Addressing Health Disparities
Among Incarcerated and Recently Incarcerated Populations
March 24, 2015
Webinar Presenters

Harold Phillips, MRP, Director, Division of Training and
Capacity Development at HRSA/HAB

Adan Cajina, MS, Chief, Special Projects of National
Significance Branch at HRSA/HAB

Melinda Tinsley, MA, Public Health Analyst, Special Projects
of National Significance Branch at HRSA/HAB

Sarah Cook-Raymond, MA, Managing Director, Impact
Marketing + Communications on the Integrating HIV
Innovative Practices (IHIP) Project

Alison O. Jordan, LCSW, Executive Director, Transitional
Health Care Coordination, NYC DOHMH/Correctional Health
Services
Learning Objectives

Better understand mission of Division of Training and
Capacity Development and SPNS’ role in addressing health
disparities

Improved understanding of intersection of HIV, mental health,
substance abuse, and other health disparities among
incarcerated/recently incarcerated populations

Public health opportunity available within jail setting for
addressing HIV-positive high-need individuals

How jail linkage work advances the HIV Care Continuum

Major steps to establishing or expanding a jail linkage
program

About the SPNS EnhanceLink jail linkage program, key
findings, and case study
Special Projects of National
Significance Projects
Harold Phillips, MRP
Director, Division of Training and Capacity Development
Adan Cajina, MS
Chief, Special Projects of National Significance Branch
Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Bureau
Overview
Division of Training and Capacity Development
• Mission: Strengthen and transform health care
systems by supporting the development of
leadership, evaluation, training and capacity
development to assure the provision of high
quality HIV/AIDS prevention, care and treatment
services.
5
Division of Training and
Capacity Development (DTCD)
Administrative
Support
Bukeeia
Goodson
Director
Harold Phillips
Deputy Director
Jose Rafi Morales
Budget
Management
Terri Newman
Chief Medical Officer
Philippe Chiliade/Rupali Doshi
Senior Policy Advisors
Raymond Goldstine (Acting)\
Jewel Bazilio-Bellegarde
Special Projects of National
Significance
Chief – Adan Cajina
Global Health Systems
Chief – George Tidwell
HIV Education Branch
Susan Becker
Acting Chief – Jewel Bazilio-
John Hannay
Bellegarde
Pamela Belton
Richard Poole
Melinda Tinsley
Philippe Chiliade
Jessica Xavier
Janette Yu-Shears
Chau Nguyen
Ellen Caldeira
Natalie Solomon
John Oguntomilade
Renetta Boyd
Christine Lim
Diana Palow
Andrea Knox
Dieunita Gamliel
Mekeshia Bates
SPNS Program (Part-F)
• The SPNS Program supports the
development of innovative models of HIV
care to quickly respond to the emerging
needs of clients served by the Ryan White
HIV/AIDS Program.
•
•
•
•
Evaluation
Dissemination
Replication
Build and Improve IT capacity
SPNS History
• Incorporated as Part F into the Ryan White Comprehensive
AIDS Resources Emergency (CARE) Act in 1996 along
with the AIDS Education and Training Centers (AETCs)
and the Dental Partnership Program
• Program began with some of the first federal grants to
target adolescents and women living with HIV
SPNS Direction
SPNS has been tasked to respond to the
emerging HIV primary care needs of individuals
receiving assistance under the RWHAP
SPNS initiatives have evolved to reflect:
• changes in the epidemic
• changes in the health care environment
• alignment with HIV national policy strategies
• Focus on Sustainability, dissemination and
replication
The National HIV/AIDS Strategy
• Vision statement calls for every person to have
unfettered access to high-quality care
• National HIV/AIDS Strategy (NHAS) 2015 targets:
– Reduce new HIV infections
– Increase access to care and improve health
outcomes
– Reduce HIV-related health disparities
The HIV Care Continuum
Source: CDC. HIV surveillance—United States, 1981–2008. MMWR 2011;60:689–93.
Overview of SPNS Initiatives
Current SPNS Initiatives
• System Level Workforce Capacity Building for Integrating HIV
Primary Care in Community Health Care Settings (2014 – 2018)
• Health Information Technology Capacity Building for Monitoring
and Improving Health Outcomes along the HIV Care Continuum
Initiative (2014 – 2017)
• Culturally Appropriate Interventions of Outreach, Access and
Retention among Latino(a) Populations (2013 – 2018)
• Enhancing Access to and Retention in Quality HIV Primary Care
for Transgender Women of Color (2012 – 2017)
Current SPNS Initiatives
(continued)
