Addressing Health Disparities Among Incarcerated and Recently Incarcerated

Populations

March 24, 2015

Webinar Presenters

Harold Phillips, MRP, Director, Division of Training and Capacity Development at HRSA/HAB

Adan Cajina, MS, Chief, Special Projects of National Significance Branch at HRSA/HAB

Melinda Tinsley, MA, Public Health Analyst, Special Projects of National Significance Branch at HRSA/HAB

Sarah Cook-Raymond, MA, Managing Director, Impact Marketing + Communications on the Integrating HIV Innovative Practices (IHIP) Project

Alison O. Jordan, LCSW, Executive Director, Transitional Health Care Coordination, NYC DOHMH/Correctional Health Services

Learning Objectives Better understand mission of Division of Training and

Capacity Development and SPNS’ role in addressing health disparities

Improved understanding of intersection of HIV, mental health, substance abuse, and other health disparities among incarcerated/recently incarcerated populations

Public health opportunity available within jail setting for addressing HIV-positive high-need individuals

How jail linkage work advances the HIV Care Continuum

Major steps to establishing or expanding a jail linkage program

About the SPNS EnhanceLink jail linkage program, key findings, and case study

Special Projects of National Significance Projects

Harold Phillips, MRPDirector, Division of Training and Capacity Development

Adan Cajina, MSChief, Special Projects of National Significance Branch

Department of Health and Human ServicesHealth Resources and Services Administration

HIV/AIDS Bureau

Overview Division of Training and Capacity Development

• Mission: Strengthen and transform health care systems by supporting the development of leadership, evaluation, training and capacity development to assure the provision of high quality HIV/AIDS prevention, care and treatment services.

5

Division of Training and Capacity Development (DTCD)

Administrative

Support Bukeeia Goodson

Budget ManagementTerri Newman

Chief Medical OfficerPhilippe Chiliade/Rupali Doshi

SPNS Program (Part-F)

• The SPNS Program supports the development of innovative models of HIV care to quickly respond to the emerging needs of clients served by the Ryan

White HIV/AIDS Program. • Evaluation• Dissemination• Replication• Build and Improve IT capacity  

SPNS History

• Incorporated as Part F into the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in 1996 along with the AIDS Education and Training Centers (AETCs) and the Dental Partnership Program

• Program began with some of the first federal grants to target adolescents and women living with HIV

SPNS Direction

SPNS has been tasked to respond to the emerging HIV primary care needs of individuals receiving assistance under the RWHAP

SPNS initiatives have evolved to reflect:•changes in the epidemic•changes in the health care environment•alignment with HIV national policy strategies

•Focus on Sustainability, dissemination and replication

The National HIV/AIDS Strategy

• Vision statement calls for every person to have unfettered access to high-quality care

• National HIV/AIDS Strategy (NHAS) 2015 targets:– Reduce new HIV infections– Increase access to care and improve health

outcomes– Reduce HIV-related health disparities

The HIV Care Continuum

Source: CDC. HIV surveillance—United States, 1981–2008. MMWR 2011;60:689–93.

Overview of SPNS Initiatives

Current SPNS Initiatives

• System Level Workforce Capacity Building for Integrating HIV Primary Care in Community Health Care Settings (2014 – 2018)

• Health Information Technology Capacity Building for Monitoring and Improving Health Outcomes along the HIV Care Continuum Initiative (2014 – 2017)

• Culturally Appropriate Interventions of Outreach, Access and Retention among Latino(a) Populations (2013 – 2018)

• Enhancing Access to and Retention in Quality HIV Primary Care for Transgender Women of Color (2012 – 2017)

Current SPNS Initiatives(continued)

•Systems Linkages and Access to Care for Populations at High Risk of HIV Infection Initiative (2011 – 2016)

•Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations (2012 – 2017)

•Secretary’s Minority AIDS Initiative Fund (SMAIF) Replication of a Public Health Information Exchange to Support Engagement in HIV Care (2012 – 2015)

Recently Ended SPNS Initiatives

• Enhancing Access to and Retention in Quality HIV/AIDS Care for Women of Color (2009 – 2014)

• Hepatitis C Treatment Expansion (2010 – 2014)

