The Massachusetts Hampden County Correctional Center's success in linking community and correctional health care inspired the Robert Wood Johnson Foundation to allocate a $7.5 million grant to create Community Oriented Correctional Health Services (COCHS). The organization will provide technical assistance and consulting services to jails looking to replicate Hampden's comprehensive health care plan for inmates during and after incarceration.
Hampden's director of health services, Dr. Thomas Conklin, who created the public health model about ten years ago while searching for a better method to track the health history of his HIV inmates, says the goal now is to institute the COCHS program in about 16 correctional institutions in the next few years.
Facilities in New Jersey, Washington, Missouri and the District of Columbia have already showed great interest in replicating Conklin's model with COCHS support, but the district's corrections director, Devon Brown, is one of the first to actively pursue implementing the plan.
“Jails, by and large, are well aware that their clientele has not received good health care when they were living in the community. If not for prison, they might not receive health care at all, which is an unfortunate consequence in our nation,” Brown says.
“We were looking into several approaches to inmate care when we learned of the Hampden initiative. We took a hard look at that model and at how other cities were doing things, and realized that in most urban areas there was a commonality in how inmates received care. Choosing the Hampden model just made sense from a monetary, humanitarian and social aspect,” he adds.
Brown contacted Hampden who referred him to COCHS project director, Steven Rosenberg.
Rosenberg explained how his organization could help Brown get this program underway at his facility. Brown bought into the idea and DC became the first COCHS site to implement a health care model where area clinics become actively engaged in inmate care.
“These are very hard to reach folks, so from the foundation's perspective we wanted to make a connection between the people who need help and the services they need from the community,” Rosenberg says.
Establishing that connection means training all those involved, like clinic staff, corrections officials and medical staff, and inmates, on the entire care process.
“When I meet with a sheriff's department or with corrections officials, and we talk about a drunk, stoned, or drug abuse inmate, everyone understands the challenge in trying to get health history from them. Once the health center gets involved, you change the rules because you can get inmate information upon their intake,” says Rosenberg.
This is mainly due to the fact that most inmates prior to prison visit clinics in their community. As a result, clinics usually have their medical history. When patients head to jail, though, the clinic is usually not notified and a gap in patient history occurs. Jail medical staff may unknowingly repeat assessments previously conducted at clinics, which results in a waste of resources and money.
“This model should prove to be a less expensive approach to inmate care because there wouldn't need to be startup costs associated with assessments. By the time an individual comes through the jail gate, he or she should be healthier, making the cost of prison health care more in line with community standards,” Brown says.
Rosenberg is currently helping Brown and his city broker a partnership with Unity Health Care, which has 30 community health centers in the district. Unity, a federally qualified health clinic, also runs an HIV/AIDS specialized clinic and provides care in local shelters.
“We target our services to those most in need, to the health conditions of the poor and underserved. We see about 65,000 patients a year, and we have case managers and social workers throughout centers all over the city,” says Unity COO Jose Aponte.
Beginning in October, Unity plans to implement and conduct health care services in two DC jails, which house inmates who have previously been to the organization's clinics.
“Unity will spend part of its time providing services in the community and another portion of its time in the jail itself,” adds Brown. “This should provide a familiarity with the inmate population, and eliminate a break in treatment.”
Upon release, Unity will keep track of where ex-offenders go and make arrangements for them to continue regular visits and regiments for existing conditions.
“This continuity offers a pretty good chance that they'll go back to their doctors. It gives us the ability to close the loop for a population that would otherwise not get the care they need,” Aponte says.
DC and Unity will pay COCHS to train health center practitioners on correctional medicine and to implement the technical changes necessary to create efficient communication between the jails and clinics. This funding, says Rosenberg, will help COCHS grow and eventually reach its goal of becoming a financially self-sustaining organization.
For now, COCHS will continue to rely on the Robert Wood Johnson Foundation for funding. The crucial element to its success, however, lies with forward thinking directors like Brown who see the need for a better health care system that connects the care inside his facility to the outside community.
Bottom Line:
A comprehensive health care system that connects local health clinics and a facility's medical unit can be a pro-active and cost effective health care solution.
Odds are local clinics have medical history data on inmates, which can save facilities the costs of initial inmate assessments.
To further explore the public health care model, contact the following resources:
Steven Rosenberg, COCHS project director, 510.595.7360, Ext. 12
Community Oriented Correctional Health Services: http://www.cochs.org/index.php
Dr. Thomas Conklin, Director of Health Services
Hampden County Sheriff's Department and Correctional Center
413.547.8000 Ext. 2344
E-mail: tom.conklin@sdh.state.ma.us
Devon Brown, Washington, D.C. corrections director, 202.671.2128
I listen to the presentation to CSPAN by Mr. Rosenberg (8/4/14) and was very much on board with his findings surrounding SUD and Mental Heath being tied to Community Health and wanted to know more about initiating policy change in Tallahassee Florida. I have worked in SUD for over 30 years and now have a 1/2 Way reentry faith based house for females returning to Leon County. Thank you for this collaborative informative venue for information.