Webinar presenter NCCHC’s Jim Martin answered a number of your questions after his presentation, Standards of Care: Mental Health in Our Jails and Prisons…Now What? Here are just a few of his responses.

Audience Question: Does NCCHC accredit Military Correctional Facilities? 

Jim Martin: We don’t currently, but we can. We accredit facilities on a local level. Sheriff’s office, of course, juvenile facilities can also be a county, state, federal. We accredit some federal facilities. We have accredited some state and federal prisons in the past. I would love to talk to anyone that would want to discuss because I think you know sometimes military installations are an afterthought and they should not be because I think it’s just as important for our men and women wearing the uniform who go through their own unique challenges. So we don’t currently but it doesn’t mean we can’t. We just have not been offered. One of the things I should probably point out, NCCHC is kind of like the Joint Commission is to hospitals. But where the Joint Commission in hospitals receive some federal funding, NCCHC is a voluntary accrediting process that we are invited in the majority of the times by the facilities themselves saying I want to go above and beyond. I want to be proactive. I want to provide a good correctional health care system in our own facility. That is the most – it’s a great Testament to our Sheriff’s, to our administrators, to our wardens into our federal officials who wanted to see that happen. In very few cases, the courts have ordered us, ordered a facility to get accredited by us because they recognized in civil judgments that that is an excellent opportunity to improve and let’s face it when there are civil lawsuits or that are brought in by a group of inmates, they’re wanting to see an improvement in the facility and we offer that for them. So not only NCCHC, but we have a technical assistance arm that can help do individual things. We keep them separate by intent because we believe in the  integrity, in the transparency of the accreditation process and how that occurs. We never want that to cross over to any technical assistance. I’m that guy on the tightrope that pushes you to which way you need to go or to least tell you about it. So I think that’s a great question. I have not thought about our military installations in a long time. But if you’re a facility that’s interested in that please reach out. I’d love to talk to you about it.

Audience Question: Where can I get a copy of the NCCHC standards manuals? 

Jim Martin: Great question. They are online and www.ncchc.org. Just look at go to accreditation or the Publications and you’ll see them they’re online. You can always drop me an email and I can send you an individual link to that. They are only right now offered in print version only. We have partnered with a company that if you are an accredited facility, you can get the electronic version only because you’re already using that system to organize your files. So, PowerDMS is that other company that I’m talking about and they have other standards like CALEA (?) and some of our competitors that are out there that have their own standards, but ours are in books, are in hard copy and you can find them on our website or email me and I’ll be happy to send you the link.

Audience Question: On slide 20 under failure to supervise staff. You have a remedy as clinical performance enhancement. Can you talk a little bit more about what you mean by that? 

Jim Martin: So yes, the purpose of this is for our clinicians more than not. I think the point I was making was that if a clinician comes in and they have the sort of certification that they’re operating under or operating within their licensure. A clinical performance enhancement is like a review of your work ethics. It’s just keeping in touch with the person making sure they’re operating within the scope of their license, that they’re using the appropriate treatment and it’s just a review just like anything if we were going to have an employee evaluation of are you abiding by our policies and procedures? You know, how’s your attitude? Do you come to work on time? This is the same thing but the clinical performance enhancement is just saying if you’re not being supervised from the types of skills that your licensure allows for, we would never know that if there was not some sort of supervision. So that’s what’s meant by the clinical performance enhancement. We have required an annual review of that. So it’s not like you’re watching them every week. It’s an annual review to make sure that they are operating within the scope of their practice.

Audience Question: In your experience among correctional officers, how common is the desire to think about the crisis that people who come under their supervision experience? In your opinion, how can this desire to help be expanded to others in the profession? 

Jim Martin: That is a great question. It’s funny, I was just talking about cultural change today on another call. A facility, they see the need for cultural change and it’s just trying to figure out how to do it. Honestly, and this is Jim Martin’s experience, back in the day, if you were sent to a certain position or assignment. Some of them could be viewed as a whipping post, you know, you’ve been banished to jail. I was lucky under the leadership in the sheriff I had that they didn’t see that the same way in our facilities, but I wanted to you know, wherever I’m assigned I’m all in a hundred ten percent. I saw I use the alliteration of our civilian correctional officers with their faces pushed up against the window looking at all the cool things the deputies had they had all the training they had all the shiny badges. They had all the equipment on their belt and they just wanted for more. And honestly, what I did is I gave them ownership into some of the things I don’t have to plan every bit of training that occurred in my facility. If I have a guy that’s really good at searches. I asked I said, you know, what could you put on a roll call training on how to provide a good pat-down search? That led into you know, what we’re developing a 40-hour basic confinement officer training that was later approved as a state accepted training for you know, Southern Indiana and I put that on my officers I sent them to instructor development school. We bought the train the trainer so it was expensive to some of them to do the training. Well, I brought the class to us put a number of our officers to that training, and then allow them to be the trainer of our own facility. You would be astonished at how it improves their morale. It was just basically asking them, hey, what cares do you have for improvement here? And I looked for ways that I could plug them in. When I did the CIT it really was not anything spectacular I did. I went to our CIT2(?) who is doing all of our law enforcers said hey can I put a couple of my correctional officers in? Like we never had that asked, but sure let’s do it. It was very intense, I mean we’re talking breaking down the brain and why things happen and you’ve got to want to be there because I saw people in my class that didn’t want to be there in the best thing we could do is show them the door and say, you know, if you don’t want to be here now, you’re not going to be able to be one of those people on the street to talk someone in this manner. When I sent out who would be interested in those who it was just amazing to see who rose out of that and said, I want to be a part of it. It’s just being willing to let go of some of the control and saying how can you help us and what’s important to you? And let’s see if we can find a way to plug you in and once people started doing that one and then they saw other people doing it, not only did they start letting their employees be shared by other members, but they started working together. You know, when we do a disaster preparedness training, some of the most fun times is when we would set up a scenario to include a shift in our nursing staff and watch them interact together. Once we started doing cell extractions, we had the healthcare staff standing by watching what we’re doing so they had an understanding of why it was important to be there. If someone got hurt during a cell extraction, it was important to have them there. when they felt included, the relationship started to build a collaboration of an environment of learning. I hope that helps answer it a little bit. I could talk about that forever. I’m just changing the environment. So I probably went all sorts of different ways in which I tend to do from time to time, but it really is just getting them involved.

