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Service Delivery Innovation Profile

Community Health Center-Jail Partnerships Improve Care During and After Incarceration, Reduce Jail-Based Violence and Deaths and Enhance Access to Community-Based Care


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Snapshot

Summary

Community Oriented Correctional Health Services fosters partnerships between local jails and community health centers. Under these agreements, the jail contracts for the provision of health care services with the community health center, which provides coordinated services at jail entry (booking), during incarceration, and upon release back into to the community. The goal is to make correctional care an extension of the existing community health care system, recognizing that each implementation will vary with local conditions. The program reduced violence and deaths in the jail setting and enhanced access to care among former inmates after their release into the community.

Evidence Rating (What is this?)

Suggestive: The evidence consists of limited pre- and post-implementation comparisons of inmate deaths in custody, along with post-implementation survey data on utilization of health care services and anecdotal reports on levels of in-jail violence.
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Developing Organizations

Community Oriented Correctional Health Services
Oakland, CAend do

Date First Implemented

2006
As a precursor to Community Oriented Correctional Health Services's efforts, the care model was first implemented in Hampden County, MA, in 1996.begin pp

Patient Population

Vulnerable Populations > Prisonersend pp

Problem Addressed

Although inmates comprise a large, vulnerable patient population1 that frequently transitions between local jails and the community, few if any linkages exist between the care provided in jail and that available in the community setting after release.
  • Large, highly vulnerable patient population: More than 9 million individuals released from local city/county jails each year comprise a highly vulnerable patient population that is generally untreated or undertreated2; one survey found that more than one-third of jail inmates had a medical problem other than a cold or virus.1 Infectious diseases carried by ex-prisoners are particularly concerning. For example, newly released prisoners in Los Angeles County experience a 4 times higher rate of active tuberculosis, a 9 to 10 times higher rate of hepatitis C, and a 5 times higher rate of acquired immunodeficiency syndrome than does the typical county resident.3
  • Frequent transitions between jail and community: Jurisdictional regulations typically place a cap on the amount of time an individual can be sentenced to local jails—usually 12 months or less; in fact, more than 80 percent of prisoners spend 30 days or less in jail. Many, however, become repeat offenders, cycling in and out of jail relatively frequently.1
  • Poor access to community health care: Jails are required by law to provide health care services to detainees. Because most jails contract with a specialized for-profit provider for the provision of such services,4 there is typically little if any continuity of care after the prisoner's release. In fact, most inmates have had limited contact with community health care settings before their incarceration, and typically, little if any attempt is made to link them to community-based sources of care upon release.1 In fact, most recently released prisoners do not have medical insurance or access to stable sources of medical services.3 In other words, even though linking recently released inmates to community-based health care resources is critical to their health, their successful reentry into the community, and to public health in general,2 relatively few communities offer such linkages to prisoners and ex-prisoners today.

What They Did

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Description of the Innovative Activity

Community Oriented Correctional Health Services fosters partnerships between local jails and community health centers. Under these agreements, the jail contracts for the provision of health care services with the local community health center, which provides coordinated services at jail entry (booking), during incarceration, and upon release back into to the community. The goal is to make correctional care an extension of the existing community health care system. Recognizing that each implementation will vary with local conditions, elements of the program include the following:
  • Onsite community health center providers: Onsite providers at the jail are either employees or affiliates of the community health center.
  • Coordinated services at booking, during incarceration, and after release: The community health center takes responsibility for providing appropriate, coordinated health care services throughout incarceration and after release. Although services, service providers, and care processes vary somewhat depending upon location, they generally include the following:
    • At booking: A nurse screens the inmate for health problems when he/she enters jail. The nurse accesses the community health center's electronic medical record system to determine whether the inmate has received treatment previously, and if so, which medications and/or treatments should be continued during incarceration. The nurse documents the inmate's current chronic illnesses, medications, dietary needs, allergies, and signs of mental illness. The individual may also be tested for sexually transmitted diseases (including human immunodeficiency virus) and tuberculosis. Based on this assessment, the nurse triages the patient for either immediate or next-day evaluation by a primary care provider in cases of medical need. For example, the nurse may recommend that the individual go to the hospital emergency department before being incarcerated or that he or she be housed separately due to an infectious condition such as tuberculosis. The nurse also arranges for an appointment with a visiting community health physician or midlevel provider if necessary, or for a checkup if the inmate has not previously been seen at the community health center (thereby ensuring that the inmate becomes established with a regular, community-based provider).
    • During incarceration: The community health center operates a full-time, onsite clinic for inmates. Inmates who have health care needs that arise or that were otherwise not identified during booking may receive treatment for acute illnesses from an onsite nurse or a visiting primary care physician. If additional care is necessary (e.g., obstetric or orthopedic care), the nurse makes an appointment with specialist physicians who visit the jail periodically to treat inmates.
    • After release: Inmates leave the jail with an appointment for follow up care in the community health center (typically with the same primary care physician who provided treatment in jail) and with appropriate medications and/or prescriptions. Inmates with special health circumstances, such as substance abuse, are provided with appropriate connections to community-based care (e.g., a referral to a substance abuse program or an introduction to a substance abuse counselor).

