Correctional Mental Health Handbook


Thomas J. Fagan & Robert K. Ax

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  • Chapters
  • Front Matter
  • Back Matter
  • Subject Index
  • Part I: Administration, Organization, and Ethics

    Part II: Services and Programs

    Part III: Training and Consultation

  • Dedication

    This book is dedicated to the memories of our fathers: Thomas J. Fagan (1926–1989) and Robert H. Ax (1908–1993)


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    Thomas J.Fagan and Robert K.Ax

    We have been providers of mental health services within correctional settings for most of our professional careers, and between us we have more than 40 years of correctional mental health experience. Over the years, we have repeatedly made the same three observations. First, the number of criminal offenders with mental health problems has been increasing steadily. In fact, correctional settings appear to be taking the place of state mental hospitals as primary sites for the treatment of mentally ill individuals in some states.

    Second, the academic community has historically placed very little emphasis on correctional facilities as places of employment when they prepare their students for mental health practice, and as a result, they have provided their students with very little training specific to this setting. Indeed, some faculty have even discouraged their students from seeking employment as correctional mental health providers. Although some graduate programs now offer training in forensic mental health, these programs typically deal more with pre-confinement issues such as the assessment of mental health concerns as they relate to determinations of competency to stand trial, criminal responsibility at the time of the offense, and mitigating factors that might influence sentencing of criminal offenders. Few graduate programs offer courses that deal specifically with the many assessment, treatment, and management issues faced by correctional mental health workers who are tasked with providing mental health services and programs to mentally ill criminal offenders during their incarceration and with preparing them for their eventual return to the community.

    EDITORS' NOTE: The editors extend a special thanks to David W. Roush, in the School of Criminal Justice at Michigan State University, for his support of this project, his assistance in identifying potential chapter authors, and his willingness to review material and provide meaningful feedback.

    Third, mental health professionals who do choose to work in a correctional setting often face difficulties in adjusting to a work environment where their services are considered subordinate to the primary missions of this work setting. Unlike other mental health settings where rehabilitation and alleviation of suffering are the primary foci for all staff, such as psychiatric hospitals and community mental health facilities, correctional settings are tasked first with protecting society from criminal elements and second with punishing felons by separating them from society for specified periods of time. Neophyte correctional mental health professionals therefore have the dual challenges of adjusting to their supporting role within the correctional environment and developing services and programs that are effective without interfering with the primary missions of the correctional setting or with the staff who are tasked with accomplishing these missions. Obviously, some mental health professionals are better suited to these challenges than are others, but without guidance and mentoring, few are able to navigate these difficult waters successfully.

    It is with these observations in mind that we began this handbook. Certainly, with the dramatic increase in the number of individuals with mental disorders in corrections, the need for well-trained mental health professionals within this setting has expanded. As mental health professionals have entered this field, they have begun to define roles beyond those traditionally assumed by mental health providers in other settings. Our goal in preparing this book was to provide a general overview of correctional mental health roles, issues, services, and programs to as broad an audience as possible.

    More specifically, we hope that this handbook will serve as a resource to academic programs considering the development of courses in correctional mental health or as an adjunct to existing forensic courses. We believe that the material in this book does a good job of introducing the diverse field of correctional mental health to students preparing to enter the mental health profession by exposing them to the various populations found in correctional practice as well as to the many roles, issues, services, and programs provided by correctional mental health professionals.

    We also expect this handbook to help clarify for mental health professionals entering the field of corrections their roles within the larger correctional community. It is too easy for neophyte correctional mental health professionals to make faulty assumptions about the importance of their role within the larger correctional organization and, as a result, to end up in conflict with the very organization they wish to serve.

    Finally, we wanted this handbook to serve as a guide for correctional administrators tasked with developing or supervising mental health programs and professionals. Very often, the training and focus of correctional administrators has not been on mental health services or programs. In some cases, correctional administrators might even view mental health professionals and programs as “necessary evils” dictated by the courts. Over the years, we have seen how mental health programs that are well integrated with the more custodial aspects of correctional work can enhance the smooth and orderly running of a facility. We have also seen how mental health programs that do not attempt to coordinate their activities with those of other institutional departments can easily fail. It is our hope that this book will provide correctional administrators with an overview of mental health issues and aid them in deciding which services and programs can benefit their facilities and offer them ideas on how best to integrate them into their overall institutional operations.

