Doug Wilson, Sheriff Andy Godzicki and Jail Administrator Abby Swank, Integrated Telehealth Partners, April 23, 2026

On our program today, we're going to be talking about integrated telehealth partners and what they are doing is basically transforming how jails address one of the biggest drivers of repeat incarceration and that's behavioral health issues. And we have Doug Wilson, Doug's here joining us today, Doug. Thanks for coming in. Yes. Thank you for having me. Happy to be here today. And you're with, well, you're with your president of integrated telehealth. I am president and founder and we provide behavioral health services throughout the state in several different settings. But one of the primary areas that we work in and really provide solutions to is in the correctional facilities and we've been doing that for about 10 years now. Okay. And one of those happens to be Boone County. Correct. Boone County. And Sheriff Andy Godzicki joins us here. Yes. Thank you. Thanks for inviting us to the conversation. And Abby, Abby Swank is a jail administrator and so you got to help coordinate all this, I'm guessing, at your level, at the local level. So we have a lot of, how do you approach the counties or did they learn about, how do you, they learn about your service? Yeah. So several years ago, we had just identified really a need, especially in the correctional facilities where prior jails are having to transport inmates to be seen and it just created a lot of challenges and there were just access issues. So we felt with telehealth and specifically with telebehavioral health that that was really a great solution to get them access to care and services when they needed it in a timely manner. So then did they approach you? Did you guys find out about it? How did it get to Boom County? Yeah. I mean, we're always looking for a solution on how to get our inmates in front of somebody that can help them through some of their crisis. I also have to imagine that maybe COVID might have helped usher in this new era of it being acceptable to visit with clients through a webcam. But yeah, we definitely had a need there. We have, quite often, we have inmates that are dealing with drug addiction, withdrawals, and we're also starting to see inmates now that don't seem to have a whole lot of nexus to substance abuse and just true mental health issues. So we have to provide them something. First of all, we're kind of stuck with them, so we have to deal with their behaviors. But also, just trying to take care of other human beings, we have to get people help. So Abby, you see prisoners all the time, and again, one of the things we always hear about, a lot of the calls that the Sheriff's Department gets, Boone Police Department gets, those kinds of things, are a lot of times mental health related. You have a lot of issues out there, and it can be a big driving factor. Yeah, we've definitely seen an increase in it in the last several years, so this has been a great resource for our inmates to have that, where they can visit just from within our jail. So as they come in, you bring them in, how do you approach them? Do you ask them if they want help? Do some of them ask for help? What's the process? You can talk about maybe our screening process, that's really our first opportunity to identify issues. So it's really a mixture of both just staff identifying any issues, and then we do an intake process where we ask them about their mental health conditions and any prior medications they've been on and kind of gauge from there, and we offer it up to them if they would like to visit with telehealth and kind of start from there. And then we have some people who come in in crisis needing it right away, and we'll just go ahead and set that up for them. Okay, those would be these. Some I'm guessing might be having a treatment elsewhere with other providers and stuff. This would be if they said, you know, I have a counselor I can visit with or something like that. That gives you a step up to, we can continue your assistance. Yeah, it certainly can. We have a jail nurse that will work with them to get their medications if they've already been prescribed elsewhere, otherwise we get them in front of a doctor and they can go over what medications they've been on or who they've seen and kind of go from there. So then how do we get them over to telehealth? How do you guys get in? Yeah, so from there, usually Abby and her team have done a screening identified that there's an inmate or an individual that could really benefit from services, and then we have a simple online scheduling tool that you just go on schedule an appointment. We see inmate six days a week, and we have appointments available on average within two days, so that way folks get seen quickly if it's a crisis or somebody needs to be seen urgently or someone that identifies their screens as a suicide risk, we can get them seen same day, and we've had several of those individuals at the Boone County Jail were able to see them right away. We actually have providers available 24-7, so even if it's a crisis situation after hours, it's simply calling our 800 number and we will get them seen that same day right away to make sure that, again, they've got access to the medications and the resources they need. So it's a collaborative, it's a kind of a team effort to continue to provide this opportunity of services to help them over these issues. Right, you know, I can't stress enough, sometimes when we're dealing with these people, we're dealing with just some very raw, sometimes uncontrollable situations with these individuals, and you've probably heard me talk in the past about our new padded cell that we installed to kind of help with some of the violent behaviors that we'll see, especially self-harm behaviors. We were previously using a restraint chair, and the restraint chair comes with a lot of problems and a lot of responsibilities, and so I think that padded cell has kind of helped us bridge that gap until we can get people sort of calmed down and get them in front of telehealth, but I tell you what, it takes everything that we have to control the situation sometimes, so it can be very challenging. And a lot of people don't really see that all the time, I mean this is one of those things where, again, you do have this issue of having enough staff. That's kind of the point, that's kind of the point of the jail, is we take these individuals and they've been charged with a crime, and most people, they just drive by and live their lives in their safe neighborhoods, and they have no idea at what's going on behind those walls, and it's really about keeping society