•Systems Linkages and Access to Care for Populations at High Risk of HIV
Infection Initiative (2011 – 2016)
•Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless
Populations (2012 – 2017)
•Secretary’s Minority AIDS Initiative Fund (SMAIF) Replication of a Public
Health Information Exchange to Support Engagement in HIV Care (2012 –
2015)
Recently Ended SPNS Initiatives
• Enhancing Access to and Retention in Quality HIV/AIDS Care for
Women of Color (2009 – 2014)
• Hepatitis C Treatment Expansion (2010 – 2014)
• Secretary’s Minority AIDS Initiative Fund (SMAIF) Retention
and Re-Engagement Project (2011 – 2014)
• Enhancing Linkages to HIV Primary Care and Services in Jail
Settings (2007 – 2012)
Upcoming SPNS Initiatives
• Use of Social Media to Improve Engagement, Retention, and Health
Outcomes along the HIV Care Continuum (2015 – 2019)
• Dissemination of Evidence-Informed Interventions to Improve Health
Outcomes along the HIV Care Continuum – Dissemination and
Evaluation Center (2015 – 2020)
• Dissemination of Evidence-Informed Interventions to Improve Health
Outcomes along the HIV Care Continuum – Implementation and
Technical Assistance Center (2015 – 2020)
• Secretary’s Minority AIDS Initiative Fund (SMAIF) Addressing HIV and
Housing through Data Integration to Improve Health Outcomes along
the HIV Care Continuum
Overview of EnhanceLink Initiative
Enhancing Linkages to HIV Primary Care
and Services in Jail Settings
(2007 – 2012)
• Design, implement, and evaluate innovative
methods for linking people living with HIV/AIDS
who are in jail or recently released with HIV
primary care and ancillary services
• 10 demonstration sites at 20 separate jails
• One technical assistance/evaluation center
• $21.7 million over 5 years
Enhancing Linkages to HIV Primary Care
and Services in Jail Settings
(2007 – 2012)
Enhancing Linkages to HIV Primary Care
and Services in Jail Settings (2007 – 2012)
Main Findings
• 65% of study participants identified as Black
• Black participants were more likely to have had advanced
HIV
• Jails as strategic venues to reach HIV+ Black MSM
• 22% of HIV+ Black male study participants were MSM
• HIV testing and linkage interventions are needed within
jails to reach Black MSM and to address racial disparities
Enhancing Linkages to HIV Primary Care
and Services in Jail Settings (2007 – 2012)
Main Findings
• 59% of Black MSM are not aware of their HIV
infection. CDC MMWR 2010; 59(37):1201-7.
• Young Black MSM constitute a segment of the
population. Prejean J, Song R, Hernandez A, et al. Estimated HIV
Incidence in the United States.
• SPNS’ study highlight the potential of expanded
jail testing and linkage may reach ~11% of this
underserved population.
Enhancing Linkages to HIV Primary Care
and Services in Jail Settings (2007 – 2012)
Main Findings
• Efforts to ensure care following release from jail
are associated with a high degree of viral
suppression.
• Linkage to care with an HIV provider within 30
days of release is an excellent measure of
success.
• People who participated in case management
were more likely to follow up on care referrals
• Coordinating social services was associated with
retention in care
Further Information
List of SPNS Initiatives
http://hab.hrsa.gov/abouthab/partfspns.html
Target Center
www.careacttarget.org/category/topics/spns
SPNS Products
http://hab.hrsa.gov/abouthab/special/spnsproducts.h
tml
Contact Information
Harold Phillips
Director, Division of Training and Capacity Development
HPhillips@hrsa.gov
Adan Cajina
Chief, Special Projects of National Significance Branch
ACajina@hrsa.gov
Melinda Tinsley
Public Health Analyst, Special Projects of National Significance Branch
MTinsley1@hrsa.gov
www.hab.hrsa.gov/abouthab/partfspns.html
301-443-7036
Presented by Sarah Cook-Raymond,
Managing Director of
www.impactmarketing.com
Introducing IHIP
 SPNS
launched the “Integrating HIV Innovative
Practices” (IHIP) Project
 IHIP
takes innovative findings from SPNS Initiatives
and assists health providers in replicating proven
models of care
 SPNS
project findings are synthesized into IHIP
instructional training manuals, curricula, pocket
guides, and webinar series
 The
result? Improved care delivery and healthier
patients
IHIP on HAB Website: You can navigate straight to SPNS IHIP products
from the HAB site or head directly to the TARGET Center site
Products
from SPNS
Initiatives
HAB Homepage
IHIP Resources on TARGET Center Website
IHIP Resources:
Enhancing Linkages to HIV Primary Care in the Jails Setting

