Mapping the Innovation
in Correctional Health Care
Service Delivery
in New York City
Spring 2008

Jeff Mellow
Steven K. Hoge
Joshua D. Lee
Mangai Natarajan
Sung-suk Violet Yu
Robert B. Greifinger
Gary Belkin

This report is available at http://www.jjay.cuny.edu/centersinstitutes/pri/publications.asp

Acknowledgements

T

he authors would like to thank the following people and organizations who
contributed to the development of this profile. First, we thank the New York
City Department of Correction, who supported our work and provided the main
data source for this analysis, and, in particular, Commissioner Martin Horn, Deputy
Commissioner Kathleen Coughlin, Assistant Commissioners Erik Berliner and Ari Wax,
and Director of Population Research Eric Sorenson. In addition, we thank the following individuals at the New York City Department of Health and Mental Hygiene: Louise
Cohen, deputy commissioner of health care access and improvement; Alison O. Jordan,
executive director, the Bureau of Transitional Health Care Coordination; Farah Parvez,
medical director, Correctional Public Health Services; and Bonnie Kerker, assistant commissioner, Bureau of Epidemiology Services.
Additional support came from Bellevue Hospital Center and the John Jay College of
Criminal Justice. We would particularly like to thank Chris Kunkle at Bellevue Hospital
Center for his valuable assistance in the collection of survey information. We also thank
Nancy Jacobs at John Jay College for her thoughtful insights and contributions to this
report, as well as Sinead Keegan, who was instrumental in getting this project started,
and John Jay graduate students Sheetal Ranjan, Amalia Paladino, and Seth Dupois, who
helped prepare the data.
Finally, we would like to thank the Robert Wood Johnson Foundation, our funder, without whom this report would not have been possible.

Acknowledgements

i

ii	

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

About the Authors

Gary Belkin, M.D., M.P.H., Ph.D., is a psychiatrist who currently serves as deputy
director of psychiatry at Bellevue Hospital Center and as associate professor, New York
University School of Medicine. Dr. Belkin has a doctorate in history and has published
historical work on the nature of ethics in medicine, the uses and contexts of mind-brain
constructions in medicine and society, and the impact and meanings of the idea of social
psychiatry. He also works with United Nations agencies and non-governmental organizations on furthering social development-relevant mental health care and mental health
policy globally.
Robert B. Greifinger, M.D., is a nationally known expert in prison and jail health care.
He is the editor of the book Public Health Behind Bars: From Prisons to Communities.
Dr. Greifinger advises on public policy and works as a consultant to courts, states, and
counties on improving correctional health care. Additionally, he is on the faculty of John
Jay College of Criminal Justice.
Steven K. Hoge, M.D., is clinical professor of psychiatry, New York University School of
Medicine, and director, Division of Forensic Psychiatry, at Bellevue Hospital Center. Dr. Hoge
has published extensively on issues related to public policy, law, and mental health. He is a
past chair of the American Psychiatric Association’s Council on Psychiatry and the Law.
Joshua D. Lee, M.D., M.S., is an assistant professor in the departments of Psychiatry,
Division of Alcohol and Substance Abuse, and Medicine, Division of General Internal
Medicine, at New York University School of Medicine and Bellevue Hospital Center. He
is certified in addiction medicine by the American Society of Addiction Medicine. Dr.
Lee’s clinical duties involve emergency inpatient detoxification, outpatient primary carebased addiction treatment, and per diem medical care within New York City jails.
Jeff Mellow, Ph.D., is an associate professor in the Department of Law, Police Science
and Criminal Justice Administration at John Jay College of Criminal Justice. Dr. Mellow’s
research includes examining the barriers ex-prisoners face when utilizing services after
release. His work has been published recently in the Journal of Criminal Justice, The Journal of Urban Health, and Federal Probation.
About the Authors

iii

Mangai Natarajan, Ph.D., is a professor in the Department of Sociology at John Jay College of Criminal Justice. She is an active policy-oriented researcher, who has published
widely in three areas: drug trafficking, women police, and domestic violence. Her wider
academic interests focus on crime theories that promote crime reduction policy thinking, and her related areas of expertise include both quantitative and qualitative methodologies, social network analysis, crime mapping and crime analysis, problem-oriented
policing, and situational crime prevention.
Sung-suk Violet Yu, M.A., is a doctoral student in the School of Criminal Justice at Rutgers University, Newark, NJ. Before coming to Rutgers-Newark, she earned her master’s
degree from the School of Criminology, Simon Fraser University, BC, Canada. Her
primary research interests include environmental criminology, crime pattern analyses,
and crime prevention techniques. She also has worked on projects on immigration and
reentry issues.

This report was prepared under grant number 053732 awarded by the Robert Wood Johnson Foundation. Data utilized in this study were made available by the New York City
Departments of Correction and Health and Mental Hygiene; all necessary permissions for
their use have been obtained. The interpretations expressed herein represent the opinions
of the authors and do not necessarily reflect the opinions of the New York City Departments of Correction, Health and Mental Hygiene, Bellevue Hospital Center, or John Jay
College of Criminal Justice, City University of New York.

iv

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Ta b l e O f C o n t e n t s

1

Introduction

3

Section 1: The New York City Department of Correction Health- and NonHealth-Related Discharge Planning
Policy Concerns Underlying the Collaboration
Legal Pressures
Current Discharge Planning Policies and Procedures
Beginning the Discharge Process
Health Screens and Discharge Services for Five Common Health Problems
Transitional Health Care Coordination: An Emphasis on Chronic
Conditions and Education
Community-Based Referrals to Medical Services
Referrals to Community-Based Non-Profits
Non Health-Related Discharge Planning
The Rikers Island Discharge Enhancement Project
Discharge Planning Support Centers
Additional Discharge Planning Services

19

Section 2: Inmates Released from the New York City Department of
Correction in 2005
Sources for Mapping Data
Analysis of Released Inmates and the Availability and Accessibility
of Services
Criminal Justice Characteristics of the Released Inmates
Health and Related Needs of Released Population: 2005

Table Of Contents

v

35

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist
Distribution of Services for Released Inmates
Gaps in Post-Release Services
Density of Inmates and Services in Brooklyn
Density of Inmates and Services in the Bronx
Density of Inmates and Services in Manhattan
Density of Inmates and Services in Queens
Density of Inmates and Services in Staten Island

57

Section 4: Service Providers’ Perception of Inter-Agency Collaboration
Characteristics of Surveyed Service Providers and Their Clients
Assessment of Inter-Agency Collaboration
Assessment of Collaboration with Government Agencies
Assessment of Community Relations
Discussion

69

Section 5: Conclusions and Recommendations for Future Work
Future Study Possibilities

vi

73

Appendix A: Lists of Tables, GIS Maps, and Figures

77

Appendix B:

New York City Correctional Health Services Intake History
and Physical Exam

83

Appendix C:

HIV Continuum of Care Model

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

85

Appendix D: Take Care New York Passport to Your Health

87

Appendix E:

New York City Department of Correction Discharge
Planning Questionnaire

89

Appendix F:

New York City Department of Correction Rikers Island
Discharge Enhancement Plan

95

Appendix G: Dial 311 Palm Card, Front and Back Side

97

Appendix H: Tables Profiling DOC Inmates Released to Communities
in New York City

111

Appendix I:

Tables Profiling the Distribution of Services for Released
Inmates

123

Appendix J:

Bibliography

127

Pertinent Acronyms

Table Of Contents

vii

viii

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Executive Summary

T

his study profiles New York City’s adoption of a community-based public health
model that makes use of periods of incarceration to identify the chronic health and
mental health needs of inmates. The goal of the model is to provide continuity of
care and to facilitate the containment of communicable disease through community health
care providers. The study is unique in that it combines multiple data sources previously
unavailable for such a purpose.
New York City has reallocated funding from short-term treatment to discharge planning for
a number of reasons. These include the need to increase the probability of effective outcomes as a result of the relatively brief and unpredictable length of inmate stays, the complexity of inmate needs, and current research demonstrating that the effectiveness of health
and human services programs for inmates should be measured over a period of months, not
days. As a result of litigation, new statutory requirements, and court orders, the New York
City Department of Correction has joined forces with several partners to develop, implement, and evaluate the efficacy of innovative approaches to facilitate the successful reentry
of these special needs populations.
The discharge-planning process begins at intake in a New York City Department of Correction facility. All inmates, within the first 24 hours of admission, have a comprehensive
medical history taken and receive a physical examination. Routine, voluntary testing also is
performed for tuberculosis, HIV/AIDS, sexually-transmitted infections, substance abuse,
and mental illness.
Transitional Health Care Coordination, operated by the New York City Department of
Health and Mental Hygiene, coordinates health education and service delivery from incarceration to release. Inside the facilities, health educators and patient care coordinators
disseminate written health education materials to inmates and their families and provide
prescriptive discharge planning services for those with chronic illness. Field staff are located
in neighborhoods of high inmate return to facilitate referrals to primary care physicians,
substance abuse counselors, and, since 2006, more than 170 community-based service
providers. Regardless of their health care needs, city-sentenced inmates have the option of
volunteering for the Rikers Island Discharge Planning Enhancement Project, which provides
Executive Summary

ix

direct transportation to community services at discharge and 90 days of post-release case
management in the community.

What is the Extent of Unmet Need?
The most common way to measure unmet need is to determine the geographic availability
and accessibility of services compared to the number of inmates released to a particular geographic area. A disproportionate share of inmates is released to specific communities within
New York City’s five boroughs. This report will describe some of the mismatch between
released inmates and services. For example, six of 59 community districts are home to 26
percent of the inmate population released in 2005. In Brooklyn, two community districts in
particular demonstrate the mismatch between returning inmates and the availability of services. There is a serious geographic mismatch in the Bronx, where the majority of available
services are clustered in four community districts, even as four different community districts
have fewer available services but are home to a greater number of returning inmates. While
inmates returning to Manhattan benefit from a higher rate of availability and accessibility
of service than inmates released to the Bronx and Brooklyn, these services are clustered in
communities with fewer released inmates.
Mapping available services in Queens against the number of returning inmates demonstrates a disparity in access to and availability of services between neighborhoods and communities. On the other hand, Staten Island shows a more even distribution of services in the
communities where the majority of returning inmates live.

Has the New Service Delivery Model Fostered Increased Inter-Agency Collaboration?
The preponderance of providers who have worked on reentry in the past agree that there is
a “culture of organizations in New York City working together to reintegrate former inmates
back into their communities.” These providers characterize the current political climate as
supportive of organizational alliances with policies that facilitate collaborative relationships.
A few, however, still cling to an often-repeated theme that competitive funding is a barrier
to greater collaboration. While most agencies gave credit to the Department of Correction
for its leadership, there was mild criticism of the quality of communication and the agency’s
ability to engage in collaborative decision-making with organizations working on reentry.
Agencies working on reentry face their own barriers to providing needed services. For
example, though not a policy issue, housing barriers and Medicaid issues seem bureaucratically intractable to many service providers. A large group felt that this could be addressed
if the Department of Correction would resolve these issues prior to inmate release. Despite
the few issues that were identified by providers, it is clear that, while coordination among
service providers and correction authorities remains in the early stages of development,
stakeholders are positively disposed toward new policies and practices.

x

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

What Potential Future Research Can Do to Build Upon This Study’s Findings
The findings suggest a mismatch between the needs of inmates returning to the community and access to providers. Building upon this study, future research should study
the significance of the availability and accessibility of service location for inmates’ postrelease service utilization. How far the formerly incarcerated will travel to services, and
if the service type is a factor in their utilization, is still an open question in New York
City. Descriptive studies will need to be implemented to help answer these questions.
Although this research identifies a lack of community support for reentry services as
one problem, little is known at the community level about how key institutions, community characteristics, and the shape and direction of criminal justice agencies and
social policies enhance or hinder reentry success. For example, it has yet to be determined to what extent policies and procedures relative to contracting with outside agencies locates or shapes availability and content of programs intended to provide health,
vocational, or other needs for the returning population. Another area of uncertainty is
the degree to which eligibility rules that govern an array of entitlement benefits might,
in fact, create reentry obstacles in communities of high inmate return. A next step is an
exploratory assessment of the level of state and city agencies and programs capacity for
flexible and blended health and human services support, coordination, and accountable
in several communities of high inmate return.
In sum, mapping the innovation in correctional health care service delivery in New
York City is only the beginning in understanding the challenges and opportunities that
lie ahead in reentering inmates back to the community. This portrait of inmate and
service characteristics lays the foundation to bring stakeholders together to visually
orientate themselves to the resources in communities of high inmate return and to
understand how to build upon the innovative continuity of care and community linkages with which New York City has so actively engaged.

Executive Summary

xi

xii

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Introduction:

T

his is a profile of the current pattern (as of 2005) of inmate reentry in New York
City, with particular focus on: a) the health and human service policies and
practices of the city agencies most involved: the New York City Department of
Correction (DOC) and the Department of Health and Mental Hygiene (DOHMH); b) the
related needs of released City inmates; and c) the capacity of the communities to which
these inmates overwhelmingly return to provide the services and support prescriptively
included in the inmate’s discharge plan. While the profile does not attempt to evaluate
policies, agencies, or service providers, it does include qualitative data from interviews
with service providers. This information allows for a more in-depth understanding of the
perceptions of current policy and practice than is possible from data alone.
This project is concerned specifically with health care. It dovetails with a primary
focus of reentry policy: the creation of social and professional networks that encourage
existing community organizations to become partners working toward the successful
integration of released inmates into their communities. While health care is just one of
the many challenges that face inmates returning to their communities, it is nonetheless
critical to successful reentry. The identification of health problems during incarceration,
with appropriate referral to community-based services at reentry, is an approach that
could have an important impact on both public health and on outcomes for inmates
themselves.
It has been well documented that incarcerated populations have a high prevalence of
chronic and communicable diseases and mental illness, conditions that significantly
impact their lives and the lives of those around them. On average, 40 percent of the
inmates in city jails access mental health services during their period of incarceration.1
Twenty-nine percent are diagnosed as mentally ill. Seventy-five percent have a history of
substance abuse; 20 percent require drug or alcohol withdrawal treatment after admission;
and seven percent of male inmates and 20 percent of female inmates are HIV-infected.2
The population dynamics of New York City’s jails help explain the challenge. The average
length of incarceration is 48 days for detainees and 38 days for those serving a City sentence. Twenty-eight percent of the inmates are released within three days of their admis-

1

City of New York, Department of City Planning, 2003
Annual Report on Social
Indicators (New York, NY:
2003).
2

New York City Department of Corrections, Official
Plan as of 10/18/2005.
Discharge Planning Action
from May 2, 2005 Retreat
(New York, NY: 2005).
3

Roger K. Parris, “Public
Health Collaborations in a
Correctional Setting: New
York City’s Model,” Corrections Today, available
at www.aca.org/publications/ctarchives.asp#oct04
(accessed on May 22,
2006).
Introduction

1

sion and 79 percent within 60 days of admission.3 Given the brief average length of stay
in a DOC facility, the Department is severely limited in terms of what it can accomplish
with individual inmates or in terms of addressing risks to public health in communities
to which the inmates return. As a result, public health, like public safety, has become a
public policy concern with regard to the return of inmates to their communities.
One of the goals of New York City reentry policy is long-term improvement in the health
care of former inmates. The current belief is that this can best be achieved through three
primary strategies: 1) the identification and education of inmates with health and mental
health problems; 2) a well-coordinated system of health care connections to the community with effective discharge planning; and 3) accessible community-based services.
This project profiles these three strategies, beginning with a discussion of the efforts of
DOC and its sister agency, DOHMH, to provide for the identification and education of
inmates and the creation of a well-coordinated system of health care. The report then
profiles the health, mental health, and criminal justice-related characteristics of the inmate population. In a first for a project of this kind, Section 3 combines several databases
to geo-map the availability of services in communities expecting the return of a disproportionate share of formerly incarcerated individuals. This section also identifies gaps
between returning inmate needs and service delivery capacity.
The structured survey of service providers relative to their perspective as to the efficacy
of the collaborative efforts is discussed in Section 4. The report concludes with a discussion of the next steps in the collaboration between John Jay College of Criminal Justice
and the Bellevue Hospital Center Department of Psychiatry.

2

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

SECTION 1:
The New York City Department of
Correction Health- and Non-Health-Related
Discharge Planning

I

n 2003, the New York City Department of Correction (DOC), under the leadership of
Commissioner Martin Horn, conducted a reassessment of the process by which inmates are prepared for their return to the community. As part of this initiative, DOC
began to create comprehensive and coordinated discharge planning services, primarily for
sentenced inmates incarcerated between 30 days and one year. That year, DOC and the
Department of Homeless Services (DHS), under Commissioner Linda Gibbs, organized
a retreat of stakeholders, including government agencies, service providers, researchers,
and advocacy organizations to focus on the discharge-planning process.4 Now organized
into the Discharge Planning Collaborative, this group’s goal is to “address the complex
issues surrounding jail reentry.” 5 A wide range of New York City government agencies are
involved in this collaboration, including DOC, DHS, DOHMH, the Human Resources
Administration (HRA), and the Office of the New York City Criminal Justice Coordinator.

Policy Concerns Underlying the Collaboration
The innovative new reentry focus was driven by four interrelated policy concerns as well
as by external legal pressures. First, data indicated that annual readmission rates (i.e., the
percent of inmates admitted to DOC custody two or more times within the same fiscal
year) were consistently high, averaging 47 percent between 1999 and 2004 and increasing
slightly in 2005 to 49 percent.6 This high rate of readmission indicated that many inmates
were not successfully being reintegrated into their communities.
A second policy concern was that the unpredictable and short length of inmates’ stays
challenged the system’s capacity to address their multiple needs. The average length of
stay for those released in 2005 was 21 days, with nearly one-third (29 percent) incarcerated between just one and three days and more than 60 percent incarcerated for no more
than seven days (Figure 1.1).

4

New York City, The
Mayor’s Management
Report Fiscal 2005
Preliminary (NY: 2005).
5

Glen Martin, “Rikers
Island Discharge Planning
Initiative: A New York
City Jail Reentry Model,”
National HIRE Network
News 3 no. 8 (2005): 1-10.
6

New York City, The
Mayor’s Management
Report Fiscal 2005
Preliminary (New York, NY:
2005).

Section 1: The New York City Department of Correction Health- and Non-Health-Related Discharge Planning

3

Figure 1.1: DOC Inmates Length of Stay

7

The Drum Major Institute
for Public Policy, Marketplace of Idea Series: On
the Power of Restorative
Justice (New York, NY:
2005): 26.
8

Jeanne Moseley, Cynthia
Gordon, Christopher Murrill,
and Lucia Torian, An Evaluation of Discharge Planning
and Community Case
Management Services for
Incarcerated Adult Males
at Rikers Island: Correction Case Management
at Rikers Island (CCARI)
(paper presented at the
2005 National HIV Prevention Conference, Atlanta,
Georgia, June, 13, 2005).
9

New York City Commission on HIV/AIDS,
Report of the New York City
Commission on HIV/AIDS
(New York, NY: 2005).
10 Anne

C. Spaulding,
Kimberly R. Jacob
Arriola, Theodore Hammett,
Sofia Kennedy, and Giulia
Norton, Enhancing Linkage
to HIV Primary Care in Jail
Setting (Cambridge, MA:
Abt. Associates, 2007).
4

A third issue that gave impetus to the collaboration was that DOC facilities, like most
urban jails, have become society’s default mental institutions and addiction centers.
Commissioner Horn has noted that “Rikers Island is the largest provider of acute mental
health care services in the city of New York, bigger than Bellevue [Hospital] by an order
of magnitude.”7 The question that Commissioner Horn and others pose is whether
incarcerating the mentally ill and drug addicts for offenses driven by their mental illness or addiction is the most effective method of treatment. An alternative strategy is to
develop a comprehensive post-release plan so that behavioral and health services in the
community can become the front-line for managing these problems.
Fourth, public health concerns have come to the fore, particularly with regard to HIV/
AIDS. In a study that compared male inmates discharged from DOC with community
case management services to a control group with no community case management, the
preliminary findings showed a reduction in sexual risk behaviors in the case-managed
population.8 Public health is affected when inmates with undiagnosed and/or untreated
communicable and chronic diseases, mental illness, and substance abuse issues are
released to the community without a transitional health care plan.9 Released inmates are
an important target population for outreach addressing communicable diseases, as they
comprise a disproportionate share of known cases. For example, a 1999 DOHMH jail
seropositivity survey of inmates found eight percent of men and 18 percent of women
were HIV positive, significantly higher than the prevalence rates in New York City’s
general population. 10

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Legal Pressures
A discussion of discharge planning would not be complete without a look at legal challenges that have materialized in the last decade, specifically statutory requirements and
court orders that mandate discharge planning for specific DOC populations. In Brad
H. et al. v. The City of New York, et al. (Brad H.), the courts required discharge planning as an essential component of mental health care delivered in accordance with the
standard psychiatric practice.11, 12, 13 The case cited several laws and regulations to support
its argument: New York State Mental Hygiene Law 29.15, which mandates “providers
of inpatient health services to provide discharge planning; a New York State regulation
that requires providers of outpatient mental health services to provide discharge planning; and a provision of the New York State Constitution prohibiting cruel and unusual
punishment.”14 New York State Mental Hygiene Law 29.15 specifically requires discharge
planning to include a written service plan prepared by staff familiar with the person’s
case history.
According to Barr, the Brad H. case in New York City is noteworthy, not because it mandates discharge planning for the incarcerated who are mentally ill, but because it states
that inmates are “entitled to discharge planning because they are the patients of a mental
treatment provider and patients have a right to discharge planning.”15 Under a settlement
with the plaintiffs, New York City agreed to provide comprehensive discharge planning
support and access to treatment for the incarcerated who are seriously mentally ill.
In 2004, building on the Brad H. case, New York City passed an even more comprehensive discharge planning law.16 The law goes beyond the Brad H. case in that it establishes
a legal right to discharge planning for all inmates who serve a sentence of 30 days or
more, and entitles them to enhanced post-release services, regardless of their health and
behavioral needs.

