correct - National Commission on Correctional Health Care

Transcription

CORRECT
C
CA
AR
RE
E
A Publication of the National Commission on Correctional Health Care
Winter 2004 • Volume 18, Issue 1
Prisoner Reentry
Juvenile Standards
New Perspectives Foster Better Health Outcomes
A preview of the 2004 revision! Find
a summary of changes on page 18.
B
y most measures, prisoners are
burdened by health concerns at
levels far higher than in the general population.
They exhibit
markedly higher rates of HIV
and AIDS,
tuberculosis,
hepatitis C and
mental illness.
They have significant histories of alcohol
and substance
abuse, and
higher levels of
addiction. (See
NCCHC’s report
to Congress on the Health Status of
Soon-to-be-Released Inmates, online
at www.ncchc.org/pubs/stbr.html.)
Yet, unlike most Americans, prisoners have access to a health care system,
paid for by taxpayers, that attends to
a wide range of their health needs.
They are typically screened for a variety of illnesses at admission, and can
call upon this health care system to
respond to needs ranging from routine illnesses to kidney dialysis and
even heart transplants.
There is a second reality of imprisonment in America that puts the
health profile of prisoners in a unique
relationship to the American system
of health care: Virtually all prisoners
return home, bringing with them
their health concerns. Except for
those few who die in prison, all prisoners return to live again in free society. In recent years, “prisoner reentry” has received substantial attention
among policymakers, practitioners
and researchers, generating a widespread interest in new approaches to
managing the inevitable return of
large numbers of prisoners.
Fourfold Increase
In a time called by some the era of
“mass incarceration,” the phenomenon of prisoner reentry today is quite
different than it was just 30 years ago.
Since the
early 1970s,
the nation
has witnessed a
fourfold
increase in
the rate of
incarceration, resulting in a
prison population of 1.3
million.
Given the
inevitability
of reentry, it is not surprising that the
size of the annual reentry cohort also
has grown substantially. In 2002, an
estimated 630,000 individuals left our
state and federal prisons, more than
four times the number who made similar journeys 25 years ago.
Once they return home, the odds
are high that they will return to
prison. Within three years, two-thirds
will be rearrested for serious crimes
and one-half will be returned to
prison. The large numbers of individuals with high rates of health problems
who are sent to prison, return home
and then, in many cases, are sent to
prison again, pose both challenges
and opportunities for health care
providers, both those in correctional
settings and those in the community.
A primary shortfall in practice to
date is the absence of mechanisms
through which community and corrections providers can collaborate to provide continuity of care for returning
prisoners. The absence of such systems disadvantages prisoners and
Photo credit: Alex L. Fradkin
BY JEREMY TRAVIS, JD, MPA, & ANNA SOMMERS, PHD
Continued on page 19
Non-Profit Org.
US Postage
PAID
Chicago, IL 60611
Permit No. 741
I
NCCHC Accreditation Paves the Way for
Correctional Opioid Treatment Programs
O
pioid treatment programs in
correctional facilities are fairly
rare due, in part, to the regulatory red tape and institutional resistance that have often stymied attempts
to establish them. But now, with the
help of NCCHC and the federal
Substance Abuse and Mental Health
Services Administration, OTPs aiming
to serve correctional populations
stand a better chance.
By federal law, opioid treatment
programs based in correctional facilities must obtain certification from
SAMHSA, an agency of the U.S.
Department of Health and Human
Services, but to become certified, the
OTPs first must be accredited by a
federally approved body. In February,
SAMHSA granted NCCHC the authority to accredit OTPs, making it one of
only six bodies so authorized and the
only one specializing in corrections.
Helping Patients
In the field of opioid addiction treatment, clinical studies and years of
experience show that the methadonebased approach to detoxification and
maintenance is an effective intervention for patients assessed as appropriate candidates for it. As well, clinical
studies of opioid-dependent pregnant
women confirm that providing
methadone during pregnancy protects
the health of the fetus.
Unfortunately, the absence of such
opioid treatment programs in correctional facilities means lost opportunities to help addicted inmates, especially those who already participate in
a community-based OTP but must forfeit continuity of care when they
become incarcerated.
NCCHC’s new accreditation pro-
N S I D E
T
gram will be a valuable service for correctional facilities that have had to
use other strategies, such as reliance
on community-based OTPs, to help
addicted inmates.
It also will smoothe the transition
when the inmates are released, says
addiction counselor Nancy White,
MAC, LPC, an NCCHC board member
who manages an integrated program
for patients, including former inmates,
diagnosed with chronic mental illness
and substance abuse problems. “We
know that opioid treatment relieves
the narcotic craving that addicts
describe as a major factor leading
them to relapse and continued illegal
drug use. If an inmate is released into
the community already receiving opioid treatment, our communities
should be much safer to live in.”
New Standards
As with health services accreditation,
NCCHC standards are the foundation
of the OTP program. The NCCHC
Standards for Opioid Treatment
Programs in Correctional Facilities
are based on federal regulations but
address the special nature of care provided in correctional facilities as well
as the necessarily limited focus of
such treatment in this setting.
OTPs actively seeking accreditation
by NCCHC are eligible for technical
assistance consultation, funded by
SAMHSA, that assesses current operations and itemizes what may be necessary to comply with the standards.
An OTP seeking accreditation from
NCCHC need not be in a facility
whose health services are accredited.
To learn more about this program, email NCCHC at OTPinfo@ncchc.org
or call (773) 880-1460, ext. 284.
H I S
I
S S U E
FEATURES
DEPARTMENTS
Evidence-based Medicine: Pharyngitis . . . . . . . . . .7
Facility Profile: Jails With Juveniles . . . . . . . . . . . .9
Managing Dental Anxiety . . . . . . . . . . . . . . . . . . .10
Meet the 330 (!) New CCHPs . . . . . . . . . . . . . . .11
Mental Health Conference Preview . . . . . . . . . . .15
Contract Management: Is It Right for You? . . . . .16
HIV Prevention Inspires Youth Creativity . . . . . . .17
2004 Juvenile Standards: Guide to Changes . . . .18
Updates Conference Preview: Chicago . . . . . . . .24
NCCHC News: Commission on the Move . . . . . . .2
Guest Editorial: John M. Harrison . . . . . . . . . . . . .3
CCHP News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Academy News . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Clinical Briefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Spotlight on the Standards: Survey Report . . . . . .20
Standards Q&A . . . . . . . . . . . . . . . . . . . . . . . . . .21
Classified Advertising . . . . . . . . . . . . . . . . . . . . .23
CORRECT
NCCHC News
CARE
A Publication of the National Commission on Correctional Health Care
Winter 2004
Commission on the Move
The National Commission on Correctional Health Care is moving its headquarters office to a new building this summer. Effective June 14, you’ll find us
unpacking boxes and hanging pictures at a newly renovated two-story building
on Chicago’s north side, about half a mile south of our current office. Our
phone and fax numbers will remain the same. Here’s how to reach us:
1145 W. Diversey Parkway, Chicago, Illinois 60614
Phone (773) 880-1460 • Fax (773) 880-2424
E-mail info@ncchc.org • Web www.ncchc.org
Odds & Ends
• CE for psychologists. NCCHC has received approval from the American
Psychological Association to provide continuing education credit to psychologists. The timing couldn’t be better: While we always offer a mental health
health track at our Spring and Fall conferences, we’re also hosting a two-day
program dedicated to mental health topics this summer. To be held in Las
Vegas on Sunday and Monday, July 11-12, the meeting will enable participants
to earn up to 13 hours of credit. Learn more about the meeting on page 15.
• Juvenile Standards. After a great deal of care to review, revise and review
again, NCCHC’s 2004 Standards for Health Care Services in Juvenile Detention
and Confinement Facilities have been finalized and are now in production. A
summary of changes vs. the 1999 version, along with a timeline for compliance, can be found on page 18. To order your copy, use the form on that page.
• More resources. In addition to the juvenile Standards, NCCHC has recently
added several resources to its publications catalog. For product descriptions
and ordering information, visit the Publications section of our Web site.
X Health Assessment & Physical Examination, 2nd Edition, With CD Rom,
by Mary Ellen Zator Estes, RN, MSN, CCRN; published by Delmar
Learning; $75.95.
Y Treating Substance Abusers in Correctional Contexts: New Understandings,
New Modalities, editor Nathaniel J. Pallone, PhD; published by Haworth
Press; $39.95.
Z English & Spanish Medical Words & Phrases, 3rd Edition; published by
Lippincott Williams & Wilkins; $28.95.
[ Spanish-English/English-Spanish Medical Dictionary, 2nd Edition, editors
Onyria Herrera McElroy and Lola L. Grabb; published by Lippincott
Williams & Wilkins; $35.95.
Board Member Update
NCCHC is
pleased to welcome Peter E.
Perroncello, MS,
CJM, to its board
of directors as
representative
of the American
Jail Association,
for which he serves as president.
“I am excited to join the NCCHC
board and represent the people
who toil, often without thanks, in
the jails of America,” says
Perroncello, who is a Certified Jail
Manager through the AJA.
Perroncello is superintendent of
detention and jail operations for
the Bristol County Sheriff’s Office,
a four-facility, 1,500 bed system in
North Dartmouth, MA. He also is
an experienced trainer and does
training consulting for both the
AJA and the National Institute of
Corrections Jail Center.
In his role as NCCHC board
member he is participating on the
program committee, which establishes the educational curricula
for conferences.
Congratulations
to Barbara A.
Wakeen, RD, on
being honored
by the American
Correctional
Food Service
Association with
its President’s
Award, which recognizes her outstanding service to ACFSA and to
it president. Wakeen represents
the American Dietetic Association
on the NCCHC board.
Calendar
October 29
Accreditation Committee meetings: Health
Services and Opioid Treatment Program
November 13-17
National Conference on Correctional Health
Care, New Orleans
November 14
CCHP and CCHP-A proctored examinations,
New Orleans
2 WINTER 2004 • CorrectCare
Nancy B. White, LPC (Secretary)
American Counseling Association
Edward A. Harrison, CCHP (President)
National Commission on Correctional Health Care
Carl C. Bell, MD, CCHP
National Medical Association
H. Blair Carlson, MD, CCHP
American Society of Addiction Medicine
Kleanthe Caruso, MSN, CCHP
American Nurses Association
Robert Cohen, MD
American Public Health Association
Hon. Richard A. Devine, JD
National District Attorneys Association
Capt. Nina Dozoretz, RHIA, CCHP
American Health Information Management Association
Charles A. Fasano
John Howard Association
Bernard H. Feigelman, DO
American College of Neuropsychiatrists
William T. Haeck, MD, CCHP
American College of Emergency Physicians
Robert L. Hilton, RPh, CCHP
American Pharmacists Association
JoRene Kerns, BSN, CCHP
American Correctional Health Services Association
Daniel Lorber, MD
American Diabetes Association
Edwin I. Megargee, PhD, CCHP
American Association for Correctional Psychology
Charles A. Meyer, Jr., MD, CCHP-A
American Academy of Psychiatry & the Law
Robert E. Morris, MD
Society for Adolescent Medicine
Peter C. Ober, PA-C, CCHP
American Academy of Physician Assistants
Joseph V. Penn, MD, CCHP
American Academy of Child & Adolescent Psychiatry
Peter Perroncello, CJM
American Jail Association
George J. Pramstaller, DO, CCHP
American Osteopathic Association
Patricia N. Reams, MD, CCHP
American Academy of Pediatrics
Sheriff B.J. Roberts
National Sheriffs’ Association
Thomas E. Shields II, DDS, CCHP
American Dental Association
Jere G. Sutton, DO, CCHP
American Association of Physician Specialists
June 25
CCHP proctored examination, multiple sites
(see page 4 for locations)
Kenneth J. Kuipers, PhD (Treasurer)
National Association of Counties
Ronald M. Shansky, MD
Society of Correctional Physicians
CCHP and CCHP-A proctored examinations,
Chicago
August 21
Eugene A. Migliaccio, DrPH, CCHP (Chair-Elect)
American College of Healthcare Executives
Douglas A. Mack, MD, CCHP (Immediate Past Chair)
American Association of Public Health Physicians
David W. Roush, PhD
National Juvenile Detention Association
May 23
CCHP proctored examination, Las Vegas
BOARD OF DIRECTORS
Thomas J. Fagan, PhD (Chair)
American Psychological Association
William J. Rold, JD, CCHP-A
American Bar Association
Updates in Correctional Health Care, Chicago
July 12
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
care in our nation’s jails, prisons and juvenile confinement
facilities. NCCHC is supported by 36 leading national organizations representing the fields of health, law and corrections.
John M. Robertson, MD
American College of Physicians—American Society of Internal
Medicine
May 22-25
Accreditation Committee meetings: Health
Services and Opioid Treatment Program
Vol. 18 No. 1
Alvin J. Thompson, MD
American Medical Association
Las Vegas, Nevada
Mental Health in Corrections: Improving Treatment to Change Lives
July 11-12 • Paris Hotel
More than ever, correctional mental health professionals face enormous
challenges in identifying and treating the growing numbers of individuals
with mental health and substance abuse disorders in their facilities. This
special two-day conference will focus on best practices in key areas as well
as collaboration with community agencies.
Among the topics to be addressed are medication management, suicide
prevention, life skills training, discharge/transitional planning, psychiatric
rehabilitation, personality disorder treatment, gang management, sex
offender treatment, impulse control methods, use of segregation, mental
health staffing, drug and mental health courts, and more. To learn more
turn to page 15, or visit our Web site at www.ncchc.org.
Barbara A. Wakeen, RD
American Dietetic Association
Henry C. Weinstein, MD, CCHP
American Psychiatric Association
Jonathan B. Weisbuch, MD
National Association of County & City Health Officials
Copyright 2004 National Commission on Correctional Health Care.
Statements of fact and opinion are the responsibility of the authors
alone and do not necessarily reflect the opinions of this publication,
NCCHC or its supporting organizations. NCCHC assumes no responsibility for products or services advertised. We invite letters of support
or criticism or correction of facts, which will be printed as space
allows. Articles without designated authorship may be reprinted in
whole or in part provided attribution is given to NCCHC.
Send change of address, subscription requests, advertising inquiries
and other correspondence to Jaime Shimkus, publications editor,
NCCHC, P.O. Box 11117, Chicago, IL 60611.
Phone: (773) 880-1460. Fax: (773) 880-2424.
E-mail: info@ncchc.org. Web: www.ncchc.org.
www.ncchc.org
Guest Editorial
Paradigm Shift: From Quality to Systems Excellence
BY JOHN M. HARRISON, RN, BSN, MHSA
T
he mere mention of the
word “quality”
usually evokes an
uncomfortable,
almost visceral
reaction in management and staff
members alike.
Staff often lament,
“All those quality people do is create
more work for me and never make
my job better. I wish they would just
let us do our jobs.” Many managers
also have negative feelings about
quality efforts, viewing mandated
activities as an expense with no tangible benefit, other than meeting the
requirements of regulations and
accreditation standards.
Unfortunately, quality has earned
this reputation for a reason. The
approach of most quality programs is
to identify “outliers,” a professional
version of the blame game. The goal
is to identify whoever was noncompliant and take “corrective action.”
This is evident today with the proliferation of retrospective record
reviews with check sheets whose tallied results are communicated to the
staff through corrective action plans
purported to address the problem.
The results of these compliancefocused drivers of quality have been
short-term and are not focused on
the true quality needs or necessary
improvements.
Despite the negative feelings about
quality programs, the professionalism
of health care employees has kept
the quality of health care today at
high levels. The Institute of Medicine
stated in its 2001 report “Crossing
the Quality Chasm” that these professionals’ “courage, hard work, and
commitment...are the only real
means of stemming the flood of
errors that are latent....”
Importantly, the report also states
that the root of problems with health
care quality lies in outmoded systems
of work, not with workers. By some
estimates, systems flaws, not people
flaws, cause 80% to 90% of errors.
A Change of Focus
Therein lies the need for change to
systems-based quality—the paradigm
shift to systems excellence. In health
care, the overarching business goal
of systems excellence is to deliver
effective care while using resources
and time as efficiently as possible.
This means that management must
focus primarily on systems and
processes, not employees, when
improving operations.
The paradigm shift has already
begun. Outside forces from the manufacturing and other business worlds
www.ncchc.org
(such as the Leapfrog Group) are
demanding improved quality as a
nonnegotiable requirement for
health care contracts. Health care
organizations that have inculcated a
business excellence culture as their
driving organizational management
force are finding that the culture
change has had a positive impact on
their ability to improve the effectiveness of care delivered as well as the
business health (the bottom line)
through improvements in efficiency,
use of resources (human and physical) and employee retention, and
through decreased waste.
No off-the-shelf “soup-du-jour” program will resolve all of the quality
issues in an organization. Each organization is unique in its problems,
resources, population requirements
and contractual/mission requirements. Management and quality professionals must customize the quality program to meet the unique needs
and requirements of the organization and its customer base.
Departmental functional silos (vertical management) must give way to
product/service delivery systems
(horizontal management). Quality
professionals must vacate the “quality
department” and join the management team, mentoring both management and staff on how to continually
improve individual processes and systems to create a positive impact on
services and products.
Clinical quality (the outcomes of
the care provider’s decision processes
in developing a plan of treatment)
must be differentiated from the quality of the support services that
implement and sustain that treatment plan (to include medication
administration, lab testing, etc.).
These decision-making systems and
support systems each impact clinical
outcomes but in a different manner.
It is essential for top management
to identify and measure key processes and systems. Managers and
employees must accept the fact that
without measurement, a process cannot be effectively managed. When a
task (process) is not performed as
defined by the procedure manual,
the deviation usually occurs for one
of two reasons—either the process
does not work as structured/designed
by management so the staff develop
a work-around, or the staff do not
know how to perform the process
correctly. Both causes are management’s responsibility to identify and
address. Measurements also are necessary to identify when processes are
not producing the desired results.
Measures of productivity, effectiveness and efficiency must become
tools used by frontline employees,
not the “quality nurse,” to evaluate
their processes and enhance efforts
to improve effectiveness and eliminate unnecessary work and waste.
Employee feedback to management
on how to further improve the
process is vital. This direct involvement fosters a work environment in
which employees actively seek to
improve processes when measures are
not within acceptable parameters.
Bringing It Home
Correctional health care will undergo this paradigm shift. Consider the
intake medical assessment. This key
activity is a horizontal system comprising multiple individual processes
and subprocesses that cross departments and functions. It is designed
to provide the desired result: an indepth, accurate medical assessment
of every newly arriving inmate. This
result includes the development of a
treatment plan, with requisite orders
and activities, to ensure high quality
care for acute and chronic conditions.
