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Survey Process

• Goals and Objectives
• Survey Methodology
• Physical and Mental Health Surveys

Goals and Objectives

The goals of the CMA are (1) to determine if the physical, dental, and mental health care provided to inmates in all state and privately operated correctional institutions is consistent with state and federal law and if that care conforms to the standards of care generally accepted in the professional health community at large; (2) to promote ongoing improvement in the correctional system of health services; and (3) to assist the Department of Corrections in identifying mechanisms to provide cost effective health care to inmates.

To achieve these goals, the CMA established specific objectives for the survey process. The objectives evaluate inmate care and treatment in terms of effectiveness and fulfillment of statutory responsibility. Specifically, the objectives include determining if:

• inmates have adequate access to medical, dental, and mental health screening and evaluation and to ongoing preventative and primary health care.
• inmates receive adequate and appropriate mental health screening, evaluation, and classification.
• inmates receive complete and timely orientation on how to access physical, dental, and mental health services.
• inmates have adequate access to medical and dental treatment that results in the remission of symptoms or in improved functioning.
• inmates receive adequate mental health treatment that results in or is consistent with the remission of symptoms, improved functioning relative to their current environment, and reintegration into the general prison population as appropriate.
• inmates receive and benefit from safe and effective medication, laboratory, radiology, and dental practices and have access to timely and appropriate referral and consultation services.
• psychotropic medication practices are safe and effective.
• inmates are free from the inappropriate use of restrictive control procedures.
• sufficient documentation exists to provide a clear picture of the inmate's care and treatment.
• there are sufficient numbers of qualified staff to provide adequate treatment.

To meet these objectives, the CMA developed a process used to guide the development of the survey protocol, the data collection instruments, the logistics of the survey process, and the format for the final report.

• The survey is based on the provisions of the DC Health Services Plan, the DC Health Care Standards, the DC Mental Health Plan, and the DC Health Services Technical Instructions (TI), which articulate these standards to the field, and the prevailing appropriate minimum standards of care generally accepted in the professional health community at large.
• Sample inmate medical records are reviewed and an analysis of the care and treatment provided to inmates is performed by the surveyor. In some cases, the surveyor conducts a comprehensive review and in other cases the surveyor focuses on a specific element of care.
• Surveyors also look at the functioning of the physical, dental, and mental health care delivery systems and their required elements through institutional operations, administrative controls, and compliance with policies and procedures.
• The focus of the survey is to verify that the general principles of adequacy are being met.
• The survey approach relies upon the guided judgment of the surveyor in making a determination which is evidence based.

Survey Methodology

The survey methodology is based on case reviews selected through random and purposeful sampling. These samples are representative of inmates who are receiving mental and/or physical health services or are eligible to receive such services at the institution. The survey is designed to assess compliance with DC policies and TIs, and whether the DC procedures and policies lead to treatment that is adequate and equivalent to that available to the community at large. In addition, this instrument seeks to verify that the general principles of adequacy are being met rather than focusing on compliance with the details of procedures.

The survey includes a review of the mental and physical health systems; specifically, the application of written policies and procedures, staff credentials, and additional administrative issues. All results are based upon reviews of medical records; interviews with inmates, health care providers, and security staff; reviews of administrative-based policies and procedures; and a physical inspection of the institution.

Sample Record Selection

To make generalizations about the population being surveyed, a representative sample is needed. Each survey sample is primarily drawn by means of a random process. This gives every individual in the inmate population an equal chance of being selected for the sample. Health care within prisons is segregated into a multitude of services, all available to every inmate.

Medical services are delivered through clinics for the chronically ill, and through other delivery venues for episodic care. In a similar manner, mental health care for inmates is delivered according to the acuity of mental disturbance. This arrangement of services provides a natural sub-grouping of the institutional population from which samples can be drawn.

Survey Process (Continued)