Prison Health and Reentry Support Programs

MILA Fellows Reentry Family Support Program- Atlanta

pharsp_img1Project Overview
Community Voices: Health Care for the Underserved at Morehouse School of Medicine put into practice a unique program for formerly incarcerated African American fathers. The program builds and improves life skills. The program also provides direct contact to reentry services. Services provided from the program allow men to meet legal, financial, and familial requirements. The men are thus expected to become a positive impact on their children, family, and community. The MILA Fellows program has two overarching goals: 1) to build healthy and active relationships between the fathers and their families, especially their children, and 2) to prevent participants from returning to jail or prison throughout the duration of the program and reduce recidivism thereafter.

Program Activities
Group sessions focused on enhancing success, strengthening social networks, building family relationships, and creating plans to accomplish personal goals are provided for program participants. Additionally, workshops and seminars on legal matters and child support issues are provided for program participants. A case manager works with each participant to increase their involvement in the lives of their children and family, manage activities associated with client services such as job readiness, parenting and co-parenting, and community-based activities, and track their progress through the program. Participants also take part in Family Fun Day events, where participants are encouraged to spend time with their children and families in family activities supported by Community Voices such as movie screenings, sporting events, and field trips.

pharsp_img2Outcomes
Participants have received monthly grocery cards and transportation gift cards, assistance with child support issues that have resulted in the reinstate of participants’ driver’s licenses, free legal advice, and free comprehensive health screenings. We have also helped secure employment for nearly half of the participants.  Our advocacy efforts on the radio, in reentry forums and community town hall events, and in court with participants have resulted in support of the program and release of participants that could have otherwise be reentering jail or prison. No participant has returned to jail or prison since enrolling in the MILA Fellows Program.  This project was funded by the WK Kellogg Foundation.


MILA Fellows Reentry Family Support Program – Mississippi

Project Overview
The MILA Fellows program has been a success in Atlanta and has been given the green light to be replicated in four counties in Mississippi. As a result, the W. K. Kellogg Foundation in partnership with Community Voices: Health Care for the Underserved at Morehouse School of Medicine established the MILA Fellows Reentry Family Support Program in Mississippi to provide services to 100 African-American fathers released from prison in the past 180 days and their children less than 15 years of age from Coahoma, Harrison, Hinds, and Sunflower Counties in Mississippi. The anticipated population served will consist of 25 fathers and 25 children per county. The program seeks to build and improve the life skills of these men and children as well as provide direct contact to reentry services. It is the hope that these reentry services will allow men to meet legal, financial, and familial requirements. The men can thus become a positive impact on their community and further enhance their relationships with their families.

Program Activities
With the ultimate goal of keeping men from returning to prison, the MILA: Mississippi program consists of weekly group activities lasting three months. All participants, including both fathers and their children, will participate in weekly group sessions focused on enhancing their success, strengthening their social networks, building family relationships, and creating a concise plan to accomplish each of their goals. Participants will also take part in volunteer opportunities around the community as well as workshops and seminars to open doorways to their success. The children who participate will be heavily involved in weekly children focused programs and family activities including a movie night, sporting event, outdoor field trip, and volunteer service project. These family activities will be a time for fun, networking, and making future plans together. Participants will also be expected to keep in contact with program staff throughout the duration of the program.

Outcomes
Throughout the implementation phase of the project the following outcomes are expected:

  • Provide men with assistance to find long-term and stable employment
  • Enable men to re-establish a strong, healthy relationship with their family and child (ren) through relationship skill building activities
  • Provide children with life skills to cope with issues, make informed decisions, and make positive impacts at home and in their community
  • Provide children and families with support to needed services
  • Decrease in the chances of these men going back to jail or prison
  • Educational awareness on how best to live healthy with physical fitness and good nutritional diets

Just For Men

Project Overview
The “Just for Men” program seeks to support underserved and/or un-insured men specifically in Fulton and DeKalb Counties, Georgia.  This program helps to build on the dearth of research on men’s health issues and expand awareness and understanding of complex health and social issues related specifically to poor men of color and to build our institutional and national capacity to address those issues. We at Community Voices have scoured the Atlanta Metropolitan area for available men’s services and men-specific health organizations and unfortunately the number of programs in operation is extremely limited. Just For Men allows us to lay the foundation on which to build this important work.