Other key medical systems include
sick call, infectious disease management and chronic care. Each system
and its subprocesses must be analyzed to identify gaps, delays, rework
and efficient flow. Employees who
perform the work, and those of other
disciplines, such as corrections officers, must take part in developing
the analysis and the processes.
Involvement of all staff, to include
security staff who control movement
and other activities, is needed for
appropriate analysis of each individual process to determine the “one
best way” to perform the process
that will consistently produce the
desired outcome in the most effective and efficient manner. The inclusion of those outside of “medical”
acknowledges both the interrelationships among process and the need to
analyze the effects of change of one
process on the other process(es).
Albert Einstein once said that we
cannot create solutions for today’s
problems if we remain embedded in
the thinking that created them. We
in correctional health care need to
focus on systems, not individuals, to
improve organizational effectiveness
and efficiency. Management must
use timely data (not retrospective
review data) to perform the daily and
periodic management oversight of
the processes in the key health care
activities. The organization must
implement a business management
system that is used daily by all managers and staff as part of “business
as usual” and not just for accreditation or regulatory reasons. On the
organizational chart, the “quality
nurse” designation must give way to
a systems excellence manager.
Health care still must hold people
accountable for their performance
but without blame. Errors will occur.
But we must build in both error prevention, to include failure mode,
effects analysis and mistake proofing
interventions, and methods for early
detection of significant variations.
As stated by Don Berwick, MD, of
the Institute for Healthcare Improvement, “All systems are perfectly
designed to achieve the results they
produce.” To change the ineffective
results of today’s quality management
efforts, we must change the way we
view “quality” and how we manage it.
It is time to discard the culture of
blame and make the paradigm shift
to systems excellence.
John M. Harrison, RN, BSN, MHSA,
is president of Healthcare Services
and Systems Excellence, Tucson, AZ.
He will present a session on this subject at NCCHC’s Updates conference
in May in Chicago. E-mail him at
johnmharrison@earthlink.net.
Letters . . . Letters . . . Letters . . . Letters
Pill-Splitting (part 1)
Kudos on the constantly improving
appearance and content that I have
noted in four years of receiving your
newspaper.
Reading Volume 17, Issue 4, however, I am concerned about a mixed
message. Page 11 states that medication errors can be reduced by following recommendations (“Medication
Errors”), while page 16 tells us that
splitting pills saves money (“Take a
Bite Out of Jail Rx Costs”). According
to evidence-based best practices, cutting pills is a cause of error. Further,
accurate dosing is difficult, there is
higher chance for contamination and
there often is significant waste.
Additionally, cutting pills might
violate prescribing laws that require
medication to be administered as prescribed, even by the nurse, let alone
by nonlicensed staff. Cutting pills is
actually dispensing and probably
should only legally be done by a pharmacist. Once that personnel cost is
factored in, there is no cost benefit.
I would not recommend that agencies try to cut costs by cutting pills.
Better, and certainly safer, to focus
on contractual issues with suppliers.
Kevin M. Hepler, MD, MBA
Medical Director, Pennsylvania Dept.
of Public Welfare, Office of Children,
Youth and Families, Harrisburg, PA
Note: Dr. Hepler’s remarks are his professional opinion rather than a policy
of the agency where he is employed.
Continued on page 20
WINTER 2004 • CorrectCare 3
CCHP News
Correctional MD Brings His Commitment to the Board
BY KRISTIN PRINS, MA
A quick look
through Joseph
Paris’ CV reveals
a rich and
diverse history.
First there’s that
list of credentials—PhD, MD,
CCHP, FSCP—
which signals
impressive academic and professional achievement.
Another thing that stands out is
his birthplace. Far from the peach
trees of Georgia, where he now lives,
Paris was born and raised in
Argentina. He came to the U.S. in
the 1960s for doctoral research in
biochemistry; he stayed to study
medicine at Boston University and
later start a family.
But it’s the newest item on the CV
that’s most exciting for the CCHP
program: his recent appointment to
the board of trustees. With nearly 20
years in correctional health care and
13 years as a CCHP, Paris is a strong
CCHP...
leader who is sure to prove invaluable to the board’s work.
Making a Difference
In 1985, after a few years of private
practice, Paris began consulting in
internal medicine at a large prison
hospital in Florida. “My correctional
initiation coincided with the availability of the first antiretroviral,
AZT,” he says. “I realized that I could
be much more useful to inmatepatients than to my former private
patients. There was a challenge and
an opportunity to make a huge difference in my new patients’ lives.”
Paris’ correctional initiation was
not an easy one, however. In an open
letter titled “What I Should Have
Said That Night—Thoughts on the
Armond Start Award,” published in
CorrDocs, the newsletter of the
Society of Correctional Physicians,
Paris writes, “If I had come prepared
with a list of those to thank… I
would have had to start with a nurse
in Florida who patiently corrected
my mistakes when, as a rookie in a
state prison, I made mistakes on
passes, medication administration
The next step in
your professional
advancement
The CCHP program, sponsored by the National
Commission on Correctional Health Care, is the only
national program to recognize the special knowledge
and skills required to provide health care in a prison,
jail or juvenile confinement facility.
The exams are given four times a year in a proctored setting. To receive an application, complete
and return this form.
For more information, call NCCHC at (773) 880-1460.
To apply online, visit www.ncchc.org.
Please send me information about the CCHP
program:
M
Address
Home
City
State
Phone
E-mail
Paris sees in certification both personal and professional improvement.
CCHPs can network with each other,
share concerns and tips, and demonstrate to themselves and others their
professionalism and dedication to
the cause of correctional health
care. “CCHP certification is about
inner satisfaction. It’s part of the
total professional package.” he says.
For Paris, the total package is a
multifaceted one. A medical/administrative track led him to his current
position as medical director of the
Georgia Department of Corrections.
His interest in systemic improvements to correctional medicine has
led to membership and leadership
roles with numerous boards, societies and committees. He has served
as president of the Florida chapter of
the American Correctional Health
Kristin Prins, MA, is the professional
service assistant at NCCHC.
F
As news of the CCHP program’s proctored test administration has gotten
around, many professionals have contacted us, concerned that they won’t
be able to participate in the exam if they can’t travel to a conference.
However, they need not worry: The CCHP Board of Trustees has established a plan to make the CCHP exam as accessible as it always has been.
The exam is offered at numerous dates and locations throughout the
year. In addition to test dates at the major annual NCCHC spring and fall
conferences, the exam will be offered at test centers across the country. If
you are interested in seeking certification but are located farther than a
two-hour driving distance from an established test center, the CCHP
Board of Trustees is committed to working with you to set up more convenient testing accommodations.
Below is a list of exam dates and locations. This list is updated on an
ongoing basis, so for the most current information, please contact us or
visit our Web site at www.ncchc.org.
CCHP Examination Schedule, 2004
Test Date
Site
Application Deadline
May 23
Chicago, IL
April 1
July 12
Las Vegas, NV
June 1
August 21
Castle Rock, CO
Orlando, FL
Chicago, IL
Lexington, KY
Westborough, MA
Portland, OR
Harrisburg, PA
Galveston, TX
July 1
October 20
Saratoga Springs, NY
September 1
November 14
New Orleans, LA
October 1
Work
Zip
Mail to: CCHP Board of Trustees
P.O. Box 11117 • Chicago, IL 60611
Fax to: (773) 880-2424
The Total Package
Services Association, is a founding
member and past president of the
Society of Correctional Physicians,
was appointed a founding member of
the editorial committee of Thrive
Magazine, serves on the Correctional
Medical Institute board, and is a
charter board member of the Correctional Medical Directors Association.
Paris also has a busy schedule publishing and presenting his work.
Asked what he hopes to achieve on
the CCHP board, Paris says his “most
cherished goal” is to help unite the
profession. “Correctional health care
workers need to labor towards a
common goal: to better the health
care of all incarcerated persons. But
we face myriad affiliations and professional organizations. More than
anything else, I want to be a healer
and a leader striving for a way to
reunite all of us.”
Professional goals aside, Paris also
has many personal interests and hobbies, including playing piano. With
commitments like his, one wonders
how he has time to pursue any of
them! But he makes time for what’s
important to him. For instance, he
finds that playing music at home
with his wife of 30 years, Mary Rose,
four children and friends is “a great
way to finish a good day.”
Proctored CCHP Test Heads to Your Region
CCHP… These four letters behind your name
identify you as a specialist in correctional health
care. Becoming a Certified Correctional Health
Professional is an achievement that demonstrates
dedication to your profession.
Name
processes and many other things
that I now take for granted.”
What Paris doesn’t take for granted is continual improvement in the
correctional health care field: He
knows firsthand what it takes to
make change happen. While he saw
that many of his colleagues were satisfied with the status quo, he instead
sought to improve procedure. “I was
happy devising better systems,
processes and policies to ensure that
every patient got his or her due.”
www.ncchc.org
In the News
Correctional Health Info Online
After a major overhaul, the CDC’s
correctional health Web site is better
than ever. Operated by the agency’s
National Center for HIV, STD and TB
Prevention, the site’s mission is “to
foster collaboration between public
health organizations and the criminal justice system” by serving as a
repository of correctional health care
information. The site has six major
sections, each with information and
resources from federal and nonfederal entities. The six sections: About
Correctional Health (introductory
material); Health Issues in Corrections (e.g, infectious disease, chronic
disease, women’s health); Special
Topics (e.g., reentry, substance
abuse); Key Tools (for health care
delivery system management); Get
Involved (listservers, policy statements, newsletters); and Links. Go
to www.cdc.gov/nchstp/od/cccwg.
of care while reducing cost. The
report identifies longstanding policy
barriers—legal, financial, regulatory,
organizational and process—and
suggests a framework for advancing
the adoption and application of telehealth technologies. Titled Innovation,
Demand and Investment in Telehealth, the report is posted online at
www.technology.gov/reports.htm.
ment (dubbed e-HIM), the American
Health Information Management
Association has issued best practice
guidance in six key areas, including
e-signatures, document management, core data sets and speech
recognition, and plans to develop
additional practice standards. The
guidance reports are available online
at www.ahima.org/infocenter/ehim.
Best Practices for Electronic Records
To further its goal of advancing electronic health information manage-
Latest Correctional Facility Census
The Bureau of Justice Statistics has
released its 2000 Census of State
and Federal Correctional Facilities.
Among the highlights:
• In the five years from midyear
1995 to midyear 2000, the number
of adult correctional facilities rose
14%, from 1,464 to 1,668.
• The number of privately operated
facilities under contract with state
or federal authorities to house
prisoners grew by 140% (to 264),
while the number of inmates in
these facilities rose 459%.
Find the report at www.ojp.usdoj.gov/
bjs/abstract/csfcf00.htm.
State Health Care Costs Outpace Budgets
From 1998 to 2001, state corrections
budgets grew 8% per year, on average, outpacing overall state budgets
by 3.7%. At the same time, correctional health care costs grew by 10%
per year, and made up 10% of all corrections expenditures. These figures
come from a recent TrendsAlert
report from the Council of State
Governments. Intended to educate
state officials about the problem of
health care costs, the report sheds
light on the factors driving costs
higher and presents policies and
practices to help them deal with it.
Among the policy options discussed
are inmate co-pay, telemedicine, privatization, early release, utilization
review, drug cost reductions, PPOs
and HMOs, and others. Find a link to
the report at www.csg.org/CSG/
Products/trends+alerts.
Sharps Safety Workbook
Just one accidental prick with a contaminated needle can cause a health
care worker to contract hepatitis, HIV
or other bloodborne diseases. Even if
disease is not transmitted, the exposure leads to costly prophylactic
measures and can take a huge emotional toll on the worker. To help
prevent such occurrences, the CDC
has developed a workbook to educate
health care personnel about steps
they can take to protect themselves.
The book also targets administrators
in its quest to foster a “culture of
safety.” Titled Sharps Safety: Be
Sharp. Be Safe, the book is available
online at www.cdc.gov/sharpssafety.
Unlocking Telehealth’s Potential
While noting that tens of thousands
of Americans now access health care
remotely from medically underserved
areas, including prisons, a report by
the U.S. Commerce Department’s
Office of Technology Policy also finds
that the nation has realized only a
fraction of the potential for the technology to improve access and quality
www.ncchc.org
Academy News
Lend a Hand and Reap the Benefits
Call for Volunteers
Participating on a committee of the
Academy of Correctional Health
Professionals is one of the best
opportunities for you to become
more involved in your profession. As
a committee member you will not
only help the growth of the organization, but also enhance your leadership skills and abilities; strengthen
your professional network; and establish new personal friendships that
will last a lifetime.
Committees provide member oversight of the programs and activities
of the Academy. Although each committee has its own charges and
responsibilities, each acts as a strategic entity of the full board. Members
are expected to participate fully in
the work of the committee; provide
thoughtful input to its deliberations;
focus on the best interests of the
Academy and the committee; and
work toward fulfilling the committee’s goals.
If you would like to be considered
for appointment to a committee,
please complete and submit the form
below to Academy headquarters by
fax, (773) 880-2424. You may also
access an online volunteer form at
www.correctionalhealth.org. If you
have more questions, please contact
us toll-free at (877) 549-2247.
Member Get a Member
Another way to help
advance the Academy—
enabling it to grow and,
thus, offer more benefits
and services for you—is
to participate in our
Member-Get-a-Member
campaign.
For each new member you
recruit, your name will be entered
into a raffle to win Academy Bucks,
which may be redeemed toward the
purchase of Academy or NCCHC
products such as publications as well
as conference registration fees.
Here’s how it works:
• You must be a current member of
the Academy to participate.
• Complete the Member-Get-aMember prospect form online at
www.correctionalhealth.org or, if
you prefer, call us at (877) 5492247 and we’ll send you a form.
• Your prospects will receive a membership kit and a letter that mentions your referral. We’ll send a
copy of the letter and application
to you. It’s your responsibility to
make sure your prospects
complete the application.
If your prospects ask why
they should consider joining, let them know about
the many benefits, such
as...
• Journal of Correctional
Health Care. Receive a free
subscription to this quarterly
publication with 400+ pages of
original research each year. Each
issue includes a self-study examination to earn continuing education
credit.
• Shared Interest Groups. These
small, focused gatherings and
online discussions foster education, information sharing and idea
exchange with your peers.
• Networking Opportunities. Share
ideas and resources with others in
the correctional health care field.
• Education and Publications.
Receive member discounts on Academy- or NCCHC-sponsored confer-
New Benefit for Members!
Future of issues of CorrectCare
will be available on the NCCHC
Web site. Academy members,
however, will continue to receive
printed copies of this important
publication in the mail.
Not a member? Join the
Academy today by filling out the
application card on the cover of
this issue (or use the one
below), or sign up online at the
Academy Web site. To ensure
uninterrupted service, send your
membership application today!
ences, seminars and publications.
• Web Site. The members-only section of our site offers access to an
online membership directory and
other features.
To receive credit for recruiting a
new member, we must receive your
prospect’s completed application
and membership dues no later than
October 1. To learn more about the
campaign, visit the Academy online
at www.correctionalhealth.org.
Academy Volunteer Request
Name
Member ID
Title
Organization
Address
City/State/Zip
Day Phone
Fax
E-mail
Please indicate on which committee(s) you would like to serve. If you
are interested in more than one committee, please rank your preference, with 1 being most interested and 4 being least interested.
____ Education
____ Membership and Recruitment
____ Mentoring
____ Shared Interest Groups
Please return this form to the
Academy of Correctional Health Professionals
via fax (773) 880-2424
or submit it online at
www.correctionalhealth.org
www.ncchc.org
Evidence-based Medicine
Antibiotics for Pharyngitis? Rethink Your Protocols
BY JEFFREY KELLER, MD
I
have practiced medicine for over
18 years and have gotten a lot of
CMEs over that time. The lectures
I enjoy most tend to be those exposing the myths of modern medical
practice. You know the ones that I
mean: These are the lectures comparing some common medical practice with the literature only to find
that the practice doesn’t work—
accepted wisdom about its efficacy is
a myth. Just prior to its lamentable
demise, the Western Journal of
Medicine had a regular series devoted to debunking medical myths.
Myth busting like this is part of the
overall movement toward evidencebased medicine, which, in a nutshell,
states that we should compare everything we do as doctors with the scientific evidence of its effectiveness.
When we do that, we will find there
is a solid base in the evidence for
only some of the things we do. Some
of our practices have inadequate support in research—nobody really
knows whether they are truly effective. And some of what we do is flat
out contradicted by the evidence.
Every year, important research
emerges that should make us change
the way we practice medicine. Too
often, however, we do not change.
We all know doctors who seem
frozen in time; practicing medicine
the way it was taught to them in
medical school and residency. We
ask ourselves, “Why is he still doing
that?” However, that doctor is most
of us. If we critically compare many
of our habits with the medical literature, we invariably will find that we
ourselves have habits we should
abandon.
Failure to change practice based
on new findings has been identified
by many sources as a major problem
with modern medicine. There is a
gap, sometimes of many years,
between what is known and what is
practiced. Over the years, some
information in medicine’s knowledge
base is verified, and some is refuted.
Whenever a new “fact” is added to
the overall medical knowledge base
through good and repeated research,
it usually takes many years until that
knowledge is incorporated into most
physicians’ practice.
Case in Point
Even a casual review of medical textbooks and the literature will bring to
light several well-demonstrated medical facts that are not widely reflected
in the practices of U.S. physicians.
One area getting a lot of press is
the overuse of antibiotics. We doctors still commonly prescribe antibiotics (and often very expensive
antibiotics) for viral illnesses such as
pharyngitis, bronchitis and sinusitis
despite the enormous amount of literature condemning the practice.
We all have heard about the emer-
www.ncchc.org
gence of resistant bacteria as a consequence of our national overprescription of antibiotics. We don’t so
often hear of another downside to
prescribing unneeded antibiotics—it
is expensive. In fact, most evidencebased medicine principles are like
that—if you adopt them, you will
save money. What could be better?
We provide better medical care to
our patients and save money to boot!
One great example is evidencebased treatment of pharyngitis, the
infamous “sore throat.” The subject
of literally hundreds of published
articles, this seems to be one of the
single most studied topics in medicine. Fortunately, the Centers for
Disease Control and Prevention in
Atlanta has published an excellent
review article along with recommendations that can serve as a basis for
your facility’s “sore throat protocol.”
Titled “Principles of Appropriate
Antibiotic Use for Acute Pharyngitis
in Adults,” the article was published
March 20, 2001, in the Annals of
Internal Medicine, along with similar
guidelines for the treatment of
sinusitis and bronchitis. (The articles
are available via the CDC Web site at
www.cdc.gov/drugresistance/
community/technical.htm.)