Current Discharge Planning Policies and Procedures
A primary goal of discharge planning is to link inmates with appropriate health and
human service providers in the community to address their problems early on, before
they might violate their conditions of community supervision or be arrested for a new
offense. The overarching goal is to have a coordinated and collaborative effort to ensure
a continuum of care and treatment during the reentry process, particularly with respect
to health needs. To meet this goal, DOC adopted a strategy to reallocate funds from
short-term behavioral treatment programs to discharge planning. As a result, the focus
has shifted from inside the walls of Rikers Island to the development of reentry plans
used by correctional officers, case managers, and service providers to ensure appropriate

11

Brad H. et al. v. The City
of New York, et al.(1999).
Complaint, class action,
Supreme Court of the
State of New York, County
of New York, Index No.
117882/99 (IAS Part
23), available at www.
urbanjustice.org (accessed
May 19, 2006).
12

Brad H. et al. v. The City
of New York, et al., order
of the Supreme Court of
the State of New York, 185
Misc. 2d 420; 712 N.Y.S. 2d
336 (July 12, 2000)
13

Brad H. et al. v. The City
of New York, et al 8 A.D.3d
142, 779 N.Y.S.2d 28, 2004
N.Y. App.Div. (N.Y. App.
Div. 1st Dep’t, 2004)
14 Heather

Barr, “Transinstitutionalization in the Courts:
Brad H. v. City of New York,
and the Fight for Discharge
Planning for People with
Psychiatric Disabilities
Leaving Rikers Island,”
Crime and Delinquency 49
no 1 (2003, p. 101) 97-123.
15

Ibid. p. 118.

16

New York City Administrative Code, Local law
no. 54: To Amend the
Administrative Code of the
City of New York, in Relation to Discharge Planning
Services, available at www.
nyccouncil.info/pdf_files/
bills/law04054.pdf (accessed May 22, 2006).

Section 1: The New York City Department of Correction Health- and Non-Health-Related Discharge Planning

5

17

City of New York, Department of City Planning, 2003
Annual Report on Social
Indicators. (New York, NY:
2003).
18

City of New York,
Fiscal 2005 Preliminary
Budget Response: Part III
Committee Reports Based
on the Preliminary Budget
Hearings (New York, NY:
March, 2004).
19 City

of New York, Department of City Planning, 2003
Annual Report on Social
Indicators. (New York, NY:
2003).
20

Ibid.

21 Douglas

S. Lipton, The
Effectiveness of Treatment
for Drug Abusers Under
Criminal Justice Supervision, National Institute of
Justice (Washington, DC:
1995), NCJ 157642.
22

Richard Cho, Putting
the Pieces Back Together:
Overcoming Fragmentation
to Prevent Post-Incarceration Homelessness (paper
submitted to Housing &
Criminal Justice Policy in
New York City, A Research
and Practice Symposium
Columbia University-Center
for Urban Research and
Poverty, 2004).
23

K. Black and Richard
Cho, New Beginnings:
The Need for Supportive
Housing for Previously
Incarcerated People (New
York, NY: Common Ground
Community/Corporation for
Supportive Housing, 2004)
p. 26.
6

supervision and case management once the inmate is released.17, 18 For example, DOC
reallocated resources previously used for substance abuse programs inside the facilities
to discharge planning services, based on the assumption that effective substance abuse
treatment cannot be achieved in the short time most inmates are in the custody of the
DOC.19 This shift is reflected in the diminishing number of inmates in substance abuse
programs. In 1999, DOC’s custodial substance abuse programs served 11,000 inmates.
By 2003 that number had decreased 24.4 percent, to 8,840.20 Research supports this
reallocation of funds. Services (e.g., educational, substance abuse, and mental health
programs) need to be long-term and provided over a period of months to increase the
probability of change. A few days are not enough time to produce positive results.21
DOHMH provides treatment and transition services for inmates through various programs and bureaus (Figure 1.2). Under DOHMH’s Division of Health Care Access and
Improvement (HCAI), Correctional Health Services (CHS) is responsible for the medical, mental health, and dental services in the City’s correctional facilities. The Bureau
of Transitional Health Care Coordination (THCC) coordinates pre- and post-release
connections to health care. The Bureau of Forensic Behavioral Health Services provides
discharge planning services for mentally ill individuals released to the community from
DOC facilities.

Beginning the Discharge Process
The discharge planning process begins at intake. Within the first 24 hours, all inmates are
administered a four-page comprehensive medical screen and physical exam to identify
their needs (see Appendix B) and the DOC Discharge Planning Questionnaire/Screening
Form 983 (Appendix E), currently used for discharge planning for sentenced inmates.
The medical screen focuses on the inmate’s behavioral and health needs; each inmate
is also given brochures on HIV-STD, health, and dental needs. Routine communicable
disease testing is performed at intake, but is voluntary.
The type of discharge planning inmates receive depends on their behavioral and medical needs, reason for incarceration, length of stay in the facility, constraints in service
delivery, and the availability of community-based resources.22 As Black and Cho note,
“discharge planning is more commonly provided to inmates with special needs such as
mental illnesses or HIV/AIDS.”23 It stands to reason that a detainee released within 24
hours with no identified special needs will receive minimal services under this system.

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Figure1.2: Department of Health and Mental Hygiene Table of Organization

Source: NYC DOHMH website. http://www.nyc.gov/html/doh/downloads/pdf/public/dohmh-orgchart.pdf

Section 1: The New York City Department of Correction Health- and Non-Health-Related Discharge Planning

7

Health Screens and Discharge Services for Five Common Health Problems
1. Tuberculosis
Tuberculosis testing via tuberculin skin tests (TST) is offered to every incoming inmate,
male and female, without a history of prior positive TST. In addition, symptom questionnaires for active TB (e.g., cough, fever, and sweats) are completed within the medical
history of every inmate. Chest x-rays are ordered for anyone with a positive TST history
and for anyone who is HIV positive or has another immunosuppressed condition. Those
with new positive TST results after intake testing are sent for chest x-rays and offered
INH/B6 treatment 24 if there are no contraindications (i.e., elevated liver enzymes from
hepatitis C or alcohol use). If the history, physical, or a chest x-ray elicit suspicions of
active TB, the patient is isolated to rule out TB via consecutive sputums. For active TB
cases that are released and for those on INH/B6 treatment, follow-up care in the community is coordinated by the DOHMH Bureau of Tuberculosis Control.

24

INH/B6 = isoniazid and
vitamin B6, daily medications x 9 months of therapy
for treatment of positive TB
skin test.
25

The Body, NYC Inmates
Being Screened With
New 20-Minute HIV Test,
available at www.thebody.
com/bp/jul04/newsline.
html#1 (accessed on June
22, 2006).
26 New

York City Commission on HIV/AIDS,
Report of the New York City
Commission on HIV/AIDS,
(New York, NY: October,
2005).
27 Anne

C. Spaulding,
Kimberly R. Jacob
Arriola, Theodore Hammett,
Sofia Kennedy, and Giulia
Norton, Enhancing Linkage
to HIV Primary Care in Jail
Setting (Cambridge, MA:
Abt. Associates, 2007).
8

2. HIV/AIDS
In 2004, the DOHMH implemented the 20-minute OraQuick HIV finger-stick test on
a voluntary basis for all incoming male and female inmates. “From the public-health
perspective, the OraQuick test is ideal for City inmates — who move quickly through
the system — to find out their HIV status, and, if positive, enroll in treatment and stop
infecting others.”25 Introduction of the OraQuick test has quadrupled the rate of inmate
acceptance of HIV screening.26 Between 2003 and 2005, inmates volunteering for the
rapid test increased from 6,500 to 26,000, indicating that the rapid test is viewed more
positively than the traditional test.27 If the test result is positive, a confirmatory blood test
is performed. Inmates have the option to take the HIV test anytime during incarceration.
HIV-related aftercare services are offered to all newly diagnosed HIV-infected inmates
identified through voluntary rapid testing and to those who self-report or are known
HIV-infected persons. Aftercare services are provided to both detainee and City-sentenced populations and consist of an evaluation performed by a discharge planning
social worker or case manager, who refers the individual to appropriate services depending on the individual’s preferences and place of residence. The inmate is provided with an
aftercare letter that summarizes jail-based treatments, laboratory and radiology results,
and medication regimens. While there are no aftercare clinics or centers specific to
released HIV-infected persons in the manner of Brad H., HIV-infected persons are given
instructions on how to access services in the community. Since March 2007, DOHMH’s
Health Care Access and Improvement (HCAI) team has put a new model in place for the
HIV continuum of care. All HIV-infected inmates now have a minimum of one meeting with a DOHMH staff member prior to release, and they have the opportunity to be
connected to community treatment clinics after release. See Appendix C for HCAI’s new
HIV continuum of care model.

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

3. Sexually Transmitted Diseases
DOHMH’s Correctional Health Services currently screens for gonorrhea and chlamydia
using urine-based nucleic-acid testing in all male inmates less than 35 years of age and all
female inmates regardless of age. They are also tested for syphilis. In addition, all female
inmates are offered pelvic examinations and Pap smears at admission. Urine submitted at admission is analyzed by an outside laboratory within 48 hours of screening. If
the individual is still incarcerated and the test is positive, they are called to clinic and
offered treatment specific to gonorrhea, chlamydia, or both. At admission, the individual
receives a pamphlet advising how to follow up on the tests at any DOHMH sexually
transmitted disease clinic if the individual is released prior to an available result. In addition, women receive a pregnancy test and PAP smear.
4. Serious Mental Illness
The Bureau of Forensic Behavioral Health Services in DOHMH provides comprehensive
discharge services to mentally ill individuals released from correctional facilities. At
the time of the intake medical evaluation at Rikers Island, a determination is made as
to whether a mental health assessment is necessary. When indicated, a mental health
assessment is performed within three days. If this assessment reveals a need for followup for further assessment or treatment, a comprehensive discharge and treatment plan
(CDTP) is completed. For those who are housed in one of the segregated mental health
units, the CDTP is completed within seven days of the mental health assessment. If the
inmate is housed in the general population, the CDTP is completed within 15 days of the
initial screening.28 Under New York City’s settlement agreement in the Brad H. litigation,
inmates become designated “class members” upon completion of the CDTP and are
entitled to services pursuant to the settlement. In addition, inmates are designated as class
members if they are prescribed certain psychotropic medications (antipsychotic medications or mood stabilizers), regardless of whether a CDTP is completed prior to release.
The Bureau of Forensic Behavioral Health Services established the Service Planning and
Assistance Network (SPAN) to serve mentally ill inmates who did not receive services
while incarcerated, either because they were released before services could be arranged,
were released from courts unexpectedly, or because they refused services at Rikers
Island. SPAN offices exist in four boroughs (the Staten Island SPAN office was closed
in 2005), located near the court centers. The SPAN offices provide services to released
inmates on a walk-in basis. Inmates who meet the New York State Office of Mental
Health definition of being “Seriously and Persistently Mentally Ill” (SPMI) are entitled to
a higher level of services, under the Brad H. settlement agreement. The determination
of SPMI status may be made at the time of the initial mental health assessment or at
any later time. In addition, inmates treated with a medication from the list of specified
psychotropics (antipsychotic medications and mood stabilizers) are presumed to have

28

Marcel Van Ooyen,
Mental Health Update
on the Implementation of
the Brad H. Settlement.
Briefing Paper of the
Human Service Division,
Committee on Mental
Health, Mental Retardation,
Alcoholism, Drug Abuse
and Disability Services
(New York, NY: New York
City Council, February 17,
2005).

Section 1: The New York City Department of Correction Health- and Non-Health-Related Discharge Planning

9

SPMI status, unless otherwise documented following assessment. The Bureau of Forensic
Behavioral Health Services provides an array of services as agreed to under the Brad H.
settlement.29
5. Substance Abuse
The Key Extended Entry Program (KEEP) was established in 1987 and provides methadone maintenance to eligible opioid-dependent inmates in the jail, followed by referrals
to participating community methadone programs at the time of release. About 4,000
inmates are admitted annually to KEEP. Of these, about 2,200 are convicted inmates
serving sentences of less than one year, and 1,800 are detainees with charges that will
not likely result in a sentence of more than one year of incarceration if they are found
guilty. These restrictions ensure that KEEP patients will not be transferred to state prison
at some point, where methadone maintenance is not available and opioid withdrawal
protocols may differ from those of DOC.
Few inmates actually serve sentences that come close to a full year. KEEP patients
receive methadone maintenance for an average of 30 days, and almost all patients serve
sentences for periods that range from 10 to 90 days. A National Institute on Drug Abuse
(NIDA)-sponsored evaluation of KEEP published in 1993 documented the relationship

Key elements of services for the seriously mentally ill pre- and postrelease are as follows:
29

1.

Mentally ill inmates are released during
daylight hours.

2.

When release dates are known, discharge
planning staff makes appointments at
appropriate mental health programs in the
community and advises inmates of the date,
time, and place of the appointments.

3.

Referral information is provided for inmates
for whom release dates are not known.

4.

Inmates who present themselves to SPAN
offices within 30 days of release are to be
provided with services to place them in appropriate mental health treatment programs.

5.

10

On behalf of SPAN inmates, discharge
planning staff make a follow up contact with
mental health programs within three days
of scheduled appointments. For inmates
who failed to appear for their appointments,
discharge planning staff makes efforts to

contact them and arrange new appointments.
6.

Inmates receiving medication for mental
health purposes are supplied with a sevenday supply and prescriptions to cover an
additional 21-day period.

7.

Eligible inmates have Medicaid benefits
activated or re-activated prior to release or
have their Medicaid application submitted and
have access to Medication Grant Program
benefits.

8.

For SPMI inmates, applications are made, as
appropriate, for public assistance.

9.

For SPMI inmates, there is assessment
of housing needs and, where appropriate,
placement in supportive or other housing, or
Department of Homeless Services shelters.

10. For SPMI inmates, transportation from jail to
the place of residence is provided.

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

between the treatment experience of KEEP patients and the likelihood that they would
report for community treatment. The study found that 82 percent of KEEP patients
who were on methadone maintenance therapy at entry to DOC reported to community
methadone programs upon release, 52 percent of KEEP patients who were not in treatment at entry to Rikers Island reported for community treatment, and only 30 percent of
patients who received methadone-assisted opioid withdrawal (detoxification) reported
for community treatment.30 Among those reporting for community maintenance treatment, 40 percent of the KEEP methadone maintenance sample was still in treatment
five to six months after release compared to 25 percent of the opioid withdrawal sample.
Being in methadone treatment at post-release follow-up was associated with less illicit
drug use, drug injection, re-offending, and illegal income.31 The KEEP program is currently implementing a pilot buprenorphine maintenance therapy program for opioid
dependence that refers patients upon release to physicians in the community who are
certified to prescribe buprenorphine.

Transitional Health Care Coordination: An Emphasis on Chronic Conditions and
Education
The work of Transitional Health Care Coordination (THCC) is a particularly good
example of the emphasis and resources DOHMH is committing to the facilitation of
transitional health care. The mission of THCC is to coordinate “health education and
service delivery from incarceration to the community for all [New York City] inmates”
with an emphasis on chronic health conditions.32 Actual policy, however, is more comprehensive and includes addressing the health conditions of the inmate’s family and
friends and other members of the community who have been involved in the criminal
justice system. The three goals of THCC are to:
1. Intervene with visitors and families to promote better access to health care
services by reaching out to those at greater risk by increasing personal health
awareness;
2. Increase community referral of those with chronic disease (e.g., heart disease,
hypertension, diabetes, and uncontrolled asthma) as well as HIV/AIDS and
STDs;
3. Improve screening, education activities, and follow-up consistent with Take Care
New York (the health policy agenda of DOHMH).33
To accomplish these goals, THCC has more than 40 employees (e.g., health educators,
patient care coordinators) who work in the jails and in community locations where

30

Stephen Magura, Andrew
Rosenblum, Carla Lewis
and Herman Joseph, “The
Effectiveness of In-jail
Methadone Maintenance,”
Journal of Druq Issues 23
(1993): 75-99.
31

Ibid.

32

New York City Department of Health and Mental
Hygiene, Transitional
Health Care Coordination2006, available at www.nyc.
gov/html/doh/html/hca/thcc.
shtml (accessed November
9, 2007).
33 New

York City Department of Health and Mental
Hygiene, Take Care New
York, available at nyc.gov/
html/doh/html/tcny/index.
shtml (accessed November
9, 2007).

Section 1: The New York City Department of Correction Health- and Non-Health-Related Discharge Planning

11

inmates and former inmates are likely to end up. These locations include Rikers Island,
Manhattan House of Detention (The Tombs), Vernon C. Baines Center (The Barge),
the Rikers Island Central Visitor Center, Queensboro Correctional Facility, New York
City probation offices, two state parole offices, two courts, homeless shelters, and the
DOHMH district health centers in Central Brooklyn and the South Bronx.
The THCC’s main focus inside the facilities is to disseminate written health education
materials to inmates and their families and to provide transitional health care planning
for those with chronic health conditions. For the visitors and families of the inmates,
THCC provides staff at the Central Visitor Center Health Station at Rikers Island. In 2006,
approximately 200,000 visitors were provided with health information and materials.
Nearly 9,000 of the visitors also received health screening, including nicotine replacement
therapy, body mass index, blood pressure testing, and referrals to community programs.
The agency’s post-release care coordination work falls under the umbrella of their Correction-Community Linkage Program where THCC field staff are located in the neighborhoods of high inmate return to provide follow-up on inmates who received THCC
services while incarcerated or criminal justice-involved individuals who are likely to
have been previously incarcerated. The activities of the Correction-Community Linkage
Program centers around the following 10 core health issues promoted in Take Care New
York, the health policy agenda of DOHMH:
1. Have a regular doctor or other
health care provider

6. Live free of dependence on alcohol
and drugs

2. Be tobacco free

7. Get checked for cancer

3. Keep your heart healthy

8. Get the immunizations you need

4. Know your HIV status

9. Make your home safe and healthy

5. Get help for depression

10. Have a healthy baby

A discharge kit in English and Spanish is available to all DOC inmates released from
jail and contains the following: 1) a list of where to apply for free- or low-cost health
insurance; 2) a threefold pamphlet listing DOHMH health clinics in all boroughs, with
particular focus on areas of high inmate return, explaining that HIV and STD counseling
and testing are free and confidential; 3) the Take Care New York Passport to Your Health
brochure, which is a personal health record plan that fits in a wallet and can be used to
chart medical care as well as to record the addresses of health care providers, medical
information, and an emergency contract person (see Appendix D); 4) three latex male
condoms with information on how to use them; and 5) a female condom, lubricant, and
easy-to-read instructions on how to use it for the female inmate population.
12

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Community-Based Referrals to Medical Services
THCC also coordinates health education and discharge-planning services for inmates
with chronic diseases who are being released to the community. Referrals are made for
diabetes, hypertension, and cardiovascular disease in particular, but any chronic disease
or condition requiring longitudinal follow-up is appropriate for THCC involvement.
Both detainee and sentenced inmates are eligible. THCC health educators receive many
of their referrals electronically from the jail’s computerized medical intake system and
are first seen on day two of their incarceration. THCC provides the inmates with an orientation to citywide health facilities, an MTA MetroCard for transportation, a discharge
medication prescription, and an aftercare letter for health services.
According to THCC Executive Director Alison Jordan, her bureau in 2006 had health
education and discharge planning discussions with approximately 72,000 jail-based
inmates. Of those, 2,081 inmates with chronic health conditions received a discharge
plan with an appointment made for them in the community. Of that number, 872 were
released from jail and seen by a community provider for medical care, substance abuse
treatment, or other health-related services. THCC has developed both formal and
informal relationships with health and human service agencies to meet the health needs
of the inmates. THCC staff members make referrals to primary care physicians at Federally Qualified Health Centers and to substance abuse counselors and clinics that provide
HIV and STD testing. In 2006, nearly 2,000 criminal justice-involved individuals (i.e.,
individuals with a history of incarceration) in the community received a health service
assessment from THCC. Of these, 63 percent kept an appointment in the community for
medical or health-related care, including substance abuse treatment, housing for people
with HIV/AIDS, health insurance, and HIV testing.

Referrals to Community-Based Non-Profits
An important part of THCC’s programs is the development of formal linkages with nonprofit agencies providing reentry services. In 2006, more than 170 agencies had partnered to work with THCC, with nearly half signing memorandum of agreements (MOA)
with THCC. The MOA formalizes what is expected of all partnering agencies that
receive and work with incarcerated persons referred to them by THCC. Additionally,
service providers under the MOA are required to refer former inmates to the HCAI’s
Bureau of Health Insurance Services to get them enrolled in managed care. Referrals
made by the service providers must be confirmed to ensure the appointment was kept.

Section 1: The New York City Department of Correction Health- and Non-Health-Related Discharge Planning

13

Non Health-Related Discharge Planning
At intake, all inmates complete the New York City Department of Correction Discharge
Planning Questionnaire, which was developed and pilot tested by the Vera Institute of
Justice and identifies employment, family, benefits, housing, health care, and substance
abuse needs.34 This screen allows discharge planners to determine the appropriate reentry strategies and follow-up services in the community for the inmates, even for those
with short length of stays (see Appendix E).

The Rikers Island Discharge Enhancement Project
The Rikers Island Discharge Enhancement Project (RIDE) provides a comprehensive
discharge plan to individuals who have a City sentence, regardless of their health needs.
The main asset of this voluntary program is that it provides direct transportation to
community services at discharge and 90 days of case management in the community
after release. No more than 14 days prior to the date of discharge, a discharge plan is
completed (see Appendix F). The following are the main components of RIDE:35

34

New York City Department of Corrections.
Discharge Planning Update
(New York, NY: 2005).
35

Glen Martin, “Rikers
Island Discharge Planning
Initiative: A New York
City Jail Reentry Model,”
National HIRE Network
News 3 no. 8 (2005): 1-10.
36

New York City Department of Corrections.
Discharge Planning Update
(New York, NY: 2005).
37

New York City Council,
Fiscal Year 2007 Executive
Budget Hearings, Committee on Finance jointly with
Committee on Fire and
Criminal Justice Services,
(New York, NY: May 2006).
14

•

Early screening assessments to determine the employment, substance abuse,
housing needs, and history of the incarcerated person;

•

Immediate access to transitional employment programs;

•

Streamlined procedures for obtaining birth certificates and social security cards;

•

Completion of Medicaid application before release; and

•

Immediate connection to case management in the community.

