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Table 2 Key features of the programmes described in included papers

From: A systematic integrative review of programmes addressing the social care needs of older prisoners

Paper No Author, Year, Country Study Aim Study type Sample Size & Type Intervention Caregivers MAIN FINDINGS for: (i) programme attendees; (ii) prisoner peer supporters (PPS); (iii) programme and prison staff; (iv) the prison; (v) costs
(I) Hospice programmes
1 Bronstein & Wright, 2007, USA To learn about social work & prison staff collaboration Qualitative –telephone interviews n = 14, All hospice co-ordinators Hospice – 14 hospices, 11 states MDT (Psychology and business); PPS & CVs (i) positive care from PPSs particularly; (ii) transformational impact (self-worth increase); (iii) MDT works well; prison staff support mixed; (iv) prison management supportive, more care = better security, prison as more humane; (v) none discussed
2 Cloyes, Rosenkranz, Wold, Berry, & Supiano, 2014, USA To explore the motivation and impact of hospice work on PPSs Qualitative survey n = 75 All PPSs – (24%) female Hospice – 5 prisons in Louisiana, inc Angola MDT PPS (i) none discussed; (ii) positive impact - (re) construct identity, redemption, expressing true self, paying it forward, developing shared collective identity; (iii) none discussed; (iv) supports sense of prison as community; (v) none discussed
3 Cloyes et al., 2016, USA To identify key factors in providing a prison hospice programme Qualitative -interviews and observation n = 43 [prison staff (n = 5), hospice staff (n = 14), PPS (n = 24)] Hospice – Louisiana, Angola MDT; PPS (i) PPS care high quality; prison staff can protect, but also limit care (eg visits); (ii) critical role, free up staff; (iii) improved hospice staff practice, shared values and teamwork; some prison staff uphold hospice values; (iv) improved prison culture, supportive management – problem solve security issues; (v) none discussed
4 Cloyes et al., 2017, USA To describe how prisoners learn to provide hospice care Qualitative - interviews and ethnography n = 43, [Prison officers (n = 5), hospice staff (n = 14), PPS (n = 24)] Hospice – Louisiana, Angola MDT; PPS (i) none discussed; (ii) critical role, work rewarding, but stressful - grief and burn-out issues; (iii) staff support and respect PPSs, with boundaries, see them as enabling the delivery of more comprehensive care; (iv&v) none discussed
5 Hoffman & Dickinson, 2011, USA To explore features of hospice programmes Survey - questionnaires n = 43 All hospice staff Hospice – 43 programmes unknown locations MDTs; PPS 93%, Dietician 45%;Pharmacist 21%; Family 24%; CVs 17%;Psychologist 7% (i) none discussed; (ii) develop confidence & compassion, but emotional toll; (iii) strongly supportive programme staff; mixed support from prison staff, but lack training; (iv) strongly supportive prisoners and administration, public less so; (v) possible reduction in health care costs (less transportation and security costs), especially if use a DNR admission criteria.
6 Loeb et al., 2013, USA To explore end-of life care values and perceptions of PPSs Qualitative -interviews n = 17 All PPSs Hospice/ End of life care, 4 prisons in one State MDT
(psychology support staff)
(half paid)
(i) some staff lack compassion, stong bonds with PPS; (ii) transformative –non-judgmental, help self by helping others, keep out of trouble to continue with work; (iii) respect and support of PPS; (iv) improved relationships and community morale, but focus on security a barrier and some prisoners can be disparaging; (v) none discussed
7 Maull, 1991, USA To describe the development of a prison hospice and its six-month pilot evaluation Survey - questionnaires n = unknown Health & prison staff; patients & PPSs Hospice –Springfield MDT (Psychologist, no social worker or Dr) PPS (i) universally positive – PPSs helped depression, increased activeness; (ii) positive about programme, essential, work as life-enhancing; (iii) bridges are in process of being built with medical staff, with small majority of prison staff supportive but most had no opinion-apathy/lack of awareness; (iv&v) none discussed.
8 Maull, 1998, USA To explore issues affecting hospice care delivery Mixed: Interviews, Questionnaires; expert opinion n = unknown. Hospice co-ordinators and staff, prison staff, PPSs Hospice programmes in 7 states MDT (psychologist); PPS; CV (i) fear and suspicion, some prefer to remain in mainstream prison – friends & more activities unless can get off unit, pain medication poor, trust PPSs and CVs more; (ii) key, redemptive, paying forward, (iii) staff trained to be wary of prisoners & CVs; (iv) security-care conflict, environments typically Spartan; may be seen as a death row; (v) hospice reputation as cost-effective.