Program Activities
Just For Men has conducted research through Key Informant Interviews, focus groups, and one-on-one interviews with randomly selected men from the community whom are underserved and/or uninsured. This research allows us to assess attitudes about seeking health care, perceived barriers to care, insurance status, health status concerns, health literacy (e.g., ability to understand prescriptions and instructions), and knowledge of what the changes will be as a result of the Affordable Care Act (as a way of teaching the details about the Act). We have also trained Community Health Workers (CHWs) to assist in community outreach. We co-hosted a health fair for men and their families to receive free health screenings and health information.

Outcomes
Thus far, we have served over 300 members of the community; nearly half were underserved and/or un-insured men targeted for this project; at a community health fair. Participants were provided with information on the Affordable Care Act, free health screenings, access to health provider organizations, a panel of health experts, and the opportunity to speak with elected officials. Future anticipated outcomes of the Just For Men project are:

  • Development of a needs assessment tool to be utilized with underserved, un-insured men concerning  health issues and concerns
  • Development and dissemination of a community resource guide that will include key health information and education about how  to identify and locate options for affordable health services
  • CHWs will engage underserved and uninsured men and advocate for and encourage policy change on pertinent men’s health related issues, especially those affecting underserved, un-insured men in the areas around Morehouse School of Medicine, including the West End, Mechanicsville, and English Avenue.

Obesity and Diabetes Prevention Programs

Addressing Adult and Childhood Obesity: Mother-Daughter Dyads Project

oadpp_img1Project Overview
Thanks to the support of the AETNA Foundation Community Voices is currently implementing a research study aimed at examining psychosocial, behavioral, socio-cultural, and environmental factors that may contribute to African American mothers and daughters being overweight. This project will also examine methods utilized by pediatricians and family medicine providers to address overweight status among African American female patients.

Research Activities
Key activities of this project will include:

Focus groups with 28 overweight African American girls’ ages 8-12 years old and their biological mothers concerning health beliefs, psychosocial and environmental risk factors and health-related behaviors that may contribute to their overweight status.

- Face-to-face semi-structured interviews with 50 primary healthcare providers concerning structural and practice specific related issues that may assist and/or prevent their capabilities to offer optimal weight reduction and/or management support services for their African American female patients.

– Use of data to inform the development of a culturally centered gender-specific primary healthcare intervention model to help prevent excess weight/overweight status among African American females.

Research Implications
The results of the proposed project will result in the design of prevention strategies that will include ‘prescriptions’ that address the needs expressed by the daughters and mothers both independently and as a dyad. These interventions will address the mother-daughter dynamic, neighborhood challenges, stress of the mother and daughter as a dyad and as individuals living in resource challenged neighborhoods. The goal is to incorporate into evidence-based best practice those variables that stand the best chance of introducing sustainable change into mother-daughter and even family wellness behavior. The equally important outcome will be a mother-daughter dyad informed protocol that will guide providers and payers’ on how to address this issue.

oadpp_img2Save Our Sons: Diabetes and Obesity Prevention Program for African American Men

Project  Overview
The Lorain Country Branch of the National Urban League and the Urban League of Greater Dallas and North Central Texas in partnership with Community Voices: Health Care for the Underserved at Morehouse School of Medicine and Pfizer established the Save Our Sons program.  Save Our sons targets African American men ages 18 and up and focused on ways to incorporate healthy eating and exercise in an effort to reduce diabetes rates and maintain a healthy lifestyle. The Save Our Sons project had two overarching goals: 1) To develop, implement, and evaluate a health education model aimed at reducing diabetes and obesity among African American men, and 2) To improve access to primary healthcare services for African-American men.

Research Activities
Workshop sessions included a six session education curriculum intervention, exercise education, medical screenings, and weight loss data for program participants. We connected program participants with medical and social services to meet their individual needs. Participants were also provided with mental health interventions and a medical home during the program.

