Commissioner's Directive

Intensive Intervention Strategy in Women Offender Institutions/Units

Responsibilities

1. The Deputy Commissioner for Women:
   1. will provide policy guidance related to the Intensive Intervention Strategy utilized in women offender institutions/units
   2. has the authority to develop guidelines for specific operational direction related to the Intensive Intervention Strategy that must be followed.
2. The Assistant Commissioner, Health Services, will:
   1. provide separate, but complimentary, policy guidance related to the Health Services responsibilities for the management of inmates as it relates to the Intensive Intervention Strategy
   2. collaborate with the Deputy Commissioner for Women to align policies in support of the operational management of this strategy.
3. The Institutional Head will:
   1. make decisions related to admission by exception to the Structured Living Environment
   2. ensure an integrated strategy is applied to managing inmates classified as maximum security and inmates with mental health needs that are incarcerated at his/her institution, including addressing the specific needs of Aboriginal inmates
   3. ensure the Standing Orders and/or Post Orders reflect the necessary operational procedures to manage women inmates classified as maximum security and/or with mental health needs.
4. The Manager, Intensive Intervention Strategy, will:
   1. be responsible for the overall administration of the Intensive Intervention Strategy
   2. chair the Interdisciplinary Team meetings for inmates residing within the Structured Living Environments and Secure Units
   3. provide mentorship and direct supervision to Behavioural Counsellors in their activities within the institution/unit
   4. collaborate with the Correctional Manager, Intensive Intervention Strategy, Case Management Teams, Health Care Team members and other managers as necessary to ensure various interventions, operations and mental health services are managed in an integrated fashion and are complimentary to each other
   5. ensure documentation is kept on inmate files, including in the Offender Management System, and assign staff members to ensure completion of Structured Living Environment admission/discharge entries and to prepare meeting documentation and minutes following meetings.
5. The Correctional Manager, Intensive Intervention Strategy, will:
   1. provide mentorship and direction to Primary Workers in their operational and case management activities related to managing inmates classified as maximum security and/or with mental health needs
   2. collaborate with the Manager, Intensive Intervention Strategy, Case Management Teams, Health Care Team members and other managers as necessary to ensure various interventions, operations and mental health services are managed in an integrated fashion and are complimentary to each other
   3. chair the Interdisciplinary Team meetings in the absence of the Manager, Intensive Intervention Strategy.
6. The Chief, Mental Health Services, or delegated health care professional will:
   1. functionally supervise Behavioural Counsellors' interventions that are directly related to Dialectical Behaviour Therapy and/or other mental health treatment modalities, in accordance with the relevant provincial regulatory body
   2. provide clinical expertise and guidance to the Interdisciplinary Team
   3. collaborate with the Manager, Intensive Intervention Strategy, Correctional Manager, Intensive Intervention Strategy, and Case Management Teams to ensure that mental health interventions are integrated with other types of interventions
   4. provide services and complete documentation in accordance with Health Services policies and procedures.
7. The Aboriginal Liaison Officer, as appropriate, will:
   1. participate in Interdisciplinary Team meetings
   2. assist the Elder to provide counselling, teachings, and ceremonial services to inmates
   3. liaise/consult with staff, and Elders to provide advice and recommendations regarding interventions for Aboriginal inmates, taking into consideration the impact of their Aboriginal social history
   4. provide ongoing assistance and support to those staff and Elders working directly with inmates following a healing path.
8. The Elder, as appropriate, will:
   1. participate in Interdisciplinary Team meetings
   2. provide counselling, teachings, and ceremonial services to inmates
   3. provide advice and recommendations, when requested, regarding culturally responsive interventions taking into consideration an inmate's Aboriginal social history, and provide her with the opportunity to participate, engage or re-engage in her healing plan
   4. assist with interpreting the impact of an inmate's Aboriginal social history, when that inmate is not following a traditional healing path.
9. The Interdisciplinary Mental Health Team will:
   1. operate pursuant to CD 800 – Health Services
   2. ensure a member of the team will be in attendance and provide input when admission and discharge referrals are reviewed at Interdisciplinary Team meetings.
10. The Interdisciplinary Team will:
    1. meet at least biweekly to discuss the cases of inmates residing in the Structured Living Environment or the Secure Units (may be separate meetings or combined), as well as overall interventions and operations for these populations, including making recommendations to the Institutional Head or other committees at the site, as appropriate
    2. make decisions related to movement levels for off-unit movement (individual or group) for inmates classified as maximum security
    3. unless discussed by the Interdisciplinary Mental Health Team, review the progress of inmates not residing in the Structured Living Environment who have mental health needs and are experiencing instability in order to support them outside of specialized infrastructure, during transition out of specialized infrastructure, on transfer and/or while they are awaiting admission to the Structured Living Environment
    4. review referrals and make decisions for admission and discharge from the Structured Living Environment, provided that a mental health representative from the Interdisciplinary Mental Health Team is in attendance
    5. ensure documentation on the meeting outcomes is available to staff and managers to assist with ongoing management of inmates
    6. ensure all recommendations and decisions for Aboriginal inmates take into consideration their Aboriginal Social History.
11. Behavioural Counsellors will:
    1. collaborate with the Manager, Intensive Intervention Strategy, Correctional Manager, Intensive Intervention Strategy, Primary Workers, health care professionals, and Case Management Team members with regard to the interventions for inmates with mental health needs and/or classified as maximum security
    2. prepare and deliver skills training (group or individual) in support of mental health interventions, under the functional supervision of a licensed health care professional
    3. prepare and deliver group and individual sessions in support of the Correctional Plan and reintegration
    4. facilitate and coordinate a variety of activities that support personal development and skills practice
    5. compile information and complete identified documentation, including the Program Performance Reports, detailing information and observations from individual or group skills sessions, as well as other observations/interactions, which will support the Mental Health Team treatment plan and progress reports, as well as Case Management Team reports
    6. present cases to the Interdisciplinary Team and other institutional committees, as appropriate.
12. Parole Officers and Primary Workers will:
    1. complete referrals for admission to the Structured Living Environment and present these to the Interdisciplinary Team
    2. make appropriate referrals for inmates managed under the Intensive Intervention Strategy
    3. share information and document interactions/observations to ensure an integrated approach to managing these inmates
    4. attend Interdisciplinary Team meetings, when available, to discuss inmates assigned to their caseload or residing in the unit where they work.
13. All staff will:
    1. support the ongoing activities and interventions that comprise the Intensive Intervention Strategy, including those that are gender and culturally informed
    2. share information and document interactions/observations related to these populations in the appropriate format.
14. Staff providing services to Aboriginal inmates will consult with institutional Elders for decision making and case planning to ensure that their Aboriginal social history is considered when making decisions and referrals.

