Correctional Health Care AssignmentCourse Objective for Assignme.docx

Correctional Health Care Assignment
Course Objective for Assignment:
· Relate strategic management principles and decision logic to
current complex health care management challenges and
formulate effective solutions.
You applied and were accepted in an internship program of a
state-level, Female Correctional Health Care Operation in the
Southeastern United States and your primary responsibility is to
work on
the assigned projects related to the provision of inmate
health care.
Case Study Associated Materials:
***Correctional Health Care Delivery: Unimpeded Access to
Care Section 2 and 4 are recommended for the main reference in
working on this assignment.
The Health and Health Care of US Prisoners: Results of a
Nationwide Survey
Public Health Behind Bars
Sample Tool Control Policy
Inmate Sick Call Procedures-Corrections
Case Study Details: For the incarcerated population in the
United States, health care is a constitutionally guaranteed right
under the provisions of the eight amendments which is the
prohibition against cruel and unusual punishment (
see Estelle v. Gamble). This particular prison can hold
in excess of 1,728 offenders and routinely houses between 1,600
and 1,700 women on any given day. This institution incarcerates
all custody classes to include minimum security, medium
security, close custody, death row, and pretrial detainees.
The health care operation provides the highest level of care for

female offenders in the state. The health care facility is a 101
thousand square foot, 150 bed, three-story building that cost the
taxpayers $50 million dollars to construct and is a hybrid of an
ambulatory care center, long-term care center, and behavioral
care center. The health care facility also houses an assisted
living dorm.
The patient demographic includes women who have multiple co-
morbidities including substance abuse, seriously persistent
mental illnesses (SPMI), diabetes, cardiovascular disease,
cancer, morbid obesity, HIV / AIDs, hepatitis, etc. On any given
day there will also be 30 to 60 offenders who are pregnant, with
98% of those offenders having a history of substance abuse; all
pregnant offenders are considered high-risk. The dental health
of this patient population is exceptionally horrendous because
of excessive drug abuse coupled with a sugary diet and poor
oral hygiene practices. It is not uncommon for a 23-year-old to
need all of her teeth extracted.
There are approximately 300 FTEs to include correctional staff
that operate the facility and provide care to the offender
population. The healthcare facility is comprised of the
following directorates: (a) Medical, (b) Nursing, (c) Behavioral
Health, (d) Pharmacy, (e) Dental, (f) Medical Records, (g)
Health Service Support, and (h) Operations and Security.
Although the health care facility has a vast amount of
capability, there limitations: (a) This facility does not have
advanced cardiac life support capability (ACLS), (b) no surgical
capability, (c) no ability to conduct telemetry, (d) no oral
surgery beyond simple extractions, (e) no obstetrical capability
beyond out-patient clinics, (f) MRI, (g) level 2 ultrasound, and
the list goes on.
Those inmates who have medical needs that cannot be addressed
by the health services staff at the correctional facility will need
appointments with external health care providers who have a
business relationship with the prisons in this area. On any given
month, there will be approximately 300 offenders who will go
to outside medical appointments, and making certain that these

appointments take place is where the challenge lies. Similar to
many health care operations, the prison Utilization Review /
Case Management Department facilitates all external
appointments and form the lynchpin between the correctional
facility health care providers who refer offenders for specialty
appointments, and the outside organization providing that
appointment.
Your assignment: You are the Case Coordinator. You have 300
patients that need to be scheduled for outside specialty
appointments every month. You are tasked by the Administrator
to develop a strategic plan organizing the out-of-the-facility
appointments without impairing internal services.
***
Note: additional personal or financial resources are not
available fortis case strategic plan. However, the question of the
additional personnel or resources can be discussed in an
Addendum. Specific justification must be presented and
supported by evidence.
As the first step, develop a Memorandum addressing:
1. Provide an overview of Estelle v. Gamble and how that 1976
Supreme Court ruling pertains to the provision of inmate health
care.
2. Examine the challenges of providing health care in a
correctional environment.
3. What are the challenges of providing health care to a female
offender population that may not exist in a male prison?
4. What framework would you apply to strategic planning?
Why? (
Strategic planning frameworks)
Make sure to cite in APA format when appropriate. Support
your statements with credible evidence.

