< PreviousADDRESSING SELF-DIRECTED VIOLENCE IN PRISONS Lessons from a corrections-academic partnership in North Carolina By Robert J. Cramer, PhD Lewis J. Peiper, PhD Andréa R. Kaniuka, MATRANSLATING RESEARCH Self-Directed Violence in the Correctional Setting Self-directed violence (SDV), including suicide, suicidal ideation, suicide attempt, and non-suicidal self-injury (Crosby et al., 2011), is a significant public health concern in correctional settings. Suicide is the leading cause of death within jails in the United States and the third leading cause of death in state prisons (Carson, 2021a, 2021b). Further, engagement in non-suicidal self-injury, or self- harm without intent to die, has a weekly prevalence of 85% in prison systems (Appelbaum et al., 2011). Within North Carolina state prisons, rates of suicide over the past 10 years have averaged 16.6 per 100,000 and are essentially identical to the state average for adults (17 per 100,000; 2011-2020) in the community for that same period (Centers for Disease Control and Prevention, 2022). Per the North Carolina Department of Public Safety (NC DPS), NC state prisons experienced an average of 3,212 SDV- related events annually from 2017 to 2019, comprising self-injurious and non-injurious overtures of self-harm (NC DPS, 2020). This average SDV event total converts to a crude population rate for the prison system equal to 8,786 per 100,000 incarcerated persons from 2017 to 2019 (36,560 average daily prison population). As these data demonstrate, suicide and the entire spectrum of SDV present a significant challenge to prison systems. Although the North Carolina prison system had a 10-year average suicide rate similar to the community rate for adults, that trend began to shift in 2016. The state prison suicide rates from 2016 through 2021 increased to an average rate of 22.4 per 100,000 incarcerated persons. This upward trend in prison suicide rates was not limited to North Carolina, as rates of suicide in state prisons rose across the country. According to data from the U.S. Department of Justice, state prisons had a national suicide rate average of 18 per 100,000 in 2015, which rose to 27 per 100,000 incarcerated persons in 2019 (Carson, 2021a). To address this trend, the North Carolina Department of Public Safety (NC DPS) and Division of Prisons Behavioral Health Services formed the Suicide Prevention and Self- Directed Violence Workgroup in 2018 (NC DPS, 2020). This team consisted of nine NC DOP behavioral health clinicians (including the director, LJP) across different state prison facilities. The workgroup identified priority project areas that included screenings and suicide risk assessment practices, suicide and suicide attempt data collection and dissemination, and training of behavioral health staff. As the workgroup studied and reviewed internal SDV-related data trends, they noticed the issue’s complexity. For instance, of the SDV-related events, only 39% involved carrying out a self-harm action, with the remaining involving some type of communication of a threat, plan, or desire to self-harm. Furthermore, only 13% of the SDV events involved a suicidal action or attempt (NC DPS, 2020). To better understand the complexity of this data and the impact it might have on training, the workgroup consulted with Dr. Robert Cramer of the University of North Carolina at Charlotte (UNC Charlotte), given his expertise in core competency training for suicide prevention. This consultation led to forming a community- academic partnership between the North Carolina Division of Prisons (NC DOP) and UNC Charlotte. Addressing Correctional SDV Through a Corrections-Academic Partnership Community-academic partnerships entail jointly developed teams focused on deriving projects and solutions to help the community (Drahota et al., 2016). Defining features of such vital partnerships include, but are not limited to, (a) fostering an equitable partnership at all research stages, (b)demonstrating mutual understanding and respect (e.g., respect for cultural needs and values), (c) focusing equally on knowledge generation and practice-focused change, (d)creating co-owned dissemination, and (e) creating a sustainable partnership (Drahota et al., 2016; Wright et al., 2011). Our community-academic partnership is not the first documented in the corrections or healthcare literature. For example, Boghossian and team members (2012) outlined a corrections-academic partnership in Oregon. We drew on the principles they espoused. For instance, they outlined three necessary elements for a successful corrections-academic partnership: (a) listening, (b)sustainability, and (c) dissemination. As we discuss in the following sections, both NC DOP and UNC Charlotte conversed in a meaningful two-way dialogue to identify mutual needs regarding improving SDV prevention and practice in correctional settings while also gathering pertinent information that would