Melissa Klein 11/6/2011

1985 Healthcare for the Homeless Project (HCHP) 1996 HCHP becomes grantee to run community health centers and becomes a FQHC 2001 Unity Health Care is named 2006 Unity takes contract to provide medical care inside the DC Jail with a community oriented correctional medicine model 2008 Unity receives Robert Wood Johnson grant to fund Reentry Health Center

Outline risk factors for incarceration Identify medical problems that disproportionately affect the incarcerated population Discuss Reentry into care for patients returning home from jail or prison

Over the past 40 years the number of people in US prisons has increased by more than 600% U.S. today has the highest incarceration rate of any country in the world Over 2.3 million men and women living behind bars This marks the highest rate of imprisonment in U.S. history Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:

Source: Bureau of Justice Statitstics. Correctional Populations in the United States, 2009 and Prisoners in 2009.

Source: FBI, Uniform Crime Reports, Crime in the United States, annually.

Substance use and dependence are prevalent with 50% of inmates meeting DSM-IV criteria for drug dependence and 20% of state prisoners have a history of injection-drug use.

50 years of movement from hospitals and treatment centers to jails and prisons Lack of community mental health systems has resulted in jails and prisons housing many patients with serious mental illness Human Rights Watch. Ill Equipped: U.S. Prisoners and Offenders with Mental Illness

Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:

Minorities are over-represented among the incarcerated 40% of the US prison population is black, while only 12% of the US population is black Black men in the US are more likely to have spent time in prison than to have graduated from college or joined the military Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:

Image taken from Prison Policy Initiative website Statistics as of June 30, 2004 from Prison and Jail Inmates at Midyear 2004, Tables 1, 14 and 15 and U.S. Census. (Peter Wagner, June 2005)

Poverty Homelessness Drug Abuse Mental Illness Low level of education

Similar to community outpatient medicine Patient seen in medical unit or on cell block Patients are younger on average, predominantly male HIV & HCV As many as a quarter of all Americans infected with HIV and one in three with Hep C pass through a correctional facility each year DM, HTN, HLD, orthopedic injuries common Specialty inside – ID, ortho, podiatry, derm Outside referrals – Radiology, ENT, heme/onc, neuro, gen surg, rheum, GI... Health Promotion challenges and opportunities Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:

Slide courtesy of Unity Health Care. Lapp D, Zabiheian V. A Model of Care: Correctional Medicine and the Community.

30 days of HIV medication 3 days of all other medications with Rx for 30 days Connection to community clinic, appointment scheduled Halfway house patients seen at ReEntry Health Center Social Services at Community Health Centers: Job training GED, literacy Housing ID Health Insurance

Providers familiar with their challenges Access to Medical Care Access to Mental Health Services Substance abuse treatment and support Education Job training and employment services Housing Community Health Inside and Out