report and recommendations. the reentry health task force originated out of growing concerns...

Report and Recommendations

The Reentry Health Task Force originated out of growing concerns regarding the health status of those returning to the community after incarceration

Pilot for the task force process for the new

Alameda County Reentry Network

Reentry Network will convene an Employment Task Force next, followed by Housing Task Force

Goal: To improve the health status of formerly

incarcerated people in Alameda County

Objective: Create a set of informed recommendations

which will increase access and improve the quality of health care after release.

Planning and Inauguration (April-September) - Arnold Perkins agrees to chair, Identified and recruited members

Key Health Topic Briefings (October and November) - Expert briefings on prevalence of various health conditions and current health care system to address conditions

Strategy, Policy and Program Briefings (December and January) - Expert briefings on strategies and policies affecting health status of formerly incarcerated

Recommendation and Report Development (February and March) - detailed recommendations and target audiences

Continuation and Sustainability – Public Health Department agrees to continue convening Reentry Health Task Force as needed

Task Force members were selected to represent the many diverse sectors concerned with reentry

Selection was made in an effort to ensure that the final recommendations would be as inclusive and comprehensive as possible

This approach was successful with attendance remaining high throughout the process

Arnold Perkins, Chair Kenyatta Arnold, Research Assistant, Urban

Strategies Council Bill Heiser, Research and Program Associate, Urban

Strategies Council Dr. Garry Mendez, Executive Director, National Trust

For The Development of African American Men Michael Shaw, Director Urban Male Health Initiative,

Alameda County Public Health Department Dr. Lawrence Van Hook, Pastor, lead organizer, Bay

Area Action Council, RCNO Junious Williams, CEO, Urban Strategies Council Rev. Eugene Williams, CEO, RCNO

Topic Name Organization General Health Care- Dr. Tony Iton, Alameda County Public Health

Department General Health Care – Alex Briscoe, Alameda County Health Care

Services Department Mental Health – Dean Chambers, Alameda County Behavioral Health

Care Substance Abuse – Lee Boone, Haight-Ashbury African American

Family Healing Center Substance Abuse– Ron Owens, Bay Area Service Network Chronic Care – Dr. Tony Iton, Alameda County Public Health

Department Communicable Diseases – Dr. Roslyn Ryals, Alameda County Public

Health Department Dental Health – Dr. Jared Fine, Alameda County Public Health

Department Transitional Health Care – Dr. Emily Wang, Transitions Clinic, SF Jail Health Care – Dr. Harold Orr, Alameda County Jail, Santa Rita Prison Health Care – Cherlita Gullem, Federal Receiver’s Office at

California State Prison- San Quentin Mental Health – Dr. Sean Fruge and Dr. Alexis Green-Fruge, Fruge

Psychological Associates

1. BASIC HEALTH CARE2. CHRONIC DISEASES3. ORAL, VISUAL, AUDITORY

CARE4. COMMUNICABLE DISEASES5. SUBSTANCE ABUSE6. MENTAL HEALTH

1. Issues, Problems and Opportunities

2. Promising Strategies, Policies & Programs

3. Interventions in Planning or Implementation

4.Task Force Recommendations

In June 2007, more than 22,249 people were on probation or parole in Alameda County (does not include Federal Probation or Parole)

The parole population in Alameda County is overwhelmingly◦Male (91%), ◦Under 50 years old (97%) and ◦People of color (84%) with African Americans

comprising 67% of the parolee population

One in every 100 Alameda County residents is currently under criminal justice supervision

Three in every 100 Oakland residents are currently under criminal justice supervision

Reentry population is concentrated in West Oakland, East Oakland and Hayward

PROBATION AND PAROLE POPULATION IN ALAMEDA COUNTY

(JUNE 2007)

Source of Supervision TotalAdult Parole 3,297Adult Probation 16,795Federal Probation and Parole N/ATOTAL ADULT REENTRY POPULATION 20,092

Juvenile Probation ( Juvenile Probation Caseload) 2,157Juvenile Parole (DJJ parolees) N/A

