|The right information|
|By Ann Coppola, News Reporter|
Last week, nearly 200 researchers, educators, and clinicians representing 20 states, Canada, and 25 academic institutions came together for the University of Massachusetts Medical School’s second annual Academic and Health Policy Conference on Correctional Health. Held in Quincy, Massachusetts, the two-day event offered nearly 50 presentations and seminars on everything from Attention Deficit Hyperactivity Disorder to HIV case management in prison, all with the goal of building a national academic consortium on correctional health. It was a rewarding opportunity for a diverse field of colleagues to share their research and to learn from one another.
“I am so often struck by the fact that there is a whole set of competencies needed to provide care in corrections that, frankly, are not taught in medical school,” said Dr. Michael Collins, Interim Chancellor for UMass Medical School, which partners with the Massachusetts Department of Corrections health care administration. “There is enormous value in developing a national academic consortium on correctional health.”
One theme that emerged right from the start was the need for not just more information in correctional research, but the need for the right information. Attendees agreed that this type of research tends to involve small studies of a single facility, making it difficult to extend any conclusions to a national level.
“There is a dearth of information about the patients we serve, and studies that are national in scope are lacking” said keynote speaker and New Mexico-based correctional care consultant, Dr. B. Jaye Anno, who discussed the barriers to research in correctional settings and a general lack of useful data throughout corrections.
“What does knowing that there were 48,860 sick call requests last month do for us, for a corrections health care administrator?” asked Anno. “Was that encounter a full physical? Was a vaccine administered? That number tells us nothing, and yet we do it over and over.”
With the crowd motivated to start sharing the “right information,” the conference broke into concurrent sessions covering a range of mental health, ethical, juvenile, reentry, and infectious disease issues. Forty people packed into the “Bioethics and Morality Behind Bars” presentation hosted by Dr. Terry Hill, chief medical officer for the California Prison Health Care Receivership Corp. The session tackled one of the toughest realities all corrections medical providers must face: how to care for patients who have committed disturbing crimes.
“You just do the job,” said one member of the audience, which was full of correctional nurses, psychologists, and doctors. “By law, it’s our duty to provide the inmate with care.”
“It’s important to talk to each other about that ‘Oh my God’ moment,” Hill said. “We can help students and newcomers to the field to cope with the ethical challenges they are going to face. It’s important for managers to raise these moral questions with their trainees.”
From moral questions to mental illness, the conference left no health care stone unturned, and looked closely at the growing prevalence of personality disorders in correctional environments. Across correctional research, the frequency of personality disorders is shown to be about the same among inmates as it is in inpatient psychiatric units. Anti-social personality disorders and borderline personality disorders are especially common.
“Borderline personality disorder in men is at least ten times greater in jails and prisons than it is in the community,” said Dr. Robert Trestman, executive director for Correctional Managed Health Care at the University of Connecticut. “They are intense, emotionally unstable, aggressive individuals, and they are high utilizers of health care. But, clinical researchers can make an enormous difference in finding the best combination of medication and psychotherapy for these individuals.”
Attendees also turned their focus onto one of the most challenging correctional environments for treatment providers: juvenile justice residential facilities (JJRF), or any facility that houses young people charged with a crime.
“With nearly two million kids coming through the facilities, it’s an ideal opportunity to provide vaccines to a generally unvaccinated population,” said presenter Catherine Gallagher, a George Mason University associate professor who is trying to map the system of vaccinations in JJRFs. “We need to find a way around the barriers to care.”
Some of the forthcoming data Gallagher discussed will examine those who provide consent for the vaccinations and who pays for them. In some states, parents remain the medical decision-maker when their child enters a facility, making it difficult for clinicians to obtain permission to treat. Some states are trying to include generalized consent forms that are signed upon entering the facility, and asking judges to give medical custody to the facility physicians.
Infectious disease, a constant source of concern for corrections, was another heavily discussed issue.
“In Massachusetts, 14 percent of our offenders are hepatitis-C positive, two percent are HIV positive, and 24 percent of our male offenders and 66 percent of our female offenders have open mental health cases,” said Massachusetts Department of Corrections Commissioner Harold Clarke, who spoke on the second day of the conference. “We have to recognize that most of these individuals will return to the community, and we have a duty to protect the community from infectious disease.”
“Research forums such as this one can help us to develop more effective reentry strategies,” Clarke added.
Nearly 8,000 HIV infected prisoners are released into U.S. communities every year. One transitional approach being considered is to pair HIV positive prisoners with life coaches to help them to maintain health-promoting behaviors upon release.
“The preliminary data shows that only assigning a case manager to these individuals is not making a significant difference in terms of reducing drug use, HIV risk behaviors, or re-arrest rates,” said Anne Spaulding, an Emory University assistant professor who is conducting a pilot study of volunteer life coaches in Georgia. “Pairing them with a volunteer life coach may be a sustainable, low-cost way to improve those outcomes.”
This argument hit home for many of the attendees. Often in correctional research, a study will show a program has positive results, but the program disappears once the research grant runs out. Strengthening the partnership between corrections and academia in order to eliminate those barriers was a main goal of the conference.
“To some extent, they’re telling us what we already know, simply because we are working in the environment, but at the same time, to have your observations scientifically confirmed is very nice,” said Dr. Aysha Hameed, medical director for the Massachusetts Correctional Institution in Norfolk. “This has been very interesting to attend.”
“I hope we can come to a greater understanding of the importance of the correctional health field to share research, to develop a scientific knowledge base together to enhance our expertise on behalf of our patients,” Collins added.
The next annual conference is scheduled for February 5 and 6, 2009 in Fort Lauderdale, Florida. With its mind set on delivering better care for correctional populations, this year’s conference crowd is looking forward to the continued growth of its national consortium.
More information on this year’s conference
See notes from last year’s conference
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