Preface |
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iii | |
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xiii | |
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xv | |
Summary |
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xvii | |
Acknowledgments |
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xxxvii | |
Abbreviations |
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xxxix | |
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1 | (12) |
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2 | (7) |
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Health Care Needs of Returning Prisoners Are High |
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2 | (2) |
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The Size and Composition of California's Prison Population Are Changing |
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4 | (1) |
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Recent Policy Changes Will Influence How California Approaches Meeting the Health Care Needs of the Reentry Population |
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5 | (4) |
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Study Objective and Scope |
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9 | (2) |
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11 | (1) |
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Organization of This Report |
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12 | (1) |
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Chapter Two What Do We Know About Prisoners' Health Care Needs and the Capacity of the Safety Net to Meet the Needs of the Reentry Population? |
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13 | (36) |
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13 | (1) |
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What Are the Health Care Needs of the Reentry Population? |
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14 | (5) |
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Where Do Prisoners Go Upon Release from Prison? |
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19 | (7) |
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Concentration and Distribution of Parolees Within California |
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19 | (7) |
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What Are the Demographic Characteristics of Parolees and of the Socioeconomic Areas in Which They Locate? |
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26 | (5) |
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Results of Analysis of Demographic Characteristics of California Parolees |
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27 | (2) |
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Results of Analysis of Demographic and Socioeconomic Characteristics of Areas in Which Parolees Locate |
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29 | (2) |
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What Does the Health Care Safety Net Look Like for Parolees in Four Focus Counties? |
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31 | (14) |
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31 | (3) |
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Analysis of Geographic Distribution of Health Care Facilities in Los Angeles County |
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34 | (6) |
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Analysis of Accessibility of Reentry Population to Health Care Safety-Net Facilities in Four Counties |
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40 | (5) |
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45 | (4) |
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Chapter Three Understanding the Challenges of Reentry: Ex-Prisoner Focus Group Results |
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49 | (36) |
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49 | (1) |
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49 | (4) |
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Key Findings from the Focus Groups |
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53 | (32) |
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How Ex-Prisoners Think About Their Health Care Needs |
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53 | (3) |
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Views About Access to Substance Abuse Treatment Programs in Prison |
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56 | (3) |
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Views About Access to and Quality of Health Care in Prison |
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59 | (4) |
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Experiences in Having Care Transitioned to Community Providers |
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63 | (1) |
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Interest in Preventive Care |
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64 | (1) |
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64 | (2) |
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Parole and Community Team (PACT) Meetings |
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66 | (2) |
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Where the Focus Group Participants Sought Care and Other Services on Release |
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68 | (3) |
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Views About Cultural Competence |
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71 | (2) |
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73 | (2) |
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The Experience of Being Released |
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75 | (2) |
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77 | (8) |
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Chapter Four Understanding the Challenges of Dealing with Released Prisoners: Provider Interview Results |
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85 | (32) |
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85 | (1) |
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Literature on Ex-Prisoners' Access to Insurance and Health Care Reform |
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86 | (10) |
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Ex-Prisoners' Access to Health Insurance |
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87 | (1) |
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Safety-Net Health Care Resources in California |
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88 | (4) |
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Potential Impact of Health Care Reform in Improving Ex-Prisoners' Access to Health Care |
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92 | (4) |
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Provider Interviews: Approach |
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96 | (1) |
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Provider Interviews: Results |
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97 | (14) |
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From the Provider's Perspective, the Reentry Population Has a Wide Range of Treatment Needs |
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97 | (2) |
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Lack of Medications and Medical Records Can Affect Continuity of Care |
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99 | (2) |
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Individuals May Be Reluctant to Seek Help from Parole |
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101 | (1) |
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Low Levels of Health Insurance and Lack of Finances Limit Treatment Options |
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102 | (2) |
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Challenge of Linking Individuals to Mental Health Treatment |
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104 | (1) |
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Communication Problems on Both the Individual and Provider Sides |
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105 | (1) |
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Difficulties in Navigating Health Care and Social Services Systems |
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106 | (1) |
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Uncertainty Among Safety-Net Providers About How to Access Reentry Population |
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107 | (1) |
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Impact of Budget Cuts on Providers |
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108 | (2) |
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Providers' Recommendations for Improving Access to Services for the Reentry Population |
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110 | (1) |
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111 | (6) |
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Chapter Five The Impact of Incarceration on Families: Key Findings |
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117 | (26) |
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117 | (1) |
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Literature on the Impact of Incarceration on Children and Families |
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118 | (7) |
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Impact of Individual-Level Effects of Parental Incarceration |
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118 | (3) |
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The Impact of Child Welfare Laws and Other Legislation |
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121 | (2) |
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What Is Known About Programs to Help Children and Incarcerated Parents |
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123 | (2) |
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Family Caregiver Focus Group: Approach |
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125 | (3) |
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Family Caregivers Focus Group: Results |
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128 | (10) |
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The Challenges Incarcerated Parents Face Upon Release |
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128 | (1) |
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The Suddenness of Being Thrust into a Caregiver Role |
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129 | (1) |
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The Degree to Which the Children Want to Have Contact with Their Parents |
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130 | (3) |
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133 | (3) |
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Caregivers' Support Needs |
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136 | (2) |
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138 | (5) |
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Chapter Six Conclusions and Recommendations |
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143 | (30) |
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California at a Crossroads |
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143 | (8) |
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An Historic Opportunity to Improve Access to Health Care for the Reentry Population |
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147 | (4) |
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What Can California Do to Prepare? |
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151 | (11) |
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Develop Informed Estimates About the Percentage of the Medicaid Expansion Population That the Reentry/Criminal Justice Population Will Represent |
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152 | (1) |
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Develop Medicaid Enrollment Strategies |
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152 | (1) |
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Leverage the Experience of Other States That Have Previously Expanded Coverage to Childless Adults Under Medicaid |
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153 | (1) |
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Develop Health Homes for the Reentry/Criminal Justice Population |
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154 | (2) |
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Develop Care/Case Management Systems That Can Account for Special Populations' Needs, Including the Reentry/Criminal Justice Population |
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156 | (1) |
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Assess Workforce-Development Strategies for Alcohol, Drug, and Mental Health Treatment |
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157 | (1) |
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Consider Developing Electronic Medical Records |
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158 | (1) |
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Consider Expanding Prerelease Planning Efforts |
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159 | (2) |
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Undertake a Comprehensive Assessment of California's New Public Safety Realignment Plan to Inform Future Policy Refinements |
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161 | (1) |
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What Can Counties and Providers Do to Prepare? |
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162 | (8) |
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Develop County-Level Estimates to Inform Planning for Rehabilitative Services and for Increased Demand for Mental Health and Alcohol Care and Drug Treatment |
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163 | (1) |
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Convene All Relevant Stakeholders for Planning and Coordination of Services |
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164 | (1) |
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Assess Local Capacity to Meet New Demands for Health Care |
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165 | (1) |
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Develop "Welcome Home" Guidebooks Tailored to Individual Counties, Particularly for Counties and Communities with High Rates of Return |
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166 | (1) |
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Train Providers on Cultural Competence |
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167 | (1) |
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Consider the Role of Patient Navigators |
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168 | (1) |
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Address the Needs of Families and Those That Care for Children of Incarcerated Parents |
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169 | (1) |
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170 | (3) |
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173 | (8) |
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181 | (16) |
References |
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197 | |