Twenty Years in Prison: Reflections on Conducting Research in Correctional Environments

Introduction

The Network Patient Health Survey (NPHS) is a large prevalence survey undertaken across correctional centers in New South Wales, Australia. NPHS is the largest and longest running survey of its kind undertaken within a single jurisdiction, anywhere in the world. The 2015 survey is the most recent iteration in a succession spanning two decades. The survey is undertaken by the Justice Health and Forensic Mental Health Network (JH&FMHN, or the Network) on an approximately five yearly basis and provides a detailed snapshot of inmates’ physical and mental health along with detailed demographic information. This work informs the provision of service to patients under the Network’s care as well as contributing to an important public health knowledge base. The research team at JH&FMHN has a built-up store of institutional knowledge concerning the conduct of research in corrections environments, assisting us to navigate pitfalls in this context, and which may assist other researchers to do the same.

Inmates ought to be the subject of far more research from across a range of disciplines; however, perennial issues associated with conducting research within such a rigid environment can stymie research projects and the enthusiasm to undertake them. A range of challenges for prison-based research have been identified in the literature but simply confirming these from our own perspective has limited value, nor will it provide guidance to researchers who may be attempting prison-based research for the first time. Our aim is to be more pragmatic and solutions-focused by outlining approaches that enable research, rather than simply describing complications.

Our task is to provide solutions, where possible, to challenges routinely encountered in prison-based research. These suggestions are based on many years of close experience and informed as much by our mistakes as by our successes. Through a review of our lessons learned, we have identified six broad domains that require particular attention during the planning and execution of prison-based research. This set of issues comprises problems of access, the importance of communication, ethical considerations, the need for good preparation, appropriate governance, and some ways to consider the needs of participants. Some of these domains represent hurdles or impediments to research. Possible solutions are suggested that have been informed by our own idiosyncratic experience with reference to literature where relevant. Other domains represent strategies that might make the research process easier. All may be described as organizational risks and are interconnected, but each has discrete features that ought to be carefully considered by those embarking on prison-based research. While essential for large-scale studies such as the NPHS, we hope that our explanation of these domains will prove helpful for projects of all sizes. We believe that a better understanding of the issues associated with research in the complex corrections environment will encourage researchers to approach the area with a realistic outlook and to build fruitful partnerships with corrective services agencies and allied organizations.

Access

The most obvious and persistent problem associated with undertaking research within a corrections environment is the simple fact that participants are difficult to access. Numerous researchers have pointed out that the processes associated with gaining approval for research and entry to custodial centers are drawn out and can take many months to navigate successfully (see Reiter, 2014; Schlosser, 2008). This is as much a reality of doing business for researchers, such as the authors, who are attached to organizations closely affiliated to corrective services, as it is for independent researchers. While difficulties with access seem obvious, they warrant discussion as a number of issues contribute to this challenge. Some researchers, such as Reiter, believe that impediments associated with accessing inmates stem from an aversion to scrutiny on behalf of corrective service organizations. We take a different view. The philosophical rationale of penology holds that removal from society constitutes the prime punishment inmates must endure (Leopold, 1966). Access to inmates is supposed to be difficult, that is the point, but access is often restricted more out of reasons of procedure and practicality than philosophy. Security is the first consideration within the correctional environment, and efforts to maintain security inform all aspects of prison life and environment (see Price, 2000). As such, researchers can expect to be searched before entering and exiting a prison. They will find restrictions limiting what they can bring in which often extend to bans on computers and recording equipment as well as other items that may seem innocuous to unseasoned eyes. Prisons are routinely “locked-down,” denoting a period when inmates are confined to their cells. In times of high risk, researchers may find that access to prisons is terminated at short notice. These periods can be unpredictable, ubiquitous, and lead to delays and inevitable timeline changes.

Prisons are specialist environments that are not naturally amenable to the conditions required for producing high-quality data. While our experience has been that corrections staff will go to great lengths to provide the most suitable venue available, data collectors have variously found themselves conducting interviews in meeting rooms and clinical examination rooms, in laundries, on basketball courts, in gymnasiums, and in visiting areas. Often, these spaces are being used simultaneously for their usual purpose, and even in more conducive spaces, prison regulations will frequently require a corrections officer to be in hearing and/or visual range of participants. Under these conditions, a researcher cannot be said to have true access, as participants may be understandably circumspect when privacy cannot be guaranteed.

