First Step Act – Revised 2022

Reduction in Recidivism

Requires the Attorney General to develop a risk and needs assessment system

  • The BOP assess the recidivism risk and criminogenic needs of all federal prisoners
  • Place them in recidivism reducing programs
  • Including productive activities to address their needs and reduce this risk.
  •  Under the act, the system provides guidance on the:
    • type,
    • amount, and
    • the intensity of recidivism reduction programming and
    • productive activities to which each prisoner is assigned, including
    • information on which programs prisoners should participate in based on their criminogenic needs.
    • on how to group, to the extent practicable,
      • prisoners with similar risk levels together in recidivism reduction programming and
      • housing assignments.
  • The Act also amends 18 U.S.C. § 4042(a), requiring the BOP to assist inmates in:
    • applying for federal and state benefits and
    • obtain identification, including a
      • social security card,
      • driver’s license or
      • other official photo identification, and
      • birth certificate.
  • The First Step Act also expands the Second Chance Act to deliver recidivism reduction programming.

Incentives for Success

  • The Act amended 18 U.S.C. § 3624(b), so that federal inmate can earn:
    • up to 54 days of good time credit for every year of their imposed sentence
    • rather than, for every year of their sentence served.
    • For example, you’re sentenced to 10 years, your maximum good time credit = 540 days.
    • These good-time credits go towards pre-release custody.
    • Ineligible for good-time credit are generally categorized as:
      • violent, or involve
      • terrorism,
      • espionage,
      • human trafficking,
      • sex and sexual exploitation; additionally
      • excluded offenses are a repeat felon in possession of a firearm, or
      • high-level drug offenses
      • For a more complete list, see disqualifying offenses

Confinement

  • 18 U.S.C. § 3621(b) requires the BOP to house inmates in facilities within 500 driving miles of their primary residence.
  • The BOP variety of factors goes into placement, including:
    • bed space availability,
    • security designation,
    • programmatic needs,
    • mental and medical health needs,
    • any request made by the inmate related to faith-based needs,
    • recommendations of the sentencing court, and
    • other security concerns.
  • The FSA reauthorizes and modifies a pilot program that allows the BOP to place certain elderly and terminally ill prisoners on home confinement to serve the remainder of their sentences.

Correctional Reforms

  • Criminal justice-related provisions, including;
    • prohibition on the use of restraints on pregnant inmates in the custody of BOP and the U.S. Marshals Service.
    • requirement the BOP to provide tampons and sanitary napkins for free
    • The FSA requires BOP to provide training to correctional officers and other BOP employees:
      • on how to interact and de-escalate encounters with people who are diagnosed with mental illness or other cognitive deficits.
      • Also included is a prohibition against the use of solitary confinement for juvenile delinquents in federal custody.

Sentencing Reforms

  • Changes to Mandatory Minimums for Certain Drug Offenders for some drug traffickers with prior drug convictions
    • the threshold for prior convictions that count toward triggering higher mandatory minimums for repeat offenders,
      • is reduced from the 20-year to a 15-year mandatory minimum,
    • The life-in-prison mandatory minimum (where there are two or more prior qualifying convictions),
      • to a 25-year mandatory minimum.
  • Retroactivity of the Fair Sentencing Act (FSA)
    •  Those who received longer sentences for crack cocaine than if sentenced for possession of powder cocaine can submit a petition in federal court to have their sentences reduced.
  • Expanding the Safety Valve

FEMALE PATTERN RISK SCORING

MALE PATTERN RISK SCORING

Violent Offense Codes for PATTERN Risk Assessment *

Cut points used when calculating an inmates Risk of Recidivism

Healthy Steps for Older Adults 2022

FSA, Productive Activities (PA)
Healthy Steps for Older Adults 2022

Program Description Healthy Steps for Older Adults is an evidence-based falls prevention program designed to raise participants’ knowledge and awareness of steps to take to reduce falls and improve health and well-being. The goal of the program is to prevent falls, promote health, and ensure that
older adults remain as independent as possible for as long as possible.
Hours 3
Location(s) All institutions
Needs Addressed Medical/Recreation/Leisure/Fitness
Program Delivery Contractors
Health Services
Recreation
Unit Team
Volunteers

Sex Offender Programs – Federal Prison

FEDERAL PRISON SEX OFFENDER:

BOP PROGRAMMING WITH 2 LOCATIONS NATIONWIDE

SEX OFFENDER PROGRAM RESIDENTIAL (SOTP-R) is a voluntary program (P5324.10) for Sex Offenders, and those with a history of multiple sexual offenses, re-offense, extensive non-sexual criminal histories, and/or a high level of sexual deviancy or hypersexuality. Inmates ordinarily participate in the program during the remaining 36 to 48 months of their sentence. The duration of the program is 12-18 months. Placement in the SOTP-R is reserved for inmates with more extensive sex offense histories, and cohousing participants permit the implementation of a modified therapeutic community, separate from the general population.

