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Behavioral Health Strategies in Restrictive Housing: The Kansas Model Ray RobertsViola Riggin Secretary of CorrectionsDirector of Healthcare, UKP Kansas.

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Presentation on theme: "Behavioral Health Strategies in Restrictive Housing: The Kansas Model Ray RobertsViola Riggin Secretary of CorrectionsDirector of Healthcare, UKP Kansas."— Presentation transcript:

1 Behavioral Health Strategies in Restrictive Housing: The Kansas Model Ray RobertsViola Riggin Secretary of CorrectionsDirector of Healthcare, UKP Kansas Department ofKansas Department of CorrectionsCorrections

2 Why review restrictive housing placements? Bring the State into compliance with standards associated with the caring for mentally ill offenders in Restrictive Housing (RH). Increase access to treatment for the mentally ill in RH. Better understand the clients we serve in RH units. Provide a safe environment in RH for staff and offenders. Provide a safer plan for releasing mentally ill offenders from RH. 2

3 Background - KDOC Special Needs Offenders The table shows the number of offenders requiring consistent mental health follow up due to serious mental illness. The graph indicates historical numbers from FY09 through FY14. On average, the special mental health needs population increased 13.8% each year (year-to-year) between FY09 and FY14. 3

4 KDOC Statistics for Mentally Ill In 2011: 646 mentally ill offenders, representing 7.0% of the population, were housed in RH Units. In 2014: the number reduced more than half to 292 mentally ill offenders in RH Units. Today, 3% of the total SMI population and 0.48% of the SPMI population are housed in RH Units. 4

5 Development Team Secretary of Corrections established a multi-disciplinary development team to investigate and improve the overall identification and treatment of the mentally ill housed in RH Units. Team members included: Deputy Secretary of Facilities Management Director of Healthcare Services Mental Health Program Administrator Wardens from five prisons with largest population of mentally ill in RH Units Classification Staff Deputy Warden for Programs 5

6 Development Team: Primary Goals Buy-in from Wardens and classification staff Standardize definition of “long-term restrictive housing” Review and establish policies to affect long-term change in RH Units Address safety issues by defining the role of members of the “Restrictive Housing Review Board’ to a multi-disciplinary team process Develop facility space for treatment / programming activities Identify alternative and creative means to provide treatment Develop additional training for behavioral health professionals and operations staff Establish outcome measures to track progress 6

7 Type of program by facility – LCMHF, TCF & EDCF are designated facilities for offenders requiring the highest level of treatment (level 5 & 6) FacilityMH ClassificationType of Program LCMHF MH Levels 4, 5 & 6 MH Level 3 in crisis RH with BH TX Program (Due Processed) Treatment Units EDCFMH Levels 3, 4, 5, & 6 RH with BH TX Program Treatment Unit TCF TUMH Levels 3, 4, 5, & 6 Treatment Unit TCFMH Levels 3, 4, 5, & 6 RH with BH Treatment LCF TRU-IMH Levels 3, 4, 5, & 6 Treatment Unit LCFMH Levels 3-4 RH with BH TX Program Treatment Unit HCFMH Levels 3-4 RH with BH TX Program Treatment Unit ECF & NCFMH Levels 3 – 4 RH with BH TX Program All Other RH Units MH Levels 1 – 2 RH with Access to BH TX no formal program 7

8 Example: RH Unit with Treatment Facility LCMHF will be the primary treatment facility for the highest acuity mentally ill offenders. LCMHF houses the following Mental Health Level 3 – 6 offenders: 1 unit (30 beds) RH-BH Treatment 3 units (90 beds) Treatment Units TCF-TU will be the primary treatment facility for the highest acuity mentally ill female offenders. 1 unit (10 Bed) RH- Behavioral Health Treatment Unit 1 unit (15 Bed) TU-Treatment Unit for Females Goals Provide approximately 10 hours of BH treatment and 10 hours of KDOC activities weekly to offenders who have proven to be especially violent when placed less-structured environments. Allow an avenue for offenders to move toward a less-structured BH unit as violent behavior lessens. 8

9 Phase I: Training Staff within RH units receive specialized training from an advanced curriculum. Those requiring specialized training include: Facility Administration Security staff in special placement units Unit management staff BHP Nursing staff Specialized training should focus on: Characteristics/risk factors associated with managing offenders in RH Understanding mental illness Recognizing symptoms of major mental disorders Suicide/self-injury prevention Detecting signs of deterioration Crisis response Indicators for referrals Motivational aspects 9

10 Phase II: Measuring Progress Secondary review process Central Office BH program staff reviews offenders placed in RH and treatment units to ensure offenders with SMI are recognized and provided treatment Self-monitor through the quality assurance process by on-site clinical staff monthly – site level Central Office BH program staff conducts at least quarterly monitoring for compliance with program requirements. Submit monthly report Identifying numbers of offenders in each program Additional outcomes to the Deputy Secretary of Facilities Management Review offenders with recurring patterns of RH placement of more than 6 times in a 12-month period and with a MH classification of 3-6. Develop outcome measures for clinical and administrative management of mentally ill offenders in RH. 10

11 Obstacles During Program Development Establishing a balance between safety and treatment options Behavioral health clinical staff: Lack clinical staff /funding for staff Where to place treatment units that had adequate community support Lack of space/space not adequate for treatment needs Current staff training and skill sets did not meet needs identified Lack of staff to mine data to identify the types of offenders and their needs Operational Issues: Training did not meet site staff needs Correctional officer staffing levels and skill set had to increase Safety concerns for dealing with erratic behavior Cost – funding Burnout for staff who work high-intensity units 11

12 Key Successes: What’s Changed Early support from the Governor Led to legislative support on budgeting for MH staff increases Buy in by senior management Development of a team approach Train staff often and early Participation of line staff to change and add ideas during the development phase provided great enhancement ideas Developed a draft plan that forces the function to create individualized case management and treatment through a multi-disciplinary approach Screened clients and mined the data to identify who needed services and where they were Made the data important Implementing follow up/monitoring tools to maintain the program long term 12

13 Resources Used in the Program Dr. Lorelei Ammons, Psy.D. Kansas University Physician Inc. Kansas Department of Corrections. American Correctional Association (2003). Standards for Adult Correctional Institutions 4 th Edition. American Correctional Association (2012) Standards Supplement. American Correctional Association (2014). Town Hall Meeting on Offenders with Mental Illness In restrictive Housing. January, Tampa, FL. American Correctional Association (2014). Plenary Session on Offenders with Mental Illness in Restrictive Housing. September, Salt Lake City, UT. American Psychiatric Association (2012). Position Statement on Segregation of Prisoners with Mental Illness. Aufderheide, D. (2013) Mental Illness in Administrative Segregation: 10 Key Components to Bulletproof Your Mental Health Program Against Litigation. Brown, J. (2013). ACLU Uncovers Increased proportion of Mentally Ill Inmates in Solitary. The Denver Post.. Dvoskin, Joel; Controversies Concerning Supermax Confinement and Serious Mental Illness; based on Metzner, JL & Dvoskin, JA. (2006) Controversies concerning Supermax Confinement and Mental Illness. Psychiatric Clinics of North America. Philadelphia: Elsevier. Volume 29, No.3. Metzner JL, Dvoskin JA: An Overview of Correctional Psychiatry. Psychiatric Clinics N Am, 29: , Morgan DW, Edwards AC, Faulkner LR: The adaptation to prison by individuals with schizophrenia. Bulletin of the American Academy of Psychiatry and the Law, 21, ,


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