Emily Wang had a keen interest in health care in the criminal justice system from the start of her medical career. Early on, she was struck by the fact that people who are incarcerated receive good medical care while in prison—but too often don’t have any continuity of that treatment once they are out. “When they’re released, we often find them in the emergency department, says Wang, director of the Health Justice Lab and associate professor at Yale School of Medicine.
To try and close those gaps, Wang co-founded the Transitions Clinic Network to manage the specific needs of patients with chronic illnesses on their release from prison, help improve their health outcomes, and facilitate their reintegration to the community. The program links people released from prison who have chronic illnesses with community health workers who also have a history of incarceration. They also ensure that these patients have support on their release, both for their health needs and for social determinants of health, like housing, food, and employment.
These programs, which are now in 12 states and Puerto Rico, have been shown to improve the health outcomes of recently released prisoners. But they can also reduce the amount of re-incarceration participants experience, according to a new study published this week. “We specifically looked at how the program changes criminal justice contact,” Wang says. “That hasn’t been looked at prior to this study. Primary care can move the needle on this.”
It’s an important question to ask, Wang noted, because reincarceration is so common—66 percent of those released from prison will be back within five years. In addition, research shows that people who have contact with the criminal justice system have poorer health than those who don’t, and that incarceration is it’s own, independent factor driving bad health outcomes. That’s compounded by the length of time a person spends in prison and the number of times they are incarcerated. Both longer lengths and more instances mean worse health outcomes. “Every single time you go in, it impacts health and health outcomes,” Wang says. “It seemed like a natural outcome to look at. Incarceration is one of the largest social determinants of health that our country faces.”
This study looked at the recidivism rates and health outcomes of 94 patients in Connecticut who’d received care through the Transitions Clinic Network, compared with 94 matched controls of similar age, ethnicity, health status, and length of time spent in prison who did not receive care through the program. Both groups had an average of one chronic conditions, such as diabetes, gastrointestinal conditions, and liver disease. Just under 40 percent of both groups had an opioid use disorder.
People in the Transitions Clinic Network program had a 62 percent decrease in their odds of returning to prison for parole or probation violations. They also spent 45 percent fewer days in jail than controls in the year after their release. If the control group had participated in the program, according to the analysis, they collectively would have spent 2,300 fewer days in prison. There was not, however, a difference in arrest rates between the two groups.
“It’s probably too much to think we could have moved the needle on arrests,” Wang says. While the study did not look at the reasons why program participants spent fewer days incarcerated if they were re-arrested, Wang thinks the relationships built with community health workers and physicians could play a role, particularly for patients with opioid use disorders or mental illnesses.
If a patient identifies opioid use disorder as an issue, and they get on medications through the program, and for whatever reason have a lapse in drug use—which is very common—the community health workers can advocate on their behalf to a judge, for example. “They’re able to say that they’re deeply engaged in care, we can get them into a higher level of care,” she says. “I could see that as a pathway to reduced time.” Relationships with physicians who might be able to speak to a judge or parole officer could contribute, as well.
The study also found that participants in the program were less likely to be hospitalized for conditions that would be preventable with primary care, and had 60 percent shorter stays if they were hospitalized.
The results of the study are an initial step towards demonstrating the role the healthcare system can play in criminal justice reform, Wang says. Engaging with formerly incarcerated people and taking steps to reduce the health harms that prison can cause is beneficial for the health system, as well, because it makes for a healthier—and less costly—population, she says. “And for health, reducing contact with prisons is one of the most profound things to do for a single patient.”