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

  • Community Education Group, Washington, DC
  • The CORE Foundation, Chicago, IL
  • Metropolitan Charities, St. Petersburg, FL
  • Volunteers of America Bay Area, Inc., Alameda, CA
  • Lationo Commission on AIDS, New York, NY
  • Dominican Sisters Family Health Services, Inc., Bronx, NY.

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

  •    Number of individuals with a clinical report of adherence to HIV treatment.
  •    Number of HIV infected individuals surviving 3 years after a diagnosis with AIDS.
  •    Number of individuals who learn their HIV status for the first time per the MAI fund.
  •    Number of individuals in receipt of HIV testing and knowledgeable of their status.
  •    Number of at-risk youth in receipt of HIV testing and counseling and knowledgeable of their HIV status.
  •    Number of individuals in receipt of HIV testing upon entry into transitional housing programs.
  •    Number of newly diagnosed HIV positive individuals referred and in receipt of comprehensive HIV/AIDS services.
  •    Number of individuals referred and enrolled into substance abuse and mental health treatment programs.
  •    Number of at-risk youth in receipt of education relative to HIV transmission.
  •    Number of at-risk youth in receipt of appropriate counseling and/or mental health services.
  •    Number of at-risk youth in receipt of substance abuse prevention education and/or treatment.
  •    Number of individuals linked to and enrolled into publicly funded social and health services programs, such as TANF, Medicaid, and HUD housing.
  •    Number of individuals linked and enrolled into job training/placement programs.

Impact Measures

  •    Increased availability of and access to prioritized services designed for the unmet needs of minority HIV/AIDS sub-populations who are knowledgeable of their status but are currently not in care.
  •    Improved efficiency and utilization of MAI funds via increased Federal interagency collaboration and leverage of MAI-funded community-based resources.
  •    Increased access to primary care, substance abuse treatment, and mental health services.
  •    Increased rates of adherence to HIV treatment.
  •    Decreased frequencies of substance abuse relapse.
  •    Decreased rates of HIV transmission.
  •    Improved quality of care, and subsequent increased rates of survival for individuals who are HIV positive.
  •    Initial decreased rates of recidivism at 1- year post-reentry.

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

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