Micaela Linder, Health Policy Researcher and Educator at The Fortune Society

Educating Healthcare Providers Through the Reentry Education Project

Tuesday, April 5, 2016

The Fortune Society was awarded a New York City Department of Health and Mental Hygiene (NYC DOHMH) grant through Public Health Solutions (PHS) to support healthcare providers in integrating culturally competent best practices into the HIV prevention, treatment, and care they deliver to justice-involved patients.

The project objectives include (1) increase the number of formerly incarcerated people who know their HIV status; (2) reduce the barriers that formerly incarcerated men and women face in accessing HIV prevention, treatment, and care; and (3) increase retention in care and viral suppression, thereby reducing new transmission.

To accomplish these objectives, The Reentry Education Project (REP) has focused on increasing provider knowledge of 1) harm reduction strategies to reduce HIV transmission among injection drug users; 2) patient-centered, gender-responsive, and trauma-informed care for formerly incarcerated women; and 3) HIV and Hepatitis C (HCV) prevention, screening, treatment, and care for justice-involved individuals.

Compared to the general population, justice-involved individuals are disproportionately impacted by infectious diseases, including HCV and HIV. Rates of HCV in correctional facilities range from 9.6% to 41%, compared with 1% to 2% in the general population. In New York City, roughly one in three individuals living with chronic HCV reported spending time in jail or prison. Additionally, HIV rates among New York City corrections entrants were 9.8% among females and 4.7% among males.

In addition to the lack of access to adequate health care in correctional facilities, an estimated 95% of incarcerated individuals will eventually be released. In New York City, there is a strong correlation between neighborhoods which have a high percentage of people recently released from NYC jails and neighborhoods with high rates of new HIV diagnoses. Impoverishment, medical vulnerability and interaction with the criminal justice system increase risk for contracting HIV. Furthermore, even though routine, opt-out HIV screening has been recommended by the CDC since 2006, clinical practice has not met the challenge.

Thus, it is crucial that clinics have the knowledge and resources to not only provide sufficient medical treatment to formerly incarcerated patients, but to communicate with them in a respectful and non-stigmatizing manner.

REP gives clinics and healthcare providers the training and materials needed to connect patients with proper healthcare resources. This year, REP’s focus is on increasing awareness and understanding of HIV as well as HCV prevention, treatment, and care of justice-involved individuals. As Fortune’s Health Policy Researcher and Educator, I carry out REP’s goals by directly communicating with clinic workers about the health barriers formerly incarcerated individuals face.

I apply a public health detailing model to share evidence-based information with various healthcare providers via face to-face meetings in clinics. I discuss the health barriers justice-involved individuals’ face and the communication strategies physicians should use when discussing their patients’ health backgrounds. After each session, I return to the clinic with a post-survey to gauge the effectiveness of these trainings.

It is important that all clinic employees are involved in these trainings given that the administrative and support staff are integral to creating the welcoming environment needed to encourage a formerly incarcerated patient to reconnect with the health care system.

As part of the training sessions, I encourage clinics to employ “people-first language,” which highlights the worth and dignity of all persons. By using phrases such as “person living with HIV” and “person who is formerly incarcerated,” providers are able to remain sensitive to stigma and discrimination while emphasizing resilience and healing. To reinforce this message, I provide clinics with a document called “Words Matter,” which shows replacement terms for phrases that clinical staff should avoid when talking to formerly incarcerated patients. The goal of this document is to build clinical staff members’ confidence which will allow them to proceed with patient care without stigmatizing patients

I will also conduct focus groups with Fortune clients, and use their input to shape REP’s training curricula and key messages. Their participation will help ensure that the toolkits I provide to clinics align with the needs of both providers and formerly incarcerated patients.

REP hopes to create a cultural shift in how clinics perceive and communicate with formerly incarcerated patients. After completing the training many healthcare providers start questioning their previous beliefs and are surprised at how they used to communicate with formerly incarcerated patients. Providers often leave the training expressing a desire to see more formerly incarcerated patients and the need for better transitional health care systems.

My hope is that REP continues to create these conversations, because navigating the healthcare system is complex and can discourage formerly incarcerated individuals from obtaining the health care they need.

By making physicians more aware of barriers to health care, REP will continue to help provide the social and medical support formerly incarcerated patients need and deserve.

REP trainings will be available to NYC clinics throughout 2016. Please contact me at mlinder@fortunesociety.org for more information, to schedule training, or to sign up for the REP mailing list.

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