Horticulture Therapy: Letting Nature Nurture

1. CORRECT
CARE
CARE
A Publication of the National Commission on Correctional Health Care
Spring 2004 • Volume 18, Issue 2
Horticulture 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 how
W
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 grow
drab street across
from the Cook County
can boost self-
esteem and be a
NCCHC Founder Passes Away After a
(IL) Jail now holds
life, delight, triumph,
jolt of indepen-
dence…. Even if it
Lifetime of Remarkable Achievement
hopes 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.
T
when 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 jails
ety’s measure, don’t potential in the (see page 10 for a timeline successfully demonstrated
have 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 voluntary
jail 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 was
ing and harvesting these plants, and public area—it was not feasible for Association, he was instru- expanded to prisons and
donating 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 held
expanded to a second site on the jail to live and work in the community. improving access to health in 1977. I first met
grounds—this horticulture therapy is Before approaching the Department care for the poor and Bernard at the second
the latest initiative of the expressive of Women’s Justice Services and the elderly with the interests annual conference, in
arts 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 comfortably
vides 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, no
expressive arts program, part of the als and to prepare the plots. He then ing, which was unprecedented in our comparison with the thousands that
mental 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 separated
ative 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-founded
ceptually, 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 support
American 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 days
and spirits of people.” (See page 14 program to lend a hand, and on June As an AMA group vice president, before the concept gained widespread
for 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, more
what expressive therapist Eric Dean there was some grumbling from skep- Washington, representing AMA con- and more jails and prisons applied for
Spruth, 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 program
ture program. However, the idea first study of health care in this country’s
struck 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. CORRECT
NCCHC News CARE
A Publication of the National Commission on Correctional Health Care
Spring 2004 Vol. 18 No. 2
New 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 health
To help correctional mental health Specialized Guidance care in our nation’s jails, prisons and juvenile confinement
care 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 treatment
oped 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 of
Psychiatric Association’s Practice line by focusing on treatment issues standards that represent the require-
ments for opioid treatment services BOARD OF DIRECTORS
Guideline 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 Executives
On 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 Physicians
and 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 Counties
schizophrenia 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 Association
U.S. population as a whole. Providing The schizophrenia guidelines Standards for Health Services, the Edward A. Harrison, CCHP (President)
National Commission on Correctional Health Care
adequate treatment to inmates with address the following areas: OTP Standards are divided into nine
Carl C. Bell, MD, CCHP
schizophrenia not only helps the • background general areas: National Medical Association
individual by reducing bizarre and • diagnosis A – Governance and Administration H. Blair Carlson, MD
American Society of Addiction Medicine
disruptive behaviors but also may • management overview (including B – Managing a Safe and Healthy
Kleanthe Caruso, MSN, CCHP
make the environment safer for treatment goals) Environment American Nurses Association
other 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, JD
High-Risk Population • content of follow-up visits (including Support National District Attorneys Association
The high prevalence of mentally ill assessment and levels of function) E – Inmate Care and Treatment Capt. Nina Dozoretz, RHIA, CCHP
American Health Information Management Association
inmates is believed to be related to • use of the assessment to guide F – Health Promotion and Disease
Charles A. Fasano
the deinstitutionalization of patients treatment efforts (including conti- Prevention John Howard Association
in mental health facilities and the nuity of care, treatment strategies G – Special Needs and Services Bernard H. Feigelman, DO
American College of Neuropsychiatrists
dismantling of mental health pro- and environmental controls) H – Health Records
William T. Haeck, MD, CCHP
grams 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 Association
street, these former patients often specific federal regulations and
JoRene Kerns, BSN, CCHP
engage in behavior that leads to Free Guidance Online therefore are essential for achieving American Correctional Health Services Association
