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Funding Mechanism: Contracts with individuals
Total Available Funding: $100.8 million
Number of Awards:158 scholarships and 1,779 new loan repayment awards (572 NHSC participants serving incarcerated populations)
Award Amount: $50,000 over 2 years for LRP; Scholarships vary by discipline
Length of Project Period: Minimum service requirement is 2 years. SP has maximum service of 4 years, LRP offers contract amendments in 1-year increments.
Federal Partners: Bureau of Prisons
Summary: The National Health Service Corps (NHSC) helps to recruit clinicians to underserved areas, which may include Federal and State prisons, through the provision of scholarships and loan repayment in exchange for a minimum two-year service commitment. The NHSC provides contracts to individuals who agree to or are currently working in a NHSC-approved site. Currently, the NHSC has 569 NHSC participants working in Federal prisons. In addition, there are 3 NHSC participants working in State prisons. While in service, NHSC participants address the physical and mental health needs of the incarcerated populations. There is a particular need for mental and behavioral health providers in the incarcerated populations. Of the 572 NHSC participants working in prisons nearly 400 of them are mental and behavioral health providers.
Background: Since 1972, more than 30,000 clinicians have served in the NHSC, expanding access to health care services and improving the health of people who live in health professional shortage areas (HPSAs). Included in the definition of HPSAs are medical facilities that the Secretary determines has a shortage of health providers, which includes Federal and State prisons. Given the nature of the incarcerated population, nearly all Federal and State prisons are eligible to be a NHSC-approved site.
The NHSC operates both scholarship and loan repayment programs. The NHSC scholarship is a competitive program that pays tuition, fees and provides a living stipend to students enrolled in accredited medical, dental, nurse practitioner, certified nurse midwife, and physician assistant training. Upon graduation, scholarship recipients serve as primary care providers between 2 and 4 years in a community-based site.
The NHSC Loan Repayment Program offers fully trained primary care physicians, family nurse practitioners, certified nurse midwives, physician assistants, dentists, dental hygienists, and certain mental health clinicians $50,000 to repay student loans in exchange for 2 years serving in a community-based site in a high-need HPSA that has applied to and been approved by the NHSC as a service site.
Location(s) of Projects: NHSC clinicians serve in HPSAs across the United States .
Evaluation Activities: None
Future Prospects: The Patient Protection and Affordable Care Act provided $1.5 billion in mandatory funding from FY 2011 through FY2015, in addition to annual congressionally appropriated funds to be determined.
More information available at: http://nhsc.hrsa.gov/
Funding Mechanism: Grants
|FY||Funding provided through regular appropriations process||ARRA Funding||Funding appropriated for operations through the ACA||Funding appropriated for construction through the ACA|
Number of Awards: 1131 grantees in 2009, operating over 7,900 service sites.
Average Award Amount per Year: Annual operational health center grants average approximately $1.5 million. New Start grantees may receive up to a maximum of $650,000.
Length of Project Period: Up to five years, based on grantee experience, organizational capability and performance.
Federal Partners: None.
Summary: HRSAs Bureau of Primary Health Care administers the Health Center program, authorized by Section 330 of the Public Health Service Act. Under this program, HRSA provides grant funding to health centers that provide comprehensive, culturally competent quality primary health care services to medically underserved communities and vulnerable populations. These include low-income populations, the uninsured, those with limited English proficiency, farm workers, individuals and families experiencing homelessness, and those living in public housing. To be eligible for grant funding, health centers must meet a range of program requirements, including being community-based and patient-directed.
In 2009, HRSA-funded health centers cared for nearly 19 million people, including providing services at approximately 60 correctional facility sites. However, the health center program does not collect data on the number of incarcerated and reentering persons and their families that the serve.
Background: The health center program originated in 1965, with the goal of providing high-quality primary and preventive care to medically-underserved areas and populations. The program is now codified in Section 330 of the Public Health Service Act. To qualify as a health center, an entity must:
HRSA does not have data on the number of health center patients who are incarcerated persons, reentering persons, or their family members.
