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

Office of the Secretary

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Assistant Secretary for Health/Office of Adolescent Health (OAH)

Teen Pregnancy Prevention: Replication of Evidence-based Programs – Tier 1 (FY 10-15)

Funding Mechanism: Cooperative Agreements

Total Available Funding: $75 million

Number of Awards: 75

Average Award Amount per Year: Range from $400,000 to $4 million per year

Length of Project Period: 5 years

Federal Partners: None for Tier 1

Summary:  These Cooperative Agreements, part of the larger OAH TPP Initiative, will support medically accurate and age appropriate programs that reduce teen pregnancy. Funding is available for two broad program types: 1) curriculum-based programs that seek to educate young people about topics such as responsible behavior, relationships, and pregnancy prevention, and 2) youth development programs that seek to reduce teenage pregnancy and a variety of risky behaviors through a broad range of approaches. Youth development programs usually incorporate multiple components, such as service learning, academic support, or opportunities to participate in sports or the arts. They also collaborate with multiple networks and /or provide youth with development focused activities. In both cases, funding under this announcement can only be provided to applicants who seek to replicate evidence-based programs that have been shown to reduce teenage pregnancy, behavioral risk factors underlying teenage pregnancy, or other associated risk factors.

Under a contract with HHS, Mathematica Policy Research (MPR) conducted an independent, systematic review of the evidence-based programs shown to be effective in preventing teenage pregnancy. The review defined the criteria for quality of an evaluation study and the strength of evidence for a particular intervention. Once completed, the study identified twenty-eight (28) evidence-based programs to be replicated. Out of the twenty-eight, two of the program models eligible for replication target populations that focus on adjudicated youth and/or youth in detention settings.

Background: The purpose of the Teen Pregnancy Prevention initiative – Tier 1, funded by the Consolidated Appropriations Act, 2010 (Public Law 111-117), Division D, Title II of the Act , is to support the replication of evidence-based program models that have been proven through rigorous evaluation to be effective in preventing teenage pregnancy. Funds were made available for projects operating in one or multiple sites with an emphasis on replication of evidence-based models that have demonstrated impact on key sexual behavioral outcomes. Teen Pregnancy Prevention Tier 1 sought to fund programs that will increase the capacity of communities to implement and evaluate evidence-based interventions to prevent teenage pregnancy. Communities with high rates of teenage pregnancies were targeted.

On September 30, 2010, OAH funded a broad range of evidence-based program models. Having multiple funding ranges allowed a wide array of evidence-based programs to be funded by a diverse set of grantees that have varying capacity to implement large-scale or smaller scale projects.

Range A: $400,000 to $600,000 per year

Range B: $600,000 to $1,000,000 per year

Range C: $1,000,000 to 1,500,000 per year

Range D: $1,500,000 to $4,000,000 per year

Selected Grantees:

YMCA of Metropolitan Detroit ( Detroit, MI)

The YMCA of Metropolitan Detroit is implementing the Making a Difference! model to address the need for teen pregnancy prevention and STI prevention for youth ages 11-14 in Wayne, Macomb, and Oakland Counties. Approximately 10,000 youth will be served over the five-year project. During the summer months, the program will be offered to youth via YMCA branches and other youth serving organizations. Incarcerated youth at two detention centers will also being served through this project.

Contact: Tricia Hamzik, 586-469-1788, thamzik@ymcametrodetroit.org

San Diego Youth Services ( San Diego, CA)

San Diego Youth Services (SDYS) is the lead agency of a 5-part collaborative effort that will implement the CAT + Project (Community Assessment Team). They will add Reducing the Risk to the existing CAT project as an enhancement. The collaborative that operates the CAT project is an established collaborative that has worked together on the CAT project (juvenile justice and life skills) and VAM (Vision Achievement Mentoring- teen pregnancy prevention). SDYS will serve 2,160 youth per year with the CAT + Project. The target population is youth ages 13-19, males and females, who are involved in the juvenile justice system or have been identified as high risk.

Contact: Steven Jella, 619-221-8600, Sjella@sdyouthservices.org

YMCA of Cumberland Maryland ( Allegany, MD)

The YMCA of Cumberland Maryland will implement Project AIM for middle school students in rural Allegany County, Maryland. The project will be implemented in four public middle schools, one private middle school, the Girls’ Group Home, and the Parenting and Pregnant Teens Program, reaching a total of 750 youth each year. In addition, the grantee will implement Project AIM with 40 highly at-risk youth each year who will be recruited from foster care, homeless shelters, and juvenile probation officers. The project anticipates success in redirecting the aspirations of the targeted youth away from risky sexual behaviors and toward positive life goals.

Contact: Sharon Cihlar, 301-777-9622, scihlar@allconet.org

Southern Nevada Health District ( Las Vegas, NV)

The Southern Nevada Health District (SNHD) will work with a core group of agencies such as the Clark County Division of Family Services, the Nevada Division of Child and Family Services, and the Clark County Family Courts to provide education and interventions for 9,000 high risk adolescents aged 13-18 years in seven zip codes. Youth will be served in detention centers or at one of two Division of Family Services sites. The initial project will serve youth in the Clark County Juvenile Detention Center, Clark County Probation, and Division of Family Services Foster Care Program. In year three, SNHD plans to expand to community-based organizations (i.e., Boys and Girls Clubs) to reach youth that reside in Clark County zip codes with high incidences of teen birth rates, HIV/STD infections and poverty, and disenfranchised youth (including immigrants, homeless and those involved with the judicial system).

