Advocacy and Collaborative Health Care for Justice-Involved Youth

Prevalent Adverse Childhood Experiences Among Young Adults Returning Home From Jail: The Need for Trauma-Informed Reentry Services

Prevalence of adverse childhood experiences (ACEs) and the extent to which they relate to health among young adults (ages 18-25) returning home from jail is underexamined. To build on the growing literature examining associations between ACE exposure among young people involved with carceral systems and health, we (1) measured ACE prevalence and (2) explored associations between ACEs and health/well-being indicators among young adults experiencing reentry. Using a telephone survey on reentry experiences, participants completed an ACE screening, single-item responses on health and social indicators, and five-item responses on substance misuse. Fisher's exact tests and t tests compared sociodemographic and health-related factors by the levels of ACEs. Among the 85 participants, 66 (78%) reported four or more ACEs and 48 (56%) reported six or more ACEs, including divorced parents (n = 69, 81%), witnessing violence (n = 63, 74%), and household member incarceration (n = 60, 71%). Higher exposure to ACEs was associated with mental health diagnoses, psychiatric medication prescriptions, psychiatric hospitalizations, drug dependence, binge drinking, and cannabis misuse. High ACE exposure among young adults experiencing reentry portends worse mental health and high rates of substance use. Findings signify an opportunity to apply a trauma-focused developmental framework to support emerging adults during the crucial reentry period.

Pediatric Health and System Impacts of Mass Incarceration, 2009-2020: A Matched Cohort Study

OBJECTIVE

The US has the highest incarceration rate in the world; incarceration's direct and indirect toll on the health and health care use of youth is rarely investigated. We sought to compare the health of youth with known personal or family justice involvement and a matched cohort of youth without known personal/family justice involvement.

METHODS

A cross-sectional matched parallel cohort study was conducted. We queried electronic health records on youth (<21 years) with a visit in a large Midwestern pediatric hospital-based institution from January 2009 to December 2020. Youth were located by searching for justice-related (eg, prison, jail) keywords within all clinician notes. Health diagnostic profiles were measured using ICD 9/10 codes. Health care use included total admissions, inpatient days, emergent and urgent visits, and outpatient visits.

RESULTS

Across all youth at one institution over an 11-year period, 2.2% (N = 38,263) were identified as having probable personal or family justice-involvement. Youth with personal or familial justice involvement had 1.5-16.2 times the prevalence of mental health and physical health diagnoses across all domain groupings compared to a matched sample and the total population sample. From 2009-2020, approximately two-thirds of behavioral health care and nearly a quarter of all hospital inpatient days were attributed to the 2.2% of youth with probable personal or familial justice system involvement.

CONCLUSION

The study illuminates the vast disparities between youth with indirect or direct contact with the criminal legal system and matched youth with no documented contact. Better investment in monitoring and prevention efforts are needed.

Justice-Involved Youth: Support for Community and Family Interventions

Justice-involved youth have high rates of mental health symptoms and diagnoses. Unaddressed mental health needs are associated with exposure to adversity and trauma, as well as unidentified or mislabeled symptoms that may be present early in life. Justice-involved youth disproportionately come from low-income families and minoritized populations. Community-based interventions that address family and community factors associated with justice involvement are key to improving mental health and life trajectory outcomes for youth. Policies and interventions that address unmet educational needs, support families, and promote early identification of youth in need of social, educational, and mental health services are reviewed.

School Suspension and Expulsion: Policy Statement

Exclusionary school discipline practices-ie, suspension and expulsion-represent some of the most severe consequences a school district can implement for unacceptable student behavior. Suspension and expulsion were traditionally used for student behaviors that caused serious harm, such as bringing a weapon to school. Currently, the most common indications for exclusionary school discipline are for behaviors that are neither violent nor criminal. There is little evidence that exclusionary school discipline practices make schools safer or deter future misbehavior. American Indian/Alaska Native students, Black students, students whose caregivers have low socioeconomic status, male students, lesbian, gay, bisexual, transgender, and queer or questioning students, and students with disabilities are disproportionately disciplined with suspension and expulsion. In addition, exclusionary school discipline in the preschool period can be harmful to early childhood development. Children and adolescents affected by exclusionary school discipline are at higher risk for dropping out of high school and for involvement with the juvenile justice system. Both of those experiences are associated with a worse profile of physical and mental health outcomes. A multidisciplinary and trauma-informed approach to reducing exclusionary school discipline practices is described. Recommendations are provided at both the practice level for pediatric health care providers and at the systems level for both pediatric health care providers and educators.