Operational Components of the Intensive Intervention Strategy

15. The Intensive Intervention Strategy provides an operational framework for integrated population management for inmates classified as maximum security and/or who have mental health needs in all women offender institutions.
16. This strategy is focused on four key aspects:
    1. Structured Living Environment
    2. Secure Unit
    3. Assiniboine Unit
    4. Support services and outreach.

Structured Living Environment

Admission Process

17. The Structured Living Environment will normally be used for inmates exhibiting at least one of the following behaviours:
    1. suicidal and/or self-injurious behaviour
    2. adjustment problems (related to mental health difficulties)
    3. difficulties with communication/life skills/activities of daily living
    4. other significant emotional or behavioural dysregulation
    5. disabilities necessitating a more supportive structure or environment.
18. Admission to the Structured Living Environment is a separate admission from the actual participation in treatment and can occur:
    1. with or without an inmate's consent in order to provide her with appropriate accommodation within the institution based on her case specific needs or in accordance with health policy related to intermediate mental health care
    2. during non-business hours without an Interdisciplinary Team review, with the approval of the Duty Correctional Manager, and in this case will be formally reviewed at the next Interdisciplinary Team meeting
    3. by exception authorized by the Institutional Head for the purpose of managing specific case dynamics or for inmate population management reasons.
19. The Structured Living Environment includes Intermediate Mental Health Care. Admission to the Structured Living Environment, including for Intermediate Mental Health Care, can be via self-referral by the inmate, via the Primary Worker and/or the Parole Officer completing the Intake Referral for Structured Living Environment (Women Offenders) form (CSC/SCC 1241), or via a health care professional completing the Psychiatric Hospital and Intermediate Mental Health Care Referral (CSC/SCC 1479).
20. In the case of an admission during non-business hours or an admission by exception, priority will still be given to those cases with greater severity of impairment and every effort will be made to not disrupt the intermediate mental health care of other inmates.
21. The Duty Correctional Manager proceeding to an admission during non-business hours or the Institutional Head or delegate authorizing an admission by exception shall complete the Intake Referral for Structured Living Environment (Women Offenders) form (CSC/SCC 1241).
22. The completed form will be presented at the Interdisciplinary Team meeting. Admissions to the Structured Living Environment are entered in the Offender Management System within five working days of the admission.
23. Participation in mental health treatment and completion of documentation related to these activities will be in accordance with the Integrated Mental Health Guidelines.
24. Upon admission to the Structured Living Environment, each inmate will be provided with information pertaining to the services offered in the unit, as well as the unit rules and behavioural expectations.