Contact: Alice Costello, 702-759-1313, Costello@snhdmail.org

Youth Services of Tulsa, Inc. ( Tulsa, OK)

This project targets high risk youth aged 12-19 years over 5-year project period. Youth in the target population are located six public housing communities, three detention centers, and five programs at Youth Services Tulsa, including adolescent emergency shelter, street outreach, first time offender, home-based counseling, and transitional living program.

Contact: David Grewe, 918-382-4491, dgrewe@yst.org

Complete state-by-state grantee lists available at: http://www.hhs.gov/news/press/2010pres/09/teenpregnancy_statebystate.html and http://www.hhs.gov/ash/oah/prevention/grantees/model.html

Evaluation Activities: OAH plans for a mixture of evaluation strategies to address the question of whether replications of evidence-based programs are effective. The evaluation strategies include: (a) Federal evaluation of a selected subgroup of all grantees and (b) grantee-level evaluations (with Federal training, technical assistance, and oversight) for projects funded in Ranges C and D. In addition, all grantees will be expected to monitor and report on program implementation and outcomes through performance measures. Performance measures are intended for monitoring purposes and to provide feedback to programs about whether they are implementing programs as intended and seeing outcomes as expected.

Future Prospects:  Dependent upon appropriation


Evelyn Kappeler
Acting Director, Office of Adolescent Health
Phone: 240-453-2837
Email: Evelyn.Kappeler@hhs.gov

Teen Pregnancy Prevention (TPP): Research and Demonstration Programs and Personal Responsibility Education Program (PREP) - Tier 2 (FY 10-15)

Funding Mechanism: Cooperative Agreements

Total Available Funding: $25 million

Number of Awards: 19

Average Award Amount per Year: Ranging from $400,000 to $1 million per year

Length of Project Period: 5 years

Federal Partners: Administration for Children and Families (ACF)

Summary: The Office of Adolescent Health (OAH) and the Administration on Children, Youth and Families (ACYF) collaborated in funding competitive discretionary grants under two similar programs to support innovative youth pregnancy prevention strategies which are medially accurate and age appropriate. This single application process was developed to link the two programs which share a common goal and to help reduce the application burden on potential applicants by eliminating the need either to determine which program to apply for or to submit two applications.

TPP and PREP - Tier 2 is part of the larger OAH TPP Initiative which will support research and demonstration programs that will develop, replicate, refine, and test additional models and innovative strategies for preventing teenage pregnancy under the TPP program, and to implement innovative strategies for preventing teenage pregnancy and target services to identified populations under PREP. These populations include high-risk, vulnerable, and culturally under-represented youth populations, including youth in foster care, homeless youth, youth with HIV/AIDS, pregnant women or mothers who are under 21 years of age and their partners, and youth residing in areas with high birth rates for youth.

Background: The purpose of the Teen Pregnancy Prevention Initiative – Tier 2, funded by the Consolidated Appropriations Act, 2010 (Public Law 111-117), Division D, Title II of the Act, is to support research and demonstration grants to develop, replicate, refine and test additional models and innovative strategies for preventing teenage pregnancy. Programs funded demonstrate that they can carefully document the intervention for possible replication by others, demonstrate the capacity to conduct a process and outcome evaluation, and plan for the dissemination of findings through various means, including but not limited to, publication of an article in a peer-reviewed journal. Funded projects are expected to address teenage pregnancy prevention and related risk behaviors in youth in communities with high need as demonstrated by high rates of teen birth or pregnancies or other associated sexual risk behaviors.

This program aims to increase the capacity of communities to develop, implement, and evaluate interventions for dissemination and replication by others. Funded projects must show that the proposed intervention is (a) based on some preliminary evidence as effectiveness, (b) a significant adaptation of an evidence-based program, or (c) is a new and innovative approach to teenage pregnancy prevention.

On September 30, 2010, OAH and ACF funded in two ranges:

Selected Grantees:

State of Alaska, Division of Public Health, Section of Women’s, Children’s & Family Health ( Anchorage, AK)

The State of Alaska, Division of Public Health, Section of Women’s, Children’s, and Family Health will implement a Making Proud Choices! adaptation using trained peer health educators. The project will target youth ages 11-19, in five communities: Anchorage, the Matanuska-Susitna Valley, the Kenai Peninsula Borough, Kotzebue, and Bethel. Participants will be drawn from behavioral health residential facilities, alternative high schools, juvenile detention centers, foster care, and transitional housing; additionally, the project will serve Alaska Native youth living in rural areas that experience high teen pregnancy rates.

Contact: Sophie Wenzel, 907-269-3466, sophie.wenzel@alaska.gov

Complete state-by-state grantee lists available at:  http://www.hhs.gov/news/press/2010pres/09/teenpregnancy_statebystate.html and http://www.hhs.gov/ash/oah/prevention/grantees/research.html

Future Prospects:  Dependent on appropriation


Evelyn Kappeler
Acting Director, Office of Adolescent Health
Phone: 240-453-2837
Email: Evelyn.Kappeler@hhs.gov


Assistant Secretary for Health/Office of Minority Health (OMH)

HIV/AIDS Health Improvement for Reentering Ex-Offenders Initiative (HIRE)

