JANUARY/FEBRUARY 2019 VOL. 28 NO. 1
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TREATING OPIOID OFFENDERS
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ACA’s Winter Show Wrap-up
Contributing Editors Michael Grohs, Kelly Mason, Bill Schiffner, G.F. Guercio Art Director
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Treating Opioid-dependant Offenders with Meds
Detectors that Uncover Contraband
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(ISSN10729275) is published bi-monthly by: Criminal Justice Media, Inc 565 Pier Avenue PO Box 213 Hermosa Beach, CA 90254 (310) 374-2700 Send address changes to:
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Engaging EHRs Help Meet Health Mandates
Live Capture: Body Cams for Corrections Officers
Doctor on Call: The Feasibility of Telepsychiatry
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MAINE PRISONS INTRODUCE TABLET PROGRAM TO TRAIN OFFENDERS The Maine DOC introduced a tablet program to prisons to help prepare offenders for their re-entry into the labor force, according to WCSH-TV in Portland. Chicago-based Edovo is leading this program, which offers over 20,000 hours of educational, vocational, and life skill content to offenders via tablets with a secure wireless network. "These tablets dramatically scale the reach of education and job training for offenders, both of which are shown to reduce recidivism," said Acting Commissioner
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Randall Liberty. The program also gives offenders the opportunity to pursue vocational training that focuses on industry. Credentials earned through Edovo allow offenders to market their skills to potential employers and show their progress to judges, probation officers, and correctional staff. Programming will consist of: GED preparation, literacy development, substance abuse treatment, and life skill programs, including personal financial management. "We've done our homework," said Deputy Commissioner Ryan Thornell. "We work closely with the Maine Department of Labor and employers throughout the state to
identify the type of training offenders need to prepare for re-entry into Maine's labor market." Edovo's tablets are specifically designed for correctional facilities with shatterproof glass, sturdy casing, and custom software without open access to the Internet. The devices come at no extra cost to taxpayers or offenders, since the program is provided through Maine's communications contract. Some units at Maine State Prison and the Women's Center at Maine Correctional Center started using the tablet program in December. Mountain View Correctional Facility also plans to introduce the program to some units early this year.
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TRAPPED IN A BOX: N.C. SHERIFF SHUTTERS TEEN SOLITARY CONFINEMENT UNIT New Mecklenburg County Sheriff Garry McFadden has ended the
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jail’s controversial practice of holding teenage offenders in solitary confinement, his latest in a series of reforms, according to a January 10 article in the Charlotte Observer.
At the jail’s disciplinary detention unit (DDU), 16- and 17-yearolds who fought, stole or broke other jail rules were once held alone for 23 hours a day. They sat in windowless cells smaller than most parking spaces, with no access to phones, visitors or library books. Critics called that torture. In January 2016, President Obama banned solitary for youths in federal custody, saying the practice often has “devastating, lasting psychological consequences.” Later that year, North Carolina officials announced a similar ban for youths in the state prison system. McFadden says he is starting to change solitary confinement practices with the teenage offenders at Jail North. On Dec. 31, the five inmates held in isolation inside the DDU were moved to new areas and given new privileges. Those inmates are now let out of their cells for at least seven hours a day. They can use the telephone, visit the library, watch television and visit relatives. They can also attend classes with other inmates—a privilege they didn’t have before. McFadden said he hopes that will help spur more conversations— and fewer confrontations—between young inmates and COs. “If you continue to disgrace (a young offender), and you continue to strip him of his dignity and you never give him a foundation to be a productive citizen—on day 13, when he gets out of the jail, what happens?” McFadden asked. One 17-year-old inmate told the Observer he spent about 10 days inside the DDU last year. He said there was little to do inside his cell but sleep, eat, think and do push-ups. “Once you get in there, it’s like being trapped in a box,” said the inmate, who has begun serving a sen-
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tence for armed robbery. “I think it’s a crazy life. Just sitting in that cell.” The inmate said he’s happy for the new opportunities outside the DDU. He’s attending classes at Jail North and hopes to get his GED. “It’s turned my whole life around, to be honest,” he said. HOW MILLIONS SPENT ON JUSTICE REFORM IS PAYING OFF The Al Cannon Detention Center in South Carolina is at the center of an ambitious project aimed at making Charleston County’s criminal justice system more efficient and equitable by lowering the number of locally arrested inmates, reducing racial disparities, collecting and using data to make informed decisions, and providing resources for courts and those with mental health issues, reports the Post and Courier. The initiative comes after decades of struggles with inmate overpopulation and a justice system that held too many minorities and poor people behind bars on relatively minor charges. After three years and $4.95
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million in grant funding, supporters say programs developed by the Charleston County Criminal Justice Coordinating Council are making a difference. CJCC’s reforms come after officials struggled for years to deal with a ballooning inmate population and chronic lack of resources. By the mid-2000s, authorities were overwhelmed. The oldest part of the jail was built in the 1960s. Dilapidated and overcrowded, it was last expanded in 1993 and built to house 661 inmates. At times, it held more than 2,000. In 2007, Charleston County Council approved a $100 million project that boosted the jail’s capacity to 2,112 inmates plus room for further expansion. The new wing opened in 2010. While it provided a buffer to overpopulation, it did little to address the underlying issues that were steering people into jail and putting strain on the courts, according to Kristy Danford, CJCC’s project director. “Many of the same underlying challenges that contributed to overcrowding in the first place remained—such as high rates of recidivism, lack of adequate information to accurately assess risk at bond hearings, high caseloads and too few options other than jail,” she said. In 2015, Charleston County officials founded CJCC with the goal of addressing these problems. The core of the council’s work is to shape a system in which crime is still addressed, public safety is not compromised and people are not stripped of their rights in the pursuit of justice. A large part of that effort has been in getting a diverse group of partners to the table. In addition to law enforcement and others who work in the criminal justice system, the council includes social workers, mental health professionals, representatives from the Department of Veterans Affairs. After initial planning phases, the group got a $2.25 million grant from the John D. and Catherine T. MacArthur Foundation in 2016. CJCC received an additional $2.46 million from the foundation in October. As of 2017, the last full year of available data, there has been a 51 percent drop in single-charge bookings on five targeted lower level offenses and a 46 percent increase in officers deciding to issue citations on those charges rather than make arrests. Inmate reduction efforts have nearly reached the council’s goal of a 25 percent decrease in three years. A risk assessment tool, expansion of public defenders to bond court and other initiatives are continuing to help drive down those numbers and steer people in need of help toward treatment programs where they can get help instead of being incarcerated. VISIT US AT WWW.CORRECTIONSFORUM.NET
BY BILL SCHIFFNER, CONTRIBUTING EDITOR
The Big Easy Plays Host to the ACA’s Winter Conference
The exhibit hall at American Correctional Association’s January meeting spotlighted software to health care, dinnerware to personal care.
