Caregiving & Incarceration Evidence of Compassion, Mercy, and Redemption in Prison

1. Tina Maschi, PhD, LCSW, ACSWAssociate ProfessorFordham UniversityGraduate School of Social ServiceExecutive Director, Be the Evidence ProjectPresident, National Organization of Forensic Social Work Caregiving & Incarceration Evidence of Compassion, Mercy, and Redemption in Prison

2. Overview • Human Rights • The State of Death, Dying, and Prison Treatment as Usual • Peer Support, Compassion, Service, among the Incarcerated • Peer Support Program Exemplars

3. Human Rights as a Framework for Care Giving and Receiving The Whole Person in the Social Environment Health & Well-Being Individual Family Community Human Rights Values Dignity, Respect, Intrinsic Value Duty to Others Human Rights • Political • Civil • Economic • Social • Cultural • Root (basic needs) • Physical • Cognitive • Emotional • Social /Cultural • Spiritual • Participatory (Maschi, 2011)

4. The Critical Omega Point:How Did You Think We Got Here? • U.S-Global Mass Incarcerator (2.3 million in prison, 16% aged 50 and older) • Accelerated aging (i.e., biological vs. chronological age, e.g., early cognitive and physical decline, dementia, early mortality) in prison populations • Record numbers die a year in prison of many causes (e.g., U.S. in 2012; N = 5,000) • Lack of adequate specialized long term and hospice care or use of compassionate release laws • Undignified Practices: Incarcerated person died in shackles chained to his bed in New Orleans hospital (1984) (BJS, 2012; Finlay, 1998; Marushak,2008 WHO, 2010)

5. Understanding the Problem From A Heightened Global Historic Consciousness Perspective • Common Cumulative Individual, Social and Structural Determinants: for Health, Well-being, and CJ Involvement • Race • Gender • Age • Physical & Mental Disabilities • Empathy and Moral Development • Decision-Making and Problem Solving Skills • Health Histories • Substance Use • Offense History • Trauma/Stress/Victimization • Poverty/Income • Education/Employment • Homelessness • Offense History • Oppression, Stigma, Discrimination • Policies (Therapeutic Jurisprudence) • Social Support • Family, Peers, Community • Access to Services or Legal Assistance • Prior Service Use • Environment (Prison, Violence, Inadequate Healthcare) The Critical Omega (End) Point- Age, Death and Dying Human Made Disaster Alpha-the Beginning

6. Trajectory of Care Giving Systems That Influence Aging, Longevity, and Justice The Pathway to the Black Box of Prison for Older and Social Disadvantaged Populations

7. Why the Rise of the Seriously Ill and Dying in Prison? • General growth in global aging population • Ebb and flow of stricter punitive approaches vs. compassionate/restorative approaches • 1980s U.S. stricter sentencing policies (e.g., violent crimes), disproportionate and unjust sentences and and then adopted worldwide • Created rapidly growing international human made disaster of the mass incarceration of elderly and other socially disadvantaged groups • Additional Lack of Prison Restorative Justice Practice and Fair Parole and Compassionate Release Laws and Practices (ACLU, 2012; Aday, 2003; HRW, 2012; Maschi et al., 2011; in press; UNDOC, 2009; Wahidin, 2004; WHO, 2011; Williams et al., 2011, 2012)

8. Problem: Multisystemic Barriers Corrections is ill-prepared to address the problem alone: • Providing holistic long-term health and social care; or • Addressing the cumulative determinants of disadvantage (‘social determinants of health’) • Multi-system service and large scale policy reform that infuses compassion and restoration • Training interdisciplinary professionals • Empowering individuals, families, and communities adversely affected • Effectively addressing negative public attitudes towards stigmatized groups and sensitive topics • attitudes towards aging, death and dying, crime and victimization, public safety counter arguments (ACLU, 2012; Aday, 2003; HRW, 2012; Maschi et al., 2011; in press; UNDOC, 2009; WHO, 2011; Williams et al., 2011, 2012)

9. Heterogeneity of Aging in Place: The Intersection of Sentence Length & Comorbid Special Needs Prison Sentence Length Possible Special Needs Comorbidities Older Prisoners Ethnic and Racial Minorities and Indigenous Peoples Prisoners with Mental Health Care Needs Prisoners with Disabilities Lesbian, Gay, Bisexual, and Transgender (LGBT) Persons Foreign National Persons Persons Under Sentence of Death Women (may have one or more special needs-implications for access to justice) • Life Course Older Adults in Prison (Long-termer Incarcerated early in life)-serving long sentences (20+ years) often for violent offenses • Acute and Chronic Older Person with Recidivism History-cycle in and out of prison • Late Onset Older Adult in Prison-incarcerated later in life and serving various sentence lengths (e.g.,Goetting, 1983; HRW, 2012; Maschi et al., 2012; Williams et al. 2012)

10. Age and Sentence Length-US State Prisons (HRW, 2012, p. 26; National Corrections Reporting Program Note: Based on 24 states reporting year-end prison population data for 2009.

