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OCTOBER & NOVEMBER 2007
Spotlight I:
Project Bridge: A Transitional Case Management Program for HIV-Infected Men and Women
Leah Holmes, LICSW Project Bridge Principal Investigator and Project Director The Miriam Hospital, Providence, Rhode Island Disclosures:None Introduction Project Bridge is an intensive case management program for HIV-positive ex-offenders at The Miriam Hospital in Providence, Rhode Island. The program is located off-site from the hospital in the neighborhood where a majority of offenders lived before incarceration. The program staff consists of two master’s level social workers who are responsible for the overall management of each case and two paraprofessional outreach workers who locate missing clients and provide support to access concrete services, such as food stamps and housing applications. The social worker meets with prospective clients from 30 to 60 days before release at the correctional facility to identify the most pressing needs facing the client. After release, they provide supportive counseling, and coordinate medical, legal, substance use, and mental health treatment. The primary goal of the program is to enhance continuity of medical care through increasing social stability. Attending to basic survival and social support needs is fundamental to retaining ex-offenders in medical care. Program Overview Client enrollment began in February 1997. Since that time, we have learned several lessons. The first lesson is the importance of having the social worker attend medical visits with the client. Clients rate this as the most salient factor in keeping medical appointments and adhering to medications. They welcome the emotional support and the assistance in understanding medical terms and directives. It facilitates in obtaining medications, and assuring that comprehension of dosing schedules, and requirements to prepare for medical tests and procedures exist. The second lesson is that clients need to be in very close contact during the initial phase of re-entry. We request that they either come to the office or have telephone contact daily for the first month. The outreach worker assists them to access many service needs, while the social worker creates a treatment plan and provides supportive counseling. Frequency of contact builds a working relationship and develops trust. The third lesson is the importance of visiting reincarcerated clients as quickly as possible after their arrest. They are at a point of crisis and change is most likely to occur when usual coping strategies are ineffective. Clients who have visits during reincarceration are more strongly committed to the program following re-release. The final lesson is to tailor length of enrollment to the client’s needs. A very small number of clients stabilize within six months. Generally, these people were first-time offenders and have intact social and financial support in the community. Most clients remain enrolled for 18 – 24 months and then transfer to other providers for continuing services. Participant Demographics Project Bridge’s most recent evaluation covered the period between 2003 and 2005. Sixty-five participants enrolled in the study. Participants were primarily male (66%) with one being transgender. They were also primarily heterosexual (82%). Race was nearly even between African American (41%) and White (42%) with the remainder Native American or Other (6%) or more than one race (5%). Hispanic ethnicity was reported by 14% and 6% were primarily Spanish speaking. The attrition rate was 20%. One participant died, three moved out-of-state, two withdrew from the study shortly after prison release, and seven were re-incarcerated and received sentences that exceeded six months. It was at that time an SPNS funded project began to find methods of outreach for out-of-care or sporadic users of care. It ended in 2006. Project Bridge has continued as a Part B (formerly Title II) funded program. The staffing has been reduced to one MSW and one BA outreach worker. Effectiveness of Medical Retention In the first six months of enrollment, 98% of the clients received medical care. In the final six months of their enrollment, 100% received medical care. The evaluation included a chart review six months after clients graduated from the program to see if there was decay in the program effects. This showed that 89% had continued to seek medical care. Future Steps Project Bridge is continuing thanks to ongoing Ryan White Part B funding provided by the Rhode Island Department of Health. This model can and should be tailored to other facilities in other states. It can also be tailored to other disease states. Drs. Peter Friedman and Lynn Taylor have recently received a National Institutes of Health (NIH) grant that will use the Project Bridge model to provide care for offenders with hepatitis C virus (HCV) infection being released from incarceration. This will allow us to start offenders on HCV treatment while incarcerated and continue therapy following community release. Presently, offenders only receive this treatment if they are serving a sentence with at least a year remaining before release.
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