Recidivism after release from a prison nursery program.

The interactions between public health and criminal justice (CJ) involvement are receiving increased attention. Although incarceration rates in the United States appear to be stabilizing after decades of rapid increase, they remain the highest in the world (Tsai & Scommegna, 2012). An estimated one in every 107 adults was incarcerated in 2011 (Glaze & Park, 2012). Estimates increase to one in 31 with the addition of persons under community supervision (Pew Center On The States, 2009). Public policy decisions and uneven law enforcement have led to endemic levels of CJ involvement in many low-income African American communities (Clear, 2007). The incarcerated population shows disparities in chronic medical conditions (Binswanger, Krueger, & Steiner, 2009), infectious diseases (Harzke et al., 2010), substance dependence and mental health disorders (James & Glaze, 2005). Incarcerated women, when compared to incarcerated men and community-residing women, have a significantly higher prevalence of medical, mental health, and substance dependence disorders (Binswanger et al., 2010). On the last day of 2010, approximately 113, 000 women resided in state and federal prisons, a 646% increase from 1980 (Guerino, Harrison, & Sabol, 2011). The rise in incarceration rates over the past three decades has created a multigenerational public health problem. Approximately 60% of incarcerated women report having an average of 2 children (Glaze & Maruschak, 2008). An estimated 6–10% of women are pregnant upon incarceration (Clarke, Phipps, Tong, Rose, & Gold, 2010). While women represent a smaller proportion of the incarcerated population than men, women are more likely to have been their child’s primary caregiver before their last arrest (Glaze & Maruschak, 2008). Incarcerated mothers also overwhelmingly report that they intend to care for their children after release (Stringer & Barnes, 2012). Children of incarcerated women are at higher risk of behavioral health problems than their peers (Lee, Fang, & Luo, 2013). This population is also more likely to have later personal CJ contact (Huebner & Gustafson, 2007). Affected children also experience parental separation, and often parental illicit substance use, mental illness, and domestic violence, all of which are adverse childhood experiences associated with morbidity and premature mortality (Brown et al., 2009). Prison Nurseries A variety of parenting programs within prisons attempt to address these multigenerational effects. Parenting classes of varying designs are now offered in prison settings (Hoffmann, Byrd, & Kightlinger, 2010). For incarcerated women with infants, eight U.S. states currently have a prison nursery, a special unit on which eligible incarcerated women with infants live together (Goshin & Byrne, 2009). This is in contrast to the more prevalent policy of removing infants from the mothers within 48 hours of birth. General eligibility criteria are that a woman be pregnant on incarceration and have no history of crimes against children (Women’s Prison Association, 2009). Women convicted of violent offenses are automatically excluded in most states. Lengths of stay range from 1– 36 months, with most programs allowing 12–18 months. Current U.S. programs are described as enriched, developmentally appropriate environments staffed by corrections officers and civilian professionals, including nurses (Fearn & Parker, 2004). Group prenatal and parenting courses are required in most facilities (Goshin & Byrne, 2009). These may be delivered by fellow incarcerated mothers (peer facilitators), professional staff, or through collaborations with community-based organizations. Other resources include: lactation support; civilian experts in child development; a day care center allowing mothers to attend counseling, drug treatment, educational and vocational programs; and advocates who facilitate contact with family members who do not reside in the nursery. Longitudinal research in the oldest U.S. prison nursery showed positive child outcomes during the nursery and after release. Development during infancy and toddlerhood was within normal limits across domains (Byrne, 2010). Attachment was more likely to be secure than what would be expected by the high proportion of insecurity and unresolved trauma in the mothers’ backgrounds (Byrne, Goshin, & Joestl, 2010). During the preschool period, children who had lived with their mothers in the prison nursery had lower anxious-depressed behavior problem scores than a comparison group of children who were separated from their mothers in infancy or toddlerhood because of incarceration (Author, in Press). Criminal recidivism, or the return to a correctional institution after release, threatens these positive outcomes. Recidivism and drug relapse were the most common causes of separation in dyads released from this prison nursery (Byrne, Goshin, & Blanchard-Lewis, 2012). Criminal Recidivism as a Public Health Nursing Outcome Given the connection between health and CJ contact, recidivism is an important public health outcome. An estimated 95% of all prisoners are released (Hughes & Wilson, 2003). Institutional factors within correctional settings create increased risk for injury, infectious disease, and other health threats, potentially leaving people sicker upon exit than entry (Ludwig, Cohen, Parsons, & Venters, 2012). Health conditions untreated during incarceration further complicate the reentry period. After release, those experiencing health problems may continue to cycle in and out of correctional institutions at great cost to their own wellbeing, and the wellness of their families and communities (Baillargeon, Binswanger, Penn, Williams, & Murray, 2009). Most women released from the general prison population will have subsequent CJ contact. Almost 60% will be rearrested, 38% will be reconvicted, and 30–45% will return to prison within three years (Cloyes, Wong, Latimer, & Abarca, 2010b; Deschenes, Owen, & Crow, 2006). More extensive history of prior arrests, incarceration for property or drug crimes, African American race, younger age, substance dependence, and mental illness are associated with recidivism (Cloyes, Wong, Latimer, & Abarca, 2010a; Deschenes, et al., 2006). Reporting dependent children has not been associated with decreased recidivism in women released from the general prison population (Huebner et al., 2010). In incarcerated mothers with a history of substance dependence, self reported expectation to live with children after release has also not been found to significantly affect recidivism after controlling for important confounders (Robbins, Martin, & Surratt, 2009). Recidivism rates appear lower for women released from prison nurseries (Carlson, 2009; Rowland & Watts, 2007). Research on recidivism in this population has thus far been limited by small sample sizes, short follow-up time frames, and unsystematic data sources, or a lack of specification for all three. Recidivism has also been analyzed dichotomously without regard to timing. Prevention and delay of recidivism are both important goals. Predictors of time to recidivism in this population have also not been explored. Finally, the effect on recidivism of prison nursery specific policy issues, such as length of stay and whether a woman’s child is released before her, has received no attention. Research Questions and Hypotheses The aim of this exploratory study was to analyze three-year recidivism in women who co-resided with their infants in X prison nursery. We hypothesized that time to recidivism would be directly associated with younger age at release, history of substance dependence, clinically significant depressive symptomatology during the nursery stay, release of the child without his or her mother, and being in the prison nursery for violation of parole conditions after a previous prison release.