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Women Offender Programs and Issues

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

I. Programming Experiences with Women with Special Needs

Women with Special Needs at Nova Institution
Treatment Issues and the Springhill Unit for Women
Women with Special Needs at Grand Valley Institution
Women with Special Needs at Prison for Women
Lessons For New Programs

 

Women with Special Needs at Nova Institution

Nova Institution opened in December of 1995 and it rapidly became apparent that there were individual women who were not coping with the new freedoms and level of responsibility in the houses. There was a fear of incidents among the women and a range of acting-out behaviours. Inmates who lived through that time at Nova report that they had a real concern for and willingness to help women who were functioning at a lower level in terms of basic hygiene, interpersonal and/or daily living skills. However, they found the pressure of this helper role to be immense when it was twenty-four hours a day in their living setting with minimal presence or support for these women with special needs from staff. Given that the women offenders doing the helping have difficulty tolerating frustration and stress on their own, it seemed inevitable that they would act out against the lower functioning women. In addition, there were women with special needs remaining in the Prison For Women for whom there was pressure to be returned to Atlantic Canada. Yet because it was recognized that these women could not cope in the regular houses, they had to remain in the Prison for Women until an alternative living option was available at Nova.

Given this context, the administration at Nova took quick action to provide an alternative and there was not time to do a careful pre-planning process, individual women had immediate needs. In March of 1996, an occupational therapist was hired to define and coordinate the program, and contract staff were put in place to provide 24-hour support and supervision in one regular house where the women with special needs were transferred. This "structured living house" continued to operate until late September of 1996, at which time violent incidents in this house and on the enhanced unit resulted in the closure of the special program and the transfer of the women who were involved to a new maximum-security environment at Springhill Institution. It is broadly recognized by a range of staff that there were very serious difficulties in the house across this period regardless of the specific events which triggered the incidents- they are beyond the scope of this report.

It is important to review the difficulties and accomplishments with respect to the "structured living house" as it provides key lessons for present efforts in establishing specialized programming at a regional facility. To this end, the author interviewed individual women who lived in the house, contract staff hired to provide support, primary workers at Nova responsible for the individual women and their correctional plans, the house coordinator, and members of the management team present at the time (see Appendix A). Documents describing the program were reviewed (Shimmel, 1996 & 1997).

Overall, there was a high level of conflict in the house and endless relationship problems and acting out among the eight women (Shimmel, 1997). When one woman appeared to be making strides, other women would sabotage her efforts. The Prison for Women culture was ever-present, "individuals who did attempt... positive changes were taunted, labeled as informants, and/or threatened to conform by other inmates who would identify them as not following "old code" behaviour such as that which sustains a `them and us' adversarial relationship with staff" (Shimmel, 1997, p. 3). Endless crises made it very difficult for staff to have the time and space to plan or put a new program into place as the house was already open. Despite the very difficult circumstances, activities and programming were developed over time: interpersonal difficulties were used as opportunities for women to learn problem-solving, functional assessments were completed, daily activity schedules were implemented, and household tasks were used as an opportunity to teach daily living skills. Some progress was observed with individual women in some skill areas (Shimmel, 1997).

There is a clear consensus as to the key issues in the functioning of the structured living house across all of the persons interviewed with respect to the experience. The specific areas of difficulty and accomplishment are highlighted below. In recounting and analyzing the difficulties, the focus must be on constructive learning for the future. The author's consistent impression is that both administrative and line staff were doing the best they could to cope with systemic difficulties- the need to take emergency measures to cope with women with special needs whom the original Creating Choices vision and plan had ignored.

Areas of Difficulty

(1) The Mix of Women. Everyone who was interviewed highlighted the broad and difficult mix of women living in the house as a primary source of problems. It is the foremost issue highlighted in the coordinator's review of the experience. In particular, there was a great diversity of difficulties, needs and incompatibilities among these women with special needs. Three constellations of issues were identified among these women. Some had significant intellectual limitations accompanied by significant deficits in daily living skills, basic social skills, and hygiene. They were assessed in the borderline or mildly mentally handicapped ranges of intelligence. Others were in the normal range of intelligence but had severe mental health problems with extreme emotional distress, persistent self-destructive behaviour, disassociations, distorted perceptions of themselves and others, etc. Finally there were women who were placed in the house because they were muscling and manipulating other women in the regular houses and were felt to be security risks who required more supervision. The "inmate code" was a primary issue with these women. This mix in a small group living situation created a negative spiral of behaviour. Lower functioning women would react to the high emotional distress of women with mental health problems by acting out with similar self-destructive behaviours. Women with high levels of distress would be muscled or taunted by others and explode. Women carrying the code from Prison for Women would respond with anger and aggression to staff attempting to be supportive and involved, yet the staff did not have the training, nor the house the physical structure, to provide effective security responses. Largely, the structured living house was the only available supervised setting and thus the admission criteria became the need for supervision, rather than the need for a particular living situation and type of programming.