11. U.S. State Prisoners Statistics on Cause of Deaths by Demographics (BJS, 2010)

12. Crime Type and Age-US State Prisons (2009) (HRW, 20120, p. 27; National Corrections Reporting Program Note: Based on 24 states reporting year-end prison population data for 2009.

13. Methods • Funder: John A. Hartford Foundation and Gerontological Society of America-Geriatric Social Work Faculty Scholars Award • Principal Investigator: Tina Maschi, PhD, LCSW, ACSW • Design: Cross-Sectional Correlational Mixed Methods Design • Sample: 677 older adults in prison • 654 men; 24 women • Measures: Life Stressors Checklist-Revised, open-ended questions • Data Collection: Mailed Survey (Dillman 4 step method) • Quantitative Analysis: Descriptive AnalysisQualitative Data Analysis: Grounded Theory Approach

14. Holistic Portrait: Participants’ Self Reported Personal Histories (N = 667)

15. Holistic Portrait: Participants’ Self-Reported Health Histories (N = 672)

16. Personal and Professional Contacts (past 3 months)

17. Life and Death in Prison Quote from ‘Mary’, 66 year old woman in prison-Served 5 years Prison is a hard place. Pure Hell! As long as you are in khaki, you are considered non-human. I miss my family and want to go home so bad. I don't feel there is enough mental health available on a regular basis or the comfortable feeling of just expressing yourself without the fear of being put in lockdown. The elder suffer the most because there isn't much for them, us. The medical here makes no sense. Until you have an ailment, you are put off and time holds you back. I have the starts of osteoporosis and seeing how some people young and old are treated makes me suffer and deal with it. I look at it that I will deal with it when I get home. In the meantime I hurt and deal with it. Prayer and God is what gets me through every day, moment, second I am here. Overall it's horrible and wouldn't wish this on my worst enemy. From T. Maschi (2010) John A. Hartford and Gerontological Society of America Geriatric Social Work Scholars Funded Project

18. Life and Death in Prison Quote from ‘Joseph’, 57 year old man in prison I was assigned to a job in the Prison Infirmary (E.C.U.) as a porter. The infirmary job was often very depressing. They have a couple of padded cells there and the screams of tormented souls could be heard throughout many shifts. There were also what we called the "death rooms". These were a row of 5-6 cells which housed terminally ill inmates. They had been brought in from prisons throughout the state. Many were fairly young. The medical "professionals" working here had minimal interaction with them; they were largely cared for by-care inmate volunteers. When one of the terminal cases passed away, and ambulance would eventually arrive to take the body out of the prison. The guards and medical staff would not help "bag and tag" the body, so it was left to us porters to assist in it. From T. Maschi (2010) John A. Hartford and Gerontological Society of America Geriatric Social Work Scholars Funded Project

19. Life and Death in Prison Quote from ‘Joseph’, a 57 year old man in prison (continued) The apathy of the guards toward dying inmates was unconscionable. We had one inmate about 30 years old whose wife and 2 small children were given permission for a special visit because he was near death. As shift change approached, a nurse entered the room and the family had to stand outside of the door. A female guard yelled to the nurse, "Isn't he dead yet? I don't want to have to stay late to do the paperwork." The two little girls were sobbing in no time. We also had an inmate turn 100 years old there. He was completely bed-ridden. He passed away eventually. I was left wondering how society was being served by that. In the 6 months that I worked there, 6-7 inmates passed away. Hepatitis and diabetes cases abounded, with many amputations. . From T. Maschi (2010) John A. Hartford and Gerontological Society of America Geriatric Social Work Scholars Funded Project

20. Qualitative Findings

21. Life Course Trauma and Social Contexts • On average, adults aged 50+ report 3 lifetime traumatic or stressful life events and current subjective distress • 80% report being witnesses to or victims of family and/or community violence, including war • 60% report an unexpected death-someone class • 40% report trauma and stress symptoms to being diagnosed with a serious physical or mental illness and retraumatization in healthcare settings • 25% caregiver of person with serious illness • 28% reported forced separation from a child • 5%-have child with a handicap • 60% report abuse and stress in prison From T. Maschi (2010) John A. Hartford and Gerontological Society of America Geriatric Social Work Scholars Funded Project

