HHS/ASPE. U. S. Department of Health and Human Services.Background

Overview and Inventory of HHS Efforts to Assist Incarcerated and Reentering Individuals and their Families

Centers for Disease Control and Prevention

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National Center for Chronic Disease Prevention and Health Promotion/
Division of Adult and Community Health

Preventing the Spread of HIV/AIDS & STD among Incarcerated African-American Males
(Prevention Research Center:  Morehouse School of Medicine)

Funding Mechanism: Cooperative Agreement

Total Available Funding: $4,000,000

Number of Awards: 1

Average Award Amount per Year: $800,000

Length of Project Period: 5 Years, 2010-2014

Federal Partners: Centers for Disease Control and Prevention

Summary: Researchers are attempting to decrease inmates’ risky sexual behaviors before the inmates return to their communities. An assessment of HIV knowledge and risk behaviors is being conducted in the Atlanta City Detention Center with inmates with a history of drug abuse who have been jailed for 48 hours to one month. The inmates are interviewed by peer educators (PEs) — African-American men recruited from the community — about sexual practices and barriers to adopting HIV risk-reduction behaviors. PEs work with inmates to discuss a post-release plan for housing, control of substance use, employment, and other issues. PEs monitor participants’ progress over the first few weeks following release from jail.

Data from this assessment will be used to create an intervention for the inmate population to prevent sexually transmitted infections (STIs) and HIV infections associated with drug use and unsafe sexual behavior. Participants will receive 12 educational modules over six weeks led by a PE facilitator on HIV knowledge, risk reduction, beliefs about condoms, safe-sex partner conversations, and social support. The 90-minute modules are delivered twice a week and are taught both during incarceration and after release. Each participant is placed in one of seven intervention groups and receives 12 modules but each group varies in the number of modules delivered during jail time and in the community.

http://apps.nccd.cdc.gov/prcresearchprojects/Projects/ProjectDescription.aspx?PID=238

Background: The rate of HIV infection in jail inmates is between four to six times higher than the national average, and African-American men are disproportionately affected. Over half of the people taken into custody have a history of substance abuse or high-risk sexual behavior, which increases their risk of HIV or other STIs.

Georgia has the fifth-largest correctional system in the country and had the seventh-highest number of HIV/AIDS cases in the United States in 2006.

Grantees:  Morehouse School of Medicine, Atlanta, GA

Evaluation Activities:  Researchers survey participants before the intervention, directly after, and 3 and 6 months later to determine changes in HIV/AIDS knowledge, drug use, sexual behaviors, perceptions of the consequences of drug use, and attitudes toward using condoms. Results from each of the seven intervention groups are compared with each other, to see if number of modules delivered in the jail or the community affects knowledge, perceptions, and behaviors and if a certain number of modules received during jail time promote higher attendance for the program after release. The results of each intervention group are also compared with those from a group of inmates who do not receive the intervention.

Future Prospects:  At the end of the five year cycle, the Morehouse PRC will work with the Atlanta City Detention Center and community partners to develop effective dissemination strategies, which may include individual consulting, group trainings, conference workshops and presentations, peer-reviewed journal articles, community reports, and fact sheets.

Contact:

Robert Hancock
Team Lead for Program Operations
CDC Prevention Research Centers Program
Phone: (770) 488-5918
Email: Robert.Hancock@cdc.hhs.gov

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National Center for Chronic Disease Prevention and Health Promotion/
Division of Cancer Prevention and Control

National Breast and Cervical Cancer Early Detection Program — State Program Outreach to Incarcerated Females — Pennsylvania

Type of Activity: Outreach

Funding Mechanism: Project grantee-initiated special focus

Total Available Funding: Part of grantee activities to administer the overall Breast and Cervical Cancer Early Detection Program (BCCEDP). Grantees are required to spend 60% of awarded funds on providing breast and cervical cancer screening services to eligible low-income, uninsured, and underinsured women. Remaining awarded funds are for patient navigation, administration, evaluation, and other activities, including outreach activities to increase breast and cervical cancer screening rates and target vulnerable populations. Grantees are encouraged to develop and conduct outreach activities, such as this one, that meet the specific needs of their community and populations.

