Collaboration between public health and corrections Finding Common Ground Between Public Health and Corrections Health: Lessons from New York Collaboration between public health and corrections

How Public Health Differs Many public health programs affect everyone, e.g. safe drinking water, food sanitation, immunizations Some public health programs affect sub-groups of society, e.g. MCH, family planning, drug users, et al In all cases the approach is keeping people healthy, usually applying to populations So what’s that got to do with corrections? Collaboration between public health and corrections

Who has Guaranteed Access to Health Care US v. AU? In the US, only incarcerated people have access to health care that is guaranteed by the Constitution Other groups such as children, disabled, elderly, et al, may have special access programs, but no guarantee Since Australia tries to provide access to all, there is no incentive to focus on or even include corrections Because incarcerated people are difficult to access (behind walls and wires and can’t come to our office) and because they are assumed to have done bad things so don’t “deserve” care, they are at the bottom of the care heap. Collaboration between public health and corrections

People who need health care should have the care they need! (and that includes preventive care!) Collaboration between public health and corrections

Corrections Health and Public Health have not seemed natural Allies “Liberal do-gooders” v. “conservative tough-on-crime” types Community v. institutional care Out of sight, out of mind Para-military organization Preventive care v. curative care “It’s the Culture, Stupid” Collaboration between public health and corrections

Public Health Implications Interrelationship between what happens on the street and inmates, e.g. injection drug users, TB, HIV, hepatitis B and C, MRSA… The better the health of our releasees, the better off society is Releasees who harbor diseases can transmit them in the community! It is easier to provide public health interventions in prison than on the street Collaboration between public health and corrections

Health Problems are Concentrated in Inmates They are risk takers—the same risk taking that leads to crime leads to diseases of public health significance Prior lack of health care (economics and health not a priority) Nearly all have abused alcohol and/or drugs Low Income and low education are risk factors for ill health Collaboration between public health and corrections

Communicable Diseases and Corrections Corrections is not a disease “breeding place” Best US studies say HIV conversion rate is 0.0 - 0.5%/yr Hammett estimated that in any given year in the US 25% of HIV infected 40% of people with active TB disease 33% of hepatitis C infected—pass through corrections 29% of acute HBV had sometime spent time in corrections, Jails and prisons see differing situations, e.g., 1999 report 25% of jailed females in NYC had syphilis Essentially none found in prisons; screened and treated in jail Collaboration between public health and corrections

Correction Health’s Response Environmentally safe living conditions Screen and test Diagnose Treat and immunize Educate Especially peer education Video and comic books Treat substance abuse Supervise Collaboration between public health and corrections

Interaction Between Public Health and Corrections in NY I Corrections Health is a Division of Department of Correctional Services (unlike South AU) Department of Health is a sister agency DOCS is expected to report reportable conditions DOCS is treated as a local health agency Collaboration between public health and corrections

Interaction Between Public Health and Corrections II We treated each other as colleagues We have a Memorandum of Agreement DOCS health senior staff and DOH senior staff meet quarterly DOCS provides funding for joint contracts with community based organizations in HIV DOH reviews (and “blesses”) DOCS primary care treatment guidelines for HIV and HCV Daily consulting regarding communicable diseases Collaboration on continuity programs Drills for health-related emergencies, e.g., norovirus … Collaboration between public health and corrections

Collaboration with Department of Health Continuous collaboration essential Environmental Health Epidemiology, Disease Investigation HIV/AIDS Immunization in facilities Hepatitis B for all Family Planning Initiative Collaboration between public health and corrections

Unique Features of Correctional Health Primary business is secure housing Disruption, cost and security of medical trips Health of incoming inmates Health care is something to manipulate Incarcerated people have time to do education including health education Collaboration between public health and corrections

Collaboration With Security Health is not primary mission of DOCS Security can’t operate well without an effective health care system Having health as a part of DOCS gives CMO authority in DOCS bureaucracy Daily contact between health and security on ALL levels For contracted services, robust monitoring of contracts is essential Collaboration between public health and corrections

Magnitude of the System in New York State NY has 55 prisons with approximately 57,000 prisoners (in 1995 was 70,000 in 70 prisons) Nationally, in the U.S., over 2.1 million incarcerated people, 2/3 in federal and state prisons The principles of organizing a system to assure public health and care don’t differ by size or number; they just need to be adapted Collaboration between public health and corrections

