"HIPAA (Health Insurance Portability and Accountability Act of 1996) and 42 CFR Part 2 (Title 42: Public Health, Part 2—Confidentiality of Substance Abuse Patient Records) are two of the most commonly cited barriers to cross-domain information sharing" (p. 1). This brief takes the ten most common myths about justice-health information sharing and explains the realities behind them.
"This document outlines a range of policy solutions that would go a long way towards addressing discriminatory and abusive policing practices, improving conditions for LGBT [lesbian, gay, bisexual, and transgender] prisoners and immigrants in detention, de-criminalizing HIV, and preventing LGBT youth from coming in contact with the system in the first place " (p. 6). Sections contained in this report include: introduction and summary; policing and law enforcement; prisons—discrimination and violence inside prions and related facilities, health and nutrition, access to programming, and placement within prison facilities; immigration; criminalization of youth; criminalization of HIV; and drivers of incarceration—drug policy, collateral consequences of criminalization and incarceration, criminalization of poverty and homelessness, lack of access to ID and social services for transgender people, and criminalization of sex work and responses to trafficking in persons.
Anyone working with female offenders should read this systematic review of 13 studies from 1980 to 2014. It provides a very good look at effective HIV prevention interventions for justice-involved women. "As compared with interventions without an explicit theoretical orientation, interventions using a social cognitive theory or motivational interviewing orientation were more efficacious. Interventions delivered fully or partially in the community setting were also more efficacious than those delivered only within a correctional facility. We conclude that extant behavioral interventions do not adequately consider contextual and social factors that influence women’s sexual behavior, but rather focus on individual deficits in knowledge and skills. Findings underscore the need for continued development of theoretically based HIV prevention interventions that follow women with criminal justice involvement from correctional settings to the community, explicitly acknowledging the role of social and contextual determinants of HIV risk" (p. 253).
Why ACA Mapping Now?
State and local criminal justice systems are poised to change the way they do business. With the Patient Protection and Affordable Care Act (ACA), it is now possible for millions of low-income individuals in the criminal justice system to obtain insurance coverage for their physical and behavioral health care needs. This far-reaching system change will affect every decision point of the criminal justice system, from pretrial to reentry, and every partner, from correctional health to behavioral health.
A large number of individuals in the criminal justice system struggle with chronic health problems and mental health and substance abuse disorders. Of these individuals, it is expected that four to six million (roughly one-third) of the newly insured Medicaid population in 2016 will include people who will have been booked into jails during the year.
As states begin to implement the ACA and the criminal justice-involved population begins to receive care through Medicaid and marketplace insurance coverage, criminal justice agencies must be part of the planning and implementation conversations.
ACA Mapping Activities
NIC's ACA Mapping Initiative began in early 2013 with the development of the Healthcare Enrollment Intercepts map (shown below) and the creation of the ACA Mapping Process. On December 2-3, 2013, the NIC sponsored a two-day mapping work session in Cheshire, Connecticut. During the two-day work session, participants developed a map of criminal justice system decision-points, discussed existing ACA enrollment activities, and identified and prioritized opportunities for increasing enrollment.
Results of this technical assistance to date include expanded Medicaid enrollment at Intercept 2: the Public Defender’s Office has offered enrollment services to medically ill individuals and individuals with substance abuse disorders and the Department of Corrections is in the process of developing a Medicaid enrollment program in their jails.
A second two-day mapping session followed in October 2014, which focused on the specific opportunity of improving information flow of health care data between agencies. This responsive technical assistance event focused on mapping the bi-directional current flow of data from point of initial detention and hearings with a focus on identifying opportunities for increased efficiency (standardization), sharing information and reducing duplication of information and services to enhance continuity of care. An outcome of the mapping meeting was the rollover of the priorities identified in the mapping session into a statewide improvement initiative (LeanCT) allowing for the continued analysis on how Medicaid and other entitlement applications are processed with the goals of addressing duplication and inefficiencies inherent in the current process to include enabling suspension versus termination of Medicaid during incarceration; increasing continuity of care opportunities and reducing duplicative work across agencies.
Systems mapping creates opportunities for dialogue and relationship building between health and justice stakeholders. By working together to build a visual portrait of how individuals progress through the criminal justice system, health and justice stakeholders gain better understanding of their respective policies and practices. In addition, mapping allows jurisdictions to consider decision points throughout the entire criminal justice system when exploring opportunities to enroll criminal justice involved individuals in insurance coverage.
During and ACA Mapping session, participants work together to map the decision points across the entire criminal justice system, from arrest to jail, prison, parole, and beyond where they might integrate health care enrollment or assessment in existing criminal justice processes. In addition, they will identify existing activities and opportunities for enhanced or new activities associated with health coverage enrollment, service referral, and other integration. The mapping process is a launching point for enhancing system efficiency and effectiveness related to the ACA.