    Organizationally, this handbook is divided into three broad sections. In the first section, administrative, organizational, and ethical issues are presented. Chapter 1 presents a three-level model for developing and implementing mental health services and programs within a correctional setting. Using this service delivery model, Level 1 services would be defined as those basic mental health services provided to all offenders, Level 2 services would be those offered to special offender groups or populations, and Level 3 services would be those offered on a consultative basis to the institution. Chapter 2 discusses who the mental health professionals are that enter correctional work. This chapter discusses the academic preparation, training, and experience of mental health professions in general as well as what roles these professionals have played and what problems they have typically faced when they enter the correctional arena. Chapter 3 discusses the ethics of correctional mental health practice. Perhaps no single area is more misunderstood and confusing to the correctional administrator than this area. Unfortunately, neophyte mental health professionals entering correctional work also sometimes misunderstand this area and find themselves in what they believe to be serious ethical dilemmas. This chapter helps to define some of the ethical standards and guidelines that govern the practice of mental health in general and provides a thought-provoking framework for understanding how to implement these standards within a correctional setting.

    The second and largest section of this handbook focuses on the many services and programs offered to detainee and inmate populations. Loosely following the three-level service delivery model presented in Chapter 1, this section describes in more depth mental health services and programs offered to individual offenders (Level 1) and to groups of offenders who share similar qualities or special needs (Level 2). Chapter 4 presents basic mental health services that should serve as a necessary core within any correctional setting. Certainly, other services or programs can be added to this core as resources allow, but no correctional setting is successfully meeting the mental health needs of its population without the provision of these basic services. Chapters 5 through 10 discuss the general characteristics, treatment needs, and management concerns of specific groups or populations of inmates. Chapter 5 highlights what is perhaps the largest special needs population in corrections today—the substance-abusing or dependent offender. Chapter 6 discusses individuals with significant mental impairment and the special challenges that these individuals present to correctional mental health professionals and administrators. Chapter 7 discusses female offenders, a group that has been growing faster than other segments of the correctional population. Chapter 8 deals with sexual offenders and predators. Chapter 9 discusses juvenile offenders. Chapter 10 covers other special offender populations such as military prisoners, geriatric offenders, and inmates with terminal medical problems that affect their mental health.

    The third and final section of this handbook presents various clinical and consultative activities offered by mental health professionals within correctional settings. Chapter 11 discusses routine mental health services offered to institution staff through employee assistance programs and also describes special services offered to staff who have responded to or witnessed highly stressful critical incidents during the performance of their correctional duties. Chapter 12 presents the multiple roles for mental health professionals in training correctional staff. This chapter also discusses the importance of training mental health staff as they enter the correctional arena. Chapter 13 highlights a variety of consultative roles offered by mental health professionals to other institution departments or to the institution as a whole. Some of these roles are fairly traditional, such as consulting with case management staff on program planning or release preparation for inmates, but other roles are less traditional, such as training hostage or crisis negotiators. Chapter 14 stresses the importance of and need for good evaluative research as we attempt to expand the programs and services we provide during an era of cost containment and conservative fiscal management. It has become increasingly clear over the years that the “one program fits all” model has not been very successful. What the authors of this chapter propose is a research-based correctional practice that seeks to determine which programs work best with which offenders in which types of settings. The book concludes with Chapter 15, which highlights several future directions or trends in correctional mental health.

    In selecting authors for the various chapters, we sought people with solid corrections or academic credentials. Our authors represent a good cross section of federal, state, and local correctional mental health practitioners with many years of hands-on experience in dealing with correctional mental health issues. Many of them are leaders in their fields. We also sought to include several authors from the academic community who have special interest and expertise in correctional mental health. We are very appreciative of the time and effort all of the authors put into their respective chapters, are pleased with the finished product, and hope that the reader finds each chapter to be informative and helpful in understanding the complexities and rewards of correctional mental health work.