9 Stone, Papadopoulos, & Kelly, 2012, UK To examine evidence of palliative care in prisons, good practice and barriers Integrative review n = 21 5 = UK studies 16 = USA studies Hospice /end-of-life care (UK = 5, USA-16) MDT (Psychiatrists, Dieticians) PPS (majority) CV (minority) (i) some emotional support esp. from PPSs, but some staff suspicious, and some feel they are undeserving of hospice; lack pain meds, adequate in one study, and some wariness of hospices and DNR orders; (ii) central role, emotionally rewarding, rehabilitative; (iii) suspicion of prisoners, (iv) most hospices fine, one suggested no advantages or special amenities; (v) within-prison hospices can be “cost-effective”
10 Supiano, Cloyes, & Berry, 2014, USA To explore the impact of caring for dying prisoners on PPSs Qualitative interviews n = 36 All PPSs Hospice – Louisiana Angola MDT (PT, OT, dietician) PPS (i) none discussed; (ii) work can exact overwhelming emotional toll on PPSs, sense of purpose and mutual support helps; (iii) support to PPSs from programme staff., prison staff not discussed; (iv) took years for prisoner community to trust in hospice (v) none discussed
11 Wion & Loeb, 2016, USA To review end of life care for prisoners Systematic review n = 19 1 = UK study 18 = USA studies Hospices/ End of life care - various MDT (Psychologist, dieticians, pharmacists, OTs, PTs, admin) PPS CV (i) good care from PPSs, promote dignity and respect, varied staff care and compassion and pain meds; (ii) transformative (increased compassion and confidence), redemptive, paying it forward, good buffer for staff; (iii) varied reports of: team cohesiveness; prison staff mixed support – security concerns, and not punitive enough; (iv) positive support from management & prisoners although some negative, prison more humane, inappropriate environments for some (buildings, equipment & comfort), lack public support; (v) seen as cost-effective.
12 Wright & Bronstein, 2007a, USA To explore prison hospice functions, integration in the prison and impact Qualitative interviews n = 14, All hospice co-ordinators Hospice – 14 hospices, 11 states MDT (inc psychologist, & business) PPS (i) positive impact, some prison staff see prisoners as undeserving; (ii) vital role, transformed, more compassionate, all positive about their role; (iii) mostly positive programme staff, unsupportive of PPSs in one hospice; prison staff mixed support; (iv) most management supportive (a couple not), more humane prison; coupled with positive media attention; (v) none discussed.
13 Wright & Bronstein, 2007b, USA To explore hospices integration in prisons, and staff team working Qualitative interviews n = 14, All hospice co-ordinators Hospice – 14 hospices, 11 states MDT (dietician, psychiatrist, PTs, OTs, pharmacists, admin) PPS (i) better, compassionate relationships with staff; (ii) vital role, increased confidence & compassion; (iii) improved staff compassion, allowed compassion to be demonstrated by staff; (iv) made prison ‘decent’ and humane; (v) none discussed
14 Yampolskaya & Winston, 2003, USA To identify components and outcomes of prison hospice programmes Qualitative interviews & literature review n = unknown 10 programmes Hospice: multiple MDT (Psychologist, psychiatrist) PPS (most prisons) CV (2 prisons) (i) advantage to dying with familiar people and surroundings, ‘better’ pain management; (ii) transformative and rehabilitative; (iii) none discussed; (iv) prison & hospice goals different, but sends message that prisoners can die with dignity; (v) hypothetically cost-effective – reduced hospital visits, transport, medical and staff costs, and use of DNR orders.
15 Cichowlas & Chen, 2010, USA Description of a hospice programme Descriptive n/a Hospice, Dixon, Illinois MDT (psychologist, psychiatrist) PPS Successful overall: (i) none discussed; (ii) transformative; (iii) none discussed; (iv) hospice as more institution-centred than patient-centred; (v) no additional prison funding; do use an inmate benefit fund
16 Evans, Herzog, & Tillman, 2002, USA To describe a prison hospice programme Service description n/a Hospice – Louisiana, Angola MDT; PPS (i) peace of mind, but mistrust staff; (ii) increase self-confidence; (iii) rewarding work for programme staff; mixed prison staff support; (iv) improved public image; prisoners supportive; (v) No extra cost (believe saves money) – healthcare redeployed; fund-raisers, outside donations.
