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Children of prisoners: a growing public health problem

Children of prisoners: a growing public health problem Simon Quilty Department of Public Health, Faculty of Medicine, University of Sydney, New South Wales Abstract Objectives: To estimate the number and proportion of children in New South Wales affected by parental incarceration, and to describe the health impact of punitive incarceration on the children of prisoners. Methods: In 2001, NSW Corrections Health Service conducted a cross-sectional survey of prison inmates randomly selected from each of the 29 prisons in NSW, representing 11% of male and 30% of female inmates in the State. The survey included questions regarding parental status and number of children. A population model was developed, which incorporated increases in the prison population and recidivism, to estimate the number of children under 16 years of age in NSW ever having experienced parental incarceration. Results: In 2001, there were approximately 14,500 children under the age of 16 years in NSW who experienced parental incarceration during the year. It is estimated that in 2001 there were 60,000 children under 16 years in NSW who had ever experienced parental incarceration in their lifetime, representing 4.3% of all children and 20.1% of Indigenous children. Conclusions: The number of children who have experienced parental incarceration is significant in NSW and across Australia. Indigenous children are much more likely to experience parental incarceration than nonIndigenous children. Implications: Children of prisoners are at high risk of negative health outcomes and are themselves at an increased risk of offending later in life. The needs of these children must be recognised and policies introduced to reduce the adversities they face. The social, politico-legal and economic conditions that are contributing to the continuing rise in incarceration rates must be recognised, and measures must be taken to reduce this trend. (Aust N Z J Public Health 2004; 28: 339-43) Michael H. Levy Centre for Health Research in Criminal Justice, Corrections Health Service, New South Wales Kirsten Howard, Alex Barratt Screening and Test Evaluation Program, School of Public Health, University of Sydney, New South Wales Tony Butler Centre for Health Research in Criminal Justice, Corrections Health Service, New South Wales he prison population in Australia has increased by 50% over the past decade, with approximately 15,500 people in prison per day in 1992 increasing to 23,000 in 2002.1 Indigenous Australians are highly over-represented in prisons, comprising 20% of this population and yet only 2% of the national population. 2 Women make up approximately 7% of the prisoner population, and rates of female incarceration are increasing disproportionately higher than the overall prison population growth rate. The prisoner population in NSW makes up 40% of all prisoners in Australia.1 There are high rates of mental illness,3,4 blood-borne viruses,5,6 and other infectious diseases7,8 in prisoner populations. This reflects environmental and socio-demographic influences, and also reflects risk-taking behaviours common in this population. Children who experience parental incarceration predominantly come from backgrounds of socio-demographic adversity – conditions known to have adverse short and long-term effects on health,9,10 and conditions that are often further exacerbated by parental incarceration. These children’s parents commonly have substance use disorders and other mental illnesses. There is a growing body of evidence of the harm that such parental illnesses can have on a child’s psychodevelopment.11 This subpopulation of parents are also known to have higher rates of infectious diseases such as hepatitis B and C, sexually transmitted diseases, and other airborne infectious diseases.5-8,12 It is thus hypothesised that children of prisoners are at greater risk of exposure to infectious diseases of higher prevalence in prisoner populations. There is a paucity of literature regarding the health of children of prisoners. The available literature suggests that these children are at greater risk of infectious diseases,13 of developing behavioral problems, and themselves becoming involved in the criminal justice system.14,15 This study describes a population model (see Box 1) that was developed to provide an accurate estimate of the number of children to have experienced parental incarceration in NSW. Ethics approval for this study was obtained from the NSW Department of Corrective Correspondence to: Mr Simon Quilty, Department of Public Health, Faculty of Medicine, Building A27, University of Sydney, New South Wales 2006. E-mail: squilty@gmp.usyd.edu.au Submitted: April 2003 Revision requested: December 2003 Accepted: April 2004 2004 VOL. 28 NO. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Quilty et al. Article Services Ethics Committee and the Corrections Health Service Research and Ethics Committee. All participants entered the study voluntarily, gave written consent, and all information collected remained confidential. Box 1: Assumptions made in population model. 1. Linear prisoner population growth in NSW, 1986 to 2001. 