PARTICIPATING PROJECTS

Illinois: Chicago Department of Public Health

Partners and Collaborators
Funding was provided to the Chicago Department of Public Health, Division of STD/HIV Prevention and Core Programs, to develop and administer the Illinois Public Health Corrections and Community Initiative (IPHCCI). The IPHCCI was charged with the development, implementation, and evaluation of a comprehensive and continuous care system for PLWHA recently released from the Cook County Department of Corrections (CCDOC) and Illinois Department of Corrections (IDOC).

Before the inception of the IPHCCI, known internally as the HIV Continuity of Care Project, no formal partnership existed between the Chicago Department of Public Health and other organizations. The following Chicago agencies formed new partnerships in the Continuity of Care Project and provided services:

The Chicago Department of Public Health Adolescent Team, in addition to serving as project coordinator, provided HIV/AIDS, STI, and pregnancy prevention education to female detainees ages 13 to 17 at the Cook County Juvenile Temporary Detention Center and the Illinois Youth Center of Chicago. Each detainee received 12 weeks of instruction, 6 weeks of which were drawn from the “Making Proud Choices” curriculum.
The CCDOC Juvenile Temporary Detention Center focused on providing health education to detained adolescents at the detention center in Cook County.
The Ruth Rothstein CORE Center provided HIV primary health care for all clients in IPHCCI in addition to client tracking. The Core Center corrections clinic (held weekly) was a vital component of the initiative because it was the one place where case managers were able to locate their clients in the event contact was lost.
Cermak Health Services and the CCDOC provided internal case management, discharge planning, and linkages to the CORE Center and Haymarket Center. A key aspect of the IPHCCI was linking incarcerated clients at the Cook County Jail to their external case managers. Cermak Health Services provided the link between internal and external case managers so that inmates could receive continuity of care and develop a work plan before their release. Cermak also provided HIV primary health care using the same physician and medical assistant who provided HIV care at the Corrections Clinic at the CORE Center. This structure promoted client adherence to scheduled appointments and medication regimens.
The Illinois Youth Center of Chicago was added during the second year of the project. The program focused on providing HIV prevention services though HIV testing, counseling, and educational sessions.
AIDS Foundation of Chicago (AFC) provided intensive community case management for the project and coordinated projectwide case management services through its corrections coordinator. The coordinator provided technical assistance and consultation to case managers via telephone, e-mail, faxes, and bimonthly case management meetings and site visits.
New Beginning Recovery Homes, Inc. (NBRHI) provided housing and employment training for IPHCCI clients. NBRHI successfully provided emergency and transitional housing to homeless ex-offenders, clients with HIV/AIDS, and clients with mental illness. NBRHI was staffed with paraprofessionals on a 24-hour basis, and the organization hired ex-offenders as staff members and offered an extensive developmental and supportive skills program. NBRHI served more than 2,064 ex-offenders during the project; 200 of those clients were male HIV-positive residents.
The Safer Foundation provided employment readiness and placement to recently released ex-offenders. The foundation focused on reducing recidivism by providing a full spectrum of employment and training services to ex-offenders.
Community Supportive Living Systems provided housing and case management for homeless, HIV-positive clients (and their
families) who were recently released from jail or prison and were enrolled in the IPHCCI. Services included comprehensive life skills training, disease treatment and follow-up, discharge planning, an accountable and supportive client-level case management model, and identification of community-based supportive resources.
For Action in Togetherness Hold Fast (F.A.I.T.H.) Inc. provided assistance to IPHCCI clients in obtaining identification and other documents, including State identification cards, birth certificates, high school transcripts, voter registration cards, and Social Security cards, upon release from correctional facilities. During the project, F.A.I.T.H. helped thousands of ex-offenders obtain State ID cards and provided transportation to various facilities by distributing public transportation farecards.
Haymarket Centers (HM), providers of mental health and substance abuse treatment and primary health care, became integral elements of IPHCCI’s comprehensive continuity-of-care system. HM provided onsite nonmedical detoxification services, residential and outpatient substance abuse treatment, mental health services, and primary medical care. In addition to accepting large numbers of project clients, HM provided a court liaison to conduct substance abuse assessments with potential clients at the Cook County Jail who requested treatment. By becoming a full partner in the IPHCCI, HM maximized treatment slots for releasees who were living with HIV and seeking treatment.
IDOC and the Chicago Center for Health Systems Development also played an important role in strengthening the depth of projects in enhancing continuity of care.
The Community Mental Health Council was added to the project as an additional mental health component of the IPHCCI’s comprehensive continuity-of-care system.

Model
Clients who were identified as HIV positive through voluntary testing while incarcerated were provided with medical services. As a priority for discharge planning, HIV-positive inmates were referred to the IPHCCI intensive case management services. Clients and IPHCCI case managers (ICMs) were linked before release. Unlike traditional Ryan White case management, ICMs provided intensive services, which included individualized treatment plans addressing client needs through partners in the initiative and frequent contacts inside and outside correctional facilities.

The IPHCCI provided services that were vital to a high-risk population with a multitude of health and social needs. It became a nationally recognized model of community-based continuity of care for HIV-positive releasees. The CDP provided significant benefits to communities of color throughout the city of Chicago, where many releasees returned to live.

LESSONS LEARNED: Chicago Department of Public Health

IPHCCI partners faced the following challenges and barriers in program development and implementation:

Reductions in funding that limited the ability to provide comprehensive services
Lack of low-income housing and substance abuse treatment beds
Inability to fully staff the project with sufficient case managers to meet the demand of all clients released from CCDOC and IDOC
Limited role from IDOC in support of continuity of care in the community
Lack of comprehensive transition planning by social workers and weak linkages between correctional staff and community referral agencies
Lack of trust among service providers in meeting client needs
Breakdowns in communications with case managers not directly affiliated with the IPHCCI
Difficulties associated with identifying jobs for clients with criminal backgrounds
Inability to provide vaccinations to juveniles without parental consent (It was difficult to find a parent or guardian to sign consent, especially for incarcerated juveniles; many parents wanted nothing to do with them.)
Limitations in access to school immunization records for juveniles.

Equally important, recommendations resulting from those barriers were as follows:

The system was most effective when individual staff members were committed to providing the best services for their clients, when they were supported by agency and project administration, and when open communication occurred.
The success of this collaborative initiative was tied to individual staff members’ commitment. Agency buy-in is crucial, however: Even the most supportive agency will not benefit the project if staff do not collaborate within the multidisciplinary team.
Effective communication and training are essential to assist diverse service providers with working toward a common goal.
Routine AFC coordination and face-to-face meetings of case managers increased the number of formal linkages with community service providers.
Ongoing communication between project administration and project partners can be affected as new programs with new priorities are implemented by partner organizations.

The Chicago Department of Pubic Health and the IPHCCI partners are committed to continuing the work of the initiative and have sought and received funding from the Illinois Department of Public Health to continue the project on a statewide basis.