When you first arrive at a new facility, an officer should conduct an “intake” with you. This is the best time for you to share if you are transgender or intersex. You can also tell the intake officer if you have a history of being “perceived”, or others seeing you as, transgender or intersex, or if you have recently had gender-affirming procedures or any similar care. If you have already had gender-affirming surgery, then you should tell your intake officer immediately. Maine’s policy is that people who have had gender-affirming procedures should be housed in accordance with their gender identity.
Once you tell the intake officer, they are responsible for contacting a person with the role of Chief Administrative Officer or someone who works for them. That intake officer should tell the Chief Administrative Officer if you are transgender or intersex. It is also possible that a defense attorney or prosecutor, a guardian, a department or jail staff member, or another officer of the court has already said that you are transgender or intersex. If someone else has told the facility, then the intake officer is still responsible for telling the Chief Administrative Officer even if you haven’t.
If the Chief Administrative Officer receives information from someone about your case before your first intake, then they might make a decision about your initial strip search and housing placement before you arrive.
If your initial strip search has not been done before your intake, then the Chief Administrative Officer should consider different factors, including your personal preference, about the gender of the officer who will conduct it. That Chief Administrative Officer will document the reasons for choosing a particular officer in your Corrections Information System (CORIS).
The Chief Administrative Officer or someone who works for them will also decide where the best place for your immediate housing is. They will make that decision based on different factors including your risk to safety. They should document all the reasons for their decision in your CORIS file. Your housing assignment might change after they conduct a more in-depth review. In the meantime, your strip searches will be conducted by staff members of the same gender as other people who are in the unit you are assigned to. If the Chief Administrative Officer wants to assign a different person to search you, they will put this in your CORIS file.
You should be given an opportunity to use the bathroom and shower privately until a full assessment takes place.
If you are already on hormonal medications when you enter the facility, you should be able to continue using them. You can continue to use them at least until you have an appointment with the facility’s physician, physician assistant, or nurse practitioner. Your facility has to follow a policy about this called the Adult Facility Policy 18.7: Pharmaceuticals.
The Chief Administrative Officer should notify the facility’s Health Services Administrator as soon as they can about your case. The Health Services Administrator should prioritize your case so that they can make a determination about whether or not you have received a diagnosis of “gender dysphoria”, have received hormonal treatment, have received transgender or intersex-related medical procedures, or any other relevant medical assistance.
In order to do that, the facility will probably ask you for a release of information to get your healthcare documents. If you want to say yes, they will be able to look through those documents and hopefully more quickly decide how to move forward with your case. The Chief Administrative Officer will then decide if you need an evaluation for “gender dysphoria” or an expedited medical health assessment. They may also look for information from Adult Community Corrections to request information about how long they have known you were transgender or intersex.
If there is a safety issue relating to being transgender or intersex, you should let officers at the facility know right away. This could include risks to safety of yourself or of another person. It also includes anything that would require a change from your immediate housing placement that was made by the Chief Administrative Officer when you entered. The facility staff should follow department policy that sets out what to do in a situation like this. That policy is called the Adult Facility Policy 15.1: Administrative Segregation Status.
Maine uses a definition for “Gender Dysphoria” from a book, written by doctors at the American Psychiatric Association, called the Diagnostic and Statistics Manual of Mental Disorders [Fifth Edition], or the “DSM-5”. The definition is:
A difference between a person’s experienced and expressed gender and their assigned gender that has taken place for at least six months. It must include two of the following:
Within 30 days of your report, the Chief Administrative Officer should put together a team to handle your case. People on that team should include your Unit Manager at your facility, the Health Services Administrator, the Department’s Medical Director, the Department’s Mental Health Director, a member of the facility’s security staff, a member of the facility’s classification staff, and the facility Prison Rape Elimination Act (PREA) monitor. There may be one or more other people on the team as well if the Chief Administrative Office thinks they should be. For example, they may contact the Chief Administrative Officer or Department’s Director of Classification at the facility where you could be transferred to.
The Prison Rape Elimination Act (PREA) is a federal law passed in 2003. Under PREA, rather than automatically assigning people to a facility, transgender and intersex people are assessed for potential safety threats and housed “on a case-by-case basis” according to gender identity. Correctional staff have to consider housing and program assignments at least twice a year to review any threats to safety experienced by transgender and intersex people living in prison.
