Exploring the impact of paternal imprisonment on infant mental health.
Historically, the effects of father absence and separation on infant emotional wellbeing have been investigated through the mediums of military deployment and divorce (Abramowicz, 2012; Ludolph & Dale, 2012; Raeder, 2012; Osofsky & Chartrand, 2013). Minimal research addresses father absence and the impact on infant mental health in other contexts.
Emerging evidence demonstrates the effects of parental absence through imprisonment and the 'collateral consequences' for families. However, many of the available studies focus on maternal imprisonment or the effects on children and families of school aged and adolescent children (Boswell, 2002; Prinsloo, 2007; Murray & Farrington, 2008; Losel et al, 2012; van de Rakt et al, 2012; Jones et al, 2013; Roberts et al, 2014).
This paper aims to present current understanding through a synthesis of available literature. Its intention is to improve professional awareness and understanding, particularly for health visitors, of the impact that paternal absence through imprisonment has on an infant's ability to achieve optimal emotional, psychological and social development in the first three years of life.
The aim of this article is to draw together current evidence in relation to the effects of paternal imprisonment on infant mental health in the zero-to-three age group Current practice recommendations focus on raising awareness of children affected by parental imprisonment in the school nurse arena as a means of supporting the child (Boswell, 2002; Mazza, 2002; Pugh, 2004; Jones et al, 2013). There is a noticeable absence of available literature discussing or directing the practice of the health visitor in working with and supporting families involved in the criminal justice system (Boswell, 2002; Salmon, 2004).
The male prison population in England and Wales stands at around 85, 000 with forecasts suggesting that this number will continue to increase (Murray & Murray, 2010; Ministry of Justice, 2014; The Howard League for Penal Reform, 2014). Despite there being data pertaining to prison populations, there is little information routinely gathered about the number of infants directly affected by the loss of a father to the penal system (Salmon, 2004; Social Care Institute for Excellence (SCIE), 2008; Raeder, 2012; Jones et al, 2013).
Both Johnson & Easterling (2012) and Jones et al (2013) assert that a correlation between the rising number of male prisoners and the number of infants affected cannot be quantified due to a lack of formal data recording and auditing tools. This results in a vulnerable, fragile population becoming 'invisible' to services unless they are already a product of ongoing safeguarding proceedings (Boswell, 2002; Mazza, 2002; Prinsloo, 2007; Glover, 2009; Rosenberg, 2009; SCIE, 2009; Losel et al, 2012; Raeder, 2012; Jones et al, 2013).
Literature intimates the numbers of children separated from their fathers by imprisonment is far higher than from their mothers as the majority of prisoners are male (Rosenberg, 2009).
Despite suggestions that paternal imprisonment has less effect on children than maternal imprisonment (Murray and Murray, 2010), a wealth of literature demonstrates that the effects of paternal imprisonment are more profound than from any other father absence (Maldonado, 2006; Rosenberg, 2009; Geller et al, 2012; Johnson and Easterling, 2012; Purvis, 2013).
While there is an assumption that children of imprisoned fathers encounter many of the same problems experienced by those with incarcerated mothers, the literature indicates specific differences.
Rosenberg (2009); Murray & Murray (2010); van de Rakt et al (2012) and Jones et al (2013) all assert that children of imprisoned fathers are not only at greater risk of developing both emotional and psychological issues in later life, but are also at risk of long term strained relationships between themselves and their mother.
Recent findings place high value on father inclusion with authors indicating the achievement of significant highly desirable outcomes when a father is actively involved in the care of the infant (Maldonado, 2006; Lee et al, 2012).
Whiie evidence infers that father absence in general poses a significant threat to child development, children whose fathers are imprisoned are at significant disadvantage due to the aggravation of underlying family issues of poverty, substance misuse and domestic violence (Makariev & Shaver, 2010; Johnson & Easterling, 2012; Jones et al, 2013).
Makariev and Shaver (2010) also identify that whilst there is limited evidence to demonstrate imprisonment as a risk factor, it is not a routine consideration. It is therefore unclear whether infant emotional wellbeing is influenced by separation from the father, the act of imprisonment itself, or by other life adversities experienced (Johnson and Easterling, 2012).
A requirement to identify all relevant literature regardless of study design guides the practice of a scoping review (Arksey & O'Malley, 2003).
Usually undertaken when there is emerging evidence or when more diverse subjects require investigation, a scoping review allows for greater flexibility when synthesising evidence and establishing the background of a subject and can be used to inform a systematic review (Davis et al, 2009).
