A "developmental disability" is a neurological condition which begins before age 18, is expected to continue indefinitely, and is a substantial handicap to the person disabled. Individuals with mental retardation represent a major subgroup within the category of developmental disability and the terms are frequently used interchangeably. A person with mental retardation is eligible for State services if he or she has an IQ of below 70 and significant deficiencies in adaptive behavior.

Inmates who were developmentally disabled were not likely to receive the custodial care prescribed by adopted County policy and Department of Adult Detention and Jail Health Services (JHS) procedures, unless they also evidenced mental or physical illness, or unmistakable vulnerability in a jail setting. Therefore improved policies, procedures, and management practices are needed in admitting, screening, evaluation and monitoring, secure housing, and release planning for inmates with development disabilities.

Most offenders with mental retardation fall in to the "mild" category (IQ between 51 and 69-75), and may be difficult to identify because of the absence of characteristic physical traits, e.g., Down's syndrome appearance, and because of skillfulness in denying and covering up the condition. Delay or failure to identify developmental disabilities may result in exploitation by other inmates or deteriorated behavior.

At the jail, however, developmental disability was not a condition screened for during the booking process, and forms used to identify special inmate conditions (mental or physical illness) did not list developmental disability or mental retardation. Screenings by classification or jail health staff which included questions about participation in special education classes generally did not occur until 2 to 14 days following booking.

Although Washington Administrative Code custodial health care standards required that jail staff be trained in recognizing the symptoms of developmental disability, a review of training materials showed minimal attention to the identification and referral of persons with developmental disabilities. Moreover, the materials used to train corrections staff recommended practices inconsistent with DAD's policy which prescribed referral, evaluation, and protective housing and treatment plans for all inmates with developmental disabilities. Finally, the database required to be maintained to document jail employee training was incomplete and not available for auditor review. Thus audit staff could not document the number of officers trained or the frequency of training.

The audit recommended that the Department of Adult Detention (DAD) and Jail Health Services (JHS) should improve the training of all jail staff in recognizing the symptoms of developmental disability, and improve screening processes by: reviewing and revising inmate screening forms and the employee training curriculum, with the assistance of professionals in the field of developmental disability; and completing and maintaining the database of employee training.

Finding II-2 - Day-to-day practices did not conform with the requirements of the jail's administrative policy related to the custodial care of developmentally disabled inmates.

DAD policies, procedures and practices:

With one exception, Policy No. 9400.3 (Mental Health Evaluation/Developmentally Disabled/Intelligence Test), voluminous DAD operating procedures designed to guide day-to-day jail operations contained minimal direction regarding developmentally disabled inmates. The policy was adopted to ensure inmates identified as possibly developmentally disabled received further evaluation to determine needed services. It also assigned primary responsibility for assessment/evaluations, safe housing, and treatment and release planning to DAD Psychiatric Evaluation Specialist (PES) staff.

However, audit fieldwork (including the analysis of incarceration records presented in Finding II-4) indicated that Policy No. 9400.3 was not generally implemented. Testing was infrequent and non-systematic, most staff were without training or experience in the field of developmental disabilities, and contact with the State Division of Developmental Disabilities to access it's central registry of clients and caseworkers was minimal.

Inmates with developmental disabilities (who were not also mentally ill or suicidal) were not assigned to special protective housing as required. Instead they were typically assigned to the jail's general population housing. Monitoring or follow-up of developmentally disabled inmates in general population was not generally performed by DAD's classification or PES staff or JHS nursing staff. Therefore, no treatment planning, advocacy, referrals to State (or other developmental disability agencies) occurred for these inmates as required by the policy.

JHS policies and procedures:

Psychiatric nursing staff from Jail Health Services who shared the responsibility for providing services to inmates with developmental disabilities were guided by Jail Health Services policies and procedures. However, the policies omitted or minimized direction regarding developmentally disabled inmates. Specifically, JHS policies failed to include the National Commission on Correctional Health Care (NCCHC) definition of developmental disability (or any other), and deleted other requirements for referral, screening, and testing of inmates who may be developmentally disabled.

Although one JHS policy (on Receiving Screening) listed inmates with developmental disabilities as one of three "special needs" populations who might require individual attention through special housing, care, unit admission, etc., subsequent policies dealt only with two other special needs groups (inmates with medical or psychiatric illnesses). Moreover, a Medical Alert Form listing numerous medical conditions to be communicated to DAD corrections staff omitted developmental disabilities, contrary to a second JHS policy (on Sharing Information).

Finally, although Jail Health and PES staff were jointly responsible for the assessment and treatment of developmentally disabled inmates, the JHS Policies were inconsistent with DAD's Policy 9400.3 on inmates with developmental disability, and did not accurately describe the functions performed by PES staff.

The audit recommended that DAD and JHS policies, procedures, and forms which guide employees in providing custodial care to inmates with developmental disabilities should be revised to incorporate improved management practices for screening, referring, evaluating, housing and treating developmentally disabled inmates, in order to fully meet the intent of Washington Administrative Code and NCCHC standards. The audit further recommended that DAD and JHS should implement the changed custodial care practices resulting from the revised procedures.

Finding II-3 - The Department of Adult Detention did not record the incidence of inmates who were developmentally disabled. However, jail health data reported 89 inmates (144 mental health visits) during 1992 with a diagnosis of mental retardation, increasing during the first two months of 1993 from 7.4 to 15 or twice as many inmates per month.

