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136th APHA Annual MeetingSan Diego, CASession 5196.0

Invisible Bars: Barriers to Womens Health During and After Incarceration

V. Diane Woods, Dr.P.H., M.S.N., R.N.Assistant Research Psychologist University of California Riverside, CaliforniaPresident & CEO, African American Health Institute of San Bernardino

Kim CarterFounder & Executive Director, Time for Change Foundation

October 29, 2008 @ 12:30pm

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Presentation Sponsored by:

African American Health Institute of San Bernardino CountyProject Funded in Part by:

Time for Change FoundationCalifornia EndowmentCounty of San BernardinoSBC Department of Public Health

*Purpose of PresentationTo identify five barriers women face in accessing health resources during and after incarceration

To understand the complexity of women accessing healthcare services while detained in prison and upon release

To identify three policy change recommendations for State Correctional Systems that have the potential to improve health outcomes of women

WOMEN IN PRISONFrom 1973 to 2007, women in prisons increased by 645% --- almost twice rate of men

Source: The Sentencing Project, Institute on Women and Criminal Justice (Mauer 2007)

*The November Coalition

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Who are these women in prison?

Women 85% convicted of drug or drug-related offenses

90% fragmented in their family histories

70% from families with other members in the Criminal Justice (CJ) System

80% survivors of physical and/or sexual abuse

overrepresented by women of color

70% poor, undereducated, unskilled, single mothers

*Whose Mother, Daughter or Sister?

*CASE STUDY:

Source: San Bernardino County Quick Facts, U.S. Census Bureau, 2007 available at http://quickfacts.census.gov City of San Bernardino largest populated area= approx 200,000

Chart1

0.448

0.384

0.095

0.056

0.014

0.004

San Bernardino County, CA 2006 Population Estimate, 1.99 million Percent by Ethnicity

Sheet1

Yes62.8

No35

No Response2

Other0.2

Sheet1

Interested in Research

Sheet2

Breast68.8

Ovarian46.9

Colorectal20.3

Other3.1

Sheet2

Breast

Ovarian

Colorectal

Other

Cancer Research Interest of Inland Empire Black Women, n=64

Sheet3

Latino44.8%

White38.4%

Black9.5%

Asian5.6%

American Indian/Alaska Native1.4%

Pacific Islanders0.4%

Sheet3

San Bernardino County, CA 2006 Population Estimate, 1.99 million Percent by Ethnicity

*U.S. Federal CourtSeizes State Prison Healthcare

In 2005, the California prison healthcare system seized by the federal government

One inmate/per week dying from medical neglect Judge cites preventable deaths of inmates - depravity of system

* U.S. Federal CourtSeizes State Prison Healthcare2008 Status Report:Fired incompetent unlicensed doctorsDemand $8 billion dollars from State Treasury Increased salaries for qualified medical staffLittle done to improve delivery systems

*Research QuestionsWhat are the barriers women face while incarcerated?

What are the barriers women face after incarceration?

What are healthcare needs of women during incarceration?

What are the risks to the publics health?

*Methods

Mixed-Methods Approach (Qualitative & Quantitative)

Current & Formerly Incarcerated Women

Location: San Bernardino County, CA

Study conducted in 2005

*Quantitative Data

Literature Review of Best Practices

GIS Mapping to Identify Resources (housing, healthcare, dental, etc.)

Survey Development for Population SamplingTarget: formerly incarcerated women (convenience sample)Key informants, n=5Survey pilot testing, n=8

*Survey DesignPaper survey: 6 pages43 questionsdichotomous (i.e., yes/no) and multiple choice responses

Face-to-Face Self-administration

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Multi-faceted sampling sites, n=17California Institution for Women (CIW)New HouseCedar HouseGibson HouseVista Recovery CenterCalifornia Rehabilitation Center (CRC)State of California Parole Department12-step Anonymous Meetings, n=10Quantitative Data Sampling

*Data CollectionTotal Survey Sample, N=152

Survey Sampling Selection Criteria: 1. Could be on parole or probation2. Experienced recidivism3. 18 years old and older4. Resident of San Bernardino County

Interviews: March - April 2005

*Data AnalysisSPSS Version 11.5

Database: 95 variables and 152 respondents

Data mining

Descriptive analysis conducted

*Post Incarceration RESULTS

Lack of Employment

Lack of Health Insurance

Mental Health Disorders

Prevalence of Drug & Sexual Abuse

Lack of Employment

*Lack of Health Insurance

Mental Health Disorders% of Respondents

Substance Abuse Do you have a history of drug abuse?