have an impact on future endeavors (e.g., long-term goal of a SDV preventionTRANSLATING RESEARCH training program). Further, we assembled teams and agreements wide enough to account for sustainability by adding new team members and identifying a strategy for the sustainable use of new tools or training in the future. Finally, we jointly devised dissemination activities to allow for scientific, laypeople, and corrections stakeholder engagement, including this article. Overview of Partners It will be helpful to at the outset to provide an overview of the two partners and the needs and goals they brought to this collaborative endeavor. North Carolina Division of Prisons (NC DOP) NC DOP is a division of the Department of Public Safety and consists of 55 state prisons across North Carolina. The prison system had an average daily population of just over 36,000 for 2017 through 2019; however, the population dropped during the pandemic related to additional release practices and is currently just over 30,000. North Carolina state prisons, like other prison and jail systems across the country, experience a unique spectrum of SDV, including various instrumental motivations in many instances. For this reason, the practical assessment, intervention, and management strategies for SDV in the NC DOP are a top priority. A challenge identified by the NC DOP partners was that the professionals on the ground with first-hand knowledge of SDV in prison are not typically equipped or prepared to complete the level of scientific study and peer-reviewed dissemination of research on this topic. Similarly, the published research on SDV in non-correctional populations often falls flat when applied to a prison context. The misfit between the literature and corrections work exists because the correctional population and socio-environmental context of the prison setting and culture are genuinely unique from clinical and community settings. In this regard, the NC DOP partners sought to identify academic experts in the study of SDV in prison and to combine their understanding of the prison population and setting with the expertise of academic partners. University of North Carolina at Charlotte (UNC Charlotte) The academic team at UNC Charlotte involved in this project formed with the following goals. First, we sought to bring methodological and statistical expertise to the partnership. Second, we aimed to provide up-to-date SDV theory, research, and practice knowledge that could be used and adapted to suit NC DOP’s needs. Third, we wanted to create a sustainable set of contributors focused on problems and solutions relevant to NC DOP’s needs. Following the initial consultation stages discussed below, in order to ensure that these three goals were achieved, a primary academic team was put together comprised of three members of the university faculty and two doctoral students with complementary expertise in suicide prevention, non-suicidal self-injury, electronic health record data work, and advanced quantitative methods. Subsequent participating team members were added based on project-specific needs or interests in expanding research and practice questions. For instance, another faculty scholar and graduate student joined the team with specific expertise and focus on carceral issues for women. Steps in Engaging in Our Corrections- Academic Partnership Partnership Step 1: Workgroup Consultation The NC DOP Suicide Prevention and Self-Directed Violence Workgroup (NC DPS, 2020), as referenced above, was formed after an increase in suicides in 2018. This increase was reflected nationally in the Bureau of Justice Statistics (BJS) mortality statistics showing an average increase in state prison suicide rates from 18 in 2015 to 26 in 2018 and 27 per 100,000 incarcerated persons in 2019 (Carson, 2021a). Throughout the workgroup’s review and project development process, one clear idea formed: we needed a validated training model that could (a) be tailored to our population, staff, and procedures and (b) be sustainably updated over time for continued use with NC DOP staff. Toward this idea, the workgroup contacted and established an initial consultation with Dr. Cramer. Through the consultation, we were able to identify areas of strong fit for his published Core Competency Model for Suicide Prevention training (Cramer et al., 2013, 2019), as well as areas for adaptation to a correction environment and the spectrum of SDV events in prison (Cramer, Peiper, et al., 2022). This initial consultation set the groundwork for a multi-step collaboration to evaluate the existing self-injury risk assessment process within our prison system and build toward evidence-based assessment and practices that could be further integrated into a validated training model for SDV in corrections.TRANSLATING RESEARCH Partnership Step 2: SIRAP-C Development A Data Use Agreement (DUA) was executed between NC DOP and UNC Charlotte, which