Melissa Klein 11/6/2011. 1985 Healthcare for the Homeless Project (HCHP) 1996 HCHP becomes grantee...
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Transcript of Melissa Klein 11/6/2011. 1985 Healthcare for the Homeless Project (HCHP) 1996 HCHP becomes grantee...
Melissa Klein
11/6/2011
Community Oriented Correctional Medicine
Unity Health Care
1985 Healthcare for the Homeless Project (HCHP)
1996 HCHP becomes grantee to run community health centers and becomes a FQHC
2001 Unity Health Care is named2006 Unity takes contract to provide medical
care inside the DC Jail with a community oriented correctional medicine model
2008 Unity receives Robert Wood Johnson grant to fund Reentry Health Center
Outline risk factors for incarcerationIdentify medical problems that
disproportionately affect the incarcerated population
Discuss Reentry into care for patients returning home from jail or prison
Goals
Over the past 40 years the number of people in US prisons has increased by more than 600%
U.S. today has the highest incarceration rate of any country in the world
Over 2.3 million men and women living behind bars
This marks the highest rate of imprisonment in U.S. history
The epidemic of incarceration
Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:2081-2083.
Source: Bureau of Justice Statitstics. Correctional Populations in the United States, 2009 and Prisoners in 2009.
The War on Drugs
Source: FBI, Uniform Crime Reports, Crime in the United States, annually.
Arrests for Drug Abuse
Substance use and dependence are prevalent with 50% of inmates meeting DSM-IV criteria for drug dependence and 20% of state prisoners have a history of injection-drug use.
Incarceration of the Mentally Ill50 years of
movement from hospitals and treatment centers to jails and prisons
Lack of community mental health systems has resulted in jails and prisons housing many patients with serious mental illness
Human Rights Watch. Ill Equipped: U.S. Prisoners and Offenders with Mental Illness. 2003.
Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:2081-2083.
Minorities are over-represented among the incarcerated
40% of the US prison population is black, while only 12% of the US population is black
Black men in the US are more likely to have spent time in prison than to have graduated from college or joined the military
Race and Incarceration
Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:2081-2083.
Image taken from Prison Policy Initiative websiteStatistics as of June 30, 2004 from Prison and Jail Inmates at Midyear 2004, Tables 1, 14 and 15 and U.S. Census. (Peter Wagner, June 2005)
PovertyHomelessnessDrug AbuseMental IllnessLow level of education
Risk Factors for Incarceration
Similar to community outpatient medicinePatient seen in medical unit or on cell blockPatients are younger on average, predominantly
maleHIV & HCV
As many as a quarter of all Americans infected with HIV and one in three with Hep C pass through a correctional facility each year
DM, HTN, HLD, orthopedic injuries commonSpecialty inside – ID, ortho, podiatry, dermOutside referrals – Radiology, ENT, heme/onc, neuro,
gen surg, rheum, GI. . .Health Promotion challenges and opportunities
Medical Care Inside
Rich JD, Wakeman SE, Dickman SL. Medicine and the Epidemic of Incarceration in the United States. N Engl J Med 2011; 364:2081-2083.
Chronic Disease Prevalence DC Jail
Slide courtesy of Unity Health Care. Lapp D, Zabiheian V. A Model of Care: Correctional Medicine and the Community.
Reentry30 days of HIV medication3 days of all other medications with Rx for 30
daysConnection to community clinic, appointment
scheduledHalfway house patients seen at ReEntry
Health CenterSocial Services at Community Health
Centers:Job trainingGED, literacyHousingIDHealth Insurance
Providers familiar with their challengesAccess to Medical CareAccess to Mental Health ServicesSubstance abuse treatment and supportEducationJob training and employment servicesHousingCommunity
Health Inside and Out