Includes lessons learned and step-bystep recommendations on how to
implement a new jail linkage program
and how to expand a current one.
POCKET GUIDE
Testimonial: “The curriculum and training guide
are everything that we've always wanted in
terms of trying to explain, not only to our family
and loved ones but to our clients and bosses,
what exactly it is that we do and why we do it.
And I can't be more thrilled with the product
and the way that this will be so useful to us and
to others in the field. I'm really excited about
it.”
— Alison O. Jordan, Executive Director at NYC Dept. of Health
and Mental Hygiene, Correctional Health
Services/Transitional Health Care Coordination, Riker’s
Island, N.Y.
TRAINING MANUAL
Incarceration Overview
 While
the terms “jails” and “prisons” are often
used interchangeably, they represent different
kinds of correctional facilities
 Approximately
solely in jails.
85% of incarcerated people were
Studying a Jail Intervention
 Given
the number of people living with HIV
passing through jail facilities and the need to reach
them, SPNS funded the “Enhancing Linkages to HIV
Primary Care & Services in Jail Settings Initiative,”
otherwise known as EnhanceLink
 EnhanceLink
filled an important research void
Why Jails?

Jails concentrate marginalized individuals with range of
social and health problems in one place

Many individuals in jail have had fragmented health care
services due to co-occurring health conditions and issues
that interfere with access (e.g. substance abuse, mental
illness)


Structural inequalities such as poverty and unstable housing also
contribute
Behaviors that often place individuals at risk for
incarceration also place them at risk for STIs, including HIV
Aligns with Federal Priorities
 CDC
strongly recommends jail-based HIV testing
 Routine
HIV screening in jails is consistent with
NHAC
 Jail
linkage helps to move individuals along the
HIV Care Continuum
Health Disparities among
Incarcerated Persons
 Higher
rates of HIV, viral hepatitis, TB, mental
illness, substance abuse
 Also
more likely to have histories of physical,
sexual, and emotional abuse
 Jails
represent a chance to test, diagnose, and treat
high-risk populations and offer an opportunity for
marginalized people to interact with the health
care system
EnhanceLink
 Individuals
in jails often return to the same
communities in which they came
 EnhanceLink
showed that while jail stays can be
brief and there can be some uncertainty around
discharge dates, engagement, testing, and linkage
coordination are all feasible within this setting
A
successful jail intervention can decrease
expensive ER visits, decrease HIV transmission,
reduce recidivism, and improve quality of life
EnhanceLink Patients

EnhanceLink engaged very high-needs patients

90% knew their HIV status for at least 2 years yet 81% had never
taken ART

66% of participants had uncontrolled viremia (viral load > 400
copies/ml)

Of those previously prescribed ART, only 55% were on HIV
medication on the 7 days leading up to incarceration

