Virginia Department of Corrections
The Virginia Department of Corrections (VADOC) found that there were three distinct populations of incarcerated individuals who typically required more intensive case management:
• People with a mental health diagnosis that result in management challenges in the general population, or people who frequently cycle in and out of Special Housing and/or licensed mental health units.
• People with a medical condition requiring frequent nursing attention, but not requiring admission to the infirmary.
• People who are vulnerable to predation, bullying, or manipulation due to characteristics such as an intellectual challenge, age, or size.
With the goal of greatly reducing the use of restrictive housing for these people, the department created and significantly expanded mission-driven Shared Allied Management (SAM) Units as an alternative to restrictive housing or to mainstream general population placement. With the implementation of these units, the number of beds available for the placement of these people in the general population—rather than restrictive housing—has been increased to 657 beds across 10 institutions: Sussex I, Sussex II, Greensville, Nottoway, Buckingham, Pocahontas, Augusta, Green Rock, Wallens Ridge, and Red Onion (Secure Integrated Pod – SIP/SAM).
The overall intent of SAM Units is to promote safety and stability within institutions while avoiding the unnecessary use of restrictive housing, or an unnecessarily high demand on security, mental health, and/or medical staff. Generally, individuals needing special attention will be gathered in a single housing unit where specialized staff can efficiently deliver services—with the goals of increasing adaptive behaviors and improving an individual’s conditions of confinement. The hope is that these people will eventually return to the mainstream general population or transfer to a lower security facility with appropriate services. For individuals who remain in a SAM Unit towards the end of their sentence, reentry preparation services will be provided to increase their likelihood of a successful return to society.
The impetus for SAM expansion reform was initiated internally by the VADOC. The internal process of developing and implementing the reform involved VADOC establishing a serious mental illness (SMI) committee in September 2016 to develop the new program with mental health and operations staff and with headquarters, regional, and facility participants to spearhead the reform. The committee included regional mental health clinical supervisors, chiefs of housing and programs, wardens, and the statewide restrictive housing coordinator. The reform was also informed by external organizations including the Vera Institute of Justice, as they are working with the VADOC currently; the Federal Bureau of Prisons; and the North Carolina Division of Corrections. The SMI committee worked diligently for 16 months to create the Secure Diversionary Treatment Program (SDTP) Operational Strategy and the SAM Operations Manual. Both programs were officially launched in early 2018. The reform was informed by research including cognitive behavioral programming, evidence-based practices, dialectical behavioral therapy, social skills training, stages of change, motivational interviewing, and systems theory. In order to prepare for the reform initiative, staff at the SDTP and SAM expansion sites were provided with training for evidence-based Interactive Journaling®, Corrections Crisis Intervention Team (C-CIT), Mental Health First Aid, and Trauma-Informed Care.
The purpose of the Shared Allied Management (SAM) Units expansion is to improve the efficient delivery of correctional services to high need populations by making them available in a single housing unit with an allied management team of staff. With the implementation of these mission-driven SAM Units, the number of beds available for the placement of “at-risk” individuals in the general populations has been increased to 657 beds across 10 institutions statewide.
Again, the target population includes the following groups of individuals:
- Mental Health Population: mentally ill or seriously mentally ill (SMI) people who are at a greater risk to cycle in and out of restrictive housing and/or licensed mental health pods for disruptive behavior related to their mental health diagnoses and symptoms.
- Medical Population: medically infirmed individuals requiring intermittent medical attention but not requiring placement in the infirmary.
- Vulnerable Population: individuals who are at greater risk for victimization or being bullied in general population due to characteristics such as a cognitive challenge, age (seniors and youthful), or small in stature or timid personality.
Program eligibility is dependent on one of the criteria below:
Mental Health Admission Criteria
- Individuals with a Mental Health Code of 2 or 2S, who are housed in the restrictive housing unit (RHU) with a history of repeated misbehavior due to their mental illness.
- Individuals recently released from Marion Correctional Treatment Center (MCTC) or other mental health units.
- Individuals who had suicidal/self-harm behaviors and/or thoughts in the last three months.
- Individuals who are having a difficult time adapting to the basic demands of general populations due to the symptoms of their mental health diagnosis, but who do not meet the criteria for a mental health unit.
Medically Infirmed Admission Criteria
- Individuals with medical conditions requiring frequent attention, which creates challenges to manage in general population housing, but does not require assignment to the infirmary.
