Correctional Employee Wellness Monograph

Correctional Employee Wellness Improving the Health of Our Greatest Asset

This monograph is a comprehensive guide to correctional employee wellness programs offered in the United States. Based on up-to-date data collection and analysis, this monograph should be used to shape the design and planning of future wellness services to benefit the corrections professionals who serve justice-involved populations throughout the U.S. and beyond.

Acknowledgements

Elizabeth Gondles, Ph.D. Senior Director

Michael Miskell, MPH, CHES ® , Director Office of Correctional Health, ACA Ariel Hoadley, MPH, Data Scientist School of Public Health, Brown University, RI.

Office of Correctional Health and Professional Development

Rosemarie Martin, Ph.D., Associate Professor School of Public Health, Brown University, RI.

The American Correctional Association would like to thank the following parties for their contributions to this work: Bureau of Justice Assistance ACA/BJA Staff Wellness Advisory Committee: American Jail Association Correctional Leaders Association Denver Sheriff Department American Probation and Parole Association Correctional Peace Officers Foundation National Governors Association North American Association of Wardens and Superintendents

This project was supported by Grant No. 2019-RY-BX-K003 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Department of Justice’s Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.

ACA Communications and Publication Staff: Kirk Raymond, Director Carla DeCarlo, Graphic Designer

Photo collage on cover page: Photos courtesy Tennessee Department of Corrections, Arlington County Sheriff’s Office and Nebraska Department of Correctional Services

Executive summary T his monograph presents the results of a national scan on correctional employee wellness programs and services currently offered by state and local correctional agencies in the United States. Participants in the scan consisted of 70 local and state correctional agencies across the United States. This scan looked at availability and type of employee wellness programming offered based on agency type and geographical area. Questions were designed to collect both quantitative and qualitative data including number of staff and institutions in the agency, number of staff wellness programs available, wellness program characteristics and included open-ended questions to allow respondents to provide comments, suggestions or further details. The findings are presented along with recommendations to offer guidance for correctional systems and policymakers as they move forward in supporting the health and wellness of corrections professionals. Among the most prominent findings in this scan are: –– The vast majority of institutions do have employee wellness programming in place; however, there are some state and local agencies that still do not offer any wellness resources; –– There is a broad range of staff wellness programs offered, with the most common being employee assis- tance programs, critical incident debriefings, disease prevention, peer support, outside referrals and fitness programming; –– The number of wellness programs offered to employ- ees does not differ between state and local agencies, but the types of wellness resources often do; –– Lack of funding, adequate staffing level and physical space are the most frequent limitations to providing staff wellness programs at both the state and local level. Based on the data from this scan, a number of recom- mendations are proposed, including: –– Conduct a comprehensive and statistically sound national scan on the efficacy of correctional employee wellness programs; –– Develop and implement a variety of effective pro- gramming that addresses multidimensional wellness, such as physical, emotional, social, financial and mental health services;

–– Enhance financial support for employee wellness in corrections to eliminate barriers to service on the organizational, logistical and individual level; –– Support research initiatives that further our under- standing of correctional employee health in order to more effectively identify the most impactful services for those professionals. Introduction Currently, there are over 400,000 persons working as correctional officers in the United States. 1 Serving a population of over two million, these employees are a vital resource for maintaining the safety and security of the correctional facility for the benefit of the in- mates, staff and community alike. 2 However, corrections professionals are increasingly responsible for not only maintaining order in a population but also facilitating rehabilitation services and actively assisting people who are incarcerated to become law-abiding citizens. 3 The myriad responsibilities combined with frequent exposure to violence, high rates of turnover and staff shortages and perceived lack of workplace safety can quickly lead to burnout, depression and chronic health conditions. 1,4-5 To combat the negative effects of workplace stress and improve the overall wellness of correctional staff, many agencies have implemented some form of an Employee Assistance Program (EAP). Services may address mental, physical, emotional, spiritual, financial or familial health and may include resources such as counseling referrals, addiction recovery support, financial services, family

istock/fcafotodigital

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counseling and crisis intervention. However, as a 2013 liter- ature review from the Department of Justice notes, “There is very little research on the prevalence and effectiveness of correctional officer (CO) wellness programs. This is largely because there have been few rigorous, replicable program evaluations conducted of officer wellness programs.” 6 A more recent literature review from the National Institute of Justice in 2017 reads similarly, finding little new research about the prevalence of such programming and stating that “very few of these programs have been scientifically evalu- ated to determine their effectiveness.” 7 The American Correctional Association (ACA) has been at the forefront of emerging issues in the field of