Piloting a Virtual Yoga and Mindfulness Program for Juvenile Court Involved Youth

Juvenile court-involved youth (JCIY) face unique psychosocial challenges, with a higher prevalence of mental health concerns and substance use disorders. The COVID-19 pandemic intensified these challenges, prompting a need for interventions that address trauma and discrimination experienced by this vulnerable population that could be delivered virtually during the pandemic. This study describes implementation and evaluation of a Raja yoga and mindfulness program among JCIY, with particular attention to barriers and facilitators to participation to inform next steps in this work. The nine-session program aimed to promote mindfulness practices, build coping skills, and address elements of JCIY's emotional health and well-being. Despite challenges in participant retention, participants expressed intent to use skills they learned in the future. Challenges related to implementation included technological barriers, staff turnover, and competing responsibilities; abrupt closure of the county juvenile detention center further strained resources. Successes included providing real-time resources during the early pandemic stages and building relationships between program facilitators and juvenile court staff. Involving youth and court personnel in program design and evaluation, adopting implementation science approaches to refine program delivery, and developing tailored support systems for JCIY are among the key lessons learned. Given the many structural inequities that make JCIY more vulnerable to poor health outcomes, insights may inform broader efforts to improve receipt of relevant services and programs to enhance their well-being, including use of virtual modalities.

Childhood Behind Bars: Children and the US Juvenile Legal System

This article examines the epidemiology of the US juvenile legal system, which disproportionately impacts youth with multiple marginalized identities and exacerbates health inequities. Policy changes that can improve the treatment of children who display disruptive behavior are highlighted, so as to lay out a path forward for supporting children and enhancing health equity while bolstering public safety. Finally, this article concludes that the systemic racism pervasive in the juvenile legal system signals an important role for pediatrics to advance racial equity and transform our approach to childhood.

Confidentiality in the Care of Adolescents: Policy Statement

Confidentiality is an essential component of high-quality health care for adolescents and young adults and can have an impact on the health care experiences and health outcomes of youth. Federal and state laws, professional guidelines, and ethical standards provide a core framework for guidance in the implementation of confidentiality protections in clinical practice. This policy statement provides recommendations for pediatricians and other pediatric health care professionals, clinics, health systems, payers, and electronic health record developers to optimize confidentiality practices and protections for adolescents and young adults across the spectrum of care.

Screening for Chlamydia and Gonorrhea in Youth Correctional Facilities, Utah, USA

We reviewed data obtained in October 2021-May 2023 from youth who reported a history of sexual activity upon admission to 1 of 12 juvenile justice facilities in Utah, USA, that offered screening for Chlamydia trachomatis and Neisseria gonorrhoeae. Urinalysis revealed C. trachomatis positivity of 10.77%, N. gonorrhoeae positivity of 1.08%, and coinfection C. trachomatis N. gonorrhoeae) of 0.90%. Prevalence of infection was similar for youths in rural and urban facilities. A total of 12.01% of those identifying as male and 14.01% of those identifying as female tested positive for C. trachomatis, N. gonorrhoeae, or coinfection. Of young adults who tested positive, 74.65% received their results while incarcerated, all of whom accepted treatment. Our research underscores the feasibility of providing prompt C. trachomatis/N. gonorrhoeae screening and treatment in juvenile correctional facilities. The pervasiveness of infection emphasizes the urgent need for early identification and treatment for C. trachomatis and N. gonorrhoeae in incarcerated youth nationwide.

Policy solutions to eliminate racial and ethnic child health disparities in the USA

Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.

Parents' Adverse and Positive Childhood Experiences and Offspring Involvement With the Criminal Legal System

Importance

Intergenerational cycles of adversity likely increase one's risk of criminal legal system involvement, yet associations with potential contributors, such as parents' adverse childhood experiences (ACEs) and positive childhood experiences (PCEs), have not been explored.

Objective

To investigate the association of parents' ACEs and PCEs with their adult children's involvement in US legal systems, from arrest to conviction.