• Secretary’s Minority AIDS Initiative Fund (SMAIF) Retention and Re-Engagement Project (2011 – 2014)

• Enhancing Linkages to HIV Primary Care and Services in Jail Settings (2007 – 2012)

Upcoming SPNS Initiatives

• Use of Social Media to Improve Engagement, Retention, and Health Outcomes along the HIV Care Continuum (2015 – 2019)

• Dissemination of Evidence-Informed Interventions to Improve Health Outcomes along the HIV Care Continuum – Dissemination and Evaluation Center (2015 – 2020)

• Dissemination of Evidence-Informed Interventions to Improve Health Outcomes along the HIV Care Continuum – Implementation and Technical Assistance Center (2015 – 2020)

• Secretary’s Minority AIDS Initiative Fund (SMAIF) Addressing HIV and Housing through Data Integration to Improve Health Outcomes along the HIV Care Continuum

Overview of EnhanceLink Initiative

Enhancing Linkages to HIV Primary Care

and Services in Jail Settings(2007 – 2012)

• Design, implement, and evaluate innovative methods for linking people living with HIV/AIDS who are in jail or recently released with HIV primary care and ancillary services

• 10 demonstration sites at 20 separate jails

• One technical assistance/evaluation center

• $21.7 million over 5 years

Enhancing Linkages to HIV Primary Care

and Services in Jail Settings (2007 – 2012)

Enhancing Linkages to HIV Primary Care

and Services in Jail Settings (2007 – 2012)

Main Findings• 65% of study participants identified as Black

• Black participants were more likely to have had advanced HIV

• Jails as strategic venues to reach HIV+ Black MSM

• 22% of HIV+ Black male study participants were MSM

• HIV testing and linkage interventions are needed within jails to reach Black MSM and to address racial disparities

Enhancing Linkages to HIV Primary Care

and Services in Jail Settings (2007 – 2012)

Main Findings• 59% of Black MSM are not aware of their

HIV infection. CDC MMWR 2010; 59(37):1201-7.

• Young Black MSM constitute a segment of the population. Prejean J, Song R, Hernandez A, et al. Estimated HIV Incidence in the United States.

• SPNS’ study highlight the potential of expanded jail testing and linkage may reach ~11% of this underserved population.

Enhancing Linkages to HIV Primary Care and Services in Jail Settings (2007 – 2012)

Main Findings

• Efforts to ensure care following release from jail are associated with a high degree of viral suppression.

• Linkage to care with an HIV provider within 30 days of release is an excellent measure of success.

• People who participated in case management were more likely to follow up on care referrals

• Coordinating social services was associated with retention in care

Further Information

List of SPNS Initiativeshttp://hab.hrsa.gov/abouthab/partfspns.html

Target Center www.careacttarget.org/category/topics/spns

SPNS Productshttp://hab.hrsa.gov/abouthab/special/spnsproducts.html

Contact Information

Harold Phillips

Director, Division of Training and Capacity Development HPhillips@hrsa.gov

Adan CajinaChief, Special Projects of National Significance Branch

ACajina@hrsa.gov

Melinda TinsleyPublic Health Analyst, Special Projects of National Significance

BranchMTinsley1@hrsa.gov

www.hab.hrsa.gov/abouthab/partfspns.html301-443-7036

Presented by Sarah Cook-Raymond, Managing Director of

www.impactmarketing.com

Introducing IHIP

SPNS launched the “Integrating HIV Innovative Practices” (IHIP) Project

IHIP takes innovative findings from SPNS Initiatives and assists health providers in replicating proven models of care

SPNS project findings are synthesized into IHIP instructional training manuals, curricula, pocket guides, and webinar series

The result? Improved care delivery and healthier patients

IHIP on HAB Website: You can navigate straight to SPNS IHIP products from the HAB site or head directly to the TARGET Center site

HAB Homepage

Products from SPNSInitiatives

IHIP Resources: Enhancing Linkages to HIV Primary Care in the Jails Setting

POCKET GUIDETRAINING MANUAL

Includes lessons learned and step-by-step recommendations on how to implement a new jail linkage program and how to expand a current one.