established both parties’ understanding of the scope of work to be included in the community-academic partnership. The DUA was found to cover two related projects: (1) the self-injury risk assessment analysis and (2) suicide prevention training for NC DOP staff. Responsibilities of UNC Charlotte included obtaining Institutional Review Board (IRB) approval; composing data security plans; completing data analyses; and disseminating findings via written summary, journal articles and conference presentations, and training materials. In addition, NC DOP agreed to assemble and securely transfer data, oversee the NC DOP research committee review process, provide subject matter expertise, ensure stakeholder engagement and feedback, and collaborate on dissemination activity. One of the first steps of the NC DOP-UNC Charlotte partnership was the development of the Self-Injury Risk Assessment Protocol for Corrections or SIRAP-C. NC DOP’s goal was to refine their current self-injury risk assessment protocol. The existing risk assessment protocol comprised documentation of the SDV event, a mental status exam, an assessment of 43 risk and protective factors, and treatment recommendation(s). With subject matter expertise assistance from NC DOP, UNC Charlotte conducted data analyses to refine the existing risk assessment protocol and generate a revised clinician- administered structured tool, the SIRAP-C, which includes a rating sheet and user guide for implementation. The SIRAP-C rating sheet covers dynamic (e.g., depressive symptoms) and static (e.g., history of SDV) risk factors as well as protective factors (e.g., coping skills). The SIRAP-C is designed to aid clinical decision-making, including suicide and self-injury risk classification and intervention recommendations. NC DOP and UNC Charlotte have engaged in a variety of dissemination methods, including: (a)peer-reviewed publication (Cramer, Peiper, et al., 2022) of the SIRAP-C development, (b) presentation of findings at an academic conference (Kaniuka et al., 2022), and (c) a stakeholder engagement presentation at NC DOP in March of 2022. Future research directions include investigating gender variation in risk assessment and using the SIRAP-C to aid research with incarcerated persons who engage in persistent self-injury. Looking Ahead: Putting Science into Clinical Practice A critical next step to build on the SIRAP-C development will be to ensure it is translated into practice through systematic implementation and training. The goal of putting the SIRAP-C into practice through training is consistent with community-academic partnership principles (e.g., Bohossian et al., 2012; Boutin-Foster et al., 2008). For example, through partnerships, SDV assessment and prevention training may improve care for underserved, difficult-to-reach populations, namely incarcerated adults in the state of North Carolina. Further, creating a technology- based training program revised after feedback from corrections stakeholders will ensure that NC DOP has a program for new staff and train-the-trainer materials. Thus, we will ensure sustainable use beyond this stepwise project partnership. The Core Competency Model (CCM) of the suicide prevention training program (Cramer et al., 2013, 2019) provides a framework for planning the next steps of our partnership. The CCM results from a comprehensive review of expert sources in suicide prevention clinical best practices. This review resulted in the following ten key clinical and self-care skills required for effective overall suicide prevention practice: • Manage personal attitudes and reactions to suicide • Maintain a collaborative stance toward the client • Elicit evidence-based risk and protective factors • Focus on the current suicide plan and intent of suicidal ideation • Determine the risk level • Enact a collaborative, evidence-based treatment plan • Notify and involve other persons • Document risk, plan, and reasoning for clinical decisions • Know the law concerning suicide • Engage in debriefing and self-care The CCM has been translated into various training formats, from half-day workshops to a semester-long graduate course (e.g., Cramer et al., 2016, 2017; La Guardia et al., 2019). Across training formats, the CCM entails social- cognitive or cognitive-behavioral training techniques such as psychoeducation, practice tool resource provision, and case study-based skill practice. Reflection through self-assessment is critical; Cramer and colleagues (2020) created the Suicide Competency Assessment Form (SCAF), a self- or observer-rated tool capturing perceived mastery of the core competencies. The SCAF is usable within the self-reflective practice, supervision, consultation, and program evaluation contexts. CCM-based trainings have been studied in community mental health, university counseling centers, online training, and undergraduate and graduate student courses. Overall trends show positive