Only a few participants had a formal mental health diagnosis yet
54% had an Addiction Severity Index (ASI) mental health score of
.22 or greater (indicative of severe psychiatric illness)

Nearly all participants had histories of substance use with 59%
with ASI drug scores of at least .16 (representing severe drug
addition)
EnhanceLink Program Steps
 Major
EnhanceLink components included:
 HIV testing or inmate self disclosure, and mental
health/substance abuse screenings
 Recruitment (including informed consent) and
enrollment into the program
 Pre-release intensive case management
intervention (typically within 24 hours or at least
within first 48 hours) and individualized
discharge plans
 Medical care and HIV education, including risk
reduction
 Post-release intensive case management
linkages
EnhanceLink Effectiveness
 EnhanceLink
was found to be cost effective from a
societal perspective
 Having case manager work closely with jail
medical staff also helped reduce costs incurred
by the jail, creating increased motivation and
justification for a partnership
 Given short stays of jails, EnhanceLink
participants did not identify a substantial
increase in pharmacy costs
 Coordinated medical records enabled
community and jail medical staff to avoid
duplicating test and lab work that was already on
file
Tips for Establishing a Jail Linkage
Program

Before getting started, examine the existing programs and
organizations operating with the jail

Consider how you may partner with these organizations

Recognize the different priorities of medical clinics versus
jails: one prioritizes health and the other safety. To work
effectively in the jail you need to abide by their “home turf”
rules

Identify the benefit you’re providing to the jail and to jail
personnel

To secure buy-in, target high-level decision makers and do
so early so they feel their opinion is valuable

It’s important to identify a champion within the jail early on
Tips (cont.)
 Really
think through the logistics of what your
program will look like within the jail setting
constraints and how you’ll adapt
 Outline
expectations early on and often
 Hire
people who understand the correctional
culture and really want to be doing this work.
 Don’t
underestimate the importance of a smile and
a thank you—both with jail staff and inmates
If Already in the Jail

Nurture partnerships and facilitate ongoing communication

Consider how you’re assessing patient needs

If there are needs you can’t address, look to partners (e.g. court
advocacy)

Create discharge plans, starting with inmates’ basic needs
and working to address their priorities as well as your own

Linkages to care aren’t automatic. They need to be active
linkages with warm handoffs.

Recognize that home visits in the community to followup with
individuals not linked immediately after release will be
necessary with some people.
Contact Information

