U.S. Department of Justice Federal Bureau of Prisons PROGRAM STATEMENT OPI: RSD/FOB NUMBER: 5200.04 DATE: January 18, 2017 Transgender Offender Manual /s/ Approved: Thomas R. Kane Acting Director, Federal Bureau of Prisons 1. PURPOSE AND SCOPE To ensure the Bureau of Prisons (Bureau) properly identifies, tracks, and provides services to the transgender population. a. Program Objectives. Expected results of this program are: ■ This policy is meant to provide guidance to staff in dealing with the unique issues that arise when working with transgender inmates. ■ Institutions ensure transgender inmates can access programs and services that meet their needs as appropriate, and prepare them to return to the community. ■ Sufficient resources will be allocated to deliver appropriate services to transgender inmates. ■ Staff will be offered training, enabling them to work effectively with transgender inmates. ■ To support staff’s understanding of the increased risk of suicide, mental health issues and victimization of transgender inmates. b. Institution Supplement. None required. Should local facilities make any changes outside changes required in national policy or establish any additional local procedures to implement national policy, the local Union may invoke to negotiate procedures or appropriate arrangements. 2. DEFINITIONS Gender – a construct used to classify a person as male, female, both, or neither. Gender encompasses aspects of social identity, psychological identity, and human behavior. Gender identity – a person’s sense of their own gender, which is communicated to others by their gender expression. Gender expression – includes mannerisms, clothing, hair style, and choice of activities. Gender nonconforming – a person whose appearance or manner does not conform to traditional societal gender expectations. Transgender – the state of one’s gender identity not matching one’s biological sex. For the purposes of this policy, a transgender inmate is one who has met with a Bureau of Prisons psychologist and signed the form indicating consent to be identified within the agency as transgender. This step allows for accommodations to be considered. Cisgender – the state of one’s gender identity matching one’s biological sex. Sexual orientation – the direction of one’s sexual interest towards members of the same, opposite, or both genders (e.g., heterosexual, homosexual, bisexual, asexual). Sexual orientation and gender identity are not related. Gender Dysphoria (GD) – a mental health diagnosis currently defined by DSM-5 as, “A strong and persistent cross-gender identification. It is manifested by a stated desire to be the opposite sex and persistent discomfort with his or her biologically assigned sex.” Not all transgender inmates will have a diagnosis of GD, and a diagnosis of GD is not required for an individual to be provided services. Intersex – a person whose sexual or reproductive anatomy or chromosomal pattern does not seem to fit typical biological definitions of male or female. Not all intersex people identify as transgender; unless otherwise specified, this policy does not apply to intersex people who do not identify as transgender. Transition – measures that change one’s gender expression or body to better reflect a person’s gender identity. 3. STAFF RESPONSIBILITIES The following Bureau components are responsible for ensuring consistent establishment of the programs, services, and resource allocations necessary for transgender offenders. P5200.04 1/18/2017 2 a. Central Office (1) The Female Offender Branch is the agency’s primary source and point of contact on classification, management, and intervention programs and practices for transgender inmates in Bureau custody. The Branch is responsible for the following functions as they relate to transgender inmates: ■ Engaging stakeholders, including serving as the primary point of contact on issues affecting transgender inmates with judges, political figures, and advocacy groups. ■ Ensuring the Bureau offers appropriate services to transgender inmates. ■ Preparing budgetary requests to deliver national and pilot programs or services affecting transgender inmates. ■ Providing guidance and direction to Regional staff and institution leadership on transgender issues. ■ Developing and implementing staff training on transgender issues. ■ Building a research-based foundation for the Bureau’s work with transgender inmates. ■ Presenting at internal and external conferences/events regarding the agency’s transgender inmates’ practices. ■ Developing and monitoring monthly reports on the transgender population and institutional programs. ■ Issuing an annual report on the state of transgender offenders in the Bureau that will be made available to all staff and stakeholders. ■ Advising agency leadership on transgender inmate needs. ■ Conducting an annual survey of transgender inmates in the Bureau and sharing results with internal and external stakeholders. ■ Providing national oversight of pilot programs and initiatives serving transgender offenders. (2) The Health Services Division oversees all medical and psychiatric activity as it applies to transgender inmates. Guidance on the most current research-driven clinical medical and psychiatric care of transgender inmates will be provided by the Medical Director. The Health Services Division also has oversight of a Transgender Clinical Care Team (TCCT). This team will be comprised of Physicians, Pharmacists, and Psychiatrists. Social Workers, Psychologists, and other clinical providers can also be included when appropriate. The TCCT will offer advice and guidance to health services staff on the medical treatment of transgender inmates and/or inmates with GD. Medical staff can raise issues to the TCCT through the Health Services Division. (3) The Psychology Services Branch oversees all psychological mental health programs and services as they apply to transgender inmates, to include providing advice and guidance on P5200.04 1/18/2017 3 identification and evaluation of transgender inmates, and making recommendations for treatment needs of transgender inmates and/or inmates with GD. (4) Central Office Branches/Divisions of Correctional Services, Psychology Services, Education, Correctional Programs, Reentry Affairs, Residential Reentry Management, Health Services, Health Programs, Social Work, Office of General Counsel, and Trust Fund meet annually with the Female Offender Branch to discuss transgender population needs and evaluate current gender-responsive services. The National Union and the Central Office LGBT Special Emphasis Program Manager will be invited to attend these meetings. (5) The Transgender Executive Council (TEC) will consist of staff members from the Health Services Division, the Female Offender Branch, Psychology Services, the Correctional Programs Division, the Designation and Sentence Computation Center (DSCC), and the Office of General Counsel. The TEC will meet a minimum of quarterly to offer advice and guidance on unique measures related to treatment and management needs of transgender inmates and/or inmates with GD, including designation issues. Institution staff and DSCC staff may raise issues on specific inmates to the TEC through the Female Offender Branch. The National PREA Coordinator is consulted as needed. b. Regional Offices ■ Provide oversight to institutions regarding services and other relevant trends managing transgender inmates. ■ Assign transgender responsibilities to the Regional Female Offender/Transgender Coordinator Collateral Duty Assignment. This individual meets quarterly with the Female Offender Branch to discuss staffing and programming needs. c. Institutions The institution CEO will establish a multi-disciplinary approach to the management of transgender inmates; specifically: ■ Ensure transgender inmates have access to services. ■ Enter tracking information for self-identified transgender inmates by updating SENTRY and other databases (e.g., PDS), as appropriate. ■ Provide appropriate reentry resources that may be specific to the population. ■ Advise the Local Union of transgender inmate management issues, as appropriate. P5200.04 1/18/2017 4 4. STAFF TRAINING Staff will be provided specialized training in working with unique issues when managing transgender inmates, with refresher training at annual training. Institutions housing known transgender inmates should provide additional training, if needed. The Female Offender Branch will be responsible for developing training materials and current information on the management of transgender inmates. This information will be made available to staff on the Female Offender Branch Sallyport page. In addition, the Prison Rape Elimination Act (PREA) regulations incorporated into the BOP Program Statement Sexually Abusive Behavior Prevention and Intervention Program have training requirements concerning pat searches and communication skills for transgender inmates. See 28 C.F.R. § 115.15(f) and 115.31 (a) (9). Please refer to this Program Statement regarding implementation of those training requirements. Staff will be provided adequate time to complete these trainings during duty hours. 