Number of Awards: This is an outreach project that one particular state grantee has decided to undertake as part of the larger BCCEDP work

Award Amount: This project is part of overall Pennsylvania BCCEDP work, which includes outreach activities. In FY 2009, Pennsylvania’s BCCEDP was awarded $2.4 million to conduct screening, outreach, etc. As described above, 60% of awarded funds must be spent on screening services. Remaining funds may be used for additional activities to support program goals, including outreach. This outreach activity will likely have relatively low costs, as costs will incur from the administration of the program, materials, etc. It is nearly impossible to calculate the specific amount of awarded funds that will be spent on this particular outreach activity, and that amount is likely a small percentage of the total $2.4 million awarded.

Length of Project Period: Pennsylvania’s BCCEDP is beginning this outreach program this year (summer 2010)

Federal Partners: CDC

Summary: This is a grantee-generated outreach activity. The Pennsylvania BCCEDP is planning an outreach activity targeting female state prisoners on pre-release status and female state parolees in community corrections centers. The Program will conduct this outreach by mailing outreach cards encouraging women to get breast and cervical cancer screening to every prison and community correction center facility. Most of these women may not be eligible for Medicaid.

Background: As noted above, Pennsylvania BCCEDP grantees are just beginning this outreach activity and are in the planning stages of conducting outreach for this population.

Examples of current grantees: Pennsylvania Department of Health

Evaluation Activities: Grantees are in the planning stage of this activity and have not yet evaluated the activity.

Future Prospects: N/A

Contact:

Nikki Hayes
Public Health Advisor, CDC
Phone: (770) 488-4879
Email: Nikki.Hayes@cdc.hhs.gov

National Breast and Cervical Cancer Early Detection Program — State Program Outreach to Incarcerated Females — South Dakota

Type of Activity: Targeted Screening Services

Funding Mechanism: Project grantee-initiated special focus

Total Available Funding: Part of grantee activities to administer the overall Breast and Cervical Cancer Early Detection Program (BCCEDP).

Number of Awards: This is an outreach project that one particular state grantee has decided to undertake as part of the larger BCCEDP work

Award Amount: This project is part of overall South Dakota’s BCCEDP work. In FY 2009, South Dakota’s BCCEDP was awarded $812,000 to conduct screening, outreach, programmatic support, etc. This funding amount is intended to cover the entire state. The amount spent on this particular screening activity is likely a small percentage of the total $812,000 awarded.

Length of Project Period: 7.5 years; November 2003 to Present

Federal Partners: CDC

Summary: This is a grantee-generated activity targeting this population. The South Dakota Women’s Prison has an on-site clinic for cervical cancer screening. The BCCEDP uses a mobile van to go to the prison twice a year for mammograms, however, most of the women served in this population are under 50 years of age and thus not at an age where routine mammography is recommended.

The South Dakota’s BCCEDP also works with the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program to conduct screening and education activities for women on lifestyle behaviors related to preventing, delaying, and controlling cardiovascular illness.

Background: In November 2003, the South Dakota BCCEDP began screening women for breast and cervical cancer in the South Dakota Women’s Prison in Pierre, South Dakota. Between November 2003 and July 31, 2010, 914 women have been enrolled and screened. A few years ago, the BCCEDP used some carryover funding to purchase a colposcopy machine for this clinic, since most of the women screened have abnormal Pap smear results.

More information on the South Dakota BCCEDP: http://doh.sd.gov/AllWomenCount/default.aspx

Examples of current grantees: South Dakota Department of Health

Location of Project: South Dakota Women’s Prison, Pierre, SD

Evaluation Activities: The South Dakota BCCEDP is currently conducting an evaluation project to evaluate the effectiveness of the current lifestyle intervention materials being used or if modified materials (e.g., a self-study booklet) would be more effective.

Future Prospects: Future activities will be informed from the evaluation findings.

Contact:

Nikki Hayes
Public Health Advisor, CDC
Phone: (770) 488-4879
Email: Nikki.Hayes@cdc.hhs.gov

Contents

National Center for Chronic Disease Prevention and Health Promotion/
Division for Heart Disease & Stroke Prevention

Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) (FY 10-11)

Funding Mechanism: Cooperative Agreement

Total Available Funding: $16.1 million for year 3

Number of Awards: Currently 1 state uses WiseWoman funds to target incarcerated women. In total WiseWoman funds 21 programs (19 states and 2 tribal organizations)

