Correctional officials from across the country convened in Phoenix Arizona last week for the American Correctional Association's Annual Winter Conference to share their knowledge and experiences. Top on their list was how to manage the challenges, both new and old, that face corrections agencies.

"It's a new year. We all need to reflect on where we are," said Gwendolyn Chunn, President of the ACA, at the conference's opening session. "Now more than ever, we need to stay committed to our mission."

Chunn also pointed out the changing offender population and the need for corrections officers and administrators to be prepared to handle it.

"We don't choose those who are incarcerated. If we did, we'd choose some better people," she said.

With this in mind, ACA offered attendees a variety of workshops from the tried and true topics of security and safety for staff and offenders to how to accommodate disabled offenders, ways to manage inmates with mental illness and the challenges of caring for offenders with major diseases such as HIV.

Chief among the populations that are growing in corrections are those offenders with mental illness. One workshop at the ACA conference highlighted the successes of a federal prison in managing different groups within this population.

Intermediate Mental Health Care

The Federal Medical Center in Butner, North Carolina has experimented over the last year with some changes in unit designation for inmates with mental illness and mental health disorders. At the facility there are a variety of units that provide a stratified care model for these inmates, according to Gary Junker, Chief Psychologist for FMC-Butner.

Included among these units is one that provides support to those inmates with the lowest acuity of mental illness, who are high-functioning and are close to stepping down to another facility or to the community, other units are on lockdown and are for those individuals who are court committed or who are refusing medication and cannot function in another environment. But new to the center is a unit called "2F" which is designed to care for those who have disruptive behavior, have either Axis I or Axis II disorders, but do not need to be in the lockdown unit.

According to Junker, prior to the creation of this unit, offenders with paranoia, for example, were part of a larger unit, but were separated from others by "a curtain", which officials said lent an element of safety. But after the creation of "2F" officials decided these offenders would be more secure there.

Junker told attendees at the ACA workshop admission criteria to the unit includes transition from the lockdown unit, non-compliance with or involuntary medicated, and/or acting out in a disruptive manner. When they arrive at 2F, these offenders become part of a behavioral management plan and are expected to stick to it while they are in the unit.

Within the unit itself, there are several levels of restriction, including restriction to the unit and its programs only, escorts off the unit and unescorted passes off the unit with a return requirement every two hours.

Junker said the staff at FMC-Butner realize that many on the unit may never be able to transition to a less restrictive environment.

"In a unit like this, statistics show that 50 percent will never move off, but it is better than lockdown," Junker said.

He added that the ultimate goal, however, is to move the inmates off the unit when they meet the conditions of  the behavioral treatment plan.

"Our plan is to always move these people off the unit," he said. "This makes good sense."

While the unit is fairly new - only about a year old - officials at FMC-Butner believe that this intermediate step for mentally ill inmates is having a positive effect on some.

"We have seen a number of patients who have previously functioned marginally who are doing much better. It's structure and predictability," he said.

Programming within the unit includes psycho-educational groups, relaxation groups, anger management groups and health and hygiene groups.

FMC-Butner Warden Arthur Beeler said the hygiene group has made a big difference for some of the offenders in the unit.

"For a chronically mentally ill population, hygiene is important. We had a guy who has kept every piece of paper that has ever been given to him, [for example]," Beeler said.

Groups that provide coping skills and art therapy have also been popular. For example, some of the patients have been able to paint murals in the facility or create quilts using old sheets from the facility that would have otherwise been thrown out in the trash.

In setting up the unit, Junker and Beeler agree that cooperation from the staff, especially custody staff, was necessary.

"One of the biggest reasons for failure [of these types of programs] is territorial issues," Junker said. "[Here] correctional staff have important information to contribute. We make sure they have a role in the process."

The cooperation and hard work expended to create the unit has paid dividends, according to Junker and Beeler. Use of restraints has dropped, suicide watches have dropped, from 165 in 2003 to 121 in 2004, and destructive behavior in the general population has also declined. Within the unit itself, assaults have been higher, but officials stress that the unit has concentrated those behaviors in one unit now and that there have been no serious injuries.

"Eighty percent of the assaults were throwing items out of the cells, but not an assault by hitting," said Beeler.

"We have had a number of successes and some still need more attention," he added.

Beeler is also quick to state that all of the staff reconfiguring and the creation of the unit was done with no additional money or staff allotment. He encouraged others at the session to also be willing to think outside the box to better manage special populations like these.

