One in every four U.S. health care dollars is spent on a person with diabetes. This presentation will discuss ways that a pharmacist-led diabetes program can improve diabetes outcomes and decrease health care costs for incarcerated patients.

Educational Objectives

• Identify the goals of diabetes treatment
• Discuss how to overcome barriers in treating incarcerated patients with diabetes
• Explain how a pharmacy-led diabetes program in corrections can achieve improved outcomes

Level: Intermediate

The American Association of Colleges of Nursing?s Core Competencies for Professional Nursing Education emphasizes the need for immersion experiences and also highlights the importance of addressing health disparities, health inequities, health literacy, and social determinants of health in the delivery of health care to underserved populations. To address those issues, one school of nursing developed a population health clinical rotation that focuses on delivering care in a correctional facility. This presentation will highlight the program?s results.

• Discuss the processes needed to set up a clinical rotation in a correctional facility
• Identify the impact on students of a clinical rotation in a correctional setting
• List stakeholders/partners who can help promote correctional nursing experiences for students

Level: Intermediate

This session will focus on NCCHC Standard MH-G-02 Mental Health Programs and Residential Units, which outlines basic expectations and best practices for mental health treatment unit operations. We will take a deep dive into the practical application of this standard, breaking down what each compliance indicator means, how to implement them, and common challenges. Special focus will be on working with security and administration, suicide prevention, and the development of multidisciplinary treatment plans.

• Explain how to ensure compliance with NCCHC Standard MH-G-02 Mental Health Programs and Residential Units
• Discuss common treatment and management problems found in correctional mental health units
• Review current research on best practices in mental health unit operations

Level: Intermediate

One of the unique challenges in correctional health care is the abundance of lawsuits and judicial oversight. Although there is no way to prevent all lawsuits, there are strategies and practices that can assist practitioners in limiting the number of lawsuits or decreasing potential liability if they are sued. This presentation will look at strategies such as communication, charting, chronic care, and more that practitioners can use to address legal concerns in corrections.

• Discuss why legal standards in corrections can lead to lawsuits
• Review strategies to reduce the risk of lawsuits
• Examine a practitioner's potential liability after being sued

Level: Basic

Moral injury and moral disengagement are concepts that traditionally have been applied to military environments. A review of the literature reveals parallels to the experiences of health care and custody staff working in corrections. Moral injury focuses on the distress that people experience when they act in opposition to their consciences. This session will discuss the role of moral injury and moral disengagement and how to recognize and mitigate their effects.

• Review key constructs of moral injury and moral disengagement
• Describe the experience of moral injury and moral disengagement in health care and custody staff
• Identify opportunities to address and mitigate the harmful effects of moral injury

Level: Intermediate

More than 10 million individuals pass through U.S. detention centers annually, of which 63% meet criteria for drug dependence or abuse. Despite proven efficacy, treatment with medications for opioid use disorder is underutilized in jails, particularly in rural areas. This session will describe a telemedicine treatment program that engages patients during incarceration with an aim to bridge to community treatment. Speakers will discuss the program?s implementation, risk and diversion mitigation strategies, post-discharge outcomes, and staff acceptance.

• Describe a clinical telemedicine addiction treatment program embedded in a rural jail
• Explain the challenges associated with opioid use disorder treatment in criminal justice settings
• Discuss the importance of staff acceptance of telemedicine for OUD

Level: Basic

This presentation covers the requirements of an often-misunderstood NCCHC standard, Continuous Quality Improvement (CQI). Historically, CQI efforts focused on medical aspects of health care. But finding opportunities for improvement in behavioral health programs is equally important. The CQI process is also frequently misunderstood, resulting in deficiencies in one or more compliance indicators. This session covers the requirements of a robust CQI program that meets NCCHC standards and applies it to mental health programs.

Educational Objectives

• Review requirements of NCCHC Standard A-06 Continuous Quality Improvement
• Discuss ways to incorporate quality improvement into behavioral health programs
• Describe a mental health quality improvement project from Augusta State Medical Prison

Level: Intermediate

The opioid epidemic continues to pose an extraordinary challenge to society, and it is acutely evident in the correctional setting, where a disproportionately high percentage of the population has opioid use disorder. Correctional facilities face many obstacles to implementing successful MOUD programs, including hiring and training additional staff, budget constraints, and coordinating discharge. This session presents ways to overcome these challenges and covers recent litigation regarding the amendment of the ADA to treat OUD in corrections.

• Discuss implementation of an MOUD program that complies with DOJ, NCCHC, and SAMHSA Guidelines
• Review challenges to a successful MOUD program
• Examine recent lawsuits and legal ramifications of inadequate implementation of an MOUD program

Level: Intermediate

Chronic wounds are common in correctional care settings. Identifying wound etiology is essential to ensuring that interventions are appropriate. Learn how a thorough wound history and review of comorbidities can help in distinguishing between common chronic wound types and atypical or acute wounds and how to manage common chronic wound types effectively by addressing underlying causes. Case examples will be explored in this dynamic, interactive session.

• Describe the most common chronic wound types and an atypical or acute wound type that is often confused with each
• Identify wound types and recognize when additional tests are needed
• Discuss appropriate wound management methods for each common chronic wound type

Level: Advanced

The landmark legal cases of Estelle v. Gamble and Bowring v. Godwin established only minimal criteria for required correctional health care, with little in the way of specifics, resulting in regional and jurisdictional differences in how the standard of care is defined. This session will explore which critical elements have emerged as fundamental to health care delivery in jails and prisons. Central tenets of what courts have deemed to be constitutionally adequate and inadequate will be discussed.

• Explain the constitutional protection of physical and behavioral health care for incarcerated individuals
• Define the relationship between foundational legal cases and correctional clinical practice
• Discuss moral, legal, ethical, and clinical models of care delivery in carceral settings

Level: Intermediate

This session will provide a basic overview of the differences between suicidal and nonsuicidal self-injurious (NSSI) thoughts and behaviors in juvenile justice populations, common characteristics and risk factors of NSSI thoughts and behaviors, and risk assessment tools and strategies. Presenters will also cover treatment modalities used to address NSSI in youth, including a review of NSSI safety planning tools and strategies.