Additional Technical Assistance Activities
- Kentuckiana Regional Planning & Development Agency (January 2015)
NIC sponsored a two- day planning session in Louisville, KY with Kentuckiana Regional Planning & Development Agency (KIPDA) and their partners Healthy Reentry Coalition of KY, Louisville Metro Criminal Justice Commission, Louisville Metro Department of Corrections, and the KY Voices of Health. The two- day work session facilitated discussion between justice and health professionals, identifying existing opportunities and challenges related to the Affordable Care Act and Medicaid eligibility and enrollment. Additionally, work session participants and discussed how the existing infrastructure can be improved and expanded to advance the work of the Lousiville Metro Dual Diagnosis/Cross Functional Team, the Lexington Department of Corrections, the KY State Department of Corrections and the Federal Bureau of Prisons, Mid-Atlantic Region.
- Commonwealth of Massachusetts - Office of Medicaid and Massachusetts Sheriffs Association (February 2015)
NIC currently working with the National Criminal Justice Association and several MA state agencies developing a training session and works sessions to improve Medicaid enrollment practices for justice-involved populations and improve the suspension process for Medicaid benefits. Goals identified include increasing continuity of care, reducing recidivism and identifying cost reduction strategies.
- NORCOR Corrections, The Dalles, OR
NIC will assist the regional jail facility develop a coordinated process to connect justice-involved individuals to appropriate medical and mental health service to reduce costs and achieve better outcomes.
If you are looking for a great overview of privatization and public-private partnerships in criminal justice and corrections, then this is the place to start. “Now in its 26th year of publication, Reason Foundation's Annual Privatization Report is the world's longest running and most comprehensive report on privatization news, developments and trends” The Criminal Justice and Corrections section contains subsections covering: A. 2012 Corrections Privatization Overview; B. State and International Corrections Privatization Update; C. State and Local Correctional Healthcare Privatization Update; D. ANALYSIS: Recent Developments in the Federal Civil-Rights Liability of Federal Private Prisons; E. FOCUS: The Emergence of Social Impact Bonds: Paying for Success in Social Service Innovation; F. FOCUS: Colorado, Washington State Vote to Tax and Regulate Recreational Marijuana for Adults.
This article "aims to demonstrate how public health issues are inherent in numerous aspects of the criminal justice system. Then it will offer a conceptual framework for applying many of the fundamental principles of public health to the realm of criminal justice—whether specifically to those who are incarcerated or otherwise under supervision of the justice system or, more broadly, to a broader range of social ills" (p. 1). Sections of this report cover: the nexus of health and justice; sentencing and health concerns; intake and screening; rehabilitation, reentry, and reintegration—health impediments; discharge planning and continuum of care; a public health approach to criminal justice; health concerns beyond incarceration; the epidemiological model; and the cycle of infection.
"On September 17, 2014, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) convened a two-day conference in Rockville, Maryland called Bridging the Gap: Improving the Health of Justice-Involved People through Information Technology. The meeting aimed to address the problems of disconnected justice and health systems and to develop solutions by describing barriers, benefits, and best practices for connecting community providers and correctional facilities using health information technology (HIT) … The following proceedings give an overview of each session and a synthesis of the obstacles to instituting HIT solutions for information sharing detailed during the meeting. The proceedings address the importance of using emerging HIT to respond to the growing problem of people with mental health and substance use disorders involved in the criminal justice system and to articulate a vision of how HIT can facilitate ongoing connections between health and justice systems" (p. 2). Sections cover: the vision—no wrong door; from correctional facilities to community providers; from community providers to correctional facilities; challenges of using health information technology to improve the health of justice-involved people; overcoming challenges—opportunities and solutions; resources for finding solutions; case study—creating a health ecosystem in Louisville, Kentucky.
Chronic care clinic procedures and protocols are provided for the following areas: cardiovascular, diabetes mellitus, gastrointestinal, hypertension, infectious disease, seizure, pulmonary, tuberculosis infection, and men's and women's wellness clinics. The document, "Drug Formulary," by the Georgia Department of Corrections is included.
A comprehensive reference that provides guidance in the provision of health services to inmates is presented. This manual contains the following chapters: introduction; historical overview -- the movement to improve correctional health care; legal considerations in the delivery of health care services in prisons and jails; ethical considerations and the interface with custody; the organizational structure of correctional health services; staffing considerations; health care delivery system model; programming for special health needs; women's health needs and services; health promotion and disease prevention; planning correctional health facilities; data management and documentation; improving the quality of correctional health care; cost considerations -- financing, budgeting, and fiscal management; and conclusions and future issues. Appendixes provide: Health Summary for Classification; sample organizational structure charts; coverage factor calculation summary; comparative analysis of health care standards in prisons and jails; sample health record forms; matrix for special health needs; sample mental health policies; NCCHC's "Position Statement on the Administrative Management of Inmates With HIV-Positive Test Results or AIDS"; sample clinic/infirmary equipment list; sample quality improvement policy and guidelines; cost-comparison tables; and about the NCCHC.
With the rates of incarceration skyrocketing, the need for effective and more efficient correctional healthcare services has skyrocketed. Many health problems that plague our society plague the corrections industry at an even greater rate; increasing demand for healthcare services for the mentally ill, substance abuse, suicide prevention, and care for the elderly to name a few… are placing greater and greater demands on an already overworked system. The NIC Information Center has collected a number of resources to provide an overview of the issues surrounding correctional healthcare.
A special thanks goes to Jefferson County Sheriff's Office for the photograph.