HIV+ Prisoner Integration
Allison C. Morrill, JD, PhD, Evaluator
Funded by Centers for Disease Control and Prevention (CDC)
and Health Resources and Services Administration (#U22/CCU116995)
via the Massachusetts Department of Public Health
The Transitional Intervention Project (“TIP”) is a statewide initiative to help incarcerated individuals living with HIV to make a successful transition back into the community. TIP case managers work with clients while they are incarcerated to assess their post-release needs. Upon the client’s release, TIP staff implement the client-specific service plan, providing help in areas such as:
- Acquiring health insurance and other benefits
- Finding a primary care physician skilled in HIV care
- Adhering to HIV medical treatment regimens
- Accessing mental health treatment, substance abuse treatment, and other community services
- Traveling to medical care and other appointments
- Obtaining safe housing
In 2004, with support from the CDC, the Massachusetts Department of Public Health hired Capacities to evaluate TIP. The evaluation included interviews and focus groups with TIP staff and clients in the community, and in-depth ethnographic interviews of five TIP clients in the community.
Client Reflections (exhibit & booklet)
As part of the TIP evaluation, Capacities conducted in-depth ethnographic interviews of five TIP clients whose lives have been transformed with the help of TIP. Photographs and text from those interviews form a documentary exhibit available for lending. In addition, we created a booklet and a web site. Both describe the results of the evaluation, and include photographs and text from the documentary exhibit.
1. Service data revealed the following:
- Most clients have multiple needs, particularly health care, housing and substance abuse treatment. TIP helped clients procure most needed services - except mental health services, which are lacking, as are housing options. Most post-release service events addressed multiple needs - described by clients as “one-stop shopping.”
- TIP helped clients keep 93% of appointments with medical, social service, mental health, and other service providers. Accompaniment and transportation were key. Doctors encourage enrollment in TIP because they know the client will keep appointments and get their medications.
- Case review events and service procurement had success rates of 89% and 84%, respectively.
- 2/3 of clients had only one case. TIP appears to reduce recidivism.
- Cases lasted an average of 8.4 months. 95% of TIP cases began while client was incarcerated. 53% of the services occurred after release.
2. Statistical analyses revealed the following significant associations:
- When a need - health/HIV care, mental health, substance abuse, housing or transportation - was assessed at intake, TIP case managers were far more likely to set up an appointment or to provide case management services that addressed that need.
- In every area of need but mental health, clients were slightly more likely to procure external services addressing that need.
3. Behavior change takes time, so recidivism can't be the only marker of success:
- Clients with more than one TIP case were far more likely to access services from the Bureau of Substance Abuse Services (“BSAS”) after release.
- Cases of clients receiving BSAS services lasted longer, included more events, and required more hours of work.
- Clients who accessed BSAS services post-TIP were also more likely to report a history of homelessness and needle use.
Three manuscripts were produced, on the following topics:
Needs of incarcerated individual living with HIV Reintegration into the community Access to substance abuse services