• Discuss common characteristics of nonsuicidal self-injury (NSSI)
• Describe risk factors associated with NSSI thoughts and behaviors and strategies for assessing risk
• Identify unique treatment considerations for youth who have engaged in NSSI behaviors

Level: Intermediate

Lawsuits involving correctional health care continue to make headlines. This presentation will review correctional health care litigation developments for the past year, media coverage, and trends and common issues. We will discuss what the litigation landscape may look like in the future. Attendees will leave with a better understanding of the legal standards for various claims that are commonly asserted in litigation. 

 Educational Objectives

• Review highlights from recent cases in correctional health care
• Explain how legal issues and standards in correctional health care litigation vary in different jurisdictions
• Discuss the current and future outlook for correctional health care litigation

Level: Basic

Substance use is a major health issue among individuals in custody, and jails and jurisdictions must be prepared to appropriately manage withdrawal, which can be life-threatening. The new BJA Guidelines for Managing Substance Withdrawal in Jails sets forth best clinical practices for withdrawal management. Subject matter experts will provide information and tools to help participants operationalize the guidelines in any size jail, with special attention to administrative issues facing small jails.

• Examine readiness for implementing comprehensive substance withdrawal management
• Describe the decision process related to the care of an individual at risk of withdrawal in jail
• Discuss implementation strategies to address differences in resources among jails

Level: Intermediate

Hepatoma rates are rising, especially among incarcerated patients. Risk factor mitigation and early detection will produce the best treatment outcomes. Screening modalities of ultrasound and multiphase MRI/CT are key to identifying patients with hepatoma. Therapy options need to be tailored to disease burden, liver reserves, and patient?s performance status as well as DOC regulations. This session will discuss these important considerations, as well as the need for on-site staff to recognize therapy complications to prevent excessive toxicity.

• Review the etiology of cirrhosis
• Describe screening methods for hepatoma
• Discuss current hepatoma treatment options

Level: Basic

This presentation discusses medication errors in a juvenile justice residential facility. Our study shows that more education and training regarding increased communication among juvenile justice staff, including nurses who administer medications to juveniles to ensure adherence to patient safety standards is necessary. The presentation identifies patient safety standards and medication error reduction strategies.

• Examine the contributing factors to medication errors in juvenile facilities
• Discuss gaps in research regarding medication errors in juvenile facilities
• Identify opportunities for further research into medication errors in juvenile facilities

Level: Intermediate

During acute periods of distress and crisis, the crisis survival strategies from DBT's distress tolerance module are exceptionally useful in helping patients navigate the crisis situation effectively. This session will teach participants some of the most important crisis survival strategies and provide ideas about when and how to coach patients in the midst of a crisis.

Educational Objectives

• Name at least three DBT-based crisis survival strategies
• Describe the mammalian dive response and how to activate it
• Demonstrate effective use of paced breathing

Level: Basic

Depositions are typically described as stressful and can leave those deposed feeling uncertain or disappointed. Attendees will gain an understanding of deposition basics, general guidelines to follow, and insights into the attorneys? deposition goals. The session will feature a simulated deposition question-and-answer format using audience participation to demonstrate the challenges and pitfalls of attorney questioning and will share strategies that can increase the likelihood of a successful deposition.

• List the nine basic rules to follow when you are deposed
• Name at least two goals of attorneys during a deposition
• Describe common pitfall questions and strategies to answer them

Level: Basic

Since its introduction in 2018, many facilities have struggled to comply with NCCHC Standard B-04 Medical Surveillance of Inmate Workers, making it one of the most frequently missed standards. This session will explore each requirement and offer practical examples on how to establish a medical surveillance program. Participants will also hear from an accredited facility administrator on the challenges and successes of their recently established program.

• Review the components of a medical surveillance program for incarcerated workers
• Describe steps necessary to implement a medical surveillance program in prisons and jails
• List key personnel needed to implement a successful medical surveillance program

Level: Basic

Since 2008, the OIG was tasked to independently monitor medical care in the California Department of Corrections and Rehabilitation. The OIG program is objective, clinically appropriate, and metric-oriented and covers medical care at each California state correctional institution. The methodology involves three phases: data request and sampling, compliance and clinical case review fieldwork, and reporting. Attendees will learn how to incorporate the OIG experience to improve their own quality processes.

• Explain the OIG medical inspection unit program
• Describe the phases of the inspection process
• Discuss ways to incorporate the program's qualitative and quantitative components into quality assurance programs

Level: Intermediate

This session will discuss how nutrition and lifestyle modifications can optimize health as patients age in corrections. The presentation includes nutrition guidelines, therapeutic diets, activity recommendations, and dietary factors that can impact healthy aging.

Educational Objectives

• Identify nutrition guidelines and factors that impact health as patients age in corrections
• Describe diet therapy associated with various disease states
• Discuss challenges to controlling chronic disease in corrections

Level: Basic

Disorders of involuntary movement represent a very frustrating management challenge in correctional settings. This session will focus on developing an understanding of the diseases that cause abnormal movements. Presenters will share tips for dealing with difficult seizure patients, pseudoseizures, and patients who attempt to fake seizures. Learn about the new generation of seizure medications and how they stack up to the traditional agents.

• Discuss diseases that cause abnormal movements and seizure symptoms
• Differentiate true seizures from fake presentations
• Review tips for dealing with difficult seizure management patients

Level: Basic

A simulation scenario is a representation of real-life events to achieve specific goals and can be applicable to many NCCHC standards/compliance indicators. Simulations are designed to assess, educate, and identify gaps in the understanding and/or application of knowledge. Education and competency can be achieved with "real-life? situations and experiences in a controlled environment. This session will provide key factors in designing simulation scenarios, goals to achieve, and evaluation of results.

• Differentiate between types of learning scenarios
• Identify the educational benefits of simulated scenarios
• Describe the elements of a comprehensive simulated scenario

Level: Intermediate

Incarcerated pregnant and postpartum women are more likely to experience mental health difficulties as they often have high rates of trauma and victimization, chronic health conditions, low social support, and previous mental health conditions. Enhanced psychosocial care can reduce maternal distress and mental health symptoms before and after birth and support smoother reentry. This session discusses the New Jersey Commission on Women?s Reentry?s template of care to address the growing needs of incarcerated mothers.