According to the law, they also have to take into account your own view of your safety. They are not allowed to separate you for housing or other program placements based solely on your LGBT+ status.
PREA also protects “involuntary segregation”, or the removal of a person to a different housing assignment against their will. You cannot continue to be kept in a different part of the prison against your will unless prison officials have determined that there is no other way to keep you safe. They have to make that determination within the first 24 hours if they do place you in separate housing against your will. People cannot be segregated against their will for more than thirty days, and they must be given access to all of the same work, educational, and programming opportunities as any other person.
The team will make the following recommendations about your case:
The team should make these recommendations based on information available about your case. That includes things like whether or not you have a diagnosis for “gender dysphoria”, as well as any other relevant medical tests. If you haven’t had an assessment for “gender dysphoria” yet, then the team will decide if you need one. They will also decide if they want to request any other medical assessments.
In making decisions about your recommendations, the team will consider things like:
The Chief Administrative Officer or someone who works for them should make the final decision about the full team’s recommendations for your current facility. They will make decisions about your health care plan and transfer to another facility in conjunction with other people.
That final decision on the recommendations should be used to create a case plan for you. That plan might include an evaluation for “gender dysphoria”, for example. If it does, then you should be brought for an assessment for “gender dysphoria” or any other relevant medical assessment. Within 15 days of that assessment, the Chief Administrative Officer should share the results with your team and finalize its recommendations.
Even after that, the Chief Administrative Officer can also bring your team together periodically or any time appropriate to make further recommendations about your care. Any time that your team meets, as well as all of your recommendations, should be documented in your CORIS file.
Your unit management team is responsible for reassessing your case and housing situation at least every six months, or more frequently if it is necessary. If you experience threats or a change in safety, you should let an officer at your facility know. Your care team should give specific attention to any threats to safety you report.
It can be more difficult to request transfer if you’ve been in a facility for a while, but there is a procedure to do so. The main differences with asking for a transfer after you have already been in a facility are that, until a full review has been completed, you will not be placed in a different housing unit with people of a different gender than where you have been living. You will also not be given the opportunity to shower or use the bathroom privately.
The first step is to let staff at your facility know that you are transgender or intersex. From there, they should contact the Chief Administrative Officer of the facility. The Chief Administrative Officer should reach out to the Health Services Administrator as soon as possible after they receive your report. The process from there looks similar to what would have happened if you had requested the transfer from the beginning.
The Health Services Administrator should prioritize your case so that they can make a determination about whether or not you have received a diagnosis of “gender dysphoria”, have received hormonal treatment, have received transgender or intersex-related medical procedures, or any other relevant medical assistance.
In order to do that, the facility will need you to sign a “Release of Information” to get your healthcare documents. If you want to say yes, they will be able to look through those documents and hopefully more quickly decide how to move forward with your case. The Chief Administrative Officer will then decide if you need an evaluation for “gender dysphoria” or an expedited medical health assessment.
The Chief Administrative Officer will also ask staff at your facility and staff from other departments about whether they knew you were transgender or intersex or had perceived you to be before you made your own disclosure. They may reach out to the adult community corrections as well.
There are options if you don’t think that the Chief Administrative Officer or the team made the right decision about your custody level or if they did not approve a transfer. You can “appeal” this decision through the Classification Appeal Process. You can ask an officer for a copy of the Prisoner Appeal of Classification Decision form. Here is a link to Procedure J of the Classification System, which also describes the process.
To make an appeal, you have to submit the Prisoner Appeal of Classification Decision form within five business days of receiving your decision—this does not count weekend days or holidays. You should submit this form to the Department’s Director of Classification for custody level or facility transfer decisions, specifically. You should submit this form to the facility Chief Administrative Officer for all other classification issues.
Appealing the decision itself will not stop it from taking place, so you will have to remain housed in your current facility during the appeals process. Whoever you submitted your appeal to, such as the Department’s Director of Classification or the facility Chief Administrative Officer, should give you a decision about your appeal within 30 days. They can choose to approve the decision, reverse the decision, modify the decision, or “remand” the decision to the Unit Management Team (UMT) for further consideration. “Remanding” the decision means that the UMT will take over and decide what to do.
