Keeping to the Straight and narrow: health in a halfway house
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

Keeping to the Straight and Narrow: Health in a Halfway House by Jody L. Vogelzang Department of Allied Health Sciences Grand Valley State University, Grand Rapids, MI

Part I – Introduction Te Straight and Narrow (S&N) is a federally funded residential reentry center for returning citizens (i.e., prisoners) located in the village of Ontonagon, the county seat of Ontonagon County. Te village falls within Ontonagon Township, at the mouth of the Ontonagon River on Lake Superior, in the Upper Peninsula of Michigan. Te town has a population of 1,324 people according to the 2014 census, and has lost over 35% of its population since 1990.

S&N provides room, board and job assistance services for men who arrive to f nish their sentence after being released from federal prison. Tis transition occurs so that men are better prepared for reentering the community. Although the unemployment rate in Ontonagon is high (8%), most of the clients secure work with an indepen- dent landscaping and snow removal company.

Clients must adhere to the rules of the house in order to stay at S&N. Clients must keep their living areas clean and tidy, take their rotation in the kitchen one week per month, and live a life free of drugs, pornography, and unsavory relationships. Curfew is strictly enforced and drug treatment is ofered in Houghton, Michigan located 57 miles away. Drug treatment is mandated for returning citizens with drug ofenses as the recidivism in this population is high. Te average length of stay at S&N is six-to-nine months. T e house has six bedrooms and the clients share rooms.

Most of the men sent to S&N have been in federal penitentiaries for 15–30 years. Many have never held a job and have no concept of healthy eating, cooking, or shopping. Te closest full grocery store is in Houghton and often times the Food Mart at the gas station is used for food purchases. Te men range in ages from 37–61 and have an average BMI of 30.5. Tree of the men are taking blood pressure medication, and one is treating his diabetes with the use of insulin. No medical care is provided at S&N but Ontonagon has a small 25 bed hospital and four physicians.

Winters are long and days are short in Ontonagon. Most of the clients use their non-working time playing cards, smoking, and watching TV. Computers are highly monitored during their stay at S&N. Te ownership of a personal vehicle is highly individualized. At this time two men have their own transportation.

Food cost for S&N is federally mandated at $2.03/meal. Men receive a hot breakfast, sack lunch, and hot supper daily. Menus are planned weekly by the men assigned to cooking detail. Tere have been many complaints regarding the monotony, lack of variety, and small portion sizes of meals that fail to satisfy hunger.

Questions 1. What type of regulations governs residential reentry centers? What are the requirements for food and nutrition in

these centers?

2. What circumstances described in the passage above will tend to hinder or promote a healthy lifestyle? Consider the geographic location, food environment, and basic living skills these men possess.

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Part II – The Sit-Down Te men staying at S&N have asked for a “sit-down” with the owners of the residential reentry center. T eir main complaints center on food and activity. Tey are constantly hungry because the “meals don’t seem to stick” and they are “bored silly.” Tere is no menu planning for the week and each evening meal is made from whatever is available. A registered dietitian nutritionist (RDN) should have approved the standard house menu but the owner is not sure where to fnd this type of health professional. Terefore, the men are really on their own in fguring out how to plan, shop, and prepare foods for the house.

Te residents are starting to argue among themselves over small things and are starting to blame each other for mild infractions. One man was sent home from work last week because he stole food from someone else’s sack lunch. T e meals are terrible; they are tired of using the gas station food market as their only source of food, and the sack lunches of bologna sandwiches and chips are not satisfying given the calorie demands of their jobs and the long hours that are sometimes required. Te only food available at work is a vending machine for sweet and salty snacks, and soft drinks. But even this is not reliable since their jobs are far fung and not ofce based.

Te owners understand that discontent could cause some real trouble in the house and in the community of Ontonagon.

Questions 1. How many calories should these men have per day? Would this number change based on the season of the year

(summer vs. winter)? Take into account their activity level. How would the information provided above impact existing health conditions? Cite your source(s)of information.