An estimated 2.5% to 3% of the general population is affected by mental retardation, and most national studies concluded that mentally retarded persons were incarcerated at higher rates than the general population. Moreover, the rate of incarceration was reported to be increasing due to the trend toward de-institutionalization. However, DAD did not identify, report, or otherwise monitor inmates with mental retardation through the primary computer system (the Subject in Process system or SIP).

A limited estimate of the incidence of mental retardation was obtained by reviewing jail health diagnostic data which resulted from health care visits provided by mental health staff. The jail health data reported 89 inmates had received mental health visits resulting in a diagnosis of mental retardation during 1992, and 30 inmates with a reported diagnosis of mental retardation during January and February 1993 (projected to 180 inmates for the year). This number was likely to substantially understate the actual prevalence of inmates with mental retardation.

A review of SIP system data for 16 inmates diagnosed as mentally retarded indicated that although a "Protective Custody" hazard code was available, it was not used for the inmates. However, the hazard code "Mental" was reported to identify half (8 of 16) of the inmates from the sample.

The audit recommended that DAD should identify and track inmates with developmental disabilities in order to determine the incidence of the condition, and to ensure mandated and appropriate custodial care is provided, using the Automated Jail Information System (AJIS) when implemented. DAD should also review the use of hazard codes and develop procedures (with assistance from the Prosecuting Attorney) to assure that confidentiality of health information is maintained.

Finding II-4-A - Inmates diagnosed as "mentally retarded" were typically recidivists jailed for non-violent misdemeanor offenses under District Court jurisdiction. Moreover, their length of stay in the jail averaged 22 days, compared to 12.5 days for all inmates during 1993.

A one-month sample of inmates diagnosed as having developmental disabilities was selected to further analyze custodial care at the jail. Analysis of booking and release records for the 16 inmates in sample indicated that the majority (69%-75%) had been jailed on non-violent misdemeanor offenses, most frequently under the jurisdiction of King County District Courts. Moreover, nearly all (81%) were recidivists, and the mentally retarded inmates in the sample had an average jail stay of 22 days, significantly longer than the 12.5 day average for all inmates. The sample data therefore underscored the need to ensure that inmates with mental retardation are identified and have access to appropriate interventions and referrals.

Finding II-4-B - Jail policies and procedures were not followed for the sample of "mentally retarded" inmates analyzed.

A review of medical record and diversion file data for the 16 inmates noted as mentally retarded confirmed statements from jail staff that practices required by DAD Policy 9400.3 were not generally implemented unless the inmates also had symptoms of mental illness:

the diagnostic "Quicktest" for mental retardation had been administered to only 1 inmate in the sample and attempted/scheduled for 2 others; 11 inmates who were also identified as mentally ill, suicidal, or needing detoxification were admitted to the Mental Health unit/infirmary; only 2 of the 11 inmates assigned to the Mental Health unit were placed in the housing tank designated as "Protective Custody/DD;" however, one inmate suffered from impaired mental functioning due to stroke, rather than developmental disability; the remaining 5 inmates with mental retardation diagnoses were determined to be "OK for General Population" and were referred for general jail housing; 3 of the inmates referred to general population were State DDD clients. Despite numerous bookings for 2 State clients, they had not been screened for mental retardation, afforded protective custody, or other services prescribed by jail policies; minimal referrals/contacts with outside social service agencies, or discharge planning activities were noted for all inmates in the sample. In fact, 4 of the mentally retarded inmates housed in the Mental Health Unit were released to the street after 8:00 p.m. contrary to other DAD SOPs.

The audit recommended that DAD should ensure appropriate custodial care for developmentally disabled inmates is provided. In addition, the review of DAD/JHS policies and procedures for custodial care of developmentally disabled inmates should address the fact that current policy directives to assess, consult, safely house and refer to community resources were not met.

Finding II-5 - Caseworkers for developmentally disabled persons from the State Division of Developmental Disabilities (DDD) reported problems in communication and coordination with jail staff and in the release of DDD clients from jail.

A survey of case managers from Region IV of the State Division of Developmental Disabilities revealed that the majority of case managers whose clients had been incarcerated at the King County jail experienced difficulties in coordination and communication with jail staff. Specifically, they were not informed when a client was incarcerated, were not given accurate information, and were unfamiliar with the jail visitation procedures.

The State DDD had also filed an Incident Report documenting problems resulting from the arrest and incarceration of one developmentally disabled person in late 1992. The report detailed the difficulty DDD staff experienced in communicating essential information to jail staff regarding medications for a seizure disorder, and a request for isolation placement because the inmate was "at risk" for sexual assault.

The Incident Report further described the failure to coordinate with jail staff on the inmate's release to ensure safe transport to a crisis bed. Although bail had been posted in the early afternoon, and despite repeated inquiries by the inmate's mother and case manager, the inmate was not released until after midnight (12:51 a.m.), contrary to DAD procedures regarding the release of inmates housed in jail psychiatric areas.

The audit recommended that DAD should improve access and liaison with the professional developmental disabilities community as follows: developing an effective method to identify developmentally disabled inmates enrolled with the State DDD and to notify case managers of booking and facilitate access to their clients; establishing a technical advisory committee from the DDD community to provide input on appropriate custodial care; and developing a protocol of agreement with the DDD to establish a troubleshooting system and a process for evaluating developmentally disabled inmates not enrolled in the State system.

Updated: 06/24/02