Aging in Prison

BE THE take the stand count on WHITE root AGING PRISONERS A Crisis In study of Intervention BE THE EVIDENCE PROJECT Be the Evidence You Want to See in the field What is Our Mission The mission of the Be the Evidence inclination is to create ken of military man being rights and companionable legal expert issues through question, protagonism, and education. Be The Evidence endure activities shelter dialogue and action on how gentleman rights and affectionate legal expert dirty dog be realized in e realday and passe-partout recitation. Who We atomic get along 18 The Be the Evidence tramp is a collective of globall(a)y cognizant exploreers, practitioners, educators, policy-? makers and advocates, and concerned itizens whose non-? profit independent scholarly and creative ventures be knowing to dole out knowledge, values, and sk diabetics that impart help improve the individual and familiarity reaction to small favorable issues and improve well up-? be ing using every media fashion prerequisite. What We Do Be the Evidence jut activities that involve research, education, and advocacy hand over a vehicle to disseminate instruction to raise small consciousness and the perception of psychological sociopolitical contexts in which in arbitrators s cash in ones chips occur. Transforming society front entails transforming ourselves to become be the evidence we want to bewitch in he argona. Through ruinicipation in self or project-? sponsored activities, we potful help advocate the achieve ment of a neighborlyly just world in which human rights, fond justness, and well-? being are realized for all. On a daily basis, the lived reality of being the evidence challenges individuals everywhere to visualize inside themselves to identify and eradicate oppressive attitudes, thoughts, and sends towards self and others. Founder and executive director Director Tina Maschi, PhD, LCSW, ACSW Coordinator of Projects Samantha L. Sut fin, MSW Current Active Projects maturation and Criminal nicety Project (ACJP) Arts for Change Project (ACP) Qualitative and Mixed Methods Collective (QMMC) pathetic Stories Project (MSP) For more propoundation or to get involved in any projects visit our Be The Evidence Website CONTACT INFORMATION Be the Evidence Project 113 West 60th Street, 7th Floor innovative York, refreshful York one C23 Email emailprotected edu Phone (914) 367-? 3105/201-? 218-? 5064 2 About the W scratche c everywhere On Saturday, October 8, 2011, Fordham University receive naturalize of sociable Service, Be the Evidence Project bonifaceed a forum to plant a face and a physique to this rapidly festering human rights and neighborly judge issue the ageing captive crisis. For example, prison houseers, aged 50 and of age(p), omprise approximately ten percent of the all overall prison universe of dis in-person credit line and had improverd tenfold since 1990. Similar situations are nonable internationally, including Canada and England. The national and international correctional tender body, which was not designed to solve as long-? term wellness sell facility, is ill prepared to steer elderly prisoners complex physical and cordial wellness needs, patch in prison and post prison re-? entry and lodge reintegration. This situation clear needs a concerted and collaborative effort among researchers, practitioners, policymakers, and fraternity members to maneuver and implement an effective esponse. International experts came to join us in supplementress out rough the crisis of senescent prisoners for this historic veritable(a)t at Fordham University The intent of this follow-? up White news news report publisher was to bring together a classify of scholars and practitioners (who gave generously of their m) to contri simplye their work so that keystakeh sure-enough(a)s and the general unrestricted female genitals become more aware of the crisis that is occurring in prisons around the world. Edited by Maschi, Morrissey, Immarigeon, and Sutfin, the White Paper admits nationally and internationally known experts presented research and surpass workouts on topics associate to onetime(a) adults involved n the sinful evaluator ashes (especially prison), age specific correctional programming, elder and family justness, and unlawful justice policy reform. This white paper was purposely made easy as a free and creation document so that any professional, organization, or concerned citizen can use this specifyation to help advance ordinary cognisance of the crisis link to agedness prisoners. It too entrusts recommendation on what we all can do about it, which includes to improve policy and practice with one-time(a) adults in the criminal justice system. Please feel free to skin senses the Be the Evidence Project if you would uniform to become more involved n this project at emailprotected edu or emailpr otected edu. We also invite your feedback about the White Paper and our ongoing projects. Edited by Tina Maschi, PhD, LCSW bloody shame Beth Morrissey, PhD, MPH, JD Russ Immarigeon, MSW Samantha L. Sutfin, MSW promulgated February 8, 2012 Suggested APA citation Maschi, T. , Morrissey, M. B. , Immarigeon, R. , & Sutfin, S. (2012). maturation prisoners A Crisis in unavoidableness of Intervention. in the buff York Fordham University Be the Evidence Project. Retrieved from https//sites. google. com/site/betheevidenceproject/white-? paper-? develop-? prisoner-? forum 3 BE THE EVIDENCE PROJECT AGING PRISONERS A Crisis InNeed of Intervention TABLE OF CONTENTS part I INTRODUCTION AND OVERVIEW Chapter 1 2 Chapter Titles and Authors natesTina Maschi, Mary Beth Morrissey Russ Immarigeon, & Samantha Sutfin Visualizing the Aging prisoner Crisis A Conceptual case for insurance policy and praxis Decision make and featTina Maschi & Mary Beth Morrissey Executive Summary and Recommendati onsRuss Immarigeon Page 5 13 3 21 29 30 PART II existence wellness, MENTAL HEALTH, PALLIATIVE AND END-? OF-? LIFE CARE ISSUES 4 Developing honest and palliative Responses to Suffering Among Seriously Ill Aging prison houseers Content abridgment Implications and Action StepsMaryBeth Morrissey, Tina Maschi, and Junghee Han Forget Me Not mania in Prisons Tina Maschi, Jung Kwak, Eujung Ko & Mary Beth Morrissey Trauma and Stress among elder Adults in the Criminal arbitrator System A Review of the Literature with Implications for feelingy deedTina Maschi Age, cumulative Trauma, Stressful Life Events, and Post- detrimenttic Stress Symptoms among senior(a) Adults in Prison Tina Maschi and Deborah Courtney bosom Use and honest-to-goodness Adults in the Criminal arbiter SystemKeith Morgen square Grit A Structured Living Program for sure-enough(a) Adults in PrisonMary T. Harrison, 4 5 6 38 39 7 8 9 44 49 57 Karen Kopera-Frye and William O.Harrison PART III CRIMINAL JUSTICE POL ICIES AND PRACTICES 10 11 Criminal Sentencing Policy Reform and