The discharge plan categories include identification, treatment plan/needs, discharge
planning needs/referrals made for substance abuse, housing assistance, family reunification assistance, education/employment, and provider information. Community-based
service providers located at Rikers Island work with the inmates to encourage them to
continue treatment and physically take them to their services in the community. The
individualized discharge planning process includes the completion of a discharge planning screening form, gathering identification information, transportation from Rikers
Island, referrals to service providers, and 90 days of after-jail case management related
to addiction treatment, employment, and housing.36 In fiscal year 2006, 4,764 inmates
participated in the RIDE project,37 representing a 73 percent increase in participation
since 2004. Agencies working with these inmates are Samaritan Village Rikers Island
Discharge Planning Project, the Osborne Association, Fortune Society, Women’s Prison
Association, Vera Institute of Justice, and the Center for Employment Opportunities.

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

These providers work under performance-based contracts in which full payment is only
obtained when continual engagement for 90 days after release is achieved.

Discharge Planning Support Centers
In addition to the RIDE project, the Rikers Island Discharge Planning Support Center at
the Rose M. Singer Center for females and the Eric M. Taylor Center for sentenced males
were established in 2006. The goal of the Centers is to connect inmates to public benefits to help facilitate their transition back to the community. Representatives of DOC,
DOHMH, and DHS all have offices at the Centers. The Centers are open to all inmates
and offer a variety of discharge services. For example, interviews for public benefits such
as SSI/SSDI can be done in person, and Medicaid services are authorized before inmates
are discharged.
In 2007, the Center for Urban Community Services (CUCS), with funding from the
Robin Hood Foundation, opened two Single Stop sites on Rikers Island that operate
within the Support Centers. The number of Single Stop sites has since grown to approximately 40, located throughout New York City. The sites offer low-income families individual legal and financial counseling. Inmates can request a Single Stop referral by asking
their RIDE provider or a DOC staff member, by completing a referral form located in
the law library or in their housing area, or by stopping by the Discharge Planning Support Center to request a referral form. The Single Stop sites include confidential benefits
counseling, assistance in applying for public benefits electronically, legal advice on civil
matters, rap sheet clean-up and counseling, and financial and credit counseling. Besides
CUCS, the Legal Action Center, The Legal Aid Society, and Credit Where Credit is Due,
Inc. provide staff for the Single Stop sites.

Additional Discharge Planning Services
Frequent Users
New York City Administrative Code now mandates the identification of frequent users
of city services. DOC defines frequent users as having at least four stays in DOC and
four in Department of Homeless Services (DHS) shelters in the last five years. In 2004,
an estimated 1,725 individuals were classified as frequent users, with 221 presently in the
shelters and another 257 incarcerated at DOC.38 Of that population, 331 were affiliated
with Brad H. and another 1,377 had been served by Office of Alcohol and Substance
Abuse Services (OASAS)-licensed facilities. This population is identified through an
integrated electronic system in coordination with DHS. DOC and DHS electronically
match their populations on a bi-monthly basis.39

38

New York City Department of Corrections, Official
Plan as of 10/18/2005.
Discharge Planning Action
from May 2, 2005 Retreat
(New York, NY: 2005).

Section 1: The New York City Department of Correction Health- and Non-Health-Related Discharge Planning

15

39 New York City Department

of Corrections, Discharge
Planning Administrative Code
9 127, 9-128, 9-129 Mandates and Operationalization
(New York, NY: 2005).
40 Cassi Feldman, “Frequent

Fliers Grounded: New
Housing for Homeless,” City
Limits Weekly, (December
19, 2005): 515.
41 New York City Department

of Corrections, Official Plan
as of 10/18/2005. Discharge
Planning Action from May 2,
2005 Retreat (New York, NY:
2005).

The Frequent User Service Enhancement (FUSE) program provides subsidized housing
units and services to approximately 100 frequent user clients in an effort to provide this
population stable housing.40,41 The New York City Housing Authority provides Section 8
housing vouchers.42 Bowery Residents Committee, Common Ground, Palladia/Samaritan, and Women’s Prison Association have contracted with the FUSE clients to provide
services to those receiving vouchers.43
Short Stayers
The Center for Alternative Sentencing and Employment Services (CASES) operates a day
custody program for offenders who have “three or more prior misdemeanor convictions
and are not classified as Operation Spotlight defendants.”44 The object of the Day Custody
Program is to provide ex-inmates “with the supportive services they need while eliminating the enormous expense to taxpayers for transporting these individuals to Rikers Island
only to have them released a few days later.”45 Individuals are “sentenced to a ten-day
term of intermittent imprisonment to be served during three eight-hour daytime periods.”46 The CASES day custody program is located at the Manhattan House of Detention.
Inmates work and participate in programming during the day and go home at night.

42 New York City Department

of Corrections. Discharge
Planning Update (New York,.
NY: 2005).
43 New York City Department

of Corrections, Official Plan
as of 10/18/2005. Discharge
Planning Action from May 2,
2005 Retreat (New York, NY:
2005).

Day Custody Program
•

Community Service: Participants
perform community service within the
DOC facility.

•

Needs Assessment: Participants
engage in a comprehensive needs
assessment in the areas of substance abuse, mental health, health
care, entitlements, employment, and
housing.

44 CASES, Criminal

Court/Community Service
Programs: Day Custody
Program, available at www.
cases.org/cssp_sub2.html
(accessed on June 12,
2006); Operation Spotlight
defendants, those who have
at least three misdemeanor
arrests within a 12-month
period, are eligible for
adjudication in specialized
court hearing only Operation
Spotlight cases.

•

Treatment Readiness Counseling:
For three days, participants receive
onsite presentations by representatives from treatment programs in
New York City. Program representatives offer immediate enrollment to
interested participants.

•

Barriers to Arrest & Convictions:
Program addresses the barriers that
participants with criminal histories
face and how to successfully address
these barriers.

•

Discharge Plan & CASES Referral
Network: Each participant receives a
discharge plan that includes linkages to community-based treatment
programs and employment, housing,
mental health, and health care assistance. Two social service agencies
have representatives working onsite
with participants.

CASES (2006a). Day Custody Program.
NY: Criminal Courts Programs.

45 Ibid.
46 Ibid.
47 Ibid.

16

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

During the day they engage in “community service (within DOC facilities), treatment
readiness counseling, discharge planning, and referrals to community and government
service agencies.”47 This program enjoys a 90 percent completion rate.48
All Inmates
All inmates have access to the 20 benefits boards located in the law libraries and counseling offices of each DOC facility. The boards provide written discharge-planning materials, including informational pamphlets and applications from the Human Resource
Administration, Social Security Administration, Departments of Health and Mental
Hygiene, Education, and Motor Vehicles, Veterans Administration, and Immigration
and Naturalization. Flyers and palm cards for the city’s telephone 311 system are also
provided. A phone call to 311 will connect inmates post-release with discharge planning
services. The 311 system is also used by family and friends of those incarcerated. The
palm cards are available in English and Spanish, written in easy-to-understand language,
and instruct the inmates to say “Jail Release Services” when the 311 operator answers the
phone (see Appendix G).49
The following two sections of this report map the spatial distribution of inmates’ residence in the five boroughs of the City and the geographic location of post-release service
providers to help identify the availability and accessibility of services in communities of
high inmate return.50

48

New York City Department of Corrections, Official
Plan as of 10/18/2005.
Discharge Planning Action
from May 2, 2005, Retreat
(New York, NY: 2005).
49

Ibid.

50

The most common way
to measure unmet needs
according to Queralt and
Witt is by determining the
spatial availability and
accessibility of services to a
client, otherwise referred to
as location. For this profile,
the service availability is
determined by the total
number of services listed
in separate health and
human service databases
at the borough and community district level. Service
accessibility; the distance
from point A (home address
of released NYC DOC
inmates) to point B (service
provider) is measured
using density maps. A
density map uses shades
of color to portray locations
of heavier concentrations
of services and or inmates;
Magaly Queralt and Ann
Dryden Witte Queralt, “Estimating the Unmet Need
for Services: A Middling
Approach,” Social Service
Review (December 1999):
522-559.

Section 1: The New York City Department of Correction Health- and Non-Health-Related Discharge Planning

17

18

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

SECTION 2:
Inmates Released by the New York City
Department of Correction in 2005

51

I

n order to aid in the analysis of the living arrangements of released inmates, DOC
provided individual case data on the 77,735 inmates discharged from DOC in
calendar year 2005. Of that total, 50,974 inmates returned to the City’s boroughs in
2005. A sample of 40,684 inmates (80 percent) was geocoded and analyzed. The sample
was selected based on the following criteria: 1) inmate had a known home address at
the time of incarceration; 2) inmate was released to one of the City’s five boroughs (i.e.,
Brooklyn, Bronx, Manhattan, Queens, or Staten Island); and 3) only the inmate’s last
discharge from DOC in 2005 was counted to avoid double-counting inmates. Among the
10,230 cases that were not geocoded, 2,584 cases were identified as homeless or living in
an institution (Table 2.1).51

The address to which
an inmate expects to
return is not available in
NYC DOC’s electronic
data. Understanding the
limitations, the address
at admission is used as a
proxy for released address.
Other research has
adopted this method, and
studies have shown that
neighborhood at admission is a reliable proxy for
neighborhood of return.
Available at www.urban.
org/publications/311213.
html - “Returning Home
Illinois Policy Brief: Prisoner
Reentry and Residential
Mobility.”

Table 2.1: Living Arrangement of DOC-Released Inmates by Borough
Brooklyn

%

Bronx

%

Manhattan

%

Queens

%

Staten Island

%

Total

Total (after
duplicates removed)

16,716

100.0

13,147

100.0

10,627

100.0

8,773

100

1,711

100.0

50,974

Matched Address

13,445

80.4

10,435

79.4

8,458

79.6

7,000

79.8

1,346

78.7

40,684

Unmatched Addess

3,271

19.6

2,712

20.6

2,169

20.4

1,773

20.2

365

21.3

10,290

Invalid Address

2,827

16.9

2,208

16.8

717

6.7

1,559

17.8

303

17.7

7,614

Homeless

414

2.5

478

3.6

1,250

11.8

194

2.2

61

3.6

2,397

Group Home

0

0.0

2

0.0

1

0.0

0

0.0

0

0.0

3

Psych Center

0

0.0

0

0.0

58

0.5

0

0.0

0

0.0

58

YMCA

0

0.0

0

0.0

1

0.0

1

0.0

0

0.0

2

HOTEL

1

0.0

1

0.0

2

0.0

0

0.0

1

0.1

5

Shelter

21

0.1

12

0.1

63

0.6

4

0.0

0

0.0

100

Correctional Facility

0

0.0

1

0.0

11

0.1

0

0.0

0

0.0

12

Salvation Army

1

0.0

0

0.0

6

0.1

0

0.0

0

0.0

7

Missing

7

0.0

10

0.1

60

0.6

15

0.2

0

0.0

92

Section 2: Inmates Released by the New York City Department of Correction in 2005

19

The dynamics that explain why some inmates use post-release services and others do not
are complex. Mapping service needs against the availability and accessibility of services
taps only one dimension of the reentry challenge.52 Individuals can be geographically
near a service and still not have their needs met due to a host of factors including space
availability, service affordability, service quality, days and hours of service operation, the
lack of culturally competent staff, and service restrictions based on gender, age, mental
health status, or type of felony conviction. Nevertheless, service location does matter.
According to Anderson, “more enabling resources (in the community) provide the means
for use, and increase the likelihood that use will take place.”53

52 Anderson’s

behavioral
health service utilization
model identifies three
characteristics that influence the use of services:
(1) a person’s predisposition to use of services
based on demographic and
socio-economic factors; (2)
enabling factors that focus
on the logistical aspect of
service utilization, e.g. the
availability and accessibility of service; and (3) the
perceived or real need for
services, which is typically
articulated by the individual
or a health care provider.
53

Ronald M. Anderson,
“Revisiting the Behavioral
Model and Access to Medical Care: Does it Matter?”
Journal of Health and
Social Behavior 36, no. 1,
(1995, p. 4): 1-10.
54

New York City Department of Corrections, Official
Plan as of 10/18/2005.
Discharge Planning Action
from May 2, 2005 Retreat
(New York, NY: 2005).
20

This profile is intended to provide a visual tool for developing, assessing, and recommending post-release programs and services. For the first time, discharge planners will
have access to maps that show where released inmates can go within their communities
for medical and mental health needs. Ideally, in the near future, a discharge planner
working with an HIV-infected inmate, for example, with computerized access to GIS
maps of the five boroughs and all available services, could enter the released inmate’s
address, generate an on-screen map of the HIV/AIDS services nearest to where the
inmate lives, identify the transportation routes to the service, and make this information
available to the individual.

Sources for Mapping Data
In order to determine the location and the degree to which post-release health and
human services are available in the areas where former inmates live, it was necessary to
compile information from a variety of sources, which are described below.

Mapping Health and Human Service Providers
For an individual health and human service provider to be part of the mapping database,
the service had to be listed in one of the following databases: 1) New York City prisoner
reentry guidebooks published in 2005, 2) the directory of mental hygiene programs and
services contracted with DOHMH, 3) the DOHMH Transitional Health Care Coordination Partner, or 4) the primary Rikers Island Discharge Enhancement (RIDE) service
providers or a service provider that the RIDE partners use for referrals.
DOC discharge planners, correctional officers, and parole and probation officers typically
rely on printed resource directories or “word of mouth” when referring inmates to postrelease services. DOC discharge planners are trained to use Lopez’s 2005 reentry guide,
which provides information on community services.54 In addition, the analysis included

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

the services listed in two other well-known New York City reentry guides: Likosky’s
Connections (2005), a published 167-page directory that is available at no charge to
discharged inmates and is available in the Rikers Island Visit Center and at various New
York public libraries, and the City’s Commission on Human Rights’ Making it Happen
& Staying Home (Whitaker, 2005, 91 pages), which has been distributed throughout
New York State correctional facilities, parole and probation offices, and various service
organizations.55
Figure 2.1: New York City Inmate Reentry Handbook Covers

The listings of services from all three reentry guides were included because many
DOC inmates are discharged without any post-release planning, and one of these three
reentry guides may serve as their primary source of information as they return home.
In addition, the reentry guides specifically target the inmate population, so any agency,
organization, or program listed in these guides, one would assume, has acknowledged
a willingness to work with former inmates. There is, however, a lack of continuity in the
reentry services listed in the three reentry guidebooks. Only 28 of 277 agencies are listed
in all three guides, suggesting that a discharge planner’s knowledge of services may be
only as good as the quality of the referral list he or she is using. As a result, the use of
different service directories could contribute to the type and quality of services to which
released inmates are referred.
Apart from the above reentry guides, the Transitional Health Care Coordination Partner
List and the RIDE service provider list were compiled for the present project. Unlike the
services listed in the reentry guidebooks, all service providers listed on the THCC partner list have been vetted to work with the released population and are used by THCC
staff members when referring inmates to health services in the community. The RIDE
service provider list was included to identify the primary referral services used by RIDE

55

Making it Happen &
Staying Home can also
be obtained in English
or Spanish by contacting
311, NYC’s Government
Services and Information
Center.

Section 2: Inmates Released by the New York City Department of Correction in 2005

21

providers as of October 2007. The list focuses on the following service types: housing,
education, clothing, employment, and substance abuse treatment.
Although this project was interested in analyzing the geographic location of agencies
that discharge planners and DOC staff use to refer the reentry population, an important
aspect of the project was to map as many New York City health and human service agencies as possible. To that end, a database of all mental hygiene programs and services (i.e.,
chemical dependency, mental health, mental retardation services) in contract with the
DOHMH during fiscal year 2004 was developed and analyzed as part of this project.

The DOHMH Medical Registry Database
DOHMH is in the process of conducting an analysis of the health conditions of individuals who have cycled through DOC custody in recent years. To accomplish this, researchers will identify inmates and former inmates who appear on one or more of the various
health and behavioral DOHMH registries (e.g., HIV/AIDS, STD, Hepatitis B, Hepatitis
C, Tuberculosis, and Seriously and Persistently Mentally Ill), and in vital statistics (death)
data. DOHMH has agreed to parse the results for inmates who were discharged from the
DOC in calendar year 2005 and to share the results, which will then be used to supplement this report.56 This data will be available for future analysis of this project.

Analysis of Released Inmates and the Availability and Accessibility of Services

56

To comply with the HIPAA
regulations protecting the
confidentiality of health information, all data provided to
us by the NYC DOHMH will
be stripped of all identifiers
more specific than United
Hospital Fund’s (UHF) zip
code cluster level. There
are 42 UHF neighborhoods
in New York City compared
to NYC’s 59 community
districts, 179 zip codes and
2, 216 Census Tracts.
Each UHF is comprised of
multiple zip codes, making
it impossible to identify the
diagnoses of an individual
from these data.
22

In addition to analyzing information on the availability and accessibility of service providers, this profile includes a map of the neighborhoods to which the released inmates in
the sample would return. In 2005, 40,684 unique inmates were discharged from DOC to
one of the City’s boroughs. The released inmates were predominately male (89 percent);
only 11 percent were female (see Table 2.8 in Appendix H). The mean age of the inmates
was 34 and the median age was 33 (Table 2.8). Fifty-nine percent of the inmates identified their race as black, 20 percent other, 14 percent white, 6 percent unknown, 1 percent
Asian and 0.2 percent American Indian (Figure 2.2, Map 2.2, and Table 2.8). Thirty-three
percent identified their ethnicity as Hispanic. From prior research on inmate populations, one can infer that the majority of those who self-identified as other are Hispanic
(Figure 2.3, Map 2.3, and Table 2.8).

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Figure 2.2: Race of DOC-Released Inmates by Borough

Figure 2.3: Ethnicity of DOC-Released Inmates by Borough

Section 2: Inmates Released by the New York City Department of Correction in 2005

23

More than half (59 percent) of the inmates released identified living in Brooklyn or the
Bronx at the time of intake (Figure 2.4).

Figure 2.4: DOC-Released Inmates by Borough at Arrest

57 The

six community
districts with the highest
inmate return were districts
303 and 305 in Brooklyn;
district 205 in the Bronx;
district 412 in Queens;
districts 110 and 111 in
Manhattan.
24

A disproportionate number of inmates were released to specific communities within
boroughs, defined as community districts for this profile, with six of 59 community districts
housing 26 percent of the released inmates (see Table 2.2 in text and Tables 2.9 and 2.10 in
Appendix H).57 The darkest area in Map 2.1 identifies the 13 community districts with DOC
inmate returns of 1,036 or more in 2005. Community districts with high inmate return
typically also face other challenges including high rates of poverty and unemployment. Four

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

community districts in New York City were identified as having the highest concentration of
released inmates. The extreme deprivation of these communities is described below.
1. Bedford Stuyvesant, Tompkins Park North, Stuyvesant Heights in Brooklyn
In 2005, 2,076 DOC inmates returned to Community District 303, which includes the
neighborhoods of Bedford Stuyvesant, Tompkins Park North, and Stuyvesant Heights in
Brooklyn. Community District 303, with a total population of 143,867, has a rate of 14
inmates per 1,000 residents. This community district has multiple challenges. Thirtyfive percent of the residents live below the poverty line (less than $19,350 for a family of
four), and 46 percent are on some form of public assistance (e.g., Temporary Assistance
for Needy Families, SSI, Medicaid). The unemployment rate is 18 percent; 37 percent of
the households are headed by females, and 19 percent of the population is foreign-born.
It is certainly not uncommon for a neighborhood with limited resources such as this to
experience high rates of released inmates.58
2. Jamaica, South Jamaica, Hollis, St. Albans in Queens
In 2005, 1,774 DOC inmates returned to Community District 412 in Queens. Community District 412 has a rate of eight inmates per 1,000 residents and a total population
of 223,602 residents. Thirty-five percent of its residents are foreign-born. Seventeen percent of the population live below the poverty line, 34 percent receive public assistance,
29 percent of the households are headed by females, and 11 percent of the residents are
unemployed.
3. Central Harlem in Manhattan
In 2005, 1,772 DOC inmates returned to Community District 110 in Central Harlem.
Central Harlem has the highest rate of inmates per population (17 per 1,000 residents).
Thirty-seven percent of its 107,109 residents live below the poverty line, and 45 percent
receive public assistance. Females head 30 percent of the households, 18 percent of the
residents are unemployed, and 18 percent are foreign-born.
4. Morris Heights, University Heights, Fordham, Mt. Hope in Bronx
In 2005, 1,515 DOC inmates returned to Community District 205 in the Bronx.
With a total population of 128,313 (35 percent of whom are foreign-born), the rate of
released inmates is high at 12 per 1,000 residents. Forty-one percent of the residents
of the district are impoverished, 58 percent receive public assistance, and 40 percent
of the households are headed by females.

58

Eric Cadora, Mannix
Gordon, and Charles
Swartz, Criminal Justice
and Health and Human
Services: An Exploration
of Overlapping Needs,
Resources, and Interests
in Brooklyn Neighborhood
(Washington, DC: The
Urban Institute, 2002).