  • About the Editors

    Thomas J. Fagan, Ph.D., is a licensed clinical psychologist and American Psychological Association Fellow. He currently consults with correctional and law enforcement agencies on a variety of mental health and crisis management issues and is an adjunct psychology professor at two Virginia colleges. For many years, he was a psychology practitioner and administrator in the Federal Bureau of Prisons, where he actively participated in the development of correctional programs and mental health policies and procedures and where he trained professional, paraprofessional, and correctional staff. He was also the bureau's chief hostage negotiator and coordinator of its crisis negotiation training program for a number of years, was on-site for several of its most serious hostage incidents, and has served as a consultant to numerous state, local, and other law enforcement agencies in the areas of crisis negotiation, critical incident stress debriefing procedures, and management of mental health services and programs. He has published regularly in correctional and psychological journals, has authored several book chapters, and is a nationally recognized trainer of law enforcement personnel. He currently serves on the editorial board of the Journal of Correctional Health Care and represents the American Psychological Association on the National Commission on Correctional Health Care's board of directors. He received his bachelor's degree from Rutgers University and his master's and doctoral degrees from Virginia Polytechnic Institute and State University.

    Robert K. Ax, Ph.D., received his doctorate in clinical psychology from Virginia Polytechnic Institute and State University. He has worked in corrections for nearly 20 years, providing direct services and administering an American Psychological Association (APA)-accredited internship program. He served as president (2001–2002) of Division 18 (Psychologists in Public Service) of the APA and is also an APA Fellow.

    About the Authors

    Andrea Fox Boardman, Ph.D., is Chief Psychologist at the Federal Detention Center in Philadelphia. A Bureau of Prisons psychologist for more than 5 years, she has previously served in the capacities of staff psychologist and drug abuse program coordinator at the Federal Correctional Institution in Fort Dix, New Jersey. Her current responsibilities include the administrative and clinical oversight of psychology services as well as the assessment and treatment of incarcerated offenders. She is actively involved in the Bureau of Prisons' annual crisis management training, particularly with respect to the use of critical incident stress management techniques following crisis situations in correctional settings. The Federal Bureau of Prisons recently recognized her as its Psychology Services Staff Member of the Year. In addition to her work in the federal prison system, she serves as an adjunct assistant professor in the Department of Clinical and Health Psychology at the Medical College of Pennsylvania–Hahnemann University, where she teaches graduate courses in personality assessment and correctional psychology. She has participated in research projects on sexual aggression, conducted pre-parole evaluations of sexual offenders, and facilitated treatment groups for inmates convicted of sexual crimes. She has published on topics such as sexual aggression and the insanity defense.

    Lisa Melanie Boesky, Ph.D., is a clinical psychologist. She specializes in the identification, management, and treatment of juvenile offenders with mental health disorders, including youth who are suicidal and/or who self-injure. She has designed several mental health training programs for correctional staff and trains justice personnel across the country. She has consulted on mental health policy and programming to a variety of juvenile correctional facilities and helped to develop a mental health screening instrument for juvenile justice agencies to use with youth in their care. She received her bachelor's degree from the University of California, Santa Barbara, and her master's and doctorate degrees from Wayne State University. Adolescents have always been the focus of her research and clinical interests, and her initial clinical work was in inpatient psychiatric settings. However, her interest in youth involved with the juvenile justice system grew and eventually became her primary focus. She has worked directly with juvenile offenders within a correctional setting providing crisis intervention, psychological screening/assessment, and management services, and she has served as the primary member of a mental health mobile team that traveled to a variety of correctional facilities providing consultation related to the mentally ill youth in their care. She is the author of a book as well as a number of chapters, articles, and training curricula on the topic of juvenile offenders with mental health disorders.

    Jennifer Boothby, Ph.D., is Assistant Professor of Psychology at Indiana State University. She is a recent graduate of the University of Alabama, where she earned her doctorate in clinical psychology. She received specialized training in the area of psychology and law and completed a predoctoral internship at the Federal Medical Center in Butner, North Carolina, and at the University of North Carolina at Chapel Hill. She has published several articles on offender adjustment to incarceration, the professional roles of correctional psychologists, and the development of attorney-client trust.

    Carl B. Clements, Ph.D., is a clinical psychologist and Professor of Psychology at the University of Alabama, Tuscaloosa, where he has helped to train psychologists and others for correctional and justice system work for some 30 years. He has consulted with a number of state and federal agencies and has served as a court-recognized expert in litigation involving prison conditions, offender classification systems, and professional standards. At the University of Alabama, he has also served as director of clinical training and as department chairman, and he is a fellow of the American Psychological Association. His recent publications and research activity have addressed issues of offender classification, prison overcrowding, attitudes about crime, delinquency intervention, program evaluation, professional roles in corrections, and risk and needs assessment. He also serves on the editorial board of Criminal Justice and Behavior.

