Background: The COVID-19 case rate on June 5, 2020, for prisoners in the United States (US) was 5.5 times higher than the US population case rate (Saloner et al., 2020). Secure facilities were challenged to mitigate the spread of COVID-19. One secure behavioral rehabilitation facility made many changes to facility and program protocols to meet this challenge.

Methods: The purpose of this program evaluation was to assess newly implemented infection control measures at a secure behavioral rehabilitation facility and to inform policy and procedure recommendations for the mitigation of COVID-19 transmission in congregate living facilities in the future. Case rates, percent positivity, and case fatality rates were used as surrogate measures to evaluate this facility's COVID-19 program. A PRECEDE/PROCEED logic model was used to guide the program evaluation.

Results: Attack rates varied significantly by unit, from 1 resident case (3.94%) to 31 cases (92.26%). The 7-day rolling average ranged from 0.0% to 4.34% positivity during the study period, and 205/355.6 residents (57.56%) were infected during the 3-month study period.

Conclusions: COVID-19 places significant logistical and human strain on residents, employees, and administrators of secured congregate settings. Despite extensive infection control measures the study facility experienced a significant number of cases, special hospitalizations, and deaths. Further research is recommended to define adequate infection control measures to vulnerable populations in such settings.



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