Incarcerated adolescents in Washington state. Health services and utilization

Chlamydia and Gonorrhea Prevalence and Treatment in Detained Youths: Strategies for Improvement

PURPOSE

Adolescents and young adults have the highest prevalence of sexually transmitted infections (STIs), accounting for more than 50% of all reported infections. An especially high-risk group includes adolescents in juvenile or correctional facilities.

METHODS

This retrospective analysis was conducted at the only juvenile detention facility in the State of Hawai'i from 2014 to 2017. Adolescents aged 12-17 years were offered STI screening and/or presumptive treatment at the time of medical evaluation.

RESULTS

Of 2,208 adolescents offered voluntary testing, 461 males and 372 females agreed to be tested for Chlamydia trachomatis and Neisseria Gonorrhea. Acceptance did not vary by age; females chose testing more often than males (67.4% vs. 27.8%; p < .0001). Females were also more likely to accept presumptive treatment (22.8% vs. 8.8%; p < .0001). In tested youth, STIs were prevalent in 24% of females and 10% of males. Before leaving the detention facility, only half the STIs in females and only 39% of male STI infections had been treated.

CONCLUSIONS

There was a high prevalence of STIs in both males and females admitted to this juvenile detention facility, with fewer than half the documented infections being treated before discharge. This indicates a need for universal and timely testing to allow the treatment of those infected. If for whatever reason rapid testing cannot be obtained, presumptive treatment offers a pragmatic approach to treatment and infection control.

The health of adolescents in detention: a global scoping review

Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0–95%), substance use disorders (22–96%), self-harm (12–65%), neurodevelopmental disabilities (2–47%), infectious diseases (0–34%), and sexual and reproductive conditions (pregnant by age 19 years 20–37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people.

Varicella zoster virus transmission in youth during incarceration

Purpose - Facility-based Varicella zoster virus (VZV) transmission is reported in a Canadian youth offender correctional centre (YOCC). Transmission occurred from an immunocompetent youth offender (YO) with localized Herpes zoster to another immunocompetent single dose vaccinated YO, resulting in Varicella zoster (VZ) breakthrough disease. The purpose of this paper is to identify infection prevention and control (IPAC) measures utilized in this setting. Design/methodology/approach - A retrospective chart and immunization record review was conducted for two VZV cases and 27 exposed YO contacts in order to obtain demographic, clinical and immunization data. Descriptive data analysis was performed. Findings - All VZV cases and exposed contacts were male with an average age of 14.2 and 15.6 years for cases and contacts, respectively. Both cases shared the same living unit in the YOCC. There were 28 identified YO contacts, of whom 70 percent were single dose vaccinated with univalent vaccine, followed by 22 percent with a previous history of Varicella disease. All cases and contacts were born in Canada. No foreign-born populations were involved with this event. Infection control measures included additional precaution management, enhanced surveillance and environmental cleaning. As such, no hospitalizations or post-exposure immunizations were required. Originality/value - This report highlights the role that VZ breakthrough disease could play in fueling an outbreak in a high-risk environment without rapid recognition and implementation of preventative measures. It also underscores the importance of IPAC presence and public health immunization programs within correctional centers to avoid infectious disease threats.

Dental triage Hydebank Wood Prison and young offenders centre, Belfast

OBJECTIVE

The aim of this study was to devise and test a triage protocol to prioritise patients' dental needs in a prison environment. Secondary aims were to include in the triage process oral health promotion and information about accessing prison dental services. Also to work collaboratively with the prison staff to improve referrals to the dental services.

METHOD

The triage system was devised to have three strands: (1) an oral health assessment conducted by the dental nurse during the induction process for each new prisoner; (2) a simple oral health examination conducted in monthly screening clinics; (3) the prioritisation of referrals from prison landing staff using the prisons computer system PRISM. The triage was evaluated by assessing the first 100 patients' records with regard to the prioritisation of the triage category at the time of the clinical dental examination.

RESULTS

Of the 100 patients triaged 95% were prioritised into the correct triage category. Seventy-two percent of patients were seen in the appropriate timeframe. Referral patterns from prison landing staff were improved along with interdisciplinary working in the prison. All new prisoners were seen within 72 hours of committal and received oral health advice and information on accessing dental services.

