By Lillian Mongeau Hughes, KFF Health News

MANTI, Utah — Garrett Clark estimates he has spent about six years in the Sanpete County Jail, a plain concrete building perched on a dusty hill just outside this small, rural town where he grew up.

He blames his addiction. He started using in middle school, and by the time he was an adult he was addicted to meth and heroin. At various points, he’s done time alongside his mom, his dad, his sister, and his younger brother.

“That’s all I’ve known my whole life,” said Clark, 31, in December.

On the day of her release from Sanpete County Jail in rural Utah in December, Shantel Clark hugs Cheryl Swapp, the jail’s community health worker, at the sheriff’s office. Clark’s sweatshirt had just been pulled from a supply of clothing for people who are released at a different time of year than when they were booked. (Lillian Mongeau Hughes for KFF Health News/TNS)

Clark was at the jail to pick up his sister, who had just been released. The siblings think this time will be different. They are both sober. Shantel Clark, 33, finished earning her high school diploma during her four-month stay at the jail. They have a place to live where no one is using drugs.

And they have Cheryl Swapp, the county sheriff’s new community health worker, on their side.

“She saved my life probably, for sure,” Garrett Clark said.

Swapp meets with every person booked into the county jail soon after they arrive and helps them create a plan for the day they get out.

She makes sure everyone has a state ID card, a birth certificate, and a Social Security card so they can qualify for government benefits, apply to jobs, and get to treatment and probation appointments. She helps nearly everyone enroll in Medicaid and apply for housing benefits and food stamps. If they need medication to stay off drugs, she lines that up. If they need a place to stay, she finds them a bed.

Then Swapp coordinates with the jail captain to have people released directly to the treatment facility. Nobody leaves the jail without a ride and a drawstring backpack filled with items like toothpaste, a blanket, and a personalized list of job openings.

“A missing puzzle piece,” Sgt. Gretchen Nunley, who runs educational and addiction recovery programming for the jail, called Swapp.

Swapp also assesses the addiction history of everyone held by the county. More than half arrive at the jail addicted to something.

Garrett Clark, left, puts his arm around his sister, Shantel, minutes after she was released from the Sanpete County Jail in rural Utah in December. Cheryl Swapp, second from right, helps smooth detainees’ transition to the outside as the jail’s community health worker. Ryan Montag, right, has been helped by Swapp in the past. (Lillian Mongeau Hughes for KFF Health News/TNS)

Nationally, 63% of people booked into local jails struggle with a substance use disorder — at least six times the rate of the general population, according to the federal Substance Abuse and Mental Health Services Administration. The incidence of mental illness in jails is more than twice the rate in the general population, federal data shows. At least 4.9 million people are arrested and jailed every year, according to an analysis of 2017 data by the Prison Policy Initiative, a nonprofit organization that documents the harm of mass incarceration. Of those incarcerated, 25% are booked two or more times, the analysis found. And among those arrested twice, more than half had a substance use disorder and a quarter had a mental illness.

“We don’t lock people up for being diabetic or epileptic,” said David Mahoney, a retired sheriff in Dane County, Wisconsin, who served as president of the National Sheriffs’ Association in 2020-21. “The question every community needs to ask is: ‘Are we doing our responsibility to each other for locking people up for a diagnosed medical condition?’”

The idea that county sheriffs might owe it to society to offer medical and mental health treatment to people in their jails is part of a broader shift in thinking among law enforcement officials that Mahoney said he has observed during the past decade.

“Don’t we have a moral and ethical responsibility as community members to address the reasons people are coming into the criminal justice system?” asked Mahoney, who has 41 years of experience in law enforcement.

Cheryl Swapp, a community health worker, makes notes between meetings with new detainees at the Sanpete County Jail outside Manti, Utah, on Dec. 18, 2023. Swapp usually meets with people inside the jail but was using a visitation room to accommodate a visiting journalist. (Lillian Mongeau Hughes for KFF Health News/TNS)

Swapp previously worked as a teacher’s aide for those she calls the “behavior kids” — children who had trouble self-regulating in class. She feels her work at the jail is a way to change things for the parents of those kids. And it appears to be working.

Since the Sanpete County Sheriff’s Office hired Swapp last year, recidivism has dropped sharply. In the 18 months before she began her work, 599 of the people booked into Sanpete County Jail had been there before. In the 18 months after she started, that number dropped to 237.

