CDC Demonstration Project:

Dallas County Jail Re-entry Project

Klaus Kroyer MadsenVice President, Programs

From the Frontline: Public Health Institutes Complementing the Public Health System Session

National Network of Public Health Institutes Annual ConferenceNew Orleans, May 15, 2008

Photo: whatknot

Dallas County Jail (DCJ)• 7th largest detention

facility in the nation• Receives over 100,000

admissions per year • 57% of which are

released within three days

• 68% released within seven days

• At 95% capacity, DCJ holds approx. 7,000 inmates

Photo: WD502

Jail Health Services at DCJ

• Managed by the Dallas County safety net hospital (Parkland Health and Hospital System)

• Serves about half of the inmates

Photo: WD502

• Large infrastructure projects including HIT to connect JH with Parkland Hospital and Community Oriented Primary Care Clinics

Health Status of DCJ Jail Health Patients

• 35% have mental health disorders

Top Medical diagnoses:1. Hypertension2. Asthma / Chronic obstructive pulmonary disease 3. Diabetes (Insulin and non-Insulin dependent)4. Chronic pain5. Heroine / Opiate

Towards a Holistic View of Jail Health

• Visits with Jail Health administrator to identify “wicked problems” to address

• On top of Wish List: improve jail health by eliminating recidivism!

• Conversations with County Commissioners, County and City staff to map stakeholders for community engagement process

THI Project Approach

CDC/NNPHI funding

Dallas community leadership group

THI staff (connections, expertise) Activity #2: Document processes

and strategies

Activity #3: Analyze methods for feasibility in community collaboration and effectiveness

Community development lore

Activity #4: Create community development/coalition building tools

Documentation of Texas Health Institute’s process for community change

Production of a model and tools for community change that others can use

Identification of processes that were and were not effective

Identification of key processes for community collaboration

An approach for PHIs to use in order to create change and improve health in their communities

Activity #1: Implement an intervention with community leadership group to address the issue.

Inputs Activities Outputs OutcomesActivity #1: Implement an intervention with community leadership group to address the issue. Inputs Activity Outputs Outcome

Concerned Community leaders

THI Staff (connections, expertise)

Community Development lore

Identify sponsor organization

Convene leadership group

Define Issue

Collect and share supporting data with community leaders

Working coalition that is engaged and energized and able to affect change

Increased interest about the issue among the leadership group

Community plan to address identified issues in the Dallas community

Collaboration of stakeholders that initiates implementation of the community plan

Community Meetings

• First Community Meeting– 75 community members (service providers, non-

profits and some former inmates) indentified 10 community priorities

Community Meetings

• Second Community Meeting– 30 former inmates and family members validated

and narrowed community priorities

Community Meetings

• Third Meeting– 45 community members (providers and inmate

organizations) developed task force structure to address the objective of reducing recidivism

• Employment• Housing• Continuity of Care• Mental Health / Substance Abuse

– Created steering committee for implementation and sustainability

Leadership Represented on SC

• Parkland Health and Hospital System• Dallas County

– Commissioners Court– Public Health – Sheriff’s Department

• Dallas Independent School District• Dallas Leadership Foundation• Dallas Police Department• Operation Oasis• Vision Regeneration

Outcomes

• THI helped Parkland Jail Health connect with governmental and non-governmental partners

• Established strong connections between consumer and family organizations and the provider system

• Created powerful action-oriented steering committee and task force structure for implementation and sustainability

• Continued strong support of the project sponsor

Project Impact to Date• Access to DCJ for HIV/AIDS advocacy NGO• Social worker hired to provide HIV/AIDS counseling• Voluntary HIV screenings by Public Health Dept. at

the Jail Health intake• Social worker hired to support pregnant inmates and

their families• Parkland Health Plan card to inmates upon release to

provide medical home and access to Rx• Release of homeless inmates to new public-private

partnership homeless center• Referral of inmates from drug rehabilitation center

to Community Oriented Primary Care Clinics

!

Next Steps

• Task forces to present implementation recommendations to Steering Committee

• Establishment of new identity for the initiative

• Presentation of project ideas to public sector and philanthropic funding partners

Photo: whatknot

Our Mission: To provide leadership to improve the health of Texans and their communities through education, research, and health policy development.

Klaus Krøyer MadsenTHI Vice President, Programskmadsen@texashealthinstitute.org512-279-3905

Contact Us: www.texashealthinstiute.org / 512-279-3910 8501 N. MoPac Expressway, Suite 420 / Austin, Texas 78759