September / October 2016

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SEPTEMBER/OCTOBER 2016 VOL. 25 NO. 5

Tools for a Highly-accountable Pharmacy Help Wanted: Felon Job Seekers

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Corrections Forum

Post-release Continuity of Care

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CORRECTIONS

FORUM

Publisher & Executive Editor

Thomas S. Kapinos Assistant Publisher

Jennifer A. Kapinos

SEPTEMBER/OCTOBER 2016

Associate Publishers Art Sylvie Peggy Virgadamo (480) 816-3448 asylvie@cox.net

4 8 16 20 30 37 41 46 49

(718) 456-7329 pegpaulv@aol.com

West

The Pulse

Northeast Central U.S. Sales Managers Bonnie Dodson (828) 479-7472

Editor-in-Chief

Donna Rogers

Stopping Drugs In Their Tracks

Contributing Editors Michael Grohs, Kelly Mason, Bill Schiffner, G.F. Guercio Art Director

Jamie Stroud

Help Wanted: Felon Job Seekers Summer ACA Conference Product Round-up

CORRECTIONS FORUM (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:

CORRECTIONS FORUM

Med Control: Mission Impossible?

To Protect, & To Serve Personal Protection for Officer Safety Clinical State— A Review of Mental Health Access for Inmates Post-release Continuity of Mental Health Care

Ad Index

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OBAMA TO GIVE INMATES A SECOND CHANCE AT COLLEGE WITH PELL GRANTS The Obama administration will give Pell grants to about 12,000 inmates in an effort to help them transition to life after prison—despite a law prohibiting inmates from receiving financial aid under the program.

The $30 million Second Chance Pell Grant program will be available to inmates at 141 state and federal correctional institutions, who will be able to use a federal Pell grant of up to $5,815 to pur-

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sue a two- or four-year degree from one of 67 approved colleges and universities.

State and federal inmates haven't been eligible for Pell grants in 22 years, a vestige of the 1994 crime bill in which Congress explicitly prohibited inmates from receiving them: "No basic grant shall be awarded under this subpart to any individual who is incarcerated in any Federal or State penal institution.'' At the time, 0.6% of Pell grants were going to inmates.

"We have called for Congress to reverse the mistake that was made in the mid '90s," Secretary of Education John King told USA TODAY.

"That ban remains in place until Congress acts. We are using our experimentation authority under the Higher Education Act." "We're squandering opportunity by not giving people with a criminal record a second chance," said Secretary of Labor Tom Perez.

"Many of the people we’re trying to help, frankly, didn’t have a fair first chance."

STATE PRISONS TO GET BODY SCANNERS TO KEEP DRUGS OUT According to the Concord Monitor, New Hampshire's Democratic governor, Maggie Hassan, recently signed a bill that places six scanners

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in each of the state's three prisons and provides for grant funds to help place scanners in county jails that want the devices. The bill makes $740,000 available in grant funding and provides for $1.1 million to purchase the scanners. It stipulates that the machines only detect contraband, and do not display or record private body parts.

JUSTICE DEPARTMENT ARGUES BAIL IS UNCONSTITUTIONAL FOR INDIGENT In August, the United States Department of Justice filed a document to a federal appeals court in Georgia, arguing that jailing someone who can't afford to make bail

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is unconstitutional, according to an article in Business Insider.

According to NBC News, the court document said the long-time practice flies in the face of the 14th Amendment's guarantee of equal protection under the law.

"Fixed bail schedules that allow for the pretrial release of only those who can pay, without accounting for the ability to pay, unlawfully discriminate based on indigence," stated the DOJ. The department filed the document in response to the case of Georgia man Maurice Walker, who was charged with "being a pedestrian under the influence," according to NBC—a misdemeanor

offense. Walker spent six nights in jail because he was unable to pay his $160 bail.

A May report from the Prison Policy Initiative shows that 70% of the 646,000 people held in 3,000 local jails across the country are there awaiting trial, "meaning they have not yet been convicted of a crime and are legally presumed innocent."

These statistics are due in large part to the money bail system, which disproportionately affects the poor. According to the report, in 2015, people in jail had a median income of just $15,109 before their incarceration—half that of non-incarcerated people, and even

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less than the median pre-incarceration income of people who are in prison.

PRIVATE PRISON COMPANIES EMBRACING ALTERNATIVES TO INCARCERATION On August 18, private prison stocks dropped like a rock when the Department of Justice announced that it would be phasing out its use of for-profit detention facilities. But it turns out that reports of the industry’s imminent death have been greatly exaggerated, according to an August 23 article in The Nation.

Experts who track the business tell The Nation that as mass-incarceration reform has become a bipartisan issue, and private prison companies large and small have seen the writing on the wall, they are aggressively moving into alternatives to imprisonment.

“These companies know what they’re doing,” says Christopher Petrella, a lecturer at Bates College who studies the industry. “They’re agile, they follow market trends, and they know where the growth is.” Accord-

ing to Petrella, two of the biggest companies—GEO Group and Corrections Corporation of America (CCA)—“have really pivoted to diversify their services away from traditional incarceration. They’ve both invested heavily in the past five or six years in prisoner rehabilitation services, mental health centers, residential reentry programs and monitoring technologies for supervised release.” These are all areas that are expected to grow as efforts to reduce the prison population gain traction.

“It’s really clear looking at mergers and acquisitions that this is where the big companies like CCA and GEO are headed,” says Caroline Isaacs, program director of the American Friends Service Committee’s Tucson office, and the author of several reports on the industry.

In its latest presentation to investors, CCA says, “residential reentry facilities provide offenders with the tools and skills necessary to successfully return to the communities without recidivating,” and brags that “in less than three years, CCA has established the secondlargest residential-reentry platform in the United States and has a robust acquisition pipeline of additional [residential reentry] operators.” The company now “owns or controls 24 residential reentry properties, representing 4,970 beds.”

PRESIDENT OBAMA GRANTS CLEMENCY TO 111 PRISONERS In his second set of clemency grants in August, President Barack Obama commuted the sentences of 111 prisoners, 72 of whom were applicants whose petitions were supported by Clemency Project 2014, according to a press release by the American Civil Liberties Union. The August 30 grants bring the total number of commutations granted by President Obama since taking office to 673.

Cynthia W. Roseberry, project manager for Clemency Project 2014, said: “Today’s grants come only a few weeks after the president granted a record number of clemency petitions. On behalf of the project and the countless people it serves, I want to express how pleased I am with the continued commitment that President Obama has shown toward commuting sentences. We are looking forward to many more grants during the remaining months of President Obama’s term in office.”

Among the 111 prisoners are Danielle Metz, Rudy Martinez, and Timothy Tyler, who are featured in the 8 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

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American Civil Liberties Union’s 2013 report, A Living Death: Life Without Parole for Nonviolent Offenses.

Ms. Metz has been in prison

since 1993 on conspiracy to distribute cocaine and related nonviolent charges. In her interview for the report, she told the ACLU, “The hardest part of all is the sep-

aration from my children. We need each other terribly. How do you tell your child, ‘Mama will never be coming home?’ My heart aches to know that all the love I pour out to them may not be enough to convince them that I haven’t left them so far away out of not caring for them.”

“We thank the president for commuting the sentences of 111 federal prisoners today and for his continued use of fairness and proportionality to push back against years of irrational sentencing laws handed down during our failed War on Drugs that have harmed thousands of people and their families,” said Ezekiel Edwards, director, ACLU’s Criminal Law Reform Proj-

“As a result of decades of harsh policies, thousands await fair treatment.” ect. “As a result of decades of harsh policies, thousands more still wait for fair treatment. We are hopeful that the president’s laudable efforts will extend to every prisoner seeking commutation of an excessive sentence and that this country moves towards more humane, equitable, and effective drug policies.”

Clemency Project 2014, an unprecedented effort by the nation's bar, has recruited and trained nearly 4,000 volunteer lawyers from diverse practice backgrounds and completed screening of over 33,000 of the more than 36,000 federal prisoners who have requested volunteer assistance.

Clemency Project has submitted more than 1,600 petitions to the Office of the Pardon Attorney, with many more nearing submission.

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BY DONNA ROGERS, EDITOR-IN-CHIEF

Stopping Drugs in their Tracks SuperviSorS rely on random drug teSt to keep their clientS on the road to recovery.

