A study authorized by Congress and released in 1994 found that the annual admissions to juvenile correctional institutions reached 690,000. The facilities were classified as short-term including awaiting placement, reception or detention centers and long-term that included training schools and ranches. According to the report, juveniles spent an average of 32 weeks in long-term facilities in 1990. In 1997, 368 juveniles per 100,000 in the population were in custody, and in the same year juvenile residential facilities housed 105,790 delinquent juveniles. There is a high rate of recidivism in juvenile correctional facilities. Approximately forty percent of adolescents who appear in court are repeat offenders. Repeat offenders are more likely to commit serious crimes than first time offenders.
Although most juveniles (eighty-six percent) held in custody are males, in 1997 approximately twenty-six percent of juveniles arrested were females. Half of the females in custody were non-Hispanic whites. African American and Hispanic juveniles accounted for about sixty percent of juveniles held in custody although their representation in the U.S. general population was far less. Racial prejudices or socioeconomic factors may explain why youth of color are over represented in juvenile correctional facilities.
Studies have shown that up to twenty-three percent of incarcerated youth have serious health problems, one third had no regular source of health care and fifty percent had no follow up for their medical needs. In addition, adolescents who are incarcerated may be at higher risk for certain health problems. Sexually transmitted infections are more likely in teenage detainees than those teens in the general population. Detainee risks include earlier onset of sexual activity and an increased likelihood of drug abuse. For juvenile detainees, the median age of first sexual intercourse was thirteen years, the median number of sex partners was eight and sixty-three percent did not regularly use a condom. Up to fifteen percent of male adolescent detainees had one sexually transmitted infection in one study and about one third of male detainees had a history of or current sexually transmitted infection. In another study thirty-three percent of incarcerated adolescent females had positive tests for chlamydia or gonorrhea.
There are few instances of HIV infection in adolescent detainees although at least sixty cases have been reported. Juvenile detainees, however, are at high risk for HIV due to multiple risky behaviors.
Juveniles in custody also may present with a broad spectrum of mental health problems. In various studies between twenty percent and sixty percent of adolescents in custody could be diagnosed as having a conduct disorder. Up to ½ of detainees could be diagnosed with Attention Deficit Disorder. Affective disorders could be seen between thirty-two percent and seventy-eight percent of incarcerated teens, and psychosis was estimated to be present in one percent to six percent of these adolescents. Many suffered from posttraumatic stress disorder.
Teens who are in custody are much more likely also to have a history of physical or emotional abuse. It is estimated that between twenty-five percent and thirty-one percent of teens in custody have been abused or neglected. For those juveniles committed due to drug use or drug distribution crimes, there is a high rate of drug abuse. There is also a higher chance that detainees have a history of illicit drug use. Up to fifty-eight percent of adolescents arrested or in detention in 1995 had a positive drug screen.
During incarceration, adolescents may acquire health problems. In one study, about sixty percent of males and thirty-five percent of females required care for an injury that was acquired during custody. Although most of these injuries occurred during recreation, about twenty percent happened during fighting. Some injuries were self-inflicted. There is a high rate of suicide or suicide attempts while in custody especially for those juveniles held in adult jails or lockups or for those teens that have a history of mental illness. Teens may be victims of sexual violence that is perpetrated by other detainees or staff. Other medical complaints include skin issues, menstrual disorders and contagious diseases.
The availability of healthcare services varies widely between localities and systems. Many detained adolescents have not had comprehensive medical services and are more likely to have a chronic medical condition. Juvenile detention centers should offer an initial screening within one hour of the detainee’s admission, a complete health evaluation should be done within seven days of the teen’s arrival and an orientation to health services should be given. Sick call, emergency services as well as routine immunizations and testing should be available also.
In April 2001, the American Academy of Pediatrics issued recommendations regarding the care of adolescents who are incarcerated. Some of these recommendations include the following:
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Incarcerated adolescents should receive healthcare services at least equivalent to those in the community.
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Comprehensive preventive adolescent health services should be provided during the incarceration.
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Pregnancy care as well as treatment for substance abuse including tobacco usage should be provided to incarcerated males and females.
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Adolescents should not be housed with adult detainees and they should have staff trained to deal with the special needs of adolescents.
Tax monies usually support juvenile detention facilities. As a result, the facility budgets may be constrained by financial pressures since funding of offender care programs usually receive less priority than other programs and medical decision-making may be affected. As a result, cost containment strategies including the amount of medical, nursing and mental health coverage can be far less than optimal for the needs of adolescents. Referrals to outside consultants as well as diagnostic testing and treatments may also be limited. Appropriate medications and special diets may also be unavailable or available only with difficulty in certain adolescent detention centers. For those adolescents who have chronic medical problems, care by their specialists may not be available due to policy, limited funding or location of the facility.
Issues of medical confidentiality occur in juvenile correctional facilities. Although medical information should be confidential and not available to correctional authorities, confidentiality may not always occur.
The teen’s release from a detention center will obviate many of these healthcare delivery issues. But parents, physicians, legal aid organizations and other interested individuals may need to advocate for detained adolescents. Significant improvements in the care given to adult inmates have occurred either through individual litigations or through class actions during the past few decades. And working with state legislatures as well as professional organizations including the American Academy of Pediatrics and the Society for Adolescent Medicine may help remedy some of the ills in juvenile correctional centers.
Related topics:
AIDS, alcohol, attention deficit disorder, child abuse and domestic violence, chronic illness, confidentiality, delinquency, learning disorders, medical decision-making, personality disorders, posttraumatic stress disorder, sexually transmitted diseases, suicide, violence and aggression
