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Public Health in the Correctional Setting: Challenges & Opportunities
 

Public Health in the Correctional Setting: Challenges & Opportunities

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Presented at the Maine Public Health Associations' Annual Meeting - October 5, 2010

Presented at the Maine Public Health Associations' Annual Meeting - October 5, 2010

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    Public Health in the Correctional Setting: Challenges & Opportunities Public Health in the Correctional Setting: Challenges & Opportunities Presentation Transcript

    • Amanda Edgar
      City of Portland Public Health Division
      Substance Abuse Prevention Program
      (207) 756-8053
      aedgar@portlandmaine.gov
      www.substanceabuse.portlandmaine.gov
      www.facebook.com/portlandprevention
      www.twitter.com/portprevent
      Public Health in the Correctional Setting: Challenges & Opportunities
    • National Statistics
      “65 PERCENT OF ALL U.S. INMATES MEET MEDICAL CRITERIA FOR SUBSTANCE ABUSE ADDICTION, ONLY 11 PERCENT RECEIVE ANY TREATMENT”
      “Of the 2.3 million inmates crowding our nation's prisons and jails, 1.5 million meet the DSM IV medical criteria for substance abuse or addiction, and another 458,000, while not meeting the strict DSM IV criteria, had
      histories of substance abuse;
      were under the influence of alcohol or other drugs at the time of their crime;
      committed their offense to get money to buy drugs;
      were incarcerated for an alcohol or drug law violation;
      or shared some combination of these characteristics...
      Combined these two groups constitute 85 percent of the U.S. prison population.”
      SOURCE: CASA Columbia, February 26, 2010 (Behind Bars II: Substance Abuse and America’s Prison Population)
      http://www.casacolumbia.org/templates/PressReleases.aspx?articleid=592&zoneid=79
    • National Statistics (cont’d)
      “Female inmates make up 8.4 percent of the total inmate population--up from 7.7 percent in 1996.
      “Female inmates are likelier to have a substance use disorder than are male inmates (66.1 percent vs. 64.3 percent). This holds true for both state prisons and local jails, but among inmates in federal prisons, males have higher rates of substance use disorders than do females.
      “Female inmates are likelier than are male inmates to suffer from co-occurring substance use and mental health disorders (40.5 percent vs. 22.9 percent).
      “Failure to address their [women’s] substance-related problems can perpetuate both high recidivism rates and a high rate of juvenile delinquency among their children.”
      SOURCE: Behind Bars II: Substance Abuse and America’s Prison Population, page 30-1
    • National Research & Case Studies
    • “A Public Health Model for Correctional Health Care”
      Issue: Traditionally many correctional facilities provide a minimum of necessary care to their inmates and return them to the community with undetected, untreated or under-treated disease which have major consequences not only for the individual, but also for the health of the community as well.
      Setting: Hampden County Correctional Center in Ludlow, Massachusetts
      Project: The Hampden County Correctional Center (HCCC) is an innovative community-based model of correctional health care. Inmates who participate in the program are less likely to recidivate and are more likely to be seen at community health care centers.
      Lessons Learned: Evidence from this project suggests that health care provided in a correctional setting should not only be comprehensive, but also continuous upon release into the community in order to facilitate reintegration and prevent recidivism. To support this continuity of care model, many key players need to be at the table, including the court, corrections, the health department, substance abuse, mental health, academia, community-based organizations, volunteer agencies, and the community.
      SOURCE: NIH, National HIV Prevention Conference (1999)
      http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102187764.html
    • “A Public Health Model for Correctional Health Care”
      Key elements for successful implementation of the model include:
      Support of the model from high-level correctional administrators, including a dedication to improving inmate and community health;
      Commitment to collaborate openly with state agencies and local non-profit providers;
      Willingness to substantially change the existing correctional health care system and culture;
      Commitment to aggressively seek new sources of funding and support to implement and sustain the model.
    • “A Public Health Model for Correctional Health Care”
