Corrections_Today_July_August_2019_Vol.84_No.4

July/August 2019 Today Corrections Top Teacher! p. 30

The 28 th Annual Wreath Laying Ceremony forThoseWho Have Fallen p. 40

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American Correctional Association Corrections Today July/August 2019 Vol. 81, No. 4

Features

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Breaking cycles of incarceration The Ridge Project’s holistic approach to reconnecting incarcerated fathers with their families By Robert Breckenridge II

40 National Correctional Officers and Employees

Week Highlights By Robert Breckenridge II, Alexander Carrigan and Molly Law

30

Top Teacher! How an educator at a juvenile detention center became National Teacher of the Year By Alexander Carrigan

On the cover: Corrections Today invites you to take an exclusive look into the Honor Guard Competition that followed the 28 th Annual Wreath Laying Ceremony. The competition featured units from Washington, D.C., Maryland and Virginia, including the Fairfax County Sheriff’s Office (pictured left), and Prince George’s County Department of Corrections (right). To see all the winners from this showcase of skill, precision and uniformity, see our coverage of the event starting on page 44.

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Purposeful Professionals Advancing employee

resiliency through spiritual wellness By Harmony Goorley, MA, LCPC, CCHP

All photos courtesy Ellis Williams

2 — July/August 2019 Corrections Today

Innovation. Partner with Although correctional health care is our sole focus, Wexford Health works with prominent academic medical centers, managed care organizations, and health care agencies to ensure we are applying the latest free-world technology and clinical breakthroughs. Let us implement our leading-edge programming to help you streamline your health care operations and achieve optimal patient outcomes. Partner with innovation. Partner with Wexford Health.

Learn about our commitment to raising the standard of correctional medicine at www.wexfordhealth.com .

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12

News&Views

6

From Jim’s Desk

6

Correctional Chaplain Perspectives

8

Juvenile Justice News

12

NIJ Update

16

59 ACA Featured Departments

80

Welcome New Members

60

Certification List

64

Bookshelf

68

Dual Chapter Spotlight

76

Membership

78

Correctional Health Perspectives

80

Professional Development Update

86

Certification Spotlight

88

Corrections Calendar

90

Index to Advertisers/ Product Index/Job Bank

92

88

4 — July/August 2019 Corrections Today

Chapters and affiliates

Alabama Council on Crime and Delinquency—Albany Criminal Justice Association—Alston Wilkes Society—American Catholic Correctional Ministries—American Correctional Health Services Association—American Institute of Architects—American Jail Association—American Probation and Parole Association—Appalachian State University Student Chapter— Arizona Probation, Parole and Corrections Association—Arizona State University ACA Student Chapter—Association for Correctional Research and Information Management—Association of Correctional Food Service Affiliates—Association of Paroling Authorities International—Association of State Correctional Administrators—Association of Programs for Female Offenders—Association of Women Executives in Corrections—Bellmont High School Student Chapter—Brown Mackie College ACA Student Chapter— California Probation, Parole and Correctional Association—Caribbean Correctional Association—Champlain Valley Educational Services— Clayton State University Justice Society—Colorado Criminal Justice Association—Columbia-Greene Community College—Criminal Justice Club Student Chapter—Concordia University Sociology of Law & Justice Club—Connecticut Criminal Justice Association—Correctional Accreditation Managers Association—Correctional Association of Massachusetts— Correctional Education Association—Correctional Healthcare Providers of the United States—Council of Juvenile Correctional Administrators—District of Columbia Criminal Justice Association—Eastern Kentucky University Corrections and Juvenile Justice Student Association—Family and Corrections Network—Florida Council on Crime and Delinquency—Harrison College Criminal Justice Association Student Chapter—Hawaii Criminal Justice Association—Historical Association for Corrections—Illinois Correctional Association—Indiana Criminal Justice Association—Integrated Correctional Association of the Philippines (ICAP) Inc.—International Association for Correctional and Forensic Psychology—International Association of Correctional Training Personnel—International Correctional Arts Network—International Corrections and Prisons Association— International Community Corrections Association—Iowa Corrections Association—Jamaica Federation of Corrections—ITT-Technical Institute ACA Student Chapter—Ivy Tech Community College Terre Haute Branch ACA Student Chapter—Juvenile Justice Trainers Association—Kansas Correctional Association—Kentucky Council on Crime and Delinquency