Grantees: Approximately 1,130 grantees, located in all 50 states, the District of Columbia, and Puerto Rico. Toc locate the closet health center site to a specific geographic area, go to:http://findahealthcenter.hrsa.gov/Search_HCC_byAddr.aspx.
Evaluation Activities: HRSA engages in on-going activities to evaluate health center quality and effectiveness. All grantees are required to submit data on an annual basis, detailing patient demographics, services provided, staffing, clinical indicators, utilization rates, costs, and revenues. These data are reviewed to ensure compliance with legislative and regulatory requirements, improve health center performance and operations, and report overall program accomplishments. The data help to identify trends over times, enabling HRSA to establish or expand targeted programs and identify effective services and interventions to improve the health of underserved communities and vulnerable populations. For more information on these data requirements, please see: http://www.hrsa.gov/data-statistics/health-center-data/index.html#what
Future Prospects: The Affordable Care Act appropriated $11 billion for the Health Center Program for the FY 2010-2014 period. A total of $95 billion is available to create new health center sites in medically underserved areas and expand preventive and primary health care services, including oral health, behavioral health, pharmacy, vision, and enabling services, at existing health center sites; $1.5 billion is for construction and renovation of health centers. HRSA expects to award up to $250 million in funding for up to 350 new health center sites in FY 2011.
Public Health Analyst
Additional information available at: http://bphc.hrsa.gov
Funding Mechanism: Grants to local agencies
Total Available Funding: The Ryan White HIV/AIDS Program is authorized and funded under Title XXVI of the Public Health Services Acts, as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009. The FY 2010 appropriation for all Ryan White HIV/AIDS Program activities was $2.29 billion.
Number of Awards: 2081 providers received awards in FY 2009
Average Award Amount per Year: Range: $15,587 (a Part C grantee) to $164,425,258 (a Part B grantee)
Length of Project Period: Annual Congressional Appropriation by Fiscal Year
Federal Partners: HRSA works with other Federal agencies on the following partnerships to improve HIV care systems:
Summary: HRSAs Ryan White HIV/AIDS Program is the largest Federal program designed specifically for people living with and affected by HIV/AIDS. It provides healthcare and support services to individuals and families affected by HIV/AIDS, filling-in the gaps in care and treatment for the underinsured and uninsured. This program is administered by the HIV/AIDS Bureau within HRSA.
The Ryan While HIV/AIDS Program reaches more than 533,000 people each year. People living with HIV disease are, on average, poorer than the general population, and Program clients are poorer still. For them, the Program is the payer of last resort, because they are uninsured or have inadequate insurance and cannot cover the costs of care on their own and because no other source of payment for services, public or private, is available.
The Ryan White HIV/AIDS Program addresses the disproportionate impact of HIV/AIDS on the poorest and most disenfranchised Americans, and the program helps to remedy the overwhelming strain on local health and social service resources by promoting the creation of more affordable and responsive HIV/AIDS care options
The program funds:
The Ryan White HIV/AIDS Program is divided into several Parts, following from the authorizing legislation.
Part A Part A provides grant funding for medical and support services to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) population centers that are most severely affected by the HIV/AIDS epidemic. EMA eligibility requires an area to report more than 2,000 AIDS cases in the most recent 5 years and to have a population of at least 50,000. To be eligible as a TGA, an area must have at least 1,000 reported but fewer than 2,000 new AIDS cases in the most recent 5 years. The FY 2010 Part A appropriation was approximately $679.1 million.
Part B Part B provides grants to States and Territories to improve the quality, availability, and organization of HIV/AIDS health care and support services. Part B grants include a base grant; the AIDS Drug Assistance Program (ADAP) award; ADAP Supplemental Drug Treatment Program funds; and supplemental grants to States with emerging communities, defined as jurisdictions reporting between 500 and 999 cumulative AIDS cases over the most recent 5 years. Congress designates, or earmarks, a portion of the Part B appropriation for ADAP. With the dramatic increase in the cost of pharmaceutical treatment, the ADAP earmark is now the largest portion of Part B spending.