corrections and quickly recognized the need to develop an evidence base to support such programs. This prompted ACA’s 105 th President, Dr. Lannette Linthicum, to sign a Proclamation encouraging all of corrections to support staff wellness in every way possible. In order to move this area forward and begin to systemically address the need for effective correctional employee wellness resources, ACA responded to a request for proposals by the Bureau of Justice Assistance (BJA). One proposal objective is to de- velop a scan with the purpose of collecting representative data regarding the current status of such wellness services across the United States. The remainder of this monograph presents the results of this scan and suggests options to ad- dress the key issue of improving the health of our greatest asset — the correctional employee. Background Work-related stress has long been acknowledged and studied, with research dating back over 100 years. 8 While traditionally high-stress positions such as physician, police officer and military personnel have received much atten- tion in the field of occupational health, one occupation has lacked the power to garner similar focus: the correctional officer. With an amount of workplace non-fatal violence second only to policing, correctional officers are continu- ally expected to maintain vigilance, prevent crises, respond to emergencies and facilitate rehabilitative services across a population far outnumbering them. 9,10,11,12 Such pressures can lead to high rates of turnover, often resulting in staff shortages and mandatory overtime. 11 Needing to practice constant vigilance while working in the harsh conditions of a secure facility for extended periods of time, correctional officers often experience significant physical and psycho- logical deterioration and frequent burnout. 13,14 Recent studies have supported the challenges, dangers and consequences of the correctional officer position. 13, 15-16 In a survey of over 8,000 current correctional officers, over half reported violent incidents are a regular occurrence at their workplace, with 80% stating that they them- selves have responded to a violent incident in the last six months. 14 In total, 17% of survey respondents have been seriously injured while on the job, 48% have feared they would be injured, and 73% have seen someone seriously hurt or killed while on the job. 14 These rates fall just below those of military veterans. 14 With violence, injury and even

Photo courtesy American Correctional Association

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Impact of COVID-19 on Correctional Staff Wellness

A s COVID-19 began to spread across the globe, congregate housing facilities were especially at risk for rampant transmission. Many businesses and services transitioned employees to remote work to limit the spread of the virus but those working in corrections had no such liberty. As CDC guidelines suggested implementing safety

workplace encounters brief and sleeping in campers or cars, away from their family. However, a Morbidity and Mortality Weekly Report by the CDC shows even brief encounters in corrections — those within six feet of proximity but fewer than 15 minutes in length, such as medication administration at a cell door — could not contain the virus. 2 Faced with little to no choice but

protocols such as virtual court, verbal screenings and temperature checks and increased disinfecting practices, the already numerous duties of the corrections officer only increased. 32 Even with limited inmate transfers, medi- cal isolations and frequent use of personal protective equipment by both staff and

continue to selflessly serve for the safety of our nation, 260 correctional employees have tragically died due to COVID-19 over the past year. 37 The average number of correctional employee deaths per year is 11. 6 With additional duties and longer hours, high risk of exposure, and the pres- sure to limit contact with coworkers and family,

The importance of accessible, quality and comprehensive wellness support for correctional employees is more evident now than ever.

inmates, the spread of COVID-19 through correctional settings could not be stopped. 1-33 Outbreaks became common in facilities across the county. 2-34 In one state, mass testing revealed 73% of inmates tested positive for COVID-19. 3 In another, 64% of inmates tested positive. 3 “Once it’s in the institution, it’s too late. It’s like a brush fire.” remarked one correctional officer. 35 Correctional officers were encouraged to stay home when sick, leave the shift if symptoms devel- oped while on duty and work revised duties if at an increased risk for severe illness. 1 Leaving the number of staff on shift often below the necessary threshold, many had to work double shifts multiple days in a row or even return to work earlier than physician and CDC recommendations advised. 36 Many tried to limit their exposure and transmission possibility by keeping

correctional officers feel similar pressures to health- care workers in the COVID-19 pandemic. 4 Many correctional employees agree, “We don’t call ourselves ‘essential.’We call ourselves ‘sacrificial’.” 4 Managing traumatic stress reactions, such as the uncertainty and responsibilities correctional employees face during the pandemic, is crucial to maintaining a high level of resiliency according to “The Psychology of CO- VID–19”. 7 Utilizing stress management techniques, increasing social support, practicing healthy lifestyle choices and identifying mental health resources are recommended ways correctional employees can sup- port themselves while working through the COVID-19 pandemic. 38-39 The importance of accessible, quality and comprehensive wellness support for correctional employees is more evident now than ever.

