Parental Incarceration and School Readiness: Findings From the 2016 to 2018 National Survey of Children's Health

Exploring Parental Incarceration, US Government Support Programs, and Child Health and Well-Being: A National Cross-Sectional Study

OBJECTIVES

To describe relationships between parental incarceration and child health and flourishing-a measure of curiosity, resilience, and self-regulation-and to identify government programs that moderate this relationship.

METHODS

Using the National Survey of Children's Health data from 2016 through 2019 for children 6-17 years old, we estimated associations with logistic regression between parental incarceration and overall health and flourishing, adjusting for child, caregiver, and household factors. We secondarily examined physical health (asthma, headaches), mental health (attention deficit disorder/attention deficit hyperactivity disorder, depression), developmental needs (learning disability, special educational plan use), and educational (missing ≥11 school days, repeated grade) outcomes. We performed interaction analyses to determine whether government program participation (eg, free/reduced lunch, cash assistance) moderated relationships between parental incarceration and child outcomes.

RESULTS

Children with parental incarceration accounted for 9.3% of the sample (weighted n = 4 400 000). Black, American Indian/Alaska Native, and multiracial children disproportionately experienced parental incarceration. Parental incarceration was associated with worse health (aOR, 1.31; 95% CI, 1.11-1.55) and higher odds of not flourishing (aOR, 1.66; 95% CI, 1.46-1.89). Physical health, mental health, developmental issues, and educational needs were also associated with parental incarceration. Participation in free and reduced lunch moderated the relationships between parental incarceration and general health and flourishing, and cash assistance moderated the association between parental incarceration and flourishing. For each, parental incarceration had an attenuated association with health among people who participated in government programs.

CONCLUSIONS

Parental incarceration is disproportionately experienced by Black and Indigenous children and associated with worse child health and well-being. Government support program participation may mitigate negative associations between parental incarceration and child outcomes.

Positive Early Childhood Experiences and School Readiness among US Preschoolers

OBJECTIVES

To characterize the relationship between positive early childhood experiences (PECEs) and school readiness, and assess whether the PECEs-school readiness relationship was robust to and/or differed across levels of adverse childhood experiences (ACEs).

METHODS

We analyzed national data on children ages 3-5 from 2016 to 2020 (n = 26 871) to examine associations between key PECE domains (nurturing relationships, home learning opportunities, safe and stable environments, and family routines) with being on track for school readiness, defined using a pilot, multidimensional measure called "healthy and ready to learn". Weighted univariate, bivariate, and multivariable analyses were conducted to generate nationally representative estimates. Multivariable models adjusted for sociodemographic factors and were assessed both with and without cumulative ACE exposure.

RESULTS

Two-fifths of children were healthy and ready to learn. Exposure to PECEs was associated with higher school readiness, irrespective of relative ACE exposure. Compared with those with low PECEs, children with moderate (aOR, 2.19; 95% CI, 1.86-2.58) and high (aOR, 4.37; 95% CI, 3.58-5.34) PECEs had greater odds for being healthy and ready to learn, net of both sociodemographic factors and ACE exposure. Significant associations were robust across demographic groups (eg, race and ethnicity), ACE levels, and ACE types (eg, parental incarceration).

CONCLUSIONS

Increasing PECEs correspond with greater likelihood of possessing capacities key for school functioning, even amidst ACEs. In concert with efforts to ameliorate early life trauma, caregivers, health care providers, educators, and systems can consider boosting PECEs to foster healthy development in childhood and beyond.

Numeracy and literacy attainment of children exposed to maternal incarceration and other adversities: A linked data study

Parental incarceration has been associated with educational disadvantages for children, such as lower educational attainment, increased grade retention, and truancy and suspensions. However, children exposed to parental incarceration often experience other adversities that are also associated with educational disadvantage; the contribution of these co-occurring adversities has not been considered in previous research. This study aimed to investigate the educational outcomes of children exposed to (a) maternal incarceration alone and (b) maternal incarceration plus other adversities (i.e., maternal mental illness and/or child protective services [CPS] contact). We used linked administrative data for a sample of children whose mothers were incarcerated during the children's childhood (i.e., from the time of mother's pregnancy through the child's 18th birthday; n = 3828) and a comparison group of children whose mothers had not been incarcerated (n = 9570). Multivariate multinomial logistic regressions examined the association between exposure to the three adversities (i.e., maternal incarceration, maternal mental illness, and child CPS contact) and above or below average reading and numeracy attainment in Grades 3, 5, 7 and 9. At all grade levels, children exposed to maternal incarceration alone and those exposed to maternal incarceration plus other adversities had increased odds of below average numeracy and reading attainment and decreased odds of above average numeracy and reading attainment compared to children without any of the recorded exposures. Children exposed to maternal incarceration and CPS contact and those exposed to all three adversities had increased odds of below average reading and numeracy attainment compared to children exposed to maternal incarceration alone. The findings highlight the complex needs of children of incarcerated mothers that must be considered when designing and delivering educational support programs. These children would benefit from the implementation of multi-tiered, trauma-informed educational and clinical services.