Design, Setting, and Participants

The study team analyzed data from the Panel Study of Income Dynamics (PSID), a nationally representative cohort study of families in the US. PSID-2013 survey data were merged with the 2014 PSID Childhood Retrospective Circumstances Study (CRCS), collected May 2014 to January 2015, which asked adults aged 18 to 97 years to retrospectively report on their childhood experiences. Parents and their adult children were linked in the data set. Data were analyzed from October 2022 to September 2023.

Main Outcomes and Measures

The child arrest outcome was regressed on parents' ACE and PCE scores using logistic regression models. In addition, multinomial logistic regression models were used to assess the associations of parents' ACE and PCE scores with the number of times their child was arrested and convicted.

Results

Of 12 985 eligible individuals, 8072 completed the CRCS. Among CRCS participants, there were 1854 eligible parent-child dyads (ie, parents and their adult children) that formed the analytic sample. The mean (SD) age of offspring at the time of CRCS completion was 38.5 (10.9) years, and 1076 offspring (51.3%) were female. Having 4 or more parental ACEs was associated with 1.91-fold (95% CI, 1.14-3.22) higher adjusted odds of arrest before age 26 and 3.22-fold (95% CI, 1.62-6.40) higher adjusted odds of conviction before age 26 years, compared with children of parents without ACEs. These associations persisted after controlling for parental PCEs.

Conclusions and Relevance

In this nationally representative study, children of parents with higher ACEs were at greater risk of arrest during adolescence and young adulthood, even after controlling for parents' PCEs. Addressing and preventing childhood adversity through multigenerational life course approaches may help disrupt intergenerational pathways to the criminal legal system.

Systems-Involved Transgender and Gender-Diverse Youth: Homelessness, Juvenile Legal Systems, and Child Welfare and Foster Care

Transgender and gender-diverse (TGD) youth are overrepresented in legal and social support systems intended to protect and support youth along their developmental journeys. However, these systems often fall short for TGD youth and further stigmatize an already vulnerable population. This article provides an overview of the experience, care, and treatment of systems-involved TGD youth. Working with systems-involved transgender and gender-diverse youth necessitates a high level of compassion and advocacy in pursuit of more equitable care and access.

United States Youth Arrest and Health Across the Life Course: A Nationally Representative Longitudinal Study

BACKGROUND

Youth are arrested at high rates in the United States; however, long-term health effects of arrest remain unmeasured. We sought to describe the sociodemographic characteristics and health of adults who were arrested at various ages among a nationally representative sample.

METHODS

Using the National Longitudinal Study of Adolescent to Adult Health, we describe sociodemographics and health status in adolescence (Wave I, ages 12-21) and adulthood (Wave V, ages 32-42) for people first arrested at age younger than 14 years, 14 to 17 years, and 18 to 24 years, compared to never arrested adults. Health measures included physical health (general health, mobility/functional limitations, death), mental health (depressive symptoms, suicidal thoughts), and clinical biomarkers (hypertension, diabetes). We estimate associations between age of first arrest and health using covariate adjusted regressions.

RESULTS

Among the sample of 10,641 adults, 28.5% had experienced arrest before age 25. Individuals first arrested as children (ie, age <14) were disproportionately Black, compared to White. Compared to individuals never arrested, people arrested before age 25 had more depressive symptoms and higher rates of suicidal thoughts during adolescence. Arrest before age 25 was associated with worse self-reported health, higher rates of functional limitations, more depressive symptoms, and greater mortality by adulthood (ages 32-42).

CONCLUSIONS

Arrest before age 25 was associated with worse physical and mental health--and even death in adulthood. Child arrest was disproportionately experienced by Black children. Reducing arrests of youth may be associated with improved health across the life course, particularly among Black youth, thereby promoting health equity.

Structural Racism in Behavioral Health Presentation and Management

Nia is a first-grade student with a history of trauma who was brought in by ambulance to the pediatric emergency department for "out of control behavior" at school. This is the first of multiple presentations to the emergency department for psychiatric evaluation, stabilization, and management throughout her elementary and middle school years. Several of the visits resulted in admission to the inpatient pediatric service, where she "boarded" while awaiting transfer to an inpatient psychiatric facility. At times, clinical teams used involuntary emergency medications and physical restraints, as well as hospital security presence at the bedside, to control Nia's behavior. Nia is Black and her story is a case study of how structural racism manifests for an individual child. Her story highlights the impact of adultification bias and the propensity to mislabel Black youth with diagnoses characterized by fixed patterns of negative behaviors, as opposed to recognizing normative reactions to trauma or other adverse childhood experiences-in Nia's case, poverty, domestic violence, and Child Protective Services involvement. In telling Nia's story, we (1) define racism and discuss the interplay of structural, institutional, and interpersonal racism in the health care, education, and judicial systems; (2) highlight the impact of adultification bias on Black youth; (3) delineate racial disparities in behavioral health diagnosis and management, school discipline and exclusion, and health care's contributions to the school-to-prison pipeline; and finally (4) propose action steps to mitigate the impact of racism on pediatric mental health and health care.

