Inside and Out illustrates a successful solution to a chronic and widespread challenge facing communities across the country: the high incidence of chronic disease among current and former jail inmates.

According to a recent report from the Pew Center on the States, one in every 99.1 American adults is behind bars. Incarceration rates are even higher for some groups, including Hispanic adults (one in 36) and black adults (one in 15). These figures represent an enormous social and financial challenge to our country. They also represent a huge health care challenge. While correctional facilities are mandated by law to provide health care, limited dollars, limited access to resources, political pressures and other forces limit the effectiveness of care.

The mission of Community Oriented Correctional Health Services (COCHS) is to help local correctional facilities improve health care delivery to inmates by brokering partnerships between jails and local community health care providers. COCHS recognizes that, while jails are required to provide health care to inmates, their top priorities are safety, order, and security. However, improved inmate health can reduce violence in the jail and in the community.

Inmates have high instances of chronic disease and at-risk lifestyles and many have little or no knowledge of proper self-care. In addition, many inmates have little or no knowledge of how to use the community health system and are likely to use emergency rooms for treatment after release. COCHS helps bring community health center staff into local correctional facilities, creating a connection that makes correctional health care an extension of the existing community health care system. Upon release, case managers steer inmates away from emergency rooms and into health centers to see the same staff that treated them during incarceration.

COCHS provides technical assistance and consulting services, including:

• Brokering relationships between community health centers and correctional facilities
• Developing satellite health center sites within correctional facilities
• Organizing inmate health and post-release services in health centers near the inmate's residence
• Extending health screening to the pre-arraignment process
• Installing, at a health center's request, an electronic medical record system that links the correctional center and the health center's records
• Correctional health medical expertise available on-call
• Legal and marketing assistance regarding most aspects of a project
• Program development resources such as model policies and procedures
• Performance standards and targeted clinical quality improvement
• Training and technical assistance

Without connections to health care outside a correctional facility, chronically ill inmates are likely to become a long-term, expensive health burden on the community. If inmates are treated by community-based providers in a correctional facility, incarceration can be a tremendous community health opportunity.

Learn more about Program Area: Vulnerable Populations