CAPT. Chad Garrett  0:28  
Thank you to everyone who's answering those poll questions. For me, we'll be switching to the next poll question here in just about 10 seconds. You

CAPT. Chad Garrett  1:11  
thank you guys for answered that poll question for me. Thank

CAPT. Chad Garrett  1:23  
I will leave the poll questions open while we're doing the introduction. I

CAPT. Chad Garrett  1:49  
I see that we have people from just about everywhere.

CAPT. Chad Garrett  1:58  
Well, my clock is telling me that it is 830 Mountain Standard Time. So Mr. Smith, the microphone is yours.

Christopher Smith, NPA  2:07  
All right. Thanks, Captain Garrett, I appreciate it. Hello, everybody. My name is Christopher Smith, and I am a national programs advisor with the National Institute of Corrections.

CAPT. Chad Garrett  2:18  
There you could change the slide for me. My name is

Christopher Smith, NPA  2:20  
Christopher Smith. I'm a national programs advisor with the National Institute of Corrections, or the NIC. And on behalf of the NIC, I would like to welcome you to our program spotlight webinar looking at the Middlesex Sheriff's Office, older adult reentry unit or the or unit. We are thrilled to have you join us for this interactive webinar that focuses on assisting aging inmates and addressing their special reentry needs. This episode is hosted by the NIC and presented by both the NIC and the Middlesex Sheriff's Office. The or unit opened at the Middlesex jail in January 2024 with the assistance from academic partners like the Boston University, like Boston University and the University of Massachusetts in Boston, extensive research and planning pave the way to create this first in the nation, unit developed to support incarcerated men ages 55 and older, specialized and mandatory treatment programs And or are focused on the specific needs of this aging population, including cognitive behavior, treatment, education, social enrichment and occupational therapy. Today, leaders from the middle six sheriff's office will present an overview of this innovative program. The goal of this webinar is to share best practices and approaches to help help agencies to enhance services for this unique population. So today, before we begin today's lesson, though, I would like to cover a few important housekeeping items. This webinar is scheduled to last an hour and a half, and the session will be recorded. Once the recording is made, 508 compliant, it'll be put on our website. You'll also receive an email indicating as such, this is a Listen Only event, meaning participant microphones are muted. However, we strongly encourage engagement through our WebEx chat function. Please use the chat to share your thoughts, ask questions or request technical support. We will address as many questions as possible during the Q and A portion at the end of the webinar to practice the chat function. Everyone, please type the answer to the following questions in your chat. As the Winter Olympics have wound down in Italy, I would like to pose the question, What is your favorite winter Olympic sport? Is it skiing, ice hockey or speed skating? Mine is the truly addictive sport of curling, and thanks to the Canadian Swedish teams this year at the Olympics, it's been pretty memorable. So go ahead and type in the chat. What's your favorite winter Olympic sport is you? I give

CAPT. Chad Garrett  5:01  
everybody a moment or so to type it in.

Christopher Smith, NPA  5:06  
I see I'm not the only one that likes curling. Excellent. Of course, the men's the men's US Men's and Women's us hockey teams did great. So those are some great answers. Now that we have had our moment of fun, let's get back to the subject at hand, which, of course, is this webinar and the oar program at the Middlesex sheriff's office. Please allow me a moment to reflect on operational security, though, as this is a webinar that will be recorded and put on our public website, please be mindful of what you post in the chat. Please don't use specific names, dates, locations or specific facility tactics or other sensitive or law enforcement only information. We are here to learn more about Middlesex Sheriff's Office, OAR program and how we can employ it in other facilities, and not to put out sensitive information about other facilities. Thank you very much for your consideration in this area. Now, if you're having any audio difficulties, we recommend connecting to the webinar audio via telephone using the number provided in your registration confirmation email throughout this series, or throughout this episode, we want to hear from you. You can always email the webinars program manager, Mr. Kevin Jones at KJones3@bop.gov within any comments, concerns or ideas for the future, I and my team from Nic, including some great staff from the Information Center, will be posting some information the chat during this presentation. So please be on the lookout for it. And again, if you have any questions, please type them in the chat and we will answer them as many as we can at the end of the webinar, next slide, speaking of the NIC Information Center, today, we have Mr. Ben Hunter, who is an information specialist with our NIC Information Center in Aurora, Colorado, with us to tell us about both the NIC Information Center and its library than what they have to offer the correctional public. Mr. Hunter has been with the NIC for five years. Mr. Hunter, please take it away, sir.

Speaker 1  7:10  
Thank you so much. Christopher Smith, hello, everyone. I'm Ben Hunter. I'm here at the National corrections Academy, which is located in Aurora, Colorado.

CAPT. Chad Garrett  7:19  
We are

Speaker 1  7:21  
in the simplest terms, your corrections librarian. So if you have any corrections related research needs, any questions relating to your field, if you have an assignment that you need help with, come to us at the NIC Information Center, and we will do everything we can to help you. So as you can see on the slide here, the number one thing we provide to the entire field across the country is the NIC help desk, which you can access by going to NIC website, nic.gov The Information Center is on mountain time because we're out here in Colorado. So we are available Monday through Friday, eight to four Mountain Standard Time. Again, our website is Nic ic.gov you can contact us directly at the help desk, at support at Nic ic.gov and this will all be going in the chat as well. Again, we offer research assistance. We also have free trainings. NIC trainings, Nic publications are all housed on our library website. So this webinar will be posting there as soon as it's five way compliant. Along with all of our other webinars, we also have Libby overdrive. If you are familiar with Libby from the public library in your community, we also have Libby as well, and we have corrections focused nonfiction, so you're not going to find heated rivalry or any of those types of books on our library. We just stick with the nonfiction to serve you and your professional needs. So yeah, again, we're always here at Nic, IC, gov. If you have any questions, put them in the Chat. Today, I'll be in there posting different resources for you guys to keep an eye on the chat and enjoy the webinar today.

CAPT. Chad Garrett  9:06  
Thanks, Chris, Thanks Ben.

Christopher Smith, NPA  9:08  
And let me just give a personal note that the good folks at the NIC Information Center are truly helpful, and they love to help. So if you have questions or you need research help, or any of the things have been mentioned, please reach out to them. They are super helpful. So thank you very much. Ben, I appreciate it. Get next slide please, before I hand the microphone over to Chief Amos, I want to talk about the silver tsunami. Correctional healthcare is facing a demographic reckoning. This silver tsunami a term coined to capture the surging wave of adult of incarcerated aging adults is crashing into prison systems nationwide. Correctional facilities across the country have quietly transformed into de facto geriatric care units. The complexities of caring for aging adults in custody has never been more urgent. And or more intricate, The once young adult incarcerated population is grave,

CAPT. Chad Garrett  10:06  
bringing with it

Christopher Smith, NPA  10:08  
a growing wave of age related psychological changes, greater health challenges and the impact that years of crime and incarceration time has had on them, chronic disease management becomes less about treatment and more about orchestrating, requiring a symphony of specialized knowledge, medication, safety, preventative care, and above all, dignity and practice. This isn't just about aging. It's about aging. Well, even behind the wall, older adults behind bars are not simply older version of younger inmates, they have unique challenges and require unique fixes. Enter the sheriff and his program and dynamic leaders redefining geriatric care in a high security setting. These dynamic leaders represent the front lines of innovation in a geriatric correctional practice. Their insights are not only informed by deep experience, but shaped by service, resilience and a commitment to optimizing outcomes for aging adults in custody. In this student, we will equip you with the strategies, tools and mindset necessary to meet the demands to face the silver tsunami, because aging with dignity shouldn't be a stand. It should be the standard, even if you're behind

CAPT. Chad Garrett  11:19  
bars. Next slide please.

Christopher Smith, NPA  11:23  
Now it's my pleasure to introduce the NIC jails division chief, Mr. Steve And Amos. Mr. Amos will introduce our speakers today and then turn the presentation over to them.