Type of Activity: Demonstration

Funding Mechanism:  Cooperative Agreement

Total Available Funding:  $1,974,999

Number of Awards: 8

Award Amount:  $230,000 to $250,000

Length of Project Period: 3 years; September 1, 2009 - August 31, 2012

Federal Partners: Not applicable

Summary: As the lead agency to improve and protect the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities, the Office of Minority Health (SMH), through the mechanism of the HIRE Program, seeks to bridge healthcare gaps that exist with this epidemic to improve the HIV/AIDS health outcomes of ex-offenders reentering the mainstream population. This demonstration project supports 8 grantees located in the three states with the highest incidence of inmates known to be infected with HIV or to have confirmed AIDS in state prisons at year end 2006: New York (4,000), Florida (3,412) and Texas (2,693). Through a systems navigation approach, the HIRE Program seeks to provide access to prevention and treatment services to the reentry population in an effort to support the Healthy People 2010 overarching goals to increase quality and years of healthy life and to eliminate health disparities. Grantees are required to form stakeholder partnerships that will plan, develop and provide community-based HIV/AIDS-related services, transitional assistance, and substance abuse and mental health services for the reentry population. Community-based and faith-based organizations will be provided the opportunity to deliver comprehensive HIV/AIDS-related services and transition assistance to include prescription drug assistance and substance abuse and mental health services as well as issues surrounding employment, family, education, housing, and community involvement. The HIRE Program places primary focus on the reentry populations in the three targeted states, with special emphasis on the following reentry subpopulations: substance abusers, men who have sex with men, and individuals impacted by mental health disorders.

Background:  Reentry into society for ex-offenders living with HIV/AIDS is a complex process. The stigma and physical challenges associated with HIV/AIDS creates barriers to employment, housing and reunification with family and friends. The need for assistance with health care is integral to an ex-offender’s ability to remain healthy and productive. The HIRE project seeks to bring together multiple stakeholders, within the public health system, to work together to implement a model transition process by establishing a connection between ex-offenders and community-based, minority-serving organizations that will provide comprehensive HIV/AIDS-related services and transition assistance to ex-offenders who are moving back into society.

According to the Bureau of Justice Statistics, the rate of AIDS has been higher among prison inmates than in the general population since 1991. At the end of 2005, the rate of confirmed AIDS cases for state and federal prisoners (0.46%) was about 2½ times that in the U.S. general population (0.17%) Three states, New York, Florida, and Texas housed 49% of all inmates known to be infected with HIV or to have confirmed AIDS in state prisons at year end 2006.

In the examination of the need for reentry population programs before the House Committee on the Judiciary in 2006, Scott A. Sylak, the President of the National TASC (Treatment Accountability for Safer Communities), a nonprofit association representing individual and agency programs across the United States that aims to improve the professional delivery of screening, assessment and case management services to justice-involved persons with substance abuse or behavioral health problems, stated that “…an estimated 80% of the state prison population report histories of substance abuse, 90% fail to obtain those services while incarcerated.” He testified that “it is estimated that only 10% of offenders receive appropriate community linkage and follow-up services upon release.” Sylak also testified that “a majority of those returning are young, lack a job, have two or more minor children and have a lower educational attainment and housing stability history than those who have never been incarcerated. More than two out of three returning from prison have a substance abuse or mental health history that will require treatment and support. Many also need medications to treat HIV and other communicable diseases. A growing number of released offenders do not have housing and become homeless after discharge from criminal justice custody. Without case management and appropriate services, this population will continue to drive up costs to our communities. Combining targeted clinical case management with services and resources that prevent new crime can solve many of these problems.”

The Office of Minority Health seeks to bridge healthcare gaps that exist with this epidemic by collaborating with SAMHSA and HIS in providing prevention and treatment services to an affected and captive population that could result in cost savings for health care and law enforcement and more importantly, save lives and support the Second Chance Act of 2007 as critically important legislation that can address multiple challenges related to the return of incarcerated persons from prisons to their communities. The Second Chance Act is a response to the increasing number of people who return to their communities from prison and jail. According to the Reentry Population Council, there are currently 1.7 million people serving time in federal and state prisons, and millions of people cycling through local jails every year. Ninety-five percent of all prisoners incarcerated today will eventually be released. The Second Chance Act helps ensure the transition ex-offenders make from prison or jail to the community is safe and successful. The Office of Minority Health, with its Federal partners, can assist that goal by improving the HIV/AIDS health outcomes of ex-offenders re-entering the mainstream population by supporting community-based efforts to ensure the successful transition of ex-offenders as they complete their state or federal prison sentences and return to the community.

Current Grantees: 

Evaluation Activities:  The grantees evaluation plan must clearly articulate how the applicant will evaluate program activities. It is expected that evaluation was implemented at the commencement of the program in order to document actions contributing to program outcomes. The evaluation plan must be able to produce documented results that demonstrate whether and how the strategies and activities funded under the program made a difference in improving the HIV/AIDS health outcomes of ex-offenders re-entering the mainstream population. The plans identify the expected results for each major objective and activity. Grantee evaluation plans include data collection and analysis methods, demographic data to be collected on project participants, measures describing indicators to be used to monitor and gauge progress towards reaching projected results by objectives, outcome measures accomplished, planned activities, and impact measures demonstrating achievement of the objectives to have a positive impact on the health outcomes of ex-offenders affected by HIV/AIDS.

Anticipated results of the HIRE program include the following:

Outcome Measures:

OMH monitoring activities include review of annual and other progress reports, quarterly group conference calls, group email list service, electronic message boarding, and individual project communication by telephone and e-mail, and site visits. Mandatory reports include the progress/mid-year and annual reports.

Future Prospects:  Unknown. Dependent upon project results and availability of MAI funds in FY 2012.