Inc.—Louisiana Correctional Association—Martin University Student Chapter—Maryland Criminal Justice Association—Michigan Corrections Association—Middle Atlantic States Correctional Association—Minnesota Corrections Association—Missouri Corrections Association—Missouri Western University Student Chapter—Moraine Park Technical College Corrections Club—National Association of Blacks in Criminal Justice— National Association of Correctional Record Administrators and Supervisors—National Association of Juvenile Correctional Agencies— National Association of Probation Executives—National Association of Adult and Juvenile State Corrections Mental Health Directors—National Correctional Industries Association Inc.—National Council on Crime and Delinquency—National Council of Juvenile Correctional Administrators— National Juvenile Detention Association—National Major Gang Task Force— National Organization of Hispanics in Criminal Justice—National Partnership for Juvenile Services—Nebraska Correctional Association—Nevada Corrections Association—New Jersey Chapter Association—New Mexico Criminal Justice Association—New York Corrections and Youth Services Association—North American Association of Wardens and Superintendents— North Carolina Correctional Association—Northern Illinois University Academic Justice Association—Ohio Correctional and Court Services Association—Oklahoma Correctional Association—Oregon Criminal Justice Association—Parole and Probation Compact Administrators Association— Pennsylvania Association of Probation, Parole and Corrections—Pierce College Criminal Justice Club—Prison Fellowship—Puerto Rico Department of Corrections and Rehabilitation Association—Richmond Community College Student Chapter—St.Augustine’s College ACA Student Chapter— Salvation Army—South Carolina Correctional Association—Southern States Correctional Association—State University of New York–Albany—Tennessee Corrections Association—Texas Corrections Association—University of Central Missouri Student Chapter—University of Illinois/Chicago Criminal Justice Society—Utah Correctional Association—Virginia Correctional Association—Volunteers of America Inc.—Washburn University ACA Student Chapter—Washington Correctional Association—Western Illinois University Corrections Club—Western Correctional Association—Westwood College Angels—Wisconsin Correctional Association—WITC New Richmond Criminal Justice Club—Wyoming Correctional Association

OFFICERS President Gary C. Mohr, Ohio Immediate Past President Lannette C. Linthicum, M.D., FACP, Texas Vice President Tony M. Wilkes, Tennessee President-Elect Tony C. Parker, Tennessee Treasurer Denise M. Robinson, Ohio Board of Governors Representatives

Elizabeth F. “Beth” Arthur Derrick D. Schofield, Ph.D. Secretary James A. Gondles Jr., CAE, Virginia

EDITORIAL STAFF EDITOR-IN-CHIEF James A. Gondles Jr., CAE Managing Editor Floyd Nelson Associate Editor Molly Law

Assistant Editors Robert Breckenridge II Alexander Carrigan GRAPHICS AND PRODUCTION STAFF Graphic Designers ADVERTISING AND MARKETING STAFF Director, Conventions, Advertising and Corporate Relations Kelli McAfee Production Coordinator Mary Misisco EPS/Printing Services MVP Press • Dulles, VA ACA Executive Office and Directors Executive Director James A. Gondles Jr., CAE Deputy Executive Director Jeffrey Washington Executive Office Director Debbi Seeger senior executive Assistant India Vargas Joe Broderick Carla DeCarlo

Article and photo submissions: Managing Editor, 206 N. Washington St., Suite 200, Alexandria, VA 22314; email submissions@aca.org. Articles must be in Microsoft Word. Please include all contact information. Unless expressly requested in writing, all photos and artwork submitted become the property of ACA and may be used in future ACA publications. Articles and photos will not be returned unless expressly requested by author. Microfilm: Corrections Today is available for electronic reproduction through ProQuest Information and Learning Co., 300 N. Zeeb Drive, Ann Arbor, MI 48106-1346; 313-761-4700.

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Statements contained in Corrections Today are the personal views of the authors and do not constitute ACA policy unless so indicated. ACA does not assume responsibility for the content of Corrections Today as submitted by contributors, reserves the right to edit all articles and, if necessary, condense them. The publication of any advertisement by ACA is neither an endorsement of the advertiser nor of the products or services advertised. ACA is not responsible for any claims made in advertisements. Mission statement: The American Correctional Association provides a professional organization for all individuals and groups, both public and private, that share a common goal of improving the justice system. Corrections Today (ISSN 0190-2563, USPS 019-640) is published six times a year in January/February, March/April, May/June, July/August, September/October, November/ December by the American Correctional Association, 206 N. Washington St., Suite 200, Alexandria, VA 22314; 703-224-0000. Periodicals postage paid at Alexandria, VA 22314 and additional mailing offices. Postmaster: Send address changes to Corrections Today, Attn: Membership Department, 206 N. Washington St., Suite 200, Alexandria, VA 22314. Subscriptions are included in annual membership dues. Nonmember subscription rates are $25 per year for Corrections Today ($36 value) or $6 per issue. Send change of address notice and a recent mailing label to Membership and Customer Service Department, ACA, 60 days before the actual change of address. ACA will not replace undelivered copies resulting from an address change. Printed in USA. Vol. 81, No. 4. Copyright 2019 by the American Correctional Association.

