Chronic medical conditions in criminal justice involved populations

Amy J. Harzke; Sandi Pruitt

Chronic medical conditions in criminal justice involved populations

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Abstract

Nationally representative data collected by the Bureau of Justice Statistics (BJS) have shown increasing and elevated prevalence of a number of non-infectious chronic medical conditions in criminal justice populations relative to the non-institutionalized population. Prevalence of these conditions, including hypertension and arthritis, are especially high among elderly and female prisoners and jail inmates. State- and site-specific prevalence estimates, however, have revealed patterns that are somewhat inconsistent with BJS national data. We summarize the extant literature regarding prevalence of chronic medical conditions in U.S. prison and jail settings, determinants of these conditions across the phases of criminal justice involvement, and potential opportunities for reducing and managing the burden of chronic medical conditions in criminal justice populations. We provide research and policy recommendations for improving measurement of the burden of chronic medical conditions in criminal justice populations, provision of healthcare in correctional settings, and post-release continuity of care and community reentry.

Original language	English (US)
Pages (from-to)	306-347
Number of pages	42
Journal	Journal of Health and Human Services Administration
Volume	41
Issue number	3
State	Published - Dec 1 2018

ASJC Scopus subject areas

Leadership and Management
Health Policy
Public Health, Environmental and Occupational Health

Cite this

@article{12dbc678b88a472fb9f0067eb8a806c2,

title = "Chronic medical conditions in criminal justice involved populations",

abstract = "Nationally representative data collected by the Bureau of Justice Statistics (BJS) have shown increasing and elevated prevalence of a number of non-infectious chronic medical conditions in criminal justice populations relative to the non-institutionalized population. Prevalence of these conditions, including hypertension and arthritis, are especially high among elderly and female prisoners and jail inmates. State- and site-specific prevalence estimates, however, have revealed patterns that are somewhat inconsistent with BJS national data. We summarize the extant literature regarding prevalence of chronic medical conditions in U.S. prison and jail settings, determinants of these conditions across the phases of criminal justice involvement, and potential opportunities for reducing and managing the burden of chronic medical conditions in criminal justice populations. We provide research and policy recommendations for improving measurement of the burden of chronic medical conditions in criminal justice populations, provision of healthcare in correctional settings, and post-release continuity of care and community reentry.",