2. The annual incarceration rate (number of individuals entering prison on one or more occasions) increased at the same rate as the annual Census population rate. 3. Constant average number of children per inmate over past 16 years, as stratified by inmate age, sex and Indigenous status. 4. Recidivism model appropriate for NSW prisoner population. 5. Accurate self-report of parenthood of participants in the Corrections Health Service Inmate Health Survey, 2001. 6. Zero mortality rate and net migration of children born in NSW between 1986 and 2001. 7. No children experienced both maternal and paternal incarceration. Methods Inmate Health Survey 2001 In 2001, NSW Corrections Health Service conducted a comprehensive cross-sectional health survey of prisoners. Inmates were randomly selected from each of the 29 correctional facilities across NSW. The survey broadly covered mental and physical health. Details of this study are described elsewhere.16 A section in the physical health questionnaire inquired about parental status of inmates, and how many children a participant had who were under 16 years of age. Number of children experiencing parental incarceration in 2001 The number of children per participant was stratified by inmate age (less than 25, 25 to 40, over 40 years of age), gender, and indigenous status (see Table 1). These data were then applied (using age, sex and Indigenous status as sampling weights) to similarly stratified records from NSW Department of Corrective Services of the number of inmates who entered prison on one or more occasion in 200117 (see Table 2), to estimate the number of children who experienced parental incarceration over that year. Data describing annual incarceration rates from 1986 to 2000 is not available. We therefore had to assume that annual incarceration rates roughly increased at the same rate as the increase in the annual census ‘daily’ prisoner population. Since the daily prisoner population is dependent on both average sentence length and incarceration rate, the sentence length must be static for this assumption to be valid. In NSW, the average sentence length has Table 1: Average number of children under 16 years of age per inmate. Average Non-Indigenous men Men under 25 years Men 25-40 years Men older than 40 years Non-Indigenous women Women under 25 years Women 25-40 years Women older than 40 years Indigenous men Men under 25 years Men 25-40 years Men older than 40 years Indigenous women Women under 25 years Women 25-40 years Women older than 40 years 0.34 1.13 1.08 0.44 1.83 0.73 1.02 1.95 2.00 1.33 2.36 1.00 remained relatively static over the past 15 years.18,19 We were thus confident that this assumption did not introduce a significant source of error into the model’s predictions. Calculation of 95% CIs was based on the assumption of normal distribution. The population rate of children under 16 years in NSW who experienced parental incarceration was then estimated based on records from the 2001 national Census.2 The number of children who had ever experienced parental incarceration The total number of children under 16 years in NSW who had ever experienced parental incarceration was estimated from results obtained as described above, using a model created in Microsoft Excel. This model is based on population rates of children experiencing parental incarceration in 2001 (as above), and takes account of increases in the prison population in NSW over the past 16 years1,20-22 and estimated recidivism rates23 (see Table 3). The model stratifies children based on Indigenous and nonIndigenous status, and those experiencing maternal or paternal incarceration. The number of children in NSW in each birth-year cohort was estimated using the 2001 Census data for children aged from 0 through to 15 years. It was assumed that Census population estimates were stable over time, that there was zero net migration, and that mortality rates were zero over this period. This assumpTable 2: Number of inmates entering prisons on one or more occasion in 2001. New South Wales Men Women Non-Indigenous Under 25 years 25-40 years Older than 40 years Total non-Indigenous Indigenous Under 25 years 25-40 years Older than 40 years Total Indigenous TOTAL 3,447 5,622 1,476 10,545 667 1,112 158 1,937 12,482 425 677 126 1,228 134 224 30 388 1,616 95% CI 0.20-0.48 0.91-1.34 0.86-1.30 0.21-0.67 1.30-2.36 0.28-1.17 0.71-1.34 1.58-2.31 0.91-3.09 0.47-2.20 1.42-3.29 – AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2004 VOL. 28 NO. 4 People on the Margins Health impact on children of prisoners tion was verified by comparing ABS yearly population estimates for children aged zero to one year old between 1986 and 2001 with 2001 Census data for children aged zero to 15. For all children born in 1986 (i.e. children who were 15 years of age as recorded in the 2001 Australian Census), the number of children experiencing first-time parental incarceration was estimated for each year of their lives. This process was conducted for children born in each year from 1986 to 2001. The total number of children ever experiencing parental incarceration was the sum total of children experiencing first-time parental incarceration. The annual population rate of children experiencing parental incarceration was assumed to increase at the same rate as the growth in the annual census ‘daily’ prisoner population. Thus, the estimated number