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Creating a treatment culture for special needs inmates.

The growing number of inmates with mental health and behavior-control problems requires that corrections practitioners develop treatment procedures that go beyond addressing isolated needs. Programs that focus solely on psychiatric intervention, literacy, social skills, vocational training or alcohol and other drug abuse counseling usually fail to enable offenders to function in an institution's general population or in the community. Corrections departments must develop a holistic treatment approach for these inmates that uses the entire institution environment, which creates a "treatment culture."

When the Wisconsin Resource Center (WRC) in Winnebago opened 10 years ago, it became one of the first correctional institutions whose primary mission was to provide treatment programming for special needs inmates. Inmates transferred to WRC typically fall into one or more of the following categories:

* mentally ill or behaviorally unable to adjust to the traditional prison environment;

* developmentally disabled;

* depressed or suicidal;

* emotionally unstable or given to stress disorders; and

* approaching mandatory release but have been retained in maximum security because of adjustment problems.

Since the institution's inception, WRC staff have developed a comprehensive approach to treatment focusing on four interrelated goals: aggressive mental health intervention to stabilize mental functioning and conduct; behavior modification through participation in unit programs; internalization of social values through involvement in productive academic, recreational, work and service activities; and development of social skills through participation in multidisciplinary treatment programs.

WRC currently serves 165 male inmates. Each inmate is evaluated immediately upon arrival. A psychiatrist, psychiatric nursing clinician, psychologist and social worker review his records and referral notes and interview him. Based on the information they gather on the inmate's behavior and needs, staff place him in one of WRC's eight units. Daily staff meetings are held to review inmates' progress and make necessary unit transfers. Each unit program targets specific needs and uses specialized techniques to modify inmates' behavior.

The Security Unit. This is a highly controlled environment for inmates with extreme behavior problems. Using a system of incentives for compliant behavior, staff in this unit attempt to stabilize an inmate's behavior to achieve basic communication and cooperation.

The Program Transition Unit. This unit accepts the inmate after he has demonstrated some willingness to participate in programming. The inmate progresses through four levels of supervision, in which he is permitted options for increased freedom and responsibility. For example, an inmate would begin at a level in which he is locked in his room most of the day, permitted to leave only in mechanical restraints. The inmate would then move to a level in which he is still confined to his unit but is permitted to take part in unit activities, then he would be allowed off the unit for certain activities, and eventually he would reach the final level of reintegration into the institution's general population.

The Psychiatric Intervention Unit. This unit is managed by medical staff and performs three major functions: assessing newly admitted inmates who are referred for special evaluation; providing care for severely mentally ill and depressed and suicidal inmates; and initiating aggressive treatment.

One Basic Skills and two Social Skills units. These units use systems of positive reinforcement to encourage inmates to develop greater self-awareness and competence in personal care, behavior control and interpersonal relationships. For example, the Social Skills units rely on a three-step system of responsibilities and privileges.

The Transfer and Release units. Staff in these units provide inmates with the necessary skills and information for successful reintegration into the general prison population or the community. For example, the inmates are enrolled in programs to develop job-seeking and consumer skills, learn about community resources and supervision rules, and learn how to cope with the emotional crises that often accompany reintegration.

Shortly after an inmate arrives and every eight weeks thereafter, he participates in a "unit staffing." The unit manager, social worker, psychologist and line staff, together with representatives from the education, activity therapy, medical and security departments, discuss the inmate's needs and progress and develop a treatment plan.

The resulting individual care plan details the inmate's problems, sets short- and long-term objectives and assigns responsibility for staff intervention. Usually included in the plan are referrals for activities, which may be academic classes, activity therapy groups or multidisciplinary treatment programs.

Unit staffing reinforces WRC's team approach. Because staff from all departments help assess inmates' needs, there is a greater general awareness and sharing of treatment objectives.

As soon as an inmate's mental functioning and conduct are stable enough to allow him to participate in activities outside his assigned unit, he is scheduled for school, activity therapy, work assignments and service projects. Each unit's program requires 25 to 35 hours of program involvement per week.

"Mainstreaming" the inmate into assignments similar to those he will encounter in traditional facilities or in the community helps him learn what is important, how to interact with others and how to accomplish daily tasks. It reinforces social values and discourages inappropriate behavior.

Special needs inmates typically have many needs in addition to their mental illness or developmental disability. Because these needs are complex and have developed over many years, WRC has designed comprehensive programs to deal with them. Teachers work with activity therapists, social workers, psychologists, and chapel and unit staff to conduct six treatment programs, which add up to 110 hours of group work per week.

Each of the six programs targets inmates with specific needs and consists of several components. They range in length from 96 to 200 hours of group work.

* Anger Control. This program is for inmates with histories of violence in their families, the community or the correctional system. It consists of groups on conflict resolution, communication skills, assertiveness and stress management.

* Self-Reliance. This is for vulnerable inmates lacking interpersonal skills. It consists of groups on self-concept, emotional awareness, communication skills, assertiveness, stress management, decision making, goal setting and therapeutic crafts.

* Daily Living Skills. This program is for inmates who, because of their mental health problems or intellectual limitations, have difficulty handling even the most basic tasks. It consists of groups on special work, exercise, hygiene, household maintenance, reading for daily life, literacy tutoring, cooking, therapeutic crafts, therapeutic recreation, seasonal activities and communication skills.

* Pre-Release. This is for inmates who will be released to the community within six months. It consists of groups on job skills, consumer skills, driver information, community resources, cooking and community supervision.

* Family Living Skills. This is for inmates who have not been able to maintain positive relationships because of their dysfunctional family background. It consists of groups on relationships, human sexuality, child growth and development, parenting, family leisure activities, family communication, gender roles, domestic abuse and family values.

* Alcohol and Drug Education. This program is for inmates who have substance abuse problems. It consists of groups on alcohol and drugs, substance abuse information, cognitive restructuring, decisions and values, problem solving, family relationships, wellness lifestyle and alternative leisure activities.

Although the inmates who participate in these programs usually have long histories of failure in educational and treatment programs, nearly 70 percent complete the WRC programs successfully. Since these programs began in 1987, more than 1,200 inmates have been awarded certificates of completion.

One of WRC's primary treatment goals is to provide inmates with the skills necessary to function in a less secure setting. Whereas 79 percent of admissions come from maximum security institutions, only 40 percent are returned to maximum security upon transfer.

During the 10 years WRC has been open and the six years the multidisciplinary programs have been in effect, WRC's staff have developed many methods for treating special needs inmates. However, because of the growing array of problems this population creates for corrections as well as society in general, a wider-ranging effort is necessary.

Because many of these inmates' problems originated before their contact with the correctional system and because they will have to function in community or correctional environments after they leave WRC, staff members have expanded their mission to reach beyond the institution. They do this by providing consultation and training to colleagues who deal with similar clientele outside WRC.

Jerry Bednarowski is the education director at the Wisconsin Resource Center and is secretary of the Wisconsin chapter of the Correctional Education Association.
COPYRIGHT 1993 American Correctional Association, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:Bednarowski, Jerry
Publication:Corrections Today
Date:Dec 1, 1993
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