Creating Partnerships and Navigating the ‘Culture of Corrections’ November 19, 2013.
Post on 18-Dec-2015
217 Views
Preview:
Transcript
Agenda
Introduction to SPNS Integrating HIV Innovative Practices (IHIP) projectSarah Cook-Raymond, Impact Marketing +
Communications
Presentations from Hannah Zellman, Philadelphia FIGHT Dr. Linda Rose Frank, PA/MidAtlantic AETC Debra D’Alessandro, PA/MidAtlantic AETC
Q & A
IHIP Jail Linkage Resources:
Lessons Learned Manual
Implementation Guide
Webinar Series HIV and Jails: A Public Health Opportunity –archive
available at careacttarget/org/ihip How to Build and Expand a Jail Linkage Program –
archive available at careacttarget/org/ihip Creating Partnerships and Navigating the “Culture
of Corrections”- November 19, 2013 at 1:30pm ET
www.careacttarget.org/ihip
Other IHIP Resources
Buprenorphine Training Manual, Curricula, and Webinars on
Implementing Buprenorphine into Primary Care Settings
Engaging Hard-to-Reach Populations Training Manual, Curricula, and Webinars on Engaging
Hard-to-Reach Populations
Oral Health Forthcoming: Training Manual and Curricula available
in December and Webinar series on Oral Health and HIV begins December 13, 2013 at 1pm ET
Enhancing Linkages was a multisite demonstration and evaluation of HIV service delivery interventions for HIV+ individuals in jail settings who are returning to their communities.
The Enhancing Linkages Initiative is sponsored by: US Department of Health and Human
Services Health Resources and Services
Administration HIV/AIDS Bureau Special Projects of National Significance
Implemented within our county jail system, the Philadelphia Prison System (PPS) Approximately 40,000 admissions per year Average daily census between 7,000 and 8,000 3% of male prisoners are living with HIV 6% of female prisoners are living with HIV
Systems level intervention to strengthen HIV continuity of care and collaboration amongst service providers, including a collaborative multi-disciplinary team approach
Establishment of a single point of contact system for referrals
Strengthened continuum of care services Utilize official visits, court advocacy, peer leadership
models, treatment education Expedited medical linkages upon release Partnership among leading AIDS Service Providers
Successfully implemented SPOC and fostered trusting relationship amongst service providers
Served 342 people over the course of the program
Linkage to care for initial appointment 73%
Retained in care after 3 visits 88% Increased visibility in the jails and reentry
community allowed for program expansion
Criminal justice system stakeholders Allows us to extend the support network of the
client by engaging, with client consent, with prison staff, parole and probation and the courts
It’s all about access! Establishing formal mechanisms for
communication Avoids confusion and misunderstandings
Education for staff Prison staff have decision making power that can
affect an individuals’ situation There are opportunities to diffuse best practices
amongst staff which will, in turn, benefit the treatment and wellbeing of the client
Jail/prison systems might ask: “What’s in it for us?"Emphasize that this is often a low or no cost to the prison/jail systemUse compelling arguments! Point out that community providers and jails share the same goals
In-reach and community follow up has the potential to reduce recidivism
Controlling the virus is not only cost saving in the community, but can also be potentially cost saving for prisons, since it might reduce urgent or emergency care needs, hospitalizations, etc
Chain of command Goals of corrections are security, control,
safety This can be challenging, but isn’t insurmountable
Often, you are a guest in the system You may have limited access to technology You have limited decision making power
Remember it’s a jail! It can be jarring to be searched, to be locked in,
and to otherwise adjust to a jail based setting if you’re accustomed to a community based setting
Experience has shown us that linkage programs are more successful with an inside-outside approach. Builds long term trust Allows for monitoring of medical care on the
inside for increased continuity upon release Increases the likelihood that someone will
present after release At it’s most basic level, this approach allows
service providers to walk with the client through their entire interaction with the criminal justice system
Relationships with jail medical staff are essential – continuity relies on communication and collaboration
Medication – corrections settings have different standards for medications upon discharge Leave with a 30 day supply Leave with the remainder of your current
meds Leave with an Rx
Insurance Prisons vs. Jails
The period of time following release is one of increased vulnerability. Best practices can include:Expedited medical appointmentsIncentives Inside-out staffing/familiar advocates One stop shopping modelsMultiple ways to contact Thorough assessment of vulnerabilities and triggers
Be flexible and open to new, innovative strategies to meet people where they’re at and support them in making their healthcare a priority.
There were variations across SPNS demonstration sites Consistent with the HRSA definition -
three medical visits in a 12 month period of time
One medical visit within 30 days of release, or within 90 days of release
Milestones in service linkage and stability in the community
Redefining “success” Developing a trusting relationship with
providers so that linkage is maintained in spite of repeated interruptions due to re-incarceration.
Employing harm reduction strategies that support individuals in active addiction to keep them in care and use creative strategies to support adherence.
Building flexibility into the program to ensure that we’re meeting participants where they’re at.
