Family Planning on the Inside Survey

A Guidebook
for
Integrating
Family Planning
Services
and Corrections
This publication was made possible by grant number 6FPHPA060898-24-01,
from the U.S. Department of Health and Human Services (DHHS), Office of
Family Planning, Public Health Region VI to the Texas Department of State Health
Services, Community Health Services, Family Planning on the Inside Project.
A Guidebook for Integrating Family Planning Services and
Corrections
A product of the Region VI Family Planning on the Inside Project
This publication was made possible by grant # 6 FPHPA060898-24-01 from the U.S. Department of
Health and Human Services (DHHS), Office of Family Planning, Public Health Region VI to the Texas
Department of State Health Services, Community Health Services, Family Planning on the Inside Project.
Produced by: Center for Health Training
Written by:
Kimberly Petrilli, Center for Health Training
With Special Thanks to Shannon Walton, MSSW
Layout assistance provided by:
Lori Weber, Center for Health Training
Acknowledgements
This manual is the culmination of a three-year long project and would not have been possible without the
support and passion of many people. It is their dedication to family planning and their support of this
project that allowed this guidebook to be created.
Original workgroup members included:
Norma Alvarez, Janet Lawson, Patricia Palm, Mary McIntosh, Debbie Hardin; Texas Department of State
Health Services
Patricio Gonzales, Diana Martinez; Planned Parenthood of Hidalgo County
Amanda Stukenberg, Planned Parenthood of Cameron-Willacy
Diane Gillit, South Plains Community Action Association
Eva Dickens, North Central Texas Medical Foundation- Wilson Family Planning Clinic
Pat Stone, Planned Parenthood of Central Texas/Waco
Betty Hoover, Planned Parenthood Center of El Paso
Ramonita Cardona, Community Council of South Central Texas
Kathie Karnes, South Plains Community Action Association
Input from the following reviewers ensured that the content of the manual was relevant and made sense:
Norma Alvarez, Sandy Rice, Shannon Walton, Ramonita Cardona, Amanda Stukenberg
Special Thanks to Patricio Gonzalez and Diana Martinez at Planned Parenthood of Hidalgo County,
Carolyn Nelson-Becker at UTMB Regional Maternal and Child Health Program, Belinda GarciaRattenbury and Maria Torres at the University Health System, Meryl Cohen and Susan Rokes at Planned
Parenthood of Houston and Southeast Texas, and Sandy Rice with the Center for Health Training for their
willingness to share information about their projects and to act as ongoing resources to other family
planning providers.
Table of Contents
Introduction
Family Planning on the Inside Project Description
Texas Issues
1
2
Public Health and Corrections: A Perfect Match
Prison Work is Important
The Role of Family Planning Providers
4
4
Gender Considerations
Female Prisoners
Male Prisoners
6
7
Planning Your Agency’s Corrections Project
Step by Step
Special Issues in Service Delivery
Barriers to Service
8
9
10
Promising Practices
Planned Parenthood of Hidalgo County
University of Texas Medical Branch: Services by the Sea
Bexar County University Health Service
Planned Parenthood of Houston and Southeast Texas
Woman to Woman: Peer Education at Its Best
11
12
13
13
14
Wisdom from the Outside In
16
Summary
17
Appendices
FPI Survey Data Summary
A Guide to Correctional Facilities
Glossary of Terms
Selected Resources on Provision of Health Services
to Current or Former Prisoners
Online Resources or Collaboration with Corrections :
Correctional System Contacts
Online Resources for Collaboration with Corrections:
Non-profit Organizations Serving Inmates and Ex-offenders in Texas
National Resources of Interest
Texas Jails
Sample Activity: The GYN Exam
i
iii
vi
ix
xii
xiii
xiv
xv
xxvi
Introduction
Family Planning services can take on many forms. It can be performing well woman exams,
talking with a client about birth control, STI/HIV testing and treatment, general physiological
education and much more. Ultimately, the goal of family planning is to make sure that a person
has a healthy reproductive system and is able to decide if/when they choose to have children. As
you look through this guidebook, you will see that we refer to family planning as any activity
that works toward the ultimate goal of reproductive health. You and/or your agency may not be
able to provide comprehensive family planning services but anything you do can make a
difference.
This guidebook was created to help family planning service providers begin building connections
with the correctional system so that they may work together to provide family planning services
to current and past offenders. The correctional system can be a complicated and confusing
system for those on the outside and although we are not able to cover every detail, we hope that
we can help with some of the basic steps you can take to meet the needs of those that are
incarcerated.
Family Planning on the Inside Project Description
With the support of a three-year grant to the Texas Department of State Health Services from the
Title X Program of the U.S. Department of Health and Human Services, Office of Family
Planning – Region VI, the Texas Family Planning on the Inside (FPI) Project sought to increase
outreach and access to services for those who are currently or have been involved in the
correctional system. In the initial phase of the project we assessed the current status of family
planning services for the incarcerated and/or recently released across the state. A workgroup of
family planning providers was formed to give guidance to the project (a list of workgroup
members is available on the inside cover). The assessment findings provided a baseline for the
workgroup to develop guidelines for linking with correctional facilities.
1
During this phase, all Title X family planning providers were sent a survey to determine what
level of work was being done with the correctional population and what support they needed in
providing services to this special population. What we found was that the majority of
respondents are currently serving this population by providing education, testing and/or
treatment. However, few providers have a collaborative agreement with a local correctional
facility and only 19% have received training on issues related to service provision for offenders
and ex-offenders. (For more details about the survey results, see pages i-ii of the Appendix)
Yet despite the low numbers of formal collaborations, family planning service providers
recognize the importance of serving this population, and have been successful in providing
services despite the barriers that have inhibited their agency’s ability to collaborate with the
correctional system. Thanks to their knowledge and experiences, the FPI Project was able to
develop this resource guide to support family planning staff to build relationships with local
correctional facilities to meet the reproductive health and educational needs of offenders and exoffenders in Texas.
Texas Issues
According to a July 2004 report by the U.S. Justice Department, more than 6.9 million adult
Americans are under some form of correctional supervision (defined as being in prison, jail, or
supervised on probation or parole). This translates into one in thirty-two adults living in the
United State being involved in the correction system; 54% of those in bureau custody are on a
drug offense1.
As of August 2003, 148,152 offenders were confined in Texas prisons, state jails and substance
abuse facilities, 76,427 persons were on supervised parole and 434,701 were under community
supervision2. These high numbers make Texas’ incarceration rate four times greater than twothirds of the countries in the world, and while men still comprise the majority of people
incarcerated in Texas, the imprisonment of women has increased at twice the rate of men
throughout the past decade3.
1
Statistic retrieved from Bureau of Prisons website, Quick Facts. www.bop.gov
Texas Department of Criminal Justice Fiscal Year 2003 Statistical Report.
3
Schiraldi V., Ziedenber J. Texas Tough: Three years later. (2003). Justice Policy Institute.
2
2
The current Criminal Justice system is required to provide health care and clinical services on
site including general health screenings, testing for TB and testing for STI/HIV infection. In
Texas, the Texas Department of Criminal Justice (TDCJ) maintains a contract with the
Correctional Managed Health Care Committee (CMHCC) to obtain correctional health services
through the University of Texas Medical Branch at Galveston (UTMB) and Texas Tech
University Health Sciences Center.
In local and/or county jails, the county will often contract with the local county health
department or another agency, including family planning agencies, to provide medical services to
men and women in the facility. Yet despite these systems, many offenders continue to face
barriers that impede their access to care. Health services often vary from facility to facility based
on available funds, staff, and need. Lack of information, stigma and a complicated system all
influence an offender’s ability to access care while incarcerated. Once released, many are lost to
follow up due to lack of coordination of referrals and knowledge of resources for continued care.
3
Public Health and Corrections:
A Perfect Match
Prison work is Important
For many communities, correctional facilities seem very far removed from daily life. Yet,
correctional facilities and their inhabitants are very much tied to the life and health of the
community. For one thing, most inmates get out. Almost every person who is incarcerated in jail
and 97% of those incarcerated in prison will eventually be released4. Their health at release will
directly impact the overall health of the community. Better health services and education for
inmates results in benefits to communities and society at large5. Family planning providers can
play a special role that will impact both the health of the prisoner and the health of the
community.
The Role of Family Planning Providers
Health Care providers have many unique and special roles in the correctional system.
•
Education
o Inmates frequently have a history of violence, sexual abuse, addiction and/or
mental illness which puts them at greater risk for infectious disease. Rates of
HIV/AIDS, Hepatitis C, and active tuberculosis are all higher among prison
inmates than the general population6. These high prevalence rates are often
exacerbated by overcrowded facilities and few health education resources.
Additionally, safer sex tools and bleach are considered contraband. Thus, inmates
who have sex (consensual or not) or who share needles are at risk for transmitting
these diseases7. Providing prisoners with information and access to testing
reduces the risk of transmission.
4
The Report of the Re-Entry Policy Council. Available at www.re-entrypolicy.org
The Need for a Public Health Model for Correctional Health Care. Massachusetts Public Health Association.
6
Davis, L., Pacchiana, S. (2003). “Health Profiles of the State Prison Population and Returning Offenders: Public
Health Challenges,” Journal of Correctional Care.
7
Understanding Prison Health Care: Communicable Diseases. Retrieved from http://www.movementbuilding.org
5
4
o Involving offenders in their own health care will help them acquire skills and
knowledge to avoid health risks. Increasing the educational components of health
services increases awareness about the risk of infectious disease and will help
promote taking a more active role with their provider8.
•
Advocacy
o Advocacy can take many different forms, including educating a patient about
STIs, contraception and preventative health care, speaking up for a patient when
they are unable to do so, and reducing barriers to health care.
