Improving Care in NYC Jail System for Transgender Patients and Patients Reporting Sexual Assault

Correctional settings create unique challenges for patients with special needs and providers charged with their care. Two groups of patients that are known to face difficulties in jail are transgender patients and those reporting sexual assault. We undertook a review of the size of these two populations and the adequacy of care for them. Although the size of the entire LGBT population is difficult to identify, transgender patients currently undergoing hormonal treatment were identified using correctional pharmacy records. A short face to face survey was conducted to evaluate their care in the community prior to incarceration, medical care in jail and experience of the jail environment. Survey findings and analysis of patient complaints revealed opportunities for improvement in the provision of care and staff understanding of this special population. Informed by the results of this survey, we developed and conducted LGBT training in all 11 jail clinics for medical, nursing and mental health staff. The training format was open discussion with a slide set of common concerns regarding LGBT identities, medical care information and reporting back to staff issues raised in our surveys. Trainings also included a “myth or fact” session and simple steps to remove barriers to care. The effectiveness of this training was assessed by reviewing patient complaints, which dropped by over 50% in the 3 months post training. Sexual assault in correctional settings is a well-documented, yet extremely polarizing topic. Due to an increase in reports of sexual assault within our system, we undertook a review of all policies and practices regarding care for these patients. While the number of reports of patients with mental illness and self-reported LGBT status are overrepresented in this group, it was clear that some patients reporting sexual assault missed services that they should receive, such as a mental health visit. With the goal of standardizing care and reporting procedures, sexual assault training was developed and conducted in all jails. This training was modeled after the LGBT training in its format and scope. Questions that came up during the training informed future sessions and led us to more carefully delineate areas of ambiguity in the policy. Important policy clarifications included rape kit collection, handling of sexual harassment versus assault reports, and communication with custody and security staff. Evaluation of this work was accomplished by review of patients who missed required services, which dropped from over 20% to less than 5%.