1. ESTELITA M. QUIMOSING, M.D. DAETC – ARKANSAS Associate Professor of Medicine, UAMS Clinical Director, Jefferson Comprehensive Care System, Inc. CLINICAL TRAINING FOR CORRECTIONS PERSONNEL

2. Objectives To describe the clinical training for corrections personnel. To understand the importance of linking the HIV+ inmate to the community once discharged from the prison.

3. TOPICS Collaboration of ADC, JCCSI and DAETC Tour of ADC Levels of Training HIV-AIDS in the Prison HIV Screening in ADC Privacy and Confidentiality Linkage to Services Discharge Planning Summary

4. Map of Arkansas The Arkansas Department of Correction (ADC), Jefferson Comprehensive Care System, Inc. (JCCSI) and the DAETC Arkansas local provider site are located in Jefferson county.

5. ADC - JCCSI - DAETC The Arkansas Local Performance Site of the DAETC is in JCCSI. Training of ADC personnel by JCCSI/DAETC has been in progress for more than 10 years now.

6. “The Club”

7. How To Get There In-patient and Out-patient clinics

8. Gate Security

9. The Club’s Lovely Landscape Dashboard view

10. The Triad Watch Tower Shackled Men in Uniform Barbed-Wire Fence

11. The Facility

12. Diagnostic Unit: In-patient and Out-patient Clinics

13. Entry to the Clinic

14. JCCSI HIV Nurse and Discharge Planner

15. ADC HIV Nurse and Security Officers Inmates in the Waiting Area ADC Nurse Ann Teer triages the inmate with a Security Officer at a distance Then the inmate goes to the waiting area until his name is called Security and Confidentiality in the Clinic

16. HIPAA Inmate’s chart is transported in a secured jacket Ideally, the examination room should be closed, but I would not dare stay in a room alone with the inmate behind a closed door.

18. Clinical Training for Correctional Personnel by DAETC Action StepsResponsible Needs Assessment Derrick Levels 1 - 2Clinical Faculty *** Levels 3 - 4Clinical Faculty Technical Assistance Derrick, Hayley, Shari, Chinetta, Darlene, Ann ***

19. Levels of Training Level I: Lecture Level 2: Skills building Level 3: Case discussion Level 4: Clinical Consultation Trainer Active Learner Patient

20. HIV-AIDS IN THE PRISON Prevalence: 3-5x higher than in the general population 1.7% of total inmate population in USA Bureau of Justice Statistics, 2007 0.7% of total inmate population in Arkansas Arkansas Department of Correction, 2011 Total Inmate Population HIV - AIDS

21. HIV Testing in the Prisons of USA NOT A ROUTINE: ON ADMISSION UPON RELEASE SYMPTOMS PRESENT UPON REQUEST INCIDENT HAPPENS HIGH RISK INMATE

22. Opt-out HIV Screening in Arkansas Department of Correction Opt-out screening: HIV test is routine unless the inmate declines HIV screening upon release started in 2010 HIV+ 2010 2011 On admission 175 Upon release 11

23. INMATE PRIVACY AND CONFIDENTIALITY HIPAA (Health Insurance Portability and Accountability Act) Discuss inmate’s care and services in private Close examining room when possible Secure medical records during transport

24. Linkage to Services Services Responsible HIV Prevention and CounselingADC nurse Medical evaluation and stagingADC Unit Physicians HIV-AIDS and OI management HIV Specialist ImmunizationADC nurse HIV in pregnancy UAMS Women’s Clinic

25. LINKAGE TO SERVICES UPON RELEASE FROM CUSTODY Services Responsible Discharge Planning ProgramADC, JCCSI List of HIV providers in Arkansas ADH, JCCSI, ARCare Housing, Food, Employment Part C, Part B, Part D Mental Health, Subs Abuse Tx Part C, Part B, Part D

26. LINKAGE TO SERVICES Discharge Planning in Arkansas Referral to RWCA- funded HIV clinics Provision of HAART x 30 days

27. 2) Date of Release 3) Date of HIV+ test Release Notification Form 4) Medication list 6) Release of Info 5) Parole Officer 1) Inmate’s Demographic

28. When going to first appointment 1. Picture ID 2. Release form for verification of residency and income 3. Verification of HIV Status 4. Copy of your most recent lab work 5. List of current HIV medications 6. SIGN A RELEASE OF INFORMATION Ann Teer ADC Disease Intervention Specialist, HIV Program 6814 Princeton Pike, P.O. Box 8707 Pine Bluff, AR 71602 Office: 870-267-6789 or 870-247-4791 Ext. 6249 Fax: 870-267-6243 Ann.teer@arkansas.gov Instruction to Inmate

29. Summary The training of Corrections Personnel by the JCCSI-DAETC staff has been a continuous process for more than 10 years now. Discharge planning and linking to care in the community are integral parts in the care of HIV+ inmates.

32. THANK YOU!