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Communications and Publications Director Floyd Nelson

Conventions, Advertising and Corporate Relations Director Kelli McAfee Financial Services and Human Resources Director Hok Gao, CPA Information technology director Chip Flater Government and Public Affairs Director Eric Schultz Membership and Customer Service Director Natahnya McKinney Office of Correctional Health Director Elizabeth Gondles, Ph.D. Professional Development Director Casandra DePalma Standards and Accreditation Director David Haasenritter

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From Jim’s Desk The Sesquicentennial and Silver Jubilee all on the same day in Arlington County

R ecently, it was my honor to be invited by Arlington County, Virginia Sheriff Elizabeth “Beth” Arthur to speak at a ceremony marking the 150 th Anniversary of the Arlington County Sheriff’s Office and the 25 th Anniversary of the construction of the Arlington County Detention Center. “I was there” for the construction of the Arlington Detention Center. During the time a bond referendum was passed, a construction man- agement company was hired, an architectural firm was selected and a construction company began work, I served as the Arlington County Sheriff. Although I was no longer the Sheriff when the facility was opened, I take pride in knowing my home coun- ty houses a facility that is humane, full of programming for residents and has been accredited many times over. Sheriff Arthur and her staff are the “best in the business” and I’m doubly proud of that office. For 25 years,

persons from all over the nation, and indeed all over the world, have visited a direct supervision, high-rise urban jail known for its forward-thinking administration and humane relation- ship with its residents. I was not there when Alexandria County created the sheriff’s office in 1869! In 1920, the county changed its name to Arlington County as to not be confused with the city of Alexan- dria. Arlington’s first sheriff, in 1869, was an African American man who freed himself from slavery at age 20. Throughout the 150 years of its continuing rich and diverse history within that office, our county has seen a sheriff who was very close to the Ku Klux Klan, if not a member himself. We have witnessed a father and son who both served in that elec- tive office. In fact, it was my honor to serve as a deputy sheriff under the son, J. Elwood Clements. Sheriff Cle- ments was far ahead of correctional thinking on the local level, and I was proud to have known him.

During the 150 years, 17 men have served the office. It only took about 140 years to finally elect a woman — far, far too long! But Arlington and the entire country are seeing more and more women serving in that role than ever before. Betty and I enjoyed the celebration at the courthouse and detention center complex. May Arlington’s Sheriff’s Office serve another 150 years. My hope is that someday, Arlington will not need a detention center. As the Rev. Jesse L. Jackson says, “Never ever, ever, give up hope!”

James A. Gondles Jr., CAE ACA Executive Director (See page 48 for more on Arlington County’s 150 th Anniversary Celebration.)

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American Correctional Association’s 149 th Congress of Correction

BOSTON

We hope to see you in Boston! As August approaches, the American Correctional Association looks forward to seeing those who have registered for the 149 th Congress of Correction in the cultur- ally-rich, beautiful city of Boston. For those who have not yet registered, online regis- tration is available until onsite registration starts on Aug. 2. If all of the workshops, pro- fessional development and accreditation opportunities, guest speakers, networking opportunities, as well as the grand prize giveaway isn’t incentive enough, the end- less sites and attractions that Boston has to offer should be added motivation. Boston is full of history, and history will certainly be made at this year’s Congress of Correction, so don’t miss out!

10 Places to See in Boston 1. Boston Common and Public Garden 2. Boston Tea Party Ships & Museum 3. Cheers Beacon Hill 4. Fenway Park 5. Franklin Park Zoo 6. Harvard University 7. Isabella Stewart Gardner Museum 8. John F. Kennedy Presidential Museum and Library

9. New England Aquarium 10. The Paul Revere House

Make your hotel reservations online at register.aca.org and click on the “Housing” tab.

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Correctional Chaplain Perspectives

Choices: Finding the true cause of the incarceration of males and how to inspire change By Roy Smith, Ph.D., MDiv S ometimes what appears to be the source of a complex issue is only the surface of an intricate

web of other problems that must be addressed in order to fully solve the main issue. Consider individuals in prison — what led them to their cur- rent situation? Many experienced a moment of choice, and rather than thinking through the situation, they acted impulsively, reactively or selfishly. They convinced them- selves that normal consequences did not matter or could somehow be avoided. Human willfulness has been a strong determinant for action ever since the beginning of humanity when Adam and Eve decided to eat the fruit in the Garden of Eden in an attempt to be like God. 1 Willfulness alone, however, does not explain the entire decision-making process. There are patterns of influential internal and external factors that in- crease the probability of destructive choices which workers, volunteers and ministers in the field of criminal justice have long recognized. 2

istock/ilkercelik

Because most individuals already have some level of awareness about their negative habits, behaviors and attitudes, it is not particularly effec- tive to simply tell someone what they

should be doing differently. Aware- ness by itself is not likely to help them make more rational and posi- tive decisions in the future because they still lack the ability to explore,