Sonsiere Cobb-Souza
Director, Division of Program Operations
Office of Minority Health
Phone: (240) 453-8444
Email: Sonsiere.Cobb-Souze@hhs.gov

The Linkage to Life Program (L2L): Rebuilding Broken Bridges for Minority Families Impacted by HIV/AIDS

Type of Activity: Demonstration

Funding Mechanism:  Cooperative Agreement

Total Available Funding:  $2,840,000

Number of Awards: Up to 6

Award Amount:  Up to $475,000 each

Length of Project Period: 3years; September 1, 2010 - August 31, 2013

Federal Partners: Health Resources and Services Administration (HRSA); Substance Abuse and Mental Health Administration (SAMHSA)

Summary: The L2L Program intends to: (1) demonstrate the effectiveness of a family-centered, integrated health and social service network approach to reducing HIV/AIDS incidence and improving health outcomes among high-risk minority populations in transition from domestic violence, incarceration, and substance abuse treatment; (2) address the health and social barriers that may contribute to HIV/AIDS incidence among high-risk racial and ethnic minorities; and (3) assist in the prevention of generational cycles of behavior that increases risk of future HIV infection among dependent youth. The L2L Program will support family-centered integrated health and social service resource networks that coordinate and assure provision of HIV/AIDS treatment and prevention services, healthcare, social and support services, substance abuse treatment, and behavioral health services.

Effective linkage to resources and services directly associated with ones hierarchy of need has proven to be successful in decreasing recidivism, improving the duration of sobriety, and reducing the likelihood of reentry into abusive relationships among individuals in transition. Furthermore, addressing social determinants of health such as housing, food, and employment will increase the likelihood of adherence to HIV treatment, and aid in the reduction of risky behavior that contributes to HIV transmission. The L2L Program aims to address the barriers caused by system and service fragmentation by establishing networks of health and social service organizations equipped to meet the complex needs of minority families in transition.

Background:  Despite significant advances in HIV prevention education and treatment, communities of color continue to suffer the brunt of the HIV/AIDS epidemic. The disproportionate impact of the epidemic on racial and ethnic minorities is well documented. Poverty, cultural barriers and other social determinants may influence the incidence of HIV/AIDS among minorities. Disenfranchisement coupled with transition from substance abuse, incarceration, and/or domestic violence increases risk for HIV infection and may exacerbate existing illness.

Upon release from incarceration, transitional housing, or substance abuse treatment programs, high-risk transitional populations may enter into a fragmented system that does not link them to appropriate health, social and supportive services, employment, and housing. While there are currently some forms of extensive case management, navigation, and coordination services provided to reentry and transitional populations, the availability of these services varies by state. Moreover, the referral and/or coordination services that are available may not be sufficiently as intensive or comprehensive, due to severely limited community resources. Decreased accessibility, lack of a medical home, and limited community resources coupled with difficulty in navigating a complex health and social service system, further decreases the quality of life of individuals who are already disenfranchised. Consequently, continued participation in risky behavior such as: unprotected sex (that may be voluntary or forced); use of substance as a coping mechanism and/or relapse into substance abuse; failure to adhere to medical treatment plans; and return to a domestically violent and/or exploitive environment may occur.

Additionally, the dependent children of high-risk minority women and men are adversely impacted by the fragmented health and social service system. Nationally, African American children are nearly eight times more likely to have a parent in prison than White Children. Latino children are nearly three times more likely than White children to have an incarcerated parent. Moreover, witnessing violence from a parent or caretaker is the strongest risk factor for transmitting violence from one generation to the next. Affected children may end up in the foster care system for prolonged periods of time, and/or may be subjected to abuse and neglect. These children are also at great risk for entering into a repetitive cycle of risky behavior and potential future incarceration. Entrance into such a repetitive cycle increases future risk for HIV infection. The HSSR Network will be expected to link children to appropriate mental health counseling, substance abuse prevention programs, HIV prevention education programs, youth violence prevention programs, and alternative education programs, as needed.

Current Grantees: 

Locations of Projects:  See above.

Evaluation Activities:  Grantees and partnering organizations will be expected to collect base-line data on participants upon entry into the program. Data is also expected to be collected for the duration of the project. Relevant base-line data will be inclusive of: HIV status; self-reported HIV treatment adherence; overall physical and mental health; history of domestic abuse, substance abuse, and mental health disorders; proposed living arrangement upon release from transitional housing and/or reentry programs; and heath and social services needs of dependent children to include re-establishing parental rights/custody and/or reuniting families. Upon determination of immediate health and social services needs, program participants will be provided services and linked to the appropriate community resources. The HSSR Coordination Specialist will provide follow-up throughout the project period to assure actual enrollment into service and maintenance of benefits, services or housing obtained. The program is expected to be evaluated using the process and impact measures detailed below.

Process Measures

Impact Measures

Future Prospects:  Unknown. Dependent upon project results and availability of MAI funds in FY 2013.


Sonsiere Cobb-Souza
Director, Division of Program Operations
Office of Minority Health
Phone: (240) 453-8444
Email: Sonsiere.Cobb-Souze@hhs.gov

Assistant Secretary for Health/Office of Population Affairs (OPA)

Family Planning Service Delivery Improvement Research — Sexual and Reproductive Health Outreach for Young Men of Color:  A New Approach

Type of Activity: Research

Funding Mechanism:  Grant; Grantee initiated special focus

Total Available Funding:  $599,881 (for the 3 year project period)

Number of Awards: 1

Award Amount: $599,881 (for the 3 year project period)

Length of Project Period: 3 years; September 1, 2008 - August 31, 2011

Federal Partners: None

Summary: OPA is currently funding a research study being conducted by the Columbia University Health Sciences Center entitled, Sexual and Reproductive Health Outreach for Young Men of Color: A New Approach. The goal of the study is to improve sexual and reproductive health service delivery targeting men in several ways. First, it will explore the feasibility of integrating information, messages and linkages to sexual and reproductive health care into environments that meet men’s non-health related needs – namely workforce development programs. Second, it will examine the applicability of a capacity-building outreach model to increase utilization of sexual and reproductive health care by young men of color. Finally, it will incorporate sustainability as well as efficacy into the evaluation. One of the study sites is Exodus Transitional Community (ETC), a prison reentry program for men recently released from Federal prison. An intervention and referral protocol are being implemented and evaluated.