Having only 2 SOTP-R facilities nationwide – before they enter the program, initial placement into a free-standing Federal Prison Camp (FPC), or satellite minimum camp (adjacent to a higher secure facility), if practical, should be part of the court’s calculation.

This is because should an inmate consider acting violently towards your client – most would likely refrain as a single incident would have them transferred behind the wall, to a higher security facility, which they would not want.

Ultimately it just may come down to you knowing your client and the facility recommendation options available during the period before SOTP-R placement. Keep in mind that no matter what the BOP says, this could be a real-life event, therefore having this discussion with your client may prove crucial.

BOP PROGRAMMING WITH 9 LOCATIONS NATIONWIDE

SEX OFFENDER PROGRAM NON-RESIDENTIAL (SOTP-NR), is also a voluntary program (P5324.10) for low to moderate first-time sex offenders with a single history of Internet Sex Crime, intended to identify offenders who are likely to re-offend. Inmates ordinarily participate in the program during the remaining 36-48 months of their sentence. SOTP-NR participants reside in the general population.

Having only 9 facilities nationwide – before they enter the SOTP-NR program, if practical, other than an FPC, or satellite minimum camp, should an inmate act violently towards your client – again, they would most likely refrain, as a single incident would have them transferred behind the wall, to a higher security facility. Otherwise, any other placement could result in a life-threatening sentence.

Consideration may again come down to knowing your client and understanding the facility options available for the period before their SOTP-NR placement.

BOP, 1 LOCATION NATIONWIDE

BUTNER’S COMMITMENT AND TREATMENT PROGRAM FOR SEXUALLY DANGEROUS PERSONS (2022-2023), “This FCI remains a flagship facility and is frequently chosen to pilot new programs such as the Sex Offender Commitment and Treatment Program,” (Page 6).

  • FCI Butner is responsible for the psychological treatment and implementation of behavior management plans, with the coordination of the multidisciplinary treatment teams. Treatment is holistic and multidimensional with the ultimate goal of reducing sexual dangerousness and criminal recidivism potential.
  • FCC Butner has an internship integrated practitioner-scholar model which seeks “the productive interaction of theory and practice in a primarily practice-based approach to inquiry”. The internship component of the Psychology Service strives to meet the training needs of doctoral candidates in applied psychology through supervised experience, didactic programs, and focused scholarship.
  • As there is only 1 location, which appears ‘court ordered’, there should be no other issues regarding inmate threats.

Fore more…

SEX OFFENDER SAFETY IN PRISON- PART OF YOUR SENTENCING CALCULATION

SEX OFFENDER SAFETY – PART OF YOUR SENTENCING CALCULATION

It is important for the court to consider your client’s, (sex offender) safety, by requesting the court grant initial placement into a Sex Offender Management Program (SOMP), while waiting for your client’s voluntary admittance into a SOTP Program.

Following their interview and investigation, the Probation Officer will draft the official Presentence Report (PSR). Together with preparation, your message stands a better chance of being part of the PSR, and is included “on the record”.

Not being placed into a SOMP, and should an incident occur, could at best result in your client spending the remainder of their sentence in isolation for their protection. Then over time, this may yield a host of mental health phobias, leading to more severe ailments.

The benefit of being proactive as you help your client during their transition into the prison environment safely; cannot be overstated. This is especially significant if the PSR includes the documentation of a mental illness with diagnosis, including the treating physician’s records and testimony.

 

ENSURING THE PHYSICAL SAFETY OF YOUR CLIENT

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Among inmates and convicts, sex offenders are at the bottom of the prison hierarchy and generally, are greeted with hostility.

The BOP, where needed, assigns sex offenders to higher security facilities, which may not be perfect. But this can be especially evident when they’re placed in general population.

Next, when the new sex offender first arrives and meets their new bunkmate, it is not unusual for them to be asked, what did you do?

No matter how they answer, eventually, their roommate or bunkmate Will Find Out! After that, at best, the sex offender is avoided – at worse, they could be robbed, beaten, or even killed. Then he/she may have to spend the rest of their entire sentence in solitary confinement?

Therefore, in your memorandum, safety may dictate placement in either a facility with a Sex Offender Management Program (SOMP) or at minimum, a camp.

For more…

Post-COVID Virus Causes Lingering or Ongoing Symptoms

The complicated care required for Post-COVID Long-Haulers is likely beyond the mission of most (if not all) prisons, jails, and detention centers.

According to researchers, this is still an active area of investigation. As we are approaching spring/fall 2022/2023, the Post-COVID Pandemic may be becoming an Endemic. Still, with that in mind, treating Post-COVID Long-Haulers and the amount and variety of staff, equipment, finances, and time needed, may just not be available to those incarcerated.

COVID is a true roller coaster of symptoms and severities, with each new day offering many unknowns.”

 “The difficulty is sorting out long-term consequences,” says Joseph Brennan, a cardiologist at the Yale School of Medicine.

