Medical provider perspectives on children with incarcerated parents: A mixed-methods study

Purpose: To understand health care providers' perceptions, clinical considerations, and clinical actions towards children with incarcerated parents. Methods: We implemented an experimental vignette study in which health care provider participants were randomly assigned a patient case describing a child with a parent absent for unspecified reasons (control) vs. incarceration (experimental). Participants completed a survey of closed- and open-ended items regarding their clinical approach. Groups were compared with chi-square and ANOVA. Qualitative data were analyzed inductively. Results: Medical providers (N = 391) were predominantly non-Hispanic white, male, and physicians who had not received training on social determinants of health. There were no significant differences between the experimental and control groups in comfort with or approach towards the patient; specific conditions of concern; or number of concerns. Across groups, providers commonly endorsed intentions for additional emotional-behavioral screening and concerns for ADHD and adjustment disorders. Providers responding to the experimental vignette indicated interest in the child's psychosocial context (e.g., behavior/attention at home), current experiences (e.g., with trauma or abuse), relationships (e.g., with grandparents), perspectives of other reporters (e.g., teachers), and additional clinical actions (e.g., in-depth medical or developmental history). Conclusion: Medical providers' approach to children of incarcerated parents may be similar to that of any child with an absentee parent, contrasting existing literature on teachers. When signaled about parental incarceration, providers evidenced attention to children's holistic contexts and needs.