Evidence-Based Decision Making in Healthcare
What is evidence-based practice?
Good-quality decisions are based on a combination of critical
thinking and the best available evidence (the quality of the
evidence is at utmost importance)
According to Dawes and colleagues (2005):
Evidence-based practice is about making decisions through the
conscientious, explicit, and judicious use of the best available
evidence from multiple sources by
ASKING (translating a practical issue or problem into an
answerable question)
ACQUIRING (systematically searching for and retrieving the
evidence)
APPRAISING (critically judging the trustworthiness and
relevance of the evidence)
AGGREGATING (weighting and pulling together the evidence)
APPLYING (incorporating the evidence into the decision-
making process)
ASSESESING (evaluating the outcome of the decision taken) to
increase the likelihood of a favorable outcome
What counts as evidence?
Evidence usually means information. It may be:
-based on numbers
-be qualitative
-be descriptive
Evidence usually comes from:
-scientific evidence
-organizational evidence
-experiential evidence

-stakeholder evidence
*Regardless of source, all evidence should be included if it is
judged to be trustworthy and relevant.
Why do we need evidence-based practice?
Personal judgement alone is susceptible to systematic errors.
Cognitive and information-processing limits make us prone to
biases that have negative effect on the quality of decisions
(Bazerman 2009; Clements 2002; Kahneman 2011; Simon 1997)
Benchmarking and “best practices” need to be critically
evaluated before adaptation to a specific situation, organization,
culture, time etc. Otherwise, use them only as a point of
evidence and not as a deciding factor in decision making
process.
Barriers to the evidence-based decision making practice
The managers need to be trained in the skills required to
critically evaluate trustworthiness and relevance of information
Important organizational information may be difficult to access,
the information available may be of poor quality or misleading.
Managers may not be aware of the current scientific evidence
concerning the key issues in the field.
Why do barriers exist?
Practitioners pay little or no attention to scientific or
organizational evidence, instead placing too much trust in
personal judgement and experience, “best practices”, and the
beliefs of corporate leaders. As a result, money is spent on

management practices that are ineffective or harmful to
organizations, their members or their clients.
Why do we have to critically appraise evidence?
Evidence is not perfect, may be overstated or misleading
Critical appraisal always follows the following pattern:
-Where and how is the evidence gathered?
-Is it the best available evidence?
-Is there enough evidence to reach a conclusion?
-Are there reasons that the evidence could be biased in a
particular direction?
Why focus on best available evidence?
A fundamental principle of evidence-based practice is that the
quality of our decisions is likely to improve when we make use
of trustworthy evidence-in other words, the best available
evidence.
Sometimes, the organizational or scientific evidence may be
limited or unavailable. Even limited-quality evidence can lead
to a better decision than otherwise as long as we are aware of its
limitations and are ready to act on it.
Common misconceptions about evidence-based decision making
(EBDM) practice
It ignores the practitioner’s professional experience: none of the
four listed evidence sources is more superior than the others.
EBDM is all about numbers and statistics: none of the four
listed evidence sources (including data processing and
statistical information) is more superior than the other.
Statistical reasoning may help assessing the evidence
trustworthiness in regard of accuracy, reliability and validity.
Managers need to make decisions quickly and do not have time

for EBDM: even split-second decisions require trustworthy
evidence. The need to make an immediate decision is generally
the exception rather than the rule. When important decisions
need to be made quickly, an EBDM practitioner anticipated the
kind of evidence that a good decision require (e.g. emergency
evacuation)
(EBDM) practice
4. Each organization is unique, so the usefulness of scientific
evidence is limited. Even though the organizations differ, they
tend to face very similar issues, sometimes repeatedly, and they
often respond to those issues in similar ways.
5. If one does not have high-quality evidence, one can do
nothing. Limited evidence at hands should be supplemented
through learning by doing on a small scale (e.g. pilot testing,
prototyping). Critical reflection on such experimentation
supplements limited evidence and improves the quality of such.
6. Good-quality evidence gives one the answer to a problem.
Evidence need to be put in appropriate context and a critical
mind-set. EBDM practitioners make decisions based on
probabilities, indications, and tentative conclusions using
available evidence along with other tools.
What is the evidence for evidence-based decision making?
Forecasts or risk assessments based on aggregated (averaged)
professional experience are more accurate vs. based on a
singular professional experience
Professional judgments based on data and statistical models are
more accurate vs. based on an individual judgment
Knowledge derived from scientific evidence is more accurate
vs. opinions of separate experts
A decision based on combination of critically appraised
multiple types of evidence yields better outcomes vs. based on a

