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Women Offender Programs and Issues

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STRUCTURED LIVING ENVIRONMENT

OPERATIONAL PLAN

 

National Implementation Working Group Office of the Deputy Commissioner for Women

National Headquarters

Correctional Service of Canada

 

Table of Contents

 

1.

BACKGROUND

 

1.1 Development of the Intensive Intervention Strategy

 

1.2 Structured Living Environment - Overview

 

1.3 Development of the Structured Living Environment

 

 

2.

LEGISLATION, POLICY AND MANDATE

 

2.1 Corrections and Conditional Release Act (CCRA)

 

2.2 Mission of Correctional Service of Canada

 

2.3 Creating Choices

 

2.4 Mental Health Strategy for Women Offenders

 

2.5 Correctional Program Strategy for Federally Sentenced Women

 

 

3.

WHO ARE THE WOMEN: IDENTIFYING AND UNDERSTANDING THEIR NEEDS

 

3.1 Constellation of Special Needs Among Federally Sentenced Women

 

3.2 Needs Analysis

 

3.3 Constellation of Needs by Sub-Groups

 

 

4.

PHYSICAL ENVIRONMENT & OPERATIONS OF THE UNIT

 

4.1 Capacity

 

4.2 Interior

 

4.3 House Telephone

 

4.4 Back Door

 

4.5 Living Room/Dining Room

 

4.7 Kitchen

 

4.7 Den

 

4.8 Washrooms

 

4.9 Laundry Room

 

4.10 Bedrooms

 

4.11 Cell Calls

 

4.12 Multi-purpose Room/Program Room

 

4.13 Open Staff Area

 

4.14 Closed Staff Area

 

4.15 Therapeutic Quiet Rooms

 

4.16 Structured Daily Routine

 

 

5.

MANAGEMENT MODEL AND STAFFING

 

5.1 Management Model

 

5.2 Human Resource Strategy and Staff Roles

 

5.3 Staff Training

 

5.4 Cross-Gender Staffing

 

 

6.

PROGRAM MODEL

 

6.1 Program Philosophy

 

6.2 Dialectical Behaviour Therapy

 

6.3 Psychosocial Rehabilitation

 

6.4 Therapeutic Quiet

 

6.5 Guidelines & Implementation for the Program Model

 

6.6 Program Process

 

6.7 Program Evaluation

 

 

 

 

7.

RELATION of the structured living environment to the rest of the FACILITY

 

7.1 Access to the Mother - Child Program

 

7.2 Access to the Structured Living Environment for Programs by other Women

 

7.3 Peer Support Team Assistance to the Structured Living Environment

 

7.4 Work Placements in the Structured Living Environment

 

7.5 Structured Living Environment Staff and the Rest of the Facility

 

7.6 Relation of the Structured Living Environment to the Community

 

 

8.

CLOSING REMARKS

 

 

9.

Appendices

 

A. Recommendations from Implementing Choices at Regional Facilities: Program Proposals for Women Offenders with Special Needs, Alan Warner, 1998

 

B. Mental Health Problems of Incarcerated Women Compared to those of Women in General

 

C. Women's Mental Health Continuum of Care

 

D. Therapeutic Quiet Guidelines

 

E. Structured Living Environment Intake Referral

 

F. Therapeutic Quiet Time Accountability Form

 

 

10

BIBLIOGRAPHY

 

1 . Background

 

1.1 Development of the Intensive Intervention Strategy

 

Accepted by the federal government in September 1990, Creating Choices , the report of the Task Force on Federally Sentenced Women, made recommendations for a new correctional approach to manage women that is responsive to their unique needs. This approach has led to the creation of four regional facilities and an Aboriginal healing lodge to replace the only federal facility for women in Canada , the Prison for Women.

The Correctional Service of Canada has achieved a major objective in establishing a more equitable and appropriate correctional regime for women in Canada with the opening of regional women's facilities between 1995 to 1997. However, while the new model is appropriate for most women, it became clear that it did not meet the needs of the small group of higher-need, higher-risk women or those with severe mental health problems. Over a two-year period, CSC has developed a long-term accommodation and management strategy, which is aimed at better addressing the needs and risks of the maximum security and mental health women. This new strategy provides safe and secure accommodation for these women while emphasizing intensive staff intervention, programming and treatment. The strategy is divided into two separate components, identified as the Structured Living Environment and Intensive Intervention in a Secure Unit and received Treasury Board approval in April 1999.

 

1.2 Structured Living Environment - Overview

 

The Structured Living Environment (SLE) provides a treatment option for minimum and medium security women with significant cognitive limitations or mental health concerns in order that their needs can be met at the regional facilities. This strategy does not apply to the Okimaw Ohci Healing Lodge.

The Operational Plan describes how this model functions. A companion operational plan for the Intensive Intervention in a Secure Environment (Secure Unit ) addresses the needs of women who require intensive intervention but who also demonstrate through their risk assessments that they require this level of intervention, in a secure environment.

Implementing the SLE strategy requires:

  • The construction of a purpose-built duplex at each of the four regional women's facilities including living space, program space, therapeutic quiet, and staff offices.
  • The hiring and training of an inter-disciplinary team to provide intensive support and specialized correctional, rehabilitation, and mental health programming on a twenty-four hour basis within the house.
  • The provision of additional support services to women living in the general populations. Whenever possible, the SLE will work toward reintegrating women into the general populations or other identified settings that most appropriately meet their needs.

The SLE duplexes are staffed 24-hours a day and have their own program areas (unlike the other housing units). Women are voluntarily placed in the SLE and have minimum or medium security classifications, and have access to the rest of the facility, activities and programs.

Where appropriate, women with special needs who are living in a regular house as well as women who have previously resided in the SLE may benefit from the specialized programming provided through the SLE. Support and administrative services are also shared with the rest of the facility.

 

1.3 Development of the Structured Living Environment

 

Subsequent to Creating Choices, there have been three reports commissioned by CSC to address the concerns of women whose special needs could not at that time, be met by the new regional facilities.

The Whitehall Report

G. C. Whitehall was contracted to provide a report to Correctional Service of Canada on the needs of women who were to be transferred from Prison for Women to Nova Institution. In her report, Mental Health Profile and Intervention Strategy for Atlantic Region Federally Sentenced Women (1995), she considered ten women from the Atlantic Region who were identified as having any combination of: serious emotional problems, serious behaviour management problems, substance abuse problems and/or low intellectual functioning.1 Of these ten women, eight had maximum-security classification and two had medium-security classifications at the time of their assessment. In addition, these women often had incompatibilities with other women in the facility that changed frequently and were based on misunderstandings or personality conflicts rather than historical/street conflicts or the prison code.

Whitehall noted:

It was agreed that six of the identified [women] would benefit by a structured environment, where there is close supervision and a philosophy similar to that of a group home for developmentally impaired adults. For the purposes of this paper, this placement option is called a Structured Living House (SLH). . . Four of them have already experienced group home living before being incarcerated . . . 2

In addition, she noted that special programming was required for the women who would live in the structured living house. This programming would take into account their lower literacy levels and challenges in the area of mental functioning. Whitehall also made recommendations regarding case conferencing, daily activities, behavioural assessments, group treatment programs, leisure and work opportunities.

 

The Rivera Report

Dr. M. Rivera's needs assessment was conducted in 1996, when both Nova Institution and Edmonton Institution for Women had opened but a number of women were still residing in Prison for Women and the Regional Psychiatric Centre, Prairies (neither Joliette Institution nor Grand Valley Institution had opened). She stated in the introduction:

I talked to women prisoners, correctional staff, health care providers, counselors and Elders, and I came to the conclusion that many of them had come to already -- that there were some women whose need for intensive healing intervention was so acute and so pressing that the new facilities, as they are now set up, would not be able to meet those needs, even minimally. In fact, their presence, without appropriate supports, would be likely to endanger the success of these facilities. At least as important a conclusion was that the emotional needs of these women are not being adequately addressed in the operation of the new facilities in a way that mirrors -- or even approaches -- the vision for change that was put forth in "Creating Choices."3

Dr. Rivera went on to make six recommendations. The first recommendation was:

Correctional Service of Canada create a healing facility to house eight women in immediate need of intensive, secure psychological treatment to enable them to deal with the problems that lead to severe self-destructive and destructive behaviour. This is a resource designed to treat non-psychotic women (often labeled borderline personality disorder, and sometimes anti-social personality disorder in psychiatric settings) who understand their difficulties as emotional in origin and therefore wish to access this kind of demanding and intensive healing program. Involvement in the healing program would be voluntary; only those women who acknowledge a need and desire for an intensive and specialized setting of this sort would be likely to benefit from treatment.4

In addition, she identified women with deficits in coping skills, adaptive behaviours, or that have somewhat limited intellectual functioning who may benefit from a SLE. Nova Institution was in the process of creating a SLE when Dr. Rivera was writing her report.

In response to Dr. Rivera's report, an intensive healing program for women was developed and became operational at the Regional Psychiatric Centre in the Prairies in September 1996. In addition, inter-disciplinary mental health treatment staff from the Regional Treatment Centre ( Ontario ) were added to Prison for Women in 1997 to work with women with special needs.

The Warner Report

Dr. Allan Warner was contracted to provide a needs analysis and program proposal for women with special needs in the Atlantic and Ontario regions. His report, Implementing Choices at Regional Facilities: Program Proposals for Women Offenders with Special Needs (1998), is the key document in the development of the Structured Living Environment. Developed within the framework of the Mental Health Strategy for Women Offenders, Dr. Warner outlined nine lessons learned from past experience in the Ontario and Atlantic regions and made 28 recommendations relevant to the creation of Structured Living Environments in the Atlantic and Ontario regions (see Appendix A for the list the recommendations ).5

 

Lessons from Past Experience

Dr. Warner's research involved a review of the literature including the Rivera and Whitehall reports, a review of women's files, and an extensive number of interviews with women, community stakeholders, and staff at Nova Institution, the women's unit at Springhill Institution, Grand Valley Institution, and the Prison for Women. Based on this review, he outlined the following important lessons that must be incorporated into new program proposals:

  • Diverse and incompatible needs : There is a distinctive constellation of needs among women with “special needs” that require distinctive program approaches. Women with different needs can be incompatible in less secure environments, resulting in explosive situations.
  • Relationship issues are paramount : These women have unstable and emotionally charged relationships that make larger group situations very difficult, if not dangerous. Their needs must be addressed through individual and small group interactions, including the ability to separate women from each other.
  • Individualized and intensive learning programs : These women have entrenched and long-term behaviour patterns and change comes slowly through programming, and practice targeted on an individual basis to their learning styles and strengths.
  • Supportive, consistent and "present" staffing : Experiences have been most positive when staff are regularly present with the women in their living environments such that they can establish supportive relationships with them. These women have difficulty establishing supportive relationships with staff if they are not present and have to be sought out.
  • Multi-disciplinary team approach with mental health expertise : Given the complexity of their difficulties, working with these women is extremely difficult and tiring for staff. A diversity of expertise is required, and staff need a team approach to effectively support each other and the individual women. Mental health expertise is essential as well as correctional experience, and staff need on-going training and support. Effective communication among staff is essential or individuals will play staff off against each other.
  • Programs require a distinctive and recognized mandate in a broader institution : Specialized programs require a specialized structure and context that has procedures which depart from those across a broader institution. This must be recognized and agreed to at the outset.
  • Therapeutic quiet behaviour management options are required : Women with limited cognitive ability or those acting (out) due to extreme emotional distress in many instances need short term sanctuary or isolation in a therapeutic context akin to options available in a psychiatric setting, rather than a formal segregation process.
  • The physical facilities must be designed to meet program need : The physical design must follow from the needs of the women and the program structure. The design must also be flexible given that programs and needs are likely to change over time.
  • Stigma and labeling issues must be addressed : There will inevitably be stigma with respect to participation in special programs, and specific measures must be taken to recognize and reduce it.6

Proposals and Recommendations

Based on these lessons learned, Dr. Warner's recommendations included the construction of a duplex housing eight women (four women per side) at each of the two regional facilities.

Dr. Warner specified an inter-disciplinary staff structure for each duplex and proposed two distinct program models. For Nova Institution, he recommended implementing an intensive psychosocial rehabilitation program that would incorporate relevant elements of psychiatric rehabilitation, the clubhouse model, and assertive community living. For Grand Valley Institution, he recommended implementing an intensive dialectical behaviour therapy program for women with emotional distress needs and severe behavioural difficulties.

Dr. Warner's proposals were designed to address many of the challenges identified in earlier programming:

  • The dual rather than single program options recognize the diverse and incompatible needs among those with "special needs" women. Placing diverse populations together in a less secure environment can be potentially explosive and is at minimum non-therapeutic. Women with low-cognitive functioning, for example, are adversely impacted by living with women demonstrating high emotional distress/volatility and self-injurious behaviours. In addition, due to distinctive therapeutic needs different programming options are required.
  • The admission criteria must be clear and each woman must be assessed against these criteria in a formal, written, multi-disciplinary assessment process. Women should only be admitted to the program when they are willing to participate, have a minimum or medium security classification, and have needs that can be specifically addressed by appropriate programming. Adhering to these procedures will help to ensure program integrity, therapeutic benefit, and reduce stigma of those living in the house. Not adhering to these criteria, for example by admitting any woman requiring additional supervision, will undermine the program integrity and will reduce the staff role to crisis intervention rather than treatment delivery or rehabilitation.
  • Having two separate living units with a maximum of four women per unit responds to the very high levels of difficulty these women experience with relationships. Large group situations can be not only difficult but also dangerous when incompatible women can not be separated or relationship demands constantly exceed the women's ability to cope.
  • A multi-disciplinary team with mental health experience is required to provide diverse perspectives, effective programming, and to support each other while working with these high-needs women.
  • The therapeutic quiet option is required to provide short-term sanctuary or isolation in a therapeutic and voluntary context akin to options available in a psychiatric setting for those acting out due to extreme emotional distress. This can meet the needs of women to gain control over themselves and their actions without recourse to the longer-term and more disruptive option of formal segregation in the enhanced unit.
  • A community integration worker is required to build strong relationships with women within the facility and to use this relationship as a bridge to assist these women to become established in the community. Women with special needs require consistent relationships to bridge this transition and to develop individualized plans, including the education and support of community resources.
  • Program evaluation is required for program improvement and accountability.

