MONITORING AND EVALUATION OF MENTAL HEALTH TREATMENT PROGRAMS AND INTERVENTIONS
Mental health treatment programs and interventions will continue to be developed and delivered based on the best and most current treatment consistent with the principles reiterated in this document and as directed in CD 840, Psychological Services (Appendix I) and CD 850 Mental Health Services (Appendix H).
All psychological services must be developed with the intent of ongoing monitoring and periodic evaluation as per CD 840, Psychological Services
(Appendix I). It is the responsibility of every mental health professional who delivers a treatment program or intervention to ensure that these are fully evaluated using both qualitative and quantitative measures and feedback from the participants. This requires that evaluation criteria
, evaluation methods, and data collection requirements are identified prior to the start of the program. Treatment programs and interventions are to be evaluated for their overall ability to meet the needs of offenders, to adhere to the Principles Underlying the Development of Mental Health Programs and Services noted earlier
, for their effectiveness, and for their ability to contribute to our knowledge of “what works” with women offenders. This could include:
Questionnaires completed by participants regarding the quality and usefulness of the material presented;
Pre- and post- tests assessing the knowledge gained by participants; and
Pre- and post-group measures of depression, anxiety, locus of control, and self-esteem as relevant for treatment groups.
Evaluation procedures must be refined and updated as the treatment programs and interventions develop.
Although each institution need not provide on-site access to all components of the continuum, each institution must provide reasonable and appropriate access for offenders to all levels of care. Each institution must also ensure that their mental health program is managed by registered mental health professionals
(CCRA Section 85).
The Institutional Standing Orders should reflect:
the level and range of care, including information regarding the Structured Living Environments and other specialized mental health units or interventions,
appropriate management and monitoring of mental health programs,
mechanisms for horizontal communications and a mental health interdisciplinary team approach to ensure integration and consistency, and
a process for continuous staff training.
Management must also ensure that the mental health professionals, psychologists, social workers, and others who are hired are highly skilled and knowledgeable and have the appropriate qualifications and experience to work effectively with women offenders. Ongoing mental health training is a priority to ensure that skills are maintained and staff are kept current on new developments in mental health. This will also ensure that the integrity of existing programs and services are maintained.
GAPS TO BE ADDRESSED
Despite the numerous developments in women's mental health, there are some significant gaps in mental health interventions that remain outstanding as follows:
The need for intermediate care for those who would not benefit from Dialectical Behavior Therapy or Psycho-Social Rehabilitation offered in the Structured Living Environments.
The need for additional intensive care treatment beds especially in the Ontario, Quebec, and Atlantic regions where transfer to the Intensive Healing Program at the Churchill Unit in Saskatoon, may be problematic.
Although it is believed that the prevalence/ incidence of Fetal Alcohol Effects/ Syndrome (FAS/E) is high, especially in correctional populations, no CSC studies have been undertaken. This is due, in part, to the lack of reliable diagnostic tools for the assessment of the disorder in adults, effective interventions, and information regarding the management of those affected. There is a need for additional research in this area.
Fiscal and operational realities may override other considerations for women with mental health needs insofar as those requiring intensive care in regions without these specific treatment services may have to be transferred to another region. This then compromises the goal of attempting to ensure that women serve their sentence as near as possible to their home community.
Further, difficulties, such as the ability to acquire staff with the appropriate expertise in the highly specialized area of women offender mental health
, may also place limitations on what can be developed in any particular location especially in some of the more remote locations. As well, the types of mental health services available in the community where the institution is located may play a role with respect to the range and types of services that can be offered to the institution.
In 1997 when the Mental Health Strategy for Women Offenders was originally published, it was believed that a three-year time frame for full implementation of the continuum of care would be sufficient. However, despite some significant developments, such as the Intensive Intervention Strategy, there have been both fiscal limitations and difficulties in recruiting and retaining staff with the necessary expertise to work with women offenders (especially in the more remote locations). As a result the implementation period has been extended. In addition, it has also become apparent that implementation is an ongoing process of reviewing and refining existing programs and developing new programs as needs become apparent and opportunities arise. The challenge of meeting the mental health needs of women offenders continues to require constant innovation and evaluation as well as collaboration with our community partners and others.
It is hoped that the revised Strategy
will provide a framework for the ongoing development of mental health services for women offenders. It is also hoped that it will give both the reader and those involved in the provision of women's mental health a sense of how much has been accomplished since the publication of the first Strategy