C
orrections administrators and staff from all over the country recently met in New Orleans to check out the latest in emerging technologies and hone their leadership skills at the American Correctional Association’s (ACA) Winter 2019 Congress of Correction held in January at the Ernest N. Morial Convention Center. “At this conference, there were amazing opportunities to participate in a myriad of groundbreaking sessions, workshops and special events,” commented James A. Gondles, Jr., executive director at the ACA. He added that dozens of vendors in the exhibit hall showcased the leading edge of technology and essential services in the world of corrections. “One of the hallmarks of ACA’s premier winter conference 10 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
was the unique opportunity to become certified and gain continuing education units. The allaround knowledge attendees gained from the thought-leaders who spoke at this year’s Winter Conference put them in the vanguard of professionals. Clearly, that is why it can be said: attending an ACA conference furthers your professional career like no other.” Here’s a sampling of some of the latest products and services that were drawing crowds.
Dissolvable Packaging RapidPak is a 3-in-1 shower, shampoo and shave product in a dissolvable “pak” where the outer layer completely dissolves in water. RapidPak promotes a cleaner environment by eliminating wrappers and bottles being left on the floor or drains being clogged.
The convenient single-application paks allow for easy distribution and saving time for staff. RapidPak is animal-fat free, alcohol-free, non-toxic and comes in a mild fresh sent. It is unique to the market and sold exclusively by Bob Barker Company. 1.800.334.9880, www.bobbarker.com
Candy Bars Mars Wrigley Confectionery introduced three new Snickers flavors: Creamy Peanut Butter, Creamy Almond Butter and
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apprehension. Coupled with WCS and other Securus technology, the company is providing a multi-layered defense solution to the most significant issues within the corrections industry. sales@securustechnologies.com, www.securustechnologies.com
Clear Typewriters Creamy Almond Maple Butter. The new Creamy Snickers offer real wholesome ingredients, new thin squares, 200 calories per serving, no artificial colors, flavors or sweeteners. They are available in three different sizes: 1.4 oz single, 2.8 oz. share size and 7.7 oz. ashley.jarrett@advantagemilitary.net, 1.757.204.2356, www.mars.com/global/brands/confectionery
Healthcare Services Centurion, LLC, is a leading provider of healthcare services to state correctional agencies and serves seven state correctional systems (Florida, Minnesota, Mississippi, New Hampshire, New
Mexico, Tennessee, and Vermont). Founded by two of the oldest and most respected companies in correctional healthcare and managed Medicaid—MHM Services, Inc. and Centene Corp.—Centurion brings a level of innovative care coordination services never before available to large correctional systems. 1.800.416.3649, www.centurionmanagedcare.com
For the past 15 years, Swintec has been providing a simple solution to correctional facilities all around the USA for the ongoing major problem of hidden contraband within prison cells. Namely, the ownership of opaque cabinet typewriters has lent itself to inmates having an ongoing hiding place for small and medium size contraband i.e.: drugs, weapons, cigarettes, tools, needles, etc. Corrections officers had to search and confiscate these items and it was not easy. They had to disassemble these older typewriters to find the hidden contraband, while making them responsible if they broke it. Ever since Swintec made the clear cabinet typewriters available, they were put to use in pris-
Wireless Containment Securus Technologies has a solution to the growing threat of cellphones in jails and prisons. Wireless Containment Solution (WCS) is a proven system safeguarding the public from illegal cellphone communications. With WCS, all contraband cellphone signals within a facility’s designated areas are detected and monitored on a continuous 24/7/365 basis by Securus. Combined with the intelligence delivered, WCS is making a real difference in fighting the contraband cellphone battle. In addition, Securus’ drone detection solution (DDS) uses AeroDefense’s AirWarden, which is a radio frequency based system using signal intelligence to identify, classify and pinpoint incoming drones and alert corrections facility staff of contraband drops. The system is also capable of identifying the drone pilot’s location, to assist in VISIT US AT WWW.CORRECTIONSFORUM.NET
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ons libraries, education classrooms, laundries, and even in inmate cells, which resulted in nearly eliminating hidden contraband. 1.800.225.0867, www.Swintec.com
Mobile Systems TimeKeeping Systems, of Solon, Ohio, showcased its Guard1 system. Guard1 provides RFID inmate identification,
Optimizing Jail Operations Tyler Corrections helps automate business processes and drive efficiencies at intake, release, and everything in between, no matter how large or small the jail facility. Integration with Tyler Odyssey Court and New World RMS/CAD allows facilities to share inmate information across public safety
country hot fries. All are priced at a great value to the inmate. 1.310.604.4626, www.unionsupplygroup.com
and justice agencies, creating a chain of efficiencies—including the automatic flow of information from dispatch to disposition—while maintaining layers of security around sensitive data. cjsales@tylertech.com, 1.800.431.5776, www.tylertech.com
Addiction Recovery Program
Meal Trays JonesZylon introduced a new meal delivery system. The meal tray is a 5-compartment selfstacking tray that seals off each compartment and has underside compartment height to keep food from getting on bottom. The trays are paired with small or
inmate tracking with real time location, officer and staff personal alarms, and well-being checks and inspections. Rugged Guard1 mobile devices enable facilities to reduce paperwork and increase officer efficiency. Guard1 technology is helping transforming corrections management. 1.800.THE.PIPE, www.guard1.com
New Snacks
large heavy-duty corrections grade carts that fit a surprisingly large number of trays. Long-lasting casters. Users can add a heat box right away or later to convert to a heated cart. 1.800.848.8160, www.joneszylon.com 12 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
Chips and snacks are best sellers in most commissaries, which is why Union expanded its product line to include nine new items. Its Coyote Valley brand items include four popcorns flavored with butter, cheese, white cheddar and jalapeno, two cheese puffs in regular and jalapeno cheddar flavor, two cheese nibbles in regular and extreme hot flavors and back
Wexford Health provides inmates with access to addiction recovery treatment services throughout their incarceration. Services include: crisis management; individual and group counseling; treatment planning; toxicology screening; pharma-
cotherapy and medication assisted treatment; alcohol, drugs, and mental health issues education; self-help support groups; case management services; and reentry planning. Their specialized program helps inmates obtain and maintain mental health stabilization and abstinence from mind-altering substances. 1.888.MED.MGMT (633.6468), www.wexfordhealth.com
Correctional Healthcare As the correctional healthcare pioneer and leader for 40 years, Corizon Health provides client partners with high-quality
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Corrections & Riot Control Suit Launched at SHOT Show healthcare and re-entry services that will improve the health and safety of its patients, reduce recidivism and better the communities where they live and work. 1.850.841.9337, www.corizonhealth.com
Jail Management System SallyPort is a web-based, enterprise class, fully agencyconfigurable jail management system developed exclusively to meet the management needs of local, city, and county-level jails. Easy to use software makes the process of booking and detention fast and simple. It works seamlessly with records management systems, commissary systems, inmate telephone systems, and other third-party applications to promote information sharing and automation of many of the booking and record-keeping tasks of any size detention facility. From intake to release, it helps agencies ensure due process and realize higher levels of efficiency throughout operations. 1.205.949.9900, www.blackcreek.com
