Horticulture Therapy: Letting Nature Nurture

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Horticulture Therapy: Letting Nature Nurture

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  • 1. CORRECT CARE CAREA Publication of the National Commission on Correctional Health Care Spring 2004 • Volume 18, Issue 2Horticulture Therapy: Letting Nature Nurture National Conference It will be here before you know it!BY JAIME SHIMKUS proposal noted, Get a preview on page 11. “[T]hink about howW hat used to be seeing nature bloom a barren plot lifts your spirits…. Bernard P Harrison, 1922 - 2004 . Photo of Taffiany Johnson by Tinisha Wilson of dirt on a Making things growdrab street acrossfrom the Cook County can boost self- esteem and be a NCCHC Founder Passes Away After a(IL) Jail now holdslife, delight, triumph, jolt of indepen- dence…. Even if it Lifetime of Remarkable Achievementhopes and goals. is only to help relax That may be a and unwind, horti- BY STEVEN S. SPENCER, MD, CCHP-A jails, he was persuasive in demonstrat-stretch, but not much culture therapy can ing the need for national standards. Twhen one considers improve any per- he field of correctional health care Aided by small grants from the fed-that the life—flowers son’s life.” has lost its patriarch, and many of eral government and other sources,and herbs—has been A home gardener us have lost a very good friend. Bernard and a handful of other pio-sown and nurtured by himself, Spruth had Bernard Harrison, JD, was a lawyer neers developed the AMA jail stan-women who, by soci- long seen wasted with a strong sense of social justice dards. A pilot project in a few jailsety’s measure, don’t potential in the (see page 10 for a timeline successfully demonstratedhave much going for empty planting of personal and profession- the feasibility and accept-them: All are former beds. But since they al achievements). Early in ability of a voluntaryjail detainees who take part in its fur- are in front of the county courthouse his career with the accreditation program,lough program. Their success in grow- administration building—in an open, American Medical and the effort soon wasing and harvesting these plants, and public area—it was not feasible for Association, he was instru- expanded to prisons anddonating them to local end-users, has detainees to work there. However, mental in shaping the leg- juvenile detention and con-proven a subtle but tangible factor in security was less of a concern for the islation that created finement facilities.their own healing and growth. furlough participants, who must Medicare and Medicaid, The first national confer- Now in its second year—and having check in daily at the jail but are free balancing the goal of ence in this field was heldexpanded to a second site on the jail to live and work in the community. improving access to health in 1977. I first metgrounds—this horticulture therapy is Before approaching the Department care for the poor and Bernard at the secondthe latest initiative of the expressive of Women’s Justice Services and the elderly with the interests annual conference, inarts program at Cermak Health other agencies that had to be on of the medical professions. Chicago. All of us attend-Services, a county agency that pro- board, Spruth found a large landscap- This was no easy task given resistance ing that gathering were comfortablyvides the jail’s health care. The ing firm to donate most of the materi- to a federal role in health care fund- seated in one hotel meeting room, noexpressive arts program, part of the als and to prepare the plots. He then ing, which was unprecedented in our comparison with the thousands thatmental health services department, presented a plan that spelled out nation’s history. attend our conferences today.seeks to help inmates through cre- logistical details, objectives and ther- In 1981 the program separatedative outlets such as poetry and jour- apeutic benefits. For the most part it Man of Vision from the AMA and became the inde-naling, visual art and music. wasn’t a hard sell: “[DWJS executive Bernard’s passion for and skill in pendent National Commission on While gardening is different, con- director] Terrie McDermott is a gar- coalition building served him well in Correctional Health Care, co-foundedceptually, it’s well-known to have dener herself, and she said OK before the early 1970s, when he had the by Bernard and B. Jaye Anno, PhD,therapeutic effects. According to the I even finished the presentation.” vision and the initiative to undertake CCHP-A. They recruited the supportAmerican Horticulture Therapy the huge effort of improving the sorry and participation of many medical,Association, “[HT is] a process in From Idea to Reality state of correctional health care, correctional and law organizations,which plants and gardening activities With the necessary approvals in place, another area with no tradition of fed- and persevered in promoting accredi-are used to improve the body, mind Spruth invited women in the furlough eral involvement. tation in those difficult early daysand spirits of people.” (See page 14 program to lend a hand, and on June As an AMA group vice president, before the concept gained widespreadfor more information from the AHTA.) 4, 2003, the Blooming Entrepreneurs Bernard had acquired experience in acceptance. That definition describes perfectly English Garden was born. Initially the political arena, both locally and in As time progressed, however, morewhat expressive therapist Eric Dean there was some grumbling from skep- Washington, representing AMA con- and more jails and prisons applied forSpruth, MA, ATR, sought to convey in tics, but no more: “People are seeing cerns even to the Oval Office. With this accreditation and the Certified Correc-his proposal for Cermak’s horticul- results, and that is changing their experience and armed with an AMA tional Health Professional programture program. However, the idea first study of health care in this country’sstruck him at a visceral level. As his Continued on page 14 Continued on page 10 Non-Profit Org. US Postage PAID I N S I D E T H I S I S S U E Chicago, IL 60611 Permit No. 741 FEATURES DEPARTMENTS Essay Contest on Transitional Planning Practices .7 NCCHC News: Schizophrenia Clinical Guidelines . .2 Facility Profile: Indiana Women’s Prison . . . . . . . .8 Guest Editorial: Jann Keenan on Health Literacy . .3 New Mexico MDs Support Opioid Treatment . . . . .9 CCHP News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 National Conference Preview: New Orleans . . . . .11 Academy News . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Antibiotic (Mis)use for Respiratory Viruses . . . . .12 Mental Health Emergency Strikes Vegas . . . . . . .10 Journal Preview: Correctional Internships . . . . . .13 In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Spotlight on the Standards: Clinical Standards Q&A . . . . . . . . . . . . . . . . . . . . . . . . . .17 Performance Enahncement . . . . . . . . . . . . . . . .16 Exhibitor / Advertiser information . . . . . . . . . . . . .18 Updates Conference Wrapup . . . . . . . . . . . . . . . .20 Classified Advertising . . . . . . . . . . . . . . . . . . . . .19
  • 2. CORRECT NCCHC News CARE A Publication of the National Commission on Correctional Health Care Spring 2004 Vol. 18 No. 2New Guidelines Aid in Schizophrenia Treatment Standards for Opioid Treatment Programs in Correctional Settings C ORRECT C ARE is published quarterly by the National Commission on Correctional Health Care, a not-for-profit organization whose mission is to improve the quality of healthTo help correctional mental health Specialized Guidance care in our nation’s jails, prisons and juvenile confinementcare providers manage patients with NCCHC’s Clinical Guidelines on the With the recent launch of its accredi- facilities. NCCHC is supported by 36 leading national organi- zations representing the fields of health, law and corrections.schizophrenia, NCCHC has devel- Treatment of Schizophrenia in tation program for opioid treatmentoped new clinical guidelines that are Correctional Institutions are intend- programs based in correctional facili-based, in part, on the American ed to supplement the APA’s guide- ties, NCCHC has published a set ofPsychiatric Association’s Practice line by focusing on treatment issues standards that represent the require- ments for opioid treatment services BOARD OF DIRECTORSGuideline for the Treatment of that are unique to a correctional set- Thomas J. Fagan, PhD (Chair)Patients with Schizophrenia. ting. (For useful principles and in such facilities. In developing the American Psychological Association The need has never been greater. guidelines on providing psychiatric standards, we used federal regula- Eugene A. Migliaccio, DrPH, CCHP (Chair-Elect) American College of Healthcare ExecutivesOn any given day in the United services in these settings, consult tions and community standards as a Douglas A. Mack, MD, CCHP (Immediate Past Chair)States, 2% to 4% of state prisoners the APA publication “Psychiatric guide and modified them to take into American Association of Public Health Physiciansand about 1% of jail detainees have Services in Jails and Prisons,” which account the issues unique to provid- Kenneth J. Kuipers, PhD (Treasurer) National Association of Countiesschizophrenia or another psychotic can be purchased at the NCCHC Web ing services in a correctional facility. Nancy B. White, LPC (Secretary)disorder, compared with 0.8% of the site or by calling our headquarters.) Conforming with NCCHC’s American Counseling AssociationU.S. population as a whole. Providing The schizophrenia guidelines Standards for Health Services, the Edward A. Harrison, CCHP (President) National Commission on Correctional Health Careadequate treatment to inmates with address the following areas: OTP Standards are divided into nine Carl C. Bell, MD, CCHPschizophrenia not only helps the • background general areas: National Medical Associationindividual by reducing bizarre and • diagnosis A – Governance and Administration H. Blair Carlson, MD American Society of Addiction Medicinedisruptive behaviors but also may • management overview (including B – Managing a Safe and Healthy Kleanthe Caruso, MSN, CCHPmake the environment safer for treatment goals) Environment American Nurses Associationother inmates and for staff. • assessment on entry to the system C – Personnel and Training Robert Cohen, MD American Public Health Association • frequency of follow-up visits D – Health Care Services and Hon. Richard A. Devine, JDHigh-Risk Population • content of follow-up visits (including Support National District Attorneys AssociationThe high prevalence of mentally ill assessment and levels of function) E – Inmate Care and Treatment Capt. Nina Dozoretz, RHIA, CCHP American Health Information Management Associationinmates is believed to be related to • use of the assessment to guide F – Health Promotion and Disease Charles A. Fasanothe deinstitutionalization of patients treatment efforts (including conti- Prevention John Howard Associationin mental health facilities and the nuity of care, treatment strategies G – Special Needs and Services Bernard H. Feigelman, DO American College of Neuropsychiatristsdismantling of mental health pro- and environmental controls) H – Health Records William T. Haeck, MD, CCHPgrams across the country. • correctional barriers I – Medical-Legal Issues American College of Emergency Physicians Left to their own devices on the • quality improvement monitors All of the standards are linked to Robert L. Hilton, RPh, CCHP American Pharmacists Associationstreet, these former patients often specific federal regulations and JoRene Kerns, BSN, CCHPengage in behavior that leads to Free Guidance Online therefore are essential for achieving American Correctional Health Services Associationtheir incarceration. Many of these The seventh in a series of clinical NCCHC accreditation. However, Daniel Lorber, MD American Diabetes Associationinmates also have other risk factors guidelines geared toward health care some may not apply, in whole or in Edwin I. Megargee, PhD, CCHPassociated with a higher incidence of providers working in correctional part, to a given facility’s program. American Association for Correctional Psychologyviolent behavior (e.g., substance settings, the schizophrenia treat- Accreditation by NCCHC allows Charles A. Meyer, Jr., MD, CCHP-A American Academy of Psychiatry & the Lawabuse, neurological impairment, ment guidelines are the first devel- OTPs to obtain legally required certi- Robert E. Morris, MDpoor impulse control) that may be oped by NCCHC that deal with men- fication from the federal Substance Society for Adolescent Medicineexacerbated by psychotic symptoms. tal illness. The others offered to date Abuse and Mental Health Services Peter C. Ober, PA-C, CCHP American Academy of Physician Assistants Because of their idiosyncratic and deal with the following chronic dis- Administration. OTPs seeking accredi- Joseph V. Penn, MD, CCHPsometimes provocative behaviors, eases: asthma, diabetes, epilepsy, tation are eligible for technical assis- American Academy of Child & Adolescent Psychiatrypeople with schizophrenia may be at high blood pressure, high blood cho- tance consultation, funded by Peter Perroncello, CJMhigher risk of being victimized in lesterol and HIV. SAMHSA, that assesses what may be American Jail Association George J. Pramstaller, DO, CCHPcorrectional settings, and often their All of the guidelines can be down- needed to comply with the standards. American Osteopathic Associationclinical conditions are intensified by loaded for free at the NCCHC Web An OTP seeking accreditation need Patricia N. Reams, MD, CCHPovercrowding, hostility and loss of site. Go to www.ncchc.org, select the not be in a facility whose health ser- American Academy of Pediatrics Sheriff B.J. Robertsbasic freedoms. Resources and Link page, and then vices are accredited by NCCHC. National Sheriffs’ Association click on Clinical Guidelines. To learn more or to order the stan- John M. Robertson, MD dards (which cost $29.95) call American College of Physicians William J. Rold, JD, CCHP-A NCCHC at (773) 880-1460, or visit American Bar Association the Web at www.ncchc.org. David W. Roush, PhD National Juvenile Detention Association Odds & Ends Ronald M. Shansky, MD Calendar Catalog keeps growing. The large number of registrants for NCCHC’s mental Society of Correctional Physicians Thomas E. Shields II, DDS American Dental Association August 21 health conference demonstrates the pressing need for more resources geared Jere G. Sutton, DO, CCHP CCHP proctored examination, multiple sites toward mental health assessment and treatment in correctional settings. To American Association of Physician Specialists (see www.ncchc.org for locations) help, we’ve added three valuable new titles from the well-regarded publishing Alvin J. Thompson, MD American Medical Association arm of the American Psychological Association. For product descriptions and Barbara A. Wakeen, RD August 27 ordering information, visit the Publications section of our Web site. American Dietetic Association Best Practices in Transitional Planning essay Henry C. Weinstein, MD, CCHP competition deadline (see page 7) Treating Adult and Juvenile Offenders With Special Needs, edited by Jose American Psychiatric Association B. Ashford, Bruce D. Sales, and William H. Reid. 2001, 518 pages, hard- Jonathan B. Weisbuch, MD National Association of County & City Health Officials October 1 cover; $49.95 Application deadline for the November 14 CCHP and CCHP-A examinations Acting Out: Maladaptive Behavior in Confinement, written by Hans Toch and Kenneth Adams, with J. Douglas Grant and Elaine Lord. 2002, 446 October 29 pages, softcover; $29.95 Copyright 2004 National Commission on Correctional Health Care. Accreditation Committee meetings: Health Treating Chronic Juvenile Offenders: Advances Made Through the Oregon Statements of fact and opinion are the responsibility of the authors Services and Opioid Treatment Program alone and do not necessarily reflect the opinions of this publication, Multidimensional Treatment Foster Care Model; written by Patricia NCCHC or its supporting organizations. NCCHC assumes no respon- November 13-17 Chamberlain. 