Background image: istock/RomoloTavani

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death so prevalent in correctional settings, only half of cor- rectional officers surveyed felt safe at their workplace. 14 The effects these workplace stressors have on cor- rectional officer mental health cannot be denied. While Generalized Anxiety Disorder (GAD) rates in the general population stand around 4%, rates of GAD symptoms reached between 32% and 60% in a recent survey of custody and non-custody staff at a variety of state insti- tutions. 15 This anxiety can affect correctional officers’ personal lives in the form of sleep disorders, such as night- mares, and distrust towards family and friends. 14 Similarly, symptomatology of depression is common, as about 1 in 3 correctional officers state someone in their lives has told them they have become more anxious or depressed since starting work in corrections, 1 in 3 report feeling down, de- pressed or hopeless, and about 1 in 3 find little interest or pleasure in various activities. 17 Even more seriously, sever- al surveys show suicidal ideation rates among correctional officers are about double that of the general population. 16, 18 This rate only increases after retirement, supporting the notion the negative effects of correctional workplace stress do not resolve at shift or even career completion. 17 The frequent crises, austere environment and volatile nature of correctional work affects the employee not only mentally, but physically. Long hours on their feet, con- stant high levels of noise and the demanding nature of the job leave correctional employees more likely to exhibit headaches, stomach aches and back pain compared to their counterparts. 19 Although in a physically demanding job, over 40% of correctional officers are overweight or obese, with higher levels associated with job tenure and male gender. Similarly, hypertension rates of both male and female officers (31% and 26%, respectively) reach almost double that of the general public (17% in males and 15% in females). These elevated levels of hypertension may be a reflection of elevated stress levels regarding security, administrative requirements and work/family life imbal- ance. 20 In addition, constant fatigue can be unrelenting, even after sleeping — especially in those who feel unsafe at work. 16 With the physical and mental health of correctional professionals suffering, many correctional institutions have been providing some types of resources for their employees in the form of an Employee Assistance Program (EAP). Typically, these programs assist employees in ac- cessing professional counseling services, critical incident

debriefing and peer support. 21 As these wellness programs expand, many now include resources to address physi- cal fitness, nutrition, marriage and family counseling and more. For decades, attention has been focused on EAP resources for law enforcement. 22,23 However, little research has been completed regarding the efficacy of such pro- gramming in the corrections field. In a 2019 meta-analysis evaluating the effectiveness of well-being interventions for correctional officers, only 71 studies were found to ad- dress a true correctional employee wellness program. After eliminating articles with either no intervention provided, no outcomes reported, or no relevant outcomes, only nine articles were found to have truly and empirically reported sufficient data. 24 With the studies ranging from 1986 to 2013, decades of research was included. Although no ef- fect was found through meta-analyses, several of the most recent studies did show a variety of wellness programming successes. One study delivering several brief, group- format stress management trainings, found significant stress reduction in officers of facilities with a high rate of inmate turnover, such as jails. 25 A second study recorded pre- and post-intervention data after they “delivered the ‘Power to Change Performance’ program, a five- module group-format stress reduction program delivered across two consecutive days. This program incorporated

Photo courtesy Arlington County Sheriff’s Office

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emotion-focusing and reframing techniques, as well as provided biofeedback training to assist participants in their learning and implementation of the training.” 21 After this program, participants had significant improvements in total cholesterol, glucose, and blood pressure, as well as mo- tivation, positive outlook and relaxation. 26 With the most recent studies showing positive results for correctional employee wellness and the history of such success in law enforcement agencies, the future of wellness programming in corrections is beginning to receive much-needed atten- tion and support. Although correctional employee wellness resources are often successful in improving employee wellbeing, several obstacles exist independent of program existence. A recent study has shown while the majority of correc- tional employees are interested in online health programs, anonymous hotlines or various trainings, fewer than 1 in 5 employees actually access the programs. 27 The most com- mon obstacle corrections agencies must overcome is their employees’ distrust in confidentiality. 22,28 Employees across the nation fear what they communicate to EAP providers, peer supporters or chaplains will negatively affect their job status, such as punitive action, restriction of duties, termination, judgement from coworkers or retaliation from administration. 22, 23 To have true efficacy, wellness initiatives “must be bidirectional, involving both top- down (organizational) efforts AND bottom-up (individual) involvement.” 23 A blended method, along with organi- zational policy changes, can be especially effective. 23 Through system-wide programs, addressing the interaction of intrapersonal, interpersonal and environmental factors within the workplace, and reinforcing a culture of well- being, effective organizational interventions can succeed in maintaining physically, mentally and emotionally strong correctional employees. Overview With decades of evidence demonstrating the physi- cal and mental toll of a career in corrections, developing meaningful and comprehensive correctional employee wellness programs is critical for the safety and security of the U.S. In 2019, the U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Assistance (BJA) sought applicants for training and technical assistance providers in eight areas, including “Improving Wellness

Photo courtesy Davidson County Sheriff’s Office

Support for Institutional Corrections Employees.” Ground- ed in data, research and best practices, the purpose was “to conduct a national scan of corrections academy and in-service trainings and develop recommendations and resources that will help institutional corrections agencies better support the retention and wellness of correctional employees.” 29 Objectives included conducting such a scan of current practices, identifying high quality curricula and gaps in available resources and developing sound guidance around effective correctional officer wellness supports. 24 The American Correctional Association (ACA) has long been at the forefront of addressing critical issues faced by correctional agencies today. In 2017, ACA iden- tified correctional employees’ wellness as a critical issue reaching crisis proportions and resolved to support and improve the multidimensional wellness of correctional employees. 30 In 2020, correctional staff wellness expected practices were published as part of ACA’s Performance- Based Standards and Expected Practices for Adult Correctional Institutions, Fifth Edition. 31 With extensive experience in conducting national data collection, estab- lishing best practices within the field of corrections and communicating updated information across correctional agencies both nationally and internationally, ACA sought to address the subject of correctional professional well- being with an evidence-based, representative approach. In October 2019, ACA and BJA entered a cooperative agreement to address the issues related to correctional