CAPT. Chad Garrett  11:33  
Be famous. The floor is yours, sir. Thank you, Chris.

Speaker 2  11:41  
Spotlighting what is an incredible program and the leadership that brought it together. First, I think it's important to recognize the innovative work that jurisdictions do and promote those nationally. That's very much part of our job, and it's my honor today to introduce two outstanding speakers with innovative programs and innovative services. If you haven't gotten to know Sheriff patusian And Sean McMaster, they're wonderful people to know. They've always offered up their time and effort to consult and or provide site visits or such, to see the programs that are put in place and promote them. And I'm honored to be in a position to introduce both of them. First, I'm going to say a true leader has the confidence to stand alone, the courage to make tough decisions and the compassion to listen to the needs of others. I say that because that's a quote from Douglas MacArthur, and to me that epitomizes share of contusions leadership. He has spent his career addressing critical issues in public safety and public health, as a public defender, Prosecutor, a legislator, professor and a law enforcement leader, serving as Middlesex Sheriff since 2011 he is the past president of both the major County Sheriffs of America and the Massachusetts Sheriff's Association. He has pioneered the development of innovative, data driven correctional programs and specialty units that have directly and substantially reduced recidivism in their participants. These results have been published in academic journals, featured by national news outlets and labeled as best practices by multiple presidential administrations. More importantly, shared contusions. Commitment to data driven research has made these programs and their results replicable across the country, and holds a master's degree in public administration from Harvard University, Kennedy School of Government, a law degree from New England School of Law, and a bachelor's degree in psychology from Bridgewater State University. He is a recipient of the United States, Ellis Island Medal of Honor, the 2023 sheriff of the Year Award and the University of ALA Dada, silver honorary medal. It's a mouthful. Bottom line, I also want to recognize him as a dear friend and colleague and a mentor to me. I also want to introduce Sean McMaster. Sean McMaster is the Assistant Superintendent of Program Services for the Middlesex sheriff's office in Massachusetts. John holds a command staff position in the Middlesex jail and House of corrections, overseeing Human Services, classification, case management, specialized housing units, treatment, programming, education and reentry services. He has worked in the law enforcement community for 27 years, having also spent time in the Massachusetts Department of Corrections and the Middlesex district attorney's office. Tom holds a bachelor's degree from Franklin Pierce College and a master's degree in public affairs from McCormack Cormac Graduate School of Public Studies at the University of Massachusetts, Boston. Again, it's a true pleasure to be able to introduce both of them at this time, I'd like to turn it over to Sheriff katusion.

Speaker 3  14:53  
Thank you very much, chief. It is a great honor to be with you in presenting and. And the people across this country that are eager to learn, and from whom I've learned so much. I'm going to speak about this older adult reentry unit, but I'd like to briefly discuss the concept of reentry before moving on to talk about how we're addressing the very real issue of older adults in correctional facilities. This is a challenge to all of us, and one if we don't face it right now, we are facing it without us knowing about it, and we'll be facing even more so those of you in who are in corrections may already be dealing with an increase in adults over the age of 55 My goal today is to provide data on the problem, walk you through how we developed our older adult re entry unit, and then discuss some of the outcomes and key takeaways we've been able to we've seen, we've we've seen to date. Thank you to the NIC for inviting me to be part of this webinar. I'm really proud to be part of this event. We do this because of the great work that occurs here. Our relationship with Steve Amos goes back many years. I really can't speak highly enough, except for the pronunciation of that university that Chief tried to address. He's a true leader in this space. He was there with us when we officially launched the or program in October. Such was his excitement and interest and caring about what we're doing in corrections across the country. And I always considered Steve to be a national treasure in the field of corrections. So I'm really pleased to be joined by Sean McMaster, our assistant superintendent of Program Services. We want to make sure our time is as interesting and fruitful as possible, so that by the end of this session, you'll have a better sense of how what we do behind the wall can positively impact the lives of our incarcerated individuals once they are outside of those walls as well. You'll hear several times throughout this presentation where we sought NIC for assistance. It should come as no surprise that they were a key partner in this effort, whether it's the national nationwide scans of similar units or other assistance at many steps in the development. One of the things that I'm most grateful for is that I've had, you know, myself and my staff regularly involved in NICs peer to peer programming like the large jail network and the National sheriff's Institute and the all sheriff's authority, not only does the NIC facilitate great conversations among leaders in the field of corrections, but NIC provides Peer to Peer funding. You should check into this in order to better learn how you can serve the people in your facilities. These offer opportunities to follow up on conversations, to come to see each other's agencies and to see the work in practice, something that we've hosted many times, but we really enjoyed going to see other places and learning from many of you out in that are that are listening to this webinar. Nic makes that exchange of best practices happen by providing funding for the flights and hotels. Yeah, we're probably one of the greatest users of that peer to peer network, whether from hosting over a dozen offices who have come to Middlesex and also traveling to many others and learning and providing in depth programmatic tours during these exchanges as well. I won't go over my whole bio in detail, but just by background, I'm a little unusual in this space. I was prior to becoming Sheriff, I was a legislator specializing in healthcare policy, as the Chairman of the Committee on healthcare here in Massachusetts, I've been a public defender and a prosecutor and a lecturer, and let me just tell you about Middlesex County as well. It's 54 cities and towns, 1.8 million residents. It's a mix of rural, suburban and urban communities, we take in and discharge about 4000 people per year law enforcement powers that we do have law enforcement powers, but we do not have patrol function. Our primary mission is management of the jail and House of Correction, which frees us up to be able to do just that, and allows us to focus on that my focus is 100% on the care of those in my custody. Now I'm really grateful that on a daily basis, a lot of this responsibility is managed by my assistant superintendent of Program Services, Sean McMaster, from whom you'll be hearing. Sean is an expert in developing and implementing correctional programming. Assistant Superintendent McMaster is on this webinar with me, and we'll be speaking to a lot of particulars as we move forward today. So first, I'd like to spend a moment talking about reentry. How many of you? I mean, sure a lot of you, I won't be able to see your hands raised, but I'm sure most of you, if not all of you, have seen the Shawshank Redemption. And there's a moment in the movie where Brooks, the old lifer, is finally released from jail, and at the main gate to the prison, the guards wish him well. They claims to close the gates behind him. You remember his that picture that you see before you, leaving him totally on his own outside the facility. Now, if he's lucky, maybe they gave him bus fare, and Brooks contemplates recidivating almost immediately, and really sadly, ultimately, takes his own life because the culture shock of reentry is too great. We know how many of those people that we release into our communities struggle in the same way once they're back out. We always see how excited they are to be knowing that they're about to get out, but as soon as they're about to get out, we see that light in their eyes dim because of these stresses. Thankfully, this is not how good facilities operate anymore. We're focused on re entry, and for this for us, that means evidence based, results driven programming that builds skills in preparation for reentry, leading to a warm handoff from inside to outside upon release, and it's upon release to family and community based programming and referrals to housing as needed. Our philosophy here at the Middlesex sheriff's office is a is unique programming for unique populations produces unique results. I don't think you can argue with that premise. It makes perfect sense, and that's specifically targeting vulnerable populations. Now, we don't believe in one size fits all approach. This is clear in the many diverse units and treatment programs we offer, specialized units and innovative programs we have a history of developing, first in the nation, programmatic units specific to the needs of groups of individuals. And I want to highlight one of our earliest programs, Pat emerging adults, young adults, 18 through 24 when the brain is still developing. Now, I started that unit a number of years ago because I could see the research building towards the understanding of how frontal lobe development comes later, and what we were doing with young adults was not working, but this development comes later, leading to maturation and executive function delays that comes later than we think. That's something that I lived from age 18 through 26 myself, and I remember when I came out of that fog at age 26 and thank God I didn't have a childhood of trauma that really exacerbated that later maturation. We're seeing this in research later, and that made perfect sense when it was coming out. Our work with older adults is really the continuation of what we did with Pat and ties in in ways that I never would have even foreseen, meeting and treating our population where they are only now at both ends of the aging spectrum. This unit is based on that same impulse that the research was building, and at the same time I was noticing it even in my own life, as I was aging now an adult over 55 myself, and so here we are addressing cognitive function at both ends of an inmate's life.

