Health Link: Helping Inmates Return to Society

Rising incarceration rates have turned public attention toward how to release and reintegrate prisoners back into society. Yet little is known about how to help individuals and communities deal with these challenges. Health Link, a model program developed by the Hunter College Center on AIDS, Drugs, and Community Health, focused on the specific problems of incarcerated women and adolescent males. The program's goal was to promote healthy reintegration of inmates leaving New York City's Rikers Island jail into their communities.

Health Link provided discharge-planning and postrelease case management to incarcerated and formerly incarcerated individuals, assisted community organizations that serve this population, and established and strengthened linkages between community organizations and city agencies to enhance postrelease services. This comprehensive approach sought to interrupt the cycle of events that lead to recidivism, as inmates returned to a deteriorating community beset by crime, violence, substance abuse, and homelessness.

The Health Link evaluation examined the impacts of the program's direct services to clients. About 1400 participants volunteered for the program and were randomly assigned to either a group that received full intensive discharge-planning and community case management services or to one that received less-intensive discharge-planning services and no community-based services. Data for the study were obtained from: (1) interviews with sample members at the time of enrollment in the study; (2) in-person interviews with sample members 12 months after release from Rikers Island; (2) hair samples, used to assess drug use over a 90-day period; (3) criminal justice system records; and (4) program data on contacts between clients and Health Link staff. Study participants enrolled between July 1997 and May 2000. Follow-up interviews were completed with 74 percent of the sample.

Key findings from the evaluation include:

• Case workers served as advocates and provided support for a very disadvantaged population, who were in poor health, and had limited education and employment. Most also had prior encounters with the criminal justice system.
• The program generated modest impacts on service receipt outcomes. Participation increased the percentage of clients who received drug treatment services in both the female and male groups. It also increased males' participation in education, and females' receipt of preventive health care services.
• The program produced modest beneficial impacts on some outcomes associated with greater service use. Males were more likely to attain a GED. In addition, male and female drug use may have decreased, although the patterns were mixed and inconsistent.
• Health Link had no impact on criminal justice system involvement or criminal activity; behaviors that cause the spread of HIV; overall use of health care or the likelihood of having health insurance; and employment rates or housing, social, and family situations.

Mathematica's evaluation of the Health Link program was funded by the Robert Wood Johnson Foundation. Health Link public use data files and documentation are available through the ICPSR website.

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