*Report of Sexual & Physical AbuseHave you had any counseling for that abuse?Sexual Abuse

*SUMMARY of RESULTSIncarcerated women dont have access to competent healthcare services in prison

Previously incarcerated women do not have access to preventative healthcare

Public Health defined as ensuring conditions exist in which people can live healthy is locked out of the prison system

Having a Felony conviction.equates into disenfranchisement of many health and social services.

*Four Critical Interrelated IssuesSubstance AbuseMental HealthPhysical HealthTrauma

Similar findings by Covington, Bloom & Owens, 2006 (NIH Gender- Responsive Strategies )

*Discussion Greater Public Health RisksMore women entering community unhealthyMore women suffering from mental health issues left untreatedReduced chances of successful reintegration into society.

*RESULTS In Prison Did not Receive treatment for substance abuse

Re-Traumatized by guards and environment

Not given appropriate counseling and mental health services Suffering from multiple health conditions

After PrisonGap in servicesavailable for substance abuse treatment

Lack of appropriate programs available

Unstable living arrangements

Ineligible for most government funded support services

*What are the Barriers to Accessing Healthcare ServicesIn Prison

The institution charges a $5.00 co-payThere are not enough slots for all the women who need substance abuse treatmentInmates are dying from preventable illnesses on average one per week which heightens fear amongst inmatesHealthcare system ineffectively dealing with Those diagnosed with mental illness are mandated to take medications but do have mental health treatment to include counseling, information on side-effects of medications and managing their stressors

*What are the Barriers to Accessing Healthcare ServicesAfter Prison

Lack of Health Insurance many responded that the County (MIA) Medical Indigent Adult insurance should be called (MIA) Missing In Action because the 3 to 4 month waiting periods for services and between referralsNo access to preventative careEmergency Room dependencyNon-existent dental services for the indigentDrug felony status excludes many from accessing food status and other welfare servicesLoss sense of entitlement amongst this group

*Policy RecommendationDept. of CorrectionsRemove the $5.00 co-pay for the indigentInmates should be classified into appropriate rehabilitative servicesAll inmates should receive an annual pap smear and those above 40 should include a mammogram

State of CaliforniaCreate a continuum of health care services coordinated for former prisonersModify the 2006 TANF welfare reform which prohibits drug offenders from receiving food stamps, welfare and public housing

*Public Health Risk FactorsWomen re-entering the community without having received healthcare during incarceration are more likely to:Carry STDs that have been undetectedBe released without their psychotropic medications in handSuffer from Post Incarceration SyndromeReturn to abusing drugs and alcoholRe-Enter Society as Homeless

*Recognition Received as a result of being inspired by Public Health2004 - NAACP Community Pioneer Award for Social Justice

2005 - KCET/Washington Mutual Unsung Hero Award

2005 County of San Bernardino Herstory Award

2005 Soroptimist International Woman Making a Difference Award

2006 League of Women Voters Citizens Achievement Award

2006 Bank of America Local Hero Award

2007 Black Culture Foundation Black Rose Award

2008- Loma Linda University Childrens Hospital Foundations Hometown Hero Award

*Free Copy of the report titled:Invisible Bars- Barriers to Womens Health and Well-Being During and After Incarceration Available on line at www.Timeforchange.usCarter, Ojukwu & Miller, 2006

*Speak about the way I visualized the environment agent and host..why I chose this method.**Over One Million Women are underCriminal Justice Supervision17% of total CJ population 111,000 in prisons 98,000 in jails 950,000 on probation and paroleLast 10 Years: 81% increase in women 45% increase in me*Reiterate this point!*Define: formerly incarcerated fix caps