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Posted 11-23-2011.

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Research Questions

  1. What are the health care needs of individuals returning from prison?
  2. How are those needs being met in prison?
  3. What are the implications for communities dealing with the reentry population?
  4. Which counties and communities are particularly affected by prisoner reentry?
  5. What factors affect access to the health care safety net in communities?
  6. What are the implications of public safety realignment and federal health care reform for the reentry population?

Abstract

When prisoners are released and return to communities, an often overlooked concern is the health care needs that former prisoners have and the role that health care plays in how successfully they reintegrate. To a large extent, the reentry population will eventually become part of the uninsured and medically indigent populations in communities.

This volume examines the health care needs of newly released prisoners in California, including the need for mental health and substance abuse treatment; which communities are most affected by prisoner reentry; the health care system capacity of those communities; and the experiences of released prisoners, service providers, and families of incarcerated individuals. The authors conducted a geographic analysis to identify where parolees are concentrated in California and the capacity of the safety net in four of these communities — Alameda, Los Angeles, San Diego, and Kern counties — to meet the health care needs of the reentry population. They then conducted focus groups in Alameda, Los Angeles, and San Diego counties with former prisoners and their family members and interviews with relevant service providers and community groups to better understand how health affects reentry; the critical roles that health care providers, other social services, and family members play in successful reentry; and how the children and families of ex-prisoners are affected by reentry. The authors discuss all this in the context of budget cuts that have substantially shrunk California's safety net and the May 2011 U.S. Supreme Court decision ordering California to reduce its prison population by 33,000. The volume concludes with recommendations for improving access to care for this population in the current fiscal environment.

Key Findings

Inmates Have Substantial Health Needs

  • California inmates report a high burden of chronic and infectious diseases; mental health and substance abuse needs are higher
  • Most inmates report seeing a physician in prison for physician health issues but fewer report care for substance abuse and mental health
  • Ex-prisoners returning to communities bring a host of unmet health needs and will depend on counties’ ability to meet the needs.

Geographic and Ethnic Differences Exist

  • Parolee concentrations are mostly in the Bay Area and in Southern California
  • Access to health care resources varies by type of health care, geographic area, and race/ethnicity

Common Ground Between Public Safety Realignment, Health Care Reform Efforts

  • Stakeholders involved in preparing for both measures overlap and need to coordinate

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    What Do We Know About Prisoner Health Care Needs and the Capacity of the Safety Net to Meet the Needs of the Reentry Population?

  • Chapter Three

    Understanding the Challenges of Reentry: Ex-Prisoner Focus Group Results

  • Chapter Four

    Understanding the Challenges of Dealing with Released Prisoners: Provider Interview Results

  • Chapter Five

    The Impact of Incarceration on Families: Key Findings

  • Chapter Six

    Conclusions and Recommendations

  • Appendix A

    Methodology

  • Appendix B

    Protocols

This work was prepared for The California Endowment and produced within the RAND Health Promotion and Disease Prevention Program and the RAND Infrastructure, Safety, and Environment Safety and Justice Program.

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