CONCLUSION

This is the first triage system to be introduced into Hydebank Wood Prison, facilitating a targeted approach to dental care. It has improved access to the prison dental services; introduced oral health advice and information into the regular prison healthcare structure; and improved the efficiency of the clinical dental sessions. It is hoped to strategically address problems with waiting times and inequity in service utilisation.

Psychotropic medication patterns among youth in juvenile justice

This paper aims to determine the prevalence, patterns, and demographic and diagnostic correlates of psychotropic medication use in a sample of youth in one state's post-adjudicatory secure facilities. The health records database of the facilities was the source of linked demographic, diagnostic and pharmacy information for the 1-year period ending June 30, 2008. Age, gender, race, offense, prior petitions and diagnoses were examined across groups, and concomitant psychotropic pharmacotherapy patterns were identified. Period prevalence was 10.2% for youth ranging in age from 12 through 22 years who had any psychotropic drug prescribed during the first 30 days after intake to the facility. Among medicated youths, almost half received concomitant therapy. Medicated youth were significantly less likely to be Hispanic and more likely to endorse one or more diagnoses. Antidepressants, antipsychotics and antihistamines were the most commonly dispensed agents. Our findings revealed that the rate of psychotropic medication use was low, concomitant medication use was common, and ethnic/race differences in psychopharmacologic treatment were present in this sample of youths in post-adjudicatory secure facilities.

Health needs of Australian Indigenous young people entering detention

AIM

To determine whether there are different health needs associated with differences between Indigenous and non-Indigenous youth in detention in Brisbane, Queensland, Australia.

METHODS

All records of young people (aged 10 to 21 years) taken into detention in Brisbane Queensland over the period 1 July 2001 to 30 June 2009 were reviewed, and data were extracted documenting the mental health and related behaviours of those referred to the Mental Health, Alcohol, Tobacco and Other Drugs Service. International Statistical Classification of Diseases and Related Health Problems - Tenth Revision (ICD-10) criteria were applied to a clinical interview. ICD-10 diagnostic outcomes and reason for referral are presented by Indigenous status and age.

RESULTS

Young male (under 14 years of age) Indigenous respondents are substantially over-represented in youth in detention. Indigenous youth in detention are disproportionately referred and diagnosed with a substance use problem. Referral and diagnosis of substance use problems was not as commonly found for non-Indigenous youth.

CONCLUSIONS

Young Indigenous persons are substantially over-represented in those taken into detention in Queensland. This study shows significant differences in relation to mental health and substance use assessment outcomes for Indigenous and non-Indigenous young people in youth detention in Queensland. Further research focusing on service delivery for Indigenous young people should focus on their specific needs.

Predicting medication costs and usage: expenditures in a juvenile detention facility

This retrospective study examined prescription medication records for 1 year in a county-funded juvenile detention facility. Findings show that 7% of the detained youths were prescribed psychotherapeutic agents, which accounted for approximately 83% of the annual medication budget. Of the 799 male and 227 female detained youths, 14% of the males and 27% of the females were prescribed medications, with some prescribed as many as 23 different medications during their short-term stay. More than 93% of the total medication costs were accounted for by psychotherapeutic agents, antibiotics, and allergy/asthma medications at an average monthly cost of $46.50 per youth. Male youths who were prescribed medications cost $324 per month; their female counterparts cost $170 per month.

Reintegrating young offenders into the community through discharge planning: a review of interventions and needs of youth in secure care

The health status of young offenders is often poorer than similar aged non-offenders. Addressing young offender needs is a key priority for their rehabilitation and reintegration into the community. The objectives were to identify programs and interventions that assist detained youth through focussed discharge planning by a systematic review of the literature. In addition, this review examined the identified health needs of young offenders in secure care. Our systematic review searched electronic databases using the keyword terms youth, secure care, health assessment and primary health care. Keyword browser terms were also entered as search strings, and only literature from 1997 onwards was retained. Twenty-two pieces of published literature were retained, and these documented the needs and service utilisation of young offenders. Mental health problems and trauma exposure were commonly identified in the literature, as was general physical health deficits and social and familial problems. Retrieved articles also made recommendations for health assessments and discharge planning, and some provided discharge planning models. Young offenders have diverse needs that can be ascertained from quality assessment measures. Effective discharge planning is important to attend to ongoing health issues and aid rehabilitation and reintegration into the community. By administering a comprehensive multidimensional screening measure upon admission to secure care, individualised care plans can be formulated with discharge planning measures. Recommendations for further study include the development and implementation of a needs assessment tool in youth secure-care facilities that complements the existing assessments and helps reintegrate young offenders to primary health care and community services.

