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HEROES IN CORRECTIONS In Idaho and Oregon two heroes have come to light in corrections: Heroes that help inmates stay connected and productive while reducing criminal activity and recidivism. Shelli Honeywell, Operations and Policy-Fiscal Services Manager for the Oregon Department of Corrections (ODOC), and Capt. Doug Hughes, Security Services Division of the James R. Munn Detention Center in Twin Falls, Idaho, were consecutively named Hero of the Month by Telmate of Ontario, Oregon.
REDUCING RECIDIVISM IN OREGON Shelli Honeywell’s involvement in the Oregon Department of Correction’s innovative programs has kept the state in the bracket of record low recidivism numbers. Upon being named a hero, Honeywell says, “True success will impact all of us, not just Oregon. In the end, reduced recidivism rates mean safer com-
munities, and therefore a better world for the next generation to come. We would love to see others embrace what we’ve done and seen.” What they’ve done started in 2012 when Director Colette S. Peters encouraged department managers to find ways to connect inmates with their families. Before then only Shelli Honeywell, 40 percent of the inApril Hero of the Month mates were receiving some form of visitation. With programs in place, today 60 percent are benefitting from connections with family and friends. This technology program is among the innovative tools ODOC employs along with its nationally-recognized program providing cognitive, behavioral and job skills needed to equip inmates to become productive citizens. The ODOC’s 14 state prisons currently house about 14,600 adult offenders sentenced to more than 12 months. In the few years since the inmate connect program inception, offenders have made over 560,000 connections through technology including electronic messages and Video Interactive Phone (VIP) calls. Addressing the observation of the positive impact the technology has across the state, Honeywell says, “The potential for additional features like education, commissary, and internet access are going to be valuable in enhancing connection and positive interactions for adults in custody.”
KEEPING INMATES PRODUCTIVE IN TWIN FALLS, IDAHO Doug Hughes ‘ goal in the Security Services Division of the James R. Munn Detention Center is to shift time behind bars to productive time. Based on recent studies that show inmates who are connected to the outside world are more likely to refrain from conduct that would cause them to receive disciplinary infractions or jeopardize early release, inmates are given safe and meaningful tools to stay connected and occupy their time with productive activity, with the goal to reduce criminal activity. The James R. Munn Detention provides inmates with phones, vis4 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
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Doug Hughes, May Hero of the Month
itation systems, and secure wireless tablets. In addition, Hughes notes, the technology allows friends and family to visit with the incarcerated without having to travel long distances. “Video visitation saves them time and money from having to drive or fly to Twin Falls…that in itself is a bonus,” Hughes says. Hughes oversees the daily operations of the 224-bed detention center along with Lt. Mike Wiggins and Lt. Robert Hass. Says Hughes, “Our mission is to work in partnership with the community to enhance safety, security, and quality of life. Telmate has been a great partner in developing new technology to better serve the public and the people incarcerated. They have been a huge supporter of our goals and where we want to go.” To further these goals, Jeff Hansen, Telmate chief marketing officer says, “It’s important for us to recognize how these men and women dedicate their lives to making our communities safer and more secure. At Telmate, we know who our real heroes are, and we work tirelessly to provide them with innovative technologies that empower them to do heroic things within their daily responsibilities.” He adds, “Our Heroes Program is our way to tell their story.” —G.F. Guercio Calling All Corrections Agencies & Technology Suppliers Keep our finger on the pulse. Inform our editorial staff of your successful programs, pilot projects, innovations or awards. Send news to: The Pulse Editor at corrforum@mac.com. Thanks.
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BY MICHAEL GROHS, CONTRIBUTING EDITOR
Healthy on the Outside The Affordable Care Act provides medical coverage to many parolees. PRISONS
are no health spas. According to the Alliance of Mental Illness, more than half of all inmates have a mental health problem. A report by the Treatment Advocacy Center also found the recidivism rate for people with mental health issues is higher than that of other inmates. Ninety percent of inmates in Los Angeles County with mental health problems were repeat offenders, and nearly
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a third of those had been incarcerated more than 10 times. And that’s just the mental health problems. As a whole, inmates tend to be a less physically healthy group than the rest of the population. Infectious disease, addiction, diabetes, coronary disease, and other chronic maladies are prevalent in many. For decades, many inmates entered the institution with such conditions, and then upon release lost access to treatment,
which affected their health as well as the risk of recidivism. According to the Urban Institute, nearly all returning prisoners have some type of chronic health condition that requires treatment or management (substance abuse, hepatitis, depression, HIV, diabetes, asthma), and many have more than one. Most have no insurance upon release. Before the ACA, Medicaid only covered five groups of people: pregnant
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“Under the Affordable Care Act…. we’ve helped enroll 85% of eligible parolees before their release.” —DANA SIMAS, CDCR women, children under a certain age, parents of those children, seniors, and the disabled. Excluded were poor, childless, single males, the group of people who make up a huge percentage of the prison population. In January 2014, the categories were eliminated in states that accepted Medicaid expansion under the Affordable Care Act (ACA), and now there are those who believe the ACA could potentially have an unintended consequence: prison reform. Corrections medical providers have taken strides to ensure that inmates who are being released are being aligned with post-incarceration medical access. Dana Simas, information officer at the California Department of Corrections and Rehabilitation says, “We have doubled our efforts to enroll inmates into Medi-Cal before their release given the new qualification criteria under the Affordable Care Act. Currently, we’ve helped enroll 85% of eligible parolees before their release.” Organizations contracted to provide the medical functions of correctional facilities are also moving full steam ahead to ensure treatment is continued upon release, and the evidence is showing that it is lowering the rate of recidivism.
The Re-entry Process Mike Pinkert, founder, chairman, and CEO of MHMCenturion, points out that navigating the Medicaid system could be a bewildering process for someone who may have not had contact with the outside world for 10 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
some time. Susanne Moore, executive vice president of NaphCare, adds, “Often, the inmates under our care in our client partner facilities have had little or no medical care prior to incarceration.” Generally, says Pinkert, upon discharge, inmates are usually given a 30-day supply of medications and then referred to a community mental health center, a federally qualified health center, or a private provider “where continued care is maintained and ongoing prescriptions can be provided.” He furthers that because of the ACA, there is a coming “convergence” of Medicaid and correctional healthcare that should make the transition from incarceration to release more seamless. Ellen Rappaport, the director of re-entry at Wexford Health Sources, explains that achieving this goal was “much more challenging before the ACA.” Wexford’s re-entry process begins at intake. When their discharge planning team gets a list of names 30 to 60 days prior to release, more intensified discharge planning is initiated. They then assess the patient’s needs, schedule follow-up appointments with community agencies who are familiar with this particular population, fill out an application for Medicaid (and Medicare, as applicable), and then align the inmate with services upon release. There is also the coordination of medication, and the inmate is given a 30-day supply of meds as well as a “Continuity of Care Form” discharge document. The Nurse Discharge Planner later makes a follow up call to ensure that the patient showed up to the initial visit.
Rappaport notes that partnerships and collaboration among the state, community, and Wexford continue to strengthen inmates’ transition from custody to community. What professionals in all aspects of the industry seem to agree on is that success depends on planning for release from the beginning and forming partnerships. Moore states, “NaphCare’s goal is that the inmate/detainee/offender patient re-enters the free world with four things in hand: a Medicaid or insurance card, a first appointment, a supply of their prescription medication, and their medical records.” Those relationships are developed during the period of incarceration. “Over time, the relationship between NaphCare providers and the outside specialists naturally develops into a collaborative arrangement, with the common goal of improving the inmate’s health.” Developing partnerships plays a crucial role in the re-entry process. As Nick Little, Wexford Health vice president of Quality, Compliance, and Business Affairs says, “As many entities as possible.”
