The Missing Link in Prison-to-Community

Transition

In their own words…

• “I’m not used to getting medical care, so I don’t know how sick I need to be before I make an appointment.”

• “I’ve never had a 1:1 relationship with a doctor. They’re so smart. What do I say to them?”

• “I’m intimidated by them telling me what to do. I don’t want them to think I’m blowing them off, but I just got out of prison – quitting smoking or going on a diet are the least my worries right now.”

• “Dentists see my record, judge me as a drug addict, then won’t give me enough pain medication. I’m too ashamed and scared [of authority] to challenge them.”

Today…

• In what ways are ex-convicts an important part of community and society?

• How does prison subculture impact access to post-release health care?

• How can WMC best serve these gentlemen?

Rationale

• Ex-convicts are a growing demographic of WMC clientele• 150 per month released in Multnomah county from Oregon

prisons (www.ODOC.gov)

• WMC is the only clinic in Rockwood, where more than 40 Phoenix members live – who will soon be insured!

• Medical care is the “first net” for multiple services

Benefits

• Medical intervention decreases recidivism (Golzari, Hunt, & Anoshiravani, 2006)

• Disease prevention is cost-effective & strengthens public health

• WMC gains insured patients

• Phoenix members want a relationship with medical community – less likely to no-show

… and what else?

• Stronger economy in Rockwood• Stronger families in Rockwood• Community organizing

Results of prison subculture exposure

• Fear of being judged (Schnittker & John, 2007)

• “Forget it” attitude (Schnittker & John, 2007)

• Got used to hearing “no”• Officers downplays medical needs; red-tape to get medical care• Learned helplessness – initiating care is unfamiliar (Griel & Loeb, 2006;

Mathis & Schoenly, 2008; Normal, 2010)

• Prison exacerbates non pro-social behavior (Morris et al., 2012)

Results of prison subculture exposure

• “Being tough” (Mathis & Schoenly, 2008)

• Prison subcultural notions of masculinity • Less forthcoming – staff may have to ask more questions

• Oral health concerns• Poor dental care in prison – bad teeth may not be due to their

personal neglect, but lack of treatment / education

• Skills learned in prison, which are maladaptive in community• Had to align with groups that may not align with their personal

values• May be averse to meds perceived negatively in prison, but they

won’t tell you directly; they will simply not take the medication

Prison is constant contradiction

• No privacy, yet lonely

• Monitored 24 hours per day, yet “no place to belong”

• Lack of personal choice, yet held responsible for personal conduct

• Lack of physical movement (locked up), yet emotions get more stirred up

• Different pressures / responsibilities • Prison skills may not translate into a job; yet expected to be employed

Prison subculture:Take-home message

Trust is severely damaged (Vaughn, 1999)

• … trust in authority and “systems”• … trust in their abilities to thrive in society

Knowing that they’ve been in prison matters• Staff can offer resources unique to ex-convicts (RTC,

Impact NW)• Prevalence of certain chronic conditions (MRSA, Hep-C;

oral health; poorly healed bones)

Current prison-to-community transition process

• Upon release• 30 days of meds & SNAP• Pre-release health insurance enrollment is currently unpredictable

• Resources available, but ex-cons have to know how to find them• Reentry Transition Center, Impact NW, SE Works

• Detailed post-incarceration paperwork• Doing anything other than trying to survive seems extraneous;

stress, anxiety; can’t contribute / participate in community as members

The Vision of Phoenix

Current prison-to-community transition process

Take home message

There is no overarching system in place to help ex-convicts access community resources, or learn how to use those resources in an on-going way.

The solution: Personal relationships make it happen!

What WMC staff can do…

• Fear of being judged: Patience, decency, respect, honesty

• “Forget it” attitude: Explain the details without patronizing

• They may not know what to ask or report• Walk them through the steps – even paperwork may be

overwhelming• Offer information & ask questions you may think are simplistic or

obvious

What WMC staff can do…

• Don’t try to save them, or treat them like children• Yet there is a lot they don’t know about the medical system, health

promotion and disease prevention – and they do want to know

• Unique to Phoenix – grounded in relational culture • Share your experiences & emotions• Members will connect with and recognize this, and want to come

back

Hold in mind…

Ex-cons want health, connection, a place to belong.

Personal, on-going relationships with medical staff can change their life (Uggen, Manza, & Thompson, 2006)

Ex-cons are members of our community;

their success is literally our community’s success.

Thanks to…

Harry Olsen, Karen Meurer,

Sherry Archer, MSN

and all the gentlemen of Phoenix.

References

• Golzari, M., Hunt, S. J., & Anoshiravani, A. (2006). The health status of youth in juvenile detention facilities. Journal of Adolescent Health, 38(6), 7.

• Griel, L.C., & Loeb, S.J. (2009). Health issues faced by youth incarcerated in the justice system. Journal of Forensic Nursing, 5, 162-179.

• Mathis, H., & Schoenly, L. (2008). Healthcare behind bars: what you need to know. The Nurse Practitioner, 33(7). 34-41.

• Normal, A. (2010). Improving offender health care. British Journal of Nursing, 19(22), 1387.

• Schnittker, J., & John, A. (2007). Enduring stigma: The long-term effects of incarceration on health. Journal of Health and Social Behavior, 48, 16.

• Uggen, C., Manza, J., & Thompson, M. (2006). Citizenship, democracy and civic reintegration of criminal offenders. The Annals of the American Academy, (605), 281-310.

• Vaughn, M.S. (1999). Penal harm medicine: State Tort remedies for delaying and denying health care to prisoners. Crime, Law and Social Change, 31, 273-302.