The main premises of Dr. Warner's report was accepted as the basis for the development of the Structured Living Environments atthe regional facilities.

 


1Whitehall , G.A. (1995). Mental Health Profile and Intervention Strategy for Atlantic Federal Sentenced Women, page 1
2Ibid, page 7
3Rivera, M. (1995). "Giving Us A Change" - Needs Assessment: Mental Resources for Federally Sentenced Women in the Regional Facilities, page 2
4 Ibid, page 2
5Warner, A. (1998). Implementing Choices at Regional Facilities: Program Proposals for Women Offender with Special Needs, pages 36 - 38
6Warner, A. page 24


 

2. Legislation, Policy, and Mandate

The management and operations of the SLE are based on the Corrections and Conditional Release Act ( CCRA), the Mission of the Correctional Service, the principles of Creating Choices, and the Mental Health Strategy for Women Offenders , and the Correctional Program Strategy for Federally Sentenced Women .

 

2.1 Corrections and Conditional Release Act (CCRA)

The foundation for the SLE is found in the Corrections and Conditional Release Act (CCRA). Section 76 states, "the Service shall provide a range of programs designed to address the needs of offenders and contribute to their successful reintegration into the community1. As is outlined in section 77, the CSC is to provide programming to meet the needs of women offenders:

Without limiting the generality of section 76, the Service shall:

  1. provide programs designed particularly to address the needs of female offenders; and
  2. consult regularly about programs for female offenders with:
    • appropriate women's groups, and
    • other appropriate persons and groups with expertise on, and experience in working with, female offenders2

In addition, the need to provide specialized programs to address the needs of Aboriginal offenders is outlined in section 80:

Without limiting the generality of section 76, the Service shall provide programs designed particularly to address the needs of aboriginal offenders.3

Section 88 also specifies that any treatment program (such as the SLE) must be voluntary:

(1) Except as provided by subsection (5):

  1. (a) treatment shall not be given to an inmate, or continued once started, unless the inmate voluntarily gives an informed consent thereto; and
  2. (b) an inmate has the right to refuse treatment or withdraw from treatment at any time.4

 

2.2 Mission of Correctional Service of Canada

In addition, the SLE reflects the Mission document of the CSC and mandates the following:

The Correctional Service of Canada, as part of the criminal justice system and respecting the rule of law, contributes to the protection of society by actively encouraging and assisting offenders to become law-abiding citizens, while exercising reasonable, safe, secure and humane control.5

And in particular,

Core Value 1 : We respect the dignity of individuals, the rights of all members of society, and the potential for human growth and development.

Core Value 2 : We recognize that the offender has the potential to live as a law-abiding citizen .

Core Value 3 : We believe that our strength and our major resource in achieving our objectives is our staff and that human relationships are the cornerstone of our endeavour.6

 

2.3 Creating Choices

Both the Intensive Intervention Strategy and the Mental Health Strategy for Women Offenders are consistent with the goals and vision of Creating Choices: The Report of the Task Force on Federally Sentenced Women (1990). Both are guided by a holistic vision and the same premises identified by the Task Force are important for program effectiveness:

  • Programs are women-centered; that is, they reflect the social realities of women and respond to the individual needs of each woman.
  • One objective of programs is to support the development of self-esteem and autonomy.
  • The element of personal choice, particularly in such areas as health care and nutrition, is critical.
  • Programs must be oriented towards release.
  • Programs must be developed and provided in a culturally sensitive manner.

In addition, the Intensive Intervention Strategy is guided by the five principles of Creating Choices:

  1. Empowerment: Empowerment is the process through which women gain insight into their situation, identify their strengths, and are supported and challenged to take positive action to gain control of their lives.
  2. Meaningful and Responsible Choices: Women need options that allow them to make responsible choices. Dependence on alcohol and/or drugs, men, and government financial assistance has denied women the opportunity and ability to make choices.
  3. Respect and Dignity: Correctional Service of Canada had often been criticized for its tendency to encourage, and therefore perpetuate, dependent and child-like behaviour among women offenders. Mutual respect is needed among offenders, among staff and between the two.
  4. Supportive Environment: The quality of the environment (both physical and emotional) can promote physical and psychological health and personal development.
  5. Shared Responsibility: There is a role to play for all levels of government, corrections, volunteer organizations, businesses, private sector services, and the community in developing support systems and continuity of service for women offenders.7

 

2.4 Mental Health Strategy for Women Offenders

The Mental Health Strategy for Women Offenders (Laishes, 1997) provides the framework for the development of all mental health services for women. It recognizes the relation between some of the mental health problems experienced by women and their early and/or continued experiences of physical, emotional, and sexual abuse. The strategy also describes a continuum of mental health care and the inter-connected nature of all programs and services in support of mental well being for women.

The goal of mental health services for women identified in the Mental Health Strategy is:

To develop and ensure a coordinated continuum of care, structured support and remediation programs which permit women offenders to maximize mental well-being and to minimize criminal recidivism through social, emotional, and cognitive skills development.8

The operations and treatment philosophy for the SLE is also guided by the five key principles outlined in the Mental Health Strategy for Women Offenders:

 

1. Wellness

The principle of wellness refers to promoting wellness rather than "treating pathology." It also implies holistic thinking and programming, avoiding labels, reinforcing personal development and independent living skills, and involving family, Elders, and others in addition to mental health professionals. It recognises the importance of all aspects of women's health and experience (body, mind, spirit and emotions) and their relationships within the facility and community.

  • The SLE focuses on supporting women to develop and use their own skills and strengths and to meet their self-identified needs and goals. Women's needs and goals are considered and supported holistically through an inter-disciplinary team approach that involves the women themselves as well as those who are supporting them (e.g. psychologists, behavioural counsellors, nurses, primary workers, Elders, chaplains, contract program providers, peer support, work placement supervisors, etc.).

 

2. Access

Access refers to providing women with reasonable access to appropriate essential and non-essential mental health services in keeping with community standards.9p.7) This includes early assessments of needs and timely intervention to minimize symptom escalation and prevent acute crisis situations.

  • The SLE provides access to intensive mental health interventions and therapeutic groups in a women-centered community-living environment and increases the availability of specialized therapeutic programming and mental health awareness and services for all women living at the regional facilities. The 24-hour staffing provides timely intervention that may prevent crisis situations and reduce the escalation of symptoms, emotions, and/or problematic behaviours. This support also assists women to maintain their mental well being at higher levels during non-crisis periods.
  • However, there are still limitations to what these environments are able to provide. Due to the small numbers of women with special needs, the diversity and sometimes incompatibility of these needs, fiscal limitations, and the need for program integrity, women may still require transfer to other regions or facilities to maximize treatment options.

 

3. Women- Centered

Programs and services must be designed to meet the specific needs of women and be delivered by personnel sensitive to women and women's issues. Personnel must acknowledge personal autonomy, connection to others, and mutually respectful relationships. When managing problematic behaviours, a women-centered approach would involve a comprehensive inter-disciplinary treatment plan that honors the women's needs, fosters hope and commitment to change, provides for empathic intervention from staff who are consistent in their approach, and also provides positive contingencies.

  • In particular, the SLE policies and programs must reflect an understanding of the impact that trauma and abuse has had on women. It is likely that many if not the majority of the women residing in the SLE have histories of abuse (physical and/or sexual) and therefore the SLE must explicitly acknowledge the need for women to have control over their lives and treatment and take every step possible to avoid the retraumatization of women suffering the effects of abuse.
  • Retraumatization can be triggered by interactions that emphasize power differentials and deprive women of the opportunity to make effective choices. For example, some security procedures that occur within a correctional setting (e.g. lock downs, strip searches, confinement to isolation cells, use of restraints) may cause a woman to feel retraumatized. There are clear areas of conflict between women-centered approaches that focus on empowerment, and the realities of incarceration. However within the SLE, approaches for managing women's problematic or dangerous behaviours must be based on the premise that it is essential to minimize the use of power based strategies to control behaviour (e.g. use of restraints) and maximize women's ability to choose to act differently. Hence, strategies such as verbal negotiations and therapeutic quiet are essential to the development of therapeutic environment.

 

4. Client Participation (a principle of fundamental justice)

Women must play an active role in their treatment including their initial assessment, treatment planning and decision-making. This point can not be over emphasized. Wellness can only be attained through a process of personal growth and a woman's commitment to change: others can not impose it. Traditional hospital settings and correctional facilities that do not acknowledge the need for client participation have an "institutionalizing" effect that disempowers and infantalizes those in their custody. This severely limits women's capacity for successful community reintegration. It also severely limits women's capacity to view themselves as effective, responsible, and capable of creating a life worth living.

  • Both staff and women must adhere to a philosophical approach similar to that, which exists in community-based supported living environments where client participation is a fundamental principle. This mitigates against the deleterious effects of institutionalization. Consistent with this principle, a commitment on the part of the inmates to participate in their own treatment plan and SLE programs must be one criterion for admission.

 

5. Least Restrictive Intervention

Treatment must be based on the least restrictive/intensive form of intervention possible with the lowest level of security requiredto ensure public safety.10

  • Women must be classified as minimum or medium security to be eligible for the SLE program and as such they have access to the rest of the facility as do other minimum and medium security women. However, the SLE has greater static and dynamic security in comparison to the other houses within the regional facilities. Therefore, less intensive intervention than the SLE should always be considered as the first option. In some instances, placing a woman in another house and providing access to SLE programs in addition to ambulatory care services such as counseling or peer support may be a preferable alternative to placement in the SLE. Similarly, women living in the SLE should be reviewed on an ongoing basis to ascertain whether they can move to one of the regular houses with ambulatory programming and support should such an approach continue to meet their needs.

The SLE houses provide the structured and intensive residential support required by some women to enhance their mental well being and increases their social, emotional, and cognitive functioning. In addition, the SLE provides additional ambulatory or intermediate care to women who can live in the general populations with appropriate support.

 

2.5 Correctional Program Strategy for Federally Sentenced Women

The Correctional Program Strategy for Federally Sentenced Women provides the framework for ensuring appropriate programming for women at the most appropriate time in their sentence. Creating Choices identified five principles for change in Correctional Service of Canada's approach to women and these principles lay the foundation for the development of the program strategy.

Additionally the program strategy identifies that programs should be "women centered" meaning that programs must reflect the social realities of women and respond to the individual needs of each woman. This strategy needs to be considered within the framework of the Mental Health Strategy for Women Offender's when developing the program model for the SLE.

The Correctional Program Strategy for Federally Sentenced Women was developed in order to provide program consistency in the new regional facilities for Federally Sentenced Women. It is based on and respects Correctional Service of Canada's Correctional Strategy, yet is flexible enough to recognize and incorporate the needs of women offenders.11

This strategy identifies the four major and often inter-related areas that are characteristics of most women:

 

1. Abuse/Trauma Issues

The high prevalence of violence in the lives of incarcerated women has only very recently been acknowledged. Surveys of women in Canada indicate that the majority of inmates are survivors of abuse and trauma in their families of origin or with their intimatepartners.

Abuse was found to be more widespread in the lives of Aboriginal women and two-thirds of women offenders surveyed indicated that they wanted some type of program or counselling to work through abuse issues.12

 

2. Education and Employment Skills

Women's offences are also linked to women's generally inferior socio-economic circumstances, which often include poverty, racism, and violence. There is considerable agreement on these common characteristics of women offenders: most are poor and lacking in marketableskills; they often demonstrate dependence on welfare, alcohol, and men; and are often single parents, solely responsible for childcare.13

Where applicable vocational programs for women in the SLE must take into consideration the impact of their mental health issues in order to appropriately meet their needs while respecting their limitations.

 

3. Parenting

Many women offenders have tremendous concern over lost custody of one or more of their children and indicated that contact with their children regardless of their age are essential to personal well-being. Programs addressing issues surrounding coping with parenting in prison and parenting from a distance are required, as well as early childhood development for those women who participate in the residential programs for children that are part of facilities.14

 

4. Substance Abuse

Research indicates that women are likely to have a different range and type of problems related to their use of substances than do male offenders. There is accumulating evidence that eating disorders, major affective mood disorders (depression), and a history of abuse, possibly related to post-traumatic stress disorder, are highly prevalent in women with substance abuse disorders. It should be noted that the impact of substance abuse is often worse for women than for men; that the serious physiological ailments caused,for example, by alcohol abuse, may occur with a lower level of consumption or after a shorter abuse history for women than for men.15

The Correctional Program Strategy for Federally Sentenced Women also identifies the common principles and elements for the development and implementation of all programs, regardless of their orientation. The elements include women-centered principles, principles of adult education, diversity, analytical principles, and program structure. These principles are incorporated into the program development for the SLE.

 

3. Who are the Women: Identifying and Understanding their Needs

In identifying the women who access the SLE, there has been recognition that women with problems functioning or special mental health needs have been previously grouped together both in research and planning (Rivera, 1996; Whiteall, 1995) and in the facilities in which they have been housed.