Collaboration between public health and corrections UPSTATE A CHATEAUGAY NEW YORK STATE DEPARTMENT OF CORRECTIONAL SERVICES FACILITIES ALTONA BARE HILL MAXIMUM SECURITY OGDENSBURG FRANKLIN FRANKLIN LYON MT. RIVERVIEW CLINTON R ATTICA GREEN HAVEN (ANNEX) AUBURN SHAWANGUNK BEDFORD HILLS (FEMALES) SING SING (ANNEX) CLINTON (ANNEX) SOUTHPORT COXSACKIE SULLIVAN (ANNEX) DOWNSTATE UPSTATE EASTERN (ANNEX) WENDE ELMIRA GREAT MEADOW CLINTON HUB WATERTOWN HUB CLINTON ST LAWRENCE GABRIELS GOUVERNEUR ADIRONDACK JEFFERSON CAPE VINCENT ESSEX MEDIUM SECURITY WATERTOWN MORIAH S ADIRONDACK MID-ORANGE ALBION (FEMALES) MID-STATE (ANNEX) ALTONA MOHAWK ARTHUR KILL ASACTC MT. McGREGOR (CAMP) BARE HILL OGDENSBURG BAYVIEW (FEMALES) ONEIDA BUTLER ASACTC ORLEANS CAPE VINCENT OTISVILLE CAYUGA RIVERVIEW CHATEAUGAY ASACTC TACONIC (FEMALES) ASACTC COLLINS ULSTER FISHKILL WALLKILL FRANKLIN WASHINGTON (ANNEX) GOUVERNEUR WATERTOWN GOWANDA WOODBOURNE GREENE GROVELAND (ANNEX) HALE CREEK ASACTC WYOMING (ANNEX) HUDSON LIVINGSTON MARCY LEWIS HAMILTON WARREN WASHINGTON OSWEGO GREAT MEADOW ALBION ONEIDA WASHINGTON NIAGARA ORLEANS ONEIDA ORLEANS WAYNE GREAT MEADOW HUB MONROE A MOHAWK HERKIMER FULTON SARATOGA ROCHESTER W BUTLER MID-STATE GENESEE A HALE CREEK MT. McGREGOR BUFFALO W ONONDAGA MARCY AUBURN R WENDE MADISON WENDE HUB ATTICA MONTGOMERY ONTARIO SENECA ONEIDA HUB SCHENECTADY WYOMING CAYUGA ERIE LIVINGSTON CAYUGA GEORGETOWN ALBANY RENSSELAER MINIMUM SECURITY WYOMING LIVINGSTON YATES WILLARD S SUMMIT COLLINS GROVELAND CORTLAND PHARSALIA SCHOHARIE BEACON (FEMALES) LYON MOUNTAIN BUFFALO MONTEREY SHOCK BUTLER MORIAH SHOCK EDGECOMBE QUEENSBORO FULTON ROCHESTER SUMMIT SHOCK LAKEVIEW SHOCK (INCL FEMALES) LINCOLN OTSEGO LAKEVIEW GOWANDA ELMIRA HUB S SCHUYLER TOMPKINS GREENE S MONTEREY CHENANGO CHAUTAUQUA CATTARAUGUS ALLEGANY COXSACKIE STEUBEN DELAWARE GREENE HUDSON CHEMUNG COLUMBIA ELMIRA TIOGA R BROOME MINIMUM SECURITY: CAMPS LEGEND SOUTHPORT ULSTER DUTCHESS SULLIVAN GABRIELS PHARSALIA GEORGETOWN R ULSTER GREEN HAVEN MAXIMUM CORRECTIONAL FACILITIES WOODBOURNE EASTERN DRUG TREATMENT CAMPUS SULLIVAN SHAWANGUNK R DOWNSTATE MEDIUM CORRECTIONAL FACILITIES SULLIVAN HUB WALLKILL FISHKILL WILLARD (INC. FEMALES) ORANGE BEACON MINIMUM CORRECTIONAL FACILITIES OTISVILLE PUTNAM GREEN HAVEN HUB MID-ORANGE (MINIMUM CAMPS) CORRECTIONAL FACILITIES WESTCHESTER ROCKLAND TACONIC R RECEPTION CENTERS DRUG TREATMENT CAMPUS R BEDFORD HILLS SING SING W WORK RELEASE EDGECOMBE BRONX W W FULTON NASSAU SUFFOLK S SHOCK INCARCERATION LINCOLN Collaboration between public health and corrections BAYVIEW W QUEENSBORO A ASACTC NEW YORK CITY HUB W QUEENS RICHMOND KINGS ARTHUR KILL A Varelli 7/99

