PARTICIPATING PROJECTS

Florida Department of Health

Partners and Collaborators
The CDP funded the Florida Department of Health (FDOH), Bureau of HIV/AIDS, Early Intervention Program. The grant included funds for the Linking Inmates Needing Care (LINC) project, which began in February 2000. During this period, the FDOH had in place a peer education program for HIV prevention in three northeast Florida prisons and the Pre-Release Planning Program in collaboration with the State Department of Corrections (DC). The LINC project was implemented in both short- and long-term Florida correctional facilities. Implementation sites included the Jacksonville-Duvall County Jail in northeastern Florida, the Central Florida Reception Center (CFRC) in Orlando, and seven satellite prisons throughout the State.

The Jacksonville/Duval County Jail, in the northeastern corner of Florida, housed the Jail LINC project. The local county health department managed the project and established contractual linkages with the Jacksonville/Duval County Jail and four community-based agencies: Lutheran Social Services, for case management; River Region Mental Health Services, for mental health and drug treatment; the Rainbow Center, for maternal and infant primary care; and the Northeast Florida Health Planning Council, for data management.

The services provided by Jail LINC staff included screening for HIV, STIs, TB, and hepatitis; HIV prevention education for inmates and corrections staff; prerelease planning; and follow-up in the community for at least 6 months. During intake, all inmates received HIV prevention education and were offered HIV/STI testing prior to the jail medical examination.

The Florida Department of Corrections operates 62 correctional facilities. Twenty-two are “HIV cluster prisons,” housing most of the HIV-infected inmates to allow for the concentrated and intensive medical care such inmates need. To implement the LINC Project, the DC contracted with the University of Miami to provide LINC services in seven correctional facilities in central Florida: Hernando Correctional Institution (CI); Lowell CI, a women’s facility in Marion County; Lake CI; Tomoka CI; Brevard CI; the Kissimmee Work Release Program; and Zephyrhills CI. The CFRC served as the hub for LINC services for inmates of the CFRC and the seven satellite facilities.

The prison network established informal, collaborative relationships with 45 case management and support service agencies around the State. The agencies were located in 13 counties, most of which were part of Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Eligible Metropolitan Areas in south central and south Florida.

Unlike the jail component, DC prison facilities release inmates from all over the State and sometimes to other States. As a result, formal agreements were not made with local community-based agencies for case management, and those agencies were not reimbursed through the LINC project. To determine what resources were available on a statewide basis, the FDOH established the Community Agencies Providing Resources for Ex-Offenders (CARE) Network, which was a network of CBOs, advocates, former inmates, and county health department and corrections staff who serve HIV-infected ex-offenders. The CARE Network continues to function as a forum for agencies and individuals serving HIV-infected ex-offenders.

The Prison LINC project provided screening and counseling and testing for HIV, HIV prevention education for inmates and staff, prerelease planning for releasees, and follow-up in the community for at least 6 months. The project began in the Lowell CI and expanded into the others.

The case management program followed releasees for a minimum of 6 months postrelease. Case managers identified clients’ needs, developed a case management plan, referred clients to both a case management program and a primary care clinic, and maintained oversight management with each client. The case managers also maintained contact with the clients’ community service providers. Case management plans were developed prior to release and were updated as needed postrelease. A major effort was made to identify community agencies by county to meet the needs of releasees.

The disease-screening component of the project was linked to HIV prevention and education. HIV screening and counseling were offered following all prevention education sessions. Quarterly, intensive, in-depth, and interactive training sessions were provided to correctional medical staff through the LINC mini-residency program and CFRC. At the end of the project, no funds were available to sustain the Prison LINC project.

Model
The goal of the LINC Project was to identify inmates with HIV, STIs, TB, and hepatitis; assist in planning for their release; and provide follow-up to determine whether project interventions made a difference. Before the CDP, limited HIV screening, counseling and testing, and linkages were provided in Florida’s correctional facilities. Some HIV prevention services were provided, but not on a large scale. Under CDP, HIV and STI disease screening, as well as discharge-planning and case management services, was enhanced and provided on a much broader scale. A supplemental hepatitis screening and vaccination program component was developed in the jail project as an ancillary service using other resources. An HIV/AIDS secondary prevention program and a major staff training initiative were implemented within the CDP.

LESSONS LEARNED: Florida Department of Health The Prison LINC project case managers found that releasees who had been in prison for more than 5 years needed special support to adjust to living outside the structured prison environment. They implemented a “Life Skills Training for DC Clients” program. This program enabled inmates to develop an understanding of the barriers they would face following prison, including treatment compliance, substance abuse, unsafe sex, family dysfunction, and the lack of marketable skills. The most overriding of the lessons learned from the LINC Project during the 5-year CDP was that public health and corrections programs can successfully work together to provide services to HIV-infected inmates within the confines of a secured environment. The burden is on public health providers to work around the security issues that dominate the corrections environment. As long as public health providers understand how to work within the constraints of correctional facilities, public health programs can flourish. Public health providers strive to provide services without disrupting the routine of the correctional facility and without putting an extra burden on security and correctional medical staff. It also is important for security and correctional medical staff, to the extent possible, to create an atmosphere conducive to the provision of public health services. Providing discharge planning and follow-up in a statewide system requires the development of a statewide network of agencies, such as the Florida CARE Network. Because it was difficult to fund contracts with agencies to provide support services to ex-offenders on a statewide basis, it was essential to provide a forum for those agencies to communicate regularly, share information, and receive the latest information about HIV prevention and education. The FDOH provided staff support for the CARE Network and for the departmental Correctional Infections Workgroup, a group of administrators at headquarters level representing key FDOH and DC programs.