Accomplishments of Kindful Restorations

Accomplishments of Kindful Restorations

Breakdown of Accomplishments of Kindful Restorations

 

After serving 24 years in prison with almost eight of those years in solitary confinement, as of 3/7/25, Ernesto Rodriguez has been out of prison for 18 months.

 

Kindful Restorations Accomplishments

Received 1,446,000 dollars in contracts and grants from:

• Choose Kindness Foundation (2024-3/2025):                                         $ 485,643.98
• Right 2.0 (2024-2026):                                                                             $ 301,359.00
• The Sierra Foundation (2025-2026):                                                        $ 500,000.00
• Riverside County Workforce Development (2024-2025, 3 months):        $ 10,737.60
• Cited 2 (2024-2025):                                                                                $ 81,485.07
• Community Solutions M.A.P. (2024-present):                                          $ 4,200.00
• Pair Teams:                                                                                              $ 120.00

Total Received:                                                                                      $1,083,545.65

Grants Submitted

• Amity Workforce Development                                                                 $360,000
• Riverside County Youth Community Based Organizations                       $521.435
• ARG Grant                                                                                                $2,249,004
• BHCIP Housing Grant                                                                               $1,554,460.90
• CARE Grant                                                                                              $657,678
• IPG Grant                                                                                                  $653,349

Total Submitted:                                                                                      $5,475,013.34

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Services for individuals with significant health and social needs

Certified to provide services in these areas:

• Department of Healthcare Services Outpatient, Intensive Outpatient Services for Substance Use Disorder. 
  
  
• Department of Healthcare Services Medical Provider (Enhanced Care Management, Community Supports, Community Health Worker). Enhanced Care Management (ECM) is a whole-person, interdisciplinary approach to care that addresses both clinical and non-clinical needs of high-need and/or high-cost Medi-Cal members. It is designed to provide comprehensive care management and service coordination through a community-based, high-touch, and person-centered model. ECM focuses on specific populations of focus, including individuals experiencing homelessness, those with high utilization of healthcare services, individuals transitioning from incarceration, and others with significant health and social needs. The goal is to improve member outcomes by ensuring access to appropriate medical, behavioral, and social services.

Key components of Enhanced Care Management (ECM)  include:

• • Outreach and Engagement: Connecting with members to build trust and enroll them in services.
    
    
  • Comprehensive Assessment and Care Planning: Identifying the member’s needs and developing a person-centered care plan.
    
    
  • Enhanced Coordination of Care: Facilitating communication between healthcare providers, social service organizations, and other stakeholders.
    
    
  • Health Promotion: Providing education and support to empower members in managing their own health.
    
    
  • Comprehensive Transitional Care: Assisting members as they transition between different care settings (e.g., from hospital to home).
    
    
  • Member and Family Supports: Engaging family and caregivers in care planning and decision-making.
    
    
  • Referral to Community and Social Support Services: Linking members to housing, food assistance, employment support, and other essential services.

Managed Care Plans (MCPs)  are responsible for ensuring that ECM services are available, coordinating provider networks, and monitoring service quality. ECM is a Medi-Cal benefit and is implemented through Managed Care Plans (MCPs) in California under the CalAIM initiative. 

Community Supports (CS) are medically appropriate, cost-effective alternatives to traditional Medi-Cal services that help address health-related social needs (HRSN). These services are offered by Medi-Cal Managed Care Plans (MCPs) as part of the CalAIM initiative to improve health outcomes and prevent higher-cost care, such as hospitalizations or institutionalization​.

Key Features of Community Supports:

• Alternative to Traditional Medi-Cal Benefits: These services replace or supplement standard healthcare benefits when they are deemed more effective

Examples:

1. Narrative 1: Carlos – From Jail to Stability Through Housing Navigation
   After serving a 14-month sentence, Carlos, a 42-year-old man with diabetes and PTSD, was released with nowhere to go. In the past, Carlos would have cycled between shelters, emergency rooms, and eventually back into the justice system due to untreated health needs and unstable living situations.
   
