Sunday, January 11, 2009

ACA Conference Exhibit Hall Opens








(Photos by Allen Moore, Bridget Bayliss and David Mckune)
Click on images to view larger - use back button to return to blog

I attended the Sunday evening grand opening of the exhibit hall and
was pleased to see a large variety of vendors despite recent economic
tough times. The vendors that are familiar to most of us were there,
many with new or updated products and services, and several new
vendors with much to offer.

Of course everyone's favorite, Grand Prize Giveaway, was immediately
underway with conference attendees seeking validation stamps from the
sponsoring vendors - each hoping for the lucky card that will win the
covered HDTV Entertainment Center.

Blogged by David R. McKune, Warden, Lansing Correctional Facility, Kansas

Correctional Officers Become End of Life Caretakers (Sun. Jan. 11, 2009 - 2:30 p.m. - 4:00 p.m.

The Winnebago County Jail partnered with the local hospice to provide care to terminally ill inmates. This workshop will examine the issues faced by detention and correctional facilities with aging populations.
Objectives: Identify national trends in end of life programs in prisons; discuss best practices models for providing care for terminally ill inmates; and identify components of the hospice and palliative care programs; explore myths and how they create barriers to the creation of Hospice and Palliative Care programs
Moderator: Marty Johnson-Swagerty, RN, Founder and Executive Director, Hospice Care of America, Rockford, Illinois
Speakers: Timothy H. Owens, Captain, Corrections Bureau Operations, Winnebago County Sheriff’s Department, Rockford, Illinois; Julie M. Sanderson, Director of Social Services, Hospice Care of America, Rockford, Illinois; Andrea Sue Tack, County Jail Superintendent, Winnebago County Sheriff’s Department, Rockford, Illinois

Correctional facilities have become one of the primary caregivers of terminally ill patients.  
When coupled with Hospice, the public can view expected deaths of terminally ill inmates within correctional institutions positively.

External healthcare workers entering the secure confines of correctional institutions to treat inmates is an issue that concerns many corrections officials.  

Items such as hospital beds can benefit terminally ill inmates and make the job of caregivers easier.

Do Not Resuscitate orders do not apply in correctional facilities.  It is the responsibility of corrections to protect the life of those incarcerated there.

Hospice will help to alleviate through many of the costs associated with caring for terminally inmates.  

It is more expensive to care for the inmate in a hospital, than it is to care for him/her in the corrections facility.

The knowledge that the terminally ill inmate might die at any moment can be very intimidating for corrections staff.  The presence of Hospice can be comforting to corrections staff.

Blogged by Sgt. Adam Wright, Orange County (FL) Corrections Department

PREA Standards for Community Corrections (Sun. Jan. 11, 2009 - 2:30 p.m. - 4:00 p.m.)


The Commission on Prison Rape Elimination has issued final standards for community corrections, and to introduce you to these new requirements Jane Browning, Executive Director of the International Community Corrections Association and Lusanne Green, Executive Director of the Ohio Community Corrections Association, will walk you through the basics. What are the fundamental principles of the Prison Rape Elimination Act (PREA)? How does the law apply to community corrections? What are your legal obligations under the new law? And what are the most effective strategies for meeting the standards in a forthright and efficient manner?
Moderator: Jane Browning, Executive Director, International Community Corrections Association, Washington, D.C. 
Speakers: Bryan Black, Clinical Operations and Accreditations Manager, Talbert House, Cincinnati, Ohio; Lusanne Greene, Executive Director. Ohio Community Corrections Association, Columbus Ohio

PROBLEM RECONFIRMED 1923/1934
Joseph Fishman visited 1,500 U.s. jails and prisons..... visited 1500 facilities.
Modern day: Society condones Seexual Assault in Prisons
Subject of late night comics jokes. A board game that centers around prisoner rape. 
Prison Rape is not a joke.. it is serious business.
Domestic violence used to be accepted and joked about. Now it isn’t. It is taken seriously. Prison Rape is analogous to how the public used to regard the issue of Domestic Violence.