of children experiencing first-time parental incarceration in 1986, based on 2001 population rates of children experiencing first-time parental incarceration, was multiplied by the ratio between the census number of prisoners in 1986 and the census number of prisoners in 2001. This process was repeated for each year, from 1986 to 2001. Recidivism rates of parents were accounted for in each birthyear cohort so as to exclude children who were experiencing parental incarceration for a second or subsequent occasion in the sum total of all children who had ever experienced such an event. The recidivism model used in this study is based on a Western Australian study23 that was supported by recent research of recidivism in NSW.24 The model used a Kaplan-Meier analysis to estimate time to failure (re-incarceration), and used an exponential-like distribution (Weibull distribution) to calculate the probability of recidivism. On the year of birth for each birth-year cohort, the proportion of parent inmates incarcerated for the first time in their child’s life was equal to 1.0, since any child experiencing parental incarceration during their first year would be experiencing such an event for the first time. The proportion incarcerated for the first time in their child’s life decreased for each subsequent year according to the recidivism model23 (see Table 4). Table 3: Data used in the population model. Indigenous Number of children 15 years and younger, NSW, 2001 Number of children 15 years and younger, NSW, 1986 Prison population, NSW, 2001 Prison population, NSW, 1986 Recidivism rate at eight years 50,857 A two-way sensitivity analysis was undertaken to determine the robustness of the conclusions of this model based on estimates of recidivism rates and of the number of children per year who experienced parental incarceration. The effect of recidivism on model conclusions was examined by varying the rate of recidivism over 95% confidence intervals as defined in Broadhurst’s study.23 The effects of the estimated rate of children experiencing parental incarceration in 2001 was examined over 95% confidence intervals as calculated from results of the 2001 Inmate Health Survey. Results There were 914 participants in the survey, a response rate of 90%, and 829 inmates (683 men and 146 women) completed the questions regarding parental status and number of children. Estimates of the number of children experiencing parental incarceration in 2001 Forty-nine per cent of men and 57% of women participating in the survey reported that they had children under the age of 16 years. The average number of children per inmate father was 2.2, and 2.4 per inmate mother. More Indigenous inmates were parents than non-Indigenous inmates (62% vs. 43% of male inmates, χ2 = 13.4, p<0.001, and 79% vs. 52% of female inmates, χ2 = 6.17, p=0.013). Over 2001, it is estimated that 14,519 children in NSW experienced parental incarceration at least once (12,266 experienced paternal and 2,253 maternal incarceration). This represented approximately 1% of children under 16 years in NSW. Indigenous children were 13 times more likely to lose a mother and nine times more likely to lose a father to incarceration than nonIndigenous children, based on population rates (see Table 5). Table 4: Proportion of people entering prison for the first time (i.e. not recidivists) over a 16-year period. Time (years) Indigenous Male Female Non-Indigenous Male Female Non-Indigenous 1,351,142 Ref. 25,431 1,300,147 1,114 men 128 women 345 mena 17 womena 80% males 75% females 6,106 men 385 women 3,769 mena 210 womena 48% males 29% females 1,21 20, 22 23 Notes: (a) Estimate extrapolated for 1986 based on linear growth in prison population from 1985 to 2001 (as described in references 20 and 22), since these were the only available years where published data were available on prisoner populations stratified by Indigenous status over this period (198588). 2004 VOL. 28 NO. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Quilty et al. Article Estimates of the number of children in 2001 ever having experienced parental incarceration We estimate that in NSW in 2001, there were 60,122 children (sensitivity analysis predicted estimates of between 42,241 and 80,105) under 16 years who had ever experienced parental incarceration. This represented 4.3% of all children, and 20.1% of all Indigenous children in the State (see Table 6). Sensitivity analyses indicated that model predictions were more sensitive to variations in estimates of annual population rates of children experiencing parental incarceration than to variation in rates of recidivism. Discussion This is the first study internationally to use rigorous methodology to accurately estimate the number of children in a defined geographical area who have experienced parental incarceration. The number of children in NSW who have experienced parental incarceration is substantial. Indigenous children are much more likely to be affected by parental incarceration than non-Indigenous children. It is likely that the number of children experiencing parental incarceration will grow, following the trend in NSW of continued increases in rates of adult incarceration. There were a number of limitations in this study that should be noted. First, it was not possible to verify the accuracy of