•
Clinical Services
o Correctional facilities recognize the importance of practices that are commonly
performed by family planning professionals, such as reproductive health
education, screening, and treatment. Unfortunately, correctional health
professionals may often be overwhelmed with limited staff and budgets geared
toward other acute and chronic health problems of inmates, so that the issues of
primary focus to family planners can be a low priority.
•
A Focus on Family Planning
o Since sexual activity is forbidden in most prisons and jails, it is easy for family
planning issues to be overlooked. Outside providers can offer a focus on
reproductive health by addressing the current and future family planning needs of
the offender through services and education.
•
“Safety Net”
o The majority of prisoners come from an impoverished background and it is likely
that “safety-net” providers will be the source of health care for them upon
release9. Family planning providers, in particular, have a set of skills and
experiences that are critical to improving the health status of this group and
reducing the public health risks that they can present to their communities as they
cycle between incarceration and the free world.
8
The Need for a Public Health Model for Correctional Health Care. Massachusetts Public Health Association.
Davis, L., Pacchiana, S. (2003). “Health Profiles of the State Prison Population and Returning Offenders: Public
Health Challenges,” Journal of Correctional Care.
9
5
Gender Considerations
Female Prisoners
The typical female offender10:
•
Is between 25-29 years of age,
•
Is unmarried with children,
•
Has a low education and skill level,
•
Is likely a victim of child sexual abuse and/or victim of physical violence, and
•
Has a past or current alcohol or drug addiction.
Things to keep in mind:
•
The Prison System was developed under a military model, which assumes a healthy, male
population. In a prison system primarily designed for men, women's health needs are
often not addressed by prison policy, programs and procedures11.
•
Women have special needs related to reproductive health that need to be identified and
addressed. For women prisoners, a lack of regular gynecological and breast exams
combined with a history of abuse and lack of previous health care in their communities
put them at great risk for having high-risk pregnancies and for developing life-threatening
illnesses such as HIV/AIDS, Hepatitis C and HPV/Cervical Cancer12.
•
Approximately 6% of women offenders are pregnant at the time of admission13.
Pregnancies among incarcerated women are often considered to be high-risk and many
are complicated by drug and alcohol abuse, smoking and sexually transmitted infections.
These factors, if combined with poor social supports and histories of abuse, put these
10
The Public Health Burden in Correctional Facilities. Massachusetts Public Health Association.
Women’s Health Care: Barriers to Care. Legal Services for Prisoners with Children.
12
Baldwin, K., Jones, J. (2000). Health Issues Specific to Incarcerated Women: Information for State Maternal and
Child Health Programs.
13
Greenfield, LA, Snell, TL. (1999). Women Offenders. Bureau of Justice Statistical Report NCJ 175688.
Washington, DC: US Department of Justice.
11
6
women and their newborns at even greater risk for increased peri-natal and postnatal
difficulties, even death14.
•
Healthcare providers who provide prenatal care to women prisoners improve birth
outcomes, prevent the vertical transmission of HIV and educate women about healthy
pregnancies and healthy babies15.
•
Abusive experience and addiction are risk factors for a poor health status. Once
incarcerated, this risk can multiply.
•
In multiple prisons throughout the United States, women are victims of sexual abuse and
rape by prison staff and other prisoners putting them at risk for infections and diseases14.
Health care providers must be prepared to address these issues.
Male Prisoners
The typical male offender16:
•
Is below the age of 35 years,
•
Belongs to an ethnic or racial minority,
•
Has a past or current history of alcohol and/or drug abuse, and
•
Has a high school diploma or equivalent.
Things to keep in mind:
•
When it comes to preventative health services, men are an underserved population. This
is due to resistance, reinforced by gender norms and limited access to male-friendly
health care services.
•
Male offenders are at an increased risk of HIV infection. Anal sex (consensual or forced)
puts men at extremely high risk for HIV. Although sexual behavior is against correctional
rules, some men participate in unprotected sexual acts while behind bars.
•
Men play a significant role in heterosexual transmission of HIV. The majority of
prisoners are released back into the community where they participate in sexual behaviors
with one or more partners. Educating men about STI/HIV prevention and testing will
help reduce the rate of their own risk as well as their partners.
14
Understanding Prison Health Care: Women’s Health. Retrieved from: http://www.movementbuilding.org
The Public Health Burden in Correctional Facilities. Massachusetts Public Health Association.
16
Statistic retrieved from Bureau of Justice Statistics website: http://www.ojp.gov/bjs/crimoff.htm#feds
15
7
Planning Your Agency’s Corrections
Project
Step by Step
1. Learn about your local correctional facility
•
Contact your local correctional facility. See pages iii-v of the Appendix for descriptions
of the main types of correctional facilities.
•
Ask your local sheriff and/or police chief.
•
Look on the Internet. A list of Internet resources is available in the Appendix, pages ixxiv.
2. Find out if there is anyone in your community already working with offenders.
•
If so, maybe you can work together.
3. Establish a relationship with the correctional authorities.
•
Family planning and corrections are very different. In order to collaborate, you have to
build a solid foundation on which to establish a relationship.
Helpful Hints
•
•
•
Acknowledge and respect the differences between the two agency’s mission
and goals
o Family planning agencies exist to improve the health and lives of their
clients and communities. Correctional facilities aim to protect society
and reduce crime. These are obviously very different goals so it is
helpful to keep them in mind and anticipate any conflicts or confusion
that could arise from the differences.
Ask them what they need and want from you!
o The needs and wants of each facility will differ. The best way to find out
those differences is to ask.
Be flexible
o Correctional schedules are very structured. Remember to consider the
prison’s hours of operation as well as the schedule of the group you are
hoping to serve. In large facilities, meal times and yard times are
stacked; meaning that not all inmates are in the same area at the same
time. Also, be prepared to be interrupted at any time for a head count, a
lockdown or any other reason.
8
4. Brainstorm ideas.
Could your agency…?
•
Build a peer education program among inmates.
•
Provide educational programs and workshops to staff and inmates.
•
Provide a range of family planning clinic services at the facility.
•
Create a referral service that includes discharge planning to allow for continuity of
services from prison to community.
•
Work with the facility to provide clinic services at your agency’s facility.
•
Work with parole officers to serve newly released offenders.
5. Provide training for staff (both correctional and clinic).
•
On security issues,
•
Facility policies and rules, and
•
Responsibility of family planning staff and correctional staff.
6. Start small and build from there.
•
Approach just one facility first and take some time to establish a relationship with that
staff.
•
Offer to provide one or two services to begin with, such as providing group classes, or
limiting clinical services.
Special Issues in Service Delivery
The correctional system has its own culture and inner workings that are often hard for someone
on the outside to figure out. Here are just a few things to keep in mind:
1. Security Concerns.
•
Security will always be the number one priority of a correctional facility.
•
FP activities must happen within the overall structure and procedures of the facility.
9
2. Confidentiality
•
Do your best at maintaining confidentiality, but recognize privacy is rare in correctional
facilities.
3. Follow-up
•
The correctional population is constantly shifting. Aim for follow-up, but act like each
appointment is your only chance to see a patient.
Barriers to Service
With any program, there are hurdles to jump. Here are a few of the most problematic ones to
keep in mind:
•
Inmates lack information about STIs and reproductive health.
•
Testing is usually done only if symptomatic.
•
Sexual activity in Texas prisons is prohibited and any sort of safer sex tools (including
condoms) are considered contraband.
•
Texas does not allow conjugal visits; therefore, there may be an assumption that there is
no need for STI testing, safer sex tools or contraception.
•
A complicated process to access services prohibits routine care.
10
Promising Practices
Many agencies have responded to the need and opportunity of working with the corrections
population. Below are a few that have been successful at jumping the hurdles and collaborating
with their local correctional facilities. Hopefully these will provide some guidance on the many
different ways family planning agencies can work with the correctional population.
Planned Parenthood of Hidalgo County
“Once you overcome the fear it will be smooth sailing17.”
Planned Parenthood of Hidalgo County (PPHC) recognized the impact they could have on the
health of their community by outreaching to the correctional population. In 1997, they began
providing services to the Edinburg Bootcamp program. Their positive experiences with the
Bootcamp encouraged them to pursue other collaborative efforts. They quickly began working
with inmates in the Starr County Jail followed by those in the local substance abuse centers.
Currently, they are hoping to be able to build a relationship with the women’s county jail so that
they may begin providing services there.
Since the inception of their program, PPHC has been able to provide a variety of services. They
always start with education about reproductive health, then follow it up with as many clinical
services as they are able to provide including: physical exams, STD testing, HIV screenings,
reproductive screenings (pap and pelvic) and breast exams. They also have a referral system in
place so that once inmates have left they can continue to receive services.
How did they get inside?
Once PPHC recognized the gap in health services provided to the inmates in their community
they chose to build a five-year plan that included serving those who engage in high-risk
behaviors. Below are the steps they took:
17
Quote from conversation with Patricio Gonzalez, CEO. Planned Parenthood of Hidalgo County.
11
1. They identified a point of contact for the local facility. They found that the infirmary is
usually a good place to begin.
2. They set up a meeting to discuss what they could offer the facility (family planning, STI
testing and treatment, education), and to provide education to those who make the
decisions for the facilities.
3. Together, the correctional facility and PPHC set up an agreement in writing to cover all
bases were covered before beginning to provide services.
4. They provided training to PPHC staff to introduce them to the correctional environment
and go over all security/safety precautions.
5. They started providing services, remembering to stay flexible and keep the lines of
communication open with the correctional staff.
It has been the immense support of the correctional facility staff that has helped PPHC be
successful at providing such a diverse range of services. According to Patricio Gonzales, CEO, if
you have the support of the medical personnel there is a 95% chance of being able to get in18.