Therapeutic Quiet Room

25. The Manager, Intensive Intervention Strategy, and the Correctional Manager, Intensive Intervention Strategy, will develop a procedure, in consultation with the Chief, Mental Health Services, or delegate, for approval and use of the therapeutic quiet room, which will consider both the clinical and operational needs of the site.
26. Use of the therapeutic quiet room is voluntary. The staff member facilitating the use of the therapeutic quiet room will complete the Therapeutic Accountability Sheet (CSC/SCC 1242).
27. The therapeutic quiet room is not to be used by inmates who are placed on High or Modified Suicide/Self-Injury Watch, as described in CD 843 – Management of Inmate Self-Injurious and Suicidal Behaviour.

Discharge Process

28. Discharge from treatment is managed in accordance with the Integrated Mental Health Guidelines and is a separate process from an inmate discharge from the Structured Living Environment. These processes may occur simultaneously or at different times.
29. An inmate's case may be presented to the Interdisciplinary Team for discharge from the Structured Living Environment as a result of:
    1. a voluntary request by the inmate
    2. behaviours identified as interfering with treatment, including bullying, intimidation, threats or acts of violence, ongoing drug/alcohol abuse (including misuse of prescription medications) and/or problematic interpersonal relationships
    3. a lack of progress/motivation against individualised treatment plan
    4. sufficient progress made by the inmate to allow her to reside in a regular living unit, transfer of the inmate to another site or release of the inmate to the community
    5. an increase in security classification to maximum security.
30. Movements to another unit may occur prior to an Interdisciplinary Team meeting if an urgent situation presents itself that cannot be managed within the unit. In these cases, the formal discharge or re-admission to the Structured Living Environment will be discussed as soon as possible by the Interdisciplinary Team.

Secure Unit

31. With the exception of inmates housed in the segregation range, including in the observation cells, normally only inmates classified as maximum security are housed in the Secure Unit.
32. Inmates placed in segregation or in an observation cell are managed pursuant to CD 709 – Administrative Segregation, GL 709-1 – Administrative Segregation Guidelines and/or CD 843 – Management of Inmate Self-Injurious and Suicidal Behaviour.
33. Upon admission to the Secure Unit, each inmate, unless admitted only for the purposes of placement in segregation or observation, will be provided with a copy of the Secure Unit Handbook and have the unit rules and expectations explained.

Movement off the Secure Unit

34. In addition to the interventions, services and activities offered within the Secure Unit, inmates in this unit will have access to shared spaces (e.g., gym, recreation facilities, health services, spiritual and vocational areas) as well as activities and interventions provided outside the Secure Unit as deemed appropriate by law, policy and their specific case.
35. The Checklist – Movement off the Secure Unit (CSC/SCC 0005-T) must be completed for each inmate and reviewed at the Interdisciplinary Team meeting at a minimum of once per month. More frequent review can occur as necessary and the final decision maker will be the Interdisciplinary Team chair.
36. Group movements off the Secure Unit will be managed in consideration of individual movement levels and as determined by institutional Standing Order(s).
37. Access to services (e.g., for a ceremony or religious services) and interventions off the unit that require modification to the movement level parameters (e.g., where direct supervision cannot be maintained or restraint equipment needs to be removed) is approved and documented by the Interdisciplinary Team. In these cases, operational,technical and/or supervision requirements will be specifically outlined.
38. Movement to and from Health Services will be conducted in accordance with the assigned movement level, but in order to ensure the inmate's privacy with regard to health matters, the inmate will not normally remain in restraints or be under the direct supervision of the accompanying staff member.
39. With the exception of the above paragraphs, movement levels will be assigned and managed as described in Annex B.
40. Inmates are not required to start at Movement Level 1, as the Interdisciplinary Team will determine the appropriate level based on all available information.
41. There is no minimum timeframe during which inmates are required to remain at one particular movement level prior to being considered for another movement level.
42. Individuals responsible to accompany the inmate off the Secure Unit may be different than the individual(s) assigned to provide supervision at the destination. All individuals assigned to move the inmate to/from the destination or to supervise the inmate at the destination off the Secure Unit will ensure they adhere to the Interdisciplinary Team's decision related to supervision standards.
43. When Secure Unit inmates are engaged in interventions off the unit, their movement schedule will be accessible to other frontline staff. Primary Workers assigned to the main institution's unit supervision or multi-function posts will increase their monitoring of the areas where inmates classified as maximum security are located.