A literature search of international academic sources was undertaken using search terms in Box 1 with a combination of Boolean operators, wildcards and truncation. PsychInfo, CINAHL, Medline, EMBASE, Cochrane, Social Policy and Practice, ASSIA and EBSCO were explored.
In addition to searching the electronic databases, web sources were also identified using Google Scholar and Google. Handsearching of specialist journal publications, reference lists and reports also identified sources of information omitted from electronic database search results.
Although identified, quantitative data was negligible with the majority of material sourced being qualitative, interpretive data due to the nature of the subject.
The identified studies were appraised against the overall research objectives, but allowed for more inductive ideas to emerge from the literature.
Data from the studies were extracted using a standard template to aid consistent processes. Articles retrieved were included based on the comprehensive information, relevance and dimension the piece conveyed as opposed to its place on the hierarchy of evidence (Wright et al 2011).
Arksey and O'Malley (2003, p26) advocate 'sifting, charting and sorting material according to key issues and themes', a strategy applied to the results returned from all searches.
Box 1: Search terms used infant, child *, father *, parental, paternal, role, biological parents, imprisonment, incarceration, prison *, attachment, development, research, mental health, infant mental health, absen *, impact, brain development, health visitor, resilience, military fathers, military famil *, deployment.
Identifying key concepts formed the basis of the literature search. Initial searches sourced articles and general information about attachment theory, resilience and father involvement. Thirteen articles reviewing and studying father-infant relationships, the effects of imprisonment on the child or father, or both subjects in conjunction were identified. A further search for academic evidence examining the effect of paternal imprisonment on infant mental health found nothing; therefore, revising the search strategy to take advantage of theoretical generalisations and discussion papers was required. Consequently, a further twelve papers, from backgrounds in military, psychology, law and social care were appraised and included. The literature is summarised in themes, below. (Full tables can be found In the app version of the journal).
Father involvement and the imprisoned father
In exploring father involvement, the literature suggests the role of the father in the early relationship is more important than previously recognised. Investigating what 'being a father' means to both families and children, Hauari and Hollingsworth (2009) suggest an increased emphasis on the importance of both emotional and economic commitment to children. There is indication that an involved father has the potential to reduce the risks of a child developing emotional problems and engaging in anti-social behaviour (Maldonado, 2006; Willerton et al, 2011; Brown et al, 2012; Lee et al, 2012; WAVE Trust, 2013).
However, a father in prison is still a parent and imprisonment does not absolve them from the roles and responsibilities involved (Prinsloo, 2007). The parenting role continues during the time of imprisonment; it cannot be suspended until the father reaches his release date (Muth and Walker, 2013). Therefore, if a father feels unable to forge and maintain a warm, positive and secure relationship or fulfill his role of financial provider under prison conditions, the adverse effects on the child are likely to be amplified (Rosenberg, 2009).
Imprisonment reduces the family system to a temporary, involuntary single-parent unit (Prinsloo, 2007). Whilst fathers separated from their children for reasons other than imprisonment are often able to continue financial contributions, fathers in prison cannot. A reduction in family income, alongside new expenses associated with imprisonment, means many children and families find themselves with increased levels of financial and material hardship (Prinsloo, 2007; Jones et al, 2013), although a parent who incurs high living costs may leave the family financially more stable after arrest. The inability to make financial contributions combined with the knowledge that the family may suffer financial hardship as a result can lead many men to feelings of guilt and worthlessness (Clarke et al, 2005), feelings echoed in the works of Palkovitz (1997) and Willerton et al (2011). They both highlight how father roles continue to occupy the mind even when the child is physically absent and discuss the feelings of grief and guilt experienced by fathers who were actively involved with their children pre-prison. Many find themselves so overwhelmed with the guilt that surrounds the consequences of their actions that they would rather choose to discontinue contact with family than continue in a relationship (Rosenberg, 2009; Purvis, 2011). Whilst acknowledging that not every condition of paternal imprisonment is conducive to continuing contact, Glover (2009) and Dixey & Woodall (2012) discuss how maintaining family ties and paternal involvement produces a plethora of benefits. In turn, this can provide a catalyst for creating new, positive, father interventions (Clarke et al, 2005; Rosenberg, 2009; Purvis, 2011).
Attachment relationships, infant resilience and the effect of imprisonment on infant mental health
Attachment relationships between infants and absent fathers are a focus of many of the works identified; however, few studies evidence the impact on infant mental health of more diverse contexts of father involvement (Willerton et al, 2011).