Educational Objectives

• Discuss the barriers to care that incarcerated mothers face during the perinatal period
• Describe the impact of enhancing maternal mental health resources
• Review current initiatives and future implications for improving outcomes for incarcerated mothers

Level: Intermediate

Carefully choosing the words you use in your medical and grievance documentation can help prevent lawsuits. Nothing says "deliberate indifference" like a callous or sarcastic comment in the chart -- or failing to document your actions. In litigation, the responses you give in statements or depositions can be the difference between a "win" and a multimillion-dollar verdict against you. Using actual depositions and video examples, this session will illustrate the importance of good communication.

• Explain the nuances of appropriate medical record documentation
• Describe techniques for documentation to minimize litigation
• Review litigation and depositions disasters caused by poor documentation or bad deposition answers

Level: Intermediate

NCCHC’s peer-reviewed professional journal is growing, improving, and making an impact on the correctional health care field. Attend this session to learn what’s new and how you can get involved. In this talk, the Journal’s editor will describe its mission, target audience, and content areas; outline the key steps in developing and writing a manuscript; and explain the peer review, acceptance, and publication processes.

Educational objectives

• Describe the Journal, including its mission, audience, and content
• Identify key steps in developing and publishing a manuscript
• Explain the importance and process of peer review

Level: Basic

This presentation discusses how hiring cross-agency correctional epidemiologists has helped improve data quality, outbreak response, and education for staff and incarcerated people. These epidemiologists were able to assist with a giardia cluster, Candida auris, and invasive group streptococcal infection, as well as creating mpox informational flyers for 161 different correctional facilities. Future projects include conducting an assessment that will identify gaps where public health resources can make a significant impact.

• Describe the benefits of collaboration between correctional health and state health departments
• Explain how collaboration improves infectious disease outbreak responses
• Discuss additional resources provided by public health collaborations

Level: Intermediate

Recent initiatives of Healthy People 2030, the Institute of Medicine, and the World Health Organization all focus on improving health care for lesbian, gay, bisexual, transgender, and queer+ patients. Studies repeatedly suggest that health care providers and students do not receive adequate education on the unique physical, mental, and sexual health considerations of the LGBTQ+ population. This session aims to improve basic cultural competency for health professionals caring for LGBTQ+ individuals experiencing incarceration.

Educational Objectives

• Define basic LGBTQ+ terminology
• Examine statistics regarding LGBTQ+ individuals and factors that produce overrepresentation in the criminal justice system
• Summarize health disparities, basic health maintenance, and important health screenings for LGBTQ+ populations

Level: Basic

Incarcerated persons may participate in vocational jobs in agriculture and farming in diverse programs ranging from aquaponics to vermiculture. Exposures to a wide range of animals, plants, and associated microorganisms may be unfamiliar to correctional practitioners and can represent a true threat to individual and population health. This session reviews correctional agribusiness zoonoses and presents cases to illustrate their presentation and management.

Educational Objectives

• Review zoonotic disease that occur in correctional agribusiness
• Describe how to identify and manage zoonotic disease
• Examine resources for developing zoonotic disease prevention programs

Level: Basic

Nurses make patient care a priority and may get so wrapped up that they forget to document. In today's litigious environment, being too busy to document can literally destroy your career. This session will focus on tips and tricks to make documentation quicker and easier while still being thorough.

Educational Objectives

• Identify critical documentation failures
• Review situations in which sanctions and loss of licensure could have been avoided with documentation
• Discuss ways to reduce the time it takes to document effectively

Level: Basic

Prevalence of serious mental illness, and treatment-resistant schizophrenia in particular, is higher in correctional settings than the general population. Management of this patient population, which is chronically nonadherent with treatment, is extremely challenging. The presenters will review the available formulations of depot neuroleptics, their associated adverse effects, and pharmacology. Standards of monitoring and management of side effects will be explored. Finally, the presenters will share successful cases where off-label dosing and frequency of depot formulations were used.

• Review available depot antipsychotic formulations and pharmacology
• Discuss necessary monitoring and recognition of adverse effects of depot antipsychotics
• Describe off-label dosing and administration for treatment-resistant patients with schizophrenia

Level: Basic

You've been sued and asked to sit for deposition testimony. Now what? This session will include mock deposition prep of a physician with his counsel. Proper, honest communication with your attorney during the deposition preparation process and practice tips will be highlighted in this mock depo prep.

• Explain the importance of open communication with your attorney during the deposition preparation process
• Review techniques to provide excellent testimony
• Describe the importance of good deposition testimony in case resolution

Level: Intermediate

This session has cancelled due to the federal shutdown.

Individuals released from incarceration face unique circumstances that make community engagement in HIV and/or HCV care and treatment challenging. To promote successful reentry, the New York State Department of Health AIDS Institute Office of Criminal Justice Services implemented the Corrections Health Initiative (CHI), which funds community-based organizations to implement prevention interventions and HIV/HCV navigation services within New York State correctional facilities.

• Review the New York State Corrections Health Initiative model
• Explain the importance of cross-sector collaborations to improve health equity and support reentry
• Describe how the CHI initiative supports New York's implementation of Ending the Epidemic

Level: Basic

Autonomous artificial intelligence (AI) can close health care gaps with point-of-care exams, obviating the need for a specialist. This session highlights the successful implementation of an autonomous AI diagnostic technology to test and diagnose diabetic retinopathy in a large state prison system. Participants will gain an understanding of the technology and its role in providing point-of-care diabetic retinal exams without the need for an eye-care specialist. Real-world data will be shared including lessons for successful adoption.

• Describe how point-of-care autonomous AI systems for diabetic retinopathy work
• Identify best practices for successful implementation of autonomous AI technology
• Discuss potential benefits of AI technology for eye exams for diabetes

Level: Intermediate

Orthopedic hardware comes in a bewildering array of shapes, sizes, and configurations. However, knowledge of basic orthopedic concepts will allow you to make intelligent decisions about hardware management. Special topics of consideration include evaluation of hardware for infection, weight-bearing decisions, bunk placement, recreational restrictions, hardware removal decisions, and management of broken/displaced hardware.

• Evaluate hardware radiographically
• Describe the different types of commonly used hardware devices
• Discuss hardware complications including infection, breakage, and pain

Level: Basic

A recent study found that "complex relationships" described the nurse-patient therapeutic relationship in correctional facilities. This relationship is characterized by the uniqueness of the setting, acculturation of health care staff, and a reconceptualizing the nurse-patient relationship as a triad with correctional officers. This presentation will discuss these findings and explore how a therapeutic triad can potentially improve the health care of incarcerated women.

