• Review capacity to address the needs of women offenders with mental health and behavioural needs;
• Develop short and long-term strategies on service, support and accommodation needs for women offenders identified in this group; and
• Pursue these through regular Treasury Board processes.

Between August 2008 and March 2009, 45 beds were added to three of CSC’s institutions for women resulting in a significant increase in capacity for women offenders.

In February 2009, a proposed long-term accommodation strategy for women was presented to and supported by CSC’s Executive Committee (EXCOM). CSC’s overall infrastructure plan will integrate elements of this approved strategy for women.

Specifically, CSC will add 152 beds over the next two fiscal years. This includes: 4 Structured Living Environment beds at each site (other than Okimaw Ohci), 8 beds at Okimaw Ohci Healing Lodge, 40 general population beds at Edmonton Institution For Women, 20 general population beds at Fraser Valley Institution for Women, 40 general population beds at Grand Valley Institution for Women, 14 general population beds at Nova Institution for Women, and 10 maximum security beds at Joliette Institution.

For women offenders with significant mental health needs requiring more acute care, 12 beds are currently available in the Churchill Unit at the Regional Psychiatric Centre (RPC) in the Prairie Region, which is a community-accredited CSC mental health facility. In June of 2011, CSC approved a plan to move the women to a larger unit within the RPC therefore increasing the capacity from 12 to 18 beds. Required renovations will commence in the fall of 2011. Treatment options are broadly based, and include, but are not limited to: psychotherapy; Aboriginal healing and services that include Elders and Aboriginal liaison officers; and gender-informed psycho-educational and behavioural interventions.

Additionally, CSC has recently expanded on an existing agreement with Native Counselling Services of Alberta (NCSA). The NCSA opened a 16 bed unit to accommodate women, classified as minimum-security, accessing Section 81 services and on Section 84 releases; Buffalo Sage Healing Centre opened in September 2011.

Finally, CSC has recently negotiated and Exchange of Service (ESA) agreement with Manitoba corrections. This will provide for an additional 25 beds for federally sentenced women in the province of Manitoba. The new facility is expected to open in January, 2012.

• Expand interdisciplinary team approach to include more precisely defined roles for Health Care and Psychology in the review process prior to and during segregation placements.

Commissioner’s Directive 709 - Administrative Segregation1was promulgated on November 9, 2007. Paragraphs 68 to 71 and Annex E were added to address offender’s health care intervention and to ensure that Nurses physically see offenders while they are placed in segregation.

• Create secure interview rooms in the Secure Units of women’s institutions to give staff and stakeholders a separate and safe space to interact with offenders.

All five secure interview rooms have been operational since August 2009.

• Conduct an operational examination of long-term segregation using a representative sampling methodology and an external review process.

A National Segregation Review Committee was established in 2009 and updated Terms of Reference (ToR) were developed in 2010.  The ToR outlines specific selection criteria for cases to be reviewed. Meetings occur on a quarterly basis and there is both regional and national representation, including the ADCIOs and the ACCOP. In April 2011, a review of all cases presented to the Committee since its inception (up to and including December 2010) was conducted. Of the 71 cases brought to the Committee, 40 or 56% were in a current general population status. Most recently, (June 2011) another six difficult long term segregation cases were reviewed and transfer agreements were put in place thus ending their long term segregation status.

In addition, to address the issue of long-term segregated inmates, in October 2009, CSC established an External Review Board composed of two independent external consultants which resulted in the production of two reports which were shared with EXCOM. A number of initiatives derived from the integrated recommendation themes of the (ERB) approved by EXCOM in November 2010 have been undertaken. Themes from the report included: Prevention and Screening, Staffing, Deployment and Training, Treatment and Interventions, Quality of Life in Segregation and Systemic Adjustments. Next steps were shared with EXCOM in March 2011. Projects underway include:

• Development of an intake-based screening tool for those offenders at risk for segregation placement during sentence (June 2015);
•  Identify a protocol to identify inmates’ health care needs in decision related to placement in segregation – BF August 2011 (new CD 709-Administrative Segregation promulgation);
•  Establishment  and facilitation of the delivery of a motivation-based segregation intervention and the tracking of same in six institutions as a pilot project (September 2011;
• The creation of an Administrative Segregation Data Monitoring Tool far more detailed than current RADAR/OMS capabilities. This is ongoing, and should be available to the Regional Segregation Oversight Managers in February 2012);
• Promulgation of on-line administrative segregation training courses for those working in a segregation unit and staff chairing segregation review boards (this has been completed and is available on the Infonet. This will be publicized after CD 709 is promulgated as the training will be amended to include the change in CD 709 -BF December 2011);
• Seeking EXCOM approval to develop a sub policy guideline (CD 709 Administrative Segregation) for the management of Transitional Units in order to establish a National framework ensuring due review process and equitable access to statutory entitlements for offenders. In the weeks and months to come, a National Working Group will be initiated by NHQ with the involvement of the ADCIO’s. This went to CMT in May 2011 CMT has requested additional work be done. (BF date is December 2011 for an approval for promulgation of the guideline);
• Enhanced reference resources pertaining to Administrative Segregation available on the Infonet such as a lengthy Frequently Asked Questions section, sample of quality reports, interesting research, a “best practices” deck etc., to provide useful information to the sites regarding segregation. (BF December 2011).
• Development of an updated and enhanced version of the Administrative Segregation Handbook for Staff. (BF December 2011 as the changes to be made will be impacted by the promulgation of the new CD 709).

