Health Care Continuity in Jail, Prison and Community Thomas.Lincoln@bhs.org Hampden County Correctional Center Baystate Brightwood Health Center Springfield, MA 2006

1. Health Care Continuity in Jail, Prison and Community [email_address] Hampden County Correctional Center Baystate Brightwood Health Center Springfield, MA 2006

2. Percent of Total Burden of Infectious Disease Found Among People Passing Through Correctional Facilities, 1996 Hammett TM, Abt Associates, Nat’l HIV Prevention Conf. Aug 1999

4. HCCC 1999 intake data in Conklin TJ et al. AJPH, 2000

5. Chronic Medical Illness: Comorbidity HCCC 2001

6. Viewed from whatever angle, whether social, economic, administrative, or moral, it is seen that adequate provision for health supervision of the inmates of penal institutions is an obligation which the state cannot overlook without serious consequences to both the inmates and the community at large.” National Society for Penal Information: Rector FL, editor. Health and Medical Service in American Prisons and Reformatories . New York: J. J. Little & Ives; 1929.

7. The Triad Corrections Public Health Community Health Public Safety

13. Community Integrated Correctional Health Care The Hampden County Community Health Model

15. EForPk 16 Acres Lib Pine Pt E Spf BosRd ForPk Ind UppH Met OldH McK Mem Bay Bri 6Cor S.End Springfield Community Partnership and Prevention Alliance, 1995

18. Challenges/Opportunities Numbers

19. Bureau of Justice Statistics: Adult correctional populations 1980-2002

21. Annual Releases of Adults Sentenced to Corrections: Massachusetts, 1989-2000 Mass DOC; Community Resources for Justice, Inc.

23. Models of Case Management release A B C E D

26. Barriers to Continuing Care In the Community after Release Chronic Illness Cohort, HCCC, 2001 1 month after release A Big Problem Somewhat of a Problem Not a Problem Not Applicable Not being able to pay for care or meds 29 ( 23%) 18 (15%) 68 (55%) 9 (7%) Not being able to get an appointment 25 ( 20%) 20 (16%) 73 (59%) 6 (5%) Not liking the care you get from providers 11 (9%) 15 (12%) 88 (71%) 10 (8%) Not having transportation 51 ( 41%) 21 (17%) 48 (39%) 4 (3%) Conflicts with work or other activities 18 (15%) 23 (19%) 78 (63%) 5 (4%)

27. Facilitators to Continuing Care In the Community after Release Chronic Illness Cohort, HCCC, 2001 1 month after release Very Helpful Somewhat Helpful Not Helpful Not Applicable Post-Release Medical Appointment Set Up in Advance 43 (35%) 83% 5 (4%) 4 (3%) 72 (58%) Dually-Based Providers 57 (46%) 54% 29 (23%) 19 (15%) 19 (15%) Health care in Jail 53 (43%) 43% 55 (44%) 14 (11%) 2 (2%) Health education in Jail 58 (47%) 48% 43 (35%) 20 (16%) 3 (2%) Drug/Alcohol Treatment in Jail 50 (40%) 53% 30 (24%) 14 (11%) 30 (24%)

38. Chronic illness cohort, HCCC 2001 Self-reported health (n=131) Intake % 6 months % General Health Fair/poor 55 34 Good 24 33 VG/excellent 21 33 Pain (mod/severe) 40 20 Emotional problem (mod/severe) 66 43

39. In Jail Services and Post-Release Health Care Use (Physical)- instrumental variable multivariate analysis Chronic illness cohort, HCCC 2001 In jail service Following Release Doctor ER Hospital Doctor Visits ↑ 0.02 ↓ NS ↓ NS Case Management ↑ 0.02 ↓ NS ↓ NS Discharge Planning ↑ NS ↓ NS ↓ NS Appointment Made ↑ 0.01 ↓ NS ↔ NS

40. Percent of Smokers Involuntarily Ceasing Smoking While Incarcerated Who Remained Cigarette Abstinent, by Length of Time Post-Release Chronic illness cohort, HCCC 2001

42. The health care system realizes net savings even when there is no incidence in prison, or there is no cost of chronic liver disease, or when only one dose of vaccine is administered. Thus, while prisons might not have economic incentives to implement hepatitis B vaccination programs, the health care system would benefit from allocating resources to them.

44. HCCC 1999