5. INITIAL DESIGNATIONS The PREA regulations, incorporated into the Program Statement Sexually Abusive Behavior Prevention and Intervention Program, state in section 28 C.F.R. § 115.42 (c): “In deciding whether to assign a transgender or intersex inmate to a facility for male or female inmates…the agency shall consider on a case-by-case basis whether a placement would ensure the inmate’s health and safety, and whether the placement would present management or security problems.” Upon receipt of information from a Pre-Sentence Report, court order, U.S. Attorney’s Office, defense counsel, the offender, or other source that an individual entering BOP custody is transgender, designations staff will refer the matter to the TEC for advice and guidance on designation. Institution staff managing pretrial or holdover offenders may also refer cases to the TEC for review. Any TEC recommendations concerning pretrial inmates will be coordinated with the appropriate United States Marshal’s Office. The TEC will consider factors including, but not limited to, an inmate’s security level, criminal and disciplinary history, current gender expression, medical and mental health needs/information, vulnerability to sexual victimization, and likelihood of perpetrating abuse. The TEC may also consider facility-specific factors, including inmate populations, staffing P5200.04 1/18/2017 5 patterns, and physical layouts (e.g., types of showers available). The TEC will recommend housing by gender identity when appropriate. 6. INTAKE SCREENING The PREA regulations in 28 C.F.R. part 115, Subpart A, incorporated into the Program Statement Sexually Abusive Behavior Prevention and Intervention Program and the Program Statement Intake Screening, address intake screening. Screening of transgender inmates will be conducted in accordance with these policies and all other applicable policies and procedures. 7. HOUSING AND PROGRAMMING ASSIGNMENTS During Initial classification and Program Reviews, Unit Management staff will twice-yearly review the inmate(s) current housing unit status and programming available for transgender inmates; this review will be documented by Unit Management. The reviews will consider on a case-by-case basis that the inmate placement does not jeopardize the inmate’s health and safety and does not present management or security concerns. In making housing unit and programming assignments, a transgender or intersex inmate’s own views with respect to his/her own safety must be given serious consideration. Transgender inmates shall be given the opportunity to shower separate from other inmates. The agency shall not place transgender or intersex inmates in dedicated facilities, units, or wings solely on the basis of such identification or status, unless such placement is in a dedicated facility, unit, or wing established in connection with a consent decree , legal settlement, or legal judgment for the purpose of protecting such inmates. In order for an inmate to be considered for transfer to another location, including a facility housing individuals of the inmate’s identified gender, the Warden should consult with the TEC prior to submitting a designation request to the DSCC, but this is not required. 8. DOCUMENTATION AND SENTRY ASSIGNMENTS a. Medical and Mental Health Information. Medical and mental health information for transgender inmates will be maintained in the current electronic recordkeeping system in accordance with the Program Statement Health Information Management. Medical and mental health information is considered confidential, and may only be released in accordance with appropriate laws, rules, and regulations. P5200.04 1/18/2017 6 b. Initial Screening. For initial designations, designations staff will assign Case Management Activity (CMA) SENTRY assignments if information in the PSR or other documentation indicates a likely transgender identity. The screening codes will be: SCRN M2F – inmate should be screened for male to female. SCRN F2M – inmate should be screened for female to male. Any inmate arriving at the designated institution with a screening code is to be referred to the Chief Psychologist or designee for review within 14 days. If the code was assigned in error, the screening code will be removed by the psychologist. If the inmate identifies as transgender, the psychologist will replace the screening code with an identifying code, as indicated below. Holdover facilities will be exempt from this initial screening requirement, as limited available records and brevity of stay do not allow for a comprehensive screening. Any inmate who arrives without a screening code but identifies as transgender during intake, or at any time during the incarceration period, is referred to the Chief Psychologist or designee and interviewed within 14 days of the inmate notification. Inmates in pretrial status at Bureau facilities may also receive a SENTRY code. c. Notification to Staff and Tracking. After consultation with Psychology Services, and if the inmate affirms his/her transgender identity, the screening code will be updated to a permanent assignment by a psychologist: TRN M2F – inmate