The exercise room at the State of Nebraska Community Corrections Center provides opportunity for preventative health and wellness. | Photo Credit: Tom Kessler Photography
By Brooke Martin, AIA, and Cassandra Franco, AIA
In 2024, the Council on Criminal Justice and the Prison Policy Initiative (PPI) revealed that women’s contact with the criminal justice system has increased by 41% over the past several decades. Approximately 190,600 women and girls are locked up in the U.S. on any given day, with 77,000 of those women in correctional facilities.
Photo Credit: Dewberry Architects Inc.
The rise in the percentage of justice-involved women necessitates gender-responsive policies, appropriate operations and intentional correctional design. According to the Vera Institute, approximately eight in 10 incarcerated women identify as mothers, the majority of whom are single parents. Historically, the smaller numbers of incarcerated women compared to men, coupled with the fact that many facilities were originally designed as gender-neutral, has led to inadequate healthcare, community and privacy considerations. Many women are housed in aging housing units and facilities that were designed for men and lack the appropriate amenities for their needs.
According to the Prison Rape Elimination Act of 2003 (PREA), more than 86% of justice-involved women have experienced sexual violence in their lifetime, often leading to complex reproductive and mental health needs in a corrections facility. Correctional policies that include shackling, full-body strip searches and supervision by male officers in areas near where women dress, shower or use the bathroom fail to reflect a trauma-informed system. Women are also far more likely to experience sexual assault while incarcerated and make up the majority of victims of staff-on-inmate sexual abuse, according to the PREA Resource Center.
Justice-involved women have limited access to healthcare resources and are dependent on others to provide them access to treatment. Traditionally, treatment takes place in an infirmary where patients are brought in for evaluation and minor treatment or are transported out of the facility to a hospital. This results in limited care options and creates the challenge of maintaining adequate staff in the facility.
Transforming Culture and Care
To better support the health and well-being of incarcerated women, correctional facilities should emphasize modern, humane and gender-responsive design elements. These designs must account for custody and classification differences across minimum-, medium- and maximum-security populations. Facilities should include specialized spaces for the 32% of women who have serious mental illnesses (SMI), the 53% of women who have major medical needs and the 82% of women who struggle with substance use disorders.
It is especially important to prioritize the stabilization of women with self-harm tendencies, chronic health conditions or those who have been assessed as high risk. Designing to the lowest risk, where appropriate, results in the greatest feeling of normalcy. Designing housing units to the needs of women can also increase the livability within classification spaces. Creating environments that foster rehabilitation and well-being is key for correctional facilities effectively support treatment services for incarcerated women.
Current Healthcare Trends in Corrections
Photo Credit: Mikki Piper Imaging
Newly designed detention facilities are addressing staffing shortages by bringing medical and mental health services on-site. Services such as dialysis, infusion, physical therapy, clinical services and obstetrics are all increasingly available in the detention environment. While this approach helps bridge staffing gaps, there are still a limited number of healthcare providers willing to work in this environment.
To address these challenges, the corrections industry is leveraging technological advances. The advances, termed FemTech, are centered on supporting women’s health with products that can track and help women make informed decisions regarding menstrual cycles, pregnancy, pelvic health and other critical aspects of care. These advancements help incarcerated women make informed health decisions despite limited access to traditional healthcare.
High-Performance Healthcare
Technological advances have been available to correctional leaders and facilities for many years, though adoption has been slow. Starting in 2015, the federal government began requiring public and private healthcare providers to transition to electronic health records (EHR), with non-compliance resulting in reduced Medicare reimbursements. The new EHR regulations replace dependance on a paper records, allowing healthcare providers to access patient information remotely. However, some correctional and forensic facilities have not fully embraced the use of EHR, which may be due to operational decisions or a lack of funding.
EHR has been a crucial first step to advance telemedicine—or distance treatment—across the U.S. Originally introduced in the 1970s, telemedicine has grown significantly over the past decade, bringing medical treatment to rural areas and underserved places like correctional facilities. The biggest challenge to adoption was that each state had different laws related to medical practices, licenses and certification. The COVID-19 pandemic cut through this red tape and helped telemedicine become more ubiquitous. Now, it is used in various ways, including virtual video consultations, remote patient monitoring and remote access to specialists.
Humanizing Correctional Spaces
To improve conditions for incarcerated women, facilities must adopt intentional, gender-responsive design principles and integrate technology. The following considerations should guide facility upgrades and new construction:
- Individualized Placement: Does the facility define safe placement for women as individuals? How are their healthcare needs being met? Is their placement within a building allowing for human dignity and connection?
- Maternal Healthcare: Consider where and how incarcerated and pregnant mothers are placed, including safety, medical access, and bringing a child to term in a way that reduces trauma to mother and baby. How is the built environment supporting the after-birth continuum for mother and child, lactation needs and dignity, and strong family connections?
- Mental Health Support: Determine best care for women incarcerated with serious mental illness, including acute self-harm tendencies. How is that individual finding hope in this environment outside of treatment? How is the built environment helping?
- Geriatric Considerations: What accommodations are designed to help support memory care? Are walking paths, low bunks and additional nurse stations being integrated into the design?
- Staffing and Trauma-Informed Practices: How are correctional staff members being used in women’s units? Are trauma-informed practices established, such as announcing when a male enters a housing unit? Can female staff representation be integrated into these areas?
- Technology Integration: Does the facility have EHR? Are there technology opportunities to increase access to healthcare and treatment?
Brooke Martin, AIA, CCHP, NCARB, LEED GA, is a senior associate and justice architect at Dewberry. bmartin@dewberry.com
Cassandra (Cassey) Franco, AIA, LEED AP, is a senior healthcare architect at Dewberry. cfranco@dewberry.com