Regional Psychiatric Centre – Assiniboine Unit

44. Intermediate and psychiatric hospital beds are available for women inmates classified as minimum, medium and maximum security, in the Assiniboine Unit at the Regional Psychiatric Centre (Prairie region).
45. Managers and staff are responsible to ensure that the Intensive Intervention Strategy (with the exception of the specific infrastructure models of the Structured Living Environment and Secure Unit), as well as operational policies and interventions for inmates are integrated into the model of the Assiniboine Unit.
46. Admissions, treatment and discharges at the Assiniboine Unit will be completed in accordance with the Integrated Mental Health Guidelines, CD 710-2 – Transfer of Inmates, GL 710-2-3 – Inmate Transfer Processes and CD 705-7 – Security Classification and Penitentiary Placement.

Support Services and Outreach

47. Support services and outreach are available to inmates with mental health needs who reside in any area outside of the specialized infrastructure (Secure Unit and Structured Living Environment) at a women offender institution (including the Okimaw Ohci Healing Lodge).
48. The purposes of the support services and outreach include:
    1. preparing for and supporting the transition of an inmate with mental health needs from maximum security to medium security
    2. supporting the inmate's stability, both emotionally and behaviourally, to maintain her residence in a housing style accommodation or in a culturally focused setting (including Okimaw Ohci Healing Lodge and Pathways)
    3. supporting inmates to maintain stability while awaiting admission to the Structured Living Environment or Assiniboine Unit or upon discharge from these specialized units
    4. being a preventative measure to maintain a lower security classification
    5. allowing access for group and individual support activities, which may include specialized treatment modalities such as Dialectical Behaviour Therapy.
49. Inmates managed for a period of time (as determined by the Interdisciplinary Team) under this portion of the Intensive Intervention Strategy will be tracked via the Structured Living Environment Admission/Discharge screen in the Offender Management System under the Reason for Admission "Outreach" and through the applicable mental health database(s).
50. All interactions and observations related to outreach activities will be communicated with others and documented in the appropriate format/system.

Commissioner,

Original Signed by:
Don Head

Annex A - Cross-References and Definitions

Cross-References

CD 001 – Mission, Values and Ethics Framework of the Correctional Service of Canada
CD 566-3 – Inmate Movement
CD 566-4 – Counts and Security Patrols
CD 568-1 – Recording and Reporting of Security Incidents
CD 577 – Staff Protocol in Women Offender Institutions
CD 700 – Correctional Interventions
CD 701 – Information Sharing
CD 702 – Aboriginal Offenders
CD 705-7 – Security Classification and Penitentiary Placement
CD 709 – Administrative Segregation
GL 709-1 – Administrative Segregation Guidelines
CD 710-1 – Progress Against the Correctional Plan
CD 710-2 – Transfer of Inmates
GL 710-2-3 – Inmate Transfer Processes
CD 726 – Correctional Programs
CD 750 – Chaplaincy Services
CD 767 – Ethnocultural Offenders: Services and Interventions
CD 768 – Institutional Mother-Child Program
CD 800 – Health Services
CD 843 – Management of Inmate Self-Injurious and Suicidal Behaviour

Integrated Mental Health Guidelines

Definitions

Admission by exception: an admission into the Structured Living Environment (not into treatment) that does not meet the normal criteria for admission.

Behavioural Counsellor: a staff member who works with women inmates at a women offender institution/unit, under the direct supervision of the Manager, Intensive Intervention Strategy, but who executes certain duties under the functional supervision of a health care professional.

Correctional Manager, Intensive Intervention Strategy: a Correctional Manager position unique to women offender institutions/units and whose incumbent oversees the management and supervision of correctional operations components of the Intensive Intervention strategy.

Direct supervision: the basic characteristics of direct supervision are the assignment of tasks; the observance, review and evaluation of performance; the administration of line personnel functions (e.g., selection, discipline, grievances, privileges); and responsibility for the worker as well as the work.

Functional supervision: the supervisor or manager is responsible for a project or recurrent activities that involve tasks performed by persons over whom she/he has authority to give direction in regard to that project or activity even though they are under the direct supervision of someone else.

Intensive Intervention Strategy: a management strategy that addresses the risk and needs of women inmates who are classified as maximum security and/or have mental health needs within women offender institutions/units. The Intensive Intervention Strategy provides parameters for operations and interventions that work collaboratively with health policies and procedures in order to support the diverse needs of inmates who are classified as maximum security or have mental health needs. It includes specialized accommodation options (Structured Living Environment, Secure Unit, and Assiniboine Unit at the Regional Psychiatric Centre) and a supportive framework for inmates residing outside those specialized accommodations.