Sarah Cook-Raymond, Managing Director
Impact Marketing + Communications
scook@impactmarketing.com
202-588-0300
www.impactmarketing.com
Linkages and Care Engagement:
From NYC Jail to Community Provider
Alison O. Jordan LCSW
Executive Director, Transitional Health Care
Coordination
NYC DOHMH / Correctional Health Services
Rikers Island, NY
AIDS Education and Training Center / National Resource Center
Health Disparities Collaborative
March 24, 2015
RIKERS ISLAND
Vernon C. Bain Center, Bronx
Brooklyn
Detention
Center
Manhattan
Detention Center
Transitional Health Care Coordination
Correctional Health Services (CHS)
At A Glance
Facilities
12 jails: 9 on Rikers Island (1 female facility, 1
adolescent facility), 3 borough houses, public
hospital inpatient unit
Average Daily Population 11,827
Annual Admissions
81,758
Community Releases
60,000 / year
Length of Stay
mean=53 days; median~8d
eClinicalworks, customized for jail setting;
Electronic Health Record
care mgt templates; unidirectional interface
(adopted 2008-2011)
with NYC DOC Inmate Information System
Sources: NYC Department of Corrections Mayoral Report – 2013 http://www.nyc.gov/html/doc/downloads/pdf/MMR-FY2013.pdf
Annual releases from NYC DOC Report of Discharges by zip code for CFY’14
CHS Background
NYC Department of Health and Mental Hygiene oversees health care
of inmates in all NYC jails
• Goals: Improve the health of incarcerated individuals and
community health.
• Correctional Health Services oversees medical care in the jails with
over 78,000 medical visits monthly
• Medicaid prescreening: 6k; Medicaid applications: 1,400
• Discharge Planning – Population-based for mentally ill (13k); HIVinfected (2.5k); others at high risk (1.5k)
• All jails use electronic health record
Twin Epidemics: Mass Incarceration & HIV
Over 70% of people
released to the
community after
incarceration
return to the areas
of greatest
socioeconomic and
health disparities
Correctional Health is Public Health
Jail Demographics
Age
ALL
Range 16 - 84
Mean 34
HIV
Race
ALL
HIV
Non-Hispanic
Black (%)
54.0%
61.0%
Hispanic (%)
33.0%
30.0%
Non-Hispanic
White (%)
8.7%
7.0%
41<51 (21.8%) 41<51 (44.3%)
Gender
ALL
HIV
51+
Male (%)
89.0%
78.3%
16 - 68
45
16<21 (13.4%) 16<21 (1.3%)
21<31 (32.8%) 21<31 (10.1%)
Break
31<41 (21.6%) 31<41 (18.6%)
down
(10.2%) 51+
(25.4%)
*2011 Correctional Health Services new admission records (N=61,853)
Prevalence by Diagnosis
• Substance abuse: >50%
• Mental Illness: 30%
• Hepatitis C: 8%
• HIV: 5%
• Diabetes: 5%
• Tuberculosis: 5%
• Other Sexually Transmitted Infections: 6%
System Challenges
•
Solutions
Barriers
Short-term stays are norm • Intake History and PE
•
•
• universal voluntary < 24 hrs
• ongoing offer thereafter
~25% leave in 2-3 days
~50% leave within 7 days
•
Limited time to diagnose
• Screen on admission
•
Multiple providers
• Single oversight
•
Limited time to treat,
maintain care
• Discharge plan asap
•
Paper records
• Electronic Health Records
•
Post-release tracking
•
• engage in housing areas
• transport / accompaniment
Health Information Exchange
Removing barriers
Establish & Maintain Relationships
• Smile
• Listen first
• Chain of Command
– Identify Champions
• Begin where you can
• Shared benefits (reduced
violence, improved security)
• Set realistic goals
• Prisons v. jails
• Build trust
• Acknowledge extra work
– then ask Key Questions
– Start with winnable battles • Be a familiar face
• Learn who to approach for:
– Deliver
jail access, security training
• Give more than you receive
& space to interview clients
HIV Continuum of Care Model
Transitional Care
Coordination
• Opt-in Universal Rapid HIV
Testing
• Primary care and treatment
including appropriate ARVs
• Treatment adherence
counseling
• Health education and risk
reduction
Jail-based Services
•
•
•
•
•
Discharge Planning starting on Day 2 of incarceration
Health Insurance Assistance / ADAP
Health information / liaison to Courts
Discharge medications
Patient Navigation: accompaniment, home visits,
transport, and re-engagement in care
• Linkages to primary care, substance abuse and mental
health treatment upon release