their incarceration. Many of these The seventh in a series of clinical NCCHC accreditation. However, Daniel Lorber, MD
American Diabetes Association
inmates also have other risk factors guidelines geared toward health care some may not apply, in whole or in
Edwin I. Megargee, PhD, CCHP
associated with a higher incidence of providers working in correctional part, to a given facility’s program. American Association for Correctional Psychology
violent behavior (e.g., substance settings, the schizophrenia treat- Accreditation by NCCHC allows Charles A. Meyer, Jr., MD, CCHP-A
American Academy of Psychiatry & the Law
abuse, neurological impairment, ment guidelines are the first devel- OTPs to obtain legally required certi-
Robert E. Morris, MD
poor impulse control) that may be oped by NCCHC that deal with men- fication from the federal Substance Society for Adolescent Medicine
exacerbated 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, CCHP
sometimes provocative behaviors, eases: asthma, diabetes, epilepsy, tation are eligible for technical assis- American Academy of Child & Adolescent Psychiatry
people with schizophrenia may be at high blood pressure, high blood cho- tance consultation, funded by Peter Perroncello, CJM
higher risk of being victimized in lesterol and HIV. SAMHSA, that assesses what may be American Jail Association
George J. Pramstaller, DO, CCHP
correctional settings, and often their All of the guidelines can be down- needed to comply with the standards. American Osteopathic Association
clinical conditions are intensified by loaded for free at the NCCHC Web An OTP seeking accreditation need Patricia N. Reams, MD, CCHP
overcrowding, 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. Roberts
basic 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. Guest Editorial
Health Literacy: The Challenges and Opportunities
BY 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 their
peanuts 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 are
pound man who also suffers from The following strategies, while not on the brochure preparing to reenter society, will
high blood pressure, eating a light comprehensive, are simple and prac- Making the brochure personal will have a better chance at positive
snack 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 interactions
of 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 in
follow the same medication instruc-
Use plain medical English good idea to have some Latinos in Health Literacy, a communications
tions. But which patient is doing the
Always use easy-to-understand terms the photographs or illustrations. If firm based in Ellicott City, MD. Reach
right 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 terms
tion 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 Backs
result 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, Accreditation
noncompliance 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 high
can result in a deadly outcome. It Be specific and avoid jargon the National Commission on Correc- prevalence of disease and serious
happens 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 History
informed consent because of the Draw a picture or use models for Health Care Services to Incarcer- “The AMA has for over 30 years
form’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 health
impact on patient care, confuses picture or model rather than just annual meeting in June. The House care in jails and prisons,” says
patients 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 the
care industry. And it is becoming an health issue such as arteriosclerosis, The policy was introduced by the AMA. He also serves on NCCHC’s
alarming 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 long
Institute of Medicine, low health lit- with plaque stopping blood flow. seat on the House of Delegates. history dating to 1970, when the
eracy affects 90 million people in the Mention an easy-to-understand anal- AAPHP also is a supporting organi- medical association first began to
United States and by some estimates ogy, such as a pipe that is clogged. zation of the National Commission. look into the conditions of health
costs the health care system more services in jails and didn’t like what
than $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 to
in the nation’s jails and prisons and the gist of the matter, providers
physicians widely supported the poli- establish jail health care standards
the 11.5 million inmates released should select three specific points to
cy in part because of “recognition and advise on accreditation. In the
each year—populations more likely summarize the patient’s illness or
that illness in prison can spill over early 1980s, that program evolved
than 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 understands
nosed health problems, and language NCCHC as “the leading organization yards of correctional medicine and
Take extra effort to make inmates
and 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” technique
and 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 still
tors, 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 materials
with grassroots health literacy initia- dards, and providers should prac- “health care services” by adding
When using informational pamphlets
tives springing up nationwide to tice in keeping with contemporary “including mental health services.”
or brochures, take a fresh look at the
enhance communication in health.