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Participants had two months to gather the necessary information and respond to the scan, which varied in length depending on the participant answers. Ensuring a comprehensive view of each agency’s services, the scan addressed various areas of employee wellness program- ming including: 1. Location, size and type of agency 2. Number of staff employed 3. Availability of wellness programming 4. Types of wellness programming offered 5. Characteristics and limitations of wellness programming offered 6. Health education offerings 7. Barriers to offering staff wellness programs 8. Oversight and funding for staff wellness programs Table 1

Photo courtesy Arlington County Sheriff’s Office

employee wellness, retention and job satisfaction. ACA has published this monograph detailing the national scan of correctional employee wellness options offered today in order to inform programming recommendations and the resources required to implement them. Methodology During the fall of 2020, ACA conducted a scan on the current landscape of staff wellness programs in cor- rections, with emphasis on number and type of services, implementation and funding. The scan was designed by ACA with input from the Correctional Leaders Association, National Association of Wardens and Su- perintendents, Correctional Peace Officers Foundation, American Jail Association, American Probation and Parole Association, Denver Sheriff Department, National Gov- ernors Association, Berkeley’s Goldman School of Public Policy and ACA-contracted researchers. Topics were chosen after multiple days of thorough discussion and feedback by industry leaders, including policy analysts, physicians, researchers, law enforcement, wardens and administration. Scan questions were continually developed over the course of several months and represent the experi- ences of professionals from all levels, as well as jails and statewide prison systems. The scan instrument was sent electronically to the correctional leaders of all 50 states as well as represen- tatives of 37 local detention facilities of various sizes.

Program Type

Total (N=70)

Employee Assistance Program

93%

Critical Incident Debriefings

79%

Preventative Health Screens/Vaccinations/ Inoculations

69%

Peer Support

60%

Outside Referrals

53%

Fitness

54%

Health Fairs

49%

Health Education

47%

Drug and Alcohol Treatment

44%

Resiliency Support/Programs

41%

Nutrition

40%

Social Engagement Activities

39%

Family Counseling

36%

Marriage Counseling

34%

Family Events

34%

Mindfulness

29%

Yoga

13%

Physical Therapy

11%

Legend:

40% or more

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Figure 1 Agency-Staff Wellness Program Offerings (N=70)

Programs offered at similar rates (within 10%) • C ritical incident debriefings • N utrition • S ocial Engagement Activities • F amily Events • P reventative Health Screens • F itness • E xternal Referrals • F amily and Marriage Counseling • M indfulness • P hysical Therapy

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

State > Local (more than 10%) • E mployee Assistance Program • P eer Support • H ealth Education • R esiliency Support Programs Local > State (more than 10%) • D rug and Alcohol Treatment • H ealth Fairs • Yoga

Local (n=25)

State (n=45)

Results Results are presented within each area addressed by the scan, as outlined in the numbered list on page 6 of this document. Overall results are presented first, followed by corrections agency type (state and local) and community setting findings. Wellness offerings The scan asked about the overall provision of employee assistance programs and 17 specific wellness program of- ferings. Four percent (three respondents) do not offer staff wellness programming. Two of these agencies are local and one is state. The range of staff wellness programs offered by correc- tions agencies is broad, as shown in Table 1. At the time of this scan (Fall 2020), 40% or more (green table cells) of agencies most commonly provide critical incident debrief- ings, preventative health programs, peer support, referrals to external entities and fitness programs. Agencies least commonly offer mindfulness, yoga and physical therapy. Corrections agency type offerings are shown in Figure 1. Almost half of programs are offered at similar rates across state and local agencies. Figure 1 also shows pro- grams offered more at local vs. state agencies and state vs.

The scan was sent to 50 states agencies as well as 37 local detention facilities. It was completed by 45 states and 25 local detention facilities for a combined response rate of 80.46%. All completed scan responses were analyzed. Scans were completed within each region of the Coalition of Correctional Health Authorities (CCHA) and Correc- tional Leader’s Association (CLA). The community setting for local agencies were catego- rized based upon the number of beds within the agency, and included rural, suburban and urban. “Rural” agencies had 0–100 beds, “Suburban” agencies had 101–400 beds, and “Urban” agencies had more than 401 beds. Respondents provided scan data for all U.S. regions and are analyzed by location, size and type of agency, col- lectively representing 1,016 institutions and 355,076 staff members. As expected, state agencies are larger in size compared to local agencies, averaging 21 vs. 2 institu- tions and 7,397 vs. 965 staff members for state and local agencies, respectively. All four rural agencies have one institution with an average of 32 staff (range 16–45). Sub- urban agencies have an average of 1.5 institutions (range 1–3) with 83 staff (range 31–200). Urban agencies have an average of three institutions (range 1–9) with 1,619 staff (range 33–10,000).

