Transcript Slide 1

Report and Recommendations



The Reentry Health Task Force originated out
of growing concerns regarding the health
status of those returning to the community
after incarceration
Pilot for the task force process for the new
Alameda County Reentry Network
Reentry Network will convene an Employment
Task Force next, followed by Housing Task
Force
Goal:
 To improve the health status of formerly
incarcerated people in Alameda County
Objective:
 Create a set of informed recommendations
which will increase access and improve the
quality of health care after release.

Planning and Inauguration (April-September) - Arnold Perkins

Key Health Topic Briefings (October and November) - Expert

agrees to chair, Identified and recruited members
briefings on prevalence of various health conditions and current
health care system to address conditions
Strategy, Policy and Program Briefings (December and
January) - Expert briefings on strategies and policies affecting
health status of formerly incarcerated


Recommendation and Report Development (February and
March) - detailed recommendations and target audiences
Continuation and Sustainability – Public Health Department
agrees to continue convening Reentry Health Task Force as
needed
 Task
Force members were selected to
represent the many diverse sectors
concerned with reentry
 Selection was made in an effort to ensure
that the final recommendations would be as
inclusive and comprehensive as possible
 This approach was successful with
attendance remaining high throughout the
process



Kevin Ary, Sergeant,
Alameda County Sheriff’s
Office
Robert Ayers, Warden,
California State PrisonSan Quentin
Mona Barra-Gibson,
District Representative,
Office of State Senator
Don Perata

Laura Bowman,
Community Partnership
Manager, California State
Prison-San Quentin


Rodney Brooks, Chief of
Staff, Alameda County
Supervisor Keith Carson
Jessica Buendia, Field
Representative, Office of
Assembly Member Loni
Hancock


Doug Butler, Director,
Men of Valor Academy
Josie Camacho, Director
Constituent Services, Office
of the Mayor of Oakland

Dean Chambers, Program
Specialist, Alameda County

Behavior Health Care
Services

Arnold Chavez, Urban Male
Health Initiative, Alameda
State Prison-San Quentin
/Federal Receivers Office

County Public Health
Department

Tony Crear, Community
Network Coordinator,
Alameda County Probation
Department

Gloria Crowell, Co-Chair of
the Allen Temple - AIDS
Ministry, Allen Temple
Baptist Church
Dennis DiBiase, Public
Health Nurse, California

Fred Degree, Chaplaincy,
Regional Congregations
and Neighborhood
Organizations
Nanette Dillard, Executive
Director, Associated
Community Action Program
(ACAP)


Mick Gardner, Measure Y
Reentry Program Manager,

Raza

Oakland Human Services
Department

Carolyn Graham,
Corrections and Reentry
Program Director,
Volunteers of America

/Federal Receivers Office
Anna Dorman, Health
Educator, La Clinica De la
Cherlita Gullem, Public
Health Nurse, California
State Prison-San Quentin
Dr. Tony Iton, Director,
Alameda County Public
Health Department
Rev. Raymond Lankford,
Executive Director, Healthy
Oakland

Rev. Jasper Lowery, Pastor,

Dorsey Nunn, Director, All
Urojas Ministries
of Us or None

Shirley Poe, District
Administrator, California
Constituent Liaison &
Organizer, Alameda County
Parole Department

