Health issues for adolescents in the justice system

Youth Incarceration in Adult Facilities and Mental Health in Early Adulthood

PURPOSE

To examine the relationship between youth incarceration in adult correctional facilities and mental health in early adulthood.

METHODS

We analyzed nationally representative data from 1997 through 2019 (N = 8,961) using the National Longitudinal Survey of Youth 1997. An ordinary least squares regression model using inverse probability weights was used to assess the influence of youth incarceration in an adult facility on average mental health scores from age 18 to 37.

RESULTS

Respondents incarcerated in an adult facility as a youth had poorer average mental health than those not held in adult prisons or jails over the course of the study period. Those incarcerated for longer in adult facilities also exhibited more mental health symptoms.

DISCUSSION

Young people incarcerated in adult correctional facilities experience poorer long-term mental health related to depression and anxiety in early adulthood.

Contact with the juvenile justice system in children treated with stimulant medication for attention deficit hyperactivity disorder: a population study

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is the most frequent neurodevelopmental disorder in children and is sometimes noted retrospectively in young people and adults who are incarcerated. We aimed to investigate juvenile justice encounters in children with and without ADHD.

METHODS

Between January, 1995, and December, 2010, we did a population-based cohort study in Western Australia. Anonymised linked population data were obtained from the Western Australia Midwives Notification System. 12 831 non-Indigenous Australian children and young people aged 10-21 years, who were diagnosed and treated with stimulant drugs for ADHD and had a record in the Monitoring Drugs of Dependence System (ADHD cohort), were identified and frequency-matched by age, sex, and socioeconomic status to 29 722 non-Indigenous Australian children and young people who had no record in the Monitoring Drugs of Dependence System (controls). Community correction records and incarceration records were retrieved for all participants from Total Offending Management Solutions. Our primary outcome was to compare justice outcomes between children with ADHD and those without this disorder. We compared cohorts by conditional logistic regression analysis.

FINDINGS

9939 boys and 2892 girls were diagnosed and treated for ADHD; 22 875 boys and 6847 girls were frequency-matched controls. 792 (8%) boys and 75 (3%) girls with ADHD had a community correction record, compared with 822 (4%) boys and 75 (1%) girls without ADHD. 132 (1%) boys and 11 (<1%) girls with ADHD had an incarceration record, compared with 108 (<1%) boys and five (<1%) girls without ADHD. Compared with controls, boys with ADHD were two and half times more likely to have a community correction record (odds ratio 2·48, 95% CI 2·22-2·76) or an incarceration record (2·63, 2·01-3·44). Compared with their non-ADHD counterparts, girls with ADHD were nearly three times more likely to have a community correction record (odds ratio 2·86, 95% CI 2·03-4·03) and seven times more likely to have an incarceration record (7·27, 2·29-23·08). Boys with ADHD received their first community correction record at a younger age compared with controls (15·9 vs 16·3 years; p=0·0005), but age at first community correction record was similar for girls (16·5 vs 16·4 years; p=0·87). Burglaries and breaking and entering were the most common reason for a first justice record (total 659 [37%]), and this offence was twice as likely in children with ADHD (for boys, odds ratio 2·24, 95% CI 1·90-2·64; for girls, 2·19, 1·40-3·42).

INTERPRETATION

Justice outcomes for boys and girls were more frequent among children and young people treated for ADHD compared with their non-ADHD counterparts. Unlike girls, boys were more likely to offend at a younger age. Early diagnosis and management of children and young people with ADHD might reduce the over-representation of children with this disorder within the juvenile justice system.

FUNDING

National Health and Medical Research Council (Australia), Australian Research Council.

Forensic child and adolescent psychiatry: from field experiences to education standards

OBJECTIVE

Forensic evaluation of children is one of the most problematic areas of child and adolescent psychiatry. In this study we aimed to examine Turkish Child and adolescent psychiatrists' attitudes and problems in forensic psychiatry.

METHOD

Thirty nine (80%) of all practitioners who are on their compulsory medical service programme countrywide were reached and requested to complete a questionnaire.

RESULTS

76.9% of the specialists found their education to be inadequate in dealing with practical issues. The most common reason of this inadequacy was endorsed as not receiving structured forensic evaluation training. The inadequate number or skills of health professionals from other disciplines and excessive workload were the leading factors mentioned as negatively affecting the quality of assessments. Most favoured solutions to solve current problems were reported as reorganising the residency training and curriculum of child and adolescent psychiatrists and establishing education programmes for other disciplines.