Testimonial: “The curriculum and training guide are everything that we've always wanted in terms of trying to explain, not only to our family and loved ones but to our clients and bosses, what exactly it is that we do and why we do it. And I can't be more thrilled with the product and the way that this will be so useful to us and to others in the field. I'm really excited about it.”

— Alison O. Jordan, Executive Director at NYC Dept. of Health and Mental Hygiene, Correctional Health

Services/Transitional Health Care Coordination, Riker’s Island, N.Y.

Incarceration Overview

While the terms “jails” and “prisons” are often used interchangeably, they represent different kinds of correctional facilities

Approximately 85% of incarcerated people were solely in jails.

Studying a Jail Intervention

Given the number of people living with HIV passing through jail facilities and the need to reach them, SPNS funded the “Enhancing Linkages to HIV Primary Care & Services in Jail Settings Initiative,” otherwise known as EnhanceLink

EnhanceLink filled an important research void

Why Jails?

Jails concentrate marginalized individuals with range of social and health problems in one place

Many individuals in jail have had fragmented health care services due to co-occurring health conditions and issues that interfere with access (e.g. substance abuse, mental illness) Structural inequalities such as poverty and unstable

housing also contribute

Behaviors that often place individuals at risk for incarceration also place them at risk for STIs, including HIV

Aligns with Federal Priorities

CDC strongly recommends jail-based HIV testing

Routine HIV screening in jails is consistent with NHAC

Jail linkage helps to move individuals along the HIV Care Continuum

Health Disparities among Incarcerated Persons

Higher rates of HIV, viral hepatitis, TB, mental illness, substance abuse

Also more likely to have histories of physical, sexual, and emotional abuse

Jails represent a chance to test, diagnose, and treat high-risk populations and offer an opportunity for marginalized people to interact with the health care system

EnhanceLink

Individuals in jails often return to the same communities in which they came

EnhanceLink showed that while jail stays can be brief and there can be some uncertainty around discharge dates, engagement, testing, and linkage coordination are all feasible within this setting

A successful jail intervention can decrease expensive ER visits, decrease HIV transmission, reduce recidivism, and improve quality of life

EnhanceLink Patients

EnhanceLink engaged very high-needs patients 90% knew their HIV status for at least 2 years yet 81% had

never taken ART 66% of participants had uncontrolled viremia (viral load >

400 copies/ml) Of those previously prescribed ART, only 55% were on HIV

medication on the 7 days leading up to incarceration Only a few participants had a formal mental health

diagnosis yet 54% had an Addiction Severity Index (ASI) mental health score of

.22 or greater (indicative of severe psychiatric illness) Nearly all participants had histories of substance use with

59% with ASI drug scores of at least .16 (representing severe drug addition)

EnhanceLink Program Steps

Major EnhanceLink components included: HIV testing or inmate self disclosure, and mental

health/substance abuse screenings Recruitment (including informed consent) and

enrollment into the program Pre-release intensive case management

intervention (typically within 24 hours or at least within first 48 hours) and individualized discharge plans

Medical care and HIV education, including risk reduction

Post-release intensive case management linkages

EnhanceLink Effectiveness EnhanceLink was found to be cost effective

from a societal perspective Having case manager work closely with jail

medical staff also helped reduce costs incurred by the jail, creating increased motivation and justification for a partnership

Given short stays of jails, EnhanceLink participants did not identify a substantial increase in pharmacy costs

Coordinated medical records enabled community and jail medical staff to avoid duplicating test and lab work that was already on file

Tips for Establishing a Jail Linkage Program Before getting started, examine the existing programs

and organizations operating with the jail Consider how you may partner with these organizations

Recognize the different priorities of medical clinics versus jails: one prioritizes health and the other safety. To work effectively in the jail you need to abide by their “home turf” rules

Identify the benefit you’re providing to the jail and to jail personnel

To secure buy-in, target high-level decision makers and do so early so they feel their opinion is valuable It’s important to identify a champion within the jail early on

Tips (cont.)

Really think through the logistics of what your program will look like within the jail setting constraints and how you’ll adapt

Outline expectations early on and often

Hire people who understand the correctional culture and really want to be doing this work.