author = "Harzke, {Amy J.} and Sandi Pruitt",

note = "Funding Information: In light of our summary of the existing literature, we offer the following recommendations for quantifying and reducing of the burden of chronic medical conditions in criminal justice populations and for understanding and addressing the multi-level factors which impede health and continuity of healthcare in the different phases of criminal justiceinvolvement. Implementation of these recommendations will improve the health of persons involved in the criminal justice system as well as the health of the communities to which they return. Moreover, given that racial/ethnic minorities are overrepresented in criminal justice populations, implementation of these recommendationsamy serveotduc erhealthespa ridties. i For improving measurement of the burden of chronic medical conditions in criminal justice populations, we reiterate recommendations of Binswanger et al. (2009) — which to date have not been implemented. These recommendations are: (1) include criminal justice populations in national health surveys and/or coordinate surveys conducted in correctional facilities with those conducted among non-institutionalized populations to allow comparisons across criminal justice settings and with the non-institutionalized population; (2) include measures of exposure and duration of exposure to the criminal justice system in other studies of health and health disparities; (3) increase quality and availability of clinical data on inmates for research purposes; (4) examine effects of specific criminal justice and fiscal policies on health outcomes. Additionally, we recommend conducting studies that validate prisoner and inmate self-report of past and current clinical diagnoses. We also recommend conduct of research at national, state, and local levels on health conditions as wellsanioce,mentitlements, and healthcareocravge. e For describing and improving healthcare in correctional settings, we offer the following recommendations: (1) conduct research to describe the scope, volume, and quality of healthcare services delivered; (2) conduct research to describe the chronic care/management models used and to assess their effectiveness; (3) implement quality measurement programs using explicit, evidence-based quality measures which parallel measures used in free-world healthcare systems, reflect the health of populations, not samples, of correctional patients, and include patient input as part of the assessment of quality (Asch et al., 2011); (4) in tandem with quality measurement, initiate evidence-based healthcare quality improvement programming , so that effective actions may be taken to address identified deficiencies (Asch et al., 2011). A key quality improvement priority area for many correctional facilities may be to increase capacity to medically screen and examine all incoming inmates or prisonersiwthin aarsonaeble, specified period of time. For improving continuity of care and community reentry, we offer a number of recommendations. Admission to jail and/or prison presents a public health opportunity to facilitate entry of high-risk and underserved populations into the healthcare system. We recommend first that, before release, jails and prisons facilitate healthcare coverage (e.g., Medicaid, ACA) enrollment (Marks & Turner, 2014; Tobler, 2014). Ideally, eligibility for coverage could be assessed upon admission, so that planning for post-release healthcare coverage begins upon entry, as is the case in several states (Tobler, 2014). The Connecticut and Massachusetts prison systems have designated discharge planners who assist with Medicaid applications, which are processed and “held” by the state Medicaid agency until parole or release (Tobler, 2014). In Massachusetts, the result is approximately 90% of parolees have coverage upon their release. To further facilitate coverage; Medicaid benefits could be suspended rather than terminated upon incarceration. Currently, at least 12 states and some counties take this approach (Tobler, 2014). More broadly, we recommend that available healthcare benefits packages from Medicaid or elsewhere are tailored to meet the needs of criminal justice populations, given comorbid substance use and mental health disorders (Marks & Turner, 2014). This requires that correctional healthcare officials, providers, and advocates educate elected and appointed officials about what is needed (Marks & Turner, 2014). Thus, in addition to supportive services, policy changes are needed to ensure timely access to medical and pharmaceutical benefits and, more generally, to better integrate publicly funded healthcaredelivery systems (Watson etl.a, 2004). Improving timely utilization of post-release healthcare will also require improved connectivity between correctional facilities and community healthcare (Marks & Turner, 2014). Strong collaboration and information exchange between correctional, community health practitioners, and human service departments to coordinate timely post-release care will be required (Binswanger, 2011b; Tobler, 2014). Data sharing will be particularly important to improve capacity to serve particularly complex patients. The potential of community supervision (probation and parole) to assist with linkage to community healthcare is largely untapped, perhaps due to underfunding in probation and parole departments. More broadly, the sufficiency of local healthcare delivery systems to meet the complex needs of criminal justice populations should be assessed. This will require collaboration across primary care, mental health, and substance abuse rehabilitative services. Such assessments may indicate a need to invest in communities with a high concentration of former prisoners (Marks &uTr, 2014). rne Along with Binswanger et al. (2011b), we recommend expanded testing of interventions to improve health and continuity of care. The common components of effective prisoner reentry service packages were identified through syntheses of existing evaluations of prisoner reentry programs. These components include: discharge planning; case management; referrals and linkage with community healthcare; assistance enrolling in benefit programs (e.g., Medicaid, SNAP); and linkage to social services related to housing, employment, and education (Freudenberg & Heller, 2016). While existing evaluations provide useful starting points for intervention development, they face limitations. The majority of intervention studies focused on reentry after prison, neglecting other potentially critical periods and places in the criminal justice system (e.g., release from local jails). These evaluations typically studied HIV, mental health, or substance abuse, rather than noninfectious chronic medical conditions. Moreover, these evaluations rarely employed experimental designs that allowed for comparison of reentry programs or services packages varying in specific components, intensity, or duration. Less intensive but optimally timed education interventions of prisoners and inmates with chronic medications may be more cost-effective than more intensive interventions—as Wohl and colleagues (2011) determined regarding interventions with HIV-infected prisoners. Finally, few evaluation studies considered the impact of broader social determinants that affect reentry, such as housing policies or employment programs reentry (Freudenberg & Heller, 2016). Thus, we recommend that future interventions tackle chronic medical conditions, other critical periods and places in criminal justice involvement, experimental designs with varying components, intensity, and duration, and multi-level analyses that address or at least account for broader social determinants. We also recommend, given the excess chronic disease burden among those who are female and/or older, that interventions consider the unique needs of these subgroups (Williams et al, 2012). Research is needed to understand the unique challenges of re-entrants from jail vs. prison, the specific needs of female and older prisoners, and the particular issues presented by different chronic medical conditions and/or clusters of conditions. Given that criminal justice research accounted for a very small portion of grants funded by the National Institutes of Health (NIH)—less than 0.1% from 2008-2012 (Ahalt, Wang, & Williams, 2015)—increased funding from NIH and other granting agencies will be needed to accomplish thesesrearcehrecommendations. Publisher Copyright: {\textcopyright} 2018 Southern Public Administration Education Foundation, Inc.All Rights Reserved.",

year = "2018",

month = dec,

day = "1",

language = "English (US)",

volume = "41",

pages = "306--347",

journal = "Journal of Health and Human Resources Administration",

issn = "1079-3739",

publisher = "Southern Public Administration Education Foundation Inc.",

number = "3",

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TY - JOUR

T1 - Chronic medical conditions in criminal justice involved populations

AU - Harzke, Amy J.