2003, 186 pages, hardcover; $39.95 sibility for products or services advertised. We invite letters of support or criticism or correction of facts, which will be printed as space National Conference on Correctional Health allows. Articles without designated authorship may be reprinted in whole or in part provided attribution is given to NCCHC. Care, New Orleans NCCHC’S NEW ADDRESS November 14 1145 W. Diversey Parkway, Chicago, Illinois 60614 Send change of address, advertising inquiries and other correspondence to Jaime Shimkus, publications editor, CCHP and CCHP-A proctored examinations, Phone (773) 880-1460 • Fax (773) 880-2424 NCCHC, 1145 W. Diversey Parkway, Chicago, IL 60614. Phone: (773) 880-1460. Fax: (773) 880-2424. New Orleans E-mail info@ncchc.org • Web www.ncchc.org E-mail: info@ncchc.org. Web: www.ncchc.org.2 SPRING 2004 • CorrectCare www.ncchc.org
  • 3. Guest EditorialHealth Literacy: The Challenges and OpportunitiesBY JANN KEENAN, EDS The movement is also taking hold in materials alongside the patient. Use you aim to reach older inmates, the pharmaceutical industry, where, a highlighter to call out important make sure the materials show older F or Susan, a for instance, marketers are develop- information. For example, if a adults. This approach helps patients petite, 100- ing reader-friendly package inserts. patient has high blood pressure, see this is “for them.” pound mark the section in the brochure woman, taking Simple Strategies that says to avoid salting food. Better Outcomes her daily medica- Despite this explosion in awareness, Similarly, highlight pictures or Undoubtedly, conquering low health tion for high day-to-day progress is slow. Part of action words to help the patient literacy will not happen overnight. blood pressure the challenge is to educate health understand specific activity. If your However, if health care providers with a light snack care providers, who may take it for patient needs to do a foot check, cir- take a critical look today at how they is easy. Each granted that their patients under- cle the picture of a person checking communicate information and the afternoon she stand them. In fact, providers them- his feet and write “do foot check” in best way to do it in a culturally sensi-grabs a banana and a handful of selves may be the best weapon in the the margin. tive way, chances are good that theirpeanuts as she takes her pills. fight against low health literacy— patients, whether they will remain in Yet, for Ned, a strapping, 240- and potential errors that can result. Ask the patient to write his or her name a correctional institution or arepound man who also suffers from The following strategies, while not on the brochure preparing to reenter society, willhigh blood pressure, eating a light comprehensive, are simple and prac- Making the brochure personal will have a better chance at positivesnack means downing two chicken tical ways that health care providers help raise the patient’s compliance. health outcomes.sandwiches accompanied by a glass can improve their daily interactionsof milk, crackers and cheese. with inmates to strengthen health Know your intended audience If you will be using the brochure with Jann Keenan, EdS, is president of Two patients, two approaches to communication and comprehension. Latino patients, for instance, it is a The Keenan Group, Inc.—Experts infollow the same medication instruc- Use plain medical English good idea to have some Latinos in Health Literacy, a communicationstions. But which patient is doing the Always use easy-to-understand terms the photographs or illustrations. If firm based in Ellicott City, MD. Reachright thing? Unfortunately, that’s when talking with patients. For her by e-mail at jkeenan@erols.com.open to interpretation. In the example above, the medica- example, providers should use termstion instructions are vague and non-descript but most likely will not such as “high blood pressure” instead of “hypertension,” “both It’s Official: New AMA Policy Backsresult in a deadly medication error.In other cases, however, medication sides” instead of “lateral” and “a cough that lasts too long” instead of NCCHC Standards, Accreditationnoncompliance or an adverse drug “persistent cough.” The American Medical Association standards.reaction due to unclear instructions has adopted a policy of support for • Incarcerated people have a highcan result in a deadly outcome. It Be specific and avoid jargon the National Commission on Correc- prevalence of disease and serioushappens every day in America. When giving medication instructions, tional Health Care’s standards for mental illness, as reported in The inability to read, understand say “in the morning” or “at night” health services and its accreditation NCCHC’s Health Status of Soon-and act on health information is instead of “a.m.” or “p.m.” When a program. The policy “encourage[s] to-Be-Released Inmates study.called low health literacy. A person pill must be taken with “plenty of all correctional systems to support • “Drastically curtailed” correction-with limited health literacy may have water,” show the patient an 8-ounce NCCHC accreditation,” and calls for al budgets have resulted in “insuf-difficulty reading labels on pill bot- glass of water or two Dixie cups full finding ways to increase funding for ficient resources.”tles, understanding directions rather than leave them guessing. correctional health services.offered by the doctor or giving Resolution 440 (A-04), Support A Long Historyinformed consent because of the Draw a picture or use models for Health Care Services to Incarcer- “The AMA has for over 30 yearsform’s lofty language. People retain and understand infor- ated Persons, was adopted by the strongly supported the need for Low health literacy has a negative mation better when they are shown a AMA’s House of Delegates at its improved health and mental healthimpact on patient care, confuses picture or model rather than just annual meeting in June. The House care in jails and prisons,” sayspatients and providers, and takes a talking about a subject. To help of Delegates is the association’s Jonathan B. Weisbuch, MD, MPH,heavy financial toll on the health inmates understand a complicated principal policy-making body. who is AAPHP’s delegate to thecare industry. And it is becoming an health issue such as arteriosclerosis, The policy was introduced by the AMA. He also serves on NCCHC’salarming public health issue. draw or show a picture. In the case American Association of Public board of directors.According to a recent study by the of high cholesterol, draw an artery Health Physicians, which holds a The AMA and NCCHC have a longInstitute of Medicine, low health lit- with plaque stopping blood flow. seat on the House of Delegates. history dating to 1970, when theeracy affects 90 million people in the Mention an easy-to-understand anal- AAPHP also is a supporting organi- medical association first began toUnited States and by some estimates ogy, such as a pipe that is clogged. zation of the National Commission. look into the conditions of healthcosts the health care system more services in jails and didn’t like whatthan $58 billion annually. Focus on key points Improvement Needed it found. The AMA collaborated with For the 2 million inmates residing To help inmates clearly understand According to a report in AMA News, other organizations in a program toin the nation’s jails and prisons and the gist of the matter, providers physicians widely supported the poli- establish jail health care standardsthe 11.5 million inmates released should select three specific points to cy in part because of “recognition and advise on accreditation. In theeach year—populations more likely summarize the patient’s illness or that illness in prison can spill over early 1980s, that program evolvedthan the general public to have seri- medication compliance. to affect the community at large.” into the independent NCCHC.ous infectious diseases, newly diag- The resolution, which describes “Those of us who labor in the vine- Understand what the patient understandsnosed health problems, and language NCCHC as “the leading organization yards of correctional medicine and Take extra effort to make inmatesand cultural issues—low health liter- working to improve the quality” of public health thank the AAPHP for really understand what is being said.acy can be dangerous. correctional health care, cites pow- introducing the resolution and the Try asking patients to repeat or Fortunately, there is good news. erful arguments for the policy— AMA for adopting it,” Weisbuch adds. explain the information just deliv-Concern about low health literacy including the fact that the U.S. The resolution is posted online at ered. This “teach-back” techniqueand how it affects patient care is Surgeon General views this as an www.ama-assn.org/meetings/ helps providers know what has suc-becoming mainstream with legisla- important public health issue. Other public/annual04/440a04.doc. cesfully sunk in and what is stilltors, public health interest groups key concerns include the following: However, this version does not con- missing in their instruction.and others. As a result, great strides • Correctional health care should tain the sole amendment to the res-are being make to quell the problem, meet prevailing community stan- olution, which expands the phrase Take a fresh look at prepared materialswith grassroots health literacy initia- dards, and providers should prac- “health care services” by adding When using informational pamphletstives springing up nationwide to tice in keeping with contemporary “including mental health services.” or brochures, take a fresh look at theenhance communication in health.www.ncchc.org SPRING 2004 • CorrectCare 3
  • 4. CCHP NewsOregon MD Treats the ‘Family Disease’ of Incarceration New CCHP Eligibility Rules In a move that makes CCHP certifi- cation more accessible to thousandsBY KRISTIN PRINS, MA “intervention to keep these kids out ing organizations of the Children’s of correctional health professionals, of the system.” Project—are popular because “Many the Board of Trustees has eliminat-In 2000, Elizabeth Sazie, MD, MPH, This is fortunate for the children inmates have not had models to ed the three-year work requirement.made a big career leap: After almost the project is focused on: According learn how to be parents. These skills This also benefits the growing num-20 years as medical director at the to the Oregon DOC, more than two- can be learned, and most inmate par- ber of employers that look for theBenton County (OR) Correctional thirds of female inmates and nearly ents want to do a good job—they credential in the hiring process.Facility as well as a county public one-fifth of male inmates have minor care about their kids.” Participants The new eligibility requirementshealth officer, she joined the Oregon children, and these children are five in the parenting class have told Sazie state that CCHPs must be of goodDepartment of Corrections as chief times more likely to be incarcerated that prison was the best thing that character and professional reputa-medical officer at the Coffee Creek, than their peers. had ever happened to them. “It tion, have no legal or ethical imped-Mill Creek and Santiam facilities. The child of an inmate is at risk for taught them to be good parents.” iment to serving in the correctional As CMO, Sazie is responsible for many reasons. She may have wit- The success of the Caregiver’s health care field, and have creden-clinical care, consultation, adminis- nessed a parent’s criminal behavior Guide cannot be measured yet, but it tials that are free of any restrictiontrative duties and public health activ- and arrest. He may have to move to is getting off to a positive start. The that would limit their practice toities. While this makes for a very live with a relative, leaving behind guide soon will be available in the correctional setting.busy schedule, these duties are quite school and friends. For some chil- Spanish, and it is already available CCHP candidates must pass afamiliar to others in her position. dren, foster care is the only alterna- online (see Web address below). proctored examination, which is What stands out about Sazie is her tive. Unfortunately, foster kids get As she continues her work at the administered several times a year atcommitment to working at the fore- moved 4 to 6 times a year on aver- front of the correctional health care test sites across the country.front of correctional health care. In age. Regardless of living arrange- field, Sazie maintains that family As always, professionals from a2003 this commitment was rein- ments, a child of an incarcerated health is a key element for the variety of disciplines, such as physi-forced when she became a Certified parent is often uncertain where the health of correctional populations. cians, nurses and mental health pro-Correctional Health