Quality Improvement Fund - Justice Involved - #H80CS00172 Needs to be Addressed: CAMcare Health Corporation plans to embark on a groundbreaking initiative to enhance healthcare access and continuity for justice-involved individuals (JI-R) reentering the community. This project addresses critical health and social needs through innovative, evidence-based approaches that leverage telehealth, a mobile health unit, and robust community partnerships. The core objectives include improving overall health care and well-being, management of chronic conditions, reducing risk of drug overdose, and addressing mental health and substance use disorders. Additionally, the project aims to tackle housing and food insecurity, financial strain, intimate partner violence, transportation barriers, and other health related social needs. Population to be Served: CAMcare will provide screenings and exams to participants who are within 90 days of release at the Camden County Jail, located in the City of Camden, New Jersey. Proposed Services: Our comprehensive program design incorporates three primary evidence-based models: the Integrated Care Model which includes a Peer Navigation Model and Social Determinants of Health (SDOH) Screening Tool. These models initiate extensive self-assessments and interventions 90 days prior to release, ensuring early and continuous access to care. Telehealth services and a peer mentorship program enhance engagement and support, while AI-driven analytics tailor interventions to individual needs. CAMcare’s Integrated Care Model combines behavioral health with primary care, initiating comprehensive mental health assessments, and substance use screenings 90 days prior to release and incorporating telehealth services as needed to establish early and continuous access to health professionals. The Peer Navigation Model leverages the lived experiences of former JI-R individuals to improve health outcomes through relatability and trust, integrating a peer mentorship program for sustained support and community integration. Lastly, our Social Determinants of Health (SDOH) Screening Tool, supported by AI-driven analytics, begins in the carceral setting and dynamically updates post-release to efficiently tailor interventions and enhance service referrals. These models are designed to be scalable and adaptable, providing a robust foundation for the successful long-term reintegration of JI-R individuals into the community, making the models suitable for implementation by other health centers working with similarly situated populations. Collaborations: CAMcare’s collaboration with local organizations, such as Volunteers of America, Center for Family Services, Puerto Rican Unity for Progress, Catholic Charities, Community Care Food & Clothing Pantry, Cathedral Kitchen, Camden County Board of Social Services, and more community service providers, forms the backbone of our holistic support system. This network addresses health care as well as essential social determinants, ensuring a seamless transition for individuals from incarceration to community life. Our project is designed for scalability and adaptability, allowing other health centers to implement similar models tailored to their specific populations and resources. By establishing strong partnerships and leveraging technology, CAMcare intends to create a sustainable framework for improving health outcomes and social reintegration for justice-involved individuals, ultimately setting a precedent for national standards in care transition and reentry support.