A variety of healthcare issues affected corrections in 2004.  Practitioners in the field faced many challenges relating to HIV treatment, mental health, and the aging inmate population.  The Corrections Connection reported on each of these topics over the past year; a summary of our correctional healthcare coverage is presented below.

HIV
Elderly Offenders
Mental Health
Keeping Offenders Healthy
Rape

HIV
While in-house HIV treatments have greatly benefited offenders across the U.S. in the past decade, paroled HIV-positive offenders still face great difficulties as they transition back into the community.  Two innovative programs in Illinois and Florida began in 2004 to ensure the health of HIV-positive parolees.

The Illinois Public Health Corrections and Community Initiative, a five-year demonstration project, began in 1999 with the goal of supporting HIV-positive offenders who are reintegrating to Chicago and surrounding communities by providing them with intensive case management services.  The project, which wrapped up in late September, was a huge success, said Kendall Moore, Director of the HIV Continuity of Care, STD/HIV Prevention and Care Program for the Chicago Department of Public Health.

"We showed if these folks could afford these types of services in the community, it would certainly cut down on the increasing rate of HIV in this population," Moore said.  "It would also cut down on recidivism.  [The program has] been a huge success, not just for Chicago, but for the state of Illinois.  They are currently in development of a state continuity of care system similar to this demonstration project."

The Florida Department of Corrections recently initiated a similar program to help HIV-positive offenders carry on productive, healthy lives after their release.  Like the Illinois program, the Florida Department of Corrections' Pre-Release Planning Program provides HIV-positive parolees with an intensive support system both before and after release. 

Through the program, HIV-positive parolees receive extensive guidance from DOC planners who help connect them with community services.

"[Once offenders are released,] we allow community organizations to take the lead.  Our job is to be sure that they are getting what they need," said Graham Smith, Medical and Health Education Director for the Florida DOC.  "The belief when we first entered into this program was that with the appropriate social support system on the outside that it would reduce people returning [to prison], which it has [done]," he said.

This program, like the Illinois Public Health Corrections and Community Initiative, has successfully helped HIV-positive offenders live healthy lives after their release, Smith said.

Elderly Inmates
While helping HIV-positive offenders to transition into the community continues to be an important issue in healthcare, meeting the needs of elderly offenders is a long-term issue as well.  Department of Justice figures from 2003 show that the number of incarcerated offenders 55 and older has risen 85 percent since 1995 and estimates are that it will continue.

"[The inmate] population is getting more vulnerable and [therefore] has increasing medical needs," said Herbert Hoelter, cofounder and chief executive officer of the National Center on Institutions and Alternatives, which has studied the elderly offender problem.

To address this issue, many corrections agencies have either built prison nursing home facilities or designated special units for aging offenders in existing facilities in order to provide more specialized care.

One example of this expanded care for elderly offenders comes from the Correctional Services Canada, which over the past 10 years has changed requirements for the older inmates it confines.

According to Julie Keravel, Director of Institutional Reintegration Operations, CSC tries to meet the physical and mental needs of the older offenders who are being housed in its correctional facilities.  In some cases, she said, facilities have been altered so that they accessible for those inmates who are in wheelchairs and special bars have been added in some showers for offenders who require extra support.

Also, Keravel said, older offenders with limited physical abilities are not required to do heavy lifting or difficult manual labor as part of their work assignments.

In the past few years, corrections officials in the U.S. and Canada have also seen that the transition back into the community is especially difficult for elderly offenders who are often unfamiliar with modern society.  In 2004, California's SCAN Health Plan and Friends Outside in Los Angeles County began to develop a program to carve a path back into the community for offenders over the age of 55.

"They're coming into a whole different world," said Kit Donaldson, vice president of programs for Friends Outside in Los Angeles County.  "Their thought process is going to be different - they might not even know what an ATM-Debit card is," she said.  "You just don't know what the prisoner is going to come out to."

In early 2005, the program will conduct focus groups with older, released offenders and their families to determine what types of issues they are faced with during re-entry and how to help ease this transition.

"They'll be coming out with somebody there to help them," Donaldson said.  "They won't be coming out into society with nothing."