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Figure 2

Staff Wellness Programs by Community Setting

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Rural

Suburban

Urban

Employee Assistance Program

Critical Incident Debriefings

Preventative Health Screens/Vaccinations/Inoculations

Peer Support

Outside Referrals

Fitness

Health Fairs

Health Education

Drug and Alcohol Treatment

Resiliency Support/Programs Social Engagement Activities

Nutrition

Family Counseling

Marriage Counseling

Family Events

Mindfulness

Yoga

Physical Therapy

local agencies. Overall, the average number of wellness programs offered by an agency is eight and does not differ between state and local agencies. Staff wellness program offerings also vary by com- munity setting of local agencies, as shown in Figure 2. Collectively, rural agencies provide half (53%) of the 17 staff wellness programs queried, with an average of five programs (range 3-9) per agency. Only critical incident debriefing (75%), nutrition (50%), and drug and alcohol treatment (50%) are offered by more than half of rural agencies. Suburban agencies provide 83% of the programs queried with an average of six programs per agency (range 3-12). Critical incident debriefing (67%), preventative health (67%), drug and alcohol treatment (67%), and out- side referrals (50%) are offered by at least half of suburban agencies. Urban agencies provide all programs queried with an average 10 programs per agency (2-17). Only physical therapy is offered by fewer than 40% of urban agencies. Characteristics and limitations of staff wellness program offerings Respondents reported if the following circumstance was true for each of the staff wellness programs offered: par- ticipation is confidential, there are frequency limitations,

copays or fees are required, participation is mandatory, tied to job performance, and available to spouses. Where appropriate, services are offered confidentially (i.e., drug and alcohol, marriage, and family counseling, preventative health screens, referral to an outside entity and peer sup- port). Few programs are mandatory (e.g., drug and alcohol treatment and critical incident debriefing) or are tied to job performance (e.g., drug and alcohol treatment and physical therapy). Copays or fees are uncommon except for drug and alcohol treatment, physical therapy, yoga and for refer- rals to outside entities. Frequency limitations are imposed on counseling programs (drug and alcohol treatment, fam- ily, marriage, resiliency support), physical health programs (physical therapy, nutrition, fitness) and referrals to outside entities. Health education offerings Health education is important for promoting staff wellness, including physical, social, emotional and financial wellness. Almost half of agencies offer health education. Stress management (40%) and suicide aware- ness (39%) are the two most offered topics, followed by financial wellness (36%), time management (27%) and other topics (17%).

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Figure 3

Figure 3 shows the frequency and timing at which health education top- ics are offered. All topics are offered “as needed,” indicating responsive- ness to circumstances as they arise. Suicide awareness is provided annu- ally among most agencies. While not yet routinely offered, providing health education during the Academy is an opportunity to provide comprehensive health education to incoming correc- tional staff on all topics.

Timing of Health Education

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Staff Suicide Awareness

Stress Management

Time Management Coping Skills Financial Wellness Other Health Education Topics

Corrections agency types differ in provision of health education. Local agencies are less likely to provide health education (40%) compared to state agencies (51%). When local agencies provide health education, coping skills, staff suicide awareness, and time management are least likely to be covered. Among local agencies, one rural agency (25%) and one suburban agency (17%) offer any health educa- tion, while 53% of urban agencies offer health education. Stress management is the only topic offered by at least one agency across rural, suburban and urban settings.

Academy Annually As Needed

Table 2

All Regions (N=61)

Barriers

Lack of funding

71%

Lack of adequate staffing level

53%

Lack of physical space

36%

Lack of interest

30%

Lack of information/knowledge

21%

Lack of community resources

15%

Organizational culture

8%

Barriers to offering staff wellness programs Identifying the barriers to offering staff wellness programs is important for prioritizing program offerings. Table 2 presents reported barriers. Overall, lack of funding, lack of adequate staffing and lack of physical space are most often cited. Overall, the rank order of barriers is the same across state and local facilities. Although percentage of state agencies reporting each barrier was higher than local agen- cies, lack of funding (73% vs. 65%), physical space (39% vs. 30%) and staffing level (61% vs. 35%) were highest for states vs. local agencies, respectively. Lack of interest (34% vs. 20%) and knowledge (24% vs. 15%) are moder- ate barriers, and lack of community resources (17% vs. 10%) and organizational culture were lowest barriers (9% vs. 4%). →

Photo courtesy Arlington County Sheriff’s Office

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Figure 4

Primary oversight for staff wellness programs

Barriers

0% 10% 20% 30% 40% 50% 60%

The scan asked about primary responsibility for oversight of staff well- ness programs and results are shown in Figure 5. Oversight differs by cor- rections agency type . Human resources are most likely to provide oversight of wellness programs for both state (51%) and local agencies (50%). State agencies are more likely to have oversight from the State Secretary, Director or Commis- sioner, whereas local agencies are more likely to have oversight from the Sheriff. Primary oversight of staff wellness

