Incarceration rarely improves any preexisting condition; instead, incarceration is more likely to exacerbate the conditions and often creates new ones.38 To improve the quality of treatment services provided and expand treatment capacity during and after incarceration, correctional health care providers working closely with behavioral health, social services and education providers need to first effectively assess the health needs of criminal justice system involved individuals and make that data accessible to practitioners across systems.
Reentry Ready project stakeholders assert firmly that incarceration and reentry systems should conduct comprehensive, evidence-based, gender-specific, trauma-informed assessment processes at first point of contact. Notwithstanding the need for additional research to improve the quality and effectiveness of assessment tools currently available, the stakeholders believe that assessment is an important first step towards improving the quality of services provided.
Making the assessment data available across systems, using electronic health and case management records, is tantamount to bridging the gaps in services that result when one system does not have the mandate or capacity to conduct assessments; even when the data could dramatically improve outcomes.
Stakeholders acknowledge that additional research and investment is needed to resolve barriers to accessing assessment data and sharing data across systems. Barriers to accessing assessment data include inadequate quality of the tools and too few staff trained to administer assessments properly, while antiquated technology and privacy concerns hinder data sharing. The stakeholders recommend additional opportunities to improve treatment quality and expand capacity as noted below.
Strategy in Practice: The Edgecombe Specialized Chemical Dependence Services program in New York City provides intensive services to people on parole housed at Edgecombe Residential Treatment Facility for a period of 10–45 days, preparing them for a return to their communities, and engagement in community-based addiction treatment. The facility houses 110 residents who have voluntarily entered treatment. The facility can serve approximately 1,200 individuals annually.
Edgecombe is staffed by a combination of Department of Corrections and Community Supervision (DOCCS) correctional officers, DOCCS rehabilitation counselors; and treatment staff of Odyssey House, the certified provider of the Office of Alcohol and Substance Abuse Services (OASAS). Individuals at Edgecombe are awaiting a determination by DOCCS regarding their possible reincarceration. The services are designed to provide intensive treatment to residents with the aim of returning them to their communities where they can continue addiction treatment. All residents are expected to have a diagnosed substance abuse disorder requiring intervention and treatment. Edgecombe effectively treats residents in a stabilization program and upon completion, they are referred to continuing care services consistent with an established treatment plan.
Strategy in Practice: The New York City jail system was a leader in and is still one of the largest jail systems to offer methadone and buprenorphine to patients with opiate use disorder.39 Recently, The New York City correctional health service has worked with the New York State Department of Corrections (DOC) on a pilot to allow parolees held at one facility under State DOC custody to also receive methadone. This pilot is the first step in bringing MAT to the larger number of prisoners in New York State custody and New York State pilot with parolees on methadone.
- Provide technical assistance to correctional leaders regarding evidence-based programs. Leaders of correctional systems have shared the need for support regarding how to select appropriate evidence-based programs for implementation. Often, they do not have assessment data, and when they do, many do not have staff qualified to make an informed decision about how to match the needs with the programs available to them. Some report that program decisions are most likely made with cost as the primary consideration, not applicability to the needs of their correctional population.
- Improve training for correctional agency staffs to help them learn how to administer assessments and conduct evidence-based interventions. Correctional staff and licensed clinical social workers need the skills to administer assessments to provide critical information needed to determine which programs and services individuals require to achieve reentry readiness goals. These staffs should be skilled in providing a range of treatment modalities, including, but not limited to, medication assisted therapies, cognitive behavioral skills training and cognitive behavioral therapy.
- Create a single formulary for medications. Ensuring continuity of care, including medication management, is critical to treatment of both physical and behavioral health conditions. When individuals are remanded to or released from custody, medical staff are loathe to interrupt the continuity of care because of the largely technical issue of not being able to prescribe the drugs that work best for the individual. In each state, the Medical Directors for the Medicaid agency and the state department of corrections can resolve this issue by creating a formulary that is utilized by both state agencies. In addition to improving continuity of care, state departments of corrections can realize some cost-benefit through multiagency purchasing agreements.
Strategy in Practice: The Maine Corrections Pharmacy Focus Group encouraged adoption of a single formulary saying that “…a standard formulary would facilitate movement of an inmate with medication needs from facility to facility.” 40 Single formularies not only save costs but may also improve inmate health outcomes.
Strategy in Practice: The Minnesota Multistate Contracting Alliance for Pharmacy offers state agencies that provide medical care the ability to negotiate with pharmaceutical companies as part of a national cooperative. Any state can join the cooperative to receive more favorable, volume discounted rates. Participating states have saved on average approximately 25 percent off the cost of brand-name drugs and 64 percent off generic drugs.41
Strategy in Practice: The United States Public Health Service Commissioned Corps plays a vital role in providing medical care to the underserved nationwide. Loan repayment is a compelling incentive for individuals to provide care. A similar program could be implemented by the Department of Justice to place psychiatrists, psychologists, behavioral health specialists, and health educators in correctional facilities and other programs serving criminal justice system involved individuals. This type of program can increase both the quantity and quality of services provided to this underserved population.
- Improve coordination of physical and behavioral health care services to criminal justice system involved individuals. Correctional health care service providers and community-based service providers should collaborate and share assessment data, clinical care plans, and medical records to ensure continuity of care. One of the critical tools for enabling better coordination of care is the electronic medical record (EMR).
By integrating physical and behavioral health delivery in one EMR, correctional health services can improve continuity of care for patients behind bars across areas of the health service and incarcerations, as well as when making collateral information requests for outside information and critically, responding to requests from court-based alternatives to incarceration and supportive housing placement.
Strategy in Practice: In the NYC jail system, hundreds of alternatives to incarceration are facilitated every year by jail-based reentry staff who leverage the EMR to quickly access vital aspects of care, including tuberculosis (TB) tests needed for inpatient programs and psychosocial assessments to help colleagues find more human and clinically appropriate settings for incarcerated or formerly incarcerated individuals.42
- Provide adequate and appropriate physical space for programming. Correctional facilities nationwide have insufficient space available to conduct all manner of programs,43 such as small group classes or parenting classes with children present, or that the space they do have is inappropriate to the purpose. The lack of adequate space for programming also means that correctional facilities must prioritize who has access to programs and, consequently, people with convictions are more likely than those without a violent offense to be eligible to participate. Excluding any group of participants from programs is counterproductive, especially if his or her assessment has indicated the need for a specific program.
Strategy in Practice: The Allegheny County Jail’s (ACJ’s) Family Activity Center (Pennsylvania) began with funding from two foundations and money from the county jail44. This center enabled the jail program staff to create a family playroom filled with toys, games. ACJ also provides relationship, parenting, and child development courses to incarcerated parents to help strengthen the bonds between themselves, their children, and the caregivers.
The individuals that participate in these classes can earn monthly contact visits and free phone calls with their children. The ACJ is trying to improve the health and well-being of children whose parents are incarcerated by reducing the repeated separations, the emotional upset and deterioration of family support that are a consequence of their parents’ incarceration.
