Thread by @MKushel

From stop & frisk to mass Incarceration as a driver of health disparities. Can’t talk about health inequities w/o discussing criminal justice system (&racism) #SGIM19 1/x

US incarceration rates exceed 20 developed democracies. Incarceration rates not related to violent crimes. 1/3 black men will be incarcerated lifetime (racism, not race). Incarceration traumatizes individuals, families, communities

Many newly dx w chronic diseases but access limited. In CT, those incarcerated pay $3 copay for (constitutionally guaranteed) healthcare = 4 days of work

Richard Medina CHW @thefortunesoc describes the trauma he experienced while incarcerated. Implores healthcare providers to understand the effect of this trauma on trust

Dr @JonGiftosMD talks about isolation as a form of violence. Kalief Browder & so many others who have suffered. Solitary confinement an independent predictor or self-harm In NY, documentation of this has led to policy changes

Opioid withdrawal as another form of trauma w devastating consequences. Standard of care for OUD in correction settings is poor #SGIM19

95% of ppl incarcerated return to community. While incarcerated, ppl have right to healthcare. When released, they don’t. Most States terminate Medicaid while incarcerated. We need to provide services to ppl who come home. High risk of mortality within 1-2 weeks of returning home

Me Medina discusses work @_Transitions Clinic.@ewang422 started TC using CBPR in partnership w incredible community members. CHW w lived experience engage ppl, meet them where they are at, navigate/advocate for #SDOH using trauma informed practices

@_Transitions led to 51% reduction in ED use. Led to expansion model nationwide. 41 programs in 12 states & PR. Secret sauce: CHW w lived experience #SGIM19

@ewang422 calls us to action. Go inside prisons, work there. Learn there. Ask about HS incarceration. Ask systematically w/o bias. Have you or any family members spent time in jail or prison. Do not ask about crime. We are here to help you avoid return.

Use person-centered language. Use Ppl w hx of incarceration or justice involved people. Beware of notations in EHR. Document & ask but complicated.

Researchers—follow participants into CJS. Black men missing from health cohort studies due to incarceration

Institutional reform: eliminate barriers to employment for ppl w hx of incarceration. Health systems/med schools are major employers. #anchorinstitions. Ppl w hx of incarceration are incredible assets for our health systems. #banthebox #SGIM19

Policy: decriminalize drug use, collateral consequences (barriers to housing, benefits, employment) bail reform, end solitary confinement and more #SGIM19

40 years of mass incarceration is 40 years too long. It is time for us to join the struggle to end it. #SGIM19