Random drug testing remains a number #1 tool for probation and parole officers to check their clients for sobriety, and for specialty courts to maintain compli12 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

ance for their participants.

While urine testing remains the standard, oral fluid testing is also picking up steam as an alternative, due to its reputation that it delivers a longer window of detection and other specialty instances and cases, such as gender differences, shy bladder, and simply ease of collection.

Personal labs are also an option, where small benchtop analyzers can provide a faster turnaround for agencies in that they can maintain control of which cases take priority.

Reporting software is available

with this equipment also organizes the data better so that monitoring supervisors can see results at a glance.

These are some of the current technologies available on the market now.

Hydrocodone Detection Hydrocodone, also known as Vicodin or Lortab, is one of the most abused prescriptions on the U.S. market today. Toxicology laboratories have been using opiate tests to detect hydrocodone

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izing in confirmation testing of both urine and oral fluid samples. eLab provides full confirmation testing of all drugs requested with “next day” service from the time specimens reach its laboratory.

Certified toxicology reports are delivered via secure data transfer direct to electronic medical records (EMR) system, fax or web portal. with lackluster results. Thermo Scientific’s newest addition to its drug test collection, the DRI® Hydrocodone Assay, provides accurate results in pinpointing the drug and its major matabolites in human urine. The readyto-use liquid applications are available for a range of clinical analyzers and provide fully automated qualitative and semi-quantitative results.

Web site: www.thermoscientific.com Contact info: Call or email at 1.800.232.3342 or sales.diagnostics.fmt@thermofisher.com

Analyzers, Services & Software The firm, eLab is a privatelyheld Atlanta, Georgia-based life sciences technology and laboratory services provider, historically serving criminal justice, clinical reference and pain management laboratories. Since its inception in 2005, it has grown to more than 150 employees, supporting the needs of toxicology and general chemistry laboratories in over 20 states and still expanding, with applications for both the government and commercial sectors.

For onsite testing, eLab offers two analyzers, the Biolis 24i and 50i, which provide fully automated random access at 240 dual reagent tests/hr and 480 tests/hr, respectively.

When a department needs results confirmed by experienced professionals eLab offers those services as well. The eLab Clinical Laboratory is a high-complexity, COLA accredited facility special14 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

The firm also offers QuikCase case management software for drug courts and similar programs.

Features include: seamless integration with QuikLIMS drug testing management system, resource and client scheduling, assessment of the customer’s drug testing menu relative to the aggregated occurrence of detected drugs of abuse in their geography, random drug test scheduling, and comprehensive reporting.

Web site: www.elabsolutions.com Contact info: 1.866-990-3522 (ELAB): Info@eLabSolutions.com

automated analyzer, providing controlled accurate analysis on site. It has a user-friendly design, and on-screen instructions guide a supervisor through the test.

To enhance accurate results, the device automatically controls analysis time and internal temperature, and the company promotes that it has one of the lowest active THC cutoffs in the industry. If results are positive, they can be confirmed with a second oral fluid sample via an independent, third-party laboratory analysis. Results are then available online in a matter of days.

The analyzer stores the last 500 test results, along with the date and time. In addition, data can be downloaded to a PC or printed

Mobile Oral Fluid Analysis Dräger Safety Diagnostics Inc. of Irving, Texas, now markets the DrugTest 5000, a mobile oral fluid drug screening and analysis device that uses oral fluid to test for seven types of the most commonly abused drugs. This quick drug test provides a non-invasive alternative to the hassle of collecting urine or blood samples.

Tests are reported to be not easily adulterated, and it provides reliable on-the-spot results within minutes, says the company. A two-step system, its components include the DrugTest 5000 Test Kit, which is a ready-to-use test cassette with a built-in sample collector and volume adequacy indicator, and the DrugTest 5000 Analyzer, a rechargeable, fully

using the Mobile Printer, an optional accessory.

For maintenance, Drager offers an in-house service department, where they offer a range of services including calibrations, service contracts and post-warranty repairs.

Web site: www.draeger.com Contact info: 1.866.385.5900

Oral Fluid Collection Devices As a leader in oral fluid specimen collection and testing, Orasure presents its latest advancement in oral fluid col-

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lection with the Intercept i2 Oral Fluid Collection Device.

The Intercept i2 is a collection system utilized for lab-based detection of drugs of abuse. Oral fluid is collected under direct observation with the average collection time of just 3-4 minutes. Collection pads are then put into a vial, sealed, and sent to the lab with a completed chain-of-custody form for analysis. Results are reported the next day on negative results, and within 48 to 72 hours for positive confirmation.

Web site: www.orasure.com, Contact info: 1.800.869.3538

Fingerprint Sweat Testing & More With an array of products designed for use in probation and parole departments, rehabilitation centers, drug courts, jails, treatment centers and many others, SMARTOX brings expertise in the drug screening and testing

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field. In addition to a diverse portfolio of drug testing products including urine cup and oral fluid testing, the company also brings the Intelligent Fingerprinting™ screening device. This cutting-edge technology analyzes sweat produced from the fingerprint. It is unique in that it analyzes the drug metabolite versus the drug itself, ensuring cross-contamination does not occur.

SMARTOX also provides fully integrated services encompassing design, customer service and administrative support for its product line. Founded in 2012, the company is based in Grapevine, Texas. Its sister company, SmartStart, has been a leader in alcohol monitoring solutions and services for over 20 years, preventing over 7 million alcohol related starts and over 600,000 installs.

Web site: www.smartox.com Contact info: info@smartox.com or 1.888.711.9906

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BY DONNA ROGERS, EDITOR-IN-CHIEF

er v O

600,000 exoffenders get released from jails and prisons every year. Of them, 67% will recidivate, according to statistics.

Education and a job are two factors that will keep them from returning.

Yet the odds are against them.

A 2014 employment poll found than men with criminal records accounted for about 34% of all nonworking men ages 25 to 54 in the United States (the Kaiser Family Foundation/New York

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Times/CBS News Non-employed Poll, Dec. 2014). How do they possibly get hired when a high percentage of job posts specifically state: “No Felons, must pass background check”?

Over the past several years social service agencies, reentry projects, and probation and parole agencies have been placing increased effort into developing innovative programs that provide education and vocational training both pre- and post-release to try to reverse this problem.

Last year, for example, the

Indiana Department of Corrections initiated a transitional employment program for 25 inmates who would be hired by Goodwill Industries of Central Indiana, Inc., an organization with a history of providing employment for people whose options have been limited by disability, a criminal history, low education level or other significant barrier.

According to John Nally, Ed.D., director of education for the IDOC, participants were to be paid $7.25/hr. to begin, with

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pay increased up to $8.00 per hour, and would work four days per week, and spend one day per week in classroom training studying popular computer software; reading, math and career planning. Upon the completion of the program, Goodwill planned to use its reasonable best efforts to assist the graduate in finding full-time employment.

Further, the IDOC conducted a study of 6,561 incarcerated adults released in 2005. The purpose was to determine the effect, if any, of education and postrelease employment on recidivism among the group. Results of the ongoing study revealed that an individual’s formal educational status at release and employment were critical predictors of recidivism.

The recidivism rate was based on the number of offenders who were re-incarcerated in IDOC facilities during the study period of 2005-2009 after their initial release from IDOC custody in

2005, Dr. Nally notes.

“The study provided clear evidence that employment is a major predictor of recidivism,” he states. “Specifically, an unemployed offender was 1.5 times more likely to become a recidivist offender compared to an offender who was employed post-release.

The results of the study also demonstrated that an offender who had not participated in any correctional education programs during incarceration is approximately 3.7 times more likely to become a recidivist offender when compared to an offender who has participated in a variety of correctional education programs during incarceration.” He furthers, “the recidivism rate is 29.7 percent among offenders who participated in a variety of correctional education programs.

Conversely, the recidivism rate reached 67.8 percent among individuals who declined to participate in any correctional education programs.”

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Job Web Site for Convicted Felons Convicted felons face “monumental barriers” when trying to find work, says the author of an article on a web site called exoffenders.net, created in 2011 to assist exoffenders reclaim their lives. “It’s already hard enough to find a job with a clean record, and finding a job with a felony may seem like an impossible task,” the writer continues. Some of those who have posted on the site have had former careers but because crimes such as conviction for felony theft (stealing from their company) have all but ruined their careers they are attempting to start over. The site offers help to do just that.

