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USPHS 2008 Scientific and Training Symposium

Transition Health Care Programs. At the conclusion of this presentation, the learner will be able to:Describe the disparity of health care service availability for released criminal offenders.Describe role of discharge planning in correctional health care system.Describe the correctional health c

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USPHS 2008 Scientific and Training Symposium

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    1. USPHS 2008 Scientific and Training Symposium “Transition Health Care Programs” CAPT Beverly Dandridge, MSN, FNP, MSAJS, CCHP June 12, 2008 Tucson, AZ

    2. Transition Health Care Programs At the conclusion of this presentation, the learner will be able to: Describe the disparity of health care service availability for released criminal offenders. Describe role of discharge planning in correctional health care system. Describe the correctional health care “Transition Health Care Model”.

    3. Transition Health Care Programs “The participation of health care staffing in reentry programs is an ethical responsibility.” Greifinger and Mellow [2008] Public Health Behind Bars: From Prisons to Communities.

    4. Transition Health Care Programs “Prisons and jails offer a unique opportunity to establish better disease control in the community by providing improved health care and disease prevention to inmates before they are released.” The Health Status of Soon-to-be-Released Inmates: A Report to Congress, Volume 1, Ch.7

    5. Transition Health Care Programs “A higher percentage of the population is incarcerated in the United States than in any other country.” The Health Status of Soon-to-be-Released Inmates: A Report to Congress, Volume 2, Ch.7

    6. Transition Health Care Programs “The increase in the percentage of newly sentenced inmates for drug offenses, coupled with longer sentences, has dramatically altered the composition of the prison inmate population.” The Health Status of Soon-to-be-Released Inmates: A Report to Congress, Volume 2, Ch.7

    7. Transition Health Care Programs “Most inmates are poor, have little education, and come from disadvantaged communities where health care services other than hospital emergency rooms are scant or underutilized. “ The Health Care for Soon-to-be-Released Inmates: A Report to Congress. Volume 2,Ch 7 [This supports the fact that inmates will appear in local emergency departments for continued services, or re-offend to receive [guaranteed] appropriate health care.][This supports the fact that inmates will appear in local emergency departments for continued services, or re-offend to receive [guaranteed] appropriate health care.]

    8. Transition Health Care Programs State correctional facilities were surveyed to determine availability of: 1. Information about the demographic composition of their inmate population A mailback questionnaire was sent to corrections officials in each State, the District of Columbia, and the Federal Bureau of Prisons A mailback questionnaire was sent to corrections officials in each State, the District of Columbia, and the Federal Bureau of Prisons

    9. Transition Health Care Programs 2. Databases on the prevalence of chronic diseases and mental disorders 3. Information of the health status of inmates recently released into the community.

    10. Chronic Illness Less than fifty percent of states were able to provide data on the chronically ill inmates released to community health providers Health Care for Soon to be Released Inmates: A Survey of Sate Prison Systems *Forty-one States, including all of the Midwestern States and the District of Columbia, responded, although missing information was a significant problem. No response was obtained from the Federal Bureau of Prisons or from 10 States: 1 in the Northeast, 5 in the South, and 4 in the West. *Forty-one States, including all of the Midwestern States and the District of Columbia, responded, although missing information was a significant problem. No response was obtained from the Federal Bureau of Prisons or from 10 States: 1 in the Northeast, 5 in the South, and 4 in the West.

    11. Chronic Illness

    12. Chronic Illness

    13. Chronic Illness Between 2005 and 2006: HIV-positive prisoner population decreased 3.1% while the overall prison custody population grew 2.2%. During 2006, 167 inmates in state and federal prisons died from AIDS-related causes down from 203 in 2005. National Prisoner Statistics series. NCJ22217

    14. Chronic Illness AIDS-related deaths : [2006 statistics] Florida (28) New York (14) Pennsylvania (13) Georgia (10) Louisiana (10) National Prisoner Statistics series. NCJ22217

    15. Transition Health Care Programs Former Surgeon General, VADM David Satcher, had the foresight to recognize a need for an intense study of correctional health care. As a result, the correctional office within CDC was established in the mid 1990s, to identify the issues and develop a prevention program suitable for the correctional environment.

    16. Transition Health Care Programs At the request of VADM Richard Carmona in 2002, CDC lead a comprehensive project assessing the relationship between community health and correctional health.

    17. Transition Health Care Programs The compiled information and analyzed data was delivered to the [then] Surgeon General as a Call to Action on Correctional Health Care in 2004.

    18. Transition Health Care Programs “The correctional health care report is pointing out the inadequacies of health care within our correctional health care system,” he said. “It would force the government on a course of action to improve that.”

    19. Transition Health Care Programs Because the administration does not want to spend more money on prisoners’ health care, the report has been delayed, Dr. Carmona said. Harris, Gardiner. “Surgeon General Sees 4-Year Term as Compromised” .

