Creating Partnerships and Navigating the 'Culture of Corrections'


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The goal of Integrating HIV Innovative Practices (IHIP) is to enable health care providers to implement proven innovations within their own practices and clinics. This Webinar is the first in a three part series featuring grantees of the Health Resources and Services Administration’s Special Projects of National Significance (SPNS) Enhancing Linkages to HIV Care & Services in Jail Settings Initiative (Jail Linkages Initiative), as they share lessons learned and advice for others hoping to create or expand similar programs.

Explore how to secure buy-in and foster partnerships within correctional settings, as well as how to navigate the “culture of corrections.” Hannah Zellman of Philadelphia FIGHT, a SPNS Jail Linkages grantee, will present alongside Dr. Linda Rose Frank and Debra D’Alessandro of the PA/MidAtlantic AIDS Education and Training Center about the work their organizations have done individually and collaboratively in the corrections setting.

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  • I
  • Whenever possible, people were seen within 2 days of release
  • Huge success to foster trusting relationships, since we are so often in the position of competing for funding
    Of the 27% who did not link, 12.5% were linked to another clinic, and 25% were reincarcerated
  • Access – building those relationships, allowing us to get a fuller picture, being able to go inside, to see things in real time, to spend time with providers, and to build the trusting relationship with the client before they come home
    Formal mechanisms – we used collaborative case conference with a set agenda
    Education means the facts of HIV, combating stigma and making sure staff know that there are services in place and that those service providers are willing to provide them with more information, assuage concerns and answer questions they may have
  • Reduce recidivism – Bruce Herdman, Chief of Medical Operations, once said that he wished he could operationalize a program like linkages to other population groups, like the mentally ill. Of course, sheer volume of that population definitely presents it’s own challenges…
    Our job is to ensure the security and safety of the inmates who are entrusted to our care, as well as the protection of the citizens of Philadelphia. We also share a fundamental responsibility to provide services that will help inmates return to our communities with the skills, knowledge and support that they need. We cooperate in this effort with public and private agencies, advocacy groups, faith based organizations and community organizations.
  • Chain of command – you don’t want to go over people’s heads because it is important to preserve relationships, but you also want to make sure to have clear communication with higher ups, because they are decision makers and influence access. You want to build good relationships with the front line and with the “higher ups” or “white shirts”
    Security, control, safety VS health, wellbeing – conflicts can arise here, but this is why relationship building is so important, and at the end of the day, there is a degree to which we just have to accept that correctional settings function differently than community based settings
  • Many of our clients don’t have strong social networks and have burned a lot of bridges, and so having someone visit you has incredible value
    A strategy we’ve used with all of our incarcerated clients is to send out, with client consent, a weekly mailing. We include articles, word searches, soduko and a letter from the staff. It’s been a really incredible retention tool, and enhances the power of in reach
  • - Even when there is a medication continuity
  • We’re always learning how to best reach people – recently, text messaging, facebook and email have become part of our outreach and retention work. With a client’s permission, we can send reminder or check in texts – and have sent silly “We miss you!” pictures when folks are at risk of becoming lost to care.
  • Emphasis is on professional competencies – understanding social determinants of health, where urgent needs take priority over linkage and retention in healthcare, vulnerability to re-incarceration, the ways in which homelessness, persistent poverty and trauma affect people’s ability to protect their own health
  • Some key questions to help new or expanding programs…
  • Thank you for your time
    -My contact information and the Impact Marketing + Communications-led Website are at the bottom, so please feel free to reach out any time if you have questions about our firm, the IHIP work or any other HRSA deliverables we’ve created, or if there are any marketing or communications projects we can help you with.
    - At this time, I’d be happy to take any questions you have about the presentation.