Speaker 3  23:10  
Now that means that we develop and deliver programs that address an individual's unique circumstances, but vision without good data is just a hallucination. Here at Middlesex, we're data driven, and I know that many of you are out there and are becoming more so as we are as well. We always ask, is it working? Is the program working? I will say that one thing I'm proud of was not we're not afraid of failure. We try to avoid it, of course, but we don't let a mistake go to waste. We use that as an opportunity to engage and learn from that failure, and we're willing to tear up a program and start over if the data shows that it is not working, or if we can make some changes midstream to make it work better, we'll do that as well, because recidivism reduction is not our only goal here at Middlesex Sheriff's Office, we also place a value on the partnerships. And you can see we have experienced positive results time after time using this method, which has been, you know, a great experience now, or the silver tsunami is as has, as it has been called, in 2018 I noticed the rise in older adult the older adult population our facility. So we asked, you know, what are the numbers? We looked internally, we looked at the data for those housed at the middle six jail and house corrections and found that about 10% of the people incarcerated are over the age of 55 and that doubled in just over one decade. I'm sure you're seeing the same in your own facilities. This is also true of the United States as a whole. By 2030 the population of people over the age of 60 will be 25% fully of our population. In fact, one thing that's scary to notice for a number of us that are of a certain age is that the youngest of the baby boomer. Baby Boomer generation have already turned 60 years old. Older adults are the fastest growing incarcerated population in our country as well. So it shouldn't be a surprise that across the country we're seeing that graying of corrections, and clearly there's a real need to address the unique needs of this population and better prepare them for their unique re entry into their communities as well. Now this is a population that is growing, but has been historically underserved. It's been right under our noses, but we haven't really paid attention or recognized it or become aware of it, and we want to make sure we do this before it's too late for each This is an interesting statistic for each person. Each year served in prison, a person could expect to lose approximately two years of life. This is from a 2013 analysis by Professor Evelyn Patterson, a sociologist at Vanderbilt University, in the American Journal of Health. This is because of these stressors and the anxiety. Anxiety of being incarcerated naturally accelerates aging and complicates reentry. Older Adults face higher rates of chronic illness, cognitive decline and victimization, as well outside and inside our facilities, adding to the re entry challenge, a lot of these individuals have been incarcerated for a great part of their adult lives. Because of that, they have fractured relationships with their partners, but especially their children, leading to increased risk of isolation, decline in ultimately reoffending, as well as something that I think we need to be more aware of and focus on is not just our recidivism rates but the issue of premature mortality. How much earlier will they die because of these experiences, and can we actually add years to their lives through programs like the or unit now, when we went about identifying what barriers we could address with this unit, the list was honestly overwhelming. Housing barriers such as cost of housing, public housing restrictions for this population, nursing homes and congregate housing restrictions as well for this population, employment and economic barriers such as logistical barriers for enrollment in Medicare and Medicaid, functional or cognitive disabilities, health, literacy, distrust of institutions and in the public benefits that can be offered in significant gaps in prior employment history over their lives. Everyone here who works in corrections deals with many of these barriers in their facilities every day. I guarantee it. A lot of family relationships have been fractured because these individuals have been incarcerated most of their lives, and for these people, that means even more so that they just don't have the ability to go anywhere, to join anyone when they get back out into that community that's family. So a really troubling element to that's not unique, but exacerbated for this population. So the first question we asked was, could we meet the needs by adding population specific programming, or do we create a new specialty unit? Because you didn't have to just jump into a unit? We were cautious at first. Our first impulse was not to just open up a new unit unless the data supported it again, you take a look at the data, and then you make informed decisions. And as I said earlier, we are data driven. If the research showed us that we just needed to focus on some older adult programming, then that's where we would have gone. So first, we initiated in it in internal data review. Now you can see we were able to find growth over time in our county population. This is external data for Middlesex County based on the US census that you can see here in the growth curve there. Now this is our internal data. We saw similar growth in our own jail population, we first noticed the numbers were going up in 2018 note, we had a peak in 2022 covid was running from 20 to 21 when many inmates, especially the elderly, were being released or not being arraigned and brought in because of their their vulnerability to covid. We are even higher today and expect to increase as well. This graph shows the population we are targeting. These are people that simply can't figure out how to live their lives on the outside. They just simply don't have the skills or the tools to make good choices, something that we try to address inside note that these are just Middlesex sheriff's office incarcerations. These do not capture any time spent in other facilities. So you can say they're even more stark when you consider that it's more limited. They've likely had many more incarcerations in other counties or. State Prison, yet still 1/3 have been with us at least four and many more times. This program is designed almost more for these individuals than for the others, the ones on the end of the spectrum that we see here we are, sadly their most continuous source of support in their lives. Now at this point, I'd like to turn it over to Sean McMaster, our assistant superintendent program services. Sean drove the development of this unit, and is the perfect one to tell the story of how we developed and then launched the older adult reentry Unit here at the Middlesex Sheriff's Office. SEAN