While some patients may fully recover, he and other experts worry others will suffer long-term damage, including lung scarring, heart damage, and neurological and mental health effects.

Long after the fire of a Covid-19 infection, mental and neurological effects can still smolder[1]. ‘Long-Haulers’ after the initial COVID-19 hospitalization: fall into 3 categories (Dr. Sanghavi)

1st) The COVID virus causes lingering or ongoing symptoms, meaning that “ symptoms do not recover completely and are ongoing because of direct cell damage from the virus,”

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2nd) involves chronic ICU hospitalization for weeks. This causes:

  • muscle weakness,
  • cognitive brain dysfunction,
  • psychosocial stress-causing post-traumatic stress disorder (from chronic hospitalization).

3rd) symptoms appearing after recovery. “Interplay with the immune system of a person, and then the impact that both those things have on the body.”

“We are still trying to understand exactly how this interplay between the immune system and inflammatory markers work, but there’s no doubt that that is a group of symptoms because of ramped up immunity or ramped up inflammatory system,” Dr. Sanghavi added.

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Peripheral nerve issues, such as Guillain-Barré Syndrome, can lead to paralysis and respiratory failure.

Post-COVID Stress Disorder is another emerging consequence of the global pandemic.

Although most cases of COVID-19 appear to be mild with a recovery time of a few weeks, health experts are seeing more patients who suffer symptoms for months or get better, and then relapse down the road.

Isolation Is Not the Answer, Precautions for Adults with COVID-19[ii]

For more…

POST – COVID A PHYSICIAN’S JOURNEY

POST – COVID, A PHYSICIAN’S JOURNEY

Post – COVID a physician’s journey in the summer of 2020 working on both general medical and COVID-positive wards. But by November of that year, the U.K. was in its second wave and second lockdown, with COVID deaths and hospital admissions rising.

“Like being on a treadmill I could not get off”

Being given only basic personal protective equipment (PPE), Dr. Fearnley and her newly graduated doctors were sent onto medical and COVID wards. While on a COVID ward, and after not feeling well, a PCR Test returned positive for COVID, and what comes next follows the phases she went through:

  • “The acute phase lasted 2 weeks – comparable to a case of mild-to-moderate flu.”
  • “As a fit and healthy 35-year-old with no comorbidities, she naively expected to recover quickly,”
  • “By week 3, she still had a lingering fever,”
  • By week 4, Dr. Fearnley wanted to return to work, but being lightheaded and jelly-legged, just made it home.

Thus began the start of her long Post-COVID Long-Hauler (as it was later defined) Journey.

Getting slightly graphic, these attacks “were associated with an unquenchable thirst, with or without an urgent need to open to my bowels, vomiting, or increased shortness of breath. These came in daily cycles lasting up to 14 hours at a time. I would frequently shake through the entire night”.

For more…

Dr. Marc Blatstein | About

Marc Blatstein was born in Philadelphia, Pennsylvania where he attended high school. He later decided to go to George Washington University in Washington DC for his undergraduate degree where he received a Bachelor of Arts in Psychology all the while working a job on the side to help offset the high costs of a college education.

Marc Blatstein later went on to Ohio College of Podiatric Medicine where he studied medical training and obtained his Doctor of Podiatric Medicine Degree. While Marc was studying there, he started the “Pink Panther Bartenders” along with his brother and two of his classmates, to help with some of the costs of higher education. At one point, he was grateful to be asked to participate in a Gala for the Cleveland Opera, to which he agreed.

He then attended a surgical residency that covered Podiatric Medicine and Surgery, which was followed by a 31+ year career as a single practitioner. While in practice Marc Blatstein incorporated a medically oriented shoe store, wound care, and physical therapy programs into his practice.

Education | Timeline

– George Washington Univ., BA in Psych. (’77),
– Externship(s): * Lutheran Hospital Baltimore MD. (’82), * Atlanta Hospital & Medical Center, Atlanta GA (’82).
– Ohio College of Podiatric Medicine, Doctor of Podiatric Medicine, DPM (’83),
– Lawndale Community Hospital Surgical Residency in Podiatric Medicine & Surgery (’84)
– Podiatric Licensure, 1985 – present

HOBBIES

As most of my joys have been spent on the water, while I have enjoyed power boats with my best 1st mate Bailey.

In the end though, the peace and quiet of sailing is where I have spent most of my time.

 

 

PUBLICATION: Nails Magazine, Contributor

 

MY PRACTICE

PLANTAR FASCITIS
According to Dr. Marc Blatstein, morning heel pain’s the most common complaint he treats. Patients relate that it is pain upon
standing first thing in the morning. While the pain initially is excruciating, with ambulating the pain may subside, only to come back again with a vengeance after sitting, and then immediately returning again after standing up again.