Dr. Warner identified in his report the "Constellation of Special Needs" to provide a foundation from which to group needs and develop programming proposals ( Earl, 1998 ). Specifically, in terms of a visual explanation there are three constellations of special needs groups each represented by a circle which overlap each other to produce what mathematicians label a venn diagram 16 (see 3.1). In particular, one circle of special needs is characterized by women who have challenged or borderline intellectual functioning and a deficiency of basic life skills, a second constellation of needs involves those with particular or more severe or intense emotional problems relating to either extreme and persistent distress and/or a major mental illness, and a third set of needs describes those with a high level of distrustful attitudes and anti-social behaviour. While some women may be categorized as having needs primarily in one sphere, others may fall in an overlapping area representing two, or even all three areas.17(p. 25)

 

3.1 Figure 1: Constellations of Special Needs Among Federally Sentenced Women

Constellations of Special Needs Among Federally Sentenced Women

 

3.2 Needs Analysis

A needs analysis of the women population identified as meeting the parameters of the Intensive Intervention Strategy was conducted in October 1999. This needs analysis was built on the previous research reports completed by Dr. Alan Warner, Dr. Donna McDonagh, and Sky Blue Morin.

The following describes the population for whom the needs analysis was completed. There were four c riteria for inclusion:

  • Those classified maximum security.
  • Those housed in a mental-health unit or a treatment centre (for example, Regional Psychiatric Centre - Prairies, or special needs unit of the Prison for Women).
  • Those who had maximum-security classifications within the last calendar year.
  • Those not housed in a mental-health unit but having significant mental health problems and/or living-skills deficits who need considerable additional support and intervention. This would include women functioning in main population with assistance.

The criteria are inclusive, that is, not all of these women require intensive intervention; many were functioning at the regional facilities with additional support or in the case of many formerly max women with little additional intervention. Women's needs for support and supervision change and it is important to understand the range of needs in planning for continuity of care, and reintegration.

For data collection and analysis purposes, the sub-groups were identified as:

  • Maximum Security (Max).
  • Max Special Needs (MaxSN).
  • Special Needs - Treatment Center (SN-Tx).
  • Special Needs - Non-treatment Centers (SN -NonTx).

 

3.3 Constellation of Needs by Sub-Groups

The constellation of needs was identified as having three major sub-groups: serious mental illness, personality disorder and cognitive difficulties. As well, all possible combinations of the three major sub-groups were looked at.18

Constellation of Needs by Sub-Groups

The findings of this analysis identified several areas of concern and include the following issues:

  • Substance abuse.
  • Suicidal behaviour.
  • Self-injurious behaviour.
  • Assaultive behaviour.
  • Institutional adjustment difficulties.
  • Difficulties with interpersonal skills.
  • Difficulties with daily living skills.

These findings also support studies relied in the Mental Health Strategy for Women Offenders (Laishes) which indicated that incarcerated women have a much higher incidents of a history of childhood sexual abuse and a history of severe physical abuse that of women in the general population.19 (See Appendix B - Mental Health Problems of Incarcerated Women Compared to those of Women in General Population.)

Additionally the needs analysis identified areas to concentrate on with respect to mental health issues, treatment needs, programming, issues surrounding supervision and support, segregation, community contact, and the need for appropriate staff training.

This information was used in the development of the Intensive Intervention Strategy and the subsequent program model for the SLE.

 


1Corrections and Conditional Release Act, page 36
2 Ibid, page 37
3 Ibid, page 38
4 Ibid, pages 41 - 42
5 Correctional Service of Canada . Mission Statement
6 Ibid.
7 Correctional Service of Canada . Creating Choices, page 128 - 135
8 Laishes, J. (1997). Mental Health Strategy for Women Offenders, page 6
9 Laishes, J. page 7
10 Laishes, J. , page 8
11 Correctional Service of Canada . Correctional Program Strategy for Federally Sentenced Women
12 Ibid.
13 Correctional Service of Canada . Correctional Program Strategy for Federally Sentenced Women
14 Ibid.
15 Correctional Service of Canada . Correctional Program Strategy for Federally Sentenced Women
16 Warner, A. Page 24
17 Ibid, page 25
18 McDonagh, D. (October 1999). Presentation at the National Implementation Meeting.
19 Laishes, J. , Page 2


 

4. Physical Environment and Operations of the Unit

The concept for the design for the SLE was initially developed in the Atlantic region based on some preliminary work they were doing to address the concerns of women identified with special needs. It was further refined in Dr. Warner's report and resulted in the basic design that has been approved for the four regional facilities.

The SLE house is residential in appearance mirroring the appearance of the other living units. Each side of the duplex contains four bedrooms, a kitchen, and a living/dining area, den, washrooms, and an open staff area. There is a multi-purpose program room, individual staff offices, and therapeutic quiet rooms. The therapeutic quiet is shared and accessible from each living unit.

The design maximizes the opportunity for staff interaction with women and observation of activities in the common areas. The provision of two small rather than one large living area allows for the separation of incompatibles and reduces the demands on women to manage multiple relationships (an area of difficulty for many of the women who may live in the house).

As the women accommodated in the SLE have minimum or medium security classification, they have access to and are encouraged to use the programs and physical spaces available in the rest of the facility. These include such areas as the chapel, sweat lodge, health care, the gym, private family visit house, visiting area, programs, work sites, social and craft activities. This will assist in reducing the stigma attached to mental health problems, allow more effective use of space, and allow more freedom for women accommodated in the SLE.

The following outlines the relationship between the physical structure of the SLE and how it is operationalized. As indicated above, its design reflects the concepts discussed in The Warner Report for implementation at the regional facilities. The SLE provides a treatment option for medium and minimum security women with significant cognitive limitations or mental health concerns. The design promotes the establishment of therapeutic environment that stresses a strong staff presence and an environment conducive to maximizing the program model of the SLE.

 

4.1 Capacity

Each of the four regional facilities has an eight-bed, one-story duplex, with each side accommodating a maximum of four women. Each half of the duplex has a patio or outside sitting area surrounded by a small hedge or similar landscaping. The house blends with the appearance of the facility overall. This area can be utilized as a quiet space option while maintaining reasonable ability for staff to physically monitor the setting.

 

4.2 Interior

The SLE house is residential in appearance, mirroring the appearance of the other living units, and is constructed to reduce sound transmission as much as possible. Each side of the duplex contains four bedrooms, a kitchen, a living/dining area, den, washrooms, and an open staff area. There is a multi-purpose program room, separate staff office, and therapeutic quiet rooms. These are shared and accessible from each living unit.

The design maximizes the opportunity for staff interaction with the women and allows observation of activities in the common areas. The provision of two small rather than one large living area allows for the separation of incompatibles and the ability to deliver separate programs, and reduces the demands on women to manage multiple relationships (an area of difficulty for many of the women who may live in the house).

As in the existing houses, the women are responsible for their own cooking, laundry, and cleaning (although these activities are assisted or supervised by staff when required).

Each side of the duplex has a front door that opens to a vestibule. From the vestibule a person enters either the living area (unlocked door) or the hall for the shared staff offices and therapeutic quiet rooms (locked door to allow staff control of entrance). If the door to the living area is open, a buzzer sounds to notify both the women and staff that someone has entered or left the living area. A person can also enter the staff offices and therapeutic quiet area by first entering the living area and then using the door from the living area to the offices/therapeutic quiet (locked door to maintain staff control of entrance). This design ensures that the staff offices and therapeutic quiet rooms can be easily accessed from the living area as needed by staff, or women accompanied by staff, while still allowing staff to physically monitor the area.

A separate entry point to the office minimizes the disruption to the women in the living unit since traffic to and from the therapeutic quiet area need not move through the living area (e.g. if the woman's behaviour escalates or if she is removed to segregation). This helps maintain the residential quality of the living space. Operational routines for the house set out specific direction for accessing these areas.

 

4.3 House Phone

The telephone for the use of the women is located either against the central wall at the end of the hallway in the bedroom area or across from the central open staff area. While the phone located at the end of the hallway is not centrally located, staff are able to monitor telephone conversations when conducting rounds or as necessary. A further phone line - phone jack should be installed in the den in order to meet the needs of women requiring a private place to use the phone, i.e. lawyers calls. This phone can be controlled by staff and can be kept in the staff office when not in use.

Additionally private telephone calls can be facilitated in staff office area's as required.

 

4.4 Back Door

The back door of the house is an emergency exit only and cannot be used by either staff or women. The door is controlled by staff and a key is required to unlock the door at all times.

 

4.5 Living Room/Dining Area

The living room/dining area is a residential style common area with natural light. It is easily viewed from the adjacent open staff area. Furnishings closely resemble that of the other houses while recognizing that acting-out behaviour by some women may occur.

To ensure the security of staff and women in the SLE, all staff entering the house are responsible to notify the house staff on duty when they enter and exit living or staff areas. If the staff choose to enter the staff offices at the front of the house, without first entering the living unit, they should notify the staff on duty of their presence via a telephone call to the open staff area.

 

4.6 Kitchen

Women are expected to prepare their own meals and use the kitchen in the SLE. It is large enough to accommodate hands-on training or assistance from staff in meal preparation as required. The dining area is easily viewed from the open staff area. The kitchen area can be viewed by physically entering the area. The kitchen work area has doors that can be locked if necessary while the kitchen is not in use. In addition, cabinets/drawers may have the ability to be locked to restrict access to them should issues arise in this area. This should be assessed on an individual basis and locking of cupboards should only take place if a hazardous or dangerous situation develops.

Decisions regarding access to the kitchen should balance the need for safety with placing the least restrictions on women in the SLE. These policies need to be flexible enough to respond to the changing needs/behaviours of the women in the house (i.e. more restrictions may be required when there are more acting out behaviours and fewer restrictions when women demonstrate more behavioural control). All policies should be thoroughly discussed with the women as it is critical to ensure understanding and consistency in the application of the policy.

 

4.7 Den

The den is a small multi-purpose room with natural light separated from the main living area. It has a door to reduce sound transmission. The upper half of one wall is a double-glazed window with enclosed lever blinds such that the room can be easily observed from the hall and the open staff area but not the main living area. It can be used for women to meet with the Chaplain/Elder, volunteers, staff or peer support persons (e.g. one-to-one check-ins, counseling, coaching or skills training). It also provides one of several quiet options for women who wish to remove themselves from the main living area when they are feeling stressed or overwhelmed. However house routines should dictate the number and period of time women are allowed to be in the room together.

 

4.8 Washrooms

There is an accessible two-piece washroom with sink and toilet as well as an accessible shower/tub room. Each room is large enough to accommodate a staff member in addition to the woman, so that women (if required) can receive assistance in maintaining their personalhygiene and learning basic self-care skills.

 

4.9 Laundry Room

There is a laundry area and locked storage area for cleaning supplies. The cleaning supplies are locked in the supply room when not in use (so that they are not available for self-harm or inappropriate use).

 

4.10 Bedrooms

The bedrooms are for women's private use: sleeping, dressing, relaxation, and homework. The furnishings and lighting are built-in to reduce possible damage during acting-out behaviours or the use of the items for self-harm. Closets have breakaway fixtures for suicide prevention. Each room has an external window for natural light that can be opened to permit air circulation but not to allow women to exit. The windows are made of a non-breakable glass so that women cannot self-injure should they try to break the window. The bedroom doors have windows with external curtains. The doors can be locked from the outside in an emergency (bolt locks controlled by staff keys). The rooms are equipped with cell calls to the main staff area. Each woman has a key to her room as in the other houses.

Given the volatility of some of the women who may be living in the SLE, crisis situations may occur more frequently than in the general population. The bedroom doors are capable of being locked by staff during crisis situations to contain and control the crisis. The bedrooms are not equipped with washroom facilities. (As such, they are not appropriate for routine or extended lock-down.)

Caution should be exercised when using this measure as lock-down has the potential to increase women's feelings of powerlessness and lack of control and tends to escalate problems such as self-injury. It may also under mind attempts to reinforce women taking control and responsibility over themselves and their actions. If there are grounds to believe that the woman or a group of women in the house pose a significant security risk then the woman or group of women should be reviewed for removal from the house and placed in a more structured environment.

 

4.11 Cell Calls

The cell call system is available in each bedroom and the therapeutic quiet rooms and function on a 24-hour basis.

The cell call alarm system has a mechanism to alarm in the main control centre panel if the alarm is not answered in a specific time period (e.g. three minutes). The call can be forwarded to the facilities central security control area.

 

4.12 Multi-purpose Room/Program Room

The program room is a multi-purpose room and includes a boardroom table, a sink and cabinets for storage. The cabinet doors have locks to maintain security of items in this area. This room can accommodate inter-disciplinary team meetings, specialized or core group programming, social events, and leisure activities (e.g. arts and crafts).The program room is accessible via doors from each side of the duplex. These doors can be locked as required. In addition, the upper half of the wall nearest to the open staff area is a doubled glazed window with enclosed lever blinds controlled by staff. This allows the program room to be observable from the open staff area on an as needed basis.

Primarily the women living in the house and house staff use this room. As well women receiving ambulatory care services who are participating in specialized SLE programming have access to this area.

However, women should be encouraged to move to the den in the main living area to engage in counselling/discussion when a smaller area is needed. Access to a desk or writing area is available in the program room, should a woman wish to work on a homework assignment. However, homework assignments can also be worked on in other areas of the duplex such as a bedroom or the den and women should be encouraged to move to these areas.

 

4.13 Open Staff Area

The SLE staff are expected to spend the majority of their time working directly with women in the program and living areas however have a work station in order to complete written work. The centrally located staff work station is equipped with a chair, telephone, computer, and counter/half-wall for any staff on duty that are not actively involved with the women in the house.

Located behind the open office area is a smaller enclosed office that may accommodate the Offender Management System hook up, camera monitors, outside phone lines, and cell call system. Additionally a key safe and locked filing cabinets can be made available in this area as required. The door to this area has the ability to be locked in order to provide a secure area for such items identified above.