Section 2: Inmates Released by the New York City Department of Correction in 2005

25

Table 2.2: Top Quartile of Community Districts with Highest Number
of DOC-Released Inmates
Inmate Return by Community
District in Descending Order of
Frequency

Frequency

%

Cumulative %

Percent Persons
Below Poverty
Level

Unemployment
Rate 16 years
and older

303 Bedford Stuyvesant,
Tompkins Park North, Stuyvesant
Heights (BK)

2,076

5.1

5.1

35.1

18.0

412 Jamaica, South Jamaica,
Hollis, St. Albans (QN)

1,774

4.4

9.5

16.7

10.8

110 Central Harlem (MHN)

1,772

4.4

13.8

36.6

18.4

305 East New York, New Lots,
City Line, Starrett City (BK)

1,768

4.3

18.2

33.2

16.3

111 East Harlem (MHN)

1,617

4.0

22.1

36.9

17.1

205 Morris Heights, University
Heights, Fordham, Mt. Hope (BX)

1,515

3.7

25.9

41.4

20.1

Thirteen community districts have rates higher than 10 inmates per 1,000 residents; six
of these districts are located in the Bronx, five in Brooklyn, and two in Manhattan (Table
2.3). Community District 412 in Queens was the only location with a high number
of inmates that did not have a rate of 10 inmates or more per 1,000 residents. This is
attributed to the high population base in Community District 412.
Table 2.3: Community Districts with the Highest Rate of DOC-Released Inmates
Community Districts

Inmate Population

Rate per 1,000

110 Central Harlem (MHN)

1,772

17

316 Ocean Hill, Brownsville (BK)

1,338

16

111 East Harlem (MHN)

1,617

14

201 Mott Haven, Melrose, Port Morris (BX)

1,110

14

202 Hunts Point, Longwood (BX)

660

14

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

982

14

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Heights (BK)

2,076

14

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

1,515

12

813

11

304 Bushwick (BK)

1,166

11

308 Crown Heights, Prospect Heights, Weeksville (BK)

1,040

11

204 Highbridge, Concourse (BX)

1,392

10

305 East New York, New Lots, City Line, Starrett City (BK)

1,768

10

206 East Tremont, Bathgate, Belmont, West Farms (BX)

26

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Map 2.1: DOC-Released Inmates by Community District

Section 2: Inmates Released by the New York City Department of Correction in 2005

27

Map 2.2: DOC-Released Non-Hispanic, Black Inmates by Community District

28

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Map 2.3: DOC-Released Hispanic Inmates by Community District

Section 2: Inmates Released by the New York City Department of Correction in 2005

29

Criminal Justice Characteristics of the Released Inmates
Sixty-one percent of the DOC inmates in our
sample were pretrial detainees, 37 percent
were individuals with misdemeanor or felony
convictions sentenced to one year or less in
a DOC facility, and two percent were parole
violators awaiting revocation hearings (see Table
2.5 in Appendix H).59 Thirty-two percent of
the inmates’ top charges were for drug-related
offenses (see Table 2.4).

59

This data did not include
the number of inmates who
were state prisoners with
court appearances in NYC
or newly sentenced felons
awaiting transportation to
New York state correctional
facilities. To safeguard
privacy, we report aggregate level data on the
highest conviction charge
at admission for those
discharged in 2005. The top
count charge data includes
all inmates released from
DOC in 2005.
60 Classification

The length of stay ranged from less than one day
to 336 days in 2005. The average length of stay was
21 days, with 29 percent discharged within three
days, 43 percent released between four and 30
days, and 18 percent incarcerated for more than 31
days (see Table 2.5 in Appendix H and Figure 1.1
in Section I). Detainees had the shortest length of
stay at 14 days, followed by sentenced inmates (30
days) and parole violators (44 days) respectively.
For those inmates with a classification score60 (i.e.,
one or greater), the mean score for sentenced
inmates was 5.61, compared to 6.43 for detainees
and 11.1 for parole violators. Citywide, 82 percent
of the inmates were classified in the low-risk range
(<11 points) with 18 percent classified as high-risk
offenders. Compared to the citywide average,
high-risk offenders are overrepresented among
inmates released to the Bronx, Manhattan, and
Brooklyn (see Table 2.5 in Appendix H and Figure
2.7).

scores
are based on criminal
justice characteristics (e.g.,
severity of current charge,
history of prior convictions
and history of escape) and
inmate’s age. The total
scores are grouped into
four risk categories: low
(0-5), low-medium (6-10),
high-medium (11-16) and
high (+17).
30

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 2.4: Top Count Charges
of DOC-Released Inmates
Top Count Charge

% of
total

(N=77,736)
Drug Misdemeanor

16%

Drug Felony Sale

10%

Misdemeanor Larceny

7%

Other Felonies

6%

Misdemeanor Assault

6%

Drug Felony Possession

6%

Robbery

5%

Warrants/Holds

4%

Vehicular

3%

Weapons

3%

Violations

3%

Assault

3%

Loiter/Prostitution

2%

Grand Larceny

2%

Burglary

2%

Other Sexual Offenses

1%

Murder/Attempted Murder/
Manslaughter

1%

Rape/Attempted Rape

1%

Other Misdemeanor

18%

Figure 2.5: DOC Inmate Status at Release

Figure 2.6: DOC Inmate Status at Release by Borough

Section 2: Inmates Released by the New York City Department of Correction in 2005

31

Inmates who have a city sentence are the largest group who are provided a comprehensive discharge plan. This is because the process of discharge planning is time consuming
and not easily accomplished without resources devoted to it and a predictable length of
stay. The need for discharge planning is no less for pretrial detainees, however. Sixty-one
percent of the inmates discharged in 2005 were pretrial detainees with demographic
and criminal justice characteristics similar to the city sentence and technical violating
discharges (see Table 2.6 in Appendix H). Pretrial detainees’ self-reported drug use was
10 percent lower than the city-sentenced inmates, but their classification scores were
significantly higher. Twenty-eight percent of the detainees were incarcerated for more
than seven days, allowing for some, if limited, discharge planning.61

Figure 2.7: DOC-Released Inmates and Their Classification Scores

61

We recognize, however,
that discharge planning for
pre-trial detainees is more
difficult than working with
a sentenced population
because of their unpredictable length of stay in the
facility.
32

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Health and Related Needs of Released Population: 2005
Only 20 percent (7,991) of the inmates self-identified as drug users at intake.62 DOC data
indicate that between 70 and 80 percent of the inmates are defined as substance abusers,
so the data clearly underreport inmate drug use. The median age of self-reported drug
users was 39, with more of the females (33 percent) self-reporting drug use than the
males (18 percent). Of those who self-reported drug use at admission, 44 percent were
black. A smaller percentage of drug users — 21 percent — were white. One should note,
however, that only 15 percent of black inmates self-reported drug use, compared to 29
percent of white inmates. American Indians (five percent) and Asians (six percent) had
the lowest rates of self-reported drug use. Two thirds of the drug users lived in Brooklyn
(33 percent) or the Bronx (32 percent) at the time of intake; 19 percent had a Manhattan
address, with 14 percent and three percent in Queens and Staten Island respectively.
Map 2.4 and Table 2.7 in Appendix H clearly identify how certain community districts
have higher rates of self-reported drug users than other areas.
Parole violators had the lowest rate of self-reported substance abuse (3.1 percent),
compared to 49 percent of sentenced inmates and 48 percent of detainees. The difficulty
of providing effective substance abuse treatment during incarceration is understandable
given that 26 percent of the drug users were discharged within three days, another 50
percent were released between four and 30 days, and just 24 percent were incarcerated
for more than 31 days.

62

Self-reported drug use
is written on the Inmate
Detention Record (Form
#239). The drug use questions are as follows:
Drug Abuser?
(If Yes, specify):
Yes/No _____________
Alcohol Abuser: Yes/No
Detox: Yes/No
There is a section on Form
# 239 where the Officer
is asked to make note of
any signs of the following;
dilated pupils, needle
tracks, staggering, tattoos,
puncture marks, scars,
signs of trauma, other ____
Section 2: Inmates Released by the New York City Department of Correction in 2005

33

Map 2.4: DOC-Released Drug-Using Inmates by Community District

34

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

SECTION 3:
Mapping Existing Service Providers:
Where Spatial Gaps Exist

T

his section maps the distribution of service providers that released inmates are
likely to use in each borough and community district. It does not purport to be a
census of all health and human service providers in each borough or community
district. No single database of addresses identifying all services for residents, or specifically for released inmates, is known to exist. Therefore, services in the four database lists
used in this report (DOHMH, THCCP, RIDE and Reentry Guidebooks) function as a
proxy measure of the availability and accessibility of services in each community.

Distribution of Services for Released Inmates
Map 3.1 identifies the location of services from all the directories: Rikers Island Discharge Enhancement (RIDE) services are identified as purple triangles, Transitional
Health Care Coordination Partner (THCC) services are green diamonds, reentry guidebook services are red squares, and New York City Department of Health and Mental
Hygiene (DOHMH) services are marked as blue circles. Maps 3.2 thru 3.5 represent the
four individual service directories with special attention on Map 3.2 to identifying the
three types of mental hygiene categories of services contracted with DOHMH. Mental
health services contracted with DOHMH are identified as green stars, mental retardation and developmental disabilities are blue squares and chemical dependency programs
and services are red circles. Green diamonds represent THCC services (Map 3.3), and
red squares are services listed in the reentry guidebooks (Map 3.4). There are five RIDE
service categories (Map 3.5): red star for clothing, purple square for education, blue star
for employment, green pentagon for housing, and red circle for substance abuse.
Disparities can be observed at the community district level (see Tables 3.1 through 3.4
in Appendix I for the number of services listed in each database by community district),
where it becomes apparent that there is a disproportionate number of available services
in certain districts. Two Manhattan community districts (105, 102), another on Staten
Island (501), and one in Brooklyn (302) account for approximately 25 percent of the
mental hygiene services contracted with DOHMH. Four community districts (105, 110,
Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

35

111, and 412) also account for 25 percent of the services on the THCC partner referral
list and the same Manhattan community districts (105, 110, 111) account for 30 percent
of services listed in the reentry guidebooks. Services located in community districts 111,
105, 201, 412, and 302 account for 27 percent of the RIDE services. For further visual
clarification, the following maps identify the address locations separately for services and
programs identified in each of the four databases. Without exception, the majority of
available services are located in Manhattan.

36

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Map 3.1: Type of Services in New York City by Community District

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

37

Map 3.2: DOHMH Services by Community District

38

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Map 3.3: Transitional Health Care Services by Community District

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

39

Map 3.4: Reentry Guidebook Services by Community District

40

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Map 3.5: Rikers Island Discharge Enhancement Services by Community District

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

41

Gaps in Post-Release Services
The maps reveal that not all returning inmates have equal access to services. Health and
human services appear to be available for inmates released to Manhattan, though this
may be a function of the quality of each database (Table 3.5). Meanwhile, services listed
in Brooklyn, the Bronx, and, at times, in Queens are underrepresented, based on the
percent of released inmates to those boroughs.
The findings also support recent data from DOHMH on the unmet chemical dependency service needs in the city. According to DOHMH, unmet needs are the “ratio of
current service capacity to estimated needed service capacity.”63 According to DOHMH,
Manhattan and the Bronx are the only two boroughs with an over-capacity of outpatient
chemical dependency services. Methadone treatment services are at under-capacity
levels in all five boroughs, though Manhattan has the greatest capacity of methadone
treatment needs met at 82 percent, compared to the Bronx (63 percent), Brooklyn (45
percent), Staten Island (40 percent), and Queens (30 percent).
Table 3.5:
The Number of Health and Human Services in New York City by Borough
Services
by
Borough

Released
Inmates

Mental Hygiene
Services
Contracted
with DOHMH

THCC Partner
Listings

RIDE Primary
Referral Sources

N

%

N

%

N

%

N

%

N

%

Brooklyn

13445

33.0%

146

21.5%

57

20.4%

78

16.8%

104

25.3%

Bronx

10435

25.6%

92

13.5%

61

21.8%

50

10.8%

80

19.5%

Manhattan

8458

20.8%

257

37.8%

116

41.4%

291

62.6%

154

37.5%

Queens

7000

17.2%

126

18.6%

32

11.4%

34

7.3%

51

12.4%

Staten
Island

1346

3.3%

58

8.5%

14

5.0%

12

2.6%

22

5.4%

Total

40684

100.0%

679

100.0%

280

100.0%

465

100.0%

411

100.0%

63

New York City Department of Health and Mental
Hygiene, Local Governmental Plan Chemical
Dependency Services2007, available at www.nyc.
gov/html/doh/downloads/
pdf/basas/basas-localgovtplan-2007.pdf (accessed on
November 9, 2007).
42

Reentry
Guidebook
Listings

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

The spatial mismatch of services listed in the directories becomes more apparent in the
individual community district level analysis (Maps 3.7, 3.9, 3.11, 3.13, 3.15 in this section and Table 3.7 in Appendix I). For example, only 26 percent of the mental hygiene
services contracted with DOHMH are located in the 14 community districts where
approximately half the inmates return. This is in comparison to 38 percent of the reentry
guidebook listings, 45 percent of the THCC partner listings, and 38 percent of the RIDE
listings. Additionally, some community districts have very few services listed in the
databases, and the services that are listed are not consistent in each database.
The profile of borough locations for mental hygiene services contracted with DOHMH
shows that 46 percent of the community districts with high rates of released inmates selfreporting drug use do not have access to city-contracted chemical dependency services
(see Tables 3.6 below and 3.9 in Appendix I). One limitation of the DOHMH data is that
it does not include programs and services funded and/or operated by New York State.64
Nevertheless, discharge planners rely primarily on these databases to connect inmates
with substance abuse services, so it is reasonable to assume that they are the exclusive
source of information used when making referrals.

Table 3.6: Chemical Dependency, Mental Health, and Mental Retardation
Programs and Services Contracted with DOHMH by Borough
Services
by
Borough

Released
Inmates

DOHMH Chemical
Dependency
Service
Addresses

Mental Health

Mental Retardation
and Developmental
Disabilities

N

%

N

%

N

%

N

%

Brooklyn

13445

33.0%

8

12.1%

115

22.7%

23

21.7%

Bronx

10435

25.6%

7

10.6%

70

13.8%

15

14.2%

Manhattan

8458

20.8%

32

48.5%

194

38.3%

31

29.2%

Queens

7000

17.2%

11

16.7%

95

18.7%

20

18.9%

Staten
Island

1346

3.3%

8

12.1%

33

6.5%

17

16.0%

Total

40684

100.0%

66

100.0%

507

100.0%

106

100.0%

64 A preliminary

analysis of
the 374 Substance Abuse
and Mental Health Services
Administration (SAMHSA)
drug and alcohol abuse
treatment programs in New
York City and licensed
by the New York State
Office of Alcoholism and
Substance Abuse Services
confirms that Manhattan
has the highest concentration of services (40
percent), followed by the
Bronx and Brooklyn (each
at 21 percent), Queens (13
percent), and Staten Island
(6 percent).

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

43

Density of Inmates and Services in Brooklyn
Maps 3.6 (previous page) and 3.7 (page 46) display areas of released inmates and social
services where density values for each are the greatest compared to other areas in
Brooklyn. While inmates, for example, may live in any community district in Brooklyn,
the majority are concentrated in the shaded purple areas of the maps. The same is true
of social services identified by zones of black, blue, orange, and green in map 3.7. The
map identifies areas of accessibility and inaccessibility of services for inmates released to
Brooklyn. Community District 304 (Bushwick) in Brooklyn is an example of the mismatch of services: a high concentration of inmates live there, but there are few available
services. For District 304, the THCC partner lists three services: Damon House (providing residential treatment), DOHMH’s TB Evaluation & Treatment Clinic, and Builders
for the Family and Youth (offering recreation programs). The reentry guidebooks also
list DOHMH’s TB Evaluation & Treatment Clinic, as well as Family Services Network
of New York and Make the Road for Walking (a legal services program). The DOHMH
mental hygiene directory lists three mental health services: Coalition for Hispanic Family
Services (adult clinic treatment), Institute for Community Living (case management) and
St. Christopher-Tillie (respite care). The primary referral resources for RIDE list seven
services in district 304: five housing (Bernard’s House, Alta House [three locations], and
Today is a Good Day) and two substance abuse services (Addiction Research and Treatment and Damon House).
Another problem area is Community District 303 (Bedford Stuyvesant, Tompkins Park
North, Stuyvesant Heights) in Brooklyn, which accounts for five percent of the known
drug users. The primary referral list for RIDE lists three substance abuse services (New
York Therapeutic Communities, Woodhull Medical/Mental Health Center, and Kingsboro Addiction Treatment Center). According to the DOHMH directory, the Brooklyn
USA Athletic Association, which focuses on youth education intervention/information
and referrals, is the only chemical dependency service contracted by the DOHMH.
Both the THCC and reentry guidebooks list Serendipity, a community-based residential
program for men and women, primarily for individuals in the criminal justice system
who have a substance abuse problem, in District 303.

44

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Map 3.6: Borough of Brooklyn – Density of DOC-Released Inmates

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

45

Map 3.7: Borough of Brooklyn – Density of DOC-Released Inmates
and Four Services by Community District

46

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Density of Inmates and Services in the Bronx
The spatial mismatch of services is also apparent in the Bronx. Maps 3.8 and 3.9 reveal
that the majority of services are clustered in Community Districts 201 through 205. Yet
inmates released to Districts 207, 209, 211, and 212 live in areas where social services
are not readily available. Another example of this disparity is Community District 209
(Soundview, Castle Hill, Union Port, Parkchester) in the Bronx, where 1,355 DOC inmates
returned in 2005. Community District 209 has only one mental health service listed in the
DOHMH database (New Era Veterans), one primary care service in the THCC partner
list (Soundview Community Health Service), and one substance abuse service in the
RIDE referral list (Albert Einstein College of Medicine of Yeshiva University). The reentry
guidebooks list no services at all in this high inmate return community district.

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

47

Map 3.8: Borough of Bronx – Density of DOC-Released Inmates

48

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Map 3.9: Borough of Bronx — Density of DOC-Released Inmates
and Four Services by Community District

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

49

Map 3.10: Borough of Manhattan –
Density of DOC-Released Inmates

Density of Inmates and Services
in Manhattan
Maps 3.10 and 3.11 confirm that
the location of social services is
more evenly distributed throughout Manhattan. Inmates released
to Manhattan have a higher rate
of availability and accessibility
of services compared to those
released in the Bronx and Brooklyn. Even in Manhattan, however,
the clustering of services is apparent in certain community districts
that are not necessarily where the
highest number of inmates are
released. For example, services
located in Community District 102
(Greenwich Village, Noho, Soho,
Little Italy) are overrepresented in
each database compared to the 0.5
percent of inmates (n=209) who in
2005 returned to the district. Seven
percent of services listed in the
reentry guidebooks (n=32) have a
102 community district address,
compared to six, four, and two
percent respectively for services
listed in the DOHMH mental
hygiene (n=43), THCC (n=11), and
RIDE (n=7) databases.

50

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Map 3.11: Borough of Manhattan – Density of DOC-Released Inmates and
Four Services by Community District

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

51

Density of Inmates and Services in Queens
Maps 3.12 and 3.13 of Queens highlight again the disparity of access to services in different
communities. Community District 412 (Jamaica, South Jamaica, Hollis, St. Albans) has
a high concentration of services to meet the inmates’ needs. On the other hand, District
414 (Rockaways, Broach Channel) is potentially underserved. It is evident from Map 3.4
that certain social service databases used during the reentry process do not have agencies
listed in certain community districts. For Queens, the guidebooks do not list any services
in districts 405, 410, 411, or 414 even though, in 2005, four percent (n=1,573) of all inmates
returned to those four districts and services are known to exist in these community
districts. For example, Community District 405 (Maspeth, Middle Village, Ridgewood,
Glendale) has a residential drug abuse facility, a non-residential mental health clinic, and
several food program and drop-in centers for adults and families, but these are not listed in
the guidebooks.

52

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Map 3.12: Borough of Queens – Density of DOC-Released Inmates

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

53

Map 3.13: Borough of Queens – Density of DOC-Released Inmates
and Four Services by Community District

54

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Density of Inmates and Services in Staten Island
Maps 3.14 and 3.15 of Staten Island show a more even distribution of services compared to
the residential location of returning inmates in Staten Island. In 2005, 71 percent (n=959)
of the released inmates on Staten Island lived in Community District 501 (North Island),
with 16 (n=215) and 13 percent (n=171) of the inmates respectively living in districts
502 (Mid-Island) and 503 (South Island). As shown on the map, however, the number of
services in district 503 is low. RIDE lists four substance abuse programs while DOHMH
and the guidebooks each list one service in this area.
Map 3.14: Borough of Staten Island – Density of DOC-Released Inmates

Section 3: Mapping Existing Service Providers: Where Spatial Gaps Exist

55

Map 3.15: Borough of Staten Island – Density of DOC-Released Inmates
and Four Services by Community District

56

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

SECTION 4:
Service Providers’ Perception
of Inter-Agency Collaboration

E

xperts increasingly agree that successful reintegration into the community is most
successful when there is a collaborative and coordinated effort by all stakeholders
who work with returning inmates. To further overall understanding of this process,
interviews were conducted with the director or a senior staff member of 13 health and
human service providers who work with inmates returning from New York City jails or
who work with the director of the provider’s reentry program.65,66 Topics of interest included agency and client characteristics, collaboration among individual service providers and
government and other non-government agencies, and overall community relations.

Characteristics of Surveyed Service Providers and Their Clients
Organizational characteristics
Service providers addressed a wide range of inmate reentry needs, describing their priorities as substance abuse treatment (three programs), homeless services (one), employment programs (three), legal assistance (one), alternatives to incarceration programs
(two), multi-tiered services for reentry populations (one), family services (one), and mental health treatment (one). (See Table 4.1.) Slightly more than half of the providers offer
24/7 access to at least one aspect of their operations, with all keeping regular Monday
through Friday business hours.
The surveyed agencies offer a mean of seven distinct reentry services, and there is wide
overlap among providers regarding the types of services offered. The most frequently
listed services were employment and job training (92 percent), case management (85
percent), drug and alcohol counseling (77 percent), alternative to incarceration programs
(69 percent), and mental health assistance and/or treatment (69 percent).

65

The criterion for an
agency to be included in
this survey was that the
agency be mentioned
in each of the following
NYC inmate reentry
handbooks published in
2005: 1). Stephan Likosky,
Connections 2005-2006
and The Job Search (New
York, NY: The New York
Public Library, 2005); 2).
Gerald Lopez, The Center
for Community Problem
Solving Reentry Guide:
A Handbook for People
Coming Out of Jails and
Prisons and for their
Families and Communities
(New York, NY: The Center
for Community Problem
Solving Press, 2005);
and 3). William Whitaker,
Making it Happen & Staying
Home (New York, NY:
Commission on Human
Rights, 2005); Thirteen
of 28 agencies contacted
participated in the survey.
66

Meetings were
scheduled with each
agency where the agency
representative answered
a closed- and open-ended
56-item questionnaire. The
questionnaire was adapted
from an Institutional and
Collaborative Relationship
survey produced in 1998
by the Center on Urban
Poverty and Social Change,
Case Western Reserve
University, Cleveland, Ohio,
and from a reentry offender
survey developed in 1994
by Department of Human
Services, Allegheny County,
Pennsylvania.

