Recognizing and Managing
the Special Needs Inmate
Presented by:
Lori Harriman, Treatment Supervisor
Mary Baker, Training Manager
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Overview
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Special Needs Inmates (SNI)
Importance of Identifying & Managing SNI
Areas Affected by, and Indicative of, SN
Common Special Needs Conditions
Stability to Crisis
Steps for Managing SNI
Mental Health Referrals
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Objectives
 Define Special Needs Inmates (SNI)
 List the 5 Reasons for Identifying &
Managing SNI
 List the 7 Common SN Conditions
 List the 5 General Areas Affected
by/Indicative of Special Needs
 List Warning Signs for Potential Violence
 List the 4 Steps for Managing SNI in Crisis
 List the Steps to Making both NonEmergency and Emergency MH Referrals
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Special Needs Inmates Defined…
Offenders who require special management
due to a congenital or acquired condition
affecting their well-being and functioning.
Categories
Psychological/Mental Illness
Intellectual
Physical/Biological
Other
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Five Reasons for Identifying
and Managing SNI
L - Law
O - Operations
R - Rehabilitation
R - Re-Entry
S - Safety
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General Areas Affected by or
Indicative of Special Needs
T - Thinking
A - Appearance
B - Behaviors
F – Functioning
M - Mood
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Seven Common Conditions
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Psychosis
Depression
Mania
Anxiety
Personality Types
Sensorial Disabilities
Cognitive/Intellectual Disabilities
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Psychosis
Psychosis is a state in which a person is
disconnected from reality.
Two major components:
»Delusions
»Hallucinations
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Psychosis, cont’d.
Delusions
are fixed, false beliefs
Paranoid Delusions
Delusions of Grandeur
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Psychosis, cont’d.
Hallucinations are sensory experiences with
no basis in reality.
• Auditory (hear)
• Visual (see)
• Tactile (touch)
• Gustatory (taste)
• Olfactory (smell)
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Psychotic Episode
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Signs of Psychosis
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Disorganized or irrational thoughts
Talking to internal stimuli
Dulled/heightened emotional expression
Disorganized speech
Withdrawal
Poor personal hygiene
Shifting eye contact
Bizarre behaviors
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Person with Psychosis
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Depression
is a state in which feelings of sadness, loss, anger, or
frustration interfere with everyday life for > 2 weeks.
Insomnia or excessive sleeping
Decreased or increased appetite
Irritability/anxiety
Lack of energy, initiative, motivation
Feelings of hopelessness, helplessness and/or
worthlessness
Reduced ability to think, concentrate or make
decisions
Loss of interest or pleasure in all or almost all
activities
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Depression
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Mania
A significantly elevated mood/heightened state of being.
Racing thoughts
Little or no sleep
Rapid, loud speech
Highly energized,creative, confident
Lack of judgment/impulsivity
Heightened distractibility/irritability 16
Mania
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Anxiety Disorders
A chronic condition characterized by an
excessive and persistent sense of
apprehension, stress, and worry.
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Emotional Symptoms of Anxiety
Feelings of apprehension or dread
Trouble concentrating
Feeling tense and jumpy
Anticipating the worst
Irritability / Restlessness
Feeling like your mind’s gone blank
Physical Symptoms of Anxiety
Anxiety is more than just a feeling. As a product of the body’s fight-or-flight
response, anxiety involves a wide range of physical symptoms. Common physical
symptoms of anxiety include:
•Pounding heart
•Sweating
•Stomach upset or dizziness
•Frequent urination or diarrhea
•Shortness of breath
•Tremors and twitches
•Muscle tension
•Headaches
•Fatigue
•Insomnia
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Types of Anxiety
•Generalized Anxiety Disorder
•Phobias
•Social Anxiety Disorder
•Obsessive-Compulsive Disorder
•PTSD
•Adjustment Disorder
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Emotional Symptoms of Anxiety
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Post Traumatic Stress Disorder
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Irritability / outbursts of anger
Exaggerated startle response(jumpiness)
Hyper-vigilance
Reactive to triggers
Shaking, sweating, cowering, etc.