In most places, people are released from county jails with no health care coverage, no job, nowhere to live, and no plan to stay off drugs or treat their mental illness. Research shows that people newly released from incarceration face a risk of overdose that is 10 times as high as that of the general public.

Sanpete wasn’t any different.

“For seven to eight years of me being here, we’d just release people and cross our fingers,” said Jared Hill, the clinical director for Sanpete County and a counselor at the jail.

Nunley, the programming sergeant, remembers watching people released from jail walk the mile to town with nothing but the clothes they’d worn on the day they were arrested — it was known as the “walk of shame.” Swapp hates that phrase. She said no one has made the trip on foot since she started in July 2022.

Folders fill several drawers in the office of Cheryl Swapp, a community health worker at Sanpete County Sheriff’s Office in rural Utah. (Lillian Mongeau Hughes for KFF Health News/TNS)

Swapp’s work was initially funded by a grant from the U.S. Health Resources and Services Administration, but it has proved so popular that commissioners in Sanpete County voted to use a portion of its opioid settlement money to cover the position in the future.

Swapp doesn’t have formal medical or social work training. She is certified by the state of Utah as a community health worker, a job that has become more common nationwide. There were about 67,000 people working as community health workers in 2022, according to the U.S. Bureau of Labor Statistics.

Evidence is mounting that the model of training people to help their neighbors connect to government and health care services is sound, said Aditi Vasan, a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania who has reviewed the research on the relatively new role.

The day before Swapp coordinated Shantel Clark’s release, she sat with Robert Draper, a man in his 50s with long white hair and bright-blue eyes. Draper has been in and out of jail for decades. He was sober for a year and had been taking care of his ill mother. She kept getting worse. Then his daughter and her child came to help. It was all a little too much.

“I thought, if I can just go and get high, I can deal with this shit,” said Draper. “But after you’ve been using for 40 years, it’s kinda easy to slip back in.”

He didn’t blame his probation officer for throwing him back in jail when he tested positive for drugs, he said. But he thinks jail time is an overreaction to a relapse. Draper sent a note to Swapp through the jail staff asking to see her. He was hoping she could help him get out so he could be with his mom, who had just been sent to hospice. He had missed his father’s death years ago because he was in jail at the time.

Swapp listened to Draper’s story without interruptions or questions. Then she asked if she could run through her list with him so she would know what he needed.

“Do you have your Social Security card?”

“My card?” Draper shrugged. “I know my number.”

“Your birth certificate, you have it?”

“Yeah, I don’t know where it is.”

“Driver’s license?”

“No.”

“Was it revoked?”

“A long, long time ago,” Draper said. “DUI from 22 years ago. Paid for and everything.”

“Are you interested in getting it back?”

“Yeah!”

Swapp has some version of this conversation with every person she meets in the jail. She also runs through their history of addiction and asks them what they most need to get back on their feet.

She told Draper she would try to get him into intensive outpatient therapy. That would involve four to five classes a week and a lot of driving. He’d need his license back. She didn’t make promises but said she would talk to his probation officer and the judge. He sighed and thanked her.

“I’m your biggest fan here,” Swapp said. “I want you to succeed. I want you to be with your mom, too.”

The federal grant that funded the launch of Sanpete’s community health worker program is held by the regional health care services organization Intermountain Health. Intermountain took the idea to the county and has provided Swapp with support and training. Intermountain staff also administer the $1 million, three-year grant, which includes efforts to increase addiction recovery services in the area.

The library and therapy room at Castle Ridge Behavioral Health in Castle Dale, Utah, is meant to be a peaceful place to study and think for people recovering from substance use disorder. (Lillian Mongeau Hughes for KFF Health News/TNS)

A similarly funded program in Kentucky called First Day Forward took the community health worker model a step further, using “peer support specialists” — people who have experienced the issues they are trying to help others navigate. Spokespeople from HRSA pointed to four programs, including the ones in Utah and Kentucky, that are using their grant money for people facing or serving time in local jails.

Back in Utah, Sanpete’s new jail captain, Jeff Nielsen, said people in small-town law enforcement weren’t so far removed from those serving time.

