Parallel Process and Multiple Needs: Parenting Intervention as HIV Prevention for Incarcerated Mothers

Background: Female incarceration rates have increased 500% from 1977 to 2004. Nearly 65% of women prisoners were caretakers of children pre-incarceration and will return to parenting upon reentry. Incarcerated women face multiple complex challenges upon release. They are at high risk for contracting HIV, with disproportionately high histories of abuse, sex work, multiple partners, and exchange of sex for drugs. They may experience considerable stress reunifying with children; many have limited/deficient parenting skills. However, “getting clean for my children” is a powerful motivator for women's health and safety. We report findings from an exploratory non-experimental study examining a novel parenting intervention for incarcerated mothers with the goals of 1)improving parenting knowledge and attitudes, and 2)decreasing HIV risk behaviors upon release.

Methods: We recruited 59 women with one or more children under age 7 and releasing within one year from the NC Correctional Institute for Women. Average age was 29.7 (SD=6.44, range=18-50), 42(71%) were White, 14(24%) Black, 5 (5%) Other. Half had completed high school/GED, and 48(81%) identified as heterosexual. The intervention was an eight class interactive program providing skills and resources for women to strengthen relationships with children. Topics in the 90-minute classes included: mothering from prison, what is family, being a “good enough mother”, barriers to effective mothering, skills for reentry and reunion. Surveys were administered at baseline(T1), immediately post-intervention(T2) , and 1-(T3) and 3-(T4) months post-release. Instruments included the Adult-Adolescent Parenting Inventory (AAPI), and the NIDA Risk Behavior Assessment sexual risk and substance abuse items (RBA). At T1 subjects were asked about risk behaviors in the month prior to incarceration and at T4 for the month prior to interview. Descriptive statistical analyses summarized responses; changes from T1-T4 in AAPI were examined using two-sided paired t-tests and RBA using McNemar chi-square test.

Results: The AAPI consists of 5 sub-scales, with a general population mean of 5.5; higher scores indicate better parenting skills. Significant T1-T4 changes were seen in the Inappropriate Expectations of Children (4.24-4.71, t=1.99, p=0.05) and Reversing Parent-Child Roles (4.40-5.36, t=3.61, p<0.001) subscales; no changes were seen in Lack of Empathy, Belief in Corporal Punishment, or Oppressing Children's Independence subscales. Positive changes T1-T4 were seen in 3 of 4 RBA measures: The number of participants having multiple sex partnerships was reduced (15-5, ÷2=8.10, p=0.004), as was Unprotected Penis/Vagina Intercourse (32-18, ÷2=16.06, p<0.001), and Using Illegal Drugs (31-11, ÷2=18.05, p<0.001). No changes in alcohol use were noted. Conclusions: Incarcerated mothers face complex risks upon release. The stresses of reunification and parenting may exacerbate these risks. Increasing parenting skills may lower these risks in two ways: by decreasing parenting stress and by increasing motivation to be healthy for one's children. The parenting intervention piloted in this study shows promise in improving parenting skills and applicability to incarcerated mothers. The findings from this study suggest that parenting intervention may be an effective way to address many of the complex needs of soon-to-be-released mothers. Additional research including testing this intervention in randomized controlled trials is needed.