For more information about the PPHC program contact: Patricio Gonzales, CEO at (956) 6883700 X3703 or Diana Martinez at X3709.
University of Texas Medical Branch: Services by the Sea
“Prisoners are brought from the back door straight to the exam room so
that they don’t have to be paraded in chains in front of other waiting patients19.”
The University of Texas Medical Branch’s Maternal and Child Health Program responded to the
needs of their local correctional facility when they had no one else to turn to. About 20 years
ago, UTMB began providing the city and county jails in East and Southeast Texas with family
planning services. Their program is designed to provide all services that fall within their scope
including family planning, office gynecology, dysplasia care and prenatal services to female
inmates. They are able to provide such a broad range of services by providing care at their
regular clinics with the cooperation of the correctional facility. Although they prefer to have a
18
19
Quote from conversation with Patricio Gonzalez, CEO of Planned Parenthood of Hidalgo County
Quote retrieved from questionnaire from Carolyn Nelson-Becker, UTMB
12
working agreement with the facility, UTMB will not turn away correctional patients even if an
agreement is not in place. Although other programs bring services into the correctional facility,
they feel that one of the advantages to having services provided at the clinic site is that the
inmate knows where to go for services in the future. The best part of it all is, “having the ladies
come back to us after being released from jail20.” For more information about UTMB program
and services, contact Carolyn Nelson-Becker at [email protected] or (409) 772-2388.
Bexar County University Hospital System
“There is so much need21.”
For years, the Bexar County University Hospital System has been providing educational
outreach in their local Juvenile Detention Centers. Two times a month, an educator enters
through security gates to talk with adolescents about healthy relationships, STDs, birth control,
decision-making and building a healthy self-esteem. Although they acknowledge that the work is
difficult, they also know how important it is to work with a population that is so much in need of
information and guidance. Some of these kids are “angry and don’t want to cooperate,” but
people who take the time to “find out what they really want to know,” 22 would be surprised.
According to the experiences of their current educator, many youth don’t even have basic
knowledge about their reproductive system. Any and all information needs to be offered. To
learn more about the work UHS does in juvenile facilities, contact Mary Torres at:
[email protected] or (210) 358-3246.
Planned Parenthood of Houston and Southeast Texas
“We like going into jails because we can access the people who are at high risk,
it’s indoor and there is a captive audience23.”
Planned Parenthood of Houston and Southeast Texas has spent the past few years building
relationships will the local correctional facilities so that they could provide HIV counseling,
testing and prevention case management. They currently provide access to these services for all
20
Quote retrieved by questionnaire from Carolyn Nelson-Becker, UTMB
Quote retrieved during interview with Maria Torres, UHS Educator
22
Quote retrieved during interview with Maria Torres, UHS Educator
23
Quote retrieved by questionnaire by Susan Rokes, Planned Parenthood of Houston and Southeast Texas
21
13
those who are incarcerated in a non-state correctional facility, including youth at boot camps.
Although they have faced barriers such as staff changes that result in less acceptance and access,
medical service company changes and confidentiality issues with jail personnel, the overall
experience has been very positive. “The jails have high rates of HIV, so it has long been
considered a great venue for finding high-risk individuals to test24.” One of their greatest
successes has been to have all known injecting drug users at the Montgomery County Jail be
automatically referred for HIV testing by the staff at the correctional facility.
Planned Parenthood of Houston and Southeast Texas attributes part of their success to their
counselor’s commitment and flexibility that has allowed them to build long-standing
relationships with several facilities. “Counselors have to be prepared to wait, to change
schedules, to be locked in or out, to quit early, to deal with tense situations and the behaviors of
those who are locked up23.” For more information about this program, contact Susan Rokes at:
[email protected].
Woman to Woman: Peer Education at Its Best
“The very reasons we’re here—domestic violence, low self-esteem—shows we need to change,
we can change how we think about ourselves, how we present ourselves to others.”26
Over the past several years, well over one hundred inmates have been trained as peer educators
through two projects in Texas Department of Criminal Justice facilities. The first project, a
collaborative partnership among Texas Department of Criminal Justice (TDCJ), University of
Texas Medical Branch at Galveston, Texas Tech University Health Science Center, AIDS
Foundation of Houston Inc (AFH), Department of Health and Human Services-Office of
Women’s Health (DHHS-OWH), and Center for Health Training (CHT)—Wall Talk—focuses
on infectious diseases, including HIV, STDs, TB and Hepatitis. Both male and female inmates
were trained to teach other inmates about these topics. Wall Talk is used in 65 TDCJ units and
through these classes, thousands of inmates have learned how to better care for their health.
24
25
Quote retrieved by questionnaire from Susan Rokes, Planned Parenthood of Houston and Southeast Texas
Peer educator comment during Woman to Woman inservice, January 19, 2005.
14
CHT and DHHS-OWH, produced a second manual that provides a basic overview of women’s
bodies, how they work and how to care for them. It covers six physiological systems and
promotes a philosophy of self-care and self-responsibility. This focus on individual
responsibility, prevention, and women’s health wellness is a cost-effective and efficient strategy
to improve women’s health. For many inmates, this philosophy is a radical departure from old
ways of viewing health care. (A sample activity is available beginning page xxvi of the
appendix)
The training manual, named Woman to Woman: Inside and Out at the suggestion of inmates, has
been enthusiastically embraced not only by the peer educators, but also by the women in their
classes. After teaching her first class, one inmate reported, “They really were not excited about
being there and had no idea what it was. But once we got started and once we really got into it
they LOVED IT!!!”27
“I like this class…you peer educators only make me hunger for this good knowledge.”28
Woman to Woman: Inside and Out can be used with community populations as well as inmates,
and can be ordered from: www.centerforhealthtraining.org Click on “Materials and Resources.”
For information on train-the-trainer sessions, contact Sandy Rice at: [email protected].
For additional information about Wall Talk, or to obtain a copy of Wall Talk, contact:
Kelly McCann at AIDS Foundation of Houston, (713) 623-6796 or [email protected].
27
Letter to Sandy Rice (Woman to Woman co-author, peer educator trainer) from LJ, TDCJ inmate, September 5,
2004.
28
Student inmate feedback after participating in Woman to Woman classes, Fall, 2004.
15
Wisdom from the Outside In
All of these agencies have spent a lot of time learning the inner workings of the correctional
system. Here are just a few of their words of wisdom:
•
Meet the client (offender) where they are, otherwise you are just another person who
doesn’t understand them.
•
Be prepared to make a long-term commitment.
•
Only provide/offer information in writing that is permitted and approved by the facility.
Keep it short. Keep it simple.
•
Introduce staff to the environment that they will work in during training, including safety
routes, procedures, personal safety, etc.
•
Remember you are there to provide services, not to change the system. You are on their
turf, play by their rules.
•
If you decide to have services provided at your clinic, invite correctional staff to the
clinic so that they will understand the physical layout.
•
Scheduling has to be decided and everyone must agree to it. And of course, you should
be paid for your work.
•
Be very, very flexible, when working with juveniles. They attend school all day, so they
may only be open to visits on the weekends and during breaks.
•
Always ask before doing anything. The situation is different each time you go.
•
Be willing to be a risk taker, be willing to change.
16
Summary
Taking on a collaborative relationship with the correctional system may be a daunting idea; but
hopefully with the help of this guidebook and the wisdom of those who have begun paving the
way for future family planning providers, we can begin to work with this in-need and at-risk
population. Doing outreach and service delivery in correctional facilities allows providers to
reach a population that is largely underserved and difficult to reach in the community. It will
ultimately benefit the individual, the community and society at large by reducing disease rates
and allowing for better use of the health care system29. Yet perhaps more importantly,
correctional facilities and their inhabitants need the services and knowledge that family planning
providers can provide. Those who are the most in need are often the hardest to reach. Good luck!
29
The Public Health Burden in Correctional Facilities. Massachusetts Public Health Association.
17
Appendix
ii
Family Planning on the Inside Survey
Data Summary
Forty-three family planning providers in the state of Texas receive Title X monies and were
asked to complete the survey. Of these, 20 (47%) provided responses to the Family Planning
Inside (FPI) survey. The following data summary reflects these 20 responses.
Service, Collaboration and Policy
•
Of the 20 Title X providers who responded, 16 serve people who are incarcerated, on
community supervision (parole or probation) or otherwise recently released from a
correctional facility.
•
Of those 16, 38% (6) have adopted a policy that addresses outreach education and/or
clinical services for that special population.
•
Only 31% (5) participate in a local collaboration or partnership that addresses issues
related to reintegration of offenders back into the community.
Service Provision
•
For those agencies that provide services, most (75-88%) provide services to women, both
adolescent and adult, with half (50%) providing services to men.
•
For many clinics, the majority of clients were in a local jail (63%), substance abuse
treatment facility (56%) or a local youth correctional authority facility (56%).
•
Delivery of services is split between agency staff traveling to the correctional facility
(56%) and correctional staff transporting the client to the clinic (44%). Some clinics also
service clients through street outreach, half-way houses and walk-ins.
•
The majority of clients (63%) are self-referred with only six clinics (38%) having a
collaborative agreement with a correctional facility.
•
The range of services delivered varies greatly. Eighty-eight percent of clinics that provide
services to the corrections population provide individual health education and counseling,
family planning exams and STD testing to females. Ninety-four percent provide STD
treatment to females.
•
The most common services provided by those who work with the male correctional
population include: individual health education and counseling (56%), STD treatment
(50%), group health education (44%) and STD testing (44%).
•
Only three of the 16 clinics provide family planning exams to males.
i
Training and Data Collection
•
Three out of the 16 (19%) have received training on issues related to service provision to
that special population. Of those who did receive training, they commented that training
was limited and targeted to correctional facility policies/procedures and/or targeted
services (such as HIV/AIDS prevention and management).
