E-training of Inmate Peer Caregivers for Enhancing Geriatric and End-of-life Care in Prisons

The US has the highest incarceration rate in the world—imprisoning 693 people per 100,000.
The older adult segment of the prison population has more than tripled since 1990 and their
health issues are common to 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. US prison systems
are facing sharply increased demands in caring for aged and dying inmates. A recent
systematic review revealed that inmate peer caregivers can figure prominently in delivery of
end-of-life (EOL) care in prison. However, the degree of training received by inmate peer
caregivers varies widely. The lack of consistent training, both in content and duration
points to a need for evidence based, current, and readily accessible training for this
abundant human resource for meeting a growing need in US prisons. In response to this need,
this Phase I STTR project, titled E-training of Inmate Peer Caregivers for Enhancing
Geriatric and End-of-Life Care in Prisons, 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 specific 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 (i.e., prisoners who are experienced caregivers, but naïve to geriatric
and EOL care) to evaluate the user interface, ease of use, and perceived barriers in order to
refine and optimize the product. In collaboration with an advisory board of experts in prison
healthcare, geriatrics, ethics, palliative/hospice care, and oversight of an inmate peer
support program, the investigators plan and develop discussion guides and then conduct focus
groups with three groups of prison stakeholders: inmates who serve as peer caregivers for
aged or dying peers; interdisciplinary staff who care for, or oversee care of aged and dying
inmates; and training and information technology staff. One focus group with each of the
above three constituent groups will be held at a men's and a women's prison. Focus groups
will permit investigators to ensure that the design and technology plans match what is
allowable for inmate training and will allow us to isolate essential geriatric and EOL
content for specification in the development of the comprehensive training program. Finally,
the investigators will create and evaluate prototypes of media rich, interactive
computer-based learning modules for inmates serving as peer caregivers. At the end of Phase
I, the investigators will have a specifications document for the design of modules that: fit
with the technology available in corrections settings; is permissible to be used by inmates;
represents the critical learning needs of inmate peer caregivers for assisting with geriatric
and EOL care; and further develops the collaborative relationships in preparation for
commercialization of the product.

Inmate Inclusion Criteria:

- Be a Mental Health Peer Support Specialist

- Be 18 years or older

- Able to speak, understand, and read English

- Able to consent.

Inmate Exclusion Criteria:

- Not be a Mental Health Peer Support Specialist

- Under 18 years of age

- Unable to speak, understand, and read English

- Unable to consent.

Prison Employee Inclusion Criteria:

- 18 years or older

- Employed by a participating at a participating prison

- Able to speak, understand, and read English

- Able to consent

Prison Employee Exclusion Criteria:

- Under 18 years

- Not employed by a participating prison

- Unable to speak English

- Unable to consent