Selected Findings

Medical Outcomes
The SOS program achieved positive changes in the health and medical status of its 542 participants. Key results include the decrease of Stage 2 hypertension decreased by 26%, the combined weight loss of over 1095 pounds among all participants for an 4lb. per male average, all participants classified as diabetic or pre-diabetic losing weight, the decrease in diabetic status by 1% as well as a 13 point on average drop on average in glucose levels among diabetic participants and achieving a dramatic 14% decrease in unhealthy cholesterol levels among participants. We assisted 37 men with obtaining a medical home through The Lorain County Free Clinic (Lorain County) or the Parkland Medical Assistance Program (Dallas, TX).

Body Mass Index
At the start of the program, 55% of program participants were classified as obese or extremely obese. Given the obesity status of the men in program, a strong focus was placed on both physical activity and proper nutrition. Post program substantial results were achieved with a 4% decrease in extremely obese status; also the obese classification achieved a remarkable 10% decrease. There was a decrease of 3% in overweight status among the men.  The decrease in the healthy range was achieved by the increased weight lifting activity of men who loss fat but gained muscle. Through this program significant weight loss was achieved with 47% of all participants, losing weight for a total of 1095 pounds loss and 4lbs on average lost. While 4lbs was the average for the program, 60 lbs. was the highest weight lost and a large number of participants lost more than 9 lbs. At the start of the program, 19% of participants were classified as either diabetic or pre-diabetic. At the conclusion of the program, the rate of diabetes dropped from 11% to 8%. This decrease can be attributed in part to the high level of physical activity among men, with their average weight loss of 4lbs or more.

Diabetic Status
All participants classified as diabetic pre-program lost weight during the program. The rate of pre-diabetes increased from 8% to 9% due to the reclassification of previously diabetic participants. Of the participants who are still classified as diabetic, blood glucose levels dropped an average of 13 points during the intervention.

The Save Our Sons Program has become a nationwide model and has led to the development of the Save Our Families Initiative.

oadpp_img3Can You Imagine Me? National Childhood Obesity Initiative

Project Overview
The joint Community Voices and Links, Incorporated National childhood obesity initiative has been embraced to give a greater voice and sustainability to the health and well-being of our children. The purpose is to develop and implement strategies targeted to addressing the specific health needs of African-American children. Building upon the initial 7 chapter pilot phase conducted in the Southern Area, this project seeks to increase awareness and heighten understanding surrounding the multi-dimensional issues that contribute to obesity in African-American children. Additional goals are to: develop an action-oriented agenda for disseminating key policy and educational messages that aid in the prevention of childhood obesity and reduce the incidence of Type II diabetes as well as pre-diabetes related to obesity among African-American children and to establish approaches that will strengthen collaborative networks regarding obesity prevention to sustain on-going health initiatives. Twenty-seven (27) Links chapters were involved in this National Initiative and engaged over 680 children and their families.

oadpp_img4Research Activities
Twenty-seven chapters nationwide were selected to implement the program in their local communities by engaging children in a six session education curriculum and fun activities such as: Cooking Demonstrations, Gardening, Zumba Classes, Skiing and Walk-a-thons.

Research Findings

Throughout the implementation phase of the project the following outcomes were achieved:

- Nationwide Project Overview: Twenty-six chapters successfully completed the program and have submitted all required documentation. Cumulatively, the program engaged 683 minority children between the ages of 8 and 12.

- Participant Profile- Ethnicity: Ninety-two percent (n=628) of the program participants were of African American descent. Hispanic and Latino children made up 6% of the overall target population. Lastly, only 1% of the participants were comprised of Asian Pacific Islanders, Arabians and Caucasians.

- Participant Profile- Gender: Of participants in the program 58% (n=396) of participants were boys; 42% (n=287) were girls.

- Body Mass Index: Forty-eight percent of the students engaged in the program had a body mass Index (BMI) which classifies them as overweight or obese. Two percent of the students were classified as underweight, while 50% were classified in the healthy weight range. Classifications were made by comparing children’s measurements to the CDC children’s BMI percentile chart based upon their age and weight. Additional Project Information Can Be Found by Visiting: www.CanYouImagineMe.com

I Am Woman: Fitness and Nutrition Program for African American Women

oadpp_img5Research Overview
The Columbia Urban League in partnership with Community Voices: Healthcare for the Underserved at Morehouse School of Medicine and General Mills provided The I Am Woman program for the Columbia, SC community.  The I Am Woman program is a comprehensive culturally tailored women’s health education program designed to increase awareness on health issues, increase physical activity and increase healthy food choices among African American women.   The program which targeted African American women and had three main goals 1) to provide a culturally tailored intervention targeting African American women and their families, 2) to increase community awareness on issues related to women’s health and 3) to assist community members with navigating the healthcare system and increasing access to a medical home.

