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TREATMENT MODULES D-370 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: THERAPEUTIC TREATMENT MODULES NO: D-370 FILE: TREATMENT MODULES EFFECTIVE DATE: 04-25-16 REVISED: AUTHORITY: Sheriff J. Zanoni APPROVED BY: Assistant Sheriff T. Gattie REFERENCE: Fresno County Sheriff's Office Policies and Procedures Section No. 102; and Hall, et al. v. County of Fresno, 1-11-CV-02047-LJO-BAM (2015). PURPOSE: The purpose of this policy is to establish standards and procedures for the use of Therapeutic Treatment Modules in order to facilitate educational and therapeutic activities for administratively segregated inmates. POLICY: It is the policy of the Fresno County Sheriffs Office Jail Division to use secure Therapeutic Treatment Modules for the provision of health services to ensure that all seriously mentally ill inmates housed in administrative segregation single-cell housing units have equal access to individual and group therapy. It is the policy of the Fresno County Sheriffs Office Jail Division to use secure Therapeutic Treatment Modules for the provision of educational and therapeutic activities for any administratively segregated inmate when necessary to facilitate small group learning and interaction, in a protected and safe environment. While the primary use of the Therapeutic Treatment Modules is to facilitate mental health treatment and programming for administratively segregated inmates, the enclosures may also be used to accommodate temporary seclusion as addressed in this policy. Under no circumstances shall the Therapeutic Treatment Modules be used for punishment or as a substitute for treatment. Any placement into and removal from a Therapeutic Treatment Module shall be documented via the OffenderTrak system. PROCEDURES: Page 1 of 4 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: THERAPEUTIC TREATMENT MODULES NO: D-370 FILE: TREATMENT MODULES I. THERAPEUTIC TREATMENT MODULES A. The Therapeutic Treatment Modules (TTM's) are specifically designed for inmates who pose a threat to staff and/or inmate safety. 1. The TTM's are steel and mesh individual enclosures that allow the enclosed inmates to view staff and each other while participating in group learning or therapy sessions. 2. Each module contains a built-in stool that is spring-loaded and can flip up to allow for wheelchair access. Inmates who require a wheelchair will remain seated in the wheelchair and can either self-ambulate or be assisted into the TTM. Some modules are also equipped with a monitor and spring-loaded desk. B. The goal is to provide inmates with a therapeutic environment that allows contact with mental health clinicians and other program facilitators (e.g., social workers, educators), as well as other group participants, while maintaining a safe environment for all, during group and individual therapeutic/educational sessions. II. SERIOUSLY MENTALLY ILL INMATES Seriously mentally ill (SMI) inmates who require single-cell housing (i.e., MJ FF, SAJ 2D)shall be offered out-of-cell structured behavioral health services a minimum of three (3)times per week, each lasting approximately one (1) hour with appropriate duration to be determined by a mental health clinician. The out-of-cell mental health contacts shall consist of structured individual or group therapeutic/educational treatment and programming, and shall take place utilizing the therapeutic enclosures. III. STAFF RESPONSIBILITY A. The pass-throughs shall be utilized to handcuff/uncuffthe inmates. Officers shall utilize safety precautions and be cognizant of the inmate's ability to reach through the pass-through. 1. Inmates who require single-cell housing should have their handcuffs Page 2 of 4 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: THERAPEUTIC TREATMENT MODULES NO: D-370 FILE: TREATMENT MODULES removed after being placed into the TTM. If the inmate is compliant with direction from staff, the inmate shall be instructed to place their hands through the pass-through for the purpose of being uncuffed. 2. The handcuffs shall be reapplied prior to removal from the TTM. 3. Shackles shall not be removed until the inmate is returned to their cell. B. Security/Floor/Escort officers shall coordinate efforts to ensure that the appropriate OffenderTrak entries are made to reflect the inmate's movement/attendance. Refusal of any event shall be documented as such. C. Staff shall not refer to the TTM's as "cages" or by any other derogatory term. Such references are demeaning and counterproductive to the therapeutic goal. IV. AUTHORIZED USE A. The primary use of the TTM's is to facilitate SMI mental health treatment and programming, however, the enclosures can also be used to accommodate: 1. Other administrative segregation inmates who require a secure environment to participate in group and individual therapeutic/ educational sessions. 2. Video visitations. 3. Telemedicine and telepsychiatry interviews. 4. The brief seclusion of an inmate in a temporary holding cell. B. Under no circumstances shall the TTM's be used for punishment or as a substitute for treatment. C. The maximum time an inmate can remain in a TTM for programming or group therapy is two (2) hours. Inmates placed in a TTM for the purpose of visitation or interview shall be removed upon completion of the visit or interview. V. TEMPORARY HOLDING CELL Page 3 of 4 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: THERAPEUTIC TREATMENT MODULES NO: D-370 FILE: TREATMENT MODULES A. A TTM may be used as a temporary holding cell to briefly seclude an inmate, and only under the following circumstances- 1. To separate an inmate who appears to be experiencing emotional or behavioral distress, anxiety, or other crisis that necessitates referral to Health Services. An inmate may be placed into a TTM while waiting for Health Services staff to respond, evaluate, and determine an appropriate plan for the inmate's safety and well-being. 2. To provide for the separation of inmates, enabling the reestablishment of order subsequent to an altercation or other disturbance. The TTM's may be used in conjunction with other areas of separation that include the gymnasiums and classrooms, while waiting for Population Management to determine the resultant housing transfers. B. Anytime a TTM is used as a temporary holding cell, the Facility Sergeant shall be notified. C. The maximum time an inmate can remain in a TTM for the purpose of temporary seclusion is one (1) hour. The time of placement, as well as the projected maximum time requiring removal shall be documented on a dry erase board, posted adjacent to the TTM. D. The inmate's placement into and removal from the TTM shall be documented via the OffenderTrak system via the barcode scanner or by manual input. E. Inmates placed in a TTM may be handcuffed if they are not compliant with direction from staff. Inmates should be uncuffed when safe to do so to assist in deescalating the situation. F. The use of the TTM shall be noted on any corresponding incident report. Page 4 of 4