selfreported parenthood of participants in the survey. Second, we assumed that the average number of children per inmate has not varied over the past 16 years. However, the average number of children per inmate is more likely to have declined with time, which would lead the model to underestimate the number of children affected by parental incarceration. We were also unable to identify children who had experienced both maternal and paternal incarceration; however, as the number of children who experience this is thought to be very low, it is unlikely to have a significant impact on the model predictions. The recidivism model used in this study is based on re-incar- ceration rates of people in prison in Western Australia between 1975 and 1983.23 This population may have different recidivism characteristics to the study population. However, more recent literature examining recidivism in NSW prison populations did not vary significantly from that used in the model.24 There has been no research examining whether recidivism rates among prisoners who are parents differs from the general inmate population. There is a chain of adversity facing children who experience parental incarceration. First, the child often undergoes the trauma of witnessing their parent’s crime and arrest. These children, along with the offender’s entire family, are then disrupted in many psychosocial aspects through the judicial and sentencing process. Children face a host of social and demographic adversities while their parent is incarcerated.25 Finally, when their incarcerated parent is released, these children’s lives are disrupted once again as the offender is reintegrated back into the family and society as a whole. On top of this, many children experience multiple episodes of parental incarceration, with recidivism rates approaching 60% within NSW prisons,24 making parental incarceration a chronic and recurring problem. Children who experience parental incarceration are likely to suffer health, developmental and psychosocial adversities, both as a result of their environment prior to, during, and after their parent’s imprisonment, and as a direct result of their parent’s incarceration.13 For some of these children, the incarceration of a dysfunctional parent may actually produce some positive outcomes by the removal of a potential negative influence. Either way, these children have high risk of psychosocial dysfunction and negative health outcomes. The needs of children who experience parental incarceration in NSW were recognised in a 1997 NSW parliamentary report, Children of Imprisoned Parents.26 The recommendations made by this report have been largely ignored. There needs to be more recognition of this issue by the NSW State Government and by all State Governments nationally, and practical policy should be Table 5: Number of children experiencing parental incarceration during 2001. Total number (95% CI) Maternal incarceration Non-Indigenous 1,516 (1,003-2,030) Indigenous 737 (382-1,061) Total 2,253 (1,385-3,091) Table 6: Estimates of the total number of children in 2001 who have ever experienced parental incarceration. Total number Maternal incarceration Non-Indigenous Indigenous Total Paternal incarceration Non-Indigenous Indigenous Total 8,091 1,876 9,967 41,795 8,360 50,155 Population ratea (95% CI) 112 (74-150) 1,449 (751-2,087) 161 (99-220) Population ratea 599 3,689 711 3,093 16,439 3,577 3,692 20,128 4,288 Paternal incarceration Non-Indigenous 9,102 (7,088-11,117) 674 (525-823) Indigenous 3,164 (2,377-3,951) 6,221 (4,674-7,768) Total 12,266 (9,465-15,068) 875 (675-1,075) Total parental incarceration Non-Indigenous 10,619 (8,091-13,147) 786 (599-973) Indigenous 3,901 (2,759-5,012) 7,670 (5,425-9,855) Total 14,519 (10,850-18,159) 1,036 (774-1,295) Note: (a) Per 100,000 children under 16 years.11 Total parental incarceration Non-Indigenous 49,886 Indigenous 10,236 Total 60,122 Note: (a) Per 100,000 children under 16 years.11 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2004 VOL. 28 NO. 4 People on the Margins Health impact on children of prisoners developed and implemented to protect these very vulnerable children. Large and expanding prison populations pose a growing social problem that has an impact on the health of the wider community. Short-term solutions to the problem of increasing prisoner populations need to be implemented; more humane prisons that provide opportunities for inmates to maintain healthy contact with their families and children; prisons that address the issue of rehabilitation and recidivism through research and evidence; and more options for punitive sentences other than incarceration, especially when offenders are parents. Studies have indicated that the principal causes of increasing crime rates, and thus increasing prison populations, are social disorganisation, disinvestments in social capital, and growing inequality between rich and poor.27 In providing long-term solutions to the problems of crime and prison populations, it is essential that these issues be addressed. Acknowledgements We acknowledge the assistance of NSW Corrections Health Service. There were no competing interests in this research. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Children of prisoners: a growing public health problem

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Wiley