• Implement new procedures to strengthen accountability in security practices and use of force interventions.  

Policy Bulletin 284 and Commissioner’s Directive 567-1 – Use of Force were promulgated on April 1, 2009. A significant portion of the Directive was changed including the definition of what constitutes “use of force”, the ability of managers to develop an intervention plan using line staff to manage a situation, and the incorporation of the content of the Security Bulletin on Use of Force on Pregnant Inmates.

Furthermore, another Policy Bulletin was issued on May 19, 2010 to provide interim direction as Commissioner’s Directives 843 and 844 are finalized regarding the use of the Pinel Restraint System in response to self-injury.

• Reinforce and communicate the importance of preservation of life across the organization to all levels of staff.

In May 2008, a Security Bulletin dated May 30, 2008 was sent to all CSC staff reinforcing the continuing need for vigilance in preventing inmate suicide. As well, the Significant Findings from National Investigations on Inmate Suicides Report was distributed to all sites.

• Discuss the importance of preservation of life at the Executive Development Symposium for all senior leaders of the organization, all Regional Management Committee meetings, and major union meetings at all sites across the country.

All regions confirm that the issue of preservation of life is discussed regularly at Regional Management Committee meetings and key union meetings. At the 2008 Executive Development Symposium, CSC’s Assistant Commissioner of Correctional Operations and Programs led a discussion with all Wardens concerning progress and challenges in this area.

• Issue a Security Bulletin to clarify “immediate intervention” in response to suicidal and self-injurious offenders.

The following Security Bulletins were distributed to staff and posted on the CSC intranet.

• April 23,2008: "REMINDER: Commissioner’s Directive 843 - Prevention, Management and Response to Suicide and Self-Injuries"
• August 20, 2009: "Self-Harm Cases"
• October 29, 2009: "Head Banging"
• May 19, 2010:  “Commissioner’s Directive 843 –   Prevention, Management and Response to Suicide and Self-Injuries, Commissioner’s Directive 844 – Use of Restraint Equipment for Health Purposes, Commissioner’s Directive 567-1 – Use of Force” (Policy Bulletin 309)

• Revise Commissioner’s Directive 567-1, Use of Force.

Commissioner’s Directive 567-1 - Use of Force was promulgated on April 1, 2009.

• Assess 14 women offenders identified as having significant mental health and/or behavioural needs using external clinical expertise to better inform how they are managed.

For the 14 women still in CSC custody, these assessments have been used to assist the treatment team in the management of these cases.
NOTE: Contracts have been in place since June 2009 for institutions to arrange external assessments as required. In addition to the original 14 assessments, five external assessments were undertaken (two for men and three for women).

• Develop an internal Mobile Interdisciplinary Treatment Assessment and Consultation (MTAC) Team.
• Expand MTAC to include male offenders who exhibit significant mental health and/or behavioural needs.

The MTAC Team pilot program was concluded in March 2010.

A management review of MTAC was completed and a presentation occurred at a Commissioner’s Management Team (CMT) meeting on February 24, 2010 to discuss next steps. CMT decided to implement Regional Suicide/Self-Injury Prevention Management Committees in all five regions. These committees began operating on April 1, 2010.

• Precisely define roles for Health Care and Psychology in the review process prior to and during segregation placements (see also page 2).

Commissioner’s Directive 709 – Administrative Segregation was promulgated on November 9, 2007. The Directive has five new annexes that provide guidelines for Memorandum of Understanding, segregation/admission, how to run a Segregation Review Board, Segregation Review Board report content and providing psychological opinions for administrative segregation cases.

• Hold quarterly meetings with Assistant Deputy Commissioners of Institutional Operations (ADCIO), Deputy Commissioner for Women and Wardens of women’s institutions to discuss issues pertinent to women’s facilities.

Quarterly meetings are ongoing. ADCIO/Warden face-to-face meetings occurred in April 2010, September 2010, and January 2011. The next meeting is scheduled for September 20-22, 2011. As well, ADCIO conference calls are held on a bi-weekly basis. These meetings and conference calls ensure consistent communication on pertinent issues related to women’s corrections including population management, staff training, and program requirements. They also provide an opportunity to share best practices and strategies for the management of challenging cases.

• Distribute results from these meetings to women’s institutions and Regional Headquarters.

Meeting minutes are distributed to ADCIO at each Regional Headquarters and Wardens.

• Share best practices as they relate to institutional operations.

Best practices are shared during ADCIO/Warden face-to-face meetings as well as in regular monthly conference calls. These best practices include the sharing of information about successes/challenges regarding self-harming behaviour.

• Complete a pilot project on integrated mental health awareness and security training for the three groups critical to success in the effective management of women offenders:  front-line health, security and management staff.
• Deliver mental health training to Correctional Officers.