8 — July/August 2019 Corrections Today

Correctional Chaplain Perspectives

understand and control the basic elements within them that affect their decision making. It is much more effective to first discover the causal factors that may create or support the problem the individual is strug- gling with, which then allows for a multifaceted approach whereby each cause is addressed as a solution is sought. Causal factors stemming from youth For many males who have been incarcerated, environmental factors in their youth inhibited their emo- tional growth; they never learned to express their instincts and emotions in healthy and productive ways. One of the most prevalent of these factors is the absence of a positive father figure who modeled a healthy lifestyle. 3 These unguided males long to be and act like men, but have been deprived of an understanding of what manhood truly means. They resort to drawing their own conclusions based on poor examples, as well as circumstances and personal feelings about their responsibilities as men. Not establishing a healthy identity structure results in inmates becoming more willing to let their choices be guided by primitive influences. A change in thinking is needed, but for personal change to occur, a clear understanding of the causal fac- tors that initially influenced them to make the choices that led to incarcer- ation is required. Specific cognitive and emotional remedies for all areas of influence must be presented and considered in order to avoid follow- ing the same maladaptive patterns. Time and time again, after males are exposed to basic concepts of identity

formation and personal growth, such as self-awareness and expression, they voice regret that they were not taught these ideas earlier in life.

to properly defend themselves can be defensive and closed off in every area of their lives. Making a change While these causal factors cer- tainly play a role in shaping the ways a male processes and responds to life situations, it is vital for each man to realize that these factors are merely explanations — not justifications — for choices and subsequent actions. In order to successfully understand his situation and change his patterns of choice, an inward evaluation of his identity and the internal struc- tures on which that identity is built is required. A multitude of ele- ments exist within each individual’s identity, including emotions, mental health, spirituality and memories of past experiences. When males learn to recognize and understand these concepts, it allows them to take responsibility for their tendencies. This responsibility, in turn, helps them identify the impulsiveness and self-destructiveness behind behav- iors previously used. By recognizing and dealing with each causal factor, the individual will gain the power to stop past habits and, instead, de- velop a strong and structured identity through nurturing their character. Through this new understanding, they gain the ability to develop plans and establish the steps that lead to positive-goal achievement instead of continuing to blindly follow their compulsions. Establishing a set of guiding principles provides a power- ful foundation for future decision making and gives a man the power to exhibit self-control instead of victimhood. Undertaking a rigor- ous self-examination will help a

It is much more effective to first discover the causal factors that may create or support the problem the individual is struggling with, which then allows for a multifaceted approach whereby each cause is addressed as a solution is sought. Lack of a positive male role mod- el also inhibits the development of fundamental life skills. Young males do not understand the importance of healthy relationships and conse- quently do not know how to develop or maintain relational support. Because they have never learned how to explore and emotionally digest their early childhood experi- ences, those experiences continue to hurt them in the present. Males who grew up in a confusing, defeating environment without knowing how

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man discover skills and abilities that are already within him, which he can now draw upon to start making healthy choices in order to control his situation and define his future. Rehabilitation For a rehabilitation program to be successful, it must address and incorporate the principles discussed above. This will require pushing participants to fully engage with their emotions and past trauma, learn to think differently and change their future patterns of choice. LiveUp Resources, a division of Pennsylvania Counseling Services, has developed specific materials to assist in teaching these concepts to both men and women. Its primary resources, “The Heroic Man’s Jour- ney” for men and “Living Better” for women, first and foremost provide a study of identity for the individual. 4,5 God said to Jeremiah, “I have put my words in your mouth,” showing that identity formation is God’s purpose for each person’s life. 6 With a goal of moral rehabilitation, materials from LiveUp Resources guide men and women in the development of their physical, emotional, mental and spiritual well-being. The aim of “The Heroic Man’s Journey” is to teach manhood ac- cording to God’s design and, in doing so, bring about genuine and lasting life transformation. Begin- ning with its first lesson, the program sets forth a standard of honor by defining manhood as living up to one’s nobility and value. Lessons guide participants to understand the various causal factors that influence their choices. Because the program is intentional about using common,

understandable language, males at any stage in life and with vary- ing degrees of education are able to comprehend essential concepts such as emotional IQ, goal setting, cognitive distortions and relationship skills. The power and importance of relationships are emphasized and fostered through creating a discussion-based environment that encourages participants to practice new skills and develop supportive interpersonal connections. Establishing a set of guiding principles provides a powerful making and gives a man the power to exhibit self- control instead of victimhood. Recidivism rates in the United States remain staggeringly high. 7 While there are many factors that play into this problem, a primary cause is a lack of understanding of the various causal factors that inhibit an individual from making responsible choices. As a result, they follow the same behavioral tendencies that initially led to those foundation for future decision