Copyright
Copyright © 2004 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.2004.tb00441.x
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Abstract

Simon Quilty Department of Public Health, Faculty of Medicine, University of Sydney, New South Wales Abstract Objectives: To estimate the number and proportion of children in New South Wales affected by parental incarceration, and to describe the health impact of punitive incarceration on the children of prisoners. Methods: In 2001, NSW Corrections Health Service conducted a cross-sectional survey of prison inmates randomly selected from each of the 29 prisons in NSW, representing 11% of male and 30% of female inmates in the State. The survey included questions regarding parental status and number of children. A population model was developed, which incorporated increases in the prison population and recidivism, to estimate the number of children under 16 years of age in NSW ever having experienced parental incarceration. Results: In 2001, there were approximately 14,500 children under the age of 16 years in NSW who experienced parental incarceration during the year. It is estimated that in 2001 there were 60,000 children under 16 years in NSW who had ever experienced parental incarceration in their lifetime, representing 4.3% of all children and 20.1% of Indigenous children. Conclusions: The number of children who have experienced parental incarceration is significant in NSW and across Australia. Indigenous children are much more likely to experience parental incarceration than nonIndigenous children. Implications: Children of prisoners are at high risk of negative health outcomes and are themselves at an increased risk of offending later in life. The needs of these children must be recognised and policies introduced to reduce the adversities they face. The social, politico-legal and economic conditions that are contributing to the continuing rise in incarceration rates must be recognised, and measures must be taken to reduce this trend. (Aust N Z J Public Health 2004; 28: 339-43) Michael H. Levy Centre for Health Research in Criminal Justice, Corrections Health Service, New South Wales Kirsten Howard, Alex Barratt Screening and Test Evaluation Program, School of Public Health, University of Sydney, New South Wales Tony Butler Centre for Health Research in Criminal Justice, Corrections Health Service, New South Wales he prison population in Australia has increased by 50% over the past decade, with approximately 15,500 people in prison per day in 1992 increasing to 23,000 in 2002.1 Indigenous Australians are highly over-represented in prisons, comprising 20% of this population and yet only 2% of the national population. 2 Women make up approximately 7% of the prisoner population, and rates of female incarceration are increasing disproportionately higher than the overall prison population growth rate. The prisoner population in NSW makes up 40% of all prisoners in Australia.1 There are high rates of mental illness,3,4 blood-borne viruses,5,6 and other infectious diseases7,8 in prisoner populations. This reflects environmental and socio-demographic influences, and also reflects risk-taking behaviours common in this population. Children who experience parental incarceration predominantly come from backgrounds of socio-demographic adversity – conditions known to have adverse short and long-term effects on health,9,10 and conditions that are often further exacerbated by parental incarceration. These children’s parents commonly have substance use disorders and other mental illnesses. There is a growing body of evidence of the harm that such parental illnesses can have on a child’s psychodevelopment.11 This subpopulation of parents are also known to have higher rates of infectious diseases such as hepatitis B and C, sexually transmitted diseases, and other airborne infectious diseases.5-8,12 It is thus hypothesised that children of prisoners are at greater risk of exposure to infectious diseases of higher prevalence in prisoner populations. There is a paucity of literature regarding the health of children of prisoners. The available literature suggests that these children are at greater risk of infectious diseases,13 of developing behavioral problems, and themselves becoming involved in the criminal justice system.14,15 This study describes a population model (see Box 1) that was developed to provide an accurate estimate of the number of children to have experienced parental incarceration in NSW. Ethics approval for this study was obtained from the NSW Department of Corrective Correspondence to: Mr Simon Quilty, Department of Public Health, Faculty of Medicine, Building A27, University of Sydney, New South Wales 2006. E-mail: squilty@gmp.usyd.edu.au Submitted: April 2003 Revision requested: December 2003 Accepted: April 2004 2004 VOL. 28 NO. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Quilty et al. Article Services Ethics Committee and the Corrections Health Service Research and Ethics Committee. All participants entered the study voluntarily, gave written consent, and all information collected remained confidential. Box 1: Assumptions made in population model. 1. Linear prisoner population growth in NSW, 1986 to 2001. 