impacts of provider suicide prevention knowledge, stigma reduction, and perceived skill mastery (e.g., Cramer et al., 2016, 2017, 2019; La Guardia et al., 2019). Based on recent evidence, results are promising in recommending best practices that will have a real impact in terms of improved use of suicide screeners (Hager et al., 2021). A fundamental CCM principle is flexibility. The 10 core competencies are transferrable and adaptable by clinical population and setting. For instance, the lead author (RC) is currently funded to pilot the Core Competency Model for Military (CCM-M) for the United States Navy. Our team recently outlined what CCM for Corrections (CCM-C) would look like regarding training format, content, and other key design considerations (Cramer et al., in press). We put forth the scientific publication (Cramer et al., in press) and a recent conference proceeding (Cramer, Kaniuka, & Peiper, 2022) to reach a broad audience including legal and correctional practitioners, mental health providers, and researchers. In the curriculum outline (Cramer et al., in press), the CCM can be adapted in numerous vital ways to meet the correctional partner needs. First, we shifted to the broader focus of SDV because of the high rates of non-suicidal self-injury and suicide in carceral settings (see review above). Second, we integrated correctional SDV literature throughout the CCM-C training curriculum. For instance, we adapt general risk/protective factor reviews to focus on corrections-specific literature. We also feature the SIRAP-C throughout relevant competencies (e.g., risk determination, and treatment planning). While a full review of the training curriculum and implementation considerations are beyond the scope of this article, we refer interested parties to the Psychological Services article (Cramer et al., in press) and, in the spirit of dissemination and corrections-academic partnership, welcome further inquiries. The Psychological Services curriculum serves as the foundation for recording, implementing and evaluating a future CCM-C pilot project. Although the adaptations to the CCM for Corrections have been identified, the piloting of the adapted training model is just beginning. To achieve the full implementation and evaluation of the CCM-C, a grant-funded project pilot is projected to start in 2023. This partnership phase will include a two-year timeline of implementation, review, evaluation, and revision of the adapted model. The outcome of the grant-funded pilot will be a validated SDV training model adapted for a correctional setting and a sustainability plan that includes a train-the-trainer component. Finally, policy and procedure revisions resulting from the integration of the SIRAP-C will be integrated into the full roll-out of the CCM-C in the North Carolina prisons. Lessons for Corrections-Academic Partnerships We learned several important lessons that may benefit future corrections-academic partnerships. 1. Identifying and Carrying Out Shared Values and Solutions. The community-academic partnership literature highlights the importance of a shared vision between community and academic partners. Given the challenges faced by carceral institutions, we believe this shared approach is particularly crucial to successful corrections-academic partnerships. Indeed, the shared vision should move beyond mere common goals, data, and work products. Early in our partnership, the leaders (RC, LJP) held conversations with corrections stakeholders and academic team members to ensure a shared understanding and values. For instance, we focused on the shared value of equal credit and visibility, as evidenced by simple matters such as ensuring corrections partners received appropriate recognition (e.g., authorship) and access to work products. Other shared values included open communication and patience. Be it through regular meetings or contractual writing such as a Memorandum of Understanding (MOU); we strove for role clarity, rigor over expediency, and a mutual understanding that each project step in the timeline may require flexibility. We continue with an overt emphasis on joint ownership of project data and work products. For instance, we have received several external inquiries about using the SIRAP-C. Team leaders (RC, LJP, AK) have collaborated on joint responses in each instance. 