Issues:

The transition from incarceration to community presents numerous challenges, including securing stable housing, employment, transportation, benefits, and basic necessities, all while facing stigma related to a history of incarceration. For reentrants living with HIV, these challenges are compounded by the need for immediate healthcare and medication to maintain treatment adherence and viral suppression.

Description:

Through CDC's “Project CARES” (Community Approaches for Releasees to Maintain Viral Suppression) funding, New York State contracted five community organizations to provide comprehensive HIV navigation services. These services were offered to individuals living with HIV six months prior to release and up to 18 months post-release from any of the state’s 44 prisons. The program included a thorough behavioral risk and needs assessment, followed by a linkage action plan addressing HIV care and social determinants of health, such as medical care, housing, substance use treatment, and mental health services.

Lessons Learned:

Care attainment and viral suppression were compared between project enrollees and a similar group of individuals with HIV, released from prison but not enrolled. Project participants consistently showed higher rates of care attainment and viral suppression.

Recommendations:

Implement comprehensive reentry support and navigation services as a best practice to enhance care retention and viral suppression for incarcerated individuals and reentrants living with HIV.

Individuals with a history of incarceration are disproportionately affected by chronic diseases compared to the general population, which is why access and continuity of care are important measures to evaluate within correctional facilities. We aimed to describe healthcare access during incarceration and continuity of care post-release among individuals with a history of incarceration in jail.

We conducted semi-structured interviews with individuals formerly incarcerated at the Monroe County Correctional Center in Bloomington, Indiana. Participants discussed facilitators and barriers to accessing healthcare services within the jail and continuity of care post-release. Questions included the process for requesting care, types of care received, privacy considerations, costs including the use of health insurance, and support from the jail and local community organizations upon release.

Preliminary findings indicate challenges in accessing healthcare while incarcerated and post-release due to cost and limited services. Specifically, barriers in accessing healthcare in the jail included copays required to receive medical services and delays in mental health care due to limited providers and availability. Barriers to continuity of healthcare post-release included cancellation of health insurance coverage and lack of medical records.

Our findings highlight a critical need for improved healthcare access and continuity of care for individuals with a history of incarceration. The significant barriers identified underscore the importance of policy reforms and targeted interventions to address healthcare access challenges. Ensuring individuals receive timely and adequate healthcare while incarcerated, and that continuity of care is maintained post-release, is essential for mitigating the disproportionate burden of chronic diseases in this population.

Background/Purpose: Incarceration significantly elevates risk of death from suicide, violence, overdose, chronic and infectious diseases, and accidents. Previous federal reporting mechanisms (i.e. Bureau of Justice Assistance [BJA]) fail to provide individual or facility-level data, limiting our ability to analyze epidemiologic trends and systemic drivers of mortality. Additionally, many deaths may remain absent from or be misclassified within official reporting structures, necessitating triangulation via alternative data collection strategies.

Methods: We track carceral mortality by creating open-source datasets (incarcerationtransparency.org/southcarolina) through public records requests (e.g. incident reports, SCDC 8-2 forms) to all prisons and jails in SC via the Freedom of Information Act. Then, we systematically review, code, and digitize the data for analysis. In this analysis, we conducted descriptive and univariate analysis of all-cause and cause-specific deaths behind bars (2020-22). Next, we cross-referenced our database (Incarceration Transparency [IT]) with the most recent data release from BJA to compare across three databases (IT, BJA, combined IT/BJA).

Results: We identified 406 deaths (including n=34 not captured by BJA) in SC prisons (n=273,67%) and jails (n=133,33%) (link). We report univariate associations between key individual characteristics (age, time in custody, sex, race, arresting offense, trial status, facility type) for medical (n=189), accident (n=7), drug overdose (n=12), suicide (n=45), violence (n=9), unknown (n=61), and pending (n=83) deaths.

Conclusions: Our approach compares to existing federal mechanisms but allows for individual- and facility-level profiling of carceral mortality data. Future inclusion of facility-level data will allow for further epidemiologic analysis of specific drivers and mechanisms of mortality behind bars.

Introduction

Little is known about the consequences of immigration detention, and the impact of release of a parent or caregiver, on children’s health. We examined changes in general health of children following release of a parent from U.S. immigration detention.

Methods

We used telephone survey data from family members of immigrants who were detained by Immigration and Customs Enforcement (ICE) and subsequently released on bond. A total of 88 family members completed the surveys. We assessed children’s health using the pediatric parent-report version of the PROMIS^® global health measure at pre-, during, and post release from detention. We limited our sample to families with children ages 5 to 17 years (N=49), for whom this measure is validated. We obtained standardized T-scores centered on the 2000 US General Census population (Mean=50, SD=10).

Results

The mean T-scores were slightly below the population mean of 50 at pre-detention (49; 95% CI: 47.1, 56.4) and release period (48.9; 95% CI: 41.1, 56.8). During the detention period, the mean T-score dropped to about 2 SD below the population mean (31.8; 95% CI: 25.7, 37.9). About 37% of children received treatment or counseling from a mental health professional during detention of their parent, compared to 15% pre-detention and 24% following release. The major problems for children during detention of their parent included increased financial responsibilities (60%), household or caregiving responsibilities (53%), and food insecurity (53%).

Conclusions

Detaining a parent or caregiver harms children's health and well-being, while releasing them can lead to improvements in these outcomes.