negative consequences. Those work- ing or serving in the criminal justice field can open up opportunities for life-changing interactions by helping inmates recognize the true source of their choices and the transforming power of a relationship with God. Rehabilitation programs such as “The Heroic Man’s Journey” that challenge old patterns will provide empowerment for creating a new identity through which an individual can take responsibility for his decision making. Only when men learn to improve their decision making will they finally begin to choose what is good for themselves, for others and for the world around them. 2 Beckett, Katherine, Lindsey Beach, Emily Knaphus and Anna Reosti. 2018. “US Criminal Justice Policy and Practice in the Twenty-First Century: Toward the End of Mass Incarceration?” Law & Policy, 40(4): 321-345. 3 Popenoe, David. 1996. Life without Father: Compelling New Evidence that Fatherhood and Marriage are Indispensable for the Good of Children and Society. New York, N.Y.: Free Press. 4 The Heroic Man’s Journey DVD series is available at www.k21.men/HMJ-dvd. 5 Living Better DVD series is available at www.realwomen21.com/LB-dvd. 6 Jeremiah 1:9. 7 Prell, Lettie, Michael J. Vitacco and Denis Zavodny. 2016. “Predicting Violence and Recidivism in a Large Sample of Males on Probation or Parole.” International Journal of Law and Psychiatry, 49(A): 107-113. https://www.sciencedirect.com/science/article/abs/ pii/S016025271630190X?via%3Dihub. Roy Smith, Ph.D., MDiv is the CEO of Pennsylvania Counseling Services, Inc. and the author/founder of LiveUp Resources. References 1 Genesis 3.

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Correctional Behavioral Health Training and Certification Program

Adult Correctional Officers • Juvenile Justice Professionals Allied Behavioral Health Staff • Community Corrections Officers

This program ensures a candidate’s knowledge of national expected practices and guidelines, legal and ethical principles and relevant security regulations. It also validates the role of correctional professionals associated with the provision of behavioral health services for mentally ill inmates or offenders in correctional settings.

“The CBHC training offered valuable perspectives for custody and health services staff working as a multidisciplinary service team.” —Terri L. Catlett, Deputy Director – Health Services North Carolina Department of Public Safety

“The program is a benchmark that targets specialized training needs for staff interacting with correctional behavioral health populations today. It promotes public safety and safer prisons by increasing the level of professionalism for our correctional officers as it builds knowledge, skills and abilities tomanage our growing behavioral health populations.” —Tony Parker, Commissioner Tennessee Department of Correction

“The American Correctional Association’s Correctional Behavioral Health Certification helps us reach the goal of successfully training our officers to be better at managing this difficult population.” —Daron Hall, Sheriff Davidson’s County Sheriff’s Office

For more information, email healthcare@aca.org

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Juvenile Justice News

Out of the mouths of babes How the implementation of an oral hygiene program led to the decrease of dental disease at a juvenile justice correctional center By Lori S. Wilson, DDS and Mark H. Murphy, MS

T ooth decay is the most com- mon chronic disease among children in the United States. Countless hours are missed from school because a child may be hurt- ing from a toothache. Most children suffer in silence, and behavioral problems are often linked to oral health disease. These children, who often come from families that earn less than 200% of the federal poverty level and are overly represented in the juvenile justice system, are three times more likely to have untreated tooth decay than their counterparts from higher income families. One- third of poor children are able to access dental care with a dentist compared to 71% of higher-income children. 1 According to a recent study conducted in Washington state, more than 65.9% of youth involved in the juvenile justice system were found to have major dental issues. 2 Faced with these significant statistics and the actual manifesta- tion of this data into real life clinical situations, preventative care became a paramount issue within the dental

istock/artisteer

The need for change

clinic located at Bon Air Juvenile Correctional Center in Bon Air, Virginia. True to form, most of the residents presented for oral health evaluations during the intake exam were found to have some type of dental care needs, whether it per- tained to simple cleanings to more complex oral surgery needs. More important than those needs were the manifestations of oral health issues that could lead to major medical problems if left untreated.

Much has been said in recent years about treating the whole patient. This has been an important focus in a health care system that is becoming increasingly reactive and specialist-driven over the years. The Virginia Department of Juvenile Jus- tice Health Services has extended this vision from treating the whole patient to include treating them throughout their whole life. With dental services’ preventative care, this took the form

12 — July/August 2019 Corrections Today

Juvenile Justice News

of repeated patient education, pro- phylactic treatments and good oral hygiene habit development. All residents were asked upon intake when they last visited their family dentist. Sixty-five percent of the residents we encountered had been to their local dentist and received some type of dental pro- cedure in the past six months, with 35% stating that it had been over two years since being seen. This ques- tion led to the gathering of important information to the resident’s expo- sure to oral health care and to the assessment of the patient’s dental IQ, which would play an important role securing the necessary treatment after release. If residents responded that they saw a dentist in the last six months, it was an indication that the resident had received some education on the importance of obtaining rou- tine oral health care. However, if the resident responded that it had been years since they had seen a dentist, it was an indication that they needed increased oral health education. When working with residents with a low dental IQ, the dentist breaks procedures up into multiple short appointments. During these ap- pointments, the dentist educates the patient about the procedure utilizing the Show, Tell, Do method of train- ing. The dentist shows the patient the problem with their tooth using radiographs or dental models. Next, the dentist tells the patient not only about the procedure to fix their den- tal problem, but also what techniques they will use to numb the area so the patient will not feel pain. Finally, the dentist does the one single proce- dure. This method greatly reduces the dental apprehension of low dental

