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Alabama Prisons Face Costly Remedy on Mental Health Care

AL.COM- MIKE CASON

A lawmaker who has led prison reform efforts in Alabama estimates it will take an extra $30 million a year to improve mental health treatment in prisons to fix what a federal judge found is an unconstitutionally poor system of care.

Sen. Cam Ward, R-Alabaster, presided over a meeting of the Joint Legislative Prison Committee today. The committee got an update on the federal court case.

U.S. District Judge Myron Thompson ruled in June that mental health care in Alabama prisons is "horrendously inadequate," so poor that it violates the Eighth Amendment prohibition against cruel and unusual punishment.

Thompson ordered the state and the lawyers representing inmates into mediation to find a remedy.

Two weeks ago, Thompson ordered the state and plaintiffs to submit a joint proposal on immediate and long-term relief for understaffing of mental health and correctional staff by Oct. 9.

Plaintiffs in the lawsuit, filed in 2014, include the Southern Poverty Law Center and the Alabama Disabilities Advocacy Program.

Thompson conducted a trial in late 2016 and early 2017 and found that the prison system failed to identify many mentally ill prisoners and failed to adequately treat those who were diagnosed. The judge found that prisoners were punished and placed in segregation for symptoms of their mental illnesses. He found suicidal prisoners were not adequately treated and monitored. The prison system failed to provide hospital-level care for prisoners who needed it, Thompson wrote. Understaffing of mental health professionals and of correctional officers were overarching problems, Thompson found, as was chronic overcrowding.

SPLC attorney Maria Morris told the Joint Legislative Prison Committee today that mental health counselors in Alabama prisons have caseloads of 100 to 150 people, about twice the number they should have. Morris said the number of inmates needing mental health care could possibly double.

Morris said it would take an estimated $20 million to hire the additional mental health staff needed. Morris said that was a rough estimate and probably on the low side.

Ward agreed that her estimate was probably low.

"I think probably, realistically, you're looking at close to $30 million more in the Corrections budget to deal with the mental health staffing," Ward said.

Morris estimated it could cost $100 million a year or more to fix the shortage of corrections officers. Morris said that was a rough estimate. She said as of June, the number of corrections officers employed by the Department of Corrections was just 41 percent of an "authorized" staff number.

Ward said he was uncertain about the cost of fixing the shortage of corrections officers.

Prison Commissioner Jeff Dunn told the committee that the DOC is working to find a remedy for mental health care that is "both responsive to the court and respectful of taxpayers."

"We're going to do that with every ounce that we can muster and we're going to provide what we believe is a constitutionally acceptable solution to the issues that we're challenged with and then we're going to seek the partnership of the Legislature to move forward on that," Dunn said.

Dunn said the prison population continues to decline. The Legislature passed sentencing guidelines that took effect in 2013 and criminal justice reforms in 2015. Dunn said the population is down about 4,000 inmates over the last three and a half years. At one time, prisons were filled to almost twice their designed capacity.

As of June, state prisons housed 21,888 inmates in facilities designed for 13,318, an occupancy rate of 165 percent.

But Dunn said the prevalence of violence, contraband and drugs in prisons remains at critically high levels.

Ward said the cost of correcting the prison problem will be the single biggest challenge facing the Legislature when it returns in January.

"But we can't say we didn't see this coming," Ward said. "We've been talking about this for years, that there's going to be a problem and there's going to be a train wreck. And it's in front of us now."

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Sen Ward's Bill Stops Revolving Door on Mental Health Inmates

By Samantha Scotti

Nearly two-thirds of all prisoners are addicted to drugs or alcohol. After being released, they are at a very high risk of using again. Inmates also report having higher rates of high blood pressure, diabetes, hepatitis C, HIV and mental health problems than the general population.

Medicaid doesn’t cover the health care  costs of inmates inside jails or prisons, except for inpatient hospital or nursing home care for those who qualify. States are responsible for the health care costs of inmates in state prisons, just as localities pay for care in county jails. Providing that care can be expensive.

States spent $8.1 billion on health care in correctional facilities during fiscal year 2015, with a median expense of $5,720 per inmate, according to a soon-to-be-released report by The Pew Charitable Trusts.

When prisoners stay healthy, states’ budgets stay healthier too.

Ensuring a Smooth Transition

Eventually, 95 percent of all inmates are released from state prison systems, and their successful transition can depend on having appropriate care and treatment services available. Achieving and maintaining healthy and productive lifestyles increases former inmates’ chances of finding work, successfully reintegrating into their communities and staying out of prison.