Prison Rape Elimination Act of 2003 -
Issue of staff sexual misconduct and prisoner sexual violence.
ELEMENT OF THE LAW
  • Abuse by offenders or staff is covered.
  • Applies to everyone who holds people in custody.
  • Problems associated with prison rape
  • High levels of violence with in facilities
  • Increased health and mental health care expenditures
  • Public Health Concerns - STDs
The Bureau of Justice Statistics suggests that 4.5 percent of those incarcerated have been victims of sexual assault.

Anyone can be at risk, but certain inmates are more likely to impacted.
  • The young
  • First timers
  • Non-gang affiliated
  • Mentally challenged.
  • Causes: In adequate facilities/programs
  • Lack of adequate supervision
  • Gags of arrestors
  • Overcrowding
  • Inadequate classification
  • Withdrawal of surveillance
  • Architectural features.
----
Code of Silence among inmates and among staff
------
PREA AND COMMUNITY CORRECTIONS
The PREA has different standards for different entities. 
These are the standars for community corrections.

PREA Community Corrections Standards were roposed in June, 2008.
Divisions were based on input from the field. Standards are expected to  be finalized in 2009
Prevention and response planning 
Prevention 
Needs to have a zero tolerance policy
All, including vendors, must have compliance with PREA standards

Does the facility provide the supervision of defendant or offenders necessary to protect them from sexual abuse?
Except in case of emergency, does the facility restrict cross-gender viewing by non-medical staff of defendants who are nude or performing bodily functions.
Firing decisions - presumption that anyone with a prior conviction for sexual misconduct, not hired, also those have been found guilty of sexual misconduct.
Protocols for Medial and Forensic exams - investigations in the allegations need to be in a timely manner and agencies must try to get law enforcement to comply.

Prevention
Training and Education. - Staff, volunteers, offenders, etc.
Screening for risk of sexual victimization and abusiveness
Female staff are overwhelmingly convicted of sexual misconduct. 
Detection and response reporting.
Should be easy to report. 
Provisions should be made for a report to an outside official or office not affiliated with the agency.
Does staff accept reports made verbally?
First responder:  agency protection for the reporter to avoid retaliation

Monitoring -Data Collection
Sexual incident reviews
Data Collection/review/storage, publication and destruction - all personal identifiers removed sent, published annual in aggregate paper copies or website.

How are we going to implement? Do we have to?
Prison in name doesn’t have a impact as to whether it applies or not. Prison in name of act doesn’t limit it to prisons. It does apply to community corrections.

Different “softer” standards custom made for Community Corrections.
Different states, different definitions for community corrections.
State laws are all over the place and across the board. PREA is attempting to apply a uniform national standard.
Community Corrections programs are already doing a lot of it if in compliance with ACA standards.

What needs to be done?
  • Adopt a screen tool for risk of victimization and abusiveness.
  • Train staff of sexual abuse and recognition of abuse.
  • Change or create policy detailing procedures.
  • Demonstrate collaboration with outside agencies (MOUs) (need to try -- even if they won’t give you an MOU)
  • Develop protocol for reporting statistics. (look for local government and other agencies for coming up with a reporting method or standard.)
We Know PREA stresses the importance of the role of  the first responder.

Train staff:
  • Control the scene
  • Preserve the evidence
  • Don’t be the investigator
Assess:
Develop risk assessment tool
  • “Red Flags” from NIC
  • “The Dirty dozen” from the Washington  State Dept. of Corrections
The Red Flgs are events, actions, or acitivities that can tip you off to the ossibility of misconduct.
  • Offender grapevine, offender sintches, and offener/staff roumers. 
  • Hosre-play
  • Offenders knowing personal information about staff members
  • Staff isolation from other staff.
  • Staff transporting offenders in a personal vehicle
  • Staff accepting or giving gifts to offenders
  • Staff allowing the offender  perform a personal service for them, such as car repair or housing cleaning
  • staff spending and explainable amount of time with an offender.
  • Drastic behavior or appearance change on the part of the offender or staff - dress, makeup, hair, ect.
  • Staff can’t account for time.
  • Staff confronting staff over an offender
  • Overheard conversations between staff and offenders which is sexualized in nature or about physical appearance.
Myths:
  • We don’t have this problem.
  • Employees know the boundaries.
  • Sexual misconduct is caused by cross gender supervision.
  • Employees will tell on their peers if something is going on.
  • New employees are the only ones that are at risk of this.
---
Nothing is mandated at this point because the standards are still under development. It is time to plan based on obvious requirements.

websites:
PREA web: www.nprec.us
National Institute of Corrections. www.NICIC.org
Bureau of Justice Statistics. www.ojp.usdoj.gov
jbrowning@iccaweb.org - email to get on an electronic newsletter distribution list and receive other materials.