Section 4: Service Providers’ Perception of Inter-Agency Collaboration

57

Table 4.1: Organization Characteristics

58

Total programs surveyed
Agency priority
Alternative to incarceration (ATI)
Employment and training
Ex-Offender services
Family service/counseling
Health – Mental
Homeless service
Legal aid counseling/service
Substance abuse prevention & treatment

N
13

%
100

2
3
1
1
1
1
1
3

15
23
8
8
8
8
8
23

Hours of Operation
24/7
7 days, 9-5
M-F, 9-5

7
4
2

54
31
15

Services Offered
Alternative to incarceration (ATI)
Anger management
Case management
Child care and development
Child welfare
Community organization/advocacy
Culture and arts
Drug and alcohol counseling
Drug and alcohol treatment
Education/literacy assistance
Emergency food/clothing/shelter
Employment & training services
Financial planning
Housing referral/assistance
Information & referral
Legal assistance
Life-skills training
Medical treatment and/or assistance
Mental health treatment and/or assistance
Mentoring
Offender support
Parent/family counseling
Psychological assistance
Religious ministry
Self-help support group
Violence prevention/conflict resolution training
Other

9
9
11
1
1
8
3
10
6
7
6
12
7
9
11
5
11
8
9
7
9
8
4
11
4
8
4

69
69
85
08
08
62
23
77
46
54
46
92
54
7
85
38
85
62
69
54
69
62
31
8
31
62
31

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Client characteristics
All of the service providers interviewed offer services to reentry populations, with four
of 13 explicitly limiting services to individuals with a criminal history (Table 4.2). Most
agencies “strongly agreed” (77 percent) that released prisoners needed specialized services. Seventy-seven percent market their services to reentry populations, and 92 percent
receive funding targeted toward reentry. A mean of 23 percent of clients per agency were
court-ordered to obtain the agency’s services. Only one of 13 agencies serve clients from
outside of New York City’s five boroughs. The majority of clients for all 13 agencies were
drawn from Brooklyn, the Bronx, and Manhattan.
Table 4.2: Client Characteristics
Programs surveyed
Do you serve returning prisoners? (Yes)
Do you explicitly limit your services to individuals with a criminal history? (Yes)
Do you identify/classify returning prisoners as such in your records? (Yes)
To what extent do you agree or disagree that returning prisoners need specialized
services which differ from the services given to your other clients:
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Approximately what percentage of our clients are returning prisoners? (mean)
Do you market your services to returning prisoners? (Yes)
What percent of your clients are court-ordered to obtain your services? (mean)
*12 of 13 programs responding, 1 of 13 = Don’t Know)
From what geographic areas do you draw your clients?
Brooklyn
Bronx
Queens
Manhattan
Staten Island
Other
To what extent do you agree or disagree that returning prisoners come from the same
geographic areas as the majority of your other clients:
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
No opinion
Do you receive monies targeted toward serving returning prisoners?
What skills or training does your staff need to be most effective when working
with prisoners returning to the community?

N
13
13
4
7

%
100
100
31
54

10
2
1
0
9
10

77
15
8
0
7
77

0.23

0.23

13
11
7
12
6
1

100
85
54
92
46
8

11
1
0
0
1
12

85
8
0
0
8
92

Various

Various

Section 4: Service Providers’ Perception of Inter-Agency Collaboration

59

Assessment of Inter-Agency Collaboration
Ninety-two percent of providers had worked with other agencies on reentry issues and
77 percent agreed that there exists a “culture of organizations in New York City working
together to reintegrate prisoners back to their communities.” Further, 92 percent characterized the current political atmosphere as “supportive” of organizational alliances (Table
4.3). Examples given of organizational collaboration included recent DOC discharge
planning initiatives involving multi-agency collaboration (cited by 54 percent of respondents), agencies sharing staff for training and programmatic purposes (31 percent), and
cooperation among agencies in lobbying and funding efforts (23 percent). Barriers to collaboration include scarce funding and competition among agencies for the same clients.
Respondents listed a mean of 4.5 other agencies with which they collaborate (when asked
to list up to five). The purpose for developing these relationships included coordination
of discharge planning and substance abuse services, lobbying/advocacy, and transitional
housing. Most of the relationships cited had existed for more than five years, and many
were established 15-20 years prior. Respondents considered these relationships successful if client-level outcomes improved, the inter-organizational relationships continued,
and if joint funding was maintained or improved.

60

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 4.3: Organizational Collaboration
Programs surveyed
Is there a culture of agencies in New York City working together to reintegrate
prisoners back to their communities? (Yes)
Can you name and describe some recent examples of your agency working together
to reintegrate prisoners back into the community?
New York City DOC reentry/discharge planning initiative
Coordinated lobbying among NGOs
Shared staff training efforts
What discourages effective cooperation between agencies working
to reintegrate prisoners back into the community?
Lack of funding
Competition among NGOs for clients
Do you believe the political atmosphere in the community where your agency works
is supportive of organizational alliances, or not supportive? (Supportive)
Follow up: What do you see that supports this belief?
New York City government support of reentry reforms
Has your agency ever worked together with other agencies relating
to prisoner reentry issues? (Yes)
Number of other agencies with which your agency has collaborated (mean)
What was the purpose or goal of each relationship and how long
has each relationship lasted?
Coordinating discharge planning and re-entry services
Substance abuse services
Lobbying/advocacy
Transitional Housing
On what basis or by what criteria do you decide whether working relationships
between agencies have been successful or unsuccessful?
Client-centered outcomes are obtained
Discharge planning processes are improved
Programs’ outcomes are obtained
Intra-agency relationships continue
Continued funding
Are you aware of any problems that generally result from agencies working together
on prisoner reentry issues? (Yes)
What problems have you noticed, and how should they be addressed?
Competition among agencies for clients and funding

N
13

%
100

10

77

7
3
4

54
23
31

6
4

46
31

12

92

8

62

12
4.5

92
4.5

8
6
5
2

62
46
38
15

8
3
7
4
1

62
23
54
31
8

4

31

3

23

Section 4: Service Providers’ Perception of Inter-Agency Collaboration

61

Assessment of Collaboration with Government Agencies
All respondents reported either an ongoing or planned relationship with the DOC, and
77 percent expected the relationship to last five or more years (Table 4.4). The motivation for cultivating the relationship was described as coming from a desire to improve
discharge planning and case management. Advantages afforded by or expected from
working with DOC included better access to clients, better client outcomes, a bolstered
organizational mission, and improved funding. The majority of respondents described
interactions with DOC as being defined by clear strategies for goal attainment, documented protocols (e.g., memoranda or contracts), and a decision-making process of
negotiation and discussion.
Generally, respondents agreed that their agency and DOC “share a common vision”
(mean score 8.0), work together in an “atmosphere of mutual trust” (8.7), and had
“communicated fully” with DOC the purpose of the relationship (8.3).67 Most felt the
relationship between their agency and DOC “will result in positive change in how we
reenter people back into the community” (8.9), and that DOC was an “important force
for change” (8.3). Reaction was more neutral to these statements: “Influence is shared
equally” (6.1), and “I am satisfied with the current relationship between my agency and
DOC” (7.1).
When asked about changes needed in their agency’s relationship with DOC, the most
common response was that no changes are needed (46 percent of respondents). Other
suggestions were for better communication and more collaborative decision making
on the part of DOC. When asked what policy changes would help the service providers be more effective in reintegrating inmates back into the community, 62 percent of
respondents felt that various government agencies and benefits could be much better
coordinated (e.g., housing and Medicaid benefits for reentry clients) and that government “silos” prevent such coordination. Increasing access to benefits prior to release
from jail was mentioned by 11 of 13 (84 percent) respondents when asked what DOC
must do next to improve reentry. In addition, six of 13, or 54 percent, of respondents
cited the importance of DOC continuing current efforts to improve discharge planning
for sentenced jail inmates in the near term as well as during subsequent administrations.

67

Seven Likert-scale
questions were used to
assess agencies’ attitudes
toward DOC. Responses
were along a 10-point scale
ranging from, “1–strongly
disagree,” to, “10–strongly
agree.”
62

When asked for summary comments, respondents commended the current DOC leadership for addressing many traditional barriers in order to improve reentry services, but also
described a need for improved reentry funding and better reentry service coordination
between New York State Department of Corrections, NYS Division of Parole, and DOC.

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 4.4: Collaboration with Governmental Agencies
Programs surveyed
Are you familiar with any DOC reentry initiatives? (Yes)
Has your agency established a relationship with DOC? (Yes)
With which component at DOC?
Discharge planning (DOC Commissioner’s office)
What is the person’s name and title of the DOC person you work with?
What is the purpose of the relationship your agency has developed with DOC?
Discharge planning
Case management
Supportive housing
What is the current status of your organization’s relationship with DOC?
Planned
Ongoing
Complete
In what ways do you believe it will be advantageous for your organization
to work with the DOC?
Improved access to clients
Congruent with our organization’s mission
Is your organization’s relationship with DOC defined by ways of organization documents,
memos, or written agreements, etc.? (Yes) *12 of 13 respondents (1 of 13 = not applicable)
Have clear strategies for goal attainment been created? (Yes)
*11 of 13 respondents (2 of 13 = not applicable)
Is there a written agenda describing these goals and objectives? (Yes)
*10 of 13 respondents (3 of 13 = not applicable)
In pursuing the relationship we are discussing here, does your organization and DOC
share responsibility for specific tasks? (Yes) *12 of 13 respondents (1 of 13 = not applicable)
Are the responsibilities documented in writing (memos, agreements, contracts, other)?
(Yes) *9 of 13 respondents (4 of 13 = not applicable)
What is the process by which DOC and your organization make decisions
in this relationship?
Collaboration & negotiation
DOC mandates policy
What specific benefits do you anticipate as a result working with DOC?
Improved client access
Improved outcomes
Collaboration among NGOs
Increased funding
Do you expect your organization and DOC to share equally in the benefits? (Yes)
Do you expect this relationship to endure? (Yes)

N
13
10
12

%
100
77
92

8

62

8
4
1

62
31
8

2
11
0

15
84
0

6
10

46
77

8

67

8

73

8

80

8

67

8

89

8
1

62
08

8
10
1
3
12
12

62
77
8
23
92
82

Section 4: Service Providers’ Perception of Inter-Agency Collaboration

63

Table 4.4: Collaboration with Governmental Agencies (cont.)
How long do you expect this relationship to continue? *12 of 13 respondents
*(1 of 13 = not applicable)
6 months or less
6 months to one year
1 year to 2 years
2 years to 3 years
3 years to 4 years
5 years or more
What policy changes in how bureaucracies work would help you be more effective
in reintegrating prisoners back into the community?
Improving coordination of benefits / dissolving government ‘silos’
With regard to the purpose of our relationship, my organization and DOC share a
common vision (mean score, 1-10 Likert scale; 1=strongly disagree, 10=strongly agree)
The atmosphere between my organization and DOC is characterized by mutual trust
(mean score, 1-10 Likert scale; 1=strongly disagree, 10=strongly agree)
My organization and DOC have communicated fully our reasons for participating in this
relationship (mean score, 1-10 Likert scale; 1=strongly disagree, 10=strongly agree)
Influence is shared equally among the participants in this relationship
(mean score, 1-10 Likert scale; 1=strongly disagree, 10=strongly agree)
I believe the relationship between my organization and DOC will result
in positive change in how we reenter people back into the community
(mean score, 1-10 Likert scale; 1=strongly disagree, 10=strongly agree)
DOC is an important force for change in this community
(mean score, 1-10 Likert scale; 1=strongly disagree, 10=strongly agree)
I am satisfied with the current relationship between my organization and DOC
(mean score, 1-10 Likert scale; 1=strongly disagree, 10=strongly agree)
If you could, what would you change about your relationship with DOC?
No changes are needed
Better communication, more collaborative decisions
Improved access to DOC facilities
What incentives would make it more likely that your organization would
form a working relationship with DOC?
Continuation of current programs and relationships
What do you believe DOC must do next in order to be more successful
in reentering prisoners back into the community?
Continue w/ discharge planning initiatives (e.g., RIDE center)
Increase pre-discharge benefit coordination
Housing and treatment referrals
Are there other agencies in the community that presently work with DOC? (Yes)
Do they have similar activities working with the same people? (Yes)
*11 of 13 responding (2 of 13 = no answer)
Is this a source of conflict? (Yes) *12 of 13 responding (1 of 13 = no answer)

64

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

1
0
0
1
0
10

8
0
0
8
0
77

8

62

8
8.67
8.33
6.11

8.92
8.27
7.08
6
5
1

46
38
8

9

69

7
11
2
1

54
84
15
1

5
1

64
9)

Assessment of Community Relations
Most respondents described a lack of community support for reentry populations as well
as a lack of support for locating reentry services in the organization’s community (Table
4.5). When asked to name members of the community that could help the agency’s
reentry efforts, the New York City Housing Authority was the entity most often listed (31
percent of respondents), followed by other city agencies and officials, community boards,
and various community-based agencies. It was noted that most of the community-based
agencies mentioned were part of the survey’s target sample.

Table 4.5: Community Relations
Programs surveyed
What attitudes or circumstances in the community your agency works in harms
the success of reentering prisoners back into the community?
Lack of community support for hosting reentry services and populations
Lack of community support for hosting re-entry housing
Can you list the names of two individuals and/or agencies in your community who are or
could be successful in helping your agency reintegrating prisoners back to the community?
New York City Housing Authority
New York City agencies and officials (various)
Community-based agencies (various)
Local philanthropic agencies
Are there further comments you would like to make about this survey, about DOC,
or about working within inter-organizational collaboration in general?
Is there anything else you would like to say about your organization and connections
with other entities or agencies within and outside the community that work
with people returning home from prison?
City and State CJS bodies should better coordinate re-entry services
Despite advances in New York City reentry services more resources are needed
Current DOC leadership has broken many traditional barriers to improving re-entry services

N
13

%
100

12
7

92
53

4
9
3
1

31
69
23
8

6
2
3

46
15
23

Section 4: Service Providers’ Perception of Inter-Agency Collaboration

65

Discussion
Representatives of the 13 New York City service agencies who were interviewed
described relationships with the DOC as largely collaborative, productive, well-established, and projected to be long in duration. The most frequently cited obstacles to
reentry work were limited funds and limited clients sought by multiple agencies (e.g.,
employment agencies and inpatient drug treatment centers recruiting the same soonto-be-released individual). Other barriers to improved reentry services include a lack of
pre-release benefit coordination and access (e.g., housing support and Medicaid), and a
general lack of support by the agencies’ home communities for hosting reentry services
such as transitional housing within these same communities.
Although just over half (54 percent) of the target service providers were reached for
the survey, it was notable that the service priorities of the 13 responding agencies were
representative of core reentry needs, including housing, employment and job training,
substance abuse and mental health treatment, and family and legal support. A comparison of agencies based on publicly available information found that agencies that did
not respond were similar in terms of size and services offered to those that did respond.
Many of the respondents were also participants in recent citywide reentry improvement efforts led by DOC and likely represent the largest “players” within New York City
reentry services.
Among the 13 responding agencies, there was a mix of programs. Some were designed
for clients whether or not they were reentering the community from a period of incarceration while others were restricted to reentering clients. While 12 of the 13 programs
agreed that reentry clients have the same geographic origins as other clientele, most
agencies stated that reentry clients need “specialized services” compared to non-reentry
clients. Four of the 13 limit their programs to reentry clients. These findings indicate that
both “blended” and “specialty” approaches to reentry programs are common and active
models among New York City agencies.
While competition for clients and limited funding was readily acknowledged, a more
prevalent assessment of these relationships was that they were long-standing, included
multiple agencies, and served to enhance lobbying and advocacy, staff training, and the
coordination of complementary services (e.g., mental health and transitional housing
services). Generally, the service providers described the expected outcomes from these
efforts as improved client services, successful programs, and the continuation of the
inter-organizational relationships. Overall, these interviews indicated a healthy culture of
support, interaction, and collaboration among reentry agencies in New York City.
Most agencies also described well-established, usually formally defined, working relationships (via contracts or other written documents) with the DOC, predominantly
66

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

involving discharge planning and post-release case management. DOC was viewed as
sharing their organization’s vision, establishing mutual trust, “communicating fully,” and
partnering for “positive change” with the responding agencies, attitudes that may indicate a broad approval of current DOC reentry policies.
However, while DOC was seen as “an important force for change,” there were no perceived guarantees that currently successful reentry initiatives involving discharge planning would last beyond the tenure of current DOC leadership. Whether or not DOC’s
present commitment and enthusiasm for such efforts would extend over the long-term
was a common and recurring concern. Respondents were largely neutral on the statement that influence was shared equally with DOC. Given that many of the agencies
depend on DOC as contractors and for access to clients, overall favorable attitudes
toward DOC may reflect unequal relationships with a powerful government body.
These interviews documented a climate of active collaboration between agencies and
strong approval of DOC reentry efforts, albeit among a limited sample of reentry service
agencies. The importance of sustained efforts to improve reentry was seen as a challenge
for future leaders of both the community agencies and government entities. Communities that are home to persons leaving jail and prison are often unsupportive of hosting
important reentry components such as transitional housing. Gaps in health insurance
coverage and other entitlements related to incarceration are viewed as crucial barriers to
successful reentry. These have persisted despite recent discharge planning improvements
at New York City jails, suggesting a need to continue and strengthen such reforms.
Coordination between service providers and correctional authorities remains at an early
stage; providers are not yet confident that the city’s commitment to partnering in reentry
efforts is stable and long-term. Specific barriers to partnering, from the perspective of
service agencies, include inconsistencies in benefit status and stability for re-entering
individuals, issues with overlapping services, and coordination of services across settings.
Broader community support, relationships with community boards, and local advocacy
to define and establish the roles of service providers’ reentry efforts were also felt to be
important by responding agencies.

Section 4: Service Providers’ Perception of Inter-Agency Collaboration

67

68

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

SECTION 5:
Conclusions and Recommendations
for Future Work

As with other major cities, New York City faces complex challenges related to the
community reentry of inmates released from jail. A large proportion of the inmates who
are released each year from the New York City Department of Correction (DOC) have
significant medical or mental health conditions that require ongoing management in the
community. DOC and the New York City Department of Health and Mental Hygiene
(DOHMH) have implemented reentry strategies that help to address these needs, including discharge planning, case management, and working with community-based service
providers. These strategies are intended to leverage improved public health outcomes
overall (as the inmate population has such a high incidence of health issues) and may
also provide benefit through lower rates of recidivism.
However, inmates return in disproportionate numbers to impoverished, disorganized
communities, with 26 percent returning to just six community districts. These communities appear to be less well-prepared for inmate reentry, as evidenced by an underallocation of service locations at the borough and community district level. Even when
services are available, awareness of these services and how to access them appears to be
dependent upon printed resource directories used by discharge planners, none of which
are comprehensive. As noted in Section 3, the different directories often list different service providers, so a returning inmate or a discharge planner is limited in knowing what
services are available by the particular directory being used. In certain instances, services
do exist in a community district, but they are not identified in the reentry guidebooks.
Service providers interviewed for this profile report problems resulting from limited
funds, poor pre-release coordination, difficulties accessing benefits, and a lack of community support for reentry services. Despite the large numbers of inmates returning to
these communities, providers report that there are few clients for their services, suggesting that there are other, underlying reasons why inmates do not seek out or continue to
utilize the community services that do exist.

Section 5: Conclusions and Recommendations for Future Work

69

Future Study Possibilities
These findings raise some important questions related to the behavior, needs, and preferences of reentering inmates and their communities. Suggestions for further study are
identified below. These result from the findings contained in this report, input from the
13 surveyed agency representatives, and comments recorded at a roundtable of 21 public
health officials and scholars (including the authors of this report) in April 2007, which
focused on the roles and applicability of public health paradigms in public policy (in
particular, policy regarding the reentry of individuals into their communities from jail).
•

Descriptive studies regarding inmates’ post-release utilization of health
care services. At present, it is not known how reentering inmates actually use
medical and mental health services. This profile suggests a mismatch between
the needs of returning inmates and access to providers. Data regarding actual
utilization will better inform policy makers.

•

Descriptive studies to help stakeholders understand the nature and extent
of barriers reentering inmates face in obtaining health care. Stakeholders
need to understand whether returning inmates, or segments of this population,
are motivated to seek medical and psychiatric care in the community, and what
resources they use to locate these services. It would be useful to know if reentering inmates are seeking treatment outside their local communities and, if so,
why. For example, it is possible that reentering inmates may seek treatment in
other neighborhoods due to the stigma attached to a number of the common
medical conditions found in the inmate population. Alternatively, some may
believe that they can obtain higher quality services in more affluent communities. Studies about service utilization and preferences would also help to inform
policy decisions regarding how best to provide transition services.
It is important to understand why service providers interviewed for this profile
report a scarcity of clients in the face of large numbers of reentering inmates.
Results of descriptive studies could inform decisions as to whether inmates need
incentives or coercion to obtain care in the community. For example, if incompetent, seriously mentally ill inmates are repeatedly failing to obtain outpatient
care, programs such as Assisted Outpatient Treatment may be useful.

•

70

Evaluation of community support problems. Service providers who were
interviewed report a lack of community support for reentry services. Policy
makers need a better understanding of the sources of support and opposition
to reentry within communities. Models of mobilizing community advocates,
educating other entities in the community, and minimizing stigma associated
with incarceration could be developed. Descriptive studies might be undertaken

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

to ascertain any sources of opposition, the level of understanding about the
importance of reentry, and the intensity of current feelings on the issue.
As part of the effort to lay the groundwork for engaging the community in the planning
and implementation of reentry, a planning initiative funded by the Langeloth Foundation
will be implemented collaboratively between New York University School of Medicine
and the John Jay College of Criminal Justice of the City University of New York. Working with DOC and DOHMH, this effort will be a preliminary effectiveness study of high
impact communities and will also evaluate the communities’ interest and readiness for
a larger demonstration pilot. The pilot study will use local planning and mobilization
resources to design more responsive health links for individuals reentering the community. In addition, city agencies and university partners will evaluate behavior and barriers
in relation to service use and will work toward changes in the discharge planning process
based on some of the suggestions contained in this report.

