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The past few decades have witnessed a significant increase in the number of ex-prisoners returning to communities nationwide. Often overlooked are this population's physical and social-behavioral health concerns and, consequently, the role that health care plays in influencing the success of reintegration. The prison population is disproportionately sicker than the U.S. population in general, with substantially higher rates of infectious diseases, serious mental illness, and substance abuse disorders — trends that are mirrored in California. To address the related public health challenges, it is necessary to better understand the health care needs of these former inmates and the capacity of the health care safety net in the communities to which they return. The first phase of this study used a variety of approaches to assess the health care needs of California prisoners upon their release, the geographic distribution of state prisoners who return to local communities, and the health care services that are available in these communities. A statewide analysis of data from a survey of inmates, geocoded corrections data on California parolees and cluster analysis, and a focused analysis of the four counties in which nearly one-third of California parolees reside (Alameda, Kern, Los Angeles, and San Diego) provide policymakers with a picture of communities' capacity to meet the needs of parolees and other underserved populations.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Socioeconomic and Health Characteristics of California State Prisoners

  • Chapter Three

    Distribution and Concentration of Parolees in California

  • Chapter Four

    Conceptual Framework and Methods for Defining the Health Care Safety Net for Parolees

  • Chapter Five

    Counties' Capacity to Meet the Health Care Needs of the Reentry Population

  • Chapter Six

    Counties' Capacity to Meet the Mental Health and Substance Abuse Treatment Needs of the Reentry Population

  • Chapter Seven

    Summary and Implications

  • Appendix A

    Parolee Clusters in Four California Counties, by Count of Parolees

  • Appendix B

    Methods

  • Appendix C

    Detailed Results Tables Used in Estimating Prevalence of Symptoms of Drug Abuse and Dependence and Mental Health Problems

  • Appendix D

    Additional Results for Physical Health and Mental Health Problems

  • Appendix E

    Sensitivity Analysis of Missing Zip Code Data and Alternate Accessibility Measures for Hospitals and Clinics

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

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