The Conditions of Concern Generally, the conditions that are of primary concern for the discharge planner, says Rappaport, are “complex medical conditions” such as cancer, uncontrolled diabetes, cardiac and respiratory conditions, seriously mentally ill patients, HIV, and hepatitis. There is, though, she explains, an automatic release process through the onsite medical teams for those inmates enrolled in chronic care clinics
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What Works? Professionals in the field seem to agree on several factors to find success in aligning inmates with
Photo courtesy of corizon health
whose conditions are under control. These inmates get a 30-day supply of medication along with the Continuity of Care form. Most providers state that the range of services is quite broad. Says Curry Butler, statewide coordinator of Case Management for MHM-Centurion’s Tennessee Department of Corrections, even if an inmate inquires about minor medical treatments such as getting a physical or a dental appointment, the case manager will assist the inmate to obtain the appointment. Dr. Jane Haddad, PsyD, vice president of Clinical Operations at MHMCenturion says, “Release planning is offered to all inmates when released from incarceration if they are receiving ongoing treatment/medication.”
A Corizon nurse counsels an inmate preparing for the reentry process by reviewing its reentry website.
community services upon release. A few that most agree on is the aforementioned development of relationships between correctional health providers and outside services, educating the inmate on the importance of taking charge of his or her health maintenance, and taking into consideration the reentry program upon intake. NaphCare, says Moore, takes “a collaborative and interdisciplinary
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approach to discharge planning that begins from the time the inmate enters the facility.” Most providers agree. Dr. Mark Fleming, director of Operations, Behavioral Health at Corizon says, “We typically work collaboratively with our client to help address the reentry needs of our inmates utilizing a multidisciplinary treatment plan approach that begins on Day One of incarceration and
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Photo courtesy of corizon health
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Corizon says they work collaboratively with agencies to help inmates address their reentry needs throughout their entire incarceration.
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does not end until the person is walking out the door.” Dr. John Wilson, PhD, CCHPMH, senior clinical operations specialist at MHM-Centurion, also explains that tele-health and telemental health has served an important function in the matter. Not only does it better the chance that an inmate will continue recommended treatment, it has often helped MHM-Centurion access the community services in the first place. “For some community health clinics and mental health centers, the rate of noshows for recently released inmates has been so high that these clinics will not make future appointments for these individuals while they are still incarcerated. These clinics have waiting lists and/or limited appointment slots available, which are prioritized for their existing community-based service recipients. We have found that, once contact is made between the inmate and the future community provider through a tele-health encounter, both parties form a commitment to work with each other.” Dr. Haddad also with MHMCenturion has realized similar success. “We have found that coordinating a meeting between community agencies/providers and an inmate either face-to-face or through tele-health significantly increases the potential of the inmate continuing medically recommended community follow-up. Bob May, senior vice president, Marketing and Development, MHM Services, Inc., furthers, “It’s not too farfetched to think that soon ex-inmates will remain in contact with their in-prison health care team via handheld devices given to them upon release.” There is another aspect of the ACA that makes the transition easier, says Moore. “Another critical piece for continuity of care is their medical records, which NaphCare has the capability to send to their new provider instantaneously using secure encrypted electronic mail.” VISIT US AT WWW.CORRECTIONSFORUM.NET
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Challenges Going Forward Naturally, there are numerous challenges to consider. Among them, the professionals seem to universally agree, is the risk of an inmate not following up on medical visits. As Little of Wexford points out, once an inmate is released from custody, the community becomes the inmate’s primary care provider. The best hope for resolution to this, says Rappaport, is to develop a system when inside to teach the inmate about their condition and to inspire him or her to take control of their own health. “Do everything you can to motivate their healthcare.” Wexford also offers brochures and pamphlets for inmates to take with them to educate their family members. Dr. Haddad agrees. “Many inmates do not prioritize continued health care follow-up upon release given their immediate concerns for housing and survival as well their limited insight into the importance of health care follow-up,” a concern that again may result in community providers being reluctant to schedule appointments for inmates upon release. May furthers. “The temptation on inmates to return to their pre-prison unhealthy behaviors and lifestyles often results in non-compliance with re-entry plans.” There is also the matter of the system itself. As Little points out, community resources are already taxed, and just because the providers inside have the links to community resources does not mean the resources can absorb a large number of released exoffender patients. On that note, Moore furthers that finding a payor source itself can also be a problem, particularly in states that have not expanded Medicaid, and few providers will schedule an appointment without one. Dr. Wilson also points out that there is a national shortage of psychiatric providers. While incarcerated, an inmate with a serious mental illness may see a provider fairly often, but once released, it could take three months to be seen by a provider, and if the supply of medications the inmate is given runs out before then, there will be a gap in coverage. There are also numerous other issues that arise such as the unpredictable nature of incarceration. It is often uncertain exactly when an inmate will be released, a situation that is compounded in jails since an inmate may be there for two hours or a year, and providers may only have a few days’ notice. Dr. Fleming also points out other issues such as a lack of experienced providers familiar with reentry in prisons and jails, insufficient funding resources, fear and prejudice of potential providers and sociopolitical realities regarding resources and support to this population. As Little says, “It’s an evolving process.” He adds, “The more you put into it, the less recidivism.” J VISIT US AT WWW.CORRECTIONSFORUM.NET
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BY BILL SCHIFFNER, CONTRIBUTING EDITOR
The NCCH C promise s to bring innovatio some med ns in deliv ical ering qua services t lity o inmates . HEALTH CARE PROFESSIONALS from all walks of the corrections industry will be heading to the Paris Hotel in Las Vegas to attend the National Conference on Correctional Health Care (NCCHC) October 18-22. Billed as the world’s largest conference for correctional health professionals, the conference offers practical research, best practices, and ideal networking opportunities with over a 100 sessions, workshops, and roundtables. The show targets education and networking opportunities 14 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
with peers and experts from every segment of the correctional health care field: clinicians, administrators, staff and management.
High Interest in Mental Health care Needs “NCCHC is receiving many calls and requests for assistance with addressing the mental health care needs of the incarcerated population. We anticipate high interest for the many
sessions on the topic, including substance abuse, crisis intervention training and suicide risk,” reports Thomas L. Joseph, president & CEO, NCCHC. “In addition, we will preview a final working draft of NCCHC’s new standards for mental health services in corrections. The standards will highlight the importance of treating mental health issues while the patient is incarcerated to help released individu-
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als maintain continuity of care and become a productive, lawabiding citizen after incarceration. We also have several sessions on treating the most challenging patients, and how to reduce operational and legal risks in health care delivery,” he adds. In conjunction with the educational sessions, attendees will have a chance to check out the latest in health care products and services for the corrections market. Here’s a sampling of what will be on the show floor.