TOTAL REENTRY POPULATION 22,249

[i] Parole Census Data June 30, 2007. CDCR. Retrieved on 10/17/07: http://www.cdcr.ca.gov/Reports_Research/Offender_Information_Services_Branch/Annual/PCensus1/PCENSUS1d0706.pdf[ii] June 2007 Monthly Statistical Report, Alameda County Probation Department. It is important to note that this number reflects all of the Adults on probation in Alameda County, not those that are actively supervised. The number of actively supervised individuals on probation in June 2007 was 2,369.[iii] June 2007 Monthly Statistical Report, Alameda County Probation Department

http://www.cdcr.ca.gov/Reports_Research/Offender_Information_Services_Branch/Annual/PCensus1/PCENSUS1d0706.pdf

Over 1 in10 Alameda County residents does not have medical insurance (n=166,000 )

The indigent care system provides free or low cost services to 90,000 of the 166,000

The indigent care system is targeted to individuals earning less than 200% of the Federal Poverty Level ($20,800/person or $42,400 for family of four)

Healthy Families/CHIP

1%

Medicare & Medicaid

3%

Medicare & Others

7%

Other public1%Privately

purchased7%

Medicaid

9%

Uninsured11%

Employment-

based

61%

Source: California Health Interview Survey

The Urban Strategies Council and All of Us or None surveyed 138 formerly incarcerated people within Alameda County to determine their health status and their access to health care

Initial Results: ◦Formerly incarcerated utilize public insurance at

about the same level as other Alameda county residents,

◦Formerly Incarcerated are five times more likely to be uninsured

(n=134, 4 respondents missing)

Accurate data on the prevalence of health conditions among the reentry population in Alameda County was not available

To gauge demand we examined data on the prevalence of health conditions among prison populations from national and state research studies and applied it to the reentry population in Alameda County

To gauge supply we attempted to obtain data on programs that focus services on or have designated slots for the formerly incarcerated

Compared to the general population, formerly incarcerated people show significantly higher rates of communicable disease, mental illness and chronic disease

In 1997 more than 1 in 3 people living with tuberculosis and almost 1 in 3 of those with Hepatitis C were released from a prison or jail that year

In Alameda County we estimated that over 17,000 persons were in need of substance abuse services

ESTIMATED NEED AND SUPPLY OF HEALTH SERVICES

HEALTH SERVICE

ESTIMATED PREVALENCE AMONG

INCARCERATED POPULATION

ESTIMATED NEED

SUPPLY FOR THE FORMERLY INCARCERATED

National State County County CountyGeneral Health 100% 100% 100% 20,092 500Mental Health 20% 4,019Substance Abuse 85% 17,078 605Communicable Disease

Hepatitis C 17.75% 34% 6,831Hepatitis B 2% 3.5% 703

HIV 1.2% 1.8% 362TB 7.4% 1,487

Chronic DiseaseAsthma 8.5% 1,708

Diabetes 4.8% 964Hypertension 18.3 3,677

Oral, Auditory and Visual

N/A

[1] Need is estimated by applying the prevalence of the given health condition at the smallest geographic region for which we have prevalence data to the total adult reentry population for Alameda County (20,092). [i] National Commission on Correctional Health Care.(2002). “The health status of soon-to-be-released inmates: A report to Congress”. Chicago: National Commission on Correctional Health Care[ii] Prevalence of HIV Infection, Sexually Transmitted Diseases, Hepatitis, and Risk Behaviors Among Inmates Entering Prison at the California Department of Corrections, 1999

Accurate supply data on health care services was difficult to determine

Compiled data on indigent care services which are immediately accessible to the formerly incarcerated regardless of health coverage

By every measure the indigent care system is operating over capacity◦ Alameda County medical center serve 103% of the

patients that they are contracted to serve◦ The Community Based Organizations have106% of the

visits that they are contracted to provide

[1] This includes the Key Health Topics pertaining to General Health, Communicable Diseases, and Chronic Diseases

Table 3: Supply and Utilization of CMSP Funded Indigent Health Care Services

HEALTH CARE UTILIZATION

ESTIMATED NEED

SUPPLY OF INDIGENT HEALTH CARE SERVICES

FY2006-2007

NEED AMONG FORMERLY INCARCERATED

Unduplicated Patients

Contracted Patients Visits

Contracted Visits

Utilization by Provider

Alameda County Medical Center

20,092 36,084 35,000 112,407 N/A

Community Based Organizations

20,092 28,201 N/A 83,449 78,287

Database of service providers that are available to or focus on serving the formerly incarcerated in Alameda County

Initial focus on health related services to coincide with the Health Task Force process

Data represents results of a phone survey to verify services provided, formal survey is forthcoming

