Transcript 136th American Public Heatlh Association (APHA) Annual

136th APHA Annual Meeting
San Diego, CA
Session 5196.0
Invisible Bars:
Barriers to Women’s Health During and After
Incarceration
V. Diane Woods, Dr.P.H., M.S.N., R.N.
Assistant Research Psychologist
University of California Riverside, California
President & CEO, African American Health Institute of San Bernardino
Kim Carter
Founder & Executive Director, Time for Change Foundation
October 29, 2008 @ 12:30pm
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Project Funded in Part
by:
Time for Change Foundation
California Endowment
County of San Bernardino
SBC Department of Public Health
Presentation Sponsored
by:
African American Health Institute of
San Bernardino County 2
Purpose of Presentation

To identify five barriers women face in
accessing health resources during and
after incarceration

To understand the complexity of women
accessing healthcare services while
detained in prison and upon release

To identify three policy change
recommendations for State Correctional
Systems that have the potential to improve
health outcomes of women
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WOMEN IN PRISON
From 1973 to 2007,
women in prisons
increased by 645% --almost twice rate of men
Source: The Sentencing Project, Institute on Women and
Criminal Justice (Mauer 2007)
The November Coalition
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Who are these women in prison?
Women …
•
85% convicted of drug or drug-related
offenses
• 90% fragmented in their family histories
• 70% from families with other members in
the
Criminal Justice (CJ) System
• 80% survivors of physical and/or sexual
abuse
• overrepresented by women of color
• 70% poor, undereducated, unskilled,
single mothers
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Whose Mother, Daughter or Sister?
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CASE STUDY:
San Bernardino County, CA
2006 Population Estimate, 1.99 million
Percent by Ethnicity
American Indian/Alaska
Native, 1.4%
Asian, 5.6%
Pacific Islanders, 0.4%
Black, 9.5%
Latino, 44.8%
White, 38.4%
City of San Bernardino
largest populated area=
approx 200,000
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Source: San Bernardino County Quick Facts, U.S. Census Bureau, 2007 available at http://quickfacts.census.gov
U.S. Federal Court
Seizes State Prison Healthcare

In 2005, the California prison healthcare
system seized by the federal government

One inmate/per week dying from medical
neglect

Judge cites preventable deaths of inmates depravity of system
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U.S. Federal Court
Seizes State Prison Healthcare
2008 Status Report:
• Fired incompetent unlicensed
doctors
• Demand $8 billion dollars from
State Treasury
• Increased salaries for qualified
medical staff
• Little done to improve delivery
systems
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Research Questions




What are the barriers women face
while incarcerated?
What are the barriers women face
after incarceration?
What are healthcare needs of women
during incarceration?
What are the risks to the public’s
health?
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Methods

Mixed-Methods Approach (Qualitative &
Quantitative)

Current & Formerly Incarcerated Women

Location: San Bernardino County, CA

Study conducted in 2005
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Quantitative Data

Literature Review of Best Practices

GIS Mapping to Identify Resources
(housing, healthcare, dental, etc.)

Survey Development for Population
Sampling
• Target: formerly incarcerated women (convenience sample)
• Key informants, n=5
• Survey pilot testing, n=8
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Survey Design

Paper survey:
• 6 pages
• 43 questions
• dichotomous (i.e., yes/no) and multiple choice
responses

Face-to-Face Self-administration
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Quantitative Data Sampling

Multi-faceted sampling sites, n=17
•California Institution for Women
(CIW)
•New House
•Cedar House
•Gibson House
•Vista Recovery Center
•California Rehabilitation Center (CRC)
•State of California Parole Department
•12-step Anonymous Meetings, n=10
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Data Collection

Total Survey Sample, N=152

Survey Sampling Selection Criteria:
1.
2.
3.
4.