Although this article promised solutions, for this first challenge, we have few. That prisons are highly rigid, secure environments is a necessary fact of life, and the difficulties and delays associated with accessing inmates are par for the course. Researchers must always recognize they are guests in this environment and comply with all procedures and policies to ensure safety and security are optimized. A measure of flexibility and forethought will go a long way, as will timelines with some elasticity. Planning for inevitable delays and clearly specifying requirements relating to data collection and venue will considerably reduce frustrations commonly entertained by researchers in this regard.

Communication

Clear communication with corrective services is vital to any successful prison-based research project. We strongly recommend that researchers work toward building functional networks with corrections staff that include positive relationships with front-line staff as well as good ties with administrative officers more senior in the organizational hierarchy. It is important to remember that researchers often represent an added workload. We have learned that approval from a senior administrator does not always mean approval from those on the ground. These are professional people who carry out high-quality work in often difficult circumstances. To them, an inbound researcher often represents little more than the expenditure of limited resources while they are being escorted, housed, and kept safe. Clear communication concerning logistics directed toward ensuring researchers cause as little disruption as possible will help to ensure the smooth carriage of the current research project and will positively predispose staff toward future projects. It lays the groundwork for solid and enduring collaborative relationships. We recommend that researchers maintain regular contact with a liaison located within the specific facility, or facilities, where the research will be undertaken. This individual should be a local leader responsible for facilitating access, rather than a more senior administrator who may grant permission for the project to be undertaken and monitor its progress through other pathways. These local leaders can be extremely valuable when it comes to securing suitable venues for research as well as informing researchers of current conditions such as lock downs.

Research findings should be communicated back to allied organizations and especially to those who have assisted in the research. For those who are not literate consumers of research, it can often seem like a pointless exercise. In Australia, in particular, those engaged in academic research can sometimes be painted as out-of-touch with practicalities or politically partisan and ideologically motivated (Glasson, 2012). This overlooks the wealth of useful and translatable knowledge that emerges from a project’s findings but which is often presented only in academic peer-reviewed publications and conferences. Sharing research findings with collaborating and allied organizations, in ways that are meaningful to them, demonstrates the value of research to those who can make the best use of it and who may be responsible for implementing change. It also goes a long way to fostering goodwill among staff in collaborating organizations who can quickly grasp the benefits arising from their efforts. This may make them more open to assist in the facilitation of future projects and improves the likelihood that these projects will run smoothly.

Ethics

The correctional environment represents an ethical minefield for researchers. Researchers should remember that inmates represent a vulnerable population. Beyond the social and health deficits associated with incarceration (see, for example, Ewert, Sykes & Pettit, 2014; Indig et al., 2010; Males & Brown, 2013), inmates exist in an environment where they are subjected to a disproportionate balance of power. In such circumstances, the need for researchers to develop and follow sound ethical practices, which transparently safeguard against the exploitation of participants, is essential.

Perhaps, the most important consideration when collecting data from inmates relates to determining whether consent is truly informed. Signed consent forms may provide a legal proof, but a number of considerations will improve the likelihood that those documents represent truly informed and freely given consent to participate. For example, providing a written outline of the methodology and aims of a study is a standard practice when working with human subjects, but these tools can be difficult for many inmates. Research indicates low levels of literacy and higher levels of cognitive impairment are more common among inmates than the rest of the community (Tuominen et al., 2014). Potential participants may not be able to read and read participant information sheets or consent forms. Given the social stigma associated with illiteracy, they may also be unwilling to acknowledge these issues (Easton, Entwistle, & Williams, 2013). This compromises their ability to give informed consent. Even in cases where a participant possesses functional literacy skills, consent forms and information sheets may be written in a way that is difficult for inmates to fully understand (Samuelsson, Herkner, & Lundberg, 2003). While researchers usually try to make this information easy to read and limit the use of jargon, extra attention is required for inmates who, on average, have lower levels of schooling and poorer educational outcomes than the rest of the community (Lochner & Moretti, 2004). The authors have developed a best practices approach to ensuring informed consent is given. Information regarding the study is written at a level appropriate for a 12-year-old and is read aloud to potential participants as a matter of course. Participants are then engaged in discussion to determine their understanding of this information and to clarify any questions or misunderstandings they may have in relation to it. This process continues until data collectors are confident that the participant understands the research topic and method of data collection; their rights regarding participation, which are not waived simply by virtue of their incarceration; and the security of their data and the parametres within which it will be used.

