Horticulture Therapy: Letting Nature Nurture


Published on

Horticulture Therapy: Letting Nature Nurture

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Horticulture Therapy: Letting Nature Nurture

  1. 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. 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. 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. 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. 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. 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. 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. 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