Rural

Suburban Urban

programs varies by community setting . Two rural agencies have human resources oversight (67%) and one (33%) has sheriff oversight. All suburban agencies have human re- sources oversight. Oversight of urban agencies varies, with 39% having HR oversight, 21% having state secretary, director or commissioner oversight, 21% having sheriff oversight and 14% having risk management oversight. Funding Sources for Staff Wellness Programs . The scan asked about funding for staff wellness programs. Respondents selected all funding sources available,

Figure 4 presents the barriers reported by local agency by community setting . Each community setting reports multiple barriers to offering programs. Rural agencies do not report lack of funding as a barrier, but half of agencies report lack of staffing, physical space, and interest. For suburban agencies, 40% of agencies report lack of funding, physical space, and interest. In the urban setting, 46% report lack of funding, followed by lack of staffing (36%), physical space (18%) and information (18%).

Figure 5

Local Agency

State Agency

60%

60%

50%

50%

40%

40%

30%

30%

20%

20%

10%

10%

0%

0%

Human Resources (HR)

State Secretary, Director, or Commissioner

Human Resources (HR)

State Secretary, Director, or Commissioner

Sheriff

Risk Management

Sheriff

Risk Management

Wellness committee

Other oversight

Wellness committee

Other oversight

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Figure 6

“Line Item” is a funding source for more than 50% of agencies, followed by facility operations (34%) and discretionary funds (25%). Corrections agency type funding sources differ. More state agencies receive funding from grants, external sources and facil- ity operations compared to local agencies. More local agencies receive funding from a line item. Local agencies do not receive funding from grants. Figure 6 presents funding sources for each community setting . Line item is the only funding source report- ed in all community settings. Rural agencies report only two funding sources (line item and external source). Suburban agencies re-

port funding from line item, external source and employee association or union funds. Urban agencies, in addition to

line item, report support from facility operations, discre- tionary funds and employee association or union funds. →

Photos courtesy Tennessee Department of Correction, Colorado Department of Corrections and Davidson County Sheriff’s Office

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Figure 7

Findings by region Information regarding the location, size and type of agency responding to the scan divided by regions are presented in Figure 7. Region 1 There were 14 completed scans from Region 1 (20% of all respondents) with nine state and five local agency scans. State agencies are comprised of 15.7 institutions on average with 7,638 staff members. Local agencies are comprised of 3.4 institutions on average with 2,836 staff members. Of the 17 wellness program offerings queried, Region 1 provides seven programs on average with state agen- cies providing 7.6 programs and local agencies providing 6.5 programs. Region 1 has highest offerings of drug and alcohol treatment (79%) and peer support (71%), but low offerings of preventive health screens (29%), social engagement activities (14%), family (29%) and marriage (21%) counseling and family events (21%) compared to other regions. Region 1 is low in preventative health screening compared to other regions, and fewer staff well- ness programs overall are offered. More Region 1 state

agencies provide EAP (100% vs. 60%), peer support (89% vs. 40%) and have referrals to external entities (67% vs. 40%) compared to local agencies. Health education is offered in more of Regions 1’s local agencies (60%) than state agencies (33%). Health education is provided by 43% of Region 1 agencies, and staff suicide awareness (38%), stress man- agement (36%), coping skills (36%) are topics most often offered. Financial wellness is offered at a quarter of agencies, but time management is offered at only 7% of agencies, the lowest of all regions. Region 1 suicide aware- ness education is offered at least annually in all agencies and is the only region to do so. Primary oversight for staff wellness programs in Region 1 is most often the Secretary, Director or Com- missioner (46%) followed by Human Resources (31%) and a Wellness Committee (15%). State agencies are more likely to have Secretary, Director or Commission oversight (56%) compared to local agencies (25%). Local agencies are more likely to have Wellness Committee oversight (25%) compared to state agencies (11%).