Along with a list of companies that offer felony-friendly job placements, the site provides a broad range of online resources, including local job searches and new is a list of reentry resources for all 50 states. A sample of the

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felon-tolerant companies are: Ace Hardware, Aramark, Best Western, Costco, Dunkin Donuts, General Mills, General Motors, KFC, McDonald’s, Petsmart, Radisson, Shoprite, Sony, United Health Care, U.S. Steel Corp. and Walgreens. For a complete list check out exoffenders.net.

The site also publishes a free guide to help first time job seekers who are felons and it also recommends several books including Jails to Jobs: Seven Steps to Becoming Employed by Mark Drevno, Beyond Bars: Rejoining Society After Prison by Jeffrey Ian Ross and Stephen C. Richards and Jobs For Felons by Michael Ford.

Finally, it reports this book to be helpful: The Ex-Offender’s Job Hunting Guide: 10 Steps to a New Life in the Work World by Ron Krannich and Caryl Krannich.

Exoffenders.net also recommends checking out Beyonds Career Network for more local, smaller business opportunities.

Signing up is free. The site also has online resources for felons such as where to find a lawyer, how to manage debt and a state-by-state resources that provide reentry and state assistance for felons. These are programs and agencies that provide food, shelter, counseling, educational and vocational services and job searches geared toward exoffenders and those on probation and parole.

Determining High Growth Job Sectors Another organization that is leading the way is the H.I.R.E. Network in New York City.

Established by the Legal Action Center in 2001, the National Helping Individuals with criminal records Re-enter through Employment (H.I.R.E.) Network is both a national clearinghouse for information and an advocate for policy change. It is one of several special projects at the Legal Action Center. The goal of the National H.I.R.E. Network is to increase the number and quality 18 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

of job opportunities available to people with criminal records by changing public policies, employment practices and public opinion, according to its web page, hirenetwork.org.

Its recently published book titled Closing the Skills Gap & Opening More Doors: Connecting Workers with Criminal Histories to Jobs in NYC’s High Growth Sectors (2016) centers around an analysis of local high growth job sectors, in which those with criminal records can target through vocational training.

In it, Roberta Meyers, director, National H.I.R.E. Network, states that “it is imperative that job market analysis includes the impact a criminal record may have on job opportunities.” The group has analyzed the New York City and New York state job market and stress that “an analysis ideally should be done in every jurisdiction across the country to assist policymakers, investors,

The top 10 entry-level positions forecasted for the highest job growth in New York City through 2022 1. personal and home care aide 2. retail salesperson 3. waiter and waitress 4. janitor and cleaner 5. cooks—restaurant 6. cashier 7. clerk—receptionist 8. customer service rep 9. bookkeeper, accounting, auditor 10. clerk—office and general Source: the H.I.R.E. Network

workforce practitioners, and jobseekers with identifying the best industries to invest time, money, and effort toward building a workforce that is capable of filling the job gaps that exist in the labor market. “ The book furthers that there are legal and policy barriers that thwart employment possibilities, yet “workforce professionals can increase the employability of people with criminal records by understanding the barriers they face and being prepared to help individuals overcome them. They can also use labor market forecasts to learn where the highest number of suitable, well-paying jobs most likely will be.”

Closing the Skills Gap builds on a prior research report, Now Hiring (2012), that profiled seven economic sectors in New York State and New York City that could yield high demand, well-paid work from 2008 to 2018. That report identified 26 occupations within those sectors that could provide individuals opportunities to work and earn decent pay without “substantial educational and training requirements.”

Closing the Skills Gap updates the labor information with a review of the same occupations and a few others over the tenyear period of 2012-2022. It states: “the coming decade is likely to see skilled worker shortages in at least four U.S. industry sectors—health care, technology, transportation and manufacturing”—and it forecasts estimates of how many jobs will be needed in each position by job title.

While those with a felony conviction have what seems like insurmountable odds to overcome, more vocational and job placement assistance is being offered, and some employers will overlook a felony conviction and will take a chance on the individual. With hard work from social service agencies and the exoffenders themselves hopefully the story will increasingly end with the words: “You’re hired!” ✪

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COMPILED BY BILL SCHIFFNER, CONTRIBUTING EDITOR

Product highlights from the American Correctional Association’s 146th Congress of Correction, August 5-10, 2016, Boston, Mass.

Summer ACA 2016 Product Round up Healthcare Systems

Mail Screener

For over a decade, CorrectCare— Integrated Health (CCIH) has provided utilization management, network access, and claims processing services solely within the correctional environment. They

The VeroVision Mail Screener is specifically developed to help improve correctional facility safety by detecting drugs and common cutting agents that may be sent to facilities through the mail.

This system features a simple, onebutton t o u c h interface

have experience with providing utilization management and claims management for small local facilities and entire state DOCs. CCIH works hand-in-hand with state correctional personnel to provide necessary data for reducing their medical costs while increasing their quality of inmate care. www.correctcare.com, 1.859.253.2097 20 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

that allows the operator to quickly scan mail. www.cisensorsystems.com, 1.412.241.7335

Case Software Northpointe, Inc. and CourtView Justice Solutions unveiled their new COMPAS Specialty Court System. COMPAS Specialty Court ensures that justice programs are aligned with evidence-based prac-

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tices by building case plans specific to participants’ criminogenic needs and tracking all details of related treatment, tests, conditions, court appearances, and other activities. www.northpointeinc.com, 1.888.221.4615 and www.courtview.com, 1.800.406.4333

Electronic Typewriter The 2640 Swintec Electronic Typewriter gives a smart collection of characters to even the most demanding office environ-

ments. From its space-saving design to its 40-character LCD display, users will have everything they need to get the job done right. The company makes seven clear cabinet models for the corrections industry. www.swintec.com, 1.800.225.0867

Inmate Phones All Telmate phones are designed specifically for correctional institutions and encased in high security, 14-gauge stainless steel.

The armored keypads are con-

The phones contain no removable parts and are designed and installed in a way that prevents safety hazards to users, and minimizes vandalism. www.telmate.com, 1.885.TELMATE

Self-Report Psychopathy The Self-Report Psychopathy Scale 4th Edition (SRP 4) from MHS is the first official self-report version of the gold standard Hare Psychopathy Checklist–Revised (PCL–R). This unique tool contains items that can be used to help identify psychopathic

behaviors across the same factor structure found in the entire PCL family of assessments. The provision of community, college, and offender samples provides context for scores and makes the SRP 4 an invaluable tool for use in psychopathy research. www.mhs.com/srp4, 1.800.456.3003

Photo Kiosk Selfie iKiosks come packed with features and offer many options.

The iKiosk can be tailored to meet needs of application or event. Inmates and visitors can take photos, print and email all

from the easy-to-use iKiosk.

They are completely integrated with Microtronic US’s payment system. http://microtronicus.com, 1.800.879.3586

viding a high level of versatility for line officers in the performance of their duties. This is due to the extensive operational record-keeping capabilities of the PDA device and because the mobility of the device is ideal for controlling the direct supervision dayroom environment of a jail. www.blackcreekisc.com, 1.205.949.9900

Inspirational Media Guideposts is a nonprofit organization dedicated to providing hope, encouragement, and inspiration. Through uplifting magazines, books, websites, a prayer network, and outreach programs, Guideposts helps people deepen their faith and inspires them to reach their true potential. www.guideposts.org, 1.800.932.2145

Criminal Justice Studies Kaplan University’s criminal justice programs are designed to help students and people in the field achieve their goals. The school’s masters, bachelors, and

Personal Detention Assistant structed of heavy chrome metal and the handsets use armored cord with steel lanyards and heavy 14-gauge steel retainers.

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Black Creek’s Personal Detention Assistant (PDA) mobile security control system has been invaluable to command staff while pro-

associates degree and certificate programs offer comprehensive

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training in criminal justice to prepare them for a career in law enforcement, corrections, or private security. Some of their criminal justice programs offer the opportunity to gain hands-on experience working on real cases. http://www.kaplanuniversity.edu, 1.800.811.9819

Inmate Transport

comprehensive management program that includes psychosocial support. www.alkermes.com, 1.781.609.6000

interface and integrated solution.