Community-based Services
•
•
•
•
•
•
•
•
HIV Primary Care
Medical Case Management
Health promotion
Patient Navigation: accompaniment, home
visits, and re-engagement in care
Linkages to Care
Treatment adherence and Directly Observed
Therapy (DOT), as needed
Housing assistance and placement
Health Insurance Assistance / ADAP
Transitional Care Services
•
•
•
•
•
•
•
Identify population – use electronic health records
Engage client – access to housing areas
Conduct assessment – universal tool
Screen for Benefits – DSS is a partner
Arrange discharge medications – 7 days + Rx
Coordinate post-release plan – Primary care, social
service orgs, Courts, attorneys, treatment providers
Facilitate continuity of care
• Aftercare letters / transfer medical information using HIE
• Make appointments / walk-in arrangements
• Arrange transportation / accompaniment
Critical Skills
Community
Health Workers
Probation
Parole
Health Dept.
Courts
Staff
Health Insurers
Hospitals
Health providers
Funders
Corrections
SPNS Jail Linkages Initiative
• HRSA Special Projects of National Significance
Enhancing Linkages Demonstration Project
– Ten site demonstration and evaluation of HIV service delivery in
jail settings to develop innovative methods for providing care
and treatment to HIV infected individuals in jail settings.
• Largest study of those released from jails to date
– NYC enrolled 40% of 1,021 released to the community and
followed by case managers. (Booker, 2013)
SPNS Jail Linkages
Initiative*
Ten Demonstration Sites
(2007-2012)
Facilitate linkage to primary care for HIV
patients leaving local jails:
• Identify HIV patients in custody
• Initiate transitional services in jail
• Facilitate post-release linkage to
primary care and community services.
*Background slide courtesy of Anne Spauding, Emory Univ.
Creating a Jail Linkages Program
Expect the Unexpected
Client Level:
–
–
Begin Where the Client is; harm reduction model.
Plan for both options: Stay or Go
Program Level:
–
–
–
Hire staff who care, clear security, culturally aware, bilingual
Train staff: Motivational Interviewing
Partner Agreements
Systems Level:
–
–
–
Track outcomes
Arrange transitional services
Partner with community health centers; walk-in hours
SPNS Jail Linkages Initiative
Local Study Protocols
Enrollment: adult HIV patients enrolled during jail stay
Exclusion criteria: newly diagnosed, receiving mental health
discharge planning, likely to have long sentence (>1year)
Baseline survey: initiated at index incarceration
Jail chart review: most recent clinical data at time of release
Post Release Services: linkage determined 30 d post-release
C6M (6-month follow up):
– Followed post release with regular check in and survey at 6m
– Recorded clinical data gathered from clinicians at 6m
SPNS Jail Linkages Initiative
Site Specific Study Design
Case Management
/ Data Collection
NYC Health Patient Care Coordinators in jails;
Community reentry providers’ dually-based transitional
counselors
PCC and counselors trained by Yale Research and
Evaluation Team
Population-based approach
Program Focus
Linkage to Care within 30 d of release
Program Enhancements Health Liaison to the Courts
SPNS Jail Linkages Initiative
Disposition of NYC participants
555
Baseline
enrollments
488
Included in
MSE sample
434
Baseline
sample
243 Seen at
follow-up
67 Not Released
in time for
MSE inclusion
54 Dropped:
3 died
10 Moved
41 Prison Return
191 Lost to
follow-up
SPNS Jail Linkages Initiative
Baseline Medical / Substance Use History
Medical / Substance use
co-morbidities
NYC Baseline
n=555 (%)
Active / other medical problem
Hepatitis C virus
Medical Insurance
History of Heroin Use
76%
40%
91%
56%
History of Methadone
Alcohol / drug treatment ever
Troubled by Drug use, last 30d
SF-12 Physical Composite Score
39%
23%
66%
47.5 (SD: 10.6)
SPNS Jail Linkages Initiative
Baseline Socio-Economic Factors
Indicator
NYC Health
n=555
Never completed high school
47%
H.S. Diploma / GED
38%
Job / skill training
Some College +
Employed 30 days prior
Committed relationship
58%
15%
10%
30%
Age <18 years at first arrest
50%
Proportion of Lifetime spent incarcerated (mean)