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Region 1 funding for staff wellness programs comes from all funding categories and has the most funding sources of all regions. Line item and facility operations are reported by 50% of agencies, followed by employee as- sociation or union funds (36%), discretionary funds (29%), and external sources (29%). Grant funding was reported by 14% of state agencies. Local agencies report no funding from facility operations, discretionary funds or grants. Among barriers to offering staff wellness programs, lack of funding (69%) and lack of adequate staffing (54%) are most reported. The lack of physical space (23%), lack of community resources (15%) and organizational culture (15%) are also barriers in Region 1. Lack of interest (8%) was reported but not often. Local agencies report only lack of funding, staffing level and physical space as barriers to offering staff wellness. Region 2 There were 21 completed scans from Region 2 (30% of all respondents), including 12 state and nine local agen- cies. State agencies have an average of 37.3 institutions and 11,289 staff members. Local agencies are comprised of an average of two institutions and 609 staff members. Two agencies (one local and one state), 9.5% of all agencies in Region 2, do not offer any staff wellness programming. Of the 17 wellness program offerings queried by the scan, Region 2 provides ten programs on average, with state agencies providing 11 programs and local agencies providing eight programs. 40% of agencies offer every program except those that are least frequently offered across all regions (i.e., physical therapy, yoga, mindful- ness, family events). Highest offerings include employee assistance program (90%) and critical incident debrief- ings (90%). More state agencies than local agencies offer preventative health screens (92% vs. 57%), health educa- tion (83% vs. 33%), family counseling (67% vs. 22%) and marriage counseling (67% vs. 33%). Health education is provided by 62% of Region 2 agencies and is offered at high rates in the Academy, annu- ally and as needed. Health education topics are covered at higher rates than other regions and are offered in local and state agencies. The primary oversight for staff wellness programs in Region 2 is most often Human Resources (65%) followed by the Secretary, Director or Commissioner (12%) or other oversight (12%). State agencies are more likely to have

wellness committee oversight (10%) compared to local agencies (0%). In addition, local agencies are more likely to have risk management oversight (14%) compared to state agencies (0%). Region 2 funding for staff wellness programs comes from all funding categories and had the most funding sourc- es of all regions. Line item and facility operations are most commonly reported by agencies (47% and 37%), followed by discretionary funds (21%), external sources (16%) and grants (16%). Region 2 agencies do not report any staff wellness program funding from employee association or union funds. Grant funding is reported by 27% of state agencies. Local agencies report no funding from external sources, grants or employee association or union funds. Among barriers to offering staff wellness programs, like in other regions, lack of funding (74%) and lack of adequate staffing (58%) are most reported. The lack of physical space (47%), lack of interest (32%) and lack of information (26%) are also barriers in Region 2. Local and state agencies report similar barriers. Region 3 There were 19 completed scans from Region 3 (27% of all respondents), including 14 state and five local agen- cies. State agencies are comprised of 18.6 institutions on average with 6,741 staff members. Local agencies are comprised on 1.2 institutions on average with 187 staff members. In terms of the 17 wellness program offerings queried by the scan, Region 3 provides 7.4 programs, on aver- age, with state agencies providing 7.2 programs and local agencies providing 8.0 programs. Most common offerings after employee assistance program are peer support (79%) preventative health (74%), critical incident debriefings (74%) and fitness programs (63%). Compared to other regions, Region 3 has lower rates of family (21%) and marriage (16%) counseling, family events (26%), mindful- ness (16%) and health education (26%). Region 3 offers minimal physical therapy and yoga. In Region 3, more local agencies compared to state agencies provide fitness (100% vs. 50%), drug and alcohol treatment (60% vs. 21%) and family counseling (40% vs. 14%). Family events (36%) and mindfulness (21%) are offered in Regions 3’s state agencies but are not offered in local agencies. Physi- cal therapy and yoga are offered in 20% of local agencies but are not offered in state agencies. →

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Region 4 There were 16 completed scans from Region 4 (23% of all respondents), with ten state and six local agencies. On average, state agencies are comprised of 11.1 institutions and 3,994 staff members. Local agencies are comprised of 2.5 institutions and 922 staff members, on average. One local agency, corresponding to 6.2% of all agencies and 16.7% of local agencies in Region 4, does not offer any staff wellness programming. Region 4 provides ten programs, on average, with state agencies providing eight programs and local agen- cies providing 13 programs. Region 4 is the only region where every program queried is offered by at least 40% of

Health education is provided by only 26% of agen- cies in Region 3, the lowest of all regions. Only 26% of agencies have health education on staff suicide awareness, stress management, time management and coping skills. 16% of agencies, all of which were state agencies, provide financial wellness. The primary oversight for staff wellness programs in Region 3 is most often Human Resources (50%) followed by the Secretary, Director or Commissioner (22%). State agencies are more likely to have oversight of the Secre- tary, Director or Commissioner (31%) compared to local agencies (0%). And local agencies are more likely to have Sheriff oversight (60%) compared to state agencies (0%). Region 3 funding for staff

wellness programs comes from all funding categories. Line item (63%) and facility operations (37%) most commonly fund wellness programs, followed by external sources (16%), grants (11%), discretionary funds (5%) and employee association or union funds (5%). Local agen- cies only report funding from line item (80%) and facility operations (40%). State agencies’ wellness programs are funded by all funding sources queried. Among barriers to offering staff wellness programs, like other regions, lack of funding (56%) is reported by most agencies. In contrast to other regions, lack of interest (50%) is the second most reported barrier. The lack of physi- cal space (44%), lack of staffing (31%), lack of information (31%) and lack of resources (13%) are also barriers in Region 3. 67% of local agencies report lack of interest was a barrier to offering programs, comparably higher than in other regions. Local agencies also report that lack of funding (33%) and lack of physical space (33%) are barriers.