It offers a new KeyFind feature. www.morsewatchmans.com, 1.800.423.8256

Digital Signage Solution

Lounge Seating Kits

CourtSight’s JailCall streamlines correctional facility processes by providing up-to-date prisoner information electronically. Our

E/Z Prisoner Transport Modules are available in 1, 2, and 3 Compartments and are re-useable over the life of many vans. Their Inmate Modules are more economical in price than leading competitors, and lighter in

weight without sacrificing security and strength. Heavy-duty smooth mill finish aluminum allows for easy cleaning, floor is skid-resistant diamond plate aluminum, windows, view-ports and access panels are lexan for visibility and security, all door hinges and fasteners are stainless steel for added strength. http://ezrideronline.com/, 1.800.277.0869

software integrates with jail management systems to deliver realtime information. With JailCall, personnel are informed of prisoner’s bond information, next appearance date, arraignment schedules and even a current docket of who is set to appear in court that day. www.Infax.com, 1.770.209.9925

All Minuet, Metro and Pinnacle kits contain 7-ply (plywood) China Birch frame parts, hardware, HR foam, Dacron and no sag spring support system. Frame pieces are precision CNC milled to strict tolerances with locator holes for interlocking assembly.

Armchair, settee and sofa kits are available. www.washington.ci.com 1.800.628.4738

Compact Inmate Phone Securus’ sPhone is the smallest multi-purpose hardware solution in corrections, delivering powerful software with the most flexible installation options. The sPhone can easily replace stan-

Key Management KeyWatcher Touch brings one touch key control to the KeyWatcher, one of their indus-

Opioid Dependence Care VIVITROL (naltrexone for extended-release injectable suspension) is a once-monthly med-

ication for the treatment of alcohol dependence as well as for the prevention of relapse to opioid dependence, following opioid detoxification. VIVITROL is the first and only non-narcotic, nonaddictive, once-monthly medication approved for the treatment of opioid dependence. Treatment with VIVITROL is also part of a 24 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

dard inmate telephones because they can be powered using the existing copper wire already installed, eliminating facility disruptions associated with installing new network or electrical cables. www.securustechnologies.com, 1.972.277.0665

try-leading electronic key cabinets.

Their new big, bright 7-inch touch screen key register systems give facilities a much easier-to-use

Dashboard Software Updates CSI specializes in software for the correctional industry with strong emphasis on correctional health-

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care and providing applications that improve the quality and delivery of healthcare in the prison environment. With CDBOARDS, users extract and dial down to serve up whatever data facilities use the most, in an attractive user interface on any device, at anytime. Users can improve oversight of their operations, control costs and ensure public safety through better management of off-site inmates. www.csi-c.us, 1.617.470.9990

portfolio of solutions spans across telephone captioning services, on-site interpreting services, and video relay interpreting (VRI), delivering a wide array of options to meet the varied communication needs including the incarcerated. At ACA, the company announced a partnership with Global Tel Link (GTL) to empower deaf and hard of hearing inmates with a new VRS using GTLs Flex video link terminal. www.purple.us, 1.800.900.9478

Secure Utensil

Intrusion Detection System

EcoSecurity Utensil (ESU) is a safer, non-weapon alternative to traditional silverware. The ESU dramatically reduces incidents of

self harm and harm to others, as well as assisting with inmate morale, CO safety and cost reduction. It’s made of slick paperboard similar to that of a milk carton and folds to create a sturdy yet simple structure that lets inmates cut through most food items. http://ecosecurityutensil.com, 1.415.924.0233

The Protection Technologies, Inc. (ProTech) G-Fence 3000 is a fencemounted sensor that detects intrusions caused by cutting, climbing or lifting the fence. The system is comprised of fence cabling, a solar powered control unit and digital accelerometer for sensitivity settings that is connected to the Maxibus input control board for control room monitoring. www.ProTechusa.com, 1.800.428.9662

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Laundry Solutions This original Laundry Loop device with sock snare is said to be the fastest, most efficient way to manage laundry for teams and other large groups. Holding 8-10 garments per loop, clothing gets cleaner, less wrinkled, and dry twice as fast compared with laundry bags, they report, and it helps conserve energy and reduce costs. http://www.laundryloops.com, 1.888.246.5667

Letter and Package Screening MailSecur’s exclusive 360° Rotation Video Imaging technique renders mail content decoding easier than ever before. Operators can watch a live video of the inspection process as they move objects by hand within the inspection

Rehabilitating Offenders MTC makes an impact in corrections by preparing offenders to successfully transition into the community. MTC secures and

Video Relay Service for the Deaf Purple Communications provides high-quality video relay service (VRS) available from multiple platforms that is a free ADA-provided service for deaf and hardof-hearing customers who use sign language to communicate via video conference and a video interpreter (VI).

The VI voices/relays the signed conversation in real-time to both deaf and hearing individuals. Purple’s

environment so offenders improve their academic, technical, job, and life skills. www.mtctrains.com/corrections, 1.202.733.3246

trains nearly 27,000 offenders and detainees daily and nearly 78,000 offenders and detainees annually.

Their mission is to reduce recidivism by providing results-oriented programming in a safe and secure

area, allowing for 360-degree angles of view for detection and content identification compared to two angles of view for x-rays.

Designed for letters, flat envelopes and small packets, it represents a monumental revolution in mail screening, says the firm, in terms of safety, accessibility and detection. MailSecur’s mmWave technology can detect and confirm powders, solids, liquids and all forms of CBREs, in the smallest of quantities. http://raysecur.com/en, 1.844.729.7328

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BY G.F. GUERCIO, CONTRIBUTING EDITOR

Med Control: Mission Impossible?

Managing medication dispensing, and all the inherent issues that come with it, can be harrowing without proper systems and equipment.

Medi-Dose President Robert Braverman secures medication with their flagship system for solid oral medication.

Every facility’s mission of medication dispensing is fraught with problems: Securing medications, dispelling diversions all the while untangling tracking and compliance complications. These just scratch the surface with deeper problems stacking up right behind: funding, staffing, and medication issues themselves such as overdoses, over prescribing, and handling hazardous medications.

“Correctional facilities, regardless of their size, need an organized, effective method for safely distributing and administering high volumes of medications to their inmates on a daily basis,” 30 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

acknowledges Wendelyn R. Pekich, MBA, CCHP, director, Marketing & Communications, Wexford Health. “While medication distribution and administration is typically the responsibility of nursing staff, custody officers are often required to accompany them.” Facilities are looking for the most efficient method to limit the time custody personnel are engaged. “It is also important that the medication is accurately given to each person and documented appropriately.

“As an experienced health care provider, Wexford Health recognizes that medication administration is a high-volume, high-risk component of correctional health

care programs,” she says. “To address this, we created an Intensive Medication Pass Review (IMPReview) program. The goal of the IMPReview is to prepare nurses for the many distractions, security requirements, and sheer patient volume they will face every day as a correctional medication distribution nurse. By proactively addressing the challenges of medication administration, we are able to educate nurses on what to expect. This equips them to better manage the process, thereby increasing patient safety as well as job satisfaction and nurse retention.”

Medical staff in nearly all correctional facilities are dealing

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Human Error Reduced

A sample Corizon Medication Therapy Management Program report. To date the program has reviewed 1,227 patient profiles and, within those, flagged 1,437 potential medication-related issues for providers to further evaluate.

with limited resources in terms of funding or staff, inmate turnover and frequent medication changes, medication accuracy and security during administration, and state regulations around pre-pouring and repackaging drugs, assesses Craig Davis, senior program manager/product manager for Vial Filling Technologies, Parata Systems.

Pharmacy automation such as the Parata Max high-speed robotic dispenser automates the prescription filling process. “This allows even the busiest pharmacies to accommodate a higher volume and has a positive impact on safety and patient care. This is a vial-filling solution that would greatly benefit correctional facilities that use primarily a medication line or Keep-on-Person administration.”

To control access to medications in the pharmacy, both Parata Max and Parata Mini support locking cells that restrict access based on operator permission levels, and replenishment, dispensing, and return-to-stocks are tracked and reported.

Further, says Davis, Parata PASS packaging, which organizes a patient’s medications by date and time of dose in individual, clearly-labeled pouches, eliminates the need for pre-pouring and repackaging. For correctional facilities that use an EMR (electronic medical record), pharmacies can print an optional bar32 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

code on each pouch, which is scanned when those medications are administered to the patient.

A problem with administering in some facilities is the majority of inmates are prescribed medications, reports Rebecca Luethy, MSN, RN, director of Operations Development, Centurion, LLC. “This requires many hours of staff time to administer, especially when medications are administered a dose at a time.”