      The benefits of adopting a public model of correctional health care are many, including:
      Improved inmate & community health
      Improved public safety
      Improved correctional staff safety
      Improved use of the health care system
      Cost savings for communities
      High quality health care at a cost no greater than the national average
    • “A Public Health Model for Correctional Health Care”
      The following five elements form the basis for all services and programs:
      Early assessment and detection
      Prompt and effective treatment at a community standard of care
      Comprehensive health education
      Prevention measures
      Continuity of care in the community upon release
    • “Infection control in jails and prisons”
      Abstract:
      Compared with the general public, newly incarcerated inmates have an increased prevalence of human immunodeficiency virus infection, hepatitis B virus infection, hepatitis C virus infection, syphilis, gonorrhea, chlamydia, and Mycobacterium tuberculosis infection.
      While incarcerated, inmates are at an increased risk for the acquisition of blood-borne pathogens, sexually transmitted diseases, methicillin-resistant Staphylococcus aureus infection, and infection with airborne organisms, such as M. tuberculosis, influenza virus, and varicella-zoster virus.
      While incarcerated, inmates interact with hundreds of thousands of correctional employees and millions of annual visitors. Most inmates are eventually released to interact with the general public.
      Tremendous opportunities exist for infectious diseases specialists and infection-control practitioners to have an impact on the health of correctional employees, the incarcerated, and the communities to which inmates return.
      SOURCE: PubMed- Abstract, 2007
      http://www.ncbi.nlm.nih.gov/pubmed/17879924
      Bick, Joseph. Clinical Infectious Diseases 2007; 45:1047–55
      http://www.wvidep.org/Portals/31/infection%20control/Jail%20Infxn%20Control.pdf
    • “Characteristics of inmates witnessing overdose events in prison: implications for prevention in the correctional setting”
      Background:
      There is scarce information about drug overdose in prison. In correctional institutions without a drug free environment, awareness of overdose events is an important public health concern.
      This study explores the frequency with which inmates in a state penitentiary system report having witnessed drug overdose events in prison. It also explores whether participants who have witnessed an overdose in prison and know someone who died from an overdose in prison significantly differ from those that do not in selected sociodemographic variables and drug use history toidentify a target population for prevention interventions.
      Data comes from a cross-sectional survey of sentenced inmates in the state prisons of Puerto Rico. A complex probabilistic, multistage sampling design was used. A total of 1,179 individuals participated for an 89% response rate.
      Results:
      Factors associated with witnessing an overdose event in prison include: male sex, age 25 or older, drug use during current incarceration, and drug injection in prison. Factors associated with knowing someone who died from an overdose in prison include: male sex, age between 25–35, previous incarcerations, and drug use during current incarceration.
      Conclusion:
      Witnessing a drug overdose is a frequent occurrence within the prison system. The likelihood of witnessing an overdose is greater with being male, polydrug use and drug injection in prison.
      Findings signal an urgent public health challenge that requires prompt interventions to reduce this drug related harm within the correctional system, including adequate access to medication with opiate agonists.
      SOURCE: Harm Reduction Journal (2009)
      http://www.harmreductionjournal.com/content/6/1/15
    • Local Statistics: Cumberland County Jail
      Average Daily Inmate Population
      350-400 (+/-)
      Average Daily Population By Gender
      Male – 82%
      Female – 18%
      Average Daily Population By Race
      White – 76%
      Black – 11%
      Latino/Hispanic – 10%
      Other – 3%
      Average Daily Population By Judicial Status
      Sentenced - 39%
      Pre-Trial – 25%
      Federal Detainees – 24%
      Pre-Arraignment – 5%
      Probation – 7%
      SOURCE: Cumberland County Jail 2008 Annual Report
      http://www.cumberlandso.org/PDF%27s/Annual%20Report%202008/CCSO%202008%20Annual%20Report.pdf
    • Our Programs: What We Offer
      Portland Women’s Task Force
      Informational brochures on opiate addiction & treatment during pregnancy
      Weekly support gathering for moms in recovery
