Prison-Based Mental Health Treatment Brian Fisher, Commissioner Doris Ramirez-Romero, Director of Mental Health Programs New York State Department of Corrections Services
JMHCP National Training and TA Event: Collaborating to Achieve and Communicate Positive Public Health and Public Safety Outcomes
Achieving and Communicating Outcomes
Residential Mental Health Unit
Title of new section
Marcy Correctional Facility Marcy, New York
Achieving and Communicating Outcomes
• • • • • • •
100 single cells 57,000 square feet for housing, program and office area 14 program classrooms Library including mental health wellness library Video teleconference equipment Medical and dental care on premises 4 observation cells
Achieving and Communicating Outcomes
• 100 inmate-patients • 105 DOCS staff (Civilian and Security)
Title new section • 26 OMH staff of (Interdisciplinary) • 7 day cross training • Treatment team approach
Achieving and Communicating Outcomes
Target Population • “S” designation (Axis I and/or Axis II) • More than 30 days of SHU or 60 days of separate Keeplock • Inmate-patients coming from STP/BHU/GTP • DOCS and OMH collaborate on referral process
Achieving and Communicating Outcomes
Typical Inmate-Patients Served • Psychotic Disorder & PolySubstance Dependence • 75 Tier 3 Misbehavior Reports 1988-2006 – Staff assaults – Inmate Assaults – Setting fires – Suicide attempts – Weapons
• Schizophrenia, Undifferentiated • 27 Tier 3 Misbehavior Reports 1997 – 2006 • Violent Conduct w/ weapons • Staff Assaults • Unhygienic Acts • Flooding
Achieving and Communicating Outcomes
Treatment Team Meets Daily
• DS of Mental Health Care Facility • Unit Chief • Captain • Social Work Supervisor • Supervising Correction Counselor • Psychiatrist
• • • • • • • •
Correctional officers Social workers Teachers Nurses (DOCS and OMH) Psychologists DOCS counselors Recreation therapists Rehab counselors Achieving and Communicating Outcomes
DOCS Programs Title of new section
• Education • Integrated Dual Disorder Treatment (Co-facilitated) • Aggression Replacement Training • Sex Offender Treatment • Transitional Services Achieving and Communicating Outcomes • Structured Recreation
OMH Services Title of new section
• • • • • •
Cognitive Behavioral Approach Skills training/insight oriented groups Behavioral Analysis for tx interfering behaviors Individual therapy Medication management Achieving and Communicating Outcomes Variety of 30+ groups
RCTP Interview Room
Title of new section
Upon Arrival: • Assessment by DOCS/OMH nursing and screened by an OMH clinician • Ensure needs are met Achieving and Communicating Outcomes
Individualized Treatment
Title of new section • Confidential individual therapy with Primary Therapists • Meet with Treatment Team every 3 months for review and as needed for stage advancement • Meet regularly with DOCS Achieving and Communicating Outcomes • Counselor
Daily Schedule • 6:00am Breakfast • 7:00am cell clean up, rounds and med pass • 7:40am Count • 8:00am Program Movement • 8:30am-10:40am Program • 11:00am DOCS Med. Rds • 11:10am Count • 11:15am Lunch
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12:00pm Program Movement 12:30pm- 2:40pm Program 3:00pm Library services / mail 3:30pm Count 4:00pm exercise begins 5:00pm meal / DOCS Med. Rds 6:00pm phones 7:00pm OMH Med pass. 9:00pm DOCS Med Rds 10:30pm Count Achieving and Communicating Outcomes
Program Design • Expectations – No violence toward others or threats of same – No violence toward self – Work toward personal growth and stability using the program and the treatment options – Comply with rules and regulations – Respect self an others
• Services – Individual, group and medication therapy – Point scoring system with routine feedback – Clear milestones to achieve Stage advancement – Incentives throughout program – Team approach to remain therapeutic and objective
Achieving and Communicating Outcomes
• Treatment stages reflect progress in treatment and improved behavioral, psychiatric and cognitive functioning • Milestones and Points provide clear guidelines and feedback regarding progress
Achieving and Communicating Outcomes
Point Rating
Description
Explanation
1
Refused/Removed
Inmate-patient did not attend scheduled activity due to choice or display of maladaptive behaviors
2
Not Acceptable
Inmate-patient displayed complacent, non-responsive and/or noncompliant behavior. Overall presentation was an attitude of being nonteachable and/or non-receptive to instruction
3
Below Average
Inmate-patient displayed appropriate behavior/social expectations, participated minimally by complying or engaging only when given a directive from staff
4
Average
Present for activity. Inmate-patient displayed appropriate behavior/social expectations. Active participation noted throughout the activity, however participation was only the result of staff prompting
5
Above Average
Present for activity. Inmate-patient displayed appropriate behavior/social expectations, answered questions, initiated conversation, shared own thoughts, feelings and opinions independent of staff prompting. Inmate-patient displayed appropriate body language as well as an overall teachable receptive attitude. Inmate-patient may have also assisted staff or peers in activity.
