Corrections to Community Trainer's Manual -- Introduction

Description of Who Wrote Manual and Why

The United States has only 5% of the world's population but the world's highest incarceration rate. Consequently, the United States has over a quarter of the world's prison population and the rate of incarceration continues to rise annually. As of mid year, 2003, more than 2 million people were incarcerated in the Nation's jails and prisons, compared with 325,400 in 1970?an increase of more than 500 percent. Many more pass through the correctional system each year because most inmates return to the community after relatively brief periods of confinement. Approximately 12 million inmates were released into the community in 2000, most from city and county jails. At year end 2001, a total of 5, 618,000 U.S. adult residents or about 1 in every 37 U.S. adults had ever served time in prison.

A highly disproportionate number of inmates suffer from infectious disease, mental illness and substance abuse compared with the rest of the Nation's population. Coupled with the expanding inmate population, these high rates of disease create a critical need for preventing, screening, and treating illness before inmates are released into the community. An important, nationally funded research study, the NIJ/NCCHC Health Status of Soon-To-Be-Released Inmates project has shown doing so can reduce the health risks and financial costs to the community that are associated with releasing large numbers of inmates with undiagnosed and untreated diseases.

Toward that end, the expert panels assembled for the NIJ/NCCHC Health Status of Soon-To-Be-Released Inmates project compiled a list of ten policy recommendations that if taken on nationwide would improve the physical and mental health of inmates, protect the public from communicable disease, and reduce the huge cost to society of inmate illnesses that go untreated. One of these critical policy recommendations is the need to "develop and maintain a national literature database for correctional health care professionals, including a compendium of policies, standards, guidelines, and peer reviewed literature."

The Southeast AIDS Training and Education Center (SEATEC) through the Correctional Technical Assistance and Training project (CTAT) has provided training to corrections staff and evaluated the effectiveness and reliability of different models of correctional infectious disease training and education for more than eight years. In preparation for the design and delivery of these trainings, the staff of CTAT continually conducts a review of the literature on correctional infectious diseases and their treatment. This has resulted in a literature database of policies, standards, guidelines, and peer reviewed literature relevant to correctional health care professionals. This literature database has become the basis of this manual, Corrections to Community: Infectious Disease ? Prevention, Treatment, and Transitional Care; a Trainer's Manual and Online Resource Guide, (CTAT Corrections Curriculum Project).

The purpose of the CTAT Corrections Curriculum Project is two-fold:

(1) to catalog in written format the academic knowledge and lessons learned from providing the corrections oriented training / technical assistance and

(2) to allow individual correctional agencies, public health departments, or community agencies to utilize this information through the use of a manual to address their specific training needs at little expense to the specific agencies.

Health care providers who interact with offenders have many opportunities to help foster the behavior changes needed to stem the spread of infectious diseases. But in order to accomplish this goal, they need access to training and medical updates. Keeping abreast of the latest medical information on infectious disease is a challenge and many health care providers rely on continuing education programs to do so. The authors hope this manual is a meaningful part of the continuing education programs for care providers to share the lessons learned through the CTAT Corrections Curriculum Project. May the result be high-quality care for all inmates and ex-offenders living with infectious diseases

Target Audience of Manual

The target audience of this manual is individuals or groups involved in the physical, mental, spiritual and academic health and well being of current and ex-offenders. Specifically, this manual, Corrections to Community: Infectious Disease ? Prevention, Treatment, and Transitional Care; a Trainer's Manual and Online Resource Guide (CTAT Corrections Curriculum Project), is written for medical staff, transition counselors, staff of Community Based Organizations and Faith Based Organizations, mental health counselors, case management staff, and school teachers.

The target audiences are delineated based on the role individuals or organizations play in the lives of offenders rather than at the "location" of these individuals/organizations. For example, medical staffs are primarily concerned with the physical health of offenders whether they interact with the offender inside the correctional facility or at a public health department as a parolee/probationer. By addressing the target audiences along these lines, the transitional line between "inside" the facility and "outside" the facility can be cohesively addressed. That is the effective transition of offenders into the community IS the concern of ALL members of the target audience regardless of where or when they interact with the offender.