Related to this issue, researchers must ensure that participants are truly volunteers and are not brought to consent through either coercion or bribery. Anecdotal reports indicate that inmates can often be specifically nominated for participation by corrections officers. We have seen no evidence of this in our own studies, but the practice of inmates being “volunteered” is historically common (Hornblum, 1997). To protect against this risk, JH&FMHN works with Corrective Services New South Wales to develop complete lists of inmates at sites who are then invited to participate in a study should their demographic information indicate they are suitable. This is by no means a perfect solution, as it involves accessing information about a potential candidate (usually a unique identification number, gender, and ethnicity) prior to their being invited and consenting to participate; however, we are scrupulous in ensuring that no individual information that could reveal the identity of a particular inmate is accessed as part of this process. In addition to coercion, there is a risk that participants will be subject to bribery through the provision of overgenerous incentives. Participants in the NPHS were issued with a payment of AUD$10, directly into their prison account, as an incentive for their participation and compensation for those who may have missed paid work as a result of participation. This money can then be used by participants to purchase items through the corrective services grocery scheme. This is the amount that has been offered as compensation over the 20-year history of the survey, unadjusted for inflation, and may no longer be adequate. Nonetheless, incentives must be considered carefully as the value of money is enhanced in a prison environment where access to funds is heavily restricted. Grant and Sugarman (2004) found that in cases where a power discrepancy exists in the relationships between researchers and participants, incentives may constitute a coercive influence on potential participants to take part when they may be otherwise disinclined to do so.

When working in prisons, individual data collectors, as well as others coming into contact with data, have an obligation to consider their duty of care in relation to the welfare of participants at all times. This is particularly so when working in a health-related organization such as the authors’. At numerous times during data collection for the NPHS surveys, participants may provide information which indicates a chronic or acute health problem. Health literacy among inmates is known to be poor (Ross, 2011), as such it is essential that these issues are reported so that the participant can be appropriately assessed and treated. To this end, a referral process was instituted for the NPHS surveys, ensuring that patients with health issues can be followed up in a manner which does not require the disclosure of unrelated information they have provided. This is done by completing a referral form and guaranteeing it is handed to an appropriate individual prior to leaving the facility. Such formal methods of feeding back to staff are encouraged because they provide a concrete demonstration of duty of care as well as provide staff with something more than ad hoc reporting of an issue. Participants are always informed of this referral process as part of the information provided to them prior to consent.

There is a very real risk that participation in research may result in participants being asked about, or volunteering details concerning, previous criminal behavior for which they may not have been brought to account. The need for researchers to report the criminal activity of participants differs across jurisdictions, usually taking into account the nature of the reported offending (Roberts & Indermaur, 2007). The associated ethical responsibility sees us stressing this requirement to potential participants before they provide consent. We also explain to participants that while we will ensure the confidentiality of their data, we may be required to surrender it if directed to do so by a court.

Preparation

Good preparation is a key requirement for all successful research projects, and this includes those undertaken in corrections environments. The challenges associated with access and good ethical practice indicate that appropriate planning is even more important in this space. There are any number of factors of particular concern to researchers in prison that can be addressed through good preparation. Those aspects of preparation mentioned here should not be considered exhaustive; rather, they represent the points that our experience has shown to be most important.

In light of the issues associated with access, it is important to consider the possibility of accessing existing data sources, where available, rather than relying on manual data collection. Accessing existing data sources can dramatically reduce the amount of time one is required to spend in the corrections environment. In turn, this will reduce the likelihood that research projects will be delayed as a result of any impediments associated with accessing participants. On the other hand, the use of existing data may represent additional hoops through which researchers must jump, usually in the form of paperwork relating to requests for access and ethical approval. As a general rule of thumb, we have found accessing existing data to be worthwhile for medium to large projects. Smaller projects or those using qualitative data may not require as much time. These projects are consequently subject to fewer delays which may make manual data collection a more attractive option.

Consideration also needs to be given to the content of the measures being used to collect data in the project. In particular, thought needs to be given to the appropriateness of measures for use with an incarcerated population. We have found many high-quality, psychometrically robust measures may not be reliable or valid for use with inmates. For example, a measure of pathological anxiety, designed to measure the construct in the general population, may not provide meaningful results when used to screen in-coming inmates at reception. A person who has just left a court room and come into custody, perhaps for the first time, is likely to be highly anxious. Even among the mainstream incarcerated population, higher than average levels of anxiety may be appropriate when considering the routine and habitual violence often encountered in correctional environments (Haney, 2012).

Measures which have not been purposefully created with inmates in mind should be deployed with caution. Where possible, preliminary research to establish the psychometric properties of the measures in a corrections environment should be undertaken. While such studies have much value, they are often not possible due to constraints of time and finance. At the very least, measures should be used only after they have been assessed by suitable subject-matter experts. These experts should include both those with general expertise as well as those with specialist criminological or forensic knowledge, and they should be prepared to be thorough—It is not simply enough to make sure that most of the items in a standardized measure are appropriate.