Mental Health
While agencies make changes to better serve the aging inmate population, mentally ill offenders continue to be treated in a dramatically different manner from state to state.

Corrections agencies need to focus on good screening at intake, said Jeffrey Metzner, a forensic psychiatrist with the University of Colorado Health Sciences Center, an author on correctional psychiatry and a contributor to several NCCHC health guidelines and publications.

"One of the things you need to do is have a process in place that adequately screens and identifies people who need mental health services. Then you need to have different levels of care and continuity of care," Metzner said.

Beyond this, Metzner thinks that corrections agencies need to also work with the community to ensure that when these offenders are released from incarceration they have access to adequate services so that they remain out of trouble and, ultimately, out of the criminal justice system.

"At a minimum, we have to do a better job of communicating with the courts at the front end and at back end with community providers. I think the mind set just needs to change in the community," said Tom Fagan, Chair of the Board of Directors for the National Commission on Correctional Healthcare.

At a time when the deficiencies in many states' mental health care practices were voiced, a new community partnership program was created in Illinois to treat offenders' mental health problems in an innovative way without crippling the finances of correctional facilities.

In 2004, the Illinois Department of Corrections partnered with Argosy University to provide interns to the DOC to assess and treat inmates' mental health issues. 

By adding additional, highly qualified manpower to its staff, the Illinois DOC has been able to provide better mental health services to more of its inmates by testing everyone coming through the door for mental health problems, said Tracy Robinson, Director of Clinical Training for the Illinois School of Professional Psychology at Argosy University/Chicago Northwest.  This enables the DOC to effectively treat inmates and send people back into the community with a decreased likelihood of reoffense.

"Hopefully, when they are released, they are going to be in a better place than when they came in," said Robinson.

Two other programs to treat mental health problems resulted from a major lawsuit against the Ohio DRC in 1993, which alleged inadequate mental health care in the system.  This lawsuit spurred the interagency collaboration that exists in the delivery of correctional mental health services in Ohio today.

Some of the best examples in the DRC of continuity of mental health care are in two pilot programs that the agency has begun with community service providers in Cincinnati and Cleveland, said Reginald Wilkinson, Director of the Ohio Department of Rehabilitation and Corrections

According to Wilkinson, the DRC has contracted with these local service providers to provide complete wrap-around services for persons with mental illness who are released from prison. These providers conduct interviews with the offenders while they are incarcerated and help set up a no-gap service delivery for after release. The partnership in the community is between adult parole and the community service providers.

"The service provider is connecting with the [offender] candidates alongside our parole staff. The minute that person gets out of prison, the parole officer knows he is a participant in that particular program," he said.

Wilkinson said the parole officer is key to ensuring that the community service delivery keeps flowing. To support this, the DRC has trained parole officers to deal specifically with a mental health caseload and to specialize in managing these offenders.

"We anticipate this is a model that can be replicated around the state. We're hoping that funds can be saved by reducing recidivism," said Wilkinson.

To help other states find ways to effectively treat mentally ill offenders, the NCCHC published new guidelines in 2004. The guidelines were meant to help agencies understand the recommended goals for treatment and how to accomplish them.

"The commission was trying to establish a clear community standard that could work in a correctional environment. There was a thought that we had done a nice job with several medical problems but had not addressed any of the significant mental health problems," said Fagan, who was involved in the development of the guidelines.

Correctional practitioners are concerned as well.  Wilkinson believes that it is only a matter of time before more agencies begin to put comprehensive mental health treatment programs in place.

"One of the biggest reason to [treat this population] is a public safety component," said Wilkinson. "We don't want people with mental illness to continue to victimize more people. [And,] if it's because of a mental illness, then it is something we can control. The philosophy is that public safety is public health and public health is public safety."

Keeping Offenders Healthy
While developing effective programs to help mentally ill offenders continued to be a priority in 2004, so too was the push to maintain the physical health of offenders while incarcerated and beyond.

