BOP Program Statement 5310.17 § 6

a. Outpatient (Nonresidential) Mental Health Treatment. Inmates with a need for mental

health services may be offered group and/or individual mental health treatment. Typically, inmates

receiving these services have an identified need for treatment, a current mental health diagnosis,

and a treatment plan supporting individual and/or group treatment. However, inmates presenting

with mild adjustment issues, or other short-term stressors, may participate in brief, individual

counseling sessions which do not require a current mental health diagnosis or a treatment plan.

These brief counseling sessions are documented in PDS as Clinical Contacts.

Under the supervision of the Chief Psychologist, the decision to engage an inmate in individual

and/or group mental health treatment is based on clinician’s professional judgment, contingent

upon such factors as:

■ The type of psychological problem(s) diagnosed.

■ Limits of professional expertise.

■ The inmate’s motivation to participate in treatment.

■ Departmental staffing level.

■ Departmental priorities.

Individual treatment; i.e., individual therapy, while a resource-intensive intervention, is more

appropriate for some inmates. The decision to offer individual therapy as opposed to group

treatment may be based on several factors, such as the inmate’s current diagnosis, presentation,

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housing assignment, and interpersonal skills, as well as other factors; e.g., security concerns,

resource limitations. Individual therapy services are documented in PDS using the Individual

Therapy note, in conjunction with a current Diagnostic and Care Level Formulation and a

Treatment Plan.

Group treatment has proven to be both a clinically effective and efficient use of resources in the

treatment of inmates with substance use disorders, mental illnesses, or behavioral problems.

Group treatments have the benefit of pro-social modeling (i.e., social learning) by the facilitator

and other participants, building social support, and allowing the immediate practice of new skills.

A number of evidence-based programs supported by the Bureau are offered in a group format.

The provision of outpatient mental health care for inmates with mental illness is detailed in the

Program Statement Treatment and Care of Inmates with Mental Illness.

b. Reentry Programming. Psychology Services clinicians are uniquely qualified to provide

reentry-related cognitive-behavioral interventions. Specifically, reentry programming is offered to

address risk factors associated with criminal conduct; i.e., criminogenic needs. This programming

facilitates successful reentry by reducing an offender’s likelihood of recidivism. In addition,

programs that effectively address criminogenic needs have also been shown to reduce institution

misconduct.

Reentry programming is offered in the context of a PTP; e.g., Journal Groups in RDAP. In

addition, psychologists may offer reentry programming independent of a PTP; i.e., on an outpatient

(nonresidential) basis; e.g., Anger Management Group, Criminal Thinking Group. Outpatient

reentry programming relies on empirically supported interventions, primarily REBT. Relying on

REBT as a guiding model creates theoretical continuity, ensuring that learning and practice are

built upon similar principles regardless of the institution, treatment provider, or treatment program

in which they occur. REBT emphasizes the learning and practice of skills associated with

adaptive, pro-social behavior. Therefore, inmates who participate in REBT are better able to

achieve goals the Bureau has for all inmates, including responsibility, self-awareness, and

independence.

Outpatient reentry programming groups may be open or closed, are evidence-based, and:

■ Use an established Bureau protocol and demonstrate fidelity to this model.

■ Are facilitated by a psychologist.

■ Meet at least every other week.

■ Have a continuity in membership, no greater than 12 participants.

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c. Restrictive Housing Interventions. In conjunction with its reentry mission, Psychology

Services utilizes a variety of strategies to intervene with inmates in restrictive housing settings.

These strategies include:

■ Prevention. Through early intervention, prevention strategies decrease the likelihood inmates

will engage in behaviors which result in restrictive housing placement. Examples of

prevention strategies include the BRAVE Program, outpatient Criminal Thinking and Anger

Management groups, and outreach efforts to reduce the likelihood inmates with a history of sex

offenses will seek protective custody.

■ Diversion. Diversion strategies offer alternative approaches to the management of inmate

misconduct, and other behaviors, which typically lead to restrictive housing placement.

Examples of diversion strategies include Psychology Services involvement in the Inmate

Discipline Program and Psychology Services review of SMU and ADX Referrals.

■ Mitigation. Mitigation strategies reduce the likelihood restrictive housing placements will

have an adverse impact on inmates. Examples of mitigation strategies are routine rounds in

restrictive housing units, referrals to recreation programs, the Psychology Advisory List, and

specialty mental health training for staff working in restrictive housing units.

■ Intervention. Intervention strategies provide direct clinical and supportive services in

restrictive housing settings. Intervention strategies in restrictive housing may include routine

psychological services, outpatient mental health treatment, reentry programming, or protocols

specifically designed for use in restrictive housing settings; e.g., Turning Point.

■ Transition. Transition strategies provide opportunities for inmates to successfully transition

from restrictive housing to general population or to the community. The Reintegration

Housing Unit, which serves inmates with a lengthy history of protective custody placements, is

an example of a transition strategy.

■ Oversight. Oversight strategies involve Central Office quality assurance reviews of restrictive

housing placements, to include reviews of specific inmates in long-term restrictive housing

placements.

The Branch’s Restrictive Housing Initiatives Sallyport page contains restrictive housing resource

materials and details programs, procedures, and practices related to each Psychology Services

restrictive housing strategy.

