Editor’s Letter
Editor’s Letter
Journal of Correctional Health Care 2014, Vol. 20(4) 269-270 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1078345814541528 jcx.sagepub.com
Dear Colleagues, I recently attended ‘‘Health Reform and Criminal Justice: Advancing New Opportunities,’’ a national policy forum sponsored by Community Oriented Correctional Health Services (COCHS) in Washington, DC. This forum provided an opportunity to discuss multiple topics including health and criminal justice policy, eligibility and enrollment into Medicaid, integration of community and jail health systems, and health information technology’s role in building connectivity between corrections and the greater health care community. The associate attorney general of the United States, Tony West, and Michael Botticelli, acting director of the Office of National Drug Control Policy, were the keynote speakers. Their comments focused on the costs and benefits of the nation’s current sentencing and incarceration policies and how alternatives may achieve similar public safety benefits at lower financial and social costs. Both focused on the significant health disparities seen in the justice-involved population cycling in and out of our nation’s prisons and jails and the importance of leveraging opportunities brought about by health reform, especially for those suffering from substance abuse and mental illness. Mr. West announced a Department of Justice solicitation requesting proposals to help states and local jurisdictions maximize Medicaid and marketplace resources on behalf of justice-involved individuals. Four panel sessions were presented: (1) Who’s in Jail? How Does the Affordable Care Act Impact Eligibility and Enrollment? (2) Breaking Down Silos, (3) Integrating Services in Managed Care, and (4) Health Information Technology: Creating Connectivity Between Jails and Communities. Panelists reviewed the critical health and criminal justice issues that affect the jail- and prison-involved populations and presented an overview of initiatives and best practices that jurisdictions and communities have undertaken to enhance continuity of care and leverage health reform. Conference materials and the full webcast can be found at http://www.cochs.org/library/health-reform-andcriminal-justice-webcast
The Critical Importance of Jails Despite NCCHC’s landmark ‘‘The Health Status of Soon-to-Be-Released Inmates: A Report to Congress’’ in 2002 and the demonstration and best practices outcomes from Hampden County, Massachusetts, and the CDC/HRSA Corrections Demonstration Projects from 2000 to 2004, few people associate health care with the criminal justice systems. While prisons are most often the focal point of correctional policy discussions, jails in the context of community health care are critically important because they serve both as an entry point to the criminal justice system and as providers of care to a population that has high levels of unmet needs and is largely uninsured and underserved in the community. There are about 3,283 county, city, and local jails. Jails serve primarily as detention facilities, operated by counties or municipalities, to confine accused people awaiting trial. They also may be used to incarcerate convicted individuals who are serving short sentences, usually up to 1 year and usually for misdemeanor offenses. Jails process more people than do prisons and account for greater and more rapid reentry into the community. In 2012, local and county jails processed
270
Journal of Correctional Health Care 20(4)
more than 11.6 million admissions and, unlike prisons, most people in jail are released relatively quickly. More than 60% of the average 750,000 jail population is released within 1 week. Since jail inmates are incarcerated for shorter periods of time, they have more regular contact with their local communities and their health problems contribute to the local public health burden. This may be in the form of spreading infectious diseases within the community or in using expensive emergency room services for problems they cannot get treated elsewhere. This then becomes an expense that the public pays. The health of the jail-involved population truly represents a public health and a public safety issue. Jails are uniquely positioned to bring high-risk disenfranchised populations into the health care system and to connect them with services in the community to stay well. Doing so would not only improve the health of the jail-involved person but also help improve the control of disease in the community and possibly reduce crime. In truth, this rarely happens because the health care provided in jails is not connected with health care provided in local communities. At the time of booking, arrestees undergo medical screening and assessment, and they receive treatment including medication for diagnosed health problems while they are in jail. However, since 90% of inmates leave jail without health insurance coverage of any kind, they lack access to routine health care in the community. It is uncertain how much money counties, cities, and local governments spend on health care, but a recent estimate by the Urban Institute is that 9% to 30% of corrections budgets are allocated to inmate health care services. Yet, sad to say, this investment in health care is largely lost when people are released back to the community, where they typically cannot access treatment for their ongoing health problems. This is a major issue for people with mental illness and substance use disorders. Left untreated, these conditions may contribute to reoffending and a cycle of incarceration and release. Can we, our communities, and our families continue this? Correctional health and community health must be connected to form a continuum of care for the most vulnerable in our population. We are all part of one community! I applaud COCHS for continuing to expand the community model of care begun by Sheriff Ashe in Hampden County and its effort to support the highest standards of care and connectivity between jails and the community. While there are many forms of connectivity and strategies for achieving it, a major part of COCHS’ mission is to help jurisdictions develop and implement a strategy for building connectivity that is tailored to their needs, resources, and circumstances. COCHS projects have demonstrated the unique role that corrections and court personnel can play in identifying eligible individuals, assisting them with the enrollment process, and linking them to care in the community. They also have shown the importance of health information technology in breaking down communication barriers between correctional health and community health systems as a way to enhance care coordination. I wish them continued success. Sincerely, John R. Miles, MPA Editor