Barbara Quintero,
Operations Manager,
Women on the Way

Vince Reyes, Assistant to
the Director, Alameda
County Social Services

Celsa Snead, Executive
Director, Mentoring Center
Daniel Stevens, Pastor, New

Darryl Stewart, Oakland

Life COGIC
Supervisor Nate Miley

Patricia Van Hook, Member,
Community Christian
Church

Arnold Perkins, Chair
Kenyatta Arnold, Research Assistant, Urban Strategies

Bill Heiser, Research and Program Associate, Urban






Council
Strategies Council
Dr. Garry Mendez, Executive Director, National Trust For
The Development of African American Men
Michael Shaw, Director Urban Male Health Initiative,
Alameda County Public Health Department
Dr. Lawrence Van Hook, Pastor, lead organizer, Bay Area
Action Council, RCNO
Junious Williams, CEO, Urban Strategies Council
Rev. Eugene Williams, CEO, RCNO
Topic
Name
Organization
 General Health Care- Dr. Tony Iton, Alameda County Public Health
Department
 General Health Care – Alex Briscoe, Alameda County Health Care Services
Department
 Mental Health – Dean Chambers, Alameda County Behavioral Health Care
 Substance Abuse – Lee Boone, Haight-Ashbury African American Family
Healing Center
 Substance Abuse– Ron Owens, Bay Area Service Network
 Chronic Care – Dr. Tony Iton, Alameda County Public Health Department
 Communicable Diseases – Dr. Roslyn Ryals, Alameda County Public
Health Department
 Dental Health – Dr. Jared Fine, Alameda County Public Health
Department
 Transitional Health Care – Dr. Emily Wang, Transitions Clinic, SF
 Jail Health Care – Dr. Harold Orr, Alameda County Jail, Santa Rita
 Prison Health Care – Cherlita Gullem, Federal Receiver’s Office at
California State Prison- San Quentin
 Mental Health – Dr. Sean Fruge and Dr. Alexis Green-Fruge, Fruge
Psychological Associates
1.
2.
3.
4.
5.
6.
BASIC HEALTH CARE
CHRONIC DISEASES
ORAL, VISUAL, AUDITORY CARE
COMMUNICABLE DISEASES
SUBSTANCE ABUSE
MENTAL HEALTH
BASIC HEALTH
CARE
 Preventative
care
 Yearly
physical
 Relevant
testing and
procedures
 Acute Care
CHRONIC
DISEASES
 Hypertension
 Diabetes
 Kidney
Disease
 Cancer
 Sickle Cell
Anemia
 Asthma
ORAL, VISUAL,
AUDITORY
 Oral surgery
 Oral
Diseases
 Glasses
 Hearing aid
COMMUNICABLE
DISEASES
 STDs
 HIV/AIDS
 Hepatitis B & C
 TB
SUBSTANCE ABUSE MENTAL HEALTH
 Alcoholism
 Depression
 Drug abuse
 Post-Traumatic
Stress Disorder
 Tobacco
 Schizophrenia
 Dual Diagnosis
 Bi-polar
disorder
1. Issues, Problems and Opportunities
2. Promising Strategies, Policies &
Programs
3. Interventions in Planning or
Implementation
4.Task Force Recommendations


In June 2007, more than 22,249 people were on
probation or parole in Alameda County (does not
include Federal Probation or Parole)
The parole population in Alameda County is
overwhelmingly
◦ Male (91%),
◦ Under 50 years old (97%) and
◦ People of color (84%) with African Americans
comprising 67% of the parolee population



One in every 100 Alameda County residents
are currently under criminal justice
supervision
Three in every 100 Oakland residents are
currently under criminal justice supervision
Reentry population is concentrated in West
Oakland, East Oakland and Hayward
PROBATION AND PAROLE POPULATION IN
ALAMEDA COUNTY
(JUNE 2007)
Source of Supervision
Adult Parole
Adult Probation
Federal Probation and Parole
TOTAL ADULT REENTRY POPULATION
Juvenile Probation ( Juvenile Probation Caseload)
Juvenile Parole (DJJ parolees)
TOTAL REENTRY POPULATION
[i]
Total
3,297
16,795
N/A
20,092
2,157
N/A
22,249
Parole Census Data June 30, 2007. CDCR. Retrieved on 10/17/07:
http://www.cdcr.ca.gov/Reports_Research/Offender_Information_Services_Branch/Annual/PCensus1/PCENSUS1d0706.pdf
[ii] June 2007 Monthly Statistical Report, Alameda County Probation Department. It is important to note that this number reflects all of the Adults on probation in
Alameda County, not those that are actively supervised. The number of actively supervised individuals on probation in June 2007 was 2,369.
[iii] June 2007 Monthly Statistical Report, Alameda County Probation Department