2. Given the food budget of $2.03 per meal what could these men bring in their lunches that would be more satisfying? Cost out each item on your proposed lunch list (remember they buy most of their groceries at a gas station food mart).

3. Is there a relationship between mood and food? If so, please describe the relationship and how it may impact the behavior of the men in this section of the case study. Please cite your source.

Ontonagon

Figure 1. Location of Ontonagon. Map of U.S. (bottom) expanded to county map of Michi- gan Upper Peninsula region (right), expanded to map of Ontonagon county (top) showing Ontonagon Township in red and rough sketch of branches of the Ontonagon River.

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Part III – Refection

Questions

1. Te case study does not specify whether any of the men are currently driving to Houghton for substance abuse counseling, however this is very common in this population as recidivism is high when inmates are returned to a community setting. Are there connections between substance abuse and food? Be sure to cite the source of your information.

2. Look at the length of time these men have been in prison. How does that play into the issues you noted at S&N?

3. Describe typical medical care available in prisons. How might this worsen medical and mental health? Why is this important? Be sure to cite your sources.

4. Is there any way that recreation (not prescribed “working out”) could mitigate hunger and boredom? Be sure to cite your sources. If so, what would you suggest they do?

5. How could the menu planning become more collaborative and better represent food preferences?

Figure 2. Ontonagon River, Ontonagon, Michigan. Credit: Tim Kiser (w:User:Malepheasant), cc by-sa 2.5, https://commons.wikimedia.org/w/index.php?curid=1081580.

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Part IV – Changes Te sit-down meeting has resulted in some changes at S&N. Tese are discussed in two sections below.

Section 1 Te owner has purchased fshing poles and a couple of kayaks for the house and the men now spend time every week fshing or paddling on the Onto- nagon River. Teir success in catching the Brook, Rainbow and Brown Trout has solved the problem of boredom. Te men have been practicing “catch and release” with the fsh but one mentioned that he “was so hungry he could eat the fsh right of his pole.” Tat led to the discussion about whether the men could actually eat these fsh. None of the men have fleted or cooked fresh fsh before. During their incarceration they occasionally had breaded f sh nuggets, which in no way resembled what they had on their pole.

Question 1. What are some of the important tips these men should know about fleting, cooking and food safety related to

trout from the Ontonagon River?

Section 2 Te weekly menus are now discussed in a meeting every Saturday morning at 10:00 a.m. Every resident is expected to attend and contribute their ideas. A weekly trip to Houghton Wal-Mart takes place on Sunday afternoon, and the men in charge for the week purchase the groceries. Tere are now ten residents in the house so they have approximately $426/week to spend on groceries. Tis amount must cover three meals/day for a full seven days. While planning ahead and using written menus and a grocery list has helped organize meal time, the men are still complaining of hunger. Tey want larger portions and more food.

Questions 2. Are returning felons eligible for SNAP or TANF in your state? Why or why not? Please cite your source for this

information.

3. What foods are relatively low cost, flling and acceptable to this population? Provide some realistic suggestions on ways to increase portion sizes on a fxed budget with no cooking skills.

Figure 3. A spring brook trout catch from the Upper Peninsula. Credit: Michigan Department of Natural Resources. https://content. govdelivery.com/accounts/MIDNR/bulletins/1460f9d.

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Part V – Progress A few of the men qualifed for SNAP benef ts. Tis is great news for the house and has increased the money available for food by $100/week. One of the residents of S&N was poking around in a resale shop and found an old copy of Te Better Homes and Garden cookbook. Te men now consult their cookbook as they plan menus and cook for the house. Tis has expanded their knowledge of cooking cheaper cuts of meat, dried beans, and casseroles.

In addition to the food assistance, fshing is going extremely well with open water continuing into November. T e freezer is full of trout flets, and with the men’s new found confdence in menu planning and cooking, they would now like to learn how to smoke fsh like the other “Yoopers” in their community (a native or resident of the Upper Peninsula in Michigan).

