Practice Profile

The number of men and women behind bars in Kentucky is growing at one of the fastest rates in the country, but if Elizabeth W. McKune, EdD, has her way, once inmates are released they won’t be coming back. As assistant director of the Division of Mental Health and Substance Abuse for Kentucky’s Department of Corrections, McKune has refocused mental health services to concentrate on helping offenders prepare for life after prison. Among her biggest changes: adding programs that help inmates find housing, health services and employment and re-establish positive relationships with family and friends after their release from prison. She is also implementing statewide training for probation and parole officers and classification and treatment officers in the facilities to identify offenders at risk for repeat crimes and help them get treatment ahead of time that can help them ease into their new life.

And perhaps most important, McKune is helping inmates maintain their sense of community while behind bars by creating opportunities for carefully screened and trained inmates to build confidence and help fellow inmates through work in hospice care and assisting with suicide watches.

“Her mission is to prepare these men and women to go back out in the community and she always has that in mind,” says Larry Chandler, former warden of the Kentucky State Reformatory and a member of the state’s parole board.” Thanks to McKune, he says, “we know we have to walk out the door a step or two with them.”

According to the most recent data, the state has already had a 5 percent drop in recidivism, from 35 percent returning to prison within two years of release in 2006 to 29.5 percent in 2008.

Focusing on transition and prevention “is a cultural change for Kentucky in the way we do case management,” says Chandler. “But we are slowly seeing a change, and you can see a difference in the inmates.”

No going back

Studies show that many offenders tend to end up back in prison when they can’t find employment or if they have strained family and marital relations. Research also shows that offenders fare best on the outside when they run through some of the sticky situations they’ll encounter ahead of time — such as talking about their prison time with a potential employer — and learn some problem-solving and social skills to help them navigate their new lives, says McKune.

To that end, she helped secure a $1.5 million grant from the U.S. Department of Justice and Kentucky’s Department of Corrections (DOC) to fund a re-entry branch for DOC that identifies offenders who are at greatest risk for returning to prison and offering them cognitive behavioral therapy and role-playing tailored to their needs. This year, 845 parole, probation and classification and treatment officers in the state completed training on the online risk-assessment tool, which is used to gather and track whether these inmates have a source of income, housing, health benefits for themselves and dependents, and if they have lingering mental health or substance abuse problems that local community health agencies could help with. The training, led by McKune, helps identify individuals at risk of recidivism. Many inmates are then targeted for participation in the newly implemented National Institute of Justice-designed curriculum called Thinking for a Change.

“We are already starting to have an impact,” says McKune. “Parole and probation officers are becoming less punitive and more about, ‘How can I help this person?’”

McKune is also focusing on the special needs of women inmates. With a grant from the Greater Cincinnati Health Foundation, she developed a program that prepares inmates at the Kentucky Correctional Institution for Women for post-prison life six months before their release. The program walks them through finding housing and employment, provides them with toiletries and other supplies, and helps them set up checkups with physicians and get mental health treatment.

The grant also funds a treatment group that addresses trauma. “We know from the literature that 90 percent of women in prison have had some sort of a trauma exposure in their past” that might hinder their post-prison adjustment, says McKune. The grant also allows staff to track and help these women for two years post-release though support groups, parenting classes, and an emergency fund to help with bills.

Also thanks to McKune, the women’s institution is getting a treatment unit devoted to helping women with both substance abuse and mental health problems. McKune helped develop the state’s first such unit for men at the Kentucky State Reformatory last year.

“Fifty percent of the women here are treated for a mental disorder, and 90 percent [for] some sort of substance disorder, so this is something we have needed for some time,” says Deborah Coleman, PsyD, program administrator of the division of mental health at the institution.

Working ‘behind the fence’

McKune went from health psychologist at a chronic pain clinic and clinical psychology professor at Spalding University in Louisville, Ky., to prison psychologist in 2002, when the Kentucky State Reformatory opened the nation’s first nursing home behind bars and needed a psychologist to run groups in pain and diabetes management. Trained as a health psychologist, McKune was intrigued at the thought of working in a new health-care setting.

“I went out there to see it and it really felt like a good fit,” says McKune. “But I do remember catching a glimpse of that enormous 10-story tower in my rear-view mirror when I was leaving that day and thinking, ‘What the heck am I doing?’”

Since that moment of nagging doubt, McKune — who was promoted to her current job in 2008 — hasn’t once regretted her decision to pursue correctional psychology “behind the fence.” She finds her job rewarding because she can be creative about providing integrated care. Having inmates close to health and mental health services offers more options than many providers have because no one worries about how to connect clients with services. Another bonus: working in a prison, by its nature, also keeps her work and personal life in balance. She knows there’s always someone on duty to cover a crisis and that her clients can easily reschedule.

“When I leave work, I know that everything will be here when I get back,” she says. “When I’m home, I’m home.”

It’s also afforded her the flexibility to work part time for the Kentucky Psychological Association, where she devotes several hours a month to helping members navigate reimbursement. Colleagues marvel at her drive and energy.

“She’s a dynamo,” says Chandler. “She always seems to have a handle on the pros and cons of every idea and how to overcome problems. As a warden, that made me feel like, ‘Hell, we could do anything.’”

That leadership ability paid off when McKune needed to convince Chandler to train inmates to help conduct suicide watches for other inmates. Training prisoners to sit with suicidal peers and look for warning signs, such as a dramatic mood changes or aggressive behaviors, bolsters those inmates’ sense of service and frees up staff for other tasks. Chandler admits he was a tough sell for giving inmates such a huge responsibility.

“She fought hard for that,” he says.

Five years later, the program runs so smoothly at the reformatory that several other facilities in the state have adopted it. “Prison is about punishment and taking responsibility away, but it’s almost like you’re catering to them,” says Chandler. Programs like this one and a similar program McKune supports at the nursing home to train inmates to do hospice care — they talk and read with their dying peers and alert staff if they need medical help — “gives them a sense of responsibility back and gives these inmates a stake in the community,” he says.