Blogged by Dr. Allen Moore, JD, APR - Orange County (FL) Corrections Department

Mentoring High Risk Juveniles: Implementation of a College-based Mentors in a Juvenile Reentry Program (Sun. Jan. 11, 2009 - 10:00 a.m. - 11:30 a.m.)

In July 2006, the Arkansas Division of Youth Services implemented Going Home, a juvenile reentry program.  Focusing on successful reintegration of high risk juveniles into the community, this initiative encompasses several community based components.  The purpose of this workshop is to discuss challenges and successes associated with providing mentors for program youth.  Participants will be provided information regarding developing and implementing an effective mentoring program utilizing college students.
Coordinator: Lisa Hutchinson, Ph.D., Associate Professor, Department of Criminal Justice, University of Arkansas, Little Rock, Arkansas
Division of Youth Services (DYS) sets the criteria for the UALR mentoring program.  Background on how the program started:
SVORI- Mentoring Program for violent and high risk offenders
Purpose- Reintegrate adjudicated juveniles who are high risk back into the community
Phases- I: Institutional Programs (2-6mos)
       II: Community Based Transition (6-12mos)

Accomplishing Reentry
System Levels- Transitions offenders into the community
Individual Level- Increase services to individuals and intense supervision on post-release

Target Population
  • Male/Female
  • Ages 14-21, committed serious or violent crimes, multiple recidivists, and/or those high risk
  • Pre-release program at all State juvenile facilities
  • Post-release-Faulkner, Lonoke, Puloski, Saline counties
  • Participation is mandatory

Program Components
Institutional Programs
Community Based Transition (Private contractors found through DYS)
UALR Component (Class and internship in the Department of Criminal Justice which offers a real world experience and academic relation)
Through this mentor program it offers the mentor and the mentee an opportunity to learn from one another and allow for the mentor and mentee to have a one on one relationship.  There is some group interaction but mainly the mentor associates with his or her mentee only.
Mentor Qualifications
  • 21 yrs. of age
  • Variety of majors accepted (i.e. Criminal Justice, Business, Sociology)
  • Commitment too two semesters (Fall & Spring Term)
  • Clear State NCIC background check & Child Abuse registry
  • Intensive screening by Project Coordinator and Project Director
Mentors go through a series of training including DYS, G4S/AJATC and UALR.  UALR wants the mentors to understand what their role will be and establish a relationship with the offender.   Ultimately the training is to ensure confidence for taking on a mentor role and mature as a positive role model.  The mentors are then matched with a mentee in which the DYS gives a list of potential offenders that are eligible for the program.  Throughout the mentoring process the mentors are monitored weekly from pre-release through post-release.
Dr. Hutchinson requires that the mentors maintain their academic position as well including Reflection Essays and several readings from various articles and books.  For a better understanding about our juveniles Dr. Hutchinson recommends the following books:
  • “Fist Stick Knife Gun, A Personal History of Violence in America” by Geoffrey Canada
  • “Frameworks of understanding Poverty” by Ruby K. Payne
Blogged by Michelle A. Hendrix, University of Central Florida - Student, Criminal Justice Program

Health Services Role in Facility Emergency Planning (Sun. Jan. 11, 2009 12:30 p.m. - 2 p.m.)

Comprehensive planning for emergencies within the correctional environment are an essential component of effective and organized response to threats of safety and security, This workshop will discuss the importance of incorporating the resources provided by trained correctional health care staff and the role they can play in the event of a potential compromise to safety and security.