Average Award Amount per Year: $800,000

Length of Project Period: 5 years. Currently in the 3rd year of funding

Federal Partners: None

Summary: WISEWOMAN provides heart disease screening and intervention services for low-income woman who participate in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) a cancer screening program for underinsured and uninsured women. The South Dakota Department of Health is a WISEWOMAN grantee who provides screening to women at the Women’s Prison in Pierre, South Dakota. The SDDH WISEWOMAN program trains interventionist to provide heart disease risk factor screenings and lifestyle interventions to incarcerated women. The prison setting offers an opportunity to initiate a heart disease risk factor screening and intervention program in an environment conducive to high levels of participation. Implementation of health promotion programs in this setting is essential because female inmates have limited access to health care. The SDDH WISEWOMAN program has adapted screening and healthy lifestyle programs to meet the needs of women’s prison population. Currently $73,000 of the $620,000 awarded to South Dakota in 2009-2010 is being used to provide WISEWOMAN Services targeting approximately 263 incarcerated women.

Background: CDC’s WISEWOMAN program provides funding for grantees to provide cardiovascular disease risk factor screenings, healthy lifestyle programs, and health care referral services to uninsured and underinsured women aged 40 - 64 years. To be eligible, participants must first be enrolled in CDC’s National Breast and Cervical Cancer Early Detection Program. CDC currently funds 21 WISEWOMAN programs, operating in 19 states and two tribal organizations. Since June 2008, WISEWOMAN programs have provided these critical screening and lifestyle services to more than 54,000 women.

Local programs provide preventive health services that include testing for high blood pressure, high blood cholesterol, and diabetes. Program participants, upon their release, receive referrals to local health care providers as needed. CDC WISEWOMAN programs partner with community-based organizations to help expand the reach of their services and coordinate patient health care referrals.

Grantees: 19 states and two tribal organizations.

Evaluation Activities:  South Dakota WISEWOMAN Program completed an evaluation in August, 2010 of the Women’s Prison program. In addition, South Dakota is participating in a two year CDC Division of Heart Disease and Stroke Prevention evaluation of funded programs.

Future Prospects:  Funding cycle is five years under FOA (DP08-804). Future plans are to introduce a new FOA in year 5.

Contact:

Lois P. Voelker
CDC WISEWOMAN 
Public Health Advisor
Phone: 770.488.8256
Email: Lois.Voelker@cdc.hhs.gov

Patty Lihs
South Dakota Department of Health
WISEWOMAN Program Manager
Email: Patty.Lhis@state.sd.us

Contents

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Jail-based Integration of HIV/STI/Hepatitis screening, Hepatitis B vaccination, and linkage to care and treatment, FY 2010

Type of Activity: Demonstration and program services to support the development and programmatic evaluation of a comprehensive, routine, opt-out HIV rapid testing jail based initiative.

Funding Mechanism: Cooperative Agreement

Total Available Funding: $980,000

Number of Awards Anticipated: 1-2

Length of Project Period: 1 year; October 2010 - October 2011

Federal Partners: None

Summary:

Strategies to conduct STI and Hepatitis screening and provide Hepatitis B vaccination to inmates who screen preliminary positive for HIV should be explored. The services are to be provided during an initial health screening or medical intake evaluation. Effective prevention strategies implemented for high risk inmates, prior to or following release are to be explored.

This project funds the development and evaluation of a universal voluntary opt-out HIV rapid testing program which is consistent with CDC HIV testing guidelines and integrated into clinical services provided to all inmates undergoing an intake medical evaluation. STI urine-based screening and Hepatitis B vaccination complement the HIV screening component, and are provided to all inmates who screen preliminary positive for HIV. The project attempts to provide integrated services to jail inmates over the project period, to include screening, vaccination, and linkage to care. Creative strategies are being explored and implemented by clinical staff to provide screening services to high-risk inmates who are released before receiving a medical evaluation. These strategies include targeting inmates based upon charge (e.g. prostitution, drug, violence), or zip code of arrest.

Background: Addressing health disparities in the United States requires a concentrated approach to increase the availability of HIV, STI, and Hepatitis testing and prevention services for correctional populations; a population disproportionately represented by minorities and disproportionately impacted by HIV, STIs, and Hepatitis infections. In the US , an estimated 800,000 persons are detained in jails on a daily basis. People detained in jails usually serve less than 1 year, and approximately 50% are released within 72 hours. Due to repeat arrests and short durations of confinement, approximately 7-10 million jail releases occur annually. Many people entering correctional facilities have a history of high-risk sexual behaviors, substance abuse, or both. Rapid HIV testing, STI, Hepatitis B and Hepatitis C screening in jails is an effective strategy to reach high-risk individuals who may not seek testing while in the community. The significant cost-savings and considerable impact jail-based screening programs would have on reduction of community-level disease is a significant and largely untapped public health opportunity, particularly in urban areas with large correctional populations.