   Through CalAIM’s Community Supports, Carlos was connected with a Housing Transition Navigator before his release. Within a week, he was placed in short-term post-hospitalization housing, which gave him a safe place to manage his diabetes and mental health while caseworkers helped him apply for permanent housing. The program also covered his security deposit and utility fees, easing his transition.
   
   Over time, Carlos began outpatient mental health counseling and enrolled in a food assistance program, all coordinated by his ECM lead care manager. With stable housing and wraparound services, Carlos hasn’t returned to jail or the ER in over a year — a marked improvement compared to his past trajectory under standard Medi-Cal, which offered no housing support.
   
   
2. Narrative 2: Tasha – Breaking the Cycle with Tenancy Support
   Tasha, a 28-year-old mother of two, was released from county jail after six months for a probation violation. She had a history of substance use and frequent ER visits for unmanaged asthma. Previously, Tasha would have been discharged with limited support and no structured plan for reentry.
   
   Under CalAIM, she was identified as eligible for Community Supports. A Care Manager from her local ECM provider collaborated with a Housing Tenancy Specialist to secure her a safe, subsidized apartment and begin tenancy support services. These included helping Tasha with lease paperwork, setting up a payment plan for utilities, and mediating issues with her landlord.
   
   In parallel, she received Asthma Remediation Services, which provided air purifiers and pest management to reduce triggers in her new home — services not offered through standard Medi-Cal.
   
   With her housing stabilized, Tasha could focus on parenting, attending counseling, and staying engaged in recovery. Her emergency room visits have drastically reduced, and she’s working toward full-time employment.

 

• Focus on Social Determinants of Health (SDOH): CS services address housing, food security, transportation, and other non-clinical factors that impact health.
  
  
• Offered by Managed Care Plans (MCPs): While MCPs are encouraged to provide all CS services, availability may vary by region.

Examples of Community Supports Services:

1. Housing Support Services

• • Housing Transition Navigation Services: Helps individuals experiencing homelessness find and secure housing.
    
    
  • Housing Deposits: Assistance with security deposits, first/last month’s rent, and essential move-in costs.
    
    
  • Housing Tenancy and Sustainability Services: Helps individuals maintain stable housing by providing landlord coordination, eviction prevention, and recertification assistance.

2. Health & Recovery Supports

• • Short-Term Post-Hospitalization Housing: Temporary housing for individuals without a stable home after hospital discharge.
    
    
  • Medical Respite Care: Short-term residential care for individuals recovering from a hospital stay but lacking housing.

3. Nutrition & Meal Support

• • Medically Tailored Meals: Provides customized nutrition for members with specific medical conditions.
    
    
  • Medically Supportive Food/Nutrition: Includes meal delivery, food vouchers, and nutrition education.

4. Environmental & Home-Based Support

• • Asthma Remediation: Home modifications to reduce asthma triggers.
    
    
  • Personal Care and Homemaker Services: In-home support for daily living activities.

5. Social and Community Integration

• Sobering Centers: Safe spaces for intoxicated individuals to recover without needing emergency care.
  
  
• Day Habilitation Programs: Services that enhance life skills and community integration for individuals with disabilities or mental health needs​​.

Why Community Supports Matter

• • Reduces avoidable emergency room visits and hospital stays.
    
    
  • Improves housing stability and overall well-being.
    
    
  • Supports equity by addressing social determinants of health.
    
    
  • Lowers healthcare costs by providing preventive and supportive services.

 

A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of the community they serve. They act as a liaison between healthcare, social services, and community members to improve access to care, health education, and overall well-being.

Key Characteristics of a Community Health Worker:

• Community-Based and Culturally Competent: CHWs share similar backgrounds, experiences, and cultures with the communities they serve, making them more effective in building trust and engagement.
•  
• Bridges Healthcare and Social Services: CHWs help individuals navigate healthcare systems, connect to social support services, and advocate for better community health outcomes.
•  
• Focus on Social Determinants of Health (SDOH): They address housing, food security, transportation, health literacy, and chronic disease management.
•  
• Promotes Preventative Care & Health Education: CHWs provide education on managing chronic conditions, vaccinations, maternal and child health, and healthy lifestyles.