The plantar fascia is a ligament attached at one end to the bottom of the heel (in a medial, central, and lateral band), then fanning out into the ball of the foot, thus acting as a shock absorber for the foot. As the foot impacts the ground, with each step the plantar fascia stretches slightly. When these excessive pressures of pulling the plantar fascia on the heel occur over time, with an innocent step (like stepping on a marble, or off a curb), they create small tears in the plantar fascia (the ligament on the bottom of the foot) resulting in a small amount of bleeding, pain & inflammation. Medical literature originally thought that heel pain was due to a bone spur on the bottom of the heel bone (or calcaneus). We now know that the pain is due to excessive tension on the plantar fascia as it tears from its attachment into the heel bone.

In the diagnosis of heel pain, Dr. Marc Blatstein relates that over the years, patient care has demonstrated that not all bone spurs are painful, and everyone with heel pain (or plantar fascitis) does not necessarily have to have bone spurs. A complete history and physical exam play a large role in approaching this diagnosis, along with weight-bearing x-rays, which are useful in determining if a heel spur is present (fractured), or associated with other pathologies contributing to the diagnosis.

Initially, treatment by Dr. Marc Blatstein can start with a combination of one or all of the following: padding & taping of the foot in a supportive nature, taking oral anti-inflammatory medications, immobilization of the foot in a walking cast, physical therapy as well as implementing specific stretching exercises. Should additional treatment be necessary, cortisone injections, as well as orthopedic functional foot orthotics, may be prescribed. Should any or all of these treatments fail, and after a detailed review of X- Rays, Lab results with your physician; surgical intervention may be considered, and according to Dr. Marc Blatstein, is very effective. Here an Endoscopic Plantar Fasciotomy is one (of many) of the possible procedures that could be recommended. A plan then is formed between you and your doctor for a successful outcome that is meant to add a full and enjoyable life to your years.

 

THE CIRCULATOR BOOT™

 

A major part of Marc Blatstein’s practice is using The Circulator Boot™ as a method of treatment that helps with the core elements of lower extremity wound therapy: bacterial control, increased blood supply, moisture, and the removal of dead or damaged tissues to help the healing of healthy tissue. Along with other modes of treatment, surgical debridement of infected wounds, the use of antibiotic medications along with home care, and boot therapy in Marc Blatstein’s eyes may improve the blood supply and control the infection when standard methods of treatment are failing.

The Circulator Boot™, from Dr. Marc Blatstein’s years of experience, the end-diastolic timing of its leg compressions, (this FDA-approved non-invasive technology) provides benefit in the prevention of leg amputation. Poor circulation and infection are the leading causes of 90,000 diabetic amputations that occur every year in the United States.

The Circulator Boot™ “A leg with poor arterial blood flow may be likened to a dirty sponge that is half wet. Squeezing such a sponge disseminates the water throughout the sponge. Soaking and wringing the water repeatedly from the sponge may help clean it. In like fashion, the heart monitor of the Circulator Boot™ is timed to allow each arterial pulse wave to enter the leg as best it can (to partially wet the leg “sponge”). Boot compressions provide a driving force to disseminate blood around the leg and at the same time press venous blood and excess tissue water from the leg. Patients with a pulse rate of 80 beats per minute might receive 4800 such compressions an hour. Patients with severe arterial leg disease might receive 100 such treatments or close to a half-million compressions! Breakdown of the clot, re-channelization of blocked vessels, and the formation of small new vessels may help restore blood flow.”

For those who may be facing amputation, this may be an option. Dr. Marc Blatstein recommends learning more about The Circulator Boot™ as a Method of Treatment, via The Circulatory Boot Service at the Mayo Clinic.

 

TARSAL TUNNEL SYNDROME
Similar to Carpal Tunnel, Tarsal Tunnel Syndrome is due to the compression of a nerve called the Posterior Tibial Nerve. Dr. Marc Blatstein, a Podiatric Surgeon, explained that Tarsal Tunnel Syndrome occurs over time as the nerve becomes inflamed resulting in symptoms such as burning, electric shocks, tingling, as well as a shooting type of pain. Other factors that Dr. Marc Blatstein, has found factors contributing to Tarsal Tunnel Syndrome come from either an overly pronated foot which puts a stretch on the nerve, pressure on the nerve from soft tissue masses such as ganglions, fibromas, or lipomas that physically compress the nerve, as well as other insults to the nerve.
The diagnosis is usually quickly made by physical exam as well as the patient’s history of their complaint. Observation may reveal a slight swelling just on the inside of the ankle joint. As part of the physical exam, Dr. Marc Blatstein finds that gently tapping the inside of the ankle joint in the acute phase will result in a tingling sensation that may shoot, both up the leg and/or into the foot. Nerve conduction studies are another tool that will reveal if there is damage to the nerve.

Treatment of the Tarsal Tunnel involves many different components, some of which are: correcting the abnormal pronation of the foot [which is accomplished with prescription functional foot orthotics]. Along with this, oral anti-inflammatory medications, vitamin B supplements, &/or steroids may provide some benefit, but are rarely curative. Should there be a soft tissue mass compressing the nerve, then surgical removal of the mass may be necessary. Surgical correction of Tarsal Tunnel Syndrome has a good chance of success, at the same time the over-pronation of the foot still needs to be followed with functional foot orthotics.