Risk profiles of suicide attempts among girls with histories of commercial sexual exploitation: A latent class analysis

BACKGROUND

Girls impacted by commercial sexual exploitation (CSE) in the juvenile legal system are three times more likely to have suicide attempts than girls without histories of exploitation. Yet, research on risk profiles and correlates that contribute to elevated suicide risk among girls with CSE histories remains scant.

OBJECTIVE

We sought to examine suicide attempts profiles among CSE-impacted girls in the juvenile legal system.

PARTICIPANTS AND SETTING

We partnered with a specialty court for CSE-impacted youth in Los Angeles County.

METHODS

Data were collected from case files of the 360 girls participating in the court from 2012 to 2016. Latent class analysis was used to identify their profiles of risk indicators.

RESULTS

Four risk profiles for suicide attempts emerged: (1) Parental Incarceration (PI; 30 %), (2) Child Welfare Contact (CWC; 25 %), (3) Disruptive Behavior and Sleep Problems (DBS; 25 %), and (4) Pervasive Risk (PR; 22 %). Among youth in the PI group, 5 % had a suicide attempt; however, contrary to our hypothesis, no youth in the CWC group had a suicide attempt. Rates of suicide attempt were significantly higher among youth in the DBS group, as 14 % had a suicide attempt. As hypothesized, youth in the PR were associated with higher risk of suicide attempts, with 28 % reporting a prior suicide attempt.

CONCLUSIONS

Findings underscore the need for standardized suicide screenings and treatment referrals for girls with CSE histories and suggest an important opportunity for multidisciplinary collaboration with courts to improve suicide prevention strategies. The present study also supports the importance of examining risk across the socioecological context.

Public Health Measures and SARS-CoV-2 Cases in the Juvenile Justice System: Implications for Pandemic Response in the Detention Setting

OBJECTIVE

The purpose of this study was to examine severe acute respiratory syndrome-coronavirus-2 case positivity in juvenile justice facilities of two different states alongside institutional, local, and state public health policies during the first 6 months of the coronavirus disease 2019 pandemic.

METHODS

This retrospective chart review examined two large, urban juvenile justice centers in California and Texas. Positive intake or day 12 tests were considered suggestive of community-acquired severe acute respiratory syndrome-coronavirus-2 infection. Researchers examined state and county restrictions, closings, and openings. The study included all of the youths 10 to 18 years residing in the facilities between March and August 2020. The main outcomes measured case positivity in each facility and compared it with community positivity rates and state public health measures.

RESULTS

In total, 530 youth were included (Texas, n = 319; California, n = 211). The Texas facility reported a higher number of positive cases (24) versus the California facility (3) (P < 0.05). Of the positive youth, 70% were asymptomatic, and none required hospitalization. Intake and day 12 tests were positive in <1% of California youth compared with a rate of 4% in Texas (P < 0.05). California and Texas instituted mask mandates in May and July 2020, respectively. California restricted indoor capacity until August, but Texas varied from 25% to 75% capacity through July.

CONCLUSIONS

The Texas facility reported a higher percentage of community-acquired infections compared with California, coinciding with reopening measures in Texas. Texas also enacted a mask mandate later than California. These public health measures, among other factors, likely contributed to higher community rates in Texas, thereby affecting rates among the detained youth.

The Hospitalized Adolescent

This clinical report provides pediatricians evidence-based information on the developmentally appropriate, comprehensive clinical care for hospitalized adolescents. Included in this report are opportunities and challenges facing pediatricians when caring for specific hospitalized adolescent populations. The companion policy statement, “The Hospitalized Adolescent,” includes detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital setting and design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.

