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Jail Health Care in the Southeastern United States From Entry to Release.

Publication ,  Journal Article
Carda-Auten, J; Dirosa, EA; Grodensky, C; Nowotny, KM; Brinkley-Rubinstein, L; Travers, D; Brown, M; Bradley-Bull, S; Blue, C; Rosen, DL
Published in: Milbank Q
September 2022

UNLABELLED: Policy Points As a consequence of mass incarceration and related social inequities in the United States, jails annually incarcerate millions of people who have profound and expensive health care needs. Resources allocated for jail health care are scarce, likely resulting in treatment delays, limited access to care, lower-quality care, unnecessary use of emergency medical services (EMS) and emergency departments (EDs), and limited services to support continuity of care upon release. Potential policy solutions include alternative models for jail health care oversight and financing, and providing alternatives to incarceration, particularly for those with mental illness and substance use disorders. CONTEXT: Millions of people are incarcerated in US jails annually. These individuals commonly have ongoing medical needs, and most are released back to their communities within days or weeks. Jails are required to provide health care but have substantial discretion in how they provide care, and a thorough overview of jail health care is lacking. In response, we sought to generate a comprehensive description of jails' health care structures, resources, and delivery across the entire incarceration experience from jail entry to release. METHODS: We conducted in-depth interviews with jail personnel in five southeastern states from August 2018 to February 2019. We purposefully targeted recruitment from 34 jails reflecting a diversity of sizes, rurality, and locations, and we interviewed personnel most knowledgeable about health care delivery within each facility. We coded transcripts for salient themes and summarized content by and across participants. Domains included staffing, prebooking clearance, intake screening and care initiation, withdrawal management, history and physicals, sick calls, urgent care, external health care resources, and transitional care at release. FINDINGS: Ninety percent of jails contracted with private companies to provide health care. We identified two broad staffing models and four variations of the medical intake process. Detention officers often had medical duties, and jails routinely used community resources (e.g., emergency departments) to fill gaps in on-site care. Reentry transitional services were uncommon. CONCLUSIONS: Jails' strategies for delivering health care were often influenced by a scarcity of on-site resources, particularly in the smaller facilities. Some strategies (e.g., officers performing medical duties) have not been well documented previously and raise immediate questions about safety and effectiveness, and broader questions about the adequacy of jail funding and impact of contracting with private health care companies. Beyond these findings, our description of jail health care newly provides researchers and policymakers a common foundation from which to understand and study the delivery of jail health care.

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Published In

Milbank Q

DOI

EISSN

1468-0009

Publication Date

September 2022

Volume

100

Issue

3

Start / End Page

722 / 760

Location

United States

Related Subject Headings

  • United States
  • Substance-Related Disorders
  • Southeastern United States
  • Prisons
  • Prisoners
  • Jails
  • Humans
  • Health Policy & Services
  • Delivery of Health Care
  • 4206 Public health
 

Citation

APA
Chicago
ICMJE
MLA
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Carda-Auten, J., Dirosa, E. A., Grodensky, C., Nowotny, K. M., Brinkley-Rubinstein, L., Travers, D., … Rosen, D. L. (2022). Jail Health Care in the Southeastern United States From Entry to Release. Milbank Q, 100(3), 722–760. https://doi.org/10.1111/1468-0009.12569
Carda-Auten, Jessica, Elena A. Dirosa, Catherine Grodensky, Kathryn M. Nowotny, Lauren Brinkley-Rubinstein, Debbie Travers, Mersedes Brown, Steve Bradley-Bull, Colleen Blue, and David L. Rosen. “Jail Health Care in the Southeastern United States From Entry to Release.Milbank Q 100, no. 3 (September 2022): 722–60. https://doi.org/10.1111/1468-0009.12569.
Carda-Auten J, Dirosa EA, Grodensky C, Nowotny KM, Brinkley-Rubinstein L, Travers D, et al. Jail Health Care in the Southeastern United States From Entry to Release. Milbank Q. 2022 Sep;100(3):722–60.
Carda-Auten, Jessica, et al. “Jail Health Care in the Southeastern United States From Entry to Release.Milbank Q, vol. 100, no. 3, Sept. 2022, pp. 722–60. Pubmed, doi:10.1111/1468-0009.12569.
Carda-Auten J, Dirosa EA, Grodensky C, Nowotny KM, Brinkley-Rubinstein L, Travers D, Brown M, Bradley-Bull S, Blue C, Rosen DL. Jail Health Care in the Southeastern United States From Entry to Release. Milbank Q. 2022 Sep;100(3):722–760.
Journal cover image

Published In

Milbank Q

DOI

EISSN

1468-0009

Publication Date

September 2022

Volume

100

Issue

3

Start / End Page

722 / 760

Location

United States

Related Subject Headings

  • United States
  • Substance-Related Disorders
  • Southeastern United States
  • Prisons
  • Prisoners
  • Jails
  • Humans
  • Health Policy & Services
  • Delivery of Health Care
  • 4206 Public health