    David DeMatteo, M.A., J.D., is completing his Ph.D. in clinical psychology at the Medical College of Pennsylvania–Hahnemann University, where he has been focusing on forensic psychology. He is currently completing his predoctoral clinical psychology internship at the Medical College of Virginia in Richmond. He earned his B.A. (psychology), magna cum laude, from Rutgers University in 1995. He earned his M.A. (clinical psychology) from the Medical College of Pennsylvania–Hahnemann University in 1999 and his J.D., magna cum laude, from Villanova University School of Law in 2001. He has worked with several forensic and correctional populations over the past six years in Pennsylvania, New Jersey, and Virginia.

    John T. Dignam, Ph.D., is Psychology Services Administrator for the Federal Bureau of Prisons' Mid-Atlantic Region. He is a clinical psychologist who has worked for the bureau since 1987. He has served as the bureau's employee assistance program administrator (1994–1998); psychology services administrator in its northeast region (1991–1994); chief of psychology services at the Federal Correctional Institution in Fairton, New Jersey (1989–1991); and staff psychologist and drug abuse program coordinator at the Metropolitan Correctional Center in New York City (1987–1989). He received his M.A. and Ph.D. in clinical psychology from Arizona State University and served his clinical internship at the Beth Israel Medical Center in New York City. Among his previous publications in the area of correctional mental health are book chapters and journal articles on the topics of substance abuse, suicide prevention, job stress and burnout, workplace violence, and critical incident stress management.

    Joel Dvoskin, Ph.D., A.B.P.P., teaches at the University of Arizona College of Medicine and maintains a private forensic and consulting psychology practice in Tucson, Arizona. He has worked as a clinician, an administrator, a consultant, an expert witness, a researcher, a trainer, and a scholar in the provision of mental health services in criminal justice settings for more than 25 years. He has worked on many of the nation's most important prison and jail mental health lawsuits, and he has authored a number of important scholarly articles on correctional mental health care. In addition to serving as New York State's acting commissioner of mental health, he also ran that state's forensic and correctional mental health system for more than a decade.

    Richard Ellis, Ph.D., has been a psychologist with the Federal Bureau of Prisons for 12 years. He has held the positions of staff psychologist, forensic study center coordinator, drug and alcohol program coordinator, and chief psychologist in federal prisons; senior examiner and chief of the program analysis section in the bureau's central office; and western regional psychology administrator in the bureau's western regional office. He also supervised the development and accreditation of an American Psychological Association psychology internship program. He has taught courses for the bureau on critical incident stress debriefing and federal forensic evaluations, and he has been an instructor for U.S. attorneys on the cross-examination of expert witnesses. Prior to his employment with the bureau, he developed community residential treatment programs for the chronically mentally ill in the Boston metropolitan area. He received a bachelor's degree in psychology from the University of California, Davis; a master's degree in psychology from California State University, Sacramento; and a Ph.D. from the California School of Professional Psychology, San Diego.

    Kathy J. Harowski, Ph.D., is a clinical psychologist who has worked as a supervisor and manager for the Federal Bureau of Prisons as well as for a state and county correctional system in Minnesota. With the bureau, she worked with staff and offenders in a medical referral center, serving mentally ill and medical cases; trained staff; and served as administrator for a residential drug and alcohol abuse treatment program. With the Minnesota Department of Corrections, she served as director of psychology services at a maximum-security prison. Currently, she works at a county juvenile detention center. Throughout her decade of correctional work, she has both formally and informally trained and mentored psychologists, other mental health providers, and correctional staff on effective functioning in a high-stress environment.

