Health records and healthcare utilization indicate that young individuals whose parents have been in prison encounter more physical and mental health obstacles. Recognizing these affected young individuals presents a challenge because most healthcare systems do not have established protocols to inquire about parental incarceration.
Researcher Samantha Boch has delved into the effects of parental incarceration on child and family well-being for over ten years.
Boch’s recent research focuses on scrutinizing the health records and healthcare engagement of young individuals, those under 21, who may have been exposed to the legal system or have family members who have. The primary obstacle lay in pinpointing young individuals affected by mass incarceration since most healthcare facilities do not routinely broach the subject of incarceration. Families may opt not to disclose this information due to social stigma, fear of Child Protective Services involvement, or possible judgment.
“There is a scarcity of large-scale community-level studies regarding the health of young individuals impacted by incarceration, or their families’ incarcerations, using medical records,” elucidates Boch, serving as an assistant professor at the University of Cincinnati College of Nursing. “Despite a substantial number of young individuals and families affected by incarceration, knowledge gaps persist regarding its prevalence and ramifications. Several factors contribute to this, including lack of provider awareness, insufficient inclusion in provider training, inadequate funding for research, and absence of routine sensitive screening for exposure.”
Boch and her research team conducted a search in electronic medical records for justice-related terms such as “prison,” “jail,” “sentenced,” “probation,” “parole,” among others, to gauge the repercussions of incarceration. The data was drawn from Cincinnati Children’s Hospital records spanning an 11-year period.
Their study, published in Academic Pediatrics, discovered that out of over 1.7 million records reviewed, 38,263 (equivalent to 2.2%) of young individuals seen between January 2009 and December 2020 likely had a parent incarcerated or faced some form of confinement during their youth. Despite this small percentage, these individuals accounted for a noteworthy number of physical and mental health diagnoses and healthcare visits at Cincinnati Children’s Hospital. They were compared against a sample without any justice-related keyword but matched socioeconomically, and the total youth population sample.
Approximately 63.3% of all behavioral health inpatient admissions, 23.7% of inpatient hospitalization days, and 45.5% of foster care visits were attributed to the 2.2% of young individuals who had documented probable personal or familial involvement with the justice system. These findings complement another study led by Boch, published in 2021 using data from Nationwide Children’s Hospital in Columbus, Ohio.
Young individuals with a justice-related keyword in their record exhibited 1.5 to 16.2 times higher prevalence of various physical and mental health disorder categories compared to socioeconomically matched youth without a justice-related keyword. They also demonstrated 428.2 more physical health diagnoses and 269.2 more mental health diagnoses per 100 youth than their matched counterparts.
According to the study, young individuals with a justice-related keyword represented a substantial portion of those diagnosed with health disorders or conditions at Cincinnati Children’s between 2009-2020. This encompassed 42.9% of all schizophrenia spectrum and other psychotic disorders, 42.1% of all bipolar and related disorders, 38.3% of all suicide and self-injury disorders, 24.5% of all trauma and stress-related disorders, 44.9% of all shaken baby syndrome cases, 13.9% of infectious diseases, 12.5% of speech-language disorders, and 12.8% of youth pregnancies.
Nationally, around 7% of U.S. youth have experienced parental incarceration. The findings from Cincinnati Children’s and Nationwide Children’s Hospital indicate a significant underestimation of the number of youth impacted by incarceration or confinement, as per Boch.
“Our data represents families who disclosed and healthcare providers who recorded,” notes Boch. “Families who choose not to disclose or those with unrecorded information were not reflected, which is a notable limitation. This study endeavors to reveal the extent of the impact of mass incarceration on the health of young individuals in Cincinnati. Our healthcare and correctional systems noticeably intersect and affect the lives of children.
“Replicating these findings in other communities would bolster the growing rationale for de-carceration efforts and other reforms, particularly if we aim for the optimal well-being of all U.S. children and families,” adds Boch. “Continued high rates of incarceration will perpetuate disparities in healthcare and position us poorly in the global arena in terms of health outcomes.”
The study’s additional authors include Joshua Lambert, PhD, University of Cincinnati; Christopher Wilderman, PhD, Duke University; and Judith Dexheimer, PhD; Robert Kahn, MD; and Sarah Beal, PhD, all affiliated with the University of Cincinnati and Cincinnati Children’s.
This research on Cincinnati youth received support from Boch’s accolades, including the Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute (AHRQ/PCORI) K12 PEDSnet Scholars Learning Health Systems Career Development Program, University of Cincinnati College of Nursing Dean’s New Investigator Award, internal funding from the Cincinnati Children’s Hospital Medical Center James M. Anderson Center for Health Systems Excellence, and the NIH/NIMHD Loan Repayment Award for Clinician Scientists from Disadvantaged Backgrounds.
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