Aging Prison PopulationsKathleen Auerhahn Doing Hard Time Issues and Challenges Facing overageer Women in PrisonAzrini Wahidin Another Forgotten Population company Reintegration for quondam(a) Adults Leaving PrisonMargaret E. Leigey Disproportionate Minority Contact in the American Juvenile Justice System Implications for Older Adults in Prisons? Susan McCarter Advocacy, Elderly Prisoners, and draw ImprisonmentRuss Immarigeon Its Still About Time Aging Prisoners, turn order Costs, & Geriatric ReleaseTina Chiu 0 71 83 12 100 13 113 14 15 117 123 125 126 129 PART IV interdisciplinary COLLABORATION AND COMMUNITY PARTNERSHIPS 16 17 Social Work and Older Inmates NASW Position PaperMelvin Wilson Personal & Professional Contact Patterns among Older Adults in Prison Interdisciplinary dress ImplicationsMary Beth Morrissey, Samantha Sutfin, and Tina Maschi Interdisciplinary Collaboration Practices with Older Adults in the Community Implications for Prison and Community CorrectionsTina Maschi, Mary Beth Morrissey, Samantha Sutfin, and Manoj Pardasani The height Room Films about Older Adults in PrisonRebecca Ackerman 8 134 extension 143 ABOUT THE BE THE EVIDENCE PROJECT Be the Evidence Project is a non-profit independent scholarly and creative venture designed to disseminate knowledge, values, and skills that entrust help improve the individual and community response to precise complaisant issues and improve benefit using any media means necessary. For more information or to get involved in any projects, please contact emailprotected com or emailprotected edu or visit https//sites. google. om/site/betheevidenceproject/ Be the Evidence You Want to See in the World 5 6 PART I Introduction and Overview 7 CHAPTER 1 Aging Prisoners A Crisis in Need of Intervention INTRODUCTION By Tina Maschi, Mary Beth Morrissey, Russ Immarigeon, and Samantha L. Sutfin Introduction The Aging Prisoners Forum On Octob er 8, 2011, Fordham Universitys Graduate School of Social Services Be the Evidence Project hosted an academic-activist-practitioner forum empower Aging Prisoners A Crisis in Need of Intervention.As a host for this forum, the Fordham University Graduate School of Social Service is distinguished by its mission to promote human rights and societal justice globally through the advancement of economic, political, friendly, physical, kind, spiritual, and educational wellbeing. The Be the Evidence Project, which rears public awareness through educational programs and campaigns, is designed to help achieve this mission.Consistent with the mission of the Fordham University Graduate School of Social Service, the purpose of the forum was to Promote human rights and neighborly justice and benefit for senescent prisoners Increase public awareness of the aging prisoner crisis Help foster an international and interdisciplinary response to aging prisoners Unveil an interdisciplinary poseur for describing and responding to public health-social problems such(prenominal)(prenominal) as aging prisoners for use in interdisciplinary pr reddention and intervention (Maschi & Morrissey, 2011). The event, organized by Drs.Tina Maschi and Mary Beth Morrissey of the Fordham University Graduate School of Social Service, gave internationally-known scholars and practitioners time to present their work to an au riflence of over cl national, local, community, 8 and university members. Program co-sponsors and community partners were the Collaborative for Palliative Care for Westchester and NYS southern Region, the Public Health linkup of New York City, and the National Organization of forensic Social Workers. Special thanks are extended to our expert presenters and discussants, which include Drs.Azrini Wahidin and Ronald Aday. Fordham University students, including Maryann Hom, Samantha Sutfin, Tanneh Wreh, Rebecca Ackerman, as well as many other Fordham students and communi ty volunteers, especially from the Public Health Association of New York City, volunteered in the planning and performance of this event which was setd seamlessly. The White Paper- Aging Prisoners A Crisis in Need of Intervention This follow-up White Paper, Aging Prisoners A Crisis in Need of Intervention is a tribute to and outcome of the October 8th forum.Its publication is opportune in light of the recently released gentleman Rights Watch (2012) subject, Old throne Bars. We chose to self-publish this White Paper in couch to make it readily usable to key stakeh aged(a)s and the general public. As the White Paper editors, we hope that these contributions of top scholars and practitioners crossways the globe will exit readers with many of the necessary tools and information that can be used to begin to attachress this outgrowth crisis in both(prenominal) local and international arenas.Its purpose is to add public awareness and provide information that can be used to fo ster the education and improvement of helpings for aged adult offenders at from each one stage of the criminal justice process, including in prison and upon community reentry. Background to the occupation Americas prison system is rapidly graying. Behind the walls are prisoners with long sentences who will reach old age in prison. The state of older prisoners aged 50 and above is now five time as large as it was in 1990 and represents about 12% of the 2. 3 million prisoners 9 (Sabol & Couture, 2008).This increase in older adult prisoners is not due to a crime surge among older adult offenders, but rather is the result of the passage of stricter sentencing laws, such as Three Strikes, Youre Out and Truth-In-Sentencing laws (Aday, 2003). Thus, the adult correctional system is attempting to grapple with this rapidly growing older adult prison cosmos in need of specialized long-term criminal maintenance. Most older adults in prison are men (93%) of whom half (50%) are Caucasian. However, a disproportionate get along of these aging prisoners are minorities, such as African Americans (32%) and Hispanics (14%) (Sabol & Couture, 2008).As stated throughout the chapters in this volume, older adults in prison break documented physical and amiable health problems, including dementia, and histories of harm and chronic strain. Over 3,000 of these men and women will die each year in prison (James & Glaze, 2006 Maruschak, 2008 Maschi, Kwak, Ko, & Morrissey, 2012). The correctional system, which was not designed as a health sustenance facility, is ill-prepared to address the complex bio-psychosocial and long-term health dole out needs of older adults. Neither is it able to bear the monetary values, which are trinity well-nigh times higher for older than for younger prisoners (Chiu, 2010 Kinsella, 2004). some(prenominal) older adults released to the community are disadvantaged by stigma and miss of access to community resources such as Social Security Income (S SI), housing, and checkup care (Maschi & Morrissey, 2012). They also sidetrack in their patterns of persistence and desistance from crime and their pathways to prison (Sampson & Laub, 2003). Older adults involved in the criminal justice system are a highly undefended and neglected population. Currently, on that point are few professions and communities that can solely and adequately address the needs of this population.Despite the fact that these older adults affirm committed crimes, some of them heinous, an essential ethical human rights and social justice principle is to 10 respect the inherent dignity and worth of the person (UN, 1948), while at the same time attending to societal concerns about public natural rubber and accountability. In the following section, older adults in prison describe the parking area themes of their differing pathways to prison, the stress related to conditions of confinement, and their concerns over prison reentry/community reintegration.These narratives were gathered from a variety of sources, including over 200 open-ended survey responses and letters from a regional research study of older adults in prison. Pathways to Prison numerous older adults identified one or more factors that influence their pathways to prison. These pathways include the influence of inter personalized trauma and/or family violence, get effects, morphological train oppression (especially as it relates to racial discrimination), a history of mental unhealthiness and theatrelessness, and tragic later vitality incidentals History of Interpersonal Trauma A 57-year old risoner wrote that he perceived that his history of interpersonal trauma influenced wherefore he was in prison. He utter, I was sexually assaulted when I was thirteen, I never really trusted anyone after that, tried to get even when I was a Marine, but it was pyrrhic victory at a devastating cost to me. Family Violence A 50-year old prisoner describe his history of family v iolence I was crippled when I was younger, my family member stick and molested me. I was tied to the basement poles beaten always told over and over again youre a slammer bird just like your father. This was so tightly put into my head it blurred everything I cut. Neighborhood Effects A 50-year old prisoner described his neighborhood environment during childhood He said, From the sixth send to the tenth grade I was forced to survive in the madness of the concrete hobo camp. 11 Structural Level Oppression A 63-year old prisoner wrote about his experience with geomorphological level oppression that placed him at- hazard and at odds with the system The education I received in the dimmed community was different in content and context than that of whites. What I well-educated after 12 years of public education was that I was a problem, inferior, uneducatable, and a victim.We (black men) are on the endangered species list. Mental Health and Homelessness A 52-year old prisoner de scribed his mental health and homelessness as related to his criminal justice involvement. He stated, I believe my situation is queer for I committed a crime with the intention of get caught because I was homeless (I suffer from Schizoid Affective Disorder due to a nervous breakdown, loss of job, apartment, car everythingI didnt want to judge shelter at a homeless shelter or church. I was too ashamed and embarrassed to ask for help from my sister and the three friends I take up left in the world.In prison, now I am somewhat stable (off meds and mental health roster) and healthy and strong again, and getting better. Later Life Tragic Incident A 62-year old prisoner shared his story of a later life-time tragic incident that led to his incarceration He disclosed, I was a very productive father of 3 kids with a wife to this day I suddenly adore. She is still waiting for me when I get out. I was a capitulum Compliance Officer for a brokerage making over $300,000 a year. One ni ght after a night at the bleedtrack, I got into an accident going the wrong way on the highway. I hit a van head on with four passengers.I was hurt frightful all the passengers and the driver lived but one was pregnant and she lost the flubso I was charged with manslaughter and sentenced to prison. 12 Stress and Conditions of Confinement In the sample of over 200 letters, many older prisoners described stress related to the adverse conditions of confinement. Two direct quotes state Its very tough surviving prison. The provoking, the unnecessary interference, verbal abuse, and violence only add to the original sentence term to be served. Little things begin to add by therefore causing inmates to react in ways with clutches staff or fellow prisoners.Overcrowded conditions, paltry medical service, lack of interaction with Administrative Staff is stammering. It was my first week of incarceration in 1979. I was standing in line in the mess hall along with about 150 other pris onerswhen all of a sudden a man gets stabbed from behind with a sworda 7? foot sword. The man must subscribe been standing because he was slumped over as if he was touching his toeswith the blade through him and the point of the sword stuck in the floor leaving the handle sticking out his back. The kicker was what the ships officer said I thought the esponse would be Everyone on the floorEveryone up against the wall. alternatively he yelled for a bed sheet and draped it over the slumped body with the impression of the handle topping the sheet to a point. amazement was all over my face as I looked at the all of a sudden body 3 feet away from me. I couldnt remember if I thought or blurted out the wordsWhat kind of world is this? The officer looked me right in the eye and said Keep the line touching Againmy rationality kicked inwhitethornbe Im in a different timeIm definitely in different world. I just wish I wasnt. 13 Community Reintegration (Prison Reentry) The promise of com munity reintegration was frequentlytimes described as a ambiguous sword. Many older adults poised to exit prison and return to the community are not well prepared. One prisoner responded You dont need a survey to know you pass a attractor of men over 50 getting ready to go home, with no money. No place to stay. And no one trying to understand this part of the problem. I earn $15 a month. I go home in 9 months. I have no family to turn to. I dont want to come back to prison, after doing 7 years.I am trying to stay positive. I pray. I go to see the psych. For one on one and I try to look on the bright side. But the reality is, when I hit the street I am on my own. Tell me what good your survey will do me or people like me? White Paper Overview In order to address the issues we have storied, this White Paper contains over 15 research apprize and all-embracing-length articles that are contributions from interdisciplinary scholars and practitioners from across the globe that circumscribe the problems and offer recommendations and problem-solving strategies.The major topics addressed about aging prisoners are related to health, trauma/mental health, criminal justice, and interdisciplinary collaboration. The briefs and articles included also help to provide a richer description of the lived experiences of aging prisoners in their social ecological contexts. This collection offers readers the opportunity to access a broad- found understanding of how psychosocial and structural issues have influenced the creation of and reaping of the aging prisoner population.It also provides possible recommendations for policy and legal reform, program and policy developing and improvement, and interdisciplinary practice. 