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Inmates Care

Inmates Care

Whether one reaches the end of his or her life in a private home, a nursing home, or a correctional facility, the need for quality, compassionate palliative care is universal.

The demographics of the American prison population are shifting at a dramatic rate requiring new approaches to prison healthcare. Current estimates suggest that there are 2.3 million incarcerated persons in the United States (1). Similar to the free world, the aging of the Baby Boom generation is occurring in prisons. Notably, inmates 50 and older constitute over 20% of prisoners in state or federal facilities (2). Many sentenced offenders are living through middle and older adulthood within the confines of prisons (3,4). These trends profoundly impact prison systems that are legally responsible for providing needed care to prisoners along with ensuring their custody and control (5). The health status of aging inmates does not mirror the free world population. Prisoners typically present with health issues common to free citizens who are 10 to 15 years their senior. Collectively, these trends have had a profound impact on prison systems and prisons are facing sharply increased demands in caring for aged and dying inmates.

Dr. Susan Loeb of Penn State University and Dr. Valerie Myers of Klein Buendel (Multiple Principal Investigators) are leading a new research project being awarded to Klein Buendel entitled, E-training of Inmate Peer Caregivers for Enhancing Geriatric and End-of-Life Care in Prisons – the Inmates Care Project. Inmates Care is a computer-based interactive training system designed to provide inmate peer caregivers with training in geriatric and end-of-life (EOL) care. Broadly defined, EOL care is the care provided to persons in their final stages of life; also referred to as hospice care, comfort care, supportive care, palliative care or symptom management (6). The Inmates Care system will provide rigorous, evidence-based best practices through media-rich and highly interactive computer-based learning modules for providing EOL and geriatric care to prison peers. It will function within institutions’ technology and connectivity limitations and be much more engaging and interactive than the educational programs commonly available to those living in prison.

Prisons are facing sharply increased demands in caring for aged and dying inmates (7). Inmates offer an abundant human resource that is poised to contribute in important ways to augment corrections staff in meeting a growing care need in U.S. prisons. This new study will refine and expand the modules that were usability-tested in a previous study and evaluate the full program for its fit with inmate peer caregivers within the restrictive constraints of prison systems. Expanded testing of Inmates Care will establish its effectiveness as a program and will provide critical insights relevant to its dissemination and implementation with correctional facilities.

This Phase II research project is funded by a Small Business Innovation Research (SBIR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG057239). Dr. Erin Kitt-Lewis from the Penn State University College of Nursing is a Co-Investigator. The CBL modules will be programmed by the Creative Team at Klein Buendel.

References

1. Sawyer W, Wagner P. Mass incarceration: the whole pie 2019. Prison Policy Initiative. Available at: https://www.prisonpolicy.org/factsheets/pie2019_allimages.pdf. Published 2019 March 19. Accessed August 30, 2019.

2. Bronson J, Carson EA. Prisoners in 2017. Available at: https://www.bjs.gov/content/pub/pdf/p17.pdf. Published 2019 April 25. Accessed August 30, 2019.

3. Palazzolo J. U.S. Prisons Grapple With Aging Population. The Wall Street Journal.

4. Carson EA, Sabol WJ. Aging of the state prison population, 1993-2013. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Special report NCJ 248766. Available at: https://www.bjs.gov/content/pub/pdf/aspp9313.pdf. Published May, 2016. Accessed August 30, 2019.

5. Rold WJ. Thirty years after Estelle v. Gamble: A legal retrospective. Journal of Correctional Health Care. 2008;14(1):11-20.

6. National Institutes of Health. National institutes of health state-of-the-science conference statement on improving end-of-life care. NIH Consensus Development Program. Available at: https://consensus.nih.gov/2004/2004EndOfLifeCareSOS024html.htm. Published 2004. Accessed August 30, 2019.

7. Williams BA, Goodwin JS, Baillargeon J, Ahalt C, Walter LC. Addressing the aging crisis in US criminal justice health care. Journal of the American Geriatrics Society. 2012;60(6):1150-1156

Using E-Training to Enhance Geriatric and End-of-Life Care in Prisons

Using E-Training to Enhance Geriatric and End-of-Life Care in Prisons

Klein Buendel Senior Scientist, Dr. Valerie Myers, presented preliminary findings from a project that provides e-training of inmate peer caregivers to enhance geriatric and end-of-life (EOL) care in prisons at the 40th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM), March 6-9, 2019 in Washington, DC.

