Rural Health Network Planning Program: West Hawaii Community Health Center, Inc.
The Georgia Health Policy Center recently spoke to Dan Mistak, J.D., acting president and director of health care initiatives for Community Oriented Correctional Health Services, about building a health justice collaborative to care for justice-involved populations transitioning back to the community in Hawaii.
To date, what has been the biggest accomplishment or win for your network planning?
We are working on the big island of Hawaii to create a health justice collaborative in order to try and help people who are leaving the justice system, be able to access services much more quickly. Our network includes two Federally Qualified Health Centers (FQHCs; Hawaii Community Health Center and Bay Clinic), Kumukahi Health + Wellness, which provides Medicaid enrollment and some services within the walls of the jail, and informally United Healthcare.
We don’t want to miss that really important period when people are leaving incarceration and are in pretty critical need. One of the most exciting things in this planning period is that we were able to bring in payers, who were also interested in being a part of this solution. This allows the partners on the outside of the jail to keep spaces open for folks who are leaving incarceration — to be able to provide a slot on the FQHCs’ calendars, which is a major challenge.
What is a tip or early learning that you would share with an organization launching a similar network?
One of the most important things we learned right away is that the criminal justice system ends up being local. They have significantly different considerations than a lot of health providers that have federal oversight and different ways of thinking about things. You really have to know and understand each of the partners in that specific community.
You have to know who the important people are, who are interested in making change, and who are interested in partnering. When you are working across silos, like between the justice system and the health systems, it is really important to find people who are champions and are open to learning about the other, and the barriers that exist inside of both systems. Learning to speak the language of the different partners and understanding what their concerns are is critically important when working across silos.
How do you see participation in the Federal Office of Rural Health Policy’s Office for the Network Planning Program impacting your broader health improvement efforts?
One of the major things that is often missed when we are thinking about how we develop health plans in different jurisdictions across the country is that the justice system actually ends up being a place where some of the most critically unmet needs end up accumulating. People with unmet mental health needs and people with unmet substance use disorders end up inside incarceration settings, and often will remain there outside of the touch of our health systems. So, bringing in the justice system partners has been incredibly important for population health more broadly, because we are taking this major place where people do receive care, and we are trying to bring that into our broader health system so that wherever people end up receiving care, we are making sure that it is high quality, and it is connected with other providers. We want to make sure it does not remain a black box, which is what so many jails across the country are.
Often re-entry services fall under the public safety side of things. We have worked really hard to reframe the conversation about re-entry around health rather than having it be around disciplining people. We are saying re-entry is about trying to meet people’s health needs as they are coming out, and their behavioral health needs in particular, so that they can actually be able to connect with the right kinds of services and be able to manage their health so that they can then really re-enter society in a way where they are supported.
What will your organization be doing more of or differently to emerge stronger from the pandemic?
One of the major recommendations from the National Academies of Science that came out at the beginning of the COVID-19 pandemic was that decarceration is an essential tool for being able to stop the pandemic. The reality is that people who are involved with the justice system are being infected and dying at much higher rates. It has been very important for us locally to be able to have communications with our jails and with the department of health, the department of human services, and the department of public safety, to actually be able to think about how we can decarcerate people much more effectively.
The state Supreme Court had mandates to decarcerate, but did not provide the systems to do that. We all came together to talk about and think through the ways in which we could decarcerate safely and quickly. That helped give birth to this program and to the justice health collaborative. COVID-19 really exposed the fact that we end up sequestering, untreated mental health conditions and substance use conditions behind the walls of the jail. Infectious diseases, like SARS-COV-2, do not care about the walls of the jail. We have really started realizing that we have to create a health system that is based around the reality of a disease, rather than think we can sequester these problems inside the jail and not worry about them.