9%
Arrests (mean)
26
SPNS Jail Linkages Initiative
Services Accessed – 30 days post release
Service category accessed
30 days post release
NYC
% (n=402 )
HIV primary care
71%
Other medical care
37%
Alcohol/Substance use treatment
52%
Housing
32%
Access to Care Strategies
non-medical strategies to facilitate access to care
• Case conferencing prerelease
• Medical summary / medications
• Accompaniment / transport
• Community case manager
• Directly Observed Connections
• Patient Navigator / Care Coordinator
SPNS Jail Linkages Outcomes
From baseline to 6 month follow-up
Indicator
NYC Health
All Sites
Clinical Care
CD 4 (mean) ↑
(374 to 412) ↑
(416 to 439)
vL (mean) ↓
(54,031 to 13,738) ↓
(39,642 to 15,607)
Undetectable vL ↑
(11% to 22% ) ↑
(10% to 21% )
Engagement in Care
# Taking ART ↑
(56% to 93%) ↑
(57% to 89%)
ART Adherence ↑
(81% to 93%) ↑
(68% to 90%)
Average # ED visits p/p ↓
(.60 to .20) ↓
(1.1 to .59)
Basic Needs
Homeless ↓
(22.4% to 4.15%) ↓
(36.2% to 19.2%)
Hungry ↓
(20.7% to 1.7%) ↓
(37.4% to 14.1%)
After Incarceration
• Along with primary medical care, Jail
Linkages clients were also connected to:
– Medical case management (53%)
– Substance abuse treatment (52%)
– Housing services (29%)
– Court advocacy (18%)
• Approximately 65% of clients accept the
offer of accompaniment and / or
transport to their medical appointment.
• 85% of those who were not known to be
linked to care were found by NYC Home
Visit team; finding 30% re-incarcerated.
“An ideal
community partner
offers a ‘one-stop’
model of
coordinated care in
which primary
medical care is
linked with
medical case
management,
housing assistance,
substance abuse
and mental health
treatment, and
employment and
social services.”
Process Improvements
• Improve acceptance of follow up rapid testing
– Acceptance rate increased from 30% to 60%
• Improve acceptance of service plans
– Acceptance rate increased from 85.4% to 92.8%
• Health Liaison to the Courts
– Release rate increased by 20%
• SPNS Jail Linkages Program Evaluation
– Over 100 followed for 12 months post-release
• Integrate with EHR
– Case management templates implemented 5/13
Linkage to Care Outcomes
2008-2012
n=17,010 self-reported HIV-positive admissions to NYC jails (2008-2012)
3000
89%
91%
2500
2008
2009
78%
2000
2010
2011
2012
74%
1500
1000
500
0
Offered a Plan
Received a Plan
2,700
Released with a Plan
2,456
1,910
Linkage to Primary Care
1,420
Community Collaborations
• NYS Links: enhance and replicate program
• NYC Care Coordination, Supportive Housing and Health
Home Providers
• Linkage agreements / Memorandum of Understanding
• SAMHSA ORP pilot collaborations
• Bronx Health and Housing Consortium
• Health Liaisons to the Courts
• NYS Criminal Justice and Health Home workgroup
• APHA Jail / Prison Health Committee
• Bronx Health Home pilot - linkages under ACA model
• SPNS Latino Populations grant – transnational approach
• SPNS Workforce Capacity grant – PR replicating model
Health Liaison to the Courts
• Health-based court advocacy to facilitate
– community alternatives to incarceration including
substance use / mental health treatment
– compassionate release to skilled nursing / hospice care
• Service plan addresses health and service needs of
the client while addressing public safety.
• Health information, records / letters from MD
• Coordinate with prosecutors, courts, defenders, care
coordination agencies, community treatment providers,
nursing homes, hospice programs and supportive /
transitional housing service network
Health Liaison Outcomes
• In 2013, 735 received Health Liaison services:
–
–
–
–
–
390 diverted to ATI
109 placed in non-mandated treatment programs
113 restored to parole
82 granted compassionate release
41 term reduced in the interest of justice.
• At least 345 (47%) would have remained incarcerated.
• Providing information to the courts improves health
outcomes and reduces the impact of incarceration on
communities with the greatest health disparities.
Health Home Collaborations
• CHS currently receives rosters from 7 NYC-based
Health Homes
– On average, about 10% of those currently incarcerated in