IQ residents that could limit future engagement in oral health care. During the intake exam, each resi- dent is educated to the importance of dental hygiene and that good oral health contributes to overall general health. All residents receive oral hygiene instruc- tions that include a strong emphasis on preventative dentistry. The dentist and dental assistant give them an overview of the detailed and focused range of dental services available to them ac- cording to their oral health needs. While they receive care from a variety of nurses depending on the time, day and nature of their medical need, the unit nurse plays a vital role in educating them and connecting them to the health care system. All resident housing units have a nurse assigned to their unit. While they receive care from a variety of nurses depending on the time, day and nature of their medical need, the unit nurse plays a vital role in edu- cating them and connecting them to the health care system. Adolescents are more amenable to suggestions

and ideas from adults with whom they have an established relation- ship, as opposed to semi-anonymous authority figures. The unit nurses participate in the ongoing dental education of their units by provid- ing periodic education on good oral hygiene practices. Challenges and solutions The aim of health services is to provide general and targeted oral hygiene instructions from multiple sources across a variety of settings. Changing any health-related behav- ior is unlikely to happen when the instructions and reminders are infre- quent and disconnected from every other aspect of a youth’s daily life. Upon initial assessment with radiographs, the dentist devises individualized treatment plans with a strong emphasis on preventive den- tistry regimes. In many correctional settings, offenders are offered one cleaning a year (or less) due to the large population of the prison and the relatively small dental staff. In rec- ognition of community standards of care and the importance of ongoing prophylactic treatment, we changed our practice to include dental ap- pointments every six months. This included a six-month recall hygiene system as well as sealant placement and the painting of Duraflor (fluoride varnish) on the facial/buccal sur- faces of all teeth. The adding of the recall system allowed the resident to receive two preventive dentistry appointments yearly, which included prophylaxis (cleanings) as well as replacement of sealants if needed and fluoride varnish. Moreover, if new carious lesions (cavities) were found during the recall/annual

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appointments, dental treatment can be administered appropriately during a subsequent appointment. As we increased our engagement with the dental care of the residents, we found that residents were having problems with personal oral hygiene with the toothbrushes that had been provided. A small two-inch tooth- brush with no floss had been the status quo of oral hygiene packets given to the residents. The residents complained about not being able to reach their back molars with such a small toothbrush, therefore they could not brush properly. The residents also wanted to have access to personal floss that had been prohibited in the past because of security concerns. Security concerns can often be attributed to a class of objects, in this case dental floss and toothbrushes, when in fact the concern is not the object itself but an attribute of that object. With dental floss the attributes that concerns most security profes- sionals is the tensile strength and hardness of most dental floss. Offend- ers can braid dental floss into strong rope or use it to saw through other materials if they are persistent enough. Security professionals sometimes, though less often, worry about the rigidity of toothbrushes. While not the most intimidating or effective weapon base, the potential is enough to cause concern in some correctional settings. Rather than a head-to-head battle over the risk/benefit of having the better oral hygiene equipment vs. safety and security, we instead chose to address the attributes of concern and identify a solution that was mutually acceptable. In this case we found rubbery, reus- able dental “floss” with finger loops that enabled the user to hold them

without adding to the length for finger wrapping. We also found semi-flexi- ble, full-length toothbrushes.

each recall visit. There was also a sig- nificant decrease in calculus buildup on teeth that can be attributed to the daily use of floss. The incidence of periodontitis (gum disease) and gingi- vitis has decreased, and residents rarely complain of bleeding gums. Residents’ dental IQ levels have also increased due to the interest in their dental health and keeping dental appointments. Residents are eager to learn about preventive dentistry regimes and imple- menting brushing techniques at least twice a day or after every meal. Work- ing in close proximity with the nursing staff at the facility allowed a true part- nership between the medical and dental departments to formulate shared goals of achieving optimal dental care for the residents housed here. The implemen- tation of this oral hygiene program with its many facets of continuity of care has contributed greatly to the goal of eradicating dental disease in this closed monitored environment. Footnotes 1 . W.E. Mouradin, E.Wehr and J.J. Crall, “Disparities in Children’s Oral Health and Access to Dental Care,” Journal of the American Medical Association . 284, no.20 (2000): 2626 2 . B. Anderson and J.A. Farrow, “Incarcerated Adolescents in Washington State.” Adolescent Health 22 (1998): 363-7

