PARTICIPATING PROJECTS

California Department of Health

Partners and Collaborators
The State of California partnered with the San Francisco Department of Pubic Health, CBOs, and correctional facilities to serve HIV-positive and high-risk inmates. The Office of AIDS also used its own resources to include the Los Angeles County Health Department and Los Angeles County Jail as separate components to address internal programmatic and political concerns. Centerforce, a CBO in San Quentin, California, was funded by the CDP to provide services for men and women at three State prisons in four core program areas: peer health education, prerelease health education, individual and group outreach, and prevention case management. The Forensic AIDS Project (FAP), part of the San Francisco Department of Public Health, and Continuum, part of Tenderloin Cares (a consortium of providers), were funded to provide case management services and housing placement to HIV-positive inmates in San Francisco County jails following their release to the community.

The CDP funded Continuum to expand existing services for HIV-positive men and women at the San Francisco County Jail to create a more comprehensive program that supported successful transition back into the community. Program components included health education, substance use counseling, transitional housing, money management, transitional case management, medical care, and mental health counseling. To provide those services, several infrastructure and capacity enhancements were implemented within jail facilities and the community.

Linkages were strengthened between Continuum and the San Francisco County Jail/FAP, the Positive Health Practice at the University of California, San Francisco (UCSF), the Tenderloin Neighborhood Development Corporation, the Northern California Psychiatric Foundation, and the City College of San Francisco. These linkages allowed a much large number of community agencies to market their services to jail inmates during community health resource fairs. During the final year of the CDP, Continuum collaborated with Centerforce to develop the Continuum Learning Institute so that lessons learned throughout the CDP could be widely disseminated in California.

Model
The State of California developed an integrated service model to deliver prerelease and postrelease HIV and STI prevention and treatment services to high-risk and at-risk incarcerated populations. The model enhanced the limited HIV/STI services that were previously available to California State prison and San Francisco County and Los Angeles County jail populations. Data from Los Angeles County are not included in the cross-site evaluation but were used to help inform and focus case management for inmates being released from prison back to Los Angeles County. The California service model emphasized prerelease education and prevention; transitional case management, including individualized needs assessment, service plans, and community service referrals; and postrelease follow-up, support, and incentives to promote and maximize client access to community care services.

California considered the CDP an enhancement to existing correctional program initiatives and chose not to participate in the ESC’s client-specific cross-site evaluation. It did, however, contribute to aggregate service data and conducted its own internal evaluation in conjunction with the San Francisco Department of Health and UCSF. The project participated in a separate HRSA-sponsored cost analysis.

Lessons Learned: California Department of Health

Developing and maintaining relationships with correctional officials and administrative departments were critical steps to the delivery of correctional health and prevention services. Lack of communication and the rapid turnover of correctional staff presented many barriers, such as delays in access; inability to gain access to program participants and, in some cases, not being permitted to work in some institutions; and difficulty with the basic logistics of providing programs in a secure environment. Prisons and jail systems participating in the project recognized the need to develop strong mutual relationships around existing services and to embrace institutional priorities of safety and security and incorporate them into program priorities. Finally, adding value to correctional programs by providing resources and services outside the corrections budget helped foster strong partnerships.

The California CDP was able to overcome some formidable challenges and has gained wide acceptance of its programs throughout the State. Although resources have been severely reduced, both programs have implemented plans to sustain operations and continue to provide services.

The following recommendations are based on lessons learned.

Case managers must foster trust and facilitate insight into the client’s behavior patterns that lead to reincarceration and medical noncompliance.

Case managers should be trained professionals with mental health training.
Use the same case managers for pre- and postrelease case management.
Implement comprehensive case management during and after incarceration.
Case managers should identify and assess the client’s strengths and challenges with the client.
Benefits enrollment, including AIDS Drug Assistance Program, and other clear medical plans should be made prior to the inmate’s release.

Ensure clients’ ownership in developing their discharge plan and their transition.

Have clients develop their own goals and step-by-step plan.
Ensure that clients understand the need for transitional housing, especially on the first night out.
Set up face-to-face meetings with personnel from community resources before release. Face-to-face meetings with community resource staff should be tailored to address the needs of the client with the resources available to them in the county of their release. Inmates from State and Federal institutions are released back to their home county, which may be hundreds of miles away, and efforts must be made to link them with services that will actually be available.
Provide training in life skills, including anger management.

Offer clients practical assistance in stabilizing their lives and attaining identified goals.

Provide transitional housing opportunities; use a community liaison to meet the client at release and escort him or her to approved housing.
Provide a structured living environment.
Provide vocational training and job assistance.
Assist or accompany clients to court appearances, medical appointments, and parole officer check-ins.
Provide a life skills class covering everything from budgeting to cooking, laundry, public transportation, and money management.