One stop shopping model/ Medical Home Model
Multidisciplinary team of jail and community providers characterized by increased communication and formalized structures
Capitalizing on the strength and power of peer leadership and mutual support
Knowing that the intersection of the parallel crises of HIV and mass imprisonment is a critical juncture – we need to work at this intersection to end the epidemic
Understanding that what people need first is safe space
Jail Linkage: Creating Partnerships and Navigating the Culture of Corrections
Dissemination of SPNS Best Practices
Linda Rose Frank, PhD, MSN, ACRN, FAANAssociate Professor of Public Health, Graduate School of Public Health
Associate Professor, Center for Translational Science Institute, School of MedicineAssociate Professor, Community and Health Systems, School of Nursing
University of PittsburghPrincipal Investigator and Executive Director
Pennsylvania/MidAtlantic AIDS Education & Training Center and Telehealth AETC Appalachian Project
HIV/AIDS
IncarcerationHomelessness
Domestic Violence
Substance Use, Mental
illness
Copyright: Linda Frank, PhD, MSN, ACRN, FAAN, University of Pittsburgh, 2005
Pennsylvania/MidAtlantic AETC Jail and Prison Intervention since 1990
Training of prison and jail administration and leadership physicians, nurses, counselors, and clergy corrections officers probation and parole personnel
Peer-based HIV education for inmates Statewide in PA
Technical assistance to prisons and jails: HIV-related policies and procedures HIV testing and prevention HIV treatment
Telemedicine consultation with prisons and jails HIV treatment Treatment of co-morbidities
On-site consultation to prisons and jails
Pennsylvania/MidAtlantic AETCPrison/Jail Related Work
APHA Jail and Prison Health Committee
State-related committees, forums on corrections
Local jail, prison committees
National and international presentations
Testimony for legislators, policy forums, etc.
Approach to Dissemination
Convene PA/MA AETC team to review materials included PA/MA AETC representatives from Philadelphia, Pittsburgh, DC, West
Virginia, Ohio, Maryland
Reviewed materials with HRSA SPNS and HRSA AETC leadership Direction Scope of work
Developed methods for dissemination which may include: Development of print and electronic pocket guide on best
practices Related slide sets for training
Posting of materials developed on AETC National Resource Center (NRC) website Regional AETC websites HRSA Target Center website
Debra D’Alessandro, MPHPublic Health Program Manager,
Health Federation of Philadelphia, Local Performance Site
Pennsylvania/MidAtlantic AETC
Pennsylvania/MidAtlantic AETCs Ongoing technical assistance with
Philadelphia Prisons: before, during & after SPNS
Since 2000, bringing onsite CME accredited lunchtime clinical updates for correctional health providers
Since 2007, convening HIV Discharge Planning Committee – Phila. Dept of Public Health (AACO), behavioral and physical health contractors, prison admin, two ASOs w/onsite case managers (ActionAIDS & Phila FIGHT)
Pennsylvania/MidAtlantic AETC activity in Phila. Prison System since 2000
Onsite training of correctional health staff, 3-6 times a year: Annual needs assessment with administration and leadership Physicians, nurses, PAs, MAs target, admin & others invited Accredited lunchtime sessions on HIV issues, co-morbidities and
other public health topics (STDs, TB, MRSA and other skin infections) When needed, training for non-medical prison audience:
TB and occupational post-exposure prophylaxis education for CO supervisors Women’s health series, taught by community NPs, for female inmates
Technical assistance: Opt-out HIV testing at intake – policy development, pilot, training Consultation regarding keep-on-person policy for HIV meds
Since 2007, bi-monthly HIV Prison Discharge Planning Meetings
Lessons Learned from Philadelphia
HIV Discharge Planning Committee Face-to-face, multi-disciplinary case discussions can speed problem solving M&M (morbidity and mortality) Reviewed cases when releasees
NOT connected to care as missed opportunities what could be different next time
Recent Example: medication upon discharge changes
Regular review of policy vs. practice can reveal need for procedure adjustments and ongoing training Opt-out testing at intake Referral to linkage staff for new or out-of-care positives
Staff turnover means work is never “once and done” Administrative and clinical staff changes can lead to confusion
and/or apathy about testing and referral
Working in the Jail: Initial Questions to Consider
What is the jail’s view of HIV in comparison to other chronic health issues?
Determine the composition of jail health professionals: how many, and what disciplines? How can you be “value added?”
How do inmates request health & social services? How can you fit into this process?
More Lessons from EnhanceLink grantees:
Relationship building takes time. Account for this
in your timeline and rollout of your program.
Know what services you hope to refer inmates to upon release, and create partnerships with those organizations.
Memoranda of Understanding are just the beginning. There needs to be follow-through.
(“MOUs are paper, not partnerships.”)
Lessons from EnhanceLink grantees, cont…
Do your homework. Know what services are in the jail and who is delivering them. How can you fill in service gaps?
Listen and learn. Organizations already in the jail know how to work in this setting without interfering with Dept. Corrections operations and protocols.
Be on everyone’s radar. To avoid “turf wars,” embrace transparency.
top related