Objectives:  The workshop will present case studies of health-related emergencies; discuss the planning process needed; practical experience in developing exercises of emergency plans

Moderator: Raul Banasco, Deputy Chief, Osceola County Corrections Department, Kissimmee, Florida
Speakers: Marc-Garcia Pierre-Louis, RN, BSN, CCHP, Health Service Administrator, Osceola County Corrections Department, Kissimmee, Florida; Lisa Morris-Howell, RN, CCHP, Quality Assurance Specialist, Orange County Corrections Department, Corrections Health Services Division, Orlando, Florida 

What is the connection between MRSA and security in the correctional setting?
MRSA threatens all aspects of any facility.  Danger of MRSA can be minimized only by combining forces with security officers and medical staff.

Bioterrorism is a growing danger to correctional facilities.  
Mr. Marc Pierre-Louis stated that the Health Department is a largely under-appreciated department.

The value of the Health Department is illustrated during infectious outbreaks, such as:
  • Food poisoning
  • Super Bugs
  • SARS
  • Avian Flu
  • MRSA

MRSA is the biggest skin problem in correctional facilities.  MRSA cannot be eliminated, but it can be controlled through constant effort. Pneumonia is the most dangerous manifestation of MRSA and often results in death.

Five “C’s” of MRSA:
  • Crowding 
  • Contact (skin to skin)
  • Compromised skin (cuts and abrasions)
  • Contaminated items and surfaces 
  • Lack of Cleanliness

Colonization vs. Infection
Colonization:  The presence, growth, and multiplication of the organism without observable clinical symptoms or immune reaction

Infection:  Invasion of bacteria into tissue with replication of the organism.  

Primary mode of transmission is hand-to-hand contact.

Combating MRSA is important in correctional facilities.  Early identification and good hygiene is key to prevention.  
Regular and thorough cleaning of the facility is another great way to limit the development of MRSA.
Of course, the single most effective method of preventing MRSA is adequate hand washing.  
If soap and water are not available, alcohol-based hand rubs are another effective way to fight MRSA.

MRSA infections are often mistaken as spider bites.

Outbreak Management requires that we monitor and track all MRSA cases.  Educating staff and inmates is important to managing MRSA.

Blogged by Sgt. Adam Wright, Orange County (FL) Corrections Department

From Line Nurse to Nurse Supervisor (Sun. Jan. 11, 2009 10:00 a.m. - 11:30 a.m. )


Providing constitutional care for our inmate population through nursing is challenging and difficult at best. In this time of resource constraints, we are finding more and more line nurses promoted into supervisory positions at the same institution where they were employed initially. Positional authority notwithstanding, it takes special skills to bring staff on board and to collaborate with other departments. These skills are not often found in any textbook or "how to" manual. It takes a person who understands that leadership is about both the heart and the head. Two former line staff nurses will provide some suggestions on how to make the transition easier.
Objectives: Examples will be used to showcase successful strategies for this transition; questions from the audience will be encouraged;  methods to improve productivity will be explained.
Moderator: Art F. Beeler Jr., M.G.A., Warden, Federal Medical Center, Federal Bureau of Prisons, U.S. Department of Justice, Butner, North Carolina
Speakers: Sally Maire, RN, Federal Medical Center, Federal Bureau of Prisons, U.S. Department of Justice, Butner, North Carolina; Shondra Stacey, Commander, United States Public Health Service, Federal Medical Center, Federal Bureau of Prisons, U.S. Department of Justice, Butner, North Carolina 

Ain't One of the Boys Anymore
  • Move form line staff to supervisory staff is difficult.
  • Move t supervisory staff at the same institution is more difficult..
  • When someone becomes a supervisor, there is no magic want to anoint one.
  • Becoming a god supervisor is learned behavior.
Benefits of having been a supervisor is you know where the line staff is coming from because you have been there.
Dealing with the crush of demands created by the shear numbers of inmates your have to provide services. It is easy to become overwhelmed. 
If you are managing folks, you should step out of your office and experience firsthand what the line staff is experiencing.
Learned Behavior?: yes. You learn from your former supervisors what you don't want to repeat as well as positive ways of how things were handled in the right ways.
With inmates, a nurse may want to do a hug or a comforting touch of reassurance. In the correctional setting you can't do that. Never take your eye off the fact that the patient is an inmate and you are in a special setting. You have to have a balance between security and being a nurse.