Although this manual is addressed primarily to individuals and organizations that interact with offenders regarding "care issues", incorporated into this manual is information relevant to individuals and organizations that interact with offenders regarding "custody issues". Correctional custody staff and sheriff departments/police/probation/parole staff share a similar security mission with regard to offenders as well as a primary concern regarding occupational exposure to infectious diseases. The chapter on Occupational Exposure includes a section designated specifically to resources for security staff regardless if they are located "inside" the facility or "outside" the facility.

Description of Format of Manual

The Corrections to Community: Infectious Disease ? Prevention, Treatment, and Transitional Care; a Trainer's Manual and Online Resource Guide follows a Train-the-Trainer format. This format allows individual correctional institutions or community agencies to utilize the manual to address their specific training needs at little expense to the specific agencies. As a Train-the-Trainer format the manual includes the following resources for training instructors:

	Resources for general training preparation including information on learning theories, writing learning objectives and how to conduct group activities.
	Resources for preparatory materials that trainers may review to increase their background knowledge on infectious diseases, prerelease planning and community collaboration.
	Resources for materials an instructor needs to design conduct and evaluate various trainings on infectious diseases prerelease planning and community collaboration including audiovisual materials, handouts, group activities, etc.

Learning Objectives of Manual

It is intended that trainers will use this manual to:

1. Educate themselves on training resources and techniques.


2. Educate themselves on topics of choice regarding infectious diseases.


3. Design training(s) for care providers on topics of choice regarding infectious diseases.


4. Conduct and evaluate training(s) for care providers on topics of choice regarding infectious diseases.


5. Locate resources in order to stay current on topics of choice regarding infectious diseases.


6. Locate continuing education resources on topics of choice regarding infectious diseases.


7. Locate resources to educate inmates on infectious diseases.


8. Locate resources to educate custody staff on occupational exposure to infectious diseases.


9. Build collaborations between the corrections and public health community for the successful treatment and transition of inmates.

Explanation of Structure of Manual

Medical treatment of infectious diseases is a continually evolving field. Obtaining current information is a challenge. New information can become obsolete quickly after it is published. In designing the structure of this manual, the authors sought not only to provide a through factual base of information but also to provide maximum flexibility for people to be able to access the most current and authoritative sources and adapt these sources to their own organizational policies and budgets. Therefore, the structure of an online resource guide seemed appropriate. Where available, each source of factual information also provides information where the reader can receive ongoing educational updates on a variety of topics regarding infectious diseases, transitional care and collaboration via mail, email or fax. Many of these sources also provide FREE or nominal cost CME or CEU credits. And finally, the authors feel the structure of the manual is in keeping with the spirit of the policy recommendation of the NIJ/NCCHC Health Status of Soon-To-Be-Released Inmates project to "develop and maintain a national literature database for correctional health care professionals, including a compendium of policies, standards, guidelines, and peer reviewed literature." Hopefully this endeavor can be maintained and updated.

In recognition of the limited training budgets of correctional and community based organizations, every effort has been made to include cited resources for both trainers and training participants that are either downloadable as PDF documents or free unless so indicated. For those organizations who have limited or no computer access, Section Four provides an alphabetic listing of all training resource citations that includes the address, phone and fax number, email address and website.

Content Area of Manual

Chapter 2 provides general training resources and correction specific training resources on how to design, prepare, conduct and evaluate trainings.

Chapters 3 and 4 begin with a statistical discussion on Infectious Disease and Corrections that provides the reader/trainer with a basic understanding of who the "Corrections Community" is. Chapter 3 provides statistical data describing the adult U.S. corrections population. In Chapter 4, statistical data related to infectious disease in the corrections community and the general population is a key focus. Providing these figures helps to define the scope of the problem and also allows the intended reader to ascertain the thin line between "inside" the facility and "outside" the facility and how those lines are blurred at times. The statistical data provides evidence as to why the public community should care about corrections and why the correctional community should care about the public community.