www.ncchc.org SPRING 2004 • CorrectCare 3

4. CCHP News
Oregon MD Treats the ‘Family Disease’ of Incarceration New CCHP Eligibility Rules
In a move that makes CCHP certifi-
cation more accessible to thousands
BY 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 the
Benton 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 requirements
health officer, she joined the Oregon children, and these children are five in the parenting class have told Sazie state that CCHPs must be of good
Department 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 restriction
trative 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 to
ities. 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 a
familiar 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 at
commitment 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 a
2003 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 for
Why would such a seasoned profes- and what her own actions had to do says, “but it is a health issue.” certification. Other professionals
sional seek certification? Sazie with Mom’s or Dad’s arrest. working in the area of correctional
explains: “[Taking the exam] gave To help the people caring for youth health care, for example attorneys,
To learn more about the Children of
me more confidence in my ability to with incarcerated parents, the pro- administrators and medical records
Incarcerated Parents Project or to
make 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 the
sustained 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 talk
served population. “Inmates are with the children—and helping them
sober and faced with reality, and may figure out how to do this—will
choose to address their health and reduce the number of these children
substance 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 or
Assisting them and witnessing these flier to give to inmate families,” says
changes are extremely rewarding. Sazie. “In my 20 years at the county
The 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 Need
In answer to such challenges, Sazie Help for Parents
has been deeply involved in an ODOC The Caregiver’s Guide has been pro-
program to aid children of prison vided to all Oregon DOC facilities
inmates. In 2002, she took advan- and county jails and is displayed in
tage of “momentum” in this area the clinic and visiting areas of these
and joined with ODOC’s public facilities. It also is available at the
affairs director and other individuals popular parenting classes developed
and groups to form the Children of by ODOC in 2002. Sazie believes
Incarcerated Parents Project. Today, that parenting classes—as well as
more 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

6. Academy News
Academy Steps Up to the Plate on National Initiatives
BY 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 endless
The 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 a
advancing the profession was meeting on the Call to Action, • Encourage policies that lead to
difficult task. Wouldn’t it be nice
acknowledged and strengthened by which was issued last summer collaboration among correc-
to have a wise, experienced and
two opportunities this year. The by the Surgeon General. tions, public health service
trusted colleague to turn to for
Academy received invitations to par- Richard Carmona, MD, organizations and the larg-
help? Now you can, through the
ticipate with national representatives MPH, CCHP, convened a er community
Academy’s mentor program. To
in the revision of the Centers for panel of experts from With these goals in
learn what mentoring is and how it
Disease Control and Prevention’s corrections and public mind and the leadership
can help you, or to sign up for the
tuberculosis guidelines for correc- health to discuss the cur- of Admiral Kenneth
program, visit the Academy online
tions, 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 deputy
Correctional 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 in
from 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, associate
to revise the 1996 TB guidelines. The major stakeholders, about the rela- Work included further clarifying director of health disparities at the
Academy is represented on two of tionship between corrections and some goals, and identifying and vali- CDC’s National Center for HIV, STD
the 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 Academy
ing 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 of
now complete, and the working of transitional programs and validation of correctional health care this organization to our profession. I
group will meet in December to health care delivery, including issues, concerns, barriers, risks and am grateful to have served the
review the guidelines before they are mental health and substance the population served, strengthened Academy as a representative to these
issued 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

7. Best Practices in Transitional Planning: An Essay Competition
BY R. SCOTT CHAVEZ, PHD, CCHP-A, AND LAMBERT charge of jurisdiction Competition Rules the property of NCCHC and may be
KING, 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 special
The 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 less
oration 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 may
announces an essay competition to the success rates of inmates who inmates with serious medical and submit the essays via e-mail at
recognize 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. Scott
will 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, IL
National Conference on Correctional law enforcement, human service One person per winning entry will 60614. Questions about the essay
Health Care, being held Nov. 14-17 agencies and other stakeholders in receive the travel, lodging and regis- competition may be directed to
in 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 is
estimated that 97% of incarcerated
individuals will eventually be released
to our communities. This translates
into staggering numbers: In 1999,
nearly 600,000 prison inmates were
released. Many of those being dis-
charged from prisons and jails suffer
from asthma, diabetes, cardiovascu-
lar disease, epilepsy, hepatitis C, HIV
infection, serious mental illness and
physical disabilities. It is vitally
important that effective discharge
planning occurs to ensure continuity
of health care, through participation
in employment, housing, school and
church opportunities.
Across the country, many initia-
tives are taking place to improve the
transition process. Some projects
help inmates to prepare for a life
beyond confinement, other projects
work to improve the discharge
process and yet others help releasees
to adjust to life in free communities.
A goal of the Searching for
Common Ground project is to identi-
fy and widely communicate replica-
ble models and best practices that
measurably improve continuity of
care for recently released inmates
with serious medical and mental
health conditions. The essay compe-
tition will help to identify of the best
of these models and practices.
