At 25 years-old, John Doe had dropped out of school, was selling drugs and was HIV-positive.  It's no surprise he ended up incarcerated.  But, with the help of a program at the Cook County Jail, this young man has reintegrated into the community, turned his life around and beat the odds of becoming another recidivism statistic - so far, at least.

"We need not forget that the fight is far from over," said Kendall Moore, Director of the HIV Continuity of Care, STD/HIV Prevention and Care Program for the Chicago Department of Public Health.  "Because for every [John Doe], there are [many] other folks who are not like him."

Those who are not able to connect with the resources they need to sustain themselves in society after release from incarceration, often reoffend.  Then, they land back behind bars.

"They have to hustle and do what they need to do to survive," Moore said about ex-offenders who sometimes have a difficult time finding housing or jobs.

The Illinois Public Health Corrections and Community Initiative, a five-year demonstration project, began in 1999 with the goal of supporting HIV-positive offenders who are reintegrating to Chicago and surrounding communities by providing them with intensive case management services.  The project, which is scheduled to wrap up in late September, has been a huge success, Moore said.

"We showed if these folks could afford these types of services in the community, it would certainly cut down on the increasing rate of HIV in this population," Moore said.  "It would also cut down on recidivism."

The project worked well, he said, because of the partnership between corrections and public health.

Working Together Towards the Same Cause

"Corrections and public health, they go hand in hand," Moore said.  "It was realized that we all had to work as one cohesive unit in order for us to be successful."

With both agencies on board, the project's goal was to cut down on the transmission of HIV among offenders and ex-offenders and ease their transitions back into the community.

"We were hoping that the project would alleviate the transmission of HIV among the incarcerated population, including juveniles and youth," Moore said.  "We also hoped to reduce the rate of HIV transmission in those Illinois communities most highly impacted by HIV [and] to cut down on recidivism."

In addition, Moore said, the project aimed to provide a continuity of care system for HIV-positive offenders returning to the community.

Linking Offenders to Services in the Community

"How do we expect a person to come out and be productive out in society [without any resources]?" Moore said.  "They really are facing an uphill battle."

According to Moore, especially with the HIV-positive offender population, it is important that people have access to the same services in the community that they utilized while they were incarcerated.

"They receive better services when they are incarcerated than when they are in the community," Moore said.  "Corrections provides a better lifestyle for these people than the community does."

To alleviate this problem, Cook County Jail offenders who were identified for the program during intake the Cook County Jail and volunteered for it or those ex-offenders in the community who enrolled themselves are provided with intensive case management services so their needs are met in the community.

For program participants who are incarcerated, those services start immediately.  While they are at the jail, they meet with both an internal and an external case manager who continues to work with them when they are released into the community.

"The external case manager goes into the jails and meets with the client and the internal case manager," Moore said.  "This ensures continuity of care and it also builds a rapport with the client prior to them being released."

According to Moore, it is important for the offender and the case manager to build this relationship while the client is still incarcerated.  Then, during first few days after his or her release, which are the most critical, the offender will feel comfortable working with the external case manager to connect to the services he or she needs.

"Once they hit the streets, their priorities change dramatically," Moore said, noting that offenders who have had time to reflect on their situations while they were in jail are sometimes motivated to turn their lives around.  Then, they parole back into the same communities where they were engaging in the behaviors that got them incarcerated in the first place.

 "We send them back into a no-win situation so their priorities shift in terms of what their needs are," Moore said.

Having a case manager to depend on is an additional support for offenders who are trying to stay on the right course and not return to those negative activities, like substance abuse and crime, Moore said.

"Behavior modification is really a big part of it," Moore said.

Waiting for Results

To help keep offenders on the right track, they remain in the program for six months after release.  While the final numbers are still being calculated to determine how many HIV-positive offenders stayed crime free through the program, Moore is confident that it was successful and he predicts it will live on, despite the end of the state's funding for the project next month.

"We are anticipating that those community-based organizations that are providing services as far as housing, mental health, substance abuse and job training [and placement] will continue to provide those services," Moore said.

In the meantime, however, the state is looking at this demonstration project as a model for future offender programs.

"It's been a huge success, not just for Chicago, but for the state of Illinois," Moore said.  "They are currently in development of a state continuity of care system similar to this demonstration project."

While the Illinois Public Health Corrections and Community Initiative may serve as a template for future continuity of care programs in the state, it may have served an even greater purpose: educating the public.

"It really has made the community aware of the true angst of what it is to be incarcerated," Moore said.

Resources:

Kendall Moore: Moore_Kendall@cdph.org