•
Out of those 16 Title X sites, six (38%) collect data and track the numbers of clients
served out of the correction population. Data collection and tracking methods range from
medical evaluation to intake forms and class logs.
Barriers to providing care
•
When asked about the reasons for not providing services to the correctional population,
two of four agencies who do not provide services felt that it would require additional
provider training.
•
Two of the four had provided targeted services previously.
•
One stated that they were told that inmates did not show an interest in women’s health
and birth control.
Overall, providers appear to recognize the importance of providing services to the correctional
population. Several providers stated that they do not provide targeted services to this special
population, but that they serve them on a self-referral basis. Others stated that they were excited
about this project and interested in participating in the advisory group for the FPI manual.
ii
A Guide to Correctional Facilities
State Facilities
State facilities are overseen by the Texas Department of Criminal Justice. They are designed for
offenders who have been convicted of breaking state law and are located throughout the state.
Most often they are run by state authorized governments such as a county and/or city, but some
are private contractors hired to oversee the facility.
Local Jail
The local jail is typically controlled by the county or municipality. The jail is used to house
those who have been charged of a crime, but not yet convicted, offenders who have been
convicted and sentenced to less than 12 months and prison parolees who have violated their
conditions of release. The local prison is generally used as a holding space. The population
varies greatly and there is a high rate of turnover.
State Jail
The state jail is managed by TDCJ and is designed for felony non-violent and drug related
offenders who have sentences of more than 75 days, but less than 2 years. State Jail offenders are
required to serve their full sentence as they are not eligible for parole.
State Prison
State Prison is designed for offenders who have been convicted of a felony and sentenced to 2
years to life. Many state prisons are managed by TDCJ, but there are some that are contracted
out to private companies.
Juvenile Youth Center
Juvenile Youth Centers are short-term, secure facilities that are operated by the local juvenile
probation department and/or private contractors and are designed to protect the community and
child from harm and to assure appearance in court. Juvenile facilities are not operated on a
federal level.
iii
Texas Youth Commission Facilities
The Texas Youth Commission (TYC) is responsible for fifteen secure institutions and nine
residential halfway houses and/or community based residential programs for the state of Texas.
TYC serves approximately three percent of the juvenile offenders that are deemed most
chronically problematic and/or violent. Youth are eligible for the TYC system when they commit
offenses between the ages of ten and seventeen years.
Federal Correctional Institutions (FCIs)
Federal facilities are designed for those who have been convicted of violating a federal law, or
those who are awaiting trial for violating a federal law. Federal facilities are located throughout
the United States and are categorized by the level of security at the site and the structure of the
facility. Currently there are six FCIs in Texas.
Minimum Security
Minimum Security facilities are also known as Federal Prison Camps (FPCs). They are designed
to be work/program-oriented and are often located next to a larger institution for whom they
provide labor. Inmates are housed in dormitory-style housing, are secured with limited or no
perimeter fencing and are supervised by minimal staff.
Low Security
Low security facilities are designed for offenders who are not considered violent or high threat.
They have double-fenced perimeters, dormitory/cubicle style housing and a higher staff-toinmate ratio than minimum security facilities. Low-security facilities also have strong work and
program components.
Medium Security
Theses facilities have strengthened perimeters (double fences, electric detection systems) and
house offenders in cell-type housing, have a higher staff-to-inmate ratio and provide a variety of
work and treatment programs.
iv
High Security
Facilities that are considered high security are also known as United States Penitentiaries (USPs).
They have strong perimeters, the highest staff-to-inmate ratio, cell housing and maintain close
control over inmate movement.
Administrative Facilities
Administrative facilities are those with a special mission such as holding pre-trial offenders or
escape-prone inmates. Included under the umbrella of administrative facilities are: Metropolitan
Correctional Centers (MCC’s), Metropolitan Detention Centers (MDC’s), Federal Detention
Center (FDC’s), Federal Medical Center (FMC’s), Federal Transfer Center (FTC), Medical
Center for Federal Prisoners (MCFP), and the Administrative-Maximum (ADX) U.S.
Penitentiary. Administrative facilities are capable of holding inmates in all security categories.
Other Facilities
In addition to State and Federal Correctional Facilities, there are several other types of facilities
that serve offenders. Some are run by the State system while others are private contractors who
work to assist offenders. All of them have a specific goal.
Substance Abuse Facilities
Substance abuse treatment facilities provide intensive therapeutic treatment for offenders who
are sentenced by a judge as a condition of community supervision or as a modification of
parole/community supervision.
Half-way Houses
Half-way houses are residential facilities that serve offenders who are working to reintegrate
back into society. Often these programs mandate a work and/or educational component in an
effort to increase the skills and employability of the offender.
v
Glossary of Terms
(An extended glossary is available at: http://www.cjpc.state.tx.us/glossary/glossary.html)
Boot Camp – residential program that is highly regimented, military-like and short-term (90-180
days) where offenders are provided with strict discipline, physical training, and hard labor
resembling some aspects of basic military training. Typically targets young, first-time offenders.
They may also offer education, life-skills training and substance abuse education.
Bureau of Prisons (BOP) – component of the United States Department of Justice and oversees
the National Institute of Corrections which administers United States Penitentiaries (USPs),
Federal Correctional Institutions, Federal Prison Camps (FPCs), and many other correctional
programs.
Correctional Facility – broad term that encompasses all types of penal institutions in which an
inmate is under correctional control such as jails, prisons, state jails, private prisons, substance
abuse treatment centers, etc.
Correctional Supervision - broad term that encompasses all types of social control of convicted
criminals as they serve out their sentences, such as incarceration in jail or prison, treatment in a
community substance abuse facility, completing programs in transitional living facility, or
reporting to an officer under parole or probation.
Community Supervision - placement of an offender under supervision for a specified length of
time, as ordered by a court, with court-imposed rules and conditions. Community supervision
(formerly called adult probation) may be ordered for misdemeanor or felony offenses and is
generally imposed instead of a jail or prison sentence.
Direct Supervision - level of community supervision requiring offenders to receive a minimum
of one face-to-face contact every three months.
Discharge Release - prison offenders who are released from the Texas Department of Criminal
Justice either by full expiration of their sentence or by court order.
vi
Ex-Offender - term to describe a person convicted of a crime who has completed his/her
sentence and is no longer under correctional supervision. Also known as being “off paper.”
Free World – slang term for life outside of prison/jail.
Halfway House - residential facility with a focus on reintegration of offenders back into the
community after a period of incarceration.
Indirect Supervision - level of community supervision that does not require face-to-face
contact.
Inmate – person who is incarcerated.
Offender – term to describe a person convicted of a crime.
Parole – the conditional release of an offender from prison, by a Board of Pardons and Paroles
decision, to serve the remainder of his/her sentence under supervision in the community, see
“community supervision.”
Parole Revocations – offender returns to TDCJ after their parole has been revoked due to
conviction of a new offense or for technical reasons.
Prison Offenders – offenders with capital, first, second or third degree felony convictions who
are serving their time in a prison setting.
Probation – an alternative to incarceration, a system by which a low-level offender may be
sentenced by the court to be supervised in his/her home community and abide by certain
conditions for a length of time. Probation is different from parole in that it is managed under the
local authority rather than the State Board of Pardons and Parole.
State Jail Offenders – offenders convicted of State jail felony offenses. An individual adjudged
guilty of a State Jail felony offense may be confined to State Jail for a term no more than two
years or less than 75 days. There is no parole or mandatory supervision release from State Jail.
vii
Substance Abuse Felony Punishment Facility (SAFPF or SAFP) - An intensive six-month
therapeutic community program (nine-month program for offenders with special needs) for
offenders who are sentenced by a judge as a condition of community supervision or as a
modification of parole/community supervision.
TYC – Texas Youth Commission, the state system of correctional facilities for offenders who
are under the age of 18 when their crime (felony or 3rd misdemeanor) was committed. TYC units
may house inmates up to age 21, at which time they may be transferred to an adult facility or
released. Most juvenile offenders sentenced to incarceration are not housed by TYC, but rather
the local youth authority.