At the January SHOT Show in Las Vegas, Point Blank Enterprises announced its new protective suit for corrections officers. The Advanced Crowd Control Suit, or A.C.C.S., is its most innovative to date and is engineered to provide maximum blunt force trauma protection from neck to ankle. The gear features slots that fit most adjustable extremity panels, body side spacer mesh, impact polymer shell and adjustable straps with two attachment options, a Ghook or synch through. Arms and legs use an adjustable daisy chain elastic strap, allowing each component to adjust to the user. Thigh panels may be removed from the daisy chain to allow thigh holsters and drop legs. A belt comes with hip pads that may be replaced with duty, rig or other belts. The forearm to elbow and shin to knee have an expanding hard connection which allows the joints to stay in the proper position while kneeling or bending the arm. Hand protection fits securely to the wrist to ensure staying in place during struggles. The front, back, forearm and thigh can take panels. 1.800.413.5155 www.pointblankenterprises.com
Health Care Programs NaphCare provides a proactive approach to healthcare programs
for correctional facilities ranging from comprehensive healthcare, on-site dialysis, off-site management, in-house pharmacy and TechCare its electronic health record (EHR) clinical operational tool. 1.800.834.2420, www.naphcare.com 14 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
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BY MICHAEL GROHS, CONTRIBUTING EDITOR
Going to the MAT
Differentiating the various Medication Assisted Treatment options for addicted opioid offenders in prisons and jails. The nation’s OPIOID CRISIS can be broken down into three waves. The first was in 1991 when a spike in deaths was attributed to opioid and opioid-combination prescriptions. The spike was exacerbated by assurances from the pharmaceutical industry and elements of the medical soci-
ety that the risk of addiction was low. Use of opioids flourished. By 1999, 86% of people using opioids were using them for noncancer related pain. The second wave began around 2010 after an effort was made to make getting opioid prescriptions more difficult and the
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by-then-addicted opioid users’ attention turned to heroin. Between 2002 and 2013, heroinrelated overdoses increased 286%. Eighty percent of heroin addicts admitted to abusing prescription opioids before making the move to heroin. The third wave arrived in 2013 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019 15
In November 2018, a federal judge issued a preliminary injunction saying that a defendant who had filed suit claiming he could not be denied access to methadone treatment for his opioid addiction would likely win his case.
with the advent of synthetics such as fentanyl. The wave of deaths has been linked to illegally manufactured fentanyl (as opposed to acquired medical fentanyl) that was used to adulterate or replace other drugs such as heroin. The epidemic has had an effect on the nation to the point that is has actually lowered the country’s average life expectancy. According to the CDC, in the 12month period ending in April 2018, 70,237 people died from drug overdoses. (On a slightly more positive note, those numbers seemed to have peaked in September 2017 and have since been declining.) The epidemic has also flooded courts and wreaked havoc in jails and prisons. Some experts have estimated that up to 25% of the nation’s incarcerated have an opioid-use disorder. There have been lawsuits. In November 2018, a federal judge issued a preliminary injunction saying that a defendant who had filed suit claiming he could not be denied access to methadone treatment for his opioid addic16 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
tion would likely win his case and such a refusal violated the Americans with Disabilities Act (ADA) as well as constituted cruel and unusual punishment. This could have significant consequences for the nation’s correctional system.
Three Treatment Drugs One method used to treat those with an opioid addiction is the use of medication assisted treatment (MAT). There are numerous terms, and many of them sound similar. There are three FDA approved drugs used to treat opioid addiction: methadone, buprenorphine, and naltrexone. According to the Justice Center at the Council of State Governments, about 220 of the nation’s 3,000+ jails offer naltrexone for inmates. In most cases, it is for those who are about to be released. As far as all drugs, they can be separated into agonists and antagonists. An agonist is a drug that activates certain receptors in the brain. Full agonist opioids activate the opioid receptors in the brain fully. This results in the
user experiencing the drug’s full effect. Heroin, oxycodone, methadone, hydrocodone, morphine, and opium are full agonists. An antagonist is a drug that blocks opioids. It attaches to the opioid receptors in the brain but does not activate them, so the user does not experience the opioid effect. Examples of antagonists are naltrexone (Vivitrol) and naloxone (Narcan). Naloxone is the drug sometimes used to reverse a heroin overdose. Naltrexone is used to block cravings for both opioids and alcohol. Buprenorphine is a partial agonist, which means it activates the opioid receptors in the brain but to a far smaller extent than a full agonist. It also acts as an antagonist, meaning it blocks other opioids while still allowing for some opioid effect of its own to suppress withdrawal symptoms and cravings. In facilities, detoxification is indeed an issue, but so is overdosing. Narcan is an intranasal form of naloxone, and now it is being more routinely stocked throughout facilities. Since opioid abuse still occurs inside facilities, access to these drugs is a safety step that jails and prisons around the country have been taking. John S. Wilson, PhD, CCHP, Centurion’s VP of Clinical Development, notes that jails are using multiple methods to address the opioid epidemic. These methods include sentencing reform, diverting inmates from jail to a court-directed treatment program and, most recently, the use of MAT during incarceration. MAT programs, says Wilson, can be structured in multiple ways. One way is to continue treatment if the individual had been prescribed and consistently had taken medication for opioid use disorder before being incarcerated. Other options include starting treatment at any time during incarceration if the detainee is determined to need MAT, or begin treatment prior to release as
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Naloxone kits are distributed to the homeless at Civic Center Plaza in Santa Ana, California.
protection for the individual as he or she returns to the community. Most jails and prisons do not give inmates access to methadone or buprenorphine, the two medications that many consider to be the gold standards for treatment of opioid-use disorder. One significant problem arises when in inmate has detoxified while in custody. His or her tolerance has been lowered. As a result, overdose is a concern upon release. Wilson notes that research confirms there is a heightened risk of opioid overdose in the weeks following release. The risk has been exacerbated with the emergence of synthetic opioids such as fentanyl. According to the CDC, synthetic fentanyl is about 50 times more potent than heroin and 100 times more potent than methadone. It is so potent it has been known to affect drug sniffing dogs to the point they need to be treated with Narcan. In September 2018, nearly 30 people (23 of them COs) at Ross Correctional Institution in Ohio were sickened when they were exposed to a mixture of heroin 18 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
and fentanyl. A statement released by the state highway patrol noted, “Several doses of Narcan were administered to victims, and an additional 300 Narcan doses are available at the facility." Wilson furthers, “Inmates’ dread of the opioid withdrawal that will occur as a result of their arrest and incarceration in jail is a major risk factor for suicide during the initial period of incarcerations. What is less well appreciated is that most individuals who are suffering from opioid use disorder are also using other illicit drugs and may suffer from multiple substance use disorders, and that there is a long-term process involved in recovery.” During the first year of abstinence, patients with opioid-use disorders are likely to experience ongoing depressive symptoms that place them at risk of relapse or suicide. “It appears that the research confirms MAT is superior to abstinence in maintaining freedom from opioid relapse after release from incarceration,” he adds. Administration of opioid-based medications requires additional staffing resources, including addi-
tional correctional officers, to ensure safety.” Wilson notes that Vivitrol is generally offered to inmates upon release in order to diminish cravings and block the impact of illicit opioid use in case the individual returns to drug use following release. Jails have the capacity to offer Vivitrol if the detainee has a known release date and has successfully completed a trial of oral naltrexone, but it is more common to see it used in prison systems for detainees being released. (It is up to the patient whether or not to accept Vivitrol.)
