"The Healthcare Provider's Guide to the Correctional Setting"

Gene C. Baldwin
Correctional Healthcare Consulting
5099 China Road * Tell City IN 47586
(812) 843-5048
www.gcbaldwin.com

“Solving Tomorrow’s Problems Today”

"The Healthcare Provider's Guide to the Correctional Setting"

Welcome to the world of correctional healthcare, one of the most challenging clinical arenas in which to apply your training and skills. The purpose of this article is to acquaint you with the unique dynamics of the correctional setting and to guide you toward a safe, even enjoyable experience.

The Prison Image

Until you have worked (or lived) in a correctional facility your conception of what a prison or jail must be like is necessarily the result of a lifetime of exposure to media portrayals and dramatizations. As the repositories of society’s misfits, sociopaths and everyday criminals , such facilities, so the misconception follows, are also home to crude, sadistic, corrupt and inept staff.

Healthcare professionals choosing to work in the prison or jail setting must therefore be either desperate, defective or both. Why subject yourself to such an environment otherwise?

The Reality

Whatever your initial beliefs, having entered the field you soon realize their inadequacy. The staff inside are unarmed and outnumbered every hour of every day, so personality means a lot. Order must be maintained, which calls for a balance of professionalism and self-control. Mutual dependency rules the day...and yes, it’s all a big game.

Generally speaking, most people living in prison would rather not be there. Some of those people will look at you as part of the society that put them there, and you are certainly part of the system which keeps them from leaving. Consequently, through your employment association you are the most convenient target for the vengeful offender to abuse and manipulate.

That being said, most prisoners will look to you as a trained professional doing a job and serving a function that is ultimately for the welfare of everyone at the facility. Some of these people are at home within the correctional system and also have a stake in secure, orderly operations.

Security Systems

There are two realms of threat in the correctional setting -- overt and covert. Escape, riot, assault, confinement and other threats to physical safety are examples of overt scenarios. Covert threats to security include smuggling/trafficking, illicit access to potentially sensitive information and personal manipulation.

The correctional system you will be working within should provide the training needed to acquaint you with these threats, but it is important to realize that every facility is different. Understanding the unique institutional culture where you work is the ultimate key to your personal security.

As a healthcare professional, your role in dealing with overt events will be primarily clinical (i.e., responding to the aftermath). As a member of the greater pool of inside staff, however, with daily face-to-face contact with convicted felons, you must also play an active role in thwarting the covert agendas that abound.

Motives and Personalities

Just as there are marked differences in attitudes and behavior among individual inmates, there is also a fairly broad ideological continuum among correctional staff. At one extreme are the small personalities and weak characters to whom the correctional system offers a personal playground of petty power trips and abuse. At the other extreme are the self-anointed doers of "God’s Work" who feel compelled to offer unlimited aid and satisfaction to specific individuals despite overriding policy or security concerns. A member of the former is more likely to be the cause and victim of an overt event, while one of the latter is more likely to support (and be victimized by) a covert agenda.

Role conflicts among staff are also built into the departmental structure. Some jobs are intended to advocate for the individual offender as a means of balance. Non-clinical staff may view a healthcare provider with disdain when that advocacy is deemed excessive or misapplied.

Above it all, remember that even at its best a correctional facility is still a bureaucracy in which part of the weaker manager’s game is to avoid accountability and thus refrain from taking meaningful action.

The Individual Approach -- Where Do You Stand?

Any person who is new to corrections will be the target of concerted initial manipulation intended to test the individual’s will and determination to follow the rules. You will be tested regarding your understanding of and adherence to operational guidelines and security measures. Your character and where you stand on the ideological continuum will also be assayed throughout your employment as a correctional healthcare provider.

As a medical provider you will also be challenged to disprove claims that you are clinically incompetent, prejudicial, dishonest, cruel (and perhaps unusual) or otherwise of despicable character. Consistency in your interpretation and application of written policy thus becomes extremely important.

But what if the situation you are facing falls outside of the realm of written guidelines? First, you should determine whether or not the decision at hand is indeed yours to make. If you are in a leadership role, chances are it is. Then realize that you will be condemned for what you do as well as what you don’t do -- decide for which course of action you would rather be criticized.

The Team Approach

So there you are working in a bureaucracy, providing services for which you are routinely criticized regardless of your approach, while also subject to varying degrees of threat to your personal security. What makes it all worthwhile are the other people with whom you train, work, commiserate and respond to crises.

While you are developing a notion of who you are within the institutional culture, of what roles you play, of where you stand on the continuum -- of how you will play the game -- you must also spend the effort needed to develop rapport within and beyond the healthcare unit. Clinicians need to operate as a team within a team. You depend on everyone else who works inside and everyone else depends on you.

The Rewards

Correctional work is real, with moments of both gravity and levity. It is complex -- a swirl of personalities, ideologies and agendas. Some of the people working in the correctional setting are fascinated by its inherent intrigue and find fulfillment in the experience of fulfilling a great need. When you experience it for yourself you will understand its uniqueness and measure your own rewards.