Section 5: Conclusions and Recommendations for Future Work

71

72

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX A

List of Tables
Section 2
2.1

Living Arrangement of DOC-Released Inmates by Borough

2.2

Top Quartile of Community Districts with Highest Number of DOC-Released
Inmates

2.3

Community Districts with the Highest Rate of DOC-Released Inmates

2.4

Top Count Charges of DOC-Released Inmates

2.5

Criminal Justice Background Characteristics of DOC-Released Inmates by
Borough

2.6

Criminal Justice Background Characteristics of DOC-Released Inmates by Status
at Release

2.7

Community Districts in the Top Two Quartiles of DOC-Released Drug-Using
Inmates

2.8

Baseline Demographic Characteristics of DOC-Released Inmates by Borough

2.9

The Frequency and Rate of DOC-Released Inmates by Community Districts

2.10

The Number of DOC-Released Inmates by Community District

2.11

The Rate of DOC-Released Inmates by Community District

Section 3
3.1

The Number of Mental Hygiene Programs and Services Contracted with
DOHMH in 2004 by Community District

Appendix A: List of Tables, GIS Maps, and Figures

73

3.2

The Number of Services in Partnership with the Bureau of Transitional Health
Care Coordination in 2006 by Community District

3.3

The Number of Services Listed in New York City Reentry Guidebooks by Community District

3.4

The Number of Rikers Island Discharge Enhancement Primary Referral Sources
by Community District

3.5

The Number of Health and Human Services in New York City by Borough

3.6

Chemical Dependency, Mental Health, and Mental Retardation Programs and
Services Contracted with DOHMH by Borough

3.7

Health and Human Services Located in the Community Districts with the Highest Rate of DOC-Released Inmates

3.8

Chemical Dependency, Mental Health, and Mental Retardation Programs and
Services Contracted with DOHMH in 2004 by Borough

3.9

Community Districts in the Top Two Quartiles of DOC-Released Drug-Using
Inmates Released by Chemical Dependency Services

3.10

Community Districts in the Top Two Quartiles of DOC-Released Inmates by
Chemical Dependency, Mental Health, and Mental Retardation Services

Section 4

74

4.1

DOC Reentry Project Organizational Survey: Organization Characteristics

4.2

DOC Reentry Project Organizational Survey: Client Characteristics

4.3

DOC Reentry Project Organizational Survey: Organizational Collaboration

4.4

DOC Reentry Project Organizational Survey: Collaboration with Governmental
Agencies

4.5

DOC Reentry Project Organizational Survey: Community Relations

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

List of GIS Maps
Section 2
2.1

DOC-Released Inmates by Community District

2.2

DOC-Released Non-Hispanic, Black Inmates by Community District

2.3

DOC-Released Hispanic Inmates by Community District

2.4

DOC-Released Drug-Using Inmates by Community District

Section 3
3.1

Type of Services in New York City by Community District

3.2

DOHMH Services by Community District

3.3

Transitional Health Care Services by Community District

3.4

Reentry Guidebook Services by Community District

3.5

Rikers Island Discharge Enhancement Services by Community District

3.6

Borough of Brooklyn – Density of DOC-Released Inmates

3.7

Borough of Brooklyn – Density of DOC-Released Inmates and Four Services by
Community District

3.8

Borough of Bronx – Density of DOC-Released Inmates

3.9

Borough of Bronx – Density of DOC-Released Inmates and Four Services by
Community District

3.10

Borough of Manhattan – Density of DOC-Released Inmates

3.11

Borough of Manhattan – Density of DOC-Released Inmates and Four Services
by Community District

3.12

Borough of Queens – Density of DOC-Released Inmates

3.13

Borough of Queens – Density of DOC-Released Inmates and Four Services by
Community District

3.14

Borough of Staten Island – Density of DOC-Released Inmates
Appendix A: List of Tables, GIS Maps, and Figures

75

3.15

Borough of Staten Island – Density of DOC-Released Inmates and Four Services
by Community District

List of Figures
Section 1
1.1

DOC Inmates Length of Stay

1.2

Department of Health and Mental Hygiene Table of Organization

Section 2

76

2.1

New York City Inmate Reentry Handbook Covers

2.2

Race of DOC-Released Inmates by Borough

2.3

Ethnicity of DOC-Released Inmates by Borough

2.4

DOC-Released Inmates by Borough at Arrest

2.5

DOC Inmate Status at Release

2.6

DOC Inmate Status of Release by Borough

2.7

DOC-Released Inmates and Their Classification Scores

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX B
New York City Correctional Health Services
Intake History and Physical Exam

Appendix B: New York City Correctional Health Services Intake History and Physical Exam

77

78

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Appendix B: New York City Correctional Health Services Intake History and Physical Exam

79

80

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Appendix B: New York City Correctional Health Services Intake History and Physical Exam

81

82

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX C
HIV Continuum of Care Model

Appendix C: HIV Continuum of Care Model

83

84

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX D
Take Care New York Passport to Your Health

Appendix D: Take Care New York Passport to Your Health

85

86

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX E
New York City Department of Correction
Discharge Planning Questionnaire

Appendix E: New York City Department of Correction Discharge Planning Questionnaire

87

88

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX F
New York City Department of Correction
Rikers Island Discharge Enhancement Plan

Appendix F: New York City Department of Correction Rikers Island Discharge Enhancement Plan

89

90

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Appendix F: New York City Department of Correction Rikers Island Discharge Enhancement Plan

91

92

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Appendix F: New York City Department of Correction Rikers Island Discharge Enhancement Plan

93

94

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX G
Dial 311 Palm Card

Figure 1.6: Dial 311

Appendix G: Dial 311 Palm Card

95

96

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX H
Tables Profiling DOC Inmates Released to
Communities in New York City

Table 2.5: Criminal Justice Background Characteristics of DOC-Released Inmates by Borough
Variable
Status at Release

Brooklyn

Bronx

Manhattan

Queens

N

%

N

%

N

%

N

Pretrial Detainee

8,597

63.9%

5,958

57.1%

4,621

54.6%

4,600

City Sentence

4,608

34.3%

4,188

40.1%

3,640

43.0%

Tech PV

240

1.8%

289

2.8%

197

< 1 day

1,060

7.9%

1,129

10.8%

1-3 days

3,865

28.7%

2,778

4-7 days

3,359

25.0%

8-15 days

1,443

16-30 days

%

Staten Island

Citywide

N

%

N

%

65.7%

845

62.8%

2,4621

60.5%

2,339

33.4%

470

34.9%

15,245

37.5%

2.3%

61

0.9%

31

2.3%

818

2.0%

999

11.8%

852

12.2%

100

7.4%

4,140

10.2%

26.6%

2,381

28.2%

2,363

33.8%

380

28.2%

11,767

28.9%

2,645

25.3%

1,922

22.7%

1,278

18.3%

351

26.1%

9,555

23.5%

10.7%

1,055

10.1%

774

9.2%

705

10.1%

123

9.1%

4,100

10.1%

1,410

10.5%

984

9.4%

775

9.2%

661

9.4%

123

9.1%

3,953

9.7%

31-60 days

1,087

8.1%

861

8.3%

671

7.9%

544

7.8%

133

9.9%

3,296

8.1%

61-180 days

988

7.3%

788

7.6%

735

8.7%

491

7.0%

103

7.7%

3,105

7.6%

181-360 days

233

1.7%

195

1.9%

201

2.4%

106

1.5%

33

2.5%

768

1.9%

Self-Reported
Drug Use

2,666

19.8%

2,523

24.2%

1,510

17.9%

1,090

15.6%

202

15.0%

7,991

19.6%

0-5 low score

6,806

50.6%

4,717

45.2%

4,053

47.9%

4,117

58.9%

670

49.8%

20,363

50.1%

6-10 low medium
score

4,181

31.1%

3,597

34.5%

2,783

32.9%

1,956

27.9%

444

33.0%

12,961

31.9%

11-16 high medium
score

1,857

13.8%

1,659

15.9%

1,262

14.9%

718

10.3%

178

13.2%

5,674

13.9%

17+ high score

601

4.5%

462

4.4%

360

4.3%

209

3.0%

54

4.0%

1,686

4.1%

Length of Stay

Classification Points

Appendix H: Tables Profiling DOC Inmates Released to Communities in New York City

97

Table 2.6: Criminal Justice Background Characteristics
of DOC-Released Inmates by Status at Release
Variable

Pretrial Detainees
(N=24,621)

City Sentence
(N=15,245)

Technical Parole
Violators
N=818

31.9

36.1

35.8

Mean age at arrest
Length of Stay

N

%

N

%

N

%

< 1 day

2,395

9.7%

1,745

11.4%

0

0.0%

1-3 days

8,546

34.7%

3,211

21.1%

10

1.2%

4-7 days

6,877

27.9%

2,658

17.4%

20

2.4%

8-15 days

2,176

8.8%

1,792

11.8%

132

16.1%

16-30 days

1,710

6.9%

2,025

13.3%

218

26.7%

31-60 days

1,412

5.7%

1,650

10.8%

234

28.6%

61-180 days

1,316

5.3%

1,587

10.4%

202

24.7%

181-360 days

189

0.8%

577

3.8%

2

0.2%

Self-Reported
Drug Use

3,837

15.6%

3,904

25.6%

250

30.6%

0-5 low score

12,056

48.9%

8,237

54.1%

70

8.5%

6-10 low medium
score

7,670

31.2%

5,007

32.8%

284

34.7%

11-16 high medium
score

3,683

15.0%

1,646

10.8%

345

42.2%

17+ high score

1,212

4.9%

355

2.3%

119

14.5%

Classification Points

98

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 2.7: Community Districts in the Top Two Quartiles
of DOC-Released Drug-Using Inmates
Community Districts

Frequency

Percent

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Heights (BK)

422

5.3%

305 East New York, New Lots, City Line, Starrett City (BK)

422

4.4%

111 East Harlem (MHN)

340

4.3%

304 Bushwick (BK)

339

4.2%

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

337

4.2%

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

329

4.1%

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

325

4.1%

204 Highbridge, Concourse (BX)

323

4.0%

201 Mott Haven, Melrose, Port Morris (BX)

320

4.0%

110 Central Harlem (MHN)

267

3.3%

206 East Tremont, Bathgate, Belmont, West Farms (BX)

247

3.1%

202 Hunts Point, Longwood (BX)

233

2.9%

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

229

2.9%

Total

4,133

50.8%

Appendix H: Tables Profiling DOC Inmates Released to Communities in New York City

99

Table 2.8: Baseline Demographic Characteristics of DOC-Released Inmates by Borough
Variable

Brooklyn
N

Number of released
inmates (%)

%

13,445

Mean Age at Arrest

33.0%

Bronx

Manhattan

Queens

Staten Island

N

%

N

%

N

%

10,435

25.6%

8,458

20.8

7,000

17.2%

33.49

33.27

35.01

Age

N

%

<18

466

3.5%

356

3.4%

18-25

3,783

28.1%

3,037

26-36

3,589

26.7%

37-47

4,044

48-65
66 <

N

%

N

N
1,346

32.42

Citywide

%

N

3.3%

40,684

33.04

%
100.0%

33.55

%

N

%

N

%

N

%

228

2.7%

309

4.4%

30

2.2%

1389

3.4%

29.1%

2,097

24.8%

2,253

32.2%

410

30.5%

11,580

28.5%

2,799

26.8%

2,215

26.2%

1,823

26.0%

381

28.3%

10,807

26.6%

30.1%

3,112

29.8%

2,649

31.3%

1,873

26.8%

383

28.5%

12,061

29.6%

1,529

11.4%

1,099

10.5%

1,215

14.4%

715

10.2%

139

10.3%

4,697

11.5%

34

0.3%

32 9

0.3%

54

0.6%

27

0.4%

3

0.2%

150

0.4%

Male

11,888

88.4%

9,207

88.2%

7,437

87.9%

6,297

90%

1,181

87.7%

36,010

88.5%

Female

1,557

11.6%

1,228

11.8%

1,021

12.1%

703

10%

165

12.3%

4,674

11.5%

Black

9,294

69.1%

5,456

52.3%

4,916

58.1%

3,776

53.9%

658

48.9%

24,100

59.2%

White

1,765

13.1%

967

9.3%

1,108

13.1%

1,439

20.6%

498

37.0%

5,777

14.2%

Asian

57

0.4%

15

0.1%

59

0.7%

221

3.2%

5

0.4%

357

0.9%

Am. Indian

9

0.1%

16

0.2%

7

0.1%

44

0.6%

0

0.0%

76

0.2%

Other

2,275

16.9%

1,869

17.9%

2,217

26.2%

1,491

21.3%

173

12.9%

8,025

19.7%

Unknown

45

0.3%

2,112

20.2%

151

1.8%

20

0.4%

12

0.9%

2349

5.8%

3,139

23.3%

4,822

46.2%

3,065

36.2%

1,915

27.4%

264

19.6%

13,205

32.5%

Sex

Race

Ethnicity
Hispanic

100

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 2.9: The Frequency and Rate of DOC-Released Inmates by Community Districts

Released Inmates by Community District

Number of
Released
Inmates

% of Released
Inmates in All
Community
Districts

Rate of Released
Inmates per 1,000
People in the
Community

101 Civic Center, Wall Street, Governors Island, Liberty Island (MHN)

140

0.3%

4.0

102 Greenwich Village, Noho, Soho, Little Italy (MHN)

209

0.5%

2.0

103 Lower East Side, Chinatown, Two Bridges (MHN)

901

2.2%

5.0

104 Chelsea, Clinton (MHN)

567

1.4%

6.0

105 Midtown, Times Square, Herald Square, Midtown South (MHN)

250

0.6%

6.0

106 Murray Hill, East Midtown, Stuyvesant Town (MHN)

200

0.5%

1.0

107 Lincoln Square, Upper West Side (MHN)

644

1.6%

3.0

108 Upper East Side, Lenox Hill, Yorkville, Roosevelt Island (MHN)

186

0.5%

1.0

109 West Harlem, Morningside Heights, Manhattanville, Hamilton Hgts (MHN)

835

2.1%

7.0

110 Central Harlem (MHN)

1,772

4.4%

17.0

111 East Harlem (MHN)

1,617

4.0%

14.0

112 Washington Heights, Inwood (MHN)

1,135

2.8%

5.0

201 Mott Haven, Melrose, Port Morris (BX)

1,110

2.7%

14.0

202 Hunts Point, Longwood (BX)

660

1.6%

14.0

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

982

2.4%

14.0

204 Highbridge, Concourse (BX)

1,392

3.4%

10.0

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

1,515

3.7%

12.0

206 East Tremont, Bathgate, Belmont, West Farms (BX)

813

2.0%

11.0

207 Kingsbridge Heights., Bedford Park, Fordham, University Heights (BX)

1,000

2.5%

7.0

208 Kingsbridge, Riverdale, Marble Hill, Fieldston (BX)

173

0.4%

2.0

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

1,355

3.3%

8.0

210 Throgs Neck, Pelham Bay, Co-op City, Westchester Square, City Island (BX)

282

0.7%

2.0

211 Morris Park, Pelham Parkway, Bronxdale, Van Nest, Laconia (BX)

374

0.9%

3.0

212 Williamsbridge, Baychester, Woodlawn, Wakefield, Eastchester (BX)

781

1.9%

5.0

Manhattan

Bronx

Appendix H: Tables Profiling DOC Inmates Released to Communities in New York City

101

Table 2.9: The Frequency and Rate of DOC-Released Inmates by Community Districts (cont.)

Released Inmates by Community District

Number of
Released
Inmates

% of Released
Inmates in all
Community
Districts

Rate of Released
Inmates per 1,000
people in the
community

301 Greenpoint, Williamsburg (BK)

683

1.7%

4.0

302 Downtown Brooklyn, Fort Greene, Brooklyn Heights, Boerum Hill (BK)

482

1.2%

5.0

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Heights (BK)

2,076

5.1%

14.0

304 Bushwick (BK)

1,166

2.9%

11.0

305 East New York, New Lots, City Line, Starrett City (BK)

1,768

4.3%

10.0

306 Red Hook, Park Slope, Gowanus, Carroll Gardens, Cobble Hill (BK)

426

1.0%

4.0

307 Sunset Park, Windsor Terrace (BK)

453

1.1%

4.0

308 Crown Heights, Prospect Heights, Weeksville (BK)

1,040

2.6%

11.0

309 Crown Heights South, Prospect Lefferts Gardens, Wingate (BK)

729

1.8%

7.0

310 Bay Ridge, Dyker Heights, Fort Hamilton (BK)

173

0.4%

1.0

311 Bensonhurst, Mapleton, Bath Beach, Gravesend (BK)

262

0.6%

2.0

312 Borough Park, Ocean Parkway, Kensington (BK)

239

0.6%

1.0

313 Coney Island, Brighton Beach, Gravesend, Homecrest, Seagate (BK)

448

1.1%

4.0

314 Flatbush, Ocean Parkway, Midwood (BK)

642

1.6%

4.0

315 Sheepshead Bay, Manhattan Beach, Kings Highway, Gravesend (BK)

249

0.6%

2.0

316 Ocean Hill, Brownsville (BK)

1,338

3.3%

16.0

317 Flatbush, Rugby, Farragut, Northeast Flatbush (BK)

757

1.9%

5.0

318 Canarsie, Flatlands, Marine Park, Mill Basin, Bergen Beach (BK)

514

1.3%

3.0

401 Astoria, Long Island City (QN)

700

1.7%

3.0

402 Sunnyside , Woodside (QN)

257

0.6%

2.0

403 Jackson Heights, East Elmhurst, North Corona (QN)

536

1.3%

3.0

404 Elmhurst , Corona (QN)

391

1.0%

2.0

405 Maspeth, Middle Village, Ridgewood, Glendale (QN)

355

0.9%

2.0

406 Rego Park , Forest Hills (QN)

97

0.2%

1.0

407 Flushing, Whitestone, College Point (QN)

377

0.9%

2.0

Brooklyn

Queens

102

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 2.9: The Frequency and Rate of DOC-Released Inmates by Community Districts (cont.)

Released Inmates by Community District

Number of
Released
Inmates

% of Released
Inmates in all
Community
Districts

Rate of Released
Inmates per 1,000
people in the
community

408 Fresh Meadows, Kew Gardens Hills, Jamaica Hills (QN)

293

0.7%

2.0

409 Woodhaven, Richmond Hill, Kew Gardens (QN)

302

0.7%

2.0

410 Howard Beach, Ozone Park, South Ozone Park (QN)

354

0.9%

3.0

411 Bayside, Douglaston, Little Neck, Auburndale (QN)

132

0.3%

1.0

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

1,774

4.4%

8.0

413 Laurelton, Cambria Heights, Queens Village, Glen Oaks (QN)

700

1.7%

4.0

414 The Rockaways, Broad Channel (QN)

732

1.8%

7.0

501 North Island (SI)

959

2.4%

6.0

502 Mid-Island (SI)

215

0.5%

2.0

503 South Island (SI)

171

0.4%

1.0

Total

40,684

100.0%

Staten Island

Appendix H: Tables Profiling DOC Inmates Released to Communities in New York City

103

Table 2.10: The Number of DOC-Released Inmates by Community District

Community Districts

104

Number of
Released
Inmates

% of Released
Inmates in All
Community
Districts

Cumulative %
of Released
Inmates

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Heights (BK)

2,076

5.1%

5.1%

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

1,774

4.4%

9.5%

110 Central Harlem (MHN)

1,772

4.4%

13.8%

305 East New York, New Lots, City Line, Starrett City (BK)

1,768

4.3%

18.2%

111 East Harlem (MHN)

1,617

4.0%

22.1%

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

1,515

3.7%

25.9%

204 Highbridge, Concourse (BX)

1,392

3.4%

29.3%

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

1,355

3.3%

32.6%

316 Ocean Hill, Brownsville (BK)

1,338

3.3%

35.9%

304 Bushwick (BK)

1,166

2.9%

38.8%

112 Washington Heights, Inwood (MHN)

1,135

2.8%

41.6%

201 Mott Haven, Melrose, Port Morris (BX)

1,110

2.7%

44.3%

308 Crown Heights, Prospect Heights, Weeksville (BK)

1,040

2.6%

46.8%

207 Kingsbridge Heights., Bedford Park, Fordham, University Heights (BX)

1,000

2.5%

49.3%

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

982

2.4%

51.7%

501 North Island (SI)

959

2.4%

54.1%

103 Lower East Side, Chinatown, Two Bridges (MHN)

901

2.2%

56.3%

109 West Harlem, Morningside Heights, Manhattanville, Hamilton Hgts (MHN)

835

2.1%

58.3%

206 East Tremont, Bathgate, Belmont, West Farms (BX)

813

2.0%

60.3%

212 Williamsbridge, Baychester, Woodlawn, Wakefield, Eastchester (BX)

781

1.9%

62.3%

317 Flatbush, Rugby, Farragut, Northeast Flatbush (BK)

757

1.9%

64.1%

414 The Rockaways, Broad Channel (QN)

732

1.8%

65.9%

309 Crown Heights South, Prospect Lefferts Gardens, Wingate (BK)

729

1.8%

67.7%

401 Astoria , Long Island City (QN)

700

1.7%

69.4%

413 Laurelton, Cambria Heights, Queens Village, Glen Oaks (QN)

700

1.7%

71.2%

301 Greenpoint, Williamsburg (BK)

683

1.7%

72.8%

202 Hunts Point, Longwood (BX)

660

1.6%

74.5%

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 2.10: The Number of DOC-Released Inmates by Community District (cont.)

