Researcher Samantha Boch has studied the impact of incarceration on child and family health for more than a decade.
Her latest research examines the health records and health care use of young people — people under age 21 — who are likely to have been involved or whose families have been involved in the justice system. The challenge was identifying young people who have been affected by mass incarceration, since most health care systems do not routinely ask about incarceration. Families may not disclose that information because of stigma, fear of child protective services involvement or judgment.
“There are few, if any, large-scale community-based studies on the health of youth affected by incarceration, or the incarceration of their families, that use medical records,” said Boch, an assistant professor at the University of Cincinnati College of Nursing. “Despite the fact that many youth and families are affected by incarceration, there are still gaps in understanding its prevalence and consequences. There are numerous reasons for this, some of which include lack of provider awareness, lack of curriculum for provider training, lack of funding for this research, and lack of sensitive systematic testing to detect exposure.”
Boch and his research team searched electronic medical records for justice-related keywords, such as “prison,” “jail,” “convicted,” “probation,” “parole” and others, to determine the impact of incarceration. The researchers used data from Cincinnati Children’s Hospital collected over an 11-year period.
Their study, published in Academic PediatricsOf the more than 1.7 million records reviewed, 38,263 (or 2.2%) of youth served between January 2009 and December 2020 likely had an incarcerated parent or faced some form of confinement as a juvenile. This small percentage was also responsible for a disproportionate number of physical and mental health diagnoses and health care visits at Cincinnati Children’s. They were compared to a sociodemographically matched sample without a justice keyword and the total youth sample population.
Nearly 63.3% of all inpatient admissions for behavioral health issues, 23.7% of all inpatient days, and 45.5% of all foster care visits were attributed to the 2.2% of youth who had documented probable personal or family involvement with the justice system. The findings complement another study led by Boch, published in 2021 using data from Nationwide Children’s Hospital in Columbus, Ohio.
Youth with a justice keyword in their record had between 1.5 and 16.2 times the prevalence of various groups of physical and mental health disorders studied compared to matched youth who did not have a justice keyword but who had similar socioeconomic backgrounds. They also had 428.2 more physical health diagnoses and 269.2 more mental health diagnoses per 100 youth than matched youth.
According to the study, youth with a justice-related keyword accounted for a large proportion of all those diagnosed with disorders or health conditions at Cincinnati Children’s between 2009 and 2020. This includes 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 all infectious diseases, 12.5% of speech and language disorders, and 12.8% of all teen pregnancies.
Nationally, about 7% of American youth have had a parent incarcerated. The findings from Cincinnati Children’s Hospital and Nationwide Children’s Hospital in Columbus vastly underestimate the number of youth affected by incarceration or confinement, Boch says.
“Our data reflects families who disclosed their status and the health care providers who documented it,” Boch says. “Families who refrain from disclosing or whose information is not documented are not represented, which is a key limitation. This study is an attempt to uncover the magnitude of the impact of mass incarceration on youth health in Cincinnati. Our health care systems and prison systems clearly overlap and impact the lives of children.”
“Replicating these findings in other communities would strengthen the growing case for decarceration initiatives and other reforms, especially if we want all American children and families to thrive,” Boch said. “We will continue to have health care disparities and lead the world in poor health outcomes if we continue to lead in incarceration.”
Other co-authors of the study include Joshua Lambert, PhD, of the University of Cincinnati; Christopher Wilderman, PhD, of Duke University; and Judith Dexheimer, PhD; Robert Kahn, MD; and Sarah Beal, PhD, all of the University of Cincinnati and Cincinnati Children’s Hospital.
The Cincinnati youth research study was supported by Boch awards including the K12 PEDSnet Scholars Learning Health Systems Professional Development Program from the Agency for Healthcare Research and Quality/Patient-Centered Outcomes Research Institute (AHRQ/PCORI), internal funding from the University of Cincinnati College of Nursing Dean’s New Investigator Award, internal funding from the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s Hospital Medical Center, and the NIH/NIMHD Loan Repayment Award for Clinician Scientists from Disadvantaged Backgrounds.
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