Don’t underestimate the importance of a smile and a thank you—both with jail staff and inmates

If Already in the Jail

Nurture partnerships and facilitate ongoing communication

Consider how you’re assessing patient needs If there are needs you can’t address, look to partners (e.g. court

advocacy)

Create discharge plans, starting with inmates’ basic needs and working to address their priorities as well as your own

Linkages to care aren’t automatic. They need to be active linkages with warm handoffs.

Recognize that home visits in the community to followup with individuals not linked immediately after release will be necessary with some people.

Contact Information

Sarah Cook-Raymond, Managing Director

Impact Marketing + Communications

scook@impactmarketing.com

202-588-0300

www.impactmarketing.com

Linkages and Care Engagement: Linkages and Care Engagement: From NYC Jail to Community ProviderFrom NYC Jail to Community Provider

Alison O. Jordan LCSWExecutive Director, Transitional Health Care

Coordination NYC DOHMH / Correctional Health Services Rikers Island, NY

AIDS Education and Training Center / National Resource CenterHealth Disparities Collaborative

March 24, 2015

RIKERS ISLAND

Manhattan Detention Center

Brooklyn Brooklyn Detention Detention

CenterCenter

Vernon C. Bain Center, Bronx

Transitional Health Care Coordination

At A Glance

Facilities12 jails: 9 on Rikers Island (1 female facility, 1 adolescent facility), 3 borough houses, public hospital inpatient unit

Average Daily Population 11,827

Annual Admissions 81,758Community Releases 60,000 / year

Length of Stay mean=53 days; median~8d

Electronic Health Record (adopted 2008-2011)

eClinicalworks, customized for jail setting; care mgt templates; unidirectional interface with NYC DOC Inmate Information System

Correctional Health Services (CHS)

Sources: NYC Department of Corrections Mayoral Report – 2013 http://www.nyc.gov/html/doc/downloads/pdf/MMR-FY2013.pdfAnnual releases from NYC DOC Report of Discharges by zip code for CFY’14

CHS BackgroundNYC Department of Health and Mental Hygiene oversees health care

of inmates in all NYC jails

• Goals: Improve the health of incarcerated individuals and community health.

• Correctional Health Services oversees medical care in the jails with over 78,000 medical visits monthly

• Medicaid prescreening: 6k; Medicaid applications: 1,400

• Discharge Planning – Population-based for mentally ill (13k); HIV-infected (2.5k); others at high risk (1.5k)

• All jails use electronic health record

Twin Epidemics: Mass Incarceration & HIV

Correctional Health is Public Health

Over 70% of people released to the

community after incarceration

return to the areas of greatest

socioeconomic and health disparities

Jail DemographicsAge ALL HIV

Range 16 - 84 16 - 68

Mean 34 45

Break down

16<21 (13.4%) 16<21 (1.3%)

21<31 (32.8%) 21<31 (10.1%)

31<41 (21.6%) 31<41 (18.6%)

41<51 (21.8%) 41<51 (44.3%)

51+ (10.2%) 51+ (25.4%)

Race ALL HIV

Non-Hispanic Black (%)

54.0% 61.0%

Hispanic (%) 33.0% 30.0%

Non-Hispanic White (%)

8.7% 7.0%

Gender ALL HIV

Male (%) 89.0% 78.3%

*2011 Correctional Health Services new admission records (N=61,853)

• Substance abuse: >50%

• Mental Illness: 30%

• Hepatitis C: 8%

• HIV: 5%

• Diabetes: 5%

• Tuberculosis: 5%

• Other Sexually Transmitted Infections: 6%

Prevalence by Diagnosis

• Short-term stays are norm• ~25% leave in 2-3 days• ~50% leave within 7 days

• Limited time to diagnose• Multiple providers • Limited time to treat,

maintain care

• Paper records

• Post-release tracking

• Intake History and PE• universal voluntary < 24 hrs• ongoing offer thereafter

• Screen on admission• Single oversight• Discharge plan asap

• engage in housing areas• transport / accompaniment

• Electronic Health Records• Health Information Exchange

Barriers Solutions

System Challenges

Removing barriers

• Smile• Listen first

– then ask Key Questions

• Begin where you can• Set realistic goals• Build trust

– Start with winnable battles

– Deliver• Give more than you receive

• Chain of Command– Identify Champions

• Shared benefits (reduced violence, improved security)

