Engaged scholarship at the Brown University School of Public Health: designing education for better prisoner and community health.

PURPOSE: The purpose of this paper is to describe the course, "Designing Education for Better Prisoner and Community Health," which provided students with the knowledge, skills and resources needed to build real-world health education materials for persons who are criminal justice involved. DESIGN/METHODOLOGY/APPROACH: A multiphase engaged scholarship course was designed and implemented through the Brown University School of Public Health in Rhode Island, USA. FINDINGS: Students collaborated closely with instructors, subject matter experts and affected community members to develop highly tailored health education projects across six topic areas. The structure and outcomes of the paper are described with the hope that other instructors and institutions might replicate components of the model. ORIGINALITY/VALUE: Engaged scholarship in public health can provide students with rich, collaborative learning experiences, and when executed effectively, these endeavors can provide underserved communities with robust and informed health education interventions and programs.

Fatherhood, Reproductive Health, and Incarcerated Men: A Qualitative Study With Implications for Reentry.

It is important to understand how incarcerated men conceptualize fatherhood for reentry. Sixteen interviews explored attitudes and feelings about parenthood, family planning, and challenges and strengths regarding fatherhood. Transcriptions were analyzed for themes using open coding. Parenting themes: being active in children's lives, financial stability, and giving children better lives. Family planning themes: preventing sexually transmitted infection, creating stable families, importance of family planning, and birth control methods. Men were motivated to be stable fathers and utilize family planning to create stability; men expressed need for better partner communication. Fathers struggled to provide support/stability for children but expressed openness to learning parenting skills and family planning methods. Reentry strategies may address these themes to rehabilitate men and enhance family planning.

A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System.

Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCV in corrections. The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. Three treatment strategies were evaluated as follows: (1) treating all chronically infected persons, (2) treating only patients with demonstrated fibrosis, and (3) treating only patients with advanced fibrosis. Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. Chronic HCV prevalence was estimated at 17% of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable.

Medicaid expansion: considerations for states regarding newly eligible jail-involved individuals.

The expansion of Medicaid eligibility to Americans with incomes up to 138 percent of the federal poverty level should greatly increase access to coverage and services for people recently released from jail and, thus, improve health outcomes and reduce recidivism in this population. The population is disproportionately male, minority, and poor; suffers from high rates of mental and substance abuse disorders; and is expected to make up a substantial portion of the Medicaid expansion population. To ensure connections to needed services after release from jail, states could help inmates determine their eligibility and enroll in Medicaid; take advantage of federal grants to automate systems that determine eligibility; and include a robust array of behavioral health services in Medicaid benefit packages. In most states, new partnerships between Medicaid and corrections agencies at both the state and local levels will be needed to support these activities.

Integrating correctional and community health care for formerly incarcerated people who are eligible for Medicaid.

Under the Affordable Care Act, up to thirteen million adults have the opportunity to obtain health insurance through an expansion of the Medicaid program. A great deal of effort is currently being devoted to eligibility verification, outreach, and enrollment. We look beyond these important first-phase challenges to consider what people who are transitioning back to the community after incarceration need to receive effective care. It will be possible to deliver cost-effective, high-quality care to this population only if assistance is coordinated between the correctional facility and the community, and across diverse treatment and support organizations in the community. This article discusses several examples of successful coordination of care for formerly incarcerated people, such as Project Bridge and the Community Partnerships and Supportive Services for HIV-Infected People Leaving Jail (COMPASS) program in Rhode Island and the Transitions Clinic program that operates in ten US cities. To promote broader adoption of successful models, we offer four policy recommendations for overcoming barriers to integrating individuals into sustained, community-based care following their release from incarceration.

Medicaid policies and practices in US state prison systems.

Medicaid is an important source of health care coverage for prison-involved populations. From 2011 to 2012, we surveyed state prison system (SPS) policies affecting Medicaid enrollment during incarceration and upon release; 42 of 50 SPSs participated. Upon incarceration, Medicaid benefits were suspended in 9 (21.4%) SPSs and terminated in 28 (66.7%); 27 (64.3%) SPSs screened prisoners for potential Medicaid eligibility. Although many states supported Medicaid enrollment upon release, several did not. We have considered implications for Medicaid expansion.

Incarceration, community health, and racial disparities.

Several recent studies have shown that the racial disparities in U.S. mortality nearly disappear in prisons. We review the social determinants of the recent epidemic of incarceration, especially the war on drugs, and describe inmate morbidity and mortality within the context of U.S. health disparities. Incarceration provides an important public health opportunity to address health disparities by accessing a high-need, medically-underserved, largely non-White population, but it has also been associated with poor long-term health outcomes. Viewing incarceration within the context of community health and community life shows that the more equitable mortality rates among inmates are not evidence of the beneficial effects of incarceration so much as an indictment of disparities in the community at large. Because people of color are incarcerated far more frequently than Whites, the experience may ultimately exacerbate rather than mitigate health disparities.