Research Activities
The intervention included seven sessions which covered topics which covered health and nutrition. Additional program activities included: mental health seminars, exercise interventions, cooking demonstrations and free health screenings.

Research Findings
Medical Outcomes: Blood Pressure: Stage 1 hypertension saw a remarkable 17% decrease, while Pre-hypertensive and Normal ranges both saw increases of 6% as a result of a decrease of unhealthy blood pressure status. Blood Glucose: At the conclusion of the program the rate of pre-diabetes dropped from 13% to only 8% while the diabetes rate remained unchanged. Of the participants who are still classified as diabetic, their blood glucose levels dropped an average of 2 points during the intervention. Program Outcomes: Increase in Knowledge: Test scores improved 15% across program concepts which demonstrate a strong increase in program concepts knowledge. Program concepts include physical activity in daily life, ways to prevent diabetes, how to eat healthier, and speaking to a healthcare provider. Retention Rate: 75% of all program participants completed the program.

Advancing Health and Informing Policy: The Atlanta Neighborhoods’ Project

oadpp_img6Research Overview
The purpose of this project is to implement a community-driven, community-based participatory research (CBPR) and informing policy campaign to address access to care systems and policy barriers in the African American community.  The target area includes underserved communities (i.e., zip codes 30303, 30310, 30318). The focus is to address the health care and economic disparities issues most relevant to them and their neighbors and train them to be their own advocates to inform and affect policy.

Research Focus: The myriad of social determinants that affect access to and utilization of comprehensive healthcare services; prominent health concerns such as obesity, asthma and diabetes and supportive community resources; neighborhoods/ environments that lack essential goods and services (e. g. grocery stores with adequate fresh fruits and vegetables, fitness facilities, etc.) and improved access to healthcare, employment and other services.

Research Activities: This advocacy and community engagement program conducted a host of activities including assessing the health and the insurance status of over 250 residents of Atlanta; hosted community forums with concerned parents; covered town hall events with local policy makers and the community to discuss health care reform; & supported health fairs and conferences to educate the community on Medicaid expansion and the provisions of the Affordable Care Act.

Mental and Behavioral Health Programs

 

mabhp_img1Psychosocial Resiliency Intervention for African American Women with Depressive Symptoms in a Community Based Primary Healthcare Center                                                                                         

Project Overview
This research project is funded by the National Institutes of Health (NIH), National Institute of Mental Health (NIMH). A paucity of research studies on depression among African American women has existed for decades; and this lack of adequate and sufficient research contributes to the problems of misdiagnoses, under-diagnoses, and under-treatment of depression for this population. Additional empirical data is needed to better determine strategies for improving diagnoses and culturally centered psycho-educational coping modalities for depressive symptoms among this population of women.

This investigation is a randomized control pilot study that will target 76 African American women with depressive symptoms between the ages of 25-44 years old that attend a primary healthcare center in a community based setting. The investigation will determine the effects of a four session culturally centered psychosocial resiliency empowerment intervention guided by the stress-diathesis model of depression. In particular, the specific aims of the study are to:  determine the efficacy of a 4 session psychosocial resiliency empowerment intervention in strengthening resiliency among African American women; determine the similarities and differences with independent psychosocial variables (depressive symptoms, resiliency, self-esteem, negative/ruminative thinking, interpersonal stress, negative/stressful life events, social support & spirituality) among women in the intervention and control groups; and determine the relationship among resiliency, other selected psychosocial variables and the perceived need for treatment of depressive symptoms among African American women in the intervention and control groups.

Research Implications
This research has a number of implications for improvements in behavioral health equity for African American women.  This study seeks to add to the dearth of research about the role of resiliency and related psychosocial variables in empowering African American women to cope with depressive symptoms.  Also, the findings will have implications for improved integration depression screening, assessment, and support for African American women receiving primary health care in community based settings and implications for stronger prevention efforts by increasing African American women’s awareness about depression and important psychosocial factors that relate to the disorder a culturally relevant and gender specific intervention.