Community Districts

Number of
Released
Inmates

% of Released
Inmates in All
Community
Districts

Cumulative %
of Released
Inmates

107 Lincoln Square, Upper West Side (MHN)

644

1.6%

76.0%

314 Flatbush, Ocean Parkway, Midwood (BK)

642

1.6%

77.6%

104 Chelsea, Clinton (MHN)

567

1.4%

79.0%

403 Jackson Heights, East Elmhurst, North Corona (QN)

536

1.3%

80.3%

318 Canarsie, Flatlands, Marine Park, Mill Basin, Bergen Beach (BK)

514

1.3%

81.6%

302 Downtown Brooklyn, Fort Greene, Brooklyn Heights, Boerum Hill (BK)

482

1.2%

82.8%

307 Sunset Park, Windsor Terrace (BK)

453

1.1%

83.9%

313 Coney Island, Brighton Beach, Gravesend, Homecrest, Seagate (BK)

448

1.1%

85.0%

306 Red Hook, Park Slope, Gowanus, Carroll Gardens, Cobble Hill (BK)

426

1.0%

86.0%

404 Elmhurst , Corona (QN)

391

1.0%

87.0%

407 Flushing, Whitestone, College Point (QN)

377

0.9%

87.9%

211 Morris Park, Pelham Parkway, Bronxdale, Van Nest, Laconia (BX)

374

0.9%

88.8%

405 Maspeth, Middle Village, Ridgewood, Glendale (QN)

355

0.9%

89.7%

410 Howard Beach, Ozone Park, South Ozone Park (QN)

354

0.9%

90.6%

409 Woodhaven, Richmond Hill, Kew Gardens (QN)

302

0.7%

91.3%

408 Fresh Meadows, Kew Gardens Hills, Jamaica Hills (QN)

293

0.7%

92.0%

210 Throgs Neck, Pelham Bay, Co-op City, Westchester Square, City Island (BX)

282

0.7%

92.7%

311 Bensonhurst, Mapleton, Bath Beach, Gravesend (BK)

262

0.6%

93.4%

402 Sunnyside , Woodside (QN)

257

0.6%

94.0%

105 Midtown, Times Square, Herald Square, Midtown South (MHN)

250

0.6%

94.6%

315 Sheepshead Bay, Manhattan Beach, Kings Highway, Gravesend (BK)

249

0.6%

95.2%

312 Borough Park, Ocean Parkway, Kensington (BK)

239

0.6%

95.8%

502 Mid-Island (SI)

215

0.5%

96.4%

102 Greenwich Village, Noho, Soho, Little Italy (MHN)

209

0.5%

96.9%

106 Murray Hill, East Midtown, Stuyvesant Town (MHN)

200

0.5%

97.4%

108 Upper East Side, Lenox Hill, Yorkville, Roosevelt Island (MHN)

186

0.5%

97.8%

208 Kingsbridge, Riverdale, Marble Hill, Fieldston (BX)

173

0.4%

98.2%

310 Bay Ridge, Dyker Heights, Fort Hamilton (BK)

173

0.4%

98.7%

Appendix H: Tables Profiling DOC Inmates Released to Communities in New York City

105

Table 2.10: The Number of DOC-Released Inmates by Community District (cont.)

Community Districts

106

Number of
Released
Inmates

% of Released
Inmates in All
Community
Districts

Cumulative %
of Released
Inmates

503 South Island (SI)

171

0.4%

99.1%

101 Civic Center, Wall Street, Governors Island, Liberty Island (MHN)

140

0.3%

99.4%

411 Bayside, Douglaston, Little Neck, Auburndale (QN)

132

0.3%

99.8%

406 Rego Park , Forest Hills (QN)

97

0.2%

100.0%

Total

40,684

100.0%

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 2.11: The Rate of DOC-Released Inmates by Community District

Community Districts

Number of
Released
Inmates

Rate of Released
Inmates per 1,000

110 Central Harlem (MHN)

1,772

16.5

316 Ocean Hill, Brownsville (BK)

1,338

15.7

111 East Harlem (MHN)

1,617

13.7

201 Mott Haven, Melrose, Port Morris (BX)

1,110

13.5

202 Hunts Point, Longwood (BX)

660

14.1

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

982

14.3

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Heights (BK)

2,076

14.4

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

1,515

11.8

206 East Tremont, Bathgate, Belmont, West Farms (BX)

813

10.7

304 Bushwick (BK)

1,166

11.2

308 Crown Heights, Prospect Heights, Weeksville (BK)

1,040

10.8

204 Highbridge, Concourse (BX)

1,392

10.0

305 East New York, New Lots, City Line, Starrett City (BK)

1,768

10.2

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

1,355

8.1

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

1,774

7.9

109 West Harlem, Morningside Heights, Manhattanville, Hamilton Hgts (MHN)

835

7.5

207 Kingsbridge Heights., Bedford Park, Fordham, University Heights (BX)

1,000

7.1

309 Crown Heights South, Prospect Lefferts Gardens, Wingate (BK)

729

7.0

414 The Rockaways, Broad Channel (QN)

732

6.9

104 Chelsea, Clinton (MHN)

567

6.5

105 Midtown, Times Square, Herald Square, Midtown South (MHN)

250

5.7

501 North Island (SI)

959

5.9

103 Lower East Side, Chinatown, Two Bridges (MHN)

901

5.5

112 Washington Heights, Inwood (MHN)

1,135

5.4

212 Williamsbridge, Baychester, Woodlawn, Wakefield, Eastchester (BX)

781

5.2

302 Downtown Brooklyn, Fort Greene, Brooklyn Heights, Boerum Hill (BK)

482

4.9

317 Flatbush, Rugby, Farragut, Northeast Flatbush (BK)

757

4.6

Appendix H: Tables Profiling DOC Inmates Released to Communities in New York City

107

Table 2.11: The Rate of DOC-Released Inmates by Community District (cont.)

Community Districts

108

Number of
Released
Inmates

Rate of Released
Inmates per 1,000

101 Civic Center, Wall Street, Governors Island, Liberty Island (MHN)

140

4.1

301 Greenpoint, Williamsburg (BK)

683

4.3

306 Red Hook, Park Slope, Gowanus, Carroll Gardens, Cobble Hill (BK)

426

4.1

307 Sunset Park, Windsor Terrace (BK)

453

3.8

313 Coney Island, Brighton Beach, Gravesend, Homecrest, Seagate (BK)

448

4.2

314 Flatbush, Ocean Parkway, Midwood (BK)

642

3.8

413 Laurelton, Cambria Heights, Queens Village, Glen Oaks (QN)

700

3.6

107 Lincoln Square, Upper West Side (MHN)

644

3.1

211 Morris Park, Pelham Parkway, Bronxdale, Van Nest, Laconia (BX)

374

3.4

318 Canarsie, Flatlands, Marine Park, Mill Basin, Bergen Beach (BK)

514

2.6

401 Astoria , Long Island City (QN)

700

3.3

403 Jackson Heights, East Elmhurst, North Corona (QN)

536

3.2

410 Howard Beach, Ozone Park, South Ozone Park (QN)

354

2.8

102 Greenwich Village, Noho, Soho, Little Italy (MHN)

209

2.2

208 Kingsbridge, Riverdale, Marble Hill, Fieldston (BX)

173

1.7

210 Throgs Neck, Pelham Bay, Co-op City, Westchester Square, City Island (BX)

282

2.4

311 Bensonhurst, Mapleton, Bath Beach, Gravesend (BK)

262

1.5

315 Sheepshead Bay, Manhattan Beach, Kings Highway, Gravesend (BK)

249

1.6

402 Sunnyside , Woodside (QN)

257

2.3

404 Elmhurst , Corona (QN)

391

2.3

405 Maspeth, Middle Village, Ridgewood, Glendale (QN)

355

2.1

407 Flushing, Whitestone, College Point (QN)

377

1.6

408 Fresh Meadows, Kew Gardens Hills, Jamaica Hills (QN)

293

2.0

409 Woodhaven, Richmond Hill, Kew Gardens (QN)

302

2.1

502 Mid-Island (SI)

215

1.7

106 Murray Hill, East Midtown, Stuyvesant Town (MHN)

200

1.5

108 Upper East Side, Lenox Hill, Yorkville, Roosevelt Island (MHN)

186

0.9

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 2.11: The Rate of DOC-Released Inmates by Community District (cont.)

Community Districts

Number of
Released
Inmates

Rate of Released
Inmates per 1,000

310 Bay Ridge, Dyker Heights, Fort Hamilton (BK)

173

1.4

312 Borough Park, Ocean Parkway, Kensington (BK)

239

1.3

406 Rego Park , Forest Hills (QN)

97

0.8

411 Bayside, Douglaston, Little Neck, Auburndale (QN)

132

1.1

503 South Island (SI)

171

1.1

Appendix H: Tables Profiling DOC Inmates Released to Communities in New York City

109

110

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX I
Tables Profiling the Distribution of
Services for Released Inmates

Table 3.1: The Number of Mental Hygiene Programs and Services Contracted
with DOHMH in 2004 by Community District

Community Districts

Number of
DOHMH Services

Percent of Total
Services

Cumulative
Percent

105 Midtown, Times Square, Herald Square, Midtown South (MHN)

46

6.8%

6.8%

102 Greenwich Village, Noho, Soho, Little Italy (MHN)

43

6.3%

13.1%

501 North Island (SI)

40

5.9%

19.0%

302 Downtown Brooklyn, Fort Greene, Brooklyn Heights, Boerum Hill (BK)

31

4.6%

23.6%

111 East Harlem (MHN)

27

4.0%

27.5%

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

27

4.0%

31.5%

110 Central Harlem (MHN)

25

3.7%

35.2%

107 Lincoln Square, Upper West Side (MHN)

22

3.2%

38.4%

101 Civic Center, Wall Street, Governors Island, Liberty Island, Ellis Island, Tribeca (MHN)

18

2.7%

41.1%

104 Chelsea, Clinton (MHN)

18

2.7%

43.7%

103 Lower East Side, Chinatown, Two Bridges (MHN)

17

2.5%

46.2%

414 The Rockaways, Broad Channel (QN)

17

2.5%

48.7%

502 Mid-Island (SI)

17

2.5%

51.3%

112 Washington Heights, Inwood (MHN)

16

2.4%

53.6%

404 Elmhurst , Corona (QN)

14

2.1%

55.7%

201 Mott Haven, Melrose, Port Morris (BX)

12

1.8%

57.4%

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

12

1.8%

59.2%

211 Morris Park, Pelham Parkway, Bronxdale, Van Nest, Laconia (BX)

12

1.8%

61.0%

307 Sunset Park, Windsor Terrace (BK)

12

1.8%

62.7%

314 Flatbush, Ocean Parkway, Midwood (BK)

12

1.8%

64.5%

411 Bayside, Douglaston, Little Neck, Auburndale (QN)

12

1.8%

66.3%

Appendix I: Tables Profiling the Distribution of Services for Released Inmates

111

Table 3.1: The Number of Mental Hygiene Programs and Services Contracted
with DOHMH in 2004 by Community District (cont.)

Community Districts

112

Number of
DOHMH Services

Percent of Total
Services

Cumulative
Percent

109 West Harlem, Morningside Heights, Manhattanville, Hamilton Heights (MHN)

11

1.6%

67.9%

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

11

1.6%

69.5%

305 East New York, New Lots, City Line, Starrett City (BK)

11

1.6%

71.1%

316 Ocean Hill, Brownsville (BK)

11

1.6%

72.8%

401 Astoria , Long Island City (QN)

11

1.6%

74.4%

108 Upper East Side, Lenox Hill, Yorkville, Roosevelt Island (MHN)

10

1.5%

75.8%

204 Highbridge, Concourse (BX)

10

1.5%

77.3%

210 Throgs Neck, Pelham Bay, Co-op City, Westchester Square, City Island (BX)

10

1.5%

78.8%

312 Borough Park, Ocean Parkway, Kensington (BK)

10

1.5%

80.3%

318 Canarsie, Flatlands, Marine Park, Mill Basin, Bergen Beach (BK)

10

1.5%

81.7%

408 Fresh Meadows, Kew Gardens Hills, Jamaica Hills (QN)

10

1.5%

83.2%

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Height (BK)

8

1.2%

84.4%

407 Flushing, Whitestone, College Point (QN)

8

1.2%

85.6%

207 Kingsbridge Heights., Bedford Park, Fordham, University Heights (BX)

7

1.0%

86.6%

309 Crown Heights South, Prospect Lefferts Gardens, Wingate (BK)

7

1.0%

87.6%

402 Sunnyside , Woodside (QN)

7

1.0%

88.7%

301 Greenpoint, Williamsburg (BK)

6

0.9%

89.5%

315 Sheepshead Bay, Manhattan Beach, Kings Highway, Gravesend (BK)

6

0.9%

90.4%

406 Rego Park , Forest Hills (QN)

6

0.9%

91.3%

208 Kingsbridge, Riverdale, Marble Hill, Fieldston (BX)

5

0.7%

92.0%

212 Williamsbridge, Baychester, Woodlawn, Wakefield, Eastchester (BX)

5

0.7%

92.8%

306 Red Hook, Park Slope, Gowanus, Carroll Gardens, Cobble Hill (BK)

5

0.7%

93.5%

403 Jackson Heights, East Elmhurst, North Corona (QN)

5

0.7%

94.3%

413 Laurelton, Cambria Heights, Queens Village, Glen Oaks (QN)

5

0.7%

95.0%

106 Murray Hill, East Midtown, Stuyvesant Town (MHN)

4

0.6%

95.6%

202 Hunts Point, Longwood (BX)

4

0.6%

96.2%

304 Bushwick (BK)

4

0.6%

96.8%

206 East Tremont, Bathgate, Belmont, West Farms (BX)

3

0.4%

97.2%

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 3.1: The Number of Mental Hygiene Programs and Services Contracted
with DOHMH in 2004 by Community District (cont.)

Community Districts

Number of
DOHMH Services

Percent of Total
Services

Cumulative
Percent

308 Crown Heights, Prospect Heights, Weeksville (BK)

3

0.4%

97.6%

310 Bay Ridge, Dyker Heights, Fort Hamilton (BK)

3

0.4%

98.1%

313 Coney Island, Brighton Beach, Gravesend, Homecrest, Seagate (BK)

3

0.4%

98.5%

317 Flatbush, Rugby, Farragut, Northeast Flatbush (BK)

3

0.4%

99.0%

409 Woodhaven, Richmond Hill, Kew Gardens (QN)

2

0.3%

99.3%

410 Howard Beach, Ozone Park, South Ozone Park (QN)

2

0.3%

99.6%

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

1

0.1%

99.7%

311 Bensonhurst, Mapleton, Bath Beach, Gravesend (BK)

1

0.1%

99.9%

503 South Island (SI)

1

0.1%

100.0%

Total

679

100.0%

Appendix I: Tables Profiling the Distribution of Services for Released Inmates

113

Table 3.2: The Number of Services in Partnership with the Bureau
of Transitional Health Care Coordination in 2006 by Community District

Community Districts

114

Number of
THCC Services

Percent of Total
Services

Cumulative
Percent

111 East Harlem (MHN)

26

9.3%

9.3%

105 Midtown, Times Square, Herald Square, Midtown South (MHN)

16

5.7%

15.0%

110 Central Harlem (MHN)

14

5.0%

20.0%

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

14

5.0%

25.0%

104 Chelsea, Clinton (MHN)

13

4.6%

29.6%

201 Mott Haven, Melrose, Port Morris (BX)

13

4.6%

34.3%

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Height (BK)

13

4.6%

38.9%

501 North Island (SI)

12

4.3%

43.2%

102 Greenwich Village, Noho, Soho, Little Italy (MHN)

11

3.9%

47.1%

204 Highbridge, Concourse (BX)

11

3.9%

51.1%

103 Lower East Side, Chinatown, Two Bridges (MHN)

10

3.6%

54.6%

101 Civic Center, Wall Street, Governors Island, Liberty Island, Ellis Island, Tribeca (MHN)

9

3.2%

57.9%

302 Downtown Brooklyn, Fort Greene, Brooklyn Heights, Boerum Hill (BK)

9

3.2%

61.1%

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

7

2.5%

63.6%

202 Hunts Point, Longwood (BX)

6

2.1%

65.7%

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

6

2.1%

67.9%

308 Crown Heights, Prospect Heights, Weeksville (BK)

6

2.1%

70.0%

109 West Harlem, Morningside Heights, Manhattanville, Hamilton Heights (MHN)

5

1.8%

71.8%

207 Kingsbridge Heights., Bedford Park, Fordham, University Heights (BX)

5

1.8%

73.6%

305 East New York, New Lots, City Line, Starrett City (BK)

5

1.8%

75.4%

107 Lincoln Square, Upper West Side (MHN)

4

1.4%

76.8%

112 Washington Heights, Inwood (MHN)

4

1.4%

78.2%

206 East Tremont, Bathgate, Belmont, West Farms (BX)

4

1.4%

79.6%

301 Greenpoint, Williamsburg (BK)

4

1.4%

81.1%

314 Flatbush, Ocean Parkway, Midwood (BK)

4

1.4%

82.5%

106 Murray Hill, East Midtown, Stuyvesant Town (MHN)

3

1.1%

83.6%

210 Throgs Neck, Pelham Bay, Co-op City, Westchester Square, City Island (BX)

3

1.1%

84.6%

211 Morris Park, Pelham Parkway, Bronxdale, Van Nest, Laconia (BX)

3

1.1%

85.7%

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 3.2: The Number of Services in Partnership with the Bureau
of Transitional Health Care Coordination in 2006 by Community District (cont.)

Community Districts

Number of
THCC Services

Percent of Total
Services

Cumulative
Percent

304 Bushwick (BK)

3

1.1%

86.8%

315 Sheepshead Bay, Manhattan Beach, Kings Highway, Gravesend (BK)

3

1.1%

87.9%

316 Ocean Hill, Brownsville (BK)

3

1.1%

88.9%

401 Astoria , Long Island City (QN)

3

1.1%

90.0%

208 Kingsbridge, Riverdale, Marble Hill, Fieldston (BX)

2

0.7%

90.7%

306 Red Hook, Park Slope, Gowanus, Carroll Gardens, Cobble Hill (BK)

2

0.7%

91.4%

402 Sunnyside , Woodside (QN)

2

0.7%

92.1%

403 Jackson Heights, East Elmhurst, North Corona (QN)

2

0.7%

92.9%

404 Elmhurst , Corona (QN)

2

0.7%

93.6%

406 Rego Park , Forest Hills (QN)

2

0.7%

94.3%

408 Fresh Meadows, Kew Gardens Hills, Jamaica Hills (QN)

2

0.7%

95.0%

414 The Rockaways, Broad Channel (QN)

2

0.7%

95.7%

502 Mid-Island (SI)

2

0.7%

96.4%

108 Upper East Side, Lenox Hill, Yorkville, Roosevelt Island (MHN)

1

0.4%

96.8%

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

1

0.4%

97.1%

307 Sunset Park, Windsor Terrace (BK)

1

0.4%

97.5%

309 Crown Heights South, Prospect Lefferts Gardens, Wingate (BK)

1

0.4%

97.9%

312 Borough Park, Ocean Parkway, Kensington (BK)

1

0.4%

98.2%

317 Flatbush, Rugby, Farragut, Northeast Flatbush (BK)

1

0.4%

98.6%

318 Canarsie, Flatlands, Marine Park, Mill Basin, Bergen Beach (BK)

1

0.4%

98.9%

409 Woodhaven, Richmond Hill, Kew Gardens (QN)

1

0.4%

99.3%

411 Bayside, Douglaston, Little Neck, Auburndale (QN)

1

0.4%

99.6%

413 Laurelton, Cambria Heights, Queens Village, Glen Oaks (QN)

1

0.4%

100.0%

Total

280

100.0%

90.0%

Appendix I: Tables Profiling the Distribution of Services for Released Inmates

115

Table 3.3: The Number of Services Listed in New York City Reentry Guidebooks by Community District

Community Districts

116

Number of
Guidebook
Services

Percent of Total
Services

Cumulative
Percent

111 East Harlem (MHN)

59

12.7%

12.7%

105 Midtown, Times Square, Herald Square, Midtown South (MHN)

44

9.5%

22.2%

110 Central Harlem (MHN)

38

8.2%

30.3%

102 Greenwich Village, Noho, Soho, Little Italy (MHN)

32

6.9%

37.2%

101 Civic Center, Wall Street, Governors Island, Liberty Island, Ellis Island, Tribect (MHN)

26

5.6%

42.8%

104 Chelsea, Clinton (MHN)

25

5.4%

48.2%

103 Lower East Side, Chinatown, Two Bridges (MHN)

21

4.5%

52.7%

302 Downtown Brooklyn, Fort Greene, Brooklyn Heights, Boerum Hill (BK)

21

4.5%

57.2%

109 West Harlem, Morningside Heights, Manhattanville, Hamilton Heights (MHN)

20

4.3%

61.5%

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Heights (BK)

19

4.1%

65.6%

201 Mott Haven, Melrose, Port Morris (BX)

12

2.6%

68.2%

501 North Island (SI)

11

2.4%

70.5%

106 Murray Hill, East Midtown, Stuyvesant Town (MHN)

10

2.2%

72.7%

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

10

2.2%

74.8%

202 Hunts Point, Longwood (BX)

8

1.7%

76.6%

308 Crown Heights, Prospect Heights, Weeksville (BK)

8

1.7%

78.3%

112 Washington Heights, Inwood (MHN)

7

1.5%

79.8%

204 Highbridge, Concourse (BX)

7

1.5%

81.3%

107 Lincoln Square, Upper West Side (MHN)

6

1.3%

82.6%

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

6

1.3%

83.9%

206 East Tremont, Bathgate, Belmont, West Farms (BX)

6

1.3%

85.2%

401 Astoria , Long Island City (QN)

6

1.3%

86.5%

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

5

1.1%

87.5%

305 East New York, New Lots, City Line, Starrett City (BK)

4

0.9%

88.4%

403 Jackson Heights, East Elmhurst, North Corona (QN)

4

0.9%

89.2%

108 Upper East Side, Lenox Hill, Yorkville, Roosevelt Island (MHN)

3

0.6%

89.9%

207 Kingsbridge Heights., Bedford Park, Fordham, University Heights (BX)

3

0.6%

90.5%

301 Greenpoint, Williamsburg (BK)

3

0.6%

91.2%

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 3.3: The Number of Services Listed in New York City Reentry Guidebooks
by Community District (cont.)
Community Districts