Table 4: Reentry Health Resources in Alameda CountyGeneral Health 141Mental Health 124Substance Abuse 123Dental 23Vision 4Reproductive Health 17TOTAL 432

Counts represent number of sites that provide services and not the number of organizations

bill heiser

Junious,I took out the private and indigent care facilities charts that listed hospitals, clinics and "other". Instead I put information on the indigent care system into the above slide. As for the private it seems to me that

Private Facilities/ProvidersHospital 3Clinic/community based organizations 47Other 125Emergency Room 3TOTAL 178

The “Other” category comprises 70% of all providers and refers to organizations that provide education and/or referrals but not direct services

Indigent Care Facilities/Providers

Indigent Care

Hospital 3

County based providers 26

Community Health Centers 4TOTAL 33

These providers comprise the Indigent Care system which is currently operating above capacity

Limited focus to community or reentry, tried not to go too far “upstream” into CDCR

Issues and problems begin at pre-release stage and extend through reentry

Found system of care is often fragmented and duplicative

Lack of and/or unrealistic pre-release planning

No set release date for undetermined sentences

Pre-release planning is often conducted with correctional staff rather than with community based providers

Pre-release planning rarely makes direct refers for medical services

The formerly incarcerated are not released with a state identification

The formerly incarcerated are not enrolled and/or screened for public benefits

Lack of medical screening prior to release Poor medication maintenance No issuance of medical records upon release No routine system for reporting communicable

disease cases to the county of release No clearly defined medical home

The transition from correctional to community based health care is fragmented and duplicative

CDCR and the county jail admit that they lack the infrastructure to transfer what medical records they do have to a county/community based provider

Parole and probation have difficulty identifying the medical needs of their wards and therefore making appropriate referrals

Difficult to connect formerly incarcerated to providers with appropriate cultural and linguistic competencies

Every presenter identified an aspect of reentry health care that could be improved through increased collaboration among relevant agencies, organizations and departments

These relationships were identified as in need of improvement:◦ Corrections and Community◦ Among County Agencies◦ County and City◦ County/City and Community/Faith based organizations◦ Among Community/Faith based organizations

Corrections/Community: ◦ to ensure continuity of care after release, ◦ to better leverage health care dollars and ◦ to ensure that community based medical providers have

access to the medical history of their patients.

County Agencies: ◦ To avoid duplication, ◦ Maximize resources◦ Engage in collaborative strategic planning

County and Cities: ◦ policy issues, ◦ maximize funding sources, ◦ align law enforcement with county services ◦ to ensure an active exchange of information concerning

reentry health care opportunities

County/City and Community/Faith Organizations : ◦ to maximize funding opportunities, ◦ to ensure referrals between services are accessible,

appropriate and complete◦ to promote the use of promising practices.

Community/Faith Organizations and Providers: ◦ to improve professional development activities, ◦ to increase knowledge and awareness of promising

practices and possible partnerships, ◦ to avoid duplication and redundancy and ◦ to best leverage resources.

Recommendations were created around the four themes emerged as issues, problems or opportunities:

1. Continuity of Care2. Payer of medical care3. Service Delivery4. Specific Issues

1. Primary and Secondary recommendations were developed for each theme

2. Target audiences were identified for each recommendation

3. Report contains information on the point in the reentry process at which the recommendation is targeted

4. Report identifies whether the recommendation is focused on the short or mid term

Make continuity of care during the period leading up to and immediately after release a reality by ensuring that those released have :

1. physical examination,2. medical records, 3. prescriptions and a supply of medications, and 4. a temporary medical home at the time of

release

1a) Structure discharge planning collaborations through formal agreements among agencies and with CBOs, designated agency liaisons, and broad community networks to allow for comprehensive referrals

1b) Develop a specialized plans for parolees with mental illnesses that account for their ongoing care and are flexible enough to prevent recidivism for mental health related incidents

2a) Pre-release plan should have a clear plan for payment of ongoing treatment

2b) Public Health Department should work with CDCR and Santa Rita Jail to develop an electronic “continuity of care record” that would serve as an electronic “health passport” for prisoners upon release

2c) Mandatory public benefit eligibility screening and enrollment prior to release

2d) Suspend public benefits for persons incarcerated in county jail

3a) Create or designate a multi-service clinic for the formerly incarcerated within Alameda County and establish it as the “medical home” for the formerly incarcerated

3b) Create a county wide resource and referral database

3c) When needed, make Substance Abuse and/or mental health treatment a requirement of parole or probation