Wexford Health’s Medication Pass Review (IMPReview) program prepares health care staff for the issues they will face as a correctional medication distribution nurses.

If the facility is not using an electronic medication ordering system, the factors that lead to a delay in timely—possibly consequential—medication dispensing increase dramatically, says Dr. Gregg Puffenberger, PharmD, MBA, vice president of Pharmacy Management at Centurion.

Human error and system malfunction can double the opportunity for mistakes. “Utilization of an Electronic Ordering and Medication Administration Record may alleviate some of the problems that occur due to staffing and the use of a manual paper system,” he says.

And security problems such as lost/stolen medication can be diminished with bar code scanning, notes Vince Grattan, RPh, Centurion’s director of Pharmacy Management, at each step of the way: as medications are checked into inventory at the site, again scanning with electronic medication administration records to track Keep-on-Person or DOT (Direct Observation Therapy) administration, and scanning to track returns.

Darrelle Knight, PharmD, MSM, CCHP, director of Clinical Pharmacy Services, Naphcare, Inc., concurs that the electronic health record (EHR) reduces issues with diverted medications because the medications can be tracked from the moment they leave the pharmacy to the administration to the patient. “The EHR has effectively closed the loop on the gaps that paper records left open.”

Once medications are dispensed from the pharmacy, they are reconciled by staff at the site.

This reconciliation verifies that everything that has been dispensed has been received at the jail. Tracking and diversion are controlled at every encounter with the medication recorded with a date and time stamp. The EHR gives clinicians opportunities to review compliance by

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recording medication administrations. “The EHR we use, TechCare, gives our clinicians a unique advantage. After three consecutive missed doses of a medication, an alert is sent to the clinician’s daily work queue.”

The Verification Process Other than tracking/diversion, one of the biggest challenges is the verification process, contends Chris Bove, president, Local Detention Division, Correct Care Solutions (CCS). “As a company, our patients undergo a very thorough intake procedure and protocol which typically provides some context about the patient’s

“The industry needs a robust, dedicated and unified national database that incorporates shared correctional patient information between accredited community, regional and national healthcare agencies, and correctional medical professionals. The ideal system needs to digitally track correctional patient information.

This would, of course, be a massive undertaking; however, it would go a long way to improving efficiencies and administrative procedures within correctional facilities across the United States,” Bove points out. “Think about it in the same light as a national crime database, but

methadone is administered during an incarceration to protect the fetus. Opioid withdrawal in general has become a very significant issue in the correctional health care environment.

Addressing these issues is a priority for CCS’s team across the country.”

The ability to dispense medications efficiently and with the lowest possible error rate is the most important benchmark of service in corrections pharmacy, according to Zane Gray, Pharm.D, with Diamond Pharmacy Services. As the nation’s largest corrections pharmacy provider, serving over

based on electronic medical records of those who have been incarcerated.”

In addition to verification, Bove notes the prevalent problem of opioid withdrawal and methadone administration. “By practice and by law, CCS does not continue a patient’s methadone treatment except in cases where the patient is pregnant and in that circumstance,

600,000 inmates in facilities across 45 states, the volume creates many medication control challenges that require customerand technology-driven solutions.

Diamond utilizes a double verification process to assure accurate dispensing of all medication orders, they report. First, pharmacists review regimens and identify any therapy duplications and drug-drug interactions and

Both Parata Max and Parata Mini support locking cells to restrict access based on permission levels.

medical background, but that information is not always reliable or verifiable.” Because a correctional facility is booking new patients on a 24/7 schedule, resources are not always available for verification purposes. “We can speak with a physician and provide a patient profile, however, this can be difficult with no familiarity with the patient’s background.

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distributing oral chemo or medication such as Avodart which pregnant women can’t touch.”

New Efficiencies

Centurion commends utilization of Electronic Ordering and Medication Administration Records to alleviate problems that may occur due to staffing issues and manual paper systems.

communicate them to the prescriber. Bar code scanning is then used to verify that the correct medication, dose and directions are dispensed and delivered to the correct facility and patient.

The pharmacy further reduces medication errors by working with clients at the facility level individually to streamline both the sending of medication orders and reception of prescriptions.

Technology plays an important role in medication control and pharmacy-client relations, Gray says. “The Reconciliation program, for example, allows both Diamond and facility staff to track reception of medication into the facility through the bar code system. This system also allows the staff to instantly refill medication, reducing the time spent on medication ordering.”

Online Reporting software allows the staff to track medication utilization, ensuring facilities understand which exact medications are being used and the costs associated with them.

There are times manual dispensing overcomes issues, says Robert Braverman, president, Medi-Dose, especially for hazardous medications and for facili36 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

ties that can’t afford automation.

“If we’re dealing with a sheriff’s department jail or a small facility we’re perfect for that; there’s no machinery, no extensive in-service training.” The flagship product is for solid oral medication— the blister pack. “The foil adhesive is an aggressive system, so it’s the same degree of protection as the heat seal. It’s similar for liquid packaging: it’s a tamper-evident seal on top of the bottle with the screw top. We have a whole array of other products for tamper evidence: Labels, bags, etc.”

As an added benefit, Braverman says the system labels the packaging to suit specifications. “For accountability, each dose can be numbered and you could even include an image of the inmate—checking from a privacy standpoint first, of course— as well as bar coding.”

The aging inmate patient population becomes an issue with cancer and other diseases occurring due to age, he cites. New USP 800 drugs for cancer, AIDS, etc. are hazardous but need to be dispensed. “Medi-Dose ideally addresses the needs of these patients while protecting the health care professional or those

Polypharmacy—the over-prescription of medications—is a serious issue, Peter Lee, Pharm.D. MBA CCHP, vice president of Clinical Pharmacy Services, Corizon Health/PharmaCorr explains, especially when statistics show the average patient is prescribed five different medications, some of which may be contra-indicated or may simply be inappropriate, leading to unnecessarily higher pharmacy costs.

“At Corizon Health, we are adopting an exciting new Medication Therapy Management Program modeled after the program used by Medicare Part D, but tailored for corrections.” To date, the program has reviewed 1,227 patient profiles and, within those, flagged 1,473 potential medication-related issues for providers to further evaluate.

In addition, Corizon Health/PharmaCorr is piloting a clinical pharmacy intervention program that utilizes technology to inform providers of the most cost-effective drug option, dose optimization, the latest clinical guidelines and other drug information. “Not only does this solution help minimize errors and ensure the most therapeutic solutions, this system already has saved clients more than $1.2 in unnecessary pharmacy costs.”

He adds that at one state contract they developed a medication refusal form that includes valuable information about possible consequences of refusing medications “and we hope will inspire a change of attitude and result in compliance. We anticipate this being converted to an electronic form that may be captured in the EHR to better inform providers of possible health issues with patients.”

All in all, organizing these practices can neutralize med control concerns and transform the mission to: possible. ✪

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BY DONNA ROGERS, EDITOR

To Protect, and to Serve PACA’s new riot helmet, called the Advanced Riot Control Helmet or ARCH, will feature hands-free lighting.

Corrections

Corrections officers

have a dangerous job. In fact, they have one of the most dangerous jobs of any occupation. Of all U.S. workers, they have one of the highest rates of nonfatal, workrelated injuries, according to the National Institute for Occupational Safety and Health.

In 2011, for example, the Department of Labor Statistics reported correctional officers experienced 544 work-related injuries or illnesses per 10,000 full-time employees (FTEs), which were serious enough to miss at least one day of work. This was more than four times greater

managers have a duty to protect their officers who are regularly

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placed in harm’s way.

than the rate of all workers who missed a day of work (117 cases per 10,000 FTEs).

Further, in 2011 COs experienced 254 work-related injuries per 10,000 FTEs due to assaults and violent acts. This is substantially higher when compared to only seven per 10,000 for all workers, furthers the DLS. The NIOSH study U.S. Correctional Officers Killed or Injured on the Job spans 10 years from 1999 through 2008. During that time, approximately half a million COs were supervising about 2 million inmates. Of those, there were 113 officer CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016 37

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In 2011, C.O.’s experienced 254 work-related injuries per 10,000 full-time employees compared to only seven per 10,000 for all workers.

—Bureau of Labor Statistics

fatalities and an estimated 125,000 emergency-room nonfatal injuries.

It states that 40% of fatalities were sustained from assaults and violent acts, while another 40% were transportation related. Falls constituted 14% of CO deaths.