The intergenerational effects of paternal incarceration on children's social and psychological well-being from early childhood to adolescence

The present study sought to unravel the psychological processes through which mass incarceration, specifically paternal incarceration, is negatively affecting the next generation of children. Data came from 4,327 families from 20 cities who participated in a 10-year longitudinal study. Parents and children reported on children's rule-breaking behaviors and depressive symptoms when they were on average ages 5 (2003-2006), 9 (2007-2010), and 15 (2014-2017). Parental surveys and disposition information were combined to assess paternal incarceration at each age. Results showed that children who experienced paternal incarceration at age 5 also demonstrated more rule-breaking behaviors at age 15. Children's age-9 depressive symptoms partially mediated our finding, such that children who experienced paternal incarceration at age 5 also showed greater depressive symptoms at age 9, which in turn predicted greater rule-breaking behaviors at age 15. Paternal incarceration predicted future rule-breaking behaviors more strongly than did other forms of father loss. Because we found paternal incarceration during childhood is associated with worsened adjustment into adolescence, we discussed the need for developmentally appropriate practices in the criminal justice system.

Entwined life events: The effect of parental incarceration timing on children's academic achievement

Parental incarceration has negative effects on children's educational outcomes. Past studies have only analyzed, and therefore only treated as consequential, parental incarceration that occurs during childhood rather than prenatally. Such analyses that emphasize the importance only of events that occur during one's lifetime are common in life course studies. This paper introduces an "entwined life events" perspective, which argues that certain events are so consequential to multiple persons' lives that they should be analyzed as events within multiple independent life courses; parental incarceration, whenever it occurs, is entwined across and shapes both parents' and children's lives. Drawing on data from the Panel Study of Income Dynamics and the Fragile Families and Child Wellbeing Study, we find that parental incarceration, both prenatal and during childhood, significantly influences children's academic ability measures and years of completed schooling. Our results show heterogeneous effects by children's race. We find that the absolute magnitude of parental incarceration effect estimates is largest for White children relative to estimates for Black and Hispanic children. At the same time, outcome levels tend to be poorer for Black and Hispanic children with parental incarceration experience. We explain this racial heterogeneity as confounded by the many other social disadvantages that non-White children encounter, resulting in the individual effect of parental incarceration not being extremely disruptive to their academic growth.

Health Care Access and Use Among Children & Adolescents Exposed to Parental Incarceration-United States, 2019

OBJECTIVE

The United States has the highest incarceration rate in the world, with spillover impacts on 5 million children with an incarcerated parent. Children exposed to parental incarceration (PI) have suboptimal health care access, use, and outcomes in adulthood compared to their peers. However, little is known about their access and utilization during childhood. We evaluated relationships between PI and health care use and access throughout childhood and adolescence.

METHODS

We analyzed the nationally representative 2019 National Health Interview Survey Child Sample to examine cross-sectional associations between exposure to incarceration of a residential caregiver, access to care, and health care use among children aged 2-17. Respondents were asked about measures of preventive care access, unmet needs due to cost, and acute care use over the last year. We estimated changes associated with PI exposure using multiple logistic regression models adjusted for age, sex, race, ethnicity, parental education, family structure, rurality, income, insurance status, and disability.

RESULTS

Of 7405 sample individuals, 467 (weighted 6.2% [95% CI 5.5-6.9]) were exposed to PI. In adjusted analyses to produce national estimates, exposure to PI was associated with an additional 2.2 million children lacking a usual source of care, 2 million with forgone dental care needs, 1.2 million with delayed mental health care needs, and 865,000 with forgone mental health care needs.

CONCLUSIONS

Exposure to PI was associated with worse access to a usual source of care and unmet dental and mental health care needs. Our findings highlight the need for early intervention by demonstrating that these barriers emerge during childhood and adolescence.

Parental Incarceration, Development, and Well-Being: A Developmental Systematic Review

Despite an increasing number of studies examining the impact of parental incarceration on children's well-being, there are few comprehensive reviews that collect this information, and even fewer from a developmental perspective. This study aims to clarify the effects of parental incarceration on children's well-being and development, as well as the moderating and mediating factors from a developmental perspective. A systematic review was conducted according to PRISMA guidelines, selecting 61 studies of children from early childhood to adolescence. The results show differences in the current evidence regarding the effects of parental incarceration on children depending on the developmental stage, with the most evidence in the 7-11-year-old stage. Being male appears as a risk moderator factor while the mental health of the caregiver and their relationship with the child appears as a mediating variable, especially from 7 to 18 years old. These results reveal the impact of parental incarceration based on children's age, providing a basis for developing protective and intervention measures.