Over 1 in10 Alameda County residents does
not have medical insurance (n=166,000 )
The indigent care system provides free or low
cost services to 90,000 of the 166,000
The indigent care system is targeted to
individuals earning less than 200% of the
Federal Poverty Level ($20,800/person or
$42,400 for family of four)
Uninsured
11%
Medicaid
9%
Healthy
Families/CHIP
1%
Medicare &
Medicaid
3%
Employmentbased
61%
Source: California Health Interview
Survey
Medicare & Others
7%
Privately
purchased
7%
Other public
1%


The Urban Strategies Council and All of Us or None
surveyed 138 formerly incarcerated people within
Alameda County to determine their health status
and their access to health care
Initial Results:
◦ Formerly incarcerated utilize public insurance at
about the same level as other Alameda county
residents,
◦ Formerly Incarcerated are five times more likely to
be uninsured
Someone
Private - 2
else's
(2%)
insurance
2
(2%)
Public
Insurance
27
(20%)
Employer
provided
26
(19%)
(n=134, 4 respondents missing)
Uninsured
77
(57%)



Accurate data on the prevalence of health
conditions among the reentry population in
Alameda County was not available
To gauge demand we examined data on the
prevalence of health conditions among prison
populations from national and state research
studies and applied it to the reentry population in
Alameda County
To gauge supply we attempted to obtain data on
programs that focus services on or have
designated slots for the formerly incarcerated



Compared to the general population, formerly
incarcerated people show significantly higher rates
of communicable disease, mental illness and
chronic disease
In 1997 more than 1 in 3 people living with
tuberculosis and almost 1 in 3 of those with
Hepatitis C were released from a prison or jail that
year
In Alameda County we estimated that over 17,000
persons were in need of substance abuse services
ESTIMATED NEED AND SUPPLY OF HEALTH SERVICES
HEALTH
SERVICE
General Health
Mental Health
Substance Abuse
Communicable Disease
Hepatitis C
Hepatitis B
HIV
TB
Chronic Disease
Asthma
Diabetes
Hypertension
Oral, Auditory and
Visual
ESTIMATED
PREVALENCE AMONG
INCARCERATED
POPULATION
National
100%
17.75%
2%
1.2%
7.4%
8.5%
4.8%
18.3
State
100%
20%
85%
34%
3.5%
1.8%
County
100%
ESTIMATED SUPPLY FOR THE
NEED
FORMERLY
INCARCERATED
County
20,092
4,019
17,078
County
500
605
6,831
703
362
1,487
1,708
964
3,677
N/A
[1]
Need is estimated by applying the prevalence of the given health condition at the smallest geographic region for which we have prevalence data to the total
adult reentry population for Alameda County (20,092).
National Commission on Correctional Health Care.(2002). “The health status of soon-to-be-released inmates: A report to Congress”. Chicago: National
Commission on Correctional Health Care
[ii] Prevalence of HIV Infection, Sexually Transmitted Diseases, Hepatitis, and Risk Behaviors Among Inmates Entering Prison at the California Department of
Corrections, 1999
[i]



Accurate supply data on health care services was
difficult to determine
Compiled data on indigent care services which are
immediately accessible to the formerly incarcerated
regardless of health coverage
By every measure the indigent care system is
operating over capacity
◦ Alameda County medical center serve 103% of the patients
that they are contracted to serve
◦ The Community Based Organizations have106% of the
visits that they are contracted to provide
Table 3: Supply and Utilization of CMSP Funded
Indigent Health Care Services
HEALTH CARE ESTIMATED
UTILIZATION
NEED
NEED AMONG
FORMERLY
INCARCERATED
SUPPLY OF INDIGENT
HEALTH CARE SERVICES
FY2006-2007
Unduplicated Contracted
Patients
Patients
Visits
Contracted
Visits
Utilization by
Provider
Alameda County
Medical Center
20,092
36,084
Community Based
Organizations
20,092
28,201
[1]
35,000 112,407
N/A
This includes the Key Health Topics pertaining to General Health, Communicable Diseases, and Chronic Diseases
83,449
N/A
78,287



Database of service providers that are
available to or focus on serving the formerly
incarcerated in Alameda County
Initial focus on health related services to
coincide with the Health Task Force process
Data represents results of a phone survey to
verify services provided, formal survey is
forthcoming

