Melissa Klein

11/6/2011

Community Oriented Correctional Medicine

Unity Health Care

1985 Healthcare for the Homeless Project (HCHP)

1996 HCHP becomes grantee to run community health centers and becomes a FQHC

2001 Unity Health Care is named2006 Unity takes contract to provide medical

care inside the DC Jail with a community oriented correctional medicine model

2008 Unity receives Robert Wood Johnson grant to fund Reentry Health Center

Outline risk factors for incarcerationIdentify medical problems that

disproportionately affect the incarcerated population

Discuss Reentry into care for patients returning home from jail or prison

Goals

Over the past 40 years the number of people in US prisons has increased by more than 600%

U.S. today has the highest incarceration rate of any country in the world

Over 2.3 million men and women living behind bars

This marks the highest rate of imprisonment in U.S. history

The epidemic of incarceration

Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:2081-2083.

Source: Bureau of Justice Statitstics. Correctional Populations in the United States, 2009 and Prisoners in 2009.

The War on Drugs

Source: FBI, Uniform Crime Reports, Crime in the United States, annually.

Arrests for Drug Abuse

Substance use and dependence are prevalent with 50% of inmates meeting DSM-IV criteria for drug dependence and 20% of state prisoners have a history of injection-drug use.

Incarceration of the Mentally Ill50 years of

movement from hospitals and treatment centers to jails and prisons

Lack of community mental health systems has resulted in jails and prisons housing many patients with serious mental illness

Human Rights Watch. Ill Equipped: U.S. Prisoners and Offenders with Mental Illness. 2003.

Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:2081-2083.

Minorities are over-represented among the incarcerated

40% of the US prison population is black, while only 12% of the US population is black

Black men in the US are more likely to have spent time in prison than to have graduated from college or joined the military

Race and Incarceration

Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:2081-2083.

Image taken from Prison Policy Initiative websiteStatistics as of June 30, 2004 from Prison and Jail Inmates at Midyear 2004, Tables 1, 14 and 15 and U.S. Census. (Peter Wagner, June 2005)

PovertyHomelessnessDrug AbuseMental IllnessLow level of education

Risk Factors for Incarceration

Similar to community outpatient medicinePatient seen in medical unit or on cell blockPatients are younger on average, predominantly

maleHIV & HCV

As many as a quarter of all Americans infected with HIV and one in three with Hep C pass through a correctional facility each year

DM, HTN, HLD, orthopedic injuries commonSpecialty inside – ID, ortho, podiatry, dermOutside referrals – Radiology, ENT, heme/onc, neuro,

gen surg, rheum, GI. . .Health Promotion challenges and opportunities

Medical Care Inside

Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:2081-2083.

Chronic Disease Prevalence DC Jail

Slide courtesy of Unity Health Care. Lapp D, Zabiheian V. A Model of Care: Correctional Medicine and the Community.

Reentry30 days of HIV medication3 days of all other medications with Rx for 30

daysConnection to community clinic, appointment

scheduledHalfway house patients seen at ReEntry

Health CenterSocial Services at Community Health

Centers:Job trainingGED, literacyHousingIDHealth Insurance

Providers familiar with their challengesAccess to Medical CareAccess to Mental Health ServicesSubstance abuse treatment and supportEducationJob training and employment servicesHousingCommunity

Health Inside and Out