Thursday, Nov. 29, 2007 

Thursday Morning Introductions

    On Thursday morning, attendees mingled over coffee and juice as ACA’s Executive Director James A. Gondles, Jr., gave a short history of the association. He spoke briefly on ACA’s mission and long-standing goals, calculating that at 138 years, ACA is likely one of the oldest, continuously operating associations in the U.S. Gondles then addressed the purpose of the coalition. He said that throughout his career in corrections, he has witnessed a schism that has marked the practice of corrections: the divide between security and treatment. By facilitating events that bring corrections professionals together, ACA is committed to working with both factions of the schism, Gondles said. “One of the best things our association can do is build a bridge between all types of corrections.”

Recruiting and Retaining a Successful Work Force Presentation

   Elizabeth Gondles, Ph.D., health care advisor to ACA President Gary Maynard, opened Thursday morning’s session with a national overview of correctional health care work force recruitment and retention. Gondles expressed gratitude to attendees, and said she felt “confident that the collective knowledge of the group will take correctional health care to the next level.”

   She and Charles J. Kehoe, vice president of marketing and communication for G4S Youth Services and a past president of ACA, explained the tenets of ACA’s Center for the Correctional Work Force of the Future and how it relates to building a strategic work force of correctional health care professionals. In 2003, ACA was awarded a grant from the Bureau of Justice Assistance (BJA) to hire four researchers, two of which were economists, to study the make-up of the correctional work force. ACA conducted more than 55 workshops at various conferences and sent out surveys to gather information. ACA formed a Work Force Advisory Committee, comprised of representatives from various affiliate organizations, to advise ACA on special work force issues and help spread the project’s mission.

   Gondles presented statistics on nationwide work force trends, focusing specifically on the drain the health care sector will experience during the next 20 years when an estimated 76 million baby boomers are expected to retire. “We need to develop the bench,” Gondles said. She said she believes corrections has a “looming crisis” because the retiring boomers will take with them a career’s worth of critical knowledge when they leave the work force. She then juxtaposed the “mass exodus” affecting the work force with the statistics on the predicted growth of America’s state and federal prisons, which are expected to increase by 192,000 inmates in the next five years.

   Results of ACA’s first work force survey were presented in graphs and projected on a screen for the attendees to read. Kehoe walked the group through the survey findings, which included how respondents perceived retention difficulties and how they dealt with the consequences. Overall, it was noted that directors of juvenile institutions found it much more difficult to recruit qualified staff, while the majority of both juvenile and adult institutions found it “fairy difficult” to retain qualified staff. Though their responses were similar, representatives of juvenile and adult institutions felt they were experiencing retention difficulties for different reasons. To read the committee’s complete report, visit www.aca.org/workforce/pdf/PI_CompleteReport.pdf.

   Gondles then got into specifics, stressing ways that attendees could positively affect recruitment and retention efforts day-to-day. She stressed the need for correctional health care professionals to tout their positions as community health care providers who supply a service to the public that improves the overall health of the communities they serve. Gondles believes corrections needs to do a better job of marketing its health care positions as specialties, like a pediatric nurse or a doctor of oncology. Advertising in not only major metropolitan newspapers but also in small community papers, nursing journals and Hispanic publications can help with recruitment. In addition, Gondles said crafting marketing campaigns and advertisements that appeal to new graduates will encourage them to apply for open positions.    

   Some of the recruitment difficulties are due to common correctional misconceptions. These include perceptions about security risks and incidence of infectious diseases and the label placed on correctional workers as people who cannot find a job elsewhere. To counter these misconceptions, Gondles suggested focusing recruitment efforts on the benefits of correctional careers. These include job security, more manageable shifts, lighter caseloads, clinic-type settings and a strong public health mission. Retention of existing staff was also addressed. Here Gondles stressed the importance of communication. “Talk often with employees to discover their concerns and needs, and act on that information.” Providing competitive, comprehensive benefit packages and flexible scheduling options can go a long way in retaining health care workers. Gondles also suggested offering extra incentives to employees such as free meals and gift certificates for staff who maintain perfect attendance.

Presentations on Individual State Recruitment and Retention Efforts

   Terre Marshall, RN, director of the Health Services Division for the Massachusetts Department of Corrections, addressed recruitment options pertaining to the roles of students and interns. She explained the programs the Massachusetts Department of Correction (MDOC) has put in place, including a community health clerkship program; fellowship programs in corrections, forensic psychiatry and forensic psychology; psychology and social work internships; and nurse practitioner preceptorships. Marshall spoke enthusiastically about the advantages MDOC gains from these programs. They establish a source for future recruitment and motivate existing staff who provide training and support to students. Marshall said she has even witnessed staff act more professionally when interns and fellows are under their supervision. In addition, students help offset some of the workload at little or no expense.

   MDOC developed a comprehensive curriculum for its health care students that prepares nurses, doctors and social workers for positions in a correctional environment. Specific knowledge and skill sets that pertain to correctional health care were included in the curriculum. Marshall emphasized patient health care literacy, managing difficult patients and discharge planning from a prison. Also of importance, Marshall said, is a health care worker’s ability to separate patients from their crimes; uphold a degree of empathy while maintaining boundaries; and apply a consistent level of care while holding a holistic view of the patient.

   Marshall stressed the many positives of working with correctional patients, estimating that 90 percent are respectful and grateful for the care they are provided. Her staff are fortunate to encounter a variety of clinical issues, provide services to patients who are often physically fit, and maintain easy access to patients for appointments and follow up. The other 10 percent of patients can prove especially challenging and often take up huge amounts of resources. These patients can be manipulative, angry, aggressive and abusive toward staff, Marshall said.