safe until either the court system is played out or people that have been sentenced, and like we said quite often, these people have an underlying mental issue or a substance abuse issue, and I tell you what, those behaviors can be very powerful and very difficult to deal with, they do cause us a lot of stress. Yeah, and I was going to say, which comes first, the underlying issue or the substance abuse? Could be either or. Correct. Absolutely. It's all part of behavioral health, so let's talk a little bit about telehealth partners. Obviously, you've got a number of people that are doing this, are they spread out around the state? How is your operation structured? Yeah, the way our operation is structured, our goal always is to bring resources to the state, and so we certainly have several providers and we employ psychiatrists, psych certified nurse practitioners, as well as therapists, and we certainly have several that live and reside here in Iowa, but we also have several that are from outside of the state that are licensed to practice here, and that's really intentional because we know that there's a shortage in the state, so our goal has been how do we bring more resources into the state, and we're able to do that through telehealth and telemedicine, and we're also able to make sure that we've got providers that are able to really focus on the specialties that, A, they're really excited about and motivated in and certainly have experiences, so we've got several providers that have forensic training and that certainly have experience in the correctional setting, so we feel that we can provide the highest level of care as a result of that. So I keep thinking back, how many times have you had to package up a prisoner, take them over to the hospital, get them restrained or something, and I'm guessing that happens a little less now. Yeah, that can be... I mean, it's still probably something that you need to do on occasion. Yeah, for medical purposes, but that can be a very dangerous time, you know, here you have somebody that's suffering from some sort of a mental crisis, and now we have to transition them into a vehicle, and then out of that vehicle, ultimately, and into a facility, and those are some of our most challenging moments because a human being that doesn't want to cooperate or is suffering some sort of a crisis, there sometimes is no negotiating with that. I mean, you and I have talked for many years about different things, sometimes you just, you cannot negotiate with these people. Especially if they're having an episode. Absolutely. So this helps out a lot, and the telehealth model and being able to offer that from within our jail by computer, by webcam, that just makes the process so much easier because then his resources can be virtually anywhere. Right. So, some people are going to say, all right, what's this cost us if we're offering this service here at Boone County? Obviously, it does cost to be able to do this. Correct. There certainly is a cost to that. The good news is that we've been doing this for a long time, and back to your earlier question on how did this get started. It was initially started with the behavioral health regions or mental health regions that have now transitioned to districts, and we do have a contract with the ASO for the state, the Iowa Primary Care Association, and so that's incorporated as a part of that. And that's certainly been their goal as they built out this statewide behavioral health plan and behavioral health services across the entire state. So we are fortunate that they've been supportive in funding that and funding the medications associated with it. So, part of the challenge, again, offering those services. So one of the big things is to avoid helping people so that once they are out, they're not going to have to come back, or don't come back. Sometimes they might come back just to visit with you, I don't know, but those, I mean, that's the big thing. Yeah, absolutely, and that's one of the big areas that we're focused on, and we've partnered with, for example, an organization called SafeNetRx that can help ensure that inmates have access to medications once they are released. We also have a direct patient care service where we can follow up with inmates after their release as well. And we also partner with several of the outpatient providers here in Boone County to make sure that there is continuity of care once they're released from jail. And so that's a big area that we're focused on. We certainly wish there'd be more continuity, so there is less recidivism, but certainly having those relationships and focus in that area. We're done visiting with you, you're coming out, you're getting out of the county jail, but we do have people you can visit with in Boone, and try to get them set up for that. That's very important that we strengthen that part of this situation or this crisis, because without having that follow-up, we will have heavy recidivism where people are just, and we get it anyways. Yeah, you're going to have some. With certain individuals, they seem to be suffering a crisis, and we'll see them quite often. They'll become a household name for us, and we become very familiar with that individual. And then, for whatever reason, they just sort of slowly just drop off and start getting stable in society and in life, and we don't see them as often. I've noticed that throughout the years with many individuals from Central Iowa that they seem to be going through a moment of crisis, and we'll see them repeatedly over and over again, but if we can get them stabilized and continue those services after they're out of our facility, that is huge. That's going to ultimately save the taxpayers a lot of money, and quite frankly, it could also help reduce the crime rate, because honestly, if they're in our jail, they've committed some sort of a crime. Sure. There's been something that's happened. It often goes hand in hand. Abby, for you guys, once, do they start having a crisis? Do they have regular schedules? Do you got to keep track of all this? How do you logistically handle it, and where do they go? Do you have a separate room? We have a computer set up that they will do their initial appointment, and then depending on what medications they get or what services they're needing, they will do follow-up appointments with them, and then most of that's just scheduled through their software. At the end of last year, we started doing therapy visits for inmates who were interested in it, and that's something that's either done weekly or bi-weekly depending on the individual's needs, but most of it's just managed through their software, and