Immunization rates in a Canadian juvenile corrections facility

In Canada's judicial system there are more than 31,700 youths admitted to correctional services each year. Given the prevalence of documented medical problems and high-risk behavior in this population, it is important to assess the immunization status of adolescents admitted to juvenile detention facilities. We completed a chart review of all youth admitted to an adolescent custody facility in Kingston, Ontario, between January 2003 and October 2005. There were 234 admissions, representing a total of 148 youths between the ages of 12 and 17 years. Of the youths, 73% had incomplete immunizations according to National Advisory Committee on Immunizations. In all, 49% (73 of 148) were missing tetanus, diphtheria, and acellular pertussis immunizations; 33% (49 of 148), meningococcus; 2% (four of 148), measles, mumps, and rubella; and 37% (55 of 148), hepatitis B. Successful immunization delivery within the detention facility increased complete immunization rates from 27% to 65%. This study shows the prevalence of incomplete immunizations in this population of adolescents. Given this data, there should be a greater focus on obtaining immunization records and on consistently delivering immunizations.

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.

Female conduct disorder: health status in young adulthood

PURPOSE

One of the risk factors for poor adult health may be adolescent antisocial behavior, especially in girls. This study was conducted to determine if negative young adult health outcomes in girls who previously had adolescent antisocial behavior could be explained by demographic factors and pre-existing health problems.

METHODS

This 3-year longitudinal study recruited 93 girls, ages 15-17 years (52 with conduct disorder [CD]; 41 with no psychiatric illness [normal controls; NC]) from the community. Baseline interviews of girls and parents collected demographic, psychiatric, and medical history data. Three annual interviews collected data about medical problems, health care service utilization, and reproductive health. In addition, the final follow-up included a standardized self-report questionnaire about young adult health status.

RESULTS

CD and NC groups did not differ in age, racial composition, social class, proportion of smokers, or drug and alcohol experimentation. They were qualitatively different in baseline medical histories. Controlling for age at follow-up and baseline medical problems, the CD group as young adults had worse overall health, more discomfort, higher rates of unhealthy habits, lower rates of healthy behaviors, and more pregnancies at earlier ages. There were no group differences in rates of disorders, injuries, or health care usage.

CONCLUSIONS

Adolescent girls with CD as young adults have poorer overall health, more discomfort, more health risk behaviors, and earlier onset of adult reproductive behaviors, even when controlling for demographic factors and pre-existing health history. Clinical and research implications are discussed.

Women with antisocial behaviour: long-term health disability and help-seeking for emotional problems

BACKGROUND

Previous studies have reported that women who display antisocial behaviour (ASB) as adults or adolescents are at increased risk of poor mental and physical health, but have not tested effects of sociodemographics, or used only incarcerated samples.

AIMS

The authors sought first to test associations between ASB and emotional or physical health problems in non-incarcerated women, and second whether any such association could be explained by sociodemographic factors.

METHOD

The sample was 1218 mothers, aged 22-59, of boys randomly selected from grades 1, 4 and 7 (aged about 7, 10 and 13 respectively) in US urban public schools in 1987 and 1988. The 30% of boys designated most antisocial on initial examination and a 30% random sample of the remainder entered the longitudinal study. Demographics for the mothers, data on their lifetime ASB, help-seeking for emotional and/or physical health problems were collected at interview with them. A history of adolescent conduct problems and/or lifetime police contacts led to classification as antisocial for this study.

RESULTS

A total of 214 (17.6 %) of the mothers met our criteria for ASB. Compared with the women without such history, the women with ASB were younger, less well educated, of lower socioeconomic status, had a higher rate of unemployment and more of them were single mothers. They more often sought help for emotional problems and reported higher rates of long-term physical health problems, even when the effects of sociodemographic factors were taken into account.

CONCLUSIONS

Although the findings rule out many sociodemographic factors as simple explanations for the association between ASB and poor emotional and physical health, more work is needed on the nature and extent of such disorder, and of temporal relationships between the key events: poor health and ASB.

