Discharge Planning and Community Case Management for HIV-Infected Inmates: Collaboration Enhances Public Health and Safety

Article excerpt

Imagine finding a puppy in poor health and taking it to a local animal shelter. The shelter invests substantial funds in the dog to return it to adoptable shape and find it a new home. Some months later, the same puppy is back on the street in poor shape. The result of the investment of a variety of public and private resources is nothing short of frustrating.

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During a 2002 Urban Institute-sponsored roundtable on inmate re-entry, a lively discussion ensued when a similar description of the links between public health and correctional health resources was introduced. In the end, the participants came to realize that the investment--however minimal some may perceive it to be--made by public funds through the provision of correctional health resources was often ineffective due to the lack of linkage to community-based public health resources. Nowhere has this been more apparent than in those individuals who are living with HIV, many of whom also have substance abuse problems and mental health disorders.

CDC and HRSA Collaborate

In 1999, the Centers for Disease Control and Prevention and the Health Resources Services Administration (HRSA) entered into a partnership to provide funding for a corrections-to-community HIV discharge planning and community case management demonstration project. Targeted toward areas with high HIV rates, the project invited applications from state and local health departments that have a working relationship with a correctional facility. Six states and one county--California, Florida, Georgia, Massachusetts, New Jersey, New York and Cook County (Chicago), Ill.--received funding support as demonstration sites, all of which include a jail-based program. Five work with state departments of correction and three operate in juvenile detention facilities.

The basic premise behind the CDC/HRSA Corrections Demonstration Project is that correctional facilities concentrate on individuals who engage in high-risk health behaviors and are difficult to reach with public health services in the community. Examples include injecting drug users, commercial sex workers/traders and young people engaging in similar high-risk behaviors. These groups have high rates of infectious diseases, including HIV and other sexually transmitted diseases, tuberculosis, and hepatitis B and C.

Once arrested and processed, these individuals introduce diseases into the correctional setting. If not treated while incarcerated, they will carry their diseases back into the community after release. If arrested again, recidivism creates a cycle--community to corrections to community--for disease transmission and individual health deterioration. The project seeks to interrupt this cycle through prevention and targeted case management of infected people before and after their release from the correctional facility. This process includes appropriate follow-up once an individual returns to the community.

Through partnerships among health departments, corrections and community-based organizations (CBOs), the project's programs can provide disease-prevention messages, STD screening, HIV counseling and testing, and hepatitis B and C prevention, treatment information and services to inmates at participating facilities. Disease prevention messages include information about community resources such as public health clinics and CBO-sponsored services that can be accessed upon release.

Currently, evaluations are being conducted to track the percentage of inmates living with HIV who knew their status upon entry versus how many detainees learned of their status as a result of counseling and testing efforts by the Corrections Demonstration Project. For those detainees found to be HIV-positive or who knew they were HIV-infected and disclosed their status while incarcerated, a caseworker conducts a needs assessment and develops a discharge plan prior to the individual's release from the facility. …