singular piece of evidence
Evaluating the decision outcomes improves both organizational
learning and performance, especially in novel and non-routine
situations
Barriers to the use of EBDM and how to overcome them
1. Policy contexts: when the policies are not aligned with
organizational capacity, managers have incentives to take
shortcuts that might promote short-term efficiency at the
expense of long-term performance.
**The managers should be advocating on all levels to support
EBDM policies that can increase the effectiveness and
efficiency of healthcare services.
2. Community and Market environments: strong social ties in
closed close-knit communities and markets (while have multiple
benefits) may restrict adoption of newer EBDM practices.
Competition for scares resources creates uncertainty and anxiety
for managers. Those forces stress importance of power and
politics in decision making within organizations and their
communities (e.g. mergers). However, the evidence shows that
mergers among hospitals do not result in improved efficiency or
quality of care.
3. Organizational factors: culture, structure and resources
(individually and collectively). Cultures that stifle open
discussions and the expression of different views may produce
disastrous decisions. Lack of psychological safety l ikely
contributes to poor managerial decisions on a daily basis.
Organizations promoting silos prevent managers from seeing the
effects of their decisions. Any barriers to open communications
create barriers to coordination of managerial work. They create

divisions based on power and politics for individual agendas vs.
the whole organizational benefit. Lack of organizational goals
measurements promote divisions and silos and prevent
meaningful and timely feedback. Incentive system promotes
individual performance vs. individual contribution to the team
or the whole organizational performance.
4. Individual managerial factors: well-documented limits of
human decision making are reflected in multitude of biases,
rigid or outdated beliefs and restricting personality traits.
**Continuous education, development of personal tool box and
ability to recognize and overcome biases build capacity and
confidence toward EBDM practice.
How to increase the use of EBDM practice in HC organizations
Organizational learning:
-frame the use of evidence and changes in decision making as
learning
-foster a culture of psychological safety
-engage in learn-how and learn-why activities
-invest in infrastructure and time to support EBDM
-set realistic expectations. The performance may get worse
before it gets getter
-use stable cross-functional teams as the building blocks for
EBDM management
-emphasize supportive senior leadership
image1.png
Evidence-Based Decision Making in Healthcare

What is evidence-based practice?
Good-quality decisions are based on a combination of critical
thinking and the best available evidence (the quality of the
evidence is at utmost importance)
According to Dawes and colleagues (2005):
Evidence-based practice is about making decisions through the
conscientious, explicit, and judicious use of the best available
evidence from multiple sources by
ASKING (translating a practical issue or problem into an
answerable question)
ACQUIRING (systematically searching for and retrieving the
evidence)
APPRAISING (critically judging the trustworthiness and
relevance of the evidence)
AGGREGATING (weighting and pulling together the evidence)
APPLYING (incorporating the evidence into the decision-
making process)
ASSESESING (evaluating the outcome of the decision taken) to
increase the likelihood of a favorable outcome
What counts as evidence?
Evidence usually means information. It may be:
-based on numbers
-be qualitative
-be descriptive
Evidence usually comes from:
-scientific evidence
-organizational evidence
-experiential evidence
-stakeholder evidence
*Regardless of source, all evidence should be included if it is

judged to be trustworthy and relevant.
Why do we need evidence-based practice?
Personal judgement alone is susceptible to systematic errors.
Cognitive and information-processing limits make us prone to
biases that have negative effect on the quality of decisions
(Bazerman 2009; Clements 2002; Kahneman 2011; Simon 1997)
Benchmarking and “best practices” need to be critically
evaluated before adaptation to a specific situation, organization,
culture, time etc. Otherwise, use them only as a point of
evidence and not as a deciding factor in decision making
process.
Barriers to the evidence-based decision making practice
The managers need to be trained in the skills required to
critically evaluate trustworthiness and relevance of information
Important organizational information may be difficult to access,
the information available may be of poor quality or misleading.
Managers may not be aware of the current scientific evidence
concerning the key issues in the field.
Why do barriers exist?
Practitioners pay little or no attention to scientific or
organizational evidence, instead placing too much trust in
personal judgement and experience, “best practices”, and the
beliefs of corporate leaders. As a result, money is spent on
management practices that are ineffective or harmful to
organizations, their members or their clients.

