Every correctional facility is unique, yet all share commonalities. As in jails and prisons nationwide, drug addiction is rife among the people being admitted to Connecticut’s York Correctional Institution.

Like some of those facilities, York CI has an extensive menu of addiction services. Unlike most other facilities, however, York operates an on-site opioid detoxification program. Further, it was the first in the nation to earn NCCHC accreditation for its opioid treatment program.

York CI has plenty of other qualities that set it apart. It is a hybrid prison-jail, the state’s only facility for females. The grounds are so large that inmates on the “other side” must be bussed to the health unit, an arrangement that creates its own challenges.

At the helm of the vast health services enterprise is Eileen Borowski, PhD, CCHP, a trained psychologist who has been York’s health services administrator for close to four years. She identifies the facility as a “jail-prison,” but opts to comply with NCCHC’s Standards for Health Services in Prisons because those are “more challenging.”

You’d think her job was tough enough. Despite a sizeable population of long-term inmates, the heavy volume of daily intakes and releases makes the facility a ringer for a jail, as does the corresponding demand on health services.

And these inmates are women, who utilize health services at rates far higher than do men. To meet their short-term and long-term needs, York offers a broad spectrum of services, including multifaceted mental health care. It also was the first female facility in the nation with a palliative care program and hospice.

Most of the addiction programs, such as education and counseling, are run from the DOC’s addiction services unit, with some assistance from community-based volunteers.

However, detoxification is a medical concern, says principal physician Monica Farinella, DO, CCHP. Thus, all women are tested for drugs during the intake health screening. They also are tested for pregnancy. With a lab on site, results are known quickly.

The Science of Detox
York has offered detoxification for years, but it simply provided methadone to everyone who tested positive for opiates. Librium was the usual answer for alcohol intoxication.

That policy changed after the federal Substance Abuse and Mental Health Services Administration was put in charge of opioid treatment program certification a few years ago.

York’s nursing supervisor Susan LaPalme, RN, CCHP, directed an overhaul of the detox program. She began by handpicking Tonya Sullivan, RN, a former obstetrical nurse, to become “detox nurse.” Sullivan and Farinella attended SAMHSA educational programs and worked with University of Connecticut Health Center experts to develop rigorous protocols for managing inmates withdrawing from alcohol, opiates and benzodiazepines.

Now, an inmate who tests positive for opiates is immediately placed in the inpatient unit. Sullivan visits the next day, giving the patient a physical examination and using clinical scales to measure withdrawal symptoms. She also finds out whether the patient was on opioid maintenance in the community and verifies the dosage.

Guided by her findings, Sullivan determines whether the patient receives methadone or simply close monitoring. Typically about 20 inmates are on methadone at any given time, and of those, 16 were in community programs.

Sullivan then creates a detox treatment plan, with tapering dosages for those who are receiving methadone. (Pregnant inmates receive maintenance doses throughout pregnancy.)

By reserving methadone for only those with a clinical need for it, the new protocol has greatly reduced the facility’s usage of the drug, Sullivan says. But while she adheres to the protocols strictly, she is not without compassion. “These girls are addicts and they’ll say anything to get the methadone. I can’t judge them; I just try to help them the best I can.”

While most detoxifying patients move out of the medical unit in two or three days, Sullivan closely monitors all of them throughout the process to help control withdrawal symptoms, especially in the case of benzodiazepine.

And what was it like being one of the first correctional facilities surveyed for compliance with NCCHC’s Standards for Opioid Treatment Programs? “We had our act together,” Sullivan says. “We were confident we were up to snuff.”

Meeting Heavy Demand
Typical of a female inmate population, rates of mental illness are high: Borowski estimates that 85% of the inmates have a comorbid diagnosis. Most prominent are trauma-related diagnoses, post-traumatic stress disorder, depression and anxiety.

Women with mental disorders are identified at intake via interviews with mental health care practitioners, says supervising psychologist Bill Chalsma, PhD. They are triaged based on need: The most extreme intervention is admission to the mental health inpatient unit. Most, however, are sent to psychiatric outpatient clinics for assessment and, if indicated, are prescribed medication. About half of the inmates are on psych meds.

“That’s a reflection of the high level of need these women come in with,” observes Chalsma, who notes that many of them are “more victim than victimizer.”

The inmates at York CI also manifest the full array of medical conditions—chronic and acute—seen in correctional settings. Asthma and hepatitis C are particularly prevalent.

The infrastructure to deal with these needs is “huge,” says LaPalme. One indicator: the health unit receives over 3,000 sick calls requests per month, and the staff usually meets its goal of seeing each request within 24 hours. Similarly, all new intakes receive health assessments and physicals within 24 hours.

The department’s work isn’t confined to York’s own inmates: It also receives visits from DOC halfway house residents needing services such as gynecological and dental care.

Virtually all care, except for childbirth, is provided on site (see box above for a partial list of services). “On any given day, 1,000 patients come through our doors,” says LaPalme. “We run nonstop.”

She wouldn’t have it any other way. Echoing sentiments expressed by Borowski, she credits a hard-working, self-motivated and skilled staff for the feats they accomplish. “At the end of the day you reflect and say, ‘We’ve done a good job.’”

— About the author: Jaime Shimkus is NCCHC’s publications editor. To contact her, e-mail jaimeshimkus@ncchc.org.