AU - Pruitt, Sandi

N1 - Funding Information: In light of our summary of the existing literature, we offer the following recommendations for quantifying and reducing of the burden of chronic medical conditions in criminal justice populations and for understanding and addressing the multi-level factors which impede health and continuity of healthcare in the different phases of criminal justiceinvolvement. Implementation of these recommendations will improve the health of persons involved in the criminal justice system as well as the health of the communities to which they return. Moreover, given that racial/ethnic minorities are overrepresented in criminal justice populations, implementation of these recommendationsamy serveotduc erhealthespa ridties. i For improving measurement of the burden of chronic medical conditions in criminal justice populations, we reiterate recommendations of Binswanger et al. (2009) — which to date have not been implemented. These recommendations are: (1) include criminal justice populations in national health surveys and/or coordinate surveys conducted in correctional facilities with those conducted among non-institutionalized populations to allow comparisons across criminal justice settings and with the non-institutionalized population; (2) include measures of exposure and duration of exposure to the criminal justice system in other studies of health and health disparities; (3) increase quality and availability of clinical data on inmates for research purposes; (4) examine effects of specific criminal justice and fiscal policies on health outcomes. Additionally, we recommend conducting studies that validate prisoner and inmate self-report of past and current clinical diagnoses. We also recommend conduct of research at national, state, and local levels on health conditions as wellsanioce,mentitlements, and healthcareocravge. e For describing and improving healthcare in correctional settings, we offer the following recommendations: (1) conduct research to describe the scope, volume, and quality of healthcare services delivered; (2) conduct research to describe the chronic care/management models used and to assess their effectiveness; (3) implement quality measurement programs using explicit, evidence-based quality measures which parallel measures used in free-world healthcare systems, reflect the health of populations, not samples, of correctional patients, and include patient input as part of the assessment of quality (Asch et al., 2011); (4) in tandem with quality measurement, initiate evidence-based healthcare quality improvement programming , so that effective actions may be taken to address identified deficiencies (Asch et al., 2011). A key quality improvement priority area for many correctional facilities may be to increase capacity to medically screen and examine all incoming inmates or prisonersiwthin aarsonaeble, specified period of time. For improving continuity of care and community reentry, we offer a number of recommendations. Admission to jail and/or prison presents a public health opportunity to facilitate entry of high-risk and underserved populations into the healthcare system. We recommend first that, before release, jails and prisons facilitate healthcare coverage (e.g., Medicaid, ACA) enrollment (Marks & Turner, 2014; Tobler, 2014). Ideally, eligibility for coverage could be assessed upon admission, so that planning for post-release healthcare coverage begins upon entry, as is the case in several states (Tobler, 2014). The Connecticut and Massachusetts prison systems have designated discharge planners who assist with Medicaid applications, which are processed and “held” by the state Medicaid agency until parole or release (Tobler, 2014). In Massachusetts, the result is approximately 90% of parolees have coverage upon their release. To further facilitate coverage; Medicaid benefits could be suspended rather than terminated upon incarceration. Currently, at least 12 states and some counties take this approach (Tobler, 2014). More broadly, we recommend that available healthcare benefits packages from Medicaid or elsewhere are tailored to meet the needs of criminal justice populations, given comorbid substance use and mental health disorders (Marks & Turner, 2014). This requires that correctional healthcare officials, providers, and advocates educate elected and appointed officials about what is needed (Marks & Turner, 2014). Thus, in addition to supportive services, policy changes are needed to ensure timely access to medical and pharmaceutical benefits and, more generally, to better integrate publicly funded healthcaredelivery systems (Watson etl.a, 2004). Improving timely utilization of post-release healthcare will also require improved connectivity between correctional facilities and community healthcare (Marks & Turner, 2014). Strong collaboration and information exchange between correctional, community health practitioners, and human service departments to coordinate timely post-release care will be required (Binswanger, 2011b; Tobler, 2014). Data sharing will be particularly important to improve capacity to serve particularly complex patients. The potential of community supervision (probation and parole) to assist with linkage to community healthcare is largely untapped, perhaps due to underfunding in probation and parole departments. More broadly, the sufficiency of local healthcare delivery systems to meet the complex needs of criminal justice populations should be assessed. This will