Pediatricians who see patients whose parent or parents are incarcerated may intentionally or unintentionally have biases as to how to approach the encounter. What do we actually know versus suspect due to biases regarding how incarceration of a parent can affect children and other family members, and what can we learn from evidence rather than biased thinking to better care for these patients? In an article early released in Pediatrics entitled, “Parental Incarceration in the United States,” authors from the University of Minnesota, Ann & Robert H. Lurie Children's Hospital of Chicago, and Johns Hopkins Bloomberg School of Public Health delineated the geography and demography of parents who are incarcerated (10.1542/peds.2023-062420). Knowing the impact of having an incarcerated parent has on a child, this study is timely, and the findings may run counter to the conventional wisdom many ascribe with regard to the demographics of incarceration. This is particularly true of low reported crime in rural areas, reported in the study, coupled with the higher percentage of parents who have been incarcerated—even more so than among children residing in urban or suburban areas.
Demographically, parental incarceration was higher among families with financial challenges, those families who are Black, Native American, and/or multiracial, and among children who have one or two non-parent caregivers (unclear if that is a cause versus effect). And there may be an interaction between the risk factors such that a higher proportion of children residing in rural areas whose families are of modest financial means experience the incarceration of a parent than those children of similar economic means in a suburban or urban environment.
The authors do discuss the implications of their work with a specific focus on directing resources to those areas and populations that are observed to have increased likelihood of having children who have a parent that has been incarcerated. And this study is another reminder to question conventional wisdom about the geography of parental incarceration. In other words, we must continue to review and check our biases with regard to patients who are perceived to be at increased risk versus those at increased risk of having a family member who is incarcerated.
Having the aforementioned data is one step toward addressing and eliminating bias in the provision of health care for our patients. It is vital that we take the next step and have this data inform our practice given the often-negative impact that bias has on pediatric health outcomes.