In the pharyngitis article, the CDC
makes the point that only about 10%
of sore throat cases are caused by
group A beta-hemolytic streptococcus (the so-called “strep throat”).
Almost all of the remaining 90% of
cases are viral in origin. Despite this,
75% of adults who present to a doctor with a sore throat will be prescribed antibiotics! What is the rate
of antibiotic prescriptions for sore
throat at your facility? It would be
worth the effort to pull the last 100
charts where the chief complaint was
sore throat and see how many of
these patients received antibiotics.
tures not be routinely performed.
This is important because many lab
facilities routinely follow up all rapid
strep screens, whether positive or
negative, with a $60 culture. Throat
cultures should be reserved for special circumstances, such as tracking
epidemic outbreaks of streptococcal
disease, or if there is a suspicion of
another bacterial pathogen, such as
gonococcus.
Finally, the antibiotic preferred by
the CDC for the treatment of strep
throat is plain penicillin. Not amoxicillin. Not Keflex. Definitely not
Augmentin! If the patient is penicillin allergic, erythromycin should
be used instead. This point is important enough to repeat: Do not use
expensive, broad-spectrum antibiotics to treat routine strep throat.
These guidelines do not apply to
complicated patients, such as those
who are immunocompromised or
those with other significant medical
problems, such as COPD or a history
of rheumatic fever. The guidelines
also assume the practitioner will
carefully exclude other serious
throat disorders, such as peritonsillar abscesses or epiglottitis. Still, at
my jail, the guidelines apply to over
95% of the patients who present to
our medical clinic with sore throat.
A Typical Patient
Here is how the guidelines apply to a
typical case. A healthy 35-year-old
male presents to the jail medical
clinic with a sore throat. His temperature is 97.6 F. He has large red tonsils but no exudate. He has 2+ tender anterior lymphadenopathy. He
has been coughing frequently.
Physical exam shows no evidence of
abscess or other complications. This
patient has only one of the CDC’s
four clinical criteria. According to
the CDC guidelines, he should not
have a rapid strep screen performed
nor a prescription for antibiotics.
Instead, he would be treated symptomatically with acetaminophen,
increased fluids and rest.
I encourage everyone to read the
CDC report. It is concise, well written and authoritative. The four basic
clinical criteria are easy to incorporate into a clinical decision model or
a flow chart for your facility. If your
facility adopts these guidelines, the
quality and consistency of your medical care for sore throat will improve
and your medical costs will fall.
Jeffrey Keller, MD, is president of
Badger Correctional Medicine, Idaho
Falls, ID. Reach him by e-mail at
badgermed@datawav.net.
Recommended Practice
The CDC recommends that antibiotics
be limited to those patients who are
most likely to have strep throat
based on four easily evaluated clinical findings: (1) tonsillar exudates,
(2) tender anterior cervical lymph
nodes, (3) fever and (4) absence of
cough. You then use these four criteria to determine who gets antibiotics
in one of the following ways:
1. If the patient has 0, 1 or 2 of the
criteria, no antibiotics should be prescribed. If a patient has 3 or 4 criteria, then antibiotic treatment may be
used. I prefer this strategy at my jail
because it does not require the use
of rapid strep screens, which cost $5
to $10 each.
2. If you prefer to use the rapid
strep test, the CDC recommends no
treatment for patients with 0 or 1
criterion, and rapid strep testing for
those with 2, 3 or 4 criteria. You
then treat those where the rapid
strep test comes back positive.
The CDC recommends throat cul-
Clinical Briefs
Prostate Cancer and Black Men
Prostate cancer is a leading cause of
death among African American men,
yet more than half of those surveyed
recently did not view themselves as
at risk of this disease. According to
the National Medical Association,
which sponsored the nationwide
study, some 5,300 African American
men died from prostate cancer in
2003, and more than 27,000 were
diagnosed with it. Compared to white
men, this population is diagnosed
with the disease at least 60% more,
and is more than twice as likely to
die of it, the report said. “Unfortunately, in the African American community there’s not enough of the
awareness that tends to lead to early
diagnosis. Knowing the risk factors
and symptoms, and getting screened
is an important start,” said Gerald
Hoke, MD, urology section chair of
the NMA. Find more information at
www.nmanet.org/pr_031804.htm.
Managing Viral Hepatitis Coinfection
The HCV-HIV International Panel has
issued a consensus statement on the
management of patients coinfected
with HIV and hepatitis C. Published
in the Jan. 2 issue of AIDS, the International AIDS Society journal, the
recommendations of the nine expert
panelists are based on review of the
latest literature on the “most relevant and currently conflicting topics” in this rapidly evolving area. The
article, “Care of Patients With
Hepatitis C and HIV Co-infection,”
is posted at www.medscape.com/
viewarticle/467365. The site also
features an interview with lead
author Vicente Soriano, MD, an
infectious disease expert and hepatologist, at www.medscape.com/
viewarticle/469674.
Syphilis on the Rise
After dropping throughout the 1990s
the number of confirmed cases of
primary and secondary syphilis in the
United States has risen each year
since 2000, reaching 7,082 in 2003,
according to data presented at the
National STD Prevention Conference
in Philadelphia in March and reported by Reuters Health. This is a 3.2%
increase over 2002. Further, the rate
per 100,000 people is now 2.5, compared to 2.1 in 2000. Men who have
sex with men account for some 60%
of the cases in 2003, say researchers
from the CDC. The resurgence in
that group is worrisome because
syphilis is linked with higher likelihood of HIV infection.
TB Cases Decline Slows
Tuberculosis cases in the U.S. fell by
1.9% in 2003 to 14,871, the smallest
annual drop since 1992, the CDC
reported in March. This compares to
an average 6.8% annual drop from
1993 to 2002. Despite the nationwide decline, rates did increase last
year in 19 states, including
California, New York and Texas.
Further, rates are four times higher
among the foreign-born population,
which now accounts for more than
half (53.3%) of the national case
total. Rates of multi-drug-resistant
TB also are higher among the foreign-born. Published in the March 19
issue of MMWR, the report notes disparities in rates among minority populations, and calls for “targeted
interventions for populations at high
risk,” among other measures. Find
the report at www.cdc.gov/mmwr/
preview/mmwrhtml/mm5310a2.htm.
Protocols to Confirm Rapid HIV Tests
If your facility is now using one of the
reactive rapid HIV tests approved by
the Food and Drug Administration
over a year ago, be sure to check out
the CDC’s protocols for confirmation
of these tests: www.cdc.gov/mmwr/
preview/mmwrhtml/mm5310a7.htm.
FDA Cautions About Antidepressants
While noting that “it is not yet
clear” whether antidepressants contribute to the emergence of suicidal
thinking and behavior, the FDA has
issued a caution about the need to
monitor patients on such drugs for
worsening depression and suicidal
thoughts and actions. Close monitoring is especially important at the
beginning of treatment or when
doses are changed. The action was
prompted by studies suggesting an
increased risk of suicidal tendencies
among youth taking antidepressants.
The agency has initiated an expert
review of behaviors reported in those
studies. It also has asked the makers
of 10 antidepressants to include
stronger warnings in product labeling. Learn more in an FDA Talk
Paper at www.fda.gov/bbs/topics/
answers/2004/ans01283.html.
Lit Review
The following articles pertinent to
correctional health care can be
found via the National Library of
Medicine’s PubMed search and
retrieval system at www.pubmed.gov.
• Treating Drug Using Prison
Inmates With Auricular Acupuncture; A Randomized Controlled
Trial; A.H. Berman, U. Lundberg,
A.L. Krook, C. Gyllenhammar;
Journal of Substance Abuse
Treatment; March.
• On the Role of Correctional
Officers in Prison Mental Health;
J.A. Dvoskin and E.M. Spiers; The
Psychiatric Quarterly, Spring.
www.ncchc.org
Facility Profile
Juveniles in Jails: Different Models, Similar Outcomes
BY JAIME SHIMKUS
I
ncreasingly, county jails are
responsible for housing juveniles.
In some cases it’s because the
juveniles are being adjudicated as
adults. In others, it’s simply the
structure that administrators think
best. Whatever the reason, providing
health care to juveniles in adult settings requires special considerations,
not the least of which is understanding how to apply NCCHC’s health
care standards.
In general the key to providing
adequate health care for youth confined in facilities primarily intended
for adults is to treat them as a “special needs” population, paying close
attention to guidance in the adult
standards that speaks to the needs of
adolescents (see box below).
That’s the approach taken at the
Wyandotte County Detention Center,
Kansas City, KS, which houses about
40 juveniles, primarily male, under
the same roof as but separate from
the adults. Although the adult and
juvenile units are under separate
administration, a single health care
team, employed by contractor
NaphCare, is responsible for provision of physical, mental and dental
health care for both sides.
Because of the need to segregate
the adult and youth populations, the
juvenile detention center, as it is
called, has its own nursing office to
handle routine medical needs, says
health services administrator Donna
McCurry, RN, NP. The designated
“juvenile nurse” is actually a dualpurpose position filled by a supervisory level nurse who moves between
the two sides.
When care is needed from a physician, psychiatrist, dentist or other
professional, again the provider visits
the juvenile detention center rather
than having the youth visit the adult
health office.
The health care team takes care to
meet the differing requirements for
youths vs. adults. For instance, while
health assessment for adults takes
place within 14 days, as specified by
jail standard J-E-04, the time frame
for youths is seven days, in keeping
with the juvenile standards.
Also, the clinicians have developed
individual treatment plans for each
youth, as required in jail standard JG-01 Special Needs Treatment Plans.
Two Groups of Youths
Sometimes the arrangement is more
complicated. In Stuart, Florida, for
example, the Martin County Jail
houses two distinct groups of juveniles in separate residences. A small
group of youths (usually about six or
eight) charged as adults lives in the
jail proper, though segregated from
the adult population. For accreditation survey purposes, the “jail” standards apply, rather than those for
juvenile facilities.
However, the sheriff’s department
also operates a military style boot
camp for about 80 males under age
18. Although the boot camp is within
the jail’s secure perimeter, it was not
included in the last jail survey (this
may change in the future) and
instead has followed standards for
health services in juvenile facilities.
Before the youths are sent to the
boot camp, which is under the jurisdiction of the Division of Juvenile
Justice, their health records are
reviewed to ensure that they are fit
for the program.
A single health services team,
employees of contractor Wexford
Health Sources, is responsible for
care of the jail inmates (adults and
youths) as well as the boot camp,
says health services administrator
Bernice Schuyler, RN. A nurse is
assigned to the boot camp 20 hours
per week, mornings from Monday
through Friday. Due to staff turnover
Schuyler is handling boot camp
duties at present.
Jail nurses cover the boot camp at
other times, distributing medications
and responding to emergencies.
Likewise, the physician, dentist and
mental health professionals visit the
boot camp as needed, sending the
youth off-site for treatment when
necessary (e.g., for dental care).
Different Needs
Besides being attuned to the standards that apply to youth, the two
health services administrators note
differences in the youths’ health care
issues and needs. For instance, at
booking the correctional staff are
trained to pay attention to bruises,
says Schuyler. At McCurry’s jail, the
youth receive quite a bit more time
from mental health professionals. At
both jails, the youths’ diets reflect
their greater nutritional needs.
Yet other issues emerge at the
boot camp. Because of the strenuous
regimen, athletic type injuries are
more common. Even so, the youths
don’t complain much, says Schuyler,
adding that “Sometimes I’ll go down
just to say hello.”
NCCHC Guidance on Youth in Adult Institutions
When the NCCHC standards revision task force tackled the standards for
health services in prisons and jails, the group took care to address the distinct needs of juveniles housed in adult facilities. Interspersed throughout
both versions of the standards are comments about issues such as nutrition and medical diets, exercise, special needs treatment plans, intoxication and withdrawal, pregnancy and sexual assault.
In addition, the 2003 editions of the adult standards contain a useful
appendix, Treating Adolescents in Adult Correctional Facilities, that
addresses substance use, assessment of physical and mental health, consent and confidentiality, general health, healthy living and more.
Additional guidance is provided in the NCCHC position statement titled
Health Services to Adolescents in Adult Correctional Facilities, which provides background on the matter as well as recommendations for adult
facilities that house juveniles.
www.ncchc.org
Anxiety Management Takes the Pain Out of Dental Care
BY SUSAN RUSTVOLD, DMD, MS
Jenny sat in the dental office only
because the nurses insisted at her
intake physical exam that she do so.
She had entered the state corrections
system taking antibiotics and NSAIDs
prescribed in the county jail to treat
several necrotic teeth and abscesses.
She had a history of methamphetamine use that had contributed to
widespread severe dental decay. She
also acknowledged that a high level of
dental anxiety had caused her to
avoid dental treatment in the past.
Dental anxiety is common among
Americans, with about half experiencing at least moderate anxiety and
10% in the “severe” category. Among
prison inmates, however, the rate of
severe anxiety soars, reaching 80%
for women in Oregon prisons,
according to an informal review of
that population.
It makes perfect sense: Patients
who report high dental anxiety
describe a sense of personal space
infringement while in a prone and
vulnerable position, unable to communicate orally while an authority
figure with sharp metal instruments
hovers above inflicting discomfort
and lecturing about dental hygiene.
Nearly all dental phobia stems
from traumatic experiences such as
not being listened to in the dental
chair, especially if not numb enough;
being pushed around psychologically;
and being given no control over the
experience.
Stressful enough in the general
population, such circumstances are
even more upsetting for inmates and
especially female inmates, many of
whom have a history of physical or
sexual abuse. In fact, recent studies
confirm a connection between such
history and extreme dental anxiety.
Such intense anxiety has negative
consequences. Patients are more
likely to miss appointments, and if
they do show up, they are tense and
difficult to treat, taking up to 20%
more chair time. They have negative
attitudes about dentistry and convey
these attitudes in and out of the dental office. Incidentally, the dental
staff absorb some of this stress and
negativity.
More detrimental, phobic patients
may self-medicate with marijuana,
narcotics or other substances to deal
with their dental pain or with the
appointment itself.
This leads to a vicious cycle given
that current and recovering substance abusers are likely to have
severe dental disease. Abuse of drugs
such as methamphetamine, cocaine,
tobacco and opiates causes
decreased saliva production, and is
often associated with high sugar
intake, poor oral hygiene and high
Journal of Correctional Health Care
John R. Miles, Editor
The Official Journal of the
National Commission on Correctional Health Care
The Journal of Correctional Health Care is the only national, peer-reviewed scientific
journal to address correctional health care topics. Published quarterly under the direction
of editor John R. Miles, the Journal features original research, case studies, best practices, literature reviews and more to keep correctional health care professionals up-todate on trends and developments important to their field. Among the topics addressed in
past issues: end-of-life care, clinical guidelines, health services administration, personnel
and staffing, ethical issues, support services, medical records, quality improvement, risk
management and medical-legal issues.
Continuing education credits are available through a self-study exam in each issue.
Individual $60
Institutional $130
U.S. subscriptions
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incidence of caries and periodontal
disease.
Measuring Anxiety
Models of human conditioning tell us
that things learned in times of
intense emotion are profoundly felt
and difficult to “unlearn” without
dealing with that gut-level feeling.
But to manage gut-level phobia, it
first has to be recognized, and that’s
where dentists sometimes come up
short. Studies have shown that
trained observers, including dentists,
failed to recognize high anxiety in
patients more than 50% of the time.
Fortunately, a number of tools
exist that can help them to gauge
their patients’ anxiety. These include
patient questionnaires, the Dental
Anxiety Scale (DAS) and the Dental
Concerns Assessment (DCA) (see
citations below).
These tools produce reliable
results. Used alone, simple patient
questioning and the DAS each have
about 80% accuracy, and this figure
increases when both are used together. They also are easy to use. The
DCA, for example, takes 5 to 10 minutes to do, while the DAS can be
completed in about a minute.
Use of these standardized instruments not only quantifies the
patients’ anxiety, it also opens the
door to discussion about it. In some
cases, that’s all that is needed to
temper their anxiety.
Jenny and I agreed that this would be
a get-acquainted appointment. She
was asked to complete two written
instruments, the Dental Anxiety Scale
and the Dental Concerns Assessment.
We then discussed her responses to
these questionnaires.
As we talked about her anxiety, I
asked Jenny what she had been doing
about the pain, and she replied sheepishly, “That’s why I’m here.” She had
been seeking Vicodin through illegal
means to relieve her intense dental
pain. Finally, she felt comfortable
enough and reassured to agree to
return to have the three necrotic teeth
removed.
Managing Anxiety
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Not every case of dental anxiety is so
easily resolved, however. When more
concrete anxiety management is
needed, relaxation training may be a
useful approach. This encompasses
behavioral techniques such as controlled abdominal breathing (slow
and deep); meditation, suggestive
relaxation therapy or self-hypnosis;
and biofeedback. Environmental
comfort can be enhanced by providing a neck pillow and music or relaxation recordings.
This will have a soothing effect on
autonomic nervous system pathways
by lowering heart rate, pulse, adrenalin levels and breathing rate while
improving blood flow to the body surface and to the digestive tract.
Another approach, known as cognitive restructuring training, aims to
help patients identify and correct
errors in thinking that generate anxiety and depression.
If necessary, anxiety can be managed pharmacologically. Drugs that
might be appropriate for this purpose include Vistaril, Buspar, benzodiasepines such as Triazolam and
Valium, and antidepressants such as
Zoloft and Trazodone.
For patients who suffer from the
highest levels of anxiety/phobia (a
score of 15 to 20 on the 20-point
Dental Anxiety Scale), even medications might not suffice. In 2% to 3%
of cases the help of a mental health
therapist might be required. This is
seen most often when the patient
cannot or will not talk about the
fear, is extremely difficult or hostile,
has unmanaged panic attacks or anxiety disorder, or has a history of
abuse.
Respect and Empathy
It’s important not to blame the victim. After all, many people who suffer from anxiety then become anxious about being anxious! Instead,
dentists should recognize their own
role in causing dental anxiety.
It is imperative that dentists
believe patients who say they are not
numb, and that dentists be resourceful and skillful in administering supplemental local anesthesia injections, particularly of the mandible.
Further, by using the dental anxiety instruments, which enable
patients to articulate their fears, and
by treating them with respect and
empathy, allowing a measure of control, we can facilitate their learning
coping skills that will continue after
their release.
Bettina sent a standard inmate
request form to the dentist stating
that a tooth had fractured. She was
called to the clinic for an evaluation a
few days later, and we had time to fill
the fractured tooth with a silver amalgam overlay. Bettina mentioned that
she would be released soon and had
feared that the tooth might have
become painful had we not restored
it. She also said she had worried that,
to treat the pain, she might have
relapsed in her recovery from heroin.