is male to female transgender (transgender female). TRN F2M – inmate is a female to male transgender (transgender male). The inmate must request to Psychology Services staff that the CMA assignment be entered, and the inmate consents that all staff will therefore be notified that the individual is transgender. The inmate’s request will be documented on BP-A1110, Case Management Activity (CMA) SENTRY Assignment Consent Form for Transgender Inmates (included as Attachment A to this policy). Psychology Services will maintain the form in the electronic mental health record and forward a copy of the form to the Unit Team. The Unit Team will maintain the form in the FOI Exempt section of the Central File. Staff should consult the CMA assignment when interacting with the inmate; e.g., use of pronouns, searches, commissary items, etc., as indicated below. P5200.04 1/18/2017 7 If there are questions about the need to continue a CMA assignment, the Warden should contact the Female Offender Branch. Should the CMA assignment change, staff members will not be disciplined for the continued provision of accommodations or use of pronouns. 9. HORMONE AND MEDICAL TREATMENT Hormone or other medical treatment may be provided after an individualized assessment of the requested inmate by institution medical staff. Medical staff should request consultation from Psychology Services regarding the mental health benefits of hormone or other medical treatment. If appropriate for the inmate, hormone treatment will be provided in accordance with the Program Statement Patient Care and relevant clinical guidance. Questions concerning hormone treatment may be referred to the TCCT. In the event this treatment changes the inmate’s appearance to the extent a new identification card is needed, the inmate will not be charged for the identification card. 10. INSTITUTION PSYCHOLOGY SERVICES Bureau psychologists are available to provide assessment and treatment services for transgender inmates, if appropriate. Guidance on assessment procedures will be provided by the Psychology Services Branch. If an inmate identifies as transgender, the psychologist will provide the inmate with information regarding the range of treatment options available in the Bureau and their implications. In addition, based upon the psychologist’s preliminary assessment and the inmate’s expressed interest, a referral to the Clinical Director and/or Chief Psychiatrist may be generated. While the initial interview must be scheduled within 14 days, an assessment may take longer in some instances. In addition to a referral to medical services, a transgender inmate may be offered individual psychotherapy. Individual psychotherapy goals might include: (1) helping the inmate to live more comfortably within a gender identity and deal effectively with non-gender issues; (2) emphasizing the need to set realistic life goals related to daily living, work, and relationships, including family of origin; (3) seeking to define and address issues that may have undermined a stable lifestyle, such as substance abuse and/or criminality; and (4) addressing any co-occurring mental health issues. Mood disorders, anxiety disorders, substance use disorders, and personality disorders, etc., may also be present; any effective treatment plan will fully address these symptoms. P5200.04 1/18/2017 8 If an institution has multiple transgender inmates, a support group facilitated by a mental health provider may also be a component of the treatment plan. Common concerns of transgender inmates, which may be addressed effectively in a group setting, include self-esteem issues and relationship issues. Psychologists who provide mental health treatment for transgender inmates address all mental health needs, including suicide risk, if present. Psychologists working with transgender inmates are encouraged to consult the Reentry Services Division in Central Office for additional resources. 11. PRONOUNS AND NAMES Staff interacting with inmates who have a CMA assignment of transgender can use the authorized gender-neutral communication with inmates (e.g., by the legal last name or “Inmate” last name). Transgender inmates often prefer to be called by pronouns of their identified gender identity. Staff may choose to use these gender-specific pronouns or salutations per the inmate’s request, and will not be disciplined for doing so. An official committed name change while in BOP custody must be done consistent with the Program Statement Correctional Systems Manual, Chapter 4. The name entered on the inmate’s Judgement and Commitment Order will remain the official committed name for all Bureau records (incident reports, progress reviews, sentence calculations, etc.). However, any additional names or aliases can be entered into SENTRY as appropriate. 