It is important to remember that the Department’s Director of Classification is the final authority for appeals about custody level or facility transfer. For all other appeals, the facility Chief Administrative Officer is the final authority.
If you want to appeal a decision made about your case that has to do with something besides custody and transfer, you can use the regular “grievance process” at your facility by filing a grievance.
All appeals will be put into your CORIS file. You can also find more information about Maine State Prison policies in this Handbook.
Whether you are entering a facility for the first time or have already been in a facility for some period of time, you can request a transfer to a gender-affirming facility. The process is a little different if you request it from the start.
At the time you first enter the facility, an officer will complete an “Internal Housing Risk Factor Assessment”, which you can find at the end of this document. That form has places to fill out issues about potential risks to your safety at a facility. That is a good time to tell the intake officer that you would like to be placed in a gender-affirming facility. Once you tell them, then they have to follow instructions from this policy, and also described below.
In order to get the right assignment, you either need to self-identify as having “Gender Dysphoria”, or request a referral for “Gender Dysphoria”. After you make your request, then you should meet with a person called the Primary Care Clinician, or PCC, who works at your facility. That PCC should complete an evaluation to determine if you have “Gender Dysphoria” as well as make decisions about how to proceed with your case.
The evaluation should consider things like safe housing, work opportunities, education, program assignments, and your individual safety. These are done on a case-by-case basis. They also consider your security level, your prior history, medical records, and vulnerability. You should also be asked about your own views on your safety and what you think would be best. In some cases, the evaluation will also include if surgery should be a part of the potential treatment plan.
Massachusetts uses a definition for “Gender Dysphoria” from a book, written by doctors at the American Psychiatric Association, called the Diagnostic and Statistics Manual of Mental Disorders [Fifth Edition], or the “DSM-5”. The definition is:
A difference between a person’s experienced and expressed gender and their assigned gender that has taken place for at least six months. It must include two of the following:
When a PCC is deciding if a person has “Gender Dysphoria”, they try to determine if a person is experiencing distress or difficulties in socializing, working, or other important areas of life. They will do a face-to-face evaluation and review things like mental health history, medical history, and any medical documents you may have. If you have already been given a diagnosis of “Gender Dysphoria” in the past, then you don’t need to get another referral.
If the PCC does not agree that you have “Gender Dysphoria” and should get the transfer, it doesn’t mean your case is over. Your case should be referred to two people: the Psychiatric Medical Director, and the Director of Clinical Programs. Then, you should get another face-to-face evaluation within thirty days of the referral.
If the PCC decides that you qualify for services under “Gender Dysphoria”, then they should ask you if you will allow a “Release of Information.” They are asking for the Release of Information so that they can see what kinds of medical care you may have been getting in the past and try to continue it.
The PCC works together with other people, including the Mental Health Director and other providers at the facility. You may meet with someone from your facility known as the on-site psychiatric provider. That person might be different from your Psychiatric Medical Director, or any of the other people you have met with so far. The PCC should then complete a form for you called the Gender Dysphoria Mental Health Referral Form in order to make sure that the facility is aware of your request to transfer. You can find that form at the end of this document.
The Psychiatric Medical Director or another officer should confirm the PCC’s Referral Form. They will consider a number of documents in this decision, including your Referral Form, a review of your medical records, and another consultation with the Psychiatric Medical Director or other officer. If there are any concerns about your diagnosis, then a person with the role Gender Dysphoria Consultant will review the case within 30 days.
After you receive a confirmed diagnosis, you should be given an individualized plan that includes the diagnosis and any other medical concerns you may have. The PCC will make your individualized plan with assistance from a number of other medical providers at the facility. The individualized plan will be sent for final approval to a group called the Gender Dysphoria Treatment Committee. That Committee should look at your plan and make sure it is a good fit for your needs.
Some types of care that they can add to your plan include hormone therapy and meetings with an endocrinologist. Endocrinologists specialize in hormones and how they control metabolism, blood pressure, cholesterol, hunger, thirst, body temperature and more. Hormone therapy may be recommended if the facility’s Primary Care Provider believes that there would not be negative physical effects.