Table 3

Region 1 (n=14)

Region 2 (n=21)

Region 3 (n=19)

Region 4 (n=16)

Total (N=70)

Program Type

Employee Assistance Program 86% 90% 100% 94% 93%

Critical Incident Debriefings

64% 90% 74% 81% 79%

Preventative Health Screens/ Vaccinations/Inoculations

29% 81% 74% 81% 69%

Peer Support

71% 43% 79% 50% 60%

Outside Referrals

57% 57% 47% 50% 53%

Fitness

43% 43% 63% 44% 54%

Health Fairs

36% 67% 37% 50% 49%

Health Education

43% 62% 26% 56% 47%

Drug and Alcohol Treatment

79% 38% 32% 38% 44%

Resiliency Support/Programs

36% 43% 42% 44% 41%

Nutrition

43% 43% 63% 56% 40%

Social Engagement Activities

14% 38% 47% 50% 39%

Family Counseling

29% 48% 21% 44% 36%

Marriage Counseling

21% 52% 16% 44% 34%

Family Events

21% 38% 26% 50% 34%

Mindfulness

29% 29% 16% 44% 29%

Yoga

21% 14% 5% 13% 13%

Physical Therapy

7% 14% 5% 19% 11%

Legend:

Low offering

High offering

40% or more

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agencies, except for physical therapy and yoga which are still offered more often than by agencies in other regions. Relative to other regions, Region 4 has the greatest dis- parities in staff wellness program offerings between local and state agencies, favoring local agencies. Compared to state agencies, more local agencies provide peer support (67% vs. 40%), referrals to external entities (67% vs. 40%), drug and alcohol treatment (83% vs. 10%), nutrition (67% vs. 30%), family counseling (83% vs. 20%) and marriage counseling (83% vs. 20%). However, more state agencies provide criti- cal incident debriefing (100%) than local agencies (50%). Health education is provided by 56% of agencies in Region 4, with health education topics offered at moder- ate rates compared to all other regions. Stress management (56%) and financial wellness (50%) are most commonly offered, followed by coping skills (44%), suicide aware- ness (38%) and time management (25%). Additionally, topics are consistently offered in local and state agencies. The primary oversight for staff wellness programs in Region 4 is most often Human Resources (53%), followed by the Secretary, Director or Commissioner (27%). Hu- man resources oversight is slightly more common in state agencies than in local agencies (60% vs. 40%). Compared to local agencies, state agencies are also more likely to have oversight by the Secretary, Director or Commissioner (40% vs. 0%). However, local agencies are more likely than state agencies to have Sheriff (60% vs. 0%), risk man- agement (20% vs. 0%) or other oversight (20% vs. 0%). Region 4 funding for staff wellness programs comes from all funding sources queried except for grants. In fact, Region 4 is the only region not reporting grant funding for their wellness programs. Discretionary funds (53%) and line items (40%) most commonly support wellness programs, followed by external sources (27%) and facility operations (13%). Local agencies report no funding from line items or facility operations, which provide funding to other regions’ local agencies. The three sources of local agency funding are discretionary funds (60%), external sources (40%), and employee association or union funds (20%). State agencies’ staff wellness programs are funded by all funding sources queried except for grants. Among barriers to offering staff wellness programs, like in other regions, lack of funding (83%) and lack of adequate staffing (67%) are reported by most agencies in Region 4. Lack of community resources (25%), lack of in- formation (25%), lack of physical space (17%) and lack of

interest (17%) are also barriers in Region 4. While a lack of funding and a lack of staffing is cited by at least half of all state and local agencies, only state agencies report a lack of interest and lack of space. Regional comparisons The range of staff wellness programs offered by correc- tions agencies is broad, as shown in Table 3. Region 1 has high offerings of drug and alcohol treatment and peer sup- port, but low offerings of preventive health screens, social engagement activities, family and marriage counseling, and family events. In Region 2, over 35% of agencies offer every program, except physical therapy, yoga and mindfulness. Region 3 has low offering of family and marriage counsel- ing, family events, mindfulness, and health education and minimal offering of yoga and physical therapy. In Region 4, over 40% of agencies offer every program (except physi- cal therapy and yoga). Region 1 and Region 3 both offer on average 7 staff wellness programs. Region 2 and Region 4 both offer on average 10 wellness programs. Table 4 presents health education topics by each re- gion. Region 2 provides consistent health education across all topics with Region 4 closely following. Region 3 agencies provide the least amount of health education. In Table 4 Health Education includes the

Region 1 (n=14)

Region 2 (n=21)

Region 3 (n=19)

Region 4 (n=16)

Total (N=70)

following topics ...

Staff Suicide Awareness Stress Management Time Management

38% 52% 26% 38% 39%

36% 62% 26% 56% 46%

7% 43% 26% 25% 27%

Coping Skills

36% 58% 26% 44% 40%

Financial Wellness

21% 52% 16% 50% 36%

Other Health Education

29% 24% –

19% 17%

Legend:

Low offering

High offering

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