Editor’s Letter
Journal of Correctional Health Care 2014, Vol. 20(4) 269-270 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1078345814541528 jcx.sagepub.com
Dear Colleagues, I recently attended ‘‘Health Reform and Criminal Justice: Advancing New Opportunities,’’ a national policy forum sponsored by Community Oriented Correctional Health Services (COCHS) in Washington, DC. This forum provided an opportunity to discuss multiple topics including health and criminal justice policy, eligibility and enrollment into Medicaid, integration of community and jail health systems, and health information technology’s role in building connectivity between corrections and the greater health care community. The associate attorney general of the United States, Tony West, and Michael Botticelli, acting director of the Office of National Drug Control Policy, were the keynote speakers. Their comments focused on the costs and benefits of the nation’s current sentencing and incarceration policies and how alternatives may achieve similar public safety benefits at lower financial and social costs. Both focused on the significant health disparities seen in the justice-involved population cycling in and out of our nation’s prisons and jails and the importance of leveraging opportunities brought about by health reform, especially for those suffering from substance abuse and mental illness. Mr. West announced a Department of Justice solicitation requesting proposals to help states and local jurisdictions maximize Medicaid and marketplace resources on behalf of justice-involved individuals. Four panel sessions were presented: (1) Who’s in Jail? How Does the Affordable Care Act Impact Eligibility and Enrollment? (2) Breaking Down Silos, (3) Integrating Services in Managed Care, and (4) Health Information Technology: Creating Connectivity Between Jails and Communities. Panelists reviewed the critical health and criminal justice issues that affect the jail- and prison-involved populations and presented an overview of initiatives and best practices that jurisdictions and communities have undertaken to enhance continuity of care and leverage health reform. Conference materials and the full webcast can be found at http://www.cochs.org/library/health-reform-andcriminal-justice-webcast
The Critical Importance of Jails Despite NCCHC’s landmark ‘‘The Health Status of Soon-to-Be-Released Inmates: A Report to Congress’’ in 2002 and the demonstration and best practices outcomes from Hampden County, Massachusetts, and the CDC/HRSA Corrections Demonstration Projects from 2000 to 2004, few people associate health care with the criminal justice systems. While prisons are most often the focal point of correctional policy discussions, jails in the context of community health care are critically important because they serve both as an entry point to the criminal justice system and as providers of care to a population that has high levels of unmet needs and is largely uninsured and underserved in the community. There are about 3,283 county, city, and local jails. Jails serve primarily as detention facilities, operated by counties or municipalities, to confine accused people awaiting trial. They also may be used to incarcerate convicted individuals who are serving short sentences, usually up to 1 year and usually for misdemeanor offenses. Jails process more people than do prisons and account for greater and more rapid reentry into the community. In 2012, local and county jails processed
270
Journal of Correctional Health Care 20(4)
more than 11.6 million admissions and, unlike prisons, most people in jail are released relatively quickly. More than 60% of the average 750,000 jail population is released within 1 week. Since jail inmates are incarcerated for shorter periods of time, they have more regular contact with their local communities and their health problems contribute to the local public health burden. This may be in the form of spreading infectious diseases within the community or in using expensive emergency room services for problems they cannot get treated elsewhere. This then becomes an expense that the public pays. The health of the jail-involved population truly represents a public health and a public safety issue. Jails are uniquely positioned to bring high-risk disenfranchised populations into the health care system and to connect them with services in the community to stay well. Doing so would not only improve the health of the jail-involved person but also help improve the control of disease in the community and possibly reduce crime. In truth, this rarely happens because the health care provided in jails is not connected with health care provided in local communities. At the time of booking, arrestees undergo medical screening and assessment, and they receive treatment including medication for diagnosed health problems while they are in jail. However, since 90% of inmates leave jail without health insurance coverage of any kind, they lack access to routine health care in the community. It is uncertain how much money counties, cities, and local governments spend on health care, but a recent estimate by the Urban Institute is that 9% to 30% of corrections budgets are allocated to inmate health care services. Yet, sad to say, this investment in health care is largely lost when people are released back to the community, where they typically cannot access treatment for their ongoing health problems. This is a major issue for people with mental illness and substance use disorders. Left untreated, these conditions may contribute to reoffending and a cycle of incarceration and release. Can we, our communities, and our families continue this? Correctional health and community health must be connected to form a continuum of care for the most vulnerable in our population. We are all part of one community! I applaud COCHS for continuing to expand the community model of care begun by Sheriff Ashe in Hampden County and its effort to support the highest standards of care and connectivity between jails and the community. While there are many forms of connectivity and strategies for achieving it, a major part of COCHS’ mission is to help jurisdictions develop and implement a strategy for building connectivity that is tailored to their needs, resources, and circumstances. COCHS projects have demonstrated the unique role that corrections and court personnel can play in identifying eligible individuals, assisting them with the enrollment process, and linking them to care in the community. They also have shown the importance of health information technology in breaking down communication barriers between correctional health and community health systems as a way to enhance care coordination. I wish them continued success. Sincerely, John R. Miles, MPA Editor