    20. Transition Health Care Programs H.R. 1593: Second Chance Act of 2007 Community Safety Through Recidivism Prevention

    21. Transition Health Care Programs H.R. 1593: Second Chance Act of 2007 Initially proposed in 2004, signed by President Bush in April 2008. Supported by more than 200 criminal justice, community service providers, faith based housing, governmental, disability and civil rights organizations

    22. Transition Health Care Programs H.R. 1593: Second Chance Act of 2007 Authorizes $362 million federal aid for state and local prisoner reentry programs Emphasizes public-private partnerships Designed to help ex-offenders transition into society after leaving prison or jail.

    23. Transition Health Care Programs “[The Act] will provide an opportunity for realistic rehabilitation for the more than 650,000 inmates who return to their communities each year,” said Sen. Arlen Specter (R-PA). Crime & Justice News and the Reentry Policy Council

    24. Transition Health Care Programs “The bill’s focus on education, job training and substance abuse treatment is essential to decreasing the nationwide recidivism rate of 66%.” Crime & Justice News and the Reentry Policy Council.

    25. Transition Health Care Programs “Public safety is public health; public health is public safety.” Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS, 17th US Surgeon General. National Conference on Correctional Health Care - Austin, Texas, October 6, 2003 “Correctional health care is public health care.” RADM Kenneth P. Moritsugu [ret], M.D., M.P.H..

    26. Transition Health Care Programs Successful reentry is becoming more recognized as being vitally important for public health and for reducing recidivism.

    27. Transition Health Care Model Discharge planning Becoming a priority by correctional systems when preparing prisoners for their reintegration into the community Added as a distinct standard in the NCCHC Standards for Health Services.

    28. Transition Health Care Programs Barriers to Discharge Planning Programs: 1. Limited executive level champions 2. Limited financial resources 3. Limited data resources 4. Minimal continuity of care post release

    29. Transition Health Care Programs Barriers to Discharge Planning Programs: 5. Loss of benefits [i.e., Medicaid] 6. Category restricted public health programs, such as tuberculosis 7. Internal barriers from policies or culture within institutions

    30. Transition Health Care Programs Barriers to Discharge Planning Programs: 8. Limited communication of cost effectiveness of early interventions 9. Minimal evaluation of cost effectiveness enabled of access to community care 10. Limited incentives for correctional agencies

    31. Transition Health Care Programs Barriers to Discharge Planning Programs: 11. Limited community receptivity 12. Limited training programs in correctional health care 13. Jurisdictional differences in correctional health care standards Greifinger and Mellow, 2008

    32. Successful Community Programs I. Hampden County, MA Hampden County Jails 2006 Program of the Year – NCCHC

    33. Successful Community Programs Seamless system of jail based health care and community partnership. Restructured program to address mental health and medical needs. The Hamden County program is currently being studied by many jail systems for implementation.

    34. Successful Community Programs II. Montgomery County, MD Montgomery County Correctional Facility – 2 facility jail system 2007 Facility of the Year – NCCHC

    35. Successful Community Programs NCCHC accreditation since 1997 Collaborative Case Management 40 community stakeholders meet every 2 weeks to discuss inmates scheduled to be released identifying services needed and initiating the community service links [County] HHS support for substance abuse and mental health services 200 bed detention center[72 hour stay, intake screening]. 1000 bed jail incl. 55 bed crisis management unit Direct supervision model Daily intake 24 Small number of adolescents under 18 charged as adults are also housed in this facility 200 bed detention center[72 hour stay, intake screening]. 1000 bed jail incl. 55 bed crisis management unit Direct supervision model Daily intake 24 Small number of adolescents under 18 charged as adults are also housed in this facility

    36. Successful Community Programs Reentry Identification Card System Provides a legal government temporary [60 day] community re-entry identification card. *** Program costs approximately $7500 – funded by inmate Council Funds generated by telephone and canteen proceeds. Assists released offender with obtaining: 1. A permanent state identification 2. Access to social services, medical and housing services 3. Employment 4. Post 9-11 identification requirement 5. Accepted as a 60 day free bus pass on local transportation system Assists released offender with obtaining: 1. A permanent state identification 2. Access to social services, medical and housing services 3. Employment 4. Post 9-11 identification requirement 5. Accepted as a 60 day free bus pass on local transportation system

    37. Successful Community Programs III. Prince George’s County, MD Prince George’s County Department of Corrections “A Partnership for Improved Life” Offers inmate programming with community and re-entry assistanceOffers inmate programming with community and re-entry assistance

    38. Successful Community Programs Community Advisory Council Representatives from public safety agencies, religious and non-profit organizations, educational institutions, community programs, and Circuit and District Courts.

    39. Successful Community Programs Model Award winning barber training program that provides employment to graduates. Auto Body shop offers apprenticeship program for 2 students, and provides $2,000 auto repair supplies/toolkit upon release, to the students.

    40. Successful Community Programs IV. Hillsborough County - Tampa, FL Hillsborough County Jail Sheriffs Office Detention Department Medical Discharge Program 2007 Program of the Year – NCCHC Hillsborough County JailHillsborough County Jail

    41. Successful Community Programs Developed a Medical Discharge Planning full time position in early 2006. Primary Focus - help patients with chronic medical and mental health conditions continue their care in the community.