Professional. parent is, what jail or prison is like, “It may not be a medical issue,” she fessionals, are eligible to apply forWhy would such a seasoned profes- and what her own actions had to do says, “but it is a health issue.” certification. Other professionalssional seek certification? Sazie with Mom’s or Dad’s arrest. working in the area of correctionalexplains: “[Taking the exam] gave To help the people caring for youth health care, for example attorneys, To learn more about the Children ofme more confidence in my ability to with incarcerated parents, the pro- administrators and medical records Incarcerated Parents Project or tomake decisions in gray areas.” ject partners developed “How to technicians, also are eligible. download the Caregiver’s Guide, visit Her hard work in the many gray Explain Jails and Prisons to Children: For further details, consult the the Web at www.doc.state.or.us/areas of correctional health care is A Caregiver’s Manual.” Sazie, who CCHP Study Guide and Candidate transition_project and click on thesustained by a belief that this setting was the guide’s lead author, hopes Handbook online at www.ncchc.org. project name.facilitates reaching a largely under- that encouraging caregivers to talkserved population. “Inmates are with the children—and helping themsober and faced with reality, and may figure out how to do this—willchoose to address their health and reduce the number of these childrensubstance abuse problems. This can who end up in the corrections sys-have a positive effect on them, and tem themselves.on their families and the community. “I had always wanted a booklet orAssisting them and witnessing these flier to give to inmate families,” sayschanges are extremely rewarding. Sazie. “In my 20 years at the countyThe challenges lie in motivating and jail, I sometimes had three genera-sustaining these changes.” tions in jail. Incarceration is a ‘family disease,’ like substance abuse.”Children in NeedIn answer to such challenges, Sazie Help for Parentshas been deeply involved in an ODOC The Caregiver’s Guide has been pro-program to aid children of prison vided to all Oregon DOC facilitiesinmates. In 2002, she took advan- and county jails and is displayed intage of “momentum” in this area the clinic and visiting areas of theseand joined with ODOC’s public facilities. It also is available at theaffairs director and other individuals popular parenting classes developedand groups to form the Children of by ODOC in 2002. Sazie believesIncarcerated Parents Project. Today, that parenting classes—as well asmore than 20 organizations support the many other family-focused activi-this project, which Sazie says is ties run by ODOC and other support- CCHP Board of Trustees Nomination Form I nominate the following CCHP to serve a three-year term on the CCHP Board of Trustees. Nominee Place of employment City, state Daytime phone Nominator Daytime phone Signature Fax this form to (773) 880-2424. Deadline: September 3, 2004 For more information, call (773) 880-1460.4 SPRING 2004 • CorrectCare www.ncchc.org
  • 5. Academy NewsAcademy Steps Up to the Plate on National InitiativesBY MARY MUSE, MSN, RN, CCHP Answering the Call • Demonstrate how effective health, Mentors Standing By! By invitation, the Academy visited mental health and substance abuse In a profession marked by endlessThe Academy of Correctional Health the Justice Department in programs impact disease and health change and significant complexity,Professionals’ commitment to Washington, D.C., for the May 10 care costs for our communities navigating one’s career can be aadvancing the profession was meeting on the Call to Action, • Encourage policies that lead to difficult task. Wouldn’t it be niceacknowledged and strengthened by which was issued last summer collaboration among correc- to have a wise, experienced andtwo opportunities this year. The by the Surgeon General. tions, public health service trusted colleague to turn to forAcademy received invitations to par- Richard Carmona, MD, organizations and the larg- help? Now you can, through theticipate with national representatives MPH, CCHP, convened a er community Academy’s mentor program. Toin the revision of the Centers for panel of experts from With these goals in learn what mentoring is and how itDisease Control and Prevention’s corrections and public mind and the leadership can help you, or to sign up for thetuberculosis guidelines for correc- health to discuss the cur- of Admiral Kenneth program, visit the Academy onlinetions, and to take part in the U.S. rent and anticipated state Moritsugu, MD, MPH, at www.correctionalhealth.org.Surgeon General’s Call to Action on of correctional health care. CCHP, who is the deputyCorrectional Health Care. The goals of the Call to surgeon general, the panel In March, the CDC convened a Action include the following: committed to a day of frank discus- Others on the panel included Capt.working group consisting of experts • Identify opportunities to raise sion, making recommendations and Dilan Noonaz, MD, senior scientist infrom the agency as well as from the awareness in the community, and identifying opportunities to support the Office of the Surgeon General,corrections and public health arenas especially among its leaders and these and related goals. and Hazel Dean, ScD, MPH, associateto revise the 1996 TB guidelines. The major stakeholders, about the rela- Work included further clarifying director of health disparities at theAcademy is represented on two of tionship between corrections and some goals, and identifying and vali- CDC’s National Center for HIV, STDthe working group’s eight subgroups: the health of the community at dating evidence-based scientific pro- and TB Prevention.diagnosis and treatment, and train- large grams and actions for possible use in The opportunity for the Academying and education. • Identify barriers that impede future programming. to contribute to this distinguished The major work on the revision is development and implementation Most important, perhaps, was the panel further supports the value ofnow complete, and the working of transitional programs and validation of correctional health care this organization to our profession. Igroup will meet in December to health care delivery, including issues, concerns, barriers, risks and am grateful to have served thereview the guidelines before they are mental health and substance the population served, strengthened Academy as a representative to theseissued in 2005. abuse treatment by input from national experts. two important groups. Academy of Correctional Health Professionals Board of Directors Nomination Form Nominee’s Name Title Employer Address City/State/Zip Telephone Fax E-mail Name of Nominator Member ID Number Address City/State/Zip Telephone Fax E-mail Signature Please submit the following information along with the nomination form by Sept. 3, 2004. 1. A brief summary (250 words or less) outlining the qualifications of the nominee and his/her vision for the Academy. 2. A copy of the nominee’s resume (no more than two pages). Please mail or fax to: Academy of Correctional Health Professionals Nominating Committee 1145 W. Diversey Parkway Chicago, IL 60614 Fax (773) 880-2424 Or submit your nomination online at www.correctionalhealth.org.6 SPRING 2004 • CorrectCare www.ncchc.org
  • 6. Best Practices in Transitional Planning: An Essay CompetitionBY R. SCOTT CHAVEZ, PHD, CCHP-A, AND LAMBERT charge of jurisdiction Competition Rules the property of NCCHC and may beKING, MD • aftercare A panel of correctional health experts used by the Searching for Common The essay should make clear how will review the entries and select up Ground project to highlight specialThe Searching for Common Ground the described model improves conti- to three winners. Essays will be eval- practices in discharge and transition-project, an effort funded by the JEHT nuity of care for recently released uated on the basis of clarity and al planning.Foundation and conducted in collab- inmates with serious medical and detail relating to the entrant’s suc- Typed essays of 500 words or lessoration with the National Commis- mental health conditions. It also cess in measurably improving conti- will be accepted through Friday,sion on Correctional Health Care, should provide sufficient detail about nuity of care for recently released August 27, at 5 p.m. Entrants mayannounces an essay competition to the success rates of inmates who inmates with serious medical and submit the essays via e-mail atrecognize best practices in transi- transition from the correctional mental health conditions. All deci- ncchc@ncchc.org, by fax at (773)tional planning. Up to three entrants institution to the community. sions are final, including the deci- 880-2424, or by mail to R. Scottwill receive air transportation, hotel Entrants may wish to describe the sion to select no winners if none of Chavez, PhD, NCCHC, 1145 W.lodging and registration to NCCHC’s collaborative efforts of corrections, the entries are judged worthy. Diversey Parkway, Chicago, ILNational Conference on Correctional law enforcement, human service One person per winning entry will 60614. Questions about the essayHealth Care, being held Nov. 14-17 agencies and other stakeholders in receive the travel, lodging and regis- competition may be directed toin New Orleans, LA. the transition process. tration award. Essays will become scottchavez@ncchc.org. There is a great need to have effec-tive and efficient transitional plan-ning in our prisons and jails. It isestimated that 97% of incarceratedindividuals will eventually be releasedto our communities. This translatesinto staggering numbers: In 1999,nearly 600,000 prison inmates werereleased. Many of those being dis-charged from prisons and jails sufferfrom asthma, diabetes, cardiovascu-lar disease, epilepsy, hepatitis C, HIVinfection, serious mental illness andphysical disabilities. It is vitallyimportant that effective dischargeplanning occurs to ensure continuityof health care, through participationin employment, housing, school andchurch opportunities. Across the country, many initia-tives are taking place to improve thetransition process. Some projectshelp inmates to prepare for a lifebeyond confinement, other projectswork to improve the dischargeprocess and yet others help releaseesto adjust to life in free communities. A goal of the Searching forCommon Ground project is to identi-fy and widely communicate replica-ble models and best practices thatmeasurably improve continuity ofcare for recently released inmateswith serious medical and mentalhealth conditions. The essay compe-tition will help to identify of the bestof these models and practices.Essay GuidelinesThe Searching for Common GroundProject will accept essays on BestPractices in Transitional Planningfrom entrants who work in criminaljustice institutions, human serviceagencies, community and neighbor-hood organizations, and other agen-cies that have an interest in improv-ing transition into communities. Essays must address efforts thatcontribute to improved public safetyby offering better inmate transitionthrough assessment, classification,programming, resource allocationand release preparation practices.Essays may address any of the follow-ing seven elements of the transitionprocess:• assessment and classification• transitional accountability plans• release decision making• community supervision and services• responding to violations of condi- tions of release• termination of supervision and dis-www.ncchc.org SPRING 2004 • CorrectCare 7
  • 7. Facility ProfileOne Size Does Not Fit All at Indiana Women’s PrisonBY JAIME SHIMKUS From visionary idea to volcanic • A summer day camp held at the eruption: That’s how family services prison for five days each July pro- Indiana Women’s Prison‘W hat can we do to help you?” It’s a good bet that many inmates in the Indiana director Janet Schadee, RN, MHA, describes the program’s evolution over eight years from a child visita- vides ample time for relationship- building activities in a stimulating environment with music, crafts and Facilities: The oldest women’s prison in the United States, IWP admitted its first inmate in 1873.Women’s Prison had heard that ques- tion center to a vast network of mul- petting zoo animals. The maximum security complextion seldom, if ever, before being tidisciplinary services, both in the • Parent-teen day, held twice a year, still occupies its original 15-acreadmitted there. Yet it’s a primary prison and outside, geared toward invites youth aged 13 to 17 to spend site just outside of downtownconcern of service providers at the fostering healthy families. the day with their mothers or grand- Indianapolis. Three miles away, amaximum security facility, where, The program was conceived by mothers and engage in problem-solv- satellite work-release facility isalong with the inherent security facility superintendent Dana Blank— ing activities that require teamwork. home to more than 50 women.mandate, the mission statement who saw that “children are victims of 4. Outreach initiatives link moth-explicitly “encourages rehabilitation their mothers’ incarceration,” as ers with home, children and care- Correctional Population: Thethrough quality programming.” Schadee notes—and was implement- givers via an outreach family care main complex holds up to 400 Medical and mental health treat- ed with the assistance of the social coordinator, who not only works with inmates. Except for new intakesment are fundamental to this reha- services director and a longtime vol- community agencies to obtain need- (up to 50 per week) all are classi-bilitation, but, given the needs of the unteer at the prison. The first step in ed resources, including transporta- fied as special populations, includ-diverse population it serves, the pro- developing what has grown into a tion for visits, but also meets with ing about 50 youth (ages 15-21),gramming is defined broadly, aiming comprehensive program of wrap- the children and their caretakers at geriatrics, death row inmates andto improve “health” in areas such as around services was establishment of their homes to ensure that the envi- those with significant mentalparenting, self-esteem and coping the visiting room within the prison ronment is healthy and safe. health or medical conditions.with past abuse. confines. Described by Hendrix as “a 5. Family planning offers educa- Health Care Services: Medical “Until recently the prison func- first of its kind,” the center offers a tion and free birth control to women care is provided by contract withtioned with the ‘one size fits all’ phi- warm, inviting