Background:  This activity was conceived as an approach to develop and refine a model of outreach to promote sexual and reproductive health to young men of color in partnership with workforce programs.

Examples of current grantees:  The Trustees of Columbia University

Location(s) of Projects:  Exodus Transitional Community; Young Men’s Clinic; and Helen B. Atkinson Community Health Center. All three project sites are in New York City

Evaluation Activities:  The investigators will evaluate the capacity-building intervention at the prison reentry program. Results are expected shortly after completion of the project period.

Future Prospects:  A manuscript will be prepared for publication to disseminate findings.


Diana Schneider
Director, Office of Research and Evaluation
Office of Population Affairs
Phone: (240) 453-2835
Email: Diana.Schneider@hhs.gov

Assistant Secretary for Health / Office on Women’s Health (OWH)

HIV/AIDS Prevention for Women Sexually Involved with an Incarcerated or Recently Released Incarcerated Heterosexual Partner

Type of Activity: Demonstration and program services

Description: Aims to increase the number of community linkages and networks for ensuring continuum of care for women sexually involved with an incarcerated or recently released incarcerated heterosexual partner at high-vulnerability for HIV/AIDS. The activity emphasis areas include:

Funding Mechanism: Competitive Cooperative Agreements

Total Available Funding: $1,200,000 [Minority AIDS Initiative funds – continuation to Aug 2012]

Number of Awards: 8

Average Award Amount per Year: $125,000

Length of Project Period:  3 years; September 2009 – September 2012

Federal Partners:

Summary: To develop and sustain comprehensive HIV/AIDS/STD prevention and support services for women sexually involved with an incarcerated or recently released incarcerated heterosexual partner in collaboration with health entities, care providers, social services, correctional facilities, community resource organizations, and criminal justice offices.


The purpose of this program is to establish gender centered HIV prevention model for women sexually involved with an incarcerated or recently released incarcerated heterosexual partner. Program intent and design mandates working with viable local health departments and/or Community AIDS Service organizations.

According to CDC’s most recent HIV infection data in the U.S. populations, the HIV incidence rate for black women is 15 times as high as that of white women (Estimated rate of new HIV infection: Black Women, 55.7 per 100,000; Hispanic/ Latino Women, 14.4 per 100,000; White Women, 3.8 per 100,000). In 2004, 74 percent of new HIV/AIDS cases for Women were due to heterosexual contact. Women of color represent the majority of new AIDS cases and have been affected disproportionately by the epidemic since its beginning. According to the most recent new HIV infection data, incidence among women declined in the early 1990’s but has remained relatively stable thereafter.

According to M. Comfort et al, (2005), build-up sexual tension and conditions of parole promote unprotected sexual intercourse and other HIV/STD risk behavior following release from prison. In 2006, high-risk heterosexual contact (31 percent) is the second leading cause of new HIV infections to Male-to-Male Sexual Contact (53 percent). HIV, STDs and other infectious diseases are much more prevalent among correctional inmates than in the total U.S. population. Approximately one fourth of all people in he U.S. who are living with HIV or AIDS in a given years pass through the correctional facility that same year.

Prisons have been described as the epicenter for new HIV infections. As of 2007, 2,299,116 persons were held in federal or state prisons or in local jails, an increase of 1.8% from year end 2006. At mid-year 2007, there were 4.618 black male sentenced prisoners per 100,000 black males in the U.S. , compared to 1,747 Hispanic male sentenced prisoner per 100,000 Hispanic males and 773 white male sentenced prisoners per 100,000 white males. In 2006, an estimated 21,980 state and federal inmates (male 19,842; female 2,138) were known to be HIV positive or to have confirmed AIDS. New York (3,650) reported the largest number of male HIV-positive inmates, followed by Florida (3,041), and Texas (2,409). Florida (371) reported the largest number of female HIV-positive inmates, followed by New York (350), and Texas (284). One state— New York (6%)—reported that over 5% of its male inmate population was known to be HIV positive. Three states— New York (12.2%), Florida (7.6%), and New Jersey (7.6%)—reported that over 5% of their female inmates were HIV positive.

Lack of knowledge about prison policies minimizes women’s abilities to accurately assess their partner’s risk and/ or maximize their denial of risk. The United Nations Development Fund for Women (UNIFEM) and the Joint United Nations Programme on HIV/AIDS collaboratively developed a comprehensive gender and HIV/AIDS web portal to provide up-to-date information on the gender dimensions of the HIV/AIDS epidemic. Their efforts support the need for gender specific approaches toward women in HIV/AIDS prevention and services. Limited HIV/AIDS Prevention programs exist for high-risk sexual behaviors.

This demonstration project heavily weighs on social influences on women and the overall social networks of women to incorporate reproductive health education, communication skills, stigma, condom negotiation, heterosexual risk behaviors, denial of risk, self-esteem and overall wellness and healthy sexual relationships. The proposed project also is in accord with the following Healthy People (HP) 2010 Goal: promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases (STDs) and their complications.