    42. Successful Community Programs Individual care plans are developed based on case review and discussions with appropriate outside agencies. Community Collaborators: Facility Discharge Planner Hillsboro County Dept. of HHS Tampa Community Health Center Almost all inmates are homeless and have nowhere to go upon release. Almost all inmates are homeless and have nowhere to go upon release.

    43. Successful Community Programs Recidivism statistics: *After the first eight months (May-December, 2006) of the program’s operation] 27% Among all released inmates 23.1% Inmates who received discharge planning 16.3% Inmates who visited the local health center for follow-up CorrectCare Winter 2008 Volume 22 Issue 1 ww.ncchc.org 27% for all inmates after one year post release 23.1% inmates who received discharge planning: (95 of 410) More current data indicates 15.3% inmates who received discharge planning 27% for all inmates after one year post release 23.1% inmates who received discharge planning: (95 of 410) More current data indicates 15.3% inmates who received discharge planning

    44. Mental Health Mental illness is over represented in the criminal justice system Mid 2005, more than 50% of the prison and jail population had mental illness diagnosis Recidivism rates are higher with the mentally ill 72% return within 3 years

    45. Mental Health “They were mentally ill before they came to us and they will be mentally ill after they leave.” Frederic Friedman, EdD, CCHP, “Mental Health Professional Lauded for Heroic Service” Correct Care, Fall 2007 Volume 21, Issue 4

    46. Mental Health

    47. Sex Offenders The number of incarcerated sex offenders has increased since the 1980s and most are released back into the community. Data indicates 10-15% of convicted sex offenders re-offend with another sexual offense within 5 years of their release.

    48. Sex Offenders Cognitive Behavior Therapy [CBT] has been proven as an effective treatment for mental illnesses and “should be considered best practice for treatment with sex offenders.” “Sex Offender Treatment that Works” - CorrectCare Winter 2008 Volume 22 Issue 1

    49. Transition Health Care Programs Correctional health is public health and we, as America’s Health Responders, must strive to provide essential, quality, and culturally sensitive care to all citizens.

    50. References Aviva Moster, Dorota W. Wnuk, and Elizabeth L. Jeglic. Cognitive Behavioral Therapy Interventions With Sex Offenders. Journal of Correctional Health Care, Vol. 14, No. 2, 109-121 (2008) Community Oriented Correctional Health Services [COCHS]. January 2008, Issue 01. CorrDocs. The Newsletter of the Society of Correctional Physicians. Winter 2008 - Volume 11, Issue 1

    51. References [cont’d] Greifinger, R.B. and Mellow, J. (2007). Public Health Behind Bars: From Prisons to Communities. Greifinger, R.B. and Mellow, J. Successful Reentry: The Perspective of Private Correctional Health Care Providers. Journal of Urban Health 84 (2007): 85-98. CorrDocs, Volume 11 Issue 1,Winter 2008

    52. References [cont’d] Harris, Gardiner. “Surgeon General Sees 4- Year Term as Compromised” The New York Times, July 11, 2007 Hornung, C.A., Anno, B.J., Greifinger, R.J., Gadre, S. The Health Care for Soon-to-be- Released Inmates: A Report to Congress, Volume 1 and 2, 2002. HR 1593: Second Chance Act 2007 National Prisoner Statistics series. NCJ22217

    53. References [cont’d] Sammons, M. Mental Health Professional Lauded for Heroic Service. Correct Care, Winter 2008- Volume 22, Issue 1 Shimkus, J. It Takes a County: Integrated Care Eases Reentry. Correct Care, Winter 2008- Volume 22, Issue 1 Surgeon General Spurs Correctional Health Care. Correct Care, Fall 2004 - Volume 18, Issue 4

    54. RESOURCES “Philanthropic Opportunities in Correctional Health Care.” Langeloth Foundation report. www.langeloth.org. Community Oriented Correctional Health Services [COCHS]. newsletter@cochs.org CorrDocs. The Newsletter of the Society of Correctional Physicians. www.corrdocs.org

    55. RESOURCES Greifinger, R.B. and Mellow, J. Public Health Behind Bars: From Prisons to Communities. “Public Health Model for Correctional Health Care”. 2002. Hampden County Sheriff's Department. http://www.mphaweb.org/documents/PHModelforCorrectionalHealth.pdf Surgeon General’s Report on Corrections and Health Care

    56. RESOURCES HR 1593: Second Chance Act of 2007 NCCHC Standards for Health Services in Jails, 2008 Standards. www.ncchc.org “1 in 100: America Behind Bars 2008”. The Pew Center on the States report. www.pewcenteronthestates.org Alleghany County Mental Health Court. U.S. News & World report. http://www.usnews.com/artoicles/news/national/2008/02/07/mental-health-courts.html

    57. CAPT Beverly Dandridge, FNP, MSN, CCHP, MSAJS Human Resource Manager Department of Homeland Security Immigration Customs Enforcement [ICE] Division of Immigration Health Services Beverly.dandridge@dhs.gov 202-732-0160

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