environment where who are soon to be released from the Prison Health Services, whichlosophy,” explains assistant superin- mother and child can bond. facility. The program is staffed with a employs the health administrator,tendent James Hendrix, MA, a From there, the prison contacted full-time registered nurse who has responsible physician, mentaltrained psychologist whose duties agencies that assist families in the both academic and practical experi- health staff and others. Nursesinclude oversight of health services. community and explained that these ence in public health. and substance abuse counselors“In the last few years, the complex- incarcerated mothers, who usually Beyond the Family Preservation are employees of the DOC.ion of the incoming population has do not lose their rights to their chil- Program, formal education is avail- Overall, staffing is about 26changed, resulting in a facility mis- dren, are in dire need of services able to all inmates, some of whom FTEs. Present full-time are thesion change.” such as counseling in family plan- earn degrees from a state university. health services administrator, As the reception and diagnostic ning, prenatal care and parenting It’s not all a one-way street, though. medical director, director of nurs-facility for all women entering the skills. From there the program grew “Giving back” programs develop es, nurse practitioner, 7 RNs, 7state’s Department of Corrections, into its current form with five major inmates’ sense of pride and responsi- LPNs, 4 psychologists, dentalIWP expects to process some 1,800 components: bility by enabling them to help those assistant and 3 medical records/inmates this year, more than twice as 1. Therapeutic education and less fortunate. For instance, they clerical staff. On site less than fullmany as in 1997. Most will be trans- support groups address parenting make clothing for poor children and time are the psychiatrist, ob/gynferred to other facilities, but the skills for mothers and grandmothers. sleeping bags for homeless shelters. physician, dentist and others.assessment process will identify 2. Responsible Mother, Healthy Students in the building trades have The facility has a 9-bed infir-those to remain at IWP, which hous- Baby provides case management and made items such as bookcases and mary and “medical rooms” in thees not only new intakes but also all more for the prison system’s preg- rocking horses. “I’m very proud of various residential zones.special populations. These popula- nant inmates, all of whom live at the work that so many of these ladiestions reside in six separate “zones”: IWP. Supervised by an RN designated do,” says Hendrix. “For many, it Accreditation: First accredited in• Intake unit as the prenatal care coordinator, the serves as a means of restoring them- 2000, the prison was last surveyed• Special needs units for mentally ill program includes the following: selves to the fabric of mankind.” in June 2003. and developmentally challenged • Comprehensive intake assess- Quoteworthy: “Incarceration is inmates ment to identify the needs of moth- Creative Funding not the end of the road but an• Youthful offender unit ers, caregivers and children As intricate as the programming opportunity for a new direction.”• Medical management unit • A family care plan for each preg- itself are the myriad relationships —James Hendrix, MA, assistant• Maximum security complex that nant inmate, with goals based on that Schadee builds between correc- superintendent houses the general population issues identified in the assessment, tional and community service agen-• Disciplinary/administrative zone, including placement of the child cies and funders. This is essential which includes segregation and • Prenatal and parenting education because the programs are not DOC tutionalize” the infrastructure that death row • Newborn care classes budget items but rather are funded underlies the programming. Key to In addition, the “progressive” unit • Support groups held weekly almost exlusively by grants or by the this is development of an electronichas 20 beds for special needs inmates • A birthing coach service agencies themselves. case management and tracking sys-in transition to general housing. • An outreach program that con- While state support helped launch tem, which not only facilitates link- This structure enables the staff, nects caregivers with community the Family Preservation Program, ing inmates with services but alsoled by a zone supervisor, to special- agencies and resources and follows the vagaries of governmental bud- enables the program to track out-ize operations and services for each the child’s progress at home gets led Schadee to look elsewhere comes: in effect, to prove its worth.group. “Consequently,” Hendrix says, 3. Parental bonding provides ways for funding. Thinking creatively, she One indicator, for example, is the“each population can successfully for inmates and their children to has secured numerous foundation recidivism rate at IWP: about 8%adjust to incarceration. This makes develop and maintain bonds during and other grants for which IWP after three years, compared to 39%the environment healthier and safer the mother’s incarceration. These would not qualify on its own, but of women who returned to prison infor staff and offenders.” settings and events also enable chil- that instead support the not-for-prof- 1994, according to a 2002 Bureau of dren to spend time with others who it agencies that provide the services. Justice Statistics report.Award-winning Program have similar family circumstances. It’s a nonstop juggling act, but two “It makes sense,” says Schadee.In a prison rich with programming, • The children’s visitation center years ago major help arrived in the “Women do better upon return tothe centerpiece, serving 80% of the operates year-round, providing a less- form of another grant, $300,000 the community if we address theirpopulation, is the Family Preserva- restrictive, child-friendly setting with from the Health Resources and family’s and children’s needs.” Justtion Program, which earned NCCHC’s books, toys and activities to foster Services Administration. With this as important, Hendrix adds, it helps2003 Program of the Year Award. interaction and nurturing. money Schadee is working to “insti- to end the cycle of incarceration within families.8 SPRING 2004 • CorrectCare www.ncchc.org
  • 8. New Mexico MDs Support Opioid Treatment in CorrectionsT he New Mexico Medical Society ical societies across the state, took by the National Institutes of Health House of Delegates has unani- the move at its annual meeting in and the Institute of Medicine con- NCCHC’s Opioid Treatment mously passed a resolution in May. cluding that, to date, methadone Standards Hit the Streetssupport of opioid replacement thera- maintenance treatment is the mostpy in the state’s jails and prisons. ORT Gaining Acceptance effective treatment for heroin addic- With the recent launch of itsSetting its sights on passage of state While opiate addiction plagues cor- tion. Another important factor is the accreditation program for opioidlegislation, the society wants to rectional facilities across the nation, FDA’s approval of buprenorphine, treatment programs based in cor-“require the initiation of a voluntary the situation is particularly dire in which is administered orally, for rectional facilities, NCCHC has(for inmates) opioid replacement New Mexico: According to the resolu- treatment by primary care providers published a set of standards thattreatment, including methadone tion, in 2001 nearly 16% of men and in office-based settings. represent the requirements for opi-and buprenorphine maintenance 19% of women newly admitted to the oid treatment services in such facil-treatment.” Bernalillo County jail tested positive Next Steps ities. In developing the standards, Mindful of the need for proof of for opiates, primarily heroin. The sit- Now come the tasks of education and federal regulations and communityefficacy, the resolution also calls for uation is exacerbated by high rates persuasion. At the state level, the standards were used as a guide butformal evaluation of the ORT pro- of hepatitis C in the state, and of society will be lobbying the legisla- modified to take into account thegrams “to determine whether such recidivism among inmates with sub- tors who are involved with health issues unique to providing servicestreatment modalities decrease stance abuse problems. care and funding for corrections. The in a correctional facility.recidivism, crime and transmission Even acknowledging these chal- resolution also will be forwarded to For more information about theof infectious diseases among popula- lenges, the medical society’s vote the American Medical Association standards, see page 2. To learntions at risk in New Mexico.” was a bold one, says Judith A. for consideration in implementing more about the OTP accreditation According to Barbara J. McGuire, Stanley, MS, CCHP-A, director of new health policy, according to program, visit the AccreditationMD, who introduced the resolution, accreditation at NCCHC. McGuire. Among its own members page at www.ncchc.org.“This may be the first time in this “Traditionally, community pro- and those of specialty societies, thecountry that the physician members viders have been strongly divided NMMS is distributing information onof a state medical society have over methadone therapy, with some a home study program by which lence, burglaries, car-jackings andpassed a resolution regarding opiate viewing it as replacing one drug with providers can become certified to drive-by shootings, we must havereplacement therapy for jail and another,” explains Stanley, who dispense buprenorphine. medically supervised opiate replace-prison inmates. It could represent a worked in correctional mental health Efforts are also underway to ment therapy—methadone or thelandmark step in the advancement of care for years before joining NCCHC. increase public awareness and sup- newer and safer buprenorphine—toinmate health care.” McGuire is “However, the medical literature and port, which is important because of offer to addicted inmates whilepresident of the Greater Albuquer- practice is slowly recognizing the concerns about drug-related crime in incarcerated,” says McGuire. “Onlyque Medical Association, whose physiological underpinnings of addic- the state, McGuire says. For exam- with effective medical therapy ofboard unanimously endorsed the res- tion and the validity of methadone ple, she has had articles on the sub- substance abuse will there be a rea-olution before sending it to NMMS. therapy. For a state medical society ject published in local newspaper. sonable chance that these inmates The NMMS House of Delegates, to address this need in incarcerated “If we are ever to break the drug- could enter addiction recovery andwhich comprises about 75 physicians populations is progress indeed.” related cycle of hepatitis C and return to productive lives uponrepresenting all of the county med- The resolution itself cites studies other infectious diseases, gang vio- release.”www.ncchc.org SPRING 2004 • CorrectCare 9
  • 9. Mental Health Emergency Strikes Las Vegas BERNARD P. HARRISON (continued from page 1)Mental illness rates in Clark County, “There are a lot of factors: Gambling was established, along with the manyNV, have long been at “crisis” levels, and its related stresses. The lifestyle other activities and programs that A Remarkable Lifebut so many psychiatric patients are of sex, drugs and rock and roll.” constitute the NCCHC we know today.flooding hospital emergency rooms The jail wasn’t directly involved in 1922 Born May 7 in Chicago andthat on July 9 the county declared a the emergency, but it too must deal Well-Deserved Recognition grew up on the city’s West Sidestate of emergency. County officials with an ever-growing mentally ill Last October Bernard and Jaye were 1940 Graduated from high schoolreport that normally about 50 such population—including many people the recipients of the National as class presidentpatients occupy the 330 local ER who could not receive treatment in Academies’ Institute of Medicine’sbeds but the number had doubled in the hospitals or who were released and 2003 Gustav O. Lienhard Award. 1942-1946 U.S. Navy lieutenantrecent weeks, to about one-third of did not receive proper follow-up care. The citation for this prestigiousall beds. This poses a public health For both hospitals and jails, the award commended these “outstand- 1946 BS University of Illinoisthreat because it limits the ability to problem can be traced to lack of pre- ing leaders…for their profound con-deal with other medical emergencies vention, Luxnor says: Mental health tributions to improvements in the 1952 JD DePaul Universitythat may arise, the county says. programming in the community is quality and humanity of the medical College of Law As a short-term fix, some patients insufficient to deal with the need. care systems for the incarcerated.”were treated at a temporary facility 1952 Admitted to Illinois Bar, Their work to develop comprehensiveset up by a local social services Dealing With the Problem Federal District Court, 1953, and standards for correctional health ser-agency. The state also agreed to pro- To ease its own mental health crisis U.S. Supreme Court, 1960 vices and to initiate the concept ofvide $100,000 for emergency assis- the jail has taken a number of steps. voluntary accreditation provided “the 1952-1961 Private practice, corpo-tance. It has boosted the number of social incentive for states, counties, and rate and zoning law workers and, to identify detainees in the federal government to upgradeJails Also on the Front Line need of treatment, mental health health care conditions in correction- 1961-1981 AMA group vice“This is is not a new issue,” says screenings are done at booking, al facilities,” the IOM noted. president and legislative directorDavid Luxner, MA, health administra- where a mental health professional is Lauding their ability to marshaltor at the Clark County Detention assigned round-the-clock. support from key organizations and 1981-1991 Co-founder, with B.Center in Las Vegas. “The ERs break Last year Luxnor opened a 64-bed constituencies and to build aware- Jaye Anno, of the National Com-these records all the time. But it mental health unit to supplement two ness of the issue, the IOM citation mission on Correctional Healthdoes magnify a situation that’s wors- existing units for psychotic patients goes on to state: “[Harrison] and Care, serving as president and CEOening everywhere in the country.” and another for suicidal patients. Anno demonstrated the gravity of Indeed, counties nationwide are (This has paid off: The jail just problems of inmates, the risk that 1991 With Anno, beganstruggling with a rising tide of un- or observed a full year with no suicides.) these problems posed to the health Consultants in Correctional Careundertreated mentally ill people, but The jail also has aided the justice of the public beyond jails and pris- Honors:in Las Vegas the numbers are partic- system in establishing a mental ons, and the inadequacy of care that • National Association of Countiesularly catastrophic. For example, the health court to divert certain offend- was being provided to inmates.