 

THE PAINFUL HAMMERTOE
According to Dr. Marc Blatstein, hammertoes appear with the toes bent in a clawing fashion. Hammertoes may be flexible or rigid, flexible infers that you can manually straighten the toes, while it is not possible to straighten a rigid toe. Because most of us wear enclosed shoe gear, the pressure caused by the shoe gear we wear causes the toes to become painful. On top of this pressure forms hard corn, while on the bottom of the foot the toe actually pushes the metatarsal bone down forming a callus. Treatment of hammertoes can be approached in many ways. Dr. Marc Blatstein starts by recommending a combination of appropriate shoe gear, as well as a functional orthotic, prescribed as a shoe insert to help the hammertoes from progressing or getting worse. In the very initial stages while the toe is still flexible, it can be tapped into its corrected position, also utilizing a functional orthotic. This conservative treatment also consists of hammertoe and buttress pads all available over the counter, in addition, to open-toe shoes.

With continued pain, correction of the deformity while successful depends on whether they are rigid or flexible. While the hammertoe is still flexible, a simple tendon release followed by taping it in the corrected position is usually effective. Then a functional orthotic may be prescribed to help maintain this correction. With a rigid hammertoe, the surgical procedure consists of removing some skin along with a small section of bone. Dr. Marc Blatstein told us that in cases of a severe hammertoe deformity a pin may be used to hold the toe in its corrected position for several weeks & then it is removed. In all cases, it is very important to follow your surgeon after surgery instructions in order to get the best result.

 

INGROWN TOENAIL

Victoria Azaranka recently dropped out of a tennis match because of an ingrown toenail. Dr. Marc Blatstein, tells us how to prevent ingrown toenails. There are several people who wait far too long to have the   procedure and they have more complications 

Most of the time people do not think that an ingrown toenail will get in the way of their profession, for one person it did. Victoria Azaranka who is the world’s No. 1 tennis player was sidelined due to an ingrown toenail in her right big toe. The toenail had become ingrown and made it so painful she had to sit out of a match against Serena Williams a former world’s No. 1 women’s tennis player. The cause behind the ingrown toenail is a surprise, a bad pedicure.

Facing The BOP With: Intellectual Disabilities, Neurological Impairments, Social Deficiencies Or Autism

CorrectionalOfficer.org © 2020 – Screen Shot[i]

 

The Skills Program[i] There are only 2 locations nationwide.

Do you have clients facing incarceration in the BOP, and who are being treated for intellectual disabilities, neurological impairments, social deficiencies, or autism? If yes; which of the BOP’s ‘2’ available prison facilities are best suited for their placement? That’s right, there are only 2 locations.

I ask this is because the concept of prison officials engaging individuals with autism (for example), has its own brand of procedural issues. For those with a documented history, this could be critical for the safety of all parties; the inmate, correction officers, and the facility general population.

Increasingly, media outlets are reporting instances whereby police officers are confronting subjects on the streets and encountering behaviors of some as “resisting verbal commands” and “obstructing justice,” among others. Eventually, the presence of autism or a different disability is discovered after these police/civilian engagements. Thus, a BOP facility who at a minimum, provides this type of care at a couple of facilities, should be made part of the BOP placement request through the PSR.

Inmates with significant functional impairment due to intellectual disabilities, neurological deficits, and/or remarkable social skills deficits are considered for the program. Participants must be appropriate for housing in a low or medium security institution. Inmates must volunteer for the program.[i] While this program is conducted over 12-18 months, inmates may continue with the program at additional times.

Autism spectrum disorder

Autism spectrum disorder (ASD[ii]) occurs in all ages, racial, ethnic, and socioeconomic groups, according to the Centers for Disease Control (CDC)[iii]. Autism is generally characterized by social and communication difficulties and repetitive behaviors. Signs of autism[iv] occur in three main areas:

  • Social interactions
  • Verbal and nonverbal communication
  • Repetitive or ritualistic behaviors
  • Characteristics 
    • having difficulty with everyday conversations
    • sharing emotions or interests less often than peers
    • having difficulty responding to or understanding social cues
    • having difficulty understanding other people’s facial expressions or emotions
    • having delayed speech or language skills
    • having trouble developing or understanding relationships
    • doing repetitive actions, such as hand-flapping or rocking
    • becoming intensely interested in certain topics
    • speaking in atypical ways, such as in a singsong voice
    • having a significant need for predictable structure and order
    • becoming overwhelmed or angry in new situations
    • having a sensitivity to certain stimulants, such as being overwhelmed by loud noises or bright lights experiencing intellectual delays

A particular focus on autism-affected inmates, classified by BOP under the umbrella category as “Intellectual Disabilities, Autism Spectrum Disorders” and “Major Neurocognitive Disorders,” seeks to treat affected inmates with a multidisciplinary modality, albeit only available at two BOP locations nationwide. The Federal Bureau of Prisons amended and published (May 2014)[v] its agenda to handle/treat mentally unstable inmates while incarcerated.