a NYC jail are on one of the health home rosters
• CHS is currently partnering with 2 NYC-based Health Homes
to actively link those currently incarcerated with their health
home care management organization
– Bronx Health Home supports a Project Officer and PCC for
their assigned patients
– South Brooklyn HH outstations two Project Liaisons to
coordinate care for their patients receiving MH services
Why Partner with Us?
Jail population is:
• Sicker and has greater health disparities than general population
• More likely to use ED and have resulting hospitalizations
CHS has:
• Demonstrated, evidence-based approach to linkages to care
• Agreements with extensive network of NYC service providers
Through our partnerships we can:
• Remove barriers to engagement in care
• Avoid unproductive outreach
• Help patients address basic needs during critical reentry period
Significant Gains
Information Dissemination
•
Papers published in peer-reviewed journals
•
National and International Conference Presentations
•
Demonstrated alternatives to incarceration
Program Sustainability
•
Cost saving at a societal level
•
Additional funding / expansion
•
Integration with ACA / Health Homes
Program Expansion
•
Health Liaisons to the Courts
•
Improve access and engagement in care
Further Evaluation
•
Women, Transwomen, Puerto Rican origin
•
Workforce Capacity; replication in PR
VALUE
ADDED
SPNS Collaborations
Inform and inspire:
Best practices
 Cost analysis
 Cross site visits & presentations
 New friends
Marry Creative Ideas &
Practical Solutions to
Wicked Problems
Ancillary cost benefit far
exceeds grant awards!
On-line Resources
http://www.careacttarget.org/ihip
Creating a Jail Linkages Program Training Manual & Curriculum Webinar Series
http://link.springer.com/search?query=enhancelink [Journal of AIDS and Behavior
Supplement 2 September 27, 2013]
http://www.enhancelink.org/
http://www.jjay.cuny.edu/Jail_Admin Toolkit.pdf
http://www.jjay.cuny.edu/NYCMappingHeathCare.pdf
http://www.aidsbeacon.com/news/2010/12/03/new-point-of-service-program-willfocus-on-hiv-aids-testing-and-treatment-for-inmates-at-rikers-island/
http://www.hcsdmass.org/
References
1. Teixeira,PA, Jordan AO, et al. Health Outcomes for HIV-Infected Persons Released from
the New York City Jail System With a Transitional Health Care-Coordination Plan. AJPH.
Volume 105, No. 2 pp 351-357. Feb 2015.
2. Draine J, et al. Strategies to Enhance Linkages between Care for HIV/AIDS in Jail and
Community Settings. AIDS Care, 23(3), 366-77, 2011
3. HRSA HAB Special Projects of National Significance Program Creating a Jail Linkage
Program, Training Manual and Curriculum, September 2013 www.careacttarget.org/ihip
4. Spaulding AS, et al. Jails, HIV Testing, and Linkage to Care Services: An Overview of the
EnhanceLink Initiative. AIDS & Behavior. Volume 17, Issue 2 S100-107. 1 Oct 2013.
5. Williams CT, et al. Gender Differences in Baseline Health, Needs at Release, and
Predictors of Care Engagement Among HIV-Positive Clients Leaving Jail AIDS & Behavior.
Volume 17, Issue 2 S195-202. 1 Oct 2013.
6. Spaulding AS, et al. Planning for Success Predicts Virus Suppressed: Results of a NonControlled, Observational Study of Factors Associated with Viral Suppression Among
HIV-Positive Persons Following Jail Release. AIDS & Behavior. Volume 17, Issue 2
Supplement, pp 203-211. October 1, 2013.
7. Jordan AO, et al. Transitional Care Coordination in New York City Jails: Facilitating
Linkages to Care for People with HIV Returning Home from Rikers Island. AIDS &
Behavior. Volume 17, Issue 2 S212-219. 1 Oct 2013.
8. Spaulding AC, et al. Cost Analysis of Enhancing Linkages to HIV Care Following Jail: A
Cost-Effective Intervention. AIDS & Behavior. Volume 17, Issue 2 S220-226. 1 Oct 2013.
Contact Us
• Alison O. Jordan, Principal Investigator
ajordan@health.nyc.gov 917-748-6145
• Jacqueline Cruzado-Quinones, Project Coordinator
jcruzado@health.nyc.gov 917-715-6841
• Paul A. Teixeira, Local Evaluator
pat2007@med.cornell.edu
Dripping water hollows out a stone
Not through force but persistence. - Ovid
Thank you! Questions?