A two-day training session on the fundamentals of mental health has been developed and implementation has begun.  Target groups to date have included maximum security institutions, women’s institutions and Regional Treatment Centres. In Fiscal Year 2011/12 and 2012/13, target groups will be all medium security institutions.

As of the end of the third quarter of Fiscal Year 2010/11, approximately 3500 institutional staff members had received training on the fundamentals of mental health. Of this 3500, approximately 2500 were Correctional Officers.

As a result of a review of CSC's Staff Suicide Prevention Training (orientation and refresher), technical amendments have been made to the training packages. CSC is exploring alternative training models for suicide prevention training and next steps will be determined in Fall 2011.

As noted above, training for staff in the fundamentals of mental health has been implemented.  Since 2009, CSC has targeted correctional officers (CX-01 and CX-02) as the first priority to receive this training. Targeted Management staff members have also received mental health-related training.  For instance, since 2009, management staff members at women’s institutions have received training specifically focused on the primary mental health interventions in women’s institutions (i.e., Dialectical Behaviour Therapy).

• Develop a strategy to fill vacant positions at Grand Valley Institution for Women.

The Ontario Region developed a strategy and all vacant positions were filled.

• Provide additional training in suicide risk assessment for CSC’s Psychologists.

In Fiscal Year 2008-09 additional suicide risk assessment training was offered to approximately 300 CSC psychologists.

• For National Training Standards 2009-10 and 2010-11, supplementary resources were provided for each psychologist to support professional development.
• As part of this, all regions conducted workshops on risk assessment.
• The Health Services Sector is actively monitoring the professional development resources provided in the regions.

• Communicate and reinforce to staff and stakeholders the Sector’s role as the functional authority on women offenders.

The Women Offender Sector’s Governance, Roles and Responsibilities document was approved by CSC’s EXCOM and shared with CSC staff and stakeholders in November 2008. It is now operational and reinforced at ADCIO & Warden meetings.

• Develop and establish local ethics advisory committees at select operational sites.

Local Committees:

Atlantic Region: Nova Institution for Women & Shepody Healing Centre
Quebec Region: Centre Régional de Santé Mentale &  Comité Consultatif Régional Multidisciplinaire
Ontario Region: Grand Valley Institution for Women
Prairie Region: Regional Psychiatric Center & Edmonton  Institution for Women
Pacific Region: Fraser Valley Institution for Women & Regional Treatment Center

• Provide workshops to staff members at all levels throughout CSC.

50 one-day ethics workshops were delivered in Fiscal Year 2010/11.

11 Quality Improvement and Patient Safety (QIPS) one-day workshops were delivered in Fiscal Year 2010/11.

• Reinforcement by Regional Deputy Commissioners (RDC) to Wardens of the importance of holding unit and town hall meetings to encourage increased staff dialogue and interaction.

The Values Integrity and Conflict Management (VICM) Branch, consistent with its Work Plans continues, with the support of the RDCs, to deliver approximately 8 ethics workshops in each region each year.

The VICM Branch and the Regions have enhanced the VICM presence and therefore the V&E dialogue in each region through the addition of a Conflict Management and Values and Ethics Consultant.

The Process of developing the new CSC Values Statement involved all regional senior managers in an intense one-day values dialogue.  This level of involvement will reoccur in each region around the roll-out of the new VS with the focus on creating awareness and understanding among regional and national managers in respect to the new values as well as the development of plans to promote awareness of these values among staff. BF March 31, 2012

• Examine ways to increase CSC’s capacity to deliver additional Values and Ethics workshops across the Service.

The National Advisory Committee on Ethics (NACE), formerly known as the National Ethics Advisory Committee (NEAC), has met quarterly. Fiscal Year 2010/11 saw the Values Integrity and Conflict Management (VICM) deliver 13 Values Statement Renewal one-day sessions directed towards generating dialogue relating to the values that CSC employees believe are important to the Service. These sessions involved approximately 300 CSC employees across all levels and disciplines within CSC.   VICMB also developed a modified one-day Ethics Workshop to speak more directly to the sorts of issues faced in the daily interaction between security and Health Services personnel. The VICM continues to meet quarterly with the Regional Assistant Deputy Commissioner Corporate Services as the values and ethics champion in each region.

• Enhance staff awareness of the Office of Internal Disclosure (OID) underscoring its availability to all CSC employees.

Ongoing. In addition to the website on CSC’s Infonet that identifies the OID, related policies and contact information, the OID has developed a new brochure that is now in circulation. The Director, OID has been to each region and has a new information tour scheduled for each region and a number of institutions in Fiscal Year 2011/12.

• Revise Commissioner’s Directive 560 - Dynamic Security to provide more direction with regard to the responsibilities of management and staff.

Consultation and final draft completed. CD 560 has undergone final revisions and will go out for final consultation Summer 2011.

• Place additional emphasis on dynamic security in the new Correctional Officer Training Program piloted in the Pacific and Ontario regions. Introduce in all other regions.

As of April 2010, all regions are delivering the Correctional Officer Training Program (CTP), which contains a module on dynamic security. The last region (Atlantic) delivered their first CTP of the year in September 2010. The Train the Trainer session for the instructors of the course was completed in July 2010.