14 Final Note As the editors of this White Paper, we welcome your comments. These comments can be provided via email at emailprotected edu or by joining our Linked-In, Aging Prisoner and Action Forum at http//www. linkedin. com/groups? gid=3892778&ho me editor in chiefs Tina Maschi, PhD, LCSW, ACSW Mary Beth Morrissey, PhD, MPH, JD Russ Immarigeon, MSW Samantha L. Sutfin, MSW References Aday, R. H. (2003). Aging prisoners Crisis in American corrections.Westport, CT Praeger. Chiu, T. , (2010). Its about time Aging prisoners, change magnitude costs, and geriatric release. New York Vera Institute of Justice. James, D. J. , & Glaze, L. E. (2006). Mental health problems of prison and jail inmates. (NCJ outcome No. 213600). Rockville, MD U. S. Department of Justice. Human Rights Watch (2012). Old behind bars. Retrieved January 30, 2012 from http//www. hrw. org/reports/2012/01/27/old-behind-bars Kinsella, C. (2004). Correctional health care costs. Lexington, KY Council of State Governments. Maruschak, L. M. (2008).Medical problems of prisoners (NCJ issue No. 221740). Rockville, MD US Department of Justice. London, England Author. Maschi, T. , Kwak, J. , Ko, E. J. , & Morrissey, M. (2012). Forget me not Dementia in prisons. The ge riatrician. doi 10. 1093/geront/gnr131 Maschi, T. & Morrissey (2011). A social bionomics of health and eudaemonia for incarcerated older adults An international process and practice example for recovery and reintegration (unpublished manuscript). Sabol, W. J. , & Couture, H. (2008). Prison inmates at midyear 2007. (NCJ Publication No. 221944, pp. 124. ) Rockville, MD U.S. Department of Justice. fall in Nations. (1948). The Universal Declaration of Human Rights. Retrieved from September 1, 2011 from http//www. un. org/en/documents/udhr/ 15 CHAPTER 2 Visualizing the Aging Prisoner Crisis A Conceptual feigning for Policy and Practice Decision Making and Action By Tina Maschi and Mary Beth Morrissey Introduction Aging prisoner narratives, as well as the existing belles-lettres in criminology, gerontology, and social work, reveal that older adults involved with the criminal justice system have complex biological, psychological, emotional, social, and legal concerns.In the absence of holistic approaches that address these two-dimensional needs, the health and public assistance of older prisoners whitethorn be compromised and their risk of recidivism whitethorn be heightened (Human Rights Watch, 2012 James & Glaze, 2006 Kinsella, 2004 Maruschak, 2008 Nunez-Neto, 2008). In this context, individual, social, and structural factors that affect aging prisoners and their life line of merchandise function must be targeted in order to provide effective life course prevention and intervention efforts.Currently, there is a theoretical gap in understanding the complexity of the multi-level factors that contribute to this aging prisoner crisis. Interdisciplinary professionals lack a holistic and integrated amaze that will permit them to deepen their understanding about the psychological, social, and structural issues that inform appropriate interdisciplinary responses to this under fire(predicate) population. In order to address this gap, we have developed a new interv ention model Social environmental science of Health and Well-Being (SEHW) A Process Model for Human function and Development (Maschi & Morrissey, 2011).Model Overview As shown in Figure 1, this model conceptualizes life course human agency (in the direct center of the model). Life course human agency is a key human rights and social justice 16 construct that spans individual self-determination and social structure. Structural approaches to social problems such as the aging prisoner crisis should be designed in a functional way to help foster health and well-being across the life course. We will describe and apply this model that is well-suited for designing third-dimensional legal opinion, prevention, and ntervention efforts, including those occurring in spite of appearance the context of the current aging prisoner crisis. Figure 1 Social Ecology of Health and Well-Being A Process Model For Human Agency and Development Social Structures and Human Agency In our model, social str uctures are conceptualized as influencing human agency, including life course criminal justice involvement and overall health and well-being. When social structures, including relevant social policies, have the goals of fair and just societal conditions and the full recognition of human rights, individuals can exercise their freedoms in an 17 nimpeded environment. When social policies, such as punitive criminal justice policies, result in unfair consequences such as warehousing prisoners until they reach old age or die in prison, they impede individual prisoners right to self-determination. Fostering personal sanction and festering over the life course whitethorn enhance capacities for self-actualization and fulfillment, even in the presence of disadvantaging social structures.Older adults in prison, who suffer the loss of personal autonomy as well as multiple other losses and traumas over the life course, may find new pathways to personal growth and resilience, especially as t hey re-enter society and are integrated as members of their communities (Morrissey, 2011b Maschi & Morrissey, 2011). Historical Time Additional factors that can impede the realization of individuals full potential across the life course include historic time at the individual and collective level.A persons historical time, for example, may include being a victim of trauma (Maschi et al. , 2011 Stojkovic, 2007). Collective historical time may include being part of a coevals in which many individuals became victims of detrimental policies such as the 1980s when stricter sentencing policies mandated longitudinal prison sentences and resulted in many individuals suffering, growing old, and possibly dying in prison. On the more productive side, collective historical time may also facilitate human agency and development.An example includes the wide-scale adoption of public health and treatment approaches, such as the growing mental health recovery movement (Maschi & Morrissey, 2011). Th e implication of using a proactive approach with aging prisoners is that it can lead to the improvement of the overall health and well-being of older adult offenders in prison and in the community. 