Speaker 4  30:44  
Thank you, sheriff. Using our internal data as a baseline, we partnered with the Gerontology Institute at UMass Boston to conduct a needs assessment. This consisted of a team of researchers from UMass who led multiple on site focus groups comprised of older inmates from every housing unit at the facility. The research team then facilitated key informant interviews with staff from human services, medical, mental health and operations. What we learned was that the overwhelming majority of older inmates wanted their own unit. They preferred to stay away from jail politics. They felt safer outside of an environment dominated by younger, stronger inmates. They desired a quieter, less chaotic living environment, and they wanted to be surrounded by peers, those to whom they could better relate next, as we always do. We looked to see if there were any national models in this space? Sheriff katusian does not shy away from replicating a program model if it works. While we're on the forefront of developing innovative, progressive minded programs, we won't dismiss a proven model for the sake of proprietorship. So we reached out to Chief Amos and his team at the National Institute of Corrections for their assistance. Nic, librarians and staff helped us to conduct a national scan, while we did find some older adult focused housing units. They were, for the most part, acute geriatric wards focusing on medical care for those with complex chronic health conditions. What we didn't find were any units centered around treatment programming and reentry planning. So we decided to create one next slide. Please. The main goal of or is to reduce recidivism among older adults by equipping them with the skills needed to live independently upon release. This is anchored in a three prong approach. One, creating a physical environment where we attempt to stabilize older adults, in other words, to lessen the rate at which someone would otherwise age while incarcerated, because we know that stress, fear, anxiety and poor sleep can create physical and mental impediments to program compliance. Two, a multi faceted programming menu that draws from the research while also supporting the interests, learning styles and needs of the population. And three, an individualized, holistic approach to reentry planning that addresses both criminogenic risk and needs while accounting for age related factors. After we developed and defined this approach, we embarked on a plan to operationalize it. Next slide, please. What you see here is an abridged timeline of the work that went into creating this program, while we've simplified it for the sake of brevity, on the slide, this timeline should still give you an idea of what went into developing a program of this nature. Again, it began in November 2019 when we first met with the Gerontology Institute at UMass Boston, followed by a needs assessment in February of 2022 also by the Gerontology Institute. Then in October of 2023 we reached out to the Sargent College of Health and rehabilitative Sciences at Boston University, several professors of occupational therapy who were also licensed. OTs conducted a physical plant assessment of an unoccupied housing unit. From that came a series of recommendations that we accepted and put into action. May of 2024, was our first training for officers. By late summer of 2024, unit renovations were completed. We also finalized an inmate screening tool to determine criteria for acceptance into the unit. By October 2024 we finally got the unit up and running. Clearly, this didn't happen overnight. It took a lot of time and effort, but things worked out as we had anticipated because we were deliberative in our planning and patient and methodical in the steps that we took. Next slide, please. The older and wiser has become our mantra for the or unit, because, for one, we've accumulated a wealth of knowledge throughout these several years of planning and development for which we're better off as an organization. And two, because with this unit, we're striving to provide our older adult inmates with a new perspective and understanding that wisdom doesn't come solely with age. Rather, it comes from an accumulation of experiences and lessons learned over a lifetime, coupled with what we offer on the unit these experiences and lessons can help older adults redefine themselves and their future. So what exactly is the or it's a first in the nation, dedicated housing unit for individuals age 55 and over who are at a higher risk of recidivism and re entry related challenges. It was designed from the ground up with the unique needs of this population in mind. It offers specialized treatment programs and a housing unit designed and modified to improve health and wellness through a series of physical plant improvements, and it features targeted programming and robust reentry planning. Next slide, please, the physical plant modifications we made to a pre existing housing unit at the time were actually informed by older adult inmates themselves through focus group data, as well as by the recommendations put forth by the BU occupational therapy team. You can see on this slide the steps we took to create a more appropriate environment for aging inmates. Next slide you you'll see here some photos of the or unit. Color Psychology was utilized on the walls with each color serving a different purpose. A soft green in the living area to create a sense of calmness and reduce blood pressure, a vibrant blue in the exercise area to boost energy, and bright yellowish orange in the bathroom to improve visibility and contrast better lighting to also assist with visibility. Grab bars in the back to prevent falls. Non slip flooring also to prevent falls. High back recreation chairs with a rocking feature to stabilize balance through the vestibular system, the sensory system located in the inner ear, raised bed frames to assist with getting in and out of bed, custom made mattresses of correctional grade for musculoskeletal health, way finding markers on the floor to address spatial disorientation, especially at night, when having to Get up to use the bathroom and age appropriate exercise equipment to encourage exercise. Next slide, please. The programming we offer in or is based on five pillars. We developed this programming model in house, each pillar drawing from the vast pool of Gerontology intervention research that we came across, these five pillars are designed to change attitudes, belief systems and behaviors, strengthen brain functioning through learning and cognitive stimulation, develop cognitive and executive functioning skills to maximize independence, reduce isolation and promote social interaction and achieve physical, mental and social well being. Next slide, please. Treatment. This pillar focuses on changing attitudes, belief systems and behaviors that lead to criminal conduct. It includes the standard cognitive behavioral treatment programs to address substance use disorder, domestic violence, interpersonal violence, anger and aggression, anti social behaviors. Those are just some of the examples, but this treatment pillar is also heavy on complementary treatments that help address physiological factors that CBT alone can't. Art therapy, in partnership with the Boston Museum of fun. Music Therapy, in partnership with the Berkeley School of Music green therapy, where we utilize hydroponics and bring our farm program, project, Earth behind the wall bibliotherapy, where we engage inmates through literature and where, after each book, they put on an interpretive production of what they read in front of command staff and what it meant to them. Expressive digital imagery, in collaboration with the EDI Institute, which uses a creative digital platform where inmates can express complex emotions through visual aids that they create complementary interventions like these, work to decrease stress and anxiety, increase engagement, provide nonverbal outlets for communication, deepen self awareness and personal insight, identify. And restructure dysfunctional thoughts, improve mood regulation and foster resilience. Next slide, please.

Speaker 4  40:10  
Education, this pillar focuses on boosting cognitive health and promoting lifelong learning. We know that education later in life is a protective factor against dementia and other forms of cognitive decline. In fact, research shows that learning a new language can delay memory loss by an average of five years. The harder the language, the harder the brain works. So we offer foreign language courses on the unit. We're about to run our second course on Hindi, an incredibly difficult language to learn. We also bring in guest speakers from the Museum of Fine Arts once a month to provide lectures on art history and culture. All of this on top of the more standard educational offerings we make available on the unit next slide, occupational therapy. This pillar focuses on developing skills for independent living. It's not occupational therapy in the sense of physical activities needed for daily living, which you'd find in a hospital, skilled nursing facility or rehab center. What these inmates need is help trying to figure out how to sustain themselves in the community after release, a vast majority of them have been incarcerated multiple times as adults as the sheriff said, about 40% have been incarcerated between four and 10 or more times just at our facility, their time in the community has been so fragmented that they've never been able to develop simple routines or learn how to do basic tasks. The occupational therapy we offer through the Sargent school at BU is centered around executive and cognitive functioning, improving memory, goal setting, planning, organizing and following directions, reducing distractions, multitasking, self regulation and time management, we identified these as being significant re entry needs through the recidivism data highlighted earlier by the sheriff, and from the qualitative data we elicited through the older adult focus groups. And all of these things are what ot specialize in addressing next slide. Social enrichment. This pillar recognizes the importance of human connection, relationships and socialization. It's driven in large part by emerging research on the topic of self isolation, particularly among older men. Research shows that loneliness and social isolation among older adults is linked to serious health conditions like heart disease, where the risk is increased by 29% stroke, where we see a 32% increase, and dementia, a 310% increase. Loneliness increases all cause mortality risk by 14% it's essentially as harmful as smoking 15 cigarettes a day in the or unit, we promote pro social activities and combat isolation through organized group activities, board games, trivia card tournaments, puzzle making and structured social events. We connect inmates to pro social activities as an alternative to rookie and unhealthy activities, with the hope that they continue engaging in these positive, healthy activities on the outside Next slide, please. Healthy Living, the focus of this pillar is on improving physical and mental well being. We achieve this through exercise, mindfulness and nutrition. Examples of some of the activities we offer include individual and group exercise, stretching, Tai Chi, Yoga, pickle ball and nutritional. Education and planning. We employ an activities and enrichment facilitator who works on the unit to engage and lead inmates in various activities. All of the programming we offer on the unit is mandatory through the five pillar approach. The or program manager is required to offer at least one program under each pillar at all times. In other words, there has to be a minimum of five programs running at all times. But in reality, program offerings have well exceeded that. At this time, I'd like to turn it back over to Sheriff katusian, who will take us through our external partnerships and where or is today.