The findings also report the way officers sustained nonfatal injuries—the majority were due to assaults and violent acts (37%) followed by overexertion (20%) and contact with objects and equipment (18%).

Further, the report outlines the

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officers’ injured body parts: 37,500 injuries were to upper limbs; 23,500 to hand and finger; 30,000 to trunk, neck and shoulder; 26,000 to lower limb and 22,000 to head and face, including eye, ear and mouth.

Overall, however, authors of the federal report found details surrounding the injuries’ circumstances were limited. While the FBI compiles such data for law enforcement killed in the line of duty, they noted, there is no comparable data base maintained for COs on the national level.

They concluded that increased information and reporting by the agencies could lead to a safer workplace for correctional personnel.

While the most serious injuries and deaths do get reported, many injuries go unreported to news media and external law enforcement agencies, in part due to the negative light injuries cast on supervisors and upper management, and to shield the local public from fear, acknowledges Walter Kreidell, director of Correctional Sales & Product Management, Point Blank Enterprises (PBE).

Double Threat One of the biggest contributors to assaults and violence is contraband, which in 2016 remains a thorny issue within prisons and jails. According to an informal survey done by Joe Bouchard at the Wisconsin Jail Association’s 2012 conference, 80% of attendees reported contraband to be a problem at their facility. While they noted that pills and drugs were the number one item smuggled in, and tobacco was second, sharpened tooth brushes and the arms of eyeglasses fashioned into pointy shanks were also on their lists.

Corrections officers face a double threat, says Kreidell, who formerly worked at Rikers Island, NYC DOC. Inside the walls, the threat is “100% sharp instrument,” but “once you cross that bridge [off of Rikers Island], it becomes ballistic,” he says. His company makes multi-threat vests that offer both ballistic and spike protection, but technically you are wearing two vests, he points out. The weight and the heat can become unbearable, and are “extremely difficult to wear,” especially inside older facilities where there is no air conditioning, and temperatures can reach over 100 degrees. An officer cannot be at his optimal awareness level when he or she is that uncomfortable, he believes.

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COs frequently address the dilemma of wearing a heavier hybrid vest by switching off and wearing two different vests—a spike-rated vest while inside the facility and a ballistic vest when doing hospital or court transport duties.

Officers face several difficulties in obtaining and actually wearing protective stab vests. First there is the mindset. “Older officers don't want to wear it,” says Kreidell.

Similarly, when ballistics vests were first introduced in the 1970s, there was resistance, which took perhaps 30 to 40 years to change, he remembers. Some agencies now do have mandatory wear regulations, like NYC DOC and the NJ DOC, which he says was in response to a need for additional protection for their officers due to a rise in officers being assaulted, but many do not. “More agencies have to get on board with mandatory wear,” and “we have to come up with a better, more comfortable wearing vest,” he says.

The National Institute of Justice hasn’t changed their standards for a spike vest since 2001, he notes, while ballistic vests have undergone several changes, so perhaps this category is overdue. NIJ is in fact currently working on developing a new spike standard. Kreidell is hopeful that fiber manufacturers, such as DuPont (Kevlar) and Toyobo (Zylon), will develop a new product that will defeat both ballistics and edged weapons. This breakthrough could be “five years down the line,” he says. “We need both avenues of protection in a hybrid vest. It’s a dream for us working in the industry.”

Further exacerbating the difficulties of implementing a mandatory wear requirement, an agency that instates such a policy must then assume the financial burden to purchase the equipment, not an easy proposition when funded by taxpayer money.

Yet, in the event an officer is attacked, Kreidell details, such a program would pay for itself in a 40 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

hurry.

When an officer goes out on long-term disability, he explains, the department has to fill his position with someone on overtime, so they would lay out salary plus time and a half pay.

Hypothetically speaking, this might cost a base salary of $70,000, plus half time, another $35,000, in addition to the disability insurance pay-out to the downed officer. It could also incur a hefty lawsuit settlement and legal fees. “The department could have outfitted everyone with a vest” for the expense of a lost legal battle, he points out.

And, he adds, “Maybe the officer would only be out a week, instead of a year, if only he had protection. For me, it’s a nobrainer….you’ve got to protect your officers.”

Protection— from Head to Torso For the hands, TurtleSkin NYDoCS Kevlar Search Gloves prevent cuts from sharp objects.

They were developed for use in corrections, and while they are not puncture resistant they are cut resistant to 680 grams of force. Point Blank Enterprises promotes its PACA Corrections line of vests. Its standard corrections vest is available in Spike 1, 2 or 3 levels and also comes as a combo with ballistic Level II or IIa protection. For tactical corrections, PACA also carries vests that are Spike 3 certified and/or offer maximum blunt trauma protection. At the end of September, PBE will be introducing a new riot helmet called the Advanced Riot Control Helmet or ARCH, which will feature hands-free lighting, often necessary in riot conditions. And at the January 2017 SHOT show, Point Blank will be announcing a new shield, which will serve as a crossover for police and corrections that will be built to withstand an attack from a machete.

The PACA Mediator Shield, coming out next January, will serve as a crossover for police and corrections and is built to withstand an attack from a machete.

Recommendations In the end, in has been documented that being a corrections officer is one of the most dangerous jobs a worker could hold. It is therefore incumbent on an officer’s supervisors and/or the department administration to provide him or her with the tools needed to withstand injury or even death. While departments such as the NJ DOC and the NYC DOC have made strides to address these issues, more needs to be done. The National Institute of Corrections in its 2008 report Managing Risk in Jails recommends a variety of strategies to keep our prisons and jails safer. Among them are to address staffing shortage issues; follow good operational procedures; provide basic medical and mental health care, including qualified health care staff; provide safety training programs; and, finally, to provide proper personal protective equipment. ✪

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BY MICHAEL GROHS, CONTRIBUTING EDITOR Stockton’s new in-patient facilities for mental health feature more windows and natural light (including skylights and courtyards), aspects normally not utilized in prison setting construction.

With the number of community psychiatric beds shrinking, corrections facilities are required to pick up the slack. How is it working?

Starting in the 1970s, the nation’s community mental health facilities began closing. As a result, correctional facilities became the de facto replacement.

They began to deal with a wide range of disorders at alarming rates. “The most prevalent mental health issues experienced by incarcerated individuals include substance use disorders, mood

disorders, psychotic disorders, and trauma-related disorders,” explains John Wilson, Ph.D., CCHP-MH, vice president of Clinical Development at MHM Services. There is also a surprising hitch to consider. He furthers, “Although the overall number of incarcerated individuals is decreasing, the number with mental health issues appears

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to be rising, placing continued strain on already stressed correctional mental health departments.”

The move in mental illness treatment was not, notes Dr. Joseph Pastor, chief psychiatric officer at Corizon Health, accompanied with an increase in funding for community resources, and since then correctional facilities CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016 41

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have been fulfilling their adopted role in a variety of ways. A study published by the Treatment Advocacy Center reported that the number of psychiatric hospital beds shrank by 14% between 2005 and 2010 alone. Currently, it is at the same level as it was in 1850, which was the beginning of the movement to provide better mental health care in hospitals to the seriously mentally ill (SMI). Joel Andrade, Ph.D.,

the prevalence of behavioral health among those involved in the correctional system. “This has led to the development of national standards regarding mental health access to care, intake, and evaluation that are not required elsewhere in the health care delivery system. In adherence to these standards, upon intake, Corizon assesses inmates for behavioral as well as physical health issues.

“Unfortunately, as the recognition

38,100 inmates—29.6% of our overall inmate population— receive some form of mental health treatment.” That’s about 200 fewer people than the population of Annapolis, Maryland.

The challenges are numerous, the greatest being, says Pastor, the complexity of the patients.

Many of them have multiple medical and mental health needs that must be addressed in a challenging arena and includes con-

of behavioral health issues has improved, service delivery resources have not kept pace with the need.” Increasingly, this leads correctional agencies to seek private correctional health providers to address behavioral health issues within the parameters available, “which we strive to do through a model of integrated care,” Pastor says.

The numbers are staggering.

According the Bureau of Justice Statistics, in 2013 there were more than 2.3 million inmates in custody in the U.S.—more than any other nation in the world. Just in California, says Bill Sessa, information officer at the California Department of Corrections and Rehabilitation, “Approximately

siderations unique to that environment such as safety, security, and Constitutional mandates.

“Our challenge is to provide the right care, at the right time, in a cost-efficient manner.”