Staff recognized these difficulties at the time and are adamant that this mix not be repeated. Contract staff and primary workers feel that they gave enormous amounts of energy and caring, far beyond the normal expectations of their positions, to cope with and maintain the women in this living situation. When the violent incidents finally occurred, line staff felt blamed for their handling of the incidents when they believed they should have been acknowledged and supported for preventing them for such a long period, given the mix and explosiveness of the house. Whatever the specific events surrounding the incidents were, and the differing perspectives of them, there remains a deep bitter feeling among some staff that resurfaces when they consider a new proposal to serve these women. They indicate that they are philosophically and professionally committed to serving women with special needs at the regional facility, but they fear that there will not be enough resources to serve them and that operational constraints will repeat the explosive mix.

(2). Relatively Large Numbers and Relationship Issues. A second related set of difficulties involved the number of women in the house and the lack of interpersonal skills and relationship difficulties between them. Particularly for the lower functioning women, there was constant instability in their relationships. Alliances were ever shifting, two women would get into a conflict and refuse to be around each other one week and be best of friends the next week. Relationship conflicts and alliances would take precedence over all other issues and make it extremely difficult for staff to work with the women on practical skills. Correctional staff who have worked with both women and men consistently report that women are much more interpersonally oriented and the relationships between them are much more of a priority. This produced major difficulties with a group of six to eight, who had particular deficits in relationship skills, interacting in one small environment where they could not get away from each other. Although staff attempted to use the conflicts as a means to teach interpersonal skills and problem-solving, this is a lengthy, on-going process, particularly for the women with intellectual limitations. The speed with which conflicts arose, outpaced the ability of staff to work through them with the women.

(3). Staff Training, Communication, and Experience. The need to get the supervised house functioning very quickly meant that it was necessary to hire contract staff from outside of correctional services who generally had no experience in corrections and security issues. The pressures of the setting and their contract status made it difficult to provide them with broader training once they were hired. They found themselves thrust into a setting, attempting to defuse crises with limited experience, while lacking key expertise in corrections and mental health. Moreover, the communication links were not well developed to the existing primary workers who were still responsible for case management functions and had important personal relationships with individual women. Thus, one contract worker articulated that there was little opportunity for her to communicate her perceptions of the various women and their needs to the case management team, even though she was spending eight hours a day with the women and the team had far more limited contact. On the other hand, some primary workers, with particular training and experience in social services, indicated that they came to their positions expecting to do more supportive and programming work with the women and yet found themselves restricted to security roles. Thus they would have liked to take on the supportive roles fulfilled by the contract workers and yet there was not the opportunity given their other duties. The differences in roles between the contract workers and the primary workers, and their differing sorts of relationships also provided extensive room for individual women to play one staff person off against another.

(4). Implementing Special Programs within a Broader Institutional Context. Another set of difficulties involved the need to implement specialized programs and to depart from standard procedures when there had not been a pre-defined mandate and rationale for the program at the outset. Staff in the house, lacking experience in the correctional system, were only able to identify and request the need for departures from regular practices as the issues arose. Then it would take time to process these requests through the administrative structure where concerns about departing from a standard set of procedures across the institution were important. Thus specialized daily schedules for women in the house would be an irritant to others in the institution who were expected to adhere to standard procedures for their schedules. In addition, given that the women in the house were also involved in regular programming and interacting with staff across the facility, specialized programs and approaches with these women had to be communicated across all of the primary workers given the regular shift rotations. This was a difficult and time-consuming process for the coordinator and contract staff, if only because of the number of people involved. Finally, security is inevitably a priority from an operational perspective in a penitentiary and was a reason for placing some of the women in the house. However, other women in the house had high emotional or programming needs without requiring high security procedures, which in fact were antagonistic to helping them to learn to function more independently.

(5). Problems with the Physical Structure. The only immediate option for physical accommodations for the women with special needs was in a regular house, one that was designed for a different purpose and this resulted in inherent difficulties. For example, the house was equipped to be in line with community standards such that it included a range of items from light bulbs to household chemicals that offered ample opportunities for self-destructive behaviours that were difficult to monitor. Contract staff, particularly at the outset, had to spend significant periods counting items that would have best been eliminated from the design of the house if it had been planned for women with higher levels of violence against themselves or others. The two floor design also made it difficult to quietly maintain a higher level of observation, and the stairs presented a physical hazard to lower functioning women with limited physical capacities. These women also required more space to get away from each other and yet the houses were built to provide for a group living environment.