Audience Question: So a problem that I see from the patrol perspective, especially for a police department communicating to our sheriff’s department, is that patrol identifies someone who needs some basic assistance but you find out later that the jail released them without providing any level of assistance. They may have the capability but the mechanism to identify someone who needs help. What is the best way to flag someone going to jail for better discharge planning? 

Jim Martin: That’s a great question and I tell you what whenever we had a collaboration with our not only – so I was member the sheriff’s office working in the jail, but we’d have deputies come in, we’d have City police officers come in. You have people there that provide great information coming in and take when we would see people that wanted to give us that information. We put it in the electronic health record. We had an opportunity in our jail management system, our JMS system that we could put a  flag in that would say make sure that this person before they are released, they need to see medical about their medications or before their release, we have CIT paperwork on there before they release notify this officer because they’ve taken a key into whatever case they were working on. We have an alert system built into our jail management system. And I think that was very effective. The other thing is, you know, everyone plays by,  it seems like everyone plays with different rules in even coming out of my CI trainer (?). Okay. I have it finally in process and we would have frustration when we would see someone that needed immediate attention. We had identified that we’re trying to defer them out of the correction then we’d go to the hospital and we would give them the all the necessary paperwork and all you know, we would wrap it up in a bow and then before we finish doing our paperwork, they’re walking out the hospital because well they answer all the currently questions correctly, we can’t hold them. That was frustrating for us. So it was all going back to the communication and talking to the leadership at those areas and saying hey, listen if this process is going to work, it’s got to work for everybody. So the early release kind of warnings coming up in your Jail Management System is one way and just speaking to the healthcare staff outside of work or during corrective action plan meetings and you know telling them hey, this is a problem that we’ve identified. How can we better communicate this kind of stuff? You’ll be amazed. They’ll be excited that you even thought about it.

Audience Question: How do jails identify folks with intellectual and/or development developmental disabilities who might have co-occurring mental health diagnosis? 

Jim Martin: Great question, you find a hefty budget line item that you can pay for a clinical psychologist or a qualified mental health practitioner. They can work in jail all the time but let’s say see that that’s not the realization for most facilities. The best that I can tell you is look at the recommended training topics like in topics of training and look for partners. If you don’t have them on your facility staff, look at partners in the community that can train to those topics because although we might look like we’re experts and everything, the correctional officers and the correctional health care folks, they are limited by their training. We want what’s best but there’s just so much that we can do. If in the absence of a mental health clinician, you do the best you can do through that program training and then no resources or identify resources in the community that you can contact when you see something. I don’t think that we’re ever going to get to the point where during every entry you’re doing a test for mental capacity. We’re just not trained for that. We don’t have that kind of time, money, or experience but if you develop partnerships if you don’t have them outside of your facility within the community that might have that kind of training, you at least have someone you can turn to when you have questions. That’s a difficult one to answer because a lot of people are just struggling and wanting to be able to do that. There are companies out there that would love to partner especially when they’re trying to test for mental capacity or how you can transfer information outside of the jail and then follow them there. They are partners out there that do that but it’s just finding the one that’s right for your facility.

Audience Question: Have you used Stepping Up case managers in your care transition process? 

Jim Martin: I have not used them in my organization because stepping up was just getting off the ground when I was leaving the sheriff’s office. Now I identified early on that NCCHC has to be a partner with Stepping Up because even though it is more of a holistic community approach, we are part of the community and I have really good relationships with some of the folks from the National Association of Counties and the Stepping Up initiative and the partners who have been a part of that. I think it’s a great program and quite honestly, I couldn’t get at the time, I was transitioning away from the sheriff’s office after 22 years. I didn’t have the partnership yet with the recommended leaders that the Stepping Up required. So I know I’ve not I have great respect for Stepping Up initiative and the things that they are providing and I’d be happy to hear what your actions with him in response to the event because in the future I can share that experience.

Click Here to Watch a Recording of Standards of Care: Mental Health in Our Jails and Prisons…Now What?