Speaker 3  44:34  
Thank you, Sean, and I hope people really paid attention to those last few pillars. You know, really remarkable how important they are, and we learn this more through our research and our partnerships, and it makes perfect sense, so glad to speak a little bit more about them as we as we entertain questions afterwards. Now I believe that or unit deploys. What may be the most substantive academic correctional partnership in the country. Partners are partnerships are key to, or is development and then its implementation. The academic experts are fully integrated with their team, with internships and so many other participations that they are proud of this unit, and by the way, a lot of the services they're providing are Do or do not cost us monies as well. So it benefits their students, their reputation, their practice, and benefits our population at the very same time. And quite honestly, they feel really good about participating. Boston University's Sargent College of Health and Rehabilitation Science Sciences has been integral to the design and programming fully they are fully integrated with our team of corrections professionals, and had critical academic support from UMass Boston's Gerontology Institute, one of the best institutions for conducting research in public education on aging and aging policy issues. They conducted a facility wide needs assessment, again, we didn't want to just jump into it. We did a needs assessment, which included interviews with incarcerated individuals, but also with staff. We also partner with the University of Wyoming on a risk assessment for folks entering the unit, and we still work with North Carolina State University, where a Principal Research UMass Boston went sure made with us and has continued to advise us as well. And as Sean had mentioned, we're also engaged with other Boston institutions such as the Museum of Fine Arts and Berkeley School of Music for some of our programming. By the way, these came because we asked, we offered a great program. We asked that they'd like to participate. We made a great pitch, and they are all in and really happy to participate with us. So to date, the or unit has served about 100 individuals. We range anywhere from 14 to 28 typically being housed in this dormitory style setting, with an average age of 60 years old. In full disclosure, we've had six individuals come back to the unit. If I were to say we've had none, you would not believe me, because that could never happen, right? We're always going to be honest with our data, but I think it also demonstrates the high risk nature of this population as many other facilities. If, in many other facilities, if someone from a specialty unit failed and recidivated, they would not be welcomed back. The Attitude of you had your shot and you missed, it would be, would be expressed to them. When we did our Young Adult Offender Program, we decided that we would consider allowing someone back into the unit on a case by case basis. We continued that philosophy with our or unit. You know, in we all should understand this. You know, they're already at a high risk for coming back. Sometimes it can be that second stint is something we really learned, is that second stitch in that unit became the most beneficial because they realized the things that we were trying to teach them now really mattered. And so that second stint really benefited them in a way that we would not have seen it gave a window into what didn't work before, and could be instructive for us for future re entry planning as well, for us as well. Now we'll give you every chance we can, as long as you participate in the programs. We had 50 specially trained officers across all three shift volunteered. There was a five hour program for specialized training before being allowed to work in the unit this training was established through our academic partners. By the way, we didn't just make it up ourselves. Or marks a significant step forward in addressing the needs of those aging in a correctional setting and preparing them for their futures. These individuals now have access to powerful tools to help them prepare for their release, enabling them to take what they learn here and continue to use it once they're back on the outside, so that they don't have to return. Soon, we'll be too soon to evaluate any recidivism data. We just opened the unit a little bit more than a year ago. We don't think we can accept expect to see the same low recidivism numbers that we've seen in other units are incarcerated, military veterans, our young adult offenders, because it's a very high risk population. But all good programs target those who are most at risk, and shows a benefit to those populations. So we don't, we don't want to, we don't want to, like say that it's going to reduce them to nothing. The fact is, we believe that it will reduce them and make people happier, more productive. On the outside, generally speaking, older adults overall are lower risk to re offend. But you've got to remember that most of these guys have had multiple past incarcerations, so they have a long history involvement in the criminal justice system and. And it's a higher

Speaker 3  50:02  
chance of recidivism. The problem with our target population here is that the men we're assessing for the unit aren't just older, they're older with significant reentry challenges that they've experienced over their lives. We're also looking at other types of outcomes, health and wellness, family reunification, and also carceral outcomes. If you talk to a lot of these guys down there now, they talk about how the system and the environment is better for them. They feel safer, more comfortable, less on edge. It's improving their family connection. It's improving their outlook. They're more likely to follow through with treatment plans and medication that they're required to take on the unit once they get out. Now we want to start doing a pre and post survey that will involve questions like, how do you how do the guys feel when they come on the unit? What's their health look like? What are they thinking? And then a survey later to see if there's any change in the attitudes and behaviors they expressed in that first survey. And we have a study underway, really exciting. This is another benefit to this, a study underway with Boston University that will measure the officer wellness. And I'd like to speak about that now, because this is another great benefit to this program. It's transformational in any specialty unit, including this unit. So I don't want to say just this unit, but any specialty unit. We found this through but this is something that we've also seen, especially with this unit. It's transformational, not just for the inmates, but for the staff. It's the latest in a long evolution of our of Middlesex sheriff's office corrections officers towards embracing specialized units. So we've kind of kind of shifted the culture here, so that new units are actually embraced, and the training is embraced as well, even if you don't serve on that unit all the time. It improves corrections officer safety. The inmates are engaged in programming. They're less disruptive. It improves corrections officer morale. It's more rewarding. It's a higher job satisfaction than just walking a tear, checking for living, breathing flesh every 15 minutes. It's a voluntary assignment, attracting corrections officers who are motivated and enthusiastic, engaged, empathetic, contributory and invested. Now when we mention the characteristics of an or officer, we're not necessarily attracting officers who are these things. They just want to be very clear, they aren't necessarily those things. When they come on. We're attracting individuals who become these things once exposed to the older adult reentry unit. We've had great success in officers completely transforming and evolving because of their service in this unit, what we're hearing from CEOs that they feel like they have purpose, whereas before, they just kept order and security and they felt like their role was very monotonous. This quote one by one of our or officers, sums it up. They feel like they Well, you can see it there. They feel like they're much more invested in the unit, and they're supported by leadership, and there's a level of ownership what they're experiencing that we actually they have some of their own ideas that we have adopted as well, because they're really good ideas that we didn't come up with in the first place. They look forward to coming to work. They feel like they're getting something out of their day, and they're giving something back as well. Now our goal is for initiatives targeting older adults to be replicable. No reason. There's no reason why other counties and states can't address this population. Let me say you will have to. You will have to population trends will demand it, and it's a big part of the reason I am here today. You know, there's a for there's a an old saying, you know, coming to a theater near you, the inevitability of it coming to your locale, that's what we are all facing now. We should be more aware of it now so that we can address it soon. There are takeaways from what we're doing that you can implement right size it for your own facility, whether it's one program, a programming track, or unit like we have, these programs have been a win win for incarcerated individuals, for our partners, for our staff, for families and the community, but I often warn other sheriffs, if you build it, they will not come. We've had a few programs that have been replicated elsewhere, and they didn't work as well as they did here, not because we were like better, or doing is because they basically used our model, but they didn't work with partners in the community. To build the model, no unit will be successful unless you have engagement with the community and building that unit, otherwise they won't be invested. So building it with partners is critical to the success of those units as well. Now successful reentry programming demands that you be actively involved with your community. A jail can't be a fortress on a hill. Community outreach is critical. This is another example of how NIC peer to peer program. Can be of great help to you. I'll tell any of you right now that you're welcome to come to Middlesex and see our or program through peer to peer or on your own, and any of the programs that we have in person anytime you like, we are always an open shop. And quite honestly, we love it, because not only do we get to share what we're doing, we get to see it through the eyes of other professionals, and then we get to learn something from everything that you've been doing as well as you've seen. It took us a long time to develop it, and we can help you to do this more quickly. Now I've shown you a lot of data breaking down the program of individuals who are constantly recidivating and the physical manifestations of aging and reincarceration. But the best way to demonstrate the impact of this unit is to show you the face of one such individual. This individual, Roger, was one of the first or participants. He has been in and out of our facility for most of his life. He is a 19 page criminal record with 16 commitments. Only half have been with us. He grew up in a neighborhood only a couple of blocks away from me, and is about my age, and quite honestly, Roger was quite comfortable in the rest of the units. It wasn't really a problem for him. He wasn't feeling threatened or victimized. He could handle himself with the jail politics. But it was until he got into this unit, he started thinking about his future and how he needed to take a real look at how he was going to live those next 15 or 20 or 25 years of his life in a way that he never had before. He's on the cover of Boston University's Sargent school magazine. It's the first time in the history of this magazine that they've ever had a consumer of a service on the cover. It's always been a professor or a student. And I got to tell you, I think it looks he looks great on here and makes us really proud. He told me that this program made him think about where he is in life, where all the time went, and how he needs to think about what to do with the time he has left for the first time, he said, I feel like I have a plan. I'm not just hoping things work out, and I'm actually preparing for what's next thanks to or he's been finally preparing for the next 15 years so he wouldn't find himself back in here again. He was released recently, by the way, in our programming, when he left our unit to go to a minimum security unit, we made sure the program followed him to that minimum security program, right? We we were not going to leave him because he left the unit out high and dry, so we continue the programming as much as we could in the minimum security now he's back on the outside. He's living with his mom that he helps care for. He's going to AA and NA meetings every day. What's really great is staying in touch with our occupational therapist, our Boston University occupational therapist. He's still staying in touch, even though he's on the outside and continuing to work with her in the community, and he's applying for jobs. So when we talk about our 40% of our older adult population having between four and 10 or more incarcerated at our facility, this exactly what we're talking about, this is what we're trying to address with the or intervention. So thank you for letting me take time out of your day to hear our story of how we developed an operational our operationalized our or I hope that we're able to help you better understand the emerging issue of individuals aging while incarcerated in its impact on reentry. I'm hoping that if you have some ideas that you can share with us, we are always interested in learning and bettering our programs as well. I'm really proud of the work that we're doing at the Middlesex Sheriff's Office, and I'm happy to answer any questions you might have. Thank you again to Chief Steve Amos, and thanks again to NIC for all that you do and for allowing us to present on our or Unit here at the Middlesex Sheriff's Office. Sheriff's

Christopher Smith, NPA  58:49  
Office slide, please. All right, that was a great presentation. I really appreciate your presentation, Sheriff. I was able to get a couple of questions, but before I do let me go ahead and introduce the let me let everybody. Let all the participants know what we'll be doing. So I've captured some questions. I'll read them to our presenters. One of them who feels most comfortable to answer the question, will answer the question, and then we will go from there. If you continue to insert questions, I'll start looking in the chat again, and I'll ask those questions. All right, if everybody is ready, Eugene J asked, What now, let me backtrack, Sheriff, some of this information you guys have already addressed, but when it was asked you hadn't yet. But Eugene J asked, what is the average length of stay for the older population in the MC jail? Also is the unit for male residents only, and is there a corresponding environment and programming modification for female residents?