2. The annual incarceration rate (number of individuals entering prison on one or more occasions) increased at the same rate as the annual Census population rate. 3. Constant average number of children per inmate over past 16 years, as stratified by inmate age, sex and Indigenous status. 4. Recidivism model appropriate for NSW prisoner population. 5. Accurate self-report of parenthood of participants in the Corrections Health Service Inmate Health Survey, 2001. 6. Zero mortality rate and net migration of children born in NSW between 1986 and 2001. 7. No children experienced both maternal and paternal incarceration. Methods Inmate Health Survey 2001 In 2001, NSW Corrections Health Service conducted a comprehensive cross-sectional health survey of prisoners. Inmates were randomly selected from each of the 29 correctional facilities across NSW. The survey broadly covered mental and physical health. Details of this study are described elsewhere.16 A section in the physical health questionnaire inquired about parental status of inmates, and how many children a participant had who were under 16 years of age. Number of children experiencing parental incarceration in 2001 The number of children per participant was stratified by inmate age (less than 25, 25 to 40, over 40 years of age), gender, and indigenous status (see Table 1). These data were then applied (using age, sex and Indigenous status as sampling weights) to similarly stratified records from NSW Department of Corrective Services of the number of inmates who entered prison on one or more occasion in 200117 (see Table 2), to estimate the number of children who experienced parental incarceration over that year. Data describing annual incarceration rates from 1986 to 2000 is not available. We therefore had to assume that annual incarceration rates roughly increased at the same rate as the increase in the annual census ‘daily’ prisoner population. Since the daily prisoner population is dependent on both average sentence length and incarceration rate, the sentence length must be static for this assumption to be valid. In NSW, the average sentence length has Table 1: Average number of children under 16 years of age per inmate. Average Non-Indigenous men Men under 25 years Men 25-40 years Men older than 40 years Non-Indigenous women Women under 25 years Women 25-40 years Women older than 40 years Indigenous men Men under 25 years Men 25-40 years Men older than 40 years Indigenous women Women under 25 years Women 25-40 years Women older than 40 years 0.34 1.13 1.08 0.44 1.83 0.73 1.02 1.95 2.00 1.33 2.36 1.00 remained relatively static over the past 15 years.18,19 We were thus confident that this assumption did not introduce a significant source of error into the model’s predictions. Calculation of 95% CIs was based on the assumption of normal distribution. The population rate of children under 16 years in NSW who experienced parental incarceration was then estimated based on records from the 2001 national Census.2 The number of children who had ever experienced parental incarceration The total number of children under 16 years in NSW who had ever experienced parental incarceration was estimated from results obtained as described above, using a model created in Microsoft Excel. This model is based on population rates of children experiencing parental incarceration in 2001 (as above), and takes account of increases in the prison population in NSW over the past 16 years1,20-22 and estimated recidivism rates23 (see Table 3). The model stratifies children based on Indigenous and nonIndigenous status, and those experiencing maternal or paternal incarceration. The number of children in NSW in each birth-year cohort was estimated using the 2001 Census data for children aged from 0 through to 15 years. It was assumed that Census population estimates were stable over time, that there was zero net migration, and that mortality rates were zero over this period. This assumpTable 2: Number of inmates entering prisons on one or more occasion in 2001. New South Wales Men Women Non-Indigenous Under 25 years 25-40 years Older than 40 years Total non-Indigenous Indigenous Under 25 years 25-40 years Older than 40 years Total Indigenous TOTAL 3,447 5,622 1,476 10,545 667 1,112 158 1,937 12,482 425 677 126 1,228 134 224 30 388 1,616 95% CI 0.20-0.48 0.91-1.34 0.86-1.30 0.21-0.67 1.30-2.36 0.28-1.17 0.71-1.34 1.58-2.31 0.91-3.09 0.47-2.20 1.42-3.29 – AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2004 VOL. 28 NO. 4 People on the Margins Health impact on children of prisoners tion was verified by comparing ABS yearly population estimates for children aged zero to one year old between 1986 and 2001 with 2001 Census data for children aged zero to 15. For all children born in 1986 (i.e. children who were 15 years of age as recorded in the 2001 Australian Census), the number of children experiencing first-time parental incarceration was estimated for each year of their lives. This process was conducted for children born in each year from 1986 to 2001. The total number of children ever experiencing parental incarceration was the sum total of children experiencing first-time parental incarceration. The annual population rate of children experiencing parental incarceration was assumed to increase at the same rate as the growth in the annual census ‘daily’ prisoner population. Thus, the