• Prisons v. jails• Acknowledge extra work• Be a familiar face

• Learn who to approach for: jail access, security training & space to interview clients

Establish & Maintain Relationships

HIV Continuum of Care Model

Transitional Care Services

• Identify population – use electronic health records• Engage client – access to housing areas• Conduct assessment – universal tool• Screen for Benefits – DSS is a partner• Arrange discharge medications – 7 days + Rx• Coordinate post-release plan – Primary care, social

service orgs, Courts, attorneys, treatment providers• Facilitate continuity of care

• Aftercare letters / transfer medical information using HIE• Make appointments / walk-in arrangements• Arrange transportation / accompaniment

Health Dept.

Courts

Probation

Community Health Workers

Corrections

Funders

Parole

Staff

Critical Skills

Health providers

Health Insurers

Hospitals

• HRSA Special Projects of National Significance HRSA Special Projects of National Significance Enhancing Linkages Demonstration ProjectEnhancing Linkages Demonstration Project

– Ten site demonstration and evaluation of HIV service delivery in jail settings to develop innovative methods for providing care and treatment to HIV infected individuals in jail settings.

• Largest study of those released from jails to date

– NYC enrolled 40% of 1,021 released to the community and followed by case managers. (Booker, 2013)

SPNS Jail Linkages Initiative

Ten Demonstration Sites(2007-2012)

Facilitate linkage to primary care for HIV patients leaving local jails:• Identify HIV patients in custody• Initiate transitional services in jail• Facilitate post-release linkage to

primary care and community services.

SPNS Jail Linkages Initiative*

*Background slide courtesy of Anne Spauding, Emory Univ.

Creating a Jail Linkages Program

Client Level: – Begin Where the Client is; harm reduction model.– Plan for both options: Stay or Go

Program Level: – Hire staff who care, clear security, culturally aware, bilingual– Train staff: Motivational Interviewing– Partner Agreements

Systems Level:– Track outcomes– Arrange transitional services– Partner with community health centers; walk-in hours

Expect the Unexpected

SPNS Jail Linkages InitiativeLocal Study Protocols

Enrollment: adult HIV patients enrolled during jail stayExclusion criteria: newly diagnosed, receiving mental health

discharge planning, likely to have long sentence (>1year)

Baseline survey: initiated at index incarceration

Jail chart review: most recent clinical data at time of release

Post Release Services: linkage determined 30 d post-release

C6M (6-month follow up):– Followed post release with regular check in and survey at

6m– Recorded clinical data gathered from clinicians at 6m

SPNS Jail Linkages Initiative Site Specific Study Design

Case Management / Data Collection

NYC Health Patient Care Coordinators in jails; Community reentry providers’ dually-based transitional counselors

PCC and counselors trained by Yale Research and Evaluation Team

Program FocusPopulation-based approach

Linkage to Care within 30 d of release

Program Enhancements Health Liaison to the Courts

SPNS Jail Linkages Initiative Disposition of NYC participants

555 Baseline

enrollments67 Not Released

in time for MSE inclusion488

Included in MSE sample 54 Dropped:

3 died10 Moved41 Prison Return434

Baseline sample

243 Seen at follow-up

191 Lost to follow-up

Medical / Substance useco-morbidities

NYC Baseline n=555 (%)

Active / other medical problem 76%Hepatitis C virus 40%Medical Insurance 91%History of Heroin Use 56%

History of Methadone 39%Alcohol / drug treatment ever 23%Troubled by Drug use, last 30d 66%

SF-12 Physical Composite Score 47.5 (SD: 10.6)

SPNS Jail Linkages InitiativeBaseline Medical / Substance Use History

Indicator NYC Health n=555

Never completed high school 47%

H.S. Diploma / GED 38%Job / skill training 58%Some College + 15%Employed 30 days prior 10%Committed relationship 30%

