· Standards for Health Services in Prisons
· Standards for Health Services in Jails

New Health Services Standards On the Way
The culmination of three years of work, NCCHC’s latest editions of the Standards for Health Services for jails and prisons will be released in mid-2008. This is the most ambitious revision to date, with many improvements to assure state-of-the-art guidelines that reflect the best in correctional health care services. The new standards were previewed at the National Conference on Correctional Health Care in Nashville in October.

NCCHC’s standards are widely recognized by the correctional and health care communities as well as the courts as being the benchmark for the delivery of correctional health care services. The revised standards benefit from the combined expertise of 38 supporting organizations, hundreds of correctional health care professionals and NCCHC’s senior accreditation surveyors.

The standards revision task force began its work by gathering feedback from surveyors about what they were seeing in the field, and how the standards could be of most relevance to contemporary practices in correctional health care delivery.

“Our task force took a hard look at surveyors’ comments, and combined with other input from the field, took a fresh and exciting approach in updating the standards,” says B. Jaye Anno, PhD, CCHP-A, who chaired the task force. “The end result is a greater focus on outcomes and more flexibility in achieving desired results.” Anno is a preeminent expert and consultant in correctional health care and a cofounder of NCCHC.

New Option for Health Assessment
One major change is the option for certain facilities to not conduct an initial health assessment on all new intakes. Under the new standards, if the jail or prison assigns a qualified health professional to do a more rigorous initial screening than what was required in the past, and there is no indication of serious medical issues, it is not necessary to also do a full health assessment of that inmate. If the facility does not choose that option, then the requirement remains for a full assessment as soon as possible, but no later than 14 days in jails and 7 days in prisons.

This modification changes a paradigm that dates back 30 years, when NCCHC was a project within the American Medical Association, but the time is right. “This approach reflects contemporary community medical practice and is supported in the medical literature,” according to Ronald Shansky, MD, who served on the task force. “There is no need to waste valuable resources on health assessments of healthy inmates.”

By identifying problems early through more in-depth screening, correctional facilities have the opportunity to allocate resources where they are needed most: on the sick.

Senior accreditation surveyor Jayne Russell, MEd, CCHP-A, also a task force member, noted that the first few days of incarceration is a critical time to identify illness and begin treatment for those in need, thus avoiding morbidity, emergency room visits and other unwanted outcomes.

An added bonus: This new option might even result in cost savings.

The Receiving Screening standard was also changed, both to reflect the above option and to emphasize the importance of starting a problem list and treatment, when warranted, on those with identified problems.

Focus on Quality
The standard on Continuous Quality Improvement was improved, as well. “We simplified the standard to make sure that the field is focusing on problem solving rather than paper pushing,” says Anno. “Of course people want to confirm they are doing a good job, but the philosophy behind CQI is that you are always looking for areas to improve and embrace the opportunity to do so.”

Some standards were eliminated and several were rewritten to ensure they clearly focused on the provision of necessary health services. “We’ve seen tremendous improvement in the overall quality of patient care throughout the country over the past few decades,” says Robby Morris, MD, NCCHC board chair. The revised standards reflect the importance of quality health services and are sensitive to the ever-present concerns of operational effectiveness and efficiency.

Task force member Kleanthe Caruso, RN, CCHP, a veteran correctional health care professional, noted that many of the new NCCHC standards are sure to be incorporated throughout the field. “Many correctional systems base their policies on NCCHC standards, as do contracted health care providers and even other standards-setting organizations.”

The Commission is no stranger to leading the field in change. Its clinical guidelines for major chronic diseases, available for free on NCCHC’s Web site, have been a pivotal force in improving patient outcomes.

The standards are organized into the categories of Inmate Care and Treatment; Health Care Services and Support; Governance and Administration; Safety; Personnel and Training; Health Promotion; Special Needs and Services; Health Records; and Medical-Legal Issues.