Creating Partnerships and Navigating the ‘Culture of Corrections’November 19, 2013

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

Hannah Zellman, MSW Director, Philadelphia FIGHT’s Institute for Community Justice

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

pamaaetc.org

21

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.

Questions?

Q&A

Twitter: @impactmc1| Facebook: ImpactMarCom |www.impactmc.net | 202-588-0300

Connect with UsSarah Cook-Raymond, Managing Director |Impact Marketing +

Communications |

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