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.

Measures

Study limitations

This was a descriptive study of a cohort of women who participated in two studies of a prison nursery in one state. Criteria used by the state to determine eligibility introduced the potential for selection bias; it also limited generalizability. Eligible women likely differ in important ways from the general prison population, such as lower likelihood of a VFO or a history of crimes against children. Research with women released from the general prison population suggests drug and property offenders, which comprised the majority of this sample, are more likely to recidivate than those incarcerated for VFOs (Deschenes, et al., 2006).

This analysis did not include a comparison group. In fact, a valid comparison group would be difficult to create. Few eligible women refuse to keep their babies in the nursery. Women denied nursery entry likely differ from eligible women in the ways described above. Randomizing women to the nursery with their babies or to the general prison population without them is unethical anywhere and illegal in X State, which has a statute identifying the right to participate in the program when it is in the child’s best interest. Finally, while it is the largest study of its kind, low numbers might have limited statistical power.

Implications for public health nursing

Public health nurses (PHN) are well positioned to support the health of CJ-involved persons. Nurses provide the majority of health care within jails and prisons, including case management to support reentry. As key members of interdisciplinary teams working with CJ-involved populations within and outside of correctional facilities, PHN have the requisite skills to provide direct care and to develop and sustain collaborations between multiple systems (Marlow & Chesla, 2009). For example, some municipal and voluntary nursing agencies near prison nurseries have embraced co-residing women and children as part of their larger community. These groups have partnered with correctional facilities to provide health supervision and developmental screening to mother and child. Broader evaluation and dissemination of these innovations could foster their replication.

PHN participation in policy development and patient advocacy is needed to broaden discussions of adequate service provision and overall CJ system reform. This can include advocacy for prison nurseries or diversion options that allow CJ-involved women to remain with their children. Nurses can also provide expert testimony and respond to media requests, as this team has done in relation to prison nurseries (Byrne, 2012). This work requires long-term relationships between nursing, corrections, and community CJ leadership. While time-consuming to build, they are vital to establishing and sustaining a public health focus within a difficult system.

Nurse researchers can also include recidivism as an important health outcome in studies with CJ-involved populations. Administrative data allow for objective measurement, and reduce the risk of self-report and attrition bias. They provide an effective, inexpensive way to follow participants post-release. These data typically include all arrests, legal charges, convictions, and incarcerations within the given area. The exact recidivism outcome must be chosen carefully for each project. For example, reincarceration is most appropriate for former prisoners, while rearrest may be a better choice for jailed populations.

These acknowledgements were submitted with the article: “The authors gratefully acknowledge these sources of funding: Columbia University Institute for Child and Family Policy, 2001; New York State Commissioners’ Priority Award, 2002; National Institute for Nursing Research (RO1NR007782), 2003–13, to M.W. Byrne, PI.