When
policy makers, advocates and the news media talk about health care for
people convicted of crimes, the focus is generally on the kinds and
quality of services provided to those who are behind bars.
It’s a complex issue that affects some 2 million inmates in American
jails and prisons, but when it comes to sheer numbers, there’s a larger
group to consider — the nearly 4.5 million individuals who are on
probation, living in the community under corrections department
supervision. With studies indicating that half of probationers don’t
have a regular doctor, a program that could link many of them to care
could potentially improve the health of a million or more people.
That’s where the University of Delaware’s Center for Drug and Health Studies
(CDHS) has stepped up. Supported by a grant from the Robert Wood
Johnson Foundation and with the cooperation of the Delaware Department
of Correction, the center has conducted a first-of-its-kind pilot
project, the Delaware Culture of Health study, working with probationers
to find ways to link them to better health care.
The results were promising, indicating that with relatively easy and
inexpensive interventions, probationers were able to find a family
doctor, increase their health screenings and decrease their emergency
room visits.
“One of the things we know in the health field is that it’s all about
catching problems early,” said Daniel O’Connell, senior scientist with
CDHS. “That’s why having a family doctor is much better than relying on
the emergency room. What we found is that a lot of these probationers
never had routine health care and they just didn’t know how to go about
finding a general care practitioner.”
The study worked with 400 probationers in northern Delaware, putting
informational materials in the waiting rooms of the offices where they
are required to meet regularly with a probation officer. The researchers
created a workbook, “Healthier You,” and made it available to the
probationers. In addition, half of the group — 200 probationers — met
with a grant-funded facilitator for additional guidance on available
resources and received help in setting up an appointment with the
Christiana Care Health System Department of Family and Community
Medicine in Wilmington.
The workbook included resources beyond direct health-care services,
such as information about housing and substance abuse assistance. The
CDHS researchers developed the workbook and other information with the
help of numerous community partners.
“I’m a big fan of what we call ‘local change teams’ that bring
together people from various agencies,” said O’Connell, who has worked
with issues involving corrections and health care for some 20 years.
“It’s empowering when we, the researchers, step out of the way and let
the people who are experts — because they’re in the field every day —
work.”
The pilot study ran for a year and found that having access to the
informational materials was associated with an increase in the number of
probationers accessing care through a primary care doctor. Those who
also met with the facilitator showed an additional, modest increase in
accessing better care.
Although the study was small, O’Connell and co-principal investigator
Christy Visher, professor of sociology and criminal justice and
director of the CDHS, said its promising results should encourage other
corrections agencies across the country to consider similar kinds of
outreach to probationers. “The project showed that probationers want
better connections to healthcare; they just need help in making that
connection,” Visher said.
Visher, O’Connell and former graduate research assistant Patricia Becker published a paper, “Linking Individuals on Probation to Health Care: A Pilot Randomized Trial,” online in the journal Health and Justice,
and the Robert Wood Johnson Foundation has supported various webinars
and other outreach for them to explain their findings to corrections
professionals.
“We’ve demonstrated that this concept can work,” O’Connell said. “As
we’re hearing interest from other agencies, we’re hoping it can grow
over the years.”
Article by Ann Manser; illustration by Jeffrey C. Chase
Published Jan. 13, 2021