The open staff areas of the duplex are connected by a lockable door. This allows staff to move from one side of the duplex to the other with free egress as part of their normal routine while working or as may be required in a crisis. The door also maintains the separateness of the two living areas. In addition, the upper half of the wall separating the two open staff areas is a double-glazed window with enclosed lever blinds to allow for visual contact between the two units/staff areas as required.

 

4.14 Closed Staff Area

The closed staff offices are located at the front of the duplex and are accessible from each living area and from the front vestibule of each side of the duplex. Staff are responsible to control access to this area. The offices can be used by the Team Leader, and Psychologist and shared among the members of the inter-disciplinary team and contract personnel. The offices are equipped with standard office furnishings. There is an accessible washroom for staff use. One of the offices has one set of monitors for the cameras used in the therapeutic quiet rooms.

 

4.15 Therapeutic Quiet Rooms

The purpose of the room is to provide a space that is quiet and secluded. It is a safe place where staff can remove the women or the women can remove themselves from over-stimulation and conflict and assist them in managing difficult emotions and/or acting-out behaviours. The therapeutic quiet room is located in the staff office area and is not in view of the staff working in the living area. The therapeutic quiet room is not to be used for counselling space and staff interaction should be minimized given the time is strictly for therapeutic quiet.

The use of the therapeutic quiet room is at the direction of the inter-disciplinary team or the woman herself. Nevertheless the room is usually unlocked while in use, however based on individual risk assessment and at the discretion of the inter-disciplinary team the door to the therapeutic quiet room may be locked. Given that there may be times when the woman in the room may be distressed and may act impulsively and/or destructively, there is the physical capacity to ensure that women using the therapeutic quiet room remain in the room until they are able to manage their behaviour appropriately or until an alternative option is arranged. The specific guidelines for the use of Therapeutic Quiet are attached as Appendix D and are discussed in the program model section of the Operational Plan.

There is an accessible washroom for the woman to use directly across from the Therapeutic Quiet room so that she does not have to return to the main living area to use these facilities.

The Therapeutic Quiet room is located away from the main living area as it is to function as a refuge, and in a quiet place to manage difficult emotions or acting out behaviours. As such it is located on the outside wall of the enclosed staff area.

The room has an external window to provide natural light. However, as the Therapeutic Quiet room is located at the front of the building, it does not allow for visual contact between the woman inside the room and those outside the house. This is achieved by using blocked glass for the external window.

This room should look therapeutic (calming, pleasant colour, with natural light) however has minimal furnishings in order to reduce the potential for self-injury, or suicide. The room contains a bed or easy chair, a desk, and a desk chair. Larger furniture such as the bed are to be built in or bolted to the floor so the woman cannot be used to barricade the room.

The door has a window to allow staff to do periodic visual checks on the woman while she is in Therapeutic Quiet. A curtain can be placed on the outside of the window for added privacy. As the room is located away from the main staff area and the rest of the living unit, a camera may at times be required to ensure the safety of the woman. A camera is installed in the Therapeutic Quiet room. Staff working in the SLE are responsible to determine if the camera is to be used however the woman is to be informed any time that the camera is turned on. The camera can also be utilized when staff believe that the woman is at risk to harming herself or others and or at the woman's request.

The camera monitors can be located in four areas; a closed office area located at the back of the SLE; the enclosed office area located at the back of the open office area, the counter in the open office area and the main central control panel. The monitor located in the main central control panel is only to be used in the event of an emergency, i.e. a crisis in the house, which prevents staff from being able to watch the monitor.

 

4.16 Structured Daily Routine

The chart below reflects the concept of a structured daily routine within the SLE. (Please note the institutional counts are conducted in accordance with policy and operational routines of the institution.)

 

ACTIVITY

DESCRIPTION/COMMENTS

Morning daily care

 

Wake up; breakfast; shower, etc.

Shift change /staff briefing

Personal time for the women

Morning house meeting

Group check-in; preparation for the day

Programming block based on individual needs/treatment goals outlined in the treatment plan

This blocks includes employment, programs, counseling sessions, tutoring, meet with/work with the Elder/Chaplain - Behavioural Counselor - Clinical Nurse case management, leisure, recreation, meeting with volunteers, personal time

Lunch / count

 

Programming block

As above

Shift change/staff briefing

Personal time for the women

Dinner/count

 

Programming/Leisure block

As above

Nightly house meeting

Check-in before bed

Shift change/staff briefing

 

Other activities:

Weekends: Structured leisure activities are recommended. This can include social activities, institutional activities; activities the women in the house organize for themselves; homework etc.

House Meetings: House meetings must be scheduled once per week. The goal is to discuss house issues. This meeting is separatefrom the group check-in.

Group Check- in: This is a daily requirement as part of the therapeutic milieu of the house and is an essential componentof the program. Issue surrounding programs and individual needs are addressed during this time.

 

5. Management Model and Staffing

 

5.1 Management Model

As evidenced by the human resources strategy and identified throughout Dr. Warner's report a strong supportive staff presence in the SLE is considered essential in meeting the needs of the women and staff and ensuring overall program effectiveness.

Dr. Warner recommended:

Supportive, Consistent and "Present" Staffing

In his review of experiences in penitentiaries in Atlantic Canada and Ontario Dr. Warner observed that:

Experiences have been most positive when staff are regularly present with the women in their living environments such that they can establish supportive relationships with them. These women have difficulty establishing supportive relationships with staff if they are not present and have to be sought out.1

The SLE has a 24-hour staff presence and initiates supportive interactions with the women. In addition, every effort should be made to reduce the change over of staff working in the house both to minimize the number of relationships that the women must cope with and to ensure that the women and staff develop strong, supportive relationships. In addition, the SLE staff receive specialized training to work in the house. A special roster for the SLE managed by a Team Leader is required.

Dr. Warner further recommended that a multi disciplinary team approach be implemented in the SLE:

Given the complexity of their difficulties, working with these women is extremely difficult and tiring for staff. A diversity of expertise is required and staff requires a team approach to effectively support each other and the individual women. Mental health expertise is essential as well as correctional experience, and staff needs on-going training and support. Effective communication among staff is essential or individuals will play staff off against each other.2

A very effective approach that utilizes the perspectives of multiple disciplines is the inter-disciplinary approach.

 

Inter-disciplinary Treatment Team Approach

The inter-disciplinary team approach is defined as a method of individual evaluation, planning, and program implementation in which the team is composed of individual members of different disciplines and all staff meet to plan and coordinate a wide range of services. The team work can be characterized by shared purpose and creativity in problem solving, with the end result being greater than the sum of the individual disciplines' treatment interventions. Most importantly, interdisciplinary planning is focused on the goals of the client rather than on the discipline specific services. These services are tailored to fit the individual's vocational and quality of life goals, cutting across all disciplines .

It is these characteristics that led to the adoption of the inter-disciplinary team approach as the model for implementation within the SLE. This approach captures the philosophical ideations and principles of the fundamental treatment initiatives of both Dialectical Behaviour Therapy and Psychosocial Rehabilitation. The inter-disciplinary team philosophy promotes a client-centered approach that involves the woman in the treatment planning process. In addition it encourages the utilization of all staff as valuable members of the treatment team.

Inter-Disciplinary Team Meetings and Communication

The development of balanced and consistent approaches to behavioural problems is a very difficult task requiring multiple perspectives and a high level of communication among staff. Formal inter-disciplinary team meetings must be held weekly to discuss the progress of the women in the program and to serve as a means to coordinate efforts and work on projects in smaller groupings. The meetings should involve all of the key staff members in the program including the Team Leader, Psychologist, Clinical Nurse, Community Integration Worker, as many Behavioural Counselors and Primary Workers as possible, and as many other staff as is possible who are relevant to the current work. Detailed minutes of these meetings must be maintained and shared with other staff in the facility. This increases communications and heighten understanding of the SLE.

DBT Treatment Team Consultation

Treatment Team Consultation Meetings are an integral part of Dialectical Behaviour Therapy (DBT). These meetings are distinct from the inter-disciplinary team meetings discussed above and need to happen separately.

The main purpose for these consultation meetings is to enhance the skills, capabilities and motivation of all DBT service providers and to keep members of the treatment team within the DBT treatment framework. It is recognized that working with the DBT client group is stressful, change is often slow, and members of the treatment team often endure extreme behaviour and verbal abuse. This population also may promote the feelings of ineffectiveness in service providers, service providers may become extreme in their thinking, blame the inmate, blame themselves, blame the therapy, and may not be open to feedback from others. The consultation meetings provide the opportunity for the team to share their thoughts, feelings, concerns within a general framework of staying on-track with DBT philosophy and treatment.

These consultations should occur once a week. As well, individual consultations may occur within the context of clinical supervision.

The four main objectives of these consultations are:

  • Discussion of one particular case. (This is not case conferencing per se -- that is done in the Inter-Disciplinary Team Meetings; rather the focus is on the application of treatment concepts and to provide ongoing education on DBT applications.).
  • Keep Treatment Team Agreements.
  • Cheerleading.
  • Promotes a Dialectical Balance.

 

5.2 Human Resources Strategy and Staff Roles

The Human Resources Strategy is developed for the Intensive Intervention Strategy is separated into two reports. The first report is titled, Human Resources Plan for the Intensive Intervention Strategy for Women Offenders Part A: Staffing Plan. This report references the background, timelines, staffing, work descriptions, Treasury Board Submissions, and relevant staffing issues.

Job descriptions have been completed for each indeterminate position, and can be accessed for reference via UCS job descriptions.

 

5.3 Staff Training

The companion document for the Human Resources Strategy is titled Intensive Intervention Strategy for Women Offenders Part B: Staff Training Plan. The report references essential staff training requirements.

 

5.4 Cross-Gender Staffing

Although the National Protocol - Frontline Staffing was developed prior to the implementation of the SLE, the same principles apply. Questions regarding cross-gender staffing must be considered within the context and principles of the protocol with specific attention to the issues, which may occur on a more regular basis in the SLE.

 

6. Program Model

 

6.1 Program Philosophy

While Dr. Warner's report recommended that each house choose a particular therapeutic intervention, (i.e. Psychosocial Rehabilitation or Dialectical Behaviour Therapy), the steering committee assessed the priorities at each facility against all reports and the completed needs analyses and recommended that both programs be available at each facility.

Specifically, the program philosophy for the SLE is based on the establishment of a therapeutic environment that adheres to and demonstrates the principles of good clinical practices and high quality care within a treatment environment.

The idea of a therapeutic environment developed from a desire to counteract the negative effects of institutional settings or of negative institutional values and beliefs. The concept has become widely accepted as a progressive perspective underlying programs for persons with mental illness. Quite simply the environment is used as an intervention technique. The goal of the therapeutic environment is the development and/or enhancement of emotional, interpersonal and practical skills to assist the women in the process of daily living.

The women share different parts of themselves with different people and the therapeutic environment allows these individual differences to express themselves. It is not limited to staff and the women but involves family, physical environment, treatment team philosophies, as well as a sharing of power.

The attitudes of staff toward the idea of creating and maintaining a therapeutic environment are paramount to its success. Key components include establishing effective therapeutic alliances and maintaining appropriate therapeutic boundaries. Toward this end, clinical judgment and good clinical practice should be the foundation of every decision. Every interaction provides the opportunity for teachable moments.

Overall, the SLE operates as a therapeutic environment incorporating the principles and practices of Dialectical Behaviour Therapy and Psychosocial Rehabilitation. The emphasis on interaction and treatment present unique opportunities for the application of behavioural contingencies, vicarious learning, and high quality care through effective rapport and consistency. Additionally within this framework, complimentary and/or core programs may be delivered. Although some revision to existing program process and content is required in order to maximize treatment responsivity, it is not necessary to deliver all programs within the SLE. Program participation within the regional facility is available as identified and required according to the woman's individual plan. While Dialectical Behaviour Therapy and Psychosocial Rehabilitation intervention strategies are discussed in detail below they are addressed in greater detail in the specialized training that is provided to staff working in the SLE.

 

6.2 Dialectical Behaviour Therapy

Dialectical behaviour therapy is a comprehensive psycho-therapeutic approach suitable for individuals with high emotional distress needs exhibiting a combination of difficulties characterized by self-destructive and/or suicidal behaviour, emotional dysregulation, severe interpersonal relationship problems, unstable and low self-image, and cognitive disturbances and distortions. It is a treatment whose efficacy has been well established for use with individuals diagnosed with borderline personalality disorders. (Linehan, 1993). The Dialectical Behaviour Therapy model has been applied in forensic settings and appears to offer the most promise of available approaches for work with these women.

Dialectical Behaviour Therapy offers a systematic approach to working with individuals who, as stated above, have serious difficulties with emotional distress and vulnerability. Often these are individuals who have:

  • High sensitivity (immediate reactions; low threshold for emotional reaction);
  • High reactivity (extreme reactions; high arousal state impeded thought processes); and
  • Slow return to baseline (long-lasting reactions; contributes to high sensitivity to next emotional event).

Philosophical Traditions

The Dialectical Behaviour Therapy approach is rooted in four philosophical and therapeutic traditions:

  1. Cognitive-behavioural approaches;
  2. Humanist relationship approaches;
  3. Biosocial theory of personality functioning; and
  4. Dialectical theory.

 

6.3 Psychosocial Rehabilitation

Psychiatric Rehabilitation, also known as Psychosocial Rehabilitation is a comprehensive strategy for meeting the needs of persons with severe and persistent mental illness. A true understanding of Psychosocial Rehabilitation starts with an awareness and sensitivity to the personal experience of severe and persistent mental illness.