vices, LabCorp delivers timely, accurate results for improved patient care. www.labcorp.com, 1.800.845.6167
Health Care Services MHM Services is a national leading provider of behavioral health and medical specialty services to correctional agencies. Through a partnership with
Diagnostic Testing LabCorp provides leading-edge diagnostic tests and services through a national network of primary clinical laboratories and its specialty-testing group. With scientific expertise in esoteric testing, genomics, clinical and anatomic pathology, and a commitment to comprehensive and high quality laboratory ser-
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Centene Corporation, MHM developed Centurion, LLC, to deliver advanced managed health care services to correctional agencies. www.mhm-services.com, 1.800.416.3649
Secure Flosser As facilities wrestle with the clinical, safety and legal issues
surrounding the offering of floss, Oraline (with input from the L.A. County Sheriff’s Office) has introduced a solution that will allow facilities to enhance their preventative dental program: a flosser designed specifically for the secure environment. Rubberized for flexibility and minimizing the opportunity to mold standard plastic, the model #30201 allows facilities to safely offer a flossing component to their preventative dental program. www.oraline.net, 1.888.296.6730
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Correctional Health Solutions eClinicalWorks has invested significantly in the development of a progressive and sustainable model for delivering quality, evidence-based medical care for the correctional health environment. For example, as part of its contract with the New York Department of Health and Mental Hygiene, eClinicalWorks implemented their Correctional Health model at Rikers Island while meeting all the complex workflows. Today, eClinicalWorks is being used at all 13 Rikers Island facilities with approximately 1,000 users. http://eclinicalworks.com, 1.866.888.6929
Innovative Medicines Alkermes plc is a fully integrated, global biopharmaceutical company that applies its scientific expertise and proprietary technologies to develop innovative medicines that improve patient
outcomes. The company has a diversified portfolio of more than 20 commercial drug products and a substantial clinical pipeline of product candidates that address central nervous system (CNS) disorders such as addiction, schizophrenia and depression. www.alkermes.com, 1.781.609.6000
Electronic Health Records CoCENTRIX develops products and solutions that help state governments, local governments and care providers, connect, collaborate and coordinate. They are said to deliver the most compre-
hensive Electronic Health Record and care coordination solutions for Health and Human Services. Organizations in 40 states utilize 18 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
their products to improve outcomes, enhance efficiencies, provide transparency and maximize revenue. www.cocentrix.com, 1.941.306.4951
Correctional Health Services NaphCare, Inc. is an independent leader in comprehensive correctional health care and corrections-based technology solutions. NaphCare manages a full range of health care programs for correc-
tional facilities throughout the country, providing quality, proactive care through creative solutions and innovative technology. www.naphcare.com, 1.800.834.2420
Innovative Services Correct Care Solutions (CCS) offers superior medical, dental, and behavioral health services to its patients and innovative solutions to its clients, says the company. They create distinct resolutions for the diverse health care issues faced by correctional organizations of all sizes. CCS has grown into a progressive and customer-oriented leader within the correctional health care field. www.correctcaresolutions.com, 1.800.592.2974
Total Health Care Solutions From its inception, CNT Infotech has adopted a systemized approach that is well received by clients in health care, the government arena, and the corrections industry, on a nation-
al basis and abroad. Its Correctional Health Electronic Health Record Techdoc—
iCHRT—is a comprehensive correctional health care product encompassing all aspects of medical, behavioral health, dental, and vision functionalities. They will showcase a demo of their pharmacy and EHR product. http://www.cntinfotech.com, 1.646.452.9350
Health Care Solutions Wexford Health Sources provides medical, mental health, pharmacy, rehabilitation, utilization management, claims processing, and technology services to state, regional, and local
clients across the country. The company helps governments, correctional facilities, and other institutions control inmate health care costs while maintaining quality of care. www.wexfordhealth.com, 1.888.633.6468
Biopharmaceutical Research AbbVie is a global, researchbased biopharmaceutical company formed in 2013 following separation from Abbott Laboratories. The company's mission is to use its expertise, dedicated people and unique approach to innova-
tion to develop and market advanced therapies that address some of the world’s most complex and serious diseases. www.abbvie.com, 1.800.255.5162
Health Information Technology KaZee Inc. health information technology is helping improve the quality and reduce the cost and risk of providing health care through the PEARL Electronic Medical Records System. KaZee, Inc. provides modern web-enabled ONC certified information technology solutions to the health
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care industry. It caters to most health care environments with emphasis on correctional health care, dialysis and public health care clinics. It supports nearly 500 clinics that rely on its solution daily. www.kazee.us, 1.678.221.9001
Drug Testing System The Siemens Viva-E System provides a complete menu of
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gold standard EMIT assays for fast analysis of drugs of abuse, therapeutic drugs and immunosuppressants, as well as sample validity testing on a single bench top analyzer. It is designed for low- to mid-volume labs, treatment centers, transplant management centers, criminal justice facilities, and industrial facilities. http://usa.health care.siemens.com/drugtesting-diagnostics, 1.888.826.9702
Health Care Plus Pharmacy Corizon provides quality health care services to 115 clients at 552 facilities across the country serving approximately 362,000 inmates in 27 states. Based in St. Louis, PharmaCorr is a pharmacy affiliate with operations in Indiana and Oklahoma, plus mail-order pharmacy services to 16 states. The programs provided
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by PharmaCorr promote proactive and clinically appropriate drug therapies, following the best practices of the health care industry. www.corizonhealth.com, 1.800.729.0069
Portable Dental X-rays The NOMAD Pro 2 portable dental x-ray offers cordless handheld operation, running on rechargeable battery packs. It is ideal for portable and forensic dentistry. A backscatter guard and internal shielding protect the user. One battery charge allows for more than 100 exposures. Optimal for remote use, the unit 2 is contained in an easily transported case with pull-out handle and wheels. www.aseptico.com, 1.866.244.2954
Pharmacy Solutions Walgreens is a leader in creating forward-thinking solutions to help government entities fulfill their commitment to provide broad access to high-quality, low-
cost health care. From providing access to limited-distribution and just-in-time medications, to providing continuity-of-care, it is committed to working with agencies to develop solutions that fit the needs of their constituents. Walgreenshealth.com/business, 1.877.727.9247
Vision Services Since 1983 Institutional Eye Care has pioneered On Site Vision Services to correctional facilities, jails, prisons, and other institutional settings across the country, serving as a leading supplier of onsite optometry, eyeglasses and other vision services. Its On Site Eye Disease and Glaucoma Management services in state and federal venue has virtually eliminated all off site ophthalmology trips for the medical management of routine glaucoma and reduced off site trips for other eye diseases. http://institutionaleyecare.com, 1.866.604.2931
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BY MICHAEL GROHS, CONTRIBUTING EDITOR
Cashless in Corrections Kiosks and tablets are allowing inmate cash intake, online deposits, more self-service purchasing and release debit cards.
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iterally speaking, a lot of money goes into jails and prisons. The Multnomah County, Oregon, auditor wrote in his 2011 report that the sheriff’s department alone managed about $3.7 million worth of inmate funds in FY 2011 and made mention of the amount of labor involved in managing it. (Their website shows the facility has since adopted the use of kiosks.) Typically, says John Lowry, product manager at Global Tel*Link (GTL), if someone is arrested, they will have some cash on them. If it is a suspicious amount, it might be confiscated. If not, it will be turned over to the jail, and an account will be set up for the inmate. In many
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cases, it is the policy that correctional employees have to handle the cash by hand. This causes a lot of work for the COs, it opens the door to liability, and it draws their attention away from their primary functions. As Lowry says, “COs don’t sign up to be bankers.” Facilities have been finding the solution to inmate cash management in technology, particularly kiosks, and more recently, tablets. Jails, says Lowry, increasingly do not want COs to have to handle cash. One way that is being used to separate the COs from cash responsibilities are kiosks. Without kiosks, the process is done at a fixed workstation, and the CO is not observing inmates. Corey Sloan, senior account man-
ager at Phoenix Kiosk, has also been involved in the shift in the industry. “Self-service kiosks are generally meant to be used by inmates and visitors to save time and provide better service, but the benefit is to both inmates and officials and the facilities they run. The facilities who take advantage of self-service kiosks will be making better use of their own labor force through less involvement with repetitive or menial tasks by expediting lines or providing services and information some may not have access to at home (visitors of course).” A trend professionals in the field have been noticing in the industry has been the increase in the use of debit cards. Often,
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Microtronic US offers kiosks for any application, including visitor management, cashless systems, prison intake, discharge, inmate commissary, and guard kiosks. They count the Los Angeles County Jail System and the Folsom State Prison in California as clients.
Lowry says, with kiosks, a facility will have a third party handling the cash. He furthers that checks are not used nearly as much anymore. They require much more administration and have to be tracked to ensure that they have cleared. There is also the matter of an inmate’s release before a check has cleared into his or her account, and thus leaving the funds in limbo. (Now, says
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Lowry, the primary use of checks is for situations such as if a larger group of inmates is being moved to a single location, in which case a single check will be written to the institution and then redistributed once the inmates are there.) Debit cards are much more detailed. It is possible to see if money had come in at a certain period of the incarceration. With debit cards, disbursement of the funds is in real time. There are, Lowry points out, two different kinds. There are those that work anywhere, and there are institutional debit cards, which an inmate can redeem upon release. “It’s all about efficiencies and operation.” Ronald Hodge, CEO of EZ Card and Kiosk, agrees that the restrictions of accepting only cash or money orders is a problem in the industry. Sending money through the mail takes a few days, and an inmate’s money can’t be spent as quickly. With an
online or a kiosk system, those funds are available immediately. He has also noticed that COs in facilities have to count the cash between three and six times. With debit cards, it is done only once. It is not only that, notes Hodge, but the systems can now load phone providers and work with phone companies as well, and the funds can be taken from the inmate’s account. These systems are making it possible for other various payments to be taken out of inmates’ accounts and can keep jails out of the cash handling business entirely. Hodge has also noticed a trend in the growing use of online deposits. They have found that the specific rates may vary a bit by the economic status of the county, but the amount of cash versus credit card deposits are now about 50/50, and that the dollar amount on the credit card side tends to be higher. Another recent development,
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says Lowry, is the use of tablets. While once inmate business transactions were conducted using paper, in some facilities it is being done using handheld devices. An officer is given a tablet and can take the device to the inmate who can order a product from the commissary. Barcode technology records the goods being delivered. That function in itself is a problem solver because it provides proof that the product was delivered, so if an inmate refuses to accept the ordered item and subsequently files a grievance, the CO has proof of the transaction or lack thereof. Some institutions (Louisiana and some facilities in Virginia, Washington, North Dakota, and Ohio) allow inmates to have their own tablets. For example, JPay offers a mini-tablet called the JP4 for about $50 that is built specifically for the corrections environment and offers a built in music
player, FM tuner, a calendar and other applications. Family members can log into the JPay account and add music tracks to an inmate’s media account. GTL offers a handheld device called the GTL Genesis. Says Lowry, in theory an inmate could use a kiosk to order a tablet, and from that tablet check his or her account balance, order products from the commissary, and access other information such as policies and procedures of the facility and library and law material. These types of technologies would free up CO time and be paid for through the inmate’s trust. Among the things customers have been asking for, says Lowry, is more self-service to free up the staff. Sloan agrees. “The main technology shift in kiosks has been a tighter integration with mobile and self-service technology.” Terri Stearns-Bryant, president of sales at Microtronic US, LLC,
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Kiosk from EZ Card accepts cash and credit cards.