Each of Chapters 5 - 9 is structured to stand alone as individual training sessions on the infectious diseases that impact corrections. The correctional population has disproportionately higher rates of infectious disease, substance abuse, high-risk sexual activity and other health problems than the general population. Specific health related topics covered by the curricula manual include HIV/AIDS, Hepatitis (B, and C), Sexually Transmitted Diseases (STDs), and Tuberculosis (TB).

In addition, the manual discusses issues related to occupational exposure to infectious diseases and includes information on how to avoid exposures and what to do if an exposure occurs. Resources on occupational exposure include a section specifically for custody/correctional staff.

Each of chapters 5-9 has two sections:

Section One: Trainer Preparation Resources = Sources for materials that trainers may review to increase their background knowledge on each of the training topics.

Section Two: Training Tool Resources = Sources for materials an instructor will need to design, prepare, conduct and evaluate trainings including audiovisual materials, handouts, case studies, etc. on each of the training topics.

In recognition of the infectious nature of these diseases, the Trainer Preparatory section of each of chapters 5-9 includes:

	Epidemiology (The extent of the problem)
	Pathogenesis and Transmission (What causes the specific disease and How it is spread)
	Prevention (How to avoid)
	Diagnosis (How to recognize it)
	Treatment (Best Practice Guidelines)
	Education (Staying current and continuing education resources)
	Employer Exposure Control Plan

The Training Tools section of each of Chapters 5-9 includes:

	Training Topics
	Resources for Learning Objectives
	Resources to build your own Presentations
	Resources for Group Activities
	Resources for Handouts
	Resources for Evaluation Tools
	Resources for Correctional Officers and Security Personnel (Occupational Exposure)
	Resources for Inmates/Patients (HIV/AIDS, Hepatitis, STDs, and TB)

Sections Two and Three make the point that correctional health is public health issue and encourages collaboration between corrections and public health organizations for the successful treatment and transition of inmates into the community. Section Two, entitled "Transition from Corrections to the Community", covers issues related to Discharge Planning, Reentry into the Community, Transitional Models, Transitional Resources for Inmates, and the final chapter on Transitional Resources for Providers provides a list of community resources to assist in successful discharge planning and transitional care. Section Three, entitled "Collaboration between Corrections and the Public Health Community", defines the community culture and the corrections culture, discusses collaboration between the corrections and public health community including how to build collaborative relationships and the specific collaborative tasks each community can be responsible for. The section also provides examples of models of collaboration between the two communities that are working.

Section Four provides a non-computer based resource list for all references cited in the manual. In recognition of the limited training budgets of correctional and community based organizations, every effort has been made to include cited resources for both trainers and training participants that are either downloadable as PDF documents or free unless so indicated. For those organizations who have limited or no computer access, Section Four provides an alphabetic listing of all training resource citations that includes the address, phone and fax number, email address and website.

Sources

	Prison and Jail Inmates at Midyear 2003, (May 2004), NCJ Publication Number 203947, Bureau of Justice Statistics, U.S. Department of Justice www.ojp.usdoj.gov/bjs
	Prisoners in 2002, (July 2003), NCJ Publication Number 200248, Bureau of Justice Statistics, U.S. Department of Justice www.ojp.usdoj.gov/bjs
	Prevalence of Imprisonment in the U.S. Population, (August 2003) NCJ Publication Number 197976, Bureau of Justice Statistics, U.S. Department of Justice www.ojp.usdoj.gov/bjs
	The Health Status of Soon to be Released Inmates , Volumes One and Two, (March 2002), National Institute of Justice and the National Commission on Correctional Health Care, www.ncchc.org/pubs/pubs_stbr.vol1.html and www.ncchc.org/pubs/pubs_stbr.vol2.html