Intellectual disabilities are classified by severity, [i]

  • Mild to Moderate
    • Mild
      • slower in all areas of conceptual development and social and daily living skills
      • can learn practical life skills, which allows them to function in ordinary life with minimal levels of support.
    • Moderate
      • care of themselves,
      • travel to familiar places in their community, and
      • learn basic skills related to safety and health.
      • Their self-care requires moderate support.
    • Severe
      • has the ability to understand speech but otherwise has limited communication skills ()[ii].
    • Profound (MH CARE LEVEL III [iii])
      • cannot live independently, and
      • they require close supervision and
      • help with self-care activities.
      • limited ability to communicate and often have physical limitations.

Social Deficiency[iv]; reasons why a person may have a social skills deficit.

    • inability to acquire new skills,
    • because of a competency deficit,
    • they may struggle to perform because of limited practice or inadequate feedback, or
    • external factors
      • anxiety or
      • chaotic surroundings.

Basic Communication

  • inability to listen,
  • follow directions and/or
  • refrain from speaking.

Empathy and Rapport

Interpersonal Skills

  • Those who have a social skill deficit may struggle with asking accurate and concise questions.
    • appear disinterested and even
    • anti-social,
    • they may struggle to understand proper manners in different social contexts and settings.

Problem Solving: involves asking for help, apologizing to others, deciding what to do, and accepting consequences;

  • morbidly shy or
  • clinically introverted.

Accountability, fear of being criticized in public;

  • struggle with accepting blame for problems or
  • dealing with constructive feedback.

Other neurological impairments[vi] (e.g. traumatic brain injury, Spina Bifida, Prader-Willi syndrome, Alcohol-Related Neurodevelopmental Disorders or FASD)

As a Police Officer, Cheri Maples, stated earlier, “…wisdom is being able to discern when gentle compassion is called for and when fierce compassion is called for.” That, my friends, rather sums it up.[ix]

Criminal Justice Advocacy – Screen Shot[i]

 ‘The responsibility for a client’s mental and physical health should be safeguarded to protect them from themselves and others, providing a safe environment for the duration of their incarceration.’

This is the responsibility of the legal defense team, court, and BOP.

The Skills Program[ii] is available at these two facilities:
FCI Coleman, FL-Medium

FCI Danbury, CT-Low

 

[i] https://www.arcnj.org/programs/criminal-justice-advocacy-program/

[ii] https://dev-pprsus.pantheonsite.io/bop-psychology-treatment-the-federal-presentence-report-sentencing-and-prison-placement-preparation/skills-program/

[i] https://www.ncbi.nlm.nih.gov/books/NBK332877/#:~:text=Historically%2C%20intellectual%20disability%20(previously%20termed,100%20in%20the%20population)%E2%80%94and

[ii] https://www.ncbi.nlm.nih.gov/books/NBK332877/#

[iii] https://dev-pprsus.pantheonsite.io/programs/bop-mental-healthcare/

[iv] https://www.masters-in-special-education.com/lists/5-types-of-social-skills-deficit/

[v] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1350917/

[vi] https://www.ninds.nih.gov/Disorders/Support-Resources

[vii] https://www.cerebralpalsyguide.com/cerebral-palsy/

[viii] https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy

[ix] https://www.correctionalofficer.org/overseeing-inmates-with-autism

[i] https://dev-pprsus.pantheonsite.io/bop-psychology-treatment-the-federal-presentence-report-sentencing-and-prison-placement-preparation/skills-program/

[ii] https://www.additudemag.com/autism-spectrum-disorder-in-adults/

[iii] https://www.additudemag.com/autism-spectrum-disorder-in-adults/#footnote1

[iv] https://www.additudemag.com/signs-of-autism-in-adults/

[v] https://www.bop.gov/policy/progstat/5310_16.pdf

[i] https://www.correctionalofficer.org/overseeing-inmates-with-autism

[i] https://dev-pprsus.pantheonsite.io/bop-psychology-treatment-the-federal-presentence-report-sentencing-and-prison-placement-preparation/skills-program/

COVID In Prison: Vaccines – mAb. What Are Your Client’s Fears? “A New COVID Drug Category – Antivirals Could Be The Holy Grail”

Globally, since 2020, we have all been waiting on science for an answer. Their efforts have led to the development of a new generation of Vaccines: (mRNA), along with the traditional J&J. Now, to the Federal Bureau of Prisons Clinical Guidance on COVID-19 Vaccines and other therapies.  

I. BOP Vaccination Policy 10/13/2021

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Per The BOP, vaccination supplies initially may be limited, and will be dispensed according to the BOP COVID-19 Vaccine Guidance Manual; October 13, 2021. This though does not take into account the new variants that may continue to evolve.