CONCLUSION

The standardisation of forensic psychiatry education in child and adolescent psychiatry training and the establishment of global standards for forensic evaluation teams and processes should be considered as the first steps in enhancing the global quality of child and adolescent forensic psychiatric evaluations.

Childhood poverty and the social safety net

Childhood poverty in the USA remains an issue that concerns the child, the family, the community, each state, and the nation. It also is a topic that pediatricians must become cognizant of because of the impact it has on the children we care for daily. It goes beyond the specific income threshold that sets the federal poverty level; rather it impacts on the ability of families to acquire life's basic needs to allow their children the opportunity to reach their full potential. These basic needs include adequate nutrition to grow and develop in an optimal fashion and a secure and stable home in a safe neighborhood, which allows for play, exploration, and physical activity. It must also include access to health insurance coverage as well as a physician, health center, and health system to meet their medical needs. In addition, we must provide early education opportunities to nurture the social and emotional health of our children and prepare each child for school. The school environment must promote academic achievement and the broader community must foster opportunities to minimize violence and reduce the need for incarceration. The integration of such provisions represents a broadening and redefinition of the Social Safety Net that incorporates both public and private sector efforts to maximize the life potential of each child.

Caring for incarcerated youth

PURPOSE OF REVIEW

Incarcerated youth are an unusually high-risk cohort with numerous unmet medical and psychiatric needs. Frequently seen medical conditions including sexually transmitted diseases, pregnancy, and psychiatric illness are reviewed along with recommended standards of care for this population.

RECENT FINDINGS

The recent realization that two-thirds of juvenile detainees have a psychiatric disorder has sparked renewed interest in screening and treating these high-risk adolescents. The push for increased identification and treatment has been prompted by the hypothesis that treating illness reduces recidivism and therefore improves individual and community public health. Although many facilities perform psychiatric and medical health screening within 24 hours of detention, there are many lacking areas. Examples include limited sexually transmitted disease, HIV and pregnancy testing; given the high rates of asymptomatic sexually transmitted disease infection, universal screening is essential. Also, interpretation of psychiatric screening tools by untrained individuals and utilization of results to incriminate juveniles are other problem areas.

SUMMARY

Incarcerated adolescents' time in detention represents a rare opportunity to provide care to this underserved population. Full implementation of recommended screening and assessment protocols could greatly enhance individual as well as community health.

Vaccinating adolescents in high-risk settings: lessons learned from experiences with hepatitis B vaccine

Meeting the health needs of adolescents who live in high-risk settings such as homeless shelters, migrant camps, juvenile detention centers, prisons, and other types of residential facilities presents many challenges. Although there is no doubt that adolescents in many high-risk settings are at increased risk for hepatitis B and human papillomavirus, acute medical and psychological problems may consume all of the provider's time and resources. Potential health threats such as vaccine-preventable diseases must necessarily be given lower priority. Lack of vaccination expertise, supplies, and access to records further complicate delivery of vaccines. Since the 1990s, a number of approaches have been used to deliver hepatitis B vaccine to adolescents in many high-risk settings. Close collaboration among state and federal programs, local health departments, and community-based organizations has been necessary to introduce and sustain the delivery of vaccines to these young people. Medicaid, Statute 317 of the Public Health Service Act, the Vaccines for Children program, and State Children's Health Insurance Program have been used to finance vaccinations for adolescents 18 years or younger, and the expanded Medicaid option in the Foster Care Independence Act of 1999 has been used for adolescents older than 18 years of age. A number of states allow adolescents under age 18 to consent to their own hepatitis B vaccination under laws passed to allow treatment of sexually transmitted infections without parental consent. In this article, we present the experiences of several model programs that developed successful hepatitis B vaccination programs in venues that serve adolescents at risk, the important role of state laws and state agencies in funding immunization and other preventive health services for adolescents in high-risk situations, and discuss barriers and means to resolve them.

A national overview of reproductive health care services for girls in juvenile justice residential facilities

PURPOSE/RESEARCH QUESTIONS: Adolescent girls involved in the juvenile justice system face a substantially higher risk for a host of reproductive health problems. This study is the first national overview of the extent to which Juvenile Justice Residential Facilities (JJRFs) are meeting their reproductive health needs. The primary focus is whether all girls/young women receive gynecologic services.

METHODS

Data are from the 2004 Juvenile Residential Facility Census, an ongoing national institution-level data collection. Respondents include facility administrators and facility health care providers. Mixed-gender and girls-only facilities are included in these analyses (n = 1,255).