As she left the clinic, she thanked us.
Citations
• Dental Anxiety Scale-Revised (DASR): Corah, 1969
• Dental Concerns Assessment:
Clarke, 1993, revised 1998
Susan Rustvold, DMD, MS, is a dentist with the Oregon Department of
Corrections; she formerly chaired a
university department of behavioral
sciences. This article is adapted from
her presentation at the National
Conference on Correctional Health
Care last October in Austin. Reach
her by e-mail at srustvo@pdx.edu.
Rustvold has prepared two supplemental documents on this subject;
they are posted on the NCCHC Web
site at www.ncchc.org/pubs/
correctcare.html.
www.ncchc.org
Newest Group of CCHPs Makes History
Congratulations to the newest class of 330 CCHPs, which represents the
largest group to take the certification test in the program’s history. That number may be staggering, but, given the value of professional certification, it’s
not surprising, says Peter C. Ober, PA-D, JD, CCHP, chair of the CCHP Board
of Trustees. “Each of these CCHPs now has a better understanding of the complexities of correctional medicine, correctional standards and the philosophy
and mission of NCCHC.” But certification doesn’t benefit CCHPs alone, he
adds. “Now they’ll take what they’ve learned back to the field. This many new
Alabama
Johnny E. Bates, MD, CCHP
NaphCare
Hamilton
Arizona
Janice Bray, MD, CCHP
Maricopa County Correctional Health
Services
Phoenix
David P. Hernandez, RN, BSN, CCHP
Services
Phoenix
Theodore B. Jolley, CCHP
Arizona Department of Corrections
Tucson
William Kesler, RN, CCHP
Marana Community Correctional
Treatment Facility
Tucson
Allan L. Noble, DDS, CCHP
Correctional Health Services
Avondale
Lujuana A. Gresham, RN, CCHP
West Valley Juvenile Hall
Fontana
Brenda J. Hastie Wilson, RN, CCHP
Camp Erwin Owen Juvenile Correctional
Facility
Kernville
Sharon Jaques, BSN, PHN, CCHP
Central Valley Juvenile Detention and
Assessment Center
Hesperia
Terry M. Masarik, LPN, CCHP
Arapahoe County Sheriff’s Office
Centennial
Cynthia Lose, PsyD, CCHP
Taft Correctional Institution
Taft
Laura L. Scheufele, RN, CCHP
Adams County Detention Facility
Broomfield
Lucinda M. McGill, MSN, CCHP
California Department of Corrections
Roseville
Connecticut
John F. Chapman, PsyD, CCHP
State of Connecticut Judicial Branch
Wethersfield
Joan M. Moldovan, RN, CCHP
Central Valley Juvenile Detention Center
Chino Hills
Lawrence A. Willis, RN, MS, CCHP
Tucson
Marion Molhook, RN, CCHP
James G. Bowles Juvenile Hall
Bakersfield
California
Jonathan E. Akanno, MD, CCHP
Wasco State Prison – RC
Bakersfield
Raymond Monarque, RN, CCHP
Chino
Stephanie Carter, RN, CCHP
Central Juvenile Hall – San Bernardino
County
Apple Valley
Divina D. Del Rosario, RN, CCHP
Juvenile Correctional Facility
Bakersfield
Brenda Epperly, RN, BSN, CCHP
Sacramento
Janice Felix, RN, CCHP
Phelan
Linda Felix, RN, BSN, CCHP
LA County Juvenile Court Health Services
El Monte
Edwin J. Franasiak, PhD, CCHP
Riverside County
Palm Springs
www.ncchc.org
Carl Wolf, MD, CCHP
Davis
Fatmata N. Longstreth, RN, CCHP
Martinez Detention Facility
Discovery Bay
Helena Ratliff, RN, CCHP
Tucson
Kimberly J. Brocklehurst, RN, CCHP
Rancho Murieta
Dwight W. Winslow, MD, CCHP
Pelican Bay State Prison
Smith River
Colorado
Raye Nell Highland, RN, BSN, CCHP
Douglas County Justice Center
Castle Rock
Bernard W. Miller, RN, CCHP
Martinez Detention Facility
Oakley
Fernanda A. Brennan, RN, CCHP
Yuba City
Alicia R. Wilson, BSN, CCHP
West Valley Juvenile Detention &
Assessment Facility
San Bernardino
Bariasa C. Kanabolo, RN, CCHP
Riverside
Radha Ramamrutham, MD, CCHP
Services
Phoenix
Scott T. Anderson, MD, PhD, CCHP
Fairfield
ambassadors can only have a strong positive impact on correctional medicine.”
The benefits of becoming certified are many, but most CCHPs accept the
challenge for more intangible reasons. According to new CCHP Janice Bray,
MD, “I had years of experience in legal psychiatry, but no direct jail psychiatric
work experience. CCHP was fantastic in allowing me the accurate perspectives
and guidelines that I needed to approach my job with confidence. The test
experience was very productive. I enjoyed every hour spent on completing the
exam. It was personally and professionally gratifying!”
Elena C. O’Mary, RN, CCHP
Contra Costa Health Services
Vallejo
Lydia Ortiz, RN, CCHP
San Bernardino County Department of
Probation
Redlands
Carlos A. Peace, RN, CCHP
Central Juvenile Detention & Assessment
Center
Loma Linda
Richard W. Saxton, MD, CCHP
Juvenile Justice Institutions Mental Health
Team
Sacramento
Kathleen Shumway, RN, CCHP
Central Juvenile Hall San Bernardino
Colton
Acel K. Thacker, MA, CCHP
Pelican Bay State Prison, California DOC
Crescent City
Johnnie H. Toole, RN, CCHP
San Bernardino County Probation – CJH
San Bernardino
Irene Mary Weir, RN, CCHP
San Bernardino County Juvenile Hall
Riverside
Nancy M. Whittier, RN, CCHP
Kern Medical Center
Tehachapi
Kathy L. Coleman, RN, MS, CCHP
University of Connecticut Health Center
Farmington
Michael C. DeSena, BSN, RN, CCHP
New Haven Community Correctional Center
Cheshire
Judith P. Robbins, LCSW, JD, CCHP
Yale Medical School
Hamden
Constance Weiskopf, PhD, CCHP
University of Connecticut Health Center
Farmington
Florida
Patricia Ameen, LPN, CCHP
Pinellas County Sheriff’s Office
Clearwater
Janina A. Branch, MHC, CCHP
South Florida Reception Center
Lauderhill
John R. Caruso, DO, CCHP
Highlands County Sheriff’s Office
Sebring
Debra R. Coon, RN, CCHP
Dunedin
Collean M. D’Acquisto, RN, CCHP
Lake County Sheriff Corrections Bureau
Tavares
Yvonne Fraddosio, RN, CCHP
Pinellas County Jail
Dunedin
Karin P. Godwin, RN, CCHP
Halifax Medical Center
Port Orange
Philip Hanna, PM, CCHP
Volusia County Branch Jail
Port Orange
Ethel E. Hines-Wright, LPN, CCHP
St. Petersburg
Mary Huffmaster, RN, CCHP
Astor
Joy U. Iwenofu, LPN, CCHP
Volusia County Corrections
Ormond Beach
Virginia King, RN, CCHP
Halifax Medical Center – Volusia County
Corrections
Edgewater
Katherine Frances Lupton, RN, CCHP
Daytona Beach
Antoinette G. Maglione, RN, CCHP
St. Petersburg
Alan Mansfield, MEd, CCHP
Dayton Beach
Karen Flor McBride, RN, CCHP
Clearwater
Yolanda Migrino, MSN, ARNP, CCHP
Jackson Health System
Weston
Onyewuchi E. Nkwocha, MSc, CCHP
Sumter Correctional Institution
Inverness
Marc Garcia Pierre-Louis, RN, CCHP
Osceola County Jail
Kissimmee
Susan J. Pischetola-Medina, LPN, CCHP
First Step Adolescent Services Inc.
Orlando
Joyce Ragland, LPN, CCHP
Spring Hill
Kathleen Roberts, LPN, CCHP
Debary
Michael L. Robinson, RN, CCHP
Clearwater
Alan W. Rodgers, RN, CCHP
Palm Coast
Connie J. Russell, RN, CCHP
St. Petersburg
Catherine Y. Terzian, LPN, CCHP
St. Petersburg
Loretha D. Tolbert-Rich, BSN, CCHP
Florida Department of Corrections,
Region III
Ocala
Georgia
Gregory James Bennett, RN, CCHP
Ware State Prison
Waycross
Pamela D. Burnette, RN, CCHP
Georgia Correctional Health Care
Pineview
NEW CCHPS
(continued from page 11)
Kimberly K. Griffin, PA-C, MMSC, CCHP
Whitfield County Correctional Center
Dalton
Patricia L. Outlaw-Clay, RN, CCHP
Cermak Health Services of Cook County
Chicago
Cheryl A. Haas, RN, CCHP
Augusta
Jeanene Payne, BSN, CCHP
McLean County Detention Facility
Lexington
Karen Johnson, RN, CCHP
Hampton
Maryland
Tracie Bourque, RN, CCHP
Montgomery County Correctional Facility
Rockville
Arthur S. Keiper III, MD, CCHP
Boonville Correctional Center
Columbia
Douglas A. Mack, MD, MPH, CCHP
Bethesda
Dana D. Meyer, RN, CCHP
Correctional Medical Services
Bowling Green
Frederick D. Quinn, MS, MJ, CCHP
Cook County Juvenile Temporary Detention
Chicago
Michael T. May, RN, MSN, CCHP
Montgomery County Detention Center
Fort Meade
William J. Miller, CCHP
St. Peters
Terry L. Lovette, RN, CCHP
Macon State Prison
Andersonville
Bruce Sloan, DDS, CCHP
DuPage County Jail
Carol Stream
Donna Plante, RN, CCHP
Eastern Correctional Institution
Salisbury
Carol A. Speers, RN, CCHP
O’Fallon
Deborah McCray, RN, CCHP
Rogers State Prison
Collins
Karen L. Stocke, LPN, CCHP
Advanced Correctional Healthcare
Peoria
Jennifer A. Walters, CCHP
St. Louis
Iris T. Oberry, RN C, CCHP
Cochran
Venkata A. Vallury, MD, CCHP
Cook County Juvenile Detention Center
Chicago
William H. Ruby, DO, CCHP
Maryland Department of Public Safety &
Correctional Services
Towson
Hawaii
Eva M. Fischer, RN, CCHP
Women’s Community Correctional Center
Kailua
Indiana
Barbara Howe, RN, CCHP
South Bend Juvenile Correctional Facility
New Carlisle
Winona L. Kauwe, RN, CCHP
Waimanalo
Julie A. Johnson, RN, BSN, CCHP
South Bend Juvenile Correctional Facility
South Bend
Abigail Medrano, RN, BSN, MSN, CCHP
Kailua
Julie A. Miller, CCHP
Camp Summit Boot Camp
LaPorte
Idaho
Steven Garrett, MD, CCHP
Idaho Correctional Center – CCA
Boise
M. Susan Pendergrass, RN C, CCHP
Fort Wayne Juvenile Correctional Facility
Fort Wayne
Maine
Lisa Davis, RN, CCHP
Kendus Keag
Patricia J. Hennessey, RN, CCHP
Downeast Correctional Facility
Marshfield
Tania L. Robert, CCHP
Mountain View Youth Development Center
Charleston
Michigan
Margaret Hudson-Collins, MD, CCHP
Wayne County Jail
Gross Point Park
Gwen D. Lanser, MSN, CCHP
Kent County Correctional Facility
Grand Rapids
Arthur J. Lee, MA, CCHP
Idaho Correctional Center
Boise
Kansas
Judy A. Fields, MSN, CCHP
Sedgwick County Detention Facility
Andover
Jeffrey A. Scharf, RN, CCHP
Idaho Correctional Center – CCA
Boise
Stephen A. Fields, DO, CCHP
Sedgwick County Detention Facility
Witchita
Lillian J. Wilcox, RN, CCHP
Idaho Correctional Center
Nampa
E. Marie Frost, LMSW, CCHP
Comprehensive Counseling/Consultation UC
Salina
Illinois
Misty Clemens, MA, CCHP
St. Louis City Justice Center
Belleville
Janet L. Myers, BSN, CCHP
Hutchinson Correctional Facility
Hutchinson
Nasim A. Yacob, MD, CCHP
Kent County Correctional Facility
Holland
Tamara J. Cox, MPA, CCHP
CDC/Chicago Department of Public Health
Chicago
Kentucky
Larry D. Chandler, MS, CCHP
Luther Luckett Correctional Complex
LaGrange
Missouri
Rhonda Almanza, RN, BSN, CCHP
Jefferson City
Michelle M. Devito, BSN, CCHP
Homer Glen
Judy F. Rose, BSN, CCHP
Department of Juvenile Justice
Louisville
Gale E. Bailey, RN, CCHP
Moberly Correctional Center
Moberly
Raymond A. Ige, BSN, CCHP
Matteson
John D. Tarrant, DMD, CCHP
Kentucky Department of Corrections
Lexington
Thomas A. Baker, MD, CCHP
Jefferson City
Carla L. Jenkins, RN, CCHP
Chicago
Ulises Vargas, CCHP
USP Big Sandy
Paintsville
Christine Gavett, OD, CCHP
Harrisburg
Raj K. Khurana, MD, CCHP
Lake County Jail
Chicago
Louisiana
Charlene G. Cormier, LPN, CCHP
Lafayette Parish Correctional Center
Lafayette
Robert Marshall Hampton, MD, CCHP
Columbia
Jean Kiriazes, RN, MPA, CCHP
Chicago
Debra A. Minniefield, RN, CCHP
Chicago
Doris A. Monroe, RDH, CCHP
Chicago
Dorothy W. Murphy, MSN, CCHP
Chicago
Ricardo A. Escobar, MA, CCHP
Orleans Parish Criminal Sheriff’s Office
Slidell
Pier Jackson, RPh, CCHP
Jefferson Parish Correctional Center
New Orleans
Massachussetts
Geraldine Crisman, RN, CCHP
University of Massachusetts Medical School
East Bridgewater
Valerie Molinaro, OD, CCHP
Massachusetts Department of Corrections
Pocasset
Hubert Filippi Williams, BS, CCHP
St. Louis
Mississippi
Lazada Dodson, RN, CCHP
Central Mississippi Correctional Facility
Byram
Beverly J. Overton, RN, MSN, CCHP
Corrections Corporation of America
Clarksdale
Montana
Laura Patricia Janes, RN, CCHP
Montana State Prison
Deer Lodge
Tanya Wilkerson, RN, CCHP
Montana State Prison
Deer Lodge
Elizabeth W. Patterson, RN, CCHP
Wayne County Jail
Detroit
North Carolina
Paula Y. Smith, MD, CCHP
North Carolina Department of Correction
Cary
Bens J. Sandaire, DO, CCHP
Wayne County Jail
Bloomfield Hills
Richard A. Walters, MSN, ANP, CCHP
Craven Correctional Institution
Greenville
Doris Patricia VanVuren, AND, BA, CCHP
Livonia
New Jersey
Christina S. Bauer, LPN, CCHP
Ocean County Department of Corrections
Toms River
Karen Jacobi, RN, CCHP
Awxvasse
Kari Ann Jean-Gilles, CCHP
St. Louis
Adrienne D. Johnson, RN, CCHP
Missouri Department of Corrections
Jefferson City
Linda S. Johnston, BS, CCHP
Ballwin
Marian Bibby, RN, CCHP
Monmouth County Correctional Institution
Farmingdale
Rosario C. Buscar, BSN, RN, CCHP
Correctional Medical Services at Northern
State Prison
Jersey City
Etta M. Caldwell, LPN, CCHP
Monmouth County Youth Detention Center
Freehold
Christine Devaney, RN, CCHP
Freehold
Deborah Franzoso, LPN, CCHP
Ocean County Jail
Toms River
Bernice M. Frinch, MSW, CCHP
Northern State Prison
Somerset
Michelle Gaito, MA, CCHP
Howell
Gayle Ingenito, RN, CCHP
Brick
Joann F. Loppe, RN, CCHP
Hillsborough
Shirley Ousley, RN, CCHP
Freehold
www.ncchc.org
NEW CCHPS
Alice M. Rosenwald, RN, CCHP
Roselle
Mark E. Gebhart, MD, CCHP
Madison Correctional Institution
Dayton
Kathie Graves, RN, CCHP
Tillamook County Corrections
Tillamook
Ileana Hiraldo-Landrau, MPA, CCHP
Correctional Health Program
Carolina
Stanley Schiff, DO, CCHP
University of Medicine & Dentistry – School
of Osteopathic Medicine
Stratford
Sandra D. Gleason, LPN, CCHP
Greene County Sheriff’s Office
Xenia
Cindy L. Harding, RN, CCHP
Marion County Sheriff’s Office
Salem
Argelio A. Lopez-Roca, MD, CCHP
Ramsay Youth Services Puerto Rico
San Juan
Karen M. Hall, RN, CCHP
Xenia
J. Diane Jennings, LPN, CCHP
Coffee Creek Correctional Facility
Salem
Joselin Martinez-Cruz, MD, CCHP
Correctional Health Program
Bayamon
Cynthia Holland-Hall, MD, MPH, CCHP
Franklin County Juvenile Detention Center
Columbus
D. Herr Lane, BSN, CCHP
Deschutes County Adult Jail
LaPine
Terry A. Hopkins, RN, CCHP
Ohio Department of Rehabilitation and
Correction
Washington Court House
Barbara E. Lieuallen, BSN, CCHP
Multnomah County Detention Center
Portland
Carmen A. Vazquez Ortiz, MD, CCHP
Bayamon Juvenile Detention Center –
Ramsay
Rio Pedras
Jean Solomine, RN, CCHP
Rahway
Thomas A. Sparber, MSW, CCHP
Scotch Plains
Myra Zapata, RN, BSN, CCHP
Jersey City
New Mexico
Katherine Armijo, LPN, CCHP
Guadalupe County Correctional Facility
Santa Rosa
John Hamilton, RN, CCHP
Bernalillo County Metropolitan Detention
Center
Albuquerque
Robert O. Krammer, RN, CCHP
Bernalillo County Metropolitan Detention
Center
Albuquerque
Kenneth J. Lundwall, RN, CCHP
Groveport
Mona C. Parks, RN, CCHP
Southern Ohio Correctional Facility
Lucasville
Tracey E. Powell, BSN, CCHP
Columbus
Lucinda B. Rees, RN, MBA, CCHP
Madison Correctional Institution
Circleville
Lynne Maynock, RN, CCHP
Tillamook County Corrections
Tillamook
Marcia E. Stone, RN, CCHP
Deschutes County Correctional Facility
Bend
Betty L. Wade, LPN, CCHP
Linn County Sheriff’s Office
Albany
Betty J. Wilson, CCHP
Snake River Correctional Institution
Ontario
Debbie Winn, RN, CCHP
Rogue Valley Youth Correctional Facility
Grants Pass
Toy Long, RN, CCHP
Lea County Correctional Facility/Addus
HealthCare
Lovington
Barbara Valentie, RN, CCHP
Xenia
Carol Sullivan, PhD, CCHP
Metropolitan Detention Center
Albuquerque
Jose Ventosa, MD, CCHP
Noble Correctional Institution
North Canton
Pennsylvania
Nancy Albus, RN, CCHP
Northampton County Prison
Easton
Nevada
Annie Y. Wilson, MSW, CCHP
Clark County Detention Center/Prison
Health Services
Las Vegas
Carol Walters, RN, CCHP
Multi-County Juvenile Attention System
Bolivar
Donna L. Beeler, RN, CCHP
State Correctional Institution Smithfield
Huntingdon
Darlene J. Webster, RN, CCHP
Multi-County Juvenile Attention Center
Canton
Stanley T. Bohinski, DO, CCHP
Dallas State Correctional Institute
Wilkes-Barre
Oklahoma
Anna Evanchyk-Wright, CCHP
Oklahoma County Detention Center
Oklahoma City
Mary Cook, RN, CCHP
PrimeCare Medical
Clarks Summit
New York
Frances J. Broadnax, RN, MPH, CCHP
