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.

Educational Objectives

• 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

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.

Educational Objectives

• 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

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 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

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.

Educational Objectives

• 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

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

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.

Educational Objectives

• 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

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.

Educational Objectives

• 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

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

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.

Educational Objectives

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

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.

Educational Objectives

• 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

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.

Educational Objectives

• 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

Meet some of our 2023 scholarship award winners and hear about their experience attending NCCHC Conferences.  Learn more about Foundation priorities and how we are working on behalf of correctional health care.  Brief Q&A at the end of the session – bring your questions and thoughts to share!  This session does not provide CE. 

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.

Educational Objectives

• 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

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.

Educational Objectives

• 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

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.

Educational Objectives

• 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

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.

Educational Objectives

• 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

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.

Educational Objectives

• 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

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

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

Significant changes in the application of HIPAA to the correctional health care environment have led to confusion as to how the law applies and what correction-specific exemptions exist. This presentation reviews the changes in HIPAA since its inception and examines the current applicability to corrections. Participants will receive advice about the safest practices when faced with requests for patients' protected health information.

Educational Objectives

• Review changes in HIPAA legislation as it relates to corrections 
• Discuss the need to obtain a HIPAA-compliant signed authorization before releasing patient information
• Express how to handle requests for protected health information, either from a patient or from an outside party such as an attorney

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.

Educational Objectives

• 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

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

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