Make no mistake: Correctional health care is on the upswing in the United States. While this field has experienced significant advances over the past 30 years, they tended to come in fits and starts, often driven by legal action.

No more. We are now in a phase of rapid progress as the vital importance of this discipline becomes widely recognized and is factored into the public health mission at all levels.

We’re seeing development of clinical guidelines and best practices for correctional health care, initiatives that bring community health services into prisons and jails, collaborations to ensure continuity of care and service when inmates are released, broad-scope research studies focusing on incarcerated populations, countless opportunities for professional development and so much more.

And with the spotlight trained on this field from the influential office of the U.S. Surgeon General, who has authorized a Call to Action on Correctional Health, it’s virtually assured that the strong positive momentum will continue. (See article at right for more about the Surgeon General’s interest in correctional health care.)

Recommendations Become Reality
Much of the work now underway was identified in the policy recommendations published in The Health Status of Soon-to-Be-Released Inmates: A Report to Congress, developed by NCCHC at the request of the National Institute of Justice and issued in 2002.

The largest and most comprehensive project of its kind, the Health Status study revealed unique opportunities to reduce the health risks and financial costs to the community that are associated with releasing large numbers of inmates with undiagnosed and untreated health care needs. (Click here to learn about the history of the project and to download the report. Or see the two-part summary in the Fall 2002 and Winter 2003 issues of CorrectCare.)

This article describes a few major initiatives that are turning those policy recommendations into reality.

Reinventing Chronic Disease Care
Some jurisdictions are tackling several policy recommendations at once by implementing programs to improve management of chronic disease. In Michigan and Georgia, for example, the departments of corrections have launched a project that is cutting-edge for the medical field as a whole, let alone correctional health care.

They seek to improve clinical care and outcomes of chronic disease by replacing the entrenched episodic treatment approach with one based on total disease management. This recasts the conceptual framework by which patients are treated and relies on standardized definitions of outcomes based on accepted national guidelines. Through data collection and analysis conducted in partnership with NCCHC, the program generates benchmarks essential for ongoing quality improvement.

Why is this important? An episodic approach looks at the symptom the patient is presenting today and seeks to eliminate that immediate complaint. Lacking a longer-term perspective, assessments fail to consider previous medical encounters and newly prescribed medications. Further, patients often receive inadequate counseling about self-care responsibilities.

In cases of chronic disease, however, this approach clearly is not only inappropriate but it also leads to higher morbidity, mortality and costs.

In contrast, the program being used in the Georgia and Michigan prisons introduces systems that strive for total disease management, with chronic care policies and protocols to guide patient care. To support this approach, NCCHC has developed clinical guidelines tailored to the correctional setting. Based on clinical guidelines from major governmental and medical organizations, they address diseases highly prevalent among incarcerated populations.

An important element of this QI program is the forms caregivers use to document patient visits. The forms were modified to collect data by which patient outcomes can be gauged in terms of benchmarks set forth in the clinical guidelines (i.e., degree of control and status of the condition compared to the previous visit).

The QI program builds in plenty of provider instruction and support. NCCHC uses custom software to analyze outcomes data, then shares feedback in the form of reports and follow-up training. The ever-growing database—which now has 100,000 records of patient encounters—also provides benchmarks by which administrators can compare providers, institutions or regions, and even enables comparisons with other systems participating in the program.

Initial findings from the project have already been presented at NCCHC’s annual conference and also will be featured at the CDC’s 19th National Conference on Chronic Disease Prevention and Control in March.

Participation in the project is growing, and it is sure to become a model for optimal chronic care management in correctional settings nationwide.

Focus on Reentry
A big buzz in correctional health care in recent years is “reentry”—shorthand for the transition that all released inmates must make when they settle into the community. Also the subject of a Health Status report policy recommendation, reentry has sparked a great deal of activity. The result is a rich mine of information that quantifies the phenomenon and related difficulties, identifies programs meant to smooth the transition with needed health care and other services, profiles successful programs, and offers guidance for future efforts.

Among the myriad entities working in this area:
· The Urban Institute, which convened a public health roundtable and shared contributors’ papers in a special issue (10-3) of the Journal of Correctional Health Care
· An NCCHC national study of current and potential capacity of jail and prison health care programs to perform effective discharge planning, facilitate continuity of care, and promote health and disease prevention in urban communities
· The CDC and the Health Resources and Services Administration, which together initiated a Corrections Demonstration Project to assess transitional services for inmates with HIV/AIDS (described in the Journal, issue 9-4)
· The federal Bureau of Justice Assistance’s Center for Program Evaluation, which hosts a Web site with resources for developing and implementing a reentry program

One of the newest, most thorough resources is from the multiagency Re-entry Policy Council, formed by the Council of State Governments to develop policies and principles to guide policymakers evaluating re-entry, and to help coordinate efforts and share information about initiatives, trends, issues and funding.

The Council recently issued an in-depth report with hundreds of bipartisan recommendations to help make prisoners’ transitions to the community “safe and successful.” The consensus-based recommendations were derived from input from over 100 leading policymakers, plus officials in law enforcement, corrections, and health and social service systems.

Restoring Mental Health
Mental illness and substance abuse problems among inmates are nearly overwhelming to many correctional facilities, which simply weren’t designed to deal with such patients.

Like reentry, this is a hot issue. In October President Bush passed the Mentally Ill Offender Treatment and Crime Reduction Act, which helps to fund collaborative programs for mental health and criminal justice agencies. Also, the President’s New Freedom Commission on Mental Health made a nod to the criminal justice system in its 2003 report.

More germane is the work coming out of the Criminal Justice/Mental Health Consensus Project (another Council of State Governments initiative), which in 2002 issued a landmark report that describes practical, flexible approaches for serving individuals needing mental health care. The Project also provides technical and other assistance.

NCCHC too is undertaking major efforts in this area, including, most recently, accreditation of corrections-based opioid treatment programs. Based on adherence to NCCHC’s new standards for opioid service delivery, such accreditation is a first step for OTPs to receive the federal certification required to provide methadone treatment to incarcerated addicts.

Finally, due to high interest in mental health and substance abuse sessions at its two annual conferences, in 2004 the Commission hosted an intensive two-day educational meeting focusing on this subject. It was so successful that a second mental health meeting will be held in July. See the Education section of our Web site for information.

A Wealth of Resources at Your Fingertips
Nearly every organization dealing with correctional health care has a Web site, which usually is easily found by using a search engine such as Google. If you're not sure what you're looking for or can't find it using the links provided above, try starting with these sites:

· NCCHC – clinical guidelines, position statements, CorrectCare articles, Journal abstracts,
  FAQs about NCCHC Standards, information and registration for educational conferences, links
  to major health care and correctional groups and government agencies and more

· NCJRS – the federally funded National Criminal Justice Reference Service offers information to
  support research, policy and program development; access to hundreds of government agency
  reports, a huge abstract database, reference services, newsletters and more

· CDC Correctional Health – operated by the National Center for HIV, STD, and TB Prevention
  as a repository of information; content on key correctional health care topics (e.g., chronic,
  infectious, juvenile, women’s and mental health) plus access to newsletters and more