22. Serving Life Documentary "Serving Life" takes viewers inside Louisiana's maximum security prison at Angola, where the average sentence is more than 90 years. The prisoners within its walls are the worst of the worst - rapists, kidnappers and murderers. With prison sentences so long, 85 percent will never again live in the outside world. Instead, the will grow old and die in Angola. "Serving Life" documents an extraordinary hospice program where hardened criminals care for their dying fellow inmates. In doing so, they embark on a journey that may end in personal rehabilitation. " 'Serving Life' reveals the humanity that exists inside each and every one of us," said Whitaker. "In the Angola prison's hospice, we meet inmates who decide to take an opportunity for redemption, reminding us of the connection that exists between each and every human being." The volunteers are trained, pushed and tested. Some fail, but some succeed and discover that the human touch can reach the soul. "I thought maybe if I helped somebody else," one inmate says, "that would help relieve some of the guilt." From: http://press.discovery.com/us/own/programs/serving-life/

23. Local to Global Innovations that Incorporate Human Rights and Compassion in Corrections IN SMALL PLACES CLOSE TO HOME

24. Findings: Wellness ActivitiesPsychosocial Spiritual Empowerment Medicine: Qualitative Findings What Kinds of Things Did You Do in the Past Month to Manage Stress? • Exercise (4) • I do yoga all the time • Pray (6) • Read (4) • Pray and read the Quran • Anger management (1) • Music (1) • Music relaxation are my stress relievers • Meditate (1) • Self Reflection (1) • Read, study, work on self, and improvement, attitude, behaviors • Leadership and Social Participation (Participatory) (5) • Programs, exercise, palliative care worker, working with at risk juveniles, etc… • Focus on victim program, exercise, computer workforce, community awareness day, HIV AIDS group • Read my Bible, I am a minister now. I do all things the word way • NA and AA • Exercise, work (strip & buff floors), write letters, talk on the phone

25. Promising Practices-Common Factors Human Rights-Based & Target One or More Domains of Well-Being [root (basic needs), physical, cognitive, emotional, social/cultural, spiritual, participatory] • Geriatric case management (medical, mental health, substance abuse,, family services, social services, housing, educational or vocational training, victim-offender mediation, spiritual counseling, physical exercise, employment or benefits counseling) • Culturally responsive-address one or more special needs populations • Establishment of safe and peaceful environment • Assessment of cognitive and physical capacity to establish service needs (as opposed to chronological age) • Availability sensitive environmental modifications (including segregated units, specialized lighting and open shared meeting space) • Holistic dementia and palliative and end-of-life care • Complementary medicine (e.g., arts, pet therapy, massage, folk healing or spiritual practices) • Family and peer accessibility • Peer support models (in-prison or community) • Victim and advocacy services • Human, Civil, and Legal Rights

26. Promising Practices-Exemplars • Prisonor Community • The Unit for Cognitively Impaired (UCI) (Fishkill, NY Corrections)-Dementia Unit-innovative, holistic design • Prison Hospices with Peer Support (Prison and Community) • Angola State Prison Hospice Unit -Hospice with peer support component • California Men’s Colony-Treatment of serious and terminally ill with peer support component • INFIRM: Community Program in Canada with Human Rights Framework • True Grit Program-Geriatric Structure Programming in Nevada Prison • India-Long Termers Family-Focused Open Prison (Aday & Krabill, 2012; Harrison, 2006. UNODC, 2009; Maschi et al., 2011, 2012)

27. What ‘Lifers’ Can Teach Us About Thinking Outside of the Prison Box: ‘Prisons of Peace” Welcome to Prison of Peace Prison of Peace is a pro bono project created by professional mediators Laurel Kaufer, Esq. and Douglas E. Noll, Esq. at the request of life and long term inmates at Valley State Prison for Women in Chowchilla, CA. Prisoners as Peacemakers? How is it that women, with dark pasts, many of them serving time for murder and manslaughter, could possibly be peacemakers? It Started With a Letter... The story is one of personal commitment to themselves and the community in which most are destined to live out their lives.“This is an environment filled with conflict and violence. There is a dire need and want for change,” said Susan Russo, one of the fifteen initial peacemakers, serving a life sentence without the possibility of parole at Valley State Prison for Women in Chowchilla, CA. “Mediation interests all of us because we are lifers and long-termers hoping to make a difference in teaching our peers that there is a better way.” Beginning her quest in 2007, Ms. Russo wrote over 50 handwritten letters from prison to mediators all over California. Her letters went unanswered until August of 2009 when one of her letters made it to Laurel Kaufer, Esq., a well-known Southern California mediator and peacemaker and founder of the post-Katrina Mississippi Mediation Project. “As soon as I read the letter, I was hooked, but also knew that I couldn’t do it alone. Still standing at the mailbox, I called my friend and colleague, Doug Noll, the only person I would consider working with on a project like this,” said Ms. Kaufer. “Doug is a superb trainer, mediator, and restorative justice expert. I read the letter to him. He was silent for about a nano-second before he said, ‘I’m in. What’s our next step?’” The Goals of Prison of Peace To teach personal emotional intelligence skills to inmates To teach essential personal problem-solving skills to inmates To introduce and teach the restorative process of peace circles To introduce and teach the principles of moral engagement To teach basic mediation skills as third party neutrals To embed peacemaking, defined as collaborative, respectful problem-solving processes to resolve interpersonal and group conflicts, within the prison. To create capacity to continue the expansion of training and knowledge within the prison by training inmates to be instructors and trainers. To create a sustainable program of peace building within the prison To provide an avenue for continuing education and training for correctional officers and administrators in conflict resolution, peacemaking, and restorative justice. http://www.prisonofpeace.org/index.html