Questions

1. What equipment would the men need to smoke fsh and what new food safety and cooking skills must they learn?

2. What are some cheaper cuts of meat that the men could look for at the Walmart during their weekly shopping trips? What type of cooking methods do these cuts of meat require? Why?

3. What is the health and nutrition impact of smoked fsh as a regular part of the diet? Please cite your source of information.

Chuck

Brisket Plate

Rib Short Loin

Flank

Bottom Sirloin

Round

Sirloin

Shank Shank

Tenderloin Top Sirloin

Head

Blade shoulder

Arm shoulder

Loin Leg

Side Spare rib

Hock

Figure 4. American-style cuts of pork (top) and beef (bootom).

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Part VI – Mason One of the men, Mason, had been treated for diabetes for years but was relatively new to insulin, beginning his injec- tion regime shortly before his release to S&N. Often he forgot to test his blood sugar, and other times he had been out fshing or playing cards, and missed a meal. Mason knew that he needed to be careful with his diabetes, but it was hard without prison personnel reminding him. One night Mason passed out shortly after coming home from working an extra-long shift, and the men called 911. He was later admitted to the small community hospital in Ontonagon with hypoglycemia.

Before he returned to S&N, he was seen by a registered dietitian. She told him that his meals needed to be better balanced and instructed him on a new method (at least to Mason) of managing his diabetes; this included counting carbohydrates, eating on a regular schedule, and checking his blood sugar three times a day. It was the frst time he had heard about carbohydrate counting and adjusting his insulin to his blood sugar.

Te residents were glad to see him come back to the house but wondered how they were going to adhere to the dietary rules and restrictions that Mason needed to stay healthy. Te counting of carbohydrates was very foreign to them, with some admitting that they did not really know what a carbohydrate was.

Questions 1. What barriers may hinder Mason from following the dietitian’s instructions? What are some possible solutions to

enhance Mason’s compliance?

2. What are the diferences between a “healthy diet” for all the men and the specifcs of Mason’s diet prescription?

3. Count the carbohydrates in this meal: ½ cup orange juice, three eggs, two slices white toast, and 2 teaspoons of margarine, 1 cup hash brown potatoes, and black cofee. Does the amount of carbohydrates appear reasonable for a meal?

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Part VII – Thanksgiving Dinner Te men at Straight and Narrow were pretty pleased with themselves. Te menu planning, shopping, cooking and eat- ing was going great! As the Fall wound down and thoughts turned to the holidays, the house received an unexpected gift. Te neighbor down the road brought a fresh turkey he had shot, and the wife of their boss gave them a big basket of crab apples. After a quick look at their cookbook, the men could not locate a crab apple recipe. Tey also had a little trouble knowing what to do with the dead, feathered bird.

A week later, the men cooked an entire Tanksgiving dinner. Tis included a 22 pound hot smoked turkey and crabapple sauce (instead of cranberry sauce). Te men were surprised at how fast the smoker cooked the turkey; it looked nice and brown, and felt done in four hours!

Dinner stretched out for several hours and when all were fnished they retired to the living room for a few hands of cards, and then went back into the kitchen for a little more to eat before they refrigerated the left-over turkey, crabapple sauce, potato salad, and green bean casserole.

By the time the left-overs were put away the men were feeling a little nauseated, which went from bad to worse.

Question 1. List all of the food safety issues noted at the S&N Tanksgiving dinner. Consider the handling of the food even

before the dinner. What actions could have prevented these issues? Set this up as a two-column table with headings of “Issues” and “Interventions.”

Issues Interventions

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Part VIII – Conclusion

Question 1. What are some of the social determinants that impacted the health of the men at S&N? How did the men respond

and/or adapt to these determinants?

Case copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Originally published March 19, 2018. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work. Licensed image in title block derived from © Sentavio | Dreamstime.com, id66251557.

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