- Grantee Organization Name: The Osborne Association
- Organization Address (Street, City, State, Zip): 809 Westchester Ave., Bronx, NY 10455
- Organization website URL (if any): www.osborneny.org
- Brief Description of the Organization: The Osborne Association is the oldest and most experienced organization in New York State serving men and women involved with the criminal justice system. Osborne operates at several sites throughout the state, including the Bronx, Brooklyn, Poughkeepsie, Rikers Island, and in several state correctional facilities. It has an 80-year history of leadership in working with currently and formerly incarcerated men, women, and children and families affected by the incarceration of a loved one.
Grant Project Information
- Title of Grant Project: Osborne Association HIV/AIDS Health Improvement for Re-entering Ex-offenders (HIRE) Initiative
- Amount of OMH Award: $250,000
- Name of Project Director: Gary Bartlett
Brief Description of the Grant Project
The primary purpose of Osborne Association's Project HIRE was to assist formerly incarcerated individuals living with HIV/AIDS to successfully reintegrate into society and remain healthy. The project targeted men incarcerated in New York's largest re-entry prison, the Queensboro Correctional Facility, who were returning to New York City neighborhoods. Its purpose was to assist HIV-positive re-entrants in understanding their serostatus, obtaining health insurance and transportation, accessing care, and addressing social and other barriers that can result in gaps or discontinuation of necessary HIV/AIDS treatment, the spread of HIV within the community, and, for those with untreated AIDS, to premature morbidity and mortality.
Given the challenges faced by HIV-positive re-entrants, the primary objectives of the project were to: 1) increase the number of individuals who were tested for HIV and knowledgeable of their serostatus prior to release, and 2) improve coordination and delivery of health and social services to HIV-positive re-entrants at high risk for HIV/AIDS infection.
Project HIRE implemented a multi-dimensional case management model based on a shared decision-making approach that engages the re-entrant to assist in planning and setting targets for a successful transition from incarceration back into the community. The intervention employed peer advocates, formerly incarcerated individuals who have been trained to serve as case managers for re-entrants. Post-release, the peer advocate served as a service coordinator and liaison between re-entrants, other Osborne Association support programs, and health care providers. Peer advocates also served as interpreters and translators for those clients that are limited-English-proficient (LEP). They also assisted clients in preparing needed documents in advance of their appointments, and maintained a relationship with a local pharmacy to confirm that medications were being filled on time, and coordinated home delivery, which was available to HIV-positive clients.
Project HIRE staff also delivered weekly HIV/AIDS awareness workshops prior to release which focused on HIV prevention, risky behaviors, and the importance of testing. One of the key strategies of this intervention was the availability of free transportation on the day of release for the re-entrant to either apply for a program or service, or to attend a medical appointment.
The intended outcomes of Project HIRE were to: 1) increase awareness of the importance of HIV testing and avoidance of risky behavior (i.e., lack of condom use, needle-sharing) that leads to HIV infection; 2) improve adherence to care post-release; 3) increase compliance with medical appointments and treatments (by measuring CD4 counts); and 4) maintain/reduce HIV infection rates within the community.
The outcome evaluation focused on measuring improvements in re-entrants' health behaviors and overall health outcomes and social functioning. Three data collection instruments were used to track key participant outcomes:
- Client medical records (lab results),
- The Global Assessment of Functioning (GAF) instrument, which collects data prior to release to determine an individual's social, occupational, and psychological functioning and
- Client Discharge/Action Plans, which serve to monitor each participant's progress toward better health practices and health care access. Additionally, at the community level, the project tracked HIV infection rates at multiple points in time.
- Increased knowledge of availability of HIV testing and increased numbers of individuals tested for HIV prior to being released from prison. Over one-third (36%) of the Project HIRE participants reported having seen the HIV testing flyers in Queensboro. By the end of the project, a total of 725 HIV tests were conducted at Queensboro.
- Improved coordination and delivery of health and social services to HIV-positive re-entrants at high risk of falling out of care. The Montefiore's Transition Clinic was especially convenient for 52% of the Project HIRE participants who were Bronx residents. A third (32%) of the patients seen at Montefiore did so within two weeks of their release, thus preventing any gaps in treatment. In addition, Montefiore patients were seen an average of nine times over the life of the project, with some individuals being seen as many as 47 times over three years. Nearly all (94%) HIV-positive participants seen at Montefiore received anti-retroviral therapy. Close to half (46%) of the Project HIRE participants were enrolled in at least one social service program. Additionally, it was reported that transportation on the day of release was provided to a total of 43 participants, providing support at a critical "fork in the road."
- Improved CD4 counts. HIV-positive individuals in the project maintained and improved their CD4 counts if they adhered to their treatment and medication regime. Of the 119 HIV-positive participants, 66% have improved their CD4 counts.
- Reduced the rate of new HIV infections among racial/ethnic minorities in the population. The infection rate of the incarcerated racial/ethnic minority population at Queensboro Correctional Facility has been steadily declining (3% vs. 1% post-intervention). Analyses did not isolate or control for counterfactuals and, therefore, the claim is not strong enough to support a causal link between the Project Hire HIV Awareness trainings and declining HIV/AIDS infection rates. However, prior to the intervention, Queensboro did not offer weekly HIV/AIDS awareness training workshops, so the intervention can be considered as contributing to the overall improvement in the infection rates.
Identified Best Practices
- Providing free transportation on the day of release. Reliable transportation is a critical, and often unmet, need for ex-offenders on the day of release. An important component of this intervention was the provision of free transportation to apply for a program or service, or to attend a medical appointment. Providing transportation also created an opportunity to reinforce the collaborative relationship between a re-entrant and their assigned peer advocate.
- Pairing participants with culturally competent peer navigators. Project HIRE strategically linked participants with peer navigators that had similar experiences with incarceration or exposure to HIV and spoke the same language. The working relationship between the re-entrant and peer navigator were also established prior to release, promoting a long-term and trusting rapport between these individuals.
National Partnership for Action to End Health Disparities Goals
- Health System and Life Experience: Improve health and health care outcomes for racial and ethnic minorities and for underserved populations and communities.
Related Healthy People 2020 Objectives & Subobjectives
- HIV-13 Increase the proportion of people living with HIV who know their serostatus