Accreditation is nothing new in corrections. Every three years, over 80% of corrections facilities across America strive to meet the standards set by the American Correctional Association (ACA). During multiple visits and auditing processes, facilities go all-out to prove that they are complying with ACA guidelines – and going the extra mile to become the best of the best in corrections.

But in Ohio, officials took on an extra challenge: field testing ACA's new health care accreditation. While the ACA typically made health care checks part of overall accreditation, the agency began to develop medical guidelines for a separate accreditation process in 2000. Now, the agency has field tested their new standards in Ohio, and has shifted focus to measuring outcomes in order to prove effectiveness.

Officials continue to reinforce the importance of ACA accreditation across the board. With the establishment of a Health Care Standards Committee, the ACA has adapted previous best practices into accreditation guidelines. The committee was created to review and adjust any of the guidelines as needed.

“With the ACA deciding to offer dual accreditation for security and health care, Ohio really wanted to take the extra step to provide the best health care possible,” says Robert Hofacre, Nursing Director of the Ohio Department of Youth Services (DYS). “Right now, we're the only state that has dual accreditation, and we field tested these new health care standards at three of our facilities.”

After setting up conferences with health service administrators, psychologists, physicians and even pharmacists, the DOC re-examined their medical practices and adjust them to provide better care. Officials combined the feedback from medical practitioners with ACA health care standards.

“My understanding is that ACA is moving towards performance-based standards,” says Hofacre. “They are taking their old standards and basically changing them into expected practices. Then, they are using outcome measures to monitor the success of those practices. In Ohio, we were happy to help them test those new standards and measure the outcomes with the ACA.”

Stepping Up to the Plate

As committees continue to work with the ACA on health care guidelines, officials continue to reinforce the importance of ACA accreditation across the board.

“ACA guidelines help to develop policies, procedure and practices,” says Hofacre. “It helps agencies understand, for example, what a health screening is and who should be conducting it. Some states that aren't accredited could have an officer performing these health screens. By creating these policies and procedures, you're providing excellent care.”

And state officials were excited to become a part of the testing process for the ACA. According to Bonnie Sweeney, DYS Statewide Accreditation Manager, ACA accreditation does more than just uphold standards – it improves corrections on the whole.

“We're very proud of our leadership involvement in this process. And one of the things I've seen across the board, for us, is an improvement in professionalism,” says Sweeney. “This helps our staff come together as a team and look at every facet of their facility and operation. I always tell our staff: Do you want to go to a hospital that is part of an accreditation process and passes rigid standards? Or do you want to go to a little cabin down the road with no certification of any kind? That makes our staff start thinking.”

Specific Standards for Juveniles

As officials began to implement performance-based standards and new health care guidelines, medical practitioners realized that juveniles had different needs than adults.

“We certainly wanted to make sure that we dealt with standards for juveniles,” says Sweeney. “For example, you have a concern about immunization for kids. You don't have that with an adult population. We also had to ensure that juvenile had access to so many other services, even in the mental health realm in terms of therapy. This included substance abuse as well, and that's different for young offenders.”

There are a number of ways in which facilities can provide better health care for juveniles, ranging from immunization to proper health screenings. While adult populations can volunteer to participate in certain programs related to mental health and substance abuse, juvenile offenders are often sentenced to those programs as part of their rehabilitation process.

Outcome Measures

For Hofacre, the accreditation process in health care is a chance for medical practitioners to re-evaluate their daily procedures.

“With these health care standards upheld, our facilities run so smoothly,” says Hofacre. “I walk into these facilities knowing that we're meeting the expected practices that we've helped to write. I know that our kids are getting excellent health care. We're using outcome measures to ensure that our practices are working. All of this is just about quality – it's about developing a sound program.”

Officials in Ohio are using outcome measures to see how effective their medical system is. For example, practitioners looked at the number of juveniles that requested medical attention versus the number of juveniles that received care. By examining these figures, officials could ensure that juveniles had a support system in health care that worked.

“Outcome measures just help us to prove that we're meeting expectations,” says Hofacre. “And it's so satisfying to meet those expectations. I feel more comfortable, as a nurse, to be able to hang a certificate in a correctional facility that says you meet those standards.”

Why Accreditation?

While Ohio looks ahead to continue maintaining ACA health care standards for juvenile facilities, Sweeney says that the newest addition to the accreditation process is just a reminder of how important it is to run a tight ship in corrections.

“There are so many reasons that facilities in across America should seek accreditation,” says Sweeney. “At the very first level, it's a terrific management tool. It focuses a facility on minimum standards and expectations for correctional practice. More than that, these standards are not stagnant, they change frequently. In corrections, we have to keep pace with how the world is changing and how the needs of our youths are changing. From various cultural influences through the improvements in technology, we have to adjust.”

According to Hofacre, re-evaluating health care practices not only ensures good medical treatment for juveniles, it also sets Ohio facilities apart for going the extra mile.