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notes that her organization offers cashless vending using an RFID card. The system can be used for both visitor and inmate vending. The visitor vending system offers the cash free ability to deposit funds into an inmate’s account using a debit or credit card through a cellular loading station. The card is then given to the inmate who can use it on readers on the vending machines. With the inmate vending sys-
Facilities have been finding the solution to inmate cash management in technology, particularly wall mounted devices, kiosks, and more recently, tablets.
photo courtesy GtL
“The main technology shift in kiosks has been a tighter integration with mobile and self-service technology.”
—COREY SLOAN
tem, which she points out is a low-cost solution, inmates are allowed to purchase a pre-loaded card from the commissary that are recycled when the funds are depleted. If any money remains in the account, the inmate places the card on the terminal, presses the red button, and he or she is printed a receipt to sign. The receipt is then turned in, the money is refunded back to the inmate’s account, and the card is zeroed out. Microtronic US has a customer in Australia with whom they have their own system tied into that of the inmate trust account. They then have wall- mounted kiosks at which in inmate can transfer funds to and from their account using their card. They then use the cards at online vending machines to order commissary items, check their bal26 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
ances, and perform other similar transactions. There are considerations to keep in mind before implementing a system. The primary, says Hodge, is integration. Jail management systems (JMS) need to be able to be integrated, and some technology on the jail side might need upgrading. There are still options to get some of the solutions for those cases, he says, but without an integratable system, the facility might not be able to get the full suite of services. Others might also question the security of allowing an inmate a tablet. While it might sound odd at first, the organization’s website points out that “GTL has implemented best practices as recommended by communications consortia such as the Wi-Fi Alliance, using Wi-Fi Protected Access II
(WPA2) Enterprise security protocols” and the system’s modular design makes it possible for administrative management to allow the activation or deactivation of a single application or across the entire environment. Kiosks have become multifunctional, and so are the handheld devices that are creeping in. Sloan states, “Kiosk hardware technology is pretty well developed and most needs are satisfied, but software with real-time integration to existing systems continues to become more important to successful kiosk implementations.” Not only are facilities folding inmate trust accounts into the devices, but also visitor visitation, phone use, educational opportunities, and inmate grievances. The same can be said for handheld devices such as Genesis. “With our wireless tablets, facilities can deploy a full suite of applications on secure behind-the-bars handheld devices to help automate and manage offender requests such as commissary ordering, law library access, policy handbook review, and more,” says Lowry. J
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photo courtesy GtL
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BY DONNA ROGERS, EDITOR-IN-CHIEF
Inmate Communications on the Move With video calls, texting, instant messaging, music on demand and social media all the rage on the outside, where does it fit into the closed world of corrections?
Telmate’s wall-mounted tablet provides in-pod video visits.
I
nmate communications have been emulating communications in the outside world for years, albeit the technology’s not moving at quite the same rapid pace. Texting, instant messaging, video chatting, tweeting, posting to Facebook, sending Instagrams, these are ways we—and especially the younger generation—are staying connected. There isn’t a moment when we don’t hear a
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beep or a ping or a twerp announcing a message notification on a cell phone, tablet, notebook or desktop. As for the types of devices currently sought after: Zigzagging lines outside Apple stores a few weeks ago when the iPhone 6 and iPhone 6 Plus were introduced have signaled the popularity of larger communications tool’s screen sizes (they are 4.7 and 5.5 inches respectively). Even so, the latest Apple
devices are actually latecomers to the bumped up screen market— this past Spring when Samsung released its 5.1 inch Galaxy S5, it shipped retailers 10 million units in 25 days, making it the fastest selling smartphone in Samsung's history, according to the International Business Times (May 10, 2014). These devices, which have been dubbed “phablets” by the tech industry, are blurring the line between phones and tablets, and seem to be fueling
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the desire for increased connectivity, apps, and other entertainment, such as games, sports, surfing, and movies and TV on the go. Now, you may ask, where does this fit with inmates who are not so “on the go” but are rather confined to one place? Well, perhaps as we will see below, it fuels the communication fever there too, for those with many idle hours.
200 correctional facilities, advising them on inmate phones, ancillary electronic messaging, MP3 players, kiosks and the like. As for newer technologies she says: “We are largely seeing the implementation of video visitation first, then messaging, and tablets have slowly started to peek in.” In an informal analysis of video visitation equipment, she
they can receive onsite, and there is no fee for the onsite visits, which some prefer, she notes. Black Creek Integrated Systems’ IP Visitor Software Suite offers both on- and off-premise video visitation. While most jails currently have video visitation on premise, the industry is now taking a serious look at the remote service, explains Randy Hill, sales manager. “It’s good, they can
The JP4 from JPay is 4.5 inch tablet that can serve as music player, ebook reader, web surfer, and allow inmates to compose draft emails. All are worked offline and synchs with an inmate kiosk.
Security is the obvious reservation corrections agencies have with tablets, especially the vulnerability of a wireless device, and the challenge of a remote visit where there is not a corrections officer near the visitor to stop a call that is going bad. For obvious reasons inmates cannot have the latest cool iPhone or Android on the inside, but companies are working to overcome the obstacles and develop tools like tablets and kiosks that they can use. Ann O’Boyle is director of the Correctional Services Division at PRAESES, LLC, a communications consulting firm that entered the pay phone market in 1997 and the corrections market in 1999. The firm now consults for over 30 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
says the “vast majority are without.” However, she furthers, “Fifty percent of RFPs we are working on request a video visitation component, or ancillary communications equipment. Video visitation is the largest growing, mostly because it solves so many operational issues.” And she adds, “telephone providers have it—or have a close partner that does it.” Remote visitation that is akin to Skype or FaceTime is growing, O’Boyle continues, and when agencies request it, the consulting firm adds on that option but they also provide information and costs regarding the more traditional onsite version. Some family and friends need assistance with the technology, which
potentially increase the visits, don’t have [visitors] coming, which is typically manpower intensive.” But it can also be problematic, he notes. “Grandma signs up for visits from home— and on the video chat the girlfriend gets on the phone, there are legal issues with that. They are also seeing peep shows. The propensity for [behavioral issues] is greater at home, because there’s no C.O. 14 feet away.” Further, a person with a restraining order or an enemy of the person may get on the line to harass the inmate. The major pitfall operationally is that “I don’t have full control of that visitor,” Hill continues. Yet, an officer online “can monitor the call, and can terminate
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the visit,” he says. Onsite visitation which typically operates from inmate housing to a location on the jail campus connects the public and the inmate on a closed network, details Hill, which has a stronger user interface, and entails little or no time consumption by the operators. On the other hand, remote visitation operates outside the secure campus, and requires a secure Internet connection. “It requires a lot of operational considerations,” adding that it is “an ongoing area of R&D with us.” Remote visiting is a revenue generator model, he says, because if [the visitor] doesn’t have to drive to the site she will pay a fee, and the payback can generate revenue for the facility. “It can also reduce the stress level at facility, and hopefully increase visitation—perhaps they can have visitation three times a week instead of once every other week. It should make it a more peaceful jail.”