…In Distinguished Service Awardsuicide rate is about twice the ers from jail. The small program has concurrence with their work, the • National Sheriffs’ Associationnational average, Luxnor says, and proven so successful that Luxnor Supreme Court ruled that states Criminal Justice Awardthat points to a disproportionate plans to appeal to the government have an obligation to ensure that an • American Medical Associationnumber of seriously ill people. for funds to expand it tenfold. individual’s basic needs are met, Recognition of Pioneering Efforts including health care.” in Correctional Health Care • Robert Wood Johnson Foundation Santa Fe Consultant Two Service Awards In 1991 Bernard and Jaye retired • Institute of Medicine from NCCHC and established a busy Gustav O. Lienhard Award consulting practice based in their home. The following year they moved 2004 Passed away July 10 to Santa Fe with their young daugh- ter Kari, and we were then neighbors Survived by his wife, B. Jaye Anno, as well as friends. Jaye is a Western four children, five grandchildren, gal from Cody, Wyoming, who likes one great-grandson, a brother, and horses, but Bernard, who was born in many nieces and nephews Chicago and lived there all of his life, now became a Westerner, too. He goodbye to all his many friends and adapted readily, sharing in the care neighbors in El Dorado and Santa Fe. of their horses, and dressed accord- By then he was going on grit alone, ingly. On our many visits to Wyoming and although his failing health was prisons on a contract with that state, apparent, he was his same old teas- he wore a cowboy hat and boots. ing, cheerful self. He was a private We spent many hours in the car on person and did not want to talk those expeditions to widely dispersed about his troubles. He had made his prisons. We had scary adventures in last contract visit to Wyoming the blinding snowstorms, and we had fun last week of May, and finished his singing together as we drove along. report on July 3. He passed away on Bernard had a good voice, and we July 10, a man who died with his knew the same oldies—You Are My boots on. Sunshine, Sweet Adeline and others. Bernard Harrison, much-loved hus- We’d tell jokes. He had a great sense band, father, brother, friend and of humor. mentor in the cause of service to the As we worked together, my respect unfortunate, we miss you. And we and admiration for Bernard steadily remember you with a smile. increased. He was a classy guy, hum- ble and always courteous, affection- ate, strong but gentle. Steven S. Spencer, MD, CCHP-A, is When Bernard’s death was an independent consultant and a sur- approaching, he reassured Jaye of veyor for NCCHC’s accreditation pro- the many satisfactions and rewards gram. A former medical director for he had experienced, of living to love the New Mexico Department of and see his children and grandchil- Corrections, Spencer received the dren and their accomplishments. 1998 Bernard P. Harrison Award of Always a genial and generous host, Merit for his long history of dedica- he and Jaye threw a large party on tion, contribution and leadership in May 31st so that he could silently say the correctional health care field.10 SPRING 2004 • CorrectCare www.ncchc.org
  • 10. National Conference on Correctional Health Care Hyatt Regency New Orleans • November 13–17This premier educational experience will be the most comprehensive meeting of its kind, with over 2,000 correctional health professionals assembled to learn,share and enrich themselves professionally. As part of our mission to provide the highest quality education in this field, this year’s program will present elementsyou’ve come to expect as well as many new features, including many “hot topics” among the 100-plus sessions in a broad range of subjects and skill levels.Why Attend the 2004 National Conference? Registration CategoriesThe educational objectives for this conference are to enable you to: Register online via secure server at www.ncchc.org. The last day to preregister is Oct. 29. After that date you must register on site.• Demonstrate understanding of skills necessary to better manage common Ear medical, dental and psychological problems found in correctional settings Academy Member: $235 for early birds, $285 on October 1 date ly bird cut : Sep o or later. Academy members save $75 off the regular fee! temb ff• List major health care and policy issues affecting incarcerated individuals, er 31 including HIV infection, mental illness and substance abuse Nonmember: $310 for early birds, $360 on October 1 or later. If you are not an Academy member but wish to join, simply sign up using• Describe legal, ethical and administrative issues and ways to prevent the conference registration form. potential problems that arise in correctional settings One Day: $185. Select the day you wish to attend: Monday, Tuesday or• Demonstrate increased understanding of common correctional health Wednesday. The one-day fee entitles you to participate in all events that day. care issues by exchanging ideas with colleagues about new developments in specialty areas Guest: $45. This special registration enables guests to attend all exhibit hall events, including the opening reception on Sunday and lunch on Monday. ItEducational sessions are offered in 10 thematic tracks: administrative, infec- does not provide access to educational sessions.tious disease, juvenile, legal/ethical, medical, mental health, nursing, oralhealth, professional development and women’s issues. Preconference Seminars: Full day seminars, $170; half day seminars, $95.Extras Extras Extras Worth a LookPreconference Seminars Set the Tone Many presentations pack the room from year to year: updates on chronic andGet your educational experience off to a good start by attending one or more infectious disease treatment, cost-cutting strategies that don’t compromiseof the preconference seminars to be held on Saturday and Sunday. The in-depth quality, how to avoid legal actions, tips on staff recruitment and retention. Butsessions address subjects essential to the delivery of high quality correctional like the ever-changing nature of correctional health care, this year’s programhealth care: NCCHC’s recently revised standards for health services (prison, offers much that is new. Below are some of the many intriguing titles:jail and juvenile), its mental health care guidelines, and quality assessment at Photos courtesy of the New Orleans Metropolitan Convention and Visitors Bureau.both introductory and advanced levels. • Digging Out of Disasters Free! A half-day seminar on infectious diseases will feature a panel of expertsdiscussing successful disease management practices in correctional settings. • Managing Intersexuality in the Correctional SettingThe Sunday afternoon session is free but advance registration is required. • Meditation Behind BarsShare a Little, Learn a Lot • Release Planning: Developing an Integrated and Comprehensive SystemFor a great networking session, be sure to attend the Shared Interest Groups • Reporting Correctional Staff Violence: Legal and Ethical Considerationssponsored by the Academy of Correctional Health Professionals. These small,informal groups enable you to meet with colleagues for focused discussions • Weight Management Programs in Juvenile Facilitiesmoderated by leaders in correctional health care. The SIGs will take place dur- Conference Site, Accommodations and Traveling the concurrent sessions on Monday, 2:15 p.m. to 3:30 p.m. HotelSunday Morning Stress Relief All educational sessions will be held at the Hyatt Regency. Situated in a perfectWith an emphasis on deep breathing and mental imagery, Tai Chi integrates locale downtown, it is adjacent to the Louisiana Superdome and New Orleansmind with body to restore vitality, inner strength, balance and natural health. Shopping Center, and a short walk from the French Quarter, Bourbon StreetThe slow, dance-like moves create balance, flexibility and calmness and help to and the Mississippi Riverfront. The hotel is offering a special conference rate ofrelieve stress. Led by Carl Bell, MD, noted mental health authority, NCCHC $148 single/double (plus taxes) for reservations made before October 22.board member and Tai Chi instructor, the free class will take place at 7 a.m. Poydras Plaza at Loyola Avenue, New Orleans, LA 70113-1805on Sunday at the convention center. Wear loose-fitting clothes. Hyatt reservations (800) 233-1234; direct (504) 561-1234 http://neworleans.hyatt.comGet an Eyeful in the Exhibit HallThe National Conference features the nation’s largest and most comprehensive Air Travelcommercial exhibit in this field. Set aside plenty of time to visit the exhibit Meeting attendees traveling within the United States are eligible for a 10% dis-hall during one of the many scheduled breaks. There you can meet with knowl- count on round-trip tickets. To book your travel contact our official carriers:edgeable representatives from 150 companies showcasing state-of-the-art prod- American Airlines (800) 433-1790 refer to ID A19N4AAucts and services, career opportunities and professional services. Southwest Airlines (800) 433-5368 refer to ID Code V0265 Presented by the National Commission on Correctional Health Care and the Academy of Correctional Health Professionals Find complete conference information and online registration on the Web at www.ncchc.org. To obtain a preliminary program with registration form, download it at our Web site, e-mail info@ncchc.org, or call (773) 880-1460. m 1
  • 11. Evidence-based MedicineDon’t Squander Your Antibiotics on Respiratory VirusesBY JEFFREY KELLER, MD sive, to the tune of $1.1 billion per Medicine and can be found online at sounds. The PA on duty explained to year! (That figures comes from a www.cdc.gov/drugresistance/ the patient the CDC criteria for anti-I suspect that almost every physi- study published in the Feb. 24, 2003, community/technical.htm. The final biotic use and then discharged her cian in the United States would Archives of Internal Medicine.) How report included pharyngitis (which I without an antibiotic prescription. agree that antibiotics are overpre- much of that money is being wasted reviewed in the last issue of CORRECT-scribed. Unfortunately, since the at your facility? CARE), acute bronchitis and rhinosi- Rhinosinusitistotal number of antibiotic prescrip- nusitis. Below I will summarize rec- The next patient who comes to thetions given to people with “cold” has Better Care, Less Waste ommendations for the latter two. jail medical clinic complains ofbeen estimated at $44 million per One of the neatest things that I have “sinusitis.” He has “stuff runningyear in this country, it would seem discovered about the evidence-based Acute Bronchitis down the back of my throat” and hasthat most physicians have not actual- medicine movement is that using evi- A patient presents to your medical had a stuffy nose for three days. Hely amended their own prescribing dence-based principles almost always clinic complaining of a cough, pro- states “my doctor on the outsidehabits. saves money. There is no better ductive of green sputum that she has always gives me Augmentin for this.” I can see how this would be the example of this than in the area of had for three days. She should get an So what do you think? Should thiscase. Too many physicians are stuck antibiotic use. antibiotic, right? Not so fast! guy get an antibiotic?in the inertia of “I have always done Three years ago, the Centers of The CDC panel defines acute bron- The CDC panel defines rhinosinusi-it this way.” Also, “my patients Disease Control and Prevention pub- chitis as an acute respiratory tract tis as an inflammation of the mucosaexpect an antibiotic when they come lished evidence-based guidelines for infection with prominent cough, of the sinuses and paranasal struc-in and they won’t be happy if I don’t the appropriate use of antibiotics for with or without sputum production. tures. Sinusitis involving the maxillaryprescribe one.” Finally, “The antibi- upper respiratory infections. The As we all know, complaints of cough and ethmoid sinuses is usually self-otic can’t hurt and it might help!” guidelines were developed by a panel that we diagnose as “acute bronchi- limited. However, sinusitis remainsMultiply each incident of an unneed- of experts that included representa- tis” are common. The CDC panel’s the fifth most common diagnosis fored prescription by, oh, a few million, tives from infectious disease, family recommendations apply to otherwise which antibiotics are prescribed.and it adds up. practice, emergency medicine, inter- healthy adults without other compli- The CDC panel makes the follow- Of course, inappropriate antibiotic nal medicine and from the CDC cations, such as COPD. In other ing recommendations:use can and does hurt. It hurts every itself. The panel used evidence-based words, they apply to the vast majority 1. Viruses account for the majority ofpatient who has an adverse effect principles to review the huge amount of the patients we see. With that in cases of rhinosinusitis.from an inappropriate antibiotic pre- of literature on these subjects. mind, here is a summary of the 2. Patients with bacterial sinusitisscription, stuff like diarrhea, yeast The guidelines they came up with, CDC’s recommendations regarding tend to have the following:infections, nausea and allergic reac- titled “Principles of Appropriate bronchitis: a. Symptoms for more than 7 daystions. It hurts the community by Antibiotic Use for Acute Respiratory 1. Viruses cause the vast majority of b. Tenderness of the face or teethbreeding antibiotic-resistant bugs. Tract Infections in Adults,” were bronchitis. The only significant c. Purulent nasal dischargeAnd it hurts the economy because published in the March 20, 2001, nonviral causes of bronchitis are 3. The CDC does not recommendinappropriate antibiotic use is expen- issue