Study Update: Recent Study Shows Negative Public Health Impacts for Children with Histories of Parental Incarceration and Need for Decarceration Strategies

A recent study confirms that incarceration is one of the major public health challenges of our time, not only for the people experiencing incarceration, but for children left behind. The study by Nia Heard-Garris MD et al, “Health Care Use and Health Behaviors Among Young Adults with History of Parental Incarceration,” found that young adults with histories of parental incarceration are less likely to use health care and more likely to engage in unhealthy behaviors compared with peers without parental incarceration. Such findings urge policy makers to reduce incarceration rates and help children maintain contact with their incarcerated parents.

The study gives us a window into the health implications as well as insight for how health care providers and policy makers may reduce health disparities for the over 5 million children in the United States who have had a parent in jail or prison.  Especially important as we know that these numbers do not fall evenly, as a disproportionate number of children are black or Latinx and low income. It is now more known that as incarceration of a parent entirely disrupts the family unit, it thereby negatively affects the children left behind. Parental incarceration is considered an Adverse Childhood Experience (ACE), or as an experience that may affect children long after the event has occurred. The difficulties that can occur for some children include

  • Emotional and psychological distress;
  • Loss of family income and financial challenges for already disadvantaged and under-resourced families;
  • Confused explanations given to children;
  • Changes in child care arrangements;
  • Difficulties in maintaining contact with incarcerated parents and actual loss of parent child relationship;
  • Stigma and homelessness associated with parental incarceration and home and school moves.

Some studies have addressed the links of economic instability for children of incarcerated parents to barriers in health care services, resulting in poor physical and mental health outcomes. However, until this study, less had been known about the health care use of children experiencing parental incarceration and how that may connect to the negative health outcomes we see. And most importantly, help point us towards strategies for intervention. The researchers start by noting that health care use and health behaviors as strong social determinants of health, and therefore understanding these relationships will allow for interventions and strategies to improve health for individuals who experienced parental incarceration.

Findings in the Heard-Garris et. al study show that young adults with an incarcerated parent during their childhood are:

  • More likely to skip needed health care
    • Having an incarcerated mother doubled the likelihood of young adults using the emergency department instead of a primary care setting for medical care.
    • Having an incarcerated father resulted in higher odds of having a health problem worsen because of lack of care.
  • More likely to smoke cigarettes, abuse alcohol, and prescription drug use
    • Individuals with incarcerated mothers were more likely to watch more television, consume sugary drinks and not use sunblock.
    • Individuals with an incarcerated father had significantly higher odds of illicit drug use and problem drug use.

The study also showed that the average young person was around ten years old when their parent was incarcerated. The study’s findings support that disruptions in the family unit, including changes in primary caregiver or housing, can lead to foregone health care, or barriers to seeking preventative care. Seeking health care in emergency departments (ED), signals seeking care after a health problem has worsened and points to the economic realities for most families experiencing parental incarceration. Heard-Garris et al point out how “[h]igher frequencies of ED use is not unexpected due to the health conditions ACE-exposed populations experience, in addition to the numerous social and economic barriers to primary care…” They also point to the reality that “financially stressed families have access to fewer resources that allow them to model good health behavior in children.”

Further, Heard-Garris et al underscore the need for our systems to better support parents and their children and how the failure to do so leads families to forego care in yet another system, the health care system. They state that:

parents and children who have experienced a history of negative interaction with institutions, such as the criminal and child welfare systems, may be less likely to interact with other systems, such as the health care system, because of fear of surveillance and formal record keeping.

These realities may lead youth as they age to continue to avoid preventative health care and health care systems altogether.

Overall, the study points to the need for more studies on the barriers to health care and studies to determine the causes for the under-utilization of care. As well as the need to prioritize interventions that increase preventative health care use and improve healthy behaviors for children who experience parental incarceration. As the long-term consequences of parental incarceration may impact generations to come, they recommend:

  • Existing partnerships between government organizations, community organizations, and health care organizations that provide services to children should prioritize access to preventative health care.
  • ACE screenings by pediatricians.
  • Group medical visits for children impacted by parental incarceration.
  • Preventative education on healthy behaviors.
  • Increased patient-provider trust, community building and support.

Most importantly, however, the study’s conclusions include recommendations for policy makers to:

  • Reduce incarceration rates by changing the policies leading to mass incarceration, e.g. touch on crime policies and the war on drugs.

And

  • Help children maintain contact with their incarcerated parent.

The study does not address the fact that the sample population was seeking care before the Affordable Care Act (ACA), and whether these results would be similar now assuming that more families and children would have greater access to health coverage. Either way, this study homes in the importance of measures such as the ACA in reducing barriers to health care generally, but particularly for historically and currently marginalized communities that are more likely to experience parental incarceration.

In light of these findings, the following resources may be helpful for pediatricians, social workers, teachers, attorneys who often engage with children of incarcerated parents:

 

 

 

 

Riley Hewko, Esq.

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