Vernon C. Bain Correctional Facility
Jamaica
John S. Gary Jr., RN, BSN, CCHP
ICE Medical Facility
Long Beach
Evelina L. Kahn-Kapp, MD, CCHP
Suffolk County Correctional Facility
Riverhead
Edith H. Mans, RN, CCHP
Onondaga County Justice Center
Skaneateles
Jamie R. Seligman, MSW, CCHP
INS Medical Facility
Jamaica
Hal Smith, MPS, CCHP
Central New York Psychiatric Center
Marcy
Ohio
Mitzi Bartee, RN, CCHP
MonDay Community Correctional Institution
Dayton
Roseanna Clagg, ASN, CCHP
Southern Ohio Correctional Facility
Wheelersburg
Lisa M. DeLuca, LPN, CCHP
Bedford Heights Correctional Facility
Bedford Heights
Christine Dubber, RN, MBA, CCHP
Cuyahoga County Correction Center
Cleveland
Robert Scott Fitzgerald, RN, CCHP
Xenia
www.ncchc.org
William R. Holcomb, DO, MPH, CCHP
Joseph Harp Correctional Center
Chickasha
Ritha McCarlson, LPN, CCHP
Edmond
Debra J. Smith, RN, CCHP
Oklahoma City
Suzzie Waldenville, MS, PA-C, CCHP
Edmond
Linda Woodside Tucker, RN, CCHP
Oklahoma City
Oregon
Jeannie Chesney, MSN, CCHP
Multnomah County Corrections Health
Portland
Ian R. Duncan, DO, CCHP
Oregon Department of Corrections at
Snake River Correctional Institution
Ontario
Sherry S. Eckstein, LPN, CCHP
Linn County Sheriff’s Office
Albany
H. Joe Giblin, RN, CCHP
Oregon State Penitentiary
Keizer
Pamela D. Hoffmann, RN, CCHP
Pennsylvania Department of Corrections
Altoona
John M. Kerr, JD, CCHP
PrimeCare Medical
New Cumberland
Kelly A. Rhoads, LPN, CCHP
Berks County Prison
West Lawn
Susan Shaffer, LPN, CCHP
Pike County Correctional Facility
Honesdale
Susan M. Spingler-Onal, RN, CCHP
New Jersey State Prison Correctional
Medical Services
Bristol
Steven M. Wacha, BSN, CCHP
Division of Immigration Health Services
Manchester
Theresa Adyseh Warner, RN, BSN, CCHP
State Correctional Institution of Pittsburgh
Monaca
Jacinta Wood, DO, CCHP
Cross Roads Counseling
Danville
Puerto Rico
Carmen N. Garcia-Oller, MA, CCHP
Ramsay Youth Services
San Juan
Rhode Island
Fredric C. Friedman, EdD, CCHP
Rhode Island Department of Corrections
Cranston
Pauline Marcussen, RHIA, CCHP
Rhode Island Department of Corrections
Cranston
Joseph V. Penn, MD, CCHP
Rhode Island Training School
Cranston
Tennessee
Elizabeth A. Beyer, RN, CCHP
Corrections Corporation of America
Charlotte
Sue Chafin, FNP, CCHP
Northeast Correctional Complex
Mountain City
Mary Jo Cheuvront, BSN, CCHP
Prison Health Services
Nashville
Norman C. Crawford, MBA, CCHP
Davidson County Sheriff’s Office
Pleasant View
Sandra K. Hodge, LPN, CCHP
Mountain City
Steven W. Pharris, MSW, CCHP
Metro Public Health Department
Smyrna
Diane M. Poe, RN, MPA, CCHP
Mountain City
Laura Quinn-Marquardt, MA, CCHP
Nashville
Catherine P. Seigenthaler, BSN, CCHP
Metropolitan Public Health Department
Goodlettsville
Donna M. Smith, LPN, CCHP
Mountain City
Melinda K. Stephens, RN, CCHP
Springfield
Sherry Good Street, LPN, CCHP
Mountain City
Patricia A. C. Widener, LPN, CCHP
Mountain City
Texas
David C. Albert, DDS, CCHP
Correctional Health Care Services
San Antonio
Daniel B. Berman, RN, CCHP
MHMRA of Harris County Jail
Houston
Melanie Calder, LVN, CCHP
Wackenhurt Corrections Corp. – Kyle
San Marcos
NEW CCHPS
Irma Carranza, CCHP
Bexar County Adult Detention Center
San Antonio
Lydia Mesquiti, MSW, CCHP
San Antonio
Patricia Kay Tamplin, LVN, CCHP
Rusk County Sheriff’s Office
Tyler
Kieth Corn, RN, CCHP
Washington State Penitentiary
Walla Walla
Donna Childs, CCHP
San Antonio
Maria Theresa O’Carroll, LVN, CCHP
Bexar County Juvenile Detention Center
San Antonio
Barbara Ann Taylor, LVN, CCHP
San Antonio
Richard C. Cross, RN, CCHP
Washington State Penitentiary – DOC
Walla Walla
Diane Del Bosque, LVN, CCHP
Wackenhut Corrections Corp. – Kyle
Kyle
Debra M. Osterman, MD, CCHP
Harris County Jail
Cypress
Vivian Flores Torres, MA, CCHP
San Antonio
Bruce P. De Leonard, PA-C, CCHP
Walla Walla
Lucia Diaz, LVN, CCHP
Wackenhut Correctional Facility
Seguin
Sylvia A. Portales, CCHP
San Antonio
Grant E. Deger, MD, FACP, CCHP
Whatcom County Jail
Bellingham
Mandy Goliday, CCHP
UTMB TDCJ Hospital
LaMarque
Rhonda M. Quinones, BA, CCHP
San Antonio
Cruz H. Vallarta, LVN, CCHP
Cyndi Taylor Krier Juvenile Correctional
Treatment Center
San Antonio
Maria E. Gomez, MA, CCHP
University Health System – Corrections
San Antonio
Carol A. Ridge, RN, CCHP
UTMB TDCJ Hospital
Galveston
Lovenia Green, RN, CCHP
UTMB
Texas City
Maria T. Soliz, CCHP
San Antonio
Martha Gutierrez, CCHP
Adult Detention Center
San Antonio
Edward Spiller, LMSW, CCHP
Bexar County Jail
San Antonio
Judy Harper, LMSW, CCHP
San Antonio
Frances M. Stephens, LVN, CCHP
Wackenhut Corrections Corp.
San Antonio
Brenda S. Leal, MA, CCHP
Bexar County Juvenile Detention Center
San Antonio
Nilah W. Stewart, MSW, CCHP
San Antonio
Sherman McMorris, MEd, CCHP
Harris County Jail
Sugar Land
Alan R. Strickland, LVN, CCHP
Treatment Center
Kirby
Correctional Mental Health Care
Standards and Guidelines for Delivering Ser vices
Thoroughly updated to conform with NCCHC’s 2003 standards for
health services in jails and in prisons, this edition of Correctional
Mental Health Care: Standards and Guidelines for Delivering Services
makes explicit what is implicit in the standards regarding mental
health care delivery and coordination of mental health care with
NCCHC’s standards for health services in the correctional setting.
As with the 2003 Standards, this edition features a user-friendly
format; new standards to address current issues such as chronic
care and end-of-life care; clear compliance indicators; specific guidelines for facilities of various sizes; best practices recommendations;
background on the legal context for correctional health and mental
health care; and appendices that address suicide prevention, issues related to segregation, juveniles in adult facilities and more. Appropriate for jails, prisons and juvenile facilities of any size,
this manual is useful to both clinicans and administrators, and works well as an independent reference or as an annotated companion to the Standards.
Quantity
______ Copies of Correctional Mental Health Care @ $34.95 each
Add $6 shipping/handling for first book, $5 for each additional item
Illinois residents add 8.75% sales tax (or enclose copy of tax exempt certificate)
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(Please allow 7 to 10 business days)
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Address____________________________________________________________________________
City _____________________________ State ________________ Zip __________________________
Phone ___________________________________ E-mail ____________________________________
PAYMENT
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Billing address (if different from above)
Mail to
Yvette Marie Velasquez, LVN, CCHP
Treatment Center
San Antonio
Isabel H. Walsh, RN, MSN, CCHP
UTMB TDCJ Hospital
Galveston
Ada L. Westbrook, LVN, CCHP
San Antonio
Utah
Anita Luke, LPN, CCHP
Utah County Sheriff’s Department
Spanish Fork
Sally Randall, RN, CCHP
Spanish Fork
Albert H. Wiggin, LPN, CCHP
Spanish Fork
Daniel Delp, PA-C ,CCHP
Walla Walla
Ronald W. Fleck, MD, CCHP
Walla Walla
Judy Ford, RN, CCHP
Multnomah County Detention Center
Vancouver
Anthony Gambone, PA-C, CCHP
Walla Walla
Colleen S. Gutmann, RN, CCHP
Correctional Nursing Services Inc.
Kennewick
Beverly J. Knodel, RN, BSN, CCHP
McNeil Island Corrention Center
Olympia
Richard S. Krebs, MD, CCHP
Whatcom County Jail
Bellingham
Virginia
Robert R. Bradley Jr., MSW, CCHP
Serenity House
Newport News
Gail Frances May, LPN, CCHP
Benton County Jail Correctional Nursing
Plymouth
Luciano Guadalupe-Rivera, CCHP
Department of Justice Health Services
Prince George
Melinda S. Michalke, RN, CCHP
Columbia River Correctional Institution
Vancouver
Dawn Hanson, EMT, CCHP
Peumansend Creek Regional Jail
King George
Robert C. Mitchell, PA-C, CCHP
Walla Walla
Timothy F. Joost, RN, MS, CCHP
Virginia Department of Juvenile Justice
Richmond
Deborah J. Park, LPN, CCHP
Whatcom County Jail
Ferndale
Katherine Lynch, CPT, CCHP
Chesapeake Community Services Board
Chesapeake
Helen Schoenfeld, RN, CCHP
Whatcom County Jail
Bellingham
Diane Purks, RN, CCHP
Spotsylvania
Wisconsin
Shari L. Heinz, BSN, CCHP
Fox Lake Correctional Institution
Fox Lake
Joseph Riddick, MBA, CCHP
Virginia Department of Juvenile Justice
Richmond
Angela B. Stroud, LPN, CCHP
Milford
Donna L. Kowske, RN, MSN, CCHP
Milwaukee County Jail Health Services
Brookfield
Judith K. Ortwerth, RN, CCHP
Pierce County Jail
Ellsworth
Washington
Alan T. Bailey, RN, CCHP
Walla Walla
Jeanne Reinart, BSN, RN, CCHP
Monroe County Jail
Tomah
Rebecca I. Bay, MD, MPH, CCHP
FDC Sea Tac BOP
Seattle
Barbara A. Ripani, DDS, MPH, CCHP
State of Wisconsin DOC
East Troy
Carole Brown, RN, CCHP
Spokane County Jail
Spokane
Linda J. Shtaida, BSN, CCHP
Ethan Allen School
Delafield
Darren M. Chlipala, BS, CCHP
Walla Walla
West Virginia
Francisca A. Terrero-Leibel, PA, CCHP
US Penitentiary – Big Sandy
Huntington
Mary E. Coomes, RN, CCHP
Benton County Jail
Kennewick
www.ncchc.org
Paris Hotel
•••
July 11-12
•••
Las Vegas
Mental Health in Corrections
Improving Treatment to Change Lives
The rising prevalence of mental health problems within correctional populations poses serious difficulties on many levels. While societal trends are turning
jails, prisons and juvenile facilities into de facto mental health institutions,
these facilities are neither designed nor, in many cases, sufficiently prepared or
funded to deal with the number or intensity of mental conditions commonly
seen. The solutions will be complex, but, at their most fundamental, they will
require more advanced capacity for identifying, treating and monitoring individuals with mental illness. As well, greater coordination and integration of
efforts between correctional systems and community health care agencies will
be required to aid inmates’ transitions into the community.
Geared toward mental health care providers working in correctional facilities, this intensive two-day conference will delve into the intricacies of mental
health disorders common among correctional populations, best practices for
treatment and models of service delivery.
Educational Program
Featured Speakers
Join colleagues for a two-day program on Sunday, July 11, from 9 am to 5 pm,
and Monday, July 12, from 9 am to 4 pm. Breakfast and luncheon programs
will be provided on both days. The educational sessions are divided into two
tracks and include the following
titles:
Specia
• Nontraditional Roles of
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Mental Health Providers
roundtable
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• Killing Time: The
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• Prescribing Practices in the
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Correctional Setting
• No Way Out: The Latest in Substance
Abuse Treatment
• Getting Acquainted: The New NCCHC Mental Health Care Guidelines
• Evaluation and Treatment of the Violent Mentally Ill Offender
• Mental Health Strategies That Work for Juveniles
• Maintaining Mental Health Costs in Tough Economic Times: Lessons Learned
• Unraveling the Complexity of Schizophrenia
• Differentiating Genuine Needs From Manipulative Behaviors
• Understanding Suicide Prevention in Correctional Facilities
• Manage Effective Opioid Treatment Programs
• Restoration to Competency for Death Row Inmates: An Ethical Dilemma
• Preparing Patients and Establishing Links for Successful Reintegration
• Andrew Angelino, MD, Assistant Professor of Psychiatry, Johns Hopkins
University School of Medicine
• Dean Aufderheide, MTH, PhD, Acting Director of Mental Health, Florida
Department of Corrections
• Barbara Bowman, PhD, Associate Professor of Psychology, Washburn
University
• R. Scott Chavez, PhD, CCHP-A, Vice President, NCCHC
• James DeGroot, PhD, Mental Health Director, Georgia Department of
Corrections
• Thomas Fagan, PhD, Consultant
• Richard Alden Greer, MD, Director, Inpatient Psychiatry Reception and
Medical Center, Florida Department of Corrections
• Lindsay Hayes, MS, Project Director, National Center on Institutions and
Alternatives
• Kirk Heilbrun, PhD, Professor, Department of Psychology, Drexel University
• Steven Helfand, PsyD, Deputy Director of Mental Health, Rikers Island PHS
• Jeffrey Metzner, MD, CCHP-A, Clinical Professor of Psychiatry, University of
Colorado Health Sciences Center
• Fred Osher, MD, Director, Center for Behavioral Health, Justice and Public
Policy, University of Maryland
• Charles Smith, MD, Lead Forensic Examiner, Mid-Hudson Forensic
Psychiatry Center
• Keith Spare, Program Director, Samuel U. Rodgers South Center
• Judith Stanley, MS, CCHP-A, Director of Accreditation, NCCHC
• Faye Taxman, PhD, Director, Bureau of Governmental Research, University
of Maryland
Continuing Education
Registration Fees
The National Commission on Correctional Health Care
is approved by the American Psychological Association
to offer continuing education for psychologists.
NCCHC maintains responsibility for the program. At
this conference, participants can earn up to 13 CE
hours. NCCHC also has applied for continuing education approval for physicians and nurses.
Academy member . . . . . . . . . . . . . . . . . . . . . . . . .$99
Academy nonmember . . . . . . . . . . . . . . . . . . . . .$125
Spouse (meal functions only) . . . . . . . . . . . . . . . .$40
Continuing education fee . . . . . . . . . . . . . . . . . . .$10
Mental health roundtable . . . . . . . . . . . . . . . . . . .free
If you are not an Academy member but would like to
join and take advantage of the discounted registration
fee, simply indicate on the registration form that you
are joining and add the $75 membership dues to your
fee. To learn more about the Academy, visit the Web at
www.correctionalhealth.org, call toll-free at (877) 5492247 or e-mail academy@correctionalhealth.org.
Hotel Information
The program will be held at the Paris Hotel, conveniently located in the heart of Las Vegas. Conference
participants will receive a special discount rate of
$109. To receive this rate, make your reservation by
June 18 and tell the agent that you are attending the
NCCHC conference.To make reservations, call the
hotel toll-free at (888) 266-5687.
Registration Confirmation
Registrants will receive written confirmation of registration. Please allow two to three weeks. Badges and other
meeting materials will not be mailed; they are distributed at the registration desk when attendees check in.
Registration Information
For fastest service, register online at www.ncchc.org.
Or, fill out the form in the conference brochure and
return it to NCCHC. If you don’t have a brochure, you
may download it at our Web site, or request one at
(773) 880-1460 or info@ncchc.org. Registration must
include check or credit card payment. Purchase orders
are accepted only from governmental agencies and
their contractors and must accompany the registration
(a $15 processing fee applies).
Cancellation Policy
Lake Mead
Cancellations must be made in writing, via fax or mail.
Cancellations received before June 15 will be refunded
less 50%. Refunds will not be made for cancellations
received after this date.
Photos courtesy of the Las Vegas News Bureau.
Presented by the National Commission on Correctional Health Care and the Academy of Correctional Health Professionals
Jointly sponsored with the American Psychological Association
Contract Management: Is It Right for Your Facility?