Two Tablet Sizes In addition to a host of offerings that include video visitation and inmate trust fund accounting, JPay has some innovations for the corrections market. The JP4 player, introduced over a year ago, and priced at $49.99, has made inroads into several state facilities. The 4.5 inch tablet is similar to the size of the new iPhone and can serve as music player, ebook reader, web surfer, host other apps and games, and allow inmates to compose draft emails. All are worked offline and can transmit once synched with an inmate kiosk. A larger JP5, which will be 7 inches (the size of a mini tablet), is expected to have its full release on December 1, says Jacob Katz, VP of Products. It is in limited release through November whilst it will go through testing in a pilot program. It has been redesigned and laid out so it’s easier to navigate and offers a better user experience for inmate 32 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
The JP4 player can draft emails and send and receive them when synched to an inmate kiosk.
education, he says. To that end, the company is now working on development with several universities. It will not only be preloaded with educational content that can be pushed out, but the inmate will also be able to respond, he notes. The DOC can also upload policy or info videos or pamphlets in an easier-to-read format. The JP5, which differs from the previous model due to its wireless capabilities, will offer friends and family a secure text message service which will be paid for on a subscription basis. The service, which is also being piloted currently, will include “three layers of security, not like a hot spot,” says Katz. “It is a very safe mode of communication because everything is recorded, filtered or can be monitored live. It is even safer than a phone call—it is searchable by text,” he says. In addition, JPay continues to offer its email service on the JP4, which can send attachments. jPay’s newest service, launched about four months ago in a number of facilities, is its VideoGram service, notes says Melissa Klunder, project manager. It allows the offender’s family to record a 30-second clip anywhere they are and send it as an attachment. “We’ve seen them send
recordings at many events.” These are paid for with pre-paid “stamps,” that family and friends fund. She expects an email or photo attachment will cost one stamp each, while a VideoGram will cost three stamps. While price depends on state and contract, the starting point or lowest entry rate averages $.25, according to Katz. The JP5 device is not priced yet. Telmate, one of the fastest growing inmate communications systems in North American, offers a comprehensive solution on one unified platform. A full service telecom provider, its services include inmate phones, secure messages and photos, video visitation, deposit options and education. In addition, using the same tools that make video visitation possible, therapists, counselors and teachers can speak face-to-face with inmates. And similar to online “status updates,” secure wall posts allow inmates to post smaller messages that are viewable by more than one family member or friend. For monitoring ease, a single Web-based application allows staff to review inmate calls, video visits, set alarms, control access, and more, from any Internet Web browser or smartphone. Telmate tablets that enable these solutions are available in
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three formats, a fixed format that is attached to the wall, a shared tablet that is placed in the pod and an individual purchase model, details Jeff Hansen, chief marketing officer. What we are finding in the tablet world is that we are the only firm with tablet technology with a browser in a shared model— inmates log in with a PIN and have access in the cloud, he explains. “Inmates are paying for use on the tablet. That is proving to have the most interest for facilities.” In addition to video visits, they can get their basic entertainment, he furthers. Media rich capabilities include: “ebooks, video, educational content, photos, message sharing and web browsing. All [sharing] is extremely controlled.”
they noted, because a phone call can be spontaneous.) While studies with the American public show that messaging is surpassing phone call usage, it is slower to change in corrections facilities. For example, according to a story on Time, Inc’s web site (http://techland.time.com dated Aug. 16, 2012): “The telephone call is a dying institution. The number of text messages sent monthly in the U.S. exploded from 14 billion in 2000 to 188 bil-
lion in 2010, according to a Pew Institute survey. Not all of that growth has come out of the hide of old-fashioned phoning, but it is clearly taking a bite—particularly among the young. “Americans ages 18-29 send and receive an average of nearly 88 text messages per day, compared to 17 phone calls,” the TIME story continues. “The numbers change as we get older, with the overall frequency of all communication declining, but even
How Modes of Communications Compare In speaking with Telmate, a firm that provides inmate phone, video visitation and email, we wondered if their experts think these services impact each other and posed that question to Hansen. “They are separate entities,” he says. “We are not finding the introduction of a tablet would cannibalize another source of business. They are not replacing the other,” he emphasizes, “they are fueling the other. All volume continues to climb.” He adds: What we are finding is pretty much what we find in daily life. Messaging is just offering a new opportunity to communicate on the go. Family and friends, want to “see the face, see the smile...a visual can’t be replaced by text message.” (We found all the experts agree video visitation is very different from phone usage because it must be scheduled in advance, sometimes limitations are imposed on the number of visits per week (i.e., one per week), and the time periods are also usually more restrictive. Video visitation is not meant to substitute calls, VISIT US AT WWW.CORRECTIONSFORUM.NET
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in the 65 and over group, daily texting still edges calling 4.7 to 3.8.” One industry player concurs. “The feedback seems to indicate the trend is going more toward email,” says Katz of JPay, “as a cheaper alternative compared with the phone.” Yet corrections may have a different vibe from the free world. “No, we haven’t seen email impact phone use,” says Tim Skaja, VP of strategic product planning, Global Tel Link. “We haven’t seen the volume—and it is used primarily for short messages.” Messages are also less interactive, journal-type writing, a substitute for a letter, adds Anthony Bambocci, executive VP and chief marketing officer, GTL. “They still want to talk live.” GTL, which has been a provider of inmate telecommunications for 25 years, has now expanded its capabilities to incorporate emerging trends in commerce (electronic debit, payment services, kiosks), control (facility management and investigative technologies), and communication (video visitation and visitation management). A recent acquisition of Renovo Software has yielded the new GTL VisitMe video visitation solution that allows facilities to transition traditional in-person visitation service to a more secure on-premise or remote alternative. The VisitMe Scheduler can also eliminate long lines due to high volume of visitors, and it minimizes staffing requirements. GTL Genesis, its inmate in-pod inmate telephone solution, integrates some of the most commonly requested inmate services into one secure application— including account management, ordering commissary items, receiving incoming email messages, communication, education, entertainment—all while seamlessly interfacing with current facility applications and those from third-party vendors. GTL’s latest products for the 34 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
The GTL wall-mounted kiosk with optional handset, an in-pod inmate telephone solution, integrates some of the most commonly requested inmate services into one secure application—including account management, commissary ordering, and receiving incoming email messages.
corrections market consist of a series of personal handheld devices to provide enhanced services for offenders. Its web site points out that they provide a restricted operating system that thwarts unauthorized attempts to modify a device’s internal settings and prohibits users from installing unapproved applications. Its wireless tablets run on a proprietary, secure network, and GTL has implemented best practices as recommended by communications consortia such as the Wi-Fi Alliance, using Wi-Fi Protected Access II. “GTL now provides more of integrated solution,” says Skaja. Applications can be coupled together—such as analytic tools and the offender management system. Investigators can monitor and record and do analytics in real time or afterwards, he notes. And through GTL’s friend and family web portal, ConnectNetwork.com, inmates’ friends can set up and manage prepaid accounts for phone and any other GTL-provided services.