Rhode Island Program In 2016, the Rhode Island Department of Corrections launched a program for people incarcerated for opioid-related crimes. The program is the result of Governor Gina Raimondo's strategy to reduce opioid overdose deaths in the state. As of November 2018, about 275 inmates and pretrial detainees were involved in the program. Among the primary differences between this and other programs is that Rhode Island offers
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methadone. The Department also screens every inmate entering the system for opioid-use disorder and offers both MAT and counseling. Judge David Tapp, circuit court judge for Kentucky's 28th Judicial Circuit, which presides over Rockcastle, Pulaski, and Lincoln Counties, notes that opioids became an overwhelming problem in the Commonwealth about a decade ago. Overdoses had become commonplace. Kentucky began using MAT about four years ago in conjunction with what other measures were being taken. There are several different avenues. Jails have a nal-
The opioid epidemic has actually lowered the country’s average life expectancy. trexone program for opioid or alcohol abuse. (The drug was originally meant for alcohol withdrawal.) They also make sure that patients have access to the Affordable Care Act upon release. Medicaid covers the cost of naltrexone. Parole or probation can also ask the court for treatment. In addition a custody credit component program is available in which a patient who has remained sober for six months (six injections of Vivitrol) receives 90 days of naltrexone. For a year’s sobriety, it is 180 days. This has proven to be a powerful incentive. The process was developed in partnership with the jail, it has been a success, and it has gone without any negative feedback. Inmates have access to naltrexone before trial, within state institutions, and in many county jails. It is not limited to those participating in a drug court program. It is available to anyone who’s qualified. He points out that naltrexone is routinely provided to law enforcement and in jails and elsewhere. There have even been cases of people overdosing while in court. Naltrexone is an injection that lasts for 28 days. Among the safety procedures is “the naltrexone challenge.” Before patients receive the injection, they receive a pill. If the patient has opioids in their system, they will become ill. (They are drug tested for opioids beforehand.) So far, no one has failed the challenge. “Better safe than sorry,” the judge says. Brian Barnett, M.D., is an addiction psychiatry fellow at Harvard Medical School and Partners HealthCare. He notes the successes of MAT. In Rhode Island, overdose deaths have gone way down. Dr. Barnett, who works with a jail in the Cleveland, Ohio, area, suggests facilities should use MAT to treat patients, which many facilities are reluctant to do because of costs, training, and introducing the substances into the facility. (Suboxone VISIT US AT WWW.CORRECTIONSFORUM.NET
and methadone can get a user high. Naloxone and naltrexone cannot.) Another consideration is the increased use of Narcan as a result of incidents of people being inadvertently exposed to fentanyl, which can get into the air, so not only users are affected. Barnett also recommends training staff in advance on using Narcan, which is not complicated. The primary need requires knowing how to assemble the unit. When the pressure is on and someone may be overdosing, it is easy for people’s minds to go blank. Detox, says Dr. Barnett, takes about four or five days to get through, and the effects can be severe but can be lessened by suboxone or methadone. The addiction can then be treated symptomatically and those are generally not particularly severe. Among the possibilities is clonidine, a drug traditionally used for treating blood pressure. Dr. Barnett points out that studies of using MAT have shown reductions in recidivism, relapse, and hospital visits. Still, the majority of jails offer no agonist or antagonist treatment. In many cases, it is the result of the cost of the drugs, the training involved, and the difficulty to get people on board. Budgets are already stretched tight. In other cases, he ponders the attitude that considers addiction to be a moral failing or a weakness rather than a disease. “The situation is improving, but we have a long way to go.” ✪
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COMPILED BY DONNA ROGERS, EDITOR-IN-CHIEF
Uncovering Stopping weapons, narcotics and cell phones before they become a problem is the job of these prized detectors.
CONTRABAND is the leading cause of violence in prisons and jails. Whether it is the coveted drugs that gangs vie for, a shank that proves deadly, or a cell phone conversation that sets up a hit on an official, the possession of contraband is one of the most brutal tribulations that corrections officers must face in their jobs. Check out these body scanners, trace narcotics and drone detectors, duress alarms and wireless containment systems that give a leg up in the battle against contraband.
Multi-zone WTMD
metal objects. This WTMD greatly exceeds the NIJ 0601.02 standard.
Real-Time Locating System To help keep personnel working in high-threat environments safe, the Flare® Real-Time Locating System instantly identifies and locates personal duress alarms at the touch of a button. In the event of danger, the user activates his/her Personal Protection Device (PPD) which emits an RF signal that is detected by a network of sensor units throughout the facility. Flare immediately locates alarms and displays the location, status, and identity of the PPD on a map-
based display in the control room. Designed for reliability in institutional and industrial environments, Flare uses proven, cost-effective technology that has been protecting staff for 25 years. info@senstar.com Senstar.com
Radio Wave Scanner TM
The SafeView from L3 is a full body scanner designed for people screening in prisons, courthouses and other facilities. It uses safe millimeter wave radio waves to reveal concealed objects—both metallic and non-metallic—hidden on the body. It does not use X-rays or ionizing radiation.
The SMD601 Plus is said to be the most sensitive walk-through metal detector (WTMD) in the market and an absolute must for correctional facilities. The SMD601 Plus provides the detection of extremely small metal masses on the body or even hidden in body cavities. A full-height, multi-zone light bar displays the location of the detected metal masses in transit resulting in rapid identification of threats and a reduction of the need for manual searches. An optional and exclusive integrated correctional profiling system allows for screening of people with or without implanted 22 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
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Contraband features a large, high-resolution, daylight-readable color touchscreen. The modernized iconbased interface provides a familiar user experience, allowing for simple and intuitive navigation. The system’s real-time detection algorithm delivers fast results, alerting the operator as soon as a threat is detected. With rapid
investigation of items including mattresses and other objects that could hide contraband. The MSD EVO provides high-reliability and lightweight design with advanced, multi-zone detection, and is flexible enough for making surprise checks fast and efficient. CEIA USA mthaxton@ceia-usa.com 440.715.0783 www.ceia-usa.com
Data Analysis Curbs Contraband SafeView quickly scans and generates a 3-D black and white image of the individual. Its imaging tools enable analysts to locate a broad range of concealed weapons, explosives, and contraband. The system offers privacy protection customized to support specific operational procedures. Remote monitoring enables analysts to be stationed in separate rooms, where they cannot see, nor be seen by, the individual being screened. It reduces the need for intrusive pat-down searches.