N/A
Not Applicable
Excused absence:
Achieving and Communicating Outcomes
RMHU Behavioral Checklist Log Please report on the inmate-patient's behavior over the past two weeks using the rating (1-5): (1 =unacceptable and 5 =excellent) Date:____
Tour: ____
Name
DIN
SelfAgitates Disruptive Movement Staff Cell ResEating Sleeping Hygiene Clean Others Behavior Proc. Direction pectful
Work Perf.
Achieving and Communicating Outcomes
RMHU Orientation • 2 hours per day • 5 – 10 days • Co-facilitated • Review of the Program • Assessment of programming needs/Treatment Goals Achieving and Communicating Outcomes • Seen by Unit Chief and Deputy Superintendent
Stage I – Assessment and Skill Development • Begin regular schedule 4 hours per day • Incentives include: – – – –
Wages and Commissary buy Weekly earned movie Continue to review for time cuts Programming counts toward Time Allowance Committee
Achieving and Communicating Outcomes
General overview of milestones to advance from Stage I • • • • • •
Attend programming Not engage in violence, self harm or threats of same Follow rules and regulations Express negative emotions appropriately Demonstrate an understanding of the Treatment Plan Get an average of at least a ‘3’ on report card
*Possible to advance to Stage II after 30 days with positive adjustment Achieving and Communicating Outcomes
Stage II – Engagement • Incentives – Phone call every two weeks – Increased commissary buy including some food items – Increased wages – Extra reading material – Extra shower(s) – Extra personal property including photos – Additional exercise and recreational opportunities
Achieving and Communicating Outcomes
General overview of milestones to advance from Stage II • Continue to meet all Stage I milestones • Attend AND participate in programs as demonstrated by an average score of at least ‘4’ in the most recent 8 weeks of group participation • Absence of negative behaviors for least 60 days • Engage in treatment as evidenced by completing homework, discussing issues and asking for help as needed, developing personal goals, routinely practicing learned skills, etc. • *Possible to advance to Stage III after 90 days with positive adjustment Achieving and Communicating Outcomes
Stage III Incentives • • • • • • • •
Phone call weekly Increased commissary buy Opportunity to have a paid job Opportunity for in cell television Opportunity for congregate recreation (up to 4) Additional in-cell amenities More personal property and clothing Additional visits Achieving and Communicating Outcomes
Overview of milestones to advance from Stage III • Continue to meet all Stage I and II milestones • Engage in pro-social behaviors by refraining from secretive, deceptive and manipulative behaviors • Use skills with minimal prompting from staff • Act as a role model to other inmate-patients in program • Write or verbalize an autobiography in individual therapy
Achieving and Communicating Outcomes
• Group and program schedule is based on individualized needs, 2 hrs/am, 2 hrs/pm. • New schedule is developed every 12 weeks to promote continued interest and opportunity for growth.
Achieving and Communicating Outcomes
Team reviews all behaviors, positive and negative, to identify learning opportunities and encourage positive behavior
Achieving and Communicating Outcomes
Relapse • Results in immediate reduction of incentives and escort under restraint - possible return to previous stage pending Treatment Team Review • Safety and security must be maintained for other inmate-patients and staff • Team reviews all incidents • Behavioral Analysis
Achieving and Communicating Outcomes
Progression • Demonstrated period of appropriate behavior • Close monitoring of inmate-patients progression through daily evaluation • Report cards bi-weekly • Meeting milestones will earn incentives and advancement in the program • Team has input into time cuts and advancement from program
Achieving and Communicating Outcomes
Successful Completion • SHU/KL time cut or suspension • Transfer to general population • Transfer to another program – ICP, IICP, or TrICP
• Consideration for Time Allowance
Achieving and Communicating Outcomes
Thank you
For further information & copies of conference presentations please visit www.consensusproject.org This material was developed by presenters for the February 2011 event: “Collaborating to Achieve and Communicate Positive Public Health and Public Safety Outcomes.� Presentations are not externally reviewed for form or content and as such, the statements within reflect the views of the authors and should not be considered the official position of the Bureau of Justice Assistance, Justice Center, the members of the Council of State Governments, or funding agencies supporting the work.
Achieving and Communicating Outcomes