On the Horizon While security of wireless technology is still an area corrections officials need to reckon with, messaging and video will be a wave of the future. Today, says Skaja, video via smartphones is used by a particular audience, yet usage is still not mainstream even though the technology is there. The future of video is bright as younger generations start to get older. It is most accepted and more familiar in county jail; the
DOC’s adoption is taking longer perhaps, he muses, because offenders have been out of the mainstream longer and haven’t seen the technology firsthand. As corrections agencies move forward with new technologies such as video and tablets, “there is always some initial concern to adopt change,” says Telmate’s Hansen. He urges departments “to remain open to the benefits and opportunities.” He has seen no instances of inmates purposefully breaking or weaponizing mobile devices, because inmates see it “as a perk. It is a huge behavior modification tool.” As we went to press it was announced the latest Android phablet, the Pop Mega (which will be available next month in a swelled up six-inch size), actually comes with a secondary, little phone for making calls, sending texts, and getting notifications, reported TheVerge.com. And the introduction in 2015 of the Apple Watch seems to be the next big thing. What’s next? Offenders wearing a watch on which they can check their schedule, make appointments and file requests? I’m jesting, but I may not be too far off. J
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BY G.F. GUERCIO, CONTRIBUTING EDITOR
the country—both on a public and personal level—becomes more environmentally conscious about water, energy and recycle issues, so too do correctional facilities. Based on numbers alone, whether the population consists of hundreds or thousands of inmates, the savings in water, energy, and associated costs like cleaning chemicals, is an effort more facilities are compelled to undertake. The Green
As
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Corrections Initiative (National Institute of Corrections), Green Prison or Sustainable Prison Initiatives (Ohio, Maryland, New York) are among those projects being studied or ongoing in the push to save costs and the environment (see NIC Information Center at www.NICIC.gov/green corrections). A focus on correctional plumbing will target the usage segments most conducive to change— including water conservation and
energy abatement—and those best to provide long-term monetary savings. In the article to follow, industry representatives cite work in this regard: their research, outcomes, challenges, progress and products in an incentive for corrections to go green.
Green Hits the Showers High Sierra Showerheads incorporate a patented nozzle that breaks up a low-pressure stream
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water annually, according to Bruce J. Jacobeen, CEM, director of Prison Services. “[We] work hard to keep up with industry trends and changes, evaluating new products for the appropriateness of use,” he says. “Not all
Photo 1 shows the High Sierra 1.5 gpm showerhead with more evenly distributed droplets versus photo 2, a typical correctional type 2.5 gpm showerhead which is concentrated in the center.
performance capabilities and it requires no specialized tools. The Zurn ZP6800 is compatible with four power supply options. www.zurn.com, 1.855.ONE.ZURN
Sustainably Saving Millions Water Management, Inc. saves customers millions of gallons of of water into a spray of large droplets. Other methods that add flow restrictors diminish the effectiveness of the shower, motivating the inmate to stay in longer in order to get clean, says Founder David Malcolm. “Shower heads have to be designed specifically for the flow rates at which they operate. But, as one prison engineer once told me, ‘We want to save water, but not if it is going to start a riot.’” www.highsierrashowerheads.com, 1.888.445.1941
A Royal Flush The Zurn ZP6800 Piezo Activated Flushometer for Penal Fixtures achieves significant water savings by featuring a piston kit valve with high-peak flow rates for maximized performance and by utilizing multiple programmable lock-out capabilities to prevent excessive flushing. The institution has control of the valve’s VISIT US AT WWW.CORRECTIONSFORUM.NET
products are appropriate for all locations, but some products are appropriate for some locations. There are many variables that come into play, piping arrangements, pressure variations, and most importantly the customer’s end-use requirements.” www.watermgmt.com, 1.800.394.5325
Tunnel Washers Gain a Convert At Medical Laundry Giant Tim King’s 43-year career included posts at four commercial laundries, which were involved in the fields of healthcare, uniforms and hospitality during his laundry industry career, none of which employed tunnel washers. Tunnel washers are essentially a tube in which laundry passes through water and chemicals, made especially for large batch washing. He points out: “I never wanted a tunnel because they weren’t able to get whites white. There is no agitation.” King came out of retirement to join as partner and general manager of ImageFIRST’s Clearwater plant. As business grew at the high volume medical laundry so did the demand on the aging equipment—two 450 lb. open-pocket washers. King understood that the production would benefit from a tunnel washer, but was unsure of the quality. He confessed after visiting a laundry using PulseFlow technology, “I saw first-hand how white the linen came out. The PulseFlow is what changed my mind about tunnel washing. By having a toptransfer tunnel, it gives you the lift-and-drop effect, as in a washerextractor, which is not available in a bottom-transfer tunnel.” Since starting up the tunnel in December 2012, the laundry’s water bill has been cut in half. www.milnor.com/pulseflow_technology CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014 37
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load, cutting dry time up to 50 percent. High programmability, safety lock-out features and simple operation ease use for inmates and staff. Pro-Series II Dryers include sensing system that helps eliminate over-drying and resulting fabric damage. www.continentalgirbau.com, 1.800.256.1073
Less Water, Less Waste
Finding the Pulse The PulseFlow system from Pellerin Milnor Corporation offers patent-pending technology with increased productivity, reduced utilities, and more efficient use of chemical energy. The technology combines traditional True Top Transfer with a standing bath and counterflow in every module except the last. The greatest part of each cycle creates standing baths to allow chemicals to work, then high-velocity counterflow provides the required dilution with less water. Dedicated rinse modules are not required. An estimated 500 million gallons of fresh water was saved in 2013 due to PulseFlow Technology systems, according to company data. www.milnor.com/pulseflow_technology, 1.504.712.7656
Heat Recovery and Half the Water The Hobart FT1000 flight-type dish machine comes in three models and saves annual energy and water costs. With triple and side rinses added to provide maximum coverage, the FT1000 consumes 50 percent fewer gallons of water per hour than previous flight-type machines. The patented Energy Recovery technology in the Advansys BD captures heat from waste air and uses it to heat 38 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
the wash tank and blower dryer, aiding the rinse-water temperature in the booster system. www.hobartcorp.com, 1.888.446.2278
Less is More E-Series Washers from Continental Girbau Inc. matched with Pro-Series II Dryers with Linen Life Extension (LLE) use less natural gas, energy, and labor. Boasting extract speeds up to 387 G-force, soft-mount washers remove more water from each
JWC Environmental’s Auger Monster is an all-in-one grinder, fine screen and compactor that eliminates pump clogs and sewer backups caused by sewage debris or sabotage. It combines five systems into one compact footprint to shred, capture, extract, wash and discard waste materials for removal. The result is cleaned, compact discharge that minimizes odors and lowers disposal costs, as less water and waste material are sent to the landfill. www.jwce.com, 1.800.331.2277
In Hot Water Mann Plumbing Inc. states that a solar hot water system works on three components. (1) Collection: the sun’s rays reach the collector which heats up the copper tubes or fins; (2) Storage: water is heated and stored in a
Branchville Correctional Facility in Indiana is the most recent corrections complex to install an MPI Solar hot water system. VISIT US AT WWW.CORRECTIONSFORUM.NET
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tank; (3) Distribution: solar hot water is disbursed as needed via the hot water heater. Wabash Valley Correctional Facility is noted as the first prison in the Midwest to utilize solar hot water to augment its heavy water demands. The system consists of 15 flat panels supplying water to 200 people with expected savings of thousands of dollars per year. www.mannplumbinginc.com, 812.334.4003
Green Water Savings “Improving water conservation begins with the flush
Green ROI To date, Aquawing has saved over 2.9 billion gallons of hot
Nexus Controller and Element Shower Manifold
valve,” states Shawn Bush, CEO, I-CON Systems, Inc. An electronic flush valve system controls runtimes and lockouts as well as water amounts. Reducing water per flush is 90 percent of the savings; 10 percent is the lockout limiting number of flushes. “Our system can take a 3.5 gallon fixture’s flush down to 1.6 gallons and a 1.6 fixture down to 0.9 gallons and still pass all plumbing tests and comply with plumbing codes.” For showers, a controller directs run length, time of day, and the number to run, all resulting in additional water savings. While the amount of water saved varies, he says, “we typically see 65 percent to 80 percent savings in water.” www.i-con.com, 1.800.240.3578
5 Keys to Boosting Laundry Efficiency Excerpts of a study titled “Keys to Boosting Efficiency and Productivity at Correctional Laundries” conducted in 2014 by Continental Girbau Inc. BY JOEL JORGENSEN
water alone, says Brett Daniels, vice president. “Aquawing is unique and has been able to find success in the corrections marketplace because our patented technologies offer many other benefits in conjunction with ecology. For instance, Aquawing is the only ozone system clinically validated to kill viruses and superbugs like MRSA. Also, our technology can save as much as 90 percent on hot water usage, 30 percent on total water usage, increase quality, decrease wash and dry times which all equate to a quick return on investment (ROI) for the clients.” Aquawingozone.com, 1.888.296.4777 VISIT US AT WWW.CORRECTIONSFORUM.NET
#1 Select a high-speed soft-mount washer-extractor. Higher speed washers remove more water from every load, which shortens dry time. Dryers run less often and use less energy and natural gas. #2 Choose a washer with a sump-less design. Many washers feature an outer sump, which holds up to three gallons of water per washer load. Select a washer without a sump and save up to three gallons of water per load. #3 Add an ozone system. Ozone systems work best using cold water and drastically reduce the need to heat water, which cuts natural gas consumption. They require fewer cleaning chemicals and PH extremes. This minimizes the need for multiple dilution rinses (and associated wasted water and chemicals). #4 Use a dryer with a moisture sensing system. These systems automatically sense when a load of laundry is dry and prevent that load from over-drying. This keeps correctional laundries from damaging them. It also ensures the laundries use only the necessary amounts of electricity and natural gas. #5 Select equipment with highly programmable controls that offer ease of use. This is important, especially if inmates do the laundry. All facets of the wash process (water temperature, extract speed, chemical injection, water levels, number of baths) should be programmable by item type. Joel Jorgensen is vice president of sales and customer services at Continental Girbau Inc. CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014 39
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An Open Letter Regarding Alzheimer’s Disease
As many of you know I have been actively involved in raising money for the Alzheimer’s Association for over 10 years. This year when I had an opportunity to attend the Alzheimer's Association International Conference 2014 it seemed like an excellent way to learn firsthand about the current state of research surrounding this most devastating disease. The conference was held in Copenhagen, Denmark, July 12-17. Attendance was in excess of 4,200, representing over 75 countries. 40 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
I attended a press conference each morning that included four to five leading research scientists and a moderator who would give an overview of the topic to be discussed. Then each scientist was asked to give a synopsis of their research after which the journalists from the Wall Street Journal and almost every major scientific journal were given an opportunity to ask questions. The following is a summary of some of the highlights that I gleaned from this global immersion experience:
Non-Invasive Early Detection The press conference included a panel of scientists that were focused on non-invasive early detection of Alzheimer’s. • Eye: Recent studies have identified beta-amyloidal plaques in the retinas and lens of people with Alzheimer’s—similar to those found in the brain—suggesting the possibility of simple, non-invasive methods of early detection. Preliminary results Continues on page 45
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BY DONNA ROGERS, EDITOR-IN-CHIEF
PROBLEM-SOLVING COURTS: CHANGING LIVES
Five different counties’ dramatic success stories.