Managing the Physically Challenged

Conference attendees also learned about what their facilities are required to provide to disabled offenders and how to comply with the Americans with Disabilities Act.

In a session presented last week, Eileen Baker, a consultant in corrections for the deaf and hard of hearing, told attendees about some of the requirements under the ADA and gave advice about how to work with disabled offenders.

Baker told the group that Title II of the ADA applies directly to correctional facilities and that title III applies to private facilities in corrections. But what are the legal implications for these facilities?

Baker told the group that communication with hard of hearing or deaf offenders is essential. That means that corrections should pay attention to providing qualified interpreters and making accommodations to ensure proper communication with these offenders.

Baker said that in recent years some agencies have been sued when they have used non-qualified interpreters. Correctional administrators would also be wise, she said, to pay attention to the environment in which they are communicating with the deaf or hard of hearing

"You may say something but they didn't hear exactly what you said. That can lead to grievances," Baker said.

Other tips that she provided to participants included paying attention to background noise and distractions, which may make communication difficult with this population.

"If someone needs to read lips, then they need to see you," Baker said.

She added that lip-reading may be more difficult for the deaf if the person they are communicating with has a moustache, and when communicating, staff should make sure that offenders understand what has been said and document it.

Required accommodations under ADA include TDD/TTY for telephone, a compatible and amplified hand held phone, closed-captioned TV/VCR Decoder, sound signalers, flashing alarms, or strobe lighting, hearing aids and batteries and qualified interpreters as necessary.

Under the Individuals with Disabilities Education Act (IDEA), which applies to juvenile offenders, facilities are required to provide speech therapy, sign language instruction, FM auditory trainers, remedial assistance or resource teacher, note-taker, sign language training for parents and youth and transportation.

Baker also said that officials should understand there is no relationship between intelligence and deafness, however, the lack of identification of hearing loss can affect language acquisition. This means that deaf or hard of hearing persons typically have a reading level between first and third grade.

This information should be passed on to staff through in-service training where staff should also review policies and procedures related to communicating with this population. In addition, agencies should develop and design specific assessment tools for deaf offenders upon intake, so they understand and can meet the needs of the offenders as they enter the facility, she said.

Meeting the serious health care needs of offenders was another focus of the workshops at ACA last week.

Corrections and Community Health

A push by the U.S. Surgeon General to recognize the importance of communication between corrections and community health prompted two sessions at ACA last week. The session focusing on prisons took a look at how some agencies are providing services to HIV-positive offenders with the help of agencies in the community.

"Prisons and public health are strange bedfellows," said John Miles, a consultant and former director of the Centers for Disease Control's National Center on HIV, STD and TB Prevention. "[But] corrections is a barometer of what is going on in the community."

Miles spoke to attendees about the differences between what jails can show about community health and what prisons indicate.

Jails, he said,  reflect more about an individual community where prisons are more removed from the community.

Either way, Miles told the group, there are good reasons for public health and corrections to work together.

Chief among them is the realization that many inmates will return to the community with diseases and may spread them if they are not treated properly.

In addition, as diseases have changed and budget allocations have changed more and more agencies need to work together to properly treat citizens, regardless of where they are "housed."

With HIV, several communities and corrections agencies have come together in what Miles described as "pilot programs" that have created leadership forums to discuss and deal with communicable diseases in the community. Among those who participate in those forums are city leaders, such as a mayor, representatives from the department of corrections, department of labor and others.

These pilot programs, which are being launched by the Centers for Disease Control, are designed to promote collaboration and problems solving  to address the most prevalent diseases in their community and their corrections facilities.

Among some of the topics under discussion were re-entry funding, Ryan White Act funding and  housing programs for offenders.

"We found there was money in the community. Funding was already there," said Miles.

Miles urged attendees to make connections with their public health counterparts and to challenge the perceptions that may be preventing agencies from working together.

"It won't be easy. [But] just because someone is incarcerated doesn't mean that public health isn't responsible or obligated to provide services and assist the department of corrections with medications, training and support," Miles said.

States such as Texas, New Mexico and Louisiana have already crated leadership forums under the program with some success, Miles added.

"We have a long way to go and we can't ignore it. More than 600,000 people are being released annually. What's going to happen to them?," Miles asked the group.

Resources:

For more information about the new mental health units at the Federal Medical Center in Butner, NC, email gjunker@bop.gov

To reach Eileen baker, email her at ebaker@snet.net

For more information about the CDC's community leadership forums, contact Miles at McKing Consulting at 770 220-0608