“We know these people,” Nielsen said. He has known Robert Draper since middle school. “They are friends, neighbors, sometimes family. We’d rather help than lock them up and throw away the key. We’d rather help give them a good life.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

By SAMY MAGDY, BASSEM MROUE and DAVID RISING (Associated Press)

CAIRO (AP) — Egypt sent a high-level delegation to Israel for talks Friday seeking to push through a cease-fire agreement with Hamas and avert an Israeli offensive on Gaza’s town of Rafah — on the border with Egypt — which it warned could ruin regional stability, officials said.

Egypt’s top intelligence official, Abbas Kamel, led the delegation and planned to discuss with Israel a “new vision” for a prolonged cease-fire in Gaza, an Egyptian official said, speaking on condition of anonymity to discuss the mission freely.

As the war drags on and casualties mount, there has been growing international pressure for Hamas and Israel to reach an agreement on a cease fire.

Hamas has been designated as a terrorist organization by the United States, Canada and the European Union.

Friday’s talks focused at first on a limited exchange of hostages held by Hamas for Palestinian prisoners, and the return of a significant number of displaced Palestinians to their homes in northern Gaza “with minimum restrictions,” the Egyptian official said.

The official said mediators are working on a compromise that will answer most of both parties’ main demands, then lead to continued negotiations with the goal of a larger deal to end the war. A Western diplomat in Cairo said that Egypt’s intensified efforts for a cease-fire aim to avert a Rafah offensive. The diplomat spoke on condition of anonymity to freely discuss the developments.

Hamas has said it will not back down from its demands for a permanent cease-fire and full withdrawal of Israeli troops, both of which Israel has rejected. Israel says it will continue military operations until Hamas is defeated and that it will retain a security presence in Gaza afterwards.

Related Articles

US says it’s reviewing new information about Israeli unit accused of abuses before the war in Gaza

Hamas again raises the possibility of a 2-state compromise. Israel and its allies aren’t convinced

Hamas releases video of American-Israeli hostage Hersh Goldberg-Polin

Pro-Palestinian student protests target colleges’ financial ties with Israel

Biden says the US is rushing weaponry to Ukraine as he signs a $95 billion war aid measure into law

In a statement Friday, Hamas said it is open to any “ideas or suggestions” that take into consideration the needs of the Palestinian people such as an end Israel’s attacks on the Gaza Strip, the return of displaced people to their homes and an Israeli withdrawal.

Both Israeli and Egyptian officials confirmed the Egyptian delegation had arrived in Tel Aviv. Later, the Egyptian official said meetings had concluded and that there was an agreement to work out a draft deal, but he did not elaborate.

Overnight, Lebanon’s militant Hezbollah group fired anti-tank missiles and artillery shells at an Israeli military convoy in a disputed border area, killing an Israeli civilian.

Hezbollah said its fighters ambushed the convoy shortly before midnight Thursday, destroying two vehicles. The Israeli military said the ambush wounded an Israeli civilian doing infrastructure work, and that he later died of his wounds.

Low-intensity fighting along the Israel-Lebanon border has repeatedly threatened to boil over as Israel has targeted senior Hezbollah militants in recent months.

Tens of thousands of people have been displaced on both sides of the border. On the Israeli side, the cross-border fighting has killed 10 civilians and 12 soldiers, while in Lebanon, more than 350 people have been killed, including 50 civilians and 271 Hezbollah members.

Meanwhile, Israel has been conducting near-daily raids on Rafah, a town where more than half of Gaza’s 2.3 million people have sought refuge after fleeing fighting elsewhere in the territory.

The Israeli military has massed dozens of tanks and armored vehicles in southern Israel close to Rafah, in apparent preparations for an invasion.

Rafah also abuts the Gaza-Egypt border. The Egyptian official said that Kamel, who heads Egypt’s General Intelligence Service, planned to make clear in Friday’s talks that Egypt “will not tolerate” an Israeli deployment of troops along that border. Egypt has said an attack on Rafah would violate the decades-old peace deal between Egypt and Israel.

The official said Egypt shared intelligence with the United States and European countries showing that a Rafah offensive would inflame the entire region.

On Wednesday, Egyptian President Abdel Fattah el-Sissi cautioned that an Israeli attack on Rafah would have “catastrophic consequences on the humanitarian situation in the strip, as well as the regional peace and security.”

El-Sissi’s comments came in a phone call with Prime Minister Mark Rutte of The Netherlands, the Egyptian leader’s office said.

Illustrating the pressures facing Israeli Prime Minister Benjamin Netanyahu from the far-right flank of his government, his ultranationalist national security minister, Itamar Ben-Gvir, scoffed on the social media platform X about the Egyptian attempts to bring about a cease-fire.