   Marshall went on to suggest some tips for online recruiting, including how to advertise online, coordinate job fairs and send e-mail blasts. She closed with information on how correctional facilities can apply to have their facilities designated as a Health Professional Shortage Area and receive funding from the government.

   Following Marshall, Dr. Mike Jackson, chief medical officer for the Oklahoma Department of Corrections (ODOC), presented ways ODOC is addressing health worker staffing shortages in its facilities. His department was able to increase the hiring rate of registered nurses by raising starting salaries and current salaries. Jackson explained how ODOC implemented creative scheduling based on merit rules, giving nurses options on various shift schedules. In addition, ODOC hired more clerical staff to perform administrative functions, freeing up licensed staff to focus solely on the work they were trained to do. Jackson outlined several ways Oklahoma facilities have been able to reduce paperwork, which has helped cut down the time it takes health care staff to complete simple procedures.

   ODOC is currently working with the state Office of Personnel Management to arrange for nurses to receive sign-on bonuses with one-year service commitments. In addition, the two state agencies will try to offer nurses the option of working full-time at a higher salary but without benefits. Jackson also said his department is trying to consolidate units to increase efficiency and increase the use of medical technology such as electronic medical administration records.

   Dr. Newton Kendig, assistant director of health services for the BOP, reported on the successes of a “suicide buddies” program at Butner (N.C.) Federal Correctional Complex. Researchers found that when inmates are used as observers for fellow inmates on suicide watch, it cuts down on the number of suicide watches and hours inmates spend under surveillance. Kendig hypothesized several reasons for the positive findings. For patients with psychological disorders, suicide watch is often used as a chance to interact face-to-face with staff. Therefore, the absence of a member of staff can act as a deterrent for future suicide watches. Kendig reported that, so far, the program has proved beneficial for both inmate observers and inmates on watch, encouraging pro-social interactions and quality peer time. It was also noted that inmate observers reported an increased sense of self-efficacy. Since Butner has used this program, there have been no suicides among those on watch, and the prison saves an estimated $300,000 a year, according to Kendig. Several in attendance reported using similar suicide buddy programs in their facilities, some for as long as 20 years. Kendig emphasized that although the program is a “hard sell” to some authorities, it can work very effectively when embraced by all levels of leadership.     

Discussion on How to Manage the Geriatric Population

   Dr. Lester Wright, assistant commissioner of health services and chief medical officer for the New York Department of Correctional Services, moderated a forum on managing the geriatric population. He said it is commonly quoted that correctional facilities spend three times the amount of money caring for geriatric inmates as they do younger inmates. Noting the lack of studies, Wright asked, “Who knows if that number is correct?” Regardless, he said, it is more expensive. Elder patients sometimes require wheel chairs and walking devices; often cannot climb to the top bunk; and need warmer uniforms in the winter. Wright wondered aloud what to do with patients once they become too old to perform the work expected of them — “How will we stimulate their minds?” Older inmates are often intimidated by younger inmates, he noted. Should they be separated, and placed in separate facilities once they reach a certain age? After summarizing some of the services New York provides, such as hospice care and assisted living units designed for geriatric patients, Wright turned to his panel to find out ways their states cope with aging inmates.

   Dr. Marc Stern, medical director for the Washington State Department of Corrections, answered that health literacy and preventative care were two ways to help manage aging patients. Also, he proposed considering community supervision for some aging offenders who may no longer pose a risk to society. He also addressed the effects of dementia, arguing that sometimes violent behavior in the aged is a result of a deteriorating mind. He presented an example of some correctional officers in Washington, who he witnessed treat a violent dementia patient with care and understanding. He cited examples of when correctional health care succeeds and even supersedes medical care in the free world, predicting that corrections also can do better in managing the elderly.

Luncheon Speaker

   James Gondles introduced the luncheon speaker, Harley Lappin, director of the BOP. Lappin opened by thanking the attendees of the conference and congratulating them on volunteering their lives to public service. He went on to explain how networking might be the most important thing attendees take away from the sessions, encouraging the audience to maintain relationships once they return to their respective states. As director of the federal prison system, he understands how many systems are experiencing a budget crisis that can place a burdensome decision on directors: whether to hire more correctional officers or increase the health care budget. He asked the health care professionals to be patient with directors and to remind them of the difficulties correctional health care professionals face. “Please keep sharing your concerns with us, as well as your suggestions,” he urged the audience, thanking them for their patience and dedication.    

Medical and Legal Case Studies

   Day two concluded with examinations and discussions of several controversial case studies encountered in the correctional health care system. The participants were broken up into five groups of about 10 people to discuss solutions to the 15 cases. Facilitating the group discussions were Kathleen Bachmeier, RN, MS, director of medical services for the North Dakota Department of Corrections and Rehabilitation; Dr. Scott Haas, medical director for the Kentucky Department of Corrections; Dr. Lannette Linthicum, medical director for the Texas Department of Criminal Justice; Dr. David Thomas, health care representative on the ACA Board of Governors; and Dr. Lester Wright, medical director for the New York State Department of Correctional Services. The cases presented such issues as: inmates as organ donors or transplant recipients, elective abortions while in custody, religious preferences in treatment, obesity, hepatitis C treatment, HIV exposure, refusal of treatment and food, practitioner error, transgender inmates, CPR training for custodial staff, and preferential treatment of high-profile inmates. Many participants had dealt with similar scenarios in their home institutions and were able to bring their personal experiences to the discussions. Others noted the laws in their states that restricted or required actions in certain situations.

   Bachmeier said she was pleased with the diversity of opinions in her group. “Everybody had a little different perspective. … Our group was interesting because we had clinicians and administrators, and we all had our own take on it,” she said. “We also learned that there is no real answer. We just have to make decisions.”

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