In many projects, particularly those requiring a large sample size, it is easy to focus on the quantum of responses received. The NPHS relies on a sophisticated stratified sampling formula designed to ensure sufficient representation across a number of key demographics; it is critical to the study that particular targets are met for certain groups of inmates. We have learned, however, that considerations of quantity cannot be allowed to jeopardize the quality and completeness of the data being received. Overly hasty data collection, where a focus on getting as many responses as possible in a limited timeframe predominates, is likely to produce poor quality and incomplete data. It is important to remember that it is not easy, and often not possible, to correct or complete poor quality data. This is not least due to problems associated with access that have already been discussed. In addition, the corrections environment is a fluid one in which inmates are often relocated or released. In light of these difficulties, we encourage precision and patience in data collection and emphasize, again, the need to realistically plan for data collection by allowing a generous amount of time to collect sound and complete responses.

A comprehensive orientation for data collectors and other research staff who may not have experience working in a corrections environment is indispensable. Beyond briefings on appropriate security protocols, which ought to be mandatory, a number of other factors are necessary to ensure effective orientation. For example, a prison and its occupants can be daunting to data collectors who do not routinely work in that environment, and a comprehensive outline of what to expect will be helpful. Most importantly, it is vital to ensure that those involved in the research project have a thorough grounding in the tools and measures to be used. This is not a requirement solely applicable to researchers working in the corrections environment, but it is particularly relevant to the success of their data collection. When working in prison, it is not an easy task to immediately clarify any uncertainty or ambiguity. Data collectors cannot simply make a call, as this will usually require leaving not only the interview session but also the center itself with a repeat of time-consuming security screening to reenter.

Governance

Most organizations working within the correctional environment will insist on some level of oversight with regard to research projects that they undertake or sponsor. These organizations carry an enormous duty of care for those in their custody, as well as an ultimate responsibility to the tax-payer. As such, they will want to scrutinize projects in all phases to ensure their inmates’ and the community’s best interests are served. All custodial organizations in New South Wales (NSW), as well as the Network itself, maintain robust ethics committees that insist on conscientious attendance to sound ethical practice in research. These committees are every bit as exacting as those researchers will encounter in an academic setting.

In addition, large projects undertaken under the Network’s auspices are almost always conducted with reference to a steering group or similar governance body. These groups consist of stakeholders including key research personnel and subject-matter experts, as well as representatives from collaborative bodies and executive representation. The makeup of these groups is important and should be considered carefully to the extent that a researcher may influence its composition. In governance, engaged and enthusiastic participation can make for a much smoother facilitation of a research project than would otherwise be encountered. We have benefited from executive engagement in projects that has opened a number of doors that may otherwise have remained closed to us. Our advice is that governance bodies should include, where possible and where such a body is deemed necessary, individuals who have influence within an organization and who are willing to enthusiastically champion the project.

Considering the Needs of Participants

It is well-established that inmates differ considerably from the general population, across a wide range of demographic factors (see, for example Indig et al., 2010). Inmates’ mean lower levels of literacy and education also impact their ability to understand and respond to any material (including key measures) with which they will come into contact. In addition, we have found that shorter measures are better for use with inmates because of the elevated prevalence of attention deficit hyperactivity disorder (ADHD; Moore, Sunjic, Kaye, Archer, & Indig, 2013) and cognitive impairment (Baldry, Clarence, Dowse, & Trollor, 2013) in the inmate population in NSW.

Perhaps the biggest issue associated with collecting data from inmates relates to the accuracy of self-report data. There are risks associated with using self-report data in the general population (see Gerald & George, 2010), but it can be especially problematic for inmates. In particular, we have found it can be difficult for inmates to accurately estimate behavior prior to incarceration. This problem understandably increases with the length of time a person has been in prison and as their memories of many aspects of their life in the community fade. Inmates may also be reluctant to respond accurately to questions relating to specific topics, such as their offending history or the likelihood they will recidivate, as doing so may have serious repercussions for them. Certain aspects of prison life have also proven difficult to explore due to inmate reluctance to self-report. For example, various studies have commented on the difficulties in accurately gauging the nature and extent of homosexual behavior, especially among male inmates (Jenness, Maxson, Sumner, & Matsuda, 2010; Levan Miller, 2010), drug-use (Carpentier, Royuela, Noor, & Hedrich, 2012), or violence within the corrections environment (Schenk & Fremouw, 2012) due to various taboos shared by many inmates or more tangible reasons such as fear of reprisals.