28. Sensei Charles "Chas" Ransome President of the Lifers & Long Termers Organization at the Otisville Correctional Facility in New York. The Lifers & Long Termers Organization (LLO) http://www.manipulatedtrial.de/Chas%20Ransome.htm

29. Lifers & Long Termers Organization Otisville Correctional Facility, Otisville, New York-1 Current Board consists of: Chas Ransome 85-A-1643 President Vacant Vacant Vice President Ronnie Bush 85-B-1355 Treasurer Alejo Rodriquez 86-A-0607 Secretary HaroldCummings 88T1116 Sgt. Of Arms

30. Lifers & Long Termers Organization OtisvilleCorrectional Facility, Otisville, New York-2 Current Board consists of: Chas Ransome 85-A-1643 President Vacant Vacant Vice President Ronnie Bush 85-B-1355 Treasurer Alejo Rodriquez 86-A-0607 Secretary HaroldCummings 88T1116 Sgt. Of Arms

31. Be theEvidence You Want to Seein the World TAKE AWAY MESSAGE “To forgive is to set a prisoner free and discover that the prisoner was you.”-Lewis Smedes

32. For More Information • If you are interested in getting of this presentation or articles referenced in this presentation: • Visit Be the Evidence Project Aging in the Criminal Justice Project at: http://www.fordham.edu/btep • Contact Tina Maschi at tmaschi@fordham.edu Principal Investigator: Tina Maschi, PhD, LCSW, ACSW Fordham University Graduate School of Social Service 113 West 60th Street New York, NY   10023/ Tel: (914) 367-3105/Fax: (914) 367-3112 Email: tmaschi@fordham.edu

33. Resource Links • Council on Social Work Education Gero-Ed Center • Aging Times Special Issue on Aging in the Criminal Justice System: • http://www.magnetmail.net/actions/email_web_version.cfm?message_id=2036636&user_id=CSWE • Web links provides bibliography and media resources, and special report links

34. Select References • Aday, R. H. (2003). Aging prisoners: Crisis in American corrections. Westport, CT: Praeger. • American Civil Liberties Union [ACLU] (2012) At America’s Expense: The Mass Incarceration of the Elderly. Washington, DC: Author. • Chiu, T., (2010). It’s about time: Aging prisoners, increasing costs, and geriatric release. New York: Vera Institute of Justice. • Davidson, L. & Rowe, M. (Davidson, L. & Rowe, M. (2010). Peer support within criminal justice settings: The role of forensic peer specialists. Retrieved May 9, 2011 from http://gainscenter.samhsa.gov/pdfs/integrating/Davidson_Rowe_Peersupport.pdf • Dawes, J. (2009). Ageing Prisoners: Issues for social work. Australian Social Work, 62(2), 258-271. • Falter, R.G. (2006). Elderly inmates: An emerging correctional population. Correctional Health Journal, 1, 52-69. • Human Rights Watch [HRW] (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.

35. Select References • Maschi, T., Sutfin, S., & O’Connor, B. (2012). Aging, mental health, and the criminal justice system. Journal of Forensic Social Work, 2 (2/3), pp. 162-185. DOI:10.1080/1936928X.2012.750254. • Maschi, T., Viola, D., & Sun, F. (2012). The high cost of the international aging prisoner crisis: Well-being as the common denominator for action. Gerontologist. doi: 10.1093/geront/gns125, first published on October 4, 2012. • Maschi, T., & Baer, J.C. (2012). The heterogeneity of the world assumptions of older adults in prison: Do differing worldviews have a mental health effect? Traumatology. doi: 1534765612443294, first published on April 24, 2012 • Maschi, T., & Baer, J.C., Morrissey, M.B., & Moreno, C. (2012). The aftermath of childhood trauma on late life mental and physical health: A review of the literature. Traumatology. doi: 1534765612437377, first published on April 16, 2012 • Maschi, T., Kwak, J., Ko, E.J., & Morrissey, M. (2012). Forget me not: Dementia in prisons. The Gerontologist, doi: 10.1093/geront/gnr131 • Prison Reform Trust (2008) Doing Time: The Experiences and Needs of Older People in Prison, London: Prison Reform Trust. • Also find more resources at: • http://www.magnetmail.net/actions/email_web_version.cfm?message_id=2036636&user_id=CSWE