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E-Training to Enhance the Care of Aged and Dying Prisoners

E-Training to Enhance the Care of Aged and Dying Prisoners

The health care needs of aged, chronically ill, and dying inmates in correctional settings face growing demands. The Enhancing Care for the Aged and Dying in Prisons (ECAD-P) research team published insights from a geriatric care learning program for corrections staff as an abstract for the Annals of Behavioral Medicine. The ECAD-P research team is led by Dr. Susan Loeb from Penn State University and Dr. Valerie Myers from Klein Buendel. They would have presented the work at the 41st Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine in San Francisco, had the conference been held as planned.

The number of older inmates in the United States continues to grow and best practices for managing geriatric issues and end-of-life (EOL) care have not been adapted for use in corrections settings. In response, ECAD-P team has developed a computer-based learning program for corrections staff comprised of six modules that address EOL and geriatric care concerns in prisons.

After conducting two rounds of usability testing at two prisons in different states, the ECAD-P program entered full-scale testing at seven state prisons. A total of 241 individuals consented to participate and 173 individuals completed all training modules and posttests. Outcomes revealed that the ECAD-P training program was acceptable, feasible, and usable in the corrections staff setting. The research team also found that corrections staff improved their knowledge of geriatric and EOL care of inmates overall after completing the training.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators and co-authors on this abstract also include Dr. Erin Kitt-Lewis from Penn State University; Dr. Rachel Wion from the Indiana University School of Nursing (formerly Penn State University); Julie Murphy from the King’s College Nursing Program; and Tiffany Jerrod, formerly of Klein Buendel.

Gaining Entry to Correctional Settings for Health Research

Gaining Entry to Correctional Settings for Health Research

In a recent publication for a special issue on Nursing Leadership in Correction in the journal Nursing Leadership, authors from Penn State University, Indiana University, King’s College, and Klein Buendel share lessons learned from implementing a large-scale health communication research project in correctional settings. The NIH-funded project developed, implemented, and evaluated computer-based learning modules to train corrections personnel in geriatric and end-of-life care for incarcerated individuals. The program, Enhancing Care for the Aged and Dying in Prison, 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.

The lessons learned, and described in detail in the publication, include the importance of building a team of experts, “planning and punting” (such as designing a reliable communication plan and adjusting to the distinctive facets of each prison), coordinating with institutional review boards to protect vulnerable populations, and examining denied applications for access to correctional facilities in order to inform future planning. According to the authors, “These lessons serve to establish best practices on how to access correctional settings and to enable more research in corrections.” Access to even one correctional facility can help researchers learn more about and help to improve healthcare for people who are incarcerated.

This research was funded by a Phase I and II STTR grant from the National Institute on Aging (AG049570). The Phase I Multiple Principal Investigators were Dr. Janice Penrod and Dr. Susan Loeb from Penn State University. The Phase II Multiple Principal Investigators were Dr. Susan Loeb and Dr. Valerie Myers from Penn State University and Klein Buendel, respectively.  The first author of the recent Nursing Leadership publication is Dr. Erin Kitt-Lewis from Penn State University. Her coauthors include Dr. Susan Loeb from Penn State University, Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel, Dr. Rachel Wion from Indiana University, and Dr. Julie Murphy from King’s College.

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

Lessons Learned: Accessing Sites for Correctional Research

Lessons Learned: Accessing Sites for Correctional Research

Dr. Erin Kitt-Lewis from Penn State University presented insights into accessing correctional facilities for research at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, was a co-author on the presentation.

Despite the imperative to engage in research in corrections, researchers face many challenges due to the restrictive nature of this setting. Dr. Kitt-Lewis shared many of the lessons learned by this collaborative research team as they worked to secure diverse prison and jail settings to research, develop, and test the Enhancing Care for the Aged and Dying in Prison program.

Lessons learned included the discovery of contextually-specific constraints such as the closing or consolidating of services or facilities, managing staffing constraints, relocating staff, ascertaining and adhering to policies and administrative directives, and working within the guidelines of the review board of the correctional system.

Establishing and maintaining relationships with key stakeholders in corrections were also important aspects of this research. In her presentation, Dr. Kitt-Lewis discussed developing networking opportunities such as connecting via social media like LinkedIn, attending corrections conferences, and discussing potential research opportunities to help build relationships with key stakeholders and decision-makers. Additional perceptions from the field included identifying potential barriers or constraints to accessing correctional sites, and sustaining relationships post-research via ongoing communication such as sharing periodic updates, final reports, and publications with partners.

The correctional system has often been called a “closed” system due to the difficulty faced by researchers in attempting to access and conduct research. However, establishing well-defined strategies to conduct research in the system appears to create efficiency and promote much needed health-related research in the correction setting. Research outcomes that are contextually-specific can support and foster equitable care for people who are incarcerated.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented, in addition to Dr. Erin Kitt-Lewis, include Dr. Susan Loeb and Kaléi Kowalchik from Penn State University; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

Implementing E-Training for Geriatric and End-of-Life Care in Corrections

Implementing E-Training for Geriatric and End-of-Life Care in Corrections

Dr. Susan Loeb from The Pennsylvania State University College of Nursing is presenting on the creation of a computer-based learning (CBL) program for corrections staff at the 32nd Annual Scientific Sessions virtual conference of the Eastern Nursing Research Society on March 26-27, 2020. Klein Buendel Senior Scientist, Dr. Valerie Myers, is a co-author on the presentation.

Experts in corrections have identified the care of older individuals who are incarcerated as a high priority area for research and policy. Therefore, there is a need to provide evidence-based training tailored to frontline corrections personnel who are charged with the care and oversight of aged and dying incarcerated individuals. In response, the research team developed, implemented, and tested a CBL program that aligned with contextual environment constraints and the infrastructure-specific needs of corrections.

The virtual presentation will describe how the adoption mechanisms and support systems were integrated from set up to full-scale usability testing of the CBL program, Enhancing Care for the Aged and Dying in Prison (ECAD-P) for corrections staff. Specifically, factors that affect adoption and support systems were identified, examined and implemented at each phase of the development and implementation process of ECAD-P. In the Set-Up phase, the format of a paper-pencil toolkit was not sustainable for long-term, broad dissemination of the program, so support systems were evaluated to determine the capabilities of CBL. Throughout the development, Expert and Community Advisory Boards critically examined the content and programming measures of the product to ensure the product complied with usual practices and institutional constraints.

During testing, small scale usability-testing was conducted to determine human capacity, infrastructure capabilities, reporting systems, and program design and function. In going to full-scale, large-scale usability testing provided valuable insights on implementation considerations, such as leadership, communication, policy, and culture of institution. Consideration of adoption mechanisms and support systems ultimately allowed for researchers to refine ECAD-P for future, effective, large-scale dissemination.

This research was funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Aging at the National Institutes of Health (AG049570; Dr. Susan Loeb and Dr. Valerie Myers, Multiple Principal Investigators). Collaborators on the work presented include Dr. Erin Kitt-Lewis and Kaléi Kowalchik from The Pennsylvania State University College of Nursing; Dr. Rachel Wion from Indiana University School of Nursing; Julie Murphy from King College Nursing Program; and Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel.

Developing Geriatric and End-of-Life E-training For Inmate Peer Caregivers

Developing Geriatric and End-of-Life E-training For Inmate Peer Caregivers

Dr. Susan Loeb from Penn State University presented on the development of computer-based learning modules for caregivers of the aged and dying in prisons at the 11th Annual Conference on the Science of Dissemination and Implementation in Health in Washington DC, December 3-5, 2018. This research is being conducted with Dr. Valerie Myers at Klein Buendel (KB), a co-author on the presentation.

The increasing numbers and complex needs of aged and dying inmates intensifies the burden of care and costs incurred by prisons. In an initial study (NR011874), best practices in the community were adapted in the Toolkit for Enhancing End-of-Life Care (EOL) in Prisons to train prison staff in EOL care. The print-based Toolkit was well received; however, not well suited for dissemination and lacked geriatric content. The Toolkit was transformed and expanded into Enhancing Care of the Aged and Dying in Prisons (ECAD-P) computer-based learning (CBL) modules in a second study (AG049570). ECAD-P development revealed the need to develop e-training for inmates to assist staff as caregivers for aged and dying inmates.

The purpose of the third study, which was presented at the D&I Conference, is to transform best practices in inmate peer caregiving into a comprehensive training program  that consists of media-rich and interactive computer-based learning modules for providing geriatric and EOL care to peers (i.e., prisoner to prisoner). Focus groups with inmate caregivers, prison staff, and training staff were conducted to determine a menu of CBL modules. An Advisory Board of experts in EOL care, geriatrics, ethics, and corrections health informed the selection of modules for development. Usability testing will soon be conducted in one men’s and one women’s prison with inmates who are experienced in providing mental health peer support, but have not been caregivers for their aged and dying peers. Focus group data will be analyzed using thematic analysis. Usability data will be analyzed using descriptive statistics and content analysis. Data are currently being collected. Analysis will be complete in October and the presentation completed by November.

The Prisoner to Prisoner (P2P) project allows the creation of innovative technology while being mindful of security and safety concerns regarding prisoners. Expanded testing of the P2P product will optimize the scalable unit for broader dissemination, establish the effectiveness of the training, provide critical insights relevant to dissemination of the commercial product, and position the research team to study broad dissemination and implementation outcomes.

This research was funded by a Small Business Technology Transfer (STTR) grant to KB 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 and Dr. Rachel Wion from the Penn State University College of Nursing, and Tiffany Jerrod and Morgan Carter from KB. The technology is being developed by the KB Creative Team.

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.