The importance of the National Commission on Correctional Health Care

When I attended the ILEETA conference in St. Louis, MO back in March, I had the pleasure of meeting Tracey Titus, RN, CCHP-RN, vice president, accreditation, of the National Commission on Correctional Health Care. Being so new to the law enforcement world, I had many questions for Tracey about the NCCHC..read more about it in our Q&A below:

LET: For those readers who aren't aware of what the NCCHC is, can you tell us a little bit about it?

NCCHC: The mission of the National Commission on Correctional Health Care is to improve the quality of health care in jails, prisons and juvenile confinement facilities. A primary way we do that is by developing standards for the management of health services in correctional facilities and accrediting facilities that meet these standards. NCCHC is widely recognized for its leadership in setting these standards, which are established by experts in the health, legal and corrections professions. The standards are reviewed and approved by NCCHC’s board of directors, which includes liaisons from the American Jail Association and the National Sheriffs’ Association. In addition, correctional experts review all accreditation reports and help determine each facility’s compliance with NCCHC standards.

The Standards are written in separate volumes for prisons, jails and juvenile confinement facilities, plus a manual for mental health services and another for opioid treatment programs. These resources have helped correctional facilities improve the health of their inmates, increase the efficiency of health services delivery, strengthen organizational effectiveness and reduce the risk of adverse legal judgments.

NCCHC accreditation provides an independent, professional assessment of compliance with the standards and has proven to be an effective tool in achieving and maintaining peak organizational performance. Correctional facilities of all sizes, from among the largest to the smallest, have been accredited using NCCHC standards. The compliance indicators listed in each standard are the same measures used by accreditation surveyors when they come on site. Compliance may be verified through health record reviews, observation, interviews and other information-gathering methods. On-site reviews are often collegial, with our expert accreditation survey team members offering suggestions for improvement based on their many years of correctional health care experience.

LET: Why does a jail need standards for health services? What are the repercussions if health standards are not met?

NCCHC: Jails that are accredited for following NCCHC standards benefit in many ways. Standards serve as a framework to ensure that systems, policies and procedures are in keeping with nationally recognized best practices, and compliance ensures that everyone on the team knows what is expected and how to achieve it. These standards have helped jails improve the health of their inmates and the communities to which they return, increase the efficiency of health services delivery, strengthen organizational effectiveness, and reduce the risk of adverse patient outcomes and legal judgments. There are no correctional health care standards that are more rigorous nor an accreditation program as thorough as that of the National Commission.

Jails that meet NCCHC’s standards and achieve accreditation are frequently regarded favorably by the courts. In case after case, NCCHC’s standards have been held as the model to which correctional facilities should strive. In addition, accreditation provides public recognition that jails are meeting national standards. It reduces exposure to costly liability and recognizes the facility’s commitment to meeting quality goals and using acceptable practices. Jails also use the accreditation application process to fine-tune their policies and streamline their operations.

LET: Can you give an example of an NCCHC-accredited prison or jail that has improved health services in its location recently? What were the challenges and additionally the positive outcomes complying with NCCHC standards had on the facility?

NCCHC: Facilities that move toward compliance with NCCHC standards naturally improve health services by developing a system that supports access to health care. The Maricopa County Jail system in Phoenix, AZ, is a great example. In 2008, after long-time participation, NCCHC withdrew the six jails from the accreditation program for challenges in maintaining compliance with the standards. In the years to follow, the facility staff worked to improve the health care system. In 2011, the facilities were surveyed again and achieved initial accreditation in 2012. Fast forward another three years and another successful survey and the Maricopa County Jail system is awarded one of NCCHC’s most prestigious recognitions - the R. Scott Chavez Facility of the Year. This award is presented to one facility selected from among the nearly 500 prisons, jails and juvenile facilities accredited by NCCHC. In making its decision, the awards committee recognized that Maricopa had developed a highly efficient system of coordinated care. In addition to achieving accreditation for health services at the six jails, four of the jails have since achieved accreditation for opioid treatment programs that they operate.

LET: What is the biggest issue the NCCHC sees in correctional health care?

NCCHC: A major ongoing problem for corrections is the high prevalence of mental illness and behavioral disorders in the incarcerated population. Jails were never meant to be mental health facilities, yet they have become just that, and in many communities jails house more individuals with mental illness than the community psychiatric facilities. A 2014 study by the National Sheriffs’ Association and the Treatment Advocacy Center found that there are 10 times as many people with mental illness in the nation’s jails and prisons as in state mental institutions.

This large subset of the inmate population puts tremendous stress on facilities and staff, and threatens the safety of these individuals and those around them. Caring for mentally ill inmates has become a central challenge for correctional institutions.

NCCHC assists with this challenge in several ways. Our Standards for Mental Health Services in Correctional Facilities parallel the Standards for Health Services in format and substance, but they make more explicit what the standards require for adequate delivery of mental health services. These standards help facilities determine proper levels of care, organize systems more effectively and efficiently, and demonstrate that constitutional requirements are being met. We also operate a corresponding accreditation program.

In addition, we host an educational conference on correctional mental health care each summer. This two-day event presents a unique opportunity for mental health professionals to gather with others who face similar challenges and share solutions.

NCCHC’s professional certification program also offers specialty certification for these professionals. Certified Correctional Health Professional – Mental Health specialty certification provides formal recognition for practitioners who have engaged in a process of ongoing, focused and targeted professional development. To earn the CCHP-MH credential, candidates must attain a passing score on a two-hour, proctored, multiple-choice examination and must meet continuing education requirements to recertify annually.

Through these programs and resources, NCCHC helps the field to better manage mental health care for inmates.

Editor's note: For information about NCCHC accreditation, visit www.ncchc.org.