Current Grantees:

Projects are in Florida, TX, Alabama, Washington, DC, California, New York and Illinois.

Eligible entities may include not for profit community based organizations, national organizations, colleges and universities, clinics and hospitals, research institutions, state and local government agencies and tribal government and tribal/urban Indian entities and organizations. Faith based and community-based organizations are eligible to apply.

Evaluation Activities: A multi-site evaluation will begin October, 2010 and continue through October, 2014. A plan or instrument will be developed in consultation with funded sites.

A. Outcome Measures

B. Project Assessment and Evaluation:

Future Prospects:  Continuation of projects in future years is contingent upon the progress and success of the first two years of allocation.


Mary L. Bowers
Public Health Advisor
Office on Women's Health
Washington, DC 20201
Phone: (202) 260-0020
Fax: (202) 401-4005
Email: mary.bowers@hhs.gov

Incarcerated Women’s Transition Project (FY 2010-2012)

Type of Activity: The Incarcerated Women’s Transition project was developed to define a best practice model and a set of recommendations for gender sensitive services to meet the health/social needs of women/girls reentering the community after release from incarceration. The model may include developing programs and/or adapting key elements of existing programs to best meet the needs of women re-entering the community after release from incarceration. Currently programs and services available to transitioning offenders do not adequately address these gendered differences surrounding women’s incarceration in the context of women’s lives.

Funding Mechanism:  Contract

Total Available Funding:  $85,000

Number of Awards: 1

Award Amount:  $85,000

Length of Project Period: 2.5 years, September 30, 2010-March 30, 2012

Federal Partners: HHS Interagency Reentry Workgroup; Department of Justice

Summary: The purpose of the Incarcerated Women and Girls in Transition Project is to provide a comprehensive set of recommendations to articulate a model for creating, expanding and/or enhancing services that promote successful transition of women and girls back into their respective communities so as to promote the health of women and their families and communities which should also function to prevent recidivism. Federal, state and local governments cannot alone provide the full range of services required for successful reentry into the community. To that end, the recommendations developed by the contractor are designed for both public systems which incarcerate women and provide health and social services, as well for community-based organizations that are located in the communities where women released from prison will return with the purpose of creating linkages both pre and post release to ensure continuity of services.


There has been renewed interest in the provision of reintegration services to newly released offenders as a means to reduce rates of recidivism, increase public safety, and decrease financial costs associated with high rates of incarceration. However, the unique needs of transitioning female offenders are often lost in the conversation surrounding reentry. Attention to issues that affect female ex-offenders is especially important as the number of women entering the corrections system continues to increase.

The female prison population grew by 832 percent in the last three decades (compared to a 412 percent male increase during the same time period). This proliferation of the rate of female incarceration underscores the need for gender-specific services that adequately address the unique social, emotional, psychological and physical challenges that impede a woman’s smooth transition back into society.

The circumstances surrounding female criminality and incarceration are significantly different from those of males. Compared to half of all male offenders, two-thirds of incarcerated females were arrested for non-violent crimes. These are often economically-motivated offenses such as drug sales and burglary or theft. The pathways for women into criminality also differ substantially from those of men. The majority of female offenders have histories of trauma and abuse — 57 percent of women in state prison reported that they were physically or sexually assaulted at some point in their lives. Their trauma histories are often catalysts to the cycle of incarceration as victims of trauma are more likely to abuse substances. In fact, half of all women confined to state prison had been under the influence of drugs or alcohol at the time of the offense3 and 74 percent reported using drugs regularly before incarceration.

The majority of women in the correctional system come from poor, inner-city neighborhoods where many do not complete their education and work opportunities are scarce. Sixty-four percent of women entering prison do not have a high school diploma and half were unemployed at the time of incarceration. Those who do not enroll in job training while in prison remain extremely under-skilled to enter the labor market upon release, thus increasing incentive to participate in economically-motivated crimes such as theft and drug sales. Many incarcerated women have engaged in illegal activity as a form of work to support themselves, their children, parents, partners, and addictions. Incarcerated women risk recidivism when they return to their former vocation upon reentry.

The parenting responsibilities of women further complicate successful reintegration. Sixty-five percent of women in state and federal prison are parents of minor children, compared to 44 percent of men. Many of these mothers are single parents and most rely on family members, acquaintances, or state or county departments to care for their children during imprisonment. Indeed, the vast majority of incarcerated fathers (88 percent) report their children in the care of their mother, compared to only 38 percent of mothers who report the father as the primary caregiver. Single parenthood creates major obstacles for a transitioning woman as she often struggles to regain custody, find housing for herself and her family, and determine how she will earn a living, all while struggling with substance abuse rehabilitation.

Examples of current grantees:  N/A

Location(s) of Projects:  N/A

Evaluation Activities:  N/A

Future Prospects:  Special one-time appropriation


Michelle Hoersch
Office on Women’s Health, Region V
Phone: (312) 353-8122
Email: michelle.hoersch@hhs.gov

Prevention and Support Services for Women Incarcerated or Newly Released Living with or at Risk for HIV/AIDS/STDs Program

Type of Activity: Demonstration

Funding Mechanism: Competitive Cooperative Agreements

Total Available Funding: $625,000 [OWH Appropriated funds ended Aug. 2010]

Number of Awards: 5

Average Award Amount per Year: $125,000

Length of Project Period: 3 years; 2007 - 2010 (funded similar grant cycles with this same focus since 2002)

Federal Partners:

Summary: The primary purpose of this OWH HIV/AIDS program is to increase health related support services available for HIV infected incarcerated and newly released women. The goals for the Incarcerated/Newly Released Program are to:

The OWH hopes to fulfill this purpose by providing funding to targeted community-based organizations to enhance their prevention and support activities to incarcerated and newly released women living with or at high risk for HIV infection.

