Does a Primary Health Clinic for Formerly Incarcerated Women Increase Linkage to Care?

Abstract

Objective This study examined a primary care-based program to address the health needs of women recently released from incarceration by facilitating access to primary medical, mental health, and substance use disorder (SUD) treatment. Study design Peer community health workers recruited women released from incarceration within the past 9 months into the Women’s Initiative Supporting Health Transitions Clinic (WISH-TC). Located within an urban academic medical center, WISH-TC uses cultural, gender, and trauma-specific strategies grounded in the Self-Determination Theory of motivation. Data abstracted from intake forms and medical charts were examined using bivariate and multivariable regression analyses. Results Of the 200 women recruited, 100 attended the program at least once. Most (83.0%) did not have a primary care provider prior to enrollment. Conditions more prevalent than in the general population included psychiatric disorders (94.0%), substance use (90.0%), intimate partner violence (66.0%), chronic pain (66.0%), and Hepatitis C (12.0%). Patients received screening and vaccinations (65.9 – 87.0%), mental health treatment (91.5%), and SUD treatment (64.0%). Logistic regression revealed that receipt of mental health treatment was associated with number of psychiatric (AOR=4.09, p<.01), and social/behavioral problems (AOR=2.67, p=.04), and higher median income (AOR=1.07, p=.05); African American race predicted lower receipt of SUD treatment (AOR=0.08, p<.01). Conclusion An innovative primary care transitions program successfully helped women recently released from incarceration receive medical, mental health, and SUD treatment. Primary care settings with specialty programs, including community health workers, may provide a venue to screen, assess, and help recently incarcerated women access needed care.

Outcomes among pregnant recently incarcerated women attending a reentry transitions clinic

“…Primary care clinics addressing needs of recently incarcerated individuals have potential to improve public health but should address unique needs of women (Morse et al, 2017). Because 60% of incarcerated women are active parents (Glaze & Maruschak, 2008), public health for recently incarcerated women must include attention to their unborn children.…”

“…Additional details regarding our approach can be found in a previous publication (Morse et al, 2017). Additional details regarding our approach can be found in a previous publication (Morse et al, 2017).…”

“…Strengths of this case series are in providing data on the little-studied topic of pregnancy among difficult-to-access recently incarcerated women, reached through the TCN model of care and community collaboration (Fox et al, 2014;Wang et al, 2012;Morse et al, 2017). Because the women were pregnant and had reported substance use in the past, their urine toxicology screens allowed biological confirmation.…”

“…Limitations include the lack of a matched comparison group among the patients of our WISH-TC program (pilot program described in Morse et al, 2017) and use of clinical diagnoses rather than a prospective study with validated measures of SUD and mental health symptoms. Relatedly, given that patients were not randomized, group sizes could not be controlled, and thus some statistical comparisons were limited by small group membership.…”

“…This retrospective case series study examined all women who received similar (i.e., standard of care for WISH-TC patients) treatment during the 2-year period studied and examined their EMRs for exposure and outcome (enrollment in clinic and pregnancy status, respectively). Additional details regarding our approach can be found in a previous publication (Morse et al, 2017).…”