Case Studies

REGION: Mid-Atlantic

We often find that detention professionals are unfamiliar with the complex field of health care — and, likewise, that community health care providers are not attuned to the unique needs of detention facilities.

In the case of this client, our help was needed in bridging these two worlds with an approach that would lead to improved outcomes for detained individuals in their care.

When we were contracted to support a comprehensive internal review of this agency’s health care operations, we assembled a multidisciplinary consulting team to ensure that the services being offered met the standards for quality care. We also reviewed medical records to reconstruct, understand, and learn at an administrative level from the events surrounding a series of in-custody deaths. Finally, we served as medical subject matter experts for the teams that were inspecting this agency’s detainee housing programs.

Our ongoing work has consisted of multiple site visits, interviews, virtual consultations, and medical records reviews with related recommendations for continuous improvement initiatives.

REGION: South

A well-respected provider of community health care services, this client came to us for help when they expanded into correctional health care for the first time in 2019.

Because the client lacked experience in this market — and did not intend to outsource medical services to a vendor — they needed an experienced consulting team that could help them design the framework for their offerings.

“I’m good at what I do, but it was a monstrous task and short time frame. One of the ways I lessened the burden was to find a partner to stand up the policies, procedures, and forms. It’s not like duplicating the hospital policies — the guidelines are a lot different, and I didn’t want to recreate the wheel.” —Client

The deliverables of our first engagement provided the procedural infrastructure for their new correctional health care offerings, and it formed the groundwork for an ongoing partnership with this valued client.

When the COVID pandemic hit in March 2020, and the client was focused on addressing the challenges of a detained population and managing the risk of large-scale infections, we provided advice as needed. Subsequently, when they experienced concerns with the mental health services being provided by an outside vendor, the client once again sought our assistance. Our consulting team began conducting on-site visits each quarter — and then consulting remotely during the periods between visits — in order to provide technical assistance and contract oversight for this subcontractor.

REGION: Northeast 

When we came on board as a consulting partner for this client, they had a variety of existing monitoring initiatives underway, and their sizable in-house staff was experiencing unusually high turnover rates.

Throughout a multiyear engagement, our team has helped them look at the macro picture to understand the division of responsibilities and coordinate initiatives across the organization. Each month, we visit their facility either on-site or remotely, spending time with correctional and medical staff; interviewing patients receiving treatment; reviewing contracts, sick call logs, and health records; checking on follow-up care; and more. Based on our findings, we generate monthly reports and follow-up milestones to ensure that the client is following health recommendations consistently and that their staffing matrices are appropriately matched to the needs of individuals in their care.

“It’s difficult for our corrections staff to get ‘into the weeds’ on medical conversations. NCCHC Resources has a wealth of folks who truly understand correctional medicine. They are always on point. They catch the things our providers miss.” —Client

In reviewing incidences of suicide at the facility, our team identified several architectural design and layout issues that potentially heightened risks and made recommendations for investing in improvements that would ensure continuous observation by their staff.

Because the client has an active inmate advocacy community, they created a Correctional Advisory Board, which includes our team and county officials. We meet regularly with them and work collaboratively with the community members to increase positive engagement and address any red flags that are raised.

REGION: Midwest

A large urban county retained NCCHC Resources to help navigate the complexities they faced in providing medical, dental, and mental health care to the thousands of individuals in their complex correctional system.

As this county’s existing contract with a private correctional health services provider was nearing completion, our team of consultants was contracted to conduct an on-site analysis of the care provided, with the goal of improving quality and continuity across the county jail and house of correction. We worked with the county — which at the time had no medical practitioners on staff — to develop an RFP for a new health services contract, ensuring that the requirements for bidders and the subsequent contract were complete and thorough. We also conducted an analysis of proposed staffing positions to ensure that professionals with appropriate licenses and credentials were hired.

In addition, the county issued an RFP for an independent third-party monitor to assess compliance with the terms of the contract over a number of years. NCCHC Resources won that RFP, and was hired to monitor the care provided by the health services contractor. Our ongoing, multifaceted oversight includes monthly site visits, analyzing clinical, fiscal, and related data to assess provider performance under the health services contract; providing health services personnel with technical support aimed at continuous quality improvement; being responsive to the county and its provider as they worked to meet the challenging ongoing health needs of incarcerated patients; and supporting alignment and continuous compliance with the NCCHC standards.

“We need to be able to oversee our medical vendor to make sure they’re doing the right things for the right reasons. NCCHC Resources’ contract monitoring team is on our side and helps us do that. At the end of the day, there’s nothing more important.” —Client

In 2021, the county board brought health care operations in-house and enlisted us to complete a comprehensive self-operation implementation analysis, including services, staffing, equipment, IT, and a review of all of their associated costs.

REGION: West Coast

When we were first contracted to work with this county facility, they were experiencing concerns with the correctional health care system and how it was being run — a common problem we encounter with clients.

Our first project with them involved assisting in creating an RFP to secure a new vendor, and then helping to manage the ongoing relationship with this contractor. Specifically, the client wanted us to ensure that the vendor contract was comprehensive, as well as to monitor clinical information through a multi-year agreement, conduct site tours and fiscal auditing, and gather and analyze data on the vendor’s overall performance.

As the client makes progress toward accreditation, we conduct monthly visits to oversee quality assurance and develop a benchmarking system to flag and address potential problems with clinical outcomes and/or patient issues before they occur. We are also creating metrics that demonstrate improvements in quality care over time (such as improved control of chronic medical conditions and fewer ER visits). Finally, we provided vital recommendations for how to improve suicide-prevention strategies, including housing and architectural changes that reduce blind spots and improve sight lines for continuous observation by staff.

In an ongoing effort to bring the most up-to-date guidance to our clients, NCCHC Resources embarked on a research project with a private funder to investigate the current state of treatment for opioid use disorder among correctional facilities across the country. We assembled a team of experts with experience in corrections, addiction medicine, epidemiology, and statistical analysis to carry out this project and ensure a rigorous research process. The study was cross-sectional and utilized an online survey that was sent to health services professionals working in correctional facilities.

As medication-assisted treatment (MAT) is increasingly offered in correctional facilities, both due to an increased recognition of its effectiveness and evolving legal precedent, this and future research will help us to better inform clients on key issues, best practices, and industry norms related to MAT.

Findings were presented at the NCCHC National Conference and will be submitted to an academic journal for publication. We were pleased to engage in a follow-up research project with this funder to further investigate findings from the initial study. The results will be disseminated to the field upon completion.