of the Annals of Internal pertussis, mycoplasma and sinus x-rays for the diagnosis of chlamydia. sinusitis since x-rays perform poor- 2. The main clinical objective for the ly compared to sinus puncture and practitioner evaluating a patient culture. If the clinician suspects with cough is to rule out pneumo- frontal or sphenoid sinusitis, CT nia. In healthy adults, this can be scanning of the sinuses is prudent. accomplished by finding symmet- 4. Most cases of rhinosinusitis ric breath sounds and normal vital resolve spontaneously without signs (no fever, a respiratory rate antibiotics. Antibiotics should be less than 24 and a heart rate less reserved for patients with moder- than 100). Chest x-ray should be ate or severe symptoms. ordered only in those with cough of greater than three weeks dura- In the case of our clinic patient, tion or asymmetric breath sounds the PA notes that he has had symp- or abnormal vital signs. toms for less than seven days. He 3. Antibiotics should not be pre- also has no significant tenderness to scribed for routine, uncomplicated percussion of the face or teeth. acute bronchitis. If the patient is a Finally, the PA cannot find any true healthy adult who does not have purulent discharge. After a discus- pneumonia, do not give antibi- sion about the CDC’s recommenda- otics! The CDC points out that a tions on the appropriate use of long series of meta-analyses and antibiotics for rhinosinusitis, the randomized trials consistently fail patient is discharged with analgesics to show any benefit of antibiotics but no antibiotics. when given for uncomplicated acute bronchitis. Tally It Up 4. Finally—and this is important— Here is the question for your facility: the CDC notes that patient satis- How much money are you paying for faction with physicians’ care for antibiotics prescribed for sinusitis, acute bronchitis depends more on bronchitis and pharyngitis? I recom- physician-patient communication mend that you find out by pulling all than on whether the patient of the charts with one of those diag- received an antibiotic. If you will noses over the past couple of months explain to your patients why they and adding up the antibiotic costs. do not need antibiotics, they most Then, I highly recommend that these often will be happy with your care. CDC guidelines be required reading I have found it helpful to refer to for all of the prescribing clinicians in the CDC guidelines when talking your jail or prison. to patients. Jeffrey Keller, MD, is president of Let us now return to our patient Badger Correctional Medicine, a con- who has been coughing up green tract management company based in sputum for three days. She was Idaho Falls, ID. Reach him by e-mail found in clinic to have normal vital at badgermed@datawav.net. sounds and symmetric breath12 SPRING 2004 • CorrectCare www.ncchc.org
  • 12. Medical Rotations in Corrections: A Promising InnovationBY WILLIAM J. ROLD, JD, CCHP-A osteopathic medical students through Next, “The Value of Correctional on Correctional Medical Rotation” is practice and training in corrections Medical Training for Correctional a personal account of a medical stu-Historically, prison health care has from three perspectives. Together, Management and Enhanced Delivery dent’s experiences on a correctionalbeen isolated from the larger public they illustrate the synergy that made of Services” looks at medical student rotation. His enthusiasm shines as hehealth care community. Many insti- this experiment work and encourage rotation from the point of view of the recounts his daily work—some oftutions are in remote rural places, its replication. prisons’ health care managers. It which is routine to the seasonedfar from medical libraries or tertiary The first article, “Developing a describes the benefits to the system, practitioner—and the breadth of hiscare centers. Prisons have experi- Correctional Medicine Rotation for to the students and to the inmate hands-on exposure to nearly everyenced enormous difficulties recruit- Medical Students,” discusses the patients from a well-run program. aspect of medicine in a way not usu-ing and retaining qualified medical genesis of a rotation program from Cost and control factors are explored, ally available in more traditionalpersonnel, in large part because of early planning through successful as are the educational prospects for rotations. His experience is a lessonlow salaries and the lingering social implementation. It addresses obsta- learning—not only by the students to other students to take advantagestigma still falsely associated with cles that had to be overcome, includ- from the prison health care staff but of the same opportunity.practice in corrections. ing student fears and initial academic also by the staff from their students Perhaps part of the problem is also misgivings. Finally, the article surveys —in an academic setting of student/ William J. Rold, JD, CCHP-A, is guestthat the notion of integration of cor- the results of its successful program faculty interaction at its best. editor of this Journal symposium.rectional health and public health is and its prospects for replication. Finally, “The Student Perspectiveimplanted too late. Giving correc-tional health care a place at the aca-demic and clinical tables of medicalschools is a promising innovation.Three PerspectivesThe next issue of the Journal ofCorrectional Health Care features asymposium discussing the rotation ofJournal Vol. 10, Issue 4:Here’s What’s in Store• The Performance-Based Standard: Implications for Juvenile Health Care David W. Roush, PhD, LPC• Lower Genital Tract Infections Among HIV-seropositive and HIV- seronegative Incarcerated Women: A Mandate for Screening and Treatment in Prisons Catherine Remollino, MD; Heidi W. Brown, BA; Jennifer Adelson-Mitty, MD; Jennifer Clarke, MD; Anne Spaulding, MD; Lori Boardman, MD; Timothy P. Flanigan, MD; Susan Cu-Uvin, MD• Prevalence and Indicators of Chlamydia trachomatis Among Men Entering Massachusetts Correctional Facilities: Policy Implications Meeta S. Nguyen, MD, MPH; Sylvie Ratelle, MD, MPH; Yuren Tang, MD, MPH; Michael Whelan, BS, MS; Paul Etkind, DrPH; Thomas Lincoln, MD; William Dumas, RN• Sending Medical Students to Prison: Integrating Correctional Medicine Into the Larger Public Health System—A Symposium in Three Parts William J. Rold, JD, CCHP-A, Guest Editor 1. Developing a Correctional Medicine Rotation for Medical Students David L. Thomas, MD, JD; Anthony J. Silvagni, DO, PharmD; James Howell, MD, MPH 2. The Corrections Perspective David L. Thomas, MD, JD; Dianne Rechtine, MD 3. The Student Perspective Noah Lee, MDwww.ncchc.org SPRING 2004 • CorrectCare 13
  • 13. HORTICULTURE THERAPY (continued from page 1) From a medical standpoint, gar- dening creates physical results such Like the garden itself, interest in the project has flourished, and this as reducing stress and lowering blood year detainees are being invited to tryperceptions,” Spruth says. for work or plant type. From 8 to 20 pressure, says Cermak psychiatrist their hand at a plot within the jail Those results come in several gardeners may show up on a given Maria Mynott, MD. But it also has confines. More local organizations,forms. Most visible, perhaps, are the day, and they are gently encouraged less tangible effects: “In an environ- including the Chicago Botanicalplants themselves. The first-year gar- to pitch in wherever help is needed. ment like this you lose power. This Garden, have signed on as supporters.den relied on starter plants rather All work is done by hand or by spade, garden lets the women reconnect Spruth has received stacks of com-than seeds to improve the odds of which enables the gardener to con- with their roots and establish com- mendation letters from local digni-success. It contained herbs and flow- nect quite literally with the soil. munity. They can progress to the taries and others.ers chosen for their marketability. From time to time, especially when point where they are providing not But, at the end of the growing sea- Before long county staffers began the weather does not permit work only for themselves, but also for the son, the most important result, artic-to express their appreciation: “It outdoors, Spruth brings in speakers community. This is very empowering.” ulated by Cermak’s chief psychologistadds beauty and life to the facility. It to teach the women about the fine The women take pride in knowing (and Spruth’s boss) Carl Alaimo,is wonderful to have something nice points of gardening or the therapeu- that the herbs and flowers they have PsyD, is this: “The gardening programto look at,” wrote one clerk. tic uses of plants. harvested are put to good use. To has proven to facilitate not only an While the aesthetic appeal to staff “I now know what will help me date they have been donated to local opportunity for our patient popula-is welcomed, the real purpose is to sleep,” wrote one woman. “I know restaurants and to a business that tion to look beyond themselves butcultivate the well-being of the gar- that rosemary oil is good for the hair uses dried flowers in specialty soaps. also deep into the future of how con-deners. By design the program is and skin. I have an herb book so I’m One restaurant has even hired one of sistent nurturing will provide a posi-informal, with no fixed assignments going to study it when I get home.” the gardeners as an apprentice chef. tive outcome in their lives.” Digging In to HT What Is Horticultural Therapy? A process in which plants and gar- dening activities are used to improve the body, mind and spirits of people. HT is an effective and beneficial treatment for people of all ages, backgrounds and abilities. Where Is It Used? Worldwide in hospitals, rehabilita- tion and vocational facilities, nurs- ing homes and senior centers, com- munity gardens, botanic gardens, schools, farms, horticultural busi- nesses and prisons. How Is It Used? As a cognitive therapy, HT helps clients learn new skills and regain those lost. Improved memory, initia- tion of tasks and attention to detail are recognized HT benefits. Social growth occurs: People caring for plants learn responsibility and expe- rience hopeful and nurturing feel- ings. HT used in physical rehabilita- tion retrains muscles and improves coordination, balance and strength. In vocational HT settings, people learn to work independently, solve problems and follow directions. Who Uses HT? Adults and children with physical, psychological and developmental disabilities. Those recovering from illness or injury. People wishing to improve their quality of life in hos- pice or nursing home settings. Victims of abuse and their abusers, public offenders and recovering addicts all find HT rewarding. What Are Its Advantages? HT is a simple and “lo-tech” treat- ment to implement with proven positive outcomes. It is nonthreat- ening to the client, encourages social activity, improves memory, provides sensory stimulation and exercise, reduces stress and ten- sion, diminishes anger and rewards nurturing behavior. HT prepares the disadvantaged and disabled for employment in horticultural busi- nesses and farms, by teaching how food and other plant-related com- modities are grown and marketed. Source: American Horticulture Therapy Association, www.ahta.org14 SPRING 2004 • CorrectCare www.ncchc.org
  • 14. CMS Asks States to Maintain Medicaid Enrollment for Inmates In the News States should suspend but not termi- nate Medicaid benefits for individuals in public correctional or mental insti- CMS is not changing its policy on payment: Federal funds for health services remain unavailable for those tutions, the Centers for Medicare and incarcerated in a public institution Medicaid Services advised state or IMD (institute for mental disease).HCV-Related Disease on the Rise Justice Statistics, the report is avail- Medicaid directors in a May 25 letter. But the letter notes that this exclu-While the exact prevalence is not able online at www.ojp.usdoj.gov/ This would enable inmates to begin sion does not affect Medicaid eligibil-known, hepatitis C may affect from bjs/abstract/jeeus01.htm. receiving Medicaid-covered services ity, and that eligible individuals may16% to 49% of U.S. prisoners, in immediately upon release and “cre- be enrolled “before, during and afterstark contrast to a 2% prevalence More Stats ate on ongoing continuum of care.” the time in which they are held invol-rate in the population as a whole, To put those figures in perspective, Issued by CMS’s Disabled and untarily in secure custody.”according to estimates in the June here’s an update on correctional Elderly Health Programs Group, the The letter also recommends thatissue of the HEPP Report. Further, populations, courtesy of BJS: letter addresses “ending chronic states coordinate health services pro-because of a lag between HCV infec- 2,078,570 men and women behind homelessness” and announces a vided during incarceration withtion and resultant disease, the preva- bars on June 30, 2003, an increase report on promising state practices Medicaid services.lence of chronic liver disease is rising of 2.9% vs. a year earlier and the to improve Medicaid access among Find links to the letter and to thein a time when overall infection rates largest increase in four years. Per homeless people, a group that often Improving Medicaid Access report onare declining. These trends have capita, there were 480 sentenced includes those leaving psychiatric the Web at www.cms.hhs.gov/important implications for correc- inmates per 100,000 U.S. residents. and correctional institutions. medicaid/homeless.tional health care, the article on“hot topics” in HCV treatment notes.A second article discusses factors toweigh in deciding whether to treatan inmate with HCV. The free report(an acronym for HIV & HepatitisEducation Prison Project) carries acontinuing medical exam and is avail-able at www.hivcorrections.org.Canada Breaks the Tattoo TabooTo curb the rampant spread of blood-borne diseases among its prisoners,Correctional Service Canada is plan-ning to set up official tattoo parlorsin the federal agency’s prisons, accord-ing to Canada NewsWire reports. Thetattooing would be done by the pris-oners themselves, after training. The“Safer Tattooing Practices Initiative”came after a study found that 45% offederal prisoners had received a tat-too while incarcerated. The Union ofCanadian Correctional Officersopposes the plan, saying it posesunacceptable risks and contradictsthe goal of rehabilitation and com-munity reintegration.AJA Examines Jail Trends“[J]ails are getting larger and thesmaller ‘Mom and Pop’ jails (ratedcapacity 0-100) are declining.”That’s one key finding from a reportin the May/June issue of AmericanJails. Published by the American JailAssociation, the magazine analyzeddata from the AJA’s 2003 Who’s Whoin Jail Management directory. Othertrends noted include an increase inregional jails, a decrease in city jails,and a growing number of women jailadministrators.Billions and BillionsIn fiscal year 2001, the nation spentabout $200 per U.S. resident on cor-rectional services at all levels of gov-ernment, an increase of over 400%from the $39 per capita expenditurein 1982. The total outlay for correc-tions in 2001 was about $60 billion. As of March 2001, correctionsemployed over 747,000 people vs.less than 300,000 in 1982. On aver-age, state and local correctionalagencies and institutions employed25 personnel per 10,000 population. These figures come from a reporton U.S. expenditures and employmentin the justice system as a whole, withdata breakouts for its three sectors,police, corrections and judicial/legal.Issued in May by the Bureau ofwww.ncchc.org SPRING 2004 • CorrectCare 15
