Transcript DISCHARGE PLANNING AND RE

Florida Partners in Crisis Annual
Conference & Justice Institute
Orlando, FL
July 12, 2012
Clinical Research Challenges & Community Collaboration
in Addressing Jail Recidivism
Presenters:
Nazim Hamid, PhD
Rolando Veloso, PharmD
2007
PROGRAM
OF THE
YEAR
AWARD NCCHC
Volume 356:157-165
January 11, 2007 Number
2
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.
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.
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
Binswanger I et al. N Engl J Med 2007;356:157-165
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
HIV-1 RNA (copies/ml)
Viral Load Increases Among
HIV Positive Prison Recidivists, USA
1000000
Pre-release
Reincarceration
100000
10000
1000
100
Recidivists
Stephenson B, Wohl D et al 13th World AIDS Conf, Durban. 2000
Maslow- Hierarchy of Needs
MOTIVATIONAL NEEDS
SOCIAL
SERVICE
HOUSING
EMPLOYMENT
BASIC NEEDS
FAMILY
EDUCATION
HEALTH
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)
STUDY:
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
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
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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
1487
106
53
90
28
23
12
6
2
1
–
–
–
–
–
–
–
–
–
-
0 time
1 X
2 X
3 X
4 X
6 X
8 X
9 X
11 X
18 X
1,852
2009-2010
1649
107
80
67
38
26
11
8
6
6
–
–
–
–
–
–
–
–
–
2,050
0 time
1X
2X
3X
4X
6X
8X
9X
11 X
12 X
2 YEAR STUDY
Recidivism - B
2007-2008
DISCHARGED INMATE PATIENTS
1852
2009-2010
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%
HILLSBOROUGH COUNTY JAILS
POPULATION: (2007-2010)
4500
4000
3500
4130
3800
3465
3100
3000
2500
2000
1500
1000
Population
7.5 %
500
0
2007
8%
2008
9%
2009
10 %
2010
Recidivism - C
2 YEAR STUDY (JAN 2007- DEC 2008)
2007/2008
Jail Av. Daily Population
Average Bookings per day
3,500
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)
“ 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.”
Comments
from Patients
who Received
Discharge
Planning
Conclusions
• In-jail partnership collaboration eliminates many reentry 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
CONTACT:
Nazim Hamid, PhD
718-810-9191
[email protected]
------------------------------------------------------------Rolando J. Veloso, Pharm.D.
CNS Principal Scientific Affairs Liaison
Janssen Scientific Affairs, L.L.C.
(305) 987-8851 (mobile)
[email protected]