Healthy Transitions

1
Healthy Transitions
Alaska Native Tribal Health Consortium

• Tracy Speier, MPA, Project Coordinator
• Gloria Eldridge, Ph.D., Evaluator, UAA

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Steps Taken to Obtain Stakeholder Buy-in

• Goal 1 Evaluation of ANTHCs Title III Early
  Intervention Services
• Cooperation from the Medical Director and Project
  Manager
• Data sharing agreement between UAA and ANTHC

3
Steps Taken to Obtain Stakeholder Buy-in

• Goal 2
• Relationship Building With Key Stakeholders
• DOC
• NSHC
• Kawerak
• Seaside Residential Community Center
• ANTHCs Prisoner Outreach program

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Steps Taken to Obtain Stakeholder Buy-in

• Goal 2 (Cont..)
• DOC
• Developed and presented proposal to the DOC in
  the fall of 2002
• Telephone conferences with local correctional
  facilities in Nome
• Met with DOC during first site-visit with OU
  and HRSA
• Gubernatorial Elections resulted in a change in
  the States Administration
• TRAIN WRECK FOR DOC PROGRAMS

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Steps Taken to Obtain Stakeholder Buy-in

• Goal 2 DOC (Cont..)
• Top down relationship building with the new DOC
  Administration
• Numerous meetings
• 3 written proposals
• Repeat phone calls
• Different layers of negotiation
• Waiting for DOCs staff appointments
• Critical point ANTHC offering DOC services
  rather than demanding services from DOC

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Steps Taken to Obtain Stakeholder Buy-in

• Goal 2 DOC (Cont..)
• Bottom up relationship building
• - Nome correctional facilities
• a. Community-level intervention
• b. Transitional AK/NA prisoners
• Signed MOAs

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Steps Taken to Obtain Stakeholder Buy-in

• Goal 2 (Cont.)
• Community (Nome)
• Community Assets Assessment
• Relationship Building Informal Meetings
• Medical and Behavioral Health Providers in Nome
• Key Personnel within NSHC
• Kawerak Native Organization
• Relationship Building Formal Meetings with
  Community Providers
• Program Introduction

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Community Intervention Model

• Goal 3 Community Intervention with providers to
  integrate HIV/AIDS education, pre- and post-
  counseling and testing into routine clinical care
  with transitional Alaska Native prisoners
• Comprehensive HIV/AIDS training
• Medical providers
• Substance abuse providers
• Mental health providers
• Correctional staff
• Transitional case manager
• Development of a community HIV/AIDS response team

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Community Intervention Model
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Staffing Needs and Challenges

• Project Coordinator and Evaluation Team hired
  November 2002
• Change in the DOC Administration
• Change in the Cultural Liaison position within
  DOC (appointed)
• Transitional Case Manager in Nome

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Staffing Needs and Challenges

• Anticipated Staffing Challenges
• Addressing the high turnover among rural
  providers and the need for continual training
• Persuading and equipping providers already
  burdened with other responsibilities to implement
  HIV risk assessments and referral for testing as
  part of routine clinical care

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Accomplishments

• Two IRB approvals to analyze existing preliminary
  data sets to support correctional intervention
• Approval pending for resubmission of Title III
  IRB
• Data input (N427) and preliminary data analysis
  of cultural program and transitional needs of
  AN/AI prisoners

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Accomplishments

• MOA with the DOC for community-based intervention
  in Nome
• MOA with DOC for state-wide survey on health
  needs of transitional AN/AI prisoners
• Preliminary planning with DOC to integrate the
  training model into two DOJ re-entry grants being
  implemented in Bethel (SW), Juneau (SE), and
  Ketchikan (SE)

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Accomplishments

• Community support for comprehensive training and
  the development of an HIV/AIDS response team
• Collaboration with ANTHC Title III EIS, NW AETCs
  MAI and the State Division of Epidemiology for
  the development of a comprehensive training
  curriculum for the community Intervention

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What Did It Take to Get the Program Up and
Running?

• Coordination among DOC institutions and regional
  tribal organizations
• Analysis of preliminary data to develop training
  specific to the transitional needs of Alaska
  Native prisoners
• Development of training and assessment tools
  tailored to community providers and culturally
  sensitive to clientele

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What Did It Take to Get the Program Up and
Running?