Could be on parole or probation
Experienced recidivism
18 years old and older
Resident of San Bernardino County
Interviews: March - April 2005
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Data Analysis


SPSS Version 11.5
Database: 95 variables and 152
respondents

Data mining

Descriptive analysis conducted
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Post Incarceration
RESULTS

Lack of Employment

Lack of Health Insurance

Mental Health Disorders

Prevalence of Drug & Sexual Abuse
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Lack of Employment
Response Category
Yes
No
No Response
Total
Number of
Percent of
Respondents Respondents (%)
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13.2
124
81.6
8
5.3
152
100.0
Lack of Health Insurance
20
Mental Health Disorders
% of Respondents
60
50
40
30
20
10
0
Depression
Bi-Polar
Schizophrenia
Other
None
Substance Abuse
Do you have a history of drug abuse?
No
15.1%
Response Category
Yes
No
No Response
Total
No Response
1.3%
Yes
83.6%
Number of
Respondents
127
23
2
Percent of
Respondents (%)
83.6
15.1
1.3
152
100.0
Sexual Abuse
Have you had any
counseling for that abuse?
Report of Sexual & Physical
Abuse
70
60
70
Yes
50
40
60
50
No
40
30
30
20
20
10
0
% of
Respondents
Yes
No
Response
10
No
No
Response
0
% of
Respondents
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SUMMARY of RESULTS

Incarcerated women don’t have access to
competent healthcare services in prison

Previously incarcerated women do not have
access to preventative healthcare


Public Health – defined as ensuring conditions
exist in which people can live healthy is locked
out of the prison system
Having a Felony conviction….equates into
disenfranchisement of many health and social
services.
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Four Critical Interrelated Issues
Substance Abuse
 Mental Health
 Physical Health
 Trauma

Similar findings by Covington, Bloom & Owens, 2006
(NIH – Gender- Responsive Strategies )
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Discussion




Greater Public Health
Risks
More women entering
community unhealthy
More women suffering
from mental health issues
left untreated
Reduced chances of
successful reintegration
into society.
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RESULTS

In Prison
Did not Receive
treatment for substance
abuse

Re-Traumatized by
guards and environment


Not given appropriate
counseling and mental
health services
Suffering from multiple
health conditions

After Prison
Gap in services
available for substance
abuse treatment

Lack of appropriate
programs available

Unstable living
arrangements

Ineligible for most
government funded
support services
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What are the Barriers to Accessing
Healthcare Services
In Prison





The institution charges a $5.00 co-pay
There are not enough slots for all the women who need
substance abuse treatment
Inmates are dying from preventable illnesses on average
one per week which heightens fear amongst inmates
Healthcare system ineffectively dealing with
Those diagnosed with mental illness are mandated to
take medications but do have mental health treatment
to include counseling, information on side-effects of
medications and managing their stressors
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What are the Barriers to Accessing
Healthcare Services
After Prison






Lack of Health Insurance – many responded
that the County –(MIA) Medical Indigent
Adult insurance should be called (MIA)
Missing In Action because the 3 to 4 month
waiting periods for services and between
referrals
No access to preventative care
Emergency Room dependency
Non-existent dental services for the indigent
Drug felony status excludes many from
accessing food status and other welfare
services
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Loss sense of entitlement amongst this group
Policy Recommendation
Dept. of Corrections



Remove the $5.00 copay for the indigent
Inmates should be
classified into
appropriate
rehabilitative services
All inmates should
receive an annual pap
smear and those above
40 should include a
mammogram
State of California


Create a continuum of
health care services
coordinated for former
prisoners
Modify the 2006 TANF
welfare reform which
prohibits drug
offenders from
receiving food stamps,
welfare and public
housing
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Public Health Risk Factors
Women re-entering the community without
having received healthcare during incarceration
are more likely to:





Carry STD’s that have been undetected
Be released without their psychotropic
medications in hand
Suffer from Post Incarceration Syndrome
Return to abusing drugs and alcohol
Re-Enter Society as Homeless
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Recognition Received as a result of
being inspired by Public Health

2004 - NAACP – Community
Pioneer Award for Social Justice

2005 - KCET/Washington Mutual
– Unsung Hero Award

2005 – County of San
Bernardino – Herstory Award






2005 – Soroptimist
International – “Woman Making
a Difference Award”
2006 – League of Women Voters
– Citizens Achievement Award
2006 – Bank of America –
Local Hero Award
2007 – Black Culture Foundation
– Black Rose Award
2008- Loma Linda University
Children’s Hospital Foundation’s
– Hometown Hero Award
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
Free Copy of the report titled:
“Invisible Bars- Barriers to Women’s
Health and Well-Being During and
After Incarceration”
Carter, Ojukwu & Miller, 2006

Available on line at www.Timeforchange.us
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