“The Egyptian proposal arrived because Hamas is afraid of a Rafah operation,” he wrote. “Rafah now!”

The Israel-Hamas war was sparked by the Hamas’ Oct. 7 raid into southern Israel, in which the group killed around 1,200 people, mostly civilians, and took some 250 people as hostages. Israel says the group is still holding around 100 hostages and the remains of more than 30 others.

More than 34,000 Palestinians have been killed in the war, according to the Health Ministry in Hamas-run Gaza, around two-thirds of them children and women.

The ministry said Friday that the bodies of 51 more people killed in Israeli strikes had been brought to hospitals in the past 24 hours.

Israel has reported at least 260 of its soldiers killed since the start of ground operations in Gaza.

Mroue reported from Beirut, Rising reported from Bangkok.

The Gophers football program declined to host a spring game to conclude practices this month, so there is no formal bow to put on how the 2024 team is beginning to take shape.

Head coach P.J. Fleck said last month the decision to forego the glorified, open-to-the-public scrimmage came down to a rash of cancelations and location changes that the U had to deal with in recent years.

Fleck also acknowledged a desire to keep new personnel and schematic changes to his team under wraps — primarily new quarterback Max Brosmer, possible wrinkles to the passing game and what new defensive coordinator Corey Hetherman will bring to the table.

Not necessarily in that order.

Reporters were allowed to watch three practices, and here are five takeaways from watching those sessions and speaking with coaches and players.

Quarterback

One lasting impression from a spring 2023 practice was quarterback Athan Kaliakmanis having trouble getting the Gophers out of the huddle and properly lined up. When it broke down, Fleck was livid.

Brosmer showed his own learning curve from the FCS level to a Big Ten program during this year’s open practices — primarily the size of pass rushers/offensive linemen and the speed of play creating tighter windows to thread passes.

But those previous baseline issues weren’t visible. He showed a level of leadership and command that was lacking last year.

“First of all, you start with the intangibles (and) they are through the roof,” Fleck said of Brosmer on March 20. “When you look at the quarterbacks, we’ve had a lot of success with (Zach Terrell and Tanner Morgan); whether Western Michigan or Minnesota, the intangibles go through the roof. That is the first thing you see when you meet (Brosmer).

“I think any successful quarterback has to have that. It can’t be all of it, because you’ve got to have some skill and talent and all that other stuff. But the intangibles, you feel like he’s already been here for 30 years.”

Brosmer, who joined the U the week leading up to the Quick Lane Bowl in December, threw more interceptions than touchdowns during the three open practices, while true freshman QB Drake Lindsay displayed a more impressive arsenal of throws and explosive plays.

Brosmer will be the starter on Aug. 29 against North Carolina, and with 15 total returning starters, how quickly he can get up to speed and the level at which he can play this fall will determine the Gophers’ success.

Transfer portal

The Gophers have had five players leave via the NCAA transfer portal this month, but none of them were starters — and only two were on the two-deep roster. The other three primarily helped clear scholarship spots for other incoming players.

On the flip side, the U has brought in four players via the portal, and two of them appear to be huge, four-star additions: LSU defensive end Jaxon Howard, a Robbinsdale Cooper product who was the top-rated in-state recruit in the 2023 class; and Georgia receiver Tyler Williams of Lakeland, Fla., who was considered a top 25 player in the nation at his position.

The Williams addition is especially vital given the lack of punch from healthy receivers in the U’s spring practices.

The transfer portal has created unprecedented volatility across college campuses in the last few years, but the Gophers appear* to have come out ahead this spring.

* Anything can change these days.

Cornerback

One of the unsung, reliable players a year ago was senior cornerback Tre’Von Jones, a transfer from Elon. With the Gophers in 2023, he had 53 tackles, two interceptions, eight pass breakups and a sack in 13 games.

The Gophers feel as though they might have an upgrade with new senior corner Ethan Robinson from Bucknell. The U got him in the portal over Auburn and new Big Ten foe USC. The Gophers’ culture was a big reason why.

“Personally, just hard work, dedication and trying to make yourself better every day are all things I take pride in,” Robinson said. “Seeing that alignment (with the U) is very nice for me.”

The Gophers will need reliable cover guys on the outside, including mainstay senior Justin Walley, with star safety Tyler Nubin off to the NFL.