For Inmates Who Are:

·      Waiting to get their Covid Vaccine while pending a Court-Ordered Release or Transfer,

They may be vaccinated either:

1.    By using a single-dose COVID-19 vaccine, or

2.    By using a multi-dose series on a case-by-case basis, or

3.    But if there is insufficient time to complete a multi-dose series, it should only be started if the final dose can be verified that it can be completed at the receiving location.

Each BOP facility will (Page 3).

1.         Create and implement a COVID-19 immunization plan to offer the vaccine (1-dose or 2-dose, initial primary series) for,

2.  Develop a plan for when, and by whom staff and inmates will be screened and scheduled for the vaccine, and

3.  Ensure that responsibility is assigned to health care personnel for patient assessment and vaccine administration.

4.   For the 2-dose vaccination series, a medical hold should be placed in the inmate’s electronic health record until the due date of the second dose. This is to keep them from being transferred or released before the last dose is given.

5.   For Third doses of mRNA COVID-19 vaccines, page 5 [See Appendix], in immunocompromised persons: they should be offered a third dose at least 28 days after 2nd mRNA dose. 

The Three Vaccines available in the BOP Will be Given In The Priority Level Order, # 1-3 (page 5)

Pfizer (page 3):

The Pfizer-BioNTech COVID-19 vaccine (Comirnaty®) – an mRNA vaccine 

Priority Level 1:

·      Inmates assigned as health service unit workers,

·      Inmates in health service unit job assignments,

·      Inmates in nursing care centers (long-term care) or other residential health care units.

Priority Level 2: Inmates aged 65 years and older or those of any age with underlying medical conditions.

Priority Level 3: All other inmates.

Fact Sheets for the approved* and EUA-authorized Vaccines,

For recipients, caregivers, and healthcare providers administering vaccines. [see appendix]

COVID-19 FDA, Approved:

·      For persons 16 years of age and older: 2-dose primary series

·      Should be offered a booster dose at least 6 months after the second dose.

COVID-19 FDA, Emergency Use Authorization (EUA):

·      For persons 12 to 15 years of age: 2-dose primary series.

·      Third dose for certain immunocompromised persons.

·      Single booster dose for certain non-immunocompromised persons.

 Moderna, (page 3)

Fact Sheets for the approved* and EUA-authorized Recipients, For caregivers, and healthcare providers administering vaccines [see Appendix]

COVID-19 FDA, Emergency Use Authorization (EUA):

·      For persons 18 years of age and older: 2-dose primary series.

·      Third dose for certain immunocompromised persons.

J&J, (page 4)

Fact Sheets for the approved* and EUA-authorized [see Appendix] Recipients, caregivers, and healthcare providers administering vaccines

COVID-19 FDA, Emergency Use Authorization (EUA):

·      For persons 18 years of age and older: 1 dose required

II. Monoclonal Antibody (mAb) Drug Therapy for COVID-19, BOP Clinical Guidance, 08/2021.

1. Mitigate the need for hospitalizations, ICU and O2 Ventilators

2. After exposure, and quickly implemented before a positive COVID-19 test.

3. At 1st glance it appears that the mAb medications are not on the most recent:

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  • Or their BOP Health Services, National Formulary Part II, Lists (above, again, here too I could be wrong, as they appear to be available, just not listed).

The BOP Monoclonal Antibody (mAb) Therapy, Clinical Guidance COVID-19, 08/2021.

BOP Nurse Charting is very good (page 14), as they use the same S.O.A.P. Note Format that we have all been taught for patent encounters. It’s a good thing to know if you are not already familiar with it. Because medicine, like law, even if treatment (or work) was done, if it was not documented, then it will not be believed as performed, and vice versa.

Subjective: The Inmate/Patient Complaints (in terms of their current condition, function, activity level, disability, symptoms, social history, family history, employment status, and environmental history).

Objective: What the healthcare provider gathers from their exam, labs, X-rays, physical findings, observations and talking, etc.

Assessment: At the end of the encounter, their detailed notes will either support Inclusion Criteria or Exclusion Criteria (see included tables), with regards to the Inmate/patient qualifying (or not) for Monoclonal Antibody Treatment. Regarding a diagnosis, here there may be multiple.

Plan: If Inclusion Criteria have been met, informed consent for mAb needs to be gotten. All mAb requires a non-formulary request to be submitted and approved.

All Criteria must be met for (mAb) Treatment:

·      Positive results of direct SARS-CoV-2 viral testing, and

·      A clinical presentation of mild to moderate COVID-19 symptoms, and

·      Symptom onset within the 10 days preceding mAb treatment and

·      Risk factors for severe COVID-19 illness (see Risk Factors for Severe COVID-19 Illness), and

·      Age ≥ 12 years old; weight ≥ 40 kg (88 lb)

Treatment symptoms to look for, within 10 days of (mAb) treatment.