Obvious exceptions exist at both ends of the parenting continuum (Palkovitz, 1997). Fathers who are unable or unwilling to provide qualitative engagement with their children, and infants whose parents demonstrate deficits in parenting through abuse, high-risk behaviour, nonchalance or excessive overprotection, all have the ability to damage the fragility of the early relationship and increase the risk of the infant developing poor mental health. Traumatic separation, economic strain, and parental loss all negatively affect an infant; the damage caused may be more severe when a parent endures repeated arrests and thus, repeated separations (Rosenberg, 2009).
A father who is frequently in and out of prison or is an inconsistent presence in a child's life indicates an infant who may display unavoidable elements of ambivalence within the relationship (Balbernie, 2003; Tyano et al, 2010). Both Balbernie (2003) and Jones et al (2013) assert that following imprisonment of the father, the ambivalent child requires stability and security. However, as imprisonment results in changing roles and circumstances for family members left behind (Geller et al, 2011; Osofsky and Chartrand, 2013), a degree of fluidity exists between styles of attachment as care giving relationships change (Murray & Murray, 2010; Obadina, 2013).
The absence of protective factors, such as competent and warm parenting, low parental conflict, parents' good mental health and cooperative parenting post separation, can heighten feelings of anxiety and helplessness (Jones et al, 2013) or a more generalized sense of personal insecurity (Murray and Murray, 2010). Exposure to both expected and unexpected environmental and familial risk factors have the potential to cause inconsistencies in care giving; this can influence the parent's ability to meet the needs of the infant and may manifest itself in the child as a negative relationship with either the remaining caregiver or the imprisoned father (Obadina, 2013; Osofsky and Chartrand, 2013).
As imprisonment can also aggravate underlying family issues of poverty, health issues, substance misuse and domestic violence, literature suggests that children of prisoners experience disproportionate exposure to preexisting social disadvantage and other environmental risks (Rosenberg, 2009; SCIE, 2009; Makariev and Shaver, 2010; Johnson and Easterling, 2012; Jones et al, 2013).
Encountering adverse situations, such as unexplained arrest or imprisonment, has the potential to exhaust the coping resources of children, and if prolonged, may reduce the potential to attain life goals (Bradley, 2007).
Separation caused by paternal imprisonment has the potential to be more damaging, and the effects more profound, than other forms of separation due to its abrupt and traumatic nature (Maldonado, 2006; Murray and Farrington, 2008; Rosenberg, 2009; SCIE, 2009; Geller et al, 2011; Johnson and Easterling, 2012; Jones et al, 2013; Purvis, 2013; Roberts et al, 2014). There is agreement in the literature that, if present, the process of arrest is a frightening, traumatising time for the child. If separation occurs in such an unexpected, frightening or angry manner with the child present, they may witness the removal of their father with no explanation; if not present they may feel confused and abandoned (Mazza, 2002) on their return. Various determining factors, including the age and level of cognitive development of the child at the time of the separation, the length of sentence and the support available to the family influence the extent to which the child is affected (Prinsloo, 2007; Roberts, 2014). It is rare that planning and discussion occurs prior to arrest; for the child there is immediate loss of control and the impact is instant (Murray and Farrington, 2008; Makariev and Shaver, 2010; Jones et al, 2013). A father who was emotionally present but is now physically absent increases uncertainty for the infant and they are no longer able to govern contact with the imprisoned parent for reassurance (Rosenberg, 2009; SCIE, 2009; Jones et al, 2013).
The role of the health visitor
As parenting occurs through the wider family system, adverse events have the potential to negatively impact on parents as well as the child; therefore, adult support in times of adversity is crucial in enabling restoration of nurturing and adaptive systems (Balbernie, 2003; Makariev and Shaver, 2010; Jones et al, 2013). A parent overwhelmed by problems or dealing with the aftermath of a partner's arrest or absence can often find themselves consumed by their own problems (Glover, 2009; SCIE, 2009; Jones et al, 2013), resulting in the neglect of the emotional, and sometimes physical, needs of the infant.
Whilst father involvement and participation are actively encouraged, the Healthy Child Programme (Department of Health (DoH), 2009) does not address the needs of the father who wishes to be involved but is absent through circumstance. Overall, minimal evidence exists for health visitor practice in the context of working with families involved in the criminal justice system (Boswell, 2002; Salmon, 2004).
There is a failure to register prisoner's children or routinely monitor a prisoner's parental status on reception into the prison. This means the numbers of children of prisoners or the number of children negatively affected by the imprisonment of their parent is an unknown quantity (Salmon, 2004; Arditti et al, 2005; Maldonado, 2006; SCIE, 2009; Rosenberg, 2009; Losel et al, 2012; Raeder, 2012; Jones et al, 2013; Purvis, 2013).