BY HOWARD SALMON
H
ealth care contract management has enabled many prisons
and jails to provide health services of a higher quality at a lower
cost than they may have been able to
do themselves. But this approach
isn’t for everyone. Most prisons and
jails can attain the
same or higher levels of quality and
service without the
management fees,
the loss of local
control and flexibility, and the additional layers of
management. Yet
county and state
governments clamor for privatization.
What to do?
Weigh your options—carefully.
This article will discuss how to
assess whether contract management is right for you and, if it is, how
to establish a solid contract that protects your interests. But first, let’s
explore why you might consider outsourcing in the first place.
Outsourcing Pros and Cons
Politically, outsourcing of health services has been growing more popular
for years. It’s easy to understand why
it appeals to administrators. With
governments under pressure to control taxes and curb expenditures, and
given their concerns about legal liability and risk management, they’re
all too happy to let a third party deal
with those headaches.
Ultimately, contract management
aims to restore the client’s focus to
its core concern: corrections. But
conventional wisdom holds that it
also yields a wealth of other benefits:
• It consolidates authority and
responsibility for health care service delivery to a single point.
• Thorough, well-written contracts
take the guesswork out of costs,
service quality and liability risk.
• With fewer bureaucratic obstacles,
outsourcing firms can more readily
implement programs and services.
• Use of the latest management
information systems helps to
streamline workflow, manage utilization and analyze data.
• Sophisticated pharmacy management ensures consistent quality
and utilization at lower costs.
• Outsourcing firms can develop and
manage networks for necessary offsite care and clinical specialists.
• Conversely, they are better able to
reduce the need for off-site care,
thus lowering transport and security costs.
• Access to medical experts provides
independent opinion about care.
• Outsourcing firms have better success at employee recruitment and
retention.
• They are more experienced and
successful in meeting NCCHC
standards to obtain accreditation.
• Inmate grievances, which may
escalate to legal challenges, are
less likely.
Whether or not contract management firms always deliver on these
promises, they generally do well in
several areas. They bring economies
of scale, national contracting with
suppliers, process standardization
and industry benchmarking.
Quality, too, benefits from their largescale scope, with
national medical
advisors, standardized treatment
paths, standardized
quality assurance
and utilization
review, and specialists in standards
compliance and
accreditation.
Other strengths of
such companies typically include lobbying clout and corporate expertise.
Contract management is not without its detractors, however. Among
the chief complaints are a perceived
“cookie cutter” approach and lack of
flexibility, a focus on profit that relegates quality to a secondary concern,
and a loss of control. If the contractor and the client disagree on how to
interpret contractual provisions or
wish to change them, the wrangling
could lead to unanticipated expenses
or to inadequate care. If the impasse
results in cancellation of the contract, the move back to local control
will present a new set of difficulties.
Contract Considerations
Openly discuss the pros and cons of
outsourcing with corrections authorities. If everybody agrees that it
makes sense, then choose a service
provider and sign a contract that
meets your needs while ensuring
your independence. Here are some
important points to address:
• Communication: Keep the lines
open with frequent (at least
monthly) reports and meetings,
discussing successes and failures.
• Quality: Require participation in
activities such as NCCHC accreditation, quality assurance and utilization review.
• Systems and processes: Quality is
best achieved by use of best practices, which generally means consistent approaches to treatment
paths, outcomes measurement,
monitoring, credentialing and
privileging.
• Specify outcomes: Despite the
focus on process what you’re really
after is outcomes. Set health care
delivery quality and expense goals
that are better than average.
• Reporting: Regular data collection,
analysis and reporting will enable
you to track performance, identify
trends—and take remedial action,
if necessary.
• Expense control: Stipulate that
your facility’s expenses must fall
within the 35th to 50th percentile
among your peers within a specified time frame.
Quality and Productivity Indices
Initial screening
Nursing/hours/100 screens
Medication delivery
Nursing hours/100 medications
Emergency encounters
Nursing hours/100 encounters
Physician hours/100 encounters
Supply cost/100 encounters
Pharmaceutical cost/100 encounters
Outside appointment transfers
Nursing hours/100 transfers
Doctor call
Physician hours/100 visits
Delay time/doctor call
Physician expense/100 visits
Physician expense/inmate day
Dental call
Nursing hours/100 visits
Dentist expense/100 visits
Dentist expense/inmate day
Supply cost/visit
Sick call encounter
Nursing hours/100 encounters
• Consultants: You want to have confidence in your outsourcing partner, but don’t shy away from using
consultants when needed. An outside perspective can be invaluable.
Monitoring Musts
A precursor to reporting is monitoring. To ensure performance, plan
from the start for objective contract
monitoring, with emphasis on key
indices in the areas of finance, quality and productivity. (See table above
for recommended indices to track.)
Financial indicators, often expressed
as per diem costs, will include items
such as salaries, operating expenses,
professional services, contracted services and telemedicine. Off-site
expenses can mount rapidly, so pay
close attention to physician visits,
ancillary services and hospital care.
In the area of pharmacy, indices to
track include statistics on inmates
taking prescription drugs, including
psychotropics, and usage of nonformulary drugs.
Moving to quality, many elements
should be monitored, including:
• Accreditation reviews
• Access to care, including specialty
clinics
• Credentialing reviews
• Operational review audits
• Quality management programs
• Quality of care
• Utilization management
• Grievances and correspondence
• Peer review activities
• Morbidity/mortality reviews
• Policy and procedure reviews
• Pharmacy and therapeutics
• Infection control activities
Before You Sign
Even the best written contract won’t
spare you the anguish if the company
that countersigns it botches the job.
So do your homework before you sign.
First, assess contractor accountability. Examine financial qualifications and due diligence. Insist on a
list of all clients, not just those on
Infirmary care – medical
Total expense/patient day
Average length of stay
Nursing hours/patient day
Supply cost/patient day
Pharmacy cost/patient day
Infirmary care – mental health
Outside hospital care
Pharmacy Expense
Pharmacy cost/day
Psychotropic cost/day
Nonformulary drug cost/day
HIV cost/prisoner day
Cost/prisoner on meds/day
the “references” list, and conduct
extensive reference checks with as
many as possible, particularly those
with similar contracts. Visit at least
three of those sites. For context, also
talk with local providers that are not
contract managed.
During contract negotiation call in
the experts. The presence of physician or nurse monitors who know
their stuff could prevent oversights,
errors and, down the road, regret.
The contract itself should be as
explicit as possible. For example,
write provisions for financial deductions if operational or clinical performance fails to meet defined parameters at a specified trigger level. But
don’t be solely punitive. Consider
using incentives when performance
is corrected or improved. Importantly, spell out precisely the conditions under which the parties are in
contract default. If the contract
must be terminated, make sure that
happens for the right reasons.
This next piece of advice is aimed
at correctional facilities: One thing
outsourcing companies do well is
innovate. Do not fear but welcome
cutting edge innovations, business or
clinical, that further your mission.
Finally, don’t overlook public relations. Despite its popularity in government circles, outsourcing is
sometimes denounced by taxpayers.
Be proactive in announcing your
plans, and the expected positive outcomes, to the community.
Howard Salmon is a partner at
Phase 2 Consulting, Salt Lake City,
Utah. E-mail him at hwsalmon@
phase2consulting.com.
Salmon presented a session on this
topic at the National Conference on
Correctional Health Care in Austin
last October. To purchased a recording (session #183, Pros & Cons of
Managed Health Care Companies),
visit Nationwide Recording Services
online at www.nrstaping.com/ncchc.
www.ncchc.org
HIV/AIDS Prevention Inspires Creativity in Confined Youth
For the fifth year, teens and young
adults in detention and confinement
centers nationwide demonstrated
poignant sensitivity to and understanding of HIV and AIDS. As contributors to NCCHC’s annual Poetry
and Poster Contest, they also shared
important messages on how to prevent the spread of these diseases.
Confined youth nationwide were
invited to design a poster or write a
poem related to HIV prevention, and
more than 2,500 of them submitted
entries. Conducted by NCCHC with
support from the Centers for Disease
Control and Prevention, the contest
reinforces messages about HIV prevention through peer communication within this high-risk group.
A team of 10 judges with diverse
backgrounds—art, health care, politics, business, jail administration,
and other disciplines—spent hours
poring over the entries, finding
themselves by turns moved, amused
and, sometimes, amazed. Ultimately,
for each art form (poster and poem),
the judges whittled the entries down
to three winners (first, second and
third) for each of three age groups
(14 and under; 15 to 17; 18 to 21).
The winners were awarded cash
prizes and certificates of
recognition, and dozens of
other youths received honorable mention certificates.
The winning entries were
displayed at the National
Conference on Correctional
Health Care, held last
October in Austin, Texas.
To see all of the winning
entries, which are presented
in their original form, visit
the Web at www.ncchc.org.
2nd place winner, age 15-17
1st place winner, age 14 and under
My Story
I live on the wild side,
And sometimes make a mistake.
Some are not as big as others,
But this one takes the cake.
I met her dancing at the club,
Boy she like to party.
She got me really drunk you see,
You know I love Bicardi.
We went back to her place,
And one thing led to another.
She took off her bra and panties,
Then I said “Oh Brother.”
It was so fast like NASCAR,
Not knowing I would soon regret it.
In an instant it was all over,
I felt like Andy Petit.
Now I’m stuck with the AIDS virus,
And no one will go out with me.
Longing for the old life,
But that can never be.
So kids if you have unprotected sex,
There’s no telling what will happen.
Lets stop the AIDS virus,
So know exactly what your tappin.
3rd place winner, age 18-21
I am Death Positive
As I enter your blood stream,
I travel through dominantly,
I’ve entered like a dream.
That you have had so commonly,
I ease into your body,
Like a thread through a needle,
Eating away your white blood cells,
Like a leaf to a beetle,
I am not the killer,
But due to my instruction,
Something so insignificant,
Will lead to your destruction,
Once I’ve completed my mission,
Your body just withers away,
Unless I am shared with another,
In your body is where I’ll stay,
No one is fully protected,
I come through bodily fluids,
I am very least expected,
You’ll never say you knew it,
I am slow pain and death,
Dancing on life’s great stage,
But don’t attend my show,
Because I am know as AIDS.
www.ncchc.org
Summary Guide to the Changes
2004 Standards for Health Services
in Juvenile Detention and Confinement Facilities
1999 Edition: 71 standards, 36 essential (51%), 35 important (49%)
2004 Edition: 72 standards, 40 essential (56%), 32 important (44%)
Numbering System
• Standards are numbered according to type
(Y=juvenile), section (A through I), and numerical order within the section.
2 Standards Combined Into 1
• (Y-38) Daily Handling of Nonemergency Medical
Requests and (Y-39) Sick Call into Y-E-07 Nonemergency Health Care Requests and Services (E)
4 New Standards
• Y-C-02 Clinical Performance Enhancement (I)
• Y-E-13 Discharge Planning (I) (separation of
issue from another standard)
• Y-G-02 Management of Chronic Disease (I)
• Y-G-12 Terminal Illness Within the Juvenile
Setting (I)
Status Changes
• Important to Essential:
Y-B-02 Environmental Health and Safety
Y-D-05 Hospital and Specialty Care
• Essential to Important:
Y-I-06 Right to Refuse Treatment
5 Deletions
• Sexually Transmitted Disease and Bloodborne
Disease Detection
• First-Aid Kits
• Continuing Education for Health Services
Administrative and Support Staff
• Direct Orders
• Position Descriptions
2 Standards Split Into 4
• Former Y-29 Pharmaceuticals (E) split into
Y-D-01 Pharmaceutical Operations (E) and
Y-D-02 Medication Services (E)
• Former Y-36 Mental Health Assessment (E) split
into Y-E-05 Mental Health Screening and Evaluation (E) and Y-G-04 Mental Health Services (E)
Significant Changes
• Y-A-06 Continuous Quality Improvement
Program (E)
• Y-A-07 Emergency Response Plan (E) (former
name: Emergency Plan)
• Y-B-04 Ectoparasite Control (I)
• Y-C-03 Continuing Education for Qualified
Health Care Professionals (E)
• Y-C-08 Health Care Liaison (I)
• Y-C-09 Orientation for Health Staff (I)
• Y-D-03 Clinic, Space, Equipment and Supplies (I)
• Y-E-12 Continuity of Care During Incarceration
(E) (former name: Continuity of Care)
• Y-F-04 Personal Hygiene (I)
• Y-H-03 Access to Custody Information (I)
(former name: Sharing of Information)
• Y-I-03 Forensic Information (I)
NCCHC Standards for Health
!
W Services in Juvenile Detention
N E and Confinement Facilities
This newly revised edition of NCCHC’s nationally recognized Standards provides guidance in
establishing and maintaining constitutionally acceptable health services systems. Compliance
indicators articulate expected outcomes in nine areas: governance and administration, environmental safety, personnel and training, health care services and support, juvenile care and
treatment, health promotion, special health needs, health records and medical-legal issues.
As with the 2003 editions of the prison and jail Standards, the 2004 juvenile Standards features a more user-friendly format and numbering system; new standards to address current
issues such as clinical performance enhancement and chronic care; clear compliance indicators; and appendices that address the legal context for juvenile correctional health care, quality
improvement, suicide prevention protocols, resources and references, and more.
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Format Changes
• Standard—the “what” and essence of the standard itself in a succinct statement giving the
expected outcome
• Compliance Indicators—the “how” and usual
way compliance is achieved, with general expectation for accreditation
• Performance Measures—see below
• Definitions—the meaning of terms as they are
applied in the NCCHC accreditation process
• Discussion—the first sentence states the intent,
which is the “why” and reason for the standard;
in addition, the discussion addresses the “when”
and “where,” with elaboration on ways to meet
the standard, and provides additional background information
• Recommendations—the “more,” suggestions for
best practices and ways to go beyond basic
requirements
Performance Measures Initiative
• Y-E-02 Receiving Screening
• Y-E-04 Health Assessment
• Y-E-08 Emergency Services
• Y-E-09 Segregated Juveniles
• Y-G-01 Special Needs Treatment Plans
• Y-G-05 Suicide Prevention Program
• Y-I-02 Use of Mechanical Restraint in Juvenile
Correctional Facilities
Transition to the 2004 Juvenile Standards
Approval
• In October 2003, the NCCHC board of directors approved the revised juvenile standards upon recommendation of the NCCHC’s standards revision
task force, its policy and standards committee and its executive committee.
Publication
• The manuals will be available for purchase starting in May at the Updates in
Correctional Health Care conference.
• Each accredited juvenile facility will receive one complimentary copy sent to
the attention of the facility’s legal authority.
Protocol for Implementation
• Currently accredited facilities have from June to December 2004 to come
into compliance.
• Facilities with initial applications received by NCCHC starting in June 2004
will be held to the 2004 Standards.
TIMELINE FOR TRANSITION
June 2004 to December 2004
• 1999 Standards continue to be the basis of accreditation surveys until June.
• As of June 2004, surveys of juvenile facilities will be under the 2004 revision.
• For a given standard, when a facility’s current policy and practice are found
to be in compliance with the 1999 requirements, the facility does not have
to change the practice, provided it has a plan to transition to the revised
standard by the end of 2004.
• When current policy and practice are found to be in compliance with the
2004 standard’s requirements but not with the 1999 version, the facility
does not have to change the practice. The survey report will reflect compliance with the 2004 standard.
• When current policy and practice are not in compliance with either the
1999 version or the revision of a standard, the facility’s corrective action
should bring it into compliance with the 2004 revision requirements.
• Facilities seeking initial accreditation will be surveyed based on the 2004
Standards.
• Accredited facilities may opt to be surveyed under the 2004 version after discussion with accreditation staff before the site visit.
December 31, 2004
• Accreditation for all juvenile facilities will be based on compliance with the
2004 Standards.
www.ncchc.org
PRISONER REENTRY
providers alike. Moreover, with respect
to prisoners entering the community
with communicable diseases, opportunities to minimize the spread of
disease have not been seized.
Three Themes
To explore the issues at the intersection of prisoner reentry and public
health, the Urban Institute convened
a meeting of the Reentry Roundtable.
The Institute commissioned papers
by some of the nation’s leading
researchers and invited a rich mix of
corrections administrators, corrections health care providers, community health care agencies, former
prisoners, police leaders, state and
local policymakers, and advocacy
groups for a two-day meeting.
Three themes emerged from the
discussions. First, a reentry perspective on the health burdens facing
America’s prison population presents
an opportunity to think differently
about improving health outcomes for
returning prisoners, their families
and the communities to which they
return. Given the inevitability of
reentry, every prisoner should be
viewed as a future member of free
society. Accordingly, the period of
time in prison should be viewed as an
opportunity to provide health interventions that will yield better health
outcomes not only in prison but,
equally importantly, after the prisoner’s release.
This perspective places new obligations on prison health practitioners
to factor in benefits incurred after
release and to communities, rather
than tailor treatment to address benefits realized only during incarceration. The reentry perspective also
envisions different relationships
between health care providers in
prison and those in the community.
For example, correctional health
care professionals should work with
their colleagues in the community to
develop discharge protocols, fixed
first clinic appointments after the
inmate’s release, and sharing of medical records and treatment plans.
Finally, the reentry perspective
would move the public health field
toward different strategies for
addressing a number of health issues
in our society. For example, public
health strategies to minimize the
spread of hepatitis would start with
the recognition that prisoners present high levels of that disease and
would take advantage of their period
of incarceration to provide screening
and appropriate interventions.
A number of researchers and practitioners have embraced the notion
that the twin realities of incarceration and reentry present what has
been called a “public health opportunity,” but realizing this opportunity
will require a new collaborative
model between community health
and correctional practitioners.
The second theme of the discussion was the value of a public health
perspective on the phenomenon of
prisoner reentry. The public health
www.ncchc.org
community brings valuable concepts,
language and practices to the work
of criminal justice professionals and
others who think about the challenges posed by hundreds of thousands of returning prisoners. The
idea of a discharge plan, the concept
of continuity of care, the concern for
a person’s well-being irrespective of
his or her social status—all are useful additions to the criminal justice
conversations about reentry.
More specifically, a public health
perspective contributes a sharpened
focus on mitigating the harmful
effects of certain illnesses associated
with heightened public safety risk,
the touchstone of most criminal justice reform efforts. For example, a
detailed discharge plan for a prisoner
with mental illness that ensures continuity in medication and treatment
could promote better mental health
and reduce the likelihood of antisocial and criminal behavior. Similarly,
a successful prison-based education
program that helps inmates avoid
risky behaviors associated with the
transmission of HIV, such as needle
injection, may also reduce the rate of
return to drug use.
