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136th APHA Annual Meeting San Diego, CA Session 5196.0 Invisible Bars: Barriers to Women’s Health During and After Incarceration V. Diane Woods, Dr.P.H., M.S.N., R.N. Assistant Research Psychologist University of California Riverside, California President & CEO, African American Health Institute of San Bernardino Kim Carter Founder & Executive Director, Time for Change Foundation October 29, 2008 @ 12:30pm 1 Project Funded in Part by: Time for Change Foundation California Endowment County of San Bernardino SBC Department of Public Health Presentation Sponsored by: African American Health Institute of San Bernardino County 2 Purpose of Presentation To identify five barriers women face in accessing health resources during and after incarceration To understand the complexity of women accessing healthcare services while detained in prison and upon release To identify three policy change recommendations for State Correctional Systems that have the potential to improve health outcomes of women 3 WOMEN IN PRISON From 1973 to 2007, women in prisons increased by 645% --almost twice rate of men Source: The Sentencing Project, Institute on Women and Criminal Justice (Mauer 2007) The November Coalition 5 Who are these women in prison? Women … • 85% convicted of drug or drug-related offenses • 90% fragmented in their family histories • 70% from families with other members in the Criminal Justice (CJ) System • 80% survivors of physical and/or sexual abuse • overrepresented by women of color • 70% poor, undereducated, unskilled, single mothers 6 Whose Mother, Daughter or Sister? 7 CASE STUDY: San Bernardino County, CA 2006 Population Estimate, 1.99 million Percent by Ethnicity American Indian/Alaska Native, 1.4% Asian, 5.6% Pacific Islanders, 0.4% Black, 9.5% Latino, 44.8% White, 38.4% City of San Bernardino largest populated area= approx 200,000 8 Source: San Bernardino County Quick Facts, U.S. Census Bureau, 2007 available at http://quickfacts.census.gov U.S. Federal Court Seizes State Prison Healthcare In 2005, the California prison healthcare system seized by the federal government One inmate/per week dying from medical neglect Judge cites preventable deaths of inmates depravity of system 9 U.S. Federal Court Seizes State Prison Healthcare 2008 Status Report: • Fired incompetent unlicensed doctors • Demand $8 billion dollars from State Treasury • Increased salaries for qualified medical staff • Little done to improve delivery systems 10 Research Questions What are the barriers women face while incarcerated? What are the barriers women face after incarceration? What are healthcare needs of women during incarceration? What are the risks to the public’s health? 11 Methods Mixed-Methods Approach (Qualitative & Quantitative) Current & Formerly Incarcerated Women Location: San Bernardino County, CA Study conducted in 2005 12 Quantitative Data Literature Review of Best Practices GIS Mapping to Identify Resources (housing, healthcare, dental, etc.) Survey Development for Population Sampling • Target: formerly incarcerated women (convenience sample) • Key informants, n=5 • Survey pilot testing, n=8 13 Survey Design Paper survey: • 6 pages • 43 questions • dichotomous (i.e., yes/no) and multiple choice responses Face-to-Face Self-administration 14 Quantitative Data Sampling Multi-faceted sampling sites, n=17 •California Institution for Women (CIW) •New House •Cedar House •Gibson House •Vista Recovery Center •California Rehabilitation Center (CRC) •State of California Parole Department •12-step Anonymous Meetings, n=10 15 Data Collection Total Survey Sample, N=152 Survey Sampling Selection Criteria: 1. 2. 3. 