According to Barbara Wakeen, a registered licensed dietitian, correctional systems are beginning to successfully incorporate nationally recognized dietary standards into correctional menus.  Yet Wakeen suggested that if more states and jails instituted a "heart healthy" menu, it could lead to fewer specialized diets and healthier inmates overall.

A heart healthy diet as promoted by the American Heart Association consists of foods high in fiber and low in saturated fat, sodium, and cholesterol.  While many states already serve healthy heart meals to inmates, Wakeen advocated the use of these kinds of diets in all correctional facilities.

"It's important to take the proactive approach to prevention instead of just maintaining health," Wakeen said. 

Concern over the accuracy of medical meals also came to the forefront in 2004.  This year saw the establishment of a Washington State program that directly addresses this concern by implementing the Universal Diet Card, a system that ensures consistency in the diets of offenders. 

According to Cheryl Johnson, Registered Dietitian and Food Program Manager for the Washington State Department of Corrections, the program "successfully reduces costs while also ensuring the dietary health of offenders."

By laminating an inmate's dietary needs to the back of each identification badge, prison officials ensure that the inmate's diet remains consistent no matter how often he is transferred from prison to prison.

According to Johnson, inmates now receive the right meal every time they come through the chow line, which helps to maintain the inmates' health.

Johnson recommends the program to prison systems across the nation.  "It has real medical implications, especially with the cost of healthcare on the rise," she said.

Two other programs instituted in 2004 partner with the community to help offenders remain healthy after their release. 

The Edward Harris men's evening clinic, run by the Whittier Street Health Center in Boston, Mass., accommodates the specific health concerns of urban-centered adult males, providing services from primary care, eye care and a dental clinic to more preventive measures, such as prostate cancer screenings, HIV counseling and testing and a diabetes clinic to ex-offenders.

Joe Rowell, the clinic's post-prison release Program Coordinator, said sky-high medical bills and overconfidence are what prevent Boston's men of color, including ex-offenders, from paying regular visits to the doctor.

"We are targeting all kinds of male populations, including ex-offenders and victims of AIDS and hepatitis C," Rowell said.

The second such program is the Wisconsin Department of Corrections' innovated partnership with the Advanced General Dentistry Program at Marquette University.  This partnership seeks to offer offenders much-needed dental services and provide students with hands-on work experience.

Typically, the inmates visit the dental school for cleanings and fillings.  Having Marquette students take care of these types of inmate dental needs is a huge help to the DOC, which is already short-staffed when it comes to dental professionals, with only 24 dentists and 12 dental hygenists for all of the institutions.

"I think it is a great opportunity for both organizations," said Dr. Barbara Ripani, Dental Director for the Wisconsin DOC.  "We are very grateful to have additional treatment help.  We don't have a facility that would be able to handle all of these inmates."

Rape
Another issue that corrections workers continue to face is inmate rape.  Since the Prison Rape Elimination Act was passed by Congress in December 2003 with the goals of gathering national information about the problem and helping states to combat inmate sexual assaults in their correctional facilities, many states have made this issue a priority.

The Ohio Department of Rehabilitation and Correction's campaign to help prevent the sexual abuse of inmates is one of the many programs instituted in 2004 to increase awareness about this problem. 

"We really wanted to tackle it head on," said Thomas Stickrath, Assistant Director of the Ohio DRC.  "We've made [addressing prisoner rape] a priority.  We've been very public about it, both within our organization as well as externally."

The agency's Ten Point Plan called for the creation of several committees to help develop goals for the future.  Additionally, enhanced staff training has already begun for both new employees, who are educated about inmate sexual abuse during their orientations, and current staff members, who receive the training during their annual in-service sessions.

While staff are educated about how to end rape in correctional facitilies, so, too are the inmates.  According to Stickrath, the DRC has created literature that is being disseminated to all offenders.  Furthermore, the Plan calls for a process improvement team to examine the issue of under-reporting.

As we head into 2005, correctional healthcare providers will continue to face issues associated with HIV treatment, mental health, the aging inmate population, rape and the like.  Undoubtedly, new concerns will also emerge for healthcare practitioners working in the field.  As developments and problems unfold, The Corrections Connection Network News will bring you information about the many facets of correctional healthcare.