Correctional Healthcare

Author(s):  
Patricia Becker ◽  
Daniel O’Connell
1999 ◽  
Author(s):  
J. Antonio Escamilla-Cejudo ◽  
Christine D. Karkashian ◽  
Robyn R. M. Gershon ◽  
Larry Murphy

2007 ◽  
Vol 28 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Robyn R. M. Gershon ◽  
Martin Sherman ◽  
Clifford Mitchell ◽  
David Vlahov ◽  
Melissa J. Erwin ◽  
...  

Objective.To determine the prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers (CHCWs).Design.Cross-sectional risk assessment study with a confidential questionnaire and serological testing performed during 1999-2000.Setting.Correctional systems in 3 states.Results.Among 310 participating CHCWs, the rate of percutaneous injury (PI) was 32 Pis per 100 person-years overall and 42 Pis per 100 person-years for CHCWs with clinical job duties. Underreporting was common, with only 25 (49%) of 51 Pis formally reported to the administration. Independent risk factors for experiencing PI included being age 45 or older (adjusted odds ratio [aOR], 2.41 (95% confidence interval (CI), 1.31-4.46]) and having job duties that involved needle contact (aOR, 3.70 [95% CI, 1.28-10.63]) or blood contact (aOR, 5.05 [95% CI, 1.45-17.54]). Overall, 222 CHCWs (72%) reported having received a primary hepatitis В vaccination series; of these, 150 (68%) tested positive for anti-hepatitis B surface antigen, with negative results significantly associated with receipt of last dose more than 5 years previously. Serologic markers of hepatitis В virus infection were identified in 31 individuals (10%), and the prevalence of hepatitis B virus infection was 2% (n = 7). The high hepatitis B vaccination rate limited the ability to identify risk factors for infection, but hepatitis C virus infection correlated with community risk factors only.Conclusion.Although the wide coverage with hepatitis B vaccination and the decreasing rate of hepatitis C virus infection in the general population are encouraging, the high rate of exposure in CHCWs and the lack of exposure documentation are concerns. Continued efforts to develop interventions to reduce exposures and encourage reporting should be implemented and evaluated in correctional healthcare settings. These interventions should address infection control barriers unique to the correctional setting.


2001 ◽  
Vol 22 (9) ◽  
pp. 555-559 ◽  
Author(s):  
Judith Green-McKenzie ◽  
Robyn R.M. Gershon ◽  
Christine Karkashian

AbstractObjectives:To determine the relation of the availability of personal protective equipment (PPE) and engineering controls to infection control (IC) practices in a prison healthcare setting, and to explore the effect on IC practices of a perceived organizational commitment to safety.Design:Cross-sectional survey.Setting:The study population was drawn from the 28 regional Correctional Health Care Workers Facilities in Maryland.Participants:All full-time Maryland correctional healthcare workers (HCWs) were surveyed, and 225 (64%) of the 350 responded.Method:A confidential, self-administered questionnaire was mailed to all correctional HCWs employed in the 28 Maryland Correctional Health Care Facilities. The questionnaire was analyzed psychometrically and validated through extensive pilot testing. It included items on three major constructs: IC practices, safety climate (defined as the perception of organizational commitment to safety), and availability of IC equipment and supplies.Results:A strong correlation was found between the availability of PPE and IC practices. Similarly, a strong correlation was found between IC practices and the presence of engineering controls. In addition, an equally strong association was seen between the adoption of IC practices and employee perception of management commitment to safety. Those employees who perceived a high level of management support for safety were more than twice as likely to adhere to recommended IC practices. IC practices were significantly more likely to be followed if PPE was always readily available. Similarly, IC practices were more likely to be followed if engineering controls were provided.Conclusion:These findings suggest that ready availability of PPE and the presence of engineering controls are crucial to help ensure their use in this high-risk environment. This is especially important because correctional HCWs are potentially at risk of exposure to bloodborne pathogens such as human immunodeficiency virus and hepatitis B and C viruses. Commitment to safety was found to be highly associated with the adoption of safe work practices. There is an inherent conflict of “custody versus care” in this setting; hence, it is especially important that we understand and appreciate the relation between safety climate and IC practices. Interventions designed to improve safety climate, as well as availability of necessary IC supplies and equipment, will most likely prove effective in improving employee compliance with IC practices in this healthcare setting.


Author(s):  
Robert L. Trestman

Correctional healthcare is funded through a range of mechanisms, reflecting many of the community fee-for-service and managed care parallels. Like community healthcare, utilization of healthcare in correctional settings is increasing. It is however, often under more significant budgetary constraints and tighter management. The funding of correctional healthcare is a complex enterprise, driven by constitutionally mandated care obligations on the one hand, and resource constraints on the other. Along with the dramatic increase in the incarcerated population during the past two decades, correctional healthcare has evolved as well. The costs of care are quite substantial, and the diversity of models of care delivery offer an administrative challenge, a financial challenge to the relevant jurisdiction, and a significant opportunity for cost effectiveness. Unfortunately, as of yet, no comparative study of funding models has been done. As integrated electronic health and financial records are gradually introduced into correctional settings, opportunities for such studies, and the policy guidance provided by those results, may yield important information applicable to health care cost and outcome management in society more broadly. This chapter includes a discussion of global capitation, per inmate costs, at-risk contracting, liability concerns, performance indicators, and a variety of contractual relationships.


The Oxford Textbook of Correctional Psychiatry addresses the history, structure, and processes of correctional psychiatry, including case law, human rights, ethics, organization and funding of systems, as well as stages of patient management that cover initial assessments through re-entry. It also discusses management issues, emergencies, psychopharmacology topics, sleep, detoxification, reassessment of community diagnoses and treatments, diversion programs, levels of care, malingering, substance use within facilities, and formulary management. It also covers common psychiatric disorders, relevant medical disorders, pain management, psychotherapeutic options, suicide risk management, and addictions treatment. Specific focus is given to aggression, self-injury, and other behavioral challenges, and it also reviews unique assessment and treatment needs of many distinct population groups. Special topics such as forensics, psychological testing, sexual assaults, quality improvement, training, and research are also covered, followed by a section devoted exclusively to current resources in correctional healthcare.


2006 ◽  
Vol 5 (1) ◽  
pp. 149-155 ◽  
Author(s):  
CURT G. BECKWITH ◽  
NICK ZALLER ◽  
JOSIAH D. RICH

2020 ◽  
pp. 1-4
Author(s):  
Colin Cameron ◽  
Najat Khalifa ◽  
Andrew Bickle ◽  
Hira Safdar ◽  
Tariq Hassan

The unique challenges of the correctional healthcare environment are well-documented. Access to community-equivalent care, voluntary informed consent of offenders with mental disorder, violence risk, suicide risk, medication misuse, and clinical seclusion, confinement and segregation are just a few of the challenges faced by correctional psychiatric services. This paper shares experiences for dealing with the ongoing challenges for psychiatrists working in the field. It provides an overview of the current state of mental healthcare in the federal correctional system in Canada, the legislative framework and initiatives aimed at addressing the healthcare needs of federal inmates.


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