245384 Employing Former Prisoners as Community Health Workers: Success and Challenges

Tuesday, November 1, 2011

Ronald Sanders, CHW , Southeast Health Center, Transitions Clinic, San Francisco, CA
Juanita Alvarado, CHW , Transition Clinic, San Francisco, CA
Emily Wang, MD, MAS , Department of Medicine, Yale University School of Medicine, New Haven, CT
Clemens Hong, MD/MPH , General Medicine Division, Massachusetts General Hospital, Boston, MA
Shira Shavit, MD , Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
Returning prisoners have high rates of chronic diseases, mental illness, and substance use. Most prisoners cite the emergency room as their source of care upon release and have little support in navigating the fragmented medical and social services. Prisoners have faced substandard care in the prison medical system leading to mistrust and fear of judgment which are barriers to seeking care. Transitions Clinic (TC) is an innovative program that engages chronically-ill adults into primary care upon release from prison. Specially-trained community health workers (CHWs) with histories of incarceration outreach to recently-released prisoners and guide them through the complex medical system to promote health and stability. CHWs successfully leverage their own incarceration to relate to their patients' struggles and advocate for patients' needs. In return, patients feel at ease which builds rapport and trust improving health outcomes. CHW's bridge the cultural gap between provider and prisoner. They are non-judgmental and provide critical emotional support during the vulnerable state of reentry. While the CHW's prior incarceration is the key component to the program's success, it also brings unique challenges. Like their patients, the CHWs face a stigma of incarceration and distrust from the medical community. Since the CHWs have been incarcerated with some of the patients, they face exclusive ethical dilemmas. Prison cultures and conflicts extend beyond the prison and sometimes leads to patients expecting inappropriate favors or tense encounters. TC has developed many strategies to mitigate these challenges, all of which come from feedback from the CHW's personal and professional experiences.

Learning Areas:
Advocacy for health and health education
Chronic disease management and prevention
Diversity and culture
Ethics, professional and legal requirements
Public health or related public policy

Learning Objectives:
1. Identify the barriers former prisoners face while trying to access the medical system. 2. Describe the advantages of having community health workers (CHW) with a history of incarceration in caring for former prisoners. 3. Discuss some of the challenges faced on a daily basis by CHWs with a history of incarceration. 4. Explain how to deal with these challenges by applying CHW’s personal and professional experiences.

Keywords: Prisoners Health Care, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Community Health Worker who works with formerly incarcerated individuals with chronic diseases.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.