  • Creating Partnerships and Navigating the 'Culture of Corrections'

    1. 1. Creating Partnerships and Navigating the ‘Culture of Corrections’ November 19, 2013
    2. 2. Agenda  Introduction to SPNS Integrating HIV Innovative Practices (IHIP) project  Sarah Cook-Raymond, Impact Marketing + Communications  Presentations  Hannah from Zellman, Philadelphia FIGHT  Dr. Linda Rose Frank, PA/MidAtlantic AETC  Debra D’Alessandro, PA/MidAtlantic AETC Q &A
    3. 3. IHIP Jail Linkage Resources:  Lessons Learned Manual  Implementation Guide  Webinar Series  HIV and Jails: A Public Health Opportunity –archive available at careacttarget/org/ihip  How to Build and Expand a Jail Linkage Program – archive available at careacttarget/org/ihip  Creating Partnerships and Navigating the “Culture of Corrections”- November 19, 2013 at 1:30pm ET
    4. 4. Other IHIP Resources  Buprenorphine  Training Manual, Curricula, and Webinars on Implementing Buprenorphine into Primary Care Settings  Engaging Hard-to-Reach Populations  Training Manual, Curricula, and Webinars on Engaging Hard-to-Reach Populations  Oral Health  Forthcoming: Training Manual and Curricula available in December and Webinar series on Oral Health and HIV begins December 13, 2013 at 1pm ET
    5. 5. Hannah Zellman, MSW Director, Philadelphia FIGHT’s Institute for Community Justice
    6. 6.  Enhancing Linkages was a multisite demonstration and evaluation of HIV service delivery interventions for HIV+ individuals in jail settings who are returning to their communities.  The Enhancing Linkages Initiative is sponsored by:  US Department of Health and Human Services  Health Resources and Services Administration HIV/AIDS Bureau  Special Projects of National Significance
    7. 7.  Implemented within our county jail system, the Philadelphia Prison System (PPS)        Approximately 40,000 admissions per year Average daily census between 7,000 and 8,000 3% of male prisoners are living with HIV 6% of female prisoners are living with HIV Systems level intervention to strengthen HIV continuity of care and collaboration amongst service providers, including a collaborative multi-disciplinary team approach Establishment of a single point of contact system for referrals Strengthened continuum of care services  Utilize official visits, court advocacy, peer leadership models,   treatment education Expedited medical linkages upon release Partnership among leading AIDS Service Providers
    8. 8.  Successfully implemented SPOC and fostered trusting relationship amongst service providers  Served 342 people over the course of the program  Linkage to care for initial appointment 73%  Retained in care after 3 visits 88%  Increased visibility in the jails and reentry community allowed for program expansion
    9. 9.  Criminal justice system stakeholders  Allows us to extend the support network of the client by engaging, with client consent, with prison staff, parole and probation and the courts  It’s all about access!  Establishing formal mechanisms for communication  Avoids confusion and misunderstandings  Education for staff  Prison staff have decision making power that can affect an individuals’ situation  There are opportunities to diffuse best practices amongst staff which will, in turn, benefit the treatment and wellbeing of the client
    10. 10. Jail/prison systems might ask: “What’s in it for us?" Emphasize that this is often a low or no cost to the prison/jail system Use compelling arguments! Point out that community providers and jails share the same goals  In-reach and community follow up has the potential to reduce recidivism  Controlling the virus is not only cost saving in the community, but can also be potentially cost saving for prisons, since it might reduce urgent or emergency care needs, hospitalizations, etc
    11. 11.  Chain of command  Goals of corrections are security, control, safety  This can be challenging, but isn’t insurmountable  Often, you are a guest in the system  You may have limited access to technology  You have limited decision making power  Remember it’s a jail!  It can be jarring to be searched, to be locked in, and to otherwise adjust to a jail based setting if you’re accustomed to a community based setting
    12. 12.  Experience has shown us that linkage programs are more successful with an inside-outside approach.  Builds long term trust  Allows for monitoring of medical care on the inside for increased continuity upon release  Increases the likelihood that someone will present after release  At it’s most basic level, this approach allows service providers to walk with the client through their entire interaction with the criminal justice system
    13. 13.  Relationships with jail medical staff are essential – continuity relies on communication and collaboration  Medication – corrections settings have different standards for medications upon discharge  Leave with a 30 day supply  Leave with the remainder of your current meds  Leave with an Rx  Insurance  Prisons vs. Jails
    14. 14. The period of time following release is one of increased vulnerability. Best practices can include: Expedited medical appointments Incentives Inside-out staffing/familiar advocates One stop shopping models Multiple ways to contact Thorough assessment of vulnerabilities and triggers Be flexible and open to new, innovative strategies to meet people where they’re at and support them in making their healthcare a priority.
    15. 15.  There were variations across SPNS demonstration sites  Consistent with the HRSA definition - three medical visits in a 12 month period of time  One medical visit within 30 days of release, or within 90 days of release  Milestones in service linkage and stability in the community
    16. 16.  Redefining “success”  Developing a trusting relationship with providers so that linkage is maintained in spite of repeated interruptions due to re-incarceration.  Employing harm reduction strategies that support individuals in active addiction to keep them in care and use creative strategies to support adherence.  Building flexibility into the program to ensure that we’re meeting participants where they’re at.