Sleep disturbances (nightmares)
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Person with
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Personality
Types…
are characterized by chronic, inappropriate and
maladaptive interactions and behaviors
Anti-Social Personality
Paranoid Personality
Borderline Personality
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Anti-Social Personality
Disregard for other people’s rights &
property or for rules, regulations, and
boundaries as manifested by:
 Repeated lying
 Impulsiveness
 Aggressiveness/Irritability
 Lack of remorse
 Cleverness
 Deceit and manipulation
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Paranoid Personality
is characterized by a chronic & pervasive
distrust and suspicion of others, i.e. a
belief that they are being lied to, deceived,
or exploited or that friends, family, and
romantic partners are untrustworthy and
unfaithful,
AND
is manifested by:
• Outburst of anger in response to perceived deception
• Looking for hidden meanings in gestures &
conversations
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Borderline Personality
is characterized by pervasive instability in moods,
interpersonal relationships, self-image, and behavior
 Unstable and intense relationships
 Impulsive behaviors that are potentially
self-damaging
 Self-injurious and/or suicidal behaviors
 Unstable emotions
 Intense anger or difficulty controlling anger
 Feelings of emptiness
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Sensorially Disabled
An inmate that has any long-lasting
conditions such as blindness, deafness, or
a severe vision or hearing impairment
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Cognitive/Intellectual Factors
Areas of Deficit:
• Memory
• Motivation/Energy
• Attentiveness/Concentration
• Adaptability
• Social Skills
• Impulse/Self Control
• Following Direction
• Information Processing
• Judgment (Naïveté)
• Planning & Problem Solving
• ADL’s
• Speech and/or Language (written or spoken)
• Mood/Coping Stability
• Knowledge/Education
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AD/HD
the co-existence of attentional
problems and hyperactivity
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Traumatic Brain Injury (TBI)
Occurs when an external force traumatically
injures the brain. TBI can cause a host of,
behavioral, cognitive, emotional, and physical
effects including seizures, paralysis, poor
coordination, weakness, headaches, and
sensory problems.
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Understanding TBI
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From Stability to Crisis
Stress +
Coping = Crisis
What are the
warning signs?
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Warnings Signs
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Ignores you completely
Excitability – ‘Amped’
Aggravated movements
Stops all movement
Acts intoxicated/Out of control
Pre-Attack body positioning
Verbal posturing/threats
Emotional meltdown
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Four Steps for Intervening
with an Inmate in Crisis
Attend
Communicate
Evaluate
Respond & Refer
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Four Steps for Intervening with an Inmate in Crisis, cont’d.
Attend
 Engage
 Make eye contact
 Minimize distractions
 Be present & genuine
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Four Steps for Intervening with an Inmate in Crisis,
cont’d.
Communicate
Engage by Asking Questions
 Self-harm, suicidality, harm to others
Listen
 Understand
Respond
 Reflect, validate, clarify (content,
feeling, meaning, intent)
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Four Steps for Intervening with an Inmate in Crisis,
cont’d.
Evaluate
Risk
Need
Person in Environment (TABFM)
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Four Steps for Intervening with an Inmate in Crisis,
cont’d.
Respond & Refer
Emergency
Code Blue
Risk Management
Emergency Referral
Non-Emergency
De-escalate
Non-Emergency Referral
Refer to Counselor/CCW, Supervisor, etc.
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Mental Health Referrals
(Hampden County)
NON-EMERGENCY
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Non-Emergency Referral Form
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TABFM
FMHS will respond within 10 days
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Mental Health Referrals
(Hampden County)
EMERGENCY
When an inmate is at risk of imminent self
harm/suicide:
•Call ESU at ext. 2328
•FMHS will respond within 1 hr., daily 9a-4p
•Maintain safety until Special Ops arrives
•FMHS staff will evaluate & provide
recommendations
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Mental Health Referral
(Hampshire County)
A. The inmate fills out a request and it is sent to Medical. Medical will
decide on a referral to forensics. If the inmate is in obvious need, the
shift supervisor will contact ServiceNet (if no one is on shift to provide the
assistance).
B. The clinician from ServiceNet or Franklin/Hampshire County Emergency
Services will provide care & services for inmates referred for mental
and/or emotional illness and intellectual disabilities.
C. The ServiceNet or Franklin/Hampshire County Emergency Services will
provide prompt emergency response to inmates referred for psychosis
and/or suicidal disorders.
D. The ServiceNet or Franklin/Hampshire County Emergency Services shall
in cooperation with the HSU or the Deputy Superintendent provide
appropriate action for Special Needs Inmates in regards to housing
assignments, program assignments, disciplinary measures, and transfers
in and out of facility.
E. Coverage from the ServiceNet is Monday-Friday 9:00am–5:00pm & from
the Franklin/Hampshire County Emergency Services Monday- Friday
5:00pm – 9:00am (weekends, holidays, & after hours if necessary).
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Mental Health Referral
(Hampshire County)
Inmates referred for mental health treatment receive a
comprehensive evaluation by a licensed mental health
professional within 14 days of the referral request date
and includes at least the following:
• Review of mental health screening and appraisal data.
• Direct observations of behavior.
• Collection and review of additional data from individual
diagnostic interviews and tests assessing personality,
intellect, and coping abilities.
• Compilation of the individual's mental health history.
• Development of an overall treatment/management plan
with appropriate referral to include transfer to mental
health facility for inmates whose psychiatric needs
exceed the treatment capability of the facility.
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Emergency Stabilization Unit
(ESU)
A 7 bed mental health inpatient
program for men housed in C Tower
Designed to give short-term intensive
psychiatric evaluation and treatment
Referrals are made directly to the ESU
Admissions are between the hours of
9am and 5pm on regular working days.
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Emergency Stabilization Unit
(ESU)Criteria for Admission
 Inmate is considered to be a danger to self
or others.
 Inmate is functioning so poorly he cannot
take care of his daily needs.
 Inmate presents with an unclear diagnosis
and a period of observation is required.
 Inmate who is acutely psychotic or suffers
from a serious affective disorder.
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Practice Referral
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