Running back

Fleck remains unapologetic when asked about putting any sort of carries limit on any star tailback, pitch counts forever be damned — despite Darius Taylor’s fabulous freshman season being derailed by leg injuries in October and November before he returned to be MVP of the Quick Lane Bowl.

Taylor, who averaged 5.8 yards per carry in six games in 2023, said he has adjusted his own process going into his sophomore season.

“Obviously, what I went through last season was unfortunate, but it’s just I knew what I needed to go into the offseason, thinking about and working and bettering myself — getting in the training room,” Taylor said.

Taylor was again sidelined during the final open practice on April 16, but Fleck — who does not share many, if any, injury details — said Taylor’s situation wasn’t a big deal.

The Gophers brought Sean Tyler in from Western Michigan via the portal last season, but fumbling issues led to his benching. The U tries again this year with a pair of new tailbacks: Sieh Bangura (Ohio) and Marcus Major (Oklahoma).

The U also brought in two freshman: Fame Ijeboi and Jaydon Wright, whose size is reminiscent of bruising former RB Kobe McCrary. Yet both of them were rehabbing injuries toward the end of spring.

Offensive line

The Gophers’ offensive line returns a budding star and future NFL Draft pick in fifth-year left tackle Aireontae Ersery, and has ton of experience returning everywhere but center.

Sophomore Greg Johnson of Prior Lake was the first-team center in spring ball and his 369 snaps at left guard as a true freshman will help ease his position switch.

For a third straight year, the Gophers are exploring moving Quinn Carroll from tackle to guard. The previous two times, he has remained at tackle because teammates haven’t consistently stepped up to play on the right edge.

“You have to win the job,” Fleck said. “And last year we didn’t have anybody win that job. I think that was maybe one of our downfalls. … We weren’t good enough there.”

Fifth-year tackle Martes Lewis and second-year Phillip Daniels, who showed a nastiness in spring ball, are the top two candidates.

Gophers Depth Chart

OFFENSE

QB — Max Brosmer (Sr.); Drake Lindsey (Fr.)
RB — Darius Taylor (So.); Sieh Bangura (Sr.)
WR — Daniel Jackson (Sr.); Kenric Lanier II (So.)
WR — Tyler Williams (Fr.); Elijah Spencer (Sr.)
WR — Le’Meke Brockington (Jr.); Donielle Hayes  (So.)
LT — Aireontae Ersery (Sr.); Tony Nelson (Jr.)
LG — Tyler Cooper (Sr.); Greg Johnson (So.)
C — Greg Johnson (So.); Ashton Beers (Jr.)
RG — Quinn Carroll (Sr.); Ashton Beers (Jr.)
RT — Martes Lewis (Jr.); Phillip Daniels (So.)
TE — Jameson Geers (Jr.); Nick Kallerup (Sr.)

DEFENSE

DE — Jah Joyner (Jr.); Anthony Smith (Jr.)
DT — Jalen Logan-Redding (Jr.); Darnell Jefferies (Sr.)
DT — Deven Eastern (Jr.); Logan Richter (Sr.)
DE — Danny Striggow (Sr.); Jaxon Howard (Fr.)
LB — Cody Lindenberg (Jr.); Devin Williams (Jr.)
LB — Maverick Baranowski (Jr.); Matt Kingsbury (So.)
NB — Jack Henderson (Sr.); Craig McDonald (Jr.)
CB — Justin Walley (Sr.); Ryland Kelly (Jr.)
CB — Ethan Robinson (Sr.); ZaQuan Bryan (So.)
SS — Darius Green (Jr.); Coleman Bryson (Jr.)
FS — Kerry Brown (Jr.); Koi Perich (Fr.)

SPECIAL TEAMS

K — Dragan Kesich (Sr.); David Kemp (Jr.)
P — Mark Crawford (Sr.); Caleb McGrath (So.)
KR — Quentin Redding (Jr.); Le’Meke Brockington (Jr.)
PR — Quentin Redding (Jr.); Kristen Hoskins (So.)

Related Articles

Gophers offensive lineman Logan Purcell enters NCAA transfer portal

Where will Gophers players be selected in NFL draft?

Gophers add third scholarship quarterback with Va. Tech transfer Dylan Wittke

Gophers fill glaring need at receiver with four-star Georgia transfer Tyler Williams

Gophers backup cornerback Victor Pless enters NCAA transfer portal