Grantee
: Emory University, Rollins School of Public Health

Location of Project: Fulton County Jail, Atlanta, GA

Evaluation Activities:

A. Outcome Measures

  1. Number of persons screened for HIV (rapid testing), STIs (e.g., Gonorrhea, Chlamydia), Hepatitis B and Hepatitis C
  2. Number of persons provided HIV, STI, Hepatitis B and Hepatitis C test results and prevention counseling
  3. Number of persons testing HIV, STI, Hepatitis B, or Hepatitis C-positive who are linked to appropriate care, treatment and services in the facility or community
    1. Proportion of cases with co-morbidities associated with HIV, STD, (Chlamydia, Gonorrhea, Syphilis), and Hepatitis B and C virus
    2. Yield of new HIV cases
  4. Number of persons provided a dose of Hepatitis B vaccination at medical intake examination
  5. Develop a best practices/model for prevention education, screening and testing, vaccination, and linkage to care and treatment protocol for jails in the U.S.

B. Project Assessment and Evaluation: This project funds a large jail facility in a jurisdiction with high HIV prevalence (>1%), which has demonstrated experience integrating HIV testing programs and has the capacity to expand and evaluate a more fully integrated program. CDC project officers are continually monitoring the key outcome measures, and are making recommendations based upon testing and vaccination coverage. At the conclusion of the project, a detailed best practices/model testing, vaccination, and linkage to care and treatment protocol for jails in the U.S. will be developed by the applicant and CDC for dissemination.

Future Prospects: Continuation of project in future years is contingent upon the progress and success of the initial allocation.

Contact:

CAPT Laurie Reid, RN, MS
Public Health Advisor, CDC, NCHHSTP, DHAP
Phone: (404) 639-8461
Email: Laurie.Reid@cdc.hhs.gov

Contents

National Center for Injury Prevention and Control/
Division of Injury Response

Statewide Investigation of Traumatic Brain Injury in Prisons

Type of Activity: Research

Funding Mechanism: Cooperative Agreement

Total Available Funding: $495,000/year

Number of Awards: 1

Award Amount: $495,000

Length of Project Period: 4 years; September 2007 - September 2011

Federal Partners: None

Summary: Conduct a population-based retrospective cohort study in South Carolina prisons that will 1) provide interval estimates of prevalence rates of Traumatic Brain Industry (TBI), substance abuse, and violence among representative samples of male and female prisoners; 2) quantify the association between history of TBI, substance abuse, and violence and estimate the impact of this association on community integration and recidivism, and 3) investigate the feasibility of conducting routine screening for TBI in prisons by measuring the predictive value positive (PVP) of a new TBI screening tool. This proposed study will identify 292 male prisoners and 292 female prisoners who will participate in in-person interviews shortly before prison release. After entering the community, they will be followed for approximately two years to identify risk factors for recidivism. To help ensure the prevalence estimates, a second cohort of 50 prisoners (25 males and 25 females) will be interviewed. The survey instrument will measure history of TBI, substance abuse, violence, and other potential confounders. The unifying hypothesis guiding the study is that prisoners who report a history of TBI have a higher rate of recidivism mediated by substance abuse and/or violence. This study is intended to provide a clearer understanding of the outcomes of TBI among prisoners and an accurate population-based estimate of the association between TBI, substance abuse, and violence in prisons. This information can assist in providing statewide public health services. Summary can be found at: http://www.cdc.gov/ncipc/profiles/acutecare/abstracts.htm#CE07-008

Background: Traumatic brain injury (TBI) is a significant public health problem in the US . Yet research is sorely lacking that can generate population-based estimates of TBI in prisons. TBI’s among prisoners is of particular concern because it often results in cognitive, social, emotional, and behavioral problems, including aggressive behavior.

Current grantee: Medical University of South Carolina

Evaluation Activities: Overall study findings will be disseminated through reports and scientific publications to inform corrections and policymakers. A final project report is due 90 days after the project period ends.

Future Prospects: Research project scheduled to end in September 2011; no additional funding for this project is expected.

Contact:

Arlene Vincent-Mark
Public Health Analyst 
Phone: (770)488-4398
Email:  avincentmark@cdc.gov


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Last updated: 02/25/11