Interdisciplinary Mental Health Team: a team chaired by the Chief, Mental Health Services, Clinical Manager or delegate, with team members that may include mental health staff, health care staff, Parole Officers, Correctional Managers, Elders, and ad hoc members as required. The Interdisciplinary Mental Health Team discusses current clinical, operational and case management issues/concerns, short-term/long-term goals, and the roles and responsibilities of all staff intervening with the inmate, in order to respond effectively, and provide advice and support to the inmate.

Interdisciplinary Team: an intervention body chaired by the Manager, Intensive Intervention Strategy, and comprised of the Correctional Manager, Intensive Intervention Strategy, health care professionals, Parole Officers, Primary Workers, Behavioural Counsellors, Elders, Aboriginal Liaison Officers and/or ad hoc members as required.

Manager, Intensive Intervention Strategy: an interventions manager position unique to women offender institutions/units who incumbent oversees the administration of the Intensive Intervention strategy, including but not limited to planning and administering of finances, directing the work of the Interdisciplinary Teams, and directly supervising Behavioural Counsellors.

Health care professional: an individual registered or licensed for the practice of health or mental health care in Canada and preferably in the province or territory of practice. (Certain positions, however, require registration in the province or territory of practice.) Individuals operate within their scope of practice and competence.

Secure Unit: a unit that provides accommodation at regional women offender institutions (not including the Okimaw Ohci Healing Lodge) for inmates classified as maximum security. An interdisciplinary team approach and intensive interventions promote change in the inmates' behaviours and strengthen skills that will allow them to safely transition to a lower security level. This unit also contains cells that may be utilized for a segregation placement and/or for observation.

Structured Living Environment: specialized accommodation at regional women offender institutions (not including Okimaw Ohci Healing Lodge) for inmates classified as minimum or medium security, which contains intermediate mental health beds as well as an accommodation option that is more structured with a higher level of staff presence. Residents of this unit are encouraged to use the facilities and participate in the activities and programs available in the rest of the institution as well as have the opportunity to access structured activities and interventions specific to inmates residing in the unit.

Support services and outreach: supportive interventions for inmates with mental health needs who reside outside of specialized accommodations, providing a continuum of specialized interventions and staff/managers associated with the Intensive Intervention Strategy, including Behavioural Counsellors, Manager, Intensive Intervention Strategy, and/or Correctional Manager, Intensive Intervention Strategy.

Therapeutic quiet room: a space for inmates in the Structured Living Environment that is quiet and secluded from over-stimulation and conflict. It is used to assist inmates to control and manage their difficult emotions and/or acting-out behaviours.

Annex B - Movement Levels off the Secure Unit

Movement Level Description	Staff Supervision RequirementsFootnote 1	Restraints and Supervision Requirements
Level 1 may be assigned to an inmate exhibiting high risk behaviours, including frequent non‑compliance with rules and direction related to the unit routine, instrumental or overt acts of violence and/or other behavioural issues that may create a concern while she is present in another area of the institution.	Two Primary Workers	One or two types of restraints are normally used for these inmates. Specific type and number of restraints will be determined by the Interdisciplinary Team based on the individual case specifics. Supervision will normallyFootnote 2 be direct at all times.
Level 2 may be assigned to an inmate recently admitted to the unit, or demonstrating behaviours such as resistance to rules/ direction and/or exhibiting interpersonal difficulties with staff or other inmates.	Two staff (where one staff is normally a Primary Worker)	No restraints are required. Supervision will normallyFootnote 3 be direct at all times and the staff compliment for the supervision at destination will take in consideration the type of activity (e.g. Aboriginal Liaison Officer and Elder for participation during a sweat) and inmate case specifics.
Level 3 is assigned to an inmate who is generally not exhibiting behavioural issues and demonstrates positive interactions with staff and inmates.	One staff (or contractor or volunteer)	No restraints are required. The inmate will normally be accompanied and supervised by the staff/contractor/volunteer designated for this activity in the main population. Supervision will normally be direct at all times.

Footnotes

Footnote 1

Please refer to Movements off the Secure Unit section for movements to and from Health Services.

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Footnote 2

"Normally" indicates there may be situations or areas where the level of supervision/restraint designated is not appropriate for the activity the inmate is participating in.

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Footnote 3

The assigned movement levels cannot be utilized to prevent an inmate from accessing interventions and services that are required by law and policy but that are not available in the Secure Unit. Variations to the requirements related to restraint equipment and direct supervision at all times will be decided and documented by the Interdisciplinary Team, including other operational/technical or supervision standards that are necessary to manage the situation if direct supervision at all times is not feasible.

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