Work with and know the corrections security staff because it is a balancing act and you need to understand both.
  • Nursing with in a Correctional setting is a challenge
  • Format for caring must be altered with inmates
  • Clear and concise communication is necessary.
Working as a team is important and you need to be supportive with staff. They have a life outside the institution which may contain challenges beyond the workplace.

Transition from Staff Nurse to Nurse Manager:
There are leadership courses available. These will really help you make the transition.

Emotions a New Supervisor Will Deal With:
  • Stay clam. Hold emotions at Bay. 
GREEN WITH ENVY:
You may have staff that sought your job but you won the position. Meet with any protagonist and keep open communications. Meet with them. Use your immediate superior to assist and resolve, if this situation becomes a problem.
"I applied for the job. You got it. No I'm mad!"

ANGER:
Remain calm and listen when  tempers flare. You may have to move them to a private place so the two of you can sort it out away from other staff and inmates. Sometimes venting solves the problem. People want to be heard and they want you to hear their concerns.

SABOTAGE???
Can surface from disgruntled or jealous employees.
As a manager, you should be keeping an eye out for advancement opportunities for your staff. Give them a chance to have something to look forward to. Share your 

Who does a new supervisor turn to during this transitional time?
  • A Mentor 
  • Staff
  • Your Supervisor or manager
Keep in touch with other managers or supervisors in your institution. It can avoid building frustrations and help discover issues that are shared. A managers or supervisors meeting at least monthly is imortant.

Learn coping skills and know your moral values. Ethical issues can arise. 
Annual Refresher Training - all staff must go through this training annually in the Federal System.
Correctional procedures, nursing procedures, policy and procedural mandates.
Do Not Try to Be Someone You Are Not!

Rules for the New Supervisor
  • Maintain professionalism toward all staff.
  • Wipe the slate clean.
  • Don't socialize with your staff unless all are invited.
If you have a friend among you new subordinates you need to have a private discussion with the person to ensure that parameters are understood.
Inmates need to know you care, but you will not tolerate inappropriate behavior. Supervisors should know which inmates are potential problems. Age makes a difference in how inmates interact with you. Knowledge is power and communication is important.

Steps New Boss Needs to Take
  • Meet individually with each employee
  • Establish expectations
  • Explain your goals and vision fo your department
  • Set high standards for yourself and staff
  • Discuss communication
  • discuss Accountability
  • Practice what you preach.
  • Prioritize - What is important for you to see or Do?
  • Giving Direction - If  they do not know what you want...
  • Inspect - For those things which are important, make sure you have mechanisms to inspect. "What gets inspected gets done."
  • Develop follow-up mechanisms - Immediate and long-term. The immediate is when a task is process to get it done.
FOR STAFF:
Make sure they see you but don't do or tell them how to do their work. Presence is a very important part of a supervisor's job. Being able to giver expertise; there is a fine line between providing direction and doing the job.
Take care of them - Make sure you do not give yourself any perk unless you can shae with your staff.
Understand thAT with supervision you become responsible for you and your staff.

REWARD GOOD BEHAVIOR
We are in a negative environment, and as such, have a tendency to concentrate on the negative. Take 15 minutes a day to complement people for doing good. This takes effort, but pays off tremendously. These awards probably should not be monetary. A simple thanks or recognition can do a lot more.  
STAFF ACCOUNTABILITY
One of the first steps a new supervisor will be when someone does not do as directed or does not meet an expectation.
How do yo manage? Do you discipline everyone?
For some things (such as refusing to obey a lawful order during an emergency) one must  discipline.
But for most issues - progressive discipline.
discuss, Counsel, Warn and discipline
Always document - memorialize conversations.
You have to make sure you don't get so involved with the needs of staff that you don't burn out. However, you have to know what your staff does at work. Who works hard and who doesn't and you have to encourage them. Especially on the line level. Sometimes you have to give staff the power to speak to their peers and say they are not holding their weight. If it elevates to a dispute, then you would become involved.
You cant' hold a grudge.
You are no long a peer or a buddy. Develop accountability. Take care of staff whenever possible. Reward bood behavior. (Pat Respect and Care) don't be afraid to ask for guidance.