Counts represent number of sites that provide
services and not the number of organizations
Table 4: Reentry Health
Resources in Alameda County
General Health
Mental Health
Substance Abuse
Dental
Vision
Reproductive Health
TOTAL
141
124
123
23
4
17
432

The “Other” category comprises 70% of all providers
and refers to organizations that provide education
and/or referrals but not direct services
Private
Facilities/Providers
Hospital
3
Clinic/community based
organizations
47
Other
125
Emergency Room
3
TOTAL
178

These providers comprise the Indigent Care system
which is currently operating above capacity
Indigent Care
Facilities/Providers
Hospital
County based providers
Community Health Centers
TOTAL
Indigent
Care
3
26
4
33



Limited focus to community or reentry,
tried not to go too far “upstream” into
CDCR
Issues and problems begin at pre-release
stage and extend through reentry
Found system of care is often fragmented and
duplicative

Lack of and/or unrealistic pre-release planning

No set release date for undetermined sentences


Pre-release planning is often conducted with
correctional staff rather than with community
based providers
Pre-release planning rarely makes direct refers
for medical services







The formerly incarcerated are not released with a
state identification
The formerly incarcerated are not enrolled
and/or screened for public benefits
Lack of medical screening prior to release
Poor medication maintenance
No issuance of medical records upon release
No routine system for reporting communicable
disease cases to the county of release
No clearly defined medical home




The transition from correctional to community based
health care is fragmented and duplicative
CDCR and the county jail admit that they lack the
infrastructure to transfer what medical records they do
have to a county/community based provider
Parole and probation have difficulty identifying the
medical needs of their wards and therefore making
appropriate referrals
Difficult to connect formerly incarcerated to providers
with appropriate cultural and linguistic competencies


Every presenter identified an aspect of reentry
health care that could be improved through
increased collaboration among relevant agencies,
organizations and departments
These relationships were identified as in need of
improvement:
◦
◦
◦
◦
◦
Corrections and Community
Among County Agencies
County and City
County/City and Community/Faith based organizations
Among Community/Faith based organizations

Corrections/Community:

County Agencies:

County and Cities:
◦ to ensure continuity of care after release,
◦ to better leverage health care dollars and
◦ to ensure that community based medical providers have access
to the medical history of their patients.
◦ To avoid duplication,
◦ Maximize resources
◦ Engage in collaborative strategic planning
◦
◦
◦
◦
policy issues,
maximize funding sources,
align law enforcement with county services
to ensure an active exchange of information concerning reentry
health care opportunities

County/City and Community/Faith Organizations :
◦ to maximize funding opportunities,
◦ to ensure referrals between services are accessible,
appropriate and complete
◦ to promote the use of promising practices.

Community/Faith Organizations and Providers:
◦ to improve professional development activities,
◦ to increase knowledge and awareness of promising practice
and possible partnerships,
◦ to avoid duplication and redundancy and
◦ to best leverage resources.

Recommendations were created
around the four themes emerged as
issues, problems or opportunities:
1.
2.
3.
4.
Continuity of Care
Payer of medical care
Service Delivery
Specific Issues
1. Primary and Secondary recommendations were
developed for each theme
2. Target audiences were identified for each
recommendation
3. Report contains information on the point in the
reentry process at which the recommendation is
targeted
4. Report identifies whether the recommendation is
focused on the short or mid term
Make continuity of care during the period leading up
to and immediately after release a reality by
ensuring that those released have :
1. physical examination,
2. medical records,
3. prescriptions and a supply of medications, and
4. a temporary medical home at the time of release
1a) Structure discharge planning collaborations
through formal agreements among agencies and
with CBOs, designated agency liaisons, and broad
community networks to allow for comprehensive
referrals
1b) Develop a specialized plans for parolees with
mental illnesses that account for their ongoing
care and are flexible enough to prevent
recidivism for mental health related incidents
2a) Pre-release plan should have a clear plan for
payment of ongoing treatment
2b) Public Health Department should work with CDCR
and Santa Rita Jail to develop an electronic “continuity
of care record” that would serve as an electronic
“health passport” for prisoners upon release
2c) Mandatory public benefit eligibility screening and
enrollment prior to release
2d) Suspend public benefits for persons incarcerated in
county jail
3a) Create or designate a multi-service clinic for the
formerly incarcerated within Alameda County and
establish it as the “medical home” for the
formerly incarcerated
3b) Create a county wide resource and referral
database
3c) When needed, make Substance Abuse and/or
mental health treatment a requirement of parole
or probation
3d) Create incentives to encourage county jails to
conduct more medical screening
4a) Make supply and demand data accessible to
better inform policy, funding and program
decisions
4b) Mandatory screening and, upon release,
reporting for all communicable diseases
4c) Mandatory transference of positive
communicable disease cases to county of release
4d) Allow for substance abuse relapse without reincarcerating
4e) Additional funding should be directed to
neighborhoods and communities over represented
by the reentry population
4f) Dedicate funding to discharge planning and
post-release follow-up