12. PAT SEARCHES Pat searches of transgender inmates will be conducted in accordance with the Program Statement Searches of Housing Units, Inmates, and Inmate Work Areas. The policy language, included here as a reference, states: “Transgender Inmates – For purposes of pat searching, inmates will be pat-searched in accordance with the gender of the institution, or housing assignment, in which they are assigned. Transgender inmates may request an exception. The exception must be pre-authorized by the Warden, after consultation with staff from Health Services, Psychology Services, Unit Management, and Correctional Services. Exceptions must be specifically described (e.g., “pat search only by female staff”), clearly communicated to relevant staff through a memorandum, and reflected in SENTRY (or other Bureau database; e.g., posted picture file). Inmates should be provided a personal identifier (e.g., notation on commissary card, etc.) that indicates their individual exception, to be carried at all times and presented to staff prior to pat searches.” P5200.04 1/18/2017 9 It is recommended the inmate request the exception by submitting an Inmate Request to Staff (BP-A0148) to the Warden. The Warden will consult with the departments listed above, and the memo approving or denying the request will be generated by the Warden’s Office. Inmates who are granted this exception under policy may have it reversed by the Warden if found to have violated institution rules concerning contraband. In exigent circumstances, any staff member may conduct a pat search of any inmate consistent with the Program Statement Searches of Housing Units, Inmates, and Inmate Work Areas. 13. VISUAL SEARCHES For purposes of a visual search, inmates will be searched in accordance with the gender of the institution, or housing assignment, to which they are assigned. The visual search shall be made in a manner designed to ensure as much privacy to the inmate as practicable. Staff should consider the physical layout of the institution, and the characteristics of an inmate with a transgender CMA assignment, to adjust conditions of the visual search as needed for the inmate’s privacy. Transgender inmates may also request an exception to be visually searched by a staff member of the inmate’s identified gender. The exception must be pre-authorized by the Warden, after consultation with staff from Health Services, Psychology Services, Unit Management, and Correctional Services. Exceptions must be specifically described (e.g., “visual search only by female staff”), clearly communicated to relevant staff through a memorandum, and reflected in SENTRY (or other Bureau database; e.g., posted picture file). Inmates should be provided a personal identifier (e.g., notation on commissary card, etc.) that indicates their individual exception, to be carried at all times and presented to staff prior to visual searches. It is recommended the inmate request the exception by submitting an Inmate Request to Staff (BP-A0148) to the Warden. The Warden will consult with the departments listed above, and the memo approving or denying the request will be generated by the Warden’s Office. Inmates who are granted this exception under policy may have it reversed by the Warden if found to have violated institution rules concerning contraband. Transgender inmates placed at an institution or in a housing unit that does not correspond with their identified gender, and who are granted an exemption as indicated above, will be searched by: bargaining unit staff of the inmate’s identified gender who consent to participate in the search; management staff of the inmate’s identified gender who consent to participate in the search; or available Health Services clinical staff. P5200.04 1/18/2017 10 Transgender inmates placed at an institution or in a housing unit of their identified gender will be searched by bargaining unit staff of the inmate’s identified gender who consent to participate in the search; management staff of the inmate’s identified gender; or available medical staff. Institutions should consider using available body scanning technology in lieu of visual searches of transgender inmates. In exigent circumstances, any staff member may conduct a visual search of any inmate consistent with the Program Statement Searches of Housing Units, Inmates, and Inmate Work Areas. 