• Develop a dynamic security refresher course.

The development of dynamic security refresher training is complete. The rollout of this training commenced in August 2010 and was delivered first to all Correctional Managers across the country. Following the completion of this phase, adjustments and amendments were made based on feedback received from the Correctional Managers.

Subsequently, it was determined that the best implementation plan would involve delivering the training using a select number of Correctional Managers from each region (two per institution), as opposed to all Correctional Managers, thus ensuring the proper level of discussion and learning would be delivered.

Upon the identification/selection of the Correctional Managers by region, individual sessions have been held in each region to prepare the Correctional Managers to deliver the training and to develop the proper applicable scenarios to be incorporated in each region. Training of all required staff is ongoing.

• Distribute letters of expectation to all Correctional Managers to ensure that staff members are supervised consistently and that issues are brought to management’s attention in a timely fashion.

Letters of expectation were distributed to all Correctional Managers to ensure consistency in supervision and issues management. The Correctional Managers were assessed, amongst other factors, against these standards in their Fiscal Year 2009-10 performance evaluation.

• Issue a Security Bulletin to remind all Correctional Officers of their responsibilities with regard to security patrols and counts, and the importance of their observations of offender activities in all areas of the institution.

On December 15, 2008 a Security Bulletin was issued to remind all Correctional Officers of their responsibilities regarding counts and rounds. Moreover, quarterly reviews and quality assurance checks for rounds and counts were instituted in August 2010 in all regions at all security levels.

• Remind all Correctional Managers of their responsibility to provide constructive feedback to Correctional Officers when necessary.

On December 15, 2008 a Security Bulletin was issued to remind all Correctional Managers of their responsibility to provide constructive feedback to Correctional Officers when necessary.

• Introduce an additional stand-to inmate count at all maximum, medium, minimum, and multi-level institutions between the hours of 6:00 p.m. and 12:00 a.m.

An additional stand-to inmate count was introduced on July 10, 2009 at all maximum, medium, minimum, and multi-level institutions between the hours of 6:00 p.m. and 12:00 a.m. This direction was included in a Security Bulletin issued on July 10, 2009.

• Introduce additional security patrols at all maximum, medium and multi-level institutions (excluding women’s institutions).

An additional security patrol was introduced at all maximum, medium and multi-level institutions (excluding women’s institutions) on July 2009.

• Confirm that all institutional policies (Standing Orders and Post Orders) are in compliance with Commissioner’s Directive 566-4 - Inmate Counts and Security Patrols.

In Fiscal Year 2008-09, CSC confirmed that all institutional policies (Standing Orders and Post Orders) are in compliance with Commissioner’s Directive 566-4 - Inmate Counts and Security Patrols.

• Randomly analyse inmate counts and security patrols regionally on a quarterly basis and report results to National Headquarters.

In all regions, rounds and counts performance results are reported quarterly.

• Complete a project to install high-resolution digital cameras in the cell range areas of all women’s institutions.

The projects for all five regions were approved by the Contract Review Board in Summer 2010.

The women’s institution camera project is part of the overall national medium and multi-level range camera project. These projects have been delayed as the Statements of Technical Requirements are re-worked to allow for a more consistent national approach. The requirements that apply to the women’s institutions were based on comments provided by the Women Offender Sector. The RFPs was posted on MERX with closing dates in mid-May 2011.

Completion of this project is forecasted for the end of Fiscal Year 2011/2012.

Camera work at Grand Valley Institution for Women in the Ontario Region was completed regionally as an independent project.

The Wardens at the sites, in consultation with the Deputy Commissioner for Women, have determined the optimal location for the installation of cameras to ensure the dignity and privacy of women offenders is respected while simultaneously ensuring necessary visual coverage of common areas to ensure good security practices. The locations are as follows:

Accommodation Areas

• Secure Unit - improving camera coverage of maximum security ranges
• Segregation - cameras for segregation ranges
• Segregation cells - for those cells identified as Observation Cells, upgrading in quality as determined by the sites.

Common Areas

• Visits and Correspondence
• Gymnasium/weight rooms areas as determined by the site
• Corridors

The following information indicates other areas the wardens can individually assess to determine if camera coverage in that specific location would be beneficial. The Women Offender Sector supports these additional areas as determined by the sites, as it is recognized that they are normally staffed when offenders have access.

Additional Areas

• Commissary
• Programs Area
• Administration Areas

The Implementation for this project will take place by end of August 2011.

• Examine the use of alternative systems, including proximity card technology that identifies, tracks, and records the presence of Correctional Officers conducting security patrols and inmate counts.

A key-based Guard Tour System (GTS) with real-time reporting is currently in use at Joyceville, Millhaven and some Quebec Region institutions. A Proximity card-based (HID cards) GTS has been installed at Kingston Penitentiary. While the system is operational, issues with the reporting format needs to be resolved. This has been reported to the contractor. In the meantime, a request has been made for assistance in training key members at Kingston Penitentiary so that the system can be launched confidently.  A thorough operator’s guide has been provided as an interim solution.  It is anticipated the system will be fully operational by the end of August 2011.

Four other Proximity card-based GTS will be installed in the Prairie Region by March 31, 2012.

