RHODE ISLAND PRISON RELEASE PROGRAM & PROJECT BRIDGE (RI)

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Program Description
The Rhode Island Department of Health, Department of Corrections, The Miriam Hospital Immunology Center, and the Brown University AIDS Program have implemented a program providing HIV-infected inmates with health care both during and after incarceration. The program provides routine HIV testing for all entering inmates and HIV care including antiretroviral medications, gynecological screening, and substance abuse counseling for those who test HIV positive. The Prison Release Program addresses the issue of continuity of care for HIV-infected inmates by connecting them with a physician in prison who will continue to treat him/ her after release. The program relies on a team of four doctors, two nurses, and a social worker. Team members meet with each patient three to six weeks before his/ her release to develop a release plan. The plan focuses on medical care, housing, substance abuse treatment, and family support, as well as connecting the individual to needed community-based services.

In October 1996, Project Bridge of The Miriam Hospital in Providence, Rhode Island, received funding from Special Projects of National Significance (SPNS), a division of the Health Resources and Services Administration (HRSA), to provide services aimed at increasing continuity of medical care for individuals who were formerly incarcerated. Since 1997, the program has served 135 men and women. Potential clients are identified by prison health services staff. The design of the project provides case management services to incarcerated men and women who are HIV positive. Project Bridge is an intensive case management program in The Miriam Hospital Brown University affiliated outpatient clinic, which serves people infected and affected by HIV. The program is an outgrowth of an ongoing collaboration between the hospital and the State Department of Corrections. Physicians provide HIV specialty care within the state prisons. To date, 96 clients have enrolled. Of that number, 65 (68 percent) were without housing at the point of prison release. All have a history of substance abuse.

The program consists of two-person teams assigned to each client. The teams are comprised of a professional social worker and a paraprofessional assistant. The social worker provides client enrollment, overall treatment planning, clinical decision-making, coordination of services, and advocacy. The social worker also acts as the medical liaison. Weekly team meetings assure timely case assignments and provide for overall sharing of information.

Program Goals
The mission of Project Bridge is to improve the retention of HIV positive former prisoners in outpatient medical care through social stabilization. The overarching goal of the Rhode Island Prison Release Program is to provide HIV-infected inmates with quality continuity of care from prison to the community, thereby resulting in improved health outcomes for the individual and reduced likelihood of continued involvement in the criminal justice system.

Networking, Partnering & Collaboration
Both programs involve a unique collaboration between the Rhode Island Department of Health, Rhode Island Department of Corrections, Brown University, Miriam Hospital, and a host of community-based service providers.

Outcomes
According to a Boston University evaluation, over 83 percent of participants visited a health care provider at least once every six months while enrolled in the Project Bridge program (See: www.bu. edu/ hdwg/ projects/ pbridge. htm). Brown University has been leading data collection and analysis efforts on the Prison Release Program. Findings from this work show a 50 percent reduction in recidivism among participants and a decrease in the likelihood of high-risk behaviors (see Flanigan et al 1996).

Additional Reading
• Andrew Skolnick. 1998. "Correctional and Community Health Care Collaborations." JAMA 279 (2): 98-99

•T. Flanigan, J. Kim, and S. Zierler, et al. 1996. "A Prison Release Program for HIV-Positive Women: Linking Them to Health Services and Community Follow-Up." American Journal of Public Health 86: 886-887.

•J. Mitty, L. Holmes, A. Spaulding, T. Flanigan, and J. Page. 1998. "Transitioning HIV-Infected Women After Release from Incarceration: Two Models for Bridging the Gap." Journal of Correctional health Care 5(2): 239-54.

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