Educational Objectives

• Describe how study participants perceived nurse-patient relationships in correctional settings
• Recognize the role that nurses and officers play in correctional health care
• Identify how a health care triad can improve the health care of incarcerated women

Level: Intermediate

Jail-based restoration of competency treatment is an established alternative to inpatient hospitalization in multiple states, which presents new opportunities for jails already challenged with responsibility for growing numbers of individuals with serious mental illness and incompetency to stand trial. JBCT programs can reduce bed days, cost, behavioral disturbances, liability, aggression, and suicide risk, and avert litigation.

• Discuss the primary objectives of the jail-based competency treatment model for augmenting state forensic hospitalization
• Review the potential advantages of hosting a jail-based competency treatment program
• Compare Early Access and Stabilization Services and off-ramping models

Level: Advanced

Correctional health care providers face unique challenges when handling varying types of ?difficult? patients. Whether the patient is known not to follow medical advice, appears to be drug-seeking, is known to be litigious, or is already suing the provider, health care professionals must patiently navigate their interactions to provide appropriate care and avoid any perception of deliberate indifference. Best practices for handling difficult interactions, charting of those interactions, and testifying regarding care will be discussed.

• Describe ways to reduce legal exposure when caring for "difficult" patients
• Review methods for charting patient encounters to provide optimal references in a lawsuit
• Discuss how to handle discovery and depositions in a lawsuit

Level: Basic

It is vital to identify individuals entering and residing in correctional facilities who have alcohol and substance use disorders. Once they are known, care providers can implement appropriate protocols for
safe detox. This session will also discuss when to refer patients who are at particular high risk to an outside medical facility for higher levels of care and how to collaborate with those facilities.

Educational Objectives
• Describe standards for management of opiate use disorder
• Explain how a correctional facility can work with a community OTP
• Identify areas of risk during transitions of custody and community

Level: Intermediate

High-profile individuals in a jail or prison have unique needs. They may have mental health issues or increased suicide risk due to shame and humiliation; they may experience media scrutiny or face increased security threats. This session address how these challenges are managed at Clark County Detention Center in Las Vegas. The speakers will discuss existing literature and interventions by custody and mental health services staff to meet the needs of this special population.

Educational Objectives

• Discuss the issues faced by high-profile incarcerated individuals
• Describe the challenges high-profile individuals pose for staff
• Summarize Clark County's efforts to address the safety and mental health needs of high-profile individuals

Level: Intermediate

Have you had a candidate not show up for to a scheduled interview, a new hire not report for their first day of work, or a current employee quit or leave without notice? This phenomenon is on the rise: Indeed research found that 83% of employers have been ?ghosted.? This session will discuss common forms of workplace ghosting, the impact it can have, and strategies to minimize its occurrence.

• Describe the most common forms of workplace "ghosting"
• Examine the reasons behind ghosting in the workplace
• Review strategies to avoid and reduce workplace ghosting

Level: Intermediate

This session includes two presentations.

Optimizing Care: Managing the Hepatitis C Patient Registry

Using clinical decision support and disease registries can provide value by increasing efficiencies and reducing waste. This session will explore how correctional health care programs can use clinical decision support and disease registries to improve communication, safety, prioritization, identification of population trends, and longitudinal management of individuals who have hepatitis C. The advantages of using spreadsheets to risk-stratify and identify specific clinical parameters will be demonstrated.

Educational Objectives

• Describe the advantages of using external clinical decision support
• Discuss the advantages of creating and/or customizing internal clinical decision support
• Explain the advantages of creating disease registries

Level: Intermediate

Why a Chronic Kidney Disease Registry is a Must

Diabetes, hypertension, and chronic kidney disease are complex and costly diseases with significant rates of morbidity and mortality that are growing among incarcerated individuals. Chronic kidney disease is a key driver for the burgeoning cost of health care delivery and death in prisons; hypertension and diabetes are the two most common causes of CKD. This session will explore the use of chronic disease registries in CKD to promote best practices, improved outcomes, and health equity.

Educational Objectives

• Discuss the challenges of managing chronic diseases within a prison
• Describe the purpose, components, and functions of chronic disease registries
• Explain how using a chronic kidney disease registry can help promote health care equity, outcomes, and cost savings.

Level: Intermediate

Strategic planning for nursing operations gives nursing staff direction and is critical in fostering a culture of professional practice, excellence in patient care, and quality patient outcomes. It can also lead to higher rates of recruitment and retention This presentation will discuss how to write and adopt a strategic and operational plan for correctional nursing and how to evaluate its effectiveness. It will also share tools and techniques to engage staff nurses in the process.

• Discuss the rationale for and benefits of adopting a strategic plan for correctional nursing
• State the essential elements to guide the development of a strategic plan for nursing operations
• Explore ways to engage nursing staff in the process for effective strategic and operational planning

Level: Intermediate

Mental health professionals recognize the importance of identifying risk and protective factors for individuals at risk for suicide, but they may not have been trained in how to synthesize this information. This session will focus on increasing skills in risk formulation by considering how acute and chronic risk factors, risk state and status, resources, and foreseeable changes interact to influence risk level.

• Describe how risk state, risk status, resources, and foreseeable changes influence risk formulation in individuals at risk for suicide
• Discuss how chronic risk factors influence risk formulation and action plans
• Explain changes to make in documentation about risk formulation

Level: Intermediate

This session will explore the types of questions correctional health care providers face if they are named in a lawsuit over care and treatment. Participants will learn about the initiation of litigation, depositions, settlement conferences, and trial in the context of strategies typically employed by plaintiffs. Included will be an overview of common questions about insurance, reports to the National Practitioner Databank and/or licensing boards, money being paid to resolve a case without consent, and more.

• Discuss the process of defending a medical malpractice and deliberate indifference claim
• Identify the most frequently asked questions regarding litigation
• Examine common litigation tactics employed by plaintiffs' counsel

Level: Intermediate

Treatment with medications for opioid use disorder in corrections is expanding rapidly, addressing an enormous gap that led to decades of increased opioid-related morbidity and mortality. This presentation will examine medical management challenges unique to correctional opioid treatment programs and share innovative strategies to adapt community OTP treatment standards to correctional environments.