A third theme emerging from the
roundtable discussion was more
strategic than substantive. Meeting
participants expressed the consensus
that a merger of the public health
and prisoner reentry perspectives
could bring new policy interest and
new allies to each policy domain.
The public health and correctional
health care communities would benefit from alliances with their criminal justice counterparts who could
help quantify, in public safety terms,
the effects of evidence-based health
interventions with the criminal justice population. The criminal justice
professionals and allied community
agencies would gain support in their
efforts to raise public awareness
about the impact of mass incarceration on American society by the language and concepts of public health.
The papers presented at the
Reentry Roundtable provide new support for the efforts of researchers
and practitioners alike to shed light
on the nation’s twin challenges of
poor health and high incarceration
and reentry rates, particularly in disadvantaged communities that
already face too many other burdens.
The Journal Devotes Single Issue to Reentry
• Health Profile of the State Prison Population and Returning Offenders:
Public Health Challenges—Lois M. Davis, PhD, the RAND Corporation
• Prison Health Services: An Overview—B. Jaye Anno, PhD, CCHP-A,
Consultants in Correctional Care
• Community Health Services for Returning Jail and Prison Inmates—
Nicholas Freudenberg, DrPH, Hunter College, City University of New York
• Dynamics of Social Capital of Prisoners and Community Reentry: Ties that
Bind?—Nancy Wolff, PhD, Rutgers University Institute for Health, and
Jeffrey Draine, PhD, University of Pennsylvania School of Social Work
• Linkages Between In-Prison and Community-Based Health Services—
Cheryl Roberts, MPA, Crime and Justice Institute, Sofia Kennedy, MPH,
Abt Associates Inc., and Theodore M. Hammett, PhD, Abt Associates Inc.
• Insiders as Outsiders: Race, Gender and Cultural Considerations Affecting
Health Outcome After Release to the Community—Raymond F. Patterson,
MD, Howard University, and Robert B. Greifinger, MD
• What Is Known About the Cost-Effectiveness of Health Services for
Returning Prisoners—Embry M. Howell, PhD, the Urban Institute, Robert
B. Greifinger, MD, and Anna S. Sommers, PhD, the Urban Institute
Editor’s note: This article and updated versions of the papers described
above are featured in a special issue
of the Journal of Correctional Health
Care, Vol. 10, No. 3 (see box above).
Jeremy Travis, JD, MPA, and Anna
Sommers, PhD, are with the Urban
Institute, Washington, D.C. Travis is
a senior fellow in the Justice Policy
Center, and Sommers is a research
associate. For correspondence, email asommers@ui.urban.org. To
learn about the Justice Policy Center,
visit its home page at the Urban
Institute Web site, www.urban.org.
Spotlight on the Standards
The Accreditation Survey Report and Compliance Findings
BY JUDITH A. STANLEY, MS, CCHP-A
L
ike each NCCHC-accredited facility, our accreditation program
uses continuous quality improvement activities to further its mission:
the support and improvement of
quality health care services in correctional settings. Each revision of the
Standards for Health Services gives
us an opportunity to review the various outcomes of the accreditation
program and make it better.
The accreditation survey report
itself can be viewed as an outcome.
After all, the report summarizes onsite findings about standards compliance at a facility, outlines corrective
action required, makes recommendations for growth and development of
health services, and documents a
facility’s subsequent response to
compliance issues.
In our own CQI effort, NCCHC
examined how well the survey report
format and contents serve the purposes for which they are intended.
Survey Report: Who Is the Reader?
The survey report is written for the
person legally responsible for the
facility and is presented in a format
that is usable to health staff.
However, correctional and health
professionals bring different perspectives and expectations when they
review the report and apply its findings. For example, the correctional
administrator wants to know how the
facility’s health services compare to
national norms and why issues raised
are important. Health care staff seek
validation of their work, and also
need details of any compliance issues
to be addressed.
If health services are contracted to
a third-party provider, the contractor
will add survey findings to its internal quality improvement process. In
turn, the facility’s contract monitor
will look to verify that contract oblig-
LETTERS
(cont. from page 3)
Pill-Splitting: Correct, but . . .
Dr. Hepler is correct to state that jail
medical personnel should not perform pill splitting. However, my article does not suggest they should! I
wrote “...don’t write ‘ranitidine 150
mg one po BID,’ costing $0.68 per
day. Instead, write ‘ranitidine 300
mg ½ tablet po BID,’ for a savings of
53%.” This clearly implies that the
pharmacist is the one who should do
the pill splitting and the dispensing.
Pill splitting is a well-established
principle in the pharmaceutical business. It is common practice in regular primary care medicine to write
for pill splitting in order to save
money. This is why many tablets are
scored—to allow easy splitting!
Another important point is that
most pharmacies do not charge extra
to split pills. At our jail, when we
ations are met. Although the confidential reports are for the facility
and its health staff (unless the facility directs otherwise), administrators
can use the reports to demonstrate
that the level of care provided meets
constitutional requirements.
Report Format: Achieving Goals
The survey report format has evolved
over the years to meet the needs of
its varied readers and to reflect revisions to the standards. In our latest
quest to do even better, we asked
whether a format change could
enhance readers’ grasp of the functioning of a health services program.
We factored in feedback and questions from customers (administrators
and health staff at accredited facilities) and other report users; professionals attending our seminars; lead
surveyors, who write the reports; and
accreditation committee members,
who use the reports to make accreditation decisions. Good feedback has
helped us to refine the report, for
example with a finer balance
between highlighting positive findings and corrective action needed.
We will begin using the new format
for survey reports completed in June,
and expect to complete the piloting
phase by year-end.
Anatomy of the Report
The revised report has four sections:
(1) Executive Summary; (2) Facility
Profile, a concise description of facility size, organization and functioning; (3) Survey Profile, detailing the
parameters of the on-site survey; and
(4) Survey Findings and Comments.
The one-page Executive Summary
distills the essence of the survey findings and accreditation decisions. It
enables readers to readily discern
overall compliance via a list of standards that are not applicable for this
facility and those for which compliance criteria are not met.
write for ranitidine 300 mg ½ po
BID, we get the same fill fee as any
other prescription.
I would not only encourage correctional centers to write for pill splitting, I would also encourage readers
to have their personal prescriptions
written for pill splitting. I suspect
that many readers take Lipitor. If
your prescription read Lipitor 80 mg
½ po qD instead of Lipitor 40 mg po
qD, you would save $54 a month.
Jeffrey Keller, MD
President, Badger Correctional
Medicine, Idaho Falls, ID
Access to Hospitalization
A continuing cause of access problems to hospitals for tertiary care for
inmates is the reluctance of some
community hospitals to take such
patients. This is often particularly
troublesome for planned admissions,
such as non-acute surgery or child-
Compliance with individual standards is assessed in Section 4, which
is divided into the nine major categories of standards. Each category
begins with a note on the role that it
plays in the health services system and
then provides succinct details on how
the facility addresses its standards.
Delving deeper, the individual standard assessments note whether the
standard has been met and highlight
areas handled particularly well.
In cases of partial compliance or
noncompliance, citations refer as
applicable to the intent of the standard and to the relevant “compliance
indicators,” a new feature of the
2003 Standards that explains the
usual way compliance is achieved.
Required corrective action is spelled
out. If such action is needed, the
facility’s subsequent documentation
will later be added to the report.
Key Changes
The most substantial change is the
new finding of partial compliance
with a standard. Now each standard
can be assessed in one of four ways:
• Compliance: Requirements for the
standard are met, the intent of the
standard is met, no corrective action
is required.
• Partial compliance: One or more
compliance indicators are not met,
or corrective action is required. The
accreditation committee will assess
the impact of the missed indicator(s)
on overall compliance with the
intent of the standard.
• Noncompliance: None of the indicators are met and/or the intent of
the standard is not met, and corrective action is required.
• Nonapplicable: The facility cannot
address the issue due to the nature
of its population or functioning. For
example, in an all-male facility, the
standard addressing care of the pregnant inmate is nonapplicable.
The partial compliance finding was
birth, as opposed to admissions from
the emergency room. The use of dedicated beds is one possible solution.
Many hospitals, in my experience,
are willing to enter into a contract
with prisons or jails to allocate a set
number of hospital rooms to institutional patients if they are paid for
them, occupied or not. Institutions
should know their average count of
inmates in “outside” hospitals, so
they can predict what is expected.
Hospitals are generally willing to
reduce their per diem rates under
such an agreement, so that corrections can analyze such an arrangement on an annual-use basis. If done
right, this is a win-win situation for
both hospitals and corrections.
Security also likes this idea. The
dedicated rooms can be secured with
window bars, solid doors and the
like, in advance, which reduces the
burden on outposted officers. In larger systems, an entire secure ward
added because it often reflects the
true picture at many facilities: Parts
of a standard’s requirements are met
but one or two aspects are not. In
such cases, a judgment of noncompliance can be disheartening. Partial
compliance acknowledges current
achievement while noting changes
required for full compliance. In some
cases, “partial” status may be
deemed acceptable by the accreditation committee, as when the facility
meets the standard’s intent without
strict adherence to every indicator.
As before, accreditation requires
satisfactory performance on all
applicable essential standards and at
least 85% of applicable important
standards.
Another notable addition is the
Executive Summary, described above.
To aid understanding of the report,
definition keys are present throughout and parenthetical explanations
provide context that will be helpful
to the nonhealth professional.
Further, the grouping of descriptive
and positive comments under the
nine standards categories gives the
reader a better perspective from
which to judge overall health service
functioning.
Assessing Outcome
We anticipate that accreditation survey report users will find that the
new format aids their understanding
of standards interrelatedness, expectations for compliance, desired outcomes, and specific concerns and
remedies.
Still, as with any good CQI process,
the format remains open to refinement. We welcome your reactions
and look forward to feedback.
Judith A. Stanley, MS, CCHP-A, is
NCCHC’s director of accreditation.
To contact her, call (773) 880-1460
or e-mail judithstanley@ncchc.org.
may be appropriate. For inmate
patients, this reduces logistical problems with continuity of care, both
pre- and post-admission, and the
need for shackles and the like where
the area is already secured.
For primary care providers in corrections, such arrangements also
enhance professional dialogue and
can help with development of relationships with secondary providers in
specialty services. Efforts to integrate
correctional health care with community health care will serve both.
As Surgeon General Richard
Carmona noted in his remarks in
Austin at the 27th National
Conference on Correctional Health
Care, we need to find better ways to
coordinate correctional health with
public health. I suggest that this is
one of them.
William J. Rold, JD, CCHP-A
Correctional health care attorney,
New York City, NY
www.ncchc.org
Standards Q&A
Expert Advice on NCCHC Standards for Health Services
BY B. JAYE ANNO, PHD, CCHP-A, AND
JUDITH A. STANLEY, MS, CCHP-A
Sexual Assault Reporting Standard
Q
I understand that the federal
Prison Rape Elimination Act
of 2003 is now in effect in
all correctional settings.
Does this have any implications for
accredited facilities?
A
We’re glad that you asked.
Compliance with the Prison
Rape Elimination Act, which
was signed into law in September 2003, falls under the jurisdiction of the correctional authorities,
not of health staff. However, one of
the act’s provisions requires accrediting organizations such as the
National Commission to address
facilities’ compliance with the act in
their standards. Accordingly, NCCHC
has adopted a new standard and in
February mailed it, along with information about its implications, to
accredited facilities.
Designated an “important” standard, P-A-11 (J-A-11) (Y-A-13)
Federal Sexual Assault Reporting
Regulations reads: “The facility has
written policy and procedures consistent with the national standards of
the Prison Rape Elimination Act of
2003.” There is one compliance indicator: “All aspects of the standard
are addressed by written policy and
defined procedures.” The discussion
reads: “The intent of the standard is
for correctional facilities to comply
with applicable federal law. The
Prison Rape Elimination Act of 2003
addresses the many aspects of rape
in correctional institutions, including the actions to be taken by correctional administrators, and is the
foundation of this standard.”
How correctional facilities choose
to comply with the federal law is
pretty much up to them. From
NCCHC’s perspective, however, the
health services department need not
add a specific policy and procedure
because health issues associated with
rape and related acts are already covered by important standard G-09
Procedure in the Event of Sexual
Assault.
Beginning in June 2004, NCCHC
accreditation surveyors will inquire
about the facility’s response to the
act during the interview with the correctional authority’s representative
or designee. The government has not
yet issued regulations or guidelines
for the act, but when it does NCCHC
will reevaluate its process.
The act as published is available
from the Government Printing Office
Web site. Visit www.gpoaccess.gov/
bills and search for “S1435enr.” The
results will give the option of viewing
it as a text file or a PDF file.
www.ncchc.org
Consent to Release Records
Q
As a medical records technician for a county jail, I have
received many requests for
copies of in-custody health
records of released inmates who are
suing the county. The requests have
no authorization or consent-torelease information. Is a release
required?
A
The general community confidentiality regulations for
release of medical records
apply to health records of
inmates. This is true not only when
the request is related to legal proceedings but also in continuity of
care matters. Without a subpoena,
you need a release of information
from the inmate. You can develop a
facility-specific release form or
accept the inmate’s written request.
You also need to check the correctional law in your jurisdiction since
additional permissions may be
required in some cases (e.g., for psychiatric records, the treating staff
may need to advise whether the
entire record can be shared given the
clinical status of the inmate).
Lawyers representing the inmate
should forward the release with their
request. In some jurisdictions, laws
require that the attorney general,
district attorney or other county official representing the facility in an
investigation have access to the
records without the inmate’s specific
consent, the interpretation being
that once the inmate raises the question of adequate care, ordinary rights
to confidentiality are not in effect.
Please consult the county attorney
assigned to your facility about this.
Food Safety
Q
Our state legislature is
proposing an exemption for
correctional facilities regarding the state’s “food rules”
by declaring them not a “food establishment.” As a staff member of the
local health district that has inspected the correctional facilities, I want
to know what impact that exemption
might have on NCCHC’s accreditation of a correctional facility.
A
NCCHC awards accreditation
to a correctional facility for
compliance of the facility’s
health services with the
applicable Standards for Health
Services. All versions (jails, prisons
and juvenile facilities) contain standards that address food safety: B-03
Kitchen Sanitation and Food
Handlers, B-02 Environmental Health
and Safety, and B-01 Infection
Control Program. No matter how a
state views food operations, the facility must meet our standards on these
issues in order to be accredited.
Review of DNR Orders
Q
In standard P-I-04, End-ofLife Decision Making, compliance indicator number 4
regarding health care proxies
and living wills requires an independent review by a physician not directly involved in the patient’s treat-
B. Jaye Anno
Judith A. Stanley
ment, while compliance indicator
number 5 states that “DNR orders
are reviewed by a medical professional.” What types of providers does the
term “medical professional” include?
A
In this case, the use of the
term “medical professional”
was intended to mean only
physicians.
For more guidance on how to
interpret the standards, visit the
Web at www.ncchc.org, go to
the Resources & Links section
and click on Standards Q&A.
There you will find all of the
questions and answers from this
column for the past three years,
arranged by subject.
B. Jaye Anno, PhD, CCHP-A, is a
cofounder of the National Commission
on Correctional Health Care. Now an
independent consultant, she chaired
the task force that developed the 2003
revisions of the adult standards for
health services. Judith A. Stanley,
MS, CCHP-A, is NCCHC’s director of
accreditation and assists in the development and revision of standards.
Do you have a question about the
NCCHC standards for health services?
Write to Standards Q&A c/o NCCHC,
P.O. Box 11117, Chicago, IL 60611.
You also may contact us by fax at
(773) 880-2424, or by e-mail at
info@ncchc.org.
Supplier Opportunities
About CorrectCare
Updates in Correctional Health Care
Chicago, Illinois • May 22-25
Reach the Decision Makers
Sponsorship Opportunities
U.S. correctional institutions house more than 2 million
people, many of whom represent medically underserved
populations. They receive a broad spectrum of health services ranging from treatment for infectious diseases (e.g.,
hepatitis, HIV/AIDS, tuberculosis) to management of
chronic illnesses (e.g., asthma, diabetes, hypertension) to
general health care. They also receive dental care, mental
health care, substance abuse treatment and health education. To meet this heavy demand for government-mandated care, correctional facilities spend nearly $6 billion dollars on health care services, supplies and equipment each
year. And as inmate populations rise, so do expenditures.
Organizations that offer products or services for this
market need to reach the key decision-makers and help
them make informed choices. A great way to do that is to
exhibit at Updates in Correctional Health Care, which
attracts highly qualified attendees with buying power and
authority. In addition to the extensive commercial exhibit, this well-attended meeting offers over 30 educational
and numerous networking opportunities.
Premier Educational Programming: Sponsorship of educational programs on hot topics enables companies to
support the correctional market and gain great exposure.
Conference Portfolio: The portfolios contain essential
conference material distributed to all attendees. The
sponsor’s logo is displayed on the back cover.
Proceedings Manual: The manual provides attendees with
a lasting record of each concurrent session, including
speaker abstracts and handouts. The sponsor’s logo is displayed on the back cover.
The Internet Lounge: The popular computer stations in
the exhibit hall enable attendees to browse the Internet.
Along with on-site signage, the sponsor’s name, logo and
link will be displayed on the computer screens.
Exhibit Breaks: The exhibit hall serves as a central meeting point, with scheduled breaks, morning coffee and
afternoon snacks that are much appreciated by attendees.
Other Opportunities: Registration bags, lanyards,
badges—all are good ways to gain exposure. Have other
ideas for sponsorship? We’d love to hear them, so call us!
Exhibitor Benefits
Registration Information
• Exhibit hall breaks and networking opportunities, with
six hours of exclusive exhibit time
• Company listing and product description in the Final
Program (deadline applies)
• Pre- and final registration lists with attendee addresses
• Preconference and on-site promotion
• Virtual Exhibit Hall listing at NCCHC Web site
• Priority booth selection for 2004 National Conference
The rental fee for each 10' x 10' booth is $1,000, which
includes one full and two exhibit-only registrations.
Additional representatives may register at discounted
rates. Advance and on-site promotions of the exhibition
include mailings, scheduled breaks, exhibitor prize drawings, and a reception and lunch in the exhibit hall. To
learn more, contact director of meetings Deborah Ross at
(773) 880-1460, ext. 286, or deborahross@ncchc.org.
Published quarterly by the
National Commission on Correctional Health Care, this newspaper
provides timely news, articles and
commentary on subjects of relevance to professionals in the field
of correctional health care.
Subscriptions: CORRECTCARE is free
of charge to all Academy of
Correctional Health Care members, key personnel at accredited
facilities and other recipients at
our discretion. To see if you qualify for a subscription, submit a
request online at www.ncchc.org
or by e-mail to info@ncchc.org.
