For those who are released from prison, reentering their communities can be a struggle. Many may return with complex mental, physical, or dental health issues. “One of the things that can be very difficult to maneuver is the health system,” explains Loretta Bush, CEO of Michigan Primary Care Association (MPCA), a statewide health center advocacy organization that represents forty-four member agencies throughout the state of Michigan. “Unaddressed mental health issues, substance use issues, and physical health issues really drive up the rates of recidivism in the correctional system.”
As a result, the MPCA launched a pilot program in October 2017 to help those released from prison connect with care providers. When an inmate is released, Bush says, a Michigan Department of Corrections social worker contacts the MPCA, which then connects the person to a health center. This warm connection is the first step in creating a system that bridges the gap between the Michigan Department of Corrections and community health centers. Macomb County, where the program takes place, has a state prison with a reentry unit attached, which will help smooth the connection between the two systems.
“We’re not talking about giving them a card with the health center’s name on it,” Bush says. “We’re talking about true care coordination and case management to really help them navigate the health system.”
The MPCA worked with Senator John Proos to secure a $75,000 appropriation in the state budget to implement the yearlong pilot program. The funding will cover the yearlong pilot program, but the MPCA’s goal is to expand the program throughout the state. Recidivism results in higher costs, but Bush and MPCA argue that creating the program offers more than just financial benefits. “There has to be that human perspective that people deserve this kind of care coordination and case management so that they can stay out of the correctional system,” she says.
Bush has been working in community health since the 1980s when she finished college and took a position at a women’s clinic. At the time, she sought a career in maternal and women’s health. But while she was working at the clinic, news began to spread of mysterious deaths of men in New York and California. Bush was working with women in Michigan—a different population and location than those that were affected—but her interest in community health drove her to research the new disease, which would come to be known as HIV/AIDS.
During the height of the AIDS crisis, Bush had the opportunity to see community health at its worst and at its best. “It gave me the opportunity to see what happens when people are empowered and when they advocate for themselves and for their friends and would not go away and die quietly,” she says.
Believing that researchers would soon find a cure for AIDS, Bush transitioned to Planned Parenthood to lead the organization’s education department, and having determined that she did not want to be a clinician, began graduate school in health administration. A cure for
HIV/AIDS did not materialize, however, and the disease became a major focus in Bush’s career.
“I do feel that it was meant for me to do that work,” she says. “It was meant for me to give voice, many times to people who did not have a voice.”
For the next two decades, Bush continued working in women’s health and HIV/AIDS administration, moving back and forth between Planned Parenthood and city and state positions. While working at the Michigan State Department as the AIDS director in the early 2000s, she began shifting her focus toward minority health.
“It was an opportunity to start thinking about other chronic conditions and other issues than infectious diseases,” Bush recalls.
When she became Wayne County’s director of public health in 2007, her role widened further. She was now in charge of the infectious disease, maternal and child health, chronic disease departments, as well as managing
environmental health issues such as restaurant and day care inspections. She also responded to public health emergencies such as the H1N1 pandemic that soon hit after she took the job. “Even though we had drilled for it, sometimes there’s nothing like the real thing,” Bush says. “It was an opportunity for me to see strong public health in action.”
Bush employs an asset-based approach to healthcare, which she first encountered in action during her two visits to Ethiopia with the National Association of State and Territorial AIDS Directors (NASTAD). An asset-based approach focuses on an individual’s, community’s, or organization’s strengths, rather than its deficiencies. In Ethiopia, she met AIDS patients who found the resources to pay for their children’s schooling while suffering from advanced stages of the disease.
“This is a community that has long been finding a way to survive and thrive in sometimes very difficult economic situations,” Bush says. “We needed to learn and listen and then adapt the skills that we were bringing to their assets.”
Bush approaches the MPCA’s member health centers the same way. The association’s 260 sites range from highly funded health centers to poorly funded centers in struggling areas. “Maybe they don’t all quite have their data keeping right, but what are their assets? Because day-to-day they’re seeing patients, and they’re making a difference,” she says.
Bush connects the work of all health centers to the legislators whose policies affect them—legislators such as Senator Proos. “The thing that excites me most right now is taking policymakers and elected officials to the health centers and watching them become true believers,” Bush says. “And of course, I take them into their own communities. They’re watching and hearing the stories from the people who elected them. It’s a great feeling.”
Photo: Jena McShane