OPERATIONALIZING THE TRANSNATIONAL FRAMEWORK: PARTICIPANTS, PROGRAMS & SYSTEMS

NYC Correctional Health Services

Alison  O.  Jordan  LCSW  Jacqueline  Cruzado-­‐Quinones  Janet  Wiersema,  MPH  Paul  Teixeira,  DrPH    

Bronx Health & Housing Consortium 5th Annual Convening December 8, 2015

NYC CHS: INTEGRATING TRANSNATIONALISM

•   Assessing transnationalism ▫  Participants, Programs and System

•  Integrating transnationalism ▫  Participants, Programs and System

•  Points of intervention ▫  Jail-based patients, Jail Health Providers, Community

network

•  Fidelity documentation ▫   Participants and Training

RIKERS ISLAND

Manhattan Detention

Center

Brooklyn Detention Center

Vernon C. Bain Center, Bronx

Transitional Health Care Coordination

Twin Epidemics: Mass Incarceration & HIV

Correc&onal  Health  is  Public  Health  

Over 70% of people released to the

community after incarceration return

to the areas of greatest

socioeconomic and health disparities

At A Glance

FaciliCes  12  jails:  9  on  Rikers  Island  (1  female  facility,  1  adolescent  facility),  3  borough  houses,  public  hospital  inpaCent  unit    

Average  Daily  PopulaCon   ~10,800 (2014)

Annual  Admissions   60,000 (2014)

Community  Releases*   60,000 / year  

Length  of  Stay   mean=37  days;  median~7d  

Return  to  Community   ~78%

CORRECTIONAL HEALTH SERVICES

*Annual releases from NYC DOC Report of Discharges by zip code for CFY’14

JAIL DEMOGRAPHICS

We estimate that Puerto Ricans are 1/3 of Hispanic population.

TRANSNATIONALISM: PARTICIPANTS, PROGRAMS & SYSTEMS

•  Transnational Checklist • Added specific ethnicity to RW assessment • EHR report reviewed weekly for recruitment • Air Bridge program integration • Curriculum Development / Partner training

TRANSNATIONAL CHECKLIST Key indicators: ▫  Ethnic identifier (e.g., Nuyorican, Boriqua, Puerto

Rican) ▫  Place of birth / childhood; Parent birth place ▫  Length of time in states? PR? ▫  Location of family / friends ▫  Air Bridge? ▫  Access to health care / services –states? PR? ▫  Finances - send /receive money from PR? ▫  Overall impact on healthcare / HIV care?

•  Interested in PR-based services?

PROGRAM INTEGRATION

EHR RW Assessment includes specific ethnicity: •  Informs study recruitment / enrollment • Discharge planning • QA / Integrity of Recruitment •  Fidelity to service model / known denominator

http://en.wikipedia.org/wiki/File:PR_Migration_1995-2000.jpg

Deren et al. 2007 found:

HIV-infected Puerto Ricans seek care in NYC

62% of NY-based Puerto Ricans lived in PR

42% of PR-based lived in NYC

“Air Bridge”

If seeking return to PR: • Refer to One Stop Career Center of PR • Over 60 MOUs with other agencies to provide

health care and other support services Limited time? • Refer to Harlem United for enrollment and services

TRANSNATIONAL CHECKLIST: PROGRAM

Arecibo  HIV  Care  

CDT  Hormigueros  PrevenCve  Medicine   Inc.  

Corporacion  Fondita  de  Jesus  

COSSMA,   Inc.  

Corporacion  SANOS  

IniciaCva  Comunitaria  de  InvesCgacion,  Inc.  

Lucha  Contra  el  SIDA,  Inc.  

Neo  Med   Center,  Inc.  

Pry  Med  Medical  Center,  Inc.  

Puerto  Rico  Dept.  of  Health  

Salud  Integral  de  la  Montana,  Inc.  

Associaconde  Salude  Primaria  de  Puerto  Rico   Caribbean  Medical  

Concilio  de  Salud  Integral  de  Loiza  ,Inc  

Hospital  University  of  Puerto  Rico  

Other  FQACs  

One  Stop  Career  Center  locaCons  

SYSTEM INTEGRATION OF TRANSNATIONALISM:

• Worked with NYU Center for Latino Adolescent and Family Health (CLAFH) to develop curriculum using: ▫  HRSA / ETAC materials ▫  Transnationalism checklist ▫  ETAC / UPR webinars

• Curriculum includes transnationalism concepts administered in two setting and in three formats: ▫  Jail- and community- based training ▫  3 training formats: 1) doctors and clinical staff, 2) mid-

level staff, 3) support staff

TRAINING ATTENDANCE (to date) Training Location

Grand Rounds

Mid-Level (Half day)

Case Mgt (Full Day)

Total

Rikers 73 42 105 220 Bronx TBD 19 47 66 Citywide Coming Soon! Total (to date) 73 61 152 286

Selected Slides from Provider Training:

Thank you!

Alison O. Jordan, Principal Investigator ajordan@nychhc.org / 347-774-7170

Jackie Cruzado-Quinones, Project Manager jcruzado@nychhc.org / 917-715-6841

Janet Wiersema, Project Director jwiersema1@nychhc.org / 347-774-8259

Paul Teixeira, Evaluator pat2007@med.cornell.edu / 646-962-9439