estimated number of children experiencing first-time parental incarceration in 1986, based on 2001 population rates of children experiencing first-time parental incarceration, was multiplied by the ratio between the census number of prisoners in 1986 and the census number of prisoners in 2001. This process was repeated for each year, from 1986 to 2001. Recidivism rates of parents were accounted for in each birthyear cohort so as to exclude children who were experiencing parental incarceration for a second or subsequent occasion in the sum total of all children who had ever experienced such an event. The recidivism model used in this study is based on a Western Australian study23 that was supported by recent research of recidivism in NSW.24 The model used a Kaplan-Meier analysis to estimate time to failure (re-incarceration), and used an exponential-like distribution (Weibull distribution) to calculate the probability of recidivism. On the year of birth for each birth-year cohort, the proportion of parent inmates incarcerated for the first time in their child’s life was equal to 1.0, since any child experiencing parental incarceration during their first year would be experiencing such an event for the first time. The proportion incarcerated for the first time in their child’s life decreased for each subsequent year according to the recidivism model23 (see Table 4). Table 3: Data used in the population model. Indigenous Number of children 15 years and younger, NSW, 2001 Number of children 15 years and younger, NSW, 1986 Prison population, NSW, 2001 Prison population, NSW, 1986 Recidivism rate at eight years 50,857 A two-way sensitivity analysis was undertaken to determine the robustness of the conclusions of this model based on estimates of recidivism rates and of the number of children per year who experienced parental incarceration. The effect of recidivism on model conclusions was examined by varying the rate of recidivism over 95% confidence intervals as defined in Broadhurst’s study.23 The effects of the estimated rate of children experiencing parental incarceration in 2001 was examined over 95% confidence intervals as calculated from results of the 2001 Inmate Health Survey. Results There were 914 participants in the survey, a response rate of 90%, and 829 inmates (683 men and 146 women) completed the questions regarding parental status and number of children. Estimates of the number of children experiencing parental incarceration in 2001 Forty-nine per cent of men and 57% of women participating in the survey reported that they had children under the age of 16 years. The average number of children per inmate father was 2.2, and 2.4 per inmate mother. More Indigenous inmates were parents than non-Indigenous inmates (62% vs. 43% of male inmates, χ2 = 13.4, p<0.001, and 79% vs. 52% of female inmates, χ2 = 6.17, p=0.013). Over 2001, it is estimated that 14,519 children in NSW experienced parental incarceration at least once (12,266 experienced paternal and 2,253 maternal incarceration). This represented approximately 1% of children under 16 years in NSW. Indigenous children were 13 times more likely to lose a mother and nine times more likely to lose a father to incarceration than nonIndigenous children, based on population rates (see Table 5). Table 4: Proportion of people entering prison for the first time (i.e. not recidivists) over a 16-year period. Time (years) Indigenous Male Female Non-Indigenous Male Female Non-Indigenous 1,351,142 Ref. 25,431 1,300,147 1,114 men 128 women 345 mena 17 womena 80% males 75% females 6,106 men 385 women 3,769 mena 210 womena 48% males 29% females 1,21 20, 22 23 Notes: (a) Estimate extrapolated for 1986 based on linear growth in prison population from 1985 to 2001 (as described in references 20 and 22), since these were the only available years where published data were available on prisoner populations stratified by Indigenous status over this period (198588). 2004 VOL. 28 NO. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH Quilty et al. Article Estimates of the number of children in 2001 ever having experienced parental incarceration We estimate that in NSW in 2001, there were 60,122 children (sensitivity analysis predicted estimates of between 42,241 and 80,105) under 16 years who had ever experienced parental incarceration. This represented 4.3% of all children, and 20.1% of all Indigenous children in the State (see Table 6). Sensitivity analyses indicated that model predictions were more sensitive to variations in estimates of annual population rates of children experiencing parental incarceration than to variation in rates of recidivism. Discussion This is the first study internationally to use rigorous methodology to accurately estimate the number of children in a defined geographical area who have experienced parental incarceration. The number of children in NSW who have experienced parental incarceration is substantial. Indigenous children are much more likely to be affected by parental incarceration than non-Indigenous children. It is likely that the number of children experiencing parental incarceration will grow, following the trend in NSW of continued increases in rates of adult incarceration. There were a number of limitations in this study that should be noted. First, it was not possible to