florida partners in crisis annual conference & justice institute orlando, fl july 12, 2012...
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Florida Partners in Crisis Annual Conference & Justice InstituteOrlando, FLJuly 12, 2012
Clinical Research Challenges & Community Collaboration in Addressing Jail Recidivism
Presenters: Nazim Hamid, PhD Rolando Veloso, PharmD
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Continuity of Care and Community Collaboration
2007 PROGRAM
OF THE YEAR
AWARD -NCCHC
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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.
Volume 356:157-165 January 11, 2007 Number
2
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.
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Binswanger I et al. N Engl J Med 2007;356:157-165
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
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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
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Viral Load Increases Among HIV Positive Prison Recidivists, USA
HIV
-1 R
NA
(c
op
ies
/ml)
Recidivists100
1000
10000
100000
1000000Pre-releaseReincarceration
Stephenson B, Wohl D et al 13th World AIDS Conf, Durban. 2000
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Maslow- Hierarchy of Needs
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MOTIVATIONAL NEEDS
HEALTH
FAMILY
HOUSING
SOCIAL SERVICE
EDUCATION
EMPLOYMENT
BASIC NEEDS
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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
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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)
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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
STUDY:
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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.
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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.
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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
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2 YEAR STUDY Recidivism - A
Inmate Patients Screened
2007-2008 1,852
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 – 11 X 1 - 18 X
2009-2010 2,050
1649 – 0 time 107 – 1 X 80 – 2 X
67 – 3 X 38 – 4 X 26 – 6 X 11 – 8 X
8 – 9 X 6 - 11 X 6 – 12 X
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2 YEAR STUDY Recidivism - B
DISCHARGED INMATE PATIENTS 1852 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%
2007-2008 2009-2010
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HILLSBOROUGH COUNTY JAILSPOPULATION: (2007-2010)
0
500
1000
1500
2000
2500
3000
3500
4000
4500
2007 2008 2009 2010
Population
8 %7.5 %
9 % 10 %
3100
4130
3465
3800
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Recidivism - C2 YEAR STUDY (JAN 2007- DEC 2008)
2007/2008
Jail Av. Daily Population 3,500
Average Bookings per day 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
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Community/Re-entry Case Management Initiatives (1)Annual Conferences:
Broward, Hillsborough, Brevard, Pensacola Counties
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CASE MANAGEMENT ADVISORY BOARD OF TAMPA BAY INITIATIVES (2)
FOCUS: Re- Entry Case Management and
Education Development for Community Case Managers
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Community Health Fair Initiatives (3)
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Comments from Patients who Received
Discharge Planning
“ 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.”
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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
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Nazim Hamid, PhD718-810-9191
NBHAMID@AOL.COM-------------------------------------------------------------
Rolando J. Veloso, Pharm.D. CNS Principal Scientific Affairs Liaison
Janssen Scientific Affairs, L.L.C. (305) 987-8851 (mobile)
CONTACT: