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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?