JAMA Forum: Forced Separation of Children From Parents: Another Consideration

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The horror of witnessing immigrant children forcibly separated from their parents when they crossed the border from Mexico into the United States was surpassed only by the discovery that the federal government had no system for identifying and tracking the more than 2800 children for eventual reunification with their families. At this writing, the government has failed to meet an initial deadline for reunifying all children younger than 5 years, as ordered in a District Court judge’s preliminary injunction. One argument presented by US Attorney Jeff Sessions in his defense of the forced separation policy was that “every time somebody…gets prosecuted in America for a crime, American citizens, and they go to jail, they’re separated from their children.”

There are 2 flaws in this argument. First, not all citizens who are incarcerated are separated from their children. Some prisons, recognizing that maternal-infant attachment is key to a child’s development and emotional stability, allow women who are pregnant or have an infant to keep their babies in prison nurseries for 12 to 30 months, provided they meet various criteria. Second, current policies around separating children from their incarcerated parents should be closely examined. Beyond prison nursery programs, there is evidence that it’s possible to maintain and build the parent-child relationship, while healing the wounds of separation.

The Trauma of Separation by Incarceration
As an adolescent, Ebony Underwood felt shame and anxiety when her father, music producer William Underwood, was arrested in 1988 and convicted for drug conspiracy and sentenced to life imprisonment without parole under harsh, new federal sentencing guidelines. She knew him to be a good, loving father. Although she and her sister cried for most of their first, 30-minute visit with him in a federal prison, she continued to visit whenever possible. But federal prisons sometimes limited physical contact between them and didn’t have weekday visiting hours. As a model prisoner for 30 years, her father has been in 8 different facilities, most far from home, making visits almost impossible at times. “He never stopped being a dad,” Underwood told me in a telephone interview. “He created a sense of normalcy when we visited. He laughed, he sent holiday and birthday cards … The prison walls did not stop his parenting.”

There are about 2.2 million people incarcerated in the United States, at an annual cost of more than $80 billion and a social cost (such as from lost income; costs of family travel; eviction, which occurs at a higher rate for families when a parent is incarcerated; adverse health effects for the prisoner, such as from sexual abuse; and the effects of the trauma of incarceration on children and families) estimated at 10 times that amount. More than 5 million children—7% of all children—in the United States have experienced a parental incarceration (a conservative estimate), and 2.7 million children currently have a parent incarcerated.

Most children of incarcerated parents succeed when they are supported, but stigma often taints public perception of these children. Allison Hollihan, MS, MEd, senior policy manager of the New York Initiative for Children of Incarcerated Parents, argues that most of the research on so-called “intergenerational criminal behavior” and other poor outcomes has not controlled for community factors and other variables such as poverty and trauma that the children may experience: “It’s hard to disentangle what variables lead to negative outcomes,” she said. But would the risk for poor outcomes be diminished if more attention were paid to the trauma of forced separation, and if more support were offered? Even children who thrive can be traumatized by the separation, as Ebony Underwood well knows.

Relatively little attention has been paid to building children’s resilience through community awareness of the impact of stigmatization or through supportive programs and policies. Hollihan said, “We need to focus on child-friendly approaches to building the relationship between the child and incarcerated parent. Every step of the way, we need to ask, What about the children?”

A Strength-Based Approach
Although more high-quality research is needed, the extant evidence suggests that maintaining and strengthening the parent-child relationship can be beneficial to both. A family-based sentencing approach would enable judges to consider the strengths of a parent and the risks he or she may present, the length of the sentence, and the repercussions of the incarceration on the family. But this approach requires flexibility in sentencing, along with other policy changes by state and federal governments and within prisons and jails, such as the following:

  • Alternatives to Incarceration. There is some evidence that community-based alternatives to incarceration can keep low-risk parents and their children together in their own home or a community facility, and at a lower cost than incarceration. Although this requires intensive case management and supervision by parole officers, it can—if done well—lead to successful outcomes.
  • Proximity and Child-Friendly Visiting Policies. Research documents that frequent family visits can foster parent-child bonding and reduce recidivism. Proximity encourages child visits by reducing travel time and the costs of transportation and overnight accommodations. But invasive search procedures, barriers to hugging the parent, boredom in the visiting room, and other prison conditions can result in negative experiences for children. To encourage positive visits, the Osborne Association oversees Hospitality Centers adjacent to 16 prisons, and Family Centers in 5 of 54 prisons in New York. The Family Centers are child-friendly spaces stocked with toys and books located within the visiting room. But these programs are not in every facility and would need community support and funding to expand.
  • Support and Development Programs for Children and Parents. Children of Promise NYC supports children of incarcerated parents through behavioral therapy to address the trauma of forced separation, and advocates on their behalf during sentencing, hearings, and at other times. The Osborne Association offers recreational activities as well as independent living skills and youth leadership programs because children benefit from peer support without stigma. Parents, too, may need help, even after release from prison. Programs such as Hour Children at New York State’s Bedford Hills and Taconic Correctional Facilities help mothers improve their parenting skills and navigate such challenges as visiting rights and custody issues. These programs need funding but they may reduce the overall costs of incarceration.

“Being a child of an incarcerated parent is a huge silent epidemic because of the stigma and trauma associated with it,” said Ebony Underwood. “You believe that you are alone and nobody cares.” Despite prison walls, Underwood’s father has worked hard at nurturing their relationship and he emails and calls daily. His efforts, and her own research as a 2016 Soros Justice Fellow, compelled her to found and lead We Got Us Now, a nonprofit organization that identifies and mobilizes the historically invisible population of children and young adults affected by parental incarceration, and advocates for institutional and public policies that can keep families connected.

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About the author: Diana J. Mason, PhD, RN, Senior Policy Service Professor and Co-Director of the Center for Health Policy and Media Engagement, George Washington University School of Nursing; and Professor Emerita at Hunter College, City University of New York. She is former president of the American Academy of Nursing. (Image: Ted Grudzinski/AMA)

 

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.



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