4. Could be on parole or probation Experienced recidivism 18 years old and older Resident of San Bernardino County Interviews: March - April 2005 16 Data Analysis SPSS Version 11.5 Database: 95 variables and 152 respondents Data mining Descriptive analysis conducted 17 Post Incarceration RESULTS Lack of Employment Lack of Health Insurance Mental Health Disorders Prevalence of Drug & Sexual Abuse 18 Lack of Employment Response Category Yes No No Response Total Number of Percent of Respondents Respondents (%) 20 13.2 124 81.6 8 5.3 152 100.0 Lack of Health Insurance 20 Mental Health Disorders % of Respondents 60 50 40 30 20 10 0 Depression Bi-Polar Schizophrenia Other None Substance Abuse Do you have a history of drug abuse? No 15.1% Response Category Yes No No Response Total No Response 1.3% Yes 83.6% Number of Respondents 127 23 2 Percent of Respondents (%) 83.6 15.1 1.3 152 100.0 Sexual Abuse Have you had any counseling for that abuse? Report of Sexual & Physical Abuse 70 60 70 Yes 50 40 60 50 No 40 30 30 20 20 10 0 % of Respondents Yes No Response 10 No No Response 0 % of Respondents 23 SUMMARY of RESULTS Incarcerated women don’t have access to competent healthcare services in prison Previously incarcerated women do not have access to preventative healthcare Public Health – defined as ensuring conditions exist in which people can live healthy is locked out of the prison system Having a Felony conviction….equates into disenfranchisement of many health and social services. 24 Four Critical Interrelated Issues Substance Abuse Mental Health Physical Health Trauma Similar findings by Covington, Bloom & Owens, 2006 (NIH – Gender- Responsive Strategies ) 25 Discussion Greater Public Health Risks More women entering community unhealthy More women suffering from mental health issues left untreated Reduced chances of successful reintegration into society. 26 RESULTS In Prison Did not Receive treatment for substance abuse Re-Traumatized by guards and environment Not given appropriate counseling and mental health services Suffering from multiple health conditions After Prison Gap in services available for substance abuse treatment Lack of appropriate programs available Unstable living arrangements Ineligible for most government funded support services 27 What are the Barriers to Accessing Healthcare Services In Prison The institution charges a $5.00 co-pay There are not enough slots for all the women who need substance abuse treatment Inmates are dying from preventable illnesses on average one per week which heightens fear amongst inmates Healthcare system ineffectively dealing with Those diagnosed with mental illness are mandated to take medications but do have mental health treatment to include counseling, information on side-effects of medications and managing their stressors 28 What are the Barriers to Accessing Healthcare Services After Prison Lack of Health Insurance – many responded that the County –(MIA) Medical Indigent Adult insurance should be called (MIA) Missing In Action because the 3 to 4 month waiting periods for services and between referrals No access to preventative care Emergency Room dependency Non-existent dental services for the indigent Drug felony status excludes many from accessing food status and other welfare services 29 Loss sense of entitlement amongst this group Policy Recommendation Dept. of Corrections Remove the $5.00 copay for the indigent Inmates should be classified into appropriate rehabilitative services All inmates should receive an annual pap smear and those above 40 should include a mammogram State of California Create a continuum of health care services coordinated for former prisoners Modify the 2006 TANF welfare reform which prohibits drug offenders from receiving food stamps, welfare and public housing 30 Public Health Risk Factors Women re-entering the community without having received healthcare during incarceration are more likely to: Carry STD’s that have been undetected Be released without their psychotropic medications in hand Suffer from Post Incarceration Syndrome Return to abusing drugs and alcohol Re-Enter Society as Homeless 31 Recognition Received as a result of being inspired by Public Health 2004 - NAACP – Community Pioneer Award for Social Justice 2005 - KCET/Washington Mutual – Unsung Hero Award 2005 – County of San Bernardino – Herstory Award 2005 – Soroptimist International – “Woman Making a Difference Award” 2006 – League of Women Voters – Citizens Achievement Award 2006 – Bank of America – Local Hero Award 2007 – Black Culture Foundation – Black Rose Award 2008- Loma Linda University Children’s Hospital Foundation’s – Hometown Hero Award 32 Free Copy of the report titled: “Invisible Bars- Barriers to Women’s Health and Well-Being During and After Incarceration” Carter, Ojukwu & Miller, 2006 Available on line at www.Timeforchange.us 33