viii
Selected Resources on Provision of Health Services to
Current or Former Prisoners
Prisoner Health
Understanding Prison Health Care
http://movementbuilding.org/prisonhealth/
Sick in Secret: four-part series on the hidden world of Texas prison health care
http://www.statesman.com/specialreports/content/specialreports/prisons/index.html
The Health Status of Soon-to-be-Released Inmates: A Report to Congress, March 2002
http://www.ncchc.org/pubs/pubs_stbr.html
Infectious Disease and Prisoners
HIV & Hepatitis Education Prison Project at Brown University
http://www.hivcorrections.org/
National Center for HIV, STD, and TB Prevention
http://www.cdc.gov/nchstp
National Hepatitis C Prison Coalition
http://www.hcvinprison.org/
Medical Advocates
http://www.medadvocates.org/marg/incar/main.html
Prisoner Peer Education Models
Insight Prison Project
http://www.insightprisonproject.org/programs
Centerforce
http://www.caps.ucsf.edu/projects/mapindex.html
Center for Health Training
http://www.centerforhealthtraining.org/searchable/pr-6.html
Wall Talk
http://www.aidshelp.org/programs_serves_edu_prison.html
ix
Families and Incarceration
Center for Children of Incarcerated Parents
http://www.e-ccip.org
Federal Resource Center for Children of Prisoners by the Child Welfare League of
America
http://www.cwla.org/programs/incarcerated/default.htm
Family and Corrections Network
http://www.fcnetwork.org/
Prisoners Returning to the Community
Urban Institute Prisoner Reentry Initiative
http://www.urban.org/content/PolicyCenters/Justice/Projects/PrisonerReentry/
overview.htm
TDCJ Rehabilitation and Reentry Programs Division
http://www.tdcj.state.tx.us
(go to organization then programs, then click on rehabilitation and reentry program
division)
Correctional Health & System Authorities
Texas Department of Criminal Justice – Health Services Division
http://www.tdcj.state.tx.us/health/health-home.htm
University of Texas Medical Branch – Correctional Managed Care
http://www.utmb.edu/cmc
Texas Commission on Jail Standards
http://www.tcjs.state.tx.us/
Texas Criminal Justice Policy Council
http://www.cjpc.state.tx.us/
Other Sources of Data on Prisoners and Correctional Health Care
U.S. Department of Justice – Prison Information
http://www.usdoj.gov/prisoninfo.htm
U.S. Department of Justice – Bureau of Justice Statistics
http://www.ojp.usdoj.gov/bjs
National Institute of Corrections
http://www.nicic.org/
x
National Criminal Justice Reference Service
http://www.ncjrs.org/
Corrections Connection
http://www.corrections.com/
National Commission on Correctional Health Care
http://www.ncchc.org/
Information Resources for Potential Funding
Re-Entry Policy Council’s Funding Opportunities
http://www.reentrypolicy.org/resources
Federal Grants Wire
http://www.federalgrantswire.com/federal_grants_by_subject.html
DSHS Funding Information Center’s
Directory of Grant Announcements
http://www.dshs.state.tx.us/fic/fgrants.shtm
Office of the Governor – State Grants Team
http://www.governor.state.tx.us/divisions/stategrants/resources
Fee-Based Grant Search-by-Subject Services
http://fconline.fdncenter.org
http://www.grantstation.com/grantstation/Public/Search_Funders/search_funders_main_p
x.html
Public Welfare Fund
http://www.publicwelfare.org
Met Life Foundation
http://www.metlife.com
Charles Stewart Mott Foundation
http://www.mott.org
xi
Online Resources for Collaboration with Corrections:
Correctional System Contacts
Texas Department of Criminal Justice (TDCJ) Facilities
http://www.tdcj.state.tx.us/stat/unitdirectory/all.htm
TDCJ Rehabilitation and Reentry Programs Division
http://www.tdcj.state.tx.us
(go to organization then programs, then click on rehabilitation and reentry program
division)
Texas Adult Probation Directory by County
(note that some departments cover multiple counties)
http://www.tdcj.state.tx.us/cjad/cjad-phones.htm
http://www.tdcj.state.tx.us/cjad/cjad-directory.pdf
Texas Adult Parole Offices
http://www.tdcj.state.tx.us/parole/parole-home.htm
Texas Youth Commission Facilities
http://www.tyc.state.tx.us/programs/facility_map.html
Windham School District
(manages educational programming in TDCJ)
http://www.windhamschooldistrict.org/divisions/index.php
Texas Juvenile Probation Department Local Contacts
http://www.tjpc.state.tx.us/publications/other/all_juvenile_departments.asp
Federal Bureau of Prisons
http://www.bop.gov
xii
Online Resources for Collaboration with Corrections:
Nonprofit Organizations Serving Inmates and
Ex-Offenders in Texas
Finding Help in Texas
(search by county using terms like inmate, prison, or offender)
https://www.helpintexas.com
Texas Inmate Families Association
http://www.tifa.org/
Crime Prevention Institute
http://www.cpiaustin.org/
MASS (Mothers for the Advancement of Social Systems) Inc.
http://www.massjab.org/
Parents and Children Together, Inc.
http://www.4PACT.org
Texas CURE (Citizens United for Rehabilitation of Errants)
http://www.txcure.org/
The Association of X-offenders (TAX)
http://www.xoffenders.org/
xiii
National Resources of Interest
Family and Corrections Network
http://www.fcnetwork.org/
Reentry National Media Outreach Campaign
http://reentrymediaoutreach.org/
American Correctional Association
http://www.aca.org
Correctional Education Association
http://www.ceanational.org
American Jail Association
http://www.corrections.com/aja/index.shtml
American Correctional Health Service Association
http://www.achsa.org
Centerforce
http://www.centerforce.org/index.cfm
American Social Health Association
http://www.ashastd.org
Stop Prison Rape
http://www.spr.org
xiv
Texas Jails
(Listed alphabetically by county)
Anderson
1200 E. Lacy
Palestine, TX
75801
903/729-6068
903/729-3022
Andrews
Courthouse, Rm. 113
Andrews, TX
79714-6517
432/523-5545
432/523-5954
Angelina
P. O. Box 114
Lufkin, TX
75902-0114
936/634-3331
936/639-4510
Aransas
301 N. Live Oak
Rockport, TX
78382
361/729-2222
361/790-0164
Archer
P. O. Box 51
Archer City, TX
76351-0517
940/574-2571
940/574-2573
Armstrong
P. O. Box 531
Claude, TX
79019-0531
806/226-3151
806/226-3711
Atascosa
1108 Campbell Ave.
Jourdanton, TX
78026
830/769-3434
830/769-2721
Austin
417 N. Chesley
Bellville, TX
77418-1344
979/865-3111
979/865-8271
Bailey
300 S. First
Muleshoe, TX
79034
806/272-4268
806/272-3879
Bandera
P. O. Box 607
Bandera, TX
78003-0607
830/796-4323
830/796-3561
Bastrop
200 Jackson Street
Bastrop, TX
78602
512/303-1080
512/332-0641
Baylor
101 S. Washington
Seymour, TX
76380
940/889-3333
940/889-3915
Bell
P. O. Box 749
Belton, TX
76513-0749
254/933-5400
254/933-5371
Bexar
200 N. Comal
San Antonio, TX
78207-3505
210/335-6010
210/335-6019
Blanco
P. O. Box 365
Johnson City, TX
78636-0365
830/868-7104
830/868-4577
Borden
P. O Box 115
Gail, TX
79738-0115
806/756-4311
806/756-4405
Bosque
P. O. Box 741
Meridian, TX
76665-0741
254/435-2363
254/435-2245
Bowie (P)
100 State Line Avenue
Texarkana, TX
75501
903/798-3512
903/798-3519
Brazoria
3602 CR 45
Angleton, TX
77515
979/849-2441
979/848-800
Brazos
300 E. 26th St., Ste. 105
Bryan, TX
77803-5359
979/361-4100
979/361-4170
Brewster
201 W. Ave. E
Alpine, TX
79830
432/837-3488
432/837-5960
Briscoe
P. O. Box 70
Silverton, TX
79257-0070
806/823-2135
806/823-2141
Brooks
P.O. Box 558
Falfurrias, TX
78355
361/325-3696
361/325-1743
Brown
1050 W. Commerce
Brownwood, TX
76801-1499
325/646-5518
325/643-323
xv
Texas Jails
Burleson
1334 State Hwy. 21 East
Caldwell, TX
77836
979/567-4343
979/567-0615
Burnet
Box 216
Burnet, TX
78611-0216
512/756-8080
512/756-4064
Caldwell
1204 Reed Dr.
Lockhart, TX
78644-2134
512/398-6777
512/398-4376
Calhoun
211 S. Ann
Port Lavaca, TX
77979
361/553-4646
361/553-4668
Callahan
432 Market St.
Baird, TX
79504-3505
325/854-1444
325/854-5998
Cameron
7300 Old Alice Road
Olmito, TX
78575
956/554-6700
956/554-6780
Camp
203 Tapp Street
Pittsburg, TX
75686-1347
903/856-6651
903/856-3681
Carson
P. O. Box 972
Panhandle, TX
79068-0972
806/537-3511
806/537-3514
Cass
P. O. Box 180
Linden, TX
75563-0180
903/756-7511
903/756-5434
Castro
100 E. Bedford
Dimmitt, TX
79027-2643
806/647-3311
806/647-2189
Chambers
P. O. Box 998
Anahuac, TX
77514-0998
409/267-8322
409/267-6736
Cherokee
Rt. 5 Box 275
Rusk, TX
75785-0275
903/683-2271
903/683-2813
Childress
Box 2 Courthouse
Childress, TX
79201-3755
940/937-2535
940/937-3479
Clay
215 W. Gilbert St.
Henrietta, TX
76365-2864
940/538-5611
940/538-5800
Cochran
Courthouse Rm. B-7
Morton, TX
79346-2558
806/266-5211
806/266-5629
Coke
Box 9
Robert Lee, TX
76945-0009
325/453-2717
325/453-2717
Coleman
100 Liveoak St., Ste. 101
Coleman, TX
76834-3533
325/625-3506
325/625-3509
Collin
4300 Community Ave.
McKinney, TX
75070
972/547-5108
972/547-5303
Collingsworth
810 Belton St.
Wellington, TX
79095-2730
806/447-2588
806/447-5037
Colorado
P. O. Box 607
Columbus, TX
78934-0607
979/732-2388
979/732-6431
Comal
3005 W. San Antonio St.
New Braunfels, TX
78130-6963
830/620-3400
830/608-2082
Comanche
300 Industrial Blvd.
Comanche, TX
76442
325/356-7533
325/356-3783
Concho
P. O. Box 67
Paint Rock, TX
76866-0067
325/732-4312
325/732-4307
Cooke
301 S. Chestnut
Gainesville, TX
76240
940/665-3471
940/665-8763
xvi
Texas Jails
Coryell
510 Leon St.
Gatesville, TX
76528-2062
254/865-7201
254/865-7774
Cottle
9th and Richards St.