Ramsey County’s ASAC in St. Paul holds court off-site at an annual picnic. It allows participants to interact with the court in a fun, sober environment.
PROBLEM SOLVING COURTS have come of age in 2014—25 years after the first Drug Court was established in Miami-Dade County, Florida. Statistics bear out dramatic results in reducing recidivism. For example, over the past 20 years the numbers in Orange County Superior Court, California, confirm an avoidance of 650,000 days of custodial beds for a savings of $75 million. Since the early days, this proven effective means of treating drug offenders has expanded into many treatment areas. Today 2,734 drug courts and another 1,122 problem-solving courts are in operation in all 50 states and U.S. territories. They include mental health courts, community courts, reentry courts, DWI courts, veteran’s courts, co-occurring courts, theft courts and others.
In 1994, to help guide others, leaders from the first 12 drug courts in the nation founded The National Association of Drug Court Professionals (NADCP), and since then have provided support and training to its colleagues. In 1997 it established a specialized institute called the National Drug Court Institute which today serves as the preeminent source for comprehensive training and cutting-edge technical assistance to the entire drug court field. Since its inception, the institute has trained more than 36,000 drug court professionals. Yet, while the diminished recidivism results for offenders are quite dramatic, it is not to say the outcomes are attained easily. Those involved in the field say those positive results are garnered by high-intensity treatment programs by multi-disciplined justice
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agencies working together, including courts, probation, parole, and health care agencies. Here are some of their stories. By 2003 Stone County, in rural Missouri, was experiencing a substantial increase in methamphetamine convictions. Judge Alan Blankenship, associate circuit judge, says that offenders were sent to prison and “95% were released to community but they came out somewhat worse than when they went in. What we were seeing was our criminal justice response to addiction behavior wasn’t working.” The area had little, if any, professional substance abuse therapy available. The judge and the prosecuting attorney attended training at NDCI and established their Drug Court in 2004, and six years later also established a DWI Court. The Drug Court can handle upwards of 100 participants at CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014 41
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one time, and the DWI court handles 15 to 20 felony cases concurrently. They now utilize a host of professional drug and mental health providers, he notes emphatically. Furthermore, Stone County has found that eight of 10 of its clients suffer from co-occurring disorders that are sometimes masked by the substance abuse, adds Shawn W. Billings, treatment court administrator, 31st & 39th Judicial Circuits. The treatment team uses standardized screening tools such as the RANT (Risk and Needs Triage) and GAIN (Global Appraisal of Individual Needs) to ascertain the prognostic risk and criminogenic needs, says Billings. Members of the Drug Court team have now also gone through specialized treatment modality training for such commonly co-occurring disorders as PTSD often found in returning military personnel and for gender-based trauma such as domestic violence. The treatment is intensive. Offenders go through urine analysis twice a week, attend Moral Reconation Therapy group therapy (MRT is a proven cognitive-behavioral program for substance abuse treatment and for criminal justice offenders), meet with counselors one-on-one and participate in a probation period. If they have not graduated from high school, participants are also required to pursue their GED. The minimum length of stay is 18 months. “We also have a medicationassisted treatment [MAT] program for severe alcohol and opium addicts,” furthers Judge Blankenship. “It eliminates cravings for alcohol and opiate drugs so they can benefit from cognitive therapy. It’s been a real game changer.” In contrast, Cook County in Chicago runs a specialty court program that is connected to the Cook County Jail, where 11,000 inmates are housed, explains Lawrence P. Fox, director of 42 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
Specialty Courts, Office of the Chief Judge. A larger program, it was instated in 1998 and it has grown to include the criminal courthouse within Chicago, and five suburban courts. Fox was judge at the time the court was conceived and was asked by the supervising judge to establish and preside over a specialty court that was to be used for offenders in violation of probation. “Offenders have far fewer choices when they violate probation. They have no right to jury trial, they have a bench hearing only,” he says. “We have them in a situation where they are more likely to agree to a
mental health court where many have very serious mental health conditions as the primary disorder, but a great percentage also have substance abuse, he points out. While the Cook County program is relatively large, they limit their numbers because “these are time-intensive cases, and are very, very challenging, especially the mental health courts,” says Fox. Because they come with cooccurring disorders is hard for these clients to conform and comply—they are exhausting to the probation officer, case manager, and others on the team, he
Before (St. Paul program)
After
drug program than go to the penitentiary….That’s one reason it has been so successful.”
Repeat Offenders, Not Diversion Being a big city, Chicago has more than enough multiplely-convicted felons, so all its programs target such people, which are considered more appropriate, the experts say, explains Fox. He furthers that “It is worth the effort to target these people. The bigger the effort, the bigger the reward.” When the Chicago specialty courts started out, they reached out to 130 to 150 clients at any given time; now that number is 400 to 500, plus youthful offenders, notes Fox. Burgeoning is the
concludes. As with most problem-solving courts in the nation, the Orange County Superior Court’s program is voluntary for participants. And like others, its four-phase program is a collaboration among the Courts, the Probation Department, the Orange County Health Care Agency, the offices of the Public Defender and the District Attorney, the Sheriff’s Department and other local law enforcement agencies, explains Paul W. Shapiro, collaborative courts officer, Orange County Superior Court, Santa Ana, Calif. It is all voluntary, all adults, and it is a post plea program for felony drug possession—for those whom we feel they might be better served in treatment courts, he says.