Designers of the CDCR California Health Care Facility, Stockton, consulted psychologists regarding what colors are soothing to those with mental illness (such as buttercup yellow) rather than relying on the standard polished concrete.

LICSW, director of Clinical Operations—Mental Health at MHM Services points out, “Correctional departments have been forced to develop innovative ways of providing mental health treatment to this population. Some systems have done so proactively while others have been forced to provide such services through litigation. In the end, all systems have been forced to significantly increase mental health services whether this is self-imposed or imposed by the judicial system.” The quality of these services is not all created equal, he furthers. “[It] varies greatly between systems.”

Pastor points out that a primary success has been in recognizing 42 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

The Inmate Compliance Issue There is also the matter of inmate compliance, says Dr. Mariann Burnetti-Atwell, senior vice president of Behavioral Health Operations at Corizon Health. Many inmates enter the facility unaware that they have an underlying behavioral health issue or issues and do not have experience in successfully managing them. Addressing those

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issues, she says, takes time, and very often it is a road the patients have never traveled. “Despite these challenges, we are seeing encouraging successes through the combination of integrated behavioral, medical, and pharmacological care combined with patient education.”

On the matter of compliance, Eva Kishimoto, a research associate and trainer for the University of Cincinnati Corrections Institute, notes that in almost every case (save for a few limited and stringent situations), the system cannot force medications or treatment on anyone. Another issue, she says, is that many people with a severe mental illness do not do well in communal environments such as general population and its constant and close contact; this in fact makes it worse. She furthers, “There are not ‘levels’ in prison where SMI offenders can be housed in a more private setting but not incur the cost associated with this type of setting. So they worsen, then get sent to much more expensive ‘treatment units,’ but this creates a revolving door scenario.”

It is also a challenge to find incentives strong enough so that they will drive behavior change.

Says Kishimoto, many of the seriously mentally ill have “burned out” their community support networks, and as a result they may not have many visitors or phone calls, which traditionally are big behavior incentives for other inmates. This makes behavior management very difficult for prison staff.

Training Challenges Presumably the shift of care being placed on correctional facilities was not an anticipated result of deinstitutionalization, and correctional officers do not sign up to be health care providers. This opens the door for required training so COs can recognize signs of behavioral disorders. In some cases this has posed challenges. Kishimoto notes that training correctional staff to use some evidence-based approaches has been met with union challenges.

She furthers, “Corrections has a very robust body of research, but most citizens, including prison staff, believe themselves to be experts on what should be done with law breakers, which may, but usually don’t, have an empirical research base.”

It also takes a lot of people to run a prison, and most populations do not want a prison in their backyards. This results in recruitment and training challenges. “Being in the business of running a prison is not usually an ‘employers market,’” she notes.

Mental illness presents in myriad ways, and the most serious ramification is suicide. According to the Bureau of Justice Statistics, suicide has been the leading cause of death in jails since 2000 (followed by heart disease). Sessa says, “Suicide prevention is a significant responsibility of CDCR. The department has many psychologists, psychiatrists, psychiVISIT US AT WWW.CORRECTIONSFORUM.NET

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atric technicians, medical doctors, and other medical professionals to identify and address suicidal risk, but the training does extend to correctional officers. That training includes a wide range of instruction on the psychology of suicide to conducting risk assessments and welfare checks on inmates who pose a risk of harming themselves. Our procedures also outline methods of intervention with mentally ill inmates and create a role for mental health professionals as the preferred first responders.”

Andrade furthers that the training offered to COs and other personnel in recognizing and preventing suicide varies between correctional departments, but many provide basic suicide prevention and mental health training for officers. Some systems provide such training on a routine basis, but “the most progressive systems provide routine comprehensive training combined with educational reimbursement and/or pay differential to security staff working in mental health units.” Corizon also works with their partners to provide suicide prevention training, crisis intervention training, symptom recognition as well as other efforts intended to assure awareness and safety.

To comply with a 2011 Supreme Court ruling, CDCR has made enormous strides in how they deal with inmates with mental health issues. In 2013, it opened the doors to several facilities around the state, including at the facility at the California Men’s Colony in San Luis Obispo that provides inpatient care to inmates and can house up to 50 inmates at a time who are in crisis and require 24hour treatment as well as complement other mental health facilities that provide out-patient treatment at the prison. (The project is also a candidate for Gold LEED certification, part of the U.S. Green Building Council’s Leadership in Energy and Environmental Design program.) The facility is one of 15 44 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

mental health treatment projects

by CDCR at a cost of $1.3 billion to comply with the court ruling (Coleman vs. Brown) requiring improved mental health treatment for inmates. The facility includes hospital-style treatment rooms, nursing stations from which to monitor inmate patients, space for individual and group counseling sessions, and administrative offices all behind an extension of the lethal electrified fence that surrounds the facility. Sessa points out, “The extent of mental health care is also expressed in our budget.” In FY 2014/2015, the total was $373 million. In FY 2015/2016, it is $397 million.

Worsening or Improving?

So is the problem getting better or worse? Andrade says, “Both.

While the number of incarcerated individuals with mental illness continues to rise, the services provided within correctional settings are improving significantly.

Establishing and implementing policies and programs to divert mentally ill individuals from prison and jail is the work that needs to be done over the next few years.” Pastor furthers that the number of inmates with mental health issues does continue to grow, but there is also a trend in improved recognition and subsequently addressing the inmate’s needs inside the facility. Mariann Burnetti-Atwell furthers, “We’re recognizing behavioral health issues as they come through the door and coordinating a rehabilitation plan with other correctional programming areas. Also, more behavioral health professionals are entering the correctional health care field.”

Some facilities are considering the situation and experimenting with alternatives. Sessa points out that CDCR has incorporated numerous architectural features into the new facility in Stockton and the new in-patient facilities for mental health such as more

windows and natural light (including skylights), aspects normally not utilized in prison setting construction. They also consulted psychologists regarding what colors are soothing to those with mental illness (such as buttercup yellow) rather than relying on the standard polished concrete. At the Stockton facility, some of the areas are color coded and have signs to assist inmates with slight dementia to navigate the facility so they can go from their housing unit to receive medical or dental care and return without getting lost. The living units for mental health were also built with small courtyards, again to give those inmates access to more natural light and to give them somewhere other than the housing unit to relax.

Hennepin County, Minnesota, has also taken action in an effort to accommodate inmates with mental health conditions. In a move to lower the number of inmates who have a mental illness, the facility will begin bringing psychologists into its Minneapolis facility to assess non-violent offenders who screen positive for mental illness. (Between 20 and 25 of the roughly 100 inmates booked into the facility each day screen positive for SMI.) The intention is that the plan will allow county officials to release dozens of inmates who have SMI into courtmonitored treatment programs rather than having them languish in jail without appropriate care.

Inmates who opt into the program will be released into programs while awaiting trial. The expectation is that in the first year the program will allow for 100 inmates who have been charged with lowlevel offenses to be conditionally released. Los Angeles, Houston, New York, and Miami are also experimenting with such programs. Regarding the matter, Hennepin County Sheriff Richard Stanek told the Star Tribune, “This is not about reducing overcrowding or saving money. This is about fairness.” ✪

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BY MICHAEL GROHS, CONTRIBUTING EDITOR

CONTINUING MENTAL HEALTH CARE AFTER RELEASE

Efforts underway to aid this very large population of ex-offenders.

It

was really bad timing. In the 1970s and 1980s, the nation began the process of deinstitutionalization, and community facilities started closing. Soon after that, the war on drugs escalated. (The federal prison population spiked nearly 800% between 1980 and 2012.)

According to the Bureau of Justice Statistics, in 2013 there were more than 2.3 million inmates in custody in the U.S.

46 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016

Despite the fact that the prison population is—finally—decreasing, the number of inmates with mental health issues is climbing.

The most common, says John Wilson, vice president of Clinical Development at MHM Services, are substance use disorders, mood disorders, psychotic disorders, and trauma-related disorders.

Bill Sessa, information officer at the California Department of Corrections and Rehabilitation

notes that nearly one-third of inmates in CDCR facilities receive some form of mental health treatment. That is more than 38,000 inmates. He furthers, “A huge percentage of our inmates also have substance abuse problems.”

Before the passing of the Affordable Care Act (ACA), when an inmate with a medical condition was released into the community, they were almost certain to return. A report by the

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Treatment Advocacy Center found the recidivism rate for people with mental health issues is higher than other inmates.

