PARTICIPATING PROJECTS

New Jersey Department of Health and Senior Services

Partners and Collaborators
Funding was provided to the New Jersey Department of Health and Senior Services, Division of HIV/AIDS Services (DHAS), to develop a program with a broad array of intervention services in prison, jail, and juvenile settings. The State Department of Corrections (DOC) is responsible for inmate health care, including HIV medications. Services beyond basic acute health care, however, were not legally required and were limited because of a lack of resources. Services not provided included programs for HIV prevention during incarceration and HIV postrelease transitional services.

Through contracts with outside agencies, the DOC was able to provide some HIV/AIDS services, but they varied across facilities. All facilities provided HIV testing and test results, but none offered posttest counseling. All testing of inmates had to be physician initiated; inmates could not request testing. The Juvenile Justice Commission (JJC) had oversight of the State’s youth correctional facilities. The contracted medical care company provided medical services to all State facilities. Discharge planning was limited or not provided at all.

DHAS contracted with eight CBOs to provide services to 13 correctional facilities: seven men’s prisons; two discharge assessment facilities for men; one women’s prison; one jail; one juvenile facility; and the Central Reception Assignment Facility (CRAF), which served adult men. The CRAF is the intake facility for all adult prisoners; it provides intake exams, medical and dental education, and psychological evaluations. Services were phased into these facilities over a 2-year period. Additional funding to enhance and complement services was secured through the State’s Ryan White Title II funding, other CDC funds, and State resources.

Listed below are CBOs, their assigned correctional facilities, and the year services were initiated:

AIDS Coalition of Southern New Jersey: Riverfront State Prison—men’s prison, Camden (2000)
Henry J. Austin Health Center: Albert “Bo” Robinson Treatment Center—discharge assessment facility for men, Trenton (2002)
Hyacinth AIDS Foundation: Edna Mahan State Prison—women’s prison, Clinton (2000); and East Jersey State Prison—men’s prison, Rahway (2001)
North Jersey AIDS Alliance: Northern State Prison—men’s prison, Newark (2001)
South Jersey AIDS Alliance: South Woods State Prison—men’s prison, Bridgeton (2001); Southern State Correctional Facility—men’s prison, Delmont (2001); Bayside State Prison—men’s prison, Leesburg (2001)
The New Jersey Association on Corrections: Midstate Correctional Facility—men’s prison, Wrightstown (includes CRAF) (2002); Talbot Hall—discharge assessment facility for men, Hackensack (2000)
Visiting Nurse Association of New Jersey: Monmouth County Correctional Institute—county jail, men and women, Freehold (2000)
University of Medicine and Dentistry of New Jersey, Division of Youth and Young Adult Medicine: New Jersey Training School for Boys—juvenile, Jamesburg (2000)

The Monmouth County Correctional Institution was the only correctional facility with educational programs in place prior to the CDP. The Visiting Nurse Association of Central New Jersey provided health education, risk-reduction counseling, and support groups. The other 12 facilities did not have anything in place at the start of the project.

Staff at the CBOs and correctional facilities were trained in HIV education, counseling and testing, and prevention education along with a variety of other health promotion and risk-reduction topics. Staff training and peer education on HIV were integral components of the CDP. Each contracted CBO hired and assigned a minimum of one HIV care coordinator and one outreach specialist to each prison facility to provide the HIV prevention, intervention, care, and discharge-planning services. An HIV specialist also was hired at each CBO. Coverage was expanded by use of peer inmate counselors trained through a curriculum developed by the National College of Wisconsin, Center for AIDS. The inmate counselors acted as peer resources within the community culture of each facility; they disseminated HIV prevention and health promotion information and encouraged inmates to get tested.

Discharge planning and case management were vital to facilitating continuity of care before and after release. Prior to release, each inmate’s needs were assessed and appointments and referrals for services were made in the community. The New Jersey protocol called for client enrollment 6 months before release and follow-up for 6 months postrelease.

Model
Formalized linkages were developed among the correctional facilities, community health centers, early intervention programs, drug treatment programs, STI and TB clinics, mental health providers, Ryan White and HIV prevention planning groups, and infectious disease physician organizations to ensure a coordinated statewide network of continuous care for inmates postrelease. Each participating agency had primary responsibility for its assigned institution, but agencies assisted each other when inmates were transferred or released to different parts of the State.

The New Jersey CDP was designed to fit the existing layout of each facility. Services involved ongoing meetings for staff and inmates, HIV education, health education and risk-reduction classes, networking, communications of various types, case management for HIV-positive inmates, and discharge planning for all inmates who enrolled in the CDP. CDP recruitment efforts included presentations at weekly orientations, parole points for health education/risk reduction (HE/RR) class attendance, the influence of other inmates, discharge-planning and HIV-related services, classes for all inmates, and the independence of the community services from the correctional system once the inmate was released.

The DOC was a strong supporter of the CDP, but even with its support and participation, the project took time to implement. Relationships had to be developed with correctional staff and administration. The development of procedures for civilian entry into the prisons and access to inmates was a critical first step. Space, especially private space, and confidentiality were concerns in many facilities. Institutional differences existed between CBO and correctional staff (helping focus vs. security focus), and CBO staff experienced a definite distrust of “outsiders” at first. The biggest challenge in the juvenile facility involved the medical provider: The CBO could not get the provider to increase the number of HIV tests because the provider did not want to increase its costs for treatment and care.

The number of correctional facilities offering the CDP services grew from 5 at the start of service implementation in 2000 to 13 by 2003. In addition, the JJC requested that the CBO expand CDP-like services to all JJC facilities.

LESSONS LEARNED: New Jersey Department of Health and Senior Services

The CBOs indicated that client health status either stayed stable or improved with community case management. The availability and comprehensiveness of services within the community were major predictors of retention of ex-offenders in case management, and utilization of services tended to improve releasees’ health status. The number and types of services increased in all communities. Releasees used services including housing resources, assistance with applying for entitlements, ex-offender agencies, food banks, mental health counseling, substance abuse treatment centers, peer mentoring, outreach, prevention case management, employment assistance, drop-in and day centers, transportation services, medical care, and vocational rehabilitation. Utilization of mental health, substance abuse, housing, and employment services increased. Linkages to services were strengthened, making it easier to refer clients to needed services.

The following points summarize key lessons from the New Jersey CDP:

Developing working relationships among the various State departments, community agencies, and correctional facility administration and staff was essential to the implementation and operation of the CDP.
Education of corrections administrators and staff about the CDP and the topics covered in inmate prevention education was important in establishing working relationships.
Use of peer educators helped recruit and retain inmates in the CDP.
One of the most significant factors in clients’ adherence to the CDP was a strong support network.
Intensive case management and development of close relationships between the case managers and CDP clients during incarceration was a factor in their participation in the CDP after release.
Inmates should be met at the gate by a case manager who serves as a “navigator” from the CBO and provides linkages to basic supports.
Ex-offenders should be escorted to their first appointments to help them access the system; the oversight aids in their retention and compliance.
Basic needs, such as food, clothing, housing, and employment, must be addressed in addition to mental and physical health needs.
Access to substance abuse treatment and mental health services improves client retention and compliance.
Care for inmates with HIV improved during incarceration and postrelease, provided they remained in the CDP.
Helping clients secure some form of legal identification is essential to their ability to access services and benefits after release.

As expected, services were reduced once CDP funding ended in September 2004. Several CBOs, however, received funding to continue some of the education and case management activities. Funding sources included Ryan White Title II and State funds for discharge planning. All CBOs have been able to retain some level of services through community linkages, but all are now operating at a reduced level.