      Advocacy to provide medications that treat addiction in the correctional setting
      Overdose Prevention Project
      Print materials on how to respond to an overdose
      Staff trainings on substance abuse trends
      Educational support groups
      Cumberland County Jail (twice/week for men and women)
      Maine Correctional Center (once/month for women)
      Overdose Prevention Jeopardy
      HBO: Addiction (DVD)
      Overdose Risk Assessment Quiz
    • Educational Support Groups: The Numbers
      January 2008-December 2008
      GROUPS HELD: 107
      PARTICIPANTS: 485
      Male: 279
      Female: 206
      January 2009-December 2009
      GROUPS HELD: 78
      PARTICIPANTS: 403
      Male: 304
      Female: 99
      January 2010-June 2010
      GROUPS HELD: 43
      PARTICIPANTS: 251
      Male: 175
      Female: 76
    • Barriers/Challenges: Our Experience
      “Red Tape” within the correctional setting
      Staff turn-over
      Funding challenges
      Training calendar/structure
      Inmate cell searches
      You may arrive onsite only to be told you have to come back another day once the searches have been completed (often, searches are due to reports of contraband within the facility)
      Wide-spread illness
      If there is an outbreak of an illness, your services may be compromised (i.e.: you have to wait until it’s clear to go back in)
    • Opportunities on the Inside
      Even though medical services are provided, incarcerated individuals are ripe for services and interventions as they often lack access to wide-ranging services on the inside
      “Captive” audience
      Many correctional settings rely on volunteers to provide services to inmates due to funding or staffing issues
      “For many, it is the first time they have received adequate health care from a caring group of providers. The commitment to continue their care is evident in the high rates of inmates who keep their medical appointments after release.” (PH Model for Correctional Health, MPHA)
      Building relationships with correctional facility staff
      Access to sub-populations
      Adolescents
      Men
      Women
      Prenatal, pregnant or postpartum women
      Minority populations
      LBGTQ populations
      Aging/elderly population
      IV drug users
    • Opportunities on the Inside (cont’d)
      HIV/STD/Hepatitis education/prevention
      Portland Public Health offers testing on a weekly basis to all interested inmates @ CCJ
      Smoking cessation tools
      Chronic disease prevention
      Multi-lingual/multi-cultural support services
      LGBTQ support services
      Substance abuse education/prevention, treatment resources
      Mental health education/support
      Parenting tips/support
      Pre-natal health screenings
      Suicide prevention
      Oral Health
      Reproductive Health
      Violence/trauma prevention
      Linking inmates to community health centers post-release
      Training of correctional facility staff
      Domestic violence education/support
      Family Crisis Services offers support groups to women @ CCJ & Windham Correctional Center
    • References & Resources
      “Behind Bars II: Substance Abuse and America's Prison Population” CASA Columbia, February 2010
      http://www.casacolumbia.org/templates/PressReleases.aspx?articleid=592&zoneid=79
      “Characteristics of inmates witnessing overdose events in prison: implications for prevention in the correctional setting” Harm Reduction Journal 2009; Jul 9;6:15.
      http://www.harmreductionjournal.com/content/6/1/15
      Cumberland County Jail Annual Report (2008)
      http://www.cumberlandso.org/PDF%27s/Annual%20Report%202008/CCSO%202008%20Annual%20Report.pdf
      “Infection control in jails and prisons” Bick, Joseph. Clinical Infectious Diseases 2007; 45:1047–55.
      http://www.wvidep.org/Portals/31/infection%20control/Jail%20Infxn%20Control.pdf
      http://www.ncbi.nlm.nih.gov/pubmed/17879924
      “A Public Health Model for Correctional Health Care” Massachusetts Public Health Association
      http://www.mphaweb.org/PublicHealthModelforCorrectionalHealth.htm
      NIH, National HIV Prevention Conference (1999)
      http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102187764.html
      “A Public Health Model for Correctional Healthcare” : 104-page manual (2002)
      http://www.mphaweb.org/documents/PHModelforCorrectionalHealth.pdf
    • QUESTIONS?COMMENTS?
    • Amanda Edgar
      City of Portland Public Health Division
      Substance Abuse Prevention Program
      (207) 756-8053
      aedgar@portlandmaine.gov
      www.substanceabuse.portlandmaine.gov
      www.facebook.com/portlandprevention
      www.twitter.com/portprevent
      Contact Information