• Describe unique features for determining OTP admission eligibility in correctional settings
• Discuss OTP medication management for incarcerated individuals
• Identify strategies to meet community standards of care for patient discharge

Level: Intermediate

This presentation will review psychotropic medications for adolescents, including indications, off-label use, and adverse effects of major classes, especially ADHD medications (stimulant and nonstimulant), antidepressants, and antipsychotics. Clinical and ethical discussions will include polypharmacy; monitoring for and management of potential adverse effects; role of standing vs. as-needed medications in managing aggression and behavioral issues; and access to continuity of psychiatric care between settings.

• Explain principles guiding the use of psychotropic medication in adolescents
• Discuss indications, FDA approval, off-label use, and adverse reactions
• Identify the necessary considerations in prescribing psychiatric medication in the juvenile legal system

Level: Intermediate

Health staff often encounter incarcerated patients under stressful conditions when they are upset, frightened, or hostile. During this session, you learn how to look at patient conflicts creatively, remain under emotional control during disagreements, find solutions to potentially difficult situations, and maintain professionalism in all patient encounters. This overview will give you options for tactically communicating to achieve voluntary compliance while maintaining professionalism, self-control, and personal safely.

Educational Objectives

• Learn how to prevent patient confrontations from becoming unsafe or dangerous
• Recognize the impact your comments can have on patients
• How to build rapport with your patients and create a successful and positive encounter

Level: Basic

Traumatic Brain Injury (TBI) is a huge silent epidemic within incarcerated populations, underdiagnosed and untreated. TBI leads sufferers to become more emotionally and behaviorally dysregulated and more likely to experience a variety of mental health disorders. This session will explore behavioral health best practices, current neuroscience research, the six TBI diagnostic trajectories, early diagnosis, and actionable treatment options.

• Review the prevalence of TBI in correctional settings and current diagnostic and treatment challenges
• Explain the current neurologic understanding of the six TBI diagnostic trajectories
• Discuss how to improve diagnosis of TBI

Level: Intermediate

The professional development of the custodial health nurse (CHN) as a nursing specialty has been accepted internationally but, until now, has been mainly overlooked in Australia. This presentation will report the preliminary results of a workforce survey of CHNs in New South Wales, Australia, which determines the demographic profile and workplace experience of this nursing cohort. Future applications, locally and internationally, of the overall results will be discussed.

Educational Objectives

• Describe the role of custodial health nurses in Australia and elsewhere
• Discuss potential role-specific recruitment and retention practices for custodial health nurses
• Construct a positive image of custodial health care

Level: Intermediate

Gender-responsive approaches are recommended when providing treatment and services to transgender and intersex people. This session will outline evidence-based treatment models including adaptive and responsive service delivery that addresses cultural elements and unique treatment needs. Additional topics are correctional barriers to providing responsive care, including staff bias and attitudes, and future areas of study. The presenters will share examples and practical applications.

• Cite recent research about incarcerated individuals who identify as transgender or intersex
• Describe evidence-based treatment models and approaches in working with transgender and intersex people
• Summarize current gender-responsive recommendations and treatment approach adjustments for transgender and intersex people

Level: Basic

NCCHC has formed an ad hoc Committee on Systemic Racism in Correctional Health Care to identify how racism toward Black, indigenous, and people of color (BIPOC) manifests in our work environments and its many negative impacts, as well as identifying ways to chip away at racism and improve our patients' well-being. Screening and discussion of the critically acclaimed film documentary "13th" directed by Ava Duvernay will continue conversations surrounding systemic racism.

Educational Objectives

• Discuss causes of systemic racism in correctional health care
• Describe how racism impacts systems and individuals
• Examine ways to reduce racism in our work settings

Level: Basic

This presentation will discuss the aging incarcerated population, criteria to assist with prescribing and deprescribing medications to those patients, and preventive health measures that are important for them. Attendees will learn new methods to take proper care of their geriatric patients and will explore the positive outcomes of a real-life case study.

Learning Objectives
• Explain how age can be defined in corrections
• Discuss criteria for prescribing and deprescribing medications in the elderly
• Review preventive health measures for this special population

Level: Intermediate

The Certified Correctional Health Professional program is the premier national certification dedicated to recognizing the special skills and knowledge necessary to provide care in the complex world of corrections. Today the program certifies over 4,000 nurses, physicians, dentists, mental health professionals, administrators, and others. This talk will present an overview of CCHP certification including guidance and practical advice on eligibility, how to apply, the exam, recertification, and the benefits of becoming a CCHP.

Educational Objectives

• Identify the eligibility criteria and application process for CCHP certifications
• Explain how to prepare for CCHP exams
• Describe the recertification process and continuing education requirements

Level: Basic

How do you support quality in a correctional setting? The Change Leader Academy at the Wisconsin Resource Center was designed to promote quality improvement methodologies within state institutions. The mission is not only to teach the concepts, but also to empower participants to lead teams through their own Change Leader projects. Attendees will learn how to initiate and grow this type of program so it becomes part of their normal improvement efforts.

• Describe the Change Leader Academy program
• Discuss follow-up reinforcement of the program's concepts
• Apply the concepts to a quality improvement initiative

Level: Basic

This presentation will identify special populations at elevated risk of type 2 diabetes sequelae: chronic kidney disease, heart failure, cardiovascular disease, common hypoglycemia, and obesity. With the anti-diabetic drug market expanding to capture relevant indications, this presentation will not only identify those at high risk, but also provide direction for providers to pinpoint those special populations and decide whether it is appropriate to continue high-cost therapies.

• Identify comorbid conditions or disease states associated with type 2 diabetes
• Construct pharmacologic treatment plans using relevant patient data
• Analyze the effectiveness of an educational-driven or process-driven prescribing practice regarding antidiabetic agents

Level: Intermediate

As advances in technology influence the medical field, the role of the nurse is evolving. One of the nurse’s primary responsibilities is to focus on the care and safety of the patient. Theory and practice are the foundations of the nursing process. An integral component of this process is critical thinking. This presentation will look at the importance of the nursing process, evidence-based practices, and the value of critical thinking in promoting patient safety and  favorable outcomes.