The FY 2010 Part B appropriation was approximately $1.25 billion of that, $835 million was for ADAP. Five percent on the ADAP earmark is set aside for the ADAP Supplemental Drug Treatment Program, which assists states needing additional ADAP funds.
Part B provides $5 million in supplemental grants to states for Emerging Communities. In 2009, $50,000 awards were made to two newly eligible U.S. Pacific Territories ( American Samoa and the Commonwealth of the Northern Mariana Islands) and three Associated Jurisdictions (the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau).
Part C Part C supports outpatient HIV early intervention services and ambulatory care. Unlike Part A and Part B grants, which are awarded to local and state governments that contract with organization to deliver services, Part C grants are awarded directly to service providers, such as ambulatory medical clinics. Part C also funds planning grants, which help organization more effectively deliver HIV/AIDS care and services. The FY 2010 Part C appropriation was approximately $206.8 million.
Part D Part D grants provide family-centered comprehensive care to children, youth, and women and their families and help t o improve access to clinical trials and research. In FY 2010, Part D programs received approximately $77.8 million in appropriations.
Part F Part F grants support several research, technical assistance, and access to care programs.
The Special Projects of National Significance (SPNS) Program supports the demonstration and evaluation of innovative models of HIV/AIDS care delivery to hard-to-reach populations. SPNS also funds special programs to support the development of standard electronic client information data systems by Ryan White HIV/AIDS Program grantees. A total of $25 million set aside for the SPNS Program in FY 2010.
The AIDS Education and Training Centers (AETC) Program supports education and training of health care providers through at network of 11 regional and 4 national centers. In FY 2010, the AETC appropriation was approximately $34.8 million.
Minority AIDS Initiative (MAI) was established in FY 1999 via the Congressional appropriations process to provide funding to improve access to HIV/AIDS care and health outcomes for disproportionately impacted minority populations, under Parts A, B, C, and D. The types of MAI-funded services provided under Parts A, C, and D were consistent with their 'base' programs while the Part B MAI focused on education and outreach to improve minority access to state ADAPs. The MAI was then codified with respect to each Part by the Ryan White HIV/AIDS Treatment Modernization Act of 2006, which also made the Part A and B MAI separated, competitive grant programs for EMA/TGAs and states respectively. However, under the Ryan White HIV/AIDS Treatment Extension Act of 2009, the Congress directed that both be returned to a formula grant basis and 'synchronized' with the Part A and B grant awards, similar to the Parts C and D MAI.
All grant programs of the Ryan White HIV/AIDS Treatment Extension Act of 2009 can support the provision of oral health services. Two Part F programs, however, specifically focus on funding oral health care for people with HIV:
In total, the Dental Program receives a combined $13.6 million in appropriations in FY 2010.
The Ryan White HIV/AIDS Program has a Living History project ( URL: http://hab.hrsa.gov/livinghistory/index.htm). The main purpose of this project is to document and honor, in a creative way, the history, knowledge, and experiences of those who have contributed much to the Nations response to providing HIV/AIDS care and treatment services to those living with the disease and their families. One experience that is chronicled is the voice of Curtis (URL: http://hab.hrsa.gov/livinghistory/voices/curtis.htm). In this narrative, we learn of the experience of a man named Curtis who learned of his diagnosis with AIDS just prior to entering prison and the role the Ryan White HIV/AIDS Programs played in helping him re-enter the community as a person living with HIV/AIDS after he had paid his debt to society.
Background: The AIDS epidemic has taken an enormous toll since its onset in the early 1980s. Approximately 583,000 Americans have died from the disease, and many others are living with HIV-related illness and disability of caring for people with the disease. An estimated 56,000 Americans become infected with HIV each year, and more that 1.1 million Americas are living with HIV disease. The epidemic has hit hardest among populations who are poor, lack health insurance, and are disenfranchised from the health care system, and are from communities of color.
In response, Congress enacted the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in August 1990 to improve the quality and availability of care for low-income, uninsured, and underinsured individuals and families affected by HIV disease. The CARE Act was amended and reauthorized in 1996, 2000, and 2006; in 2009 it was reauthorized as the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87).