Age <18 years at first arrest 50%

Proportion of Lifetime spent incarcerated (mean) 9%Arrests (mean) 26

SPNS Jail Linkages Initiative Baseline Socio-Economic Factors

SPNS Jail Linkages Initiative Services Accessed – 30 days post release

non-medical strategies to facilitate access to care

• Case conferencing prerelease• Medical summary / medications• Accompaniment / transport • Community case manager• Directly Observed Connections• Patient Navigator / Care Coordinator

Access to Care Strategies

Indicator NYC Health All SitesClinical CareClinical Care

CD 4 (mean) ↑ (374 to 412) ↑ (416 to 439)vL (mean) ↓ (54,031 to 13,738) ↓ (39,642 to 15,607)

Undetectable vL↑ (11% to 22% )

↑ (10% to 21% )

Engagement in CareEngagement in Care

# Taking ART ↑ (56% to 93%)↑ (57% to 89%)

ART Adherence ↑ (81% to 93%)↑ (68% to 90%)

Average # ED visits p/p ↓ (.60 to .20)↓ (1.1 to .59)

Basic NeedsBasic Needs

Homeless ↓ (22.4% to 4.15%)↓ (36.2% to 19.2%)

Hungry ↓ (20.7% to 1.7%)↓ (37.4% to 14.1%)

SPNS Jail Linkages OutcomesFrom baseline to 6 month follow-up

• Along with primary medical care, Jail Linkages clients were also connected to:– Medical case management (53%) – Substance abuse treatment (52%) – Housing services (29%) – Court advocacy (18%)

After Incarceration“An ideal

community partner

offers a ‘one-stop’ model

of coordinated

care in which primary

medical care is linked with medical case management

, housing assistance, substance abuse and

mental health

treatment, and

employment and social services.”

• Approximately 65% of clients accept the offer of accompaniment and / or transport to their medical appointment.

• 85% of those who were not known to be linked to care were found by NYC Home Visit team; finding 30% re-incarcerated.

Process Improvements• Improve acceptance of follow up rapid testing

– Acceptance rate increased from 30% to 60%

• Improve acceptance of service plans– Acceptance rate increased from 85.4% to 92.8%

• Health Liaison to the Courts – Release rate increased by 20%

• SPNS Jail Linkages Program Evaluation– Over 100 followed for 12 months post-release

• Integrate with EHR– Case management templates implemented 5/13

Linkage to Care Outcomes2008-2012

2,700 2,456 1,910 1,420

n=17,010 self-reported HIV-positive admissions to NYC jails (2008-2012)

Community Collaborations

• NYS Links: enhance and replicate program• NYC Care Coordination, Supportive Housing and Health

Home Providers• Linkage agreements / Memorandum of Understanding• SAMHSA ORP pilot collaborations• Bronx Health and Housing Consortium • Health Liaisons to the Courts• NYS Criminal Justice and Health Home workgroup• APHA Jail / Prison Health Committee• Bronx Health Home pilot - linkages under ACA model• SPNS Latino Populations grant – transnational approach• SPNS Workforce Capacity grant – PR replicating model

• Health-based court advocacy to facilitate – community alternatives to incarceration including

substance use / mental health treatment– compassionate release to skilled nursing / hospice care

•Service plan addresses health and service needs of the client while addressing public safety. •Health information, records / letters from MD•Coordinate with prosecutors, courts, defenders, care coordination agencies, community treatment providers, nursing homes, hospice programs and supportive / transitional housing service network

Health Liaison to the Courts

• In 2013, 735 received Health Liaison services:– 390 diverted to ATI– 109 placed in non-mandated treatment programs – 113 restored to parole– 82 granted compassionate release– 41 term reduced in the interest of justice.

• At least 345 (47%) would have remained incarcerated.

• Providing information to the courts improves health outcomes and reduces the impact of incarceration on communities with the greatest health disparities.

Health Liaison Outcomes

Health Home Collaborations • CHS currently receives rosters from 7 NYC-based

Health Homes– On average, about 10% of those currently incarcerated in

a NYC jail are on one of the health home rosters• CHS is currently partnering with 2 NYC-based Health

Homes to actively link those currently incarcerated with their health home care management organization

– Bronx Health Home supports a Project Officer and PCC for their assigned patients

– South Brooklyn HH outstations two Project Liaisons to coordinate care for their patients receiving MH services

Why Partner with Us?