Development of an Evidence-based, Culturally Centered Integrated Care Model to Address Depression and Selected Co-occurring Chronic Diseases: Implications for Health Policy

mabhp_img2Project Overview
This study was funded by the NIH, National Institute on Minority Health and Health Disparities (NIMHD). Our multi-disciplinary health and mental health team seeks to add to the existing, yet limited body of literature concerning integrated healthcare models to help address one of the most deleterious mental disorders, depression and selected co-occurring chronic health conditions.

The specific aims of the proposed research investigation are (1) to design, implement, and evaluate the effectiveness of a culturally centered integrative healthcare model to address depression and selected co-morbid chronic diseases among underserved ethnically and culturally diverse adults; and (2) to assess the impact of mental health insurance mandates and coverage on access to a community-based integrated mental and primary healthcare model for vulnerable populations (e.g., veterans, LGBT, homeless, and uninsured individuals). It is our intention to provide greater insight into use of an innovative culturally-centered integrated care model and strategies to support the health, mental health, and well-being of these understudied populations. To address specific aim 1, we will use a mixed methods approach to develop a culturally tailored approach to integrated care. Specifically, we will test the feasibility and compare an integrated care model in one of two community based primary healthcare centers.   We will assess similarities, differences, and outcomes between the two clinic sites concerning clinic/system level, provider level, and patient level outcomes. Findings will yield significant information about the interrelationship between these factors in offering a unique framework for patient care. To address specific aim 2, we will examine the extent that mental health coverage mandates are implemented and provide care for specific mental and behavioral health disorders among selected underserved populations in states of Region IV. We will conduct secondary analyses of data sources to compare mental health claims/reimbursement data from government sponsored health coverage programs (Medicaid/Medicare), private health insurance coverage (Blue Cross/Blue Shield), Veterans Administration (VA) hospitals, and Federally Qualified Health Centers (FQHC) that are within Region IV.

Research Implications
This research study is designed to provide evidence for these strategies and to develop insights that may inform additional policy recommendations that lead to improved health and behavioral health care outcomes.

Screening for Depression among African Americans in Primary Healthcare

mabhp_img3Project Overview
This research study includes screening for depression among 602 African Americans seeking primary healthcare. This study seeks to: (1) assess the feasibility of administering the Patient Health Questionnaire ( PHQ-9+), a depression screening tool, in two busy community-based clinics, (2) compare the sensitivity of detecting depression of the PHQ-9+ with an internal validation scale (mental composite scale of the SF-36), (3) relate functionality measured by the SF-36 with levels of depression and compare with non-depressed patients, and (4) develop the psychometric methods for analysis of data, including item response analysis.

Research Findings
Preliminary study outcomes indicate that approximately 30% of African American women and 20% of African American men present with depressive symptoms in two primary healthcare centers in underserved urban communities. The screening tools yielded adequate reliability and validity psychometric information and appears to be adequate for use with an African American population.  This research project was funded by the National Institutes of Health (NIH) and the National Institute of Mental Health (NIMH).

Understanding Psychosocial, Socio-cultural, and Environmental Correlates of Depression among Diverse African American Women

mabhp_img4

Project Overview

This is a cross-section research investigation, funded by the Office of Ethnic Minority Affairs at the American Psychological Association, examining similarities and differences about perceptions of psychosocial, socio-cultural and environmental contributors to depression for 63 African American from various socioeconomic backgrounds from 1) an urban community, 2) a primary healthcare center, 3) and an academic institution. Three mental health and wellness empowerment sessions were held for each of the three sub-samples of African American women. Each of the women completed an assessment, participated in a focus group, viewed an educational presentation about depression and African American women, reviewed a video about depression in the African American community and completed an evaluation.

Research Findings

Sixty-five percent of the sample displayed mild symptoms of depression.  There were significant positive associations between depressive symptoms and negative and ruminative thinking, self-esteem, stressful life events, social support, depression stigma, and chronic diseases and significant negative associations with resiliency and spiritual well-being. Themes identifying issues that may increase risk for depression included family discord, personal relationship challenges, traumatic life experiences, employment concerns, poor spiritual and/or religious support, and culturally centered issues that support stigma. Similarities and differences about views that contributed to depression were delineated among the three cohorts of African American women.