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.

Lack of recent condom use among detained adolescent males: a multilevel investigation

OBJECTIVE

To investigate multiple levels of influence with respect to the lack of recent condom use among a high risk sample of adolescent males recruited from short term detention facilities.

METHODS

A cross sectional survey of 231 adolescent males serving, predominantly, short term detention sentences. Assessments were conducted using audiocomputer assisted self interviewing. Condom use during the most recent sexual event was assessed as well as 20 potential correlates of not using condoms. Correlates were assessed within five levels of causation: personal, relational, peer affiliation, family, and societal.

RESULTS

Nine correlates achieved bivariate significance (p<0.05). Of these, the personal level correlates were particularly important in a multivariate model. The motivation subscale from the Condom Barriers Scale was the strongest multivariate correlate of recent condom use. Adolescents scoring below the median were about 3.4 times more likely to report lack of recent condom use (p=0.0006). Adolescents indicating they had ever caused a pregnancy were about 2.5 times more likely to report lack of condom use (p=0.02). Finally, those reporting their peers did not use condoms were about twice as likely to report lack of use (p=0.048).

CONCLUSION

Upon investigating multiple levels of potential influence on condom use, the multivariate findings suggest that personal level factors may be the most important determinant of non-use among adolescent males in short term detention facilities. Although structural changes may be needed to influence some forms of safer sex behaviour, direct intervention with adolescent males may be justified to favourably alter determinants of condom use.

Supporting psychosocial adaptation for the pregnant adolescent in corrections

This article addresses an aspect of adolescent healthcare that is often forgotten: pregnancy in correctional detention. Young women in corrections face unique problems socially, personally, and with their healthcare. Stress, environmental and legal restrictions, unhealthy lifestyle behaviors prior to pregnancy, and weakened or nonexistent social support systems are common among pregnant adolescents who are incarcerated. Nurses who strive to deliver perinatal care consistent with a feminist-based, gender-sensitive framework, in which pregnancy is considered a health state and rights to self-determination are preserved, are challenged when caring for girls in correctional settings. Assumptions about health and freedom of choice do not always apply to minors who are detained in correctional settings. Ensuring safety for pregnant adolescents within a correctional setting requires attention to issues of security and to issues of timely access to healthcare. There must be a balance between restricting movements because of security concerns and expanding movement privileges necessary to support essential healthcare and other support services. Nurses who care for adolescents in any setting should understand more about the multiplicity of issues surrounding healthcare and pregnancy for these adolescents, for these young women will interact with the healthcare system again in the future.

Healthcare for adolescents in juvenile facilities: increasing needs for adolescent females

In 1999, 2.4 million youth between the ages of 10 and 17 were arrested. On any given day that year, 133,000 juveniles were detained in long-term detention facilities. Since 1990, there has been a wide disparity in the number of minority youth in the juvenile justice system. In 1999, 41% of youth in this system were African American. Additionally, there has been growth in the percent of arrests of females (29% in 1999) and adolescents younger than 15 years of age (32%).

American Academy of Pediatrics: Health care for children and adolescents in the juvenile correctional care system

Over the past decade, there has been a dramatic increase in the population of juvenile offenders in the United States. Juveniles detained or confined in correctional care facilities have been shown to have numerous health problems. Such conditions may have existed before incarceration; may be closely associated with legal problems; may have resulted from parental neglect, mental health disorders, or physical, drug, or sexual abuse; or may develop within the institutional environment. Delinquent youths are often disenfranchised from traditional health care services in the community. For these adolescents, health care provided through correctional services may be their major source of health services. Pediatricians and correctional health care systems have an opportunity and responsibility to help improve the health of this underserved and vulnerable group of adolescents.

Changes in incarcerated adolescents' human immunodeficiency virus knowledge and selected behaviors from 1988 to 1996

Data were collected from juveniles in Alabama and Florida correctional facilities. The samples were closely demographically matched. Analysis indicated significant increases in knowledge about human immunodeficiency virus between 1988 and 1996 and increased sexual risk behaviors. Knowledge levels were lower for ethnic minority groups and boys, suggesting ethnic- and gender-specific pedagogical aids are needed.