Context of the Innovation

Community Oriented Correctional Health Services is a nonprofit organization that fosters partnerships between community health providers and local jails to ensure that inmates receive appropriate, seamless health care. The model began in Hampden County, MA, in 1996, after physicians at the Brightwood Health Clinic in Springfield noticed that chronically ill patients often missed appointments due to incarceration in the Hampden County Jail. The county sheriff's department decided to allow the clinic's medical staff to provide treatment for one chronically ill inmate; the medical staff then made a follow up appointment for the inmate so that he could continue treatment at the clinic after his release. Eventually, the sheriff's department contracted for medical services with four nonprofit neighborhood health centers in the Springfield area. The Robert Wood Johnson Foundation became aware of the program and provided funding to Community Oriented Correctional Health Services to encourage adoption of this approach nationwide. Partnerships have since been developed at two additional sites: the District of Columbia, where the department of corrections contracted in October 2006 with Unity Health Care (the District's largest Federally Qualified Health Center) to provide health care to a population of roughly 3,500 inmates, and Marion County, FL, where the sheriff's department contracted in January 2007 with Ocala Community Care (a nonprofit organization created by local health care providers) to deliver health care services to a population of approximately 2,000 inmates.

Did It Work?

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Results

Survey data and anecdotal evidence suggests that the Community Oriented Correctional Health Services approach reduced violence and deaths in the jail setting and enhanced access to care after release into the community.
  • Less violence: Anecdotal information from Marion County, FL suggests that the approach has led to a significant decline in inmate–inmate and inmate–correctional officer violence, primarily as a result of better control of psychosis via medication management.
  • Fewer deaths: In Washington, DC, the number of inmate deaths while in custody has been cut in half, largely due to a decline in suicides resulting from better mental health medication management.
  • Enhanced access to care after release: A survey of inmates conducted in Hampden County, MA, found that the approach resulted in enhanced utilization of needed services after release. (Anecdotal information from the Washington, DC, and Marion County, FL, sites also suggest that access to care increased after program implementation.)
    • Among participants with a medical condition: Among participants with a medical condition, 53 percent had an appointment to see a community-based health care provider set up before release, and 65 percent of those individuals kept the appointment. (In the absence of this program, the overwhelming majority of inmates would likely not have had access to these services.) More participants saw a health care provider—and fewer were hospitalized—in the 6 months after release than in the 6 months before incarceration. Inmates who received services in jail were more likely to see a physician following release than were those who did not receive jail-based services.
    • Among participants with a mental health condition: Among participants with a mental health condition, 36 percent had an appointment to see a community-based mental health care provider set up before release, and 70 percent of those individuals kept the appointment. (Again, in the absence of the program, the vast majority of inmates would likely not have had access to these services.)

Evidence Rating (What is this?)

Suggestive: The evidence consists of limited pre- and post-implementation comparisons of inmate deaths in custody, along with post-implementation survey data on utilization of health care services and anecdotal reports on levels of in-jail violence.

How They Did It

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Planning and Development Process

The planning and development process for a community health center interested in expanding its mission to serve jail inmates is highly individualized based on community characteristics and involves the navigation of a number of Federal and local legal issues and regulatory requirements. A manual, entitled Affiliations Between Health Centers and Local Correctional Facilities to Provide Continuity of Care for Offenders, can help community health centers and local jails develop such a partnership; it is available at http://www.cochs.org/files/cochs_manual.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software External Web Site Policy.).

Resources Used and Skills Needed

  • Staffing: Health care staffing requirements will vary by site, depending primarily on the capacity of existing community health centers to assume additional duties at the jail and the number of inmates (i.e., potential patients) housed at the jail.
  • Costs: Costs vary by program site.
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Funding Sources

Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation has provided grant funding to Community Oriented Correctional Health Services; the organization also receives programmatic support from the Jacob & Valeria Langeloth Foundation and the California Endowment.