Why do we have to critically appraise evidence?
Evidence is not perfect, may be overstated or misleading
Critical appraisal always follows the following pattern:
-Where and how is the evidence gathered?
-Is it the best available evidence?
-Is there enough evidence to reach a conclusion?
-Are there reasons that the evidence could be biased in a
particular direction?
Why focus on best available evidence?
A fundamental principle of evidence-based practice is that the
quality of our decisions is likely to improve when we make use
of trustworthy evidence-in other words, the best available
evidence.
Sometimes, the organizational or scientific evidence may be
limited or unavailable. Even limited-quality evidence can lead
to a better decision than otherwise as long as we are aware of its
limitations and are ready to act on it.
(EBDM) practice
It ignores the practitioner’s professional experience: none of the
four listed evidence sources is more superior than the others.
EBDM is all about numbers and statistics: none of the four
listed evidence sources (including data processing and
statistical information) is more superior than the other.
Statistical reasoning may help assessing the evidence
trustworthiness in regard of accuracy, reliability and validity.
Managers need to make decisions quickly and do not have time
for EBDM: even split-second decisions require trustworthy
evidence. The need to make an immediate decision is generally

the exception rather than the rule. When important decisions
need to be made quickly, an EBDM practitioner anticipated the
kind of evidence that a good decision require (e.g. emergency
evacuation)
(EBDM) practice
4. Each organization is unique, so the usefulness of scientific
evidence is limited. Even though the organizations differ, they
tend to face very similar issues, sometimes repeatedly, and they
often respond to those issues in similar ways.
5. If one does not have high-quality evidence, one can do
nothing. Limited evidence at hands should be supplemented
through learning by doing on a small scale (e.g. pilot testing,
prototyping). Critical reflection on such experimentation
supplements limited evidence and improves the quality of such.
6. Good-quality evidence gives one the answer to a problem.
Evidence need to be put in appropriate context and a critical
mind-set. EBDM practitioners make decisions based on
probabilities, indications, and tentative conclusions using
available evidence along with other tools.
What is the evidence for evidence-based decision making?
Forecasts or risk assessments based on aggregated (averaged)
professional experience are more accurate vs. based on a
singular professional experience
Professional judgments based on data and statistical models are
more accurate vs. based on an individual judgment
Knowledge derived from scientific evidence is more accurate
vs. opinions of separate experts
A decision based on combination of critically appraised
multiple types of evidence yields better outcomes vs. based on a
singular piece of evidence
Evaluating the decision outcomes improves both organizational

learning and performance, especially in novel and non-routine
situations
1. Policy contexts: when the policies are not aligned with
organizational capacity, managers have incentives to take
shortcuts that might promote short-term efficiency at the
expense of long-term performance.
**The managers should be advocating on all levels to support
EBDM policies that can increase the effectiveness and
efficiency of healthcare services.
2. Community and Market environments: strong social ties in
closed close-knit communities and markets (while have multiple
benefits) may restrict adoption of newer EBDM practices.
Competition for scares resources creates uncertainty and anxiety
for managers. Those forces stress importance of power and
politics in decision making within organizations and their
communities (e.g. mergers). However, the evidence shows that
mergers among hospitals do not result in improved efficiency or
quality of care.
3. Organizational factors: culture, structure and resources
(individually and collectively). Cultures that stifle open
discussions and the expression of different views may produce
disastrous decisions. Lack of psychological safety likely
contributes to poor managerial decisions on a daily basis.
Organizations promoting silos prevent managers from seeing the
effects of their decisions. Any barriers to open communications
create barriers to coordination of managerial work. They create
divisions based on power and politics for individual agendas vs.
the whole organizational benefit. Lack of organizational goals

measurements promote divisions and silos and prevent
meaningful and timely feedback. Incentive system promotes
individual performance vs. individual contribution to the team
or the whole organizational performance.
4. Individual managerial factors: well-documented limits of
human decision making are reflected in multitude of biases,
rigid or outdated beliefs and restricting personality traits.
**Continuous education, development of personal tool box and
ability to recognize and overcome biases build capacity and
confidence toward EBDM practice.
How to increase the use of EBDM practice in HC organizations
Organizational learning:
-frame the use of evidence and changes in decision making as
learning
-foster a culture of psychological safety
-engage in learn-how and learn-why activities
-invest in infrastructure and time to support EBDM
-set realistic expectations. The performance may get worse
before it gets getter
-use stable cross-functional teams as the building blocks for
EBDM management
-emphasize supportive senior leadership
image1.png
COUC 521
Benchmark Intake Report Part Two: Mental Status Exam (MSE)
Assignment Template
Note: This template includes Part One of the assignment

