NCCHC’s Standard A-06 Continuous Quality Improvement is an essential requirement for accreditation. Historically, CQI efforts generally focused on medical aspects of health care. But finding opportunities for improvement in behavioral health programs is equally important. The CQI process is 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 them to mental health programs.

Educational Objectives

• Review NCCHC Standard A-06, Continuous Quality Improvement
• Explain the importance of applying the CQI process to a behavioral health program
• Identify topics appropriate for behavioral-health quality improvement programs

From 2010-2020, the suicide rate for children younger than 15 doubled. For all ages, incarceration is a significant risk factor that increases the likelihood of suicide. As such, youth correctional facilities need to provide interventions for youth who are at high risk for suicide. This presentation will provide several models for completing an evidence-based suicide risk assessment with risk stratification suggestions and discuss the challenges in the resulting recommendations within a state-run juvenile correctional facility.

Educational Objectives

• Discuss the epidemiology of youth suicide over the last decade
• Describe several evidence-based suicide assessment models within a youth correctional facility
• List the 4 Ps of suicide risk among youth in the correctional system

Nearly all lawsuits by incarcerated patients involve allegations that the facility denied care because of a “rule” or “mandate” cited by medical or security staff, such as “the facility never treats pre-existing conditions.” This presentation examines the “rules” that most commonly lead to lawsuits and provides alternative ways to explain treatment plans using less liability-prone language. Attendees will learn it is best to never say never!

Educational Objectives

• Define negligence and deliberate indifference
• Describe how clinical discretion informs patient treatment plans and should not be replaced by inflexible rules or policies
• Identify patient-centered language to explain treatment plans that avoids strict, generalized statements

We developed a dynamic prediction model to predict criminal recidivism in individuals under community supervision. The model accounts for adverse events, changes in circumstances, and offense-free time, resulting in improved discrimination performance. Our comparison of the dynamic model with its static equivalent highlights the benefits of incorporating offense-free time in actuarial risk assessment tools. Our findings reveal that traditional actuarial tools, when used as monitoring instruments, systematically overestimate recidivism risk over time.

Educational Objectives

• Describe the importance of incorporating adverse life events and desistance effects in actuarial risk assessment tools
• Identify the limitations of actuarial tools not specifically developed for risk monitoring, including the potential for bias towards overestimation
• Discuss the process of developing a dynamic risk assessment tool

One challenge of providing mental health services in prison is the high rates of trauma and post-traumatic stress disorder coupled with limited mental health resources. This presentation will introduce participants to a group trauma-focused yoga protocol used in the Washington State Department of Corrections. The presenter will discuss the research, explain polyvagal theory, describe the group process and exercises, and present quantitative data measuring group members’ impressions of their PTSD symptoms before and after the 12-week group.

Educational Objectives

• Define polyvagal theory
• Discuss how polyvagal theory supports the use of yoga and meditation to treat trauma symptoms
• Describe the trauma-focused yoga group protocol

Transgender and gender diverse (TGD) individuals who are incarcerated experience a higher level of discrimination and adversity than the general incarcerated population. This holds even more true for the TGD individuals who have committed sex crimes. There is limited information available for health care and security staff to address the mental health, medical needs, and risks for this population. This presentation will discuss the assessment, treatment, ethics, and legal needs for incarcerated TGD individuals.

Educational Objectives

• Discuss the assessment and treatment needs of incarcerated transgender and gender diverse individuals
• Describe the special assessment and treatment needs of TGD individuals who have committed sex crimes
• Examine ethical and legal issues pertaining to the TGD population

Equal partners in the health care team, mental health professionals and nurses can sometimes find themselves at odds about how to achieve a common goal. Participants will delve into common situations that can create disharmony between the two professions. Participants will be prompted to communicate in the language of another profession, to understand the differences in prioritization skills, and to find a balance that results in quality care.

Educational Objectives

• Review common issues that create disharmony between nurses and mental health workers
• Analyze case studies involving conflicts between nurse and mental health workers
• Demonstrate through role play, the application of newly learned skills in communication and prioritization techniques

Correctional settings might seem like the last place where laughter and humor would seem appropriate. This presentation will demonstrate how humor can be a useful therapeutic tool in the treatment of incarcerated individuals by showing the medical and physiological benefits of humor for both treatment providers and those receiving care. The history of humor in medicine will be reviewed as well as the medical, psychological, physiological, and social benefits. There will also be a demonstration of therapeutic laughter techniques to be used in a variety of treatment settings.