This is particularly true for inmates who have mental health or substance use disorders. Without health care coverage, many of them are released without the ability to get the medicines they need.

Jails vs. Prisons

Jails typically house people awaiting trial and inmates convicted of misdemeanors who are serving sentences of less than one year. In most states, they are run by counties or cities. Prisons house convicted inmates serving sentences of more than one year. Both experience similar inmate health care challenges.

Obtaining health insurance, or at least access to routine health care services, has long posed challenges for prisoners after their release. When former inmates don’t find coverage, states often end up paying for their expensive, but often avoidable, health care and social services needs down the road.

In the District of Columbia and the 31 states that have recently expanded their eligibility requirements under the Affordable Care Act, many former inmates now qualify for Medicaid.

Lawmakers and agency heads in several states have worked hard to find ways to connect inmates with affordable health care or Medicaid before they get out to ensure there is continuity of care. At least nine states have programs that begin the Medicaid application process early enough to have the inmate’s enrollment ready the day of his or her release. Efforts like these often require good communication and coordination between the department of corrections and the state Medicaid program.

Ohio’s Department of Rehabilitation and Correction, for example, works with the state’s Department of Medicaid to help inmates obtain a Medicaid managed care plan at least 90 to 100 days before their release. When released, they have a care coordinator to help them find a primary care doctor, make and confirm appointments, and learn about urgent care, health care specialists and transportation benefits.

“This program has allowed thousands of Ohioans to transition back to the community with their health care already in place,” says Ohio Department of Medicaid Director Barbara Sears.

Suspend Rather Than Terminate

Lawmakers in at least 35 states and the District of Columbia have taken a slightly different approach to ensuring a continuum of care for released prisoners. They have adopted policies that suspend, rather than terminate, Medicaid for inmates while they’re incarcerated, though some do so only temporarily.

Suspension allows Medicaid coverage and services to resume immediately upon release from prison, avoiding the lengthy reapplication process—which can take anywhere from 45 to 90 days and leave former inmates without services while waiting to be re-enrolled. Suspension also can save on administrative costs related to the Medicaid reapplication and eligibility determination process.

Attacking Addiction

High rates of substance abuse among inmates have motivated some states to look for ways to decrease the likelihood of inmates relapsing when they get out, which right now is very likely. Twenty states self-report that they offer, as one option, some form of medication-assisted treatment (from dispensing medications to referring inmates to clinics that dispense them). Approved medications—naltrexone, methadone, buprenorphine, etc.—have been shown to prevent drug or alcohol relapses.

Alabama lawmakers passed Medicaid-suspension legislation this year “to stop the revolving door for people with serious mental illnesses in our jails and prisons, and to reduce prison medical costs to the state,” the bill’s sponsor, Senator Cam Ward (R), says. “In short, if the state terminates Medicaid coverage upon incarceration, the state loses the ability to shift the costs to the federal government,” since funding for Medicaid is a shared state-federal responsibility.

Ensuring that ex-offenders don’t have to worry about how and where to get health coverage after their release helps them readjust to life in their communities, says Sears, the Ohio Medicaid director. It’s “one less stressor for them.”

And who wouldn’t want less stress?

Samantha Scotti is a policy associate in NCSL’s Health Program​.

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Great Teachers Make Great Students

BY SENATOR CAM WARD

Over the past few years, I have made it a point to visit elementary and high school classrooms across Senate District 14. The passion of the teachers I meet never fails to inspire me. For many teachers, education is both a career and a calling to shape the lives of young people. Most educators work long hours, taking papers and tests home with them to grade after dinner with their own family.

The impact that a great teacher has on a young person’s life is fairly dramatic. According to research by the economists Raj Chetty and John N. Friedman of Harvard and Jonah E. Rockoff of Columbia, a student who has a strong fourth-grade teacher is 1.25 percent more likely to go to college than if she has a weak fourth-grade teacher. Students with a strong fourth-grade teacher will earn, on average, $25,000 more over their lifetime than students with poor teachers. (The authors found similar effects for teachers across all elementary and middle school grades.) Taken in the aggregate, the impact an excellent teacher has on an entire classroom is quite profound. The trajectories of dozens of young people can be altered for the better by a passionate, engaged and knowledgeable educator.

