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Addressing Health Disparities

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Title: Addressing Health Disparities


1
  • Addressing Health Disparities
  • Among Incarcerated and Recently Incarcerated
    Populations
  • March 24, 2015

2
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

3
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

4
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

5
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.

6
Division of Training and Capacity Development
(DTCD)
Administrative Support Bukeeia Goodson
Budget Management Terri Newman
Chief Medical Officer Philippe Chiliade/Rupali
Doshi
7
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
  •  

8
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

9
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

10
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

11
The HIV Care Continuum
Source CDC. HIV surveillanceUnited States,
19812008. MMWR 20116068993.
12
  • Overview of SPNS Initiatives

13
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)

14
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)
  • Secretarys Minority AIDS Initiative Fund (SMAIF)
    Replication of a Public Health Information
    Exchange to Support Engagement in HIV Care (2012
    2015)

15
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)
  • Secretarys 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)

16
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)
  • Secretarys Minority AIDS Initiative Fund (SMAIF)
    Addressing HIV and Housing through Data
    Integration to Improve Health Outcomes along the
    HIV Care Continuum

17
  • Overview of EnhanceLink Initiative

18
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

19
Enhancing Linkages to HIV Primary Care and
Services in Jail Settings (2007 2012)
20
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

21
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.

22
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

23
Further Information
  • List of SPNS Initiatives
  • http//hab.hrsa.gov/abouthab/partfspns.html
  • Target Center www.careacttarget.org/category/topic
    s/spns
  • SPNS Products
  • http//hab.hrsa.gov/abouthab/special/spnsproducts.
    html

24
Contact Information
  • Harold Phillips
  • Director, Division of Training and Capacity
    Development
  • HPhillips_at_hrsa.gov
  • Adan Cajina
  • Chief, Special Projects of National Significance
    Branch
  • ACajina_at_hrsa.gov
  • Melinda Tinsley
  • Public Health Analyst, Special Projects of
    National Significance Branch
  • MTinsley1_at_hrsa.gov
  • www.hab.hrsa.gov/abouthab/partfspns.html
  • 301-443-7036

25
  • Presented by Sarah Cook-Raymond,
  • Managing Director of

www.impactmarketing.com
26
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

27
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
28
IHIP Resources on TARGET Center Website
www.careacttarget.org/ihip
29
IHIP Resources Enhancing Linkages to HIV
Primary Care in the Jails Setting
  • Includes lessons learned and step-by-step
    recommendations on how to implement a new jail
    linkage program and how to expand a current one.
  • 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, Rikers Island, N.Y.

TRAINING MANUAL
POCKET GUIDE
30
Incarceration Overview
  • While the terms jails and prisons are often
    used interchangeably, they represent different
    kinds of correctional facilities
  • Approximately 85 of incarcerated people were
    solely in jails.

31
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

32
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

33
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

34
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

35
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

36
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 gt 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)

37
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

38
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

39
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 youre 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
  • Its important to identify a champion within the
    jail early on

40
Tips (cont.)
  • Really think through the logistics of what your
    program will look like within the jail setting
    constraints and how youll adapt
  • Outline expectations early on and often
  • Hire people who understand the correctional
    culture and really want to be doing this work.
  • Dont underestimate the importance of a smile and
    a thank youboth with jail staff and inmates

41
If Already in the Jail
  • Nurture partnerships and facilitate ongoing
    communication
  • Consider how youre assessing patient needs
  • If there are needs you cant 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 arent 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.

42
Contact Information
  • Sarah Cook-Raymond, Managing Director
  • Impact Marketing Communications
  • scook_at_impactmarketing.com
  • 202-588-0300
  • www.impactmarketing.com

43
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
44
RIKERS ISLAND
Vernon C. Bain Center, Bronx
Brooklyn Detention Center
Manhattan Detention Center
Transitional Health Care Coordination
45
Correctional Health Services (CHS)
At A Glance 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 mean53 days median8d
Electronic Health Record (adopted 2008-2011) eClinicalworks, customized for jail setting care mgt templates unidirectional interface with NYC DOC Inmate Information System
Sources NYC Department of Corrections Mayoral
Report 2013 http//www.nyc.gov/html/doc/download
s/pdf/MMR-FY2013.pdf Annual releases from NYC DOC
Report of Discharges by zip code for CFY14
46
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) HIV-infected (2.5k) others
    at high risk (1.5k)
  • All jails use electronic health record

47
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
48
Jail Demographics


Race ALL HIV
Non-Hispanic Black () 54.0 61.0
Hispanic () 33.0 30.0
Non-Hispanic White () 8.7 7.0
Gender ALL HIV
Male () 89.0 78.3
Age ALL HIV
Range 16 - 84 16 - 68
Mean 34 45
Break down 16lt21 (13.4) 16lt21 (1.3)
Break down 21lt31 (32.8) 21lt31 (10.1)
Break down 31lt41 (21.6) 31lt41 (18.6)
Break down 41lt51 (21.8) 41lt51 (44.3)
Break down 51 (10.2) 51 (25.4)
2011 Correctional Health Services new admission
records (N61,853)
49
Prevalence by Diagnosis
  • Substance abuse gt50
  • Mental Illness 30
  • Hepatitis C 8
  • HIV 5
  • Diabetes 5
  • Tuberculosis 5
  • Other Sexually Transmitted Infections 6

50
System Challenges
Solutions
Barriers
  • Intake History and PE
  • universal voluntary lt 24 hrs
  • ongoing offer thereafter
  • Screen on admission
  • Single oversight
  • Discharge plan asap
  • engage in housing areas
  • transport / accompaniment
  • Electronic Health Records
  • Health Information Exchange
  • Short-term stays are norm
  • 25 leave in 2-3 days
  • 50 leave within 7 days
  • Limited time to diagnose
  • Multiple providers
  • Limited time to treat, maintain care
  • Paper records
  • Post-release tracking

