Development and implementation of the Telepsychiatry service in the Correctional Health System (2005)
The most prevalent health condition in the correctional population of Puerto Rico is Addictive Disorders. In 2005, CHS developed an agile model based on scientific evidence, which made it possible to manage this condition in a more efficient and effective way.
The treatment model for addictive disorders established by CHSC was one developed with consideration for the needs of the inmate from the time of admission, detoxification, and outpatient and residential services. Among the novelties established by CHS are detailed:
a) Development of a treatment protocol for detoxification: Concerned about the situation of deaths of inmates during detoxification treatment, CHS developed and established a clinical model of detoxification and rapid response. This model included the introduction of two scales that categorize opioid and alcohol withdrawal syndrome, allowing the physician to determine the level of service that corresponds to the inmate (CIWA-AR for alcohol detoxification and COWS for opioid detoxification). This protocol contemplated the early identification and timely management of the patient's symptoms from the moment they entered the system, at the level of service required by their health condition.
Achievements: Decreased deaths during the detoxification process from 21 to almost zero (0).
b) Development and establishment of the Outpatient Detoxification Unit: In 2003, CHSC conducted a study on the Categorization of Substance Withdrawal Syndrome of inmates entering the correctional system with the aim of in order to know what the health condition of these inmates was like. From the results of the study, it was determined that only 2% of newly admitted inmates required hospitalization services. Despite this, the Infirmaries (hospitalization areas) were 90% occupied by detoxification cases due to a lack of other alternatives. For this purpose, a type of lower intensity treatment unit similar to free community outpatient detoxification services was developed.
c) Development and establishment of the Addictive Medicine Clinics: CHS established the addictive medicine clinics to manage, for a maximum period of 90 days, residual withdrawal symptoms that tend to persist in those patients who are discharged from these detoxification units. The mental health staff of the outpatient service clinics support these patients, as a way of pulling them out of the outpatient service.
Achievement: Reduction in appointment requests was achieved to doctors in outpatient clinics. The inmate entered directly to the mental health clinics of the outpatient level.
d) Development of a Model of Outpatient Services for the Treatment of Addictive Disorders: The basis of the model is spiritual biopsychosocial, where the inmate is viewed as a holistic being. Our model contemplated the development of cognitive, value and social skills that manage to maintain abstinence from substances in the confined.
e) Development of the Units for the Transformation of Addictive Disorders (URTA): These are residential units that prepare inmates who are 6 months or less from the moment of their release to be able to stay in abstinence in the community.
Achievements: 85% of the inmates released from these units did not re-enter during the following 6 months after their release.
