me and I love them all. 

First Day Forward changed my life and put people in my path who believe in me and helped me to believe in myself. Thank you, with all of my heart, First Day Forward and everyone at ART!

—Casey, FDF participant, Clark County

First Day Forward could have a positive impact for individuals like Donnie, Brandon, and Casey and for communities. Data will be collected throughout the project to assess recidivism, employment rates, housing linkages, and other outcomes. Having expanded the program to Montgomery County and to provide support to the re-entry program in Rowan County, St. Claire is in the process of submitting a new grant to replicate FDF in Carter County.

Individuals standing in front of a sign
Brandon (center), a First Day Forward participant, and Ryan and Kelly, peer support specialists

This article was adapted from content provided by St. Claire HealthCare.