Sometimes, the plan also includes housing recommendations. Final decisions about your housing are the responsibility of the Department of Corrections. Every six months, you should get something called an Internal Housing Risk Factor Assessment. You can find that at the end of this document. This Assessment is to make sure that your placement is correct for your case and includes a review of any safety risks you may be exposed to.
If you are going to be transferred, then the facility has to follow a special Transportation plan called “103 DOC 530, Inmate Transportation”. This is not available to the public, but you can ask someone for a copy of it and they might provide one.
Also, once you have been identified as Gender Non-Conforming, you have a right to shower separately from other people in your facility. This rule is part of a document called 103 DOC 750, number 11, which you can find here. Whether you have a “Gender Dysphoria” diagnosis or not, you should be allowed to shower, perform bodily functions, and change your clothing without non-medical staff of another gender viewing your body, except if there is an emergency.
If the Treatment Committee doesn’t approve your plan, they need to provide specific and justifiable reasons in writing. Their reasons need to explain why they are denying the recommended treatment. They have to base their decision off of proof that your treatment plan presents an overwhelming security, safety, and/or operational concern.
Your treatment plan should contain at least three parts. You should be able to participate in at least monthly individual appointments with the facility’s mental health provider. Your treatment plan should also have personalized recommendations about clothing and canteen items that are approved for your use. If you are a woman seeking to be reassigned to a female facility, then you should be able to purchase clothing items and articles available to male individuals as well as female individuals with the same security clearance as you. You can find a full list of the types of items you are allowed to purchase and keep here.
If there are parts of your Treatment Plan that you do not want to participate in, then the facility should write those down and make potential modifications to the plan if medically necessary.
If you already took hormones before entering your facility, then you should tell the PCC that as soon as possible. They will want to review your Release of Information and prior medical records so that they can continue your care. If you don’t want to give them a Release of Information, then you don’t have to, but that may mean that your care plan changes and you can’t access hormones or other medical care you want.
There could be a time that the facility decides that your treatment plan presents an “overwhelming security, safety or operational” difficulty. If they want to make that claim, then the Director of Behavior Health has to refer the treatment recommendation to two people: the Deputy Commissioner of the Prison Division, and the Deputy Commission of Re-entry. They will complete a “security review”, which takes into account your personal history, how long you have been at that facility or other facilities, and your current situation.
If those two people agree that your plan presents a security, safety, or operational problem, then they have to forward your plan to the Commission for a final review. If the Commissioner agrees and wants to reject your treatment plan, then that security review needs to include specific and justifiable reasons for denying it. The review also needs to be in writing. It has to be completed within 60 days.
The Prison Rape Elimination Act (PREA) is a federal law passed in 2003. Under PREA, rather than automatically assigning people to a facility, transgender and intersex people are assessed for potential safety threats and housed “on a case-by-case basis” according to gender identity. Correctional staff have to consider housing and program assignments at least twice a year to review any threats to safety experienced by transgender and intersex people living in prison.
According to the law, they also have to take into account your own view of your safety. They are not allowed to separate you for housing or other program placements based solely on your LGBT status.
PREA also protects “involuntary segregation”, or the removal of a person to a different housing assignment against their will. You cannot continue to be kept in a different part of the prison against your will unless prison officials have determined that there is no other way to keep you safe. They have to make that determination within the first 24 hours if they do place you in separate housing against your will. People cannot be segregated against their will for more than thirty days, and they must be given access to all of the same work, educational, and programming opportunities as any other person.
If you identify as transgender, gender non-conforming, or intersex, a facility should “assess”, or determine, the right placement for you during your first intake with the Connecticut Department of Corrections (CTDOC). Prison staff may ask you if you are gender non-conforming or intersex. If you are transgender, gender non-conforming, or intersex, you can answer yes to that question because they will use it to give you a referral for assignment to a gender-affirming facility.
The facility should base your initial assessment on your safety and security. If this “assessment” has been done before you get to the place you’ll be housed, then you should be transported to the right facility from the start. If you get to an intake facility and they have not received your request from the Judicial Marshals or other officials, then the Unit Administrator at your facility will notify their boss.
