Addressing the impact of working with formerly Incarcerated people on the multi-disciplinary staff at the Center for Comprehensive Care in New York City

Background New York State Correctional facilities release over 25,000 people each year; almost half return to New York City. Additionally, 100,000 people cycle through NYC jails annually. People returning from prison have greater health and social service needs than the general population. Left untreated, medical conditions can become costly and life threatening; unaddressed social service needs pose risks for recidivism. Methods The Center for Comprehensive Care (CCC) at St. Luke's-Roosevelt Hospital is a New York City-based Designated AIDS Center serving 6,000 patients. Its Coming Home Program (CHP) has served over 900 formerly incarcerated people since 2006. CHP employs formerly incarcerated staff to address re-entry needs of people returning home while providing them a robust array of medical and psychosocial services. The success of CHP relies, in part, on professionals and peers with sensitivity for the needs of individuals in this life station. In 2009, the program opened its doors to formerly incarcerated HIV-negatives recognizing the dearth of services for this population with similar chronic disease management and social service needs as HIV-positives. Results As of December 2011, 72% of CHP patients are HIV-negative. The majority lives with multiple chronic conditions (69%) and have substance abuse histories (64%); many cope with mental illness (43%). Rebuilding relationships and self-respect, establishing stable housing and finding employment all while dealing with stigma after incarceration is complicated. Managing the complex issues CHP patients present, and caring for a growing number of HIV-negatives, pose challenges to CCC's multi-disciplinary staff. Staff must gain familiarity with the needs of people coming home and have the resources to meet them. They must also work through their own preconceived notions and fears about people who have been incarcerated. Since CCC patients have historically been HIV positive, staff must re-orient to the needs of and services available to HIV-negatives. These individuals are less likely to have experience with healthcare systems, so they face more adjustments in some ways than their HIV-positive counterparts, and sometimes pose greater demands on the providers caring for them. Conclusion Providing health care for people returning from imprisonment is a public health imperative; not a simple task. Sensitively meeting the needs of formerly incarcerated patients requires engaging staff not only in training about their needs and the injustices they face, but also in hearing and validating staff's concerns and frustrations. The CCC's experiences addressing challenges with CHP implementation could be useful to providers developing similar programs.