The prevalence of new caries/lesions has significantly decreased during each recall visit. Oral hygiene packets were effec- tively changed to a 4.25-inch Loops Flexbrush Toothbrush and Loops Safety Floss with an emphasis on oral hygiene instructions. These products were ADA accepted, and designed for prison safety. The Flexbrush handle is flexible and bends easily with a non- shank design. The Loops Safety Floss are latex-free loops that are breakable when stretched and cannot be used to make rope or string that could be a safety concern. One issue encountered with the start of the issuing of safety floss was that the residents wanted to use the floss as bracelets on their wrist or hair ornaments in their hair. Reedu- cation of the actual usage of the floss was incorporated into their next den- tal appointment. In this case, we also added a risk/benefit discussion. In the end we could agree that uniform com- pliance could be addressed directly by staff easily and that there was no need to eliminate the safety floss. Conclusion The prevalence of new caries/le- sions has significantly decreased during

Lori S. Wilson, DDS, MPH, FACD, is the chief dentist at Bon Air Juvenile Justice Correction Center

Mark H. Murphy, MS, LPC, CCE-Juv, is the Health Services director for the Virginia Department of Juvenile Justice

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NIJ Update

Caring for those in custody Identifying high-priority needs to reduce mortality in correctional facilities By Joe Russo

F or most people, the notion that our prisons and jails are fortified against escape is sufficient. The general public knows relatively little of what goes on be- hind the walls, in terms of the health

This article does not necessarily reflect the findings, views and/or opinions of the American Correctional Association. Further- more, the findings and conclusions reported in this article are those of the author and do not necessarily represent the official positions or polices of the U.S. Department of Justice.

and welfare of inmates. Recently, however, in light of a rise in deaths attributed to suicide and drug and al- cohol intoxication, renewed attention has focused on the issue of inmate mortality (Figure 1).

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Figure 1 2014 Bureau of Justice Statistics data on distribution of mortality types in jails and state prisons, and long-term trends in mortality rates.

SOURCE: Noonan, M., Mortality in Local Jails, 2000–2014—Statistical Tables, Washington, D.C.: Bureau of Justice Statistics, NCJ 250169, December 2016a; Noonan, M., Mortality in State Prisons, 2000–2014— Statistical Tables, Washington, D.C.: Bureau of Justice Statistics, NCJ 250150, December 2016b.

NOTE: Pie charts show the number of deaths from each mode recorded in 2014 by the Bureau of Justice Statistics. Line graphs show the incidence rate for each type of mortality per 100,000 inmates. SOURCE: BJS data. Figure does not include deaths that occurred in federal prisons (444) that are not categorized by mortality type and deaths that occurred in jails (44) or state prisons (32) for which the cause was categorized as missing/other.

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A new study by the RAND Corporation and the University of Denver (DU) analyzed insights from a working group of experts with practical expertise in and knowl- edge of inmate mortality trends. To reduce inmate mortality, the study, sponsored by the National Institute of Justice (NIJ), identified a series of systemic needs grouped under the following six themes: 1. Supporting evidence-based practices and national stan- dards for inmate health care. 2. Improving capacity to provide medical and mental health care. 3. Improving organizational culture and operations. 4. Strengthening coordination and continuity of care. 5. Leveraging pharmacological advances. 6. Strengthening analysis and use of data. The working group’s findings, dis- cussed below, suggest that reductions in inmate mortality can be achieved through organizational change sup- porting emphasis on care objectives equal to the emphasis on custody and control objectives, adherence to best practices and adequate resources to provide quality care to individuals before, during and after incarceration. Nature and scope of the problem Maintaining the health and safety of inmates — and ultimately reduc- ing the mortality rate — is a complex and challenging task, albeit one that should be at the core of the cor- rectional mission. Prisons and jails have a constitutional obligation to care for the inmate population and,

ultimately, most forms of mortal- ity within correctional facilities are preventable, to varying degrees, with the proper interventions. Many in- mates enter facilities in poor health. They disproportionately suffer from mental illness, disease and addic- tion; many are prone to violence. The conditions of confinement can be detrimental to overall health and safety in a variety of ways and can exacerbate certain preexisting condi- tions. Studies have established that these findings are consistent. 1 One consequence of the growth in incarceration rates has been the confinement of greater numbers of generally unhealthy

constraints at all levels of govern- ment, make it difficult to maintain appropriate standards of inmate care. Study purpose The joint RAND-DU study on inmate mortality, “Caring for Those in Custody: Identifying High Priority Needs to Reduce Mortality in Correc- tional Facilities,” is part of a multiyear research effort, the Priority Criminal Justice Needs Initiative, to identify innovations in technology, policy and practice that benefits the criminal justice sector. 2 In response to a recent increase in inmate mortality rates, the study aimed at producing a better understanding of factors contributing to mortality and identifying key needs associated with improving outcomes. The results also help inform NIJ’s research agenda moving forward and, along with future research, will help guide policy-makers and facility lead- ers on addressing care needs. Methodology The research team assembled a group of 16 individuals with exper- tise and knowledge of corrections and correctional health care to par- ticipate in a two-day workshop. Care was taken to include participants with experience and expertise in jails or prisons (or both), recognizing that each setting is unique. One noteworthy difference is the higher overall incidence of suicide in jails than in prisons, attributable, in part, to the fact that those entering jail, as opposed to prison, often face an immediate crisis situation as they experience penal confinement for the first time. Before the workshop, in order to focus discussion, participants were given a copy of the Bureau of

individuals for longer periods of time.

One consequence of the growth in incarceration rates has been the confinement of greater numbers of generally unhealthy individuals for longer periods of time. That, coupled with rising health costs, generally represents a significant taxpayer bur- den. Although there is great variance in the quality of care provided by facilities across the country, in general these factors, combined with resource

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nEWS & vIEWS

Justice Statistics’ (BJS) most recent report on deaths in correctional facilities, “Mortality in Local Jails and State Prisons, 2000-2013.” This report provides national and state- level data on the number and rate of inmate deaths across a number of variables, including cause of death, type of facility, state and inmate characteristics — such as age, sex and race — over a 14-year period. During the two-day workshop, participants were divided into two breakout groups (prisons and jails). Researchers conducted highly- structured exercises with each group in order to elicit information about the most pressing problems related to inmate mortality and to assess how the problems could be addressed. Discus- sions focused on each of the five major mortality types identified in the BJS

report (illness or disease, homicide, suicide, drug or alcohol intoxica- tion and accidental death), as well as general or more cross-cutting issues that were not specific to any particular type of mortality. From these discus- sions, the research team identified a set of discrete needs. This process yielded a total of 81 needs between the two breakout groups (Figure 2). To provide structure to this large set of identified needs, participants ranked each need in terms of ex- pected benefit (relative importance of meeting that need) and probability of success of actually meeting that need. These ratings were multiplied to produce an expected value score, and that score was used to group the needs into top, medium and low tiers. In the final analysis, 15 of the 81 identified needs were

ranked in the top tier and are listed (Figure 3). The following key themes emerged: Supporting evidence-based practices and national standards At various times during the workshop, the group discussed the importance of best practices and estab- lished standards with respect to general health care, agreeing that compliance is key to better outcomes. Much of the focus was on suicide prevention, with an emphasis on risk assessment. Re- flecting the group’s view that the use of benchmarks is uneven across the coun- try, four top-tier needs emerged within this theme. Overall, there is a need to more effectively promulgate best prac- tices as they evolve. On the research side, the working group identified a need to better understand current levels

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Figure 2 Overall breakdown of needs identified by the breakout groups (prisons and jails — combined).

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Figure 3: Top Tier Needs

Evidence-based suicide prevention strategies, including the use of risk assessment instruments validated in the correc- tional environment, are not uniformly implemented across the country. There is a need to assess the extent of implementa- tion, identify barriers and develop strategies to incentivize and support implementation. Because suicide risk is dynamic rather than static, processes are needed to support rescreening at regular intervals and after key events in the inmate’s life. Suicide risk assessment is not always reliable. There is a need to promulgate best practices, specifically related to the use of skilled screeners in private environments more condu- cive to sensitive discussion. With respect to mental health services, there is a wide discrepancy between the community level of care and that which is provided in correctional facilities. There is a need for cost-benefit analyses of providing community-level of care in correctional facilities. There is a lack of coordination between providers of health care services in facilities and those in the general community. This has a negative impact on the health care of individu- als, particularly those who are frequently incarcerated for relatively short periods of time. There is a need to incentivize partnerships between providers to improve health care outcomes. As individuals move from jails to prisons, pertinent health care information is not consistently shared. Systems, stan- dards and methodologies are needed for facility health care information exchange between correctional entities. Education is also needed to clarify common misinterpretations of HIPAA regulations. Many facilities suffer from a shortage of mental health treat- ment providers. There is a need for creative funding solutions or other incentives to support the required capacity.

National standards governing medical screening are not being universally adopted and used by facilities. Research is needed to assess the level of compliance with these standards and to quantify the impact that compliance has on morbidity and mortality. Further, financial and other support is required for facilities that wish to meet these standards. Because some types of mortality are relatively rare, more granular data on “near misses” should be collected and analyzed. These data are critically important to better under- standing incidents and developing prevention strategies. To better serve the health care needs of inmates, facilities need greater capacity to both detect the acute chronic condi- tions and to respond with intermediate level of care. To help ensure that health care issues receive the appropriate level of attention within an agency or facility, organizational structures should designate authority and autonomy to medical officials. The inherent conflicts between security and medical objec- tives can make it challenging to deliver quality health care on a day-to-day basis. There is a need for collaborative approaches to overcome these obstacles. The prevailing correctional culture tends to encourage secu- rity and medical staff to focus only on their individual areas, which inhibits innovative approaches to reduce mortality. Strategies are needed that promote greater cooperation and collaboration in processes such as death reviews. To help prevent inmate death due to drug overdose, staff need greater access to countermeasures, such as naloxone, as well as supporting policies, procedures and standards to guide their use. Corrections agencies need to expand the use of medication- assisted treatment, a proven intervention in community-level care, in support of desistence from drugs.

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