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Incarcerated Adults Address Chronic Illness

Living Well workshops transform prisoners' lives, save taxpayers' money



A four-year-old program is saving taxpayers more than $10,000 per prisoner, per year, and making life better for people with chronic illnesses living behind bars.

Since adopting the Living Well with Chronic Conditions program (LWCC) in 2012, more than 1,000 incarcerated adults in Oregon have improved their health and well-being by completing the course. According to Ann Shindo, PhD, "We've seen people embrace the concepts and transform their lives."

Shindo is the Health Promotion Coordinator at the Oregon Department of Corrections and has seen the program, which is offered across the state in and out of the prison system, positively impact individuals who suffer from chronic conditions. LWCC, also known as Chronic Disease Self Management Program (SMP), was originally developed and tested at Stanford University. It offers support and practical coping skills for those dealing with illnesses including HIV/AIDS, depression, diabetes, heart disease, chronic pain, anxiety, multiple sclerosis and other health concerns.

As the program has grown, the curriculum has branched out to address diabetes, chronic pain, and Tomando Control de su Salud, a Spanish-based self management program. With the exception of the former, Master Trainer Kim Curley Reynolds teaches all branches of programing.

Curley, who works for Commute Options, reflects on a prime example of one person's progress: "A participant was dealing with chronic depression and pain issues. On week one she arrived, dressed in black, sat by herself, and was in a sour mood. Her action plan was to open the curtains and blinds in the house one time this week. By week three she was wearing bright orange clothing, laughing, and chatting with her fellow participants."

Curley is careful to point out that she is not a health professional, and that workshops typically are led by lay-leaders or peer facilitators. Her role is to evoke motivation, helping participants gain the confidence they need to better manage symptoms and day-to-day challenges of living with chronic conditions. By developing self-management skills, participants are empowered to improve their own health and well-being.

Curly has been facilitating workshops regularly at Deer Ridge Correctional Facility in Madras and occasionally at Warner Creek Correctional Facility in Lakeview since 2009. The two-and-a half-hour meetings, once a week, over six weeks, teach symptom and medication management, how to work with a healthcare team, weekly goal setting, effective problem-solving, communication, relaxation and handling difficult emotions, eating well, and exercising safely.

Each participant in the workshop receives a copy of the companion book, "Living a Healthy Life with Chronic Conditions."

Curley says, "There is a person I'm currently working with who has lost over 100 pounds of unwanted weight since he became a leader in November 2015. He is a facilitator of the Hepatitis/HIV Aids Awareness Program and just keeps adding to his healthy habits."

LWCC is not meant to supplement or replace other professional medical treatment. The program can be especially helpful for people dealing with multiple conditions, as it teaches skills to coordinate and manage multifaceted health needs. The program has led to outpatient cost savings by ending insulin-dependence, and ending medication use for diabetes, cardiovascular issues, and other health conditions like depression.

Referring to state-wide prison programs specifically, Shindo says, "Quantitative outcomes show an outpatient cost savings on average of $11,050 per individual (who has) taken LWCC and also had outpatient visits for chronic conditions repeatedly prior to and less often after the program." She has also witnessed positive changes in decision-making, relationships, nutrition and physical activity.

Baseline data are collected for each participant prior to the LWCC course, at the end of the program, and three to six months post-intervention. Shindo cautions that correctional facility sample sizes are small, and studies are ongoing. Nevertheless, decades of data are available through Stanford University at

Workshops are not limited to correctional facilities. Brenda Johnson, Regional Coordinator for Chronic Disease SMPs in the Deschutes County Health Department, says they offer the program to between 200 and 250 non-incarcerated Central Oregonians each year. She says, "Stanford's programs are considered evidence-based and the gold standard." The county relies on Stanford's resources and health outcome data and can anecdotally report similar outcomes locally.

In Central Oregon, LWCC is a collaborative regional initiative made possible with support from Deschutes, Crook and Jefferson counties, La Pine Community Health Center, St. Charles Health System, Central Oregon Council on Aging, Mosaic Medical, PacificSource and Oregon Health Authority (OHA). The OHA also granted Deschutes County initial funding in 2008 for community LWCC programs and they continue to provide opportunities for leader training.

"What really sticks with me," Curley reflects, "is that people can accomplish their goals if they break them down into doable steps. Living Well helps flip the switch from feeling bad and being bummed about living with a health problem that will never be solved. I think everyone on the planet should take LWCC."

LWCC workshops are offered widely throughout Central Oregon and in every county in Oregon. See for community LWCC offerings.

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