2. Identify Necessary Expertise and Gain Buy-In. Prison systems have developed a reputation for being leery of anything that needs to be explicitly corrections-based or corrections-initiated. The development of this partnership from the initial consultation stage through the generation of TRANSLATING RESEARCH DUAs and MOUs occurred with a healthy respect for and inclusion of the voices, input, and perspectives of those who work inside the prisons. Those comprising the Suicide Prevention and Self-Directed Violence Workgroup were all chosen from among internal representatives in the prisons. During the process, ongoing updates and briefings were provided to DOP executive leadership, including ongoing monthly briefings to a DOP project manager by the prison lead in this partnership. Our efforts to build the foundation of this partnership using input from internal experts with front- line correctional experience, and our emphasis on regular briefings to executive leadership, have been successful and thereby prove the value of having a solid foundation from the beginning. This has facilitated our work and implementation of new training and procedures, and all participants acknowledge the importance of maintaining the strength of that foundation as we collaborate in this process. 3.Understand That It Takes Time to Translate Science into Practice. Good clinical science takes time. The development of the SIRAP-C, from the initial data, use agreement and human subjects review through data analysis publication, was a two-year process. This was to develop the instrument, worksheet, and short user guide. We continue the clinical science portions at the time of this writing by disseminating the clinical materials and preparing to implement the SIRAP-C within the NC DOP electronic health record. Anticipating that it would require considerable time and effort, we began the funding search for training development during the clinical science phase. This was a correct assumption. Through collaboration with state agencies and grant developers, it took more than a year to identify and attain funding for the CCM-C training. As a precursor, we strategically developed presented, and published the CCM-C curriculum to provide a tangible example to funders and other potential stakeholders. At the time of this article, we anticipate receipt of funding to conduct a two-year CCM-C design and pilot evaluation. Patience can pay off in creating a sustainable, evidence- based solution for the correctional partner. 4.New Opportunities Will Arise, So Maintain Flexibility. Our success is largely a function of remaining agile. During the life of the collaboration, several instances occurred where new ideas, issues, and questions arose that required flexibility and new team members. For example, in discussing the clinical observations by prison mental health providers and results of preliminary SIRAP-C analyses, we observed that a small number of persons accounted for a high percentage of self-injury risk assessments. As a result, we jointly developed a secondary goal to identify characteristics associated with those engaging in persistent self-injury risk to further target finite prison resources to higher-risk individuals. Doing so required us to expand our team to include an NC DOP intern with public health experts as well as a UNC Charlotte faculty scholar and doctoral student with requisite statistical and non-suicidal self-injury expertise, r espectively. Our agile approach to partnership produces additional meaningful information to improve clinical approaches to SDV for NC DOP, other networking and training opportunities for team members, and contributions to the broader correctional healthcare literature. References Appelbaum, K. L., Savageau, J. A., Trestman, R. L., Metzner, J. L., & Baillargeon, J. (2011). A national survey of self-injurious behavior in American prisons. Psychiatric Services, 62(3), 285–290. Bohossian, P., Glavin, M., O’Connor, T., & Boyer, J. (2012). Prisons, community partnerships, and academia: Sustainable programs and community needs. Federal Probation, 76, 30-34. Boutin-Foster, C., Phillips, E., Palermo, A. G., Boyer, A., Fortin, P., Rashid, T., Vlahov, D., Mintz, J., & Love, G. (2008). The role of community-academic partnerships: Implications for medical education, research, and patient care. Progress in Community Health Partnerships: Research, Education, and Action, 2(1), 55–60. https://doi. org/10.1353/cpr.2008.0006 Carson, E. A. (2021a). Mortality in state and federal prisons, 2001–2018— Statistical tables (NCJ 255970). Department of Justice, Bureau of Justice Statistics. https://www.bjs.gov/ index.cfm?ty=pbdetail&iid=7387 Carson, E. A. (2021b). Mortality in local jails, 2000–2018— Statistical tables (NCJ 256002). Department of Justice, Bureau of Justice Statistics. https://www.bjs.gov/index. cfm?ty=pbdetail&iid=7386 Centers for Disease Control and Prevention, National Center for Health Statistics (2022). National Vital Statistics System, Mortality 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data TRANSLATING RESEARCH provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Cramer, R. J., Bryson, C. N., Eichorst, M. K., Keyes, L. N., & Ridge, B. E. (2017). Conceptualization and pilot testing of a core competency-based training workshop in suicide risk assessment and management. Journal of Clinical Psychology, 73, 233-238. https://doi.org/10.1002/jclp.22329 Cramer, R. J., Bryson, C. N., Stroud, C. H., & Ridge, B. E. (2016). A pilot test of a graduate course in suicide theory, risk assessment, and management. Teaching of Psychology, 43, 238-242. https://doi.org/10.1177/0098628316649483 Cramer,R.J.,Ireland,J.L.,Long,M.M.,Hartley,V., & Lamis,D.A.