Roles and Responsibilities of CHWs:

1. Outreach & Engagement: Identifying and enrolling individuals in health and social service programs.
   
   
2. Health Promotion & Education: Teaching individuals and families about disease prevention, wellness, and self-care.
   
   
3. Care Coordination & Navigation: Helping clients schedule appointments, complete paperwork, and access medical and community resources.
   
   
4. Advocacy & Support: Empowering individuals to advocate for their healthcare needs and working with healthcare providers to address barriers.
   
   
5. Home Visits & Community-Based Support: Meeting people where they are to provide direct support and follow-up care.
   
   

Impact of CHWs:

• Improve Health Outcomes: Increase preventive care use and chronic disease management.
  
  
• Reduce Health Disparities: Address social and cultural barriers to care.
  
  
• Enhance Patient Engagement: Build trust and encourage long-term health behavior change.
  
  
• Lower Healthcare Costs: Reduce emergency room visits and hospitalizations by promoting preventive care.

CHWs play a critical role in Enhanced Care Management (ECM) by supporting high-need populations, including people experiencing homelessness, justice-involved individuals, and those with serious mental illness or chronic conditions.

• Moral Recognition Therapy
  
  
• Anger Management
  
  
• Domestic Violence
  
  
• Substance Abuse
  
  
• Parenting
  
  
• Life skills provided by Kindful Restoration Outpatient Program include:
  
  
  • Communication Skills – Enhancing interpersonal communication and conflict resolution.
    
    
  • Decision-Making – Teaching problem-solving techniques for everyday situations.
    
    
  • Time Management – Helping individuals organize and prioritize tasks effectively.
    
    
  • Financial Literacy – Educating on budgeting, saving, and understanding credit.
    
    
  • Digital Literacy – Training in basic digital skills, such as using computers and common software applications.
    
    
  • Job Preparation – Resume building, interview coaching, and workplace readiness.
    
    
  • Personal Development – Life coaching and mentoring for goal-setting and self-improvement.

Specialty Services Link

Kindful Restorations will generate revenue from contracts to provide services from these organizations:

• Managed Care Plan: Molina Healthcare
  
  
• Managed Care Plan: Inland Empire Health Plan
  
  
• Managed Care Plan: Kaiser Permanente

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Services Only for Individuals Impacted by the Criminal Justice System

Contracts and agreements are to provide these services for people outside of prison with the focused population of persons reentering society from incarceration, on parole, probation, or system-impacted. 

 

Adults:

• Probation Day Reporting Centers in Riverside County: Riverside, Blythe, and Temecula
  
• California Department of Corrections and Rehabilitation Parole Division
  
• Managed Care Plans:
  
  • Molina
    
  • Inland Empire Health Plan: Inland Empire Health Plan (IEHP) offers an Enhanced Care Management (ECM) program designed to provide comprehensive support to Medi-Cal members with complex health needs. This no-cost benefit addresses both clinical and non-clinical aspects of care through systematic coordination and personalized management.
    
    
  • Kaiser: ​Kaiser Permanente offers an Enhanced Care Management (ECM) program as part of California's CalAIM initiative, aiming to provide comprehensive support to Medi-Cal members with complex health and social needs.

 

• County Jails: Establishing a relationship to get inside of the county jails.
  
  
• Self-Referrals: for our outpatient and medical reentry and continuum of care model outpatient medical programs.
  
  
• Community-Based Organization Referrals: for our outpatient and medical reentry and continuum of care model outpatient medical programs.

Youth:

• Spark: for our outpatient and medical reentry and continuum of care model outpatient medical programs.
  
  
• Riverside County Probation Department: For our outpatient and medical reentry and continuum of care model outpatient medical programs.
  
  
• The 3 Juvenile Halls in Riverside County: For our youth Cultures of Collaboration model (Stepping Stones will be implemented).
  
  
• Judges: for our outpatient and medical reentry and continuum of care model outpatient medical programs.
  
  
• Public Defenders: for our outpatient and medical reentry and continuum of care model outpatient medical programs.

 

Ernesto has been appointed to these committees:

• Riverside County Juvenile Justice Coordinating Council District 1 representative.
  
  
• Board Member: Community Based Organizations Alliance (CBO Alliance).
  
  
• Being considered for: National Association of Anger Management

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