Sara Wakai

Conducting Research in Corrections: Challenges and Solutions

Research in correctional settings has progressed from the exploitation of a vulnerable population in the years prior to 1978 to its current overly protective and restrictive state. With the considerable growth in the numbers of inmates with medical and mental health care needs, developing effective interventions to serve this population is paramount. There now appear to be signs of interest in and support for research with inmates by correctional agencies, academia, and health care organizations. Innes (2003) has articulated the following strategies for implementing research in prison: (1) gather stakeholders; (2) include one or more experienced research collaborators; (3) consider obtaining technical assistance from a university or the National Institute of Corrections (NIC); (4) define potential opportunities/interests that support the institutions mission; (5) develop a relationship with an IRB; (6) pilot a small proposal that is of interest and potential value to the organization. The authors illustrate the implementation of a study in a correctional system that uses these strategies.

Algorithm-Driven Pharmacological Management of Bipolar Disorder in Connecticut Prisons

The objective of this study was to assess adaptation of the Texas Implementation of Medication Algorithm (TIMA) for bipolar disorder (BD) in the Connecticut Department of Correction. A nonrandomized sample of 20 males and 20 females, with diagnoses of BD Type I or II, was enrolled in the study. Two TIMA-trained psychiatrists treated the participants over a 12-week period following the TIMA protocol. The primary outcome measure was the Bipolar Disorder Symptom Scale. Secondary outcome measures evaluated global clinical status, comorbid symptomatology, and quality of life. Significant improvement was seen with the primary and secondary outcome measures (p < .001). Subanalyses showed differences in outcomes based on gender and whether a manic or depression algorithm was used. Antidepressant and antipsychotic medication use decreased, with increase in anticonvulsant and anxiolytic medication usage. This pilot study confirmed the effectiveness and benefits of TIMA for BD adaptation in the correctional setting.

Traditional and environmentally preferable cleaning product exposure and health symptoms in custodians.

Background We investigated the associations between traditional and environmentally preferable cleaning product exposure and dermal, respiratory, and musculoskeletal symptoms in a population of custodians. Methods We analyzed associations between symptoms and exposure to traditional and environmentally preferable cleaning product exposure among 329 custodians. Results We observed increased odds of dermal (P < 0.01), upper (P = 0.01) and lower respiratory (P = 0.01), and upper extremity (P < 0.01), back (P < 0.01), and lower extremity (P = 0.01) musculoskeletal symptoms associated with increased typical traditional cleaning product exposure. We observed significant trends for increased odds of dermal (P = 0.03) and back (P = 0.04) and lower (P = 0.02) extremity musculoskeletal symptoms associated with increased typical environmentally preferable cleaning product exposure. Conclusions Fewer positive associations and reduced odds of health symptoms associated with environmentally preferable cleaning product exposure suggest that these products may represent a safer alternative to traditional cleaning products. Am. J. Ind. Med. 58:988–995, 2015.

Women in Prison Self-Injurious Behavior, Risk Factors, Psychological Function, and Gender-Specific Interventions

Treating self-injurious behavior (SIB) is a challenge in any environment. There is an increased level of complexity when this type of behavior occurs in a female correctional facility. This article focuses on SIB in incarcerated women, including the importance of identifying risk factors, understanding the psychological functions of SIB, addressing the influence of gender on treatment, and acknowledging challenges unique to the correctional environment. Treatment recommendations specific to incarcerated females, such as motivational interviewing and a cognitive behavioral approach, provide guidance to address the underlying causes of SIB and the development of healthier coping behaviors for female inmates. Effective management of SIB in a female correctional facility simultaneously reduces the burden on staff and increases the safety of staff and inmates.

A Process Evaluation of START NOW Skills Training for Inmates With Impulsive and Aggressive Behaviors

AIM: To conduct a formative evaluation of a treatment program designed for inmates with impulsive and aggressive behavior disorders in high-security facilities in Connecticut correctional facilities. METHOD: Pencil-and-paper surveys and in-person inmate interviews were used to answer four evaluation questions. Descriptive statistics and content analyses were used to assess context, input, process, and products. FINDINGS: A convenience sample of 26 adult male (18) and female (8) inmates participated in the study. Inmates were satisfied with the program (4-point scale, M = 3.38, SD = 0.75). Inmate hospital stays were reduced by 13.6%, and psychotropic medication use increased slightly (0.40%). Improved outcomes were noted for those inmates who attended more sessions. CONCLUSIONS: The findings of the formative evaluation were useful for moving the START NOW Skills Training treatment to the implementation phase. Recommendations for implementation modifications included development of an implementation team, reinforcement of training, and attention applied to uniform collection of outcome data to demonstrate its evidence base.