Grantees: The Ryan White HIV/AIDS Program has at least one grantee in every state in the Nation, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, and the U.S. territories.
Evaluation Activities: The Division of Science and Policy (DSP) of the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), is HABs focal point for program data collection and evaluation, development of innovative models of HIV care, and coordination of program performance activities and development of policy guidance.
The three branches within the DSP have distinct roles that support evaluation activities:
Future Prospects: The Ryan White HIV/AIDS Program is authorized through FY 2013.
RADM Deborah Parham-Hopson, PhD, RN, FAAN
Assistant Surgeon General, US Public Health Service and
Associate Administrator, HIV/AIDS Bureau, Health Resources and Services Administration
Funding Mechanism: Grant (Demonstration Sites); Cooperative Agreement (Evaluation and Support Center)
Total Available Funding: $4.55 million
Number of Awards: 11
Average Award Amount per Year: $400,000 (10 Demonstration Sites); $550,000 (1 Evaluation and Support Center)
Length of Project Period: 4years; September 1, 2007 August 31, 2011
Federal Partners: None
Summary: The SPNS Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative is a multi-site demonstration and evaluation of HIV service delivery interventions coordinated by Emory University, the evaluation and support center selected for this initiative.
This initiative funds 10 demonstration sites to design, implement and evaluate innovative methods for linking persons living with HIV/AIDS who are in jail settings or have been recently released from local jail facilities to primary medical care and ancillary services. Interventions include flexible and suitable case management strategies that promote durable linkages and follow up as the person moves between jail and the community. The study design assesses the effectiveness of the selected model(s) in identifying HIV positive persons in jail settings and providing linkages to HIV primary care services upon release and integrating services for releases within the community's HIV continuum of care.
Background: Correctional systems have an opportunity to provide coordinated prevention and treatment interventions for infectious diseases in concert with local public health officials. Individuals who are disproportionately affected by high rates of infectious diseases and adverse social conditions often cycle through jail and prison systems for various offenses, including drug related and sex offenses. Both behaviors place individuals at risk for contracting HIV disease. It is estimated that over one-quarter of all HIV-infected individuals in the U.S. pass through the correctional system each year. Many people released from jails have serious, unmanaged infectious diseases and mental illnesses. Public health and safety could be improved through greater collaboration among correctional facilities, public health agencies, and community-based organizations. Ideally, the interventions are initiated with inmates and coordinated upon their release to the community.
Grantees: AID Atlanta, Inc. (Atlanta, GA), Care Alliance Health Center (Cleveland, OH), AIDS Care Group (Chester, PA), Yale University AIDS Program (Hartford, CT), University of Chicago School of Public Health (IL), Baystate Medical Center, Inc. (Springfield, MA), University of South Carolina Research Foundation (Charleston, SC), Philadelphia FIGHT (PA) New York City Department of Health and Mental Hygiene (New York, NY), Miriam Hospital (Providence, RI) and Emory University Evaluation and Support Center (Atlanta, GA)
Evaluation Activities: A multi-site evaluation is coordinated by Emory University, Rollins School of Public Health, under cooperative agreement awarded by the HIV/AIDS Bureau. The evaluation will assess the effectiveness of the selected models in providing appropriate health services to the target population, in integrating those services within the communitys HIV continuum of care, and in maximizing reimbursement for health care services, when available.
Future Prospects: A manual titled Jail: Time for Testing will be released August 2010. The purpose of this guide is to provide point-of-reference guidance for persons working within agencies involved with the criminal justice system, public health departments, or AIDS service organizations to assist them in implementation of an opt-out HIV testing program in a jail setting. This guide will discuss the benefits and challenges of instituting an expanded HIV testing program. For persons working in correctional settings, it will discuss the merits of collaborating with outside agencies. For outside personnel, it will focus on the essentials for getting your foot in the door to effectively partner with the criminal justice system.