Essay Guidelines
The Searching for Common Ground
Project will accept essays on Best
Practices in Transitional Planning
from entrants who work in criminal
justice institutions, human service
agencies, community and neighbor-
hood organizations, and other agen-
cies that have an interest in improv-
ing transition into communities.
Essays must address efforts that
contribute to improved public safety
by offering better inmate transition
through assessment, classification,
programming, resource allocation
and release preparation practices.
Essays may address any of the follow-
ing seven elements of the transition
process:
• 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

8. Facility Profile
One Size Does Not Fit All at Indiana Women’s Prison
BY 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 complex
tion seldom, if ever, before being tidisciplinary services, both in the • Parent-teen day, held twice a year, still occupies its original 15-acre
admitted there. Yet it’s a primary prison and outside, geared toward invites youth aged 13 to 17 to spend site just outside of downtown
concern of service providers at the fostering healthy families. the day with their mothers or grand- Indianapolis. Three miles away, a
maximum security facility, where, The program was conceived by mothers and engage in problem-solv- satellite work-release facility is
along 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: The
through 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 intakes
ment 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 and
to improve “health” in areas such as around services was establishment of their homes to ensure that the envi- those with significant mental
parenting, 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 with
tioned with the ‘one size fits all’ phi- warm, inviting environment where who are soon to be released from the Prison Health Services, which
losophy,” 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, mental
trained psychologist whose duties agencies that assist families in the both academic and practical experi- health staff and others. Nurses
include 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 26
changed, resulting in a facility mis- dren, are in dire need of services able to all inmates, some of whom FTEs. Present full-time are the
sion 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, 7
state’s Department of Corrections, into its current form with five major inmates’ sense of pride and responsi- LPNs, 4 psychologists, dental
IWP 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 full
many as in 1997. Most will be trans- support groups address parenting make clothing for poor children and time are the psychiatrist, ob/gyn
ferred 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 the
es 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 ladies
tions 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 electronic
has 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 also
led 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 in
for 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 to
the centerpiece, serving 80% of the operates year-round, providing a less- form of another grant, $300,000 the community if we address their
population, is the Family Preserva- restrictive, child-friendly setting with from the Health Resources and family’s and children’s needs.” Just
tion Program, which earned NCCHC’s books, toys and activities to foster Services Administration. With this as important, Hendrix adds, it helps
2003 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

9. New Mexico MDs Support Opioid Treatment in Corrections
T
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 Streets
support of opioid replacement thera- maintenance treatment is the most
py in the state’s jails and prisons. ORT Gaining Acceptance effective treatment for heroin addic- With the recent launch of its
Setting its sights on passage of state While opiate addiction plagues cor- tion. Another important factor is the accreditation program for opioid
legislation, 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 that
treatment, 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 community
efficacy, the resolution also calls for uation is exacerbated by high rates persuasion. At the state level, the standards were used as a guide but
formal evaluation of the ORT pro- of hepatitis C in the state, and of society will be lobbying the legisla- modified to take into account the
grams “to determine whether such recidivism among inmates with sub- tors who are involved with health issues unique to providing services
treatment 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 the
of infectious diseases among popula- lenges, the medical society’s vote the American Medical Association standards, see page 2. To learn
tions 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 Accreditation
MD, 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, the
country that the physician members viders have been strongly divided NMMS is distributing information on
of a state medical society have over methadone therapy, with some a home study program by which lence, burglaries, car-jackings and
passed a resolution regarding opiate viewing it as replacing one drug with providers can become certified to drive-by shootings, we must have
replacement 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 the
landmark step in the advancement of care for years before joining NCCHC. increase public awareness and sup- newer and safer buprenorphine—to
inmate health care.” McGuire is “However, the medical literature and port, which is important because of offer to addicted inmates while
president of the Greater Albuquer- practice is slowly recognizing the concerns about drug-related crime in incarcerated,” says McGuire. “Only
que Medical Association, whose physiological underpinnings of addic- the state, McGuire says. For exam- with effective medical therapy of
board 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 and
which comprises about 75 physicians populations is progress indeed.” related cycle of hepatitis C and return to productive lives upon
representing all of the county med- The resolution itself cites studies other infectious diseases, gang vio- release.”
www.ncchc.org SPRING 2004 • CorrectCare 9