Download Improving Access to and Utilization of Health and Social Services for

Improving Access to
and Utilization of Health
and Social Services for
HIV-infected Jail and Prison
Releases: Evaluation Results
from the Corrections
Demonstration Project
Sofia S. Kennedy, Abt Associates Inc., Cambridge, Massachusetts USA
Ted Hammett, Abt Associates Inc., Cambridge, Massachusetts USA
Ronald Braithwaite, Rollins School of Public Health, Emory University, Atlanta Georgia USA
Kimberly Jacob Arriola, Rollins School of Public Health, Emory University, Atlanta Georgia USA
Expanded Access to HIV Services in Correctional Facilities
Background
Rates of HIV/STIs are up to five times higher among US inmates than in the total population
Inmates have a legal right to health care in prison/ jail but often do not have access to health and social
services after release, and are often denied services post-release because of their criminal record or
the behavior that led to their arrest (e.g., drug sales)
Funding
The Corrections Demonstration Project (CDP) is funded by two US federal agencies: the Centers For
Disease Control and Prevention and the Health Resources and Services Administration
CDP Interventions
Continuity of care: pre-release discharge planning & post-release case management
HIV/STI testing & treatment, HIV prevention, peer educator training, staff training (not addressed
in this poster)
CDP Intervention Sites
Departments of public health in six states (California, Florida, Georgia, Massachusetts, New Jersey and
New York) and one city (Chicago, Illinois) were funded
Services are provided in jails (non-sentenced & sentenced inmates, short sentences), prisons (sentences
of >1 year), juvenile facilities, alternative & transitional correctional settings and in the community
after release
Evaluation
Background
Participation in the program and the evaluation is voluntary
The evaluation follows clients from program recruitment (during incarceration) through 6 months
after release
Evaluation is ongoing
Preliminary results from 30 days after release presented here
Continuity of Care For People Living With HIV Being
Released From Correctional Facilities
Public Health Departments partnered with correctional facilities and contracted with NGOs to provide services
NGO case managers work with inmates living with HIV (and some HIV-negatives) in
the correctional facility
Assess post-release needs related to: medical, mental health and substance abuse treatment,
housing, benefits, employment, family and HIV prevention
Provide discharge planning prior to release (make appointments for and referrals
to post-release services)
Provide case management in the community after release (escort client to appointments,
make additional appointments & referrals, provide support during the transition)
Transition client to permanent long-term case manager
Table 1: Total clients served and participating in the evaluation
Program Clients1
Longitudinal Evaluation Clients
30-Day
Follow-up3
Served 2
Recruited3
Released3
Jail
3757
658
267
237
Prison
2103
448
335
247
Total
6027
1106
602
484
1 California
data are not included, not participating in the client-level evaluation
2 February 2000-March 2004 (program start dates vary by site)
3 January 2001-September 2003 (evaluation start dates vary by site)
Table 2: Service Utilization Before and After Incarceration (Prison Clients)
Prior to
30 Days Post P-value
Incarceration
Release
Total
247
HIV+
211 (85.4%) 1
Mental Health Diagnosis
86 (34.8% )1
HIV Care
116 (55.0)2
165 (78.2)2
<0.0001
HIV Meds
87 (41.2)2
145 (68.7)2
<0.0001
Mental Health Care
37 (43.0)3
29 (33.7)3
NS
Substance Abuse Treatment
84 (34.0)1
107 (43.3)1
0.0221
1
% of all clients
2
% of HIV-infected
clients
3%
of clients with a mental health diagnosis
Discussion
Almost 20% of clients served participated in the evaluation
Not all clients were offered the option to be in the evaluation due to delays in the implementation of the evaluation
(e.g., instrument development, IRB approval, site readiness)
Over half the clients recruited for the evaluation were released and eligible for community services
80% of releasees were in case management 30 days after release
Prison Programs
Significantly more clients received HIV care,
took HIV medication and participated in drug
treatment after release than before prison
This population may be interested in case
management because they have been incarcerated
for one or more years and may have initiated
treatment in prison and never had HIV care
in the community
Jail Programs (n= 237)
Significantly fewer clients received HIV care after release
than before jail (data not shown)
There were no other significant changes
Less than half the program clients were released
to community case management
Clients who have been in jail for a short time may
still be connected to community services
Clients who receive care in jail may not need to
see a provider right after release
Lessons Learned/Recommendations
Partnerships between correctional facilities (especially prisons), public health entities and NGOs help
inmates to transition back to the community
Connecting releasees to HIV care and medications can reduce the spread of resistant strains of HIV and may
reduce the risk of transmission
Connecting releasees to substance abuse treatment may reduce the risk of recidivism
for drug-related crimes
Access to some services in the community is limited
Housing and mental health and substance abuse treatment are scarce
Programs can and do bar people with criminal records (especially drug offenses)
from services
Jail-based programs are less common than prison programs and models may have to be
altered to meet the needs of this population
The high volume of clients, short stays and not being released to the community
all need to be addressed
For more information and final evaluation results contact:
Sofia Kennedy
Abt Associates Inc
55 Wheeler Street
Cambridge MA 02138 USA
+1-617-349-2797
[email protected]
www.abtassoc.com
www.sph.emory.edu/HIVCDP/index.html