Chief, Demonstration and Evaluation Branch
Additional information can be found at www.enhancelink.org.
Funding Mechanism: Competitive grant
Total Available Funding: $105 million available in FY 2010
Number of Awards: 104 awards of which 4 serve women that are incarcerated
Award Amount: range from $200,000 to $2.3 million
Length of Project Period: 5 years
Background: The purpose of the Healthy Start Eliminating Disparities in Perinatal Health program is to address significant health disparities experienced by Hispanics, American Indians, African-Americans, Asian/Pacific Islanders, and immigrant populations, particularly pregnant and postpartum women and their infants. Substance abuse is included in the health issues addressed. Differences in perinatal health indicators may occur by virtue of education, income, disability, or living in rural/isolated areas. To address disparities and the factors contributing to it in these indicators, the scope of project services covers the pregnancy and inter-conception phases for women and infants residing in the high risk communities. Living within these high risk communities are women that have been incarcerated. Many children of the incarcerated with undiagnosed developmental disabilities are drug and/or alcohol exposed.
A brief description of the projects that indicated within their grant application that they outreach to women that are incarcerated is listed below.
Black Health Coalition of Wisconsin: The project serves clients identified as high risk, from the Milwaukee County Jail (MCJ), homeless shelters, W-2 (TANF) agencies and the Milwaukee Bureau of Child Welfare regardless of the zip codes where a client resides in Milwaukee County.
Indianapolis Healthy Start (IHS): Indianapolis Healthy Start provides specialized case management services to women who are victims of domestic abuse. These services include one-on-one counseling and case management services to 151 women residing in the Indiana Womens Prison who are pregnant and victims of domestic abuse. In 2009, 77 clients from the Indiana Womens Prison were served. By the end of 2009, 59 were still incarcerated and 18 had been released. The Case Manager had a total of 385 encounters with these clients, and provided 181 referrals. The top referrals were for domestic violence support (66), legal services (26), baby supplies (25), and car seats (17). Additional referrals were made for depression treatment (8), employment (7), housing (7), and clothing (6).
Utilizing funds from the State of Illinois Funds provides case management and health education services to pregnant women that were in Cermak, the health component of Cook County jail. Once released, they are linked to one of the Healthy Start Projects in Chicago or a family case management project. A referral is established prior to their discharge from the correctional facility.
The Cleveland Moms First Project reaches out to pregnant and parenting incarcerated women in the Cuyahoga County Jail. They also serve women in the Cleveland House of Corrections and on occasion the Juvenile Detention facility.
Evaluation Activities: While we are currently conducting an evaluation of the Healthy Start program, the evaluation does not specifically address services to incarcerated or re-entering women and their families.
Future Prospects: As a result of a preference, there are no additional dollars to expand funding to additional communities.
Beverly Wright, C.N.M., M.S.N., M.P.H,
Division of Healthy Start and Perinatal Services
Phone: (301) 443-5691
Funding Mechanism: Grant
Total Available Funding: $1.15 million
Number of Awards: 8
Award Amount: Awards range from $143,750 to $147,000
Length of Project Period: 3years; August 1, 2009 to July 21, 2012
Federal Partners: None
Summary: The purpose of this program is to support projects which develop, implement, evaluate and disseminate novel approaches that concurrently address the relationship between womens physical health and mental health during the perinatal period. For the purposes of this grant the perinatal period is defined as during pregnancy and up to one year after delivery, including women who may not have had a positive birth outcome. One of the awarded grantees provides mental health services to a womens correctional facility.
Background: Broadening the scope of primary care for women by adopting a womens health approach for the MCH population could be an efficient means of improving both birth outcomes and womens health status. Current areas of interest and focus in the field include the influence of pregnancy weight on maternal and child health, postpartum weight retention and perinatal depression. Currently one grantee, Christiana Care Health System, a Federally Qualified Community Health Center headquartered in Wilmington, Delaware conducts a perinatal depression support group at Baylor Womens Corrections. The MOMs HEAL (Moms Outreach to Moms through Helping, Empowering, Advocacy and Listening) support group meets weekly with additional weekly phone support from several other community locations. The MOMs HEAL support group uses peer support mothers to lead the weekly groups. Peer support mothers follow the clients for 6-12 months through monthly phone calls and inpatient visits. Current reported barriers for women in this program include stigma, location, child care and time. The grantee plans to expand the MOMs HEAL support groups to three additional sites including the YWCA, Claymont Community Center, the Peoples Settlement and add one more group at the Baylor Womens Corrections facility.