MAIN FINDINGS

Full population testing for pregnancy and sexually transmitted diseases occurs in <18% of all facilities. Although about 25% of all JJRFs report housing > or =1 pregnant teens, an equal number offers no obstetric services. Most JJRFs (about 85%) report that only some girls receive care from a gynecologist, largely "as necessary" and based on self-reports of sexual activity or suspected pregnancy. Provision of gynecologic services to all girls/young women is significantly more likely in all-female, state-owned, large population, and longer stay facilities and less likely in short stay, mixed-gender, crowded, and locally and privately owned facilities.

CONCLUSIONS

Results indicate that most facilities can garner a few necessary services. However, contrary to recommendations of national organizations, the services tend to be provided in an ad hoc manner rather than to the full population of young women. Results of multivariate models predicting facility types most likely to provide full population services should be useful as leaders in the area retarget their recommendations to address this gap in services.

Can juvenile justice detention facilities meet the call of the American Academy of Pediatrics and National Commission on Correctional Health Care? A national analysis of current practices

OBJECTIVE

Despite the recommendation of the American Academy of Pediatrics, just 53 of the approximately 3500 juvenile justice residential facilities in the United States have received voluntary accreditation for facility health care from the National Commission on Correctional Health Care. This suggests either that facilities do not meet the standards of care or do not seek accreditation. This study describes whether and under what conditions juvenile detention facilities (a narrowly defined subset of all facility types) adhere to some of the standards outlined by the National Commission on Correctional Health Care and promoted by the American Academy of Pediatrics.

METHODS

Data from 2 national censuses of juvenile justice residential facilities (n = 726) were used to describe detention facility performance in terms of 10 types of service provision, ranging from health screening to communicable-disease testing. Multivariate models predicting high levels of service provision were estimated.

RESULTS

Juvenile detention centers partially meet some of the minimum standards. Most services can be garnered at some level; however, they tend to be provided on an ad hoc basis for portions of the population rather than systematically for the whole population. Detention centers most likely to provide a higher tier of services tend to be those that have longer average lengths of stay, are larger, and are government owned. There are also geographic and racial differences in quality and scope of health services.

CONCLUSIONS

Juvenile facilities have been provided a single set of standards for a diverse system with tremendous variation across and within facility types. Detention centers are just one specialized type. Very few detention centers meet a minimum standard of care, which suggests that standards are simply not being met (hence the low levels of accreditation). The findings of this study call into question whether detention facilities with little in the way of health care infrastructure can benefit from National Commission on Correctional Health Care standards as they are currently packaged, regardless of whether accreditation is the ultimate goal.

Adolescent detainees in an adult prison in Geneva

Despite the Convention on the Rights of the Child, some adolescents are still detained in adult prisons in Europe. Little is known about their health status. This cross-sectional study of 67 teenagers detained in an adult prison in Switzerland shows that morbidity in this group is high.

CONCLUSION

These results highlight the need for developmentally appropriate health services for teenagers in adult prisons. The long-term implications of detention of adolescents in adult detention facilities also need to be discussed.

Detecting mental disorder in juvenile detainees: who receives services

OBJECTIVES

We determined whether or not juvenile detainees with major mental disorders received treatment, and the variables that predicted who received services.

METHODS

Our sample was 1829 randomly selected juvenile detainees taking part in the Northwestern Juvenile Project. To determine need for mental health services, independent interviewers administered the Diagnostic Interview Schedule for Children and rated functional impairment using the Child Global Assessment Scale. Records on service provision were obtained from the juvenile justice and public health systems.

RESULTS

Among detainees who had major mental disorders and associated functional impairments, 15.4% received treatment in the detention center and 8.1% received treatment in the community by the time of case disposition or 6 months, whichever came first. Significantly more girls than boys were detected and treated. Receiving treatment was predicted by clinical variables (having a major mental disorder or reported treatment history or suicidal behavior) and demographic variables.

CONCLUSIONS

The challenge to public health is to provide accessible, innovative, and effective treatments to juvenile detainees, a population that is often beyond the reach of traditional services.

REENTRY OF YOUNG OFFENDERS FROM THE JUSTICE SYSTEM: A Developmental Perspective

This article presents a developmental perspective on the reentry of young offenders into the community. We begin with a discussion of the psychosocial tasks of late adolescence. Next, we discuss contextual influences on the successful negotiation of these psychosocial tasks. Third, we examine whether and to what extent the contexts to which young offenders are exposed in the justice system are likely to facilitate normative psychosocial development. Finally, we argue that the psychosocial development of youthful offenders is disrupted, or "arrested," by their experiences within the justice system. Interventions designed to facilitate the successful reentry of young offenders into the community must be informed by what we know about healthy psychosocial development in late adolescence.