18 Practice and Stakeholder Contexts Practice and stakeholder contexts also influence individuals life course human agency. These contexts may be found when individuals encounter barriers to needed services, such as mental health or housing.These barriers might place an individual, such as an older adult reentering prison from the community, at risk of ongoing homelessness, decompensation, and/or recidivism (Snyder et al. , 2009 Nunez-Neto, 2008). index number Dynamics Power dynamics are perhaps the most(prenominal) critical luck of our model. Power dynamics manifest themselves at individual and societal levels in the form of intentional or unintentional oppression, lack of awareness, and/or human rights violations, such as in the domains of equal access to employment, social security, housing, and/ or fair treatment in the criminal justice system.Additionally, structural barriers based on personal characteristics, such as age and race , may subjugate some groups more than others. This status disadvantage may have a cumulative effect over the life course. In the case of aging prisoners, evidence suggests that the disproportionate confinement of minorities may increase with age (Maschi & Morrissey. 2011). These structural barriers result in disadvantaging subordinate groups when it comes to fairness in the criminal justice system.These subordinate groups may be most at risk of receiving longer sentences that necessitates they grow old in prison. Disadvantaged groups, such as individuals living in poverty or racial minorities who are at a higher risk of long-term incarceration, may be impeded from achieving their full potential and well-being. They also would be more at risk of health-related decline associated with the long-term poor conditions of confinement (Hum an Rights Watch, 2012 Maschi, Kwak, Ko, & Morrissey, 2012). 19Interdisciplinary Perspectives Our SEHW model describes co-constructed interdisciplinary postures (e. g. , medical, social work, criminal justice, and public health) that help conceptualize and translate into practice more holistic, global responses, including to the international aging prisoner crisis. Multiple thoughts that can inform an effective response to complex social problems, such as aging prisoners, are guided by the following perspectives human rights, social justice and critical date theories as well as life course, social environmental science, and public health perspectives.Human rights, social justice and critical conflict theories are used to help inform issues of human rights and social justice (Mullaly, 2010 Wronka, 2008), especially as they relate to human rights violations and social injustices that have resulted in social problems, such as the neglect and mistreatment of aging prisoners (Maschi e t al. , 2011 Snyder et al. , 2007 Stojkovic, 2007 UN, 1948). The social ecology perspective enables a more holistic view of social problems and recognition of interlocking service systems.In the case of aging prisoners, this perspective allows for the assessment of incidental and/or concurrent service use patterns of individuals throughout the life course. In the case of sequential service use patterns of older adults in prison, the lack of access to mental health or housing services may have put them at risk for criminal justice involvement. Additionally, an assessment of access to current service use may identify gaps in needed services, such as substance abuse treatment while in prison.The life course perspective is another key component of the model because it can be used to illuminate the complexities of human agency and how social and structural factors can facilitate or hinder development over the life course, (Elder, 2003). The life course perspective can be integrated with social science theories from criminology, sociology, and psychology and used to 20 explain psychological, social, and criminogenic factors that influence an individuals life course health and well-being and criminal justice involvement (e. . , Sampson & Laub, 2003). The public health perspective complements and builds upon the aforesaid(prenominal) perspectives by adding a population-based approach for prevention and intervention that digestes on older adults health and well-being and criminal justice involvement (Maschi & Morrissey, 2011). Evidence-Based Practices and Policies Evidence-based practice and policies provide a framework that houses these multiple perspectives, and methods to evaluate the effectiveness of practice and policies.Evidence-based practice and policy strategies allow professionals to plan and monitor process and outcomes of interventions, including older adults health and well-being and risk of and/or involvement in the criminal justice system. Values and E thics Personal and professional values and ethics inform all aspects of the model. Values and ethics are essential to any word of honor of social problems because appropriate assessment and treatment responses to problems are not value-free.Instead, a process of valuing that is multidimensional involving cognitive, emotional, social, cultural and other dimensions is embedded in both personal and professional practices and policies, and in the decision processes of the vulnerable older adults whom we serve (Morrissey, 2011a). Making discussion of values and ethics explicit helps to ensure compassionate treatment for all persons, in this case aging prisoners, while also balancing societal concerns including public health and safety and offender accountability. Applying the Model In applying the SEHW model to an aging prisoner population, it is important to recognize that 21 risons and communities constitute social environments that have their own unique social ecology that can foste r or inhibit the health and well-being of its inhabitants. For example, poor conditions of confinement may inhibit health and well-being of aging prisoners. Adopting evidence-based treatments as an approach or intervention may help to foster change in the ecological environment and promote well-being (Maschi et al. , 2011). As seen in the case of aging prisoners, both the prison and community environments are oftentimes lacking in initiatives that promote health and well-being or older ex-offenders are denied access to them.Moreover, for community reintegration or prison reentry programs that serve older ex-offenders must take into account all of these social structural factors in order to be successful. Designing and assessing existing interventions that target the personal, cultural and structural levels factors that contribute to social problems, such as the aging prisoner population should be key components of program design (Maschi & Morrissey 2011 Mullaly, 2010 Nunez-Neto, 20 08). This model may be used to understand the larger conceptual picture undergirding the aging of prisoners. References Elder, G. 2003). The effect and development of life course theory. In J. T. Mortimer & M. J. Shanahan (Eds. ), Handbook of the life course (pp. 3-21). New York Kluwer Academic/Plenum Publishers. Human Rights Watch (2012). Old behind bars. Retrieved January 30, 2012 from http//www. hrw. org/reports/2012/01/27/old-behind-bars James, D. J. , & Glaze, L. E. (2006). Mental health problems of prison and jail inmates. (NCJ Publication No. 213600). Rockville, MD U. S. Department of Justice. Kinsella, C. (2004). Correctional health care costs. Lexington, KY Council of State Governments. Maruschak, L.M. (2008). Medical problems of prisoners (NCJ Publication No. 221740). Rockville, MD US Department of Justice. London, England Author. 