This study helped to determine the feasibility of using selected assessment tools and instruments, and the identification of appropriate constructs for a larger scale study that will test a conceptual bio-psychosocial model for evaluating the risks and protective factors that may increase susceptibility for depression among diverse African American women.

Mental Health and Substance Abuse Prevention for Male Adolescent Detainees

mabhp_img5

Project Overview

This psycho-educational intervention for male adolescent detainees is designed to improve African American youth’s general psychological well-being, decrease depressive symptoms, positively modify attitudes and decision-making skills relative to alcohol and drug use, and increase self-efficacy to avoid conflict. 53 African American youth between the ages of 13-17 years old that were detained at three regional youth detention centers in DeKalb County, Gwinnett County, and Fulton County in the metro Atlanta area participated in the study. Participants completed pre/post intervention assessment measures in a classroom setting. A nine session intervention was implemented by two African American male Master of Public Health students from Morehouse School of Medicine, with supervision from the principal investigator. Intervention sessions were conducted twice per week over a 6-8 week period at each facility. All youth were provided with supportive mental health and substance use resources and a certificate of completion at the end of the program.

Research Findings

Study findings suggested that these individuals reported chronic drug/alcohol use, minimal depression, and moderate self-efficacy to avoid conflict. Program participants demonstrated interest in learning strategies to avoid conflict. Only slight changes in knowledge based on pre and post intervention session survey changes were indicated.  This study was funded by NIH and the National Institute for Drug Abuse.

New Beginnings: Mental Health, Substance Abuse Treatment and Reentry Support for Men and Women

mabhp_img6

Project Overview

In an effort to reduce the rate of recidivism the United States Attorney’s Office for the Northern District of Georgia, the Georgia Department of Corrections, and the Georgia State Board of Pardons and Parole, and Community Voices at the Morehouse School of Medicine have partnered to create a reentry program aimed at helping formerly incarcerated citizens on probation and parole properly re-integrate into society.  Community Voices is providing an evaluation of The Urban League of Greater Atlanta’s (ULGATL) Think UP Program which is designed to foster the reintegration and independent growth and development of 60 violent formerly incarcerated men and women who live in high crime neighborhoods.  The Think UP program comprises seven phases, beginning with intake, orientation, assessment and the development of an individualized life plan and provides knowledge and skills through job training, social and emotional skills building, and family reintegration.  ULGATL has developed strong relationships with partner organizations and agencies that are available to offer their services in areas of need such as employment, education and literacy training, mental health & substance abuse counseling, housing, as well as family and children services.  The primary outcomes of this program are to reduce recidivism among program participants as compared to a match sample of individuals on probation and parole, evidenced in part by no new violent charges among Think UP participants and participant reintegration within their communities.

Evaluation Implications

The implications from this evaluation may impact multiple outcomes of this population.  This program seeks to strengthen the evidence base of reentry programs that include a focus on employment training and job placement, often considered the most critical resource upon release, transportation, housing, physical and mental health care access and assistance with legal issues. Also, results may contribute to the evidence base that the program feature of utilizing a broad based coalition of collaborative partners and stakeholders is a critical to achieving outcomes, reducing public stigma around formerly incarcerated individuals, and highlighting important economic and health disparities among this population and their children and families.

Reentry and Young Men of Color

Program Overview

The P.A.T.H. program was created by Community Voices: Healthcare for the Underserved at Morehouse School of Medicine to transform high-risk youth. This school-based intervention was designed to increase employability and educational attainment by providing social support through life skills and career awareness training, peer and community-based mentoring, service and resource mobilization, and the promotion of cross-system coordination among youth, parents and caregivers, and the community. The key elements of P.A.T.H. are: 1) promote positive socialization and reduce maladaptive behaviors; 2) advance educational attainment by improving in-school retention and reducing absenteeism; 3) transform abilities through the provision of supportive services; and 4) highlight effective practices for reducing recidivism and youth violence.

complete overview

Empty section. Edit page to add content here.