The “Referral for Gender Assessment,” also called a CN 81701, is an important form you’re entitled to. It should be completed either by the staff member you disclosed your transfer request to, or the staff member who is regularly conducting a Prison Rape Elimination Act (PREA) screening. That staff member will submit your Referral and it should be submitted to the CTDOC Chief of Psychiatric Services within 72 hours.
The Prison Rape Elimination Act (PREA) is a federal law passed in 2003. Under PREA, rather than automatically assigning people to a facility, transgender and intersex people are assessed for potential safety threats and housed “on a case-by-case basis” according to gender identity. Correctional staff have to consider housing and program assignments at least twice a year to review any threats to safety experienced by transgender and intersex people living in prison.
According to the law, they also have to take into account the individual’s own view of their safety. They are not allowed to separate them for housing or other program placements based solely on their LGBT+ status.
PREA also protects “involuntary segregation”, or the removal of a person to a different housing assignment against their will. A person cannot continue to be kept in a different part of the prison against their will unless prison officials have determined that there is no other way to keep them safe. They have to make that determination within the first 24 hours if they do place them in separate housing against their will. People cannot be segregated against their will for more than thirty days, and they must be given access to all of the same work, educational, and programming opportunities as any other person.
In July 2018, the Connecticut legislature passed Senate Bill 13 § 8, a new statute in line with the Prison Rape Elimination Act, to require that transgender people in correctional facilities are housed in accordance with their gender identity.
After your Referral form is submitted, staff should house you separately from any other people until the facility has finished all other custody and medical assessments. You have a right not to be given a medical or physical health examination for the sole purpose of identifying your gender. Staff should continue to house you separately until a CTDOC committee called the Gender Non-Conforming Review Committee is consulted. Additionally, you should be given a mental health assessment within three days of your Referral submission.
If you have been receiving gender affirming care in the community, you can share that and any treatment or medications you take with the individual completing your health services screening. The medical provider doing your intake will seek a Release of Information (ROI) from you in order to obtain your medical records from outside providers.
If you don’t want to agree to an ROI, your current treatment plan may be changed or stopped altogether. This depends on a “complete medical assessment” by a licensed physician or person called an advanced practice registered nurse (APRN). This may include things like having blood work done. If you were taking non-prescribed gender affirming hormones prior to incarceration, a referral will be made for you to meet with a licensed physician or APRN to complete an evaluation within three days.
If you are housed separately, you still have a right to participate in any orientation, recreation, and social time with everyone else in your unit. You should also be allowed to shower separately from other people. The facility should ask you what gender officer you would prefer to do your pat-down and/or strip searches. Facilities are instructed to take into account what your preferences are and accommodate them if possible. In routine pat and strip searches, the facility will consider your request, but reserves the right to place facility safety first in an emergency event.
Once the facility’s PREA Compliance Manager reviews your case and makes a recommendation, your programming and housing assignments may change.
If you feel that you have been segregated against your will, you can file an appeal about your placement, detailing any parts of the segregation that you feel are unfair or are impacting your stay and safety. You should be as specific as possible about what you would like to challenge and why.
Staff are supposed to maintain your privacy and confidentiality to the fullest amount possible once you have shared that you are gender non-conforming or intersex. The only information shared should be things that are necessary for particular staff members to do their specific job duties.
It is illegal for you to be discriminated against due to your gender identity. All people are afforded the same treatment and protection guaranteed under harassment policies.
It can be more difficult to request a transfer if you’ve been in a facility for a while, but there is a procedure to do so. If a Judicial Marshall or other official has not informed an intake facility about your gender identity, then you will just move forward with an intake like everyone else. Once you are at the new facility, you can tell an official that you would like an intake for a gender-affirming facility.
The Unit Administrator there will notify their District Administrator and then have a staff member complete a Referral. The custody staff member completing the PREA screening (or the staff member to whom you told about your request) will submit the referral form to their Unit Supervisor. That person must forward the form to the CTDOC Chief of Psychiatric Services within 72 hours. Once that is complete, the same procedure will happen as though you told an official about your request during your initial intake.