Widely distribute the report
Present the report and advocate for the
recommendations with critical audiences:
◦
◦
◦
◦
◦
◦
◦

Alameda County Board of Supervisors,
County Department Heads,
CDCR officials,
city officials within Alameda County,
groups representing the formerly incarcerated
Alameda County Reentry Network Decision Makers Committee
health service providers
Continue the collection of data and
development/implementation of recommendations
through the Public Health Department


Provide prisoners with a copy of their medical
records upon release
Mandated transfer of communicable disease
cases to relevant Public Health Department
1. Connect all recently released persons to with
Diabetes, hypertension and congestive heart
failure to the CMSP-ACE program
2.Create tools and literature that can be used
by case managers and the formerly
incarcerated to identify possible sources of
health care insurance and services
1. Community Based Service providers should
hire community health workers to conduct
outreach
2. Annual screening for communicable
diseases and mental health problems
3. Eliminate co-payment for health care during
incarceration
4. Identify culturally competent community
based health care and treatment providers
that serve the formerly incarcerated
1. Develop a set of preferred health care
providers that serve the formerly incarcerated
2. CPOs and/or medical staff need to be
trained to identify person’s in need of mental
health assessment
3. Ensure prisoners have direct access to
medical staff
1. Funding should be allocated to help service
providers pay for community health workers
2. Provide education and intervention funding for
faith & community-based organizations that are
collaborative partners
3. Provide technical assistance funding to counties
to foster collaboration w/ faith & communitybased providers
1. Ensure that additional allocations are targeted
to communities over-represented by recently
released inmates
2. Dedicate funding for discharge planning and
post-release follow-up
3. Create a multi-service clinic for the formerly
incarcerated
4. Establish a system for making supply and
demand data accessible so that program,
funding and policy decisions can be used more
efficiently
1. Funding should be allocated to help service
providers pay for community health workers
2. Provide education and intervention funding for
faith & community-based organizations that are
collaborative partners
3. Provide technical assistance funding to counties
to foster collaboration w/ faith & communitybased providers
1. Structure discharge planning collaborations
through formal agreements among agencies and
with CBOs, designated agency liaisons, and
broad community networks to allow for
comprehensive referrals
2. Develop a specialized plan for parolees with
mental illnesses
3. Establish a system for making supply and
demand data accessible
1. Develop an electronic “continuity of care record”
that would serve as an electronic “health
passport”
2. Mandatory public benefit eligibility screening
and enrollment prior to release
3. Create a county wide resource and referral
database
1. Make Substance Abuse treatment a
requirement of parole
2. Mandated transfer of communicable disease
cases to relevant Public Health department
3. Connect all recently released persons to with
Diabetes, hypertension and congestive heart
failure to the CMSP-ACE program
4. Pre-release plan should have a clear plan for
payment of ongoing treatment including the
transference of medical records
1. Identify culturally competent community based
health care and treatment providers that serve
the formerly incarcerated
2. Develop a set of preferred health care
providers that serve the formerly incarcerated
3. Create a multi-service clinic for the formerly
incarcerated
4. Make mental health care a requirement of a
person’s parole
5. Funding should be allocated to help service
providers pay for community health workers
1. Funding should be allocated to help service
providers pay for community health workers
2. Provide technical assistance funding to
counties to foster collaboration w/ faith &
community-based providers
1. Mandatory public benefit eligibility screening
and enrollment prior to release
2. Mandatory screening for all communicable
disease
3. Establish a robust and competent public
health infrastructure within CDCR
4. Ensure that additional allocations are
targeted to communities over-represented by
recently released inmates
1. Dedicate funding for discharge planning and
post-release follow-up
2. Provide prisoners with a copy of their
medical records upon release
3. Mandated transfer of communicable disease
cases to relevant Public Health department
4. Pre-release plan should have a clear plan for
payment of ongoing treatment
1. Eliminate co-payment for health care during
incarceration
2. Create a multi-service clinic for the formerly
incarcerated
3. Funding should be allocated to help service
providers pay for community health workers
4. Provide education and intervention funding for
faith & community-based organizations that are
collaborative partners
5. Provide technical assistance funding to counties
to foster collaboration w/ faith & communitybased providers
1. Structure discharge planning collaborations
through formal agreements among agencies
and with CBOs, designated agency liaisons,
and broad community networks to allow for
comprehensive referrals
2. Develop a specialized plan for parolees with
mental illnesses
3. Create a multi-service clinic for the formerly
incarcerated
1. Develop an electronic “continuity of care
record” that would serve as an electronic
“health passport”
2. Create a county wide resource and referral
database
3. Make Substance Abuse treatment a
requirement of parole
4. Establish a system for making supply and
demand data accessible so that program,
funding and policy decisions can be used
more efficiently
1. Mandatory screening for all communicable
disease
2. Allow for substance abuse relapse without
recidivating
3. Establish a robust and competent public
health infrastructure within CDCR
4. Provide prisoners with a copy of their
medical records upon release
5. Mandated transfer of communicable disease
cases to relevant Public Health department
1. Connect all recently released persons to with
Diabetes, hypertension and congestive heart
failure to the CMSP-ACE program
2. Pre-release plan should have a clear plan for
payment of ongoing treatment including the
transference of medical records
3. Develop a set of preferred health care
providers that serve the formerly incarcerated
4. Ensure prisoners have direct access to
medical staff
5. Make mental health care a requirement of a
person’s parole
1. Structure discharge planning collaborations
through formal agreements among agencies
and with CBOs, designated agency liaisons,
and broad community networks
2. Develop an electronic “continuity of care
record” that would serve as an electronic
“health passport”
3. Mandatory public benefit eligibility screening
and enrollment prior to release
4. Make Substance Abuse treatment a
requirement of parole
1. Establish a system for making supply and
demand data accessible
2. Mandatory screening for all communicable
disease
3. Allow for substance abuse relapse without
recidivating
4. Establish a robust and competent public
health infrastructure within CDCR
5. Dedicate funding for discharge planning and
post-release follow-up
6. Mandated transfer of communicable disease
cases to relevant Public Health department
1. Connect all recently released persons to with
Diabetes, hypertension and congestive heart
failure to the CMSP-ACE program
2. Pre-release plan should have a clear plan for
payment
3. Annual screening for communicable
diseases and mental health problems
4. Eliminate co-payment for health care during
incarceration
5. CPOs and/or medical staff need to be
trained to identify person’s in need of mental
health assessment
1. Ensure prisoners have direct access to
medical staff
2. Restructure CPOs and probation officers
training/professional development practices
so they stay informed of current prisoners
current medical needs
3. Provide technical assistance funding to
counties to foster collaboration w/ faith &
community-based providers
4. Create tools and literature that can be used
by case managers and the formerly
incarcerated to identify possible sources of
health care
1. Pre-release plan should have a clear plan for
payment of ongoing treatment including the
transference of medical records
2. Community Based Service providers should
hire community health workers to conduct
outreach
3. Develop a set of preferred health care
providers that serve the formerly incarcerated
4. CPOs and/or medical staff need to be
trained to identify person’s in need of mental
health assessment
1.Create tools and literature that can be used
by case managers and the formerly
incarcerated to identify possible sources of
health care
2. Create a multi-service clinic for the formerly
incarcerated
1. Structure discharge planning collaborations
through formal agreements among agencies
and with CBOs, designated agency liaisons,
and broad community networks to allow for
comprehensive referrals
2. Create a county wide resource and referral
database