Creating a coordinated system of care for mother-baby pairs transitioning from a prison nursery to their home community
Introduction
The development of prison nurseries is a positive innovation to promote the care and attachment of mother-baby pairs (Byrne et al, 2010; Carlson, 2001), improve developmental outcomes for infants (Goshen et al, 2014a) and prevent recidivism (Carlson, 2001; Goshen et al, 2014b). Challenges remain as these mother-baby pairs transition to their home community (Goshen et al, 2014b; Byrne et al, 2012). Urged to address these challenges by a mother who experienced incarceration at the Indiana Women’s Prison nursery, our interdisciplinary team integrated a human rights-based approach to health (Yamin, 1997) and health equity framework (Bravemen et al, 2017) to develop Mothers on the Rise (MOR), a coordinated system of care serving mother-baby pairs transitioning from a prison nursery to their home community.
A human rights-based approach to health builds the capacity of rights-holders to claim their human right to health. In addition, it builds the capacity of duty-bearers (institutions) to promote and protect the health and human rights of individuals they serve (Yamin, 1997). This approach conceives of health broadly, considering both physical and mental health and the social determinants that influence them (World Health Organization, 2017).
It prompts us to ask what knowledge, capabilities, and resources do rights-holders need to attain wellbeing, and what are the needs of duty-bearers to assist in this realization? Simultaneously applying a health equity framework requires duty-bearers to implement policies and practices that address inequitable systems that result in health disparities (Bravemen et al, 2017).
As the number of women who are incarcerated has grown substantially over the past several decades (Ervin et al, 2020; Koski & Costanza, 2015), so too has the demand to develop genderspecific programming and policies within and beyond the prison system (Miller, 2021; see also Brown & Bloom, 2009; Koski & Costanza, 2015; Spjeldnes & Goodkind, 2009). Women who experience incarceration have often been victimized and (Koski & Costanza, 2015; Jung & LaLonde, 2015; Killian et al, 2018; Lynch, et al., 2012) frequently report behavioral health issues, diagnoses of substance use disorders and/or mental health diagnoses (Ervin et al, 2020; Visher & Bakken, 2014; Lynch et al., 2012). Justice-involved women are more likely than men to have chronic health conditions (Miller, 2021). These realities require duty-bearers to ensure adequate trauma-informed care and wrap around support both during and after incarceration.
More than half of women who are incarcerated identify as mothers and primary caregivers to young children (Maruschak, 2021). Mothers who are incarcerated face additional challenges. They often feel maternal guilt and lack confidence in their parenting skills, which not only impacts their mental health, but also the quality of care and attachment with their baby (Robison & Hughes Miller, 2016; Arditti & Few, 2008). This is important, as the confidence and identity of a mother can be a major motivating factor in the success of her reentry process (Cobbina & Bender, 2012). The community transition can also place the mother in immediate financial distress as a host of competing priorities (e.g. unresolved health concerns, post incarceration supervision requirements, transportation, and childcare) make securing employment challenging (Arditti & Few, 2008; Brown & Bloom, 2009; McGrath, 2012). Frequently unable to establish their own household, women may reenter violent, toxic, or unsupportive relationships (Brown & Bloom, 2009; Gobena et al, 2022). Thus, any successful effort aimed at improving the transition from prison to community needs to include a positive social network that supports and empowers the mother as she navigates societal challenges. Article 9: Creating a coordinated system of care for mother-baby pairs transitioning from a prison nursery to their home community 127
While several programs support women transitioning to the community, coordination and peer support to encourage use of these resources is often lacking (Brown & Bloom, 2009; Byrne et al, 2012; Gobena et al, 2022; McGrath, 2012). Mothers need support managing the emotional and legal challenges of reuniting with their children, finding safe housing, securing employment, and navigating the social safety net (McGrath, 2012). Furthermore, social networks can heavily influence the risk of recidivism. Family support is often a powerful protective factor, whereas peers may exert negative influence (Bowman & Mowen, 2017). Recognizing the compelling influence of social networks, we developed a coordinated system of support using community navigators as a central element to empower the mother and holistically promote her safety and well-being during and after the transition of her and her baby to the community.
Mothers on the Rise offers an individualized, coordinated system of care that is mediated through a peer who is not in a position of authority. At the same time, the process allows for the identification of social system patterns and gaps. This provides opportunities to build the capacity of duty-bearers to make system changes that better serve these mother-baby pairs. Described here are the key steps taken to establish the program, and its functions as mother-baby pairs transition to the community.