Jail population is:•Sicker and has greater health disparities than general population•More likely to use ED and have resulting hospitalizations

CHS has:•Demonstrated, evidence-based approach to linkages to care•Agreements with extensive network of NYC service providers

Through our partnerships we can:•Remove barriers to engagement in care•Avoid unproductive outreach•Help patients address basic needs during critical reentry period

Significant Gains Information Dissemination•Papers published in peer-reviewed journals•National and International Conference Presentations•Demonstrated alternatives to incarcerationProgram Sustainability•Cost saving at a societal level•Additional funding / expansion•Integration with ACA / Health Homes

Program Expansion•Health Liaisons to the Courts•Improve access and engagement in care

Further Evaluation•Women, Transwomen, Puerto Rican origin•Workforce Capacity; replication in PR

VALUEADDED

Best practices Cost analysis Cross site visits & presentations New friends

Marry Creative Ideas & Marry Creative Ideas & Practical Solutions toPractical Solutions toWicked ProblemsWicked Problems

Ancillary cost benefit far Ancillary cost benefit far exceeds grant awards!exceeds grant awards!

SPNS Collaborations

Inform and inspire:Inform and inspire:

http://www.jjay.cuny.edu/NYCMappingHeathCare.pdf

http://www.jjay.cuny.edu/Jail_Admin Toolkit.pdf

On-line Resourceshttp://www.careacttarget.org/ihipCreating a Jail Linkages Program Training Manual & Curriculum Webinar Series

http://link.springer.com/search?query=enhancelink [Journal of AIDS and Behavior Supplement 2 September 27, 2013]

http://www.enhancelink.org/

http://www.aidsbeacon.com/news/2010/12/03/new-point-of-service-program-will-focus-on-hiv-aids-testing-and-treatment-for-inmates-at-rikers-island/

http://www.hcsdmass.org/

References1. Teixeira,PA, Jordan AO, et al. Health Outcomes for HIV-Infected Persons Released from

the New York City Jail System With a Transitional Health Care-Coordination Plan. AJPH. Volume 105, No. 2 pp 351-357. Feb 2015.

2. Draine J, et al. Strategies to Enhance Linkages between Care for HIV/AIDS in Jail and Community Settings. AIDS Care, 23(3), 366-77, 2011

3. HRSA HAB Special Projects of National Significance Program Creating a Jail Linkage Program, Training Manual and Curriculum, September 2013 www.careacttarget.org/ihip

4. Spaulding AS, et al. Jails, HIV Testing, and Linkage to Care Services: An Overview of the EnhanceLink Initiative. AIDS & Behavior. Volume 17, Issue 2 S100-107. 1 Oct 2013.

5. Williams CT, et al. Gender Differences in Baseline Health, Needs at Release, and Predictors of Care Engagement Among HIV-Positive Clients Leaving Jail AIDS & Behavior. Volume 17, Issue 2 S195-202. 1 Oct 2013.

6. Spaulding AS, et al. Planning for Success Predicts Virus Suppressed: Results of a Non-Controlled, Observational Study of Factors Associated with Viral Suppression Among HIV-Positive Persons Following Jail Release. AIDS & Behavior. Volume 17, Issue 2 Supplement, pp 203-211. October 1, 2013.

7. Jordan AO, et al. Transitional Care Coordination in New York City Jails: Facilitating Linkages to Care for People with HIV Returning Home from Rikers Island. AIDS & Behavior. Volume 17, Issue 2 S212-219. 1 Oct 2013.

8. Spaulding AC, et al. Cost Analysis of Enhancing Linkages to HIV Care Following Jail: A Cost-Effective Intervention. AIDS & Behavior. Volume 17, Issue 2 S220-226. 1 Oct 2013.

• Alison O. Jordan, Principal Investigatorajordan@health.nyc.gov 917-748-6145

• Jacqueline Cruzado-Quinones, Project Coordinatorjcruzado@health.nyc.gov 917-715-6841

• Paul A. Teixeira, Local Evaluatorpat2007@med.cornell.edu

Dripping water hollows out a stone Dripping water hollows out a stone Not through force but persistence. - OvidNot through force but persistence. - Ovid

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