Florida Partners in Crisis Annual Conference & Justice Institute Orlando, FL July 12, 2012 Clinical Research Challenges & Community Collaboration in Addressing.

Florida Partners in Crisis Annual Conference & Justice InstituteOrlando, FLJuly 12, 2012

Clinical Research Challenges & Community Collaboration in Addressing Jail Recidivism

Presenters: Nazim Hamid, PhD Rolando Veloso, PharmD

Continuity of Care and Community Collaboration

2007 PROGRAM

OF THE YEAR

AWARD -NCCHC

Release from Prison — A High Risk of Death for Former Inmates

Ingrid A. Binswanger, M.D., Marc F. Stern, M.D., Richard A. Deyo, M.D., Patrick J. Heagerty, Ph.D., Allen Cheadle, Ph.D., Joann G. Elmore, M.D., and Thomas D. Koepsell, M.D.

Volume 356:157-165 January 11, 2007 Number

2

Conclusions Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison.

Binswanger I et al. N Engl J Med 2007;356:157-165

Mortality Rates among Former Inmates of the Washington State Department of Corrections during the Study Follow-up (Overall) and

According to 2-Week Periods after Release from Prison

Increased Risk of Death for Parolees, USA

• Safer in prison than the streets

• Fewer homicides in prison than streets

• Higher parolee deaths: guns, car crash, HIV, drug overdose, cardiovascular

May J. In Management and Administration of Correctional Health Care; Moore J., CRI 2003

Viral Load Increases Among HIV Positive Prison Recidivists, USA

HIV

-1 R

NA

(c

op

ies

/ml)

Recidivists100

1000

10000

100000

1000000Pre-releaseReincarceration

Stephenson B, Wohl D et al 13th World AIDS Conf, Durban. 2000

Maslow- Hierarchy of Needs

MOTIVATIONAL NEEDS

HEALTH

FAMILY

HOUSING

SOCIAL SERVICE

EDUCATION

EMPLOYMENT

BASIC NEEDS

PROFILE – Typical Client

• Middle-Aged (40 and over), Male, Single• Unemployed, No income• 6TH grade literacy• Multiple prior arrests• Transient dweller (family, friends, temporary housing)• Little community or family support• Neglect health care needs• Generally, no money or valuables upon exiting jail• Circulate in an environment where basic needs are

competitive

Typical Client Health Conditions

• Chronic illness/pain• Seizures• HTN/Cardiac• Asthma/COPD• Addiction to alcohol and other

drugs• Mental illness• Infectious disease (such as

STD)

Health Status of Patients

CHRONIC CARE 2007/2008

Patients examined/treated 11,444

Cardiac/HTN/Lipids 2,410

HIV/AIDS 1,875

Asthma/COPD/Pulmonary 1,821

Diabetes/Endocrine 1,295

Seizures 893

Coumadin 354

TB 250

Population on Prescription meds

48 %

Mental Health/Av Month 3,110

% on Psych Meds 44.6

STUDY:

Discharge Planning - Services• Pre-release patients are interviewed to assess their health

and social needs.

• Health forms are filled out: Patients clinical history and enrollment in County Health Care Plan. Screening for social service assistance.

• Referrals to social service agencies for assistance; phone calls to families for re-entry assistance and assist with medical appointments for follow up services.

• Identify health centers close to patient’s residence and provide contact information.

• Referrals to agencies for assistance in housing, employment, education, community resources including DMV, SSA, etc.

Discharge Planning – Services(continued)

• Obtain release medications – Supply of 3-day meds or 7 day psychotropic meds and script for 30 day supply of medication. This is preceded by discussion with the patient.

• Provide a completed “Healthcare Passport: (Continuity Care Program) providing clinical information and instructions for medications. Includes a copy of the patient’s jail identification that they may use to prove identity for Food Stamp benefits and in securing temporary housing assistance

• Encouragement and emotional support.

• Liaise with Community Case Managers for follow up support

• Follow-up to treatment at Community Health Centers.

Recruitment – Clinical Trials Jail Re-entry Center Jail Medical Provider Public Defender , Probation Mental Health Institution Salvation Army Faith Based Institution Half Way Homes Assisted Living

2 YEAR STUDY Recidivism - A

Inmate Patients Screened

2007-2008 1,852

1487 – 0 time 106 – 1 X

53 – 2 X 90 – 3 X

28 – 4 X 23 – 6 X 12 – 8 X 6 – 9 X

2 – 11 X 1 - 18 X

2009-2010 2,050

1649 – 0 time 107 – 1 X 80 – 2 X

67 – 3 X 38 – 4 X 26 – 6 X 11 – 8 X

8 – 9 X 6 - 11 X 6 – 12 X

2 YEAR STUDY Recidivism - B

DISCHARGED INMATE PATIENTS 1852 2050

ENROLLMENT- COUNTY HEALTH PLAN 74% 75%

APPROVALS- COUNTY HEALTH PLAN 94.5 % 95%

PATIENTS/ FOLLOW-UP/HEALTH CENTERS 70% 71%

RECIDIVISM- ALL DISCHARGE PATIENTS 19.7% 19.1%

RECIDIVISM- FOLLOW UP @ HEALTH CENTERS

17.9% 18.1%

2007-2008 2009-2010

HILLSBOROUGH COUNTY JAILSPOPULATION: (2007-2010)

0

500

1000

1500

2000

2500

3000

3500

4000

4500

2007 2008 2009 2010

Population

8 %7.5 %

9 % 10 %

3100

4130

3465

3800

Recidivism - C2 YEAR STUDY (JAN 2007- DEC 2008)

2007/2008

Jail Av. Daily Population 3,500

Average Bookings per day 185

Recidivism within 12 months

37%

Annual cost/inmate $28,652

Annual cost/prison $23,871

Nationally = 66.0% of those released from prison are rearrested within 3 years

Community/Re-entry Case Management Initiatives (1)Annual Conferences:

Broward, Hillsborough, Brevard, Pensacola Counties

CASE MANAGEMENT ADVISORY BOARD OF TAMPA BAY INITIATIVES (2)

FOCUS: Re- Entry Case Management and

Education Development for Community Case Managers

Community Health Fair Initiatives (3)

Comments from Patients who Received

Discharge Planning

“ I am just amazed that this program exists and I am thrilled with the help that I am being offered. This is an excellent opportunity for me to get ‘ re-started in life’. I intend to use this chance to better my life.”

“ I really appreciated the wonderful way the County has provided Health Care Plan for people like myself who cannot afford to have one. Being a single woman, homeless, I feel I have a fresh start in living again. Now I don’t have to walk the streets again, or sell dope to buy medication.”

“ I have been in jail multiple times, selling drugs, trespassing, prostitution and larceny. I live in the streets and fend for food to survive as I have no source of income. No one would offer employment due to my chronic medical condition. The county Health Plan, access to housing and social services benefits will most definitely lead me to recovery and rejoining my lost family.”

Conclusions

• In-jail partnership collaboration eliminates many re-entry barriers - transition planning

• Reduction in jail recidivism • Access to community and social service benefits• Access to housing, employment, education assistance• Community case management• Budget deficits/cost savings• Safe community

Nazim Hamid, PhD718-810-9191

NBHAMID@AOL.COM-------------------------------------------------------------

Rolando J. Veloso, Pharm.D. CNS Principal Scientific Affairs Liaison

Janssen Scientific Affairs, L.L.C. (305) 987-8851 (mobile)

[email protected]

CONTACT: