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Drug Testing Inhouse Vs. Outsourced Latest Trends: Education, Technology & Reentry


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Dementia in the Incarcerated: Ready or Not?

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Lab Services Prove Vital: Inhouse Vs. Outsourced


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MISSOURI GOV. COMMUTES DEATH SENTENCE Kimber Edwards, who was convicted of hiring someone to kill his ex-wife in 2000, had his death sentence commuted by Missouri Gov. Jay Nixon on Oct. 2, after a newspaper reported that the murderer now says he acted alone, Reuters said. Edwards had been scheduled to die on Oct. 6 for his involvement in the death of Kimberly Cantrell. In a statement, Nixon, a Democrat, said he was convinced that the evidence supports the decision to convict Edwards of first-degree murder, and that Edwards will remain in prison for the rest of his life.


"This is a step not taken lightly, and only after significant consideration of the totality of the circumstances," Nixon said. Orthell Wilson, who had said Edwards hired him to kill Cantrell, has recently recanted his statement, telling a reporter that he had acted alone, according to the St. Louis Post-Dispatch. Edwards confessed to the crime, but said at his trial and ever since that he was innocent, the newspaper said. His lawyers say Edwards had a form of autism that could have made him vulnerable to aggressive interrogation techniques, and led to a false confession, the newspaper said. Elsewhere on Oct 2, the Okla-

homa Court of Criminal Appeals granted a state request to halt three upcoming executions so it can examine a drug mix-up discovered about two hours before inmate Richard Glossip was to have been put to death earlier that week. Oklahoma Attorney General Scott Pruitt filed the request on Thursday so the state could examine what went wrong with its execution protocols. Glossip's planned execution had received global attention with his case raising questions about whether the state may be executing an innocent man and about the drug combination Oklahoma plans to use in its lethal injection mix, reported Reuters. Oklahoma revised its death


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chamber protocols after a flawed execution last year when medical staff did not properly place an IV line on murderer Clayton Lockett, who was seen twisting in pain on the gurney. He died about 45 minutes after the procedure began because of an accumulation of lethal injection chemicals that had built up in his tissue. A total of 22 people have been executed in the United States so far this year, including six in Missouri, according to the Death Penalty Information Center.

TRIPLE MURDERER ALFREDO PRIETO IS EXECUTED IN VIRGINIA The Washington Post reported Alfredo Rolando Prieto, convicted of


two murders in Fairfax County, one in California and linked by DNA and ballistics to six more, was executed by lethal injection Oct 1 at the Greensville Correctional Center. Prieto, 49, said: “I would like to say thanks to all my lawyers, all my supporters and all my family members. Get this over with.” The short statement represented just about the only words Prieto has ever said publicly since he was caught 25 years ago. He never spoke to detectives investigating his crimes, did not testify during any of his four trials and never gave an interview. In one hearing in Fairfax in 2010, he told a judge that “I was using a lot of drugs. I

was drinking” at the time of his Northern Virginia crimes in 1988. Prieto’s death was witnessed by Deidre Raver of Yorktown, N.Y., the sister of Rachael A. Raver, who was 22 when she was shot in the back in a vacant lot near Reston. She had watched Prieto fatally shoot her boyfriend, Warren H. Fulton III, in the back while on his knees, law enforcement authorities have said. Investigators believe that Raver ran but that Prieto chased her down, shot her and raped her as she lay dying. “Today ends a long and painful ordeal for my family,” Deidre Raver said, “that has haunted us for over 26 years. I speak on behalf of my sister, Rachael Angelica, who will have the last word after all....” It was the first execution in Virginia since January 2013 and the first by lethal injection since August 2011. Prieto’s attorneys tried a late appeal for a stay by challenging one of the three drugs used to execute him, which Virginia obtained from Texas in August. But U.S. District Judge Henry Hudson denied the request for a postponement. Prieto had spent the last quarter-century of his life behind bars. Prior to that, he did a two-year stint as a teenager for a drive-by shooting in California. And in between those two prison stays, police believe, he fatally shot four people—raping two of them—in Virginia, then returned to California and shot and killed five people, also raping two of them. In seeking to persuade a Fairfax jury to impose a death sentence on him, Fairfax Commonwealth’s Attorney Raymond F. Morrogh said in 2010, “Anyone who would commit crimes this dastardly, amoral and inhuman is someone who poses a threat to society.” CF


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in the Incarcerated Ready or Not?

Case Study A.C., an 82-year-old male with diabetes, hypertension and coronary artery disease, was a firsttime offender who entered the correctional system at an advanced aged. Since his incarceration, he was also diagnosed with dementia after clinicians observed that he was having difficulties in remembering. While this case raises several challenges around delivery of opti8 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015

mal care in patients with dementia, incarceration adds another layer of complexity. For the purpose of this article we will focus on the following challenges: (1) aging population in custody (2) dementia and incarceration

Aging population in custody Baby boomers (over 71 million people born between 1946 and 1964) are now aging into senior citizens and this, coupled with an increase in life expectancy due to

advances in medicine, has resulted in a growing number of people with longer lifespans. Greater numbers of senior citizens are now living with one or more chronic disease conditions. Correspondingly, there is higher prevalence of chronic disease conditions in jails and prisons. (Binswanger, I., Krueger, P., & Steiner, J., 2009) Aggressive management of chronic medical diseases by existing health care delivery in prisons and jails and longer incarcer-


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ation periods have led to a disproportionate increase in older inmates. In addition, a number of older prisoners are sex offenders who pose a perceived threat to alternative housing solutions like skilled care or assisted living facilities. Reports from various

One inmate reads to another in the Buddy Program.

groups have projected that the number of prisoners aged 55 or older is growing at a higher rate than the overall prison population. Ronald Aday, a professor of aging studies and author of Aging Prisoners: Crisis in American Corrections, predicts that by 2020, 16% percent of those serving life sentences will be in this age group (Aday, R., 2003). The American Civil Liberties Union published a report in 2012 stating that in 1981 there were 8,853 state and federal prisoners aged 55 and older; by 2030 this number will be almost 400,000, amounting to over one-third of prisoners in the United States. Most jails and prisons do a great job in providing care for chronic conditions; however, the question is, are they equipped to care for this debilitated population, not only from a physical perspective, but also in offering emotional support, mental health services and additional help where needed? While better understanding of geriatric needs has led to the creation of community programs to provide support for patients with dementia, similar measures have not, for the most part, been brought into correctional facilities. How do we as a society want to treat our incarcerated elderly? And how do we prepare for the increased number of them who are projected to be behind bars in the next 15 years? (Fellner, J., 2012)

Dementia and incarceration

Dementia Awareness and Evaluation According to the Alzheimer’s Association, dementia is a term that describes a condition that develops when nerve cells die or no longer function normally, causing changes in memory, behavior and the VISIT US AT WWW.CORRECTIONSFORUM.NET


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ability to think clearly. Dementia can be related to Alzheimer’s, or many other conditions. While age may be one of the causes, other conditions that can contribute to dementia include vascular dementia, dementia related to Parkinson’s disease and dementia from chronic alcohol abuse. Many inmates have pre-incarceration risk factors that further predispose them to developing dementia at a younger age compared to the general population. Some of these risk factors include

other inmates. All these factors raise the question regarding the safety, physical and mental wellbeing of elderly inmates with dementia. Initial evaluation of older inmates should include assessment for dementia. Testing with recall and other methods are simple techniques that can be used to assess for cognitive impairment. This enables a better understanding of the person’s health status by clinical and correctional staff and also provides a baseline from which to assess as

A Corizon program matches up inmates with dementia with healthy inmates.

inadequate access to health care, drug and alcohol abuse, traumatic brain injury, smoking and HIV/AIDS. Limited social and intellectual stimulation during incarceration may accelerate the development of dementia. Inmates with dementia may go undiagnosed due to the structured prison life, and minimal requirements to make independent decisions. Some prisoners with dementia may be withdrawn and this “quiet behavior” may be rewarded by the corrections system. As the disease progresses, an inmate may get agitated, hostile or may be unable to cope with everyday activities; this behavior may be punished due to lack of understanding on the part of corrections officers. Inmates with dementia may also be victims to the bullying behavior of 10 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015

inmate with dementia can display. They should receive special training on other methods of interaction and options for any necessary intervention before the inmate is punished. Dementia training must be provided to all officers, not only in the corrections system but also in the field (Schoenly, L., 2012). Understanding the psychological and behavioral symptoms of dementia and the effect the condition can have on those diagnosed will allow for higher vigilance in detecting progression of the disease so appropriate and timely care can be delivered.

Adapting the prison environment

the person ages. Understanding of an inmate’s cognitive capacity will also assist in making decisions regarding placing them in appropriate housing units. In the case of inmate A.C. noted above, observation of his difficulty in remembering and inability to function in the general population were factors that led to his diagnosis of dementia.

Training for correctional staff Caring for patients with dementia requires special communication skills, compassion and respect. While these skills are generally a part of the medical/mental health expectation, officers should also be wellversed in the behaviors that an

Simple changes in environment may facilitate independence in inmates with dementia. Colored cell doors, pictures and calendars will definitely assist in maintaining orientation and coping. Handrails and non-slippery floors, placing older inmates on lower bunks, in-housing units close to dining halls, and giving them more time to respond to activities related to a drill performed by custody may allow this population to continue to function independently while maintaining their dignity (Schoenly, L., 2012).

Memory units and specialized programs Often correctional facility limitations leave clinicians no choice but to put patients like A.C. in an infirmary with medically ill patients. Not only does this create problems with cost-effective use of infirmary beds, but it also puts undue pressure on infirmary staff to shift the focus of care from medical to supportive, creating conflicting priorities. In addition, the level of acuity and frequent change in inmate population at the infirmary can only


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A doctor offers treatment to an older inmate. The American Civil Liberties Union predicts that by 2030 the number of inmates 55 and older will be almost 400,000, amounting to over one-third of prisoners in the United States.

contribute to confusion for patient with dementia. Some facilities have set up programs and enhanced care units to provide care to these patients outside of an infirmary setting. These programs offer daily monitoring by a nurse, periodic monitoring by a mental health professional and activities provided by activity coordinators. Modification of housing from bunk beds to side-by-side beds can assist with safety (Hill, M., 2007). In some programs, screened and trained offenders can provide support for people with dementia. In a companion program or “buddy program” select offenders are identified to be trained and serve as companions to those patients who are bedridden, debilitated, agitated and confused or with other memory impairments. These companions sit with the patients, interact and read to them, and provide other activity support. They may also help with activities of daily living, taking them to medication and clinic appointments and walking with them (Missouri Department of Corrections, 2015). A.C. has been assigned a Daily 12 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015

Living Assistant (DLA) who takes him to the medical unit for his medications and appointments and assists him with activities of daily living. Programs like these offer A.C. and other offenders like him the benefit of being housed close to medical services while being able to more fully participate in socialization and recreation. While these specialized units are a great example, they are few and far between. We as a nation need to take measures on a large scale to manage this challenge that is right at our doorstep. There is a need to expand Memory Care Units or geriatric care units within correctional facilities.

While there are no clear numbers on how many people with dementia exist in the prison system, the projected increase in the aging population indicates that these conditions will continue to rise. A collaborative approach between policy, research and health care delivery teams will ensure that this vulnerable group is protected. Many inmates with life sentences depend on the social support of fellow inmates in similar situations, and special care units are a way to create this environment. As family support wanes, over time these specialized units become “home” and the fellow inmates become their family. While there is no data on the risk of recidivism in individuals with dementia, aggressive behavior should not be the sole reason for continued incarceration in these individuals; a path of compassionate release should be considered where appropriate. As for A.C., he can be found sitting and visiting, playing cards or doing puzzles with other offenders assigned to his unit who are now his family, as his personal support system on the outside has declined.  Dr. Parul Mistry is the Chief Medical Information Officer for Corizon Health. Dr. Leonora Muhammad is Corizon Health’s Regional Clinical Services Manager for the Western Region.


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Lab Services Prove Vital Both inhouse and outsourcing drug testing contributes to a comprehensive program for facilities.

Over 50 percent of inmates currently in federal prisons are there for drug offenses, according to data released by the Federal Bureau of Prisons in 2014. That percentage has risen fairly consistently over decades, jumping up from 16 percent in 1970.

Forensic Source specializes in products for forensics professionals, including narcotics identification.


As the number of people convicted of these drug offenses continues to rise, random drug testing of inmates has become commonplace. This has led to the need for faster and more accurate drug testing procedures in correctional facilities across the country either being outsourced or performed in house. Although urine testing is still considered a predominant method to detect drug and alcohol use, saliva testing as well as other methods are starting to gain ground because


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of their convenience. “A comprehensive drug test program extends well beyond rapid qualitative testing many correctional institutions have available within their own facilities,” comments Richard Williams, director of Product Development, eLab Solutions, Huntsville, Ala. “Indeed, many of these rapid, high-volume screening systems have our software controlling their immunoassay instruments. These local laboratory systems provide the first line of defense in the release of criminal offenders, continual monitoring of parolees, and accountability for recovering drug court participants. From an institutional, behavioral, and economic perspective this testing is critical to the success of their intended mission.” Williams adds that beyond the effectiveness of these systems, the services of outside sophisticated laboratories are just as important. “These labs provide unprecedented accuracy using state-of-the-art testing methodologies and ultrasensitive instrumentation, delivering quantitative results for not only suspected drug positives but their metabolites as well. These metabolites are often detectable for days after their parent drug has disappeared. The result is indisputable legal evidence that provides a safety net for the insti-

tution’s local testing process.” “Accurate and timely results are a critical component for decision makers in the criminal justice system,” points out Kathy Ruzich, manager, Global Marketing Communication at Thermo Fisher Scientific, Fremont, Calif. “Whether participating in a drug court program or testing/monitoring inmates during incarceration, judges, probation agents, parole officers and others use the results of drug screening tests as one of their key components in determining the next steps in judicial review, or at critical decision points in child custody cases. Running tests in a lab environment using standardized protocols and with properly maintained equipment helps to ensure fairness and compliance with any program,” she adds.

Best Practices Ruzich furthers that most laboratories will set guidelines and good laboratory practices to ensure the instruments are working correctly and tests being performed follow the proper instructions for use. “Through the criminal justice system, we can offer a total solution for compliance, from collection to confirmation, with collection devices, instrumentation, reagents, quality controls, and client management

software. To maximize the integrity of the system, specimen validity tests can be performed on collected samples to ensure that they have not been adulterated.” Jackie Pirone, director marketing SAT and IR, OraSure Technologies, Bethlehem, Pa., adds that lab services such as the accuracy of the drug test, confirmation testing, expert testimony, timely reporting of results and the chain of custody are all vital to a comprehensive drug testing program. “Additionally, labs can test for a wide variety of drugs at varying cutoff levels which allows for greater flexibility for drug testing programs. With the availability of newer drugs such as Spice, K2 and Bath Salts, it is critical that drugtesting programs be able to keep up with the trends. Because labs can adjust their testing based on their clients needs, you can be sure you are getting the most out of your drug testing program.”

Providing Total Solutions Ruzich says that they are able to provide a total solution to laboratories, including the screening instrument, reagents, quality controls and software tools custom designed to efficiently run your drug screening lab. “Thermo Fisher Scientific can

Combat the use of additives and adulterants to mask controlled substances in urine samples with the Thermo Scientific DRI Indiko pH-Detect Specimen Validity Test. Liquid and ready-touse, these tests can be performed on a variety of general chemistry analyzers.



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also support your need for confirmation equipment. We have worked extensively with correction facilities on both the county and state level, and have empowered drug courts and problem solving courts in state after state to take control of their testing and compliance procedures. Our experienced field technical service staff is there to help complete the instrument installation and will ensure your staff is properly trained to run these drug tests, and our technical service hotline call center available is available to answer any questions 24 hours a day, 7 days a week.”

Other Testing Options Besides testing urine and saliva there are other emerging options. Michelle Lach, associate brand manager, United States Drug Testing Laboratories, Inc. (USDTL), Des Plaines, Ill., reports that USDTL offers a wide array of drug testing assays to fit the particular needs of the collector and

donor. “By offering multiple windows of detection and multiple specimens for collection there are more opportunities available for services. The testing services are completely contingent on what the collector is trying to test for.” She points out that assays that use specimens such as oral fluid, blood and urine, can detect drugs and alcohol currently or very recently in the donor’s system, where as assays such as hair and fingernail can test for heavy use in the previous months. She adds that additionally, labs go through rigorous certification procedures to make sure they are following proper protocol. “USDTL, for example, is accredited by numerous bodies such as the College of American Pathologists (CAP) and is in the final stages of ISO 17025 accreditation, through the international organization of standardization.” Lach says they provide drug testing laboratory services, specializing in alternate specimen testing


such as fingernail testing, which has all of the benefits of hair drug testing, without the risk of adulteration. “Clipping hair and fingernails prior to collection does not prevent the drug test from showing signs of ingestion, it simply delays collection. Whatever is in the hair and fingernail when it was clipped, will still be in the hair or fingernail in 1-2 weeks when it grows back out.”

Outsourcing Versus Onsite Services Ruzich says that depending on your testing volume and other factors, agencies have a choice to outsource or bring in house. Do they set up their own lab or do they send out their samples to another regional type lab? “The benefit of the send outs is that the labor burden on the actual agency is minor, ensuring samples collected are properly sent out. The benefits to establishing an onsite lab, however, may far outweigh the send outs,” she says.


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“With an onsite lab, the court can experience a turnaround time for client samples that can be measured in minutes instead of days, which in turn can help in time sensitive situations. For example, using the Thermo Scientific Indiko or Indiko Plus can provide the screening results in less than 15 minutes. This intuitive, bench top system is simple to use and provides accurate results, and can help to reduce repeat testing, providing an additional cost savings. Agencies that take the steps to set up an onsite laboratory usually see significant cost savings over the total price of the send out testing when freight costs and lost productivity time is accounted for. Additionally, the multiple options for customizing and digitizing the laboratory solution means that the software automates and helps to keep track of your clients in the system, supporting your random testing needs, and maintaining client historical test results for the decision


makers to review,” Ruzich explains. “Contrarily, correctional facilities outsourcing substances to a laboratory service to analyze contraband confiscated is cumbersome and can challenge resources like time and budget,” says T. Allen Miller, product manager/ Forensics, The Safariland Group, Ontario, Calif. “Often, illicit dugs seized by correctional officers are small amounts compared to street busts. Considering the position of the majority of the inmates and their current sentences, expending much needed funds in order to provide a disciplinary sentence to any particular inmate may not justify the cost associated with the result. A system that utilizes our presumptive tests to deal with the incident of contraband onsite, and the internal hearings associated with those results, are accurate and can protect against costly investments whether personnel hours or the hard costs of lab fees,” Miller adds.

Outsourcing Options Williams of eLab says that every agency’s build versus buy situation is unique. “Outside labs are an essential part of a comprehensive drug testing program. The decision of an institution to invest in its own screening system or send its samples elsewhere includes consideration of internal staffing budget and qualified personnel availability, sample volume, turnaround time, and targeted drugs of abuse. And in the light of new technologies and screening techniques may need reevaluating on a periodic basis by every agency.” He reports that where the agencies are large and spread across wide areas, technology solutions may also play a part in this decision. “For example, the Arkansas Community Corrections agency used eLab’s QuikLIMS software to place 30 remote test sites across the state, all tied to a centralized system in Little Rock, controlling all of the instruments and relay-


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USDTL offers a wide array of drug testing assays to fit the particular needs of the collector and donor.


ing their results directly into the state's Electronic Offender Management Information System,” he explains. Kelli Mogush, senior marketing manager at Siemens, Global Marketing Syva Drug Testing Diagnostics, Malvern, Pa., says onsite testing allows facilities to get accurate results quickly. “All of our products are designed to be as turnkey and easy to use as possible, and with our consultative approach, we are confident onsite testing can be conducted in a way that reliably enhances their drug testing and rehabilitation programs. Implementing a drug testing program directly at the facility allows them to avoid safety issues that could arise while waiting for an outside lab result (11 minutes versus days). This can be done easily, without adding additional manpower and can actually save costs.” Lach says outsourcing laboratory services can provide better information and more options than using an in house lab or dip-stick drug testing. “Labs such as USDTL offer state-of-the-art instrumentation, strict chain of custody protocols for evidentiary purposes, as well as expert review and confirmations on all reported positives.” Pirone adds that since lab personnel are trained to perform the test and an instrument interprets the results, there is no “second guessing” like might be possible with point of care or instant tests. “Sometimes it can be difficult to read the line on a


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Drug Testing System

point of care test and know whether the result is negative or positive. With lab based testing, the instrument takes the guesswork out, preserving the integrity of the result. And with a neutral third party performing the testing, you know the result will be unbiased.” “Also, by not having corrections staff perform the testing, this frees them up to continue their everyday job responsibilities and duties,” she concludes. 

The Siemens Viva-E System provides a complete menu of gold standard EMIT assays for fast analysis of drugs of abuse, thera-

Outsourcing & Onsite Testing Equipment Here’s a sampling of some of the latest equipment and lab testing services for the corrections market.

Analyzers Thermo Scientific Indiko or Indiko Plus, their benchtop clinical and specialty chemistry analyzers, are fully automated for performing immunoassay drug

mines, methamphetamine, barbiturates, methadone and benzodiazepines., 1.800.869.3538

Web-Based Call System Call2test is a randomized, webbased, call-in system for drug and alcohol testing and probation reporting. The system can be configured in less than 60 seconds, is fully automated, and can

screening tests. Both are considered to be flexible systems which are fully self-contained and do not require any external hookups to water systems. They offer a very intuitive user interface and are set up to maximize load up and walk-away convenience., 1.800.232.3342

Oral Fluid Drug Testing System OraSure’s Intercept Oral Fluid Drug Testing System was the first FDA-cleared in-vitro diagnostic laboratory-based oral fluid drug testing system, and is the only one that is FDA cleared for detection of nine commonly abused drugs, including marijuana, cocaine, opiates, PCP, ampheta20 CORRECTIONS FORUM • JULY/AUGUST 2015

peutic drugs and immunosuppressants, as well as sample validity testing on a single bench top analyzer. It is designed for lowto mid-volume labs, treatment centers, transplant management centers, criminal justice facilities, and industrial facilities., 1.800.242.3233

New Software Introduced at NADCP 2015, QuikCase will be a new offering in the Case Management space for Drug Courts and similar programs. Features include: seamless integration with QuikLIMS drug testing management system, resource and client scheduling, assessment of the customer's drug testing menu relative to the aggre-

be used by courts of any size. By utilizing existing Interactive voice response technologies, call2test is able to provide service at a low cost per offender., 1.888.972.9166

Drug Testing Solutions US Diagnostics drug testing products are engineered to give users the quickest and clearestreading results available and are easy for clinicians to store, handle and administer. From corrections facility to drug courts, they can provide the best on-site testing products to conform to a facilities needs., 1.888.669.4337

gated occurrence of detected drugs of abuse in their geography, random drug test scheduling, and comprehensive reporting. In addition, QuikCase can accommodate program administration of multiple court types like Family Court, Heroin Court, and Veterans Court among multiple jurisdictions such as Municipal, District, and County Courts., 1.866.990.3522


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tudies show that inmates are biologically older than their chronological age, often by more than a decade. They also tend to have more health issues than the general community. Infectious diseases such as hepatitis, addiction, diabetes, coronary disease, and other chronic maladies are prevalent in many inmates. Then there is the matter of mental health. A 2014 report by the Treatment Advocacy Center stated that not only is the number of inmates with mental health issues growing, the severity of the illnesses is on the rise as well. The numbers are staggering. In 2012, the report says, there were 356,268 inmates with severe mental illness—more than the population of Tampa. In comparison, there were only 35,000 patients in state psychiatric hospitals. Medicating all of these conditions is a major challenge for correctional facilities and requires considerable planning, policies, and procedures. Says Martha Ingram, RN, CCHP, CPHQ director of Quality Management & Performance Improvement at Wexford Health Sources: “Facilities are looking for the most efficient method of medication administration to limit the amount of time that custody personnel are tied up with each medication distribution.” Becky Luethy, RN, director, Operations Development, Centurion, LLC, adds that facilities are looking for “systems that are intuitive, efficient, and simple. Popular today are electronic medication administration record (eMAR) systems, which allow staff who administer medications to do so accurately and efficiently.” (There are several such systems on the market manufactured by organizations such as CorrecTek, AssistMed and



Diamond.) Naturally, there are difficulties when it comes to distributing inmate medication, especially when it is a particularly large population. Many factors that can be a challenge, says Becky Pinney, MSN, CCHP-RN, VP Business Operations & Facility Performance at Corizon Health, are “officer availability, patience on the part of patients who grow weary of lines, little time for proper documentation, and ensuring that patients are actually consuming the medications vs. ‘cheeking’ them.” There are also concerns about interruptions in the availability of medications from the manufacturer as well as the correctional environment itself, which

Good medical practice, says Martha Ingram at Wexford, requires that there are “no interruptions of life-sustaining medications, or those needed to maintain therapeutic blood levels for serious health conditions.”

is in its way, organized chaos. Often, says Luethy, administration occurs in the cellblock where noise and crowds of offenders can be a distraction, and offenders sometimes approach the health care professional with

medical questions unrelated to the task at hand. One issue, Ingram furthers, includes the continuity of medication upon an inmate’s arrival at the facility. “This is especially troublesome for the initial booking of detainees in jails.” As she states, inmates rarely come to facilities with their medication on their person. “They are typically not good historians, and do not always know the name of the medication prescribed or the dosage.” Ingram explains that among the most important considerations of medication distribution is that “the medication is accurately given to each person and documented appropriately.” Good medical practice, she furthers, requires that there are “no interruptions of life-sustaining medications, or those needed to maintain therapeutic blood levels for serious health conditions.” She furthers that every medication needs to be verified with the physician or pharmacy before it can be administered. If the medical personnel are unable to verify the medications, the inmate often must wait until a physician can meet with him or her and receive an order for the prescription. “This is a very time-consuming and labor-intensive mission.” Protocol and policy requires training. Corizon’s medication management protocols train nurses to manage the numerous challenges as effectively as possible so as not to hinder delivery. They also maintain awareness that when volume is as high as it is in a correctional facility, inventory and refills can be a challenge. Says Pinney, “We provide alternative sources for medications to alleviate or minimize delays until full inventory can be restored.” One method of addressing this challenge might be the use of automatic dispensing units (ADUs). Says Luethy,


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“Centurion uses an automatic dispensing unit in one of our contracts where we maintain a licensed pharmacy. Advantages include having medications ready to provide to offender patients when new orders are received from the provider—we don’t have to wait until the next day to receive them from our pharmacy partner.” There is an issue, though. Ingram notes, “While automatic dispensing units are seen as a safer form of medication administration, there are few county and state governments that have the funding available to provide automatic dispenser systems for their correctional health care services.” A primary concern with medication, naturally, is ensuring that the correct inmate gets the proper medication and actually takes it. One consideration correctional facilities have that traditional medical providers do not is that in correctional facilities, as the California Department of Corrections and Rehabilitation’s Division of Correctional Health Care Services Inmate Medical Services Volume IV states, medication distribution requires collaboration between health care and custody staff and that “at the time of medication administration, licensed nursing staff shall ensure that the right patient receives the right medication and right dose, by the right route, at the right time. In addition, nursing staff shall ensure that each patient's Medication Administration Record (MAR) includes the right documentation.” To put some scale to the task, in 2011, the population of CDCR inmates was 287,444; more than the population of Newark, N.J. Many need to be medicated every day, and that requires a profound sense of organization. The policy at CDCR regarding patient medication is straightforward. “The California Department of Corrections and Rehabilitation (CDCR) shall pro26 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015

vide medications to patients in a timely manner, in accordance with state and federal laws.” The procedure to ensure these goals are met are clearly described in the manual and include procedures such as how licensed nursing staff must compare the medication’s label with the MAR as well as check the MAR for allergies before distribution. Licensed nursing staff shall also verify that the medication order is current and that the medication has not expired. The practitioner must also verify the patient’s name and CDCR number before administering the medication and details of administration such as the route and administration site “shall

also be recorded on the back of the MAR if a medication is administered by injection.” A medication error report must be completed for any deviation from the procedure. There is a specific form for licensed staff to notify the prescriber of suspicion that the patient is not taking the medication. Hoarding and “cheeking” medication is a serious concern and something providers need to have a policy to monitor. On that note, says Luethy, Centurion partners with their colleagues in the facility to establish policies and procedures in dissuade and avoid hoarding and cheeking medications with the intent to

CDCR’ s health care policy states: At the time of medication administration, licensed nursing staff shall ensure that the right patient receives the right medication and right dose, by the right route, at the right time. VISIT US AT WWW.CORRECTIONSFORUM.NET

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avoid taking them or to sell them. “We are also very mindful of the use and misuse of abusable medications in prison, and we have policies for strict controls on those medications.” For example, abusable medications are never distributed as “Keep on Person” medications. While malingerers are a nuisance, says Luethy, they are usually well known to the staff and they create individual treatment plans for those who malinger. Those plans focus on the root cause of the malingering, and often they are able to meet their patients’ needs in other ways “so malingering is kept to a minimum.” CDCR’s policy in regards to malingerers and hoarders in cases involving security or safety issues in which medication management is compromised, such as hoarding or selling medications, is the inmate will be referred to the health care manager and the appropriate associate warden or designee for resolution.

While malingerers are certainly an issue when it comes to medication protocol, Pinney points out that, “It is critical that providers make good clinical judgments without bias about the patient. Clinicians must not become apathetic or jump to conclusions, but base decisions on individual assessment and discernment of the presenting conditions. If meds are needed, they should be ordered. If not, the clinician should provide education to the patient about other treatment approaches.” One tactic, she states, is that “it takes teamwork between custody and nursing at the point of administration to avoid patients hoarding and/or selling medications. The team must carefully consider KOP meds, and must commit to periodic checks and discussions at chronic care encounters to reevaluate the appropriateness of the process for each patient.” One policy to address this sort of medication misuse, says


Ingram, is to ensure that administration is orderly and that inmates are not allowed to crowd around the window or medication cart, that they arrive one at a time, and that they remain quiet to prevent unnecessary distractions for the nursing staff administering the medications. (The Inmate Handbook for the Monroe County, Fla., Sheriff’s Office clearly states, “During medication, inmates will line up in a single file line and remain QUIET.”) Ingram furthers, “Protocol should require that inmates always present their identification to the nurse to ensure the medication is administered to the correct inmate. In an ideal situation, the inmate must go to a specific location and is directly given the medication by the responsible nurse after providing appropriate identification. The inmate then takes the medication and steps to the side, and the accompanying officer performs the


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mouth check. This scenario keeps the medication administration moving at an appropriate pace, and provides another level of security to impede the inmates’ ability to hide, hoard, and then traffic the medications received.” Other policies Centurion adheres to, says Luethy, reflect NCCHC standards and include policies in regards to “accounting of medications, administration of medications, dispensing


of medications, disposal of medications, distribution of medications, use of over-the-counter medications, procurement of medications, refusal of medications, and others.” Ingram points out that policies, procedures, and protocols regarding medication administration depend on a variety of factors including the size, layout and security level of the facility. A few of those issues that can be

addressed in the institution’s policies and procedures include ensuring the provision on adequate supply of stock medication that can be utilized on an interim basis. There should also be the availability of a local back-up pharmacy for urgent medication needs that are not carried in stock. Facilities should also have a formulary system that “provides access to regularly prescribed medications, along with a comprehensive procedure that enables the use of non-formulary medications when medically indicated.” Facilities should also adhere to a “patient-specific system” (that is to say sealed pre-packaged unit dose) because that will provide for increased accuracy in patient medication administration. One such provider is Pennsylvania based MediDose/ EPS. Bob Braverman of MediDose notes that one issue that arises is “shrinkage in the pipes,” a term used to refer to the disappearance of medications in transit. Using such a system can help avoid that because the packages are tamper resistant and MediDose offers a software package to help the pharmacy label medications as well as print bar codes and graphics. Ingram furthers that facilities should also adopt “protocols that address and allow for proper continuity of medication upon intake (jails) as well as continued administration for prescriptions scheduled to expire.” 


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AGING INMATE CARE: A SPECIAL REPORT he saying may be that time stands still in prison, but that couldn’t further from the truth. In a way it speeds up. “Many inmates,” says Bill Sessa, information officer at the California Department of Corrections and Rehabilitation (CDCR), “are older medically than they are chronologically, often because of poor nutrition and drug or alcohol use before they came to prison.” (Studies have found that age difference to be between 10 and 15 years.)



According to the Administration on Aging, in 2013 the U.S. population aged 65 and older numbered nearly 45 million. By 2060 that figure will double. The silver tsunami is deluging the correctional environment just as fast as it is the community. According to 2013 data from the Federal Bureau of Prisons (BOP), inmates aged 50 and older were the fastest growing segment of the inmate population. Between 2009 and 2013 that population increased 25%. During that same period, the data show, the inmate popu-



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lation under 50 decreased by 1%. There was also a nearly 30% decrease in the number of inmates under 29 years old. Simply put, the inmate population is getting older. Not only that, says Dr. John Wilson, Ph.D., vice president of Clinical Development, MHM Services, Inc. “The aging inmate population is not just driven by inmates growing old inside correctional facilities. There has been an uptick in older individuals being arrested.” In May 2015, the Office of the Inspector General (OIG) at the U.S. Department of Justice (DOJ) released the study The Impact of an Aging Inmate Population on the Federal Bureau of Prison. Among the findings were that aging inmates were more costly to incarcerate than younger ones, mostly due to increased medical needs and accommodation considerations. On that note, Dr. Wilson furthers, “The price tag is sending state budgets reeling. The cost of


incarcerating geriatric individuals is two to three times the cost of incarcerating younger offenders.” As the saying goes, time and tide wait for no one. Dr. Kurt Johnson, MD, regional medical director, Corizon Health, Wyoming DOC, notes that challenges include “polypharmacy [use of five or more medications], prolonged exposure to heat/lack of air conditioning, fall risks, inexperienced or under-trained officers, providers and/or nurses with regards to providing care, and security to this population.” Other concerns are the lack of geriatric housing units in this rapidly growing population, and victimization of elderly patients. “We are also challenged with addressing the behavioral challenges of the demented patient, care for the bed-ridden, special nutritional requirements, and the appropriate use of resources in meeting their many needs.” As Dr. Steve Krebs, the former

chief medical officer of Denverbased Correctional Heath Partners points out, “Prisons were not designed for elderly prisoners with geriatric needs.” Older inmates need assistance in transportation, and facilities may need to retrofit bathroom and shower facilities. Dr. Wilson furthers, “Installing hand rails, widening cell doors for wheelchairs, and providing the multiple interventions that are required for this population is expensive.” It can also put other inmates at risk. “To take one example, a wheelchair can be disassembled and made into multiple weapons.” Dr. Krebs also mentions that things like crutches can be used as weapons, and needles for diabetics can be both a weapon and a commodity. There may also be the need for hands-on physical assistance.

Out of Reach Upper bunks can become an impossible barrier for older


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inmates to negotiate, so occupancy can become an issue. According to the OIG report, the BOP operated at 36% over capacity, and the lack of lower bunks has affected inmates in several ways. During the OIG’s visit to one facility, they noticed that some bunks did not have ladders or steps, and the aged inmate had to climb on desks and chairs to reach the upper bunk. The lack of lower bunks has also caused problems in retrofitting facilities. One supervisor of education told the OIG that her facility was unable to accommodate all of those who required a lower bunk and had to add beds to a room not designed for housing. The OIG also found that some cells had been retrofitted from “two-man cubes” to three, in which the bottom two bunks were classified as “lower.” Further, inmates with a history of high blood pressure or seizures who receive middle bunks could create a liability for the facility if the inmate were to fall. Finally, the lack of lower bunks requires staff to reassign them by reorganizing bed assignments, which can create tension among the inmates being reassigned. The distance between cells and chow halls and pill lines is becoming an issue, says Dr. Wilson. An easy journey for a 30year-old, may not be for an 80year-old. Dr. Krebs says that even clothing can become an issue. A zipped jumpsuit for an inmate with two bad shoulders can be impossible to put on. “Imagine an inmate with severe arthritis lacing up a state boot.”

Legal Ramifications There are also legal matters such as ADA compliance and privacy matters in regards to assistance that is traditionally provided by the family. There is the matter of mandates of “no release” or a crime that makes release an issue such as sex offenders and where to put them. Legislatively they are considered 34 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015

a predator, and they cannot simply be placed in an assisted-living or nursing facility. Says Dr. Krebs, at 30 years old the sentence might be appropriate. By 90, the threat might be “washed out,” but legislatively they are still considered just as dangerous. “There is literally no place for us to rehab these people.” Furthermore, Dr. Wilson points out, there is the consideration of an inmate who is 80 and has been locked up continuously since he was 30 and has developed severe signs of Alzheimer’s. “His ability to recognize others, his surroundings, and even the fact that he is incarcerated may no longer be reliable. Is it ethical to continue to punish someone who no longer knows he’s being punished?”

Rising Costs in Caring for the Aging The biggest challenge, many agree, is, and will continue to be, medical needs. Dr. Neil A. Fisher, MD, CCHP, corporate medical director, Quality Management & Pharmacy at Wexford Health Services, notes that as the number of aging inmates increases, many county and state governments are not fully prepared for the exponential increase in medical costs. “There is an increase in medical conditions and also disabilities among aging inmates, and the need for chronic care clinics, follow-up care, and pharmaceuticals drive costs up significantly per inmate.” There are numerous conditions to consider including heart disease, diabetes, cancer, COPD, dementia, renal failure, and sleep apnea, and often these conditions must be tested and treated at off-site facilities. “With the higher rates of illness, county and state governments need to prepare for increased costs in pharmaceuticals, laboratory work, x-rays, MRIs, CT scans, and an increased

frequency of off-site care.” For example, says Dr. Fisher, “A geriatric inmate who has cancer will need to have a plethora of tests completed that are often off-site (i.e. biopsies, CT scans, PET/bone scans), and pharmaceutical treatment, chemotherapy, and radiation therapy. In addition, this inmate will need to be in special housing due to fragility and security reasons. While these services and accommodations are necessary and reasonable, they are also expensive.”

What Is Being Done? CDCR’s Sessa points out that California has been under a court order to provide a “constitutional” level of medical care to inmates. One step that has been taken to ensure that this happens is a state-of-the-art medical facility in Stockton. The California Health Care Facility houses inmates who have acute health care needs as well as some with serious mental health issues. It has an advanced system for storing and dispensing medications. At the time it was being built, it was the largest municipal construction project in the country coming in at a price tag of $900 million. (It opened in June 2013.) It is not, says Sessa, a hospital. Inmates who require surgery are taken to a hospital in Stockton and treated in a wing that has been revamped as part of the health care facility construction. All of the inmates assigned to the California Health Care Facility have long-term and acute health care needs, for which the facility is staffed to treat. He also points out that by housing those inmates in the Stockton facility, medical clinics in each prison are freed up, which improves the day-to-day health care needs for everyone else. CDCR also has hospice programs at the California Men’s Colony (CMC) in San Luis Obispo and in the California


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Medical Facility in Vacaville. Also at CMC is the “Gold Coat Program,” in which able-bodied inmates assist those who have dementia with daily tasks. This sort of assistance is seemingly becoming more and more of a logical tactic and one recommended in the OIG Report, though it found that some facilities had inmate companion programs, but there was little consistent oversight and implementation varied from facility to facility. (Their recommendation for the BOP is to “develop national guidelines for the availability and purpose on inmate companion programs.”) Dr. Fisher also notes that many other counties and states are establishing geriatric and hospice

units and providing a secure location staffed with personnel who are trained in such type of care. Others are creating educational programs for all medical and correctional staff regarding security for elderly inmates and ensuring that everyone is aware of the specific safety concerns surrounding that population. “We are also seeing more facilities providing onsite testing including ultrasounds, MRIs, and CT scans. Whether they utilize mobile services companies or decide to build their own in-house service areas, they are seeing this as a feasible solution to preventing too many elderly inmates going offsite for tests.” The Wyoming DOC, says Dr. Johnson, offers a geriatric unit

that has numerous special accommodations such as adequate climate control, space for wheelchair access and safe maneuvering around the unit and the two hospice cells, and a private area directly outside the unit where an inmate “can walk, tend to a vegetable garden, sit in the sun, and eat their lunches.” (No other inmates have access to this area.) There is also a fully-equipped medical exam room nearby with access to EMRs [electric medical records], which reduces the need for transport to the medical department. The Wyoming DOC also staffs the unit with officers who have been screened and are sensitive to the older inmate population’s needs and are able to discern security concerns from

There are numerous conditions to consider including heart disease, diabetes, cancer, COPD, dementia, renal failure, and sleep apnea, and often these conditions must be tested and treated at off-site facilities.



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behavioral issues presented by the older population, so the officers will respond accordingly on a situation-by-situation basis. Training is a word often mentioned among those in the field. Dr. Fisher suggests that one tactic is to ensure that all clinicians should be trained in geriatric and end-of-life care. Dr. Johnson notes that the Wyoming DOC provides ongoing medical education to primary care providers and nurses such as familiarity with the Beers List, which is the American Geriatric Society’s list of potentially inappropriate medications for the elderly and why they are on the list. “Polypharmacy is particularly dangerous in this population. We foster an awareness of and action plans to prevent or fix overprescribing.” There is also the admonition against using chronic indwelling catheters and avoiding the use of bed restraints amongst this population. The OIG recommends furthering training so that all staff are trained to identify signs of aging and assist in communicating with aging inmates. Dr. Wilson points out that most correctional facilities are struggling to find solutions. Many are looking hard at activating or strengthening what has long been a dormant option: medical furlough and other compassionate release policies (The OIG recommended doing this as one of their suggestions in their study.) “There are challenges with these policies, as no one has a crystal ball, and estimating life expectancies with precision is mostly a grim art.”

What Should Be Done? Dr. Krebs points out that staff are aware of the issues. It is more a matter of funding and legislative changes. Facilities require space and mental care capital. “The corrections world needs to say what they would do to pro38 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015

“PRISONS ARE NOT DESIGNED AS NURSING HOMES, BUT THAT IS WHAT THEY ARE BECOMING.” – Dr. John Wilson, Ph.D., vice president of Clinical Development, MHM Services, Inc. vide a facility and to do so in a secure environment.” Another issue that is often not addressed, says Dr. Fisher, is the need for additional correctional officers to transport the inmates to multiple specialist appointments. One point of concern, says Dr. Johnson, is looking to the future and being able to have the capacity to provide adequate staffing and geriatric housing when the geriatric prison population truly explodes. “Currently we are meeting the needs of the elderly despite these numbers having increased significantly in the past two years. Nevertheless, this increase hasn’t represented an explosion yet. In anticipation of an increase in inmate populations, empty shell units were built as part of construction in 2010. One or more of these shell units will most certainly be converted into geriatric units as the baby-boomer generation continues to age.” Dr. Wilson points outs out that staffing is also one of the primary issues to address. “There is a significant shortage of healthcare professionals specializing in gerontology.” This shortage, he says, is being felt in the community and will only worsen. “It will negatively impact correctional systems’ ability to provide the standard of care. These specialists focus on maximizing the quality of life and managing the totality of the individual’s medical conditions, not necessarily on maximizing specialized treatments for spe-

cific diseases. Treatment for aging inmates needs to be provided in a holistic, integrated manner— not in silos by specialists who don’t talk with each other. We need correctional gerontologists.” Dr. Johnson has also been thinking about the matter. “There will need to be some thought given to the answers to this challenge. Perhaps there could be a joint effort by the state (DOC, Medicaid, DOH) to contract with existing nursing homes so that there is a landing spot for these patients. Or perhaps an RFP could be submitted so that a vendor contracts with the state to build and run such a facility. Or it may be more feasible to simply add on to an existing prison. These are questions we should be answering now so that we are prepared when the anticipated increase in elderly patients gets into full swing.” The fact of the matter is, says Dr. Wilson, “We are reaping what we have sown.” The aging population, healthcare costs and demographics were not likely considered when mandatory minimum sentences and harsh sentencing laws were enacted. Correctional officers are not trained as nursing assistants, and most of them don’t want to be. They are being asked to manage patients rather than inmates. Says Dr. Wilson, “No wonder that one disoriented and demented inmate told us, ‘This is the worst nursing home I’ve ever been in.’” 


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CORRECTIONS PROGRAMS THAT TIE IT ALL TOGETHER. THE LONG LAZY DAYS of summer have come to a close. As the September days grow shorter and nights grow cooler, many students return to their studies, and by October most have delved deeply into their new curriculums. Some corrections departments have also seen the benefits of education—and this fall inmates are no exception in their quest for knowledge. The U.S. Department of Education (ED) is backing them up with a new study called Educational Technology in Corrections, 2015 published in June that emphasizes the benefits of advanced technology for inmates and reports the availability of it for those incarcerated— which remains low. In addition, it highlights a few examples where technology is a successful part of the corrections experience. At the same time, more corrections agencies are conducting research into how academic and vocational training have impacted recidivism. As you will see below, they are beginning to dip their toes into some innovative 40 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015

Female offenders in the Building Maintenance classroom at Indiana’s Rockville Correctional Facility learn carpentry, basic plumbing, electrical and framing.

vocational reentry programs. First, however, let’s begin with the report from the ED. It cited the 2014 RAND Corporation study (sponsored by the Bureau of Justice Assistance) that found that incarcerated individuals who received general education and vocational training were significantly less likely to return to prison after release and more likely to find employment than their peers who not did not receive such opportunities. The RAND Report found that corrections education has a significant impact on post-release recidivism. It found that, “on average, inmates who participated in correctional education programs had 43 percent lower odds of recidivating than inmates who did not…. This translates into a reduction in the risk of recidivating of 13 percentage points for those who participate in correctional education programs versus those who do not.” Education was also shown to improve inmates’ chances of obtaining employment after release, and employment has been shown to have a positive VISIT US AT WWW.CORRECTIONSFORUM.NET

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impact on recidivism rates. The odds of obtaining employment post-release among inmates who participated in either academic or vocational correctional education was 13 percent higher than the odds for those who did not participate. In addition, it was found that “those who participated in vocational training were 28 percent more likely to be employed after release from prison than those who did not receive such training.” RAND researchers concluded that prison education programs were cost-effective. But the study also documented a cautionary tale within the good news: access to education in correctional institutions was limited, and significant knowledge gaps existed regarding the nuances of educational program effectiveness in the correctional context.

INMATES ‘LEFT BEHIND’ IN USE OF TECHNOLOGY The National Education Technology Plan, developed in 2010 by the ED, underscores the necessity of advanced technologies to support all student learning. Yet, it reports: “As states, districts, higher education institutions, and other education providers implement these plans, education programs in correctional facilities are being left behind.” It states: “For example, according to a 2013 survey of state correctional education directors, although most states offer students limited use of computers in their prisons, less than half reported that one or more of their prisons provided students with off-line access to Internet content and even fewer allowed restricted Internet access (Davis et al. 2014).”

OBJECTIONS TO TECHNOLOGY The report notes that the primary concern about adopting educational technology in correc42 CORRECTIONS FORUM • JULY/AUGUST 2015

tions is the potential for security breaches, though the lack of funding to purchase, implement and maintain equipment is another reason that hinders its use. While the objections are well founded, the report goes on to outline numerous case examples of departments that have found a way to overcome the concerns. It includes a section on how the Ohio Department of Rehabilitation and Correction in 2005 implemented a policy to allow restricted Internet access, and an appendix contains the policy for others to consider. In the ED report, Brant Choate, former director of Inmate Education Programs with the Los Angeles County Sheriff’s Department (he is now superintendent of California’s Office of Correctional Education), made a case for inmate technology education. He said if correctional agencies are serious about preparing incarcerated individuals for release, they cannot ignore technological advances, including the Internet, occurring outside the facility walls. As noted, the Rand Report found education on the whole, whether academic or vocational, extremely promising. It did not find a statistical difference as to which is best suited to post release success, though those in the field report studies are under way.

INDIANA TRANSITIONAL EMPLOYMENT PROGRAM A transitional employment program for 25 inmates being released to the Indianapolis metropolitan area during the next 12 months has just been initiated by the Indiana Department of Corrections (IDOC). The agreement is with Goodwill Industries of Central Indiana, Inc., an organization under the umbrella of the United Way with a history of providing employment for people whose options have been limited by disability, a criminal history, low education level or other sig-

nificant barrier. Using donor and community funding of about $400,000 annually, Goodwill Industries' Retail Division employs nearly 2,000 people. According to John Nally, Ed.D., director of education with the IDOC, participants will be paid $7.25/hr. to begin, with pay increases up to $8.00 per hour based on program milestones, and will work four days per week, for 32 or 40 hours; and spend one day per week (six hours) in classroom training. This training will include instruction in: Microsoft Word, Powerpoint and Excel; reading (participant must be at 8th grade level by graduation), math (must be at 5th grade level by graduation) and career planning. To be considered for the program, each participant must complete or acquire (or be ready to, immediately upon graduation), the following: ○ Housing: a participant must have a “secure home,” defined as living with family, a support group, or a transitional home. A participant must have a permanent address. A shelter is not considered a permanent address. ○ Medical Care: a participant must acquire a primary care physician or primary facility, and acquire medical insurance. ○ Financial Skills: a participant must have acquired an understanding of financial planning, and must complete a personal budget. Each participant must obtain a personal checking or savings account or obtain a personal pay card account and demonstrate the ability to keep it balanced. ○ Support System: a participant must obtain a Participant Champion from outside the Program, approved by Goodwill, whom they meet with regularly. ○ Full-Time Employment: upon the completion of the program, a participant must obtain fulltime employment (at least 30 hours). The employment could


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Availability of Technology in Corrections Education, 2013

be at Goodwill or with an outside employer, including one of Goodwill’s many employer partners. Dr. Nally along with Susan Lockwood, Ed.D., director of Juvenile Education for the IDOC, conducted a comprehensive study that followed inmates released from Indiana state prisons over five years with strong results toward education, particularly vocational training. The study showed that recidivism was greatly reduced based on the offender participating educational programs. “The study found the recidivism rate is 29.7 percent among offenders who participated in a variety of correctional education programs,” Nally said in an email. “Conversely, the recidivism rate reached 67.8 percent among individuals who declined to participate in any correctional education programs.” Dr. Nally has said he doesn’t think it serves society well to exclude citizens from a formal education program. A citizen, he believes, regardless of “where they sleep at night” should still be able to get an education.


Source: Educational Technology in Corrections, 2015 (Davis et al. 2014)

To carry out that mission, the IDOC has an array of reentry plans. One is a joint-partnership with Televerde ( for a call center at the Rockville Correctional Facility (female). The current number of inmates employed through the joint partnership is 37 with an agreed upon goal



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Graduates of Indiana DOC’s Televerde inmate call center certification program, which aids in honing communications and customer service skills.

of 150 individuals gainfully employed while incarcerated. Inmates will be paid on a climbing scale based on their length of employment, i.e., $1/hr for trainees, up to $2.50/hr. after two years. Among the learning outcomes of the Televerde call center training are: honing communications skills, discerning customer needs, becoming knowledgeable in webbased customer service, managing stressful situations and proper time management skills—all readily transferred to the outside business world. Graduates will earn a certification from the International Business Training Association. Unfortunately, Dr. Nally notes, inmates are not meeting the basic standards to be considered for the training. Televerde had 30 applicants in May but 17 did not pass the pre-employment assessment. “To increase the probability of employment within the call center, we will provide access to a WorkINdiana on-site program,” he says. This partnership, in conjunction with Oakland City University, provides offenders who failed the pre-employment assessment with a six-week, 15hour classroom and distance learning skills class. Among the 44 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015

remedial topics covered are basic typing, locating information and interviewing skills. Technology skills and post release follow-up are also part of the call center plan. “Beyond the learning outcomes, the training will be combined with computer training and/or employability skills training, to add depth,” Dr. Nally explains. “Completers will also qualify for post-release support through the H.I.R.E. program. Mobile devices are the new wave, and the ED report discusses several providers, among them is Innertainment Delivery Systems (IDS), a tech-enabled Nashville company supporting content delivery for users within secure environments ( The company, which was founded in 2009 when they began supplying counties with MP4 devices, began producing educational tablets in 2011. It now offers both proprietary customized hardware and software solutions, which are specifically for jail and prison use, according to Dr. Turner Nashe, president. The company produces 4-, 7-, and 10-inch tablets, which can be either wifi enabled and non-wifi enabled for the most secure requirements. IDS reports 50 installations, including the

California Department of Corrections and Rehabilitation. We generally partner with DOCs, counties, and their schools (K12 through post secondary), notes Dr. Nashe. “We offer curriculum and content on everything from primary, secondary, and post-secondary schools. We also offer ABE, ESL, religion, life skills, vocational, substance abuse. We provide over 45,000 titles of content across all program needs. “Everything we sell was born out of customer need,” he furthers. “We began trying to show that electronics, under the right circumstance, could be a force multiplier when used in an educational setting. We have spent the last six years developing new and secure technologies to meet the needs of budget-strapped jail and prison administrators around the country. This increased access to a mobile learning environment, we hope, will lead to increased quality of life and employability upon release,” concludes Nashe. 

REENTRY TOOLS & TECHNOLOGY PROVEN BEHAVIORAL TOOL Moral Reconation Therapy— MRT—has been employed in drug court treatment programs since the mid-1990s. The cognitive-behavioral program was developed by Correctional Counseling Inc. and is used for substance abuse treatment and for criminal justice offenders across the U.S. A recent study provided a comprehensive review of 56 recidivism outcome studies published in journals, independent program evaluations, and technical reports over the past two decades, reporting on the effects of MRT in drug court operations. Seven of the published studies of adult courts included recidivism data with a


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comparison between groups that utilized MRT and groups that did not. Six of these seven studies showed that MRT treatment in adult courts led to lower recidivism. The average recidivism reduction rate of the MRT treatment group in all seven studies was 21.6%, which compares favorably to the 10%-15% recidivism reduction rate of other drug courts. Comparable studies were conducted for juvenile court, family courts, wellness court and veterans courts., or 901.360.1564

ONLINE JOB SEARCHES Some 2,000 inmates in Fulton County jail in Atlanta have been given access to JobView tablets in a pilot program, according to WSB-TV, Atlanta. With these mobile devices inmates get limited access to the cyber world and command tablets can be used to control them. Anything we can use to get inmates to follow institution rules without having to use force and without having to be coercive, I think is a good tool, said jail commander Colonel Mark Adger. We can extend to the inmates the opportunity to entertain themselves productively, he added. In the pilot, Securus has given the jail the tablets at no charge for inmates who rent them for $20 per month. Among the programs loaded on the tablets is a solution called JOBview 2ndChance, which has no keyboard or connection to the Internet, and it allows inmates to search through current job listings that are updated daily. Because staff often have the onus to find job listings for offenders, they had been faced with the need to bring handwritten listings or newspaper clippings for inmates to peruse for jobs, and “they are always out of date,” notes Ryan Solberg, vice presi-

dent of the Minneapolis company which developed the solution. “This can provide something much closer to what they will actually see on the outside.” The solution is used by correctional facilities, probation offices, halfway houses and other reentry locations., or 1.866.562.8439.

S.F. TABLET PILOT Some San Francisco jail inmates are now in possession of computer tablets they can use to do homework, read novels and prepare for their criminal cases, according to NBCbay The tablets were distributed in October 2014 to more than 100 inmates as part of a two-year, $275,000 pilot program. The inmates will have access to four secure websites, including a law library and a digital book site. They can also use a calculator, an education application and an education curriculum developed by the jail's Five Keys Charter School. Inmate Dennis Jones, an army veteran, has been in and out of the prison system for more than a decade. He is hoping the computer tablet can help him break the negative cycle and help him earn his high school diploma. San Francisco Sheriff Ross Mirkarimi said the tablets could help make sure inmates don't return to jail. "This is really cutting edge,'' he told a group of sheriff's deputies and charter school teachers receiving tablet training. "Historically, there's been resistance, if not prohibitions, on allowing technology into the living quarters of inmates.'' New York-based American Prison Data Systems developed the tablets. The company also provides the devices to juvenile jails in Kansas and Indiana and an adult prison system in Maryland, CEO Chris Grewe said., or 646.592.1072.



Alcolock, USA .........................17 ASSA .........................................6 Black Creek Integrated Systems Corp. ....................29 Bob Barker..............................47 Corizon .....................................7 Correctional Counseling ........43 Correctional Medical Care .....27 Diamond Drugs Inc. ...............25 Endur ID Incorporated ...........28 Infax........................................31 Institutional Eye Care .............46 Jinny Corp.................................4 Keefe Group ...........................48 Mars........................................35 Medi-Dose Company ........23,41 MHM Correctional Services, Inc..........................2 Microtronic US .......................32 Morse Watchmans, Inc. .........37 NaphCare .................................9 NCIC Inmate Telephone Services...............................39 OraLine, Inc. ...........................18 OraSure Technologies, Inc. ....19 Point Blank Industries ..............5 StunCuff Enterprises, Inc. ........4 Thermo Fisher Scientific.........15 Time Keeping Systems, Inc. ...33 Tribridge.................................11 TrinityServices Group, Inc......21 Wexford Health Sources ........13 This advertisers index is provided as a service to our readers only. The publisher does not assume liability for errors or omissions. CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015 45

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As the creators of Hot Pots for the Correctional Markets, West Bend/Focus Products Group Int’l, LLC has introduced their new “Security Enhanced, Patent Pending” Prison Hot Pots. Each model is designed to meet a different security and electrical requirement. Hot liquid is considered a weapon. West Bend’s “high security” model #53645R retains an average temperature of 155F to prevent boiling liquids and scalding. At 350 Watts and under 3 amps, this hot pot prevents an overload on the electrical system. The “low security” model #53525R retains an average temperature of 195F and is 600 Watts. Available at










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