2003 Model Practice Application (Public)

Office of Minority Health/Wellness Curriculum

Orange County Health Department

Incarcerated persons are more at-risk for health problems than non-incarcerated persons. Lack of adequate medical care prior to incarceration, combined with specific prison characteristics, places incarcerated people at higher risk for STDs, HIV, hepatitis C, and also aggravates chronic conditions such as hypertension and diabetes. The Wellness Curriculum, a collaborative project between the Orange County Health Department and the Orange County Corrections Department, helps to address the health needs of inmates by providing information and education that is useful to them not only while they are in prison but, even more, as they are released into the community. The target population includes incarcerated adults and juveniles currently held at the Orange County Jail. Currently, Orange County Jail has 3,334 inmates. In the six-month pilot, the project has successfully reached 355 inmates (over 10 percent of the inmate population).

The Wellness Curriculum was developed 1) to address the racial/ethnic disparities in health outcomes and 2) to fill the need for information that the inmates themselves expressed. In the spring of 2001 the Office of Minority Health (OMH)/ Orange County Health Department (OCHD) conducted a survey of male and female inmates to determine areas of health need, specifically those areas in which they wanted more information. Survey findings revealed the following six areas of need: high blood pressure, diabetes, prostate cancer, breast cancer, colorectal cancer, and HIV/STD. OMH developed a curriculum to address these areas. The program is definitely innovative as it represents the first joint OCHD/OCCD attempt to address the health education needs of inmates. Because, for the most part, this population would not normally attend community health fairs or forums, this project is their only opportunity to receive health education. The OMH will continue to respond to their needs by revising and expanding the curriculum to include other topics, such as the effects of substance abuse.

The OMH took the initiative in developing the Wellness Curriculum; however, OCCD immediately showed interest and support for the project. Informal conversation with inmates revealed the major areas of interest. This information was used to design the surveys. The survey confirmed these areas of concern and also confirmed the confirmed the need to develop the curriculum. While inmates took an active role in identifying areas of need, OMH and OCCD have undertaken equal collaborative roles in the carrying out the project. The OMH developed the materials and hired the facilitators while OCCD ensured the project was introduced into the various correction facilities.

The Orange County Health Department paid for the entire pilot phase of the curriculum. The services of eight facilitators at $4,000 apiece, cost $32,000. Curriculum materials, including instructor manuals, student texts, pre-tests and post-tests cost $5,000. Total cost of the pilot for six months was $37,000.

The OCCD has expressed an interest in seeking funding within their agency to continue the project after the pilot phase.

Currently the program is being evaluated at two levels: process and outcome.

Process evaluation reveals that the implementation has worked very smoothly because of the vested interest from both agencies, particularly from the OCCD given that they had to provide the entry for the facilitators. Furthermore, at the end of each session, inmates are asked to complete a three-question survey regarding the usefulness and delivery of the information. For the most part, inmates seem to either "strongly agree" or "agree" that both the information and the delivery were acceptable.

Outcome evaluation looks at knowledge gained from participants as a result of attending the classes. Knowledge gain is being measured through pre and post-tests. Pre-tests are given at the beginning of each session (each session is represented by a chapter in the curriculum). At the end of the session participants are asked to complete a post-test to determine knowledge gained during the 60-minute instruction. Data analysis reveals that there has been a high success rate in knowledge acquisition. Percent increases in the number of correct answers between pre and post-tests are between 5% and 32%. Informal comments from inmates and jail staff indicate that the curriculum is a worthwhile and needed project. The impact of the curriculum goes beyond the jail walls as some inmates have called their relatives and asked them to be screened for diabetes, breast cancer, etc. Recently, one of the facilitators, who is also an outreach worker in the community, was contacted by a released inmate requesting referral information. She was able to place him in the appropriate agency. Inmates have suggested making the course a pre-release requirement.

For a project of this nature to succeed:

• OCCD must be committed to the program. Program staff have learned that building rapport and credibility with the OCCD has been the key in getting the resources (i.e., classroom, audio visual equipment, etc.) and volunteer inmates to participate in the sessions.
  
  
• Flexible facilitators who have had experience working with inmate populations are also very useful because they provide a comfort level that may take longer to achieve otherwise.

Although all of the classes have been very well–attended on a voluntary basis, the agencies are considering making the classes mandatory. Some inmates said they found the Wellness Curriculum useful and applicable to their lives than skills building or some of the required classes. Program staff have also learned that inmates find the 60-minute sessions allotted for each health topic insufficient time because, for many of them, this is the first opportunity they have had to learn about these topics.

Key elements needed to replicate this program include willing partners; buy-in from DOC staff, usually facilitated by a high ranking official; qualified and flexible facilitators; funds to pay facilitators; and coordination of materials (available pre-tests and post-tests for each session along with necessary audiovisual material and equipment).