Whilst many families are aware of the importance of maintaining contact and make efforts to facilitate the relationship with the imprisoned father, others would prefer to keep their situation hidden from friends, family and professionals (Glover, 2009). There is risk of non-disclosure by prisoners or their families who fear a negative outcome for their child on voluntarily disclosing such information to authority figures (Jones et al, 2013). This has the potential to prevent children with emotional needs gaining access to care givers, interventions or services aligned to their needs, who could ultimately offer support (Mazza, 2002; Maldonado, 2006; Makariev and Shaver, 2010; Ludolph and Dale, 2012; Jones et al, 2013). Whilst it is acknowledged that not all children with a father in prison require support (Jones et al, 2013), there is little available information of the resilience process in children of prisoners (Rosenberg, 2009; SCIE, 2009; Jones et al, 2013).
RECOMMENDATIONS FOR PRACTICE
In choosing to address the issues highlighted, there are many ways to continue to develop current practice. Preventative interventions reduce the drain on resources as well as decreasing long-term incidences of anti-social behaviour, mental ill health and intergenerational crime and insecurity (WAVE Trust, 2013). Future health service provision should consider the inclusion of fathers, as directed by the Healthy Child Programme (DoH, 2009), whilst in prison.
Evidence strongly suggests that by increasing imprisoned fathers' involvement in early years care, there is potential to reduce intergenerational insecure attachment relationships, break the cycle of dysfunction and reduce recidivism (Pugh, 2004; Maldonado, 2006; Prinsloo, 2007; SCIE, 2009; Makariev and Shaver, 2010; Purvis, 2011; Lee et al, 2012; Roettger and Swisher, 2013).
Therefore, if the father is willing to participate but is unable to be present by circumstance, alternative methods of programme delivery should be considered to provide an inclusive service.
Additionally, the success of intensive, evidence-based programmes of health visitor support for vulnerable families, such as Family Nurse Partnership (Family Nurse Partnership (FNP), 2014), indicates that a similar programme of intensive support should be a practice consideration for families living within the criminal justice system where risk factors and insecure attachment relationships are consistently evidenced.
RECOMMENDATIONS FOR RESEARCH
The literature selected and explored in this work demonstrate the need for further research in an obviously under explored area.
A lack of empirical data about paternal imprisonment suggests little evidence is available with the sole focus on the emotional and psychological health of infants and children of fathers in prison; further study is required to identify the effects of paternal imprisonment on emotional well-being in the zero-three age group
Further research is also required to assess and establish the effects of intensive family support on the correlations between mother support and resilience development in the infant, to influence the provision of support offered by society, family and health care professionals.
The conclusions drawn from the literature establish that paternal absence through imprisonment does have an influence on infant emotional wellbeing and mental health. However, the evidence suggests that there is no singular reason, but rather that these effects are multi-faceted and underpinned by a considerable number of significant factors.
There is no definitive data to determine who should oversee the care of infants affected by paternal imprisonment. In being an 'invisible population' (Boswell, 2002; Mazza, 2002; Prinsloo, 2007; Losel et al, 2012), children are at risk of becoming victims of a lack of mainstream provision, unrecognised as a distinct group and often falling between the guidelines of various departments, such as health, the justice system and social care (Murray, 2007; Murray and Murray, 2010). Identifying those affected at the earliest opportunity enables implementation of early intervention strategies for those considered to be in need; an appropriate vehicle for offering such an intervention and support would be an intensive home visiting package.
As the aim of the health visitors' professional practice is to promote optimum child development and positive parentinfant relationships through the delivery of the Healthy Child Programme (DoH, 2009), the health visitor is well placed to play a pivotal role in supporting the families of those within the criminal justice system.
Tables to accompany this article can be found in the app version of the journal.
* Father absence through paternal imprisonment does influence infant mental health and emotional development; however, in many cases, it is not the sole factor.
* Consideration to alternative methods of delivering The Healthy Child Programme for fathers who are unable to participate through circumstance is required.
* There is no definitive data to determine who should oversee the care of infants affected by paternal imprisonment, thereby leading them to become an 'invisible population'.
* Early identification of children affected by paternal imprisonment enables timely implementation of intervention strategies.
* The health visitor is well placed to support families within the criminal justice system.
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RGN, SCPHN MSc (Health Visiting), Public Health Nurse Prescriber. Health Visitor, Leeds Community Healthcare NHS Trust, Leeds.
DR JAMES WOODALL
BSc (Hons), MSc, PhD Reader in Health Promotion, Leeds Beckett University Leeds
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|Author:||Waldegrave, Kathryn; Woodall, James|
|Date:||Jun 1, 2015|
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