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| U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau • December 2007 | |
PARTICIPATING PROJECTS
New York State Department of Health AIDS Institute
Partners and Collaborators
CDP funding was provided to the New York State Department of Health (NYSDOH)
AIDS Institute. The AIDS Institute established partnerships with the
New York City Department of Public Health, the New York State Department
of Correctional Services (NYSDOCS), and CBOs to enhance and evaluate
programs promoting continuity of care for HIV-positive and at-risk
inmates and recent releasees of correctional facilities.
The AIDS Institute had been providing HIV intervention and prevention services in correctional settings for more than 15 years through State aid to localities and funds from HRSA and CDC. Services were provided to State correctional facilities, local county jails, and juvenile justice centers throughout the State. The institute also funded community reentry programs to provide case management and supportive services in targeted metropolitan communities, to which a majority of parolees and releasees return. The existing Criminal Justice Initiative (CJI) consisted of the corrections and community reentry programs. Prior to the CDP, the CJI was a $3.3 million initiative that funded 13 agencies throughout New York State.
Prior to the CDP, the AIDS Institute had established limited collaborations with NYSDOCS and the NYS Office of Children and Family Services, the agency responsible for juvenile correctional facilities. Other relationships included the Division of Parole and the NYS Commission on Correction, the State oversight agency responsible for ensuring a safe, stable, and humane correctional environment and the delivery of essential services to inmates. Those existing relationships provided the administrative infrastructure for the CJI and the delivery of public health services.
Through its direct and contracted services, the AIDS Institute provided HIV counseling and testing in 62 State correctional facilities and test kits and laboratory support for adolescents tested at juvenile detention centers. Characteristics of the service network were as follows:
- Seven contracted CBOs provided HIV counseling and testing services at 30 State correctional facilities in central and northeastern New York, the Hudson Valley, and New York City. The CBOs complemented services provided by the AIDS Institute’s Bureau of Direct Program Operations.
- Nine State correctional facilities and nine local county jail sites provided transitional planning for inmates living with HIV/AIDS and returning home. Planning started 3 months prior to an inmate’s discharge date; about 500 transitional plans were completed annually.
- Case management services were supported by the Medicaid fee-for-service reimbursement through the Consolidated Omnibus Budget Reconciliation Act (COBRA) Community Follow-Up Program and by State and Ryan White Title II funds. The AIDS Institute maintains an extensive case management network to provide inmates with readily accessible services upon release. The CJI also supports intensive, time-limited services for inmates who return to the New York City area (about 85 percent of all State inmates). This program allows HIV/AIDS inmates to be met upon their return to their home community and escorted to housing and initial medical or social service appointments.
Model
The model was rooted in the utilization, coordination, and implementation
of a vast service delivery network that provided a wide array of services,
including education, disease screening, discharge planning, community-based
transitional services, training, and evaluation, as described below.
The AIDS Institute, through the Bureau of Direct Program Operations, offered educational services in three State correctional facilities: Auburn, Butler, and Marcy. Comprehensive educational sessions included topics such as HIV, STIs, hepatitis, and discharge-planning and transitional services. Access to inmates was the most limiting factor, especially for inmates in drug treatment, who had little time to participate in other programs. The program overcame time constraints by offering additional education sessions and increasing counselor availability. Inmates were trained as representatives of the AIDS Institute and presented information on HIV counseling and testing, referral, and education services when counselors were not available. HIV counselor acceptability and inclusion as part of the corrections team increased significantly during the CDP.
The Altamont Program, which implemented the CDC curriculum “Be Proud! Be Responsible!”, was offered in three State juvenile detention facilities, four proprietary (privately funded) juvenile centers, two county jail adolescent units, and one community adolescent program. Inmate peer educator training was offered at two State correctional facilities with the largest number of adolescent inmates. All training sessions used the AIDS Institute’s Criminal Justice HIV Peer Educator curriculum. Altamont provided programs to juveniles at all of those sites except for the four proprietary centers. The CDP allowed services to expand to the proprietary juvenile centers, thereby complementing services provided at the State-operated sites. The major challenge facing the Altamont program was providing the HIV peer educator program to adolescents in State correctional facilities because of constant changes in the inmate census.
Rural Opportunities, Inc. (ROI) expanded its education and supportive services to women at the Albion Correctional Facility. Two new components were added to the facility’s education and peer education programs. A CBO was contracted to facilitate a curriculum-based group-level intervention, and support services were provided by Sisters Healing Old Wounds, a support group for inmate peer educators. Under the CDP, a newsletter written by inmates was published, and three ROI-sponsored AIDS awareness activities were open to all inmates. The greatest challenge ROI faced was training staff and maintaining staff stability.
The AIDS Council of Northeastern New York (ACNENY) developed and implemented a curriculum for incarcerated adolescents at highest risk of contracting HIV. The curriculum was provided to youth who tested positive for any STI upon intake. ACNENY overcame the problem of multiple-site placement of youth and staff limitations by training the Office of Children and Family Services nursing staff to deliver an individual-level intervention that was comparable to the group-level intervention for youth who were transferred.
The Center for Community Alternatives (CCA) provided education, supportive services, and discharge planning for women at the Onondaga County Correctional Facility. Additional funding allowed CCA to expand beyond client recruitment and HIV prevention to include in-facility community reentry assistance. The program addressed life skills, anger management, self-worth, and self-esteem. Funds also were provided for disease screening for chlamydia and gonorrhea for men entering the OCFS reception center in the Bronx. During the project, the STI urine-testing program expanded to three additional sites, and it further expanded to include women during Year 3. ACNENY provided enhanced education on HIV and STIs for adolescents who tested positive. All adolescents testing positive were encouraged to be tested for HIV.
The CDP supported discharge planning in two jail settings: Onondaga County Department of Correction (OCDC) and Riker’s Island Correc-tional Facility. The CCA provided discharge planning at the OCDC for high-risk female inmates recruited through an educational program. CCA helped link to community services through case management and a support group limited to women with chronic or mental health needs.
The Riker’s Island Transition Consortium also provided discharge-planning activities through a well-established community services provider at Riker’s Island. Through the CDP, services were enhanced in three areas: supporting a dedicated corrections officer to conduct outreach and facilitate inmate movement within Riker’s, an enrollment specialist to expand disease screening, and additional transitional planners to reach more inmates. Working with the contracted health provider, the Community Action Prenatal Care Program offered assistance to link pregnant women to care and to monitor their access to prenatal and perinatal services.
The Osborne Association in New York City was funded to provide an early recovery and relapse prevention program for substance users upon their release to the community. The service model was based on harm reduction and was one of the few programs that allowed active substance users to participate. The Division of Parole was the largest source for referrals. The program provided HIV prevention education, skills building, counseling, and behavioral change interventions with a high level of client participation and supportive case management.
LESSONS LEARNED: New York State Department of Health Aids ServicesLongstanding relationships between the NYSDOCS and the NYSDOH were reinforced through the CDP. Services for HIV education, counseling, and testing will be continued at facilities participating in the demonstration and will continue to be expanded to others. The AIDS Institute has implemented plans to retain the services of all providers under the CDP through a new application and award process for the CJI. A partnership with the State Bureau of STD Control will enable continued screening for STIs at select juvenile facilities. The following lessons were learned as a result of the project:
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