The United States imprisons more people than any other country in the world. Within the U.S., Louisiana has the highest incarceration rate with 40,000 people, or approximately 1.6% of the state’s population currently incarcerated. The majority of these people are non-violent offenders (64%). While those in jail may serve sentences of less than 10 years, those in prisons often carry sentences of over 20 years. Many are incarcerated in their youth, prior to developing illness and disease, and thus may only access healthcare for the first time while within the criminal justice system. The prison population is disproportionately sicker than the general U.S. population, with HIV/AIDS, Hepatitis B and C, tuberculosis, mental illness, diabetes and hypertension causing the greatest burden of disease. Fortunately for inmates, access to medical services is available during incarceration.
Upon release, however, healthcare access for the formerly incarcerated diminishes drastically, while mortality and morbidity increase significantly. In the first two weeks following release, formerly incarcerated persons (FIPs) are 12 times more likely to die than others in their community. This is often due to lack of health insurance and poorly coordinated follow- up care after release. Additionally, FIPs face unique challenges as a result of prolonged incarceration. Prisoners are stripped of basic freedoms, personal agency and responsibility, which can devalue and diminish their critical thinking and decision-making skills. The transition from this environment back into a community that has likely changed significantly (due to rapid technical advances and new geopolitical climates), is difficult. Many FIPs do not feel empowered or adequately skilled to find necessary resources, particularly for medical services.
The FIT (Formerly Incarcerated Transitions) clinic seeks to fill gaps in healthcare accessibility for recently released individuals by providing primary care, coordinated subspecialty care, mental and behavioral health counseling, and general case management.
One unique feature of the FIT clinic is the student liaison group. The student liaison group of the FIT clinic was started by New Orleans Fellow William Vail as part of the Albert Schweitzer Fellowship. Today, the project continues through Fellows Kristen Whalen and Katelyn Yoder. Members of this student group function as patient navigators and advocates. One medical student is paired with one FIP and is responsible for ensuring medication acquisition, for following up with primary care and referral appointments, and for assisting with allied health services such as dental and vision care. Each student serves as an ongoing point of contact for his or her partner FIP to ensure continuity of care within the medical system. Additionally, each student works with local insurance enrollers to assist with FIP Medicaid and ACA enrollment.
Since June 2016, the clinic has partnered with Positive Living to hold monthly peer support groups for patients and other formerly incarcerated community members. Patient education outreach sessions will also occur in the prisons within the next couple of months. Here, Fellows will train teams of two to three medical and public health students and these teams will visit state prisons and hold education sessions on topics such as cancer screening, hepatitis, and diabetes prevention and management.
By providing student directed and performed case management, the FIT clinic is supplementing the clinical aspects of the care it provides with social work, health discussions, and health advocacy. Students are put to work in a way that makes them invaluable. Medical students do not wear their white coat in the FIT clinic because they act as case managers in the treatment teams, not “junior” clinical practitioners. Unlike other spaces in medical education, if students don’t do their work, the work simply will not get done. This responsibility is one we do not take lightly. Ultimately, the FIT clinic will become a humbling, pedagogical tool for medical students. By having students actually live and breath psychosocial medicine, the FIT clinic offers them the opportunity to confront the harsh, confusing realities of navigating healthcare in the 21st century. This experience will ensure that regardless of what kind of medicine participating students pursue in the future, they will take the experience of working in the FIT clinic with them and will remember that medicine doesn’t end at the clinic door.