    17. 17.  One stop shopping model/ Medical Home Model  Multidisciplinary team of jail and community providers characterized by increased communication and formalized structures  Capitalizing on the strength and power of peer leadership and mutual support  Knowing that the intersection of the parallel crises of HIV and mass imprisonment is a critical juncture – we need to work at this intersection to end the epidemic  Understanding that what people need first is safe space
    18. 18. Jail Linkage: Creating Partnerships and Navigating the Culture of Corrections Dissemination of SPNS Best Practices Linda Rose Frank, PhD, MSN, ACRN, FAAN Associate Professor of Public Health, Graduate School of Public Health Associate Professor, Center for Translational Science Institute, School of Medicine Associate Professor, Community and Health Systems, School of Nursing University of Pittsburgh Principal Investigator and Executive Director Pennsylvania/MidAtlantic AIDS Education & Training Center and Telehealth AETC Appalachian Project
    19. 19. 21
    20. 20. Substance Use, Mental illness Domestic Violence HIV/AIDS Homelessness Incarceration Copyright: Linda Frank, PhD, MSN, ACRN, FAAN, University of Pittsburgh, 2005
    21. 21. Pennsylvania/MidAtlantic AETC Jail and Prison Intervention since 1990  Training of prison and jail      Peer-based HIV education for inmates     HIV-related policies and procedures HIV testing and prevention HIV treatment Telemedicine consultation with prisons and jails    Statewide in PA Technical assistance to prisons and jails:   administration and leadership physicians, nurses, counselors, and clergy corrections officers probation and parole personnel HIV treatment Treatment of co-morbidities On-site consultation to prisons and jails
    22. 22. Pennsylvania/MidAtlantic AETC Prison/Jail Related Work      APHA Jail and Prison Health Committee State-related committees, forums on corrections Local jail, prison committees National and international presentations Testimony for legislators, policy forums, etc.
    23. 23. Approach to Dissemination  Convene PA/MA AETC team to review materials   Reviewed materials with HRSA SPNS and HRSA AETC leadership     included PA/MA AETC representatives from Philadelphia, Pittsburgh, DC, West Virginia, Ohio, Maryland Direction Scope of work Developed methods for dissemination which may include:  Development of print and electronic pocket guide on best practices  Related slide sets for training Posting of materials developed on    AETC National Resource Center (NRC) website Regional AETC websites HRSA Target Center website
    24. 24. Debra D’Alessandro, MPH Public Health Program Manager, Health Federation of Philadelphia, Local Performance Site Pennsylvania/MidAtlantic AETC
    25. 25. Pennsylvania/MidAtlantic AETCs O ngoing technical assistance with Philadelphia Prisons: before, during & after SPNS   Since 2000, bringing onsite CME accredited lunchtime clinical updates for correctional health providers Since 2007, convening HIV Discharge Planning Committee – Phila. Dept of Public Health (AACO), behavioral and physical health contractors, prison admin, two ASOs w/onsite case managers (ActionAIDS & Phila FIGHT)
    26. 26. Pennsylvania/MidAtlantic AETC activity in Phila. Prison System since 2000  Onsite training of correctional health staff, 3-6 times a year:     When needed, training for non-medical prison audience:    TB and occupational post-exposure prophylaxis education for CO supervisors Women’s health series, taught by community NPs, for female inmates Technical assistance:    Annual needs assessment with administration and leadership Physicians, nurses, PAs, MAs target, admin & others invited Accredited lunchtime sessions on HIV issues, co-morbidities and other public health topics (STDs, TB, MRSA and other skin infections) Opt-out HIV testing at intake – policy development, pilot, training Consultation regarding keep-on-person policy for HIV meds Since 2007, bi-monthly HIV Prison Discharge Planning Meetings
    27. 27. Lessons Learned from Philadelphia HIV Discharge Planning Committee  Face-to-face, multi-disciplinary case discussions can speed problem solving    Regular review of policy vs. practice can reveal need for procedure adjustments and ongoing training    M&M (morbidity and mortality) Reviewed cases when releasees NOT connected to care as missed opportunities what could be different next time Recent Example: medication upon discharge changes Opt-out testing at intake Referral to linkage staff for new or out-of-care positives Staff turnover means work is never “once and done”  Administrative and clinical staff changes can lead to confusion and/or apathy about testing and referral
    28. 28. Working in the Jail: Initial Questions to Consider    What is the jail’s view of HIV in comparison to other chronic health issues? Determine the composition of jail health professionals: how many, and what disciplines? How can you be “value added?” How do inmates request health & social services? How can you fit into this process?
    29. 29. More Lessons from EnhanceLink grantees:   Relationship building takes time. Account for this in your timeline and rollout of your program. Know what services you hope to refer inmates to upon release, and create partnerships with those organizations. Memoranda of Understanding are just the beginning. There needs to be follow-through. (“MOUs are paper, not partnerships.”) 
    30. 30.    Lessons from EnhanceLink grantees, cont… Do your homework. Know what services are in the jail and who is delivering them. How can you fill in service gaps? Listen and learn. Organizations already in the jail know how to work in this setting without interfering with Dept. Corrections operations and protocols. Be on everyone’s radar. To avoid “turf wars,” embrace transparency.
    31. 31. Questions?
    32. 32. Q&A To be informed when these upcoming IHIP resources are ready, sign up for the IHIP listserv by emailing Connect with Us Sarah Cook-Raymond, Managing Director |Impact Marketing + Communications | Twitter: @impactmc1| Facebook: ImpactMarCom | | 202-588-0300