Juvenile confinement exacerbates adversity burden: A neurobiological impetus for decarceration

Every year, about 700,000 youth arrests occur in the United States, creating significant neurodevelopmental strain; this is especially concerning as most of these youth have early life adversity exposures that may alter brain development. Males, Black, and Latinx youth, and individuals from low socioeconomic status households have disproportionate contact with the juvenile justice system (JJS). Youth confined in the JJS are frequently exposed to threat and abuse, in addition to separation from family and other social supports. Youths’ educational and exploratory behaviors and activities are substantially restricted, and youth are confined to sterile environments that often lack sufficient enrichment resources. In addition to their demonstrated ineffectiveness in preventing future delinquent behaviors, high recidivism rates, and costs, juvenile conditions of confinement likely exacerbate youths’ adversity burden and neurodevelopmentally harm youth during the temporally sensitive window of adolescence. Developmentally appropriate methods that capitalize on adolescents’ unique rehabilitative potential should be instated through interventions that minimize confinement. Such changes would require joint advocacy from the pediatric and behavioral health care communities. “The distinct nature of children, their initial dependent, and developmental state, their unique human potential as well as their vulnerability, all demand the need for more, rather than less, legal and other protection from all forms of violence (United Nations Committee on the Rights of the Child, 2007).”

Trends in the Diversity of Pediatric Faculty: 2000 to 2020

OBJECTIVE

Academic medicine diversity is important for addressing health disparities and training the next generation. A recent study highlighted the lack of diversity among pediatric trainees over time. However, trends in US pediatric faculty diversity have not been clearly illuminated. The aim of this study is to evaluate pediatric faculty diversity trends and compare racial/ethnic representation between pediatric faculty and the US population.

METHODS

Repeat cross-sectional study of the Association of American Medical Colleges Faculty Roster of pediatric faculty from 2000 to 2020. Trends in sex, race, ethnicity, and rank were compared with the Cochran-Armitage test. Data on faculty race/ethnicity were compared with the general and child population by using US Census Bureau data.

RESULTS

Trends in underrepresented in medicine (URiM) faculty representation significantly increased at all ranks: professor (+3.5%, P < .0001), associate professor (+3.0%, P = .0001), and assistant professor (+2.5%, P = .0001). URiM male representation remained unchanged (P = .14), whereas significantly increased trends occurred in URiM female representation (+3.4%, P < .0001). African American/Black males significantly decreased representation at associate (-0.4%, P = .04) and assistant professor levels (-0.6%, P < .0001), and American Indian/Alaska Native males significantly decreased representation at the assistant professor rank (-0.1%, P < .0001). The percentage of URiM pediatric faculty representation was considerably lower compared with 2020 US overall and longitudinal child population representation.

CONCLUSION

The stagnation of URiM male representation and lack of faculty diversity reflective of the US population may have a critical impact on the ability to recruit/retain a diverse pediatric workforce and promote equitable care.

Caring for Children in the Juvenile Justice System: A Trauma and Surgical Subspecialty-Focused Approach

INTRODUCTION

Youth in the juvenile justice system are a vulnerable, high-risk population. While the role of pediatricians and mental health professionals in providing care for these children is well studied, the surgical needs of this population are not well understood. We sought to characterize the physical trauma and surgical subspecialty needs of this population.

METHODS

A retrospective chart review was performed of all children transported under custody to a stand-alone urban children's hospital. Demographic information and inpatient and outpatient encounter data were collected and analyzed.

RESULTS

Between January 2020 and March 2021, 74 patients were transported for 199 subspecialty evaluations. Sixty-nine (93%) were male, 66 (89%) identified as Black, and the median age was 16 y (range, 13-20). Of all patients, 19% had at least one documented medical condition, 43% had behavioral health history, and 73% had previous arrest. Of the 199 encounters, 137 were for physical trauma (65%). Of these, 47 (34%) were for physical trauma incurred at the time of their arrest. Sixty-three patients (85%) experienced previous physical trauma (69% blunt, 12% penetrating, and 7% both), 54% had documented head trauma, 23% had a history of self-harm, and 60% of girls had experienced sexual trauma. Of the 54 children with a previous arrest, 91% had a history of physical trauma compared to 70% who were not previously incarcerated (P = 0.03).

CONCLUSIONS

Most subspecialty and emergency encounters for incarcerated children are for physical trauma, revealing an opportunity for trauma-focused care in this vulnerable population. Pediatric surgeons and emergency physicians play a major role in the care of incarcerated children.