Speaker 3  59:48  
Yep. So I mean, I can answer this, but Sean, why don't you address you'd know a little bit more about the time that people are spending in the unit. And of course, you can answer the other questions as well, in that quite easily. Sean, go ahead.

Speaker 4  59:59  
John. Sir, thank you, sheriff. So the average length of stay really mirrors our the rest of our population. So about six and a half, seven months for someone who's serving a sentence, and about two and a half months for somebody who is being held as a pretrial detainee. It is just for males, and the reason for that is we only house lower security females. We have a partnership with the Department of Correction, where they house our medium security females. So this program is within the secure perimeter of medium security facility, and for that reason, it is only for male inmates.

Speaker 3  1:00:43  
I will also say it's important to note, and I don't think we noted this. This is also a mixed population of sentenced and pretrial population. Here in Massachusetts, the sheriffs led the effort to make sure that you have a specialty unit, that you could actually mix these populations, because we saw that, you know, so often was the case years ago that our pre trial populations are getting no services, no educational opportunities, no benefits, even if they didn't get good time for it, and they would sometimes walk out of the facility, you know, or walk out of court one day and be much worse for their institutionalization and better for it. So we actually had the law change so that we could offer programming to pre trial. And now, especially, and I'm sure you're seeing it across the country, but you know, pre trial is used to be 1/3 and sentence was two thirds. Now it's the opposite. The sentence is, you know, 1/3 maybe even less sometimes, and the pre trial is more so the opportunity to provide these services for those that are in this unit and but what's also really important is that we're offering it the people that we're expecting to come back out, so that is part of the the selection process, people that we know that are coming back out that can benefit from these programs as well. Excellent.

Christopher Smith, NPA  1:02:00  
Thank you. Thomas M asked, your jail is quite large. Many county jails have population under 200 in your experience, is this program feasible for a smaller facility?

Speaker 3  1:02:12  
Yes, as I said, you can do a unit or you can do a program track. I think whatever suits your facility is important. One thing that, by the way, it's really important to note, is this is not just a geriatric unit. This is not just where you put a bunch of older adults because of medical needs or frailty concerns. This is a re entry unit. So it's not just a treatment unit or like a like a healthcare geriatric unit, which is really important to remember. Yes, this could be replicated in smaller fashions and larger fashions or in different tracks. Anything you'd like to add to that. Sean,

Speaker 4  1:02:49  
yeah, just what you said, Sheriff, I just, I really reaffirm that. You know, I think identifying the needs of your older adult population, even if you're a smaller shop is important, but understanding that this isn't a monolithic population, right? Older adults who are 5556 57 have very different needs than older adults who are in their 70s or 80s. So there's, you know, it's really a heterogeneous population, and you have to look at your internal data in your profile of your older adult population to address their needs, and you can do that through different types of programming, through re entry planning, through community partnerships. So I think start with looking at your population profile of older adults, seeing what that looks like. And then, you know, tailoring your approach. You know, with that in mind,

Speaker 3  1:03:46  
it can even really be not just the treatment inside, but really that reentry, you know, the connections on the reentry. So in many ways, you could shape it a little bit more on that side, not just the internal treatment, but the external reentry and supports when they get back out in communities. You can do it on numerous number of different ways. Number of different

Speaker 3  1:04:12  
ways. You're muted. Christopher, thank you very much, sir. I love when I get to tell you that you're muted for a change, yes, sir,

Christopher Smith, NPA  1:04:23  
I have to leave myself open for one little comment like that every webinar, pretty much. All right, so Stephanie G asked so grateful for the comprehensive support you are all offering for the population. No doubt, the improved conditions of confinement are critical to enhancing many health and social outcomes during incarceration. What does the post incarceration landscape look like in your region? And what are and what of those with life limiting illness in this space? Show what

Speaker 3  1:04:53  
you start with that. I've got a couple of thoughts, but you're probably better to address it directly first.

Speaker 4  1:04:59  
So. It? Well, this is actually a really good question, and it's it's something we've thought a lot about here, and it's difficult because the post incarceration landscape isn't really great for those who have dementia, who have criminal histories. And so we've been thinking about this from a policy standpoint, thinking about this from, you know, stakeholder engagement standpoint. But you know, of those who have been committed on the unit, we've had 97 total commitments, but 82 unique individuals committed, which is what the sheriff had referenced. Some of these guys have come back. Some of them have come back multiple times. And in the trend we see is that those tend to be really two populations, those who have significant substance use histories, who end up relapsing and recidivating, and those who have dementia. And that dementia category is the real tough one. One of the things that the sheriff always talks about is, as much as we will highlight the things that you know we think we're doing well. We also are really cognizant of the things that we think we can and should do better. And one of those things is on the post release case management piece, the sheriff created a mat navigator model here that has done really, really well the next iteration of or where we're trying to get is to have a community based geriatric case manager who's really embedded in the community, who's really well versed in these issues, who can really make the types of connections and hopefully placements needed for this population, and then to also work with us and some external stakeholders to develop some of these policy gaps that we might be able to assist through legislative change or administrative change, Sheriff, anything else in that.

Speaker 3  1:06:51  
And a lot of these are limitations, because, you know, these units cost more money, but it's not exponentially more money. Please, understand a lot of this work can be done with partners. Boston University and others are supporting us in many ways. Part of the challenge is, as we've spoken about their you know, their family histories and where they can go and their records and where they can live in congregate housing and others. But you know, one of the great support systems for other older adults is councils on aging. For these men, it's not really a natural fit, you know, they generally tend to be, you know, they're just not going to be comfortable in that environment, and that environment will not be comfortable with them. I will say one thing that we really do push is that you take these five pillars and you continue to embed them in your life when you get back. One of the main things that I try to push because I saw the research coming some years ago, is the pro social activities, to get out there, to to engage with organizations or clubs or meetings or friendship groups. We all know from the research that men especially tend to isolate as they age, we just don't want to open ourselves up. We don't want to reach out, we don't want to become vulnerable. We don't want to, like, go out and kind of connect with people we don't know it doesn't feel comfortable. We feel like, you know, uncomfortable doing it. But that's exactly what people need to do, and so part of what we're always trying to do is provide them with pro social activities inside that they can continue outside. Now I'm going to bring it up. We mentioned pickleball. Pickleball is a great sport for, I think, for jails generally, right? Silly sound, but it's a great sport for jails. It's a great sport for older adults, because it's a lower barrier for physical you know, you know strength, that you know activity, ability to be able to play it, but it's a really great social activity. And the fact is, you can go on an app on your phone and or you can join a club, and you can play pickleball anywhere in your communities, on public courts, anywhere you go. So it's a great opportunity to do something physical, but it's a pro social activity. These are the sorts of endeavors that we try to take to make pass them on, especially that pro social. Let them not become isolated and let them not die prematurely because of that isolation as well.