Psychosocial Rehabilitation has its conceptual roots in a response to the failure of the mental health system to assist disabled clients in coping with the psychosocial devastation brought on by severe mental or emotional illness, severe behavioural problems, and traditional treatment methods, (i.e. institutionalization and medication, Nel, 1994). Women with basic needs and cognitive challenges in federal facilities have similar characteristic, backgrounds, and histories of institutionalization. Their successful return to the community is halted by:

  • their limited resources, skills and supports;
  • their isolation, sense of hopelessness, and despair brought on by institutionalization;
  • their deviant behaviour patterns learned through institutionalization;
  • their loss of community living opportunities and supports that accompanied institutionalization.3

The Psychosocial Rehabilitation approach is the most appropriate and potentially effective programming model for individuals with basic skill needs and cognitive challenges such that they can reside in the least restrictive environment in a regional facility. The approach must be adapted to the regional penitentiary setting by staff trained in the Psychosocial Rehabilitation approach. 4

The Correctional Program Strategy identified core programs essential to women's programming.

They are identified as:

  • Substance abuse;
  • Life Skills Programs (include anger management, cognitive skills);
  • Survivors of abuse in trauma (skill focus in SLE); and
  • Education and literacy.

These programs are offered to women as needed/required.

Beyond the above programs, complementary programs, (i.e. art therapy, leisure, etc.), that are consistent with the woman's needs and her treatment plan are offered as required.

Additionally the SLE also incorporates other elements essential to the delivery of mental health services consistent with the Women's Mental Health Continuum of Care (Appendix C) and the woman's individual treatment plan.

It is important to note that Dr. Warner agreed in principle with the concept of a strong therapeutic environment grounded in good clinical practice that respects program integrity, provides high quality care in a treatment environment that incorporates the psychosocial rehabilitation and dialectical behaviour therapy principles and practices, and is subject to evaluation.

 

6.4 Therapeutic Quiet

The need for a continuum of quiet options for women living in the SLE has been identified as an essential element of the program model.

These quiet options are considered a key element of behaviour management in working with individual women in order to improve their coping and problem-solving skills with respect to specific stresses. The women require a continuum of options through which they can take steps to control their behaviour and/or ask for help from staff. There must be space to "get away" within the setting when they are under stress. Dr. Warner identified these options as:

  1. enabling their bedroom to be a relaxing spot through their ability to decorate and control its appearance, and by insulating it from sound from the rest of the setting.
  2. establishment of an outdoor quiet spot behind each side of the duplex where a woman can relax.
  3. provision of a den/quiet spot in the setting as an alternative refuge which is attractively furnished, well lighted, and insulated for sound.
  4. provision of a therapeutic quiet, a safe room which can be locked and viewed by camera. A woman should be able to ask to enter therapeutic quiet for her own safety, or she may be placed there for her own safety by staff according to specific policies and procedures.5

Further Dr. Warner provided the following comments specific to therapeutic quiet:

Therapeutic quiet is an essential element of the duplex design and must be regulated by specific procedures developed for the setting. Women with cognitive challenges may lose control of their behaviour and/or act out that they require short-term, externally locked control and clear consequences; be it for a few minutes or a few hours. However, lengthy isolation is counter-productive as the offender loses focus on why she is isolated and she may become more desperate, hopeless, and dependent. Invoking segregation is often inappropriate for the circumstances and yet a brief therapeutic quiet option is required if it is to be avoided. Segregation always does exist as a last resort but one would not expect to use it, and if it was used with some frequency for an individual, staff would have to question the effectiveness of the program for this woman. The psychologist should work with the staff team in consultation with the institutional administration to define specific written procedures for the use of therapeutic quiet. For experienced correctional staff unfamiliar with the use of therapeutic quiet, there may be a perceived risk in using it in instances where the staff might have formerly relied on segregation. It is important to train staff to use therapeutic quiet.6

Dr. Warner recommended:

Therapeutic quiet must be an essential element of the duplex design through which women can better manage stressful situations, and through which they can be secured when a danger to themselves. Specific written procedures must be developed to monitor its use. Staff must be trained in its use. Medication may also be a useful tool to assist women in stressful situations but its use requires stringent monitoring and written procedures.7

The exact nature of its use depends on the specific and changing needs of the women in the house and the nature of the programming (psychosocial rehabilitation or dialectical behaviour therapy). However , the house is not the place for a woman to be completely out of control.

If soft restraints are necessary they must be used elsewhere . (Contingency plans should be in place should a woman become out of control in the house.)

Given the use of Therapeutic Quiet is for treatment purposes and completely voluntary force will not be used to place a woman in Therapeutic Quiet .

While Therapeutic Quiet is to be used with women to cope with specific stresses and to control their behaviour, it should not be used for women who are suicidal or imminently self-injurious.

To that end, a specific procedure (Appendix D) has been developed surrounding the use of Therapeutic Quiet. Additionally, a therapeutic quiet accountability checklist (Appendix E) for staff use has been developed.

 

6.5 Guidelines and Implementation of the Program Model

Based on the program philosophy identified above the following guidelines have been developed for implementation of the program model within the SLE.

Treatment Targets

It is important that treatment gains are identified in order to provide feedback to program participants and staff as well as informing managers of issues to revise. A brief list of potential treatment targets is included below:

a. Areas of Strength to Improve :

  • Coping skills
  • Daily living skills
  • Communication skills
  • Symptom management
  • Motivation
  • Treatment readiness
  • Program participation
  • Problem solving abilities
  • Self esteem
  • Socialization

b. Areas of Need to Manage:

  • Therapy interfering behaviour (dialectical behaviour therapy specific)
  • Unit destructive behaviour (dialectical behaviour therapy specific)
  • Self-injurious behaviour
  • Institutional adjustment problems
  • Aggression
  • Assaultive behaviour
  • Institutional charges
  • Interpersonal relationship difficulties
  • Polypharmacy
  • Need for increased staff supervision
  • Need for protection
  • Use of segregation
  • Institutionalization
  • Antisocial peer involvement

Matching the needs of individuals with the appropriate program goals and structure is essential to success and must be adhered to ensure program effectiveness and to avoid further disabling the woman.

Admission and Discharge Process

Placement in the SLE is the responsibility of the Coordinated Care Committee . This is discussed in detail under the program process section of this report. With respect to the admission criteria the following list has been developed consistent with the needs analysis and constellation of needs. The admission criteria for the SLE has been divided into five areas:

 

1. Suicidal vs. Para-Suicidal Behaviour

Potential indicators:

  • Lethality
  • Frequency
  • History - chronic and acute

 

2. Adjustment Problems (related to mental health difficulties)

Potential indicators:

  • Major/minor charges
  • Interpersonal problems - need for protection
  • Rule violations
  • Level of staff intervention
  • Failure to follow correctional plan

 

3. Communications/Life Skills/Activities of Daily Living

Potential indicators:

  • Personal care, problem solving, communication skills
  • Interpersonal skills
  • Demand upon staff resources

 

4. Mental Health/Symptom Management/Cognitive Ability

Potential indicators:

  • Intellectual ability
  • Anxiety
  • Depression
  • Psychosis

 

5. Externalization Factors

Potential indicators:

  • Dysregulation - external and internal
  • Inability to tolerate distress
  • Assaultive behaviour
  • Verbally abusive behaviour
  • Aggression

 

Admission Criteria General

  • Reintegration
  • Assessment must be completed
  • No after-hours admissions
  • Assess hidden agendas
  • Commitment/motivation for treatment
  • Once admitted an update of the correctional plan progress report must be completed
  • Impact on others already in house

Along with the admission criteria to the SLE there is the need for both discharge criteria and exclusion criteria. Flexibility for admission may be exercised by the Co-ordinated Care Committee.

 

Discharge Criteria

  • Non-compliance with correctional plan
  • Trafficking in drugs/ongoing drug abuse/alcohol abuse
  • Individualized treatment plan progress
  • Intimate relationships with women in SLE treatment program
  • Acute substance intoxication requiring detox

 

Exclusion Criteria

  • Maximum security
  • Relationship with a client in the SLE (qualifier)
  • Acute or crisis phase (i.e. psychotic or actively slashing)
  • Acute substance intoxication requiring detox

 

Discharge Process

As there is a formal admission process for the SLE so must there be a formal discharge process under the auspices of the Coordinated Care Committee. Upon discharge a formal discharge report must be completed on each woman.

 

Assessment and Treatment Plan

It is a requirement that a 30-day assessment be effected for all admissions to the SLE. It is agreed that there needs to be a set of standard assessments to assist with program evaluation.

The following assessments are considered essential:

  1. Clinical interview;
  2. A standardized symptom inventory;
  3. Standardized case history; and
  4. Nursing assessment.

In addition depending upon whether the woman has been identified for Psychosocial Rehabilitation or Dialectical Behaviour Therapy, further assessments are conducted, and these may include the following:

  1. Standardized psychological assessments;
  2. Neuropsychological assessment;
  3. Assessment by Elder; and
  4. Other assessments as required (occupational therapy, neurological assessment etc.).

As identified earlier the need for a structured and supportive environment is critical to meeting the needs of the women and ensuring the most appropriate environment is available to effect the requisite programs.

Finally, given the emphasis on program evaluation, it is imperative that these front-end assessment measures are integrated into both the treatment plan and process and outcome measures.

 

Monitoring of implementation of Program Model

National Headquarters will monitor, both on site and through ongoing correspondence, the implementation of the program. Attention is paid to the implementation of an effective therapeutic environment in general, and in particular to the implementation of the specific treatment approaches (PSR and DBT). This monitoring process distinguishes itself from the evaluation component insofar as it is directed specifically at the fit between the program philosophies and actual clinical application/intervention.

 

6.6 Program Process

In order to ensure a comprehensive and consistent approach to addressing the mental health services in the regional facilities and specifically, access to the SLE, the concept of a Coordinated Care Committee has been developed. The following section identifies the function, role, and the process of the Coordinated Care Committee with respect to mental health services and the SLE.

The Coordinated Care Committee consists of the following members:

  • Team Leader, SLE
  • Team Leader, Secure Unit (if different from above)
  • Program Coordinator (if position identified in SLE)
  • Behaviour Counselor
  • Clinical Nurse and Team Leader, Health Care, if possible
  • Primary Worker/Parole Officer
  • Program Officer (if identified)
  • Chaplaincy
  • Native Elder/Native Liaison
  • Psychologist/Psychiatrist
  • Assistant Team Leader
  • Adhoc contracts as identified/ and staff members as identified.

The Coordinated Care Committee is the initial step in considering a woman for placement in the SLE. The woman has come to the attention of the Coordinated Care Committee for a variety of reasons. These could include difficulties with levels of functioning, serious mental illness, or she may require the benefits of a structured and therapeutic environment to enable her to focus and

be successful in programming. Any staff member or the woman herself can make a referral to the Coordinated Care Committee. Additionally, the following is a list of possible reasons a person may choose to refer a woman to the Coordinated Care Committee:

  • A sudden and unanticipated change in behaviour that results in the woman's inability to participate meaningfully in her activities of daily living.
  • An insidious changes in behaviour that over time results in the woman's inability to participate meaningfully in her activities of daily living.
  • Accessibility to the most appropriate program, at the right time, based on her respective needs.
  • Individual behaviours (bizarre, intrusive, etc.) that make it virtually impossible for the woman to meaningfully integrate into the regular houses.
  • On-going adjustment difficulties in a regular houses that requires a supportive environment.

The staff member referring a woman is required to document his/her findings in a written format such as the casework record, e-mail, or memo. The information is then forwarded to the woman's primary worker or parole officer in the absence of the primary worker. The primary worker/parole officer liaisons with other disciplines as needed to complete the SLE Intake Referral Form (Appendix F). Once this process is completed the primary worker/parole officer (CMT) takes the information collected to the Coordinated Care Committee and presents the woman's case. An inter-disciplinary review of the woman's case and discussion of the information presented ensues. Any decision taken with respect to the woman's case must be provided, in writing, to the woman and referral agent. Several decisions could be taken following a referral and a flow chart identifying the potential decision outcomes is provided below.

If the woman is accepted into the SLE, it is based on at least one of the following two reasons: to participate in treatment or as a transitional placement while attempts are made to engage the woman in treatment. In either case, the correctional progress plan report is amended to reflect the woman's placement in the house.

A formal record (minutes) must be completed for each Coordinated Care Committee meeting. These minutes are shared with other staff members in the facility for information sharing purposes and heighten understanding of the SLE.

Following admission to the SLE, a comprehensive 30-day front-end assessment is completed. This results in a decision with respectto the most appropriate program model either DBT or PSR to address the needs of the woman.

 


1 Warner, A. , Page 5
2 Warner, A., Page 5
3 Warner, A. , Pages 6 and 7
4 Warner, A. , Page
5 Warner, A. , Page 47
6 Warner, A. , Page 48
7 Ibid, Page 48


 

Flow chart for Structured for Living Environment (SLE)

Flow chart for Structured for Living Environment

The following provides a general definition of the elements of the Coordinated Care Committee process:

 

Coordinated Care Committee

Referrals are presented to the Coordinated Care Committee for decision. Decision are made by consensus however the Team Leader, SLE, is the final decision-maker for the committee. Should there be continued dissenting opinion among the committee, the case can be referred to the Deputy Warden and/ or Warden for final disposition. The case can be presented by the Team Leader, Clinician, and the staff member with the dissenting opinion.

The Committee is also responsible for case conferencing, new admission review, and review and prioritization of ongoing waiting lists. The Committee meets at least weekly or more often as needed.

 

Referral for Admission to Structured Living Environment

The Primary Worker (Parole Officer) is the formal referral agent and is responsible to present the case for review. This includes completion of the entire SLE Referral Form - (Appendix F). The case is presented at the weekly Coordinated Care Committee meeting where the chair of the Coordinated Care Committee comments and signs the Intake Referral Form as the decision maker.

 

Decision to Place in Structured Living Environment

The Coordinated Care Committee determines if the woman meets the criteria for admission to the SLE and is subsequently accepted for placement. This may happen immediately or at a later date if a waiting list has been established.

 

Admission

Admission to the house results in the woman being placed in the house, initiation of the 30- day assessment period and formulation of correctional progress plan and discharge planning. The woman is asked to sign a consent to voluntary treatment form.

 

Transitional Placement

The woman's placement in the house is based on the most appropriate environment for her to live in. Placement in the house does not equal participation in treatment and transitional placement should be focused on the woman's quality of life and attempts to engage into treatment or increase motivation for treatment.

 

Treatment

The woman is required to participate in treatment programs, identified following completion of the 30-day assessment. Treatment takes place over a period of time depending on the identified need.

 

Discharge

At some point discharge from the SLE is expected at the most appropriate time in the woman's treatment program and sentence. Treatment and programs focus on preparing the woman for discharge to an alternative environment, i.e. another house, community, psychiatric facility, etc. This could happen at any time following admission to the house however placement for a longer period of time is also possible. Discharge could take place for other reasons as identified in the admission and discharge process.

 

Structured Living Environment Waiting List

For a woman accepted for admission to the SLE potential waiting lists may be utilized due to lack of bed spaces, or due to other circumstances, i.e. out to court. This waiting list is reviewed on a weekly basis at the Coordinated Care Committee meetings.

 

Triage

Triage allows staff to provide the necessary support services to the woman while she is accommodated in an area other than the SLE i.e. regular house, segregation, secure unit. This

can be used for all cases including referrals, discharges, waiting list, bring-forward process, etc. The triage component assists in maintaining a woman in her current settings, identify problem areas and need for increased services, and linkage with the Coordinated Care Committee.

 

Main Facility

This decision results in the woman remaining in or being discharged to her current house with the provision of adjunctive services in order to support and assist her to maintain or improve the level of wellness or health in her present living environment.

 

Secure Unit

If a woman is classified or re-classified as maximum security, she is placed in the Secure Unit.

Please note that the SLE is not the place for an acutely ill or actively, overtly psychotic woman. These individuals could be extremely disruptive to the therapeutic environment and interfere with the other women's treatment processes. In these rare cases, other safe and secure treatment accommodations should be sought. These women, however, should continue to be monitored by the Coordinated Care Committee, because once stable they may require accommodation in the SLE. This would ensure a more gradual reintegration back into the regular houses. This approach is in keeping with the philosophy of Mental Health Strategies for Women Offenders Staff must remain aware of the legal framework involved, when assisting these women. Considerations would include but not limited to, mental health acts, health care consent acts, and any other appropriate regional legislation.

 

6.7 Program Evaluation

The program evaluation for the SLE is completed by the Research Branch of the

Correctional Service of Canada . The evaluation of this initiative is multifaceted and include discussion with staff working directly with the women.. The evaluation consists of two components:

  1. Evaluation of Dialectical Behaviour Therapy approach;
  2. Evaluation of Psychosocial Rehabilitation approach.

Within the evaluation framework key areas that are being targeted include progress of the women, staff satisfaction, program integrity, and the impact of this program upon the facility.

Program evaluation is done using pre, interim, and post-testing measures. In choosing the test measures the following are considered:

  1. Appropriateness of the measure to assess treatment targets/program goals;
  2. Cost of the measure (if under copyright, training manuals, etc.);
  3. Validation/availability of the tests in both English and French;
  4. Validation of the tests for women, for women offenders, for Aboriginal peoples; expertise required to administer the test; if self-administration, the reading level required; time to complete the test while there is no test that meets all the criteria.

Every effort was made to select measures to meet as many of the above criteria as possible.

Staff are trained to use and administer these measures during the specialized training.

Along with the front-end assessments discussed earlier, the tests are administered when the woman arrives in the SLE (and prior to the update of the correctional plan progress report), at a pre-determined interval, and when they are discharged from the SLE. Conducting the test measures takes about three hours for the DBT assessment and about one hour for a PSR assessment. Guidelines are available as to when to test (for example if the woman is going in and out of the SLE on short term stays or for women who may be in the SLE for a long time).

For women identified as requiring PSR, a weekly progress checklist is available to track behaviour over time. This weekly report is linked to the PSR Technology and program philosophy.

The paperwork required is suitable for both the program evaluation and for the program itself, i.e., duplication does not occur; multiple forms with similar information are not required.

Interviews with staff are conducted as part of the evaluation, tentatively identified as occurring after six months of operation and then at intervals to be decided thereafter. The interview is approximately one hour in duration.

Overall, there is an expectation that the program has an impact on the facility. Proper referral, assessment, and treatment initiatives contribute to a decrease in institutional problems. Examples may include an overall decrease in externalizing behaviour, more timely releases to the community, transition of women to the regular houses, a decrease in the use of segregation, and a reduction in the amount of staff resources devoted to woman's problems within the institution among others. Evaluation is ongoing and it is the responsibility of the Team Leader for the SLE to ensure the identified forms are correctly completed and forwarded to the Research Branch. Feedback from the Research Branch occurs in a timely fashion and includes information for both staff and the women living in the house.

 

7. Relation of the Structured Living Environment to the Rest of the Facility

A woman in the SLE has access to and is encouraged to use the programs and physical spaces available in the rest of the facility including health care, the gym, private family visit house, visiting area, programs, work sites, social activities and crafts. Like the other women at the regional facility, she may also spend time in segregation if she cannot be safely managed in the SLE.

 

7.1 Access to the Mother-Child Program

Notwithstanding the above, a woman in the SLE are not eligible for full participation in the mother-child program. The SLE has been constructed to provide intensive therapeutic intervention to women with special needs and does not contain rooms for children. Women otherwise eligible for full participation in the mother-child program would be required to move to another house and receive intermediate or ambulatory care services as required. There should be flexibility however in meeting the needs of women and children through modified visiting programs and partial mother child programming.

 

7.2 Access to the Structured Living Environment for Programs by Other Women

A woman with special needs previously accommodated in the SLE may attend day programming in the SLE with the approval of the Coordinated Care Committee. She may also receive additional one-to-one support from SLE staff to assist her in maintaining herself and the gains she has made in her own house. This is particularly true for a woman who receive follow-up care once discharged. Additionally ambulatory care services and day programming can be offered to a woman who has not resided in the SLE, should it appear that she may benefit from these services.

 

7.3 Peer Support Team Assistance to the Structured Living Environment

The peer support team concept should be considered for implementation in the SLE. Consideration should be given to the appropriateness of the request and the peer support team member identified. Individual assessments must be made to determine the benefit to the woman, the relationship of the person support member and the ability to provide the service through staff members. A peer support member may meet one-to-one with the woman in an area such as the den. Consideration should be given to providing peer support with additional training to allow the peer support member to work with the special needs women in the SLE

The Inmate Committee should be asked to assist in facilitating the woman's reintegration into the regular houses and through education and other programs, assist in reducing the stigma that is attached to living in or going to programming within the SLE.

 

7.4 Work Placements in the Structured Living Environment

The SLE may be an excellent opportunity to develop meaningful work opportunities for women not accommodated otherwise in the house. Suitable women may be trained to work with women in the SLE in areas such one-to-one daily living-skills training, i.e. cooking or basic hygiene. This initiative can be further developed at each regional facility as appropriate.

 

7.5 Structured Living Environment Staff and the Rest of the Facility

To ensure consistent and qualified staff with specialized training in mental health issues, those hired for these positions are assigned specifically to the SLE. The SLE has a separate roster from the rest of the facility and when staffing coverage is not adequate the facility is required to have a staffing strategy in place to ensure appropriate staffing coverage.

Communication is facilitated via the Co-ordinated Care Committee which includes, weekly meetings, case conferencing, distributionof minutes from the Co-ordinated Care Committee meetings, and regular management committee meetings.

In addition, non-Structured Living Environment staff should be provided regular updates on the SLE programs and protocols so thatthey are aware of both the treatment goals and the procedures for achieving them.

 

7.6 Relation of the Structured Living Environment to the Community

The use of community-based volunteers in the SLE is encouraged. They require information and awareness of the program model. Contact between the women and community support services is also facilitated by staff to improve reintegration planning and to develop relationships to bridge the transition on release.

The Community Integration Worker assigned to the SLE plays a significant role in this initiative.

 

8. CLOSING REMARKS

The Operational Plan for the SLE is intended to provide a framework for the physical design and a program model for minimum and medium security women with significant cognitive limitations or mental health concerns in order that their needs can be met at the regional facilities. The detail of the operational routines and implementation of the program model will evolve as staff work together in a team environment with the tools provided through leadership, specialized training, the vision of the Structured Living Environment and Creating Choices.

 

APPENDICIES

APPENDIX A

Review of Recommendations of Alan Warner report

" Implementing Choices at Regional Facilities: Program Proposal
for Women Offenders with Special Needs
"

Recommendation 1:

 

Implementing the psychosocial rehabilitation approach for women offenders with basic skill needs and cognitive challenges through a specific program model appropriate for the regional facilities, which incorporates relevant elements of psychiatric rehabilitation, the clubhouse model, and assertive community living. This model shall reflect the specific strengths and limitations of the women with this constellation of needs and be based on a specific purpose and set of objectives. The psychosocial rehabilitation program model should initially be implemented as a pilot project at Nova Institution in Truro, Nova Scotia.

Implemented in part . While the intent was originally to introduce the psychosocial rehabilitation model in the Atlantic region, following the completion of a comprehensive needs analysis the psychosocial rehabilitation model will be implemented in all regional women's facilities (exclusive of the Healing Lodge). This approach is the most appropriate and potentially effective programming model for individuals with basic skills needs and cognitive challenges such that they can reside in the least restrictive environment in a regional facility. Components of the clubhouse model and assertive community living have been built into the program model.

Recommendation 2:

 

A formal written, multi-disciplinary assessment process with admission criteria based on the consent of the women offender, a medium or minimum security classification, significant basic skill needs, significant cognitive challenges, and the need for staff supervision, is required for entry into the program. There must be an official, approved program description with clear admission criteria, which requires staff at the regional facility to make the final decision on admission.

Implemented . A formal interdisciplinary team and admission criteria based on the consent of the individual woman is an essential component of the Structured Living Environment (SLE). The SLE will house women with a minimum and medium security classification who have identified mental health concerns and who meet the admission criteria. The Coordinated Care Committee, which oversees mental health services for he entire institution, established in each facility will be the final decision-maker with regard to admission to the house.

Recommendation 3:

 

The individual programming with women with basic skill needs and cognitive challenges should be driven by the psychosocial rehabilitation technology process in which staff practitioners competent in the approach develop partnerships with the women offenders on an individual basis. Supportive relationships between the women offenders and a consistent and small number of staff is required to support this process.

Implemented. The psychosocial rehabilitation technology process will be implemented in each of the regional facilities. The Human Resource Staffing Strategy for the SLE identified the requirement for consistent and present staffing with the appropriate qualifications to work in the SLE.

Recommendation 4:

 

Plan and construct a duplex house with up to four women living on each side at the regional facility utilizing the proposed structure and criteria as a starting point for planning. The architects must utilize staff expertise, and input from relevant women offenders, to plan the house. The program coordinator must be hired as soon as possible such that the coordinator is able to facilitate staff and woman offender input into the design. A committee made up of the lead architect, the builder, the warden, and the PSR coordinator must have the final authority on all phases of the design and construction process.

Implemented. Each facility is constructing an eight-bed duplex. The design is based on an initial model developed in the Atlantic region. Regional input was sought from across the country with minor changes made. A National Coordinator was hired in early 1999 and worked with the design and construction groups. The institutional Team Leader is now in place and continues to oversee the process at the institutional level. Four National Sub Committees have been developed including SLE and Secure Unit Operational Sub-Committee, Mental health and Program Sub Committee and Human Resource Sub-Committee. These Sub -Committees are made up of representatives from the women's facilities, Regional Headquarters and National Headquarters and include specialists in construction, staffing, mental health, programs, aboriginal programs, security and operations. Ongoing meetings and conference calls have provided guidance in the development of the SLE.

Recommendation 5:

 

Staff should plan skills training in order to take advantage of daily activities, which are completed as part of the regular lifestyle as teaching opportunities. Interpersonal communicating and relationships should also be utilized as context for teaching social skills. Skills-teaching action plans should be based on the psychosocial rehabilitation plan. Daily structured meetings should be held to facilitate management of daily tasks, interactions and responsibilities in the home.

Implemented . The program model, which includes PSR and DBT, focuses on skill acquisition and skills training. The program philosophy is that of a therapeutic environment where good clinical judgement and good clinical practice is the foundation for every decision and every interaction provides the opportunity for teachable moments. Skills teaching action plans are based on the PSR rehabilitation plan and daily structured meetings (group check-ins) are part of the daily routine for the SLE.

Recommendation 6:

 

Deliberate individual and small group activities defined through each person's psychosocial rehabilitation plan should provide opportunities for integration into regular programs, specific work and service projects, participation in creative arts activities for self-expression and awareness, and the development of a sense of ownership in the living setting. A clubhouse philosophy should guide this programming so as to promote recognition through work and service and teach skills through practical experiences.

Implemented in part . Individual and small group activities are an essential part of the PSR program. Integration into the main facility is a focus for all of the women living in the SLE. Not all programming will need to take place in the SLE and use of additional services such as recreation, library, programs area etc. are part of the overall philosophy for the SLE. Contract money is provided for services such as art and/or music therapy to assist women with self-expression and awareness. The club house philosophy has not been implemented in its entirety, however, components of this philosophy are captured in the day to day operations of the SLE, i.e,. house meetings, shared duties, teaching skill acquisition and the therapeutic milieu itself which promotes reciprocal respect, gratifying relationships and focuses on individual strengths as opposed to weaknesses.

