Rhode Island Program Helps Offenders Bridge the Gap between Confinement and the Community

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By Meghan Mandeville, News Research Reporter

Published: 09/29/2003

For most offenders, there is life after incarceration. And for many inmates, especially those with HIV, it's a tough transition back into society. Offenders in Rhode Island, however, are being guided through this difficult process with the help of Project Bridge, a collaborative effort to provide case management to HIV-positive individuals who are leaving the prison system and re-entering the community.

"The goal of the program is to enhance medical continuity of care through social stabilization," said Leah Holmes, Project Director/ Principal Investigator for Project Bridge. "We make sure that they have everything they need to stay as healthy as they possibly can," she said.

The necessities that Project Bridge provides range from basic food and shelter to transportation and mental health treatment programs.

"You take care of the most pressing survival needs [first]," said Holmes. "Then we'll start working on whatever is the most urgent part of the plan."

For example, if ex-offenders have no housing or clothing, they are sent to a shelter and given some donated clothing. Once these basic needs are provided for, they are linked up with whatever other social and medical services they need.

To facilitate this process, ex-offenders are each assigned a social worker and an outreach worker who work as a team to ensure that their needs are being met and that they are keeping up with their medical treatments.

While incarcerated, HIV-positive inmates are eligible for state-of-the art health care, Holmes said. Getting ex-offenders to their doctors' appointments to ensure that they continue the HIV treatment that they were receiving in prison is extremely important, she added. "If they don't [have continuity of care], they will become much, much sicker, much, much faster."

More than Just Medicine

A unique advantage of Project Bridge is that "[offenders] can see the same medical provider when they get out," Holmes said.

One such medical provider is Dr. Josiah Rich, who works at Miriam Hospital in Providence, R.I. and treats offenders and ex-offenders.

"With the appropriate amount of support, all of them can get into HIV care," Rich said at a recent conference where he discussed discharge planning and Project Bridge, which is viewed by many in corrections as a model program.

The success of Project Bridge lies not only in its ability to secure medical treatment for ex-offenders, but also in its ability to get them involved in other programs they might need.

"Treating someone's medical care alone in isolation is not really going to cut it," Rich said. "You really have to address substance abuse and their social environment," he added. "It's quite clear to me that addiction is really the problem, especially among those people with HIV."

Holmes agrees that addiction is the greatest challenge in ensuring that ex-offenders stay on the right path and continue with their medical treatment.

"Virtually all of our clients have a list of addictions," she said. "When we can't find them for a while, it's usually because they're involved with their drugs."

But overall, Project Bridge has been successful in connecting ex-offenders with programs to help them combat their addictions.

From 1997 to 2000, nearly one-third of the program's 97 clients received the substance abuse treatment they needed. Even better, all of them received HIV treatment.

"It's just wonderful having that kind of support," Rich said about the Project Bridge.

Teamwork is Essential

Project Bridge's relationship with a client begins while an individual is still incarcerated. Although HIV-positive inmates are not required to participate in the program, they are all informed about it and encouraged to enroll by the health services division within the prison. If an inmate chooses to become involved with Project Bridge, then a social worker visits the individual about three months prior to his or her release to discuss the details of the program.

"If they feel that [Project Bridge] is going to be helpful to them, then they'll sign a consent [form]," said Holmes. Inmates must not only agree to the intervention, but also to participate in a research study because Project Bridge is a demonstration project, funded through a grant from Special Projects of National Significance (SPNS).

Those inmates who choose to enroll in the program are assigned a social worker and an outreach worker, who, as a team, help the ex-offender settle back into society. The team will go to ex-offenders' homes, their friends' homes or meet with them at the Project Bridge office to develop a plan of action as soon as they are released.

Medical appointments are typically set-up prior to an inmate's release from prison, but Project Bridge workers also make sure individuals make it there by calling to remind them about the visit and arranging taxi-cab transportation for them to and from the office. In addition, they accompany the ex-offender to the appointment to provide support and answer questions for them about information that can be confusing, such as prescriptions and required forms.

"The clients really like that," Holmes said about having someone from Project Bridge accompany them to the doctor's office.

The clients also enjoy the fact that they are openly embraced by the Project Bridge staff.

"[The program works because] the clients feel that they are given unconditional acceptance," Holmes said. "They never feel any shame about being either an ex-offender or a person with HIV," she added. "Our clients tend to be enthusiastic about the services they have received here."

A Bigger Challenge

While Rhode Island has experienced much success with this model program, whether or not this type of program will work as well in other states is another question.

"We have unique advantages here," said Rich, because of Rhode Island's small size, with a population of 1,058,920 and only 1,045 square miles of land. "That's a luxury."

In comparison, Texas has 21,325,018 people and 267,797 square miles of land, a situation far less conducive to the tight-knit, comprehensive care being offered by Project Bridge in Rhode Island, where travel throughout the state is much quicker and there is only one prison complex where offenders are housed.

Holmes believes, however, that it is possible to implement programs like Project Bridge in other states.

"What they need to do is to break down the services," she said. "They can provide by area," she added, noting that people typically go back to where they came from. "By partializing it, segmenting it, you can break it up so you can do this kind of project," she said.

Other states such as North Carolina, have begun to follow Rhodes Island's lead, taking a closer look at discharge planning and seeing what they can do within their communities to stabilize ex-offenders' lives and keep them in treatment for their HIV.

"Success in the community depends on continuity of care for multiple needs," Rich said. "If you don't have that linkage, it's almost as if you might as well have not done anything."

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