As a legislator, one of my top priorities has been supporting great teachers. For each of the past seven years, I have co-sponsored proposals to give public school teachers a pay raise, and fortunately, in 2016 the Legislature was able to come to an agreement on a four percent raise for most educators. I am continuing to work hard to find a fiscally sustainable pathway for giving another pay raise to teachers in the 2018 Legislative Session that starts in January, and if the state budget’s condition allows it, I will also advocate to increase the financial resources available to special education teachers.

The academic research verifies what each parent knows intuitively: a great teacher can have a huge impact on the life of a child. So let us continue to celebrate the profession of teaching and find innovative ways to reward the great teachers in our classrooms; and may many of our brightest students aspire to become teachers themselves – for what other profession molds the dreams and aspirations of so many?

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Big Plans for National Assisted Living Week

CLANTON ADVERTISER

It is National Assisted Living Week and the Gardens of Clanton has something special planned to celebrate each day.

It was made official on Sept. 11 with Sen. Cam Ward and Clanton Mayor Billy Joe Driver both on hand to present Vickie Jones, administrator at the Gardens of Clanton, with a proclamation.

The proclamation announcement took place during the Gardens of Clanton’s celebration of Patriot Day and remembrance of the events that took place and the lives that were lost on 9/11.

The rest of the week’s schedule includes a fashion show on Sept. 12, Hawaiian day on Sept. 13, Mexican day on Sept. 14 and wraps up with spirit day on Sept. 15.

“They look forward to it every year,” Jones said. “The atmosphere changes with each day. We try to make it lots of fun, so that the residents can participate.”

Bob Sanders will hold a magic show and Dr. Lucy Collins will perform belly dancing during Hawaiian day, while the food and decorations will resemble island life.

A horse show will take place with weather permitting on Sept. 14 as part of Mexican day and cheerleaders and band members from Chilton County and Verbena high schools will perform during spirit day on Sept. 15.

Former Alabama football player Thomas Rayam will be a special guest on spirit day and will talk to the residents about his experience.

Although each day has its own unique theme, the theme for the entire week is “family is forever.”

“I have been very pleased and they’ve been very good to me,” said William Doyle, the longest tenured resident at the Gardens of Clanton. “I look forward to all the decorations and occasions.”

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Time to Fight Opiod Crisis in Alabama

By Senator Cam Ward, who represents District 14 in the Alabama State Senate, which includes all or parts of Shelby, Bibb, Chilton, Hale, and Jefferson counties. He serves as Chairman of the Senate Judiciary Committee. Follow him on Twitter: @SenCamWard

In 2016, more Americans died from drug overdoses than were killed in the entire Vietnam War. Two-thirds of those overdoses were linked to opioids, a class of drugs that includes illegal substances like heroin, but which is primarily composed of legal painkillers like oxycodone, hydrocodone, and methadone.   

Unfortunately, Alabama is center stage in the opioid crisis: according to the Center for Public Integrity, in 2015 Alabama had the highest per capita number of opioid prescriptions of any state in the country, with a rate of 1.2 prescriptions for every resident. Not surprisingly, for the past several years the number of persons dying from overdoses in Alabama has been climbing, with 282 people dying from opioid overdoses in 2015, per data from the Centers for Disease Control and Prevention. According to the company's own research, 6.5% of BlueCross and BlueShield of Alabama's members were on a long-duration opioid regimen in 2015, compared to the 3.8% national average.

The numbers are grim, and will continue to get worse in Alabama and across the nation unless lawmakers, pastors, and community leaders band together to address the crisis.

What is driving the surge in opioid abuse? Some experts argue that drug manufacturers and doctors are to blame. In this narrative, during the 1990s doctors began to over-prescribe opioids as patients increasingly expected "pain-free" healthcare. Meanwhile, drug companies overhyped the safety of painkillers and ignored research indicating that some opioids were highly addictive.

Some writers and researchers, like Johann Hari, have pointed to increasing social isolation as the primary driver of the opioid epidemic. As Americans spend more and more time staring at screens and have fewer strong social ties with neighbors and relatives, a web of psychological problems arises. People, in this rendering, turn to painkillers to make up for frayed or non-existent social connections.

Additional academic studies will hopefully shed more light on the complex factors driving the crisis. But solutions, even provisional ones, are needed now. I think that at the least, more treatment centers are needed in Alabama for those struggling with opioid addictions. A central challenge is that these persons have few places to go for counseling and treatment. As public policy writer German Lopez puts it, "it is much easier to get high than it is to get help."