Ninety percent of inmates in Los Angeles County with mental health problems were repeat offenders, and nearly a third of those had been incarcerated more than 10 times. The passing of the ACA, though, has had an impact on that—at least in those states that expanded Medicaid.

“The good news,” says Joel Andrade, Ph.D., LICSW, director of Clinical Operations—Mental Health at MHM Services, “is that correctional systems are paying attention to this issue and implementing programming for individuals with substance use disorders. In some systems this includes Medication Assisted Treatment (MAT) for certain individuals as they re-enter the community. Providing needed substance use treatment services will have long-term positive outcomes for individuals, communities, and local and state budgets.”

Sessa furthers that CDCR, which does not outsource medical services, operates numerous treatment programs, especially for those who are in the “closing years of their sentence, as well as outpatient treatment to prevent relapses during the most critical 90 days after being released on parole.” (In 2013, according to the BJS, there were more than 850,000 people on parole.)

Among the CDCR programs is the offender mentor certificate program, in which inmates who have successfully undergone substance abuse treatment are able to become counselors to assist other inmates with their addiction.

This helps ensure that such programs are widespread.

Aligning Services on the Outside Upon the passing of the ACA, correctional facilities became responsible for aligning inmates with health care in the communi-

ty. Doing so is not a one-size-fitsall procedure. At CDCR, the process begins about 120 days prior to release. Some organizations actually begin the process when the inmate first arrives at the facility. Andrade says the process “varies significantly based on the location of the correctional department. Mental health professionals in correctional settings spend a great deal of time and energy attempting to link individuals with needed services as they re-enter society.

“Often community-based agencies do not accept recentlyreleased individuals into treatment because they do not meet the clinical criteria, whereas, while the individual was incarcerated, he/she was provided mental health services. This can often be a daunting task due to the limited mental health services in the community,” he points out.

Dr. Mariann Burnetti-Atwell, senior vice president of Behavioral Health Operations at Corizon Health points out, “It’s about releasing a better person with a better plan. Most systems in which we work have programs in place to meet basic needs and link patients with services, but too often it is a passive system that requires the patient to proactively pursue outside services with few resources in a system that is often very difficult to navigate.

“We believe successful reentry is one of the most important factors in reducing recidivism and are actively working with our partners to enhance reentry programs. We’re getting involved much earlier in the process to help patients enroll in Medicaid and other programs to eliminate delays in the start of benefits.

Electronic Health Records are helping to ensure continuity of care, and whenever possible we seek to facilitate a warm hand-off to community providers.”

Eva Kishimoto is a research analyst at the University of Cincinnati Corrections Institute (UCCI), an organization that con-

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ducts research, publishes articles, presents at conferences, and consults with agencies at the federal, state and local levels. “In particular, we work with many agencies through the Justice Reinvestment Initiative through the Bureau of Justice Assistance. As a result of these interactions, and in collaboration with Counsel of State Governments (CSG), we have developed a program designed to reduce recidivism that also has a modification for delivering the materials to the OMI (offender with mental illness).

“This program, Cognitive Behavioral Interventions—A Comprehensive Curriculum (CBI‐CC), is designed to provide a thorough intervention that broadly targets all criminogenic needs.” This intervention, continues Kishimoto, “relies on a cognitive behavioral approach to teach participants strategies to manage risk factors.” The program emphasizes skill-building activities to assist with social, cognitive, emotional, and developing coping skills.

“The curriculum provides modifications so that offenders with mental illness can participate, though it is not dedicated exclusively to this population.

This curriculum uses a modified closed group format with multiple entry points to allow for flexibility across various service settings and intervention lengths,” Kishimoto says. The complete curriculum is comprised of 56 sessions, which are divided into nine modules.

Multiple Challenges Despite the fact that the ACA has made it easier for people to afford treatment after release, there are a number of hurdles.

The main challenge, says Andrade, is “connecting individuals to community services as they are released from prison and jail [with] the limited amount of available services.” Since the programs and services are limited, “the acceptance criteria are often CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2016 47

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stringent. This results in services for the most acutely mentally ill, but little or no services for those with less severe symptoms.”

Another challenge, says BurnettiAtwell, is maintaining compliance upon release. However,

despite the obstacles, “We are seeing encouraging successes through the combination of integrated behavioral, medical, and pharmacological care combined with patient education.”

Kishimoto notes that the chal-

We believe successful reentry is one of the most important factors in reducing recidivism and …we’re getting involved much earlier in the process to help patients enroll in Medicaid and other programs to eliminate delays in the start of benefits.

—Dr. Mariann Burnetti-Atwell

lenges vary location to location.

Among them, she says, is that “Some prisons routinely dispose of inmate belongings including IDs and other critical paperwork necessary to eventually link them to community services. Inmates with SMI need more assistance in establishing links with community services. This takes a lot of work from the releasing facilities. Even if a prison worker was to go the extra mile to secure an appointment upon release, many simply will not get there and often do not have secure housing or community case management services to assist. There are many links and gaps where SMI offenders can get lost. Our social service networks are very complex organizations with many gaps and navigating those systems can be challenging even for those who are highly functioning in society.”

Reentry Centers and Day Reporting Reentry Centers and Day Reporting link patients with services and monitor patients. Dr. Joseph Pastor, chief psychiatric officer at Corizon Health, says, “We work with probation and parole on transitioning information to the community—it is an important part of continuity of care and we are active in this process.”

Kishimoto furthers that the role of these services vary. Some common roles include facilitating a smoother transition into community life, continuing to address untargeted criminogenic needs, and providing supervision.

Naturally this breeds its own set of challenges such as access to resources to provide effective programming and offender participation. “They need the programming, but they also need to make a living. These needs begin competing with each other.”

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are released.” Among the programs offered is the Substance Abuse Treatment and Recovery (STAR) program, which is designed to provide relapse prevention education to inmates on parole who have substance abuse treatment needs.

The program, which is education based, is facilitated by California certified teachers from the Contra Costa County Office of Education and utilizes what is known as the DEUCE (Deciding Evaluating, Understanding, Counseling, Education) model.

The model addresses criminogenic need interventions including substance abuse treatment and the prevention of relapse, pro-social thinking and communication, self-management skills, planning for community transition, and developing a healthy support system. There are 17 parole offices statewide, and the program lasts for 20 days.

Enrollment is not assured.

Requirements include parolees having an identified Correctional Offender Management Profiling for Alternative Sanctions need, and all parolees are subject to the jurisdiction of the Division of Adult Parole Operations in order to participate.

So What Should Be Done?

Burnetti-Atwell says that “a more robust re-entry process” is needed on a national level.

Currently few locations are realizing success in this area. There is also the matter of prejudicial attitudes of former convicts. (Ninety seven percent of all offenders will be released into the community.)

“Community providers need to be more willing to look past the criminal records of these patients and recognize they meet their definitions as a priority population.

Anything that can be done to hasten the return of Medicaid benefits or the enrollment in benefits would help ensure continuity of care by expediting appointments on the outside,” she says.

Pastor furthers that substance abuse treatment must be targeted early. He notes that Corizon has realized “encouraging success” in identifying patients with substance abuse issues early on and subsequently facilitating safe detox, as well as in the early identification of other behavioral health issues. He adds that a greater commitment to MAT is needed. Often patients who suffer from substance abuse issues are actually self-medicating mental illnesses that may or may not be diagnosed. “With the challenges these patients have maintaining medication compliance upon release, the counseling associated with MAT may be a big differentiator in maintaining sobriety upon release.”

Kishimoto says that some of UCCI’s recommendations are to become informed on the eligibility criteria for the community mental health system. Institutions should also reach out to local social security offices and human service financial assistance or other state or county services to get access to public assistance and insurance.

Part of re-entry planning should include assisting with inmates’ access to legal identifications and other necessary documents to expedite access to services and resources. There should also be documentation on an inmate’s mental health status and facility workers should conduct planning to connect the inmate with mental health services prior to being released. “Some states/counties have formal collaborations with prisons’ mental health units. If not, they should be encouraged to establish them.”

Burnetti-Atwell stresses that it is also important that community providers look beyond the “convict label” and recognize the needs of the individual. “Many of these individuals possibly would not be involved in the criminal justice system if a mental health safety net existed outside the walls. We have traded one form of institutionalization with another.” ✪

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