Recommendation 7:

 

Staff must balance the need for hope and empowerment inherent in psychosocial rehabilitation with the need to cope with offenders' behavioural difficulties. Setting the appropriate balance should involve the use of group defined house expectations, natural contingencies, multi-disciplinary team meetings, staff reflection on values and interaction style, and a continuum of quiet options.

Implemented. Training for staff working in the SLE is focused on programming, treatment, women centered, crisis management and team building. Values teaching is a central component of the PSR training and is reflected in the overall program philosophy of the SLE. Interdisciplinary Team meetings, group check-ins, quiet options, program planning and focus on good clinical care are priorities for the SLE staff.

Recommendation 8:

 

Therapeutic quiet must be an essential element of the duplex design through which women can learn to better manage stressful situations, and through which they can be secured when a danger to themselves. Specific written procedures must be developed to monitor its use. Staff must be trained in its use. Medication may also be a useful tool to assist women in stressful situations but its use requires stringent monitoring and written procedures.

Implemented. Therapeutic Quiet is an intervention technique available in the SLE. Both guidelines and accountability documents have been developed to assist staff in the use of Therapeutic Quiet. Medication must be prescribed by the physician and the clinical nurse will provide continuity of care between the woman and health care.

Recommendation 9:

 

Stigmatization and labeling of these women offenders poses a serious threat to the success of the program and should be minimized or avoided through: a peer support program, peer education, facilitation of a sense of ownership in their home, adherence to the admission criteria, and their integration into regular programs.

Implemented .Stigmatization has been identified as a concern at the outset and numerous initiatives have been put into place to address this issue. Transition planning has included members from the regional facilities visiting inmates in the co-located maximum security units, open houses for staff and inmates upon completion of the SLE houses, education of the inmate committees and peer support inmates at each site and information sessions with staff.

Recommendation 10:

 

There must be an alternative release mode in which a community integration worker builds a strong relationship with the individual woman in the penitentiary and then uses this relationship as a bridge to establishing her in a supported community setting. Sufficient funds must be provided to support this community integration process. The community integration worker must be based in the institution in order to develop the strong relationship with the individual offender that is required for success.

Implemented . A scope of work for a contract position and a job description for a Community Integration Worker have been developed with the emphasis on building relationships both in the institution and the community. The Community Integration Worker will be based in the SLE, however, will network with the community on a regular basis. Funding for other operating costs have been provided to each site for additional supportive services as required.

Recommendation 11:

 

It is essential to select staff with strong interpersonal skills and values for work with these women while allowing for a mix of expertise to provide for diverse perspectives. Programming will be most effective if there is a small, multi-disciplinary staff who can support each other and provide a consistent approach to work with the women. Core staffing should include a program coordinator and a community integration worker, two PSR workers on day and evening shifts, a night security staff, and a part-time psychologist, occupational therapist, and program evaluation consultant. Part-time PSR worker positions should be avoided where possible, as intermittent staff presence makes communication and coordination more difficult. Night staff should only provide a security and supervision function.

Implemented in part . The Human Resource sub-committee developed a comprehensive Staffing Plan based on the Treasury Board Submission provided for the SLE. Indeterminate staffing is the focus for the SLE including a Team Leader, psychologist (program director), clinical nurse, primary workers, and behavioural counselors. Additionally, contract funding is identified for services such as chaplaincy, art therapy, elders etc. The focus is an interdisciplinary team with strong interpersonal skills and values who consistently work in the SLE and provide both program and security functions. Primary workers cover the night shift.

Recommendation 12:

 

All core staff must participate in an eight- week training program including six weeks of training in psychosocial rehabilitation, one week of training in clubhouse and assertive community living approaches, and one week devoted to team building, program planning and evaluation, and selected mental health topics. A brief training program should be provided for auxiliary staff. There must be on-going commitment and resources for staff communication and support.

Implemented in part .All core staff will receive up to 10 weeks of training. This includes specialized training specific to the SLE. While six weeks of training for PSR was recommended a blend of the program model along with the decision to provide ongoing training through the development of individual expertise at the sites and ongoing site visits resulted in a modified training schedule. The specialized training for the SLE will include 2 days Mental Health, 5 days PSR and 5 days DBT. An evaluation component is built into the last day of both the DBT and PSR with follow-up site visits identified as part of the initial start up of the program.

Recommendation 13:

 

Either a team member with evaluation expertise or an external consultant should design and conduct the program evaluation in consultation with the staff team and the woman offenders.

Implemented . The Evaluation component has been developed in consultation with the Research Branch at NHQ, the regional facilities and the experts in the DBT and PSR program.

Recommendation 14:

 

Specific strategies must be adopted from the outset to overcome these obstacles to the effective implementation of the PSR program with women offenders.

Implemented . This recommendation is in response to barriers identified for the implementation of PSR. This has been identified earlier and a comprehensive process is in place to address this. Activities include visiting the co-located units, open houses so the women can see the facility and a graduated introduction of women into the SLE. Additionally the staff will have time to review process and familiarize themselves with the SLE prior to admitting women.

Recommendation 15:

 

New nurses hired within the regional facilities should be required to have psychiatric training and/or experience. Existing nurses should be offered an extensive in service training program to upgrade relevant mental health and substance abuse expertise for working with women offenders. Existing psychiatric nurses at the Prison for Women would be helpful in defining the training program.

Implemented . The Statement of Qualifications and job description for the Clinical Nurse requires psychiatric experience and knowledge.

Recommendation 16:

 

Implement the dialectical behaviour therapy approach for women offenders with emotional distress needs and severe behavioural difficulties at Grand Valley Institution in Kitchener, Ontario through a specific program model which is appropriate for regional facilities. This model shall reflect the specific strengths and limitations of the women with this constellation of needs and be based on a specific purpose and set of objectives. Given the limited clinical resources presently at Grand Valley and the high demands on those who are present, it is recommended that senior staff from Prison for Women who are familiar with DBT approaches serve as consultants to Grand Valley Institution in setting up the DBT program.

Implemented. The DBT program will be implemented into each of the SLE houses. This is reflected in the program model, specialized training developed by NHQ Health Services. A staff member from Prison for Women familiar with DBT has assisted in the development and delivery of the DBT training ( Note: at the time the Warner report only identified Grand Valley Institution and Nova Institution were assessed)

Recommendation 17:

 

A formal multi-disciplinary assessment process with admission criteria based on the consent of the woman offender, a medium or minimum-security classification, significant coping, communication and problem-solving skill needs, and the need for staff supervision, is required for entry into the program. There must be an official, approved program description with clear admission criteria, which requires staff at the regional facility to make the final decision on admission.

Implemented . A comprehensive strategy for the management of the mental health services for the women's facilities has been developed in the form of the Coordinated Care Committee. This Committee is consistent with the Mental Health Strategy for Women Offenders. This includes clear admission criteria with the chair of the Coordinated Care Committee (the Team Leader for the SLE) as the final decision-maker. Following admission to the SLE a formal 30 day assessment for each women will take place.

Recommendation 18:

 

The individual counseling and coaching, group skills training, daily meetings, and informal staff consultation components must be implemented in a coordinated manner by a multi-disciplinary staff team with specific training in the approach. The DBT program should also be accessible to a limited number of women with emotional distress needs who are able to cope in regular houses with the extra support provided by the program.

Implemented . DBT programming is being offered to women in the main facility as well as women in the SLE as identified on their treatment plans. This includes both individual and group treatment, daily meetings, weekly DBT consultation with staff and formal weekly interdisciplinary team meetings.

Recommendation 19:

 

Plan and construct a duplex house with up to four women living on each side at the regional facility utilizing the proposed structure and criteria as a starting point for planning. The architects must utilize staff expertise, and input from relevant women offenders to plan the house. The program coordinator must be hired as soon as possible such that the coordinate is able to facilitate staff and woman offender input into the design. A committee made up of the lead architect, the builder, the warden, and the DBT coordinator must have the final authority on all phases of the design and construction process.

Implemented . As above - see recommendation # 4

Recommendation 20:

 

Staff should utilize informal interactions as a means to foster trusting relationships with the women. Emphasis should be placed on using difficulties resulting from conflicts generated by relationship and/or daily living tasks as opportunities for individuals to apply their coping and problem-solving skills to practical situations. The amount of staff supervision may vary over time in relation to the specific grouping of women. It should balance needs for staff to develop strong relationships with the women, to provide for the safety of everyone, and to foster the independent functioning of the women.

Implemented. As above see recommendation #5. Skills training and staff supervision are integral components of the program model.

Recommendation 21:

 

Excepting their involvement in DBT specific program components, women in the duplex would participate in general programming in relation to their correctional plans like any other woman offender.

Implemented. As with the PSR program integration with the main facility will be a focus for the DBT program. Not all programming will take place in the SLE and a concentrated effort to ensure a continuum of options are available in the facility overall is encouraged. As with other women, leisure activities, health care, programming etc. may take place in the main facility.

Recommendation 22:

 

Staff must balance the need for hope and personal motivation inherent in dialectical behaviour therapy with the need to cope with offenders' behavioural difficulties. Setting the appropriate balance should involve the use of group defined house expectations, natural contingencies, dialectical concepts, multi-disciplinary team meetings, staff reflections on values and interaction style, and a continuum of quiet options.

Implemented. As above - see recommendation # 7. The focus of the DBT training includes the theory of dialectical concepts.

Recommendation 23:

 

Therapeutic quiet must be an essential element of the duplex design through which women can learn to better manage stressful situations, and through which they can be secured when a danger to themselves. Specific written procedures must be developed to monitor its use. Staff must be effectively trained in the use of this option.

Implemented . As above see recommendation # 8. The provision of quiet options is available for both DBT and PSR program in the SLE house.

Recommendation 24:

 

There must be an alternative release mode in which a community integration worker builds a strong relationship with the individual woman in the penitentiary and then uses this relationship as a bridge to establishing her in a community setting. The community integration worker must be based in the institution in order to develop the strong relationship with the individual offender that is required for success. Sufficient funds must be provided to support this community integration process. Consistent relationships with DBT staff must also be maintained if a woman moves from the DBT duplex to a regular house within the penitentiary.

Implemented. As above - see recommendation # 10. Additionally an ambulatory care component has been built in to the program model for both DBT and PSR to assist with issues such as transition into the main facility, supportive services following discharge and follow up care.

Recommendation 25:

 

It is essential to select staff with strong interpersonal skills and values for work with these women while allowing for a mix of expertise to provide for diverse perspectives. Programming will be most effective if there is a small, multi-disciplinary staff who can support each other and provide a consistent approach to work with the women. Core staffing should include a program coordinator/psychologist, one DBT worker on day and evening shifts, a second psychologist, a community integration worker, and a program evaluation consultant. Night shift staff, if required, should not be DBT workers in the program and should be limited to a security and supervision function. Core part-time staff positions should be avoided wherever possible as their intermittent presence makes communication and coordination more difficult. It may be difficult to fill the coordinator position and it is recommended that senior staff from the Prison for Women assist with the recruitment and hiring process for key staff, as well as a professional with specific DBT expertise.

Implemented in part. As above - see recommendation # 11.

Recommendation 26:

 

All core staff must participate in a DBT training program designed in consultation with DBT specialists at the University of Washington, plus two weeks of training on team-building, program planing, evaluation, and selected mental health topics. A brief training program should be provided for auxiliary staff. There must be on-going commitment and resources for staff communication and support, including supervision and peer support for the individual therapists.

Implemented in Part. A comprehensive training package for DBT has been developed by NHQ Health Services in consultation with DBT specialists. All Core staff working in the SLE will receive DBT training. The Team Leaders and psychologist will participate in a national team building session and will conduct a team building session with their staff prior to admitting women into the SLE. Program planning has been ongoing through sub-committee meetings, conference calls and site visits. This is also incorporated into the specialized training. Both interdisciplinary team meetings and DBT consultation meetings have been built into the program model for staff communication, support etc. Information sessions, open houses and regular staff meeting are held to ensure auxiliary staff are kept informed.

Recommendation 27:

 

Either the psychologist or an external consultant should design and conduct the program evaluation in consultation with the staff team and the woman offenders.

Implemented in Part . The program evaluation has been developed through the Mental Health Sub-Committee meeting, the PSR and DBT specialists, NHQ research and feedback from the staff working in the SLE.

Recommendation 28:

 

Specific strategies must be adopted from the outset to overcome these obstacles to the effective implementation of the PSR program with women offenders.

Implemented . As above - see recommendation #14.

 

Nine Lessons Learned

Dr. Warner identified 9 lessons learned from past experiences that he identified as being important for inclusion in the program model for the SLE. They are identified below with a brief description of how these issues are being managed in the new Structured Living Environment.

1. Diverse and incompatible needs: There are distinctive constellations of needs among women with “special needs” that require distinctive program approaches. Women with very different needs can be incompatible in less secure environments, resulting in explosive situations.

Response: Two program approaches, Psychosocial Rehabilitation and Dialectical Behaviour Therapy have been adopted as the program model for the SLE. Overall the SLE will operate as a therapeutic environment incorporating the principles of PSR and DBT. The emphasis on interaction and treatment present unique opportunities for the application of behavioural contingencies, vicarious learning, and high quality care through effective rapport and consistency.

 

2. Relationship issues are paramount: These women have unstable and emotionally charged relationships that make larger group situations very difficult, if not dangerous. Their needs must be addressed through individual and small group interactions, including the ability to separate women from each other.

