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Diane Morse, MD; Precious Bedell, MA;
Jennifer Silverstein, BS; Emily Wang,
MD; Shira Shavit, MD; Geoffrey
Williams, MD, PhD
University of Rochester, Yale University,
University of San Francisco
Funding: Center for Medicare and Medicaid Services - E Wang
PI, NIDA 1K23DA031612-01A1 - DS Morse PI, UR DCFAR: NIH
P30AI078498
Women’s
Initiative
Supporting
Health
 Released
prisoners have over 12x increased
mortality in the first 2 weeks compared to
general population
 Top conditions




Drug overdose
Cardiovascular disease
Homicide
Suicide

Binswanger et al. N Engl J Med 2007
 Asthma
 HTN
 Hepatitis
C
 HIV/AIDS
 Diabetes
mellitus
 Cardiovascular disease
 Cirrhosis
 Kidney disease
 Mental health disorders

Rich et al., NEJM 2011 from BOJ statistics
 More
than one million women behind bars or
under control of criminal justice system
 Fastest growing segment of incarcerated
population - increasing at nearly 2x rate of
men since 1985

From 2003 to 2007, arrests of women for drug
violations increased 29%, compared to 15% for
men

Women Prison Association Institute on Women & Criminal
Justice, 2009; American Civil Liberties Union, 2007
Race/ethnicity
Percentage of
incarcerated
women
Number
incarcerated/
population
White
45.5%
93/100,000
Black
32.6%
349/100,000
Hispanic
16%
147/100,000
Women Prison Association
Institute on Women & Criminal Justice, 2008
 Approximately
65,600 women in federal and
state custody reported being mothers of
147,400 minor children
 77% of incarcerated mothers reported
providing most daily care for their child(ren)
before incarceration

American Civil Liberties Union, 2007
WISH-TC
 Primary care transitions clinic for women
recently released from incarceration
 Part of university medical center
 One of 11 site national consortium providing
medical care after incarceration
 Community health workers, who also have been
incarcerated, guide patients through complex
healthcare systems and social services


Wang, et al. Am J Pub Health 2012
 Legal

Probation, Parole, Drug Treatment Court, public
defenders, jail
 Re-entry

Multi-disciplinary state-funded county
consortium
 Half-way
houses, YWCA
 Substance abuse treatment centers
 Domestic violence shelter
 AIDS provider and DCFAR
Autonomy Support
•Elicit & acknowledge patient
viewpoint
•Explore patient values
•Provide rationale for advice
•Provide options for change
•Acknowledge option of no change
•Support patient initiation for change
•Minimize pressure and control
•Perceived
competence
•Autonomous
self-regulation
Increased Health
Care Utilization
Types
Number
Age range
Appts kept
Race/eth
Current
11
25-46
67.6%
POC 64%
Potential
16
24-60
NA
POC 87%
Not followed
9*
22-58
NA
POC 90%
*4 lost contact, 5 declined
Precious Bedell, MA
Project Health Counselor


Dec 20. I really didn’t think I would be cleared to go into the
facility. Part of me hoped that I wouldn’t. I have seen enough of
jails and prisons to never want to go back. As I walked up the path,
I remembered my last visit here. I had to serve weekends, four of
them. Something about them changed me. My daughter came to
pick me up on the last Sunday. I vowed never to return. The
experience from the deputy sheriff, who stripped searched me
coming in, was cruel and degrading.
I knew there had to be another way. My confidence waned a bit, as
I walked up the cemented pathway. I kept going. I believed in what
I was going in there for. Until I got this job, which I feel is designed
for me, I knew first hand the barriers, housing, employment, of
feeling that you’re never good enough. The legal second class
citizenship that are part of the continuing and perpetual racial
caste system, which legalizes the old Jim Crow Laws, loom like a
dark cloud. I kept going. I thought about other women inside, other
former prisoners who were successful. When they shared their
stories, they all said that someone supported them unconditionally
and walked the journey with them. I kept walking into the facility.
 Family
Reunification
 Healthcare (mental health and substance
abuse treatment)
 Employment
 Education
 Trauma history

Didlick-Davis, 2009
 Recruitment
Process
 Monroe County Correctional Facility
 Transitional Housing, Bethany House,
Jennifer House, and Penny Cook Supportive
Housing
 Home Intakes
 Referrals from service providers
 Empowerment Group (Gender-Responsive)
Self
Determination Theory
Practices
Patient is in the Driver’s Seat
Role of CHW using SDT
Provides Client-Centered
Practices
Cultural Humility
Predictors
of who will stick and
stay
Patients in Supportive Living
Patients who go home
Follow up with patients
Supportive Advocacy (Walk the
Journey)
 What
kind of atmosphere does the WISHTC provide for patients?
 What are the challenges for patients to
keep appointments?
 How do we keep track of our patients?
 What barriers are the most difficult for
patients to address or overcome?
 How do CHW’s provide their own self-care
and self-awareness?