Educational Objectives
• Describe the nursing process
• Define the concepts of critical thinking
• Discuss nursing interventions and the goals of patient care

Level: Basic

There are considerable risks to consider when prescribing psychiatric medications to incarcerated patients. This presentation will review the challenges and focus on safely helping this vulnerable population receive the mental health care they need. We will also look at documentation strategies to make sure providers are legally protected. Part 1 will focus on antidepressant, sleep, and antianxiety medications.

Educational Objectives

• Identify the unique pitfalls for psychiatric prescribing in corrections
• Review the classes and challenges for specific medications
• Discuss documentation strategies for prescribing

Level: Intermediate

Many health professionals struggle with creating adequate and thorough charting. By the time a case reaches an attorney's desk, there are often omissions, misspellings, inconsistencies, or failures in following up. Examples will be used to help illustrate charting's impact in the judicial setting and how to avoid common pitfalls associated with poor documentation.

• Review proper medical charting procedures and techniques
• Identify common mistakes in charting
• Explain the legal impact of documentation errors

Level: Basic

Over a three-year period, an expanded EHR supported a transition to a population health model within a jail, enabled improvements in clinical practice, enhanced patients and clinician experience, and supported advancing health equity in a vulnerable population. The Quintuple Aim within correctional health care necessitates a strong technological infrastructure. This presentation discusses how the EHR provides an infrastructure that supports patient- and population-centered quality improvement in a jail.

Educational Objectives

• Describe how an EHR can standardize clinical practice, identify care gaps, and automate metric monitoring
• Identify population trends pertaining to specific health conditions
• Recognize the value of the Quintuple Aim in correctional health care

Level: Intermediate

This session continues from session 453 with a discussion and screening of the critically acclaimed film 13th directed by Ava Duvernay.

Educational Objectives

• Discuss causes of systemic racism in correctional health care
• Describe how it impacts systems and individuals, incarcerated and not
• Explore ways to reduce racism in our work settings

Level: Basic

Continuing Medications for Opioid Use Disorder (MOUD) for those reentering the community following incarceration remains a top public health priority as those individuals are at high risk for returning to nonprescribed substance use and fatal opioid overdose. This presentation examines the comprehensive psychosocial treatment approaches necessary to care for individuals on MOUD during incarceration and postrelease and proposes key strategies for successful reentry.

• Define the importance of comprehensive clinical services and supportive case management when treating incarcerated individuals on MOUD
• Explain strategies for individualized patient treatment and support services pre- and postrelease
• Identify opportunities to reduce risk for overdose

Level: Intermediate

See the titles on the Roundtables page

The geriatric population in correctional settings has increased over time. This presentation will review many aspects of caring for this population, including a discussion of a hospice program with incarcerated workers, completing POLST/MOLST advance directives with incarcerated patients, and the legal landscape surrounding physician-assisted suicide. 

Educational Objectives

• Describe common disorders leading to hospice care in corrections
• Identify different types of dementia and the importance of early advance directives
• Discuss state law variances regarding advance directive options

Level: Intermediate

Correctional nursing requires a diverse skill set, including medical-surgical, emergency, critical care, and mental health care. These topics are often not well taught in nursing school or traditional medical settings. In this presentation, we will evaluate the nurse's ability to provide care for a variety of needs and develop a lesson plan to address areas where there are deficiencies. Creating education and routine follow up on nursing skills is essential to maintaining staff and improving patient care.

Educational Objectives

• Explain how to assess nursing skill levels
• Design a lesson plan for correctional nurses
• Discuss methods of enhancing education for incarcerated patients

Level: Intermediate

This session will explore the use of jail-based competency programs and involuntary medication orders as possible interventions to assist facilities dealing with the expanding mental health crisis. The speakers will discuss the challenges faced within correctional facilities and the potential benefits of using these interventions, as well as criticisms and ethical considerations. Guidance to help those looking to implement such a program at their institutions also will be provided.

• Identify the benefits of jail-based competency programs and involuntary medication orders
• Discuss the ethical, legal, operational, and systemic concerns associated with JBCPs
• Explain how to implement a JBCP

Level: Intermediate

Outside consultation with specialty providers continues to be a hot topic in correctional health care litigation. This session will include a discussion of when outside consultations are reasonable and necessary from a medical director's and an attorney's perspective, as well as why consultations are frequently litigated. Documentation will be highlighted.

Educational Objectives

• Review medical reasons for outside consultation with specialty providers
• Discuss chart documentation regarding outside consultation
• Describe various scenarios in which outside consultations can be used against a provider in litigation

Level: Intermediate

Unconscious (implicit) bias is a social attitude or stereotype about certain groups of people that individuals form subconsciously and usually operate contrary to conscious beliefs. Unconscious bias can adversely impact progress involving health care equity; influence service type, location, and if or how service is delivered; and may erode or destroy patient-provider trust. This session explores possible solutions to negative health care impacts of unconscious bias on incarcerated people.

• Define diversity, equity, inclusion, health equity, unconscious bias, tokenism, and workplace culture
• Identify how unconscious bias affects health care delivery in corrections
• Discuss countermeasures to unconscious bias to help ensure health care equity of incarcerated persons

Level: Intermediate

This session includes two presentations.

All Together: Creating a Prison-Based Therapeutic Community

Learn the story of WestCare's therapeutic community at an Illinois prison. Speakers will describe the overall structure and function of the TC model, explore the challenges of implementing a TC in a correctional setting (especially with the complications of COVID-19), and discuss how to measure program effectiveness in terms of impact on the lives of program participants, including recidivism data.

Educational Objectives

• Discuss the challenges of implementing a therapeutic community in a correctional setting
• Identify promising strategies for developing and implementing a therapeutic community
• State the advantages of facilitating therapeutic communities in correctional facilities

Level: Intermediate

Shared Life Experiences: Augmenting Treatment and Recovery Through Peer Support

This session explores the value of a corrections-based peer support program that offers continued support postincarceration, including through probation supervision and as a support to specialty dockets. Details include how to select appropriate peer supporters, the specific services provided by peer supporters, how the services are promoted to eligible individuals and effectively delivered, as well as the importance of building cooperative partnerships with corrections professionals, medical and mental health staff, and local treatment providers.

