University and sheriff's office create a model collaboration.

The University of Massachusetts School of Nursing (UMA-SON) in Amherst and the staff and inmates at the Hampshire County Sheriff's Office Jail and House of Correction (HSO) in Northampton, Mass., have maintained a unique four-year collaboration. UMA-SON has a strong community health mission and a curriculum focused on health promotion and disease prevention. Service learning is a key element in the undergraduate experience for all students. HSO, a 300-bed county correctional facility, is involved with the local Office of Community Corrections (OCC), an agency that offers an alternative sanctioning program and a monitoring site for clients on parole or probation.

HSO is cutting edge in its approach to incarceration. In addition to offering typical educational, substance abuse, and health programs, a wealth of alternative treatment is also available to the inmates. Programs such as job fairs, meditation, art therapy, poetry writing, mural projects, quilting, a father-child reading program, service dog training and formal panel presentations conducted by inmates are a few of the "electives" available at HSO. In an effort to address its need for inmate health education, it seemed only natural for HSO to develop a relationship with an area university nursing department. UMA-SON's curriculum goals meshed very well with some of HSO's unmet health and educational program needs. This partnership has proved beneficial to inmates, staff and students.

Inmate Health Programs

During the past four years, student nurses have offered programs for inmates on topics such as meditation, nutrition, HIV and hepatitis C virus (HCV) prevention, dental hygience, fluprevention, and employability skills. An important aspect of the students work is their creation of curricular modules that become permanent educational tools for the facility. Two honors students have completed their health-focused thesis work at HSO. Of significance is the high number of drug-related sentences being served at HSO. Eighty-five percent of supervised offenders struggle with some form of substance abuse, (1) and it has been estimated that 30 to 40 percent of all those in short-term incarceration are infected with HCV and are at risk of transmitting it to others upon release. (2) UMA-SON brings expertise in health promotion and disease prevention that expands existing program priorities.

UMA-SON and HSO have just completed the first Mobile Outreach Project, which offered free testing for HIV and HCV, and vaccinations for hepatitis A and hepatitis B, for 48 of the 160 inmates enrolled in treatment programs. Funded in part by the Massachusetts Department of Public Health, the aim is to uncover new cases of HIV and HCV. The project goals are to prevent the transmission of infectious diseases and refer high-risk individuals for consultation upon release. These outreach events are staffed by student nurses as part of their clinical rotation at OCC and HSO. Rotations are three months long, and students spend six hours a week at the facility. All students are required to pass a background check and attend an orientation. Course requirements include weekly journals, curriculum development, conducting inmate education classes and a final presentation to the staff.

Inmate Health Fair

The most successful project undertaken has been the biannual inmate health fair. Booths with brightly colored posters are set up in the visitors' room. There are hands-on demonstrations and literature on all topics available to participants. Offerings include information on nutrition, exercise, smoking cessation and communicable diseases. UMA-SON and HSO staff provide education and screening materials on diabetes, obesity, hygiene, and prostate and testicular cancer. With the help of the medical unit staff and the city public health nurse, inmates are offered vaccinations for hepatitis A and B and tetanus.

Upon entering the fair, each inmate is given a "health profile" to keep (see Figure 1). As inmates visit each screening health station, they fill in their blood pressure, blood sugar, body mass index (BM1), height and weight. This hard-copy record then serves as a guide for lifestyle changes that may result in health improvements. At the end of the event, evaluations are completed by all participants and recommendations are reviewed by UMA-SON staff before the end of their rotation. The nursing students and staff use this information to plan for the next health fair activity.

[FIGURE 1 OMITTED]

Staff Health Programs

Education programs are not limited to inmates; HSO staff also need continuing health education. Two areas they selected as important were stress reduction and infection prevention. The School of Nursing sponsored a half-day workshop for staff that featured a lecture on methicillin-resistant Staphy lococcus aureus (MRSA) by a local infectious diseases specialist and mindfulness training to reduce stress. This kind of programming reinforces the important job done by staff and offers them strategies to work effectively and safely.

Conclusion

Dissemination of these activities and outcomes informs clinical practice and can be used to change clinical practice and can be used to change organizational operations. These innovations in correctional health care education were showcased in 2005 at the annual meeting of a large national conference in San Francisco. An overview of UMA-SON and HSO programs was recently presented at a nursing honor society conference in Holyoke, Mass., and at a correctional medicine conference in Boston in March 2007. The partners again spoke about their collaboration in November 2007 at the biennial convention of Sigma Theta Tau International in Baltimore.

In the context of on-going program budget cuts and increasing rates of incarceration, the creative approaches initiated by the student nurses and HSO staff are working well. As a team, HSO and UMA-SON are able to enhance health education and offer strategies training for nursing students while providing valuable learning opportunities for correctional staff and inmates. This highly effective collaboration is a model that could be replicated across the country, becoming a catalyst for positive change throughout the correctional health system.

ENDNOTES

(1) Washington County Community Corrections Department. 2005. Community corrections--Program services. Washington County, Ore,: Washington County Community Corrections Department. Available at www.co.washington.or.us/deptmts/comm_cor/program.htm.

(2) Davis, G.L., J.E. Albright, S.F. Cook and D.M. Rosenberg. 1998. Projecting the future healthcare burden from hepatitis C in the United States (abstract). Hepalology, 28 (supplement I):390A.

Donna M. Zucker, RN, Ph.D., is an associate professor for the University of Massachusetts School of Nursing. Catherine Rigali is director of volunteer programs for the Hampshire Sheriff's Office.