Blogged by Dr. Allen Moore, JD, APR - Orange County (FL) Corrections Department


Contraband Interdiction Technologies (Sun. Jan. 11, 2009 - 10:00 a.m. - 11:30 a.m.)

Most, if not all, correctional systems struggle to prevent contraband from being introduced through staff and visitor access and the mail. This workshop provides insight into the latest technologies currently in use in the Federal Bureau of Prisons to detect and deter the introduction of contraband such as cell phones, weapons, and drugs into secure facilities. Technologies addressed will include metal detectors, x-ray devices, urinalysis program, alcohol sensors and ion spectrometry. Correctional managers, intelligence specialists and practitioners will gain an understanding of both detection systems and their effectiveness in preventing contraband introduction. 
Moderator: Jim Mahan, Senior Technologist, Office of Security Technology, Federal Bureau of Prisons, United States Department of Justice, Washington, D.C.
Speaker: John Ely, Security Specialist, Office of Security Technology, Federal Bureau of Prisons, United States Department of Justice, Washington, D.C.

Types of contraband:
  • Weapons
  • Tools
  • Illegal substances

A lot of effort is put into metal detection technologies.
Reducing the sensitivity of the metal detector will result in contraband “beating” the system.
Bureau of Prisons (BOP) standards for walk-through metal detectors are in the process of implementation.  Standards will allow each facility to maintain a definite level of security.
Hand-worn metal detectors will accomplish a metal scan during a pat-search, and are very useful.

The B.O.S.S. metal detector chair will detect metal inside the body without being intrusive.
Mail scanners are a practical and easy way to detect metal with envelopes.  The scanner can detect items inside and object as thick as a phonebook.
Wood and plastic detection is accomplished using body scan machines. A body scan machine costs around $125,000.
Ion Mobility Spectrometry (IMS) Drug Detention Device is a device that will instantly detect drugs on or in the body.
Some issues associated with IMS are:
  • False alarms
  • Policy/procedures
  • Cost - $25 thousand and higher
  • Service agreements
Laser-Based Raman Spectrometry Drug Detection is a portable lab that can test and identify substances on the street.

Inmate Urinalysis On-Site Cups allow drug tests to be conducted immediately.  The cup contains tests strips that can be read on-site.

Passive Alcohol Sensors – Detects alcohol without the need of blowing into a tube.
This is useful for detecting alcohol in unwilling subjects.

Cell Phone Detectors – The problem of cell phones in correctional facilities is growing.  
Jamming cell phones is an illegal act and not an option for the Federal Bureau of Prisons. Testing is becoming more and more popular.  
  • Passive Interception is legal but a warrant is necessary, making interception impractical.
  • Hand-Held scanners will detect cell phones, but must be very close to an active phone.
  • Fixed installation cell phone detectors (WALS) work well, but are very expensive ($250,000).
Thermal Imager detects heat sources whether it is day or night and can be useful for finding objects that were held by a person in the last 30 minutes.   

Sgt. Adam Wright, Orange County (FL) Corrections Department

Borderline Personality Disorder and Treatment in Corrections (Sun. Jan. 11, 2008 -10:00 a.m. - 11:30 a.m.


Borderline Personality Disorder is a term frequently used in corrections, but as a descriptor, the reality of the DSM-IVTR diagnosis has been blurred. This workshop will discuss the Borderline Personality Disorder within the public and correctional systems. It will also look at the epidemiological studies that examine the prevalence of this illness within the populations and the unexpectedly high rate of Borderline Personality Disorder in the male population.


Borderline Personality Disorder (BPD) is an illness not a behavior.  People assume BPD is a common disorder.  The onset of BPD is adolescence or early childhood.  One of the most famous cases of BPD was Judy Garland, Wizard of OZ ‘s Dorothy and also known as America’s little sweetheart.  Judy Garland’s stage career started in early childhood at the age of two years.  From early childhood through adolescence she fought weight gain and in due time in her early twenties became pill dependent, started psychiatric treatment, dealt with anxiety issues and later slit her throat by the age of twenty-eight.  From her late twenties through late forties Judy Garland made several attempts to end her own life and eventually by age forty-seven she died of accidental barbiturate. 


