Many correctional agencies focus on the inmates who look sick, act sick and need immediate treatment. But there is a whole segment of the inmate population that may have a chronic disease, such as diabetes, that they don't know they have. Inmate education can help offenders manage these diseases at an early stage before they become debilitating. 

'We tend to forget about education and yet there are so many ways to educate them. Over 80 percent of our inmates have never had any regular healthcare,' said Thomas Conklin, Medical Director at the Hampden County, Mass., Correctional Center.

Conklin said inmate education can help put an individual on the right direction toward better health and may lessen the costs of heath care in the community once they are released. To that end, the correctional center has developed a health education department to teach inmates how to care fro themselves and address specific problems they may have.

The Health Care Network recently spoke with officials at Hampden County Correctional Center about their philosophy and the program.

Q: At what point are inmates educated about certain diseases?

Thomas Conklin: My thought is that any person in the jail within 24 hours should get basic health education and hopefully someone can point them in the right direction. We do a lot of education during assessment. They go to an assessment unit [at the beginning of their incarceration] where we educate them on diseases such as Hepatitis C, HIV, STDs and use films and props. Every inmate on the day they are admitted goes to that day's health session. We also have a pretrial pod where we teach health education every week. Then there is also peer education. What is nice is that it is held on three different days and if they go to all three, they get a day and a half of good time. Everybody goes because of that and there are no adverse feelings about the people who are there. There is no stigmatization because everyone goes.
Just the other day, we counted up how many inmates went to health education. One third were in a health education class and 100 percent of those with diabetes are being seen.
We decided we would go to disease specific education because 15 percent of our inmates have chronic illness. We do a lot with HIV, TB and STDs, but not with chronic illness.

Q: What is offered for inmates with diabetes?

Joanne Dorman, RN, Certified Diabetes Educator at Hampden County: We find between three and four percent of patients are diabetic and two thirds know they have it but have had little or no education prior to admission. We have individual and group sessions, support groups and family education sessions. We offer to meet with families and significant others of those who are getting ready for release. We talk about what they can do to encourage [the patients] to take care of themselves.
We have extensive release planning. We introduce them to a health care provider; I make sure they go home with a glucometer and prescriptions. If they are not hook up with [state health insurance when they leave] I try to connect them with an indigent drug program so they can receive their medications. The real goal is to teach them to care for themselves. The cost of caring for a diabetic who is not taking care of himself or herself is $11,000. [This] is a savings to the community. If they don't learn or care for themselves they could have high blood pressure, blindness, life-threateningly high blood sugar levels.

TC: Every Tuesday our health educator teaches a class for one and half hours. We were told it wouldn't work with inmates but people ask good questions it is kind of a support group. So many didn't understand the need for a specific diet and the need for insulin. Also we set up an exercise program three times per week and a nurse is there to supervise. We have had people who have lost tremendous amounts of weight. Also we do individual classes for asthma and heart disease. All [of them] are turning into a homerun.
We have between 30 and 60 cases of diabetes and a third have discovered this in the jail. Also a lot of people [here] with chronic illness have never had regular health care. By getting people into the health care system you teach can them more appropriate use of health care resources.

Q: What is taught the inmates with diabetes?

JD: The level of the class sessions is determined by the patients; it can be basic survival skills or we can teach them how to make changes in their treatment plan.  
We talk about signs and symptoms of the disease, what they should be eating, the standard of care [as well as] giving insulin shots. Some do require Insulin. When I show someone, I teach them step by step together. They demonstrate it back. I also follow their blood glucose levels.
With the standard of care I teach them to know they should have an eye exam and the tests that should be taken. They know what the health care provider should be asking and the patient is empowered. 
Many corrections agencies are good at covering the immediate costs and the costs today but not the long-term care. By doing this education we see decreases in blood sugar levels and in blood pressure. We are getting them in for treatment earlier. 

For more information, contact the Hamden County Correctional Center at 413-547-8000