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

Viral Load Increases Among HIV Positive Prison Recidivists, USA

1000000 Pre-release Reincarceration 100000 10000 1000 100 Recidivists

Stephenson B, Wohl D et al 13 th World AIDS Conf, Durban. 2000

Maslow- Hierarchy of Needs

MOTIVATIONAL NEEDS

SOCIAL SERVICE EMPLOYMENT

BASIC NEEDS

HOUSING FAMILY EDUCATION HEALTH

PROFILE – Typical Client

• • • • • • • • • Middle-Aged (40 and over), Male, Single Unemployed, No income 6 TH 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

Patients examined/treated Cardiac/HTN/Lipids HIV/AIDS Asthma/COPD/Pulmonary Diabetes/Endocrine Seizures Coumadin TB Population on Prescription meds Mental Health/Av Month % on Psych Meds

2007/2008

11,444 2,410 1,875 1,821 1,295 893 354 250 48 % 3,110 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

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 1,852 2009-2010

1487 – 0 time 106 – 1 X 53 – 2 X 90 – 3 X 28 – 4 X 23 – 6 X 12 – 8 X 6 – 9 X 2 – 1 11 X 18 X 1649 – 67 – 0 time 107 – 1 X 80 – 2 X 3 X 38 – 26 – 11 – 4 X 6 X 8 X 8 – 6 6 – 9 X 11 X 12 X

2,050

2 YEAR STUDY Recidivism - B

DISCHARGED INMATE PATIENTS ENROLLMENT- COUNTY HEALTH PLAN APPROVALS- COUNTY HEALTH PLAN PATIENTS/ FOLLOW-UP/HEALTH CENTERS 2007-2008 2009-2010 1852 2050 74% 75% 94.5 % 95% 70% 71% RECIDIVISM- ALL DISCHARGE PATIENTS RECIDIVISM- FOLLOW UP @ HEALTH CENTERS 19.7% 19.1% 17.9% 18.1%

HILLSBOROUGH COUNTY JAILS

POPULATION: (2007-2010) 4500 4000 3500 3000 2500 2000 1500 1000 500 0 4130

7.5 %

3800

8 %

2007 2008 3465

9 %

2009 3100

10 %

2010 Population

Recidivism - C 2 YEAR STUDY (JAN 2007- DEC 2008)

Jail Av. Daily Population Average Bookings per day Recidivism within 12 months Annual cost/inmate Annual cost/prison

2007/2008

3,500 185

37%

$28,652 $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 re entry 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]