Fall - National Commission on Correctional Health Care

(continued) Self-Injury (continued from page 18)staff and inmates to develop more adaptive coping skills.Management of these inmates requires flexibility in boththe application of correctional directives and treatmentstrategies, and calls for mental health professionals to providebehavioral consultation to other staff on mental healthneeds and the disciplinary process. All staff should be educatedthat chronic self-injury has numerouscauses and requires reasoned, planned individualinterventions.Each distinct act each of self-injury shouldbe evaluated for motivation, intent, lethalityand context. The repetitive self-injurer withnonlethal intent then can receive specificmanagement strategies. A key strategy isto develop, with inmate input, a behaviormanagement plan. Broadly defined, this is aplanned set of interventions or treatmentthat uses positive reinforcers and/or restrictionsto increase desired behaviors. TheJCHC article presents a detailed discussionthese plans.The final element of treatment discussedis psychiatric referral. When less restrictiveinterventions are not effective in allowingthe inmate to assume adequate self-control,psychiatric restraint may be indicated. Thereis no definitive evidence that psychopharmacologicaltreatments are helpful except in emergencies.Foundations of an Effective ProgramEffective programs to identify, assess and treat suicidal andself-injurious behavior are essential and must be foundedon principles such as risk, need and responsivity. Three principlesare offered to guide such programs.Innovation. The corrections industry is continuallyadjusting to changes in public opinion and budget constraints.Innovative and alternative strategies may be necessaryto ensure the integrity of the program.Education. An educational initiative should be undertakenthat conceptualizes self-injurious behaviors in correctionsas a public safety/public health issue. For example,these behaviors may result in security risks, or they maybecome endemic, increase in severity or result in death.Leadership. Mental health staff must understand andappreciate their leadership role in the self-injury preventionand treatment program. Accordingly, they must establishcredibility with other involved correctional staff throughcompetence, communication and collaboration.Recommendations for a <strong>National</strong> StrategyBeyond self-injury programming at the parochial level,opportunities exist to improve methodology for comprehendingthese complex and high-risk incidents, and to formulatea consensual and coherent strategy for prevention.To this end, the JCHC article presents eight goals.Goal 1. Promote awareness that self-injury in correctionalsettings is a public safety/public health problem that is preventable.Develop a listserver where professionals can communicateabout these issues. Establish national forums thatfocus on self-injury programming and that bring togetherstakeholders to increase awareness. Greater awarenesslinked with dispelling myths will reduce the stigma associatedwith self-injurious behaviors.Goal 2. Develop broad-based support for self-injuryprevention programming. Include the correctional leadership,professional groups and other advocacy groups.Partnerships among key groups will help build momentumand provide continuity and legitimacy. Solicit funding fromgovernmental grants and charitable foundations.Goal 3. Develop evidence-based programming for theidentification, assessment and treatment of the full range ofself-injurious behaviors. Develop a standardized assessmentinstrument (such as the Multidimensional Risk Assessmentform) that identifies both risk and protective factors and isnormed on a correctional population. Develop treatmentalgorithms and postintervention protocols with outcomemeasures to evaluate effectiveness.Goal 4. Promote efforts to reduce access to means andmethods of self-injury. Design educational material forstaff about how self-injuries occur with serial self-injuringinmates. Include security and health care staff in monitoringand controlling objects used for potential self-injury.Develop standardized practices for controlling access.Goal 5. Provide training for recognition of at-risk behaviorand delivery of effective treatment. Standardize trainingfor staff who come into contact with serial self-injuringinmates. Define minimum learning objectives for these staffand tailor the training to their assigned responsibilities.Goal 6. Develop and promote effective clinical and professionalpractice. Use the 24 core competencies for mentalhealth professionals from the training curriculum Assessingand Managing Suicide Risk (developed by the SuicidePrevention Resource Center and the American Associationof Suicidology). Promoting effective clinical practices inthe assessment and treatment of all forms of self-injury willimprove the probability of successful outcomes. Use of protectivefactors is also important in reducing risk.Goal 7. Standardize the nomenclature used to describethe spectrum of self-injury phenomena. Developing languageand defining terms will help in interdisciplinary communication,accuracy in reporting and research.Goal 8. Promote and support research on self-injuriousbehaviors in correctional settings. To date, little is knownabout how to modify certain risk factors associated withself-injurious behaviors without suicidal intent. Developinga database to collect information that can be analyzed andinterpreted is critical for program viability.This summary was written by CorrectCare editor JaimeShimkus. The authors of the original article are ThomasFagan, PhD, Nova Southeastern University, Fort Lauderdale,FL; Judith Cox, MA, CCHP, JFC Consultation Services,Clifton Park, NY; Steven Helfand, PsyD, CCHP, CorrectionalManaged Health Care, University of Connecticut HealthCenter, Farmington; and Dean Aufderheide, PhD, FloridaDepartment of Corrections, Tallahassee.20<strong>Fall</strong> 2009 • CorrectCarewww.ncchc.org