Vulnerable Offender Admission Criteria
- Individuals housed in general population who have been identified as high-risk to be victims of predation, including physical, psychological, or sexual abuse. Vulnerable offenders who may be intellectually challenged, senior, youthful, and small in stature or other factors causing them to be targeted by offenders who are more predatory.
A SAM Committee co-facilitated by the unit manager and qualified mental health professional (QMHP ) and consisting of the counselor or cognitive counselor, director of medical services or designee, and often a treatment officer collaborate to provide direction for the SAM units. Other staff members may be added to this committee as assigned by the warden and/or assistant warden. At various times the SAM committee may invite staff from other areas of the facility who have familiarity with the individual in question. The SAM committees meet weekly or more often as needed, to make decisions on admissions, removals, pathway assignments, treatment plans, and the overall status and stability of the SAM unit, including operations and culture. The SAM committee makes decisions by consensus, and utilizes a working dialogue process to support decision-making. The SAM unit operates as a social system with staff in leadership, offenders participating in program and treatment activities and performing duty assignments needed for the safe and efficient operation of the housing unit. A system of rules, expectations and earned privileges, and pod operating guidelines for incarcerated individuals promote safe and efficient daily operations.
Staff are vetted carefully to be posted in SAM units, and those with the needed knowledge, skills, and abilities are often assigned to spearhead the initiatives in these special posts. These professionals are often easily identified and selected based on their observed rapport and interactions with other staff and incarcerated individuals alike, their disposition toward de-escalation, their experience, and their communication strengths. SAM-assigned staff are dedicated to listening with open minds, actively utilize empathy and patience, and share an ultimate goal of giving each individual the support needed to successfully and positively transition to mainstream general population settings. The SAM unit operates similarly to a mainstream population environment by allowing access to in-unit as well as outside recreation, programming services, double-celled assignments, and congregate group activities equal to the privilege level of the assigned facility. Colorful therapeutic murals created by SAM participants are common throughout the unit.
Operating procedures and strategies were developed, establishing guidelines on SAM description, purpose, goals, operating guidelines, admission acceptance criteria, declination criteria, voluntary requests for transfers, readmissions to SAM units, involuntary removal, behavior standards for the pods, SAM program pathways, adjunctive programming, and the referral process.
Shared Allied Management (SAM) Expansion has been fully implemented as of this date. The Serious Mental Illness and Restrictive Housing Unit collaborated with the VADOC Statistics and Forecasting Unit to allow for efficient data to be tracked through well-planned data collection and analysis. Four months into the implementation of the SAM expansion, we do not yet have quantifiable data from the reform project metrics; however, the feedback from staff and incarcerated individuals has been positive. Several higher security level individuals have successfully transitioned into lower security level SAM facilities as a result of the expansion. Thus far, the SAM expansion has not resulted in a reported negative impact on facility safety.
Of note, the Secure Management Pod (SAM) and Secure Integration Pod (SIP) Pod at ROSP, originally part of the WRSP ROSP Restrictive Housing Reduction Step-Down Program, functionally are similar to the remainder of the SAM units statewide but serve only a Security Level 6 population. The SIP population at ROSP serves offenders who chronically commit minor disciplinary infractions in order to remain housed in restrictive housing. Strategies for both of these specialized ROSP groups are to stabilize these individuals and encourage pro-social social interaction toward their eventual transition into a Security Level 5 general population setting.
The SAM expansion reform has produced positive results. As of May 2018, 72 percent of the allocated beds are currently occupied with SAM participants.
Critical factors to success of the program include:
- Collaboration between various disciplines from facilities, regional, and headquarters at reform inception to ensure stakeholder buy-in and ensure optimal results.
- Tasking the SMI committee with mission-driven achievable goals.
- Leadership who are invested in the process; holding town hall meetings, speaking to staff, modeling the way, being involved in team reviews, providing the resources and stability throughout the process, and being visible.
- Develop Operating Procedure to support initiative.
- Training and supporting line staff.
If the Agency were to start over with this reform, some ideas for improvement would be:
- More creative options for the ongoing training of staff.
- Increased staff incentives.
- For agencies who might want to implement something similar, VADOC recommends the inclusion of many differing disciplines from facilities, regional, and headquarters together at inception, tasking a committee with mission-driven achievable goals, ensuring leadership is invested in the process, developing Operating Procedure to support their initiative, and training of staff.