From a legal perspective, we need to give our law enforcement officers more tools to crack down on fentanyl, an opioid mix that is fifty times more powerful than heroin. Used as a pain reliever for patients, fentanyl is among the most powerful opioids prescribed by medical providers. Its street form is uniquely dangerous since the drug can be absorbed via the skin or inhalation. In next year's legislative session, I plan to sponsor a bill to make the illicit distribution of fentanyl a Class C felony.

We must see the opioid crisis in the context of broader social problems. As a conservative, I believe government programs are limited in their effectiveness at solving complex social challenges. We need churches, businesses, and community leaders to continue to form creative partnerships, like job-training programs for recovering addicts. The social science publication STAT estimates that 650,000 Americans will die over the next ten years from opioid overdoses. Perhaps no other social crisis in America demands our attention with as much urgency.

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Alabaster 119 Businesses Give to Back to School Kids

SHELBY COUNTY REPORTER

ALABASTER – Businesses along Alabama 119 in Alabaster teamed up to help families and students in need during the first 119 Gives Back to School event on Sunday, Aug. 6. According to Pit Stop Barbershop owner and event organizer Gray Keith, the event helped about 90 kids and their families.

For the 119 Gives Back to School, local businesses donated food, school supplies and gift cards, which were collected and distributed at the Pit Stop and Salon 119, which also provided free haircuts. Boohaker Family and Cosmetic Dentistry provided free teeth cleanings and Marc 1 Car Wash cleaned family cars for free.

Keith said that he decided to organize 119 Gives Back for the first time after he achieved several personal successes and wanted to see the same happen for someone else.

Keith said that the feedback he received from families was overwhelmingly positive.

“Everybody was in disbelief that we were doing this, and they were so grateful,” Keith said. “I had one family in particular that thought this was so great. They lad literally spent their last paycheck to pay for school expenses.”

In the future, Keith said he hopes to expand the event to include more businesses and provide for more businesses.

“We could have taken on more,” Keith said. “Hopefully, we’ll do it next year and it will be bigger.”

Keith said he appreciates that so many businesses came forward for a good cause.

“I’m thankful for all of the businesses that took the time out of their schedules to help me orchestrate this,” Keith said.

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Pelham High School Soccer Team Recognized for State Championship

Pelham, AL – Pelham High School’s boys soccer team was recognized at a City Council meeting on Monday, July 24, for winning the Class 6A boys soccer state championship.

State Reps. Matt Fridy and Arnold Mooney and Sen. Cam Ward, members of Pelham’s Legislative Delegation, attended the meeting to present the team and coaches with a proclamation recognizing their accomplishment.

The 2016-2017 boys soccer team secured the school system’s first ever state championship. Pelham took down Daphne High School 1-0 in round one and defeated the defending 6A champs in Cullman 2-0 in the championship match.

The Shelby County Reporter named goalkeeper Seth Torman as one of two boys soccer Players of the Year and head soccer coach Patrick McDonald as the boys’ soccer Coach of the Year.

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Don't Eliminate Rehab Funds

DECATUR DAILY- OPINION

One of the primary missions of a prison system is to rehabilitate its inmates and eventually return them to society as productive, law-abiding citizens.

In Alabama, that has become less of a priority, thanks to more budget cuts.

The Alabama Department of Corrections has a two-year, $18.7 million contract with a private company to provide substance abuse treatment and job training to hundreds of inmates.

That amount has been trimmed to $3.8 million because of what a prisons spokesman describes as budget constraints.

This is yet another bad turn of events for Alabama’s prison system.

Under the terms of the contract with GEO Reentry Inc., of Boca Raton, Florida, 750 inmates are to be enrolled in the rehabilitation and training programs for six months. After the budget cut, the number will be 325 inmates.

According to state prisons information, in 2016, 649 inmates were enrolled in the re-entry program with 575 of them receiving vocational certification, and 27 inmates earning a GED. Those enrolled are nonviolent offenders.

The inmates are enrolled at the Alabama Therapeutic and Education Facility, which provides services to men and women. Since it opened, the facility has graduated more than 5,000 people. They received substance abuse treatment, and vocational training, before being released.

Recidivism is cut by about half for offenders who successfully complete the courses, officials said. That is what prisons work toward — reducing repeat offenders — and Alabama has made strides in accomplishing that goal.