Exploring the Link Between Neighborhood Violence and Health Among African-American and Latinx Youth Returning Home After Incarceration

Background

African-American and Latinx youth are disproportionately exposed to neighborhood violence and are overrepresented in the U.S. juvenile justice system. Perceived neighborhood violence is associated with negative health outcomes.

Objective

We examined associations between African-American and Latinx youths’ perceived neighborhood violence and health during reentry after juvenile incarceration.

Methods

Youth (n = 50) returning home after incarceration completed health questionnaires at one-month post-incarceration. A subset of participants (n = 25 youth) also participated in one-on-one, semi-structured longitudinal interviews.

Results

Twenty-eight (56%) participants reported neighborhood violence in quantitative surveys. Quantitative analyses revealed that perceived neighborhood violence was positively associated with reported asthma diagnosis, doctor recommendations for medical follow-up, perceived stress, and adverse childhood experiences (ACEs). Perceived neighborhood violence was negatively correlated with perceived family support. Stress ratings were associated with ACE total scores, moderate to severe depression symptoms, and family support. Moderate-to-severe depression symptoms were significantly correlated with lower ratings of family support. Qualitative interviews supplemented our quantitative findings and showed that responses to perceived neighborhood violence were linked to specific health-related behaviors, such as substance use or avoidance of gang activity.

Conclusions

Overall, our quantitative and qualitative results indicate that perceived neighborhood violence is associated with many negative psychosocial factors that could impact overall health and wellbeing of youth undergoing reentry. Treatment implications include the development and testing of family-centered interventions that help improve the transition back into the community for youth undergoing reentry and especially, their access to evidence-based treatment, including leveraging family telehealth substance use interventions.

Vaccination for Justice-Involved Youth

Justice-involved youth are at increased risk for coronavirus disease 2019 (COVID-19) infection, and structural barriers may limit their access to vaccination. We implemented a COVID-19 vaccination initiative for justice-involved youth residing at the county juvenile detention center and enrolled in local community-based monitoring programs. Our overarching goal was to increase COVID-19 vaccine access and uptake for justice-involved youth in Allegheny County, Pennsylvania. Our efforts incorporated: a virtual forum with youth, guardians, and community partners; one-on-one outreach to guardians; motivational interviewing with youth; and coordination with organizational leaders. We collaborated with a multidisciplinary medical team to offer individualized education and counseling to parents and youth expressing vaccine hesitancy. We developed a logistical framework to ensure complete COVID-19 vaccination series for all youth, including centralized tracking and implementation of multiple community-based vaccine clinics. Through our initiative, 31 justice-involved youth have received at least 1 dose of the Pfizer-BioNTech COVID-19 vaccine. A total of 50 doses have been administered as a result of this initiative. This work has reaffirmed hypothesized barriers to vaccine access among justice-involved youth, including limited parental involvement, inadequate transportation, vaccine misinformation, and distrust rooted in histories of medical mistreatment of communities of color. Best practices for promoting equitable vaccination efforts among vulnerable subgroups include partnering closely with diverse community members; offering individualized, strengths-based counseling on vaccine safety, efficacy, and importance; and demonstrating provider trustworthiness by recognizing histories of oppression.

Striving for Equity in Community Mental Health: Opportunities and Challenges for Integrating Care for BIPOC Youth

Supporting the mental health of youth who identify as Black, Indigenous, or Persons of Color (BIPOC) continues to be a challenge for clinicians and policymakers alike. Children and adolescents are a vulnerable population, and for BIPOC youth, these vulnerabilities are magnified by the effects of structural, interpersonal, and internalized racism. Integration of psychiatric care into other medical settings has emerged as an evidence-based method to improve access to psychiatric care, but to bridge the gap experienced by BIPOC youth, care must extend beyond medical settings to other child-focused sectors, including local governments, education, child welfare, juvenile legal systems, and beyond. Intentional policy decisions are needed to incentivize and support these systems, which typically rely on coordination and collaboration between clinicians and other stakeholders. Clinicians must be trauma-informed and strive for structural competency to successfully navigate and advocate for collaborative systems that benefit BIPOC youth.

Addressing Child Mental Health by Creating a National Minimum Age for Juvenile Justice Jurisdiction

In August 2020, in the midst of a national conversation about racism in the United States, news of a Black eight-year-old boy being arrested for sitting improperly in the school cafeteria spread through the country.¹ Body-camera footage showed police attempting to place the boