The Problem

A largely unrecognized public health crisis among the more than 9 million people who cycle in and out of America’s jails annually is eroding the health of communities across the nation, particularly those struggling with poverty, disease, and crime.

People in jail have high rates of contagious and chronic diseases, including HIV, hepatitis C, and tuberculosis. They also have high rates of mental health and substance abuse problems and high rates of homelessness. Yet most have had little to no recent contact with the health care system prior to entering jail.

For many of these people, jail is a revolving door. They come in sick, leave sick, and bring whatever diseases they may have back with them to their communities, where their problems often go untreated and the effects of those problems go unchecked.

Jails are not the problem here. The problem is failure to recognize that jail detainees are members of their communities – even when they are in jail – and that their health has an impact on the health and safety of their communities.

COCHS

In 2006, the Robert Wood Johnson Foundation created COCHS to assist jurisdictions in establishing partnerships between local correctional facilities and community-based health care services.

Connectivity is the guiding principle to the COCHS approach: Bringing community health care providers into jails to treat offenders creates a bridge that makes correctional health care an extension of the existing community health care system. Upon release, offenders are encourages to see the same providers in the community who treated them in jail. An evaluation of this approach in Hampden County, MA, found that a significant number of offenders continued to see the health care providers they met in jail after they were released.

Connectivity may take many forms, and there is no turnkey solution for creating connectivity. For that reason, COCHS provides technical assistance to communities engaging in a number of activities, including:

• Fostering collaborations between community health centers , local correctional facilities, and other stakeholders
• Developing satellite health centers within local correctional facilities
• Organizing health and other services for offenders in the communities where they are likely to return following release
• Extending health screening to pre-arraignment
• Implementing electronic medical records systems
• Establishing model policies and procedures
• Applying performance standards and targeted clinical quality improvement strategies

Improving the health of people who cycle in and out of jail will improve the health and safety of their communities. Creating connectivity between jails and their communities is the way to do this.