14. CLOTHING AND COMMISSARY ITEMS Consistent with safety and security concerns, inmates with the CMA assignment of transgender will have the opportunity to have undergarments of their identified gender even if they are not housed with inmates of the identified gender. Institutional laundry will have available institutional undergarments that fulfill the needs of transgender inmates. Undergarments will not have metal components. Standardized lists of Commissary items for transgender inmates are available in accordance with the Program Statement Trust Fund/Deposit Manual. Additional items based on an individualized assessment of the transgender inmate may be approved by the Warden. Additional items may be provided by the institution or purchased by the inmate, as appropriate. Inmates who purchase and/or are provided items under this section will be subject to disciplinary sanctions, including the removal of these items, if they are found to have violated institution rules relating to the possession of these items. 15. REENTRY NEEDS In accordance with the Program Statement Release Preparation Program, institution staff should assist transgender inmates in addressing these issues prior to release or placement in a Residential Reentry Center/Home Confinement. During initial classifications and Program Reviews, Unit Management will formulate a prerelease plan that will assist transgender inmates in obtaining appropriate identification, finding housing and employment, and providing community resources to reintegrate into the community. P5200.04 1/18/2017 11 The Reentry Affairs Coordinator may assist staff with identifying these resources. Institution and/or Regional Social Workers should be contacted concerning the continuity of medical care. The Female Offender Branch and/or Social Workers can be contacted to provide guidance and resources for reentry needs of transgender inmates. 16. ADMINISTRATIVE REMEDIES Inmates may use the procedures of the Program Statement Administrative Remedy Program concerning any issues relating to this policy. P5200.04 1/18/2017 12 REFERENCES Program Statements P1330.18 Administrative Remedy Program (1/6/14) P4500.11 Trust Fund/Deposit Fund Manual (4/9/15) P5100.08 Security Designation and Custody Classification Manual (9/12/06) P5290.15 Intake Screening (3/30/09) P5310.12 Psychology Services Manual (03/07/95) P5310.16 Treatment and Care of Inmates with Mental Illness (5/1/14) P5322.13 Inmate Classification and Program Review (5/16/14) P5324.08 Suicide Prevention (4/5/07) P5324.12 Sexually Abusive Behavior Prevention and Intervention Program (6/4/15) P5325.07 Release Preparation Program (12/31/07) P5521.06 Searches of Housing Units, Inmates, and Inmate Work Areas (6/4/15) P5800.15 Correctional Systems Manual (9/23/16) P6031.04 Patient Care (6/3/14) P6090.04 Health Information Management (3/2/15) Federal Regulations 28 CFR part 115 Additional Resources For Clinicians Diagnostic and Statistical Manual of Mental Disorders (DSM), most current version. World Professional Association for Transgender Health (WPATH) standards. BOP Forms BP-A0148 BP-A1110 Inmate Request to Staff Case Management Activity (CMA) SENTRY Assignment Consent Form for Transgender Inmates ACA Standards (see Program Statement, Directives Management Manual, sections 2.5 and 10.3) ■ American Correctional Association Standards for Adult Correctional Institutions, 4th Edition: 4-4056M, 4-4084M, 4-4084.1M, 4-4133M, 4-4180M, 4-4194M, 4-4278M, 44281.1M, 4-4281.2M, 4-4281.3M, 4-4281.4M, 4-4281.5M, 4-4281.6M, 4-4281.7M, 44281.8M, 4-4362M, 4-4371M, 4-4406M. ■ American Correctional Association Performance Based Standards for Adult Local Detention Facilities, 4th Edition: 4-ALDF-2A-29, 4-ALDF-2A-32, 4-ALDF-2A-34, 4-ALDF-6B-03, 4-ALDF-2C-03, 4-ALDF-4C-22M, 4-ALDF-4C-30M, 4-ALDF-4D-22, 4-ALDF-4D-22-1, 4P5200.04 1/18/2017 13 ALDF-4D-22-2, 4-ALDF-4D-22-3, 4-ALDF-4D-22-4, 4-ALDF-4D-22-5, 4-ALDF-4D-226M, 4-ALDF-4D-22-7, 4-ALDF-4D-22-8, 4-ALDF-7B-08, 4-ALDF-7B-10, 4-ALDF-7B-101. ■ American Correctional Association Standards for Administration of Correctional Agencies, 2nd Edition: None. ■ American Correctional Association Standards for Correctional Training Academies: None. Records Retention Requirements and retention guidance for records and information applicable to this program are available in the Records and Information Disposition Schedule (RIDS) on Sallyport. P5200.04 1/18/2017 14 Attachment A. Case Management Activity (CMA) SENTRY Assignment Consent Form for Transgender Inmates (BP-A1110) I agree that Bureau of Prisons staff may enter a CMA assignment on SENTRY concerning my gender identity. I understand that this CMA assignment will identify me as transgender to all staff members. I understand that the purpose of the CMA assignment is to assist staff members in providing programs and taking measures as described in the Program Statement Transgender Offender Manual. I understand that specific medical and mental health information will not be disclosed to all staff using the CMA assignment; specific medical and mental health information is maintained separately. Inmate Name: Register Number: Signature: Date: P5200.04 1/18/2017 15