Evaluation of Correctional Service of Canada’s health services: Summary

According to section 86(1) of the Corrections and Conditional Release Act (CCRA), CSC is mandated to provide essential health care, and reasonable access to non-essential mental health care that will contribute to the inmate's rehabilitation and successful reintegration into the community.

Compared to the Canadian population, offenders demonstrate a higher prevalence of mental and physical health concerns. As well, CSC's offender population is aging. In 2014-15, 24% of federal offenders were 50 years or older and the number of offenders over the age of 50 at admission has risen over the last ten years. As such, CSC's Health Services represent an important opportunity to address offenders' diverse health care needs throughout the continuum of care.

Health services are delivered by CSC's Health Services Sector in three areas: clinical services, public health and mental health. Services include health promotion, disease prevention, health maintenance, patient education, diagnosis and treatment of illnesses. In 2014-2015, Health Services accounted for approximately 11% of CSC's total direct program spending.

Initial scoping for the evaluation of CSC's Health Services started in FY 2013/14 and the evaluation finished in FY 2016/17. The evaluation focuses on the relevance and performance of CSC's mental, clinical, and public health services throughout the continuum of care, which includes: intake, incarceration, and pre-release and community supervision.

Evaluation questions examine the following areas: effectiveness and efficiency of the intake assessment process, offender access to care and services throughout incarceration, public health education and harm reduction, institutional mental health services, pre-release and community health services and the management and coordination of health services.

The evaluation uses a mixed-method research design, incorporating both quantitative and qualitative methodologies. Several lines of evidence were used, including: literature and document reviews, interviews with staff and offenders, electronic questionnaires and analysis of automated data pertaining to offenders, human resources and finances.

Overall, the evaluation found that CSC's Health Services are relevant and meet the needs of federal offenders. Positive impacts were found regarding institutional mental health care where offenders' had a reduced likelihood of incidents, serious charges and involuntary segregation following treatment. Several key areas were identified for service improvements, such as:

• Access to institutional health services, for example limited access to some health education programs, bleach kits and community health care specialists;
• Effectiveness and efficiency of the health services intake assessment process, for example duplication of offender health information through intake processes and tools;
• Gaps in policy and procedures to support offenders in obtaining necessary ID required to transition from CSC's Health Services to provincial and territorial health services upon release; and,
• Missing or unreliable data among referrals to specialist services (in person or telemedicine), clinical health services information and the mental health needs scale.

Recommendations were made to support decision makers with improving the efficiency and effectiveness of CSC's Health Services. Program managers responded to these recommendations. The major recommendations and their associated management responses are outlined below.

Maintain productive relationships with partners who support individuals with mental health disorders.

CSC is responsible for providing health services to federal offenders; there is an ongoing need for partnerships to effectively and efficiently deliver these services to offenders.

• In response: CSC will strengthen partnerships to support the delivery of mental health services for federal offenders and will share information and practices related to mental health through the Federal Provincial Territorial Working Group on Health/Mental Health.

Ensure offenders are referred to the appropriate mental health services.

CSC has developed a Mental Health Need Scale to assess offenders' mental health need and determine the appropriate level of care required in accordance with its new refined model of mental health care (primary, intermediate, psychiatric hospital). The validity and reliability of this scale are yet to be assessed.

• In response: CSC will assess the validity and reliability of the Mental Health Needs Scale and will strengthen the process for recording and maintaining offender level of need data.

Ensure community mental health services are provided to offenders with the greatest mental health needs and that clinical discharge planning activities are tracked electronically.

Offenders with significant mental health needs may be referred for clinical discharge planning. This process aims to ensure that offenders receive continuity of care by establishing comprehensive plans and transitional services. The number of offenders receiving clinical discharge planning services could not be determined due to inconsistencies in data recording.

• In response: CSC will review the community mental health service delivery model to ensure that community health services are being provided to the offenders with the greatest mental health need; and, will ensure that clinical discharge planning activities are tracked in electronic information systems.

Adopt measures to support a continuum of health care for offenders during their transition from CSC Health Services to provincial/territorial health coverage. Specifically, obtaining health cards and payment for community health services.

Procedures in obtaining provincial/territorial health cards vary across regions and depend on provincial/territorial health authority requirements. CSC may cover the cost of some medical expenses in the community if offenders are not covered by provincial/territorial health insurance or other provincial/territorial plans (e.g., disability benefits, drug plans).

• In response: CSC will develop guidelines to obtain, track and store ID at intake; work with Canadian provinces and territories to determine how offenders can better access health care services and disability benefits following their release; and, clarify national guidelines regarding CSC payment for health services in the community.

Increase the efficiency of health-related intake assessments processes.
Health services intake assessment tools and processes are effective in identifying offender health needs; however, duplication of offender health information collected through intake assessment processes results in inefficiencies in assessing offenders' health care needs.

• In response: CSC will eliminate the requirement for repeated administration of health assessments and unnecessary repetition of health information between assessment tools. CSC will also ensure health referrals are appropriately recorded and monitored electronically.

Collect data on wait times to access selected specialist services for non-urgent care and implement strategies if wait times exceed Canadian benchmarks.

The provision of community health care specialist services for offenders for non-urgent care is subject to wait times in the community. CSC uses telemedicine (where provincial telemedicine programs are available) to address procedural issues associated with health care specialist appointments in the community. CSC does not systematically collect data regarding referrals to specialist services (in-person or telemedicine).

• In response: CSC will implement a national approach to tracking offender referrals and services for selected community specialist services.

Continue to implement and report on the Chronic Disease Management Strategy.

CSC has implemented policies, guidelines and strategies to address the special health care needs of women and Indigenous offenders. Additional support related to the chronic disease needs of older offenders is required.

• In response: CSC will continue to implement the Chronic Disease Management Strategy and will report on progress against expected results to track and identify gaps in service.

Ensure offenders have timely access to health education programs and harm reduction products.

Health education programs, particularly those aimed at infectious disease, are associated with increased offender health-related knowledge and related behavioural changes (e.g., reduced risk-taking behaviours). Results of a review indicated that bleach was not always available as required in all CSC institutions and no recent data were available to confirm the accessibility of other harm reduction products (e.g., condoms).

• In response: CSC will provide clear direction and accountability for delivery and tracking of health education programs; monitor the distribution of harm reduction products; and, address any identified accessibility issues.

Evaluation of CSC's Health Services