Number of
Guidebook
Services

Percent of Total
Services

Cumulative
Percent

304 Bushwick (BK)

3

0.6%

91.8%

306 Red Hook, Park Slope, Gowanus, Carroll Gardens, Cobble Hill (BK)

3

0.6%

92.5%

309 Crown Heights South, Prospect Lefferts Gardens, Wingate (BK)

3

0.6%

93.1%

314 Flatbush, Ocean Parkway, Midwood (BK)

3

0.6%

93.8%

316 Ocean Hill, Brownsville (BK)

3

0.6%

94.4%

402 Sunnyside , Woodside (QN)

3

0.6%

95.1%

408 Fresh Meadows, Kew Gardens Hills, Jamaica Hills (QN)

3

0.6%

95.7%

211 Morris Park, Pelham Parkway, Bronxdale, Van Nest, Laconia (BX)

2

0.4%

96.1%

404 Elmhurst , Corona (QN)

2

0.4%

97.0%

409 Woodhaven, Richmond Hill, Kew Gardens (QN)

2

0.4%

97.4%

413 Laurelton, Cambria Heights, Queens Village, Glen Oaks (QN)

2

0.4%

97.8%

210 Throgs Neck, Pelham Bay, Co-op City, Westchester Square, City Island (BX)

1

0.2%

98.1%

307 Sunset Park, Windsor Terrace (BK)

1

0.2%

98.3%

310 Bay Ridge, Dyker Heights, Fort Hamilton (BK)

1

0.2%

98.5%

313 Coney Island, Brighton Beach, Gravesend, Homecrest, Seagate (BK)

1

0.2%

98.7%

315 Sheepshead Bay, Manhattan Beach, Kings Highway, Gravesend (BK)

1

0.2%

98.9%

317 Flatbush, Rugby, Farragut, Northeast Flatbush (BK)

1

0.2%

99.1%

318 Canarsie, Flatlands, Marine Park, Mill Basin, Bergen Beach (BK)

1

0.2%

99.4%

406 Rego Park , Forest Hills (QN)

1

0.2%

99.6%

407 Flushing, Whitestone, College Point (QN)

1

0.2%

99.8%

503 South Island (SI)

1

0.2%

100.0%

Total

465

100.0%

Appendix I: Tables Profiling the Distribution of Services for Released Inmates

117

Table 3.4: The Number of Rikers Island Discharge Enhancement
Primary Referral Sources by Community District
Community Districts

118

RIDE Services

Percent of Total
Services

Cumulative
Percent

111 East Harlem (MHN)

30

7.3%

7.3%

105 Midtown, Times Square, Herald Square, Midtown South (MHN)

24

5.8%

13.1%

201 Mott Haven, Melrose, Port Morris (BX)

20

4.9%

18.0%

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

19

4.6%

22.6%

302 Downtown Brooklyn, Fort Greene, Brooklyn Heights, Boerum Hill (BK)

18

4.4%

27.0%

104 Chelsea, Clinton (MHN)

17

4.1%

31.1%

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Heights (BK)

17

4.1%

35.3%

103 Lower East Side, Chinatown, Two Bridges (MHN)

16

3.9%

39.2%

501 North Island (SI)

16

3.9%

43.1%

106 Murray Hill, East Midtown, Stuyvesant Town (MHN)

15

3.6%

46.7%

107 Lincoln Square, Upper West Side (MHN)

11

2.7%

49.4%

308 Crown Heights, Prospect Heights, Weeksville (BK)

11

2.7%

52.1%

110 Central Harlem (MHN)

10

2.4%

54.5%

204 Highbridge, Concourse (BX)

10

2.4%

56.9%

109 West Harlem, Morningside Heights, Manhattanville, Hamilton Heights (MHN)

9

2.2%

59.1%

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

9

2.2%

61.3%

206 East Tremont, Bathgate, Belmont, West Farms (BX)

9

2.2%

63.5%

211 Morris Park, Pelham Parkway, Bronxdale, Van Nest, Laconia (BX)

8

1.9%

65.5%

309 Crown Heights South, Prospect Lefferts Gardens, Wingate (BK)

8

1.9%

67.4%

102 Greenwich Village, Noho, Soho, Little Italy (MHN)

7

1.7%

69.1%

304 Bushwick (BK)

7

1.7%

70.8%

101 Civic Center, Wall Street, Governors Island, Liberty Island, Ellis Island, Tribeca (MHN)

6

1.5%

72.3%

202 Hunts Point, Longwood (BX)

6

1.5%

73.7%

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

6

1.5%

75.2%

301 Greenpoint, Williamsburg (BK)

6

1.5%

76.6%

305 East New York, New Lots, City Line, Starrett City (BK)

6

1.5%

78.1%

314 Flatbush, Ocean Parkway, Midwood (BK)

6

1.5%

79.6%

108 Upper East Side, Lenox Hill, Yorkville, Roosevelt Island (MHN)

5

1.2%

80.8%

306 Red Hook, Park Slope, Gowanus, Carroll Gardens, Cobble Hill (BK)

5

1.2%

82.0%

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Table 3.4: The Number of Rikers Island Discharge Enhancement
Primary Referral Sources by Community District (cont.)
Community Districts

RIDE Services

Percent of Total
Services

Cumulative
Percent

316 Ocean Hill, Brownsville (BK)

5

1.2%

83.2%

112 Washington Heights, Inwood (MHN)

4

1.0%

84.2%

210 Throgs Neck, Pelham Bay, Co-op City, Westchester Square, City Island (BX)

4

1.0%

85.2%

212 Williamsbridge, Baychester, Woodlawn, Wakefield, Eastchester (BX)

4

1.0%

86.1%

307 Sunset Park, Windsor Terrace (BK)

4

1.0%

87.1%

401 Astoria & Long Island City (QN)

4

1.0%

88.1%

408 Fresh Meadows, Kew Gardens Hills, Jamaica Hills (QN)

4

1.0%

89.1%

409 Woodhaven, Richmond Hill, Kew Gardens (QN)

4

1.0%

90.0%

503 South Island (SI)

4

1.0%

91.0%

310 Bay Ridge, Dyker Heights, Fort Hamilton (BK)

3

.7%

91.7%

313 Coney Island, Brighton Beach, Gravesend, Homecrest, Seagate (BK)

3

.7%

92.5%

402 Sunnyside & Woodside (QN)

3

.7%

93.2%

404 Elmhurst & Corona (QN)

3

.7%

93.9%

406 Rego Park & Forest Hills (QN)

3

.7%

94.6%

413 Laurelton, Cambria Heights, Queens Village, Glen Oaks (QN)

3

.7%

95.4%

414 The Rockaways, Broad Channel (QN)

3

.7%

96.1%

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

2

.5%

96.6%

317 Flatbush, Rugby, Farragut, Northeast Flatbush (BK)

2

.5%

97.1%

318 Canarsie, Flatlands, Marine Park, Mill Basin, Bergen Beach (BK)

2

.5%

97.6%

410 Howard Beach, Ozone Park, South Ozone Park (QN)

2

.5%

98.1%

502 Mid-Island (SI)

2

.5%

98.5%

207 Kingsbridge Heights., Bedford Park, Fordham, University Heights (BX)

1

.2%

98.8%

208 Kingsbridge, Riverdale, Marble Hill, Fieldston (BX)

1

.2%

99.0%

312 Borough Park, Ocean Parkway, Kensington (BK)

1

.2%

99.3%

403 Jackson Heights, East Elmhurst, North Corona (QN)

1

.2%

99.5%

405 Maspeth, Middle Village, Ridgewood, Glendale (QN)

1

.2%

99.8%

407 Flushing, Whitestone, College Point (QN)

1

.2%

100.0%

Total

411

100.0%

Appendix I: Tables Profiling the Distribution of Services for Released Inmates

119

Table 3.7: Health and Human Services Located in the Community Districts
with the Highest Rate of DOC-Released Inmates

Services Located in the Community Districts of Highest
Inmate Return -- 49.3 percent of the released inmates live in
these 14 community districts

THCC Partners
Listings

Reentry Guidebook Listings

RIDE Primary
Referral Sources

N

%

N

%

N

%

N

%

303 Bedford Stuyvesant, Tompkins Park North,
Stuyvesant Heights (BK)

8

1.2%

13

4.6%

19

4.1%

17

4.1%

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

27

4.0%

14

5.0%

10

2.2%

19

4.6%

110 Central Harlem (MHN)

25

3.7%

14

5.0%

38

8.2%

10

2.4%

305 East New York, New Lots, City Line, Starrett City (BK)

11

1.6%

5

1.8%

4

0.9%

6

1.5%

111 East Harlem (MHN)

27

4.0%

26

9.3%

59

12.7%

30

7.3%

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

12

1.8%

7

2.5%

5

1.1%

9

2.2%

204 Highbridge, Concourse (BX)

10

1.5%

11

3.9%

7

1.5%

10

2.4%

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

1

0.1%

1

0.4%

0

0.0%

2

0.5%

316 Ocean Hill, Brownsville (BK)

11

1.6%

3

1.1%

3

0.6%

5

1.2%

304 Bushwick (BK)

4

0.6%

3

1.1%

3

0.6%

7

1.7%

112 Washington Heights, Inwood (MHN)

16

2.4%

4

1.4%

7

1.5%

4

1.0%

201 Mott Haven, Melrose, Port Morris (BX)

12

1.8%

13

4.6%

12

2.6%

20

4.9%

308 Crown Heights, Prospect Heights, Weeksville (BK)

3

0.4%

6

2.1%

8

1.7%

11

2.7%

207 Kingsbridge Heights., Bedford Park, Fordham,
University Heights (BX)

7

1.0%

5

1.8%

3

0.6%

1

0.2%

Total

120

NYC DOHMH
Service Listings

25.7%

44.6%

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

38.3%

36.7%

Table 3.8: Chemical Dependency, Mental Health, and Mental Retardation Programs
and Services Contracted with DOHMH in 2004 by Borough
Services by Borough

Released
Inmates

NYC DOHMH Chemical
Dependency
Service Addresses

Mental Health

Mental Retardation
and Developmental
Disabilities

N

%

N

%

N

%

N

%

Brooklyn

13445

33.0%

8

12.1%

115

22.7%

23

21.7%

Bronx

10435

25.6%

7

10.6%

70

13.8%

15

14.2%

Manhattan

8458

20.8%

32

48.5%

194

38.3%

31

29.2%

Queens

7000

17.2%

11

16.7%

95

18.7%

20

18.9%

Staten Island

1346

3.3%

8

12.1%

33

6.5%

17

16.0%

Total

40684

100.0%

66

100.0%

507

100.0%

106

100.0%

Table 3.9: Community Districts in the Top Two Quartiles of DOC-Released
Drug-Using Inmates by Chemical Dependency Services
Frequency
of Drug Users

Community Districts with the Highest Numbers of Self
Reported Drug Use

NYC DOHMH Chemical RIDE Substance Abuse
Treatment Services
Dependency Services

N

%

N

%

N

%

303 Bedford Stuyvesant, Tompkins Park North, Stuyvesant Hgts (BK)

422

5.3%

1

1.5%

7

1.9%

305 East New York, New Lots, City Line, Starrett City (BK)

422

4.4%

0

0.0%

3

0.8%

111 East Harlem (MHN)

340

4.3%

3

4.5%

29

7.9%

304 Bushwick (BK)

339

4.2%

0

0.0%

2

0.5%

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

337

4.2%

0

0.0%

2

0.5%

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

329

4.1%

1

1.5%

8

2.2%

412 Jamaica, South Jamaica, Hollis, St. Albans (STN)

325

4.1%

2

3.0%

16

4.3%

204 Highbridge, Concourse (BX)

323

4.0%

0

0.0%

10

2.7%

201 Mott Haven, Melrose, Port Morris (BX)

320

4.0%

3

4.5%

19

5.2%

110 Central Harlem (MHN)

267

3.3%

1

1.5%

10

2.7%

206 East Tremont, Bathgate, Belmont, West Farms (BX)

247

3.1%

0

0.0%

8

2.2%

202 Hunts Point, Longwood (BX)

233

2.9%

2

3.0%

4

1.1%

203 Melrose, Morrisania, Claremont, Crotona Park East (BX)

229

2.9%

0

0.0%

6

1.6%

4,133

50.8%

13

19.5%

124

33.6%

Appendix I: Tables Profiling the Distribution of Services for Released Inmates

121

Table 3.10: Community Districts in the Top Two Quartiles of DOC-Released Inmates
by Chemical Dependency, Mental Health, and Mental Retardation Services

Highest Inmate Return by Community District

122

Frequency

DOHMH Chemical
Services

Mental Health
Services

Mental Retardation
Services

N

%

N

%

N

%

N

%

303 Bedford Stuyvesant, Tompkins Park North,
Stuyvesant Heights (BK)

2,076

5.1%

1

1.5%

7

1.4%

0

0.0%

412 Jamaica, South Jamaica, Hollis, St. Albans (QN)

1,774

4.4%

2

3.0%

24

4.7%

1

0.9%

110 Central Harlem (MHN)

1,772

4.4%

1

1.5%

22

4.3%

2

1.9%

305 East New York, New Lots, City Line, Starrett City (BK)

1,768

4.3%

0

0.0%

9

1.8%

2

1.9%

111 East Harlem (MHN)

1,617

4.0%

3

4.5%

23

4.5%

1

0.9%

205 Morris Heights, University Heights, Fordham, Mt. Hope (BX)

1,515

3.7%

1

1.5%

10

2.0%

1

0.9%

204 Highbridge, Concourse (BX)

1,392

3.4%

0

0.0%

10

2.0%

0

0.0%

209 Soundview, Castle Hill, Union Port, Parkchester (BX)

1,355

3.3%

0

0.0%

1

0.2%

0

0.0%

316 Ocean Hill, Brownsville (BK)

1,338

3.3%

1

1.5%

10

2.0%

0

0.0%

304 Bushwick (BK)

1,166

2.9%

0

0.0%

3

0.6%

1

0.9%

112 Washington Heights, Inwood (MHN)

1,135

2.8%

1

1.5%

15

3.0%

0

0.0%

201 Mott Haven, Melrose, Port Morris (BX)

1,110

2.7%

3

4.5%

9

1.8%

0

0.0%

308 Crown Heights, Prospect Heights, Weeksville (BK)

1,040

2.6%

0

0.0%

3

0.6%

0

0.0%

207 Kingsbridge Heights., Bedford Park, Fordham,
University Heights (BX)

1,000

2.5%

0

0.0%

4

0.8%

3

2.8%

Total

20,058

49.3%

13

19.5%

150

29.7%

11

10.2%

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

APPENDIX J
Bibliography

Anderson, Ronald M. “Revisiting the Behavioral Model and Access to Medical Care:
Does it Matter?” Journal of Health and Social Behavior 36, no. 1, (1995): 1-10.
Barr, Heather. “Transinstitutionalization in the Courts: Brad H. v. City of New York, and
the Fight for Discharge Planning for People with Psychiatric Disabilities Leaving Rikers
Island.” Crime and Delinquency 49 no 1 (2003): 97-123.
Black, K., and Richard Cho. New Beginnings: The Need for Supportive Housing for
Previously Incarcerated People. New York, NY: Common Ground Community/
Corporation for Supportive Housing, 2004.
Brad H. et al. v. The City of New York, et al 8 A.D.3d 142, 779 N.Y.S.2d 28, 2004 N.Y.
App. Div. N.Y. App. Div. 1st Dep’t, 2004.
Brad H. et al. v. The City of New York, et al. 1999. Complaint, class action, Supreme
Court of the State of New York, County of New York, Index No. 117882/99 (IAS Part
23). Available at www.urbanjustice.org.
Brad H. et al. v. The City of New York, et al., order of the Supreme Court of the State of
New York, 185 Misc. 2d 420; 712 N.Y.S. 2d 336. July 12, 2000.
Cadora, Eric, Mannix Gordon, and Charles Swartz. Criminal Justice and Health and
Human Services: An Exploration of Overlapping Needs, Resources, and Interests in
Brooklyn Neighborhood. Washington, DC: The Urban Institute, 2002.
Cho, Richard. Putting the Pieces Back Together: Overcoming Fragmentation to Prevent
Post-Incarceration Homelessness. Paper submitted to Housing & Criminal Justice Policy
in New York City, A Research and Practice Symposium Columbia University-Center for
Urban Research and Poverty, 2004.
City of New York. Department of City Planning. 2003 Annual Report on Social
Indicators. New York, NY: 2003.

Appendix J: Bibliography

123

City of New York. Fiscal 2005 Preliminary Budget Response: Part III Committee Reports
Based on the Preliminary Budget Hearings. New York, NY: March, 2004.
Feldman, Cassi. “Frequent Fliers Grounded: New Housing for Homeless.” City Limits
Weekly (December 19, 2005): 515.
Likosky, Stephan. Connections 2005-2006 and The Job Search. New York, NY: The New
York Public Library, 2005.
Lipton, Douglas S. The Effectiveness of Treatment for Drug Abusers Under Criminal
Justice Supervision. National Institute of Justice. Washington, DC: 1995. NCJ 157642.
Lopez, Gerald. The Center for Community Problem Solving Reentry Guide: A Handbook
for People Coming Out of Jails and Prisons and for their Families and Communities. New
York, NY: The Center for Community Problem Solving Press, 2005.
Magura, Stephen, Andrew Rosenblum, Carla Lewis, and Herman Joseph, “The
Effectiveness of In-jail Methadone Maintenance.” Journal of Drug Issues 23 (1993): 75-99.
Martin, Glen. “Rikers Island Discharge Planning Initiative: A New York City Jail Reentry
Model.” National HIRE Network News 3 no. 8 (2005): 1-10.
Moseley, Jeanne, Cynthia Gordon, Christopher Murrill, and Lucia Torian. An Evaluation of
Discharge Planning and Community Case Management Services for Incarcerated Adult Males
at Rikers Island: Correction Case Management at Rikers Island (CCARI). Paper presented at
the 2005 National HIV Prevention Conference., Atlanta, Georgia, June, 13, 2005.
New York City Administrative Code. Local Law No. 54: To Amend the Administrative
Code of the City of New York, in Relation to Discharge Planning Services. Available at
www.nyccouncil.info/pdf_files/bills/law04054.pdf.
New York City Commission on HIV/AIDS. Report of the New York City Commission on
HIV/AIDS. New York, NY: October, 2005.
New York City Council. Fiscal Year 2007 Executive Budget Hearings, Committee on
Finance Jointly with Committee on Fire and Criminal Justice Services. New York, NY:
May 2006.
New York City Department of Corrections. Discharge Planning Administrative Code 9
127, 9-128, 9-129 Mandates and Operationalization. New York, NY: 2005.

124

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

New York City Department of Corrections. Discharge Planning Update. New York, NY: 2005.
New York City Department of Corrections. Official Plan as of 10/18/2005. Discharge
Planning Action from May 2, 2005 Retreat. New York, NY: 2005.
New York City Department of Health and Mental Hygiene. Local Governmental Plan
Chemical Dependency Services-2007. Available at www.nyc.gov/html/doh/downloads/
pdf/basas/basas-localgovtplan-2007.pdf.
New York City Department of Health and Mental Hygiene. Take Care New York.
Available at nyc.gov/html/doh/html/tcny/index.shtml.
New York City Department of Health and Mental Hygiene. Transitional Health Care
Coordination- 2006. Available at www.nyc.gov/html/doh/html/hca/thcc.shtml.
New York City, The Mayor’s Management Report Fiscal 2005 Preliminary. New York, NY:
2005.
Parris, Roger K. “Public Health Collaborations in a Correctional Setting: New York City’s
Model.” Corrections Today. Available at www.aca.org/publications/ctarchives.asp#oct04.
Queralt, Magaly, and Ann Dryden Witte Queralt, “Estimating the Unmet Need for
Services: A Middling Approach.” Social Service Review (December 1999): 522-559.
Spaulding, Anne C., Kimberly R. Jacob Arriola, Theodore Hammett, Sofia Kennedy, and
Giulia Norton. Enhancing Linkage to HIV Primary Care in Jail Setting. Cambridge, MA:
Abt. Associates, 2007.
The Body. NYC Inmates Being Screened With New 20-Minute HIV Test. Available at
www.thebody.com/bp/jul04/newsline.html#1.
The Drum Major Institute for Public Policy. Marketplace of Idea Series: On the Power of
Restorative Justice. New York, NY: 2005: 26.
Van Ooyen, Marcel. Mental Health Update on the Implementation of the Brad H.
Settlement. Briefing Paper of the Human Service Division, Committee on Mental Health,
Mental Retardation, Alcoholism, Drug Abuse and Disability Services. New York, NY:
New York City Council, February 17, 2005.
Whitaker, William. Making it Happen & Staying Home. New York, NY: Commission on
Human Rights, 2005.
Appendix J: Bibliography

125

126

Mapping the Innovation in Correctional Health Care Service Delivery in New York City

Pertinent Acronyms
BK

Brooklyn

Brad H.

Brad H. et al. v. The City of New York, et. al.

BX

Bronx

CASES

Center for Alternative Sentencing and Employment Services

CDTP

Comprehensive Discharge and Treatment Plan

CHS

Correctional Health Services

DHS

Department of Homeless Services

DOC

New York City Department of Corrections

DOHMH

New York City Department of Health and Mental Hygiene

EMTC

Eric M. Taylor Center

FUSE

Frequent User Service Enhancement

GIS

Geographic Information Systems

HCAI

Health Care Access and Improvement

HHC

New York City Health and Hospitals Corporation

HIPPA

Health Insurance Portability & Accountability Act

KEEP

Key Extended Entry Program

MHN

Manhattan

MOA

Memorandum of Agreement

NIDA

National Institute on Drug Abuse

NYC

New York City

OASAS

Office of Alcohol and Substance Abuse Services

PHS

Prison Health Services

QN

Queens

RIDE

Rikers Island Discharge Enhancement Project

SI

Staten Island

SPAN

Service Planning and Assistance Network

SPMI

Seriously and Persistently Mentally Ill

SSDI

Social Security Disability Insurance

SSI

Supplemental Security Income

STD

Sexually Transmitted Disease

THCC

Transitional Health Care Coordination

UHF

United Hospital Fund

Pertinent Acronyms

127

New York University School of Medicine
Bellevue Hospital Center
462 First Avenue
New York, NY 10016
Criminal Justice Research and Evaluation Center
John Jay College of Criminal Jutice
City University of New York
555 West 57th Street, 6th floor
New York, NY 10019
This report is available at
http://www.jjay.cuny.edu/centersinstitutes/pri/publications.asp