Narcotics/ Explosives Detector The H150ETM is a handheld narcotics and explosives detector that rapidly detects and identifies an extensive library of narcotics and trace amounts of military, commercial, and homemade explosives. The network-ready system is operator friendly and
Cell and Ferrous Metal Detector
The illegal use of contraband cell phones in prison is not a victimless crime. Contraband cell phones allow inmates to operate criminal enterprises or arrange for harm to come to someone outside a facility’s walls. GTL’s patented inmate telephone system (ITS), data analysis tools, and professionally-trained intelligence analysts have assisted correctional facilities in curbing the influx of contraband ranging from cell phones to drugs and more, further helping to increase
The CEIA MSD (Magneto Static Detector) is a single pole detector designed to detect all cell phones and magnetic (ferrous) contraband including key fob cell phones, smart phones, radio transceivers, etc. The new MSD EVO enables a pass-through configuration that extends the transit width up to 51” with consistent detection sensitivity from pole to pole. This uniform solution allows reliable screening of inmates transiting through a corridor or large transit areas, along with the extremely accurate
safety both inside facilities and their surrounding communities. www.gtl.net/intelligence marketinginfo@gtl.net 1.800.306.2957
clear-down and other features that minimize system contamination, the H150E is ready for the next sample within seconds, even after a positive detection. L3 Security & Detection Systems inforequest.sds@L3T.com
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CORRECTIONS FORUM • JANUARY/FEBRUARY 2019 23
drugs, weapons and cellphones into corrections facilities,” says Mark Southland. Since the launch of the program, they have assisted corrections agencies in their battle against contraband deliveries. Securus Technologies msouthland@securustechnologies.com 972.277.0687 www.SecurusTechnologies.com
Trace Detectors Smiths’ IONSCAN 600 wand swabbing a handbag, e.g., that of a visitor to a corrections facility.
Full Body Screening
Wireless Containment
B-SCAN from Smiths is a full body X-ray inspection system for screening inmates prior to entering a correctional facility. The scanner yields X-ray images that reveal ingested contraband. The B-SCAN can also show objects concealed beneath clothing and hidden in body cavities. The device greatly reduces the need for hands-on invasive searches and improves the safety and security of the facility.
Securus Technologies has a solution to the growing threat of cellphones in jails and prisons. Wireless Containment Solution (WCS) is a proven system safeguarding the public from illegal cellphone communications. With WCS, all contraband cellphone signals within a facility’s designated areas are detected and monitored on a continuous 24/7/365 basis by Securus. What distinguishes WCS from metal detectors, body searches and simple electronic detection is that WCS prevents communications from contraband cell phones, while also providing the agency a real-time dashboard with actionable intelligence investigators can use.
Trace Narcotics & Explosives Detector IONSCAN 600 is a portable desktop trace detection system capable of detecting and identifying invisible amounts of narcotics. By swabbing hands, clothing, and inmate and visitor’s belongings, staff can immediately tell if someone has come in contact with a narcotic. Positive results for trace amounts of narcotics can lead staff to finding larger quantities of hidden narcotics. In addition, by rapidly identifying trace amounts of potent narcotics, such as fentanyl, personal protective precautions can be implemented to reduce exposure risks. Michael.Burrows@SmithsDetection.com 203.417.0919 www.smiths-detection.com 24 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
Drone Detection Securus’ drone detection solution (DDS) uses AeroDefense’s AirWardenTM, which is a radio frequency-based system using signal intelligence to identify, classify and pinpoint incoming drones and alert corrections facility staff of contraband drops. It’s also capable of identifying the drone pilot’s location, to assist in apprehension. “While drones or unmanned aerial vehicles (UAVs) can be fun for hobbyists and videographers, they are also the latest technology used to introduce contraband such as
Drugs and firearms are two of the biggest threats a secure facility faces. The N2000 from Scintrex Trace, Autoclear’s trace detection division, is a lightweight yet robust handheld narcotics detector. It surpasses others in the detection of fentanyl, cocaine, opiates, cannabis, hashish, methamphetamine, and other amphetaminetype stimulants. In addition, Autoclear’s metal detection handhelds, the Model 20 and SuperOmni are vital in body searches for metal threats. Customs and borders, schools, mail screening, and corrections are just a sampling of applications that have used this valuable tool to discover cleverly concealed threats.
Line of Detectors Autoclear is advancing threat detection with versatile products for screening mail, packages, baggage and cargo. Offering an extensive line of security X-ray machines, walk-through and handheld metal detectors, its products enhance security at any venue: schools, parks, prisons, courts. This enables fast, more confident decision-making, especially when screening densely packed items for explosives. From the tiny footprint of the 4535 X-ray scanner, to the mammoth 150180 Xray cargo scanner, to the popular mid-sized 5333 and 6040, as well as Dual View and Backscatter units, there is a size and a technology for every application. Autoclear LLC info@autoclear.com 973.276.6161 Autoclear.com
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BY G.F. GUERCIO, CONTRIBUTING EDITOR
! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Electronic Health Record mandates set by The Center for Medicare & Medicaid Services (CMS) with Medicare payment adjustments as incentives for meaningful use continue to cast their long shadows over the corrections medical offices. Even with a new 2019 delayed timeline for Stage 3 compliance to the CMS mandate, which involves coordination of care through patient engagement, health information exchange and public 26 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
health reporting, correctional facilities should view this as a beacon beckoning compliance. Achieving and maintaining federal compliance and correctionsspecific accreditation status with an EHR solution is the ultimate goal, says Michael Jakovcic, EVP Business Development at Fusion. As the Electronic Health Record industry has seen an explosion in the number of systems developed over the past decade, he says that the Certified Commission for
Health Information Technology (CCHIT) certifying EHRs since 2006 has established the first comprehensive, practical definition of what capabilities are needed in these systems. “A CCHIT accredited EHR is a critical ‘seal of quality’ when choosing an EHR, as it distinguishes the EHR as being a complete system as determined by the independent CCHIT/ONCATCB (Office of the National Coordinator for Health Information Technology/
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Authorized Testing and Certification Bodies) accreditation board.� “Next to hands-on offender care, no part of health care carries as much importance as protecting an offender’s personal information from a breach of privacy and auditing the compliance of the health care provider or facility,� he says. “In addition to having a secure system, providers and facilities should have a compliance officer to assure compliance with all facets of HIPAA rules, procedures are updated, training is performed, rooms are modified, computers and other electronic means are secured, and audits and reporting are carried out. It is imperative, now more than ever, for agencies and health care vendors alike to recognize these certified systems not just as a luxury but as a requirement in the provision of health care within a corrections setting, just like it is a requirement for any other practice or hospital outside the wires.� Important interfaces include JMS/OMS, laboratory and radiology, Jakovcic notes, “However, there is one interface that is largely overlooked, which is the interface with local, regional, and state Health Information Exchange (HIE) systems.� This allows outside providers to have access to offender medical records and vice versa, a Stage 3 focus. Fusion’s Centricity system can exchange offender health information with external systems in CCD (Continuity of Care Document) or CCR (Continuity of Care Record) format. Users can generate export, import, and display CCD documents for offenders with charts in the Centricity database. He furthers that Centricity increases efficiencies for inpatient and outpatient services, including but not limited to, annual exams/initial intake screenings, clinic visits, chronic disease monitoring, telemedicine, vaccine records, sick call triage, medication administration, mental
health and discharge planning for offenders. “It also possesses a robust reporting environment that provides real-time data to enable effective decision-making through the integration with third-party systems.�
The TechCare Electronic Health Records system from Naphcare connects all critical sys-
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tems—including the OMS, lab system, pharmacy, diagnostics, food service, kiosk, hospitals and Medicaid—to provide a complete, real-time picture of a patient's history of care, which is the end goal of EHR compliance, says Byron Harrison, director for TechCare EHR Services at NaphCare. “More than an EHR, TechCare is an operating system that automates and standardizes clinical workflow to guarantee clinical processes are followed,
CORRECTIONS FORUM • JANUARY/FEBRUARY 2019 27
Centurion’s built-in decision support tools in its EHR prevent correctional health care staff from making inadvertent medication errors by providing a high-level review automatically during the ordering process, and again through the pharmacy interface.