• Explore the use of new technologies (by way of market survey) to enhance security and increase staff ability to verify offender well-being, especially during the night shift.

In 2009, CSC undertook a review of technologies that are currently available and was not able to identify a system that would operate with a high level of accuracy in CSC’s physical environment with uncooperative inmates. CSC continues to investigate new technologies.

• Implement an enhanced mental health screening tool at 13 of the 16 intake assessment sites in Fiscal Year 2008-09.
• Implement the mental health screening tool at the remaining 3 of the 16 intake assessment sites by end of Fiscal Year 2009-10.

Mental health screening has been implemented at 16 CSC intake sites including women’s institutions. The Computerized Mental Health Intake Screening System (CoMHISS) is a standardized process to identify offenders that require a more in-depth mental health assessment and/or intervention. Early identification of mental health issues enables timely intervention, prevents further deterioration of mental health and contributes to an appropriate penitentiary placement for offenders with mental health needs. The CoMHISS version II project is underway to identify and implement further improvements such as a cognitive screening tool.

• Train CSC Psychologists in suicide risk assessment (see also page 10).

In Fiscal Year 2008-09 additional suicide risk assessment training was offered to approximately 300 CSC psychologists.

• Develop guidelines on sharing mental health-related information and communicate them to staff.

The Guidelines for Sharing Mental Health Information were distributed to staff in February 2011.

• Review resources available and allocated to the care of women offenders to ensure efficient use and capacity to achieve correctional results.

This exercise was completed in November 2009 and sufficient funding has been allocated to the Women Offender Sector.

• Implement new deployment standards for correctional staff.

Commissioner’s Directive 004 was promulgated on June 8, 2009 and national standards for the deployment of Correctional Officers at all institutions were implemented. This increased standardization is aimed at promoting consistency, equity, efficiency and transparency across institutions, which will in turn enhance the security of the public, staff and offenders. These standards also provide a common blueprint and useful tool for all institutional managers and will enable overtime challenges to be addressed systematically.

• Develop a more effective approach to offender case management by focusing psychological and specialized assessment resources on the highest risk/needs offenders.

On November 12, 2008 CSC revised its policy on intake assessments to emphasize the importance of specialised psychological assessments for offenders who demonstrate the highest risk/need.

Commissioner’s Directive 705-5 – Supplementary Intake Assessments directs psychologists to conduct comprehensive supplementary assessments for those “at risk” offenders who demonstrate situational adjustment difficulties, suicide risk indicators, and self-injurious indicators. These assessments are normally conducted within the first 30 days of admission.

• Amend Commissioner’s Directive 843 - Prevention, Management and Response to Suicide and Self-Injuries, to include information about the use of psychological and psychiatric services in the assessment and intervention of offenders at risk for suicide or self-injury.

Promulgation of this revised policy occurred in June of 2011.

• Seek advice from an expert consultant on the following:
• Best practices in the assessment of risk of suicide and self-injury;
• Intervention techniques for offenders at risk; and

• Processes to allow for the sharing of information between staff when an inmate is exhibiting suicidal or self-harming ideations.

The Health Services Sector has developed a Self-Injury Strategy to facilitate better management and prevention of self-injury by offenders.  An updated version of this strategy was distributed in March 2011.

• Integrate elements of the Women’s Violence Prevention Program into a Women’s Modular Intervention (WMI) to allow for delivery to women offenders in Secure and Segregation Units.

A new correctional program was developed incorporating not only elements from the Women's Violence Prevention Program, but other programs as well (e.g. Women Offender Substance Abuse Program). The newly designed Women’s Modular Intervention (WMI) includes integrated skills and targets all problematic behaviours linked to a maximum security classification and crime.

Experienced program facilitators completed training in August 2009. Grand Valley Institution for Women started a pilot in October 2009, Edmonton Institution for Women started in January 2010, Joliette Institution started in June 2010 and Fraser Valley Institution for Women started in September 2010. It is expected to remain in pilot program mode until July 2011.

• Compile a review of construction-related deficiencies identified in reports, reviews and investigations to develop appropriate criteria for future construction projects.

A comprehensive list of construction-related vulnerabilities was compiled and corrective strategies were identified.  Regions were tasked with initiating projects to address the vulnerabilities.

• Develop mitigating strategies for identified deficiencies.

Identified vulnerabilities included the lack of a Secure Interview Room in all Secure Units, and the absence of service hatches (i.e. food slots) in all five institutions’ maximum-security cells. All five multi-level women’s institutions constructed a Secure Interview Room and service hatches in the identified maximum-security cells.

• Implement corrective measures immediately following incidents at the local level while the investigative process gets underway.

Notwithstanding whether CSC initiates an investigation, Situation Reports on serious incidents include corrective measures. Follow-up and closure on these measures is completed by the Regional Deputy Commissioner and when applicable, their actions are verified through the investigative process.

• Produce quarterly summaries highlighting all pertinent issues and statistical information regarding deaths in custody (excluding deaths by natural causes) and share with the OCI.
• Share these summaries with all regional and institutional management committees as part of their meeting agendas on a quarterly basis.

