1. CDC Demonstration Project: Dallas County Jail Re-entry Project Klaus Kroyer Madsen Vice President, Programs From the Frontline: Public Health Institutes Complementing the Public Health System Session National Network of Public Health Institutes Annual Conference New Orleans, May 15, 2008 Photo: whatknot

2. Dallas County Jail (DCJ) 7th largest detention facility in the nation Receives over 100,000 admissions per year 57% of which are released within three days 68% released within seven days At 95% capacity, DCJ holds approx. 7,000 inmates Photo: WD502

3. Jail Health Services at DCJ Managed by the Dallas County safety net hospital (Parkland Health and Hospital System) Serves about half of the inmates Photo: WD502 Large infrastructure projects including HIT to connect JH with Parkland Hospital and Community Oriented Primary Care Clinics

4. Health Status of DCJ Jail Health Patients 35% have mental health disorders Top Medical diagnoses: 1.Hypertension 2.Asthma / Chronic obstructive pulmonary disease 3.Diabetes (Insulin and non-Insulin dependent) 4.Chronic pain 5.Heroine / Opiate

5. Towards a Holistic View of Jail Health Visits with Jail Health administrator to identify “wicked problems” to address On top of Wish List: improve jail health by eliminating recidivism! Conversations with County Commissioners, County and City staff to map stakeholders for community engagement process

6. THI Project Approach CDC/NNPHI funding Dallas community leadership group THI staff (connections, expertise) Activity #2: Document processes and strategies Activity #3: Analyze methods for feasibility in community collaboration and effectiveness Community development lore Activity #4: Create community development/coalition building tools Documentation of Texas Health Institute’s process for community change Production of a model and tools for community change that others can use Identification of processes that were and were not effective Identification of key processes for community collaboration An approach for PHIs to use in order to create change and improve health in their communities Activity #1: Implement an intervention with community leadership group to address the issue. InputsActivitiesOutputsOutcomes Activity #1: Implement an intervention with community leadership group to address the issue. Inputs Activity Outputs Outcome Concerned Community leaders THI Staff (connections, expertise) Community Development lore Identify sponsor organization Convene leadership group Define Issue Collect and share supporting data with community leaders Working coalition that is engaged and energized and able to affect change Increased interest about the issue among the leadership group Community plan to address identified issues in the Dallas community Collaboration of stakeholders that initiates implementation of the community plan

7. Community Meetings First Community Meeting – 75 community members (service providers, non- profits and some former inmates) indentified 10 community priorities

8. Community Meetings Second Community Meeting – 30 former inmates and family members validated and narrowed community priorities

9. Community Meetings Third Meeting – 45 community members (providers and inmate organizations) developed task force structure to address the objective of reducing recidivism Employment Housing Continuity of Care Mental Health / Substance Abuse – Created steering committee for implementation and sustainability

10. Leadership Represented on SC Parkland Health and Hospital System Dallas County – Commissioners Court – Public Health – Sheriff’s Department Dallas Independent School District Dallas Leadership Foundation Dallas Police Department Operation Oasis Vision Regeneration

11. Outcomes THI helped Parkland Jail Health connect with governmental and non-governmental partners Established strong connections between consumer and family organizations and the provider system Created powerful action-oriented steering committee and task force structure for implementation and sustainability Continued strong support of the project sponsor

12. Project Impact to Date Access to DCJ for HIV/AIDS advocacy NGO Social worker hired to provide HIV/AIDS counseling Voluntary HIV screenings by Public Health Dept. at the Jail Health intake Social worker hired to support pregnant inmates and their families Parkland Health Plan card to inmates upon release to provide medical home and access to Rx Release of homeless inmates to new public-private partnership homeless center Referral of inmates from drug rehabilitation center to Community Oriented Primary Care Clinics !

13. Next Steps Task forces to present implementation recommendations to Steering Committee Establishment of new identity for the initiative Presentation of project ideas to public sector and philanthropic funding partners Photo: whatknot

14. Our Mission: To provide leadership to improve the health of Texans and their communities through education, research, and health policy development. Klaus Krøyer Madsen THI Vice President, Programs kmadsen@texashealthinstitute.org 512-279-3905 Contact Us: www.texashealthinstiute.org / 512-279-3910 8501 N. MoPac Expressway, Suite 420 / Austin, Texas 78759