COJENT Initiative

The Criminal Justice & Health Program at UCSF, the Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and the San Francisco Sheriff’s Department recently partnered on the COJENT Initiative (“Criminal Justice-Involved Older Adults in Need of Treatment”). The number of criminal justice-involved older adults (in jail awaiting trial, on community-based probation or parole, or serving prison sentences) is growing rapidly. This population’s need for health and social services –in correctional facilities and in the community - is also on the rise. COJENT’s 5-Step Initiative was designed to develop the evidence needed for a community-wide, interdisciplinary action plan to meet this population’s needs.

The 5-step COJENT Initiative Framework draws on three approaches to health care and health system research (Patient-Centered Outcomes Research, Health impact Assessment and the Sequential Intercept Mapping Model for Criminal Justice Services) to account for the complex intersection of criminal justice, public health, and medically vulnerability by emphasizing local landscape analysis and data gathering to inform subsequent action planning. COJENT’s 5-Steps:

  • Step 1. Identify stakeholder perceptions of the challenges faced by, and created by, criminal justice-involved older adults
  • Step 2a. Conduct community-based needs assessments: The health and social services needs of the community’s criminal justice-involved older adults
  • Step 2b. Conduct community-based needs assessments: The educational needs of community professionals who are interacting with criminal justice-involved older adults
  • Step 3. Implement quick-response interventions based on the needs assessments of older adults and local professionals
  • Step 4. Communicate findings to community stakeholders in a public forum to generate public feedback, engage additional stakeholders in advance of action planning, and recruit “champion” stakeholders to develop an action plan for a community-wide response
  • Step 5. Use information from needs assessments, evaluations of quick-response interventions, and public feedback to engage an interdisciplinary group of “champions” to collaboratively develop an action plan that could optimize services for this population

With funding from the UCSF Department of Medicine, the public face of the COJENT Initiative was launched in 2015 at a public convening held at the San Francisco Public Library to describe the research collected to date attended by over 200 professionals, community-based organizations, and criminal justice-involved older adults and their families. Subsequent working group meetings were held to identify the population’s most critical needs, the gaps in city services that prevent those needs from being met, and the resources available to improve San Francisco’s health and social safety net for these medically vulnerable older adults. A final 2-day working group meeting, facilitated by outside experts in “Sequential Intercept Mapping” systems of care for medically complex criminal justice-involved populations, resulted in a Strategic Action Plan that is currently being vetted by key stakeholders.

Priority Strategic Action Plan items identified through the COJENT Initiative include:

  1. Increase training and educational resources for law enforcement and other criminal justice professionals to increase knowledge of the healthcare needs of older adults and to divert more older adults to incarceration alternatives;
  2. Improve the identification and assessment of older adults with cognitive impairment at multiple “intercepts” along the criminal justice involvement pathway (e.g., at arrest, adjudication, incarceration) and develop responsive policies and practices;
  3. Improve and expand post-incarceration discharge planning for older adults, including better linkages to existing aging-specific city resources.

Academic Products

  • Metzger L, Ahalt C, Kushel M, Riker A, Williams B. “Mobilizing cross-sector community partnerships to address the needs of criminal justice-involved older adults: A framework for action” The International Journal for Prisoner Health (Under review)
  • Green M, Ahalt C, Stijacic-Cenzer, Metzger L, Williams B. “Older Jail Inmates: High rates and early onset of geriatric conditions” Journal of the American Geriatrics Society (Under Review)
  • Humphreys J, Ahalt C, Stijacic-Cenzer I, Williams B. Geriatrics Factors associated with Emergency Department use among older adults after release from jail” Journal of Urban Health (Under Review)
  • Ahalt C, Sudore R, Bolano M, Williams B. Clinical Research with Correctional Populations: The overlooked role of assessing comprehension in informed consent (Under 1st revisions review, American Medical Association’s Journal of Ethics)
  • Ahalt C, Rothman A, Williams B. “Examining the role of physicians in long term solitary confinement” (under 1st revisions review at British Medical Journal)
  • Buiskar T, Ahalt C, Stijacic-Cenzer, Williams B “Smoking and smoking cessation in older jail inmates” Journal of healthcare for the poor and unserved (under review)
  • Brown RT, Ahalt C, Rivera J, Stijacic Cenzer I, Wilhelm A, Williams BA. Good Cop, Better Cop: Evaluation of a Geriatrics Training Program for Police. J Am Geriatr Soc. 2017 Apr 24. PMID: 28436006.
  • Bolano M, Ahalt C, Ritchie C, Stijacic-Cenzer I, Williams B, et al. Detained and Distressed: Persistent Distressing Symptoms in a Population of Older Jail Inmates. J Am Geriatr Soc. 2016 Aug 18. PMID: 27534904.
  • Flatt JD, Williams B, Barnes D, Goldenson J, Ahalt C, et al. Post-traumatic stress disorder symptoms and associated health and social vulnerabilities in older jail inmates. Aging Ment Health. 2016 Jul 1; 1-7. PMID: 27367335.
  • Ahalt C, Williams B. Reforming Solitary-Confinement Policy--Heeding a Presidential Call to Action. N Engl J Med. 2016 May 5; 374(18):1704-6. PMID: 27144846.

Future Funding and Grants Received during the course of COJENT Initiative Funding

  • R01: Cognitive impairment and older jail inmates (Submission October 2017, CVP and Criminal Justice and Health Program at UCSF)
  • Contract: Under negotiation with a Bay Area Jail to develop an evidence-based cognitive impairment assessment tool for older adults admitted to jail
  • Contract under negotiation with the State of Idaho to build a correctional dementia unit
  • The National Palliative Care Research Center “Bringing Advanced Care Planning to Prison” 07/01/2016 – 06/30/2018) – with CVP Faculty Member Rebecca Sudore
  • The California Department of Corrections and Rehabilitation, “Creating a Gender Responsive Plan for Palliative Care and Geriatrics in a Women’s Prison” (06/15/2017 – 09/15/2018)
  • The Irish Research Council, “Leadership, Culture and Managing Prisons: Knowledge exchange between the USA and Europe” (LEADERS) (01/01/2017 – 12/31/1-17)
  • The Cambia Foundation “Leveraging compassionate release reform to advance palliative care for seriously ill prisoners, the Sojourns Scholar Leadership Program Award” (10/01/2016 – 09/30/2018)
  • The Prison Law Office “The European-American Criminal Justice Innovation Program”(01/01/2015-06/30/2018) – annual competitive renewal
  • The Jacob and Valeria Langeloth Foundation “The health risks and costs of solitary confinement: Advancing evidence for policy reform” (01/01/2016 - 12/31/2018)

The Criminal Justice and Health Program at UCSF and the Center for Vulnerable Populations are deeply grateful to the UCSF Department of Medicine for its support over the last 2 years. This support has been instrumental in bringing the two programs together, for developing contracts and grants both in progress and successfully received, and for mentoring junior faculty and trainees in research and manuscript preparation and publication.

For further information please contact Brie Williams at or 415-514-0720.