verify the accuracy of selfreported parenthood of participants in the survey. Second, we assumed that the average number of children per inmate has not varied over the past 16 years. However, the average number of children per inmate is more likely to have declined with time, which would lead the model to underestimate the number of children affected by parental incarceration. We were also unable to identify children who had experienced both maternal and paternal incarceration; however, as the number of children who experience this is thought to be very low, it is unlikely to have a significant impact on the model predictions. The recidivism model used in this study is based on re-incar- ceration rates of people in prison in Western Australia between 1975 and 1983.23 This population may have different recidivism characteristics to the study population. However, more recent literature examining recidivism in NSW prison populations did not vary significantly from that used in the model.24 There has been no research examining whether recidivism rates among prisoners who are parents differs from the general inmate population. There is a chain of adversity facing children who experience parental incarceration. First, the child often undergoes the trauma of witnessing their parent’s crime and arrest. These children, along with the offender’s entire family, are then disrupted in many psychosocial aspects through the judicial and sentencing process. Children face a host of social and demographic adversities while their parent is incarcerated.25 Finally, when their incarcerated parent is released, these children’s lives are disrupted once again as the offender is reintegrated back into the family and society as a whole. On top of this, many children experience multiple episodes of parental incarceration, with recidivism rates approaching 60% within NSW prisons,24 making parental incarceration a chronic and recurring problem. Children who experience parental incarceration are likely to suffer health, developmental and psychosocial adversities, both as a result of their environment prior to, during, and after their parent’s imprisonment, and as a direct result of their parent’s incarceration.13 For some of these children, the incarceration of a dysfunctional parent may actually produce some positive outcomes by the removal of a potential negative influence. Either way, these children have high risk of psychosocial dysfunction and negative health outcomes. The needs of children who experience parental incarceration in NSW were recognised in a 1997 NSW parliamentary report, Children of Imprisoned Parents.26 The recommendations made by this report have been largely ignored. There needs to be more recognition of this issue by the NSW State Government and by all State Governments nationally, and practical policy should be Table 5: Number of children experiencing parental incarceration during 2001. Total number (95% CI) Maternal incarceration Non-Indigenous 1,516 (1,003-2,030) Indigenous 737 (382-1,061) Total 2,253 (1,385-3,091) Table 6: Estimates of the total number of children in 2001 who have ever experienced parental incarceration. Total number Maternal incarceration Non-Indigenous Indigenous Total Paternal incarceration Non-Indigenous Indigenous Total 8,091 1,876 9,967 41,795 8,360 50,155 Population ratea (95% CI) 112 (74-150) 1,449 (751-2,087) 161 (99-220) Population ratea 599 3,689 711 3,093 16,439 3,577 3,692 20,128 4,288 Paternal incarceration Non-Indigenous 9,102 (7,088-11,117) 674 (525-823) Indigenous 3,164 (2,377-3,951) 6,221 (4,674-7,768) Total 12,266 (9,465-15,068) 875 (675-1,075) Total parental incarceration Non-Indigenous 10,619 (8,091-13,147) 786 (599-973) Indigenous 3,901 (2,759-5,012) 7,670 (5,425-9,855) Total 14,519 (10,850-18,159) 1,036 (774-1,295) Note: (a) Per 100,000 children under 16 years.11 Total parental incarceration Non-Indigenous 49,886 Indigenous 10,236 Total 60,122 Note: (a) Per 100,000 children under 16 years.11 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2004 VOL. 28 NO. 4 People on the Margins Health impact on children of prisoners developed and implemented to protect these very vulnerable children. Large and expanding prison populations pose a growing social problem that has an impact on the health of the wider community. Short-term solutions to the problem of increasing prisoner populations need to be implemented; more humane prisons that provide opportunities for inmates to maintain healthy contact with their families and children; prisons that address the issue of rehabilitation and recidivism through research and evidence; and more options for punitive sentences other than incarceration, especially when offenders are parents. Studies have indicated that the principal causes of increasing crime rates, and thus increasing prison populations, are social disorganisation, disinvestments in social capital, and growing inequality between rich and poor.27 In providing long-term solutions to the problems of crime and prison populations, it is essential that these issues be addressed. Acknowledgements We acknowledge the assistance of NSW Corrections Health Service. There were no competing interests in this research.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Aug 1, 2004

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