Response: The design of the duplex reduces the number of women living together in the same area to only four women. Additionally the program model in the SLE focuses on individual interactions and small group programming.

 

3. Individualized and intensive learning programs: These women have entrenched and long-term behaviour patterns and change comes slowly through programming and practice targeted on an individual basis to their learning styles and strengths.

Response: This was taken into consideration in the development of the program model with respect to program approaches, a centralized accommodation area, ambulatory care services for continuing support upon discharge and the development of individualized treatment plans.

 

4. Supportive, consistent and "present" staffing: Experiences have been most positive when staff are regularly present with the women in their living environments such that they can establish supportive relationships with them. These women have difficulty establishing supportive relationships with staff if they are not present and have to be sought out.

Response: The Human Resource Strategy identifies a comprehensive Staffing Plan for the recruitment of staff whose services are dedicated to the SLE house.

 

5. Multi-disciplinary team approach with mental health expertise: Given the complexity of their difficulties, working with these women is extremely difficult and tiring for staff. A diversity of expertise is required and staff need a team approach to effectively support each other and the individual women. Mental health expertise is essential as well as correctional experience, and staff need on-going training and support. Effective communication among staff is essential or individuals will play staff off against each other.

Response: An Interdisciplinary team approach has been developed to assist staff with communication, supportive relationships, effective treatment planning and sharing of knowledge and experience. The Staffing strategy provides the framework for the recruitment of a number of disciplines including Primary Workers, Clinical Nurses, Behavioural Counselors, Psychologists, and administrators. Additional contract services are identified for other team members including Chaplaincy, Elders, Art Therapists, Psychiatrists and other ad hoc members.

 

6. Programs require a distinctive and recognized mandate in a broader institution: Specialized programs require a specialized structure and context that will have procedures which will depart from those across a broader institution. This must be recognized and agreed to at the outset.

Response: The program model is distinctive from regular institutional programs and is supported by the broader institution. A comprehensive mental health team in the form of the Coordinated Care Committee will ensure a coordinated approach to mental health services across the institution.

 

7. Therapeutic quiet behaviour management options are required: Women with limited cognitive ability or those acting (out) due to extreme emotional distress in many instances need short term sanctuary or isolation in a therapeutic context akin to options available in a psychiatric setting, rather than a formal segregation process.

Response: The need for a continuum of quiet options for women living in the SLE has been identified as an essential element of the program model. These quiet options are considered a key element of behaviour management in working with individual women in order to improve their coping and problem solving skills with respect to specific stresses.

 

8. The physical facilities must be designed to meet program need: The physical design must follow from the needs of the women and the program structure. The design must also be flexible given that programs and needs are likely to change over time.

Response : The physical design of the SLE allows for the program, accommodation, and staff work area. Additionally not all programming is required to take place in the SLE and the min facility will provide other services such as leisureactivities chaplaincy, programs employment etc. on a regular basis

 

9. Stigma and labeling issues must be addressed: There will inevitably be stigma with respect to participationin special programs, and specific measures must be taken to recognize and reduce it.

Response: Stigmatization has been identified as a concern at the outset and numerous initiatives have been put into place to address this issue. Transition planning has included members from the regional facilities visiting inmates in the co-located maximum security units, open houses for staff and inmates upon completion of the SLE houses, education of the inmate committees and peer support inmates at each site and information sessions with staff. This sharing of information and education ofstaff and inmates will continue to be identified as an ongoing issue.

 

APPENDIX B

Mental Health Problems of Incarcerated Women Compared to those of Women in General Population

 

  Women
in General
Population
Women
Inmates

Schizophrenia

1.1% lifetime prevalence

7% lifetime prevalence

Major Depression

8.10%

19%

Substance Use Disorder - Alcohol

4.30%

36%

Substance Use Disorder - Drugs

3.80%

26%

Psychosocial Dysfunction

 

70%

Antisocial Personality Disorder

1.20%

29%

Childhood Sexual Abuse

20 - 54%

47 - 90%

Physical Abuse in Adult Intimate Relationships

27%

69%

Ref: Alexander & Luper, 1987; Badgley, R.F. 1984; Finkelhor, D. 1979; Herman, J.
1981; Kristiansen et al. 1995; Russell, D. 1984 and 1986.

 

APPENDIX C

Women's Mental Health Continuum of Care

 

APPENDIX D

Therapeutic Quiet Guidelines

The need for a continuum of quiet options for women living in the Structured Living Environment has been identified as an essential element of the treatment program model. These quiet options are considered a key element of behaviour management to help individual women improve their coping and problem-solving skills with respect to specific stresses.

These guidelines are intended to provide a framework for the use of Therapeutic Quiet in the SLE and specifically address the use of the Therapeutic Quiet Room. Other quiet options are available in the house including the use of the den, bedroom, patio, etc.and should be utilized as an initial step whenever possible.

Each woman's case must be reviewed against these guidelines and must be included in her individual treatment plan prior to the useof the Therapeutic Quiet Room.

More generally, the following outlines possible uses for the Therapeutic Quiet Room:

  • It may be used as a quiet place for time-out when women are feeling overwhelmed, over-stimulated, or pressured due to conflicts with other women or staff. The Therapeutic Quiet Room allows women to remove themselves from this stimulation and to re-establish their personal coping resources by: engaging in self-soothing skills and/or practice relaxation techniques.
  • Some women, expressly state their wish to be locked in and may do so to feel safe; they could be voluntarily locked in the Therapeutic Quiet Room, but they should be encouraged to move toward developing alternative coping strategies that will serve them better within the facility and the community.

The Therapeutic Quiet Room shall not be used for women who are suicidal or imminently self-injurious.

The following key points must be considered when using the Therapeutic Quiet Room:

  • The Therapeutic Quiet treatment option will be explained to each woman prior to using this option in her treatment plan.
  • A signed Treatment Plan must be in place identifying the use of Therapeutic Quiet as a treatment option for the individual woman.

Use of the Therapeutic Quiet Room is a voluntary process. Physical force will not be used to place a woman in Therapeutic Quiet. Soft restraint equipment shall not be used in Therapeutic Quiet.

The use of the Therapeutic Quiet Room will be at the direction of the Interdisciplinary Team or at the request of the woman herself.

The Therapeutic Quiet Room Accountability Sheet must be completed each time a woman utilizes this treatment option

  • The use of the Therapeutic Quiet Room will be normally no longer than three hours however the time period may be less depending on the individual woman. Visual checks of the woman must be made and documented every 15 minutes as identified in the Therapeutic Quiet Accountability Sheet.
  • The Therapeutic Quiet Room door will be left unlocked except under the following circumstances:
  • Following the completion of an assessment with respect to the individual woman's level of distress which indicates the woman may be at risk to act out impulsively and /or destructively and;
  • At the request of the woman herself and upon agreement of staff assessing the request.
  • Under exceptional circumstances where a staff presence is not available within, or near the staff office area.

Use of the Therapeutic Quiet Room by women who are not current residents of the Structured Living Environment:

The Therapeutic Quiet Room is intended for use only by women who are current residents of the Structured Living Environment. Use of the Therapeutic Quiet Room by non-residents has the potential to be disruptive to current residents of the House and could alsodrain staff resources.

Nevertheless, a non-resident (particularly a former resident of the House) could be allowed access to this treatment option, butonly under exceptional circumstances.

Prior to exercising this option, approval by the Coordinated Care Committee, and parameters for the use of this option must be clearly articulated in the woman's Correctional Treatment Plan. Included in these parameters must be a plan by which the frequency and durationof use of the Therapeutic Quiet Room is reduced and eventually limited.

 

APPENDIX E

Structured Living Environment Intake Referral Form,
Page 1

This form is for presentation to the Coordinated Care Committee to request admission to the Special Living Environment. To be completed in full (all sections) by Primary Worker (Parole Officer). Complete the referral form and attach a signed consent to disclosure for health information form.

 

NAME:
_____________________________________________________________

FPS#:
_____________________________________________________________

Date of Birth:
_____________________________________________________________

PRESENT OFFENCE:
_____________________________________________________________

PRIMARY WORKER:
_____________________________________________________________

INSTITUTION:
_____________________________________________________________

ALERTS / FLAGS / SPECIAL NEEDS:
_____________________________________________________________

 

REASON for ADMISSION REQUEST:
(Identify Area of Concern and a Brief Explanation)

1) Suicidial vs Para-Suicidal Behavior:
_____________________________________________________________

2) Adjustment Problems:
_____________________________________________________________

3) Communication/LifeSkills/Activities of Daily Living:
_____________________________________________________________

4) Mental Health /Symptom Management/Cognitive Abilities:
_____________________________________________________________

5) Externalization Factors:
_____________________________________________________________

Explanation
_____________________________________________________________

 

GENERAL INFORMATION:
(consult OMS, Case Management etc. to complete)

REFERRAL: Complete___ Incomplete___

CONSENT for TREATMENT: Yes___ No___

ASSESSMENT (30 DAY): Complete___ In Process___ Not Complete___

PREVIOUS ADMISSION to SLE: Yes___ No___

MOTIVATION LEVEL: High___ Med.___ Low___

INCOMPATABLES CURRENTLY in SLE: Yes___ No___

PROXIMITY to RELEASE : (date and status)
_____________________________________________________________

CONSENT for RELEASE of HEALTH INFORMATION SIGNED:
Yes___ No___

HISTORY of POTENTIAL for ASSAULT: No___ Yes_____
If yes by what means and when
_____________________________________________________________

 

HEALTH INFORMATION:
(consult with Health Care and Psychology as needed to complete)

PSYCHIATRIC DIAGNOSIS:
_____________________________________________________________

 

PAST PSYCHIATRIC HOSPITALIZATIONS: Yes___ No___

When and where:
_____________________________________________________________

 

CURRENT PSYCHIATRIC CONDITION :

MOOD:
normal range___ elated___ depressed___ irritable___ sad___
labile (mood swings) ___

AFFECT: appropriate___ inappropriate___ blunted___ flat___

SLEEP DISDURBANCES: Yes___ No___ If yes explain:
_____________________________________________________________

WEIGHT CHANGES: Yes___ No___ Gain_____ Loss_____

DELUSIONAL THOUGHTS: (explain)
_____________________________________________________________

PARANOID IDEATIONS: (explain)
_____________________________________________________________

CURRENT PSYCHIATRIC MEDICATION: (list)
_____________________________________________________________

SUICIDE STATUS: Currently Suicidal: Yes___ No___

If yes, by what means
_____________________________________________________________

How intense are the feelings: Low___Med___ High____
Has offender developed a plan
_____________________________________________________________

History of Suicidal Behaviour: No___ Yes___
By what means
_____________________________________________________________

When (dates)
_____________________________________________________________

History of Self Injurious Behavior: No___ Yes___
If yes, by what means
_____________________________________________________________

CURRENT MEDICAL PROBLEMS and MEDICATION: (list)
_____________________________________________________________

COORDINATED CARE COMMITTEE RECOMMENDATION

Admission Approved:

Admission Deferred/Rational:

Admission Declined/Rational:

____________________________________ DATE: _____________________

Chair, Coordinated Care Committee

 

APPENDIX F

Therapeutic Quiet Accountability Sheet - Page 1

Therapeutic Quiet Accountability Sheet

 

APPENDIX F: Therapeutic Quiet Accountability Flow Sheet Page 2

Complete the following form. Include the time of each intervention and your initials in the box provided. Interventions must be no more than 15 minutes apart. Start at the top left and move across, then down.

 

 

 

 

 

 

Example
1700hrs
JD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

USE FOR ANY ADDITIONAL NOTES AS NEEDED.

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

 

BIBLIOGRAPHY

1. Correctional Service of Canada (1997). Corrections and Conditional Release Act. Ottawa : Correctional Service of Canada . (p.36,37,38,41,42).

2. Correctional Service of Canada . Correctional Program Strategy For Federally Sentenced Women. Ottawa. Correctional Service of Canada . (p.1,5,6)

3. Correctional Service of Canada (1990). Creating Choices: The Report of the Task Force on Federally Sentenced Women. Ottawa . Correctional Service of Canada . (p.128-135)

4. Correctional Service of Canada (October, 1999). Draft: Intensive Intervention in a Secure Environment Operational Plan . Ottawa : Correctional Service of Canada .

5. Correctional Service of Canada . Mission Statement. Ottawa . Correctional Service of Canada .

6. Correctional Service of Canada (199 ). CSC Women's Institutions and Maximum SecurityUnits: National Operational Protocol - Front-line Staffing . Ottawa . Correctional Service of Canada . (p.3,4,5,6)

7. Laishes, J. (1997). Mental Health Strategy for Women Offenders. Ottawa : Correctional Service Canada . (p.6,7,8)

8. Linehan, M. M. (1993). Cognitive Behavioural Treatment of Borderline Personality Disorder. New York: The Guilford Press

9. McDonagh, D. (1999). Federally Sentenced Women Maximum Security Interview Project: "Not Letting the Time Do You." Ottawa . Correctional Service of Canada .

10. Rivera, M. (1995). "Giving Us A Chance" - Needs Assessment: Mental Health Resources For Federally Sentenced Women In The Regional Facilities. Ottawa : Correctional Service of Canada . (p.2)

11. Warner, A. (1998). Implementing Choices at Regional Facilities: Program Proposals for Women Offender with Special Needs . Ottawa : Correctional Service of Canada . (p. 5, 6, 24, 25, 32, 36-38, 41, 42,47,48)

12. Whitehall , G. A. (1995). Mental Health Profile and Intervention Strategy for Atlantic Region Federally Sentenced Women . Ottawa : Correctional Service of Canada . (p. 1,7)

13. Presentation at the National Implementation Meeting by Donna McDonagh Constellation, October 1999.