Local governments typically fund the provision of health services to inmates, as dictated by law. Once an inmate is released, his or her health care services are covered by their usual sources of funding, such as Medicaid, a Federally Qualified Health Center, or another safety net provider.end fs

Tools and Other Resources

More information about Community Oriented Correctional Health Services is available on its Web site: http://www.cochs.org.

Affiliations Between Health Centers and Local Correctional Facilities to Provide Continuity of Care for Offenders, a manual that describes possible legal relationships between community health centers and local jails, is available at http://www.cochs.org/files/cochs_manual.pdf.

The Community Oriented Correctional Health Services Map Tool, which allows jurisdictions to identify community health centers and other community-based services, is available at http://www.cochsmaptool.org/.

A questionnaire to help interested parties determine whether the Community Oriented Correctional Health Services approach is suitable for their jurisdiction is available at http://www.cochs.org/cochs_survey.

More information about correctional health care, including standards for health services and clinical guidelines pertinent to the inmate population, is available from the National Commission on Correctional Health Care at http://www.ncchc.org.

Following the passage of the health care reform bill in 2010, Community Oriented Correctional Health Services solicited input from several academic sources on how health care reform may influence health care policies and operations in the setting of jails. The group organized a conference held in November 2010, in Washington, DC, for national and state health policy and corrections personnel to discuss the implications of health care reform on state policy, particularly as it relates to the population incarcerated in jails. The entire conference is archived on the group's Web site at http://www.cochs.org. A set of papers will be released in 2011 as the original papers are refined.

Adoption Considerations

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Getting Started with This Innovation

  • Understand population being served: Many community health centers have historically treated a population comprised largely of women and children, as well as elderly and other populations. In contrast, the inmate population is typically young, male, and non-White, with low levels of education and high levels of mental illness. This population can be difficult to treat, often requiring different communication strategies. Community health center staff must understand the special needs of this patient population before offering treatment.
  • Understand how corrections facilities work: Community health centers must learn how local corrections facilities operate and interact effectively with them to integrate health services into the existing workflow at the jail.
  • Focus on positive outcomes: Sell the program to relevant stakeholders by emphasizing the program's potential to not only provide care that inmates are legally entitled to receive, but also to ensure appropriate, seamless care for a vulnerable patient population.

Sustaining This Innovation

  • Tailor approach to local jurisdiction: The Community Oriented Correctional Health Services approach is not a one-size-fits-all program, but rather should be adapted to fit the needs and circumstances of each individual jurisdiction and its constituencies.
  • Use information technology: Connectivity is key to optimizing the success of the approach. Over time, communities should invest in information technology that provides a link between the jail and the clinic, thus allowing functionality such as the tracking of health-related data, scheduling of appointments, and the creation of medication reminders.

Spreading This Innovation

In addition to Marion County, FL, and Washington, DC, Community Oriented Correctional Health Services is currently providing technical assistance to several other sites in various jurisdictions with a myriad of interests and needs. A similar approach is now being piloted in the juvenile corrections setting; more information on these efforts is available at the Juvenile Offenders Community Health Services Web site (http://www.jochs.org).

More Information

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Contact the Innovator

Keith Barton, MD
Medical Director
Community Oriented Correctional Health Services
675 61st Street
Oakland, CA 94609
(510) 595-7360, Ext. 19
E-mail: Kbarton@cochs.org

Innovator Disclosures

Dr. Barton has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

Robert Wood Johnson Foundation. Linking re-entry planning to community-based correctional care. Issue Brief. February 2009. Available at: http://www.cochs.org/files/rwjf_090205.pdf

Robert Wood Johnson Foundation. Linking health care in jails and communities through information technology. Issue Brief. January 2010.

Robert Wood Johnson Foundation. Jails and community-based health care. Issue Brief. September 2008. Available at: http://www.cochs.org/files/rwjf_080902.pdf

Footnotes

1 Robert Wood Johnson Foundation. Jails and community-based health care. Issue Brief. September 2008. Available at: http://www.cochs.org/files/rwjf_080902.pdf
2 Robert Wood Johnson Foundation. Linking re-entry planning to community-based correctional care. Issue Brief. February 2009. Available at: http://www.cochs.org/files/rwjf_090205.pdf
3 American Public Health Association. Public health and returning offenders in Los Angeles County. Summer 2006 Newsletter. Available at: http://www.apha.org/membergroups/newsletters/sectionnewsletters/public_edu/summer06/2708.htm
4 Interview with Steven Rosenberg, September 1, 2009.
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: October 28, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: February 26, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: January 03, 2011.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.