    Shelia M. B. Holton, Psy.D., is a licensed clinical psychologist who is currently Drug Abuse Program Coordinator at the Federal Correctional Institution in Waseca, Minnesota. Prior to holding this position, she served as a staff psychologist with the Wisconsin Resource Center, where her duties consisted of providing psychological services to inmates who had been removed from the general population of the Wisconsin Department of Corrections due to clinical or management issues related to their psychopathology. She also worked for the Virginia Department of Corrections first as a staff psychologist in a correctional facility and later as the director of a mental health unit. The latter was a 60-bed unit located within a medium-security prison. The primary diagnoses of inmates housed in this unit included schizophrenia, bipolar disorder, delusional disorder, and major depressive disorder. She received her clinical training from the Minnesota School of Professional Psychology. During her training, she worked with mentally ill offenders at the Federal Medical Center in Rochester, Minnesota, where she conducted psychological and forensic evaluations for federal inmates requiring inpatient or structured services within the correctional environment. She also completed a practicum placement at the Minnesota Security Hospital, where she provided psychotherapy, conducted psychoeducational groups, and completed psychological evaluations with inmates who were committed under the Mentally Ill and Dangerous statute in the state of Minnesota. She completed her predoctoral internship at the Federal Correctional Institution in Petersburg, Virginia. During this experience, she provided psychological services and conducted forensic evaluations with inmates experiencing a wide range of psychopathology.

    Phil Magaletta, Ph.D., provides psychology services in the Federal Bureau of Prisons as the clinical training coordinator in Washington, DC. In this role, he has administrative responsibilities for the recruitment of and continuing education for more than 300 doctoral-level psychologists. He also provides national administration for the bureau's predoctoral psychology internship programs. He is a licensed clinical psychologist who earned his doctorate from St. Louis University. He has been practicing correctional psychology for 5 years and has published and presented papers on the practice of telehealth in the correctional environment, psychological treatment in segregation, and parenting from prison. He has been a bureau employee at the U.S. penitentiary in Allenwood, Pennsylvania, where he worked as a staff psychologist and drug abuse program coordinator. He was also responsible for the implementation and treatment coordination for a 120-bed residential program for violent offenders. In 1998, the director of the bureau recognized him for his innovative work in developing and implementing Allenwood's telehealth program for treating the mentally ill.

    Charles O. Matthews, Ph.D., serves as National Institute on Drug Abuse Public-Academic Fellow in Substance Abuse Services Research in the Department of Mental Health Law and Policy at the Louis de la Parte Florida Mental Health Institute (FMHI), University of South Florida, and at the Substance Abuse Program Office of the Florida Department of Children and Families. Prior to coming to FMHI, he served as a research consultant on a joint project examining the impact of managed care on human resources in public behavioral health care systems. He also previously served as a research consultant to the American Psychological Association's Office on AIDS. He received his Ph.D. in clinical and community psychology from the University of Maryland at College Park, following completion of a predoctoral internship at the Perry Point and Baltimore VA Medical Centers in Maryland. He has developed a number of co-occurring disorders (substance abuse/mental health) group treatment manuals for the Suncoast Practice and Research Collaborative and has provided training on the topic of co-occurring disorders treatment in a number of settings. He has also developed relapse prevention group treatment manuals for the Florida Department of Corrections dual diagnosis prison programs. He is currently involved in a Center for Mental Health Services community action grant focused on implementing evidence-based practices and improving integration of treatment for co-occurring disorders. He has also recently co-authored book chapters on substance abuse treatment in jails and prisons.

    Alix M. McLearen, M.A., received her master's degree from Southwest Missouri State University and is currently a doctoral candidate in the University of Alabama's clinical psychology-law program. In addition to a wide range of therapy, testing, and teaching activities, she has worked in several correctional facilities, including prisons and jails at the county, state, and federal levels. She currently works at a state forensic hospital. Her research and professional interests include assessment of malingering, identification and treatment of mentally disordered offenders, forensic assessment, correctional ethics, and jail policy and staff training.

    Robert Morgan, Ph.D., is Assistant Professor in the Department of Psychology at Texas Tech University. He completed his doctoral studies in counseling psychology at Oklahoma State University; predoctoral internship at the Federal Correctional Institute in Petersburg, Virginia; and postdoctoral fellowship in forensic psychology in the Department of Psychiatry at the University of Missouri–Kansas City and the Missouri Department of Mental Health. His research interests include group psychotherapy for incarcerated adults, correctional mental health treatment, issues in forensic psychology, and professional development/training issues.