Educational Objectives

• Describe the medical, physiological, psychological, and social benefits of laughter
• Recognize how we can bring more humor into our lives, which in turn can be used to help our clients
• Employ techniques for effectively using therapeutic laughter with incarcerated clients

There is a direct correlation between homelessness, incarceration, and recidivism, particularly for people who are Black, Latinx, women, or have more than one incarceration. Recovery housing for those with substance use disorders provides structure and support for individuals not available in traditional transitional and halfway houses. Participants will learn about the crucial role of SUD recovery housing in holistic, person-centered reentry, national standards, appropriate placement, and how to identify and access quality recovery houses.

Educational Objectives

• Define substance use disorder recovery housing levels of care
• Discuss the role of recovery housing in reentry, long-term SUD recovery, and recidivism reduction
• Review the reentry processes and professionals need to connect individuals with recovery housing

Correctional stress happens to us physically and emotionally when work exposes us to distressing situations. Even on a good day, it is a serious hazard for staff working in corrections. The pandemic and other national events have unbalanced our lives. Recognizing how these events impact chronic stress exposure will help staff maintain the high judgment necessary to optimally cope. The speaker will explore these risks and share ways to reduce the impact through life-balancing techniques.

Educational Objectives

• Discuss correctional stress and its impact in today’s environment
• Explain correctional stress as an occupational risk
• Describe choices for prevention and intervention

While the concept of moral injury has traditionally been applied to the experience of military service members, there is growing research on the role of moral injury among health care workers. Findings from a qualitative research study in Colorado indicate that correctional mental health professionals experience significant components of moral injury from their clinical practice. This presentation explores definitions of moral injury, warning signs, clinical considerations, and recommendations for practice.

Educational Objectives

• Define the theoretical concept of moral injury
• Examine the ways in which moral injury may affect the experiences of correctional mental health professionals
• Identify strategies to mitigate the effects of moral injury on correctional mental health staff

Jail and prison suicide deaths are increasing as are the number of deaths attributed to alcohol and substance use. The two are inextricably related. This presentation will review co-occurring mental health and substance use disorders and suicide within the correctional system, including risk factors and gaps in the existing medical and mental health systems. Methods to establish a comprehensive suicide prevention program will be presented, and case examples will be used to illustrate research and statistics.

Educational Objectives

• Describe individual and environmental risk factors for suicide in jails and prisons
• Cite three ways that jails and prisons can lessen the risk of suicide within their facilities
• Discuss how expanding medications for opioid use disorders can help decrease the risk of suicide

Traumatic Brain Injury (TBI) is a huge silent epidemic within the 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, understanding of the six TBI diagnostic trajectories, and accessible methods for early diagnosis and actionable treatment options.

Educational Objectives

• Review the prevalence of traumatic brain injury in the correctional setting
• Apply the six TBI diagnostic trajectories to incarcerated individuals’ behavioral health
• Discuss ways to improve diagnosis and treatment of TBI

In Indiana, the volume of competency orders increased by more than 200% in just five years, impacting hundreds of people lingering in county jails. With a cross-collaborative agency approach, Indiana reduced average wait time from 124 days to 21.7 days in a year. This presentation will review the innovative pathways and unique collaborations undertaken to meet the demand for competency evaluation and restoration services, as well as new methods that promote safety while engaging the individual in treatment.

Educational Objectives

• Describe the impact of competency trends on criminal justice and mental health systems
• Identify new intervention methods to promote treatment while addressing incompetence and restorability
• List ways to improve competency programs and guide courts toward diversion

Many correctional facilities face resource strain, from staffing shortages to overcrowding to physical plant issues. With many of these resource strains unlikely to level off in the near future, staff are required to develop and implement creative solutions to maintain quality care. This session will focus on strategies to address resource strains by effectively adapting mental health care practices to meet the needs of incarcerated individuals.

Educational Objectives

• Describe the conservation of resource model and its application to correctional facilities
• Identify data on the types of resource strains correctional facilities are experiencing nationwide
• Analyze strategies used nationally to adapt care to meet the needs of patients during periods of resource strain

The MassHealth Behavioral Health Supports for Justice Involved Individuals initiative helps justice-involved people with their mental health and substance use needs; connects them with the right health care and community services; and improves health, reduces overdoses, and supports successful health care use for people enrolled in the program. After starting in two counties in 2019, the initiative launched statewide in 2022. Participants will learn about the program’s history, successes, and key collaborators.

Educational Objectives
•    Describe effective development of a statewide reentry program
•    Explain the importance of multi-agency collaboration to the program’s success
•    Identify new perspectives on reentry to assist with successful integration of returning citizens