The paper also is posted at the
NCCHC Web site.
Change of Address: Send notification four weeks in advance, including both old and new addresses
and, if possible, the mailing label
from the latest issue.
Editorial Submissions: We may, at
our discretion, publish submitted
articles. Manuscripts must be original, unpublished elsewhere and
submitted in electronic format.
For guidelines, contact the editor
at jaimeshimkus@ncchc.org or
(773) 880-1460. We also invite
letters of support or criticism or
correction of facts, which will be
printed as space allows.
Advertisers: Get the Word Out With CorrectCare!
The leading newspaper dedicated to correctional health care, CORRECTCARE features timely news, articles and commentary on the subjects that our readers
care about: clinical care, ethics, law, administration, professional development and more. The quarterly paper is free of charge to members of the Academy
of Correctional Health Professionals, as well as to thousands of key professionals working in the nation’s prisons, jails, juvenile facilities, departments of corrections, health departments and other organizations. The paper also is available on the NCCHC Web site. In addition, a special conference issue is distributed to attendees at the National Conference on Correctional Health Care. New in 2004: Special packages for exhibitors/advertisers! Contact us for details.
Production Schedule
Issue
Spring 2004
Summer 2004
Fall 2004
Special issue: National Conference
on Correctional Health Care
Winter 2005
Spring 2005
Insertion Order Due
April 2
June 11
August 6
Ad Copy/Art Due
April 16
June 25
August 20
Paper Distributed
May 7
July 9
September 10
Notes
October 1
December 20
March 25
October 15
January 7
April 8
November 13
January 21
April 22
3. Frequency discounts are based on total
number of insertions within the next four
issues. Ads need not run consecutively.
Advertising Rates
Display Ad Size
Full page
Junior page
1/2 horizontal
1/2 vertical
1/3 vertical
1/4 horizontal
1/4 vertical
1/8 vertical
Width x Height
10 x 14 1/8
7 1/4 x 10
10 x 6 1/2
4 3/4 x 13 1/2
4 3/4 x 10
7 1/4 x 5
4 3/4 x 6 3/4
2 1/4 x 6 3/4
1x
$1,450
1,235
1,090
1,090
870
725
725
510
Black & White Rates
2x
3x
$1,380
$1,305
1,175
1,110
1,035
980
1,035
980
825
785
690
655
690
655
485
460
4x
$1,235
1,050
925
925
740
615
615
435
Classified Advertising: Ads appear under the following categories: Employment, Meetings, Marketplace.
The text-only ads cost $1.25 per word. Box your ad with a solid border for an additional $50. Text for
classified ads should be submitted in electronic form (e.g., via e-mail).
For More Information
To learn more about advertising and other marketing opportunities, call Lauren Bauer, meetings and sales
representative, at (773) 880-1460, ext. 298, or e-mail laurenbauer@ncchc.org.
To obtain NCCHC’s 2004 Marketing and Resource Guide, which contains an insertion order form, visit the
Web at www.ncchc.org and go to the Supplier Opportunities section.
1. Ad sizes encompass live area, no bleeds.
2. Color ads cost $250 per color additional
per page or fraction.
4. Recognized advertising agencies receive a
15% discount on gross billing for display
ad space and color if paid within 30 days
of invoice date.
5. Special opportunities are available for
conference exhibitors; please see the
2004 Marketing and Resource Guide or
contact NCCHC for information.
6. Electronic files (Quark, Pagemaker or
PDF) preferred; include font files. We
also accept camera-ready copy and film
(120 line, right reading, emulsion side
down). Proofs must accompany all ads.
7. Cancellations must be received in writing
before the insertion order deadline.
8. We reserve the right to change rates at
any time; however, we will honor the
rates in effect when the order was placed.
9. Acceptance of advertising does not imply
endorsement by NCCHC.
www.ncchc.org
Conference & Jail Expo will be held April
25-29 at the Birmingham, AL, convention
center. To learn more, call (301) 790-3930
or visit www.corrections.com.
Classified Advertising
Employment
LCSW/LPC
Immediate Administrative Opening
Do you enjoy client-centered work
with diverse populations? If so, BHC
might have the perfect position for
you! BHC is seeking a Full Time
LCSW/LPC for the Institutional Chief
of Mental Health Services position at
Farmington Correctional Center.
Administrative experience in a mental
health setting and Missouri licensure
required. EOE. If you’re looking for an
administrative mental health position
with a great company, please send
cover letter and resume to:
BHC, Inc.
Attn: Megan Holcomb
2716 Forum Blvd., Suite 4
Columbia, MO 65203
Apply online: www.bhcinfo.com
Marketplace
Health Assessment & Physical Examination, Second Edition, With CD Rom.
New to the NCCHC catalog, this book is
the new standard in nursing assessment.
Author Mary Ellen Zator Estes, RN, MSN,
CCRN, presents assessment as an ongoing
process that evaluates the whole person as
a physical, psychosocial, functional being.
Comprehensive in scope and illustrated
with full-color photos, this revised edition
presents physical assessment skills, clinical
examination techniques and patient teaching guidelines in a manner that is easily
read and assimilated. 25 chapters in 5
units address the foundations of assessment, special assessments, physical assessment, special populations and putting it
all together. Appendices, references, bibliography, glossary and index. CD-ROM with
Flashcard software reviews concepts in
each chapter. Published by Delmar
Learning (2002). 932 pages. $75.95 +
shipping & handling. Order online at
www.ncchc.org, or call (773) 880-1460.
The Correctional Mental Health
Handbook offers a comprehensive overview
of mental health services for correctional
populations. The handbook has three
major sections: a flexible model for organizing mental health services based on
staffing levels, facility mission and local
need; typical offender programs and how
they are customarily managed; and various
clinical and consultative activities offered
by mental health professionals. Edited by
Thomas Fagan, PhD, and Robert Ax, PhD,
experts with over 40 years of experience in
this discipline. Published by Sage (2002).
Hard cover, 376 pages. $69.95 + s/h.
Order online at www.ncchc.org, or call
(773) 880-1460.
Mental Health Titles. Updated to conform
with the revised 2003 NCCHC Standards,
the new edition of Correctional Mental
Health Care: Standards and Guidelines for
Delivering Services makes explicit what is
implicit in the standards regarding mental
health issues and coordination of delivery
with health services. Appropriate for
prison, jail and juvenile facilities of any
size, the manual works well as an independent reference or as an annotated companion to the Standards. Soft cover, 275
pages. $34.95 + shipping and handling.
Food Service Conference. The American
Correctional Food Service Association will
host its annual Spring conference April 1821 in New Orleans. Find the details online
at www.acfsa.org, or call (952) 928-4658.
DIRECTOR OF MENTAL HEALTH
The LSU Health Sciences Center School of Public Health is seeking a full-time faculty member (open rank) to serve as Director of the Mental Health Program for the
Juvenile Justice Program (JJP). The JJP is a comprehensive health care program
that interfaces with the juvenile justice system in Louisiana to ensure that all incarcerated juvenile offenders in Louisiana receive appropriate medical, dental and
mental health care, and that quality assurance and outcomes measures are closely
monitored. The mental health care program is a cutting edge program using the
most current methodological tools and best practice research. It includes a diagnostic and reception center in which all youth entering into secure care receive a comprehensive mental health assessment (as well as physical and dental assessments).
LSUHSC is responsible for overseeing all health care, dental care, and mental
health care services system-wide.
The Director of Mental Health will provide program oversight and development of
the mental health care assessment and treatment services. The faculty member will
be responsible for academic partnerships, growth, and professional development of
mental health staff; as well as interfacing with multiple disciplines and agencies.
There are many opportunities for development of position and interests via academic and public liaisons.
Incumbent must be able to interface with various diverse disciplines, such as the
judiciary, health care personnel, community agencies, academic institutions, and be
able to effectively manage a public mental health care program via a large academic medical center. Incumbent will report directly to the LSUHSC Program Director
(or designee). The position is located in New Orleans.
*LSUHSC provides competitive salaries and an EXCELLENT benefits package*
Minimum qualifications: Licensed Clinical Social Worker or Licensed Clinical
Psychologist with significant administrative experience, and significant clinical
experience in adolescent mental health assessment and treatment.
Desired qualifications: Health care administration background. Extensive clinical experience with juvenile justice involved adolescents in the areas of mental
health/substance abuse assessments and treatment. Salary is commensurate with
experience and education. Experience in both academic and public health care.
Please indicate the position you are applying for and send resume/curriculum vitae:
Assistant Business Manager
LSU Health Sciences Center, Juvenile Corrections Program
1600 Canal Street, Suite 1200
New Orleans, LA 70112
LSU is an EEO/AA Employer
www.ncchc.org
Meetings
Mental Health Symposium. The Mental
Health in Corrections Consortium will
host “Mental Health Training for the
Correctional Environment: Research,
Practice, Results” April 19-21 in Kansas
City, MO. Visit www.mhcca.org to learn
more, or e-mail bmoyer@forest.edu.
AJA Meeting. The American Jail
Association’s 23rd Annual Training
Psych Conference. The American
Psychiatric Association will hold its annual
meeting May 5-6 in New York City. Learn
more at www.psych.org, or e-mail
apa@psych.org.
Co-Occurring Disorders Programs. The
theme of the GAINS Center’s 2004 national conference will be “From Science to
Services: Emerging Best Practices for
People in Contact with the Justice
System.” It’s being held May 12-14 at the
Flamingo Hotel in Las Vegas. Learn more
online at www.gainsctr.com.
NCCHC ‘Updates.’ Newly renamed
Updates in Correctional Health Care to
reflect its broad educational programming, NCCHC’s spring conference will
take place May 22-25 in Chicago. Learn
more online at www.ncchc.org, e-mail
ncchc@ncchc.org or call (773) 880-1460.
PA Meeting. The American Academy of
Physician Assistants will meet June 1-6 for
the 32nd Annual Physician Assistant
Conference, to be held at the Las Vegas
Convention Center. Visit www.aapa.org, or
call (703) 836-2272 for details.
Juvenile Services. The National Juvenile
Detention Association will hosts its
National Juvenile Services Training
Institute June 11-16 at the Sheraton Hotel
& Suites, Indianapolis. To learn more, visit
the Web at www.njda.com, call (859) 6226259 or e-mail sherry.scott@eku.edu.
2003 Conference
Proceedings
The 2003 Conference Proceedings book contains hundreds of pages of program abstracts,
outlines and handouts from the National Conference on Correctional Health Care held in
Austin in Texas. This publication is a great resource whether you attended the conference or
not. It’s also the perfect companion to the session audiotapes and CDs available from
Nationwide Recording Services. (Visit www.nrstaping.com or call (972) 818-8273, ext. 114.)
Quantity is limited, so order your copy today! If you prefer to order online, visit www.ncchc.org.
Please send me _________ copies of the 2003 Conference Proceedings at $10 each.
$6 shipping/handling for first item, $5 for each additional item. $____________
Illinois residents add 8.75% sales tax (or enclose a copy of tax exempt certificate)
$___________
TOTAL ENCLOSED
SHIP TO
$___________
Name ________________________________________________________________________
Address_______________________________________________________________________
City ___________________________State _______________Zip ________________________
Phone _________________________________________________________________
PAYMENT
Bill my
Visa
MasterCard
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Card # ____________________________________________________________________________________________
Exp. Date________________________Signature _______________________________________________________
Mail to: NCCHC, P.O. Box 11117, Chicago, IL 60611
Fax credit card orders to: (773) 880-2424
For more information, contact NCCHC: (773) 880-1460
E-mail: ncchc@ncchc.org
Updates in Correctional Health Care
Hyatt Regency Chicago • May 22–25
More than ever, correctional health care providers need innovative strategies to address the complex issues facing their profession. Updates in Correctional
Health Care will provide tools and resources to help them do that. Sponsored by NCCHC and the Academy of Correctional Health Care, this annual conference
offers a superior program in the highest quality environment, one that maximizes opportunities to learn, share and network. With more than 40 focused educational sessions covering the industry spectrum, this meeting will provide ideas you can use immediately. Whether you seek updates on the latest issues and trends
or ground-breaking solutions for perennial problems, you will hear it from some of the most widely respected names in the field.
Program Highlights
A World-Class Destination
The meeting offers two full
days of more than 40 educational sessions in five tracks—
medical, nursing, legal/ethical, mental health care, professional development—plus
two days of preconference
seminars. Attendees also will
enjoy plenty of networking.
Preconference Seminars
• In-Depth Look at NCCHC’s
Standards (Prisons/Jails or
Juvenile)
• In-Depth Look at NCCHC’s
Mental Health Guidelines
• The Correctional Nursing
Assessment
• Risk Management in the
Correctional Environment
• Mental Health: Where Are
We Now (free, but registration is required)
Conference Objectives
• List major health care issues that commonly affect incarcerated individuals, including HIV, hepatitis, hypertension, diabetes, mental illness and substance abuse.
• Describe current legal, ethical and administrative issues and
ways to prevent potential problems that arise in correctional
settings.
• Employ new practices for the treatment of major health care
issues in order to better manage common medical and nursing problems found in correctional settings.
• Express increased understanding of common correctional
health care issues by exchanging ideas with colleagues about
new developments in specialty areas.
Continuing Education
NCCHC is approved to provide up to 25 hours of continuing
education credit for physicians ($10 fee required), plus APAapproved credit for psychiatrists and psychologists. CCHPs
may earn up to 25 hours of Category 1 credit toward recertification. We also have applied for continuing education credit
for nurses (up to 30 hours); check the Final Program to confirm approval. Other attendees may request a general certificate of attendance.
Exceptional Exhibits: The Lineup
This is your chance for some face time with all of
those companies that support the correctional
health care industry. From the opening reception
on Sunday evening to the final break and raffle
drawing late Tuesday morning, you’ll have plenty
of time to talk with the representatives whose
products and services can help you to do your job
better. The list below is current as of March 29.
Exhibitor
Booth No.
Abbott Laboratories
112/110
Academy of Correctional Health
Professionals
134
Albany Medical Center
102
American Assn. of Public Health Physicians 233
American Correctional Health Services
Association
330
American Diabetes Association
320
AstraZeneca
212
A city of unmatched beauty, Chicago draws visitors from around the globe. Located on the shore
of Lake Michigan, the city is home to the blues, world-championship sports teams, an internationally acclaimed symphony orchestra, spectacular live theater, celebrated architecture, thousands of restaurants, a galaxy of museums and an array of shopping. Best of all, many of these
destinations are easily accessible from the Hyatt Regency, the conference hotel! Overlooking the
Chicago River, this grand, full service hotel is within walking distance of gems such as Grant
Park, the Magnificent Mile, Rush Street nightlife, world-class museums and downtown shopping.
Restaurants You’ll never worry about finding a
place to eat in Chicago, which has more fourstar restaurants than any other U.S. city and
thousands of others to suit every culinary taste,
every budget, every mood. Soul food, Italian,
Chinese, French, Japanese, Mexican, Spanish,
Ethiopian, Afghan, Cajun, Persian, Vietnamese,
Bohemian, Guatemalan, Lithuanian, Thai...
there’s a virtual United Nations of choices.
Museums Chicago is world-renowned for its
diverse collection of museums. Try to visit the
Museum Campus, a scenic park that joins the
Adler Planetarium & Astronomy Museum, the
Shedd Aquarium/Oceanarium and the Field Museum of Natural History. Other notable museums
near downtown are the Chicago Historical Society (the city’s oldest cultural institution), the
DuSable Museum of African-American History, the Art Institute of Chicago (one of the world’s
leading art museums), the Museum of Contemporary Art, and the Chicago Cultural Center.
Attractions Chicago is home to a variety of spectacular attractions. Navy Pier, the city’s lakefront
playground, offers a blend of family-oriented attractions, from the serene Crystal Gardens to the
magnificent Smith Museum of Stained Glass Windows. The Pier also boasts the 150-foot high
Ferris wheel, a musical carousel, the Chicago Children’s Museum, the Chicago Shakespeare
Theater and a variety of restaurants. Other attractions that you won’t want to miss include
Buckingham Fountain at Grant Park, the Hancock Observatory and the Sears Tower Skydeck.
Architecture The birthplace of the modern building, Chicago boasts unparalleled marvels that
have shaped American architecture. From historic landmark buildings to contemporary technological masterpieces, the city is a living museum of architecture thanks to the work of such
greats as Daniel Burnham, Louis Sullivan, Frank Lloyd Wright, Ludwig Mies van der Rohe,
Helmut Jahn and hundreds of others. The Chicago Architecture Foundation offers more than 50
walking, bus and boat tours conducted by knowledgeable guides. For details call (312) 922-3432.
Shopping Shopping in Chicago began on State Street when the original Marshall Field’s department store opened in 1852. State Street also is home to Carson Pirie Scott, whose ornate ironwork entrance was designed by architect Louis Sullivan in 1899. On the famed Magnificent Mile
(Michigan Avenue from the Chicago River to Oak Street) countless specialty shops and boutiques are found amid giants such as Neiman Marcus, Lord & Taylor, and Saks Fifth Avenue.
Finally, swank Oak Street, at the north end of the Mag Mile, is a boutique shoppers dream.
Asystar Medical Record Solutions
AutoMed Technologies
Axium Healthcare Pharmacy
Boehringer Ingelheim
Bristol Myers Squibb - Abilify
Bristol-Myers Squibb Immunology
Contract Pharmacy Services
CorrecTek
Diamond Pharmacy Services
Efoora
Eli Lilly
FailSafe Air Safety Systems
Federal Bureau of Prisons
Gilead Sciences
GlaxoSmithKline
Global Diagnostic Services
Health Professionals Ltd.
Henry Schein
Humane Restraint Co.
Links Medical Products
312
129
127
100
200/202
217/219
231
201
103
126
104
105
203
113
120/122
111
118/116
109
101
221
Making the Difference, Intl.
Maxim Healthcare Services
Merck Human Health
MHM Correctional Services
Moore Medical Corp.
National HIV/AIDS Clinicians
National Institutes of Health
NCCHC
Norix Group
Owen Mumford
Pfizer
PharmaCorr
Quick Med
Serapis
Society of Correctional Physicians
Solvay Pharmaceuticals
Terumo
U.S. Health Services
U.S. Medical Group Inc
Virologic
234
308
108
106
227
110
205
132/133
226
208
211/213
128
124
130
232
229
209
204
210
223
Find complete conference information and online registration on the Web at www.ncchc.org.
To obtain a preliminary program with registration form, download it at our Web site, e-mail info@ncchc.org, or call (773) 880-1460.

correct - National Commission on Correctional Health Care

Transcription

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