**6.1. Building competencies and workforce capacity**

The World Health Organisation [4] (p. 3) states that 'Capacity-building of the workforce is essential to improve knowledge and awareness of the benefits of a coordinated response to care'. Correctional healthcare services have the opportunity to provide screening and treatment for a section of the population recognised as marginalised where healthcare is involved [61]. Providing services using standardised clinical guidelines will ensure the healthcare provided is of the same standard of care provided in the general community, and does not set lower standards of care for prisoners [61]. Developing agreements between correctional healthcare and correctional services to reduce the barriers that currently exist between healthcare and security will provide a more streamlined standard of care [61]. Ensuring all staff within the facility where there are prisoners identified as having cognitive impairment or dementia have education on recognition and management of dementia will reduce the vulnerability while in prison [61]. These actions will support the National Health Performance Framework by addressing Health System Performance to provide improved 'effectiveness, safety, responsiveness, continuity of care, accessibility, efficiency and sustainability' [54].

mobile, with ramps and hand rails being provided instead of stairs, and they have customised

Fishkill Correctional facility in New York provides a unit for inmates who have been identified with cognitive impairment, and once admitted to the unit, there is a policy of regular assessment [7]. Apart from the commonly used assessment tools for cognitive impairment they also use 'Early Warning Signs' and 'Dementia Symptoms and Behaviour Triggers' [7]. All staff working in this facility are chosen from a pool of people who want to work there rather than being allocated to this facility, and they all must complete a 40-hour program of

Long Bay Correctional Complex in Sydney provides a program that collaborates with agencies specialising in dementia care to deliver better services to prisoners with dementia and cognitive impairment [10]. Some of these are the provision of access to allied health professionals who specialise in areas of need for these prisoners, long term supported care in the hospital facility, an aged-care offender's area of independent living that is separate to the mainstream prison with support from disability services [10]. A program is being developed to support appropriate aged care placement within the correctional setting, and collaboration on the development of processes for identification and assessment of prisoners with dementia

The state of Texas in the United States of America has geriatric units that have been designed for prisoners who are 60 years and older to provide more support for these prisoners with the activities of daily living [18]. They also have a geriatric unit for prisoners that is higher level and arranges access for the prisoners in this unit to specialist services for their higher acuity

**6. Environmental and sustainable practice approaches in correctional** 

The World Health Organisation [4] (p. 3) states that 'Capacity-building of the workforce is essential to improve knowledge and awareness of the benefits of a coordinated response to care'. Correctional healthcare services have the opportunity to provide screening and treatment for a section of the population recognised as marginalised where healthcare is involved [61]. Providing services using standardised clinical guidelines will ensure the healthcare provided is of the same standard of care provided in the general community, and does not set lower standards of care for prisoners [61]. Developing agreements between correctional healthcare and correctional services to reduce the barriers that currently exist between healthcare and security will provide a more streamlined standard of care [61]. Ensuring all staff within the facility where there are prisoners identified as having cognitive impairment or dementia have education on recognition and management of dementia will reduce the vulnerability while in prison [61]. These actions will support the National Health Performance

their wash rooms to accommodate the less mobile [7].

as well as their management [10].

**settings**

132 Cognitive Disorders

health needs such as dialysis and physiotherapy [18].

**6.1. Building competencies and workforce capacity**

training developed and delivered by the Alzheimer's Association [7, 10].

Best practice management recognises early identification of dementia as being important, and also specific training in dementia care and support for correctional staff [10]. It is suggested that dementia training should incorporate information on helping staff to understand what dementia is and signs of its development, as well as how it can impact the person with dementia and those they are living with [10]. If staff are adequately informed and trained this could lead to early identification of the person with dementia, which can ultimately lead to early interventions and support being provided [10]. Feczko [5] supports this by acknowledging that correctional staff need to be trained in identifying the early stages of dementia, and how to recognise a prisoner's inability to undertake basic tasks rather than staff focusing on behaviour problems. It has also been identified that correctional officers need education and training to help them understand that if a prisoner is not following an order or direction it may not mean they are deliberately being disobedient, rather it may be due to their deteriorating cognitive abilities through the dementia process [52]. Prison health staff are not trained in aged care or early identification and care support for those with cognitive impairment and dementia, therefore specific training will assist those predominantly responsible for prisoner health to care for this vulnerable group [32].

The other aspect of training and support for correctional and healthcare staff is to ensure those working closely with people who have dementia are provided regular debrief sessions to safeguard their own wellbeing [10]. This will then link into the World Health Organisation prison health guide where health promotion and management is needed for correctional staff to reduce stress and to maintain the workforce [66]. Developing resources for health promotion should not only encompass prisoner care, it should also develop a partnership to provide for staff across the facility [66]. There can be high sick leave in some correctional settings and if staff members feel that they have a health promotion service available to them through work this could lead to them feeling more fulfilled in their employment and therefore lead to reduced sick days [66].

Other strategies to improve workforce capacity within the correctional setting are modifications or adaptions in the correctional environment which can help to avoid disruptive or unacceptable behaviour from a person with dementia. Meanwhile, if prisoner behaviour becomes easier to manage, the staff will have a reduced burden within their work shifts [10]. This modification could be as simple as a process change to provide carers within corrections by training selected prisoners to be support people for the prisoner with dementia [10].