(2020).Initial validation ofthe Suicide Competency Assessment Form among behavioral health staff in the National Health Services (NHS) Trust. Archives of Suicide Research, 24, S136-S149 Cramer, R. J., Johnson, S. M., McLaughlin, J., Rausch, E.M., & Conroy, M. A. (2013). Suicide risk assessment forpsychologydoctoralprograms:Corecompetencies and a framework for training. Training and Education in ProfessionalPsychology,7,1-11.https://doi.org/10.1037/ a0031836 Cramer, R. J., Kaniuka, A. R., & Peiper, L. J. (In Press). Adaptingasuicidepreventioneducationprogramfor managing self-directed violence in correctional institutions. Psychological Services. Cramer, R. J., Kaniuka, A. R., & Peiper, L. J. (March, 2022). Adapting a suicide prevention education program for managing self-directed violence in correctional institutions. Paper presented at the annual conference of the American Psychology-Law Society (Denver, CO). Cramer, R. J., Long, M. M., Zapf, P. A., & Gordon, E. (2019). Preliminary effectiveness of an online-mediated competency-basedsuicidepreventiontrainingprogram. ProfessionalPsychology:ResearchandPractice,50(6), 395-406. https://doi.org/10.1037/pro0000261 Cramer, R. J., Peiper, L. J., Kaniuka, A. R., Diaz-Garelli, F., Baker, J. C., & Robertson, R.A. (2022). Development of the Self-Injury Risk Assessment Protocol for Corrections (SIRAP-C). Law and Human Behavior. Advance online publication. Crosby, A. E., Ortega, L., & Melanson, C. (2011). Self- directed violence surveillance: Uniform definitions and recommended data elements (Version 1.0). Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Drahota, A., Meza, R. D., Brikho, B., Naaf, M., Estabillo, J. A., Gomez, E. D., Vejnoska, S. F., Dufek, S., Stahmer, A. C., & Aarons, G. A. (2016). Community-academic partnerships: A systematic review of the state of the literature and recommendations for future research.The Milbank Quarterly,94(1), 163–214. https://doi.org/10.1111/1468- 0009.12184TRANSLATING RESEARCH Hager, N. M., Cramer, R. J., Kaniuka, A. R., Vandecar- Burdin, T., Badger, N., Holley, A. M., Foss, J., Glenn, C. R., Judd, S., South, G., & Judah, M. R. (2021). An evaluation of the core competency suicide prevention training program for university health service providers.Journal of College Student Psychotherapy.Advance online publication. https:// doi.org/10.1080/87568225.2021.1911726 Kaniuka, A. R., Cramer, R. J., Peiper, L. J., Diaz-Garelli, F., Baker, J. C., & Robertson, R. A. (March, 2022). Development of the Self-Injury Risk Assessment Protocol for Corrections (SIRAP-C). Paper presented at the annual conference of the American Psychology-Law Society (Denver, CO). La Guardia, A. C., Cramer. R. J., Brubaker, M., & Long, M. M.(2019). Community mental health provider responses to a competency-based training in suicide risk assessment and prevention. Community Mental Health Journal, 55, 257-266. https://doi.org/10.1007/s10597-018-0314-0 North Carolina Department of Public Safety. (2020). Suicide prevention and self-directed violence: Project description, outcomes, and recommendations from the 2019 Suicide Prevention and Self-Directed Violence Workgroup. Wright, K. N., Williams, P., Wright, S. Lieber, E., Carrasco, S.R., & Gedjeyan, H. (2011). Ties that bind: Creating and sustaining community-academic partnerships. International Journal of Community Research and Engagement, 4, 83-99. https://doi.org/10.13016/5mmn-0lzy Biographical note: Robert J. Cramer, Ph.D., is an Associate Professor and Irwin Belk Distinguished Scholar in the Department of Public Health Sciences at UNC Charlotte. His primary research interests include suicide prevention, hate crimes/violence prevention, LGBTQ health, program evaluation, and the intersection of social science and law. Lewis J. Peiper is a licensed psychologist and Director of Behavioral Health Services for North Carolina prisons. In his official capacity, Dr. Peiper oversees all clinical behavioral health services and substance use disorder treatment for the state prisons. He is an active member of state and national committees including: the North Carolina Psychological Association’s Public Sector Committee; the American Correctional Association’s Behavioral Health and Substance Use Disorder committees; and the American Psychological Association, Division 18’s Taskforce on Correctional Psychology Training Competencies. Andréa R. Kaniuka holds a Ph.D. in Public Health Sciences from the University of North Carolina at Charlotte and an MA in Clinical Psychology from East Tennessee State University. Her research expertise includes suicide prevention, sexual and gender minority health, and positive psychology.LESSONS LEARNED THE USE OF VIDEO VISITATION IN A COMMUNITY CORRECTIONAL