For the past 40 years, the United States has relied increasingly on incarceration and lengthy prison sentences to deal with crime. Recently, pressure has mounted to release more prisoners due to prison overcrowding, growing correctional health expenditures and constrained legislative budgets. In turn, communities are challenged to care for former prisoners – a population that is more likely to suffer from mental illness, substance abuse, complex medical problems and chronic disease than the general population.
In Arkansas, the majority of released prisoners settle in central Arkansas. Upon release, most will not have a primary care physician or access to regular health care. They also may not have health insurance. The transition from prison to the community significantly impacts the health of former prisoners, and continuity of care during this period is critical but often absent. Individuals will be at a great risk of suicide, overdose or an acute cardiovascular disease episode, and they are nearly 13 times more likely than the general population to die in the two weeks following release.
Release from incarceration is accompanied by stress and anxiety associated with re-establishing the basic conditions of community membership – including ties to family, a place to live and a means of subsistence. Following release, former inmates face barriers to health care, such as costs, long waits and discrimination in medical settings.
A new program, the Little Rock Transitions Clinic, based at the UAMS Family Medical Center, addresses former prisoners’ critical medical and social needs. The program is a collaboration of the UAMS Center for Primary Care, the UAMS College of Public Health and the Central Arkansas Re-Entry (CARE) Coalition, a local network of community-based and social service organizations serving the re-entry needs of formerly incarcerated individuals. The program will provide transitional services to individuals upon release from prison as well as ongoing primary care to former prisoners living in the greater Little Rock area. Anyone with a chronic illness, which may include mental health or substance abuse conditions, or individuals over age 50 are eligible for services.
The program will serve as a one-year pilot to test a primary care clinic model, now at 13 other sites around the country, that provides comprehensive medical care to former prisoners. The model, developed by the San Francisco-based Transitions Clinic Network (TCN), utilizes formerly incarcerated individuals to serve as community health workers (CHWs). Similarly, the UAMS program has hired a former prisoner to serve as a CHW at the clinic to help patients obtain the health care and other services that they need.
TCN provides consultation, education, training and evaluation support to other clinics using its model. On August 25, TCN Executive Director Shira Shavit, M.D., and TCN Evaluation Director and Co-Founder Emily Wang, M.D., MAS, came to UAMS. Dr. Shavit and Dr. Wang presented on the TCN clinic model and met with stakeholders for the UAMS clinic program.
In Dr. Shavit’s presentation, she noted that U.S. rates of incarceration are the highest in the world – about 1 in 100 adults or 2.2 million people are in prison. Ninety-five percent of U.S. prisoners are eventually released, with more than 700,000 released annually. Those who are incarcerated come largely from the most disadvantaged segments of the population. Poor communities of color are disproportionately affected by incarceration; one in three black men face incarceration in their lifetimes. Most will return to their former communities.