then we, with our jail nurse, we make sure we're keeping on top of those inmates that are needing to be seen again or any medication adjustments. I'm guessing you get some prisoners in that it can be a little stressful being in there. Yep. For sure. I need to talk to somebody now, kind of thing. Yep. Generally speaking, people don't like to be locked up. Yeah. That's kind of the point, but sometimes, and we're very much aware that sometimes the experience itself can induce behaviors that would far exceed anything that they probably would have gone through, had they not been incarcerated. We're careful about that too, because sometimes you can get in trouble within the jail where you have to be locked down. That's something we have to be very careful with, because that can induce behaviors, which we don't want to cause problems. Yes. Your jailers have to be. They have to live with that. Yeah. Telehealth, a lot of people will go, well, I don't know about this being doing telehealth, but it is becoming much more prevalent. We're seeing it more and more. I've interviewed people, well, actually, I think she was a psychiatric nurse that started doing it for schools and created programming for them, and I know different schools have contracts with them, and they have mental health services for some of the students. Same for this, I'm guessing people are more familiar with now doing things online. Yeah. Absolutely. And all of the data and studies show that telebehavior health services are equivalent to face to face. Certainly, there's no decline as far as quality of care with that, and it's certainly becoming more and more widely acceptable. And I think the reality is, across the state of Iowa, just given our rural nature, we're able just to reach patients where they need services in a more timely manner. And I just think it's going to become a crucial part of us building out this statewide behavior health system. It's also a lot safer. Yeah. Yeah. Well, yeah, you don't have to have people face-to-face, and we see it a lot of times with some of the, even their appearances for the judge. Right. They don't do a video thing. Again, this is all about integrated telehealth partners, which offer services. More than just, I'm good, more here. I guess, do you have contracts in other districts, too? How much of the state do you cover? We do. We've provided services in all 99 counties over the years, and certainly have a large presence throughout the state, and are just happy to be a part of helping fill a big need and big gap that services are needed. Well, when I see, even the schools, they look for having counselors or people that can specialize in providing assistance for behavioral health issues. Even our local providers. It's just hard to find enough people to meet the demand. It is. And one of the other advantages is we also provide services here at the hospital, here in Boone County, so anytime there, if there is an inmate that does need that higher level of care, we can certainly coordinate with the hospital. Otherwise, we do see folks that may present there in a crisis as well, so it's really having a collaborative service. So being able to provide all of that service. And you have, people don't fall between the cracks so often. And again, those are the ones that can, well, come back. They'll come back to visit the jail, I'm sorry, but they will. If people, it's not in our best interest to allow people to fall between the cracks. If they do, we ultimately lose. Boone County and the people that live, this is not that big of a community that we can't go, take those few extra steps to try to help somebody improve their life. And really it's in our best interest as a society to do that. I think we are starting to see more of a shift and you can feel free to agree or disagree, but I think we're starting to see more of a shift where this problem is, we're starting to see more light shed on it and a little bit more of a reaction. The mental health crisis is not a new conversation, but if we can deal with it and stay ahead of it, at least try, society is way better off in ways that sometimes you'll just never even be able to measure. For example, if you have a police officer that is, say, ticketing people for running a stop sign, trying to change behaviors, and sometimes you don't even realize if you've impacted because it could be the accident that just never happened because you changed somebody's behavior, it's kind of the same way with mental health too. If you can work on that behavioral health issue, you can, again, give them ways to deal with the issues and help them out. Do you like it when you know somebody's been successful? Yes, it's a very rewarding part of the job. You can see and go have a successful life and try not to come back to visit, or they could just come back to visit you. We do get a few that come back and just say hello. Yeah, well, that's good. That's the easiest way to do that. Well, in the community being a small, I mean, it's a large community, but not really. You know how many times we run into people that we've either dealt with or have been incarcerated in our facility. We run into them at Walmart and at the store, or they could even be serving us food as we're going through drive-thru. That can be rewarding too. I've come across people that I've met earlier in my career and watched them just kind of work through it and grow up a little bit and make better decisions and live a healthier life, and that does make you feel better. Doug, I know that Integrated Health Partners, you mentioned, again, you focused on providing that assistance right away, emergency if you need to have it at that level, and then the ongoing services, but the services after the fact, and for people that you don't get over behavioral health issues very quickly. Sometimes it takes sometimes. Sometimes you never get over it. Correct. Yeah, for a lot of people, they'll be receiving services for the rest of their lives. Or, certainly, maybe on medications for the rest of their lives. So, at least get them started down the path where they know there is assistance, and again, please use that assistance. Yeah, absolutely. No, we're doing a lot of good work. We certainly have gaps that still need filled, and we're certainly working to do that. But certainly, partnerships with the Sheriff's Department, the jail, the hospital, and community providers is going to be what ultimately gets us to where we need to be. Doug Wilson's President of Integrated Health Partners. We've been visiting also with Sheriff Andy Godzicki and our jail administrator, Abby Swing. Thanks so much for joining us. Thank you. Thank you.