State Sen. Cam Ward, R-Alabaster, has led efforts to reform the prison system. He points out that not spending money on rehabilitation is not a savings. The money eventually will be spent, he said, on more prison beds because inmates did not get the help they needed to avoid returning to their criminal past.

This is particularly true for offenders with addiction problems. Without treatment and vocational training, most of them will return to substance abuse.

Alabama’s General Fund, which pays for prisons among other state services, is anemic because of a lack of money. The problem, other than earmarks, is a ridiculously low property tax scale. Lawmakers have known this for decades but have refused to act because powerful business interests are content with avoiding paying their fair share of taxes.

The federal government is monitoring Alabama prisons because of the severe crowding. If the feds finally step in, the solutions likely will be more expensive than anything lawmakers approve.

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Gardens of Clanton Recognized

Clanton Advertiser

The Gardens of Clanton received a resolution from Sen. Cam Ward on Wednesday that recognized the assisted living facility as one of the top in the state.

The initial honor was bestowed upon the Gardens of Clanton in April after being voted among the top five in Alabama by Assisted Living Magazine.

“This is special recognition, because it comes from something that we did not apply for and is something she didn’t ask for,” said Brad Eisemann, CEO of Great Oaks Management and parent company of the Gardens of Clanton. “They just recognized the quality work.”

“It seems like it is becoming a yearly event, and it is a testament to the good job and the care that they bring here,” Ward said. “The fact that they are getting recognized tells you that it’s not just good, but it’s great.”

A fifth place ranking was earned, which was two spots higher than a year ago.

“When we are down there [Montgomery] passing bills or defeating bills that’s great, but when you get to come back and see folks that are truly happy in their daily lives, that matters more than anything else,” Ward said. “It brings it all home.”

Ward began representing Clanton after being elected to the senate in 2010. Since then, he has been a regular guest at several of the facility’s holiday events and gatherings.

The Gardens of Clanton is a parent company of Great Oaks Management, which has eight assisted living locations spread across the state.

Eisemann was joined by representation of other members of the corporate office. Chilton County Probate Judge Bobby Martin and Circuit Court Clerk Glenn McGriff were also on hand.

According to Eisemann, he believes that the top five honor is most likely the highest that the Gardens of Clanton has ever received.

“We want our facilities to be an active part of the cities that they are in,” Eisemann said. “The Gardens of Clanton is a showpiece for us.”

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Task Force to Tackle Juvenile Justice

A 22-member task force representing the governor's office, Legislature, courts, law enforcement, mental health, education and other services is launching a study of how Alabama can reduce juvenile crime.

The Alabama Juvenile Justice Task Force met for the first time today. It will work with the Pew Charitable Trusts to develop recommendations that members say will be based on evidence and data.

The approach has parallels to efforts to fix Alabama's prisons, including sentencing guidelines that took effect in 2013 and criminal justice reforms that passed in 2015. Alabama's prisons remain overcrowded and understaffed. But the inmate population is declining.

Sen. Cam Ward, R-Alabaster, who has helped lead prison reform efforts and is a member of the new task force, said a comprehensive state-led approach to juvenile justice is needed, in part, because counties vary greatly in their ability to support the needed programs.

Community-based interventions can be more effective in stopping teens from repeat offenses than confinement in state institutions, Noah Bein of the Pew Charitable Trusts told the task force during a presentation today. Bein showed some positive results from reform efforts in other states, including Georgia and Kentucky.

Montgomery County District Attorney Daryl Bailey, a task force member, said the violent nature of crimes committed by young teens is alarming.

"We're on the cusp of losing a whole generation of kids," Bailey said. "The kids that I see coming into the criminal justice system now are becoming younger and younger, the ones that are committing these violent crimes. I'm seeing 14, 15, sometimes 13-year-olds committing the robberies, murders, these type of violent crimes that used to be reserved for the older adults."

Bailey said there are multiple factors, including mental health issues, drug abuse and social media bullying. A common thread for many youthful offenders, Bailey said, is a fundamental lack of parental guidance.

Ward said there won't be simple answers. He said a proactive effort can divert young offenders from landing in the adult system.

"There is not one silver bullet answer," Ward said.

The goal of the task force is to reach a consensus on policy recommendations and issue a report in November.

Roundtable discussions are planned for this summer with families, probation officer, judges, crime victim advocates, faith leaders, prosecutors, educators and others.

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