require collaboration across primary care, mental health, and substance abuse rehabilitative services. Such assessments may indicate a need to invest in communities with a high concentration of former prisoners (Marks &uTr, 2014). rne Along with Binswanger et al. (2011b), we recommend expanded testing of interventions to improve health and continuity of care. The common components of effective prisoner reentry service packages were identified through syntheses of existing evaluations of prisoner reentry programs. These components include: discharge planning; case management; referrals and linkage with community healthcare; assistance enrolling in benefit programs (e.g., Medicaid, SNAP); and linkage to social services related to housing, employment, and education (Freudenberg & Heller, 2016). While existing evaluations provide useful starting points for intervention development, they face limitations. The majority of intervention studies focused on reentry after prison, neglecting other potentially critical periods and places in the criminal justice system (e.g., release from local jails). These evaluations typically studied HIV, mental health, or substance abuse, rather than noninfectious chronic medical conditions. Moreover, these evaluations rarely employed experimental designs that allowed for comparison of reentry programs or services packages varying in specific components, intensity, or duration. Less intensive but optimally timed education interventions of prisoners and inmates with chronic medications may be more cost-effective than more intensive interventions—as Wohl and colleagues (2011) determined regarding interventions with HIV-infected prisoners. Finally, few evaluation studies considered the impact of broader social determinants that affect reentry, such as housing policies or employment programs reentry (Freudenberg & Heller, 2016). Thus, we recommend that future interventions tackle chronic medical conditions, other critical periods and places in criminal justice involvement, experimental designs with varying components, intensity, and duration, and multi-level analyses that address or at least account for broader social determinants. We also recommend, given the excess chronic disease burden among those who are female and/or older, that interventions consider the unique needs of these subgroups (Williams et al, 2012). Research is needed to understand the unique challenges of re-entrants from jail vs. prison, the specific needs of female and older prisoners, and the particular issues presented by different chronic medical conditions and/or clusters of conditions. Given that criminal justice research accounted for a very small portion of grants funded by the National Institutes of Health (NIH)—less than 0.1% from 2008-2012 (Ahalt, Wang, & Williams, 2015)—increased funding from NIH and other granting agencies will be needed to accomplish thesesrearcehrecommendations. Publisher Copyright: © 2018 Southern Public Administration Education Foundation, Inc.All Rights Reserved.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Nationally representative data collected by the Bureau of Justice Statistics (BJS) have shown increasing and elevated prevalence of a number of non-infectious chronic medical conditions in criminal justice populations relative to the non-institutionalized population. Prevalence of these conditions, including hypertension and arthritis, are especially high among elderly and female prisoners and jail inmates. State- and site-specific prevalence estimates, however, have revealed patterns that are somewhat inconsistent with BJS national data. We summarize the extant literature regarding prevalence of chronic medical conditions in U.S. prison and jail settings, determinants of these conditions across the phases of criminal justice involvement, and potential opportunities for reducing and managing the burden of chronic medical conditions in criminal justice populations. We provide research and policy recommendations for improving measurement of the burden of chronic medical conditions in criminal justice populations, provision of healthcare in correctional settings, and post-release continuity of care and community reentry.

AB - Nationally representative data collected by the Bureau of Justice Statistics (BJS) have shown increasing and elevated prevalence of a number of non-infectious chronic medical conditions in criminal justice populations relative to the non-institutionalized population. Prevalence of these conditions, including hypertension and arthritis, are especially high among elderly and female prisoners and jail inmates. State- and site-specific prevalence estimates, however, have revealed patterns that are somewhat inconsistent with BJS national data. We summarize the extant literature regarding prevalence of chronic medical conditions in U.S. prison and jail settings, determinants of these conditions across the phases of criminal justice involvement, and potential opportunities for reducing and managing the burden of chronic medical conditions in criminal justice populations. We provide research and policy recommendations for improving measurement of the burden of chronic medical conditions in criminal justice populations, provision of healthcare in correctional settings, and post-release continuity of care and community reentry.

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Chronic medical conditions in criminal justice involved populations

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