The proposed program must address HIV prevention and support services for incarcerated and newly released women through a gender-specific approach. Information and services provided must be culturally and linguistically appropriate for the individuals for whom the information and services are intended. Women's health issues are defined in the context of women's lives, including their multiple social roles and the importance of relationships with other people to their lives. This definition of women's health encompasses mental, dental, and physical health and spans the life course.

The objectives of the OWH program are to:


Current Grantees:

AIDS Foundation Houston, Inc., Houston, Harris Co., TX; Women Accepting Responsibility, Baltimore, Maryland; Hyacinth AIDS Foundation, New Brunswick, New Jersey; Greenhope Services for Women, Inc., New York, NY; Center for Health Justice, Inc., West Hollywood, CA

Evaluation Activities: Multi site evaluation conducted from 2006 to 2009 by GEARS, Inc. an 8-a firm based in Atlanta, GA. Report is available.

Future Prospects:  N/A


Mary L. Bowers
Public Health Advisor
Office on Women's Health
Phone: (202) 260-0020
Fax: (202) 401-4005
Email: mary.bowers@hhs.gov


Assistant Secretary for Planning and Evaluation/Office of Disability, Aging, and Long Term Care Policy

Report on “Collaborative Law Enforcement, Health, and Community Mental Health Strategies in the Care and Emergency Room Diversion of People with Mental Illnesses: Principles and Promising Practices”

Type of Activity: Research

Funding Mechanism:  Contract with Mathematica Policy Research

Award Amount:  Known.  This task was part of a larger contract on identifying mental health policy issues in the context of health care reform.

Length of Project Period:one year, FY 2009 - FY 2010

Federal Partners: Bureau of Justice Assistance, U.S. Department of Justice

Summary: This is a report on the key principles communities should consider when designing strategies to reduce the inappropriate use of emergency rooms and jails by people experiencing mental health crises. It is intended to stimulate and support an on-going dialogue among professionals in the law enforcement, emergency medicine, and mental health systems about how top better serve people with mental illnesses in crisis. This report highlights unique efforts to assist law enforcement to manage mental health crises, use local mental health services more appropriately, and work with hospital staff to improve efficiency and effectiveness. An expert panel was convened to inform the development of this report which includes case studies on several communities throughout the country.

Background:  The concerns about people with mental illnesses and their interactions with law enforcement and community health systems are longstanding. Previous work to develop recommendations for improving outcomes for people with mental illnesses who come into contact with the justice system have focuses on practices that should be adopted by criminal justice system staff and community mental health service providers. This report updates that work and focuses on best practices that also incorporate emergency rooms and hospital systems as key partners.


Kirsten Beronio
Email: Kirsten.beronio@hhs.gov


Assistant Secretary for Planning and Evaluation/ Office of Human Services Policy

Enhanced Services for the Hard-to-Employ Demonstration and Evaluation Project, 2001 - 2011

Type of Activity: Evaluation

Funding Mechanism:  Contract with MDRC (in partnership with the Urban Institute and the Lewin Group)

Total Available Funding:  The Enhanced Services for the Hard-to-Employ Demonstration and Evaluation Project, which includes the evaluation of the Center for Employment Opportunities Prisoner Re-entry Program as one of its four sites, will be funded over ten years at $23,386,610.

Number of Awards: 1

Award Amount:  $23,386,610

Length of Project Period: FY 2001 - FY 2011 (10 years)

Federal Partners: Administration for Children and Families and the Department of Labor

Summary: The Center for Employment Opportunities (CEO) is one of four sites in the Enhanced Services for the Hard-to-Employ Demonstration and Evaluation Project, sponsored by the Administration for Children and Families and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services (HHS), with additional funding from the U.S. Department of Labor. The overall project is evaluating diverse strategies designed to improve employment and other outcomes for several hard-to-employ populations. MDRC, a nonprofit, nonpartisan social and education policy research organization, is leading the evaluation, in collaboration with the Urban Institute and other partners.

Based in New York City, CEO was included in the Hard-to-Employ study because it is a comprehensive employment program for former prisoners — a population confronting many obstacles to finding and maintaining work — and because it has a special focus on parenting and child support issues for participants who have children. The other three sites in the Hard-to-Employ Project are targeting Medicaid recipients with serious depression, Early Head Start parents and children, and long-term welfare recipients.

Background:  There has been a tremendous increase in incarceration over the past three decades. Consequently, unprecedented numbers of prisoners are being released each year: four times as many prisoners were released in 2004 as in 1980. Ex-prisoners face a range of challenges to successful reentry into the community, and rates of recidivism are high. Within three years of release, two-thirds are arrested and more than half return to prison or jail. Many individuals are in and out of prison or jail multiple times for the same original offense, meaning they were re-incarcerated for a violation of parole. Over one-third of prison admissions each year are for parole violations. The large number of former prisoners who fail to reintegrate and who end up back in prison costs taxpayers billions of dollars each year. Expenditures on corrections by state governments were estimated to be more than $40 billion in 2005.

Work seems to be a key ingredient in determining the success or failure of former prisoners’ transition back to society. Studies have shown a correlation between higher employment and lower recidivism, particularly for older former prisoners. Positive employment outcomes can help pave the way to better housing conditions and improved relations within the family and community. Moreover, employment may help ex-prisoners feel more connected to mainstream society and help move them away from criminal activity.