Paducah, TX
79248-0887
806/492-2145
806/492-2145
Crane
P. O. Box 1175
Crane, TX
79731-1175
432/558-3571
432/558-3743
Crockett
Box 1931
Ozona, TX
76943-1931
325/392-2661
325/392-2045
Crosby
201 W. Aspen St., Room 109
Crosbyton, TX
79322-2500
806/675-7301
806/675-2804
Culberson
P.O. Box 159
Van Horn, TX
79855-0159
432/283-2060
432/283-9002
Dallam
P. O. Box 1240
Dalhart, TX
79022-1240
806/244-2313
806/244-6740
Dallas
133 Industrial Blvd LB 31
Dallas, TX
75207-4313
214/749-8641
214/653-3420
Dawson
P. O. Box 1268
Lamesa, TX
79331-1268
806/872-7560
806/872-9396
Deaf Smith
235 E. 3rd, Room 102
Hereford, TX
79045-5542
806/364-2311
806/363-7058
Delta
200 W. Bonham
Cooper, TX
75432
903/395-2146
903/395-0337
Denton
127 N. Woodrow Ln.
Denton, TX
76205-6397
940/898-5620
940/898-5604
Dewitt
208 E. Live Oak
Cuero, TX
77954-2959
361/275-5734
361/275-3199
Dickens
P. O. Box 59
Dickens, TX
79229-0059
806/623-5533
806/623-5369
Dimmit
103 N 5th St.
Carrizo Springs, TX
78834
830/876-3508
830/876-9263
Donley
Box 910
Clarendon, TX
79226-0910
806/874-3533
806/874-3458
Duval
P. O. Box 547
San Diego, TX
78384
361/279-3351
361/279-2670
Eastland
201 W. White
Eastland, TX
76448-1893
254/629-1774
254/629-2500
Ector
P. O. Box 2066
Odessa, TX
79760-2066
432/335-3050
432/335-3588
Edwards
P. O. Box 156
Rocksprings, TX
78880-0156
830/683-4104
830/683-2459
Ellis
300 S. Jackson
Waxahachie, TX
75165
972/825-4901
972/825-4941
El Paso
Box 125
El Paso, TX
79941-0125
915/546-2006
915/546-2028
Erath
1043 Glen Rose Hwy.
Stephenville, TX
76401-5321
254/965-3338
254/965-3598
Falls (P)
P. O. Box 401
Marlin, TX
76661-0401
254/883-1431
254/883-1434
xvii
Texas Jails
Fannin
725 Country Road 4200
Bonham, TX
75418-8901
903/583-2143
903/583-4392
Fayette
1646 North Jefferson
La Grange, TX
78945-5442
979/968-5856
979/968-5080
Fisher
Box 370
Roby, TX
79543
325/776-2273
325/776-2815
Floyd
120 E. Missouri
Floydada, TX
79235
806/983-4901
806/983-4904
Foard
P. O. Box 309
Crowell, TX
79227-0309
940/684-1501
940/684-1947
Fort Bend
1410 Ransom Rd.
Richmond, TX
77469-0399
281/341-4700
281/341-4701
Franklin
P. O. Box 718
Mt. Vernon, TX
75457-0718
903/537-4539
903/537-2632
Freestone
Drawer 47
Fairfield, TX
75840-4227
903/389-3236
903/389-5730
Frio (P)
502 S. Cedar St.
Pearsall, TX
78061
830/334-3311
830/334-4510
Gaines
301 E. Avenue A
Seminole, TX
79360-3625
432/758-9871
432/758-4051
Galveston
715 19th St.
Galveston, TX
77550
409/766-2310
409/770-5296
Garza
300 West Main
Post, TX
79356-3242
806/495-3595
806/495-4446
Gillespie
1601 E. Main St.
Fredericksburg, TX
78624-5405
830/997-7585
830/997-9541
Glasscock
P. O. Box 89
Garden City, TX
79739-0089
432/354-2361
432/354-2661
Goliad
701 E. End St.
Goliad, TX
77963
361/645-3451
361/645-2230
Gonzales
P.O. Box 1757
Gonzales, TX
78629-1757
830/672-6524
830/672-2517
Gray
217 N. Russell
Pampa, TX
79065
806/669-8022
806/669-8026
Grayson
200 S. Crockett
Sherman, TX
75090-7105
903/893-4388
903/868-2977
Gregg
101 E. Methvin, Suite 559
Longview, TX
75601
903/236-8400
903/753-3560
Grimes
382 FM 149W
Anderson, TX
77830
936/873-2151
936/873-2010
Guadalupe
2611 N. Guadalupe St.
Seguin, TX
78155-7356
830/379-1224
830/372-5408
Hale
1900 Columbia
Plainview, TX
79072-9340
806/296-2724
806/296-5725
Hall
512 Main, Box 7
Memphis, TX
79245
806/259-2151
806/259-5078
Hamilton
1108 S. Rice
Hamilton, TX
76531
254/386-8128
254/386-8762
xviii
Texas Jails
Hansford
10 Northwest Court
Spearman, TX
79081
806/659-4140
806/659-2025
Hardeman
P. O. Box 266
Quanah, TX
79252-0266
940/663-5374
940/663-2597
Hardin
P. O. Box 1990
Kountze, TX
77625-1990
409/246-5100
409/246-3277
Harris
1200 Baker Street
Houston, TX
77002
713/755-6044
713/755-6228
Harrison
P. O. Box 568
Marshall, TX
75670-0568
903/923-4003
903/935-4884
Hartley
P. O. Box I
Channing, TX
79018-0001
806/235-3142
806/235-2316
Haskell (P)
P. O. Box 675
Haskell, TX
79521-0675
940/864-2345
940/864-6164
Hays
1307 Uhland Road
San Marcos, TX
78666-8289
512/393-7808
512/393-7878
Hemphill
Box 127
Canadian, TX
79014-0127
806/323-5325
806/323-5260
Henderson
206 N. Murchison
Athens, TX
75751
903/675-9275
903/677-6344
Hidalgo
P. O. Box 1228
Edinburg, TX
78540
956/383-8114
956/383-4187
Hill
P. O. Box 283
Hillsboro, TX
76645-0283
254/582-5313
254/582-3848
Hockley
1310 Avenue H
Levelland, TX
79336-6030
806/894-3126
806/894-1682
Hood
400 N. Gordon
Granbury, TX
76048-1876
817/579-3307
817/573-7372
Hopkins
298 Rosemont St.
Sulphur Springs, TX
75482-2672
903/438-4040
903/438-4061
Howard
P. O. Box 1149
Big Spring, TX
79721-1149
432/264-2244
432/263-5355
Hudspeth
P. O. Box 39
Sierra Blanca, TX
79851-0039
915/369-2161
915/369-4168
Hunt
2700 Johnson St.
Greenville, TX
75401-4240
903/455-3501
903/454-3447
Houston
112 E. Houston
Crockett, TX
75835
936/544-2862
936/544-8061
Hutchinson
Box 1426
Borger, TX
79008-1426
806/274-6343
806/273-0117
Irion
P. O. Box 859
Mertzon, TX
76941-0859
915/835-2551
915/835-2008
Jack
1432 Post Oak
Jacksboro, TX
76458
940/567-2161
940/567-2144
Jackson
115 W. Main St., Room 104
Edna, TX
77957-2733
361/782-3541
361/782-7574
Jasper
101 Burch St.
Jasper, TX
75951
409/384-5417
409/384-7016
xix
Texas Jails
Jeff Davis
P. O. Box 1061
Fort Davis, TX
79734-1061
432/426-3213
432/426-3937
Jefferson
1001 Pearl Street, Suite 103
Beaumont, TX
77701-3544
409/835-8662
409/784-5817
Jim Hogg
211 E. Galbraith
Hebbronville, TX
78361-3403
361/527-3389
361/527-4310
Jim Wells
P. O. Box 1286
Alice, TX
78332-1286
361/668-0341
361/668-0569
Johnson
1800 Ridgemar
Cleburne, TX
76031
817/556-6058
817/556-6051
Jones
Box 821
Anson, TX
79501-0821
325/823-3201
325/823-2714
Karnes
119 N. Panna Maria St.
Karnes City, TX
78118
830/780-3931
830/780-3273
Kaufman
P. O. Drawer 849
Kaufman, TX
75142-0849
972/932-4337
972/932-9751
Kendall
840 E. Adler
Boerne, TX
78006-1745
830/249-9721
830/249-8027
Kenedy
P. O. Box 10
Sarita, TX
78385-0010
361/294-5205
361/294-5260
Kent
P. O. Box 7
Jayton, TX
79528-0007
806/237-3801
806/237-3306
Kerr
400 Clearwater Paseo
Kerrville, TX
78028
830/896-1216
830/896-7380
Kimble
415 Pecan Street
Junction, TX
76849
325/446-2766
325/446-4341
King
P. O. Box 66
Guthrie, TX
79236-0066
806/596-4470
806/596-4316
Kinney
P. O. Box 1200
Brackettville, TX
78832-1200
830/563-2788
830/563-9114
Kleberg
P. O. Box 1347
Kingsville, TX
78364-1347
361/595-8500
361/595-7870
Knox
Box 257
Benjamin, TX
79505-0257
940/459-2211
940/459-2016
Lamar
125 Brown Avenue
Paris, TX
75460
903/737-2400
903/737-2498
Lampasas
410 E. 4th St.
Lampasas, TX
76550-0465
512/556-8255
512/556-5809
La Salle
Courthouse
Cotulla, TX
78014-0000
830/879-3044
830/879-3623
Lamb
1200 E. Waylon Jennings
Littlefield, TX
79339
806/385-7900
806/385-6485
Lavaca
P. O. Box 373
Hallettsville, TX
77964-0373
361/798-2121
361/798-4468
Leon
P. O. Box 278
Centerville, TX
75846
903/536-2749
903/536-4357
Lee
P. O. Box 98
Giddings, TX
78942-0098
979/542-2800
979/542-1446
xx
Texas Jails
Liberty (P)