Objectives: To understand the effects of Borderline Personality Disorder; discuss Borderline Personality Disorder in a correctional setting and offer examples of treatments.

Moderator:  Allen Peaton, CCE, Deputy Director, Department of Youth Services, Mount Meigs, Alabama 
Speakers: Bruce A. Sieleni, M.D., Department of Corrections Mental Health Director, Des Moines, Iowa

Dr. Sieleni described BPD as an expensive chronic illness also known as the revolving door syndrome.   Throughout his session he stated that the Etiology is made up of 35% Genetic and 40% environment.  Suicidality is the worse symptom and the greatest demand on the MH profession. 

  • 73% attempt suicide
  • 75% engage deliberate self harm
  • 4-10% commit suicide

BPD is prevalent in 1-20% of the population

Ages 18-25

70% women/30% men

Affects all cultures


Psychological Treatment

Doctors treat with medications but may add more medications than needed.  Medications target the patients symptoms.  Rather than medications many patients can benefit from psychosocial therapies such as STEPPS.


Mood Instability = Mood Stabilizers

Anger/Irritability= Antipsychotics

Depression= Antidepressants

Psychotic-like symptoms= Antipsychotics


STEPPS Program

Used as an environment with positive roll modeling.


Blogged by Michelle A. Hendrix, University of Central Florida Student, Criminal Justice Program 

The Importance of Reducing Waist in Corrections (Sun. Jan. 11, 2009 - 8:00 - 9:30)

Obesity in the general population is mirrored and magnified in the correctional setting. Significant morbidity and associated costs make it imperative that correctional professionals recognize the causes and focus on solutions for this weighty problem. Strategies include smoking cessation, improved diet, increased exercise and attention to co-morbid diseases such as impaired glucose tolerance, hypertension and dyslipidemia. 
Objectives:   The barriers to implementation of a plan of care and strategies to overcome them will be discussed.
Moderator: Melanie Wahl, Director, Medical Resource Services, Correctional Medical Services, Creve Coueur, Missouri
Speakers: Renee Fall Howe, Vice President, Medical Affairs, Correctional Medical Services, Creve Coeur, Missouri; Holly Mathis MSN, ANP-BC, Disease Manager, Correctional Medical Services, Medical Resources, Corporate, St. Louis, Missouri
The purpose of this workshop was to promote the health of men and women in the correctional setting.  The cost of caring for unhealthy inmates is significantly higher than caring for healthy inmates.

Having a weight more than 20% of your ideal weight is considered obese.
Body Mass Index is an accepted method for determining vulnerability for disease such as heart disease.  
Some of the consequences associated with obesity are:
  • Cancer
  • Lower back pain
  • Infertility
  • Heart disease
  • Osteoarthritis (knees)
  • Gout
  • Diabetes
  • Hypertension
  • Sleep apnea
  • Liver diseases
Economic impact of obesity
  • State-level $87 million (Wyoming) per year
Contributors to obesity
  • Sedentary lifestyle
  • Genetic influences
  • Diseases and drugs
  • Demographic shift
  • Social acceptability
  • Cultural influences
Cardio metabolic risk can be affected by:
  • Age
  • Race 
  • Gender
  • Family History
  • Smoking
  • Physical inactivity
Waist measurement is a good indicator of obesity.  For men, a waist of >40 is considered obese.  For women, a waist of >35 is considered obese.

A modest weight loss of 10 pounds will result in significant drops in blood pressure and other negative health factors.  

Inmates are subjected to an enforced sedentary lifestyle that leads to less healthy population, which translates to higher costs for medical care.

Nurse should constantly encourage inmates to exercise and eat better on a regular basis.

Healthy commissary choices should be made available to inmates.  
  • Arkansas DOC removed the saltshakers from tables and changed doughnuts to granola bars. 
  • Arkansas DOC created dedicated walking times in the yard.
Making changes to improve the health of the inmate population can only be achieved when medical and corrections officials work as a team.  Medical cannot do it alone.

Blogged by Sgt. Adam Wright, Orange County (FL) Corrections Department