Policies and Procedures 🤰

This section highlights the importance of having an official jail policy and protocol for pregnant and postpartum patients at your jail, including those who use opioids. This section describes key things that the policy should include. 

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Key Points

HOW

  • Use the MOMCARE Preparing a Model Jail Pregnancy Policy Checklist to assess your jail’s current pregnancy policy
  • Create a plan of how to address items flagged as ‘insufficient, missing, and unsure.’ This may include adding more details to the policy or developing new procedures.
  • Once the policy is revised, disseminate it to all staff and bring special attention to newly added or updated content. Consider reviewing the policy reviewing the policy during in-service training or designated team meetings to ensure all staff are informed.
  • When a pregnant patient enters custody, reorient medical and custody staff to your policy, including when to transport a pregnant patient to the hospital.  Host weekly multidisciplinary meetings with staff from medical, custody, behavioral health, etc., to discuss updates on pregnant and postpartum patients custody. 
  • If policies and protocols are not being followed, leadership should discuss options for reinforcement (g. post visual 1-pagers, individual check-in meetings, etc.)
  • Update (and announce/educate) the policy as needed, including addressing any identified gaps, changes in services, and contact persons listed. Policies should be reviewed at least every 6 months.


WHY

  • A comprehensive jail policy for pregnant patients with OUD serves as a guidebook and reference for staff, increases accountability, and fosters thoughtful and coordinated care.
  • A robust policy also decreases the chances of non-standard care and thus prevents possible litigation.


KEEP IN MIND

  • The policy should explicitly state practices that are illegal and/or not recommended for pregnant patients in custody due to the risk of harm to the fetus and pregnant patient. These include forced withdrawal, discontinuing MOUD (also referred to as MAT) postpartum, custody restraints, segregated housing (special housing unit), top bunk assignments, and male officers present for pelvic/breast exams or delivery.
  • The policy should direct staff on what to do if a pregnant patient goes into labor while in custody or has other urgent maternal warning signs.
  • The policy should be updated (and disseminated) if there are any changes including those made to treatment protocols, community partnerships, and contact persons.
  • All care should be documented in the patient’s chart
  • The contact information (address, telephone, specific person) should be documented for all community partners and providers, including the nearest labor and delivery unit.

Deeper Dive

HOW


Action Items 

  1. Use the MOMCARE Preparing a Model Jail Pregnancy Policy Checklist to assess your jail’s current pregnancy policy
  2. Create a plan of how to address items flagged as ‘insufficient, missing, and unsure.’ This may include adding more details to the policy or developing new procedures.
  3. Once the policy is revised, disseminate it to all staff and bring special attention to newly added or updated content. Consider reviewing the policy reviewing the policy during in-service training or designated team meetings to ensure all staff are informed.
  4. When a pregnant patient enters custody, reorient medical and custody staff to your policy including when to transport a pregnant patient to the hospital.   Host weekly multidisciplinary meetings with staff from medical, custody, behavioral health, etc., to discuss updates on pregnant and postpartum patients in custody. 
  5. If policies and protocols are not being followed, leadership should discuss options for reinforcement (g. post visual 1-pagers, individual check-in meetings, etc.)
  6. Update (and announce/educate) the policy as needed including addressing any identified gaps, changes in services, and contact persons listed. Policies should be reviewed at least every 6 months.

Policies and protocols should be detailed and thorough. They direct staff what to do, when to do it, who is involved, and where to go (or who to contact) for additional services and support. Including information on outside entities (e.g. local hospital, opioid treatment provider, and prenatal care provider) in your protocols will also help foster relationships between the jail and the community, making it easier to coordinate care. 

Your jail’s policy for pregnant and postpartum individuals in custody should be informed by national guidelines and standards on perinatal care, correctional health, and substance use disorder treatment. Organizations that publish such national guidance include (but are not limited to) the American College of Obstetricians and Gynecologists (ACOG), the National Commission on Correctional Healthcare (NCCHC), the American Correctional Association (ACA), the American Society of Addiction Medicine (ASAM), and Substance Abuse and Mental Health Administration (SAMHSA). 

Use the MOMCARE Preparing a Model Jail Pregnancy Policy Checklist to get a better understanding of what a robust, comprehensive policy for pregnant and postpartum individuals with OUD should entail and to assess your jail’s current policy.

All procedures in the policy should follow the SMART principles: 

Specific Does the directive clearly state what needs to be done to address the issue and/or provide care?
Measurable How should jail staff document that the procedure was performed?
Achievable Do jail staff have the support and resources they need to accomplish the procedures?
Relevant Do the procedures align with the national standards, the needs of the patients, and the values of the jail?
Time-bound Does the procedure indicate when (and how often) it should be completed/performed?

WHY

Having an official jail policy for pregnant and postpartum patients in custody, including those with OUD, promotes a standardized approach to treatment and suggests readiness to provide care. The policy can serve as a reference and resource for medical and custody staff on what to do when a pregnant or postpartum individual with OUD enters and leaves custody and will keep staff accountable. Creating or enhancing your jail’s policy for pregnant patients with OUD will also foster a thoughtful approach and coordinated care if challenges arise when caring for this population. From a risk management perspective, a detailed policy can help protect the health of your pregnant patients and decrease the chances of non-standard care, which can prevent possible litigation. 

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