Turning Point Handouts for Restrictive Housing. The Turning Point handouts for restrictive

housing offer a nationally standardized approach to pretreatment and rapport building for inmates

in this setting. Turning Point handouts are to be utilized as the primary in-cell self-help resource

for inmates in restrictive housing. Psychologists are required to offer Turning Point handouts to

any inmate housed in SHU for more than 30 days; however, use of the protocol is voluntary and

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inmates may refuse to make use of the materials. Turning Point is not a treatment program, it is a

set of adjunctive materials used as a toolkit for intervening with inmates in restrictive housing.

The Turning Point handouts build on the concepts and skills taught in the Bureau’s evidence- based

PTPs (e.g., RDAP, Challenge Program) and outpatient Priority Practices (e.g., Criminal Thinking

Groups). The two primary goals of the Turning Point handouts are: (1) to engender positive

rapport and cooperative interaction with Psychology Services staff, and (2) to motivate and prepare

inmates for participation in evidence-based programs upon their return to the general population.

The handouts also offer suggestions to improve coping and adjustment in SHU, as well as a

preliminary discussion of reentry-related issues; e.g., preparing to change, attitudes, and criminal

thinking. The handouts are organized into sets or series, which are generally completed in a

prescribed sequence. The Turning Point handouts for restrictive housing, and accompanying

resource materials, are available on the Branch’s Restrictive Housing Sallyport page. For

information about how to obtain other Turning Point protocols (e.g., Turning Point for SOMP),

contact the Psychology Services Branch.

d. Crisis Intervention. The Chief Psychologist ensures a system is in place to respond promptly

to emergency Psychology Services referrals, to include establishment of a fair and equitable on call

Mental Health Duty Officer rotation for the department. After-hours referrals by staff are

discussed by telephone with the Mental Health Duty Officer, who assesses and responds to the

mental health needs of the inmate in ways that meet acceptable clinical, community, and

correctional standards. The Mental Health Duty Officer determines how best to respond to the

emergency, using a full range of clinical options; e.g., talking with the inmate and staff via

telephone, or going into the institution. When a staff member makes a referral based on observed

behavior or inmate statements, the psychologist who interviews the inmate ordinarily interviews

the referring staff member. The referring staff member’s remarks are summarized in the clinical

notes.

Psychologists provide crisis intervention services in a variety of contexts. Most importantly,

psychologists work actively to prevent inmate suicides. Suicide prevention is a vital function of

the agency, which contributes directly to the safety and security of staff and inmates. Specific

requirements for intervening with suicidal inmates are found in the Program Statement Suicide

Prevention Program.

Potentially suicidal inmates are not the only inmates who may warrant crisis intervention services.

For example, inmates who have recently experienced a very significant loss, a serious assault or

injury, or a highly charged interpersonal conflict may benefit from crisis intervention services. In

these instances, when there is no suggestion of suicide risk, crisis intervention contacts are

documented in PDS as a Crisis Intervention note.

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e. Management of Disruptive Behaviors. The Chief Psychologist ensures Psychology Services

staff assist appropriately with the identification and management of disruptive inmates, in

particular those inmates with mental illness. Identification of potentially disruptive inmates

reduces the risk of harm to staff and other inmates. Potentially disruptive inmates may be

highlighted in the institution’s Psychology Advisory List.

Bureau psychologists may be asked to lend their expertise as behavioral scientists to the

management of disruptive inmates. Psychologists’ understanding of de-escalation techniques and

other communication skills; antisocial attitudes and behaviors; interactions between criminality,

mental illness, and substance abuse; and basic principles of behavior therapy contribute to their

ability to assist in the management of disruptive behavior.

Psychologists’ value as behavioral scientists lies in two primary domains. First, psychologists have

the ability to advise Executive Staff on broad environmental issues that, if changed, may prevent or

minimize future incidences of disruptive behavior and ensure all staff appreciate the essential role

of positive reinforcement, consistency, and responsiveness in the effective management of

inmates. Second, psychologists have the ability to actively engage in rapport building with

inmates to increase their leverage and credibility in confrontation avoidance situations.

Although Psychology Services Departments are committed to applying behavioral sciences

expertise to assist with inmate management, the effectiveness of these approaches is limited by the

institutional context. Specifically, contingencies cannot be closely controlled in most settings,

therefore, the impact of behavioral management interventions on an individual level is often

constrained. When lending their behavioral sciences expertise to inmate management,

psychologists must ensure any efforts to manipulate environmental factors to control inmate

behavior are consistent with relevant ethical guidelines; i.e., the efforts are not limited to various

forms of deprivation.

Collaboration with Correctional Services staff in the development of contingency contracts, which

rely heavily on positive reinforcement, is the behavioral management approach most likely to

result in favorable behavior change. Additional information regarding the use of contingency

contracts is available on the Branch’s Sallyport page.

When psychologists intervene with disruptive inmates, these contacts may be documented in PDS

in a variety of notes, depending on the specific nature of the contact; e.g., Disruptive Behavior

Interventions, Suicide Risk Assessment, Suicide Risk Management Plan, Contingency Contract.

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