Educational Objectives

• Define peer support and applicable core competencies
• Describe the social framework and importance of peer support
• Examine effective means for integrating peer recovery services into corrections

Level: Intermediate

Fentanyl has made the probability of adverse events in jails even more likely. With fentanyl, withdrawal treatment is more complicated and changes such as ECG findings of prolonged QT/QTc (not described in the literature) may occur. Withdrawal screening, monitoring, treatment, and toxicologic data will be presented. The session will include case studies and strategies to counter fentanyl's challenges.

• Describe epidemiologic trends in fentanyl usage, risk, and environmental factors
• Differentiate the pharmacologic and physiologic actions of fentanyl versus other opiates
• Identify fentanyl use assessment, monitoring, and treatment for improved outcomes

Level: Intermediate

This session will detail how LA County initiated the use of a supervising psychiatrist and psychiatric nurse practitioners in the Inmate Reception Center to provide continuity of care and initiate a psychiatric treatment plan. Attendees will learn about the change in staffing and new workflow, pre- and post-staffing data about patients seen, and common issues encountered when changing a process in the facility.

• Describe the impact of placing psychiatric nurse practitioners in reception
• Explain the components of a psychiatric treatment plan that improves psychiatric care
• Discuss strategies for resolving issues that arise when working across disciplines

Level: Intermediate

The decline in nursing graduates and high turnover rates are creating problems in hiring and retaining these essential professionals. This presentation will discuss Relationship-Based Care, which includes leadership, teamwork, professional practice, care delivery, resources, and outcomes. RBC improves safety, quality, and patient and staff satisfaction by improving every relationship within the health care system. Learn about evidence-based RBC practices and how the model can be applied in corrections and positively affect staff retention.

Educational Objectives

• Describe how Relationship-Based Care supports employee retention
• Identify how RBC can create a positive transformation in workplace culture
• Discuss how RBC affects the therapeutic relationship and patient outcomes

Level: Intermediate

The infection control program is responsible for patient safety and policies for infection prevention and control in correctional health care. The coordination of department, state, federal, CDC, OSHA, and nongovernmental organization policies, regulations, recommendations, and guidelines must be evaluated for adaptation to the correctional setting. This session will address access, adaptation, and evaluation of the infection prevention and control program as medical and scientific knowledge evolves.

• Identify current state, federal, and NGO regulations, recommendations, and guidelines related to infection control
• Differentiate between regulations, recommendations, and guidelines
• Apply the evaluation process to policies and procedures for compliance with the governing entity

Level: Intermediate

Achieving compliance with industry standards is instrumental to maintaining correctional facility operations, protecting staff and inmates, and achieving optimal patient outcomes. However, the process is often daunting and time-intensive. This presentation will detail how to efficiently create and maintain an electronic compliance program, from policies and practices to external protocols. Gain a clear understanding of best practices for developing a multifacility compliance program that will create continuity of operations for years to come.

• Review the core elements of a compliance program
• Describe modern approaches to developing and managing a compliance program
• Explain how to leverage technology to coordinate compliance activities

Level: Intermediate

Is every NCCHC standard and compliance indicator mentioned in your policies and procedures (P & P)? Do your P & P have different numbering/naming than the corresponding NCCHC Standards? Is it hard to find NCCHC Standards information in your P & P? Solving these problems makes a P & P crosswalk invaluable. This session explains why and when a P & P crosswalk with NCCHC standards is important, how to create/set it up, and how to maintain it going forward.

Educational Objectives

• State why and when a crosswalk of facility policies and procedures and NCCHC standards is beneficial
• Describe how to create a P & P vs. NCCHC standards crosswalk
• Discuss how to maintain the crosswalk going forward

Level: Intermediate

This session includes two presentations.

First, Do No Harm: Applying a Harm Reduction Public Health Lens to Corrections

The Maine Model of Corrections is a transformative model of correctional care established by the Maine Department of Corrections to promote self-actualization and reduce stigma for incarcerated individuals. This session demonstrates two aspects of the Maine Model: Expanding access to medications for opioid use disorders and adopting harm reduction philosophies and practices to promote health within correctional facilities and community correction settings.

Educational Objectives

• Identify evidence-based approaches to health care and community integration
• Discuss the benefits of reducing stigma associated with incarceration, mental illness, and substance use disorders
• Review elements of training that promote staff buy-in for integrating harm reduction programs

Level: Basic

Expanding Access to Substance Use Treatment and Integrating Harm Reduction Philosophies*

The overdose crisis and associated rise in drug poisonings among incarcerated people make jails a promising site for public health interventions using a harm reduction lens. This presentation will highlight opportunities to implement interventions to advance public health and health equity in carceral settings. Participants will learn about initiatives including the successful program at Louisville Metro Department of Corrections that provides naloxone inside dorms to empower incarcerated people to save the lives of their peers.

Educational Objectives

• Describe relevance of harm reduction principles to carceral settings and identify areas for partnerships with public health.
• Review case study of Louisville, Kentucky?s successful partnership between the local jail and public health department.
• Discuss best practices and strategies that attendees can use to implement harm reduction interventions in carceral settings.

Level: Basic

Highly effective, well-tolerated, oral-only treatment for hepatitis C with direct-acting antiviral agents has been available for nearly a decade. Although curative treatment with DAAs is recommended for essentially everyone with hepatitis C, comprehensive hepatitis C testing and treatment in correctional settings has been challenged by various organizational, staffing, and budget constraints. This session presents strategies to advance hepatitis C elimination in correctional settings.

• Describe how hepatitis C testing and treatment in corrections advances national HCV elimination goals
• Discuss the most effective HCV screening policies and mechanisms to lower testing costs
• Examine approaches to treatment prioritization mechanisms to lower the cost of direct-acting antivirals

Level: Advanced

Nurses in detention facilities sometimes encounter patients who stop eating or drinking to reach a goal, because of mental illness, or for religious reasons. This session will review evidence-based research related to hunger strikes, refeeding syndrome, and force feeding by NG tube. Attendees will learn about the role of the nurse, patient education, and common labs of concern for patients on hunger strikes.

• Summarize the current understanding of hunger strikes, force feeding by NG tube, and refeeding syndrome
• Review the role of the nurse clinician and interventions with patients on hunger strikes
• Recognize abnormal lab values and objective assessment findings related to patients on hunger strikes

Level: Basic

There are considerable risks to consider when prescribing psychiatric medications to incarcerated patients. This presentation will review the challenges and focus on safely helping this vulnerable population receive the mental health care they need. We will also look at documentation strategies to make sure providers are legally protected. Part 2 will focus on mood stabilizers and antipsychotic medication.