• (Cont.)
• Development of data sharing agreements with
  ANTHC, NSHC, Kawerak, DOC and Seaside Community
  Residential Center
• Obtaining MOAs and IRBs
• On-going training and supervision

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Formative Data Collection

• Three Formative Data Sets
• ANTHCs Ryan White Title III Early Intervention
  Services
• Spring Creek Correctional Center
• ANTHCs Prisoner Outreach Program

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ANTHCs Ryan White Title IIIEarly Intervention
Services

• HIV clients enrolled N 103
• AN/AI 102
• White 1
• Male 65
• Female 38
• 13-24 years 4
• 25-44 years 69
• 45-64 years 29
• gt 65 years 1

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ANTHCs Ryan White Title IIIEarly Intervention
Services

• HIV clients enrolled N 103

HIV, not AIDS 47 AIDS status unknown
9 CDC-defined AIDS 47 HIV counseling
testing tracked through RPMS HIV pre-test
counseling 5500 HIV testing 4966 HIV
post-test counseling 0 HIV (Newly
Identified) 12
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Interviews with Prisoners and Correctional
Officers at SCCC
1. Inmates and officers want more
information/education about HIV and
AIDS 2. HIV and AIDS are stigmatized in the
prison system 3. Limited opportunities for
HIV-testing in the prison system a. Prison
policy (clinical indication, incident, inmate
request) b. System impediments (cost, sick
call, requests) c. Stigma d. Concern about
privacy and confidentiality
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ANTHCs Prisoner Outreach Program Data

• Survey on cultural programming and transitional
  needs of AK/NA prisoners in AK DOC facilities,
  including Arizona
• N 427
• 41 questions
• Qualitative and quantitative data
• Demographic information

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ANTHCs Prisoner Outreach Program Data

• What are your needs when you are released?
• Job
• Look for work
• Subsistence gathering for winter
• Getting back with family
• Help with my family
• Rebuild father/children relationships
• Make up for lost time with my kids and family
• Be accepted by my family
• Housing/place to stay

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ANTHCs Prisoner Outreach Program Data

• What are your needs when you are released?
• Money
• Financial assistance/educational funding
• Disaster relief/loan for fishing
• Help with cost of sex offender treatment
• Stay sober
• Stay away from drugs and alcohol
• Support to quit drinking
• Attend programs
• AA/Aftercare
• Counseling/mental health counseling
• Native programs

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ANTHCs Prisoner Outreach Program Data

• What are your needs when you are released?
• Support system in community
• Elders
• Support group, counselor, or helper
• Transportation
• Get in a plane and go HOME!
• Car/vehicle
• Stay out of trouble
• Stay away from friends that are drinking
• Stay away from people who commit crimes
• Further my education
• Training so I can find a permanent job
• To go back to college

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ANTHCs Prisoner Outreach Program Data

• What are your needs when you are released?
• Spirituality and religion
• Christians to help me live a good life with God
• Find a good church to go to
• Find Christian employers who dont condemn
  felons
• Clothing
• Coat and shoes
• Freedom
• Getting used to being free
• Starting over again
• Learn how everything works been incarcerated
  since 1979
• Readjustment to society how to cope with
  different people
• Get caught up on what I missed

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ANTHCs Prisoner Outreach Program Data

• What are your needs when you are released?
• Medical care
• To see a doctor of my choice and get the proper
  medical treatment which I have been needing
• Back surgery got 3 ruptured disks in the lower
  spine
• Corrective medical care
• Medical

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Summary of Formative Data

• Title III Data
• Approximately 5,000 HIV tests, directed mostly at
  women in the context of prenatal care
• Need to reach AN/AI males for routine testing
• Spring Creek Correctional Center Data
• HIV-testing not routinely available in prison
• System-wide impediments to testing
• Few prisoners tested for HIV during incarceration

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Summary of Formative Data

• Prison Outreach Project Data
• Health needs are not a priority for AN/AI men
  being released from prison
• Immediate needs are jobs, family reunification,
  housing, staying sober, treatment (MH, SA, Sex
  Offender, Anger Management) community support,
  readjustment to life outside prison

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Conclusions

• 1. HIV Testing focused on AN women in context
  of health care
• 2. High risk AN/AI males disproportionately
  represented in prison but HIV testing not
  routinely available
• 3. HIV counseling testing must be addressed
  in the context of more pressing post-
  release needs
• 4. HIV risk screening and testing must be
  integrated into routine clinical practice

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ANTHCHealthy Transitions

• 4210 Tudor Centre Dr. Suite 305
• Anchorage, Alaska 99508
• 1-907-729-3951
• tspeier_at_anmc.org