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After arrest, candidates are sent back to the Justice Center (there are four) in the jurisdiction where they live, he describes. Once there, the person in custody is placed in a holding cell to await arraignment. “They have the opportunity to see and hear what goes on at end of the [Collaborate Court] session and are asked if want to participate.” “These new offenders in orange jump suits hear how difficult others in program have it but how they’ve changed,” he details. They plead into the program with a guilty plea and are placed on formal probation. “They cannot
devised for them by the Health Care Agency and will also comprise individual counseling and 12-step programs. Everything is supervised by probation, and the monitoring may include IIDs for their car, transdermal alcohol monitoring devices—like SCRAM, or other types of e-monitoring if necessary. Orange County’s Collaborative Courts encompass a DUI court, Drug Court, Mental Health Court and a Vet’s Court, the latter of which was the second in the nation to be established, says Shapiro. He says many have cooccurring issues, such as veterans,
Graduate in the St. Paul program
Beginning offender in the St. Paul program
be convicted of drug sales or crimes of violence or sex, or have gang ties,” to get into the program, he says. Otherwise they are eligible. When they hear others’ success stories, it is hoped that they may be ready to make a commitment and really be in a situation to change their lives. The duration of the process will be at least 18 months. It might be the hardest thing they’ve ever done. Shapiro describes: “It is very difficult, their days are structured 24/7. They undertake group counseling, unannounced house calls by probation, must have a job or full-time school, and must associate with a different group of friends.” Their treatment program is
for example, who also may be homeless or on the verge of homelessness. In 2002, its Drug Court was one of the first four in the state of Minnesota, says Heidi Heinzel, adult drug court coordinator, Second Judicial District, Ramsey County Adult Substance Abuse Court (ASAC), St. Paul, Minn. Since then they have established a DUI court and a standalone Mental Health Court, and last year they formed a Vet’s Court. All of its programs are voluntary, and candidates need to be willing to participate, she says. For Drug Court, candidates must have been convicted of a felony. ASAC serves between 55 and 65 people at any given time; 174 people have graduated. It is a
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well-rounded treatment program. “We have 30-plus treatment providers with a variety of treatment modalities,” states Heinzel. These include: faith-based; 12step model; cognitive/behavioral and motivational enhancement techniques and pharmacology, she says. The treatment continuum can and will involve: detox, residential programs, outpatient programs, continuing care and support group meetings. And the types of treatment utilized include co-occurring, gender-specific, GLBT and other culturally sensitive programs. Further, ASAC staff provides Motivational Enhancement Therapy (MET), and gender-specific cognitive behavioral groups (Helping Women Recover for women, Thinking for a Change for men and Driving with Care for DWI participants). In addition, ASAC developed an in-house Psychiatric Court Clinic (PCC) that provides psychiatric services that are intended to bridge the gap between immediate intervention and community resources. Services include: assessment and diagnosis of mental illness; medication management and health education; and preparation for community integration. Any participant may be referred to the PCC by their case manager, regardless of their insurance status, if there a belief psychiatric intervention is necessary or would be beneficial. There were 92 individuals served in ASAC in 2012-2013. Of the 43 individuals who left the program, 29 (67%) graduated. These graduates were in the program for an average of 716 days (1.96 years) and were sober for an average of 598 days (1.64 years). To date, ASAC has served 381 participants and 174 individuals have successfully completed the program, notes Heinzel. “Our program focuses on treating the whole person. They may be chemically free but unless they are in recovery we will not see recidivism go down,” she says. CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014 43
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Sober Sluggers, a program of ASAC, is a fun way to stay in touch with other graduates.
They also try to provide a few extra services to get them on track—such as earning a GED, employment, housing and a driver’s license. They have also begun a 501c3 not-for-profit agency to fund raise for participant requests, i.e., to provide rent and transportation monies. Five hundred miles to its south, the St. Charles County, Missouri, Adult Drug Court, is alive and vibrant. It was established in 2000 and eventually grew to six different tracks, says Julie Seymore, treatment court administrator, St. Charles County Treatment Courts. These include Adult DUI, Cooccurring, Family, Revocation Track (for those already on probation) and this past January saw the addition of Vet Court. We had a lot of young people that were repeat offenders, Seymore explains, 17-to-23-year olds with substance-abuse-related charges. Also “we saw many veterans from current conflicts, and even those going back to the Viet Nam War, diagnosed with PTSD and TBI (traumatic brain injury). We want to offer them extra resources while holding them accountable for their actions.” The court averages between 200 and 300 participants at any given time, she says, and has 1,000 graduates. Like other courts mentioned here, it was named a national mentor court by the National Drug Court Institute, and serves as a 44 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2014
model for those wishing to establish a new court. It is one of just 10 in the nation that hold that designation (Stone County Circuit Court, Cook County WRAP, and Ramsey County Adult SA Court are also mentor courts). A local university is now conducting a recidivism study for them, but Seymore points to the numbers they last have collected. “Less than 7 percent of our graduates have gotten re-offenses and convicted and we’re very proud of that. I venture to guess it’s still under 10 percent.”
Successful Re-entry & Positive Outcomes However you name them— Specialty Court, Problem-Solving Court, Collaborative Court—they have accomplished amazing results for participants’ lives. The following are a few statistics from those this writer spoke with. In Ramsey County, at the oneyear and three-year follow-up, fewer ASAC participants re-offended. In the one-year post Drug Court exit study, only 8% reoffended compared with 33% in the comparison group. They also had fewer convictions than those in the comparison group. In 20122013, there were 3,977 drug tests conducted and less than one percent were positive. There were 10 graduates (34%) who improved their educational status by attending college or obtaining a GED/diploma. Perhaps even more
impressive, of those who graduated and were eligible for employment, 100% were employed at graduation or were full-time students while 54% of those who were terminated were employed or full-time students when they left the program. From the inception of Orange County Superior Court Drug Court in 1995 through 2013, 1,911 participants have graduated from the program. The recidivism rate for Drug Court graduates, three years after graduation, is 28.8% for any crime, compared with a recidivism rate for comparable non-participants of 74%. In 2013, seven drugfree babies were born to program participants, bringing the total since inception to 143 babies born free of addiction. Shapiro explains their success. “Back in ’95, Drug Courts seemed like a promising practice. Since then it has become a proven treatment that is an alternative to incarceration. They work, they are very effective at changing people’s lives, keeping them out of the criminal justice system forever. “Many people believe [all offenders] need to be locked up,” Shapiro comments. “But it is not a long-term solution…but changing their lives is a long-term solution.” If nonviolent offenders are kept out of jail, then jails and prisons are available for serious and violent offenders, he says. “Public safety is served by that.” J
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Continued from page 40 suggest that amyloid levels detected in the retina were significantly correlated with brain amyloid levels as shown by PET imaging. The retinal amyloidal test also differentiated between Alzheimer’s and non Alzheimer’s subjects with 100% sensitivity and 80.6 percent specificity. • Smell: There is growing evidence that the decreased ability to correctly identify odors is a predictor of cognitive impairment and an early clinical feature of Alzheimer’s. As the disease begins to kill brain cells, this often includes cells that are important to the sense of smell. The research suggests that there may be a role for smell identification testing in clinically normal, older individuals who are at risk for Alzheimer’s disease. It may prove useful to identify proper candidates for more expensive or invasive tests.
Potential Risk Factors and Risk Reduction Strategies New data on possible protective behaviors and dementia risk factors emerges. Determining more specifically the factors that raise and lower risk of Alzheimer’s disease and other dementia is an essential component in the battle against the Alzheimer’s epidemic. • Brain Activity and Exercise: Participation in activities that promote mental activity, and moderate physical activity in middle age, may help protect against the development of Alzheimer’s disease and dementia
in later life. Cognitively stimulating activities are associated with greater brain volumes and higher cognitive test scores. Moderate exercise in middle age is associated with decreased risk of dementia. • Sleep Problems: Research reported at AAIC>2014 also showed that sleep issues—especially when combined with post-traumatic stress disorder (PTSD)—may increase dementia risk in veterans. • People 90 and older—late onset Hypertension May Protect Against Dementia: While hypertension during midlife is considered to increase the risk for Alzheimer’s and other dementia, there is emerging research evidence suggesting that its role in dementia risk may change over time, and may instead help p r o t e c t a g a i n s t dementia in people age 90 and over. The researchers found that participants with hypertension onset age of 80 to 89 years had a significantly lowered risk of developing dementia compared with participants with no history of hypertension. Participants with onset at age 90 or older had an even lower dementia risk.
Conclusion The conference provided great insight into the large body of research that is occurring worldwide to combat Alzheimer’s on so many fronts. If you would like additional information or copies of the various white papers surrounding the studies I referenced, please feel free to contact me at eyankellow@correctrxpharmacy.com. J Ellen H. Yankellow is president and CEO with PharmD.
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