Addressing the Unique Needs of Patients Returning Home from Prison and Jail

1. Session # C6b, Period 6 October 17, 2015 Addressing the Unique Needs of Patients Returning Home from Prison and Jail Aaron Fox, MD, MS, Assistant Professor of Medicine Albert Einstein College of Medicine/Montefiore Medical Center; Attending Physician, Comprehensive Health Care Center Beth Hribar, MPP, Program Director Institute of Advanced Medicine of the Mount Sinai Health System Martha A. Sparks, PhD, Associate Director Mental Health Services, Spencer Cox Center for Health, Institute of Advanced Medicine of the Mount Sinai Health System Collaborative Family Healthcare Association 17th Annual Conference October 15-17, 2015 Portland, Oregon U.S.A.

2. Faculty Disclosure The presenters of this session • have NOT had any relevant financial relationships during the past 12 months.

3. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • Describe how the high rate of incarceration in the United States affects the health of returning citizens and communities of color. • List barriers to care and care engagement for returning citizens in traditional models of healthcare delivery and changes that can be made at the clinic level to address these barriers. • Describe features of culturally sensitive healthcare for individuals returning home. • Identify at least one benefit of having a formerly incarcerated individual as a member of the care team.

4. Selected References Binswagner, I.A. et. Al. (2011). "From the prison door right to the sidewalk, everything went downhill," a qualitative study of the health experiences of recently released inmates. International Journal of Law and Psychiatry, 34(4). Carson, E. A. (2014). Prisoners in 2013. Bulletin from the United States Department of Justice. Retrieved from: http://www.bjs.gov/content/pub/pdf/p13.pdf Cloud, D. (2014). On life support: Public health in the age of mass incarceration. Vera Institute of Justice. Retrieved from http://www.vera.org/pubs/public-health-mass-incarceration Drucker, E. (2011). A plague of prisons: The epidemiology of mass incarceration in America. The New Press: New York. Glaze, L. E., and Kaeble, D. (2014). Correctional populations in the United States, 2013. Bureau of Justice Statistics. Retrieved from: http://www.bjs.gov/index.cfm?ty=pbdetail&iid=5177

5. Learning Assessment • A learning assessment is required for CE credit. • A question and answer period will be conducted at the end of this presentation.

6. Outline • Background: serving the formerly incarcerated matters • Barriers post-incarceration • The Transitions Clinic model • Bronx Transitions Clinic • Coming Home Program

7. Prisons are overflowing http://america.aljazeera.com/articles/2013/12/12/calif-judgesextend-deadlineforinmatereduction.html

8. Chronic Health Conditions Overrepresented Among Inmates CASA Behind Bars; Wilper AJPH 2009

9. Incarceration history in primary care Shah JHCPU 2009

10. Medical care post-incarceration www.imdb.com

11. Reentry and mortality Deaths per 100,000 person-years By weeks after release * 12x increased risk of death Binswanger. NEJM. 2007

12. Barriers to medical care post-release Van OlphenJ Urban Health 2006; Binswanger Int J Law & Psychiatry 2011; Richie Crime & Deliquency2001

13. Transitions Clinic Models Hong et al. 2011

14. Community Heath Workers http://transitionsclinic.org/whychws/

15. Overcoming barriers to care

16. Bronx Transitions Clinic

17. Overcoming barriers to care

19. Provider Training Curriculum http://training.transitionsclinic.org/training/modules/

20. Acknowledgments • Richard Medina, Osborne Association, Bronx Transitions Clinic patients • The Coming Home Team: Mary Johnson, Kimalee Garner, Iris Bowen, Monique Carter, Donna Hylton • Victoria Sharp, MD, Former Director of the Spencer Cox Center for Health