Sandy Tarlow and Dodie Isberg admire many of their clients.  Given the circumstances they are faced with when they leave prison or jail, they recognize that it is hard for many of these offenders to get their feet on the ground and make a fresh start.  They have criminal records.  They are HIV-positive.  And many times, they have no place to go when they are released from incarceration.

"I am amazed any of them do it," said Tarlow, admitting that she would find it difficult to overcome the obstacles that many of the women she works with face when they re-enter the community.  "Most of them didn't finish school.  It's hard for people to support themselves."

Because HIV-positive offenders have so many needs when they return to the community - healthcare, housing, employment and substance abuse treatment, to name a few - the Massachusetts Department of Public Health (MDPH) started the Transitional Intervention Project (TIP) five years ago with a grant from the Center for Disease Control and the Health Resources and Services Administration.  TIP's goal is to help offenders with HIV get the services they need to stay healthy and crime-free after they are released.

"In the beginning, the support is so important," said Isberg, who, along with Tarlow, is a case manager for TIP.  The two work for Cambridge Cares About AIDS, one of the community-based organizations that has partnered with TIP to provide case management services to offenders being released from prisons and jails in Massachusetts.

Cambridge Cares About AIDS is one of six agencies in various regions of the state that works with TIP, assigning case managers to offenders who are relocating to the communities in their area.  When HIV-positive offenders who want to participate in TIP are nearing their release dates, the HIV coordinators at their correctional facilities refer the inmates to one of these agencies.

"The TIP case managers and the HIV coordinators all know each other and have a very efficient communication network," said Tom Barker, Director of the Correctional Health Program for the MDPH HIV/AIDS Bureau.  "That is one of the really neat features of the project - the collaboration between the community-based agencies and the correctional staff."

Working Together

TIP case managers initiate contact with their clients by visiting them in prison or jail about three months prior to their release.  This enables offenders and case managers to start building a relationship prior to an inmates' release.  It also gives the case managers a head start on making connections in the community for their clients so that their transition from a correctional facility back into society is a smooth one.

When a TIP case manager initially meets with an offender, he or she conducts an intake interview to assess what some of the client's needs may be in the community.

"In that first meeting, usually, the HIV coordinator will be [present] so it's sort of a gradual hand-off.  [It's] not abrupt," Barker said.  "We feel that is a strong component of this."

During the intake assessment, the case managers cover various topics, including mental health issues, substance abuse problems, housing and employment needs and general health considerations.

"That is the information that is going to help the case manager and the inmate develop the service plan for when they are released," Barker said, noting that, based on the case manager's judgment, there may be a few additional meetings beyond the initial intake to further evaluate inmates' needs.  "The other subgoal of these meetings is to develop a relationship with the inmates before they are released to gain their trust, just as the HIV coordinators [at the prison or jail] have gained their trust."

Once inmates' needs have been determined, the case managers have a few months to find services in the community to support the offenders.

Having those needs met immediately upon release is vital to the offenders' success in the community, Barker said. 

Quick Connections

"It is important, especially with housing, [because] many housing facilities have waiting lists and the TIP case managers, in concert with the HIV coordinators, sometimes are able to get the inmates on the waiting list before they are released, which helps reduce the lag time after they are released," Barker said.  "The more things that can be done in advance of release, the easier it is going to be."

Aside from trying to establish housing for the offenders, TIP case managers will also set up their first appointment with a primary care physician in the community and determine which pharmacy will be the easiest for the offenders to access for their medications.

Ensuring that the inmates are linked to adequate healthcare services is important, Barker said, so that they receive the proper treatment for their HIV infection.

"The quicker folks start to get their health needs met and [the more likely they are] to keep pretty disciplined about their adherence to their HIV medications," Barker said.

Having all of these details worked out for the offenders is helpful, because, according to Tarlow, many of them are frightened about re-integrating into the community.

"People are really scared," Tarlow said.  "I think [that] they are very, very vulnerable."

Having the TIP program in place eases some of their anxiety, she said.

Barker agrees.  He also believes that TIP helps offenders achieve stability in society and decreases their chance of reoffending.

"[We do this] so that there's no wondering what is going to happen the day [they] walk out the door [of the correctional facility]," Barker said.  "There is a whole set of things lined up [by the case manager]," he added. 

According to Barker, if an inmate gets released and is immediately hooked up with either a doctor's appointment or a substance abuse treatment appointment, he or she has a better chance of succeeding in the community and not returning to the lifestyle that resulted in their incarceration in the first place. 

While the hard data to back that claim is on its way, there is currently an evaluation underway to determine how TIP is operating, what its clients' greatest needs are, how well it is meeting those needs and what could be improved about the program.

Getting Results

With the help of an independent researcher the MDPH is in the midst finding those answers through both quantitative and qualitative data collection.

"[We wanted to determine] how we can tweak the model to make it better for the future," said Jennifer Logan, TIP Evaluation Program Manager. 

One of the highlights of the evaluation, Logan said, is a montage that has been created with photographs of offenders, accompanied by excerpts that TIP clients have written in their own words about the impact the program has had on their lives.

According to Logan, the exhibit will be used to demonstrate the need for TIP to policymakers and others working in corrections by showing the value of TIP through the eyes of HIV-positive offenders.

"I think it puts a human face on it," said Barker.  He added that, although the five-year grant from that originally funded the program ran out in September, TIP will continue.

"If anyone can learn from our program, I think it's great," Barker said.  "If it worked here, it has to be able to work elsewhere."

Resources:

Barker (617) 624-5309