    Roger H. Peters, Ph.D., is Professor in the Department of Mental Health Law and Policy at the Florida Mental Health Institute (FMHI), University of South Florida, where he has been a faculty member since 1986. He serves as coordinator of the FMHI Collaborative on Substance Abuse Treatment and Policy Research and is an adjunct professor with the Department of Rehabilitation and Mental Health Counseling. He is the principal investigator and director for several grant projects, including the Suncoast Practice and Research Collaborative (SPARC) project. He has served since 1995 as the lead consultant to the National GAINS Center for People With Co-occurring Disorders in the Justice System. He received his Ph.D. in clinical psychology from Florida State University, following completion of a predoctoral internship at the University of North Carolina School of Medicine in association with the Federal Bureau of Prisons. He has pursued research, consultation, and training initiatives involving substance abuse treatment within the criminal justice system. He has published frequently in major journals and served on federal expert panels, grant and document reviews, and national advisory boards and committees. His research, consultation, and training efforts have focused on six interrelated areas within the justice system: treatment of dually diagnosed offenders, relapse prevention strategies, screening and assessment approaches, evaluation of treatment program effectiveness, alternative case processing approaches such as drug courts, and knowledge adoption and application strategies.

    Steven E. Pitt, D.O., is Clinical Associate Professor of Psychiatry at the University of Arizona Health Sciences Center. He is a board-certified psychiatrist with specialty training and board certification in forensic psychiatry. A graduate of Michigan State University's College of Osteopathic Medicine, he completed his residency training in psychiatry at the University of Michigan Medical Center and a fellowship in forensic psychiatry at the University of Maryland School of Medicine. He is the former director of forensic psychiatric services at the Arizona State Hospital. In addition to maintaining a private practice in forensic and general psychiatry, he is an associate at Park Dietz and Associates, serves as a physician adviser to Magellan Behavioral Health, and is on the advisory panel of

    Linda Richardson, M.S.N., Ph.D., is currently with the Los Angeles County Department of Mental Health as head of the Community Reintegration of Mentally Ill Offenders (CROMIO) program, a state-funded clinical and research grant project with the goal of reducing recidivism among dually diagnosed offenders at high risk for incarceration in state prisons. She is also an adjunct professor at Alliant International University. She received her bachelor's degree in nursing and French from Simmons College, a master's degree in psychiatric nursing from Yale University, and a Ph.D. in clinical psychology from the University of Houston. She served her internship in clinical psychology at the University of Rochester Medical School. A registered nurse and licensed psychologist, she has been on the faculties of the University of Michigan, Texas Christian University, Louisiana Tech University, and the University of Louisiana, Monroe. In addition, she has served as a program manager for mental health services in prison units with the Texas Department of Corrections, the North Carolina Department of Corrections, the Louisiana Department of Corrections, and the Harris County Jail (Houston). She has published book chapters and journal articles and has made numerous presentations at local, state, and national organization meetings, and she has consulted with many groups and organizations on mental health issues.

    Erin M. Spiers, M.A., completed her master's degree at Sam Houston State University and is currently a doctoral student of clinical psychology at the Arizona School of Professional Psychology. She has extensive correctional mental health experience at the state and federal levels. She has practiced in a wide range of correctional settings, including intake and diagnostic units, medical centers, and special and general population facilities. She has worked with mentally ill offenders across multiple security levels. In addition to her clinical work, she has been actively involved in correctional program development and outreach service planning.

    G. Lane Wagaman, Ed.D., is a licensed psychologist who currently maintains a private practice dedicated to the provision of clinical, forensic, and consultative services. Prior to establishing this practice, he served for many years as the chief psychologist at the federal prison for female offenders in Alderson, West Virginia, where he offered a variety of assessment and treatment services and programs to female offenders. He also served as a resource on many regional and national workgroups tasked with developing programs for female offenders, substance abusers, and mentally ill individuals as well as on many quality assurance teams formed to assess the overall functioning of psychology programs. He developed both pre- and postdoctoral training programs in correctional psychology and served as an expert consultant for U.S. attorneys and the federal courts. Throughout his professional career, he has been an active member of numerous professional organizations and has demonstrated a long-standing commitment to professional education and training. He has held a number of adjunct faculty appointments and has taught a variety of courses at the undergraduate, graduate, and professional school levels. He has also conducted numerous workshops, seminars, and training sessions at the local, state, and national levels.

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