3d) Create incentives to encourage county jails to conduct more medical screening

4a) Make supply and demand data accessible to better inform policy, funding and program decisions

4b) Mandatory screening and, upon release, reporting for all communicable diseases

4c) Mandatory transference of positive communicable disease cases to county of release

4d) Allow for substance abuse relapse without re-incarcerating

4e) Additional funding should be directed to neighborhoods and communities over represented by the reentry population

4f) Dedicate funding to discharge planning and post-release follow-up

Widely distribute the report

Present the report and advocate for the recommendations with critical audiences:◦ Alameda County Board of Supervisors, ◦ County Department Heads, ◦ CDCR officials, ◦ city officials within Alameda County, ◦ groups representing the formerly incarcerated◦ Alameda County Reentry Network Decision Makers

Committee◦ health service providers

Continue the collection of data and development/implementation of recommendations through the Public Health Department

Provide prisoners with a copy of their medical records upon release

Mandated transfer of communicable disease cases to relevant Public Health Department

1. Connect all recently released persons to with Diabetes, hypertension and congestive heart failure to the CMSP-ACE program

2.Create tools and literature that can be used by case managers and the formerly incarcerated to identify possible sources of health care insurance and services

1. Community Based Service providers should hire community health workers to conduct outreach

2. Annual screening for communicable diseases and mental health problems

3. Eliminate co-payment for health care during incarceration

4. Identify culturally competent community based health care and treatment providers that serve the formerly incarcerated

1. Develop a set of preferred health care providers that serve the formerly incarcerated

2. CPOs and/or medical staff need to be trained to identify person’s in need of mental health assessment

3. Ensure prisoners have direct access to medical staff

1. Funding should be allocated to help service providers pay for community health workers

2. Provide education and intervention funding for faith & community-based organizations that are collaborative partners

3. Provide technical assistance funding to counties to foster collaboration w/ faith & community-based providers

1. Ensure that additional allocations are targeted to communities over-represented by recently released inmates

2. Dedicate funding for discharge planning and post-release follow-up

3. Create a multi-service clinic for the formerly incarcerated

4. Establish a system for making supply and demand data accessible so that program, funding and policy decisions can be used more efficiently

1. Structure discharge planning collaborations through formal agreements among agencies and with CBOs, designated agency liaisons, and broad community networks to allow for comprehensive referrals

2. Develop a specialized plan for parolees with mental illnesses

3. Establish a system for making supply and demand data accessible

1. Develop an electronic “continuity of care record” that would serve as an electronic “health passport”

2. Mandatory public benefit eligibility screening and enrollment prior to release

3. Create a county wide resource and referral database

1. Make Substance Abuse treatment a requirement of parole

2. Mandated transfer of communicable disease cases to relevant Public Health department


4. Pre-release plan should have a clear plan for payment of ongoing treatment including the transference of medical records

1. Identify culturally competent community based health care and treatment providers that serve the formerly incarcerated



4. Make mental health care a requirement of a person’s parole



2. Mandatory screening for all communicable disease

3. Establish a robust and competent public health infrastructure within CDCR

4. Ensure that additional allocations are targeted to communities over-represented by recently released inmates


2. Provide prisoners with a copy of their medical records upon release


4. Pre-release plan should have a clear plan for payment of ongoing treatment


2. Develop a specialized plan for parolees with mental illnesses





4. Establish a system for making supply and demand data accessible so that program, funding and policy decisions can be used more efficiently


2. Allow for substance abuse relapse without recidivating


4. Provide prisoners with a copy of their medical records upon release






5. Make mental health care a requirement of a person’s parole

1. Structure discharge planning collaborations through formal agreements among agencies and with CBOs, designated agency liaisons, and broad community networks




1. Establish a system for making supply and demand data accessible


3. Allow for substance abuse relapse without recidivating





2. Pre-release plan should have a clear plan for payment

3. Annual screening for communicable diseases and mental health problems




2. Restructure CPOs and probation officers training/professional development practices so they stay informed of current prisoners current medical needs


4. Create tools and literature that can be used by case managers and the formerly incarcerated to identify possible sources of health care


2. Community Based Service providers should hire community health workers to conduct outreach



1.Create tools and literature that can be used by case managers and the formerly incarcerated to identify possible sources of health care


report and recommendations. the reentry health task force originated out of growing concerns...

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