Removing barriers
51
Establish Maintain Relationships
  • Smile
  • Listen first
  • then ask Key Questions
  • Begin where you can
  • Set realistic goals
  • Build trust
  • Start with winnable battles
  • Deliver
  • Give more than you receive
  • Chain of Command
  • Identify Champions
  • Shared benefits (reduced violence, improved
    security)
  • Prisons v. jails
  • Acknowledge extra work
  • Be a familiar face
  • Learn who to approach for jail access, security
    training space to interview clients

52
HIV Continuum of Care Model
53
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

54
Critical Skills
Community Health Workers
Probation
Parole
Health Dept.
Courts
communicate negotiate connect advise
oversee provide assist maintain
support
Staff
Health Insurers
Hospitals
Corrections
Funders
Health providers
55
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)

56
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.
57
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

58
SPNS Jail Linkages InitiativeLocal Study
Protocols
  • Enrollment adult HIV patients enrolled during
    jail stay
  • Exclusion criteria newly diagnosed, receiving
    mental health discharge planning, likely to have
    long sentence (gt1year)
  • 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

59
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
Case Management / Data Collection PCC and counselors trained by Yale Research and Evaluation Team
Program Focus Population-based approach
Program Focus Linkage to Care within 30 d of release
Program Enhancements Health Liaison to the Courts
60
SPNS Jail Linkages Initiative Disposition of NYC
participants
555 Baseline enrollments
67 Not Released in time for MSE inclusion
488 Included in MSE sample
54 Dropped 3 died 10 Moved 41 Prison Return
434 Baseline sample
243 Seen at follow-up
191 Lost to follow-up
61
SPNS Jail Linkages Initiative Baseline Medical /
Substance Use History
 Medical / Substance use co-morbidities NYC Baseline n555 ()
Active / other medical problem 76
Hepatitis C virus 40
Medical Insurance 91
History of Heroin Use 56
History of Methadone 39
Alcohol / drug treatment ever 23
Troubled by Drug use, last 30d 66
SF-12 Physical Composite Score 47.5 (SD 10.6)
62
SPNS Jail Linkages Initiative Baseline
Socio-Economic Factors
 Indicator NYC Health n555
Never completed high school 47
H.S. Diploma / GED 38
Job / skill training 58
Some College 15
Employed 30 days prior 10
Committed relationship 30
Age lt18 years at first arrest 50
Proportion of Lifetime spent incarcerated (mean) 9
Arrests (mean) 26
63
SPNS Jail Linkages Initiative Services Accessed
30 days post release
Service category accessed 30 days post release NYC (n402 )
HIV primary care 71
Other medical care 37
Alcohol/Substance use treatment 52
Housing 32
64
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

65
SPNS Jail Linkages Outcomes From baseline to 6
month follow-up
Indicator NYC Health All Sites
Clinical Care Clinical Care 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 Engagement in Care 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 Basic Needs Basic Needs
Homeless ? (22.4 to 4.15) ? (36.2 to 19.2)
Hungry ? (20.7 to 1.7) ? (37.4 to 14.1)
66
After Incarceration
  • Nearly 80 of clients in who receive a discharge
    plan were connected to care, post-release. Along
    with primary medical care, 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.
  • The THCC home visit team has been able to locate
    90 of people referred to it, finding that
    approximately one-third of those referred have
    been re-incarcerated.
  • 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)

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.
  • 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.

67
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

68
Linkage to Care Outcomes2008-2012
n17,010 self-reported HIV-positive admissions to
NYC jails (2008-2012)
2,700
2,456
1,910
1,420
69
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

70
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

71
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.

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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

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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

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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
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SPNS Collaborations
Marry Creative Ideas Practical Solutions
to Wicked Problems
Inform and inspire
  • ?Best practices
  • ? Cost analysis
  • ? Cross site visits presentations
  • ? New friends
  • Ancillary cost benefit far exceeds grant awards!

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On-line Resources
http//www.careacttarget.org/ihip Creating a Jail
Linkages Program Training Manual Curriculum
Webinar Series http//link.springer.com/search?qu
eryenhancelink Journal of AIDS and Behavior
Supplement 2 September 27, 2013 http//www.enhan
celink.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-poin
t-of-service-program-will-focus-on-hiv-aids-testin
g-and-treatment-for-inmates-at-rikers-island/ htt
p//www.hcsdmass.org/
  • In 2007, THCC was awarded a grant from the Health
    Resources and Services Administration (HRSA) to
    participate in the Enhancing Linkages to HIV
    Primary Care Services in Jail Settings project,
    part of the Special Projects of National
    Significance (SPNS) projects.
  • This SPNS Initiative is a multisite demonstration
    and evaluation study of HIV service delivery
    interventions in jail settings. The purpose of
    these projects is to develop innovative methods
    for providing care and treatment to HIV positive
    individuals in jail settings who are returning to
    their communities.
  • The THCC home visit team attempts to follow-up
    with all eligible (current NYC resident) clients,
    offering them a home visit and / or accompaniment
    to their first community-based medical
    appointment.

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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
    Non-Controlled, 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.

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Contact Us
  • Alison O. Jordan, Principal Investigator
  • ajordan_at_health.nyc.gov 917-748-6145
  • Jacqueline Cruzado-Quinones, Project Coordinator
  • jcruzado_at_health.nyc.gov 917-715-6841
  • Paul A. Teixeira, Local Evaluator
  • pat2007_at_med.cornell.edu
  • Dripping water hollows out a stone
  • Not through force but persistence. - Ovid

79
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