Alaska Native Tribal Health Consortium Healthy Transitions Project A Special Project of National Sig

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Alaska Native Tribal Health ConsortiumHealthy
Transitions ProjectA Special Project of
National SignificanceTracy Speier, Project
CoordinatorSocial Work and HIV Conference
Albuquerque, NM May 30, 2003 Funding provided
by the Health Resources Services Administration
Special Project of National Significance Grant
No. H97HA00256A0
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Statementof the Problem

• Alaska Natives in Prison A Silent Crisis

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Alaska Natives In Prison

• In 2000
• AK/NA represent 36 of the incarcerated
  population in Alaska but only 19 of the states
  population
• AK/NA represent 32 of the total out-of-state
  prisoner population located in Florence, AZ
• 80 of crimes committed by AK/NA involved alcohol
  (1996)

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Alaska Natives In Prison

• In 2000
• 54 of crimes committed by AK/NA were sex
  offenses
• 42 of AK/NA had their parole/probation revoked
• 53 of AK/NA incarcerated were considered
  violent offenders
• Precluding them from eligibility for community
  corrections

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Healthy Transitions Project Service Area
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Goals
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Overview

• Goal 1 Examine the medical outcomes of HIV
  positive individuals receiving care from ANTHCs
  Title III EIS Program
• Goal 2 Development of collaborative relationship
  between Regional Tribal Health Organizations and
  DOC
• Goal 3 Conduct in-depth assessments to screen
  for risk of infectious diseases and make
  appropriate referrals

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Goal 1

• ANTHCs Ryan White Title III Program
• New program (In existence for 1 year)
• First Title III program awarded to an
  Native-owned and operated health care facility in
  the country
• Unique model offers a continuum of care and
  serves to urban, rural, and remote areas of
  Alaska through a healthcare network referred to
  as the Alaska Native Tribal Health Consortium
  (ANTHC)

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Service Area of Alaska

• Alaska Native Health Care System Referral
  Pattern, Same Scale Comparison-Alaska to Lower 48

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Goal 2

• Develop collaborative relationships
• Regional Tribal Health Organizations
• State of Alaskas DOC
• Prerelease planning provides a window of
  opportunity to address important personal,
  cultural, and public health issues.
• Veterans Center
• Develop an integrated system

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Goal 3

• Conduct in-depth health assessments to screen for
  risk of co-occurring infectious diseases
  including HIV, Hepatitis, STIs, TB and dual
  diagnosis including Substance Abuse and Mental
  Illness.
• Make appropriate referrals for Alaska Natives who
  are on pre-release status or who are in community
  corrections
• Discharge planning and transitional case
  management

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Research Questions
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Research Questions

• What are the demographic characteristics of
  ATNHCs Title III EIS patients?
• Are there differences between patients living in
  rural and remote areas of the State and those
  living in urban areas?
• Are there differences between Alaska Native and
  non-Native patients in rural and remote areas?
• Are there differences between male and female
  patients?
• What are rates of co-occurring infectious
  diseases dual diagnoses including HIV, TB,
  Hepatitis, STIs, SA, MH?

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Barriers to Developing Prison Programs

• Complexity of Care Coordination

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Barriers

• Correctional systems are mandated to provide
  security and custody
• Health care programs and rehabilitation are
  secondary
• Correctional systems have limited budgets
• Treatment for HIV Hepatitis is expensive

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Barriers

• Correctional systems are under public scrutiny
• Stigma against prisoners, substance abuse, metal
  Illness, and infectious diseases, including HIV
• Attitude that all prisoners should do hard time
• Lack of professional and community awareness that
  there is an increase risk of prisoners returning
  to the community with communicable or infectious
  diseases

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Barriers

• Stigma and lack of knowledge about infectious
  diseases in correctional institutions
• Administrators
• Correctional officers
• Program staff
• Inmates
• Community
• Visitors

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Barriers

• Prison rules and regulations constrain
  HIV-education and prevention
• Harm reduction methods not available in most
  prisons
• Substance use is a disciplinary infraction
• Sexual activity is disciplinary infractions
• Mississippis policy on conjugal visits

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Barriers

• Limited history of cooperation between CBOs,
  Tribal Organizations and the Department of
  Corrections (DOC)
• Who should be responsible for services for
  incarcerated Alaska Natives
• Conflicting values between Alaska Native
  cultures vs. corrections culture vs. Public
  Health culture

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Summary
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Summary

• Alaska Natives In Prison
• More than 2x of AK/NA in prison than are in the
  general population
• Large of crimes committed by AK/NA are done
  under the influence of alcohol
• Large of these crimes tend to be sexual and/or
  violent in nature.
• As prisoners, AK/NA tend to be passive and
  considered a non-security risk.
• Lack of culturally appropriate activities and
  treatment available while incarcerated and upon
  release.

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Summary

• Alaska Natives In Prison
• Lack of appropriate life skills necessary for
  required employment, thus resulting in parole and
  probation violations.
• DOC has a history of being a closed system
• Limited collaboration between Tribal governments,
  CBO, and DOC in providing health and social
  services for transitional prisoners
• Different values between AK/NA, DOC, and PH
• Increased risk of spreading infectious diseases
  in the rural and remote villages upon release.

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Conclusion

• Alaska Native Tribal Health Consortiums Healthy
  Transitions Project
• Dr. James Berner, Principal Investigator, ANTHC
• Dr. Gloria Eldridge, Principal Evaluator, UAA
• Tracy Speier, Project Coordinator, ANTHC
• 4201 Tudor Centre Drive Suite 305
• Anchorage, Alaska 99508
• [phone]
• tspeier_at_anmc.org
• Thank you