To date, three quarterly summaries have been produced and widely distributed to operational staff and managers throughout CSC, as well as the OCI.

• Establish an independent review group to assess CSC’s actions and responses to deaths in custody on an annual basis.  

The Independent Review Committee was established in June 2010. The members include a senior provincial government official as well as a provincial Chief Coroner and Criminology University Professor. CSC will benefit from the committee members’ experience and seek their suggestions and advice on the approaches and techniques that would enhance CSC’s capacity to respond more effectively to these types of incidents. The Independent Review Committee will also provide feedback on the appropriateness and adequacy of the corrective measures initiated by CSC in response to its prior investigations into deaths in custody. Their final report was submitted to EXCOM on February 15, 2011 and the management action plan is currently being developed: the report will be presented to EXCOM in August 2011.

• Share significant findings so that CSC can prevent the occurrence of similar incidents.

To date, six significant finding documents have been completed and widely distributed. Some of the topics covered include suicides, hostage takings, murders in institutions and major disturbances.

• EXCOM to conduct monthly reviews of investigation reports and corrective measures for each death in custody.

Since March 2010, 54 national investigation reports and their corrective measures have been presented at EXCOM meetings. In many cases the corrective measures were already implemented at the time of review.

• Include CSC’s commitment to enhancing its capacity to assess and respond to issues related to preventable deaths in custody in the Report on Plans and Priorities to Parliament.

CSC's Report on Plans and Priorities 2010-11 makes specific reference to staff responsibility for preventing self-injury and unnatural death by offenders. It identifies plans that are directly targeted at reducing self-injury and death such as mental health interventions, gang prevention strategies, and the use of technology. A reduction in self-injuries and deaths is one of the outcomes expected from a number of strategies such as reinforcing dynamic security, eliminating drugs in institutions, hiring and training specific groups of staff and addressing other health issues amongst offenders.

• Clarify and communicate the role and responsibilities of the Deputy Commissioner for Women and the Women Offender Sector to National Headquarters, the regions and women’s institutions (see also Recommendation 1.6).

The Women Offender Sector’s Governance, Roles and Responsibilities document was approved by CSC’s EXCOM and shared with CSC staff and stakeholders in November 2008. It is now operational and reinforced at ADCIO/ Wardens meetings.

• On a regular basis, discuss with the OCI how issues of concern in women’s facilities can be brought to the national level when an urgency or serious difference of opinion exists relating to the care of women offenders.

Discussions occur at quarterly meetings. Meetings between the OCI, Health Services and the Women Offender Sector were held on February 12, 2010 and May 20, 2010.

A consultation with the OCI on management protocols in place to deal with high-risk women was held on February 18, 2010. The consultation report was shared with the OCI in June 2010.

• Amend Commissioner’s Directive 709 - Administrative Segregation to provide guidelines for segregation placement/admission, segregation review board report content, and mental health assessment for administrative segregation.
• Conduct a management review to assess the level of compliance with this direction.
• Expand definitions and the formalization of a number of principles related to administrative segregation.
• Provide clearer identification of roles and responsibilities in administrative segregation at the national, regional, and institutional levels.
• Provide clearer direction on responsibilities related to administrative segregation.
• Provide psychological opinions for administrative segregation cases.
• Establish a role for Health Care and Psychology to supplement the existing review mechanisms for long-term segregation placements.

Commissioner’s Directive 709 – Administrative Segregation is being revised to include guidelines for segregation placement/admission, segregation review board report content, and mental health assessment for administrative segregation.  Regions have been consulted, feedback has been reviewed and we are now waiting for all the changes to be included into a new version so it can be submitted to EXCOM.  The new CD provided the requested key actions.  It is anticipated for promulgation in the second half of 2011.

The Commissioner’s Directive 709 – Administrative Segregation that was promulgated on November 09, 2007 clearly identifies roles and responsibilities in administrative segregation at the national, regional, and institutional levels. It contains changes in policy objectives, expanded definitions and the formalization of a number of principles.   This action has been completed.

The Commissioner’s Directive has five new annexes, which provide guidelines for memorandum of understanding, segregation/admission, how to run a Segregation Review Board, Segregation Review Board report content, providing psychological opinions for administrative segregation cases and offender reintegration plans.

Regions began submitting 2010-2011 Administrative Segregation Audit results in April 2011 to verify and ascertain compliance with CD 709. Two sites per region were audited with 10 sample cases selected at random.  Upon finding deficiencies, all regions must ensure these are being addressed through an Action Plan with Regional Segregation Oversight Manager follow-up. The results will be analysed and National Trends identified, and subsequently discussed with the Regional Segregation Oversight Managers at the Annual Meeting to be held in October 2011.

• Produce and distribute a segregation handbook for staff to clarify the policy expectation for the timely review of these cases.

A segregation handbook for staff was produced in June 2008 and widely distributed to clarify the policy expectation for the timely review of these cases. It is also intended to serve as a reference and guide for all CSC staff involved in any aspect of the administrative segregation process. The handbook is also available on CSC’s Infonet. When the revised CD 709 is promulgated, the Handbook will be released and communicated to the field.