(6). Stigma & Labeling. Within the larger Nova population, the structured living house quickly became known as the "crazy house" because behavioural difficulties of one form or another seemed to distinguish the occupants. Lower functioning women inevitably have had to cope with a stigmatized status over long periods of their life but this was a more novel experience for some of the women who were there for security and mental health reasons (at least the magnitude of the stigma from their peers). One woman with high mental health needs indicated that she then responded to the labels by acting them out. The coordinator reports (Shimmel, 1997) that individual women frequently appeared to act out in order to have themselves removed from the house, which was the eventual result after the September 1996 incidents.

(7). Constraints on Developing a Coherent and Consensus Vision. Given that the program was designed on an emergency basis as the women were already living in the house, it was extremely difficult to create a broad consensus and clear vision for it among the management team and primary workers. There was a specific program proposal but not the time for the dialogue to clarify ideas and promote a consistent vision, including the program's relationship to the broader facility. As the result, different staff would bring differing criteria based on their positions and responsibilities to bear on decisions involving the program or the treatment of individual women within it.

Strengths in the Structured Living Program

Despite the diversity and magnitude of the difficulties outlined above, it is important to emphasize that those interviewed identified important strengths and some accomplishments. These areas also provide a valuable experience base from which to build future programs.

(1). Utilization of a Mental Health Treatment Model. It was felt that the mental health approach involving the provision of supportive relationships and experiential problem-solving in a more treatment-oriented context offered potential or was helpful for some of the women, particularly for those with practical skill deficits or severe mental health problems. Although the difficulties cited above hampered this model, staff gained experience over time that provided them with hope for on-going improvements. Contract staff found the time spent simply "being" with the women during the early months allowed them to develop relatively strong personal relationships with individuals, which could have been a foundation for change and growth. Unfortunately the relationship dynamics and mix of the house often prevented these relationships from supporting growth in the individuals.

(2). Mental Health Expertise. The provision of an occupational therapist as the coordinator who came from a mental health background and provided individual support and training for contract staff in occupational therapy and mental health was seen as a very valuable asset. Again, a number of those interviewed supported this approach and the critical need for a range of mental health expertise to make a program for women with special needs effective.

(3). Successes in Life Skills-teaching. Staff reported that some individuals, particularly those with cognitive limitations, did gain specific life skills and confidence through the life skills programming that was a part of the program. This programming was seen as effective when there was repetitive practice on an individual basis, or when staff were working with small groups of compatible women. In fact, two women who were a part of the house are now doing well in the regular houses at Nova.

Treatment Issues and the Springhill Unit for Women

The women with special needs and/or maximum-security classifications were moved from Nova to a maximum-security unit at Springhill which was refurbished on an emergency basis. They have resided there up to the present and McDonagh (1998) has recently completed interviews with these women which investigate their perceptions of this setting, their needs, and the reasons for their ending up in a maximum-security facility. The author spent two days visiting this unit: interviewed staff and inmates with special needs, reviewed files, and read reports (Tobin, 1997). There have been serious acting-out behaviours on this unit over the 18 months of its operation, and the women report, as well as the staff, that they are extremely unhappy with the physical size of the unit and the lack of programming opportunities. The physical structure resembles a fish bowl in which small living areas are immediately adjacent to and in sight of each other, with the staff office in the middle. The on-going relationship problems and incompatibilities among inmates have required that small groups be segregated from one another at times. The physical structure has the security to provide for the locked physical separation, although noise travels across areas and provokes others.

Despite many difficulties, some of the women, particularly those with high mental health or security needs now report that the environment has had a positive impact on them in some ways. The small size of the unit, the regular immediate presence of a small number of staff, inmates' relationships to these staff, the ability to restrict drugs, the high level of structure, and the segregation from the pressures of a larger population of federally sentenced women, has resulted in some women from Prison for Women dropping the "code" and showing a willingness to embrace programming and rehabilitation. On the other hand, the limited programming opportunities, cramped environment, and high security has not been helpful to some of the lower functioning women who require basic skills programming. Much as at Nova, adversity and crisis management have provided insights into what can be helpful in future programming efforts.