Christopher Smith, NPA  1:09:12  
All right, thank you. Sheriff Jacqueline, a asks, Does your program exclude individuals with certain offenses like sex offenses or violent crimes. Also, does this program involve connection with your community release agencies? And additionally, do you assist with nursing home placement as a social worker on the community with parole, we often struggle to immediately place homeless individuals in such institutions,

Speaker 3  1:09:39  
yeah, Sean, once you take first crack at that, I know that we've spoken about these issues a lot, sure.

Speaker 4  1:09:46  
Thank you, sheriff. So on the charge piece, so there are no disqualifying crimes, other than crimes for which somebody has been indicted, where they're facing the potential for state. Prison, and that's not meant to be punitive. It's because within the name or older adult re entry we are we are focusing our efforts on those who we know will be re entering from the facility. So it's either somebody who is sentenced and they're serving their time in our custody, or their pre trial and likely facing a House of Correction sentence, which we can anticipate based on the on the charge. So we that's the that is the only you know disqualifying basis would be somebody who does not meet some other internal criteria, but who has open superior court case where they're facing state time. With respect to the sex offenders, we do have individuals on the unit who are serving House of Correction sentences for various sexual offenses, and this is something very early on. I got a lot of questions from our security staff, from the program manager herself, you know, question being, we really going to take this guy down there? You know, not sure he'll be accepted. And my response is always, do you think he's better off at Delta pod or Charlie pod or as a peer support model? We don't want guys on the unit who are not going to accept people for who they are, what they've done and where they are. None of them are in a position to judge. So you know that has always been my response. As the sheriff knows, we did have one individual who another individual found out about his charges. He asked for his papers, and was creating some angst among that individual who was convicted and serving time for a sex offense. We swiftly got rid of the person who was trying to check the other individual off of the unit, and I made it very clear to the population personally, that that will not be accepted. So we haven't had any further issues. But that was something that we that we attempted to address very early on when questions came up about sex offenders. It's not a PC unit, so I want to make that clear. You know, this is a population who has access to other parts of the facility, whether it's video court, the library, the classroom or whatnot. So they're entitled to participate in other types of activities and programming outside of the or unit in in they do the question about the nursing home. Our Health Services team will actually work on that. To be candid, we haven't had a placement from the or unit in a nursing home, but there is that coordinated collaborative care with both medical and mental health providers in the community, including the Department of Mental Health.

Speaker 3  1:13:00  
So I can, and I want to address a little bit more, you know, it's on the charges and being checked off, you know, the qualification is, you know, not beige, not based on age alone. There are risk factors that we've developed with these universities, right? That was the frailty index for the University of Wyoming Sean, or was that North Carolina?

Speaker 4  1:13:22  
So with all of the academic partners, we've looked at various frailty assessments from which we extracted the ones that we thought were really applicable.

Speaker 3  1:13:37  
Yeah, right, yeah. And then added some, right? So most, yeah, yeah. I'm sorry. So basically, yes, though, those that needed it most, right? That's where we use this frailty index, so to speak. You know, as part of our risk assessment, you know, risk factors like, you know, chronic health issues, homelessness, family estrangement, mental health needs and reentry barriers. And we use the we're using the risk assessment tool developed by BU and UMass and NC State and University of Wyoming. It's not risk for recidivism, it's the likelihood of, will this person fail generally, on outcomes unless they have the intervention. So we took a look at these assessments, a lot of health related questions. The more incarcerations you've had, you know, you know, the higher you score on the tool. Because theoretically, the re entry will be more difficult because the fragmented time in the community. Someone who's 60 and got a, you know, drunk driving for the first time is not necessarily eligible because of their age. And the assessment was developed in keeping mind the significant input that occupational therapists, speech therapists and physical therapists can have in re entry, you know, things like climbing stairs and that type of stuff. So it's really to prepare them and to see what their risks are. And we don't foreclose anyone, except, as Sean said, it's a re entry unit, so we want to make sure. Sure that you have the opportunity to re enter before we'll take you on the unit, but no one's excluded on their charges alone. All right.

Christopher Smith, NPA  1:15:10  
Thank you, gentlemen. Now we do have a couple more questions, but I'm going to take advantage of being the one asking the questions to ask my own question. I guess that's speaker's privilege. So you guys said you had 33 bed unit. Do you have you had it completely full at any time? Or is it currently completely full? And you develop a wait list for those wanting to get in. Or how do you handle that? You want

Unknown Speaker  1:15:32  
to start that one? Sean, go ahead.

Speaker 4  1:15:36  
Thank you, sheriff. So yes, it's a 33 bed unit. We have tried to keep it, I would say, between 18 and 24 and the reason for that is because it gets very complicated. The more older adults you bring into a dormitory style housing unit, one of the learning lessons that we've encountered is that this is a very challenging population. One of the things that we did is we looked to the data very early on for a lot of the perks that we offer in the unit in terms of different types of games and exercise equipment and whatnot, to show our correctional officers, the the fact that very few of these guys, historically as older adults, this incarceration, prior incarcerations, have disciplinary problems or disciplinary histories, and the disciplinary histories that they have more indicative of aging, so It might be insolence that stems from a sundowning incident. It might be, you know, poor living area standards or cell standards, indicative of, you know, hoarding type of behavior, being out of place, which is more indicative of, you know, not being able to get back to your your cell in time, as in missing your door, you know, not following the

Speaker 3  1:17:08  
hearing and sight impairments to Sean, right? I mean the hearing and the sight impairments, which our officers addressed on their own too.

Speaker 4  1:17:16  
Yeah, right. So, though, so So with that, you know, we were able to demonstrate why we're, you know, doing certain things on the unit that are unusual that we wouldn't really do in in other housing units. I just digressed there, Chris, you want to go back to the I was getting to your your question. And I, let

Speaker 3  1:17:40  
me, let me. Let me, let me. Just add one other thing to what you were saying, Sean. And this is some this is one of the unique things about this unit. Sean mentioned, if you look for the the disciplinary reports in the facility, you're not going to find a lot of these guys on the disciplinary reports. But that doesn't mean they're not that doesn't mean they're easy to get along with, right, which I think is probably where you're going. And so what you find is you got a bunch got a bunch of Grumpy Old Men, sometimes in a, in a in a dormitory facility, that are kind of stuck in their like ways, and have these little kind of things that they fixate on, and they have a hard time sometimes getting over little things. Little Things become big things in this unit. So it's really interesting, the dynamic that we didn't even realize at this point, right? Sean, and so I'll just give you a funny example. We this one group that works with young adults, decided they wanted to bring in restorative justice circles. And, you know, there's an I think it's always can be good. I think they work better in a inside a inside a correctional facility than they do in the communities often, quite honestly. And so it's this group that they do a lot of great work at, called Roca. They do great work in Springfield Mass and Chelsea in Boston and Baltimore. Now they're really highly regarded, and they wanted to do restorative justice. And honestly, this group is great. And we just said anything they want to do, we just say yes, because they're just that type of group. So they can group. So they came in and led a restorative justice circle training in the facility. What's great about this was our offices participated, and there were points when they were passing around a feather, which meant that you had the right to speak. And you know, some some stuff that you know, even even as a you know that sometimes people aren't as comfortable, right? And it seems looks kind of not, I don't know, it just looks kind of silly sometimes, I guess, on the outside. So we had a session or two, and then we were like, then talking Shawn, I were saying, Oh, we got to get them back in to finish off the training. And then Sean learned that actually, they had, usual, utilized the restorative justice training circle training without us even knowing about it on their own, which, again, is the type of culture you want to create where the inmates themselves use this vehicle to resolve a problem that was conflicting them inside this unit and really growing to be more and more problematic with their behaviors and. You want just tell them what it was about. Sean, briefly, it's just kind of interesting, a small thing that grew up to be a big problem that was then resolved through restorative just a restorative justice circle, without us even knowing that they were going to utilize it. They did it on their own. Very proud of that, sure.