• Conduct an operational examination of long-term segregation using representative sampling methodology and an external review process (See also Recommendation 1.1).

In addition, to address the issue of long-term segregated inmates, in October 2009, CSC established an External Review Board composed of two independent external consultants. They produced two reports with the same terms of reference which were shared with EXCOM:  Themes of their findings were shared in November 2010 and next steps were shared with EXCOM in March 2011.

• Review CSC’s capacity to address the needs of women offenders with mental health and/or behavioural needs (See also Recommendation 1.1).
• Develop short and long-term strategies on service, support and accommodation needs for women offenders identified in this group (See also Recommendation 1.1).

As previously mentioned, between August 2008 and March 2009, 45 beds were added to three of CSC’s institutions for women resulting in a significant increase in capacity for women offenders.

In February 2009, a proposed long-term accommodation strategy for women was presented to and supported by CSC’s Executive Committee (EXCOM). CSC’s overall infrastructure plan will integrate elements of this approved strategy for women.

Specifically, CSC will add 144 beds over the next two fiscal years. This includes: 4 Structured Living Environment beds at each site (other than Okimaw Ohci), 40 general population beds at Edmonton Institution For Women, 20 general population beds at Fraser Valley Institution for Women, 40 general population beds at Grand Valley Institution for Women, 14 general population beds at Nova Institution for Women, and 10 maximum security beds at Joliette Institution.

• Engage an expert consultant to assist CSC in its efforts at making improvements to Commissioner’s Directive 843 - Prevention, Management and Response to Suicide and Self-Injuries.

Information received from the external consultant was used to make proposed revisions to Commissioner’s Directive 843. This revised Directive was promulgated in June 2011.

• Enhance Commissioner’s Directive 843 -  Prevention, Management and Response to Suicide and Self-Injuries to include improved communication to front-line staff about offenders’ risk levels and observation status, as well as best practices for the assessment of suicide and self-injury risk.

Changes have been incorporated into the revised version of the Commissioner’s Directive. The revised Directive was promulgated in June 2011.

• Develop and finalize standardized tools and guidelines for use by operational staff to create plans to address self-harming behaviours.

These tools are included as an annex to Commissioner’s Directive 843 - Prevention, Management and Response to Suicide and Self-Injuries. This CD was promulgated in June 2011. Both the annex and Directive will assist staff in the management of offenders who engage in self-injury.

• Utilize and optimize existing processes and CSC resources to ensure that each Board of Investigation understands that it can access a wide variety of external experts and specialists as deemed necessary.

All CSC investigators are trained and understand that they have access to a wide variety of experts as needed. During a Board of Investigation, the Chair of the board can access external experts, and for more complex investigations, specialized expertise is added to the board where feasible.

• Ensure that Regional Segregation Review Boards and Regional Segregation Oversight Managers across CSC perform the delegated responsibilities of the regional reviews and ensure that each case of an inmate in segregation is reviewed regionally every 60 days (see also Recommendation 5).

All five regions are committed to working in collaboration with the Regional Segregation Oversight Manager (RSOM) to ensure proper reviews of cases and to pursue the true resolution of long-term segregation cases.

CSC has produced an Annual National Trends Report to monitor placement in segregation.

• Issue a reminder to reinforce the importance of performing and documenting physical and mental health assessments during these daily visits

A reminder was issued to staff in July 2009. This message continues to be reinforced verbally with all Health Services staff.

• Introduce a National Population Management Committee to provide national monitoring of the use of administrative segregation.

This committee meets on a regular basis and has established Terms of Reference.

• Women Offender Sector to provide input and support and perform a functional oversight role regarding women offenders placed in segregation through a review of a random sample of segregation cases.

A review of a random sample of segregation cases was completed by CSC’s Women Offender Sector in Summer 2009. Individual (site level) results were communicated with the Assistant Deputy Commissioners Institutional Operations and Wardens in July 2009. Where required, corrective measures were identified and implemented.

• Undertake an operational examination of segregation placements of inmates with mental health concerns using a representative sampling methodology and an external review process.

In addition, to address the issue of long-term segregated inmates, in October 2009, CSC established an External Review Board composed of two independent external consultants. They produced two reports with the same terms of reference which were shared with EXCOM:  Themes of their findings were shared in November 2010 and next steps were shared with EXCOM in March 2011.

• Reinforce and communicate the importance of preservation of life across the organization to all levels of staff.(See also Recommendation 1.3).

In May 2008, a message was sent to all CSC staff reinforcing the continuing need for vigilance in preventing inmate suicide. As well, the Significant Findings from National Investigations on Inmate Suicides Report was distributed to all sites.

• Issue a bulletin clarifying that “past behaviour” includes an offender’s history of self-harm.

A Security Bulletin was issued on August 19, 2009 to remind all staff that that the CSC Situation Management Model requires staff to consider the offender’s “past behaviour” during and throughout an incident.

This includes giving consideration to an offender’s history of self-harm and the potential for future cumulative self-harm when determining whether immediate intervention is required.

• Complete written responses for all complaints and grievances submitted.

Written responses for all complaints and grievances were completed on August 14, 2008 and December 15, 2008.

• Share a summary report with the OCI.