·      Fever

·      Cough

·      Sore throat

·      Malaise

·      Headache

·      Muscle pain

·      Gastrointestinal symptoms

·      Shortness of breath with exertion.

At a minimum‘1’ of the following must be present to qualify for treatment.

·      Body mass index (BMI) ≥25

·      Chronic kidney disease (CKD)

·      Type 1 or type 2 diabetes

·      Immunosuppressive disease

·      ≥ 65 years of age

·      Currently receiving immunosuppressive treatment

·      Cardiovascular disease (CVD) or hypertension

·      Chronic obstructive pulmonary disease (COPD) or other chronic respiratory diseases

·      Sickle cell disease

·      Neurodevelopmental disorders or other conditions that confer medical complexity

·      Medical-related technological dependence (i.e. tracheostomy, gastrostomy, positive pressure ventilation not related to COVID-19)

·      Oxygen saturation (SpO2) ≤ 93% on room air

·      Respiratory rate ≥ 30 per minute

·      Heart rate ≥125 per minute

Patients must have positive results of direct SARS-CoV-2 viral testing no more than 10 days before starting the mAb infusion 

All of these Tests are acceptable for confirming COVID:

·      Commercial lab PCR test,

·      A rapid PCR test (Abbott ID Now) or

·      Rapid Ag test (BinaxNOW) 

III. Monoclonal Antibody Medications:

1)    REGEN-COV (casirivimab and imdevimab, administered together),

When there is a Limited Supply, The BOP has created: PATIENT CRITERIA LEVELS (Page 5) to determine who gets treated.

PRIORITY 1, Patient Criteria:

• Three or more risk factors for progression to severe disease or

• ≤ 3 days of symptoms or

• Any one of the following risk factors:

1.   Body mass index (BMI) ≥35, or

2.   Type 1 or type 2 diabetes, or

3.   ≥ 65 years of age. 

PRIORITY 2, Patient Criteria:

• Two or more risk factors (from PRIORITY 1) for progression to severe disease. 

PRIORITY 3, Patient Criteria:

• One risk factor for progression to severe disease

• Contact the Regional Medical Director (RMD) to discuss any proposed deviation from the below criteria.

• Submission and approval of a non-formulary request is required before initiation of any mAb for COVID

2)    Tocilizumab (Actemra) – hospitalized patients only

3)    Sotrovimab – hospitalized patients only

4)    Baracitinib (works better with either Tocilizumab or Remdesivir)

Where: Treatment Is NOT‘ Indicated.

·      Pregnancy and lactation: considered on a case-by-case basis

·      Allergies to any of the medication ingredients

·      Hospitalized due to COVID-19

·      Require oxygen therapy due to COVID-19, OR

·      Require an increase in baseline oxygen flow rate due to COVID-19.

·      For those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity, these Inmates/Patients should be considered for hospital transport.

IV. Antivirals: The “holy grail” of viral therapeutics, The Atlantic 11/29/2021

“Until now, the only outpatient therapeutic for COVID-19 has been monoclonal antibody treatments, which are effective in preventing severe disease in high-risk patients. “The New COVID Drugs Are a Bigger Deal Than People Realize”.

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Photo Credit, The Atlantic

Merck’s molnupiravir (EAU for mild-to-moderate cases of COVID-19 who were not hospitalized). Initially, in Nature, 10/8/2021, Merck’s antiviral was touted as it may cut hospitalizations and deaths among people with COVID-19 by half. Recently, on November 26, 2021, Merck revealed its Covid antiviral treatment is less effective than first thought. Full analysis of their trial results shows Molnupiravir had a risk reduction of 30%, Reuters.

Pfizer’s Oral Antiviral PAXLOVID™ (“Potential Game-Changer in the pandemic”), Reduced The Risk Of Hospitalization or Death By 89%.

Appendix:

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In closing, we believe that the responsibility for a client’s Mental and Physical Health should be safeguarded to protect them from themselves and others, …while providing a safe environment for the duration of their incarceration. This is the responsibility of the Court, Defense Team, and BOP.

If this was helpful, please share it with your colleagues. With more to follow, should you have any questions, are interested in engaging my services, or have any ideas for future topics, I am easy to reach, and thank you for your time.

 

 

 

Marc

  • email, info@PPRSUS.com, or
  • Voice: 240-888-7778.
  • Or through my website: PPRSUS.com

I also have a 50+ minute PowerPoint (which time-wise, can be adjusted to meet your needs), for groups, some of the topics covered:

  • COVID
  • Medical History
  • Medication Availability
  • Dementia Wing- 1 Facility, with 35 beds
  • Security Level / Public Safety Factors
  • Medical and Mental Healthcare, CARE LEVEL I-IV
  • Psychology Programs Availability (Security Level Specific)
  • Military Veteran-1 facility with 1 wing, where Veterans Train Service Guide Dogs for other Veterans With PTSD or other disabilities.

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