  • 15. Spotlight on the StandardsClinical Performance Enhancement Made ClearBY JUDITH A. STANLEY, MS, CCHP-A were the result of much discussion sor is a clinician of equal or better What of the lone provider in a facili- by the revision committee. qualification in the same discipline ty? This is one of the “target staff”T he Clinical Performance The standard itself is succinct—“A and the evaluation also includes a for this standard: the provider who is Enhancement standard (C-02), clinical performance enhancement review of clinical practice, the typical often isolated both professionally introduced in the 2003 edition process evaluates the appropriateness performance evaluation does not and geographically.of the prison and jail Standards for of all primary care providers’ services” meet the intent of this standard. So what should be done whenHealth Services, was one of the most —as is its statement of intent: “to In all cases, the reviewer should there is only one physician or psychi-difficult to articulate. Now that it enhance patient care through peer first inspect some treatment records atrist? Possibilities include contact-has been implemented, it is turning review of the clinicians’ practice.” and then provide a written evalua- ing a community physician or psychi-out to be one of those standards To clarify intent, three definitions tion and recommendations, if any. atrist in private practice or a statemost often misunderstood. are provided: Clinical performance Ideally, the two parties will meet medical school to provide such ser- While the NCCHC standards are enhancement is the process of having face-to-face, though a phone call may vices, or, for those in remote facili-not clinical performance standards a health professional’s work reviewed suffice. Exchange of written materi- ties, use of a university telemedicineper se, the expected outcome of by another professional of at least als is less desirable but could work program.compliance is provision of health equal training in the same general well in the hands of experienced pro- If limited remuneration to offercare that not only meets constitu- discipline. Primary care providers fessionals. At minimum, a written the reviewer is a problem, perhapstional requirements but also con- are all licensed practitioners provid- report is forwarded to the provider, the correctional care provider mightforms with community standards. ing the facility’s primary care includ- who signs the evaluation to acknowl- give a lecture at a professional meet-The NCCHC standards are based on ing medical physicians, psychiatrists, edge the feedback. ing, provide evaluation services for athe assumption that correctional dentists, midlevel practitioners (i.e., Beyond that, two criteria must be hospital provider, or cover for ahealth care providers practice their nurse practitioners, physician assis- met. First, the reviewer must be in weekend for the reviewer. Afterclinical skills as they would in any tants), and PhD-level psychologists. the same general discipline as the record reviews are completed, thereother health setting. Finally, primary care is defined as provider being reviewed—for exam- might be nothing better than dinner With that in mind, the NCCHC the provision of integrated, accessi- ple, both are dentists or both are during which the two professionalsstandards revision committee saw ble health care services by clinicians psychiatrists. Second, the reviewer can discuss findings and share expe-this new standard as a push to the who are accountable for addressing a has received the same or a higher riences. In drafting the standard, thecorrectional health care system to large majority of personal health level of training—e.g., an MD review- revision committee hoped thatfocus on clinical skills and practice care needs, developing a sustained ing other MDs or midlevel practition- encouraging professionals to reachat least once per year. It is an oppor- partnership with patients, and prac- ers; a PhD-level psychologist review- out to community colleagues fortunity to pause, step back from the ticing in the context of family and ing PhD-level psychologists. these reviews would establish lines ofday-to-day demands of treating, and community. Review of the responsible physi- communication and professionalconcentrate on quality practice cians, dentists and psychiatrists gen- sharing.issues with an experienced and Meeting the Intent erally is conducted by corporate orunderstanding colleague. Despite these efforts at clarification, system-level medical directors, den- Other Considerations In contrast to a healthy continuous a number of accredited facilities and tal directors or mental health coordi- Another common area of confusionquality improvement program, which those seeking accreditation are nators. Where there are two or more relates to documentation. How muchraises red flags when a provider is engaging in practices that may be providers in the same discipline, is needed? How much must benot practicing according to usual worthwhile in themselves but do not mutual reviews are fine. While it shared with the surveyors?expectations, the performance satisfy the intent of this standard. would be great for midlevel providers From a supervisory standpoint,enhancement process is an opportu- For example, an annual perfor- to be reviewed by a midlevel col- clinical performance reviews are con-nity to spotlight the professionalism mance evaluation most often is done league, for purposes of this standard fidential communication. However,and currency of clinical care. by a supervisor who focuses on physicians are considered to be in documentation is worthwhile only if The name chosen for this standard, administrative matters such as com- the same discipline because of the it contains sufficient information tothe definitions used to clarify intent pletion of work and compliance with unique relationship between physi- be able to understand any problemsand the compliance indicators all attendance rules. Unless the supervi- cians and PAs/NAs. noted and follow up on any correc- tive actions recommended. From an accreditation standpoint, while it would be ideal if the survey- ors could review the evaluation report, only the following basic infor- mation must be shared: the names of reviewee and reviewer, title or posi- tion of the reviewer, the review date and confirmation that the findings were shared with the provider being reviewed. If corrective actions were recommended, a statement as to whether such actions were taken must be noted. What lies in the future for this standard? Professional nurses on the revision committee were concerned that the standard did not require this type of clinical practice review for RNs despite the critical role they often play in the correctional facility. This raises the question of whether such reviews should be required for all licensed professionals. Another question is whether this important standard should move to the essen- tial category. Stay tuned for updates! Judith A. Stanley, MS, CCHP-A, is NCCHC’s director of accreditation. To contact her, call (773) 880-1460 or e-mail judithstanley@ncchc.org.16 SPRING 2004 • CorrectCare www.ncchc.org
  • 16. Standards Q&AExpert Advice on NCCHC Standards for Health Services may determine that a one-day “drug (in your case, the psychiatrist) is the B. Jaye Anno Judith A. StanleyBY B. JAYE ANNO, PHD, CCHP-A, ANDJUDITH A. STANLEY, MS, CCHP-A holiday” or other length of time sole representative of a profession is without the medication will not actually one of the situations the interfere with treatment. Skipping a standards revision committee wanted this standard as “important” (asDocumentation of Meetings dose may not make a difference in to address. The standard’s intent is opposed to “essential”) so noncom-Q Our jail is seeking accredita- the case of some medications. to promote the professional pliance should not affect your tion for the first time. How However, some medications need to exchange of ideas and practice that accreditation status. must we document the be taken daily and on time so that can occur only with another profes- For more details about compliance meetings we are required to the therapeutic levels remain within sional of equal or more advanced with this standard, see Spotlight onhave? Is there a form you require or the proper range. This is especially training and experience in the same the Standards on the facing page.recommend? true of psychotropic medications, discipline. So, while medical physi- including those for depression, anti- cians can review other medical physi- A NCCHC does not specify the B. Jaye Anno, PhD, CCHP-A, is a seizure medications, HIV medica- cians and midlevel practitioners, only cofounder of the National Commis- format for meeting minutes tions, and others as determined by psychiatrists should be reviewing psy- sion on Correctional Health Care. required by the standards. the physician. chiatrists. Now an independent consultant, she We try to give facilities as Your policy should include consult- So, what are you to do? Is there a chaired the task force that developedmuch flexibility as possible in such ing with the designated health ser- community psychiatrist in private the 2003 revisions of the adult stan-matters, as long as the format used vices staff in the situation at hand practice willing to do such a review? dards for health services. Judith A.provides an appropriate vehicle for and then making appropriate Will a state medical school provide Stanley, MS, CCHP-A, is NCCHC’sdocumenting the necessary informa- arrangements. Policy should include such services? Ideally, the perfor- director of accreditation and assiststion or processes and the intent of such issues as whether the medica- mance review is a face-to-face meet- in the development and revision ofthe particular standard is met. tion is to be sent with the inmate to ing, but telephone reviews following standards. Information that needs to be cover him or her for the duration of sample record reviews might be an Do you have a question about therecorded in the minutes depends on the absence, or whether a prescrip- option. Exchange of written materi- NCCHC standards for health ser-the type of meeting and the require- tion is sufficient. This is important als may not be best, but it could vices? We’re here to help. Write toments of the individual standard(s). when the medication may not be work. Yet another possibility is the Standards Q&A c/o NCCHC, 1145In the standards that require written readily available at the receiving use of a university telemedicine pro- W. Diversey Parkway, Chicago, ILdocumentation, the Compliance institution. gram, if one is available. 60614. You also may contact us byIndicator section provides guidance As well, there should be provision Failing all of the above, you should fax at (773) 880-2424, or by e-mailas to what is required. for steps to take when an inmate on note that NCCHC has designated at info@ncchc.org. For example, in J-A-04 Administra- medication is moved out withouttive Meetings and Reports, adminis- notification of the medical staff.trative meeting minutes need to be Training for transporting staff whokept to document discussion of all may need to give the medicationthe topics listed in the standard, must be addressed. When the physi-while the documentation of monthly cian determines that the medicationhealth staff meetings need include is not needed during the temporaryonly attendees and topics or agenda. absence, be sure the policy includesHowever, for CQI meetings (J-A-06 informing the inmate of this so theContinuous Quality Improvement inmate does not worry when theProgram), the minutes need to medication is not available.record topics or problems discussed,assigned responsibilities, actionplans, findings, evaluation, subse- Peer Review in Jails Qquent actions, etc. This question concerns the new standard for peer review.Meds for Off-Site Inmates We are a small jail, average daily population about 200,Q I have been given the task of in a rural area. We understand that developing a statewide policy our consulting psychiatrist now for our prison system on pro- needs an annual review of her perfor- viding prescribed medica- mance at the jail, but she is the onlytions to inmates who are not avail- psychiatrist who works at the jail inable to take them due to court trips, our area. Can our licensed psychi-appointments outside the facility, atric social worker do her review?transfers to other institutions, admin- Aistrative leaves such as funerals, etc. You are referring to impor-Can you help? tant standard C-02 Clinical Performance Enhancement, A The guidance you need is which is new to the 2003 jail based on one principle: If and prison Standards and included the medication is clinically in the 2004 juvenile Standards. To necessary, provisions must quote from the discussion section:be made to supply that medication. “The intent of this standard is to When it is the judgment of the enhance patient care through peertreating physician, psychiatrist or review of the clinicians’ practice. Theother primary care provider that the clinical performance enhancementmedication needs to be continued review process is neither an annualwhen the inmate is temporarily out performance review nor a clinical caseof the facility, provision must be conference process. It is a professionalmade either for the inmate to self- practice review focused on the prac-medicate or for transporting agents titioner’s clinical skills; its purpose isor health staff at the “temporary” to enhance competence and addressfacility to provide the medications. areas in need of improvement.” On the other hand, the physician Facilities in which the practitionerwww.ncchc.org SPRING 2004 • CorrectCare 17