leading to consistent and efficient patient care and outcomes.â€? At NaphCare a proactive care model supports early identification of issues to prevent costly emergency situations and off-site trips and improve overall care, the company notes. To combat the growing population of patients in correctional settings with mental health and/or substance abuse issues, the TechCare system is designed with protocols consistent with NCCHC (National Commission of Correctional Health Care) standards to conduct screenings and assess treatment options for patients at intake. “For instance, if a patient reports alcohol use during the Intake Screening, TechCare will generate a prompt requiring clinical staff to initiate an alcohol withdrawal screening protocol, such as CIWA (Clinical Institute Withdrawal Assessment).â€? With access to a full spectrum of information on the patient, health care providers can proactively address these and ‘unseen’ medical issues, such as alerting food service to an allergy or possible drug interactions. “We understand the complexities of serving a unique and diverse population in a regulated environment.â€? Access to clear, accurate and current health infor28 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
mation for individual patients in TechCare and the ability to identify trends via report generation “allows our health care management team and providers to make reasonable, appropriate and costeffective decisions specific to each facility, creating opportunities for programs to continually improve and evolve with current needs.�
“With an EHR system, we can more easily obtain data and act upon the information to provide a higher quality of care to patients,� agrees Diana L. Grover, RN, MPM, CCHP, vice president, Operations, EHR, and Transition at Wexford Health. “For example, the data
from A1C monitoring, hypertension checks, and BMI gauging, and so forth has become a hot button for improving the quality of care for patients.� With the lab interface, doctors and patients receive virtually immediate feedback on tests, receiving timely reports that can be acted upon quickly and accurately, she says. With an EHR system, everyone has access to medical records,
within the constraints of HIPAA, as they are all in the system, adds Wanda Melocchi, CCHP, EMR & project manager, also at Wexford. “With an EHR, medical personnel no longer have to send a request for files or information. It also makes transfers much easier too as files can be sent electronically.� That gives an advantage, in that corrections patients transfer between jails or between prisons on a regular basis, says Christie Nader, VP, IT, Centurion. “Providers can have patient information available at their fingertips, without having to wait for a paper chart to arrive, or for a fax of the chart. Most importantly, multiple clinicians can access a patient chart simultaneously, enabling them to conduct processes concurrently such as chart reviews, medication reorders, and lab sign offs.� And Stage 3 mandates put added emphasis on data sharing and interoperability to improve patient care amidst the electronics involved. Built-in decision support tools prevent correctional health care staff from making inadvertent medication errors by providing a high-level review automatically during the ordering process, and again through the pharmacy interface, she adds. “Orders can be set up to automatically prompt a provider to renew a medication and even notify nurses when a patient has been noncompliant. Most correctional EHR systems also allow for corrections-specific functions such as release medication notifications, KOP (Keep On Person), and alerts due to diversion.� While a key component to a successful pharmacy interface is to have an electronic medication administration record, “one of the most advantageous connections is with a state’s health information exchange which allows for accurate and timely medication verification, behavioral health status, and recent hospitalizations,� says Nader. “Correctional systems should
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turn towards their EHR when developing new initiatives such as expanded telemedicine, Hep C tracking, or MAT (Microbial Antiattachment Technology) programs and build into their system all of the needed functions for staff to be able to accurately document the care they provide,� Nader says. “More than just capturing information, agencies should see their EHR systems as a tool for cost containment by identifying trends and using the data gathered in the EHR for predictive modeling to identify high-risk/high-cost medical cases. EHRs should be looked
at as electronic workflows and not as simply the electronic translations of paper forms.� It is key, she says, that “correctional systems seek staff input on accurately creating these workflows and on continuous improvement efforts to make the most of the investment into an electronic health record system.�
In this EHR investment where the compliance intention is higher-quality data, enabling providers to practice better patient care, Michael J. Mover, chief information officer, Corizon Health, sums up the issues and opportunities: “The single biggest issue in this area is unnecessary clinical variance. In correctional health care there is often variance between facilities, states and clinicians. “The EHR can drive standardization once it is defined. It can make it easier to do the right thing (evidence based treatment) and harder to do the wrong thing. With an EHR you can rapidly take new treatment options and get them to the clinicians in a much shorter time frame than without an EHR.â€? And with the final EHR Stage 3 compliance rule hovering, he says interoperability, data sharing 30 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
N.J.-based Fusion showed how its Centricity EHR system can exchange offender health information with external systems at the fall 2018 National Commission of Correctional Health Care conference.