A summary report was shared with the OCI on August 14, 2008 and December 15, 2008.

• Review and prepare recommendations concerning the procedures for collecting and receiving segregation grievances at all institutions to ensure confidential, complete access to the process, as well as expeditious receipt of complaints and grievances across the Service.

As of October 31, 2008, the policy states that the Institutional Head must ensure that complaints and grievances are collected and reviewed daily.

• Revise Commissioner’s Directive 081 - Offender Complaints and Grievances.

Commissioner’s Directive 081 - Offender Complaints and Grievances was amended as per the above in October 2008.

• Review access to the grievance process at Grand Valley Institution for Women and make changes to ensure timely, effective and appropriate responses.

The process at Grand Valley Institution for Women was reviewed and changes were made to the process in September 2008.

• Deliver training sessions to staff at Grand Valley Institution for Women on how to process and respond to grievances.

Staff from CSC’s National Headquarters visited the institution, reviewed its process, recommended and implemented changes, and provided training and assistance to institutional staff.

• Revise grievance procedures and policies.

As previously mentioned, Commissioner’s Directive 081 - Offender Complaints and Grievances was amended as per the above in October 2008.

• Complete internal audit and initial action plans and present to the CSC Audit Committee.

The audit was completed in May 2009 and recommendations were accepted.

• Complete Audit Committee action plans.

The action plans have been completed and the only outstanding issue is finalizing CD 081. CD081 has been sent out for consultation and responses were due back August 31, 2011. It is expected that we will have an approved/revised version of CD081 by October 2011.

• Develop a process for an external review of the Offender Complaint and Grievance process.

An external independent review was completed as per the above. Recommendations were presented to EXCOM.

• Development of the process will follow consultations with key stakeholders, including the CI.

The independent review included engagements with key stakeholders such as the CI.

• Develop a cross-jurisdictional approach to mental health services that includes identifying gaps in the continuum of care, building stronger partnerships with stakeholders outside of the federal correctional system, and developing innovative solutions.

In November 2008, the Heads of Corrections (HOC) created a new Federal/Provincial/Territorial (FPT) Working Group on Mental Health (WGMH). The WGMH serves as an advisory body to the HOC and was tasked to develop a national corrections mental health strategy in consultation with the Mental Health Commission of Canada.

The HOC FPT WGMH met for the fifth time in February 2011 to continue work to build partnerships within/outside CSC, to improve flow of information / services, including gap analysis, best practices, identification of risks, and opportunities for future collaboration.

The framework and action plan for a Mental Health Strategy for Corrections in Canada was finalized at the HOC meeting in June 2011. The framework includes consideration for self-injurious behaviour and suicide.

• Host a symposium on mental health that brings together international and Canadian experts to examine practical solutions for improving the delivery of health services.

A symposium was held in May 2008.

Continued implementation of the mental health strategy, ongoing work of the Federal/Provincial/Territorial Mental Health Working Group, and discussion at EXCOM will expand on some of the issues raised during this symposium.

• Hold a forum to explore the nexus between Canada’s mental health and criminal justice systems.

A forum was held in June 2009 to identify opportunities for improvement with partners. Engagement with key stakeholders is ongoing.

• Review the status of efforts with federal/provincial/territorial and non-governmental partnersto address these complex issues.

Both the Health – Federal/Provincial/Territorial (FPT) Working group and the Mental Health - FPT Working Group are working collaboratively to improve the continuum of health care for offenders across all jurisdictions. Emphasis is placed on opportunities for collaboration and knowledge exchange. For example, CSC has actively shared and trained other jurisdictions on its two-day mental health awareness training.

• Develop a framework to assess alternative models for the provision of health care services to federal offenders.

In December 2010, CSC finalized a framework to assess alternative models for the provision of health care services to federal offenders. The result of this project was a focus on mental health services.

• Actively participate in the Federal/Provincial/Territorial Heads of Corrections Working Group on Health.

Next meeting will be held in October 2011. Last meeting was in February 2011 with active participation from members including representation from jurisdictions and the Mental Health Commission of Canada.

The framework and action plan for the Mental Health Strategy for Corrections in Canada was finalized at the Heads of Corrections meeting in June 2011.

• Share best practices for assessments, treatment, training and discharge planning.
• Chair the Federal/Provincial/Territorial Heads of Corrections Working Group on Mental Health, which includes membership from the Mental Health Commission of Canada. CSC also works closely with other partners, including provincial coroners’ offices, to discuss opportunities to prevent future deaths in custody.
• Hold a meeting with the Coroners and Medical Examiners from across Canada to discuss information sharing and to reinforce CSC’s commitment to cooperation.

Next meeting will be held in October 2011. Last meeting was in February 2011 with active participation from members including representation from jurisdictions and the Mental Health Commission of Canada.

The framework and action plan for the Mental Health Strategy for Corrections in Canada was approved at the Heads of Corrections meeting in June 2011.

To allow for maximum cooperation within the parameters and legal frameworks of the respective jurisdictions, these meetings help clarify the cooperative process and provide a valuable opportunity to identify recurring and evolving issues related to deaths in custody. The second meeting occurred in Ottawa in August 2010.