Educational Objectives

• Identify the unique pitfalls for psychiatric prescribing in corrections
• Review the classes and challenges for specific medications
• Discuss documentation strategies for prescribing

Level: Intermediate

Electronic health records can provide tools to identify patient risk behaviors in acute and chronic care and allow providers to focus on patients while providing safer care. A well-designed EHR helps ensure communication between disciplines and departments; it also relies significantly on cooperation. This session will highlight a process that allows users to submit suggestions for improvements. The presenters will review the process from initiation to implementation and discuss the role of the EHR team.

Educational Objectives

• Describe the structure of an effective EHR team
• Discuss the mission and responsibilities of an EHR team
• Identify future initiatives that benefit clinical and technology teams

Level: Intermediate

A cluster of serious invasive Serratia marcescens infections was identified in a California State Prison Facility from 2020 ? 2022. Investigation into the cluster revealed a majority of cases reported recent injection drug use. Environmental investigation revealed several opportunities for enhancement of environmental disinfection practices. Learn how mitigation strategies, including patient education on risks of IDU, substance use disorder treatment, and improved environmental disinfection practices, were effective in reducing the incidence of infections.

• Describe the risk factors for infection with Serratia marcescens and other opportunistic environmental pathogens
• Summarize case identification strategies using the investigative process
• Discuss mitigation strategies for infection prevention and control

Level: Intermediate

Utilization management is one of the most important and effective tools for quality care and patient satisfaction. This presentation highlights the importance of including physical exam basics and the types of imaging and labs that must be included to streamline approval for a consult request. Specific examples include neurology, neurosurgery, orthopedics, and rheumatology.

• Discuss how collaborative utilization management can improve outcomes
• Describe the dynamics that drive consult decisions
• Review next steps after receiving an alternative treatment plan/denial

Level: Intermediate

The challenges of reentry can be particularly daunting for low-income adults in urban areas. With the right support and resources, reentry services can help reduce recidivism and support successful integration into the community. Services may include job training, housing assistance, mental health services, substance abuse treatment, and access to education.

• Explain the reentry challenges faced by low-income adults
• Review the role of reentry services in reducing recidivism and supporting successful integration
• Identify strategies for addressing the needs of low-income adults during reentry

Level: Basic

The session Reducing Inpatient Hospitalization Costs has been cancelled. 

The nursing team is essential to ensure patients receive access to care for nonurgent health care requests. With the staffing shortage and changes in processes since the pandemic, conducting sick call is even more challenging. In this session, we will present an overview of sick call options and invite discussion on how nurses can overcome barriers in meeting NCCHC sick call requirements.

• Describe various systems for conducting sick call
• Discuss at least three nursing scope-of-practice issues related to sick call
• Identify at least two best practices related to managing sick call

Level: Intermediate

This session describes the implementation of a comprehensive, evidence-based medical opioid treatment/prevention initiative in one state juvenile system during the fentanyl era. It will provide an overview of the opioid epidemic and evidence-based medical opioid and overdose treatment/prevention strategies. The presentation includes interactive cases to reinforce content and attendees are encouraged to share resources and strategies.

Educational Objectives

• Describe current data on opioids and overdoses among incarcerated and justice-involved youth
• Review evidence-based treatments and prevention strategies for overdoses
• Create facility-specific strategies to reduce overdose risk

Level: Intermediate

Many people with HIV do not remain in HIV care after release from prison. Programs that support continuity of HIV medical care for PWH released from prison are vital. This presentation will highlight three program models that support continuity of care and viral suppression among PWH released from state prisons. Key strategies and lessons learned for successful collaborations between public health entities and correctional facilities will be discussed.

Educational Objectives

• State strategies to support continuity of care for people with HIV released from state prisons
• Describe three program models implemented to support continuity of care for PWH
• Identify key strategies for successful collaborations between public health entities and correctional facilities

Level: Intermediate

As leaders, we often get hung up on the day to day of operations and forget our most important asset, the people. This presentation analyzes Simon Sinek's book "Leaders Eat Last" and focuses on the key concepts of empathy, safety, and trust when leading others. Through real examples from correctional health care with application from Sinek's theories, we can increase retention and improve daily operations through increased job satisfaction.

Educational Objectives

• Describe how to practice empathy when leading others
• Discuss how to create safety when leading others
• Explain how to increase trust when leading others

Level: Basic

This session will focus on the importance of collaborative leadership among custody command staff and medical and mental health administrators. All levels of the operation must work together to ensure the best care, custody, and control. Regular interaction that includes formalized meetings and impromptu problem-solving sessions will be discussed. The importance of data-driven decision-making and Continuous Quality Improvement programs will be explored.

Educational Objectives

• Identify leadership challenges in fostering collaboration between custody and health care staff
• Discuss Continuous Quality Improvement and its impact on interdisciplinary collaboration
• Describe methods of building collaboration through education, training, and awareness

Level: Basic

The Massachusetts Behavioral Health Supports for Justice Involved initiative (BH-JI) is a reach-in, reentry model that provides specialized behavioral health supports to justice-involved individuals with mental health or addiction needs. This presentation discusses how the project connects recently released individuals to health care services and community services and shows improved health outcomes, decreased fatal overdoses, and reduced recidivism.

• Describe the key outcomes of the Massachusetts statewide reentry program
• Identify how multiagency collaboration assists with successful reentry
• Discuss keys to developing a successful statewide reentry program

Level: Intermediate

Part 1 of this session, Progression of MOUD in the BOP: Using Pharmacists to Expand Access, cancelled due to the Government shutdown.

State-Mandated MAT Programs in Jails: Crisis or Opportunity?

In 2022, Colorado mandated Medication Assisted Treatment (MAT) programs in all jails by July 1, 2023, without offering funding or assistance. This created a tremendous panic, especially for the smaller rural county jails. A group of these small jails banded together to find creative solutions. They developed unique MAT programs and created a Regional Jail Project hub to share resources for MAT, community transition programs, training programs, future grant projects, and technology innovation.

Educational Objectives

• Review Colorado's jail-based MAT mandate
• Examine common issues and options for meeting the MAT mandate in Colorado jails
• Describe solutions developed to offer MAT in rural jails

Level: Basic