and better transitions of care are going to be critical. “The ARRA (American Recovery and Reinvestment Act) with its meaningful use incentives largely missed health care in correctional settings, because of this, sometimes the electronic systems still materially lag their counterparts in the traditional health care setting. “We need to move that bar, improve the systems, look for new, more efficient ways to treat patients in a high-risk environment and focus on better analytics and outcomes.� To focus on better outcomes, step out of the shadows of compliance and into the habit of gaining more from the EHR, which includes increased access
and improved ability to assess the needed patient care. âœŞ
For more information Fusion, 732.218.5705, BD@fusionmgt.com, www.fusionmgt.com TechCare by NaphCare, 844.849.3211, www.techcareehr.com Wexford Health Sources, Inc., Annette M. Testa, senior proposal, marketing, and communications specialist, 412.539.0191, atesta@wexfordhealth.com Corizon Health, Marc Fucci, chief growth officer, 615.660.6846, marc.fucci@corizonhealth.com, www.corizonhealth.com Centurion, LLC, 800.416.3649, www.CenturionMCare.com
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BY DONNA ROGERS, EDITOR-IN-CHIEF
“He said, she said� can make for a tangled investigation and a dubious outcome for a trial, whereas the use of a body worn camera (BWC) can deliver an open and shut case. In corrections, cameras are most often used in transports and in cell extractions, and a distinct stable of companies are marketing to them. Here are a few of the BWC available in this market and how they are deployed. In November 2018, the Randolph County Jail in Asheboro, N.C., became the first within its county to purchase and deploy BWC for its detention officers. Through their experience and research, according to Major Chris Toriello, who oversees the jail, they decided to contact Axon Enterprise Inc., the company through which their Tasers are provided, in order to conduct a trial run of body worn cameras. (As way of background, Axon
CAPTURE
32 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
cameras are deployed in 47 major cities across the U.S.) “They left them with us for a month and we put it on two of our officers that are actively working,� Toriello said, according to the Courier-Tribune, “and immediately the officers came back after using and said that just the mere presence of it was having a more secure effect for the officer.� Using asset seizure monies, they purchased enough for all 10 of their detention officers to use with 10 additional devices so they can alternate docking them immediately after the shift with those used by the incoming shift officers. The new shift officers take fresh cameras from the loading dock that have already been downloaded and fully recharged. When a Randolph County officer is wearing a body camera, the camera is constantly buffering, but recordings aren’t saved unless the camera is turned on.
Reveal Media body worn cameras are used in over 40 countries worldwide.
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The previous 30 seconds of buffering are automatically saved with the video, allowing an officer to add to the video 30 seconds of what led to an event. Thirty seconds are also recorded after the officer manually stops the device from recording. The footage downloaded from the cameras at the end of each shift can be used as evidence if an incident warrants charges to be filed, or if clarification of what happened is needed. Major Toriello speaks to the benefit of having the devices on hand. “We—as administrators— will go in and dismiss what we don’t need to keep, that way we keep the storage free. If there’s an incident and an incident report has happened, we get those reports, so we’ll know about the date and time that something may have happened, and was recorded, and we can go back and capture it and put it in an actual case file.â€? He adds that it is like having a second set of eyes in the room. “When things happen, you might not see or hear everything,â€? Toriello said, â€œâ€Ś but you can go back and reflect upon what you heard and saw to refresh your memory‌. When things are happening, sometimes we can get focused on one [event] and the camera can pick up other things.â€?
The Reveal Media Inc. body camera solution has been over 10 years in the making, with customers using them in corrections and police in over 40 countries around the world, explains Ben Read, marketing executive with Reveal. They count the Maine Department of Corrections, Rikers Island and Prince Georges County, Maryland, Department of Corrections as their customers. Officers mount the camera on
Veho’s Muvi HD Pro2
their uniform and record as and when a situation arises. Like the previous mentioned device, the camera can be maintained in pre-record mode, whereby it is constantly recording but only retaining the previous 30 or 60 seconds. This enables officers to capture the events leading up to a situation when they trigger the recording. At the end of their shift, the officers dock the camera in the docking station, which simultaneously uploads the footage to what Read calls “our award-winning� digital evidence management software DEMS 360, where it is decrypted and securely stored. The cameras have a number of features that help improve officer safety and efficiency in dealing with incidents. A noticeable differentiator between Reveal and competitors is the prominent front facing screen which displays footage in real time as it is being recorded, notes Read. “This has been shown all over the world to enhance the deterring nature of the body camera by showing perpetrators their actions like holding up a mirror. When people see themselves being recorded they
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tend to alter their behavior, which can reduce and diffuse aggression and hostility, thus protecting officers from potential harm.â€? Read furthers: “Reveal cameras also feature an industry leading low light mode whereby the camera closely mimics the human eye and captures high quality footage in extraordinarily low light environments. Crucially, however, the camera does not record in night mode or infrared. This ensures that when reviewing the footage the camera does not pick up more than the officer was able to see, thus making it clear why decisions were made.â€? In addition, the latest Reveal D-Series body cameras have the ability to live stream footage over a 4G or Wi-Fi network,â€? he points out. Read also relays some feedback he’s gotten from corrections users. One comment came from a 221-bed corrections facility, which noted that the size of the Reveal camera was a plus. They said: “We tested five products and there were several drawbacks, [including that] one of them was like a brick‌ You put that on a shirt, unless you have a very large area of support, it will pull down on your shirt. With Reveal, because of the articulated head, CORRECTIONS FORUM • JANUARY/FEBRUARY 2019 33
The Veho Muvi HD Pro 2 camcorcorder is designed for professional use, with IR night vision, 32 GB built-in memory, record time up to 3.5 hours, date and time stamp and password protection.
you can wear it on the epaulette or on a shirt.â€? This facility also added that the DEMS software was a valuable addition. â€œâ€Ś. We looked at a lot of people’s software but, again, you need a software that is easy to use, [and] it’s a world class software. That’s another thing a lot of competitors failed on—software.â€?
Bob Barker/Officers Only is the primary U.S. distributor of the U.K.-designed Veho Global Group camcorder for law enforcement, emergency services and security use. Two distinct products are offered, a Muvi Micro and Muvi HD, both of which have recently had new designs released. “Most of our customers are on the corrections side of law enforcement. The two main uses are for the departments’ transport teams, and the Cell Extraction 34 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
Response Teams, explains William Schultz of Bob Barker. Because most jails and prisons have cameras throughout, there is not a need for the officers to always wear cameras, he adds. He furthers that most departments interested in a body worn camera are looking for a cost effective solution that provides a high enough resolution video to be used in court, internal investigations, or for training purposes. The Veho body cameras are easy to set up, and are dependable, he says. “They are pretty much point and shoot,� notes Steven Lewis, Veho’s CEO. One of the biggest obstacles to a great penetration into the corrections market, believes Schultz, is the budgetary constraints. However, both of the original Muvi camera models have been used successfully in the field, says Paul Noble, senior account manager, with Veho. “The products seem to be at the right price for
officers compared to a lot of the “specialist� BWC camera companies that insist you purchase all of their evidence software and packages to enable the cameras to work, putting them way over budget for a lot of departments.� And as for a drawback to using only a CCTV system, Lewis adds that even the micro sized/lightweight Muvi cameras record audio, which CCTV can't do. The updated Muvi Micro HDZ Pro Camcorder, capable of recording HD footage 1080p @ 30 fps, captures all the action as it happens. The company tells us that HDZ Pro measures at just 55mm x 22mm x 20mm, making it one of the smallest action cameras on the market. The diminutive size allows the camera to be mounted in a variety of situations including extreme sports (and of course cell extractions). The recording time is up to 80 minutes and it includes an 8 GB microSD card, with max capacity of 32GB. Still photo resolution is up to 2MP. The Muvi HD Pro 2 with more advanced features is designed specifically for professional use. It includes a greater resolution up to 16MP, IR night vision, 32 GB built-in memory, record time up to 3.5 hours, date and time stamp and password protection. Hands-free video seems to be taking the world by storm. In our evidence-based society video is as ubiquitous as the smartphone. There’s no reason to get into a he said/she said tussle with the law anymore, which can cost a department millions in litigation. In the long run, it’s better to have the video working in the favor of your agency—rather than the alternative. % For more information: Axon/Taser International, Inc. www.axon.com/connect Reveal Media Inc. http://us.revealmedia.com/ salesusa@revealmedia.com Veho Global Group/Bob Barker www.veho-world.com www.bobbarker.com
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BY DONNA ROGERS, EDITOR-IN-CHIEF
Doctor on Call Telepsychiatry provides a clinical standard of care whether in person or remote, yet hurdles still exist.