because it should be included in Part Two
Identifying Information
Client name, address, phone number, DOB, gender, marital
status, occupation, work/school, work phone, emergency
contact, date of interview
Reason for Referral
Referral source, reason for referral (why has the client been sent
to you [e.g., consultation, clinical intake, counseling]);
presenting complaint (hint: they are coming in for an
evaluation)
Current Situation and Functioning
A description of typical daily activities, ability to complete
normal activities of daily living (ADLs); general assessment of
coping/character skills (e.g., stress management skills,
emotional regulation ability; problem-solving, conflict
resolution, empathy, cooperation, etc.); self-perceived strengths
and weaknesses
Relevant Medical History
Previous and
current medical problems (major illnesses and injuries),
medications, hospitalizations, and disabilities; any significant
major medical disorders in blood relatives (e.g., cancer,
diabetes, seizure disorders, thyroid disease, etc.)
Psychiatric Treatment History
Description of previous treatment received, including

hospitalization, medications, psychotherapy or counseling, case
management, etc. Include a description of all psychiatric and
substance abuse disorders found in all blood relatives (i.e., at
least parents, siblings, grandparents, and children, but also
possibly aunts, uncles, and cousins)
Family History
Information about the client’s family background, including
information about first-degree relatives (parents, siblings), the
composition of the family during the client’s childhood and
adolescence, and the quality of relationships with family
members both past and present.
Social and Developmental History
Significant developmental events that may influence current
problems or circumstances. This should include, as aplplicable,
issues surrounding pregnancy or birth; social, behavioral, and
cognitive milestones; and relational history (include i nteraction
with peers, people in authority, academic performance, and
extra-curricular activities – e.g., sports, clubs, etc.); current and
previous marital/non-marital relationships, children, and social
supports.
Educational and Occupational History
Schools attended, educational level attained, and any
professional, technical, and/or vocational training; current
employment status, length of tenure on past jobs, military
service (rank and duties), job performance, job losses, leaves of
absence, and occupational injuries.
Cultural Influences
Potential assessment issues (see chapter 3) when working with a

diverse populations.
Mental Status Exam
Appearance and Behavior
Susan C. is a 5’4” single White female of average weight. At
the time of the interview, she had a pasty white complexion and
several scars from adolescent acne. She presented herself in a
cooperative, friendly manner during the interview, was
appropriately dressed for the season, and answered questions in
a direct fashion. Her eye contact was appropriate. Psychomotor
activity was within normal limits as she moved comfortably
during the interview. No atypical physical characteristics were
noted. Her speech patterns and expressive/receptive language
were within normal limits. No evidence of current drug or
alcohol intoxication was observed.
Sensorium and Mental Ability
During the interview, Susan C. appeared alert and oriented x4.
While not formally assessed, she appears to have average to
above average intelligence as evidenced by her vocabulary and
reported GPA in college. There was no difficulty with questions
assessing her recent or remote memory, or mathematical
calculations. Some abstract thinking difficulty was observed in
her difficulty describing what the difference was between a lie
and a mistake.
Thought
Susan displayed a logical, sequential, coherent flow of thought.
No tangential thinking, flight of ideas, or looseness of
associations were noted. Thought content appeared to be within
normal limits. No evidence of hallucinations, delusions,
paranoid ideation, or ruminations was apparent. No compulsions
or obsessions were reported.
Sensory Motor and Perceptual Processes

Sensory motor and perceptual processes appeared within normal
limits. Susan C. was able to adequately duplicate the drawing of
a clock. There was no evidence of fine motor tremor, auditory,
or perceptual difficulties.
Affect and Mood
During the interview, Susan displayed a moderately depressed
affect. While eye contact was appropriate, she seldom smiled
even when an amusing incident occurred while we were in the
office. Her voice tone had monotone qualities and she often
sighed during the interview. She verbalized feeling depressed
since her recent miscarriage (3 weeks ago). No history of
manic-like symptoms was reported. She denied suicidal and
homicidal ideation. There was no evidence of a risk for violence
or impulsivity.
Self-regulation
Susan C. displayed adequate impulse control and judgment.
These interview qualities are consistent with her history.
2
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