Inmates may also be circumspect because they do not trust researchers. This lack of trust has been reported across a range of criminological and penological studies and is often reported as a serious impediment in qualitative studies which require close interaction with participants (see Liebling, 1999). Waldram (2009) claims this is due to an automatic suspicion of outsiders or new people stemming from inmates’ vulnerability within an authoritarian and often dangerous environment. Whatever the cause, trust can be gained when inmates are approached honestly, with respect, and when the purpose of research is explained to them in meaningful ways. Whenever we engage with inmates, we make a point of introducing ourselves. This usually includes assurances that we are not employed by corrective services and, as employees of the organization tasked with providing their health care, we assure them we neither regularly interact with clinic staff nor have a direct role in the provision of health care. This usually leads into a discussion concerning anonymity and confidentiality. Our position is to respect a participant’s anonymity except, as mentioned above, when they disclose serious offending behavior or a medical problem that requires attention. We also explain that we may be compelled to surrender data if directed to do so by a court. We also find that full disclosure regarding the purpose of the study and the use of data puts to rest the majority of concerns participants may have, as does the assurance that they may withdraw from participation at any time and their data will be destroyed.

In December 2016, the Aboriginal people of Australia accounted for just under one quarter (23.85%) of the prison population in NSW (NSW Bureau of Crime Statistics and Research, 2017), but only 3% of the general community (Australian Bureau of Statistics, 2014). Ethnic minorities are similarly overrepresented in other jurisdictions, for example, the Maori people in New Zealand (New Zealand Department of Corrections, 2007). We feel that researchers have a responsibility to familiarize themselves with the demographics of the prison population they are sampling and ensure they approach research in a manner that is culturally competent and safe for vulnerable ethnic groups. Data collectors involved in the NPHS were required to complete Respecting the Difference; a cultural awareness training designed by Aboriginal people to effectively orient people working with Aboriginal men and women in the corrections system. Working with minority groups may also entail specific ethical considerations to avoid exploitation. In Australia, the National Health and Medical Research Council and the Aboriginal Health and Medical Research Council requires health-related projects to demonstrate appropriate engagement with relevant peak bodies and to ensure that research is owned and led by Aboriginal people in circumstances where Aboriginal people are likely to be overrepresented in the study’s sample. Similar stipulations may exist in other jurisdictions, and the onus is on researchers to ensure they fully comply with requirements. For our part, we have found opportunities to engage with Aboriginal partners on an equal footing to be an enriching and instructive experience that promises better outcomes for some of the most vulnerable in the corrections environment.

Conclusion

Throughout this article, we counsel a pragmatic approach which considers the fundamental issues associated with accessing the incarcerated population. Be realistic when assessing the time and resources needed to collect data and the conditions in which it is likely to be collected. Crucially, we encourage researchers to build productive relationships with organizations and individuals working within the corrections environment and to ensure that procedures are in place to ensure proper oversight and clear, appropriate feedback. Researchers should not simply rely on communication with organizational leaders to guarantee easy carriage of a research project, nor should they only rely on front-line staff. We strongly believe that research quality will benefit through the involvement of champions working at all levels of the corrections system.

Inmates represent a vulnerable population and, while more research examining their needs and experience is vital, this vulnerability must be weighed against the expected benefits of any particular research project. While research indicates that inmates are keen to participate in research and find the experience rewarding (Bosworth, Campbell, Demby, Ferranti, & Santos, 2005), it is important that rigorous and appropriate ethical practice is adhered to in research with inmates due to the vulnerable position they occupy. Prison-based researchers should never forget that inmates must live in a tightly controlled environment which prompts a degree of stress that will influence their decision making and interactions with others (Starcke & Brand, 2012). As such, researchers must avoid exploiting this power imbalance by ensuring they approach participants as partners in research. This is best accomplished by guaranteeing all aspects of a research project are communicated in simple, unambiguous, and meaningful manner.

While undertaking research in the corrections environment is by no means easy, it remains, for those who undertake it, an exceptionally rewarding experience. Our purpose in this article has not been to dissuade researchers from undertaking research by painting it as a futile. We have tried to frankly outline the challenges which we routinely encounter and to offer suggestions on how to overcome them or at least manage them with greater efficacy. Entering into research pragmatically, with a reasonable understanding of the challenges to be faced will, we feel, prepare researchers and enable them to successfully bring their projects to a conclusion.