2400 Beaumont Ave.
Liberty, TX
77575-5902
936/336-4500
936/336-4536
Limestone
1221 E. Yeagua
Groesbeck, TX
76642
254/729-3278
254/729-8342
Lipscomb
P. O. Box 120
Lipscomb, TX
79056-0120
806/862-2611
806/862-2214
Live Oak
P. O. Box 250
George West, TX
78022-0250
361/449-2271
361/449-3035
Llano
2001 N. State Hwy. 16 Suite A
Llano, TX
78643
325/247-5767
325/247-7967
Loving
P. O. Box 104
Mentone, TX
79754-0104
432/377-2411
432/377-2701
Lubbock
P. O. Box 10536
Lubbock, TX
79408-0536
806/775-1400
806/775-1491
Lynn
P. O. Box 295
Tahoka, TX
79373-0295
806/998-4505
806/998-4658
Madison
2005 E. Main
Madisonville, TX
77864
936/348-2755
936/348-3763
Marion
Box 547
Jefferson, TX
75657-0547
903/665-7201
903/665-7590
Martin
P. O. Box 1127
Stanton, TX
79782-1127
432/756-3336
432/756-2992
Mason
P. O. Box 391
Mason, TX
76856-0391
325/347-5252
325/347-6194
Matagorda
2323 Avenue E
Bay City, TX
77414-0000
979/245-5526
979/245-1071
Maverick
Rt. 3, Box 1033
Eagle Pass, TX
78853-0000
830/773-2321
830/757-1075
McCulloch
300 W. Main
Brady, TX
76825
325/597-0733
325/597-0606
McLennan
219 N. 6th St.
Waco, TX
76701-1392
254/757-5000
254/757-5091
McMullen
Box 242
Tilden, TX
78072-0242
361/274-3311
361/274-3618
Medina
801 Avenue Y
Hondo, TX
78861
830/741-6150
830/741-6156
Menard
Box 307
Menard, TX
76859-0307
325/396-4705
325/396-2458
Midland
400 South Main
Midland, TX
79702
432/688-1228
432/688-4970
Milam
103 S. Fannin St.
Cameron, TX
76520
254/697-7033
254/697-7037
Mills
P. O. Box 1497
Goldthwaite, TX
76844-1497
325/648-2245
325/648-3797
Montague
P. O. Box 127
Montague, TX
76251-0127
940/894-2871
940/894-2004
Montgomery
#1 Criminal Justice Dr.
Conroe, TX
77301-2897
936/760-5871
936/760-5815
xxi
Texas Jails
Moore
700 S. Bliss
Dumas, TX
79029-4448
806/935-4145
806/935-2699
Morris
502 Union Street
Daingerfield, TX
75638
903/645-2232
903/645-7228
Motley
P. O. Box 727
Matador, TX
79244-0727
806/347-2234
806/347-2220
Nacogdoches
2306 Douglas Rd.
Nacogdoches, TX
75963-0227
936/560-7790
936/560-6446
Navarro
312 W. 2nd Ave.
Corsicana, TX
75110-4603
903/654-3001
903/654-3044
Newton
110 E. Court Street
Newton, TX
75960-3230
409/379-3636
409/379-3071
Nolan
100 East 3rd, Suite 110
Sweetwater, TX
79556
325/235-5471
325/235-5750
Nueces
P. O. Box 1940
Corpus Christi, TX
78403-1940
361/887-2222
361/887-2206
Ochiltree
21 S. E. 6th
Perryton, TX
79070
806/435-8000
806/435-8011
Oldham
P. O. Box 452
Vega, TX
79092-0452
806/267-2163
806/267-2362
Orange
P. O. Box 1468
Orange, TX
77630-1468
409/882-7922
409/883-7545
Palo Pinto
P. O. Box 279
Palo Pinto, TX
76484-0279
940/659-2085
940/659-3801
Panola
314 W. Wellington
Carthage, TX
75633
903/693-0333
903/693-9366
Parker
129 Hogle Street
Weatherford, TX
76086
817/594-8845
817/594-7809
Parmer
P. O. Box 860
Farwell, TX
79325-0860
806/481-3303
806/481-3305
Pecos
Box 1647
Fort Stockton, TX
79735-1647
432/336-3521
432/336-2519
Polk
1733 N. Washington
Livingston, TX
77351-2127
936/327-6810
936/327-6892
Potter
608 S. Pierce
Amarillo, TX
79101
806/379-2900
806/379-2945
Presidio
P. O. Box V
Marfa, TX
79843-0000
432/729-4308
432/729-3171
Rains
P. O. Box 398
Emory, TX
75440-0398
903/473-3181
903/473-3008
Randall
9100 S. Gerogia Street
Amarillo, TX
79118
806/468-5800
806/468-5762
Reagan
P. O. Box 832
Big Lake, TX
76932-0832
325/884-2929
325/884-2252
Real
P. O. Box 445
Leakey, TX
78873-0445
830/232-5201
830/232-5102
Red River
500 N. Cedar Street
Clarksville, TX
75426-2702
903/427-3838
903/427-5913
xxii
Texas Jails
Reeves
Box 910
Pecos, TX
79772-0910
432/445-4901
432/445-9403
Refugio
P. O. Box 1022
Refugio, TX
78377-1022
361/526-2351
361/526-2659
Roberts
P. O. Box 66
Miami, TX
79059-0066
806/868-3121
806/868-6521
Robertson
P. O. Box 1109
Franklin, TX
77856-1109
979/828-3299
979/828-5845
Rockwall
950 T. L. Townsend
Rockwall, TX
75087-4905
972/882-0300
972/882-0328
Runnels
612 Strong
Ballinger, TX
76821
325/365-2121
325/365-5807
Rusk
210 Charlevoix Street
Henderson, TX
75652-3154
903/657-3581
903/655-8318
Sabine
P. O. Box 848
Hemphill, TX
75948-0848
409/787-2266
409/787-2150
San Augustine
110 S. Harrison
San Augustine, TX
75972-1994
936/275-2424
936/275-5133
San Jacinto
75 West Cedar Avenue
Coldspring, TX
77331
936/653-4367
936/653-3085
San Patricio
P. O. Box 1382
Sinton, TX
78387-1382
361/364-2251
361/364-5832
San Saba
104 S. Water
San Saba, TX
76877
325/372-5551
325/372-3277
Schleicher
P. O. Box 1119
El Dorado, TX
76936-1119
325/853-2737
325/853-2713
Scurry
1300 26th
Snyder, TX
79549-2897
325/573-3551
325/573-4456
Shackelford
P. O. Box 877
Albany, TX
76430-0877
325/762-2000
325/762-3432
Shelby
100 Hurst
Center, TX
75935
936/598-5601
936/598-7893
Sherman
P. O. Box 526
Stratford, TX
79084-0526
806/366-5551
806/396-5670
Smith
Box 90
Tyler, TX
75710-0090
903/535-0900
903/535-0724
Somervell
1505 N. E. Big Bend Trail
Glen Rose, TX
76043
254/897-2242
254/897-3400
Starr
100 East 6th Street
Rio Grande City, TX
78582
956/487-5571
956/487-3070
Stephens
200 W. Walker
Breckenridge, TX
76424
254/559-2481
254/559-2882
Sterling
Box 928
Sterling City, TX
76951-0928
915/378-4771
915/378-2071
Stonewall
P. O. Box 388
Aspermont, TX
79502-0388
940/989-3333
940/989-3334
Sutton
309 N. E. Oak
Sonora, TX
76950
325/387-2288
325/387-5245
xxiii
Texas Jails
Swisher
136 E. Broadway
Tulia, TX
79088
806/995-3326
806/995-3326
Tarrant
300 W. Belknap St.
Fort Worth, TX
76102
817/884-3118
817/884-3173
Taylor
450 Pecan St.
Abilene, TX
79602-1621
325/674-1300
325/672-8066
Terrell
P. O. Box 320
Sanderson, TX
79848-0320
915/345-2525
915/345-2653
Terry
P. O. Box 1106
Brownfield, TX
79316-1106
806/637-2212
806/637-9424
Throckmorton
P. O. Box 578
Throckmorton, TX
76483-0578
940/849-3431
940/849-3220
Titus
304 S. Van Buren
Mt. Pleasant, TX
75455
903/572-6641
903/577-8038
Tom Green
122 W. Harris
San Angelo, TX
76903
325/655-8111
325/655-5393
Travis
1010 Lavaca St.
Austin, TX
78701
512/854-9770
512/473-9722
Trinity
P. O. Box 95
Groveton, TX
75845-0095
936/642-1424
936/642-2869
Tyler
702 N. Magnolia
Woodville, TX
75979-4515
409/283-2172
409/283-8656
Upshur
405 N. Titus
Gilmer, TX
75644
903/843-2541
903/843-2368
Upton
P. O. Box 27
Rankin, TX
79778-0027
432/693-2422
432/693-2303
Uvalde
120 E. Nopal
Uvalde, TX
78801-5314
830/278-4101
830/278-2986
Val Verde (P)