Best practices: disseminating best practices for bipolar disorder treatment in a correctional population.

Use of medication treatment algorithms may facilitate clinical decision making, improve consistency, and reduce polypharmacy in the correctional setting. A feasibility study was conducted investigating use of Texas Implementation of Medication Algorithms (TIMA) guidelines for bipolar disorder in the Connecticut Department of Correction. Forty inmates with diagnoses of bipolar disorder were treated over a 12-week period adhering to the TIMA algorithm for bipolar disorder. Significant improvement was seen in the primary and secondary outcome measures (p<.001). This pilot project confirmed the feasibility of algorithm adaptation to the correctional setting and provided specific recommendations for successful dissemination of the TIMA algorithm for bipolar disorder in correctional settings.

Psychotropic medication adherence in correctional facilities: a review of the literature.

Despite the high percentage of incarcerated persons with mental illness, surprisingly little is known about effective ways to increase psychotropic medication adherence in prison and upon release. Currently, there are limited definitive data regarding psychotropic medication adherence patterns among incarcerated persons, and the data that exist often miss specific information on changes in behaviour, symptom management and adherence patterns over the length of a persons sentence, which has implications for post-release ability to live in the community. This paper presents the current literature regarding psychotropic medication adherence among mentally ill persons who are incarcerated. The factors identified in support of medication adherence, future clinical research and care strategies are provided.

Transitioning from Traditional to Green Cleaners: An Analysis of Custodian and Manager Focus Groups

Custodians represent one of the largest occupational groups using cleaning agents, and yet their voices are infrequently heard in relation to the introduction of “green” cleaners and the laws regarding environmentally preferable products (EPP). This study reflects worker voices on use and effectiveness of chemicals, as well as incentives and obstacles for green cleaning programs. Sixty-four custodians and staff participated in 10 focus groups. Data were entered into Atlas Ti and the constant comparative method of qualitative data analysis was used to identify themes. Themes included satisfaction in a “well-done” job, more effort required for job, lack of involvement in EPP selection process, EPPs ease of use for workers with English as a Second Language (ESL), misuse of disinfectants, health complaints, and need for training. This study shows that custodians have a voice, and that improved communication and feedback among all the stakeholders are needed to make the transition to green cleaning more effective.

Development of an Assessment of Functioning Scale for Prison Environments

This paper reports the development of a global assessment of functioning (GAF), modified from the DSM Axis V GAF for the prison environment. Focus groups, which were conducted with 36 correctional officers and clinicians in two prisons, provided descriptions of behavior in prison settings to re-align the GAF scale. Face validity was established. It was found that Habitation/Behavior, Social, and Symptoms emerged as important domains of functioning in prison. Gender differences were noted with regard to cleanliness, relationships and coping strategies. The cut-off score was identified at a score where offenders were unable to participate in a disciplinary process due to their mental illness. The structure of prison alters human functioning, requiring different assessment language and ratings to measure perceived behavioral norms and/or expectations. Front-line staff need the ability to observe and communicate behavioral changes quickly and accurately in a prison environment without undue burden upon their workload. This assessment was modified by front-line staff specifically for the prison environment to document quick and frequent assessments of observed changes over time in the offender population.

Adaptation of the Texas Implementation Medication Algorithm for Bipolar Disorder in Adult Female Offenders

Use of medication algorithms in the correctional setting may facilitate clinical decision making, improve consistency of care, and reduce polypharmacy. The objective of the present study was to evaluate effectiveness of algorithm (Texas Implementation of Medication Algorithm [TIMA])-driven treatment of bipolar disorder (BD) compared with Treatment as Usual (TAU) in the correctional environment. A total of 61 women inmates with BD were randomized to TIMA (n = 30) or TAU (n = 31) and treated over a 12-week period. The outcome measures included measures of BD symptoms, comorbid symptomatology, quality of life, and psychotropic medication utilization. In comparison with TAU, TIMA-driven treatment reduced polypharmacy, decreased overall psychotropic medication utilization, and significantly decreased use of specific classes of psychotropic medication (antipsychotics and antidepressants). This pilot study confirmed the feasibility and benefits of algorithm-driven treatment of BD in the correctional setting, primarily by enhancing appropriate use of evidence-based treatment.