FACILITY FOR WOMEN: Beatriz Amalfi Wronski, MS Lori Brusman Lovins, PhDTRANSLATING RESEARCH Introduction The current project was designed to explore the impact of increasing family contact during confinement via the use of video-visitation. By arranging weekly video chat sessions between confined women and those in their support systems, the research team explored how this affected family connectedness and successful reentry. The current pandemic underscores the need for correctional agencies to offer an array of mechanisms for keeping confined individuals connected to family members. This paper discusses the relative ease with which this program was implemented in hopes that other correctional sites can use similar programs to safely connect residents to the community rather than revert to telephone and letters as the only contact mechanisms. Below we describe the benefits that having augmented video-visitation contact had on participants of the program, and we also share information on our step-by-step implementation of this project, as that may be of assistance to any agencies who are at the decision point regarding whether they will implement similar initiatives, Background Among the negative aspects of the prison experience, social isolation is identified as one of the most significant detriments of confinement (Adams, 1992). Hence, visitation is paramount to provide detained individuals with social support from loved ones. Research clearly demonstrates that individuals benefit from regular contact with support persons while incarcerated (Cochran, 2012), and visitation even helps people in prison resist deviant subcultures (Duwe & Johnson, 2016). Evidence of specific interest to correctional staff shows that frequent visits lead to improved behavior (Cochran, 2012; Jiang & Winfree, 2006). Beyond the prison walls, a positive relationship exists between family support and successful reentry (Bales & Mears, 2008; Duwe & Clark, 2013; Mears, Cochran, Siennick, & Bales, 2012). Studies have also shown visitation to benefit recidivism reduction (Bales & Mears, 2008; Mears et al. 2012; Mitchell et al. 2016), although a more recent study found the relationship to be more tenuous (Cochran et al., 2020). While male facility visitation rooms are often filled with girlfriends and wives, female facility visitation rooms tend to be occupied with close relatives such as mothers, sisters, and children (Jiang & Winfree, 2006). Jiang and Winfree suggest that this difference reflects women’s more social and conventional relationships with families. Research also suggests that visitation may be equally crucial for the children visiting their incarcerated parents, helping them deal with the separation and the harm caused by it (Tasca et al., 2016). Poehlmann et al. (2010) argue that allowing a child to maintain attachment with an incarcerated parent improves the child’s social and emotional functioning. Despite this need, and even though women tend to be the children’s primary caregiver, incarcerated women are less likely to receive visitors than men, leaving letters and phone calls as their main outlets for connecting with family members while confined (Arditti & Few, 2006). Families often face barriers—such as lack of economic resources, difficulties with work schedules, or lack of proximity to the institution—that impede their ability to make visits (Rubenstein et al., 2021; Mauer & Chesney-Lind, 2002), which is especially problematic for confined females. Even at baseline, the visitation needs of women are often not being met. Adding to the problem was that the onset of the COVID-19 pandemic caused many facilities to have to ban or limit their use of face-to-face visitation to control the spread of the disease (Hanna, 2020). This unprecedented situation underscored the need for facilities to explore various ways to connect confined individuals to their families so that programs can better address the support needs of those they serve. This project explores the impact of video-visitation to augment family contact opportunities in a residential treatment program. The Project Table 1 provides an outline of how the video-visitation project was designed. This project was implemented before the onset of COVID--19, but data collection continued until July of 2020, just after the onset of COVID-19, allowing us to experience the impact of video-visitation during these two distinct phases. Materials Needed for Implementation We acquired 15 iPads with 15 headsets to be used in a semi-private space to allow multiple clients the ability to participate in the video chats at once.1 Internet access was provided with the use of two hotspots. A portable storage/ charging cart was purchased to store the iPads securely, and sanitizer wipes were needed to disinfect the equipment between uses. The total cost to provide video-visitation opportunities for particip ants approximated $7,000, with an Next >