FEATURES

A Hidden Epidemic: Parental Incarceration and What To Do When It Affects Your Patients

September 18, 2019
Written by

Andrew Axelson and Samantha Boch, PhD, RN, share insights gathered from a look into parental incarceration data across the country.

If having an incarcerated parent was classified as a chronic health condition, it would be the second most prevalent chronic condition in the United States for children under the age of 18 – just behind asthma. In fact, the percentage of American youth with an incarcerated parent is about 10 times higher than the percentage of youth diagnosed with diabetes.

Over 5.7 million children, or 1 in every 14 youths, in the United States have had a parent incarcerated at some point during their childhood. And nearly 2.7 million children currently have a parent in jail or prison.

What are the effects of having an incarcerated parent?

Children with incarcerated parents can face tremendous challenges due to the associated economic strain, household churning and instability, and trauma that parental-child separation by incarceration often brings.

Children or young adults who have had an incarcerated parent are more likely to have educational, economic, mental and physical health problems than those unexposed. Parental incarceration has been classified as a particularly stigmatizing Adverse Childhood Experience, or ACE, disproportionately impacting children of color and children in poverty. While the exposure to parental incarceration is often included in ACEs checklists, the experience is rarely solely investigated. Despite new research indicating that these children experience up to three times as many additional ACEs, children exposed to parent incarceration are largely left out of national conversations and political debates surrounding mass incarceration. For these reasons, little research is focused on the differential and contextual impacts of household incarceration (e.g., understanding the difference between parents detained in privately operated facility vs. state/federally operated facility, the frequency of incarceration, prison vs. jail, non-violent offense vs. violent offense, mother vs. father incarceration, sibling vs grandparent incarceration).

While parental incarceration’s effects vary by child, the evidence available points to potential behavioral, emotional and attachment challenges to healthy development. It is also important to note that despite the numerous and unique challenges facing children of incarcerated parents, many children are resilient, rising above multitude barriers to achieve great success.

How can health care providers help?

Understanding and supporting these children and their caregivers through each phase of incarceration (upon arrest, through incarceration and after release) and designing appropriate ways to screen, track and support these families would minimize associated negative impacts.  Yet, no such coordinated system exists.

Because incarceration can be a driver of housing stability, food security, transportation and income, parental incarceration or mass incarceration should be viewed as an important social determinant of health. Connecting and referring these families to mental health and coordinated social services that address the financial, housing, educational and emotional/behavioral health consequences of household incarceration would give affected children much needed access to care and stability. For youth service providers and teachers, use inclusive familial language and be mindful of the potential barriers of obtaining parental consent to access educational supports (e.g., Individualized Education Program, or IEP) and other school related functions/activities.

Since many of these children have little home stability in their lives and face a fragmented social services system. It is crucial that clinicians make themselves aware of existing Nationwide Children’s community-based resources for at risk youth from intensive home-based treatments and group therapies to school-based programs available to support at risk youth in school, at home, and in the community. If the child has witnessed violence (e.g. including the witnessing of a traumatic arrest of a parent within the home), referrals to the Center for Family Safety and Healing are also highly encouraged. Other incarceration-specific resources include:

  • The Amachi Program through Big Brother/Big Sisters, a tailored youth mentoring program for those with an incarcerated parent
  • The Sesame Street televised series called Little Children: Big Problems– Coping with Incarceration, in which age-appropriate materials for younger children (aged 2-5 years) to assist in introducing subject of incarceration and advice to caregivers are relayed
  • Unlocking Futures is a Columbus-based organization providing support to families raising children with an incarcerated parent/parental figure (including the Generational Leadership program that uses the evidenced based curriculum, Creating Lasting Family Connections)
  • A Tip Sheet for Incarcerated Parents: Planning for a Visit from Your Child/Children, which includes age specific guidance and advice for caregivers. 

In addition, less than half of the parents in state prisons reported receiving any visits from any of their children. This is unsurprising, as a recent examination of all 50 state’s published correctional visitation and family programming policies, conducted at Nationwide Children’s Hospital, found vast inconsistencies between states and even between facilities within the same state. To support parent-child relationships during parental incarceration, consistent, transparent and family-friendly visitation policies and parent education programs that can allow children to have contact with their parent in a positive way are essential. Transportation services and preparing the child with visit expectations and associated safety plans on what to expect, are also encouraged. The lack of contact between incarcerated parents and their families can lead to additional trauma in children and greater difficulties during the re-entry process. Some states and facilities have already established family-friendly visitation centers and programming in prisons, and it is time to expand these services nationwide.

Similar to the work being done through Nationwide Children’s On Our Sleeves initiative to reduce stigmas surrounding mental health, we should also work to support children by reducing stigmas the stigma of having an incarcerated parent, a part of many children’s lives that is out of their control. In addition to recognizing the effects of parental incarceration and treating it as a unique childhood experience when working directly with patients, advocating for sentencing and mental health reforms in the prison and child welfare systems could bring about much needed positive change for numerous families in Ohio and beyond. Health care providers and hospital staff have a unique opportunity and position to advocate on behalf of patients, and children affected by parental incarceration deserve better than what the system designed to protect them currently has to offer.

 

Andrew Axelson was a Healthy Neighborhoods, Healthy Families undergraduate student intern during the summer of 2019 under Kelly Kelleher, MD. He is currently an undergraduate student at Rice University in Texas studying political science. 

Dr. Samantha Boch is a postdoctoral scientist in the Patient-Centered Pediatric Research Program (PC-PReP) under Dr. Kelleher and Deena Chisolm, PhD, in the Center of Innovation for Pediatric Practice (CIPP). She is also a visiting assistant professor in the Department of Nursing at Otterbein University. Her research centers on the social determinants of health with most of her work uncovering the effects of parental incarceration on youth well-being.

If you are interested in helping support children of incarcerated parents through advocacy, research or staff education, please reach out to Dr. Samantha Boch at Samantha.boch@nationwidechildrens.org. Dr. Kelleher also contributed and approved this article.