Unfortunately, finding a steady job upon release is a major challenge for this population. Many employers are reluctant to hire someone with a prison record. In a survey of 3,000 employers, two-thirds reported that they would not knowingly hire a former prisoner. Most recently released people also have other attributes, such as low educational attainment and limited work history, that make them less appealing to potential employers, and they may have competing demands from drug treatment programs and curfews or other restrictions on mobility that can further exacerbate the problem of finding and keeping full-time employment.

Well-rounded employment services for former prisoners may be critical to ensuring better post-release outcomes. While there are many community programs that aim to provide these needed supports, few operate on a large scale and little is known about how effective they are. CEO in New York City is one of the nation’s largest and most highly regarded employment programs for formerly incarcerated people.

Evaluation Activities:  The evaluation rigorously tests whether the core components of CEO’s program produce impacts on employment, recidivism, and other outcomes. The impacts of CEO’s program are being assessed using a random assignment research design.

Future Prospects:  N/A


Kristen Joyce
Co-Project Officer, Office of Human Services Policy, ASPE
Phone: 202-690-5739
Email: Kristen.Joyce@hhs.gov

Girley Wright
Co-Project Officer, Office of Planning, Research, and Evaluation, ACF
Phone: 202-401-5070
Email: Girley.Wright@acf.hhs.gov

Amy Madigan
Co-Project Officer, Office of Human Services Policy, ASPE
Phone: 202-690-6652
Email: Amy.Madigan@hhs.gov

National Evaluation of the Responsible Fatherhood, Marriage, and Family Strengthening Grants for Incarcerated and Re-Entering Fathers and their Partners

Type of Activity: Evaluation

Funding Mechanism:  Contract with RTI, International

Total Available Funding:  $11 million

Number of Awards: 1

Award Amount:  $11 Million

Length of Project Period: FY 2006 - FY 2014

Federal Partners: Office of Family Assistance within the Administration for Children and Families

Summary: The Evaluation of the Marriage and Family Strengthening Grants for Incarcerated and Reentering Fathers and their Partners (MFS-IP) is part of the U.S. Department of Health and Human Services (HHS), Administration for Children and Families (ACF) initiative to support healthy marriage and responsible fatherhood. 

While incarceration takes a huge toll on families and children, research suggests that supportive families and positive marital/partner relationships are important for promoting positive adaptation for children of the incarcerated and for preventing subsequent criminal involvement among reintegrating prisoners.  To evaluate the overall effectiveness of the MFS-IP grantees, the Assistant Secretary for Planning and Evaluation (ASPE), awarded a contract to RTI to conduct an implementation evaluation as well as a multi-site, longitudinal, impact evaluation of selected grantees.

The implementation and impact evaluation includes on-site data collection regarding program implementation and a longitudinal survey data collection effort of 2000 couples to study the effect of program participation using experimental and quasi-experimental designs.  Outcomes of interest include couple and parent-child relationships, employment, and recidivism.  This evaluation will add to research, policy, and practice by helping to determine what types of programs work best for those involved in the criminal justice system, what does not work, and what effects these programs may have on fostering healthy marriages, families, and children.

Background:  Many relationships, including those between intimate partners and among parents and children, are affected by incarceration. In mid-year 2006, more than 2.2 million individuals were incarcerated in federal or state prisons or in local jails. The majority of incarcerated and reentering prisoners are parents, with 1999 estimates indicating that 55 percent of state and 63 percent of federal prisoners had a minor child (the total estimated minor children of these parents was 1.5 million). Relationships are at particularly high risk of disruption when parents are involved in the criminal justice system, and there is currently very little institutional support to assist inmates in maintaining these relationships and transitioning back into their families upon release.

On September 30, 2006, the Department of Health and Human Services’ Administration for Children and Families (ACF), Office of Family Assistance (OFA) announced grant awards to 226 organizations to promote healthy marriage and responsible fatherhood. Originally fourteen awards were funded under the Responsible Fatherhood, Marriage and Family Strengthening Grants for Incarcerated and Reentering Fathers and Their Partners (MFS-IP) priority area. MFS-IP grantees include government (state, local, and tribal) and private (community- and faith-based) organizations. With a funding level of up to $500,000 per year for five years, the programs implemented under the MFS-IP priority area are designed to promote and sustain healthy marriages and strengthen families affected by incarceration.  Twelve grantees are currently operating programs.

Location(s) of Projects: Responsible Fatherhood, Marriage, and Family Strengthening Priority Area V Grantees — Child and Family Services of New Hampshire, Indiana Department of Corrections, Maryland Department of Human Resources, New Jersey Department of Corrections, Shelby County Division of Corrections (Memphis, TN), Centerforce (Bay Area, CA), Council on Crime and Justice (Minneapolis-St. Paul, MN), Lutheran Social Services of South Dakota, Oakland Livingston Human Service Agency (MI), Osborne Association (New York), People of Principle (West Texas), Ridge Project (Northwest Ohio)

Evaluation Activities:  This is the national impact and implementation evaluation of ACF’s Responsible Fatherhood, Marriage and Family Strengthening grantees that implemented programs under the MFS-IP priority area.  A description of the Responsible Fatherhood, Marriage and Family Strengthening Grants for Incarcerated Fathers and their Partners is located in the Office of Family Assistance section of this compendium.

Future Prospects:  One-time funding


Erica Meade
Social Science Analyst, ASPE-HSP
Phone: (202) 690-5937
Email: erica.meade@hhs.gov

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Last updated:  02/25/2011