Location(s) of Projects: Delaware
Evaluation Activities: Each project is responsible for designing and implementing their own evaluation, which include pre- and post-tests on knowledge, attitude and behaviors.
Future Prospects: one-time funding
Lisa R. King, MA, Project Officer
Division of Healthy Start and Perinatal Services
Funding Mechanism: Grant
Total Available Funding: $1 million
Number of Awards: 1
Average Award Amount per Year: $250,000
Length of Project Period: 4 years; (September 1, 2009 to September 30, 2013)
Federal Partners: Informal partnering with CDC-Division of Injury
Summary:There are approximately 106,000 children and youth in the Texas juvenile justice system, the majority of whom are from diverse cultural backgrounds whose socioeconomic conditions are usually below the Federal Poverty Line. Most are at least five years below their educational grade level, are victims of abuse and many have co-existing substance dependency issues. Many of these youth may have previously sustained a traumatic brain injury (TBI) that contributed to their behavioral dysfunction. Texas goal is to expand and strengthen statewide, multi-agency collaboratives to screen, identify and coordinate services for those individuals found to have TBIs in order to assist them receive the necessary treatment to become productive, responsible members of society. The end result will also ameliorate economic burden on families and government agencies.
The grantee will provide training for appropriate juvenile justice personnel to administer TBI and pre-neuropsychological screenings to about 3,000 youth per year. Those diagnosed with TBI and their families will be referred to person and family-centered educational, medical, behavioral, social, economic and vocational supports and services. Data will be collected, evaluated and shared. Partners will provide individualized services and programs to ensure a seamless reintegration to school, community or the workplace. Conferences will be provided for all partners, stakeholders juvenile justice system personnel who are responsible for the care and rehabilitation of adolescent offenders, and an annual end-of-year conference will be held for stakeholders, policy-makers, and all agencies, families and the public.
Background: This grant is part of a larger grant program to address state partnerships to implement programs for those with traumatic brain injury. In July 1996, Congress enacted Public Law 104 166 to provide for the conduct of expanded studies and the establishment of innovative programs with respect to TBI. Under the Law, the Health Resources and Services Administration, (HRSA), Maternal and Child Health Bureau, is charged with implementing a state grants program, to improve access to health and other services for individuals with TBI and their families. The Federal TBI Program was reauthorized as part of the Childrens Health Act of 2008. Through this program states and territories are eligible to receive two types of TBI Grants, Protection and Advocacy and State Implementation grants. State Implementation grants are to be used by states to establish an infrastructure for the delivery of TBI related services and to improve the states ability to make system changes that will sustain the TBI service delivery infrastructure.
Grantees: Texas Health and Human Services Commission
Evaluation Activities: The Texas Juvenile Probation Commission and Texas Youth Commission will maintain complete records of the numbers of juveniles screened, diagnoses, treatment referral and outcome over the continuum of the grant. An evaluator will collect, evaluate and maintain data, and all will be provided to the Texas Health and Human Services Commission. Evaluation will be based on number of juveniles screened and diagnosed with TBI, the culturally competent service array referred for youth and parents, their educational progress, reduction in recidivism. Ongoing monitoring and evaluation of the program, communication and collaboration with juvenile justice personnel and other partners, and quarterly leadership team meetings will ensure efficacy and sustainability.
Future Prospects: Unknown
Donelle McKenna, Project Officer
Division of Services for Child with Special Health Needs
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Human Services Policy (HSP)
Assistant Secretary for Planning and Evaluation (ASPE)
U.S. Department of Health and Human Services (HHS)
Last updated: 02/25/11