O
ffenders too often do not have access to mental health services in a timely manner for various reasons: prisons in remote places, lengthy security protocols, unpleasant and intimidating working conditions make it difficult to attract mental health staff. Now, too, federal mandates to maintain constitutionality of care are in force. In recent years, many agencies have come under scrutiny for failure to give inmates proper treatment, and mental health has been a primary deficiency, according to Edward Kaftarian, MD, CEO of Orbit Health Telepsychiatry. Dr. Kaftarian has served in a variety of executive roles within the California prison system, including chief psychiatrist and medical director. As a representative for California Correctional Healthcare Services he also worked alongside federally appointed court auditors in the California prison system to examine how deficiencies could 36 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
be remedied. He is the founder of California’s Statewide Prison Telepsychiatry Program, virtually the largest correctional telepsychiatry program in the world. In 2015 he founded Orbit Health, a company that provides telepsychiatry services to jails and prisons. We spoke to him by phone in his California offices. “Psychiatry is challenging work. We want offenders to rehabilitate, to become productive members of society. It’s an honorable thing to help these people.” However, he acknowledges, jails and prisons are a difficult place to work, they are dingy, not clean, not comfortable. “They were designed years ago when mental health treatment wasn’t important.”
Authoritarian Feeling He points out that there is also an authoritarian feeling within a prison setting that may not be ideal for a client in enabling vulnerability to open up to a mental health care provider. Staff must also comply with
greater safety protocols, such as wearing stab-proof vests, alarms, and facemasks. In some cases, it might make the medical staff feel that they are going to war, rather than treating patients. This may bring out more aggressive and hostile feelings, which can possibly spill into the dynamics of the treatment session, according to the Orbit Health web page. Compounding the problem, says Dr. Kaftarian, is a nationwide staffing shortage for qualified psychiatrists. In contrast, when doctors work from home, they can create a work environment ideal for them. Telepsychiatrists are less likely to succumb to the authoritarian culture because they are not as entrenched in it, notes the Orbit web site. Telemedicine providers do not have the heavy restrictions on what to wear and what to bring to the office. They are not as affected by the local mood in the institution. They are less worried about what the custody officer may think of
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Study after study affirms that telepsychiatry is as effective as in-person treatment for a variety of mental health care issues, say experts.
them or of office politics. They are virtually out of danger and have no fears for their safety or retaliation. They are better able to focus on the task at hand, and enjoy working with the inmates, he says. On the security side too, “if we [medical staff] are out of the way,” Dr. Kaftarian continues, “it creates less of a burden on officers; when a lockdown or riot occurs, that’s one less staff member to account for.” Cost savings are also significant because telepsychiatry minimizes the need for transport. For example, if an inmate becomes acutely psychotic, they might need to be transported to another facility to be housed in a crisis unit or a hospital, he observes. A patient may be acting psychotic because of an underlying medical illness, which can be easily remedied with a change in medication, through televisit. “This has saved many, many admissions,” he says, saving thousands of dollars, in that it usually involves two officers and a nurse to accompany the inmate to the emergency room. In remote areas that are typical-
ly understaffed, Dr. Kaftarian furthers, an on-call televisit system means fewer psychiatrists can cover more facilities than can inperson doctors. For night coverage for example, he says, “each doctor may be covering five to 10 facilities; clustered together the position makes a reasonable work day.” Savings are even more powerful at night,” he emphasizes. It’s very inefficient to hire a full time psychiatrist, especially for nighttime, when the need is lower. Because the doctors work from home, they can work for less, thus passing the cost savings to the agency. According to CloudVisit, a Cold Spring, N.Y., telepsychiatry service firm, a 2013 report on the usage of telepsychiatry in correctional facilities found that widespread adoption is leading to exponential efficiencies. Through the study, conducted by the National Center for Biotechnology Information (a branch of the National Institutes of Health), which reviewed 49 sources across seven states, researchers documented an annual savings ranging between $12,000 and $4 million (an average of $850 per visit)
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through the use of telepsychiatry at correctional facilities.
Effectiveness of Telepsychiatry A question one might ponder is How effective is the use of telepsychiatry? Does it provide less benefit than a face-to-face encounter? According to Arcadian Telepsychiatry, a company that provides the service to various underserved populations, corrections among them: “Study after study affirms that telepsychiatry is as effective as in-person treatment for a wide variety of mental health care issues. Some patients even seem to prefer remote service as opposed to in-person service, citing (among other reasons) the ease of establishing rapport between provider and patient.” General telemedicine has been used successfully in many corrections facilities. As far back as between 1997 and 2008 California prisons benefited from more than 70,000 telemedicine consults, an average of more than 10,000 annually (note: overall telemedicine, not specifically psychiatry). CORRECTIONS FORUM • JANUARY/FEBRUARY 2019 37
Possible Abuses However, in October 2018 a negative alleged report marred some of the progress being made in remote mental health. The chief psychiatrist for California's prison system accused state officials of providing inaccurate and misleading data to a federal court and to lawyers for prison inmates fighting to improve psychiatric care inside state prisons, according to court documents, it was reported by www.governing.com. According to the article cited by Sam Stanton of the Tribune News Service, “Dr. Michael Golding compiled a ‘lengthy, detailed report’ that inmate attorneys say contains ‘serious allegations’ that data reported to the court overseeing a long-running case involving medical and mental health care inside California prisons ‘is inaccurate and has been presented in a materially misleading way,’ court documents say.” Michael Bien, the lead attorney for the inmates, said in the article that “Golding's report included ‘disturbing’ information that prison officials were conducting cell-front telepsychiatry sessions using laptops pointed through cell door windows or food ports, something that provides no privacy for inmates.” Finally, while abuses to the system are possible, hopefully that is the exception, rather than the rule. “Resistance is futile,” says Dr. Kaftarian. “This is the way doctors want to practice.” He also believes “a quality exam can be conducted” in this way, and patients can sometimes even connect with their counselors with less intimidation, and on a more positive emotional level. And because doctors are connecting with inmates online from anywhere, they can follow the patient through the course of incarceration, and follow their care through outpatient care. “It helps prevent recidivism. It helps with continuity of care.” % 38 CORRECTIONS FORUM • JANUARY/FEBRUARY 2019
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