17 Head, 2005, USA Commentary of hospice tour by hospice experts Descriptive n/a Hospice, Louisiana, Angola MDT, PPS (i) less scared of dying alone and in pain; (ii) dedication and transformation; (iii) none discussed; (iv) less violent, more caring prison culture, “not plush by any stretch of the imagination” (p 357); (v) no additional costs
18 Linder, Knauf, Enders, & Meyers, 2002, USA To describe a prison hospice Descriptive n/a Hospice care, Vacaville, California MDT (Psychiatrist) PPS CV (i) described as providing for all needs, peaceful place to die; (ii) cornerstone, paying it forward, may be rehabilitative; (iii) prison staff difficulty reconciling security & care; (iv) hospice transformed from a ‘snake-pit’ to respectful environment to die; (v) none discussed
19 Ratcliff & Craig, 2004, USA Description of the GRACE project Descriptive n/a Hospice −4 states MDT PPS in two sites (i) positive impact, with ‘exceptional’ PPS support; (ii) transformative; (iii) increase in staff morale; (iv) decline in violence and litigation; (v) cost neutral, but lack of funds limited educational activities
20 Zimmermann, 2009, USA To describe the development of a prison hospice Descriptive n/a Hospice, Connecticut MDT PPS CV (i) positive impact; (ii) transformed, allowed to be compassionate;
(iii,iv) none discussed; (v) cost neutral, potentially cheaper – transport, PPS & CV, DNR orders and redeployed staff; training by community hospice at no cost
(II) Structured programmes
21 Kopera-Frye et al., 2013, USA To examine effects on prisoners, (veterans and non-veterans) Cross-sectional standardised questionnaires n = 111
True Grit – a structured living programme Community Volunteers & Psychologist (i) Increase in prisoners’ self-reported physical & mental health, and satisfaction - no significant difference between veterans and non-veterans; (ii) not applicable; (iii) none discussed; (iv) supportive management; (v) no cost due to volunteers and donations from community organisations; believe better prisoner health will reduce costs
22 Harrison, 2006, USA To describe a programme and its impact Descriptive n/a True Grit – a structured living programme Psychologist; CVs (i) Reduced infirmary appointments, meds & fear of dying alone; increased wellbeing, activeness & hope; (ii) not applicable; (iii) none discussed; (iv) prison-more humane, management support, better held away from medical centre; (v) No funds – donations, volunteer labour.
23 Harrison & Benedetti, 2009, USA Description of programme Descriptive n/a True Grit – a structured living programme Psychologist; CVs (i) accomplishment and self-esteem, may aid health, reduction in infirmary visits and medications; (ii) not applicable; (iii) supportive; (iv) management supportive; (v) negligible – donations and volunteers
24 Hodel & Sánchez, 2013, USA Description of programme content and delivery Descriptive n/a Special Needs Program for Inmate-Patients with Dementia (SNPID) MDT (healthcare, prison staff) PPS (i) person with dementia can function in prison; quality of life increases, behavioural problems reduce; (ii) none discussed; (iii) work is rewarding for programme staff; (iv) important to adjust environment or provide specific units; (v) None discussed
(III) Personal care-focused programmes
25 Chow, 2002, USA To describe the establishment of a programme Descriptive n/a Nursing programme & Hospice – South Western State Nurses; Hospice MDT; PPS (i,ii,iii) none discussed; (iv) challenge in reconciling security and philosophy of care; (v) belief in ‘efficient and cost-effective nursing’.
26 Sannier, Danjour, & Talamon, 2011, France To describe a service adapted for older prisoners Descriptive n/a In-cell care programme, Liancourt prison Healthcare staff (i) increased self-respect; (ii) not applicable; (iii) staff communication to broader medical team improved quality/timeliness of health intervention; consent issues re sharing information with staff; (iv,v) none discussed.
(IV) Regime & accommodation adaptation
27 Moll, 2013, UK To identify and share good practice in treatment & management of prisoners with dementia Qualitative n = unknown (14 prisons) Prison staff, CVs, healthcare staff Regime/accommodation adaptation, Structured programmes, Hospice: (UK = 8, USA = 4, Japan = 1, Belgium = 1) Varied – MDT, PPS (in 10 prisons); CV (i) prisoners’ improved mental/physical/social wellbeing at day centre & structured programme (True Grit); wing exercise & forums positive; strong PPS-prisoner relations and SNPID success; environmental change increase confidence/independence, reduce anxiety/confusion; (ii) none discussed; (iii) integration hampered by staff shortage, with PPS boosting capacity; dementia trained staff more confident; (iv) none discussed; (v) no costs presented, but specialist units and environmental change costly, voluntary sector input can be no cost or inexpensive
28 Hunsberger, 2000, USA To describe the conversion of a mental hospital to a prison Descriptive n/a Accommodation adaptation, Life Skills Program, Pennsylvania (Laurel Highland) MDT (i,ii) none discussed; (iii) third of prison staff are nurses so may aid the security-care conflict; (iv) management support, media attention: “a prison with compassion”; (v) $26 million conversion from mental health hospital to prison, but programme costs themselves not presented.
29 McCarthy & Rose, 2013, USA Discussion of how States are addressing ageing prisoners Descriptive n/a Regime & Accommodation adaptation, Hospice (8 states) MDT PPS (hospice) (i,ii,iii,iv) none discussed; (v) hope health care prison facilities will be cost-effective. Couple of prisons had similar or less costs for older prisoners than nursing homes; one hospice programme (Angola) had no extra costs; costs of specialist health unit beds in two prisons (inc Laurel Highland) were greater than for average prisoner beds.
  1. MDT = Social workers, nurses, doctors, chaplains and prison staff, all else listed are in addition to this core group; PPS = Prisoner Peer Supporters; CV = Community Volunteers