Research Protocol:



Impact of Incarceration on Outpatients in the Bronx: A Card Study

Minesh Shah, MD

Sadiqa Myles, MD

Matthew Anderson, MD, MSc

Miriam Shapiro

Carolyn Chu???

Department of Family & Social Medicine

Montefiore Medical Center & Albert Einstein College of Medicine

Bronx, NY

Corresponding Author:

Matthew Anderson

Department of Family & Social Medicine

3544 Jerome Ave,

Bronx, NY 10467

Phone: 917 817-1986

Fax:

Email: Bronxdoc@

Word count:

Tables:

Figures:

Acknowledgements

Conflicts of Interest

Abstract:

Background:

Objective:

Methods

Results

Discussion:

Introduction

The US has some of the highest incarceration rates in the world, New York City has one of the highest incarceration rates in the nation and the Bronx has one of the highest incarceration rates in New York City. In 2006, there were over 72,000 arrests made in Bronx County, NY, about 2/3 of which were for misdemeanors, and fewer than 2% violent felonies. About 14,000 of those arrests resulted in incarceration in either jail or prison.[1] The phenomenon of arrests being concentrated in specific, usually minority neighborhoods has been called mass incarceration. The deleterious social and health effects of mass incarceration have considered a public health problem with the spread of prisons in the US being considered a plague. Using state correctional and U.S. life expectancy data, Drucker has estimated that 286,000 person-years of life are lost to incarceration in New York State from 1974-2002, with a mortality equivalent of of 8,667.[2] Incarceration overwhelming affects poor persons of color..

Beyond the health consequences to the individual who is involved in the criminal justice system[3],[4], there are important repercussions for their families and communities. [5],[6],[7] Our daily experience as clinicians working in the Bronx is full of anecdotal evidence that having an imprisoned family member can be catastrophic for a family. This anecdotal experience has been reinforced by studies carried out in community clinics. (CITE) A genogram study in an impoverished community similar to the Bronx found that incarceration of one family member has a high correlation with incarceration, substance use, and HIV/AIDS infection in one or more other family members.[8] Parental incarceration has many short- and long-term deleterious effects on young children, including mental health problems, dropout from school, and social isolation.[9] Despite this knowledge, there is currently no data looking at the prevalence of incarceration histories among primary care patients..

We undertook a card study at three primary clinics within the Montefiore Medical Group to assess the impact of incarceration on our patients and their families.

Methods

Setting:

The study was conducted in three community clinics run by Montefiore Medical Group; the Family Health Center (FHC), the Williamsbridge Family Practice (WB), and Comprehensive Health Care Center (CHCC). The clinics are teaching sites for residency programs in Family Practice (FHC & WB), Internal Medicine (CHCC) and Pediatrics (CHCC). FHC and CHCC are federally funded community health centers located in neighborhoods with high rates of incarceration.

Study Population

All patients presenting for care at the clinic were eligible for participation in the study. If the patient was less than 18 years of age we interviewed the accompanying adult (if any) and the answers reflected the adult’s experiences. Patients were excluded if the visit was an emergency.

Recruitment and consent

At the end of the clinical encounter, providers asked patients if they might be interested in participating in the study. A brief consent form was then read to them and they were asked to provide verbal consent. Patients were free to withdraw from the study or omit any question. No personal identifying information was recorded about the patient other than gender and age.

Administration of the card survey

D.5.1. Training of providers

Clinicians will receive a training session on how to introduce and complete the card study. The study authors will conduct the training. They will be instructed to ask every patient or every parent/guardian who meets inclusion criteria to participate in the study to avoid selection bias. They will also be instructed to fill out each question with a Y (yes) or N (no).

Administration of the survey

The survey itself consisted of nine questions which were asked of the patient. The provider completed the card. Providers who spoke Spanish could translate and administer the survey in Spanish.

Data Management & Analysis:

Data was inputted directly from the cards into an Access database and analyzed using SPSS 15.

Ethical Analysis:

This study was approved by the Institutional Review Board at Montefiore Medical Center.

Results

Prevalence of Incarceration

Of the patient: (what characteristics were associated with this)

Of the patients family members

Acuity of problem (currently in jail, criminal proceedings, return home)

By clinic

Pediatrics

Perceived impact of Incarceration

On family

On child

Discussion

What we found

Limitations

Nature of a card study

Language

Strengths/Existing literature

Future research

Clinical Pearl

Table: Impact of incarceration

|Who |Who |All sites |FHC |WB |CHCC-P |CHCC-M |

|Current involvement in criminal proceedings |Self or family | | | | | |

|Currently in jail |Family | | | | | |

|Came home from jail w/in a year |Self or family | | | | | |

| | | | | | | |

|Ever arrested |Self | | | | | |

| |1ST degree relative | | | | | |

| |2nd degree relative | | | | | |

| |Spouse or family | | | | | |

| | | | | | | |

|Ever spent time in jail or prison |Self | | | | | |

| |1ST degree relative | | | | | |

| |2nd degree relative | | | | | |

| |Spouse or family | | | | | |

| | | | | | | |

|Affected your health? | | | | | | |

|Affected your child’s health? | | | | | | |

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[1] New York State Division of Criminal Justice Services, Computerized Criminal History system. Apr 2007.

[2] Drucker E. “Population impact of mass incarceration under New York’s Rockefeller drug laws: an analysis of years of life lost.” J Urban Health. 2002; 79(3): 434-5.

[3] “Mental health problems of prison and jail inmates.” US Department of Justice, Bureau of Justice Statistics. Sep 2006.

[4] “Medical problems of jail inmates.” US Department of Justice, Bureau of Justice Statistics. Nov 2006.

[5] Freudenberg N, et al. “Coming home from jail: the social and health consequences of community reentry for women, male adolescents, and their families and communities.” Am J Public Health. 2005; 95(2): 1725-1736.

[6] Freudenberg N. “Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health.” J Urban Health. 2001; 78(2): 214-35.

[7] Golembeski C, Fullilove R. “Criminal (in)justice in the city and its associated health consequences.” Am J Public Health. 2005; 95(2): 1701-6.

[8] Barreras RE, et al. “The concentration of substance use, criminal justice involvement, and HIV/AIDS in the families of drug offenders.” J Urban health. 2005; 82(1): 162-70.

[9] Parke R, Clarke-Stewart KA. “Effects of parental incarceration on young children.” US DHHS Conference “From Prison to Home,” January 2002.

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