Women with Special Needs at Grand Valley Institution

The author's interviews and research at Grand Valley Institution, the regional facility in Kitchener, Ontario, was limited to one day. Hence, there was inadequate time to gain a full picture of the issues and the perceptions of staff and inmates relative to the multiple days spent at Nova Institution and Springhill. The research was limited to an extended meeting with the management team, a meeting with representatives of the inmate committee, the Citizen's Advisory Committee, and the Elizabeth Fry Society, as well as a brief review of the files of some of the individual women which were presented by the management team.

The range of interviewees at Grand Valley presented similar perspectives on the difficulties faced in working with women with special needs at their institution, including many of the same concerns that had been expressed and experienced by Nova staff, Regional Advisory Council members, and inmates. There was consensus that there are a range of women with needs for special programming presently in Grand Valley whose needs are not being met due to inadequate staff resources, program options, and facilities. The management team identified eighteen women as needing specialized supports and exhibiting a wide range of difficulties: self-destructive behavior, dramatic attention-seeking and drug-seeking behaviour, depression and isolation, psychotic episodes, borderline personality characteristics, severe interpersonal relationship problems, and/or low cognitive functioning and basic skill deficits. A brief review of the files supported their perspectives of the range and severity of difficulties.

Inmate representatives expressed strong feelings that it was inappropriate and unjust for both the women with special needs and the women living with them to be co-existing in the same group living environment. They again expressed the view that women offenders are committed and willing to help those at lower levels of functioning within reasonable limits but that they were unable to cope with them on a twenty-four hour basis while sharing a home. They also felt it inappropriate that the women with special needs be restricted to the enhanced unit where there was not sufficient programming to meet their needs.

It seemed that the very limited psychology and mental health resources at Grand Valley, combined with an individual counseling model initiated at the discretion of the women, resulted in some of these women with serious difficulties living in the general population with very limited monitoring and supervision. Often women with high needs do not seek outpatient mental health treatment voluntarily or appropriately. They may require an inpatient, multi-disciplinary treatment approach where they are attended-to indirectly at the least, regardless of their reluctance to seek help, relative to an outpatient model in which they come at their discretion for weekly visits. The outpatient model may work appropriately and provide choices for a majority of the women, but may not be meeting the needs of women with more severe behavioural or mental health difficulties.

The Grand Valley management team expressed a firm commitment to try to maintain and work with these women with special needs within the institution at the medium-security level. They felt it was inappropriate to send medium-security women to the maximum-security Prison for Women unit, only because they did not have the resources to support them at Grand Valley, and would only do so if there was no other safe choice for the individuals. The circumstances that the management team reports seem similar to the situation which existed at Nova prior to the violent incidents in which the women with the most extreme behaviours were transferred to Springhill. The major difference relative to Nova has been that Grand Valley has twice the number of cells on the enhanced unit with higher security such that they have transferred women with higher needs to that area. Although this would not appear to be a suitable long-term or least restrictive living environment for these women, it does have the security structure to maintain control in a stressful situation. In a couple of other instances, Grand Valley has also transferred medium- security women with high needs to the maximum-security, special needs unit at the Prison for Women. Again, it would seem that women are being maintained there because there is no less restrictive environment with the program and living options necessary to safely support them. Overall, one must be concerned that the mix of women with high needs and difficult behaviours, along with staff who are putting high levels of energy into avoiding crises with them with inadequate resources, represents a recipe for a serious violent incident much as occurred at Nova.

Women with Special Needs at Prison for Women

The author spent three days at the Prison for Women (P4W), interviewing inmates, and staff, observing team meetings, reviewing files, and reading background documents relevant to recent programming efforts (Tobin, 1996 a & b; 1997 a & b). The plan had been to close Prison for Women and shift the women to a special unit at the Regional Treatment Centre (RTC) in the Kingston Penitentiary for Men. However, a law suit by some of the women opposed to this involuntary transfer, and the Elizabeth Fry Society, resulted in the Correctional Service of Canada agreeing to leave the women in Prison for Women until such time as an alternative facility could be provided which did not require transfer to the men's penitentiary. As the result, the Regional Treatment staff who were to work on the RTC unit were transferred to the Prison for Women in June of 1997. Over the past nine months, they have taken over responsibility for programming and are working with the correctional staff who were already present at the P4W. Given the short time period that the new staff have been in place, and the entrenched long-term nature of the problems which the women have with whom they are working, it is difficult to assess the outcomes. However a range of staff and inmates report that the new model demonstrates potential.