  • 17. Supplier Opportunities About CorrectCare Published quarterly by the National Conference on Correctional Health Care National Commission on Correc- tional Health Care, this newspaper New Orleans, Louisiana • November 13-17 provides timely news, articles and commentary on subjects of rele- vance to professionals in the fieldReach the Decision Makers Sponsorship Opportunities of correctional health care.U.S. correctional institutions house more than 2 million Premier Educational Programming: Sponsorship of edu-people, many of whom represent medically underserved cational programs on hot topics enables companies to Subscriptions: CORRECTCARE is freepopulations. They receive a broad spectrum of health ser- support the correctional market and gain great exposure. of charge to all Academy ofvices ranging from treatment for infectious diseases (e.g., Conference Portfolio: The portfolios contain essential Correctional Health Care mem-hepatitis, HIV/AIDS, tuberculosis) to management of conference material distributed to all attendees. The bers, key personnel at accreditedchronic illnesses (e.g., asthma, diabetes, hypertension) to sponsor’s logo is displayed on the back cover. facilities and other recipients atgeneral health care. They also receive dental care, mental Proceedings Manual: The manual provides attendees with our discretion. Submit your sub-health care, substance abuse treatment and health educa- a lasting record of each concurrent session, including scription request online attion. To meet this heavy demand for government-mandat- speaker abstracts and handouts. The sponsor’s logo is dis- www.ncchc.org or by e-mail toed care, correctional facilities spend nearly $6 billion dol- played on the back cover. info@ncchc.org. The paper also islars on health care services, supplies and equipment each The Internet Lounge: The popular computer stations in posted at the NCCHC Web site.year. And as inmate populations rise, so do expenditures. the exhibit hall enable attendees to browse the Internet. Organizations that offer products or services for this Along with on-site signage, the sponsor’s name, logo and Change of Address: Send notifica-market need to reach the key decision-makers and help link will be displayed on the computer screens. tion four weeks in advance, includ-them make informed choices. A great way to do that is to Exhibit Breaks: The exhibit hall serves as a central meet- ing both old and new addressesexhibit at Updates in Correctional Health Care, which ing point, with scheduled breaks, morning coffee and and, if possible, the mailing labelattracts highly qualified attendees with buying power and afternoon snacks that are much appreciated by attendees. from the latest issue. For NCCHC’sauthority. In addition to the extensive commercial exhib- Other Opportunities: Registration bags, lanyards, mailing address, see page 2.it, this well-attended meeting offers over 30 educational badges—all are good ways to gain exposure. Have otherand numerous networking opportunities. ideas for sponsorship? We’d love to hear them, so call us! Editorial Submissions: We may, at our discretion, publish submittedExhibitor Benefits Registration Information articles. Manuscripts must be orig-• Exhibit hall breaks and networking opportunities, with The rental fee for each 10 x 10 booth is $1,000, which inal, unpublished elsewhere and six hours of exclusive exhibit time includes one full and two exhibit-only registrations. submitted in electronic format.• Company listing and product description in the Final Additional representatives may register at discounted For guidelines, contact the editor Program (deadline applies) rates. Advance and on-site promotions of the exhibition at jaimeshimkus@ncchc.org or• Pre- and final registration lists with attendee addresses include mailings, scheduled breaks, exhibitor prize draw- (773) 880-1460. We also invite• Preconference and on-site promotion ings, and a reception and lunch in the exhibit hall. To letters of support or criticism or• Virtual Exhibit Hall listing at NCCHC Web site learn more, contact director of meetings Deborah Ross at correction of facts, which will be• Priority booth selection for 2004 National Conference (773) 880-1460, ext. 286, or deborahross@ncchc.org. printed as space allows. Advertisers: Get the Word Out With CorrectCare! The leading newspaper dedicated to correctional health care, CORRECTCARE features timely news, articles and commentary on the subjects that our readers care about: clinical care, ethics, law, administration, professional development and more. The quarterly paper is free of charge to members of the Academy of Correctional Health Professionals, as well as to thousands of key professionals working in the nation’s prisons, jails, juvenile facilities, departments of cor- rections, health departments and other organizations. The paper also is available on the NCCHC Web site. In addition, a special conference issue is distrib- uted to attendees at the National Conference on Correctional Health Care. New in 2004: Special packages for exhibitors/advertisers! Contact us for details. Production Schedule Issue Insertion Order Due Ad Copy/Art Due Paper Distributed Notes Fall 2004 August 6 August 20 September 10 1. Ad sizes encompass live area, no bleeds. Special issue: National Conference 2. Color ads cost $250 per color additional on Correctional Health Care October 1 October 15 November 13 per page or fraction. Winter 2005 December 20 January 7 January 21 Spring 2005 March 25 April 8 April 22 3. Frequency discounts are based on total number of insertions within the next four issues. Ads need not run consecutively. Advertising Rates Black & White Rates 4. Recognized advertising agencies receive a Display Ad Size Width x Height 1x 2x 3x 4x 15% discount on gross billing for display Full page 10 x 14 1/8 $1,450 $1,380 $1,305 $1,235 ad space and color if paid within 30 days Junior page 7 1/4 x 10 1,235 1,175 1,110 1,050 of invoice date. 1/2 horizontal 10 x 6 1/2 1,090 1,035 980 925 5. Special opportunities are available for 1/2 vertical 4 3/4 x 13 1/2 1,090 1,035 980 925 conference exhibitors; please see the 1/3 vertical 4 3/4 x 10 870 825 785 740 2004 Marketing and Resource Guide or 1/4 horizontal 7 1/4 x 5 725 690 655 615 contact NCCHC for information. 1/4 vertical 4 3/4 x 6 3/4 725 690 655 615 6. Electronic files (Quark, Pagemaker or 1/8 vertical 2 1/4 x 6 3/4 510 485 460 435 PDF) preferred; include font files. We also accept camera-ready copy and film Classified Advertising: Ads appear under the following categories: Employment, Meetings, Marketplace. (120 line, right reading, emulsion side The text-only ads cost $1.25 per word. Box your ad with a solid border for an additional $50. Text for down). Proofs must accompany all ads. classified ads should be submitted in electronic form (e.g., via e-mail). 7. Cancellations must be received in writing before the insertion order deadline. For More Information To learn more about advertising and other marketing opportunities, call Lauren Bauer, meetings and sales 8. We reserve the right to change rates at representative, at (773) 880-1460, ext. 298, or e-mail laurenbauer@ncchc.org. any time; however, we will honor the rates in effect when the order was placed. To obtain NCCHC’s 2004 Marketing and Resource Guide, which contains an insertion order form, visit the Web at www.ncchc.org and go to the Supplier Opportunities section. 9. Acceptance of advertising does not imply endorsement by NCCHC.18 SPRING 2004 • CorrectCare www.ncchc.org
  • 18. Meetings Classified Advertising Foodservice Meeting. The American Correctional Foodservice Association is hosting its annual international confer- ence August 15-19 in Sacramento, CA. To learn more about “Keys to Correctional Employment • Treating Adult and Juvenile Offenders With Special Needs, edited by Jose B. • Correctional Mental Health Care: Standards and Guidelines for Delivering Foodservice Management,” visit the WebPhysicians Network Association needs Ashford, Bruce D. Sales, and William H. Services. Updated to conform with the at www.acfsa.org, or e-mail info@acfsa.org.Arizona-licensed PhD psychologist, two Reid. 2001, 518 pages, hardcover, $49.95 2003 NCCHC Standards, the second edi-LPC’s or LMSW’s, psych RN, and part- tion makes explicit what is implicit in the Centerforce Summit. The fifth annualtime psychiatrist for 1,400-bed facility for • Acting Out: Maladaptive Behavior in standards regarding mental health issues Inside/Out Summit will focus on “ModelsDWI offenders in Kingman, AZ. Confinement, written by Hans Toch and and coordination of delivery with health for Change—Delivering Services to ThoseCall Dr. King, (806) 799-1326 or apply via Kenneth Adams, with J. Douglas Grant and services. Appropriate for prison, jail and Affected by Incarceration.”Hosted bywww.pnamedical.net. Elaine Lord. 2002, 446 pages, softcover, juvenile facilities of any size, the manual Centerforce, the meeting will take place $29.95 works well as an independent reference or Sept. 11-15 at the San Francisco Airport Marketplace • Treating Chronic Juvenile Offenders: as an annotated companion to the Standards. 2003, softcover, 275 pages, Marriott. For details, visit www.center- force.org/summit or call Merjo Roca at Advances Made Through the Oregon $34.95 (415) 456-9980, ext. 124. Diabetic Supplies - Save 30% Multidimensional Treatment Foster Care Most manufacturers’ products available. Call or Fax for Free Meter Kits for evalu- Model; written by Patricia Chamberlain. Notices AHIMA Convention. The American Health 2003, 186 pages, hardcover, $39.95 Information Management Association’s ation. We supply most manufacturers’ AJPH Call for Papers on Prison Health. 76th National Convention and Exhibit meters at No Charge, as many as you The Latest From NCCHC The American Journal of Public Health is (being held in conjunction with the may need. Visit our website for Free The following updates of NCCHC stan- seeking articles for a theme issue that will Congress of International Federation of Samples of the latest Medical and Dental dards and guidelines can be obtained via examine quality of care and health dispari- Health Records Organizations) will occur supplies. the Publications section of our Web site ties in the U.S. criminal justice system. Oct. 9-14 in Washington, DC. Learn more Unimed (USA) Ltd (www.ncchc.org), or by calling NCCHC Contributions should focus on major at www.ahima.org or call (800) 335-5535. The Correctional Healthcare headquarters at (773) 880-1460. research issues and practice activities Supply Company related to delivery of health services to this Opioid Treatment Meeting. The American Tel: (800) 835-3003 • Standards for Health Care Services in population. All papers will undergo peer Association for the Treatment of Opioid Fax: (415) 459-0553 Juvenile Detention and Confinement review by AJPH editors and this issue’s Dependence is holding its 20th national www.unimedusa.com Facilities. The 2004 edition provides guid- guest editors, who are with the conference Oct. 16-20 in Orlando, FL. ance in establishing and maintaining con- Community Voices Initiative of the Find a brochure and registration informa- stitutionally acceptance health care. As National Center for Primary Care, tion online at www.aatod.org.New Mental Health Titles. The NCCHC with the 2003 editions of the prison and Morehouse School of Medicine. The dead-catalog now carries three valuable new jail Standards, the new juvenile edition line for submission is Oct. 1. Author Youth Psychiatry. The American Academytitles from the publishing arm of the features new standards on clinical perfor- instructions and online submission are of Child & Adolescent Psychiatry will con-American Psychological Association. For mance enhancement and chronic care, available at http://submit.ajph.org. For vene Oct. 19-24 at the Washington (DC)descriptions or to order, visit the clear compliance indicators, and a more more information contact one of the guest Hilton for its 51st Annual Meeting. ForPublications section of our Web site user-friendly format and numbering sys- editors: htreadwell@msm.edu or details, visit the Web at www.aacap.org or(www.ncchc.org) or call (773) 880-1460. tem. 326 pages, softcover, $59.95 joyce_nottingham@msm.edu. e-mail meetings@aacap.org.www.ncchc.org SPRING 2004 • CorrectCare 19
  • 19. Updates in Correctional Health Care Attendees weather the storm and come out shiningWe know, we know ... NCCHC and the Academy practically promised perfect late spring weather in our hometown of Chicago. We just forgot to check in withMother Nature. After thunderstorms in Chicago and many other parts of the nation wreaked havoc with weekend flight schedules and travel plans, many travelerstrudged to the conference check-in desk exhausted and sometimes crabby. But exchanging travel horror stories is wonderfully cathartic (it’s also a special formof networking!), and by the time Monday morning rolled around, everybody was back on track and raring to go. Below are pictorial highlights from the meeting. A warm Chicago welcome. The Hon. Richard A. Devine, JD, welcomed attendees to Chicago before Tuesday’s educational lun- Serious business. cheon. Devine is the Cook County State’s Attendees had their Attorney and an NCCHC board member. evenings free to explore Chicago’s many charms, but the days were packed with education. Undivided attention. Maybe it was the weather or maybe it was just the phenomenal pro- gramming, but the presenters enjoyed large crowds of learners in their sessions. Refreshing. As always, the exhibit hall was the place to meet and greet friends new and old while enjoying refreshments between sessions. Hands on. Nothing substitutes for the experience of visiting with exhibitors and getting a hands-on demonstration of their wares. You’ve got mail! The sleek com- puter kiosks in the exhibit hall were a big hit with people who wanted to stay in touch with their e-mail...and who doesn’t??? Raffle time. Things quiet down in the exhibit hall when the raffle drawings begin. The folks in this crowd are hoping to walk away with a free future conference registration, gift basket or one of the many other prizes... Great to see you again! One of Lucky lady. ... including, the best things about NCCHC if they’re really lucky, a conferences is the chance to stylish Academy cap! reconnect with friends.