The United States has an incarceration rate of 655 people per 100,000, making it the highest globally. The older adult segment of the prison population has more than tripled since 1990 and their health issues are comparable to those of free people who are 10-15 years their senior. Inmates over the age of 55 have a death rate that is 10 times that of prisoners aged 25-34. United States prison systems are facing increased demands in caring for aged and dying inmates. A systematic review revealed that inmate peer caregivers can figure prominently in delivery of EOL care in prison. However, the degree of training received by inmate peer caregivers varies widely.

The lack of consistent training points to a need for evidence-based, current, and readily accessible training for this population to mitigate the growing need for EOL care in United States prisons. In response to this need, the E-training of Inmate Peer Caregivers for Enhancing Geriatric and End-of-Life Care in Prisons project, will demonstrate the scientific merit and feasibility of developing cutting edge, media-rich learning modules to train inmate peer caregivers in geriatric and EOL care. The aims of the project are to: (1) transform best practices in inmate peer caregiving into a comprehensive training program that consists of media-rich and highly interactive computer-based learning modules for providing geriatric and EOL care to their peers; and (2) conduct in-person usability testing of the media-rich and highly interactive web-based prototypes with inmates who are currently Mental Health Peer Support Specialists (that is, prisoners who are experienced caregivers, but naïve to geriatric and EOL care) and prison staff to evaluate the user interface, ease of use, and perceived barriers in order to refine and optimize the product.

Focus groups were conducted with three different groups, inmates, IT staff, and interdisciplinary staff, at a men’s and a women’s state correctional institution to inform content and program development of the training modules. Focus group participants prioritized the Universal Precautions, Loss/Grief, and Role of Inmate Caregivers in the Final Hours modules. These modules will be programmed and tested in state prisons in a mid-Atlantic state. The System Usability Scale, a validated tool for assessing the usability and acceptability of technological products, will serve as the primary outcome.

This research was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG057239; Dr. Susan Loeb, Principal Investigator) and Dr. Valerie Myers, Co-Investigator. Additional collaborators on the work presented at the conference include Dr. Erin Kitt-Lewis, Dr. Rachel Wion, and Julie Murphy from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from Klein Buendel. The technology-based modules are being developed by the Creative Team at Klein Buendel.

Insights on Computer-Based End-of-Life Training in Prisons

Insights on Computer-Based End-of-Life Training in Prisons

Dr. Valerie Myers, KB Senior Scientist and SBM Fellow, presented a poster on the Enhancing Care of the Aged and Dying in Prison project at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine (SBM), April 11-14, 2018 in New Orleans, Louisiana.

The prison population is aging at a rapid rate and is expected to continue to do so into the foreseeable future. As a result, prisons in the United States are facing increased demands in caring for aged, chronically ill, and dying inmates. Despite advances in the free world, best practices for managing geriatric issues and life-limiting or terminal illness have not been adapted for use in corrections settings. Implementing a training program addressing the health issues related to this population could mitigate legal risks and enhance care. However, the paramount focus on security makes technological advances available in the free word inaccessible inside prison walls.

Lessons learned from prior development, implementation, and evaluation research targeted at enhancing care for the aged and dying in prison led to the development of a media-rich interactive computer-based learning prototype, Enhancing Care of the Aged and Dying in Prison (ECAD-P). ECAD-P contains six modules that address end-of-life and geriatric care issues in prisons. The purpose of this aim of the project focused on a small-scale evaluation of ECAD-P. Specifically, in-person usability testing was conducted at one state department of corrections and one large city jail. Twelve participants evaluated the user interface, ease of use, and perceived barriers of the prototype, so that the research team may further understand user preferences, optimize the learning modules, and prepare for implementation.

A summary evaluation of the computer-based prototype training includes the participants’ impressions regarding the user interface of the computer-based training modules, beliefs about ease of use of the computer-based training modules, perceived barriers regarding the use of the computer-based training modules. Findings will be used to refine the computer-based training modules for large-scale usability testing targeting 12 prisons and jails across the United States. Lessons learned from this usability study and the larger scale usability study will inform future dissemination of the product. The intent of this educational product is to extend our reach to promote quality of health and health equity, as well as narrow the gap in health disparities experienced by a group that has often been described as “the least among us.”

This research project is funded by a grant from the National Institute on Aging (AG049570; Dr. Janice Penrod, Penn State University, Principal Investigator). Collaborators included Dr. Valerie Myers, Sophia Strickfaden, and Tiffany Jerrod from Klein Buendel, and Dr. Susan Loeb, Dr. Erin Kitt-Lewis, and Rachel Wion from the Penn State University College of Nursing.