Speaker 4  1:20:15  
Thank you, sheriff. So a lot of the older adults on the unit, enjoy feeding the pigeons in the rec yard. And you basically have two groups of older adults, a group that has a real affinity for pigeons, and they really enjoy them, and it helps them de stress. They like to feed them and watch them. And then another group who they just think it's kind of funny to throw food out at the pigeons. So that caused a significant amount of conflict, because the guys who had the affinity for the pigeons only like to feed them bread and rice, which they thought was more appropriate diets for pigeons. And then you had the other group of guys who was throwing spaghetti and meatballs and stuff out there. And then you had pigeons that had red sauce all over their face, and it wasn't agreeing with their digestive system. And then you had a problem out on the yard and on the rails, where they had to hold because they're older to walk into the unit. So they on their own, had a peacemaking restorative justice circle to talk through this issue, and they came up on their own with some ground rules that the pigeons would only be fed certain types of food, certain type of debt, a certain time of day, and in a certain location in the recreation yard. And it sounds a little silly, but point this is, and I'm glad he brought this up, because this is where I was attempting to go is, you know, we didn't anticipate really having many disciplinary problems once we opened this unit, but we certainly did not anticipate having the type of discord that we see with older adults over very little, trivial types of issues that really lead to big issues. Because these guys being older, they're just stuck in their ways. They have very strong belief systems. They expect things to be done a certain way, usually the way they want it done. And those types of things, you know, leaving a microwave door open in the morning when guys are trying to heat up their water, I'm sorry, shutting the door as opposed to leaving it open for the next person. That was a big issue on the unit. I mean, a significant issue. And those, the problems that we've had, they've been few and far between, where people have had to be reclassified stem from issues like this, not anything that you would normally see in another housing unit, that you know, it's just really trivial things. So that's been a learning

Speaker 3  1:22:51  
we've given them. We've given them a skill set that they didn't have before that hopefully can help them when they re enter their communities, by figuring out how to resolve the conflicts over the little stuff, right? Something that, honestly, I should be doing more with my own family, but this is something that a skill that is really important to their successful reentry and welcoming by their own families and friends as well. Next question, Christopher,

Christopher Smith, NPA  1:23:17  
yes, sir. And actually, we have a whole list of questions, but I'm going to read two more, and then we'll start to wrap it up that way. Give everybody a two. We have a few more things, and then we'll close it out. I picked two that I thought in order the best or just were interesting and may provide some good information to our listeners. So Annette asked, were there any specific studies referenced for the color psychology component, secondarily, it sounds like a lot of the therapies and programming are offered via partnerships with schools. How are those partnerships initiated? Are their services voluntary, or is there a MoU slash financial agreement?

Speaker 3  1:23:58  
Sean, I'd love to answer this one. Why don't you give them, like, a quick thumbnail, and then I can follow up on this one too.

Speaker 4  1:24:05  
Thank you, sheriff. Lots of research on color psychology. You can just go on, you know, Google Scholar, if you have, you know, JC, or any type of a search engine, and you'll find it. We did a lot of internal research on that with respect to the partnerships, yes, all of the colleges, even the Museum of Fine Arts, they partner with us at no cost to us, Berkeley School of Music and bu we have memorandums of understanding with

Speaker 3  1:24:37  
so I will say this too. A lot of this just started with writing to an organization. You know, we've got this concept. We're proud of it. We'd write a letter to Boston University. They were the number one school for occupational therapy, which is something really important to older adults as well as younger adults. We wrote to them. They said, We're in and we started this amazing partnership Berkeley. School of Music, by the way, that is not just a music therapy. It's going to be grounded in research, in science, and have some outcome testing as well. So it's not just a let's play some music and feel good about it. It's going to be research and data driven as well. And the Museum of Fine Arts, we found that a lot of these guys, you know, they said they wanted to participate. After a tour of our facility, a lot of these guys were interested in history, so they actually came up with a Art History kind of program that they could bring to our facility. As far as the science, we've got, you know, studies, we've got a literature review Sean that we can also give out that was done prior to us starting the unit. And quite honestly, it's like little things, little things like, you know, we were going to double up the mattress, just interesting things that you think about, right? We're going to just double up the mattresses, give them a softer mattress, because a lot of that's what a lot of guys want to do when they double up the mattresses, when they can sneak another mattress in. Well, you know, Boston University says, probably not healthy for them. You know, they're, what are you? Muscular, skeletal recovery, right? Sean, is you use the proper verbiage. And so we said, Well, what do you recommend? And so they actually went and researched and found a couple of studies on the basic the proper density of mattress for this type of age group, and we're able to make it. We're able to have it the made at no extra cost to us, even the beds. We were cutting off the top bunks and letting them sleep in the lower bunks, because that's, of course, where the older adults would be. We didn't realize that the lower bunks were too low and that older adults would have trouble getting up out of those lower bunks, you know, when you're trying to push off as you get older. And so we went to, I don't know which university it was, and they came up with research to show they should be this height, so all these little decisions which are kind of important later. They may not seem important at the time, but it's really interesting to engage with your partners so that they can guide you as well. But again, it all started with us just reaching out and saying, Would you like to participate, pitching the program well, and they become all in on this stuff, really part and parcel. The whole thing that's

Christopher Smith, NPA  1:27:01  
good to hear. Thank you, sheriff. Okay, the last question, once a person leaves, oh, this comes from Charlotte H, once a person leaves your facility without family support or housing. Do you provide housing? How are those housings funded, and how long do they stay in in the housing on the outside?

Unknown Speaker  1:27:19  
You want to talk on that Sean,

Speaker 4  1:27:23  
well, they may qualify for housing voucher. So whether it's federally subsidized or state subsidy, more likely than not. The reality is they're probably going to some sort of community program, a residential program, a sober home or whatnot. So it really depends on a number of factors. You know, if they're veterans, they may have priority for subsidized housing. You know, if they're at risk for for homelessness, there may be other types of assistance that can be offered at the state level. So it's really case. It's really case by case.

Speaker 3  1:28:04  
Yeah, it's really, this is the next stage for us, as we've built this model, is now that, like Sean said, we really want to get to the point where we can provide a navigator. You know, budgetary issues being what they are adding a navigator in we're actually working with, I think it was Boston University to provide, to get grants and things like that, so that can also be opportunities. But those supports, as we all know that if you have a navigator for those with, you know, substance use disorder or mental health, we use navigators for programs with mental those that leave our facility with mental health, those six those success of finding housing and stable supports is much higher. So that's really is our next generation of we're going to build this out to as well.

Christopher Smith, NPA  1:28:46  
And let me just say, gentlemen, that there were a number of questions and complimentary statements that I did not get to so it appears, by the questions and compliments that it was very well received.

Speaker 3  1:28:57  
But let me just say that I know it'll be said at the end, but if you have a question or you know, or you want to talk, please email us. I'm assuming that our information is up there, or call us glad to speak with you at any time. Send presentations, whatever you need, that literature review whatever you need. We're here because this is what we're supposed to all be about, is, you know, getting a good program, replicating a good program and making it better. If there's nothing out there creating a program, but collecting data and then creating the model, and then sharing that model so other people can make it better, and then you can learn from their experience as well. We're all into this. If you want reach out, we'd love to help you out and then learn as well from this sharing of information,

Christopher Smith, NPA  1:29:40  
along with that Sheriff for those, if you still have questions or something you want to pass on, you can still type in the chat, and we will have this log when we're done. And if it's a question that we can pass on or something like that, we'll certainly pass it on to the sheriffs, one of one of our staff here, so this not typed and lost in the nether world. We will still have the log. So. So slide please. So again, what a great presentation. If everybody listening could please type into your chat let our speakers know how much you appreciated it. Finally, I want to give our program manager Kevin Jones and chief Amos one last chance to say something in summary. So Mr. Jones, would you like to say anything in summary,

Transcribed by https://otter.ai