ACA Correctional Health Care Standards - Looking Forward
Midberry, Keith, Corrections Today
Health care delivery has experienced unprecedented change during the past decade Advances in medical technology, new generations of pharmaceuticals and a shift toward preventive measures and managed care are among several key areas of change that have "trickled down" to the correctional health care environment. During this same time period, the prevalence of serious diseases such as HIV and HCV (hepatitis C virus) infection and drug-resistant tuberculosis (TB) has increased dramatically. Not surprisingly, the cost of providing health care continues to rise significantly and represents the fastest-growing segment of most correctional agency budgets.
The decisions being made by clinical and correctional decision-makers are more complex and difficult than ever before. Correctional health care has been described as a huge jigsaw-puzzle with many interconnecting and interdependent pieces. Access standards, disease management, quality improvement, security controls, staffing issues and legal requirements represent just a few of the critical issues in building a quality correctional health care system.
So, where does a correctional agency or correctional health care provider turn for guidance and assistance in putting all the pieces of the puzzle together? The answer is the American Correctional Association (ACA). Health care standards have been an integral part of ACA accreditation programs since their creation in the 1970s.
In 1989, ACA published its first health care-specific program -- Certification Standards for Health Care Programs. In addition to health care standards, this program included standards on safety and emergency procedures, sanitation, security and control, training and staff development, and fiscal and personnel procedures. Several facilities continue to maintain certification in this program. Through various forums, ACA's membership has become more aware of correctional health care issues and the need to better evaluate the performance of correctional health care operations.
In 1999, ACA's senior leadership responded to the concerns of its membership and committed to a major revision of the Certification Standards for Health Care Programs. A health care task force was formed and charged with updating existing health care standards and developing a new health care program based on contemporary correctional health care practices. The health care task force is comprised of prominent health care and corrections professionals from a variety of clinical and correctional disciplines. Key members of the health care task force include three state medical directors, a correctional nurse, a clinical psychologist, the director of a large state correctional system, a correctional health services administrator, a senior federal sector representative, a corrections consultant, an infectious disease specialist and the sheriff of a large metropolitan area. When completed, the new manual program will be titled Standards for Correctional Health Care Programs.
Another endeavor for the task force was for the new correctional health care program to be developed as a performance-based standards model. Performance-based standards are a growing trend in both the public and private sectors. The federal Government Performance and Results Act was instrumental in setting an example and requires all federal agencies to develop a set of performance measures to evaluate whether they have achieved their missions and goals. Other organizations and businesses were encouraged to follow the government's lead and to embrace similar performance-based models. Performance-based standards are not unique to ACA accreditation programs and currently are being used in various formats by other accreditation organizations. However, they are relatively new to the health care setting.
ACA formally endorsed performance-based standards several years ago and already has revised Standards for Adult Community Residential Services to include performance-based standards. …