Demographics Differ from the Community Ave. age 36.5 years, women slightly older 5 % are age 55 or older 94.5% male 51.1% African-American, 26.3% Hispanic 47% have less than high school education 20% married 59% have children Collaboration between public health and corrections

Blinded Seroprevalence Surveys Done by DOH in collaboration with Corrections on blinded-collection blood samples from admission exams Every other year Provides a window on the community HIV and Hep B and C Collaboration between public health and corrections

Collaboration between public health and corrections Major disease issues: Approximately 4 % of males HIV infected, 10.6 % of females [Was 18% m and 20% f ] Collaboration between public health and corrections

HIV Seroprevalence Trend HIV seroprevalence rates for male inmates dropped 83% between 1988 and 2005 HIV seroprevalence rates for female inmates dropped 43% over the same period HIV seroprevalence declined over time for both male and female inmate Collaboration between public health and corrections

HIV-Related Death Rate in DOCS (Rate per 10,000) Collaboration between public health and corrections

Collaboration between public health and corrections Major disease issues: Approximately 11.2 % of males infected with hepatitis C, 15.5 % of females [Was 13.4 % m and 24.1 % f ] Collaboration between public health and corrections

Collaboration between public health and corrections Hepatitis C Seroprevalence Among Incoming Inmates Entering NYS DOCS 2000 - 2007 Collaboration between public health and corrections

Collaboration between public health and corrections Major disease issues: 19% have TB infection at reception 90 – 95% decrease in disease if prophylaxis for those with infection Annual PPD test with “mandatory” prophylaxis if infected Disease has decreased from 225/100,000 to 6 or less (no new disease cases for several years) Collaboration between public health and corrections

TB Case Rate per 100,000 DOCS Inmates Collaboration between public health and corrections

Collaboration between public health and corrections Major disease issues: 90% give history of drug abuse or test positive for alcohol abuse Use incarceration time for something useful like drug and alcohol education and prevention programmes rather than just for punishment Collaboration between public health and corrections

Major Health Issue: Pregnancy All women are tested for pregnancy and STD’s at reception 6% pregnant Prenatal care starts immediately High risk deliver at medical centre; normal risk at community hospital Room-in with baby/infant for up to 18 months to allow bonding; structures to maintain relationships Training in parenting Collaboration between public health and corrections

Collaboration between public health and corrections Women’s Health Peer education Family planning services before discharge Collaboration between public health and corrections

Collaboration between public health and corrections Major Health Issues: Incredible dental neglect (m. 13 teeth mdf, f. 15) Dental care for all Office of Mental Health estimates 14 % are mentally ill They estimate 1/3 of these are seriously and persistently mentally ill Spectrum of care from outpatient to forensic hospital MRSA (NIH funded study with Columbia University) Collaboration between public health and corrections

Collaboration between public health and corrections Major disease issues: Aging population Longer term sentences mean older inmates with increasing health issues and needs for accommodations NY built 5 LTC facilities in maximum security including a unit for the cognitively disabled Collaboration between public health and corrections

Increase in % of Aging Population Collaboration between public health and corrections

Collaboration between public health and corrections

Collaboration between public health and corrections

Description of NYS System: Greater Focus on Prevention Health education Peer education Video and comic books Immunizations (including HBV) Treat latent TB Infection Screening informed by US Preventive Medicine Task Force Guidelines Collaboration between public health and corrections

Transition from Prison to Community Most inmate/patients return to the community (Average LOS in NYS DOCS about 4 years) CBO assistance in arranging continuity of care for HIV infected patients OMH working with continuity for mentally ill Hepatitis C Continuity Program Other chronic diseases? Collaboration with NYAM Family Planning for women in last 90 days of prison term, begun March 2009 Collaboration between public health and corrections

Collaboration between public health and corrections Continuity Issues Linking with Medical Home Health care SYSTEM literacy Don’t we all need that? Effect of health care continuity on recidivism? Collaboration between public health and corrections

Description of NYS System: Use Telemedicine Decrease medical trips More ready access to care More humane for sick Serendipitous education for primary care staff Use equipment of staff education Tele-triage potential ER trips 25% avoided Collaboration between public health and corrections

Collaboration between public health and corrections

Collaboration between public health and corrections Research Projects Comparison of babies born to incarcerated mothers—NIH funded study Prevalence and incidence of MRSA—NIH funded study with Columbia University Diagnosis of diabetes mellitus Age-specific death rates in HIV/AIDS Development of Peer Education curriculum for women Collaboration between public health and corrections

NYS DOCS Health Care System Lessons in Collaboration Collaboration between public health and corrections