Assessment of US Federal Funding of Incarceration-Related Research, 1985 to 2022

IMPORTANCE

The US leads the world in the raw number of incarcerated persons as well as the rate of incarceration, with detrimental effects on individual-, family-, community-, and population-level health; as such, federal research has a critical role in documenting and addressing the health-related impacts of the US criminal legal system. How often incarceration-related research is funded at the National Institutes of Health (NIH), National Science Foundation (NSF), and US Department of Justice (DOJ) levels has a direct association with the public attention given to mass incarceration as well as the efficacy of strategies to mitigate negative effects and poor health related to incarceration.

OBJECTIVE

To understand how many incarceration-related projects have been funded at the NIH, NSF, and DOJ.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used public historical project archives to search for relevant incarceration-related keywords (eg, incarceration, prison, parole) since January 1, 1985 (NIH and NSF), and since January 1, 2008 (DOJ). Quotations and Boolean operator logic were used. All searches and counts were conducted and double verified by 2 coauthors between December 12 and 17, 2022.

MAIN OUTCOMES AND MEASURES

Number and prevalence of funded projects related to incarceration and prison keywords.

RESULTS

The term incarceration resulted in 3540 of 3 234 159 total project awards (0.11%) and prisoner-related terms resulted in 11 455 total project awards (0.35%) across the 3 federal agencies since 1985. Nearly a tenth of all projects funded at NIH since 1985 related to education (256 584 [9.62%]) compared with only 3373 projects (0.13%) that related to criminal legal or criminal justice or correctional system and 18 projects (0.0007%) that related to incarcerated parents. Only 1857 (0.07%) of all NIH-funded projects have been funded related to racism since 1985.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that a very low number of projects about incarceration have historically been funded at the NIH, DOJ, and NSF. These findings reflect a dearth of federally funded studies investigating the effects of mass incarceration or intervention strategies to mitigate adverse effects. Given the consequences of the criminal legal system, it is undoubtedly time for researchers, and our nation, to invest more resources into studying whether this system should be maintained, the intergenerational effects of mass incarceration, and strategies to best mitigate its impact on public health.

Locating Youth Exposed to Parental Justice Involvement in the Electronic Health Record: Development of a Natural Language Processing Model

BACKGROUND

Parental justice involvement (eg, prison, jail, parole, or probation) is an unfortunately common and disruptive household adversity for many US youths, disproportionately affecting families of color and rural families. Data on this adversity has not been captured routinely in pediatric health care settings, and if it is, it is not discrete nor able to be readily analyzed for purposes of research.

OBJECTIVE

In this study, we outline our process training a state-of-the-art natural language processing model using unstructured clinician notes of one large pediatric health system to identify patients who have experienced a justice-involved parent.

METHODS

Using the electronic health record database of a large Midwestern pediatric hospital-based institution from 2011-2019, we located clinician notes (of any type and written by any type of provider) that were likely to contain such evidence of family justice involvement via a justice-keyword search (eg, prison and jail). To train and validate the model, we used a labeled data set of 7500 clinician notes identifying whether the patient was ever exposed to parental justice involvement. We calculated the precision and recall of the model and compared those rates to the keyword search.

RESULTS

The development of the machine learning model increased the precision (positive predictive value) of locating children affected by parental justice involvement in the electronic health record from 61% (a simple keyword search) to 92%.

CONCLUSIONS

The use of machine learning may be a feasible approach to addressing the gaps in our understanding of the health and health services of underrepresented youth who encounter childhood adversities not routinely captured-particularly for children of justice-involved parents.

The Health and Development of Young Children Who Witnessed Their Parent's Arrest Prior to Parental Jail Incarceration

Most U.S. incarceration occurs in jails, with more than 10 million annual admissions, and most individuals in jail are parents of minor children. In this short-term longitudinal study, we examined the health and development of young children who did or did not witness their parent's arrest prior to parental jail incarceration. 228 individuals in 76 triads (incarcerated parents, children, at-home caregivers) were enrolled from four jails in two states. Jailed parents and caregivers reported on whether the child witnessed the parent's arrest or crime. Children's caregivers completed questionnaires about children's emotional symptoms during the prior 6 months and demographics, as well as children's emotional reactions to separation from the parent and child health at the initial assessment and 2 weeks later. Trained researchers conducted a developmental assessment with children while waiting to visit parents. Results of regression-based moderated mediation analyses indicated that when their emotional symptoms were high, children who witnessed parental arrest were more likely to have poorer health initially and more intense negative reactions to the parent leaving for jail. In addition, when children's general emotional symptoms were low, children who witnessed their parent's arrest were more likely to exhibit developmental delays, especially in their early academic skills, compared to children who did not witness the arrest. Witnessing the parent's crime related to missed milestones in social and adaptive development. Findings have implications for policies regarding safeguarding children during parental arrest and referrals for health- and development-promotion services following parental criminal justice system involvement.