P. O. Box 1201
Del Rio, TX
78841-1201
830/774-7513
830/775-9678
Van Zandt
1220 W. Dallas Street
Canton, TX
75103-1016
903/567-4133
903/567-5317
Victoria
101 N. Glass
Victoria, TX
77901
361/574-8007
361/574-8019
Walker
717 FM 2821 W
Huntsville, TX
77320
936/435-2400
936/435-2440
Waller
701 Calvit
Hempstead, TX
77445
979/826-8282
979/826-7667
Ward
300 E. 4th
Monahan, TX
79756
432/943-6703
432/943-6265
Washington
1206 Old Independence Rd.
Brenham, TX
77833
979/277-6251
979/277-6258
Webb
1000 Washington St.
Laredo, TX
78040
956/523-4500
956/523-5059
Wharton
P. O. Box 726
Wharton, TX
77488-0726
979/532-1550
979/282-2849
Wheeler
Box 88
Wheeler, TX
79096-0088
806/826-5537
806/826-3282
xxiv
Texas Jails
Wichita
P. O. Box 8466
Wichita Falls, TX
76307-8466
940/766-8170
940/766-8102
Wilbarger
P. O. Box 1556
Vernon, Texas
76385-1556
940/552-6205
940/553-2318
Willacy
576 W. Main
Raymondville, TX
78580
956/689-5576
956/689-3867
Williamson
508 S. Rock St.
Georgetown, TX
78626-5699
512/943-1300
512/943-1444
Wilson
P. O. Box 7
Floresville, TX
78114-0007
830/393-2535
830/393-7402
Winkler
P. O. Box 860
Kermit, TX
79745-0860
432586-3461
432/586-3902
Wise
200 Rook Ramsey Dr.
Decatur, TX
76234-1489
940/627-5971
940/627-3797
Wood
Box 307
Quitman, TX
75783-0302
903/763-2201
903/736-5464
Yoakum
P. O. Box 189
Plains, TX
79323-0189
806/456-2377
806/456-5431
Young
505 Second
Graham, TX
76450
940/549-1555
940/549-0011
Zapata
Box 2311
Zapata, TX
78076-2311
956/765-9960
956/765-9941
Zavala
200 E. Dimmit
Crystal City, TX
78839-0000
830/374-3615
830/374-3007
xxv
Sample Activity
Skill Builders
The GYN
The GYN Exam
Activity Overview
Time required
45 minutes
Preparation
Write on a sheet of newsprint or
dry erase board:
What happens during this step?
Why is this done?
What can we do to make it more
comfortable?
Materials
Handouts: You Want to Put What Where?
and Breast Self-Examination
Purpose
Participants discuss what happens during a
gynecological exam, why, and how to
make it more comfortable. Participants
also discuss prevention and early detection
of common cancers in women.
When to use
During any lesson on reproductive and
sexual health
In this activity you will…
•
•
•
•
Introduce the topic and explain the activity (5 minutes).
Ask the groups to break into smaller groups and work together to answer questions about
each step of an exam, then report back (20 minutes).
Distribute and review the handouts (10 minutes).
Lead a discussion to summarize (5 minutes).
Instructions
Ask the group: How many of you have had a pelvic exam and Pap smear? (Most will probably
raise their hands.)
Ask: How many of you are really looking forward to your next pelvic exam and Pap smear?
(Probably no one will raise their hands!)
xxvi
Acknowledge that while having a gynecological exam is not anyone’s idea of a great time, it’s
an essential tool to stay healthy and catch any potential problems early, which greatly increases
the likelihood of successful treatment. The more we understand what is involved in this kind of
exam, and why each step is needed, the more okay we’re likely to feel about the whole thing.
Break the group up into seven smaller groups or pairs. (If you don’t have enough people to do
that, simply give one or more of the groups two steps.)
Assign each group one of the steps from the handout You Want to Put What Where? Point out
the newsprint or dry erase board you prepared, and tell them they’ll have about 10 minutes to
work on their step.
Once everyone has finished their task, ask each group to report back to the others. Hand out You
Want to Put What Where? for their reference.
Wrap up by reminding the group how important annual gynecological exams are. Share this
fact: According to the American Cancer Society, between 60% and 80% of American women
with newly diagnosed invasive cervical cancer have either not had a Pap test in the past 5 years
or have never had one.
Remind the group that the more we take charge of our own health, the more comfortable we can
be with this exam. Ask the group to think of things that each of us can do to make the exam more
comfortable. List the ideas on newsprint. Make sure the list includes the following:
• Breathe
• Relax the muscles in your abdominal area as much as possible.
• Speak up! Tell your provider if you’re uncomfortable at any time.
• Ask questions; ask what the provider is doing and why.
• If you have specific concerns or questions, write them down in advance so you remember
to ask them.
• Ask the clinician for a mirror so you can see what he or she is doing.
• Tell your provider if you’re nervous.
Breast Cancer Discussion
Tell the group that in addition to getting a clinical exam, we also have a great deal of power in
early detection of breast cancer.
Ask the group the following questions and provide the correct answer after taking a few guesses
for each one:
Q:
About how many cases of breast cancer are detected per year in the US?
A:
About 180,000 cases of breast cancer will be diagnosed this year while about 44,000 will
die from the disease.
Q:
Women without a family history don’t have anything to worry about. True or False?
A:
False. Genetically-linked breast cancers account for only about 5% of cases.
xxvii
Hand out How to Perform a Breast Self-Examination.
Tell the group that the best way to control breast cancer is early. Cancers confined to the breast
have a 5-year survival rate of over 95%. Amy Langer, executive director of the National
Alliance of Breast Cancer Organizations (NABCO), says, “There are two ways to think about
breast self-examination. One is as a particular technique that has to be learned, demonstrated,
practiced, and be done consistently and correctly. Another way to think of BSE … is being
familiar with the landscape of your breasts. It’s knowing that you already have a bump here, a
wrinkle there, and that that freckle by your nipple has always been there, so that you get a sense
in your mind and in your hands of what feels normal for you.”
Go over each step of the How to Perform a Breast Self-Examination handout with the group.
You can even have them practice the steps with you if they are comfortable doing so. Remind
the group that we are more familiar with our own bodies than anyone else is; the more we take
charge of our health, the more comfortable we can be with doing this exam ourselves.
Wrap Up
Make the following points:
• For some people, there’s some nervousness or anxiety around having a GYN
exam; this is not uncommon. Knowing what to expect and understanding
why it’s so important to have the exam can help alleviate some of this worry.
• Fortunately, we have a lot of power and control over prevention and early
detection of reproductive health problems.
• The most important thing is to become familiar enough with our own bodies
that we know what feels “normal” and can detect a change. Don’t get hung
up about technique!
• These are the only bodies we have, and no one else will take care of them for
us—it’s up to us!
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You Want to Put What Where?
Step
What happens
Why is this done
Medical
history
You are asked questions, either
verbally or on paper, about you
and your family’s medical
history.
To inform your provider of any previous
conditions that might put you at higher
risk for certain genetically-related
diseases (e.g. heart disease) or behaviorrelated diseases (e.g. lung cancer).
Sexual history
Breast exam
Vulvar exam
Speculum
insertion
Pap smear
Bimanual
exam
If you’re at risk for certain conditions
You are asked questions, either (e.g. sexually transmitted infections),
your provider can recommend screening
verbally or on paper, about
tests and make suggestions or referrals
your sexual behavior and/or
for help with concerns.
concerns.
The clinician presses down on
your breasts and armpit area.
Your provider feels for any lumps or
other abnormalities that could indicate
breast cancer.
The clinician inspects your
outer vaginal area.
The clinician looks for lumps, rashes, or
other indicators of an infection or
problem.
The speculum opens the walls of the
vagina to allow for visual inspection and
A plastic or metal device,
so the clinician can see to conduct the
shaped like a duck bill or hair
clip, is inserted into the vagina. Pap smear.
A small brush is used to swipe
a few cells from your cervix.
A lab will check these cells for
abnormalities that could lead to cancer or
other problems. Cervical cancer is nearly
100% preventable with regular Pap tests,
which can detect abnormalities before
they become cancerous.
The clinician puts two gloved
fingers into your vagina, and
with the other hand, presses
down on your abdomen.
The clinician feels for lumps, tenderness,
or other indicators of potential problems
with your fallopian tubes, ovaries, and
uterus. The sooner problems are found,
the better the chances of curing them.
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How to Perform a Breast Self-Examination
By regularly examining her own breasts, a woman is likely to notice any changes that occur. The best
time for breast self-examination (BSE) is about a week after your period ends, when your breasts are not
tender or swollen. If you are not having regular periods, do BSE on the same day every month. Women
who are pregnant, breast-feeding, or have breast implants also need to do regular breast selfexaminations.
• Lie down with a pillow under your right shoulder and place your right arm behind your head.
•
Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right
breast.
•
Press firmly enough to know how your breast feels. A firm ridge in the lower curve of each breast
is normal. If you're not sure how hard to press, ask a clinician.
•
Move around the breast in a circular, up and down line, or wedge pattern. Be sure to do it the
same way every time, check the entire breast area, and remember how your breast feels from
month to month.
•
Repeat the exam on your left breast, using the finger pads of the
right hand. (Move the pillow to under your left shoulder.)
•
Repeat the examination of both breasts while standing with one
arm behind your head. The upright position makes it easier to
check the upper and outer part of the breasts (toward your
armpit). This is where about half of breast cancers are found. You
may want to do the standing part of the BSE while you are in the
shower. Some breast changes can be felt more easily when your
skin is wet and soapy.
Breast changes that warrant follow-up
The vast majority of breast lumps are not cancerous. In the United States, 80% of breast biopsies are
negative. Most women will experience some kind of non-cancerous breast change during their lives. It is
normal for lumps to come and go during the menstrual cycle, and many women have lumpy (or cystic)
breasts. However, any new or unusual change in breast tissue or appearance should be brought to the
attention of a health care provider as soon as possible. In particular, the following should be reported to a
clinician:
• A lump or thickening in or near the breast or in the underarm area (particularly a lump that is
painless and hard with irregular edges)
• Swelling and/or pain in part of the breast, or a change in the size or shape of the breast; irritation,
ridges or dimples in the skin.
• Nipple pain or skin irritation, including redness, scaliness, or discharge
• An inverted (turned-in) nipple, if the nipple was not inverted previously
• A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm,
swollen, red, or scaly)
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