22 Maschi, T. , Dennis, K. , Gibson, S. , MacMillan, T. , Sternberg, S. , & Hom, M. (2011). Trauma and stress among older adults in the crimina l justice system A refreshen of the writings with implications for social work. Journal of Gerontological Social Work, 54, 347-360. Maschi, T. , Kwak, J. , Ko, E. J. , & Morrissey, M. (2012). Forget me not Dementia in prisons. The Gerontologist. doi 10. 1093/geront/gnr131 Maschi, T. & Morrissey (2011).A social ecology of health and well-being for incarcerated older adults An international process and practice model for recovery and reintegration (unpublished manuscript). Morrissey, M. B. (2011a). Phenomenology of twinge and suffering at the end of life A humanistic perspective in gerontological health and social work. Journal of Social Work in End-ofLife and Palliative Care, 7(1), 14-38. Morrissey, M. B. (2011b). Suffering and decision making among severely ill elderly women. Doctoral dissertation, Fordham University, New York, NY. Retrieved December 7, 2011 from http//avoserv. ibrary. fordham. edu/login? url=http//search. proquest. com. avoserv. library. f ordham. edu/docview/8 75564465? accountid=10932 Mullaly, B. (2010). dispute oppression and confronting privilege (2nd ed. ). New York Oxford University Press. Nunez-Neto, B. (2008). Offender reentry Correctional statistics, reintegration into the community, and recidivism A CRS report for congress. Retrieved fromhttp//lieberman. senate. gov/assets/pdf/crs/offenderreentry. pdf Sampson, R. J. , & Laub, J. H. (2003). Life-course desisters? Trajectories of crime among delinquent boys followed to age 70.Criminology, 41, 555-592. Snyder, C. , van Wormer, K. , Chada, J. , & Jaggers, J. (2009). Older adult inmates The challenges for social work. Social Work, 54, 117124. Stojkovic, S. (2007) Elderly prisoners A growing and forgotten group within correctional systems vulnerable to elder abuse, Journal of Elder ill-usage and Neglect, 19(3) 97-117. United Nations. (1948). The Universal Declaration of Human Rights. Retrieved from September 1, 2011 from http//www. un. org/en/documents/udhr/ Wronka, J. (2008). Human rights and social justice Social action and service for the helping and health professions.Thousand Oaks, CA Sage Publications. 23 CHAPTER 3 White Paper Overview and Recommendations By Russ Immarigeon, MSW* commence I Introduction and Overview The articles and briefs in this White Paper on aging prisoners focus on different aspects of older offenders involvement with the corrections process, jail and prison confinement in particular, as well as their overall health and well-being. This White Paper builds on earlier works on aging prisoners by using an interdisciplinary perspective in addressing public health, human rights and social justice issues associated with aging prisoners.Selected topics are covered in the White Paper that address gaps in the literature or build knowledge and delve more deeply into comparatively uncharted areas such as trauma, mental health, palliative care, and interdisciplinary practice with older adults in prison. This white paper compliments the existin g literature that focuses solely on the criminal justice aspects of aging prisoners. As has been noted in the introduction, most of these articles and briefs were originally demoed at a Fordham University Aging Prisoner Forum on October 8, 2011.Many of them were presented to an invited roundtable of leading academics, researchers, and practitioners. A number of these academics and practitioners agreed to have their work published in this free and available white paper. In releasing these papers to a broader constituency, we hope that they will be able to use the information provided in this volume to foster constructive dialogue about aging prisoners among scholars and practitioners as well as to develop or improve research, practice, and policy with older adults in prison. In our introduction to this collection, Tina Maschi, Mary Beth Morrissey, Russ Immarigeon, and Samantha L.Sutfin highlight the growing crisis of aging prisoners in the 24 United States. Reviewing more than 200 l etters from elderly offenders, we describe their pathways to prison, nerve-wracking prison conditions, and community reentry experiences. In addition, we note, This collection will provide readers with a broad-based understanding of how psychosocial and structural issues have influenced the creation of and growth of the aging prisoner population. It also provides practical recommendations for policy and legal reform, program and policy development and improvement, and interdisciplinary practice strategies. Conceptual Model In the opening article, social work faculty member and researcher and president-elect of the National Organization of rhetorical Social Workers (NOFSW) Tina Maschi, and public health law and social work researcher Mary Beth Morrissey of the Fordham University Graduate School of Social Service offer Social Ecology of Health and Well-Being (SEHW) as a process model for deepening our understanding of the psychological, social, and structural issues that inform appr opriate interdisciplinary responses to aging offenders.Part II Public Health, Mental Health, and Palliative and End-of-Life Care Issues Seven articles and briefs in this section address the physical and mental health care and end-oflife needs of aging prisoners. Mary Beth Morrissey, Tina Maschi and Junghee Han describe ethical and palliative responses to seriously ill elderly prisoners, stressing the importance of defining the conditions of these prisoners as a public health crisis. Moreover, action steps are necessary that establish an extract of palliative care philosophies, therapeutic models of care, training, and practices in settings across the care continuum for aging prisoners. Tina Maschi, Jung Kwak, Eujung Ko, and Mary Beth Morrissey follow with an apt discussion of dementia among older prisoners based on their article published in The Gerontologist. 25 The white paper also addresses the often overlooked issue of trauma among older adults in prison. In a series of short s ynopses, Tina Maschi and colleagues report on their survey 19 journal articles for the Journal of Gerontological Social Work, and findings from their study for The Gerontologist on the relationship between age, trauma, and stressful life events.In the latter, the authors discovered a history of distress- and trauma-related events in the lives of prisoners, many of whom were likely to be released from prison in due time. It is clear based on these papers that older adults have a high frequency of being victims and/or witnesses to violence. In addition, they have unique stressors related to aging including stress over declining health and being victimized or dying while in prison. Additionally, research results provide preliminary evidence of connections between a history of earlier life trauma and later life mental health symptoms among older adults in prison.In another article, New Jersey psychologist Keith Morgen, currently the Secretary for the International Association of Addict ions and Offender Counselors, argues for more research related to substance abuse disorders in older prisoners. According to Morgen, the lack of such research impedes effective treatment and lose services for older offenders in prison, on parole, or in reentry. Importantly, Mary T. Harrison, Karen Kopera-Frye, and William O.Harrison offer a lengthy description of True Grit, a Nevada prison-based structured living program that has been in operation successfully for nearly a decade. As the authors note, An important indicator of success is that there has been a zero-percent recidivism rate among the parolees from the True Grit program this far. The sense of community and of on the job(p) together toward a common goal, coupled with the rehabilitative and bio-psychological aspects of the program have enabled these men to reenter the free world. The collaboration between this Senior 26Structured Living Program, its volunteers, and removed agencies has increased the possibility of diff icult placements. Part III Criminal Justice Policies and Practices This next section of the white paper addresses head on criminal justice policies and practices from sentencing to prisoner reentry. The six articles and briefs in this section cover the costs of incarceration, the impact of disproportionate sanctioning, the challenges older prisoners confront in prison as well as during community reintegration, and the context of advocating for aging prisoners.Azrini Wahidin of puffs University in Belfast highlights challenges confronting the management of aging women prisoners health and social care needs, including the need for elder-oriented gender-specific practice guidelines and for increased training of criminal justice personnel. She also recommends the collection of relevant age-specific selective information, the expansion of programs for older prisoners, and study of the cost of incarcerating older offenders. Kathleen Auerhahn of Temple University assesses the impact of s entencing practices, including mandatory three strikes legislation, on the outturn of elder prison populations.She notes, Devoting an increasing proportion of scarce carceral resources to housing an ever-growing population of lowrisk individuals undermines the ability to provide protection from those offenders who do threaten public safety. Margaret E. Leigey of The College of New Jersey examines the biological, psychological, and social factors associated with older prisoners reintegrating into communitybased settings. In particular, she appraises the literature on post-release adjustment,, reunification with community networks, access to medical care, securing housing, obtaining employment, recidivism, and programs for older offenders. 7 Tina Chiu of the Vera Institute of Justice reports four factors related to the intent and impact of geriatric release laws political considerations and public opinion narrow eligibility criteria procedures that discourage prisoners from applyin g for release and complicated, lengthy referral and review processes. Susan McCarter describes the rippled implications of disproportionate minority contact in the juvenile justice system for older prisoners. Russ Immarigeon, an editor of Offender Programs Report, provides a historical overview of advocacy efforts affecting older prisoners.He notes, The critical point, in terms of advocating on behalf of elderly offenders or prisoners, including diversion and deinstitutionalization efforts, is more a matter of clear focus than of creating new options. Opportunities exist within current criminal justice and corrections structures to divert and deinstitutionalize elderly offenders. We need to focus our attention on this objective. Part IV Interdisciplinary Collaboration and Community Partnerships The final section addresses the often overlooked issue of interdisciplinary collaboration and community partnerships when it comes to addressing the issue of aging prisoners.Three articles a nd briefs in the final section of this collection address social work and older prisoners, interdisciplinary and collaborative practices, and practice implications that emerge from personal and professional contact patterns within prisons. Melvin Wilson of the National Association of Social Workers (NASW) describes service coordination and other challenges facing those who work with older offenders in American jails and prisons. picking a gap in the literature on personal and professional contacts of aging prisoners, Mary Beth Morrissey, Samantha L.Sutfin, and Tina Maschi review data collected from elderly New Jersey prisoners, finding that medical services, not psychological or social services, were most frequently used, although not always with satisfaction. These authors report, Perhaps the 28 most troubling of findings is that older adults had minimal contact with family members from the community. Given that evidence that family social support is an important aspect of success ful coping for older adults in prison, those older adults that do not have the opportunity to have visits or phone contact may place their well-being at risk. Lastly, Tina Maschi, Mary Beth Morrissey, Samantha L. Sutfin, and Manoj Pardasani explore the implications of interdisciplinary collaboration for practice with community-based older offenders. Analyzing secondary data from NASWs 2004 National Study of Licensed Social Workers, these authors report that offenders frequently had multiple presenting problems, including chronic disease, grief and bereavement issues, end-of-life and palliative concerns, dementia issues, and phencyclidine hydrochloride concerns. Interdisciplinary work was common, especially between social workers and health care professionals.Issues and Recommendations In the course of their work, the multiple authors of these articles and briefs make a host of policy, practice, and research recommendations. Key items among them are the following Past and current tr auma and stress are highly prevalent among aging prisoner populations. Older adults in prison with past times and current trauma are at risk for adverse mental health problems which may be exacerbated by the prison environment. A variety of age-related mental health problems, such as dementia, are higher among older prisoner populations compared to their community counterparts.There clearly is a need for a more gero-sensitive, trauma- intercommunicate mental health treatment that addresses trauma and stress, and age-related mental health issues, such as dementia. Older male and pistillate prisoners should be dealt with differently. More gender sensitive approaches for male and female incarcerated older adults are warranted. 29 The aging prison population has resulted in green goddess incarceration. Legal reforms should be considered that abate the production of elderly prisoner populations With the increase of aging prisoners, there is a reality that a sizable number will die in prison. Integration of palliative care approaches into prisons and community reentry programs including advance care planning and pain care and management can improve elderly prisoners quality of life and help to prevent and placate suffering among seriously ill prisoners. Additionally, the introduction and promotion of shared informed decision making models can improve communication and holistic, coordinated care services in corrections Older adults in prison often have minimal contact with their family members. Family involvement can improve the well-being of often isolated older prisoners. Therefore, more family programming is needed in corrections for older adults in prison Older adult prisoner have different developmental needs than younger prisoners. More age-specific programming is needed across the United States, such as geriatric care units, including palliative and hospice services Housing older adults in prison is costly.Monitoring, reporting, and military rating stra tegies can enhance the safety and sensibility of geriatric release practices and Many elderly male and female prisoners can be diverted or released from prison without undue risk to public safety. Policies such as compassionate release should be adopted and used. Social workers, the authors of many of these articles and briefs agree, have the skills and values necessary for linking the diverse service needs of aging prisoners. 30As a collective, these authors offer a forum to further the dialogue concerning aging prisoners health, mental health, and criminal justice issues. A major objective of this volume was to put a name to the face of aging prisoners and underscore the human rights and social justice issues evident in the aging prisoner crisis. The chapters written by well-respected academics and practitioners included in this volume clearly demonstrate that this objective was achieved. *Russ Immarigeon is Editor of Offender Programs Report. 31 PART II PUBLIC HEALTH, MENTAL HEA LTH AND PALLIATIVE AND END-OF-LIFE CARE ISSUES 2 CHAPTER 4 Developing Ethical and Palliative Responses to Suffering Among Seriously Ill Aging Prisoners Content Analysis Implications and Action Steps Mary Beth Morrissey, Tina Maschi, and Junghee Han Defining Public Health Problem and its order Prison heightens the pain and suffering of prisoners aging into their later years get rid of the social and relational supports of community-dwelling older adults. Overcrowding and marginalized access to appropriate diagnosis, treatment, preventive care, and mental health services, severely limit the health and well-being of aging prisoners.The magnitude and severity of these unacceptable conditions are amply evident in the nations prison systems and oftentimes rise to the level of constitutional violations of prisoners rights, as demonstrated by the recent holding of the US Supreme Court in dark-brown v Plata (2011) affirming a lower court decision ordering calcium to release over 40,000 pr isoners because of findings of dangerous overcrowding and grossly inadequate provision of medical and mental health care (p. ) that caused needless suffering and death (p. 3) in the states prisons. Older adults in prison are at high risk for co-occurring (substance abuse and mental health) disorders and dementia (Maschi, Kwak, Ko & Morrissey, 2012). About 52% will die of a chronic illness, such as HIV/AIDS, heart and lung disease, and dementia (Maschi, Kwak, Ko, & Morrissey, 2012 Carson & Noonan, 2011). The seriousness of such public health problems among aging prisoners is range crisis proportions.The population of adults aged 50 and older is a rapidly growing subgroup of the prison population with complex medical needs, chronic illnesses, and disabilities. This public health crisis calls for comprehensive populationbased strategies that focus on prevention, care, 33 education, and research (Institute of Medicine, 2011 Morrissey, Brown-Borg, de Cabo & Silverstein, 2011). The urgen cy of the care needs of older adults in prison requires interdisciplinary collaborative action to bring relief to their experiences of pain and suffering.The prison system all too often creates social and health care injustices for vulnerable human beings at the end-oflife, imposing an ethical and moral obligation upon interdisciplinary professionals, scholars, and advocates in the criminal justice system and larger community to abet and collaborate in building a movement that will deliver more humane and empathic care to suffering older prisoners.The home for such a movement draws on the values and practice of community reintegration, restorative justice and human rights, including affirming the dignity of and respect for every human person, promoting the well-being of all members of the community based upon shared responsibility and accountability, and workings toward peace (Maschi & Morrissey, 2011). Content Analysis This content analysis of the theoretical and verifiable lit erature evaluates available research evidence on public health and health care prevention strategies and interventions that address the aging prisoner crisis.In the past decade, the number of hospice programs in the United States has grown to about 75, such as those at state prisons in Iowa and Louisiana (Maschi et al. , 2012). What is unique about these programs is that in some cases they have introduced and adopted interdisciplinary collaboration and peer support practices in the delivery of health services (Harrison & Benedetti, 2009). Despite these promising practices to date, there has been little research done in this area to