The following issues were noted through the interviews and the observations of the author:

High Level of Multi-Disciplinary Staff Resources: The P4W includes many of the women with the highest level of difficulties in the country and thus a high level of staff resources are required. P4W has this high level of resources with staff who come from a range of mental health disciplines: psychiatric nursing, psychology, behaviour science technicians, chaplaincy, consulting physicians, etc. This is striking in that Grand Valley and Nova do not have a proportionate level of resources relative to the numbers of women they serve and the level of their difficulties. This level of resources enables P4W to make important strides in programming and work with the women. Trained psychiatric nurses are a particular asset in this environment in that nurses in the regional facilities typically only have training in physical health and yet all of them are inevitably required to intervene with respect to psychiatric and physical health issues simultaneously. There are also behaviour science technicians (BSTs) at P4W who provide an extremely valuable resource to the program. The primary workers at the regional facilities tend to have a significantly higher level of training in mental health and social services than the correctional staff at Prison for Women, and thus could compensate for some of the expertise offered by the BSTs (particularly with some additional training). However, the job duties of the primary workers do not provide the time for them to focus on treatment issues as is the case with the BSTs. The BSTs also deliver programs which are staffed through individual contractors from the community at the regional facilities.

Multi-Disciplinary Team Approach: The program is specifically based on a multi-disciplinary team approach in which there is particular attention to communication across disciplines and a coordination of approaches with individual women. This process provides support for staff and fresh perspectives such that one or two people are not feeling entirely responsible for working with women with great difficulties. Women with special needs have a complex mixture of problems, issues, and behaviours such that the team approach seems essential in that it allows multiple staff perspectives to be utilized to make the best sense out of the women's experiences and difficulties.

Specialized and Individualized Programming: The programming approach and the staffing level allow the team to deliver support and programming to women with special needs in a more individualized format. The offenders appear to benefit from this specialization and there is the ability to avoid the incompatible relationships between the women that caused so many difficulties in the former structured living house at Nova. P4W is presently opening up another unit so as to sub-divide the special needs unit which now houses 11 women based on their experience of the diversity of needs and the importance of offering different programming to different groups. In particular, one group will have more freedom and less staff supervision than the other group.

Importance of Staff Relationships: Interviews by McDonagh (1998) indicate that in many instances the presence of correctional staff who are immediately on the special needs unit (most all of the time) has fostered positive relationships between the women and staff, promoting positive pro-social attitudes among the women. McDonagh did not observe the same level of relationships and their positive effects on the maximum unit next door where correctional staff are not stationed on the unit. Another important element of the relationship building is the BST role as they have the ability to spend informal time with the women in a supportive manner as well as providing supportive programming.

Multiple Options for Private Space When Under Stress-The Use of Therapeutic Quiet: P4W has implemented a therapeutic quiet procedure in which women can voluntarily request, or be placed by staff, in a empty or "stripped" cell on the unit for their own safety, particularly with respect to self-destructive behaviour. Women use this option relatively frequently and it seems to defuse crises and avoid the need for segregation. Unfortunately, the physical setting results in women having to be placed in cells on the unit with no sound proofing such that they are still exposed to the verbal goings on of other women, from whom they may need sanctuary. Staff recognize the importance of having multiple options for allowing a woman space when under stress, so that she can learn to take greater levels of responsibility for coping with stress without acting out. Heney (1990) reported that 97% of a sample of women interviewed from P4W, a majority of whom had previously engaged in self-injurious behaviour, indicated that segregation was an inappropriate response to self-injury and was perceived as punishment by the women.

The Quality and Structure of the Physical Environment: The physical environment at P4W has an oppressive and restrictive design and appearance that impacts on everyone living and working in it, as has been documented over many reports and many years (e.g., see Creating Choices). As one person noted, "you can feel the pain in the walls." One experiences a feeling of hopelessness and it is an atmosphere that is in sharp contrast with the regional facilities that were designed to counter this environment. It seems particularly inappropriate as a place to house women with special needs who do not require a maximum facility. Yet at present there are no safe and appropriate options for these women at the regional facilities. However, it should be noted that for some women, this environment is home and it represents the only relationships they know, and at present there are more programming options available to them here. Movement of women from P4W, once appropriate programs are available elsewhere, must be an individualized and voluntary process which the women offenders work through with staff.

Lessons For New Programs

A review of the experience in penitentiaries in Atlantic Canada and Ontario with women with special needs over the past two years provides the following important lessons which must be incorporated into new program proposals:

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.

2. Relationship Issues Are Paramount: These women have unstable and emotionally charged relationships which 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.

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.

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.

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.

6. Programs Require a Distinctive and Recognized Mandate in a Broader Institution: Specialized programs require a specialized structure and context which will have procedures which will depart from procedures across a broader institution. This must be recognized and agreed to at the outset.

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.

8. The Physical Facilities Must Be Designed to Meet Program Needs: 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.

9. 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.