Senate Bill 13 states that any person who has a gender identity that differs from the person’s assigned sex at birth:
If you have a birth certificate, passport, or driver’s license that reflects your gender identity, you should provide that to correctional officers when you enter a facility or after you would like a transfer. If you don’t have those things, you can try to meet other established standards for obtaining that kind of documentation to confirm your gender identity.
People must also have a diagnosis of “gender dysphoria,” as defined in the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders.” According to them, “gender dysphoria” refers to “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.”
If you have given them proof of your gender identity, you must be placed in a correctional institution with people of gender consistent with your gender identity. The only way for an official from CTDOC to prevent your transfer is to prove that the placement would present “significant safety, management, or security problems.” The Commissioner is required to give serious consideration to your views with respect to your safety.
Once the CTDOC Chief of Psychiatric Services and an APRN receive your Referral, they should schedule an in-person interview with you within 10 business days. This time is used to assess the situation and determine if you meet the criteria outlined for a diagnosis of “gender dysphoria.”
If you meet the guidelines for this diagnosis, you will have an appointment with a licensed physician or APRN and another facility psychologist for an evaluation to discuss possible medical and psychological support. If you are seeking gender affirming hormone care, but you have a medical condition that prevents this care from being prescribed, you will be informed by the medical provider what that condition is. The provider will also share these findings with the CTDOC Chief of Psychiatric Services and APRN.
If you didn’t meet the criteria in your initial interview, a qualified mental health clinician within the CTDOC Health and Addiction Services, who was in no way involved in your initial interview stage, will conduct a second interview within five business days of your initial interview.
If the second interviewer presents a finding of “gender dysphoria,” then you will be given a provisional diagnosis for “gender dysphoria” to be reviewed within six months.
If you disagree with the diagnosis that was determined by the interviewers, then you have a right to file a Health Services Administrative Remedy form.
If you are awarded an inter-facility transfer, it will be done in accordance with Directive 9.3 overseeing all admissions, transfers, and discharges. Prior to the transfer occurring, a group of people called the Gender Non-Conforming Review Committee will be notified. The Review Committee will provide consultation with the receiving facility to make sure your care plan, called a Gender Non-Conforming Management Plan, can be honored and executed at the receiving facility.
A person with a diagnosis of “gender dysphoria” may be given an alternate commissary as part of their Gender Non-Conforming Management Plan. You can ask about this and make sure it is part of your Plan.
The Review Committee is a multi-disciplinary group that provides recommendations regarding people identifying as gender non-conforming and/or who identify as being intersex. The Committee is chaired by the CTDOC Chief of Psychiatric Services. Other members include CTDOC staff, contracted healthcare staff, and other people who are deemed appropriate for membership by the Review Committee chair.
This committee is in charge of developing your Management Plan within 14 business days of the completion of the “gender dysphoria” assessment. The Management Plan will be kept in your master file and health record, only distributed to those who need to know the information.
The Review Committee reviews all existing Management Plans twice a year.
The Supervision Group is a group of Review Committee members who provide oversight and direction to the contracted healthcare staff members who provide direct care to people who identify as gender non-conforming or as being intersex. The Supervision Group meets quarterly to discuss care and custodial management issues.
Each Unit Administrator or health service administrator from a contracted healthcare service is responsible for ensuring that a staff member who provides direct care or custody oversight of you or any other person who identifies as gender non-conforming will be present at each meeting.
After your Management Plan is provided by the Review Committee, a final review will be completed within 14 business days of the Review Committee’s recommendation. Once the Commissioner makes the final determination and approves your Referral and Management Plan, the Commissioner will send the approved Management Plan to the Review Committee, the facility-specific Unit Administrator, and the District Administrator. From there, those individuals will develop an implementation plan for your care. The Unit Administrator or designee will have you sign onto your Management Plan.
If the Commissioner and/or designee reviews the Review Committee’s recommendations and denies any part of them, the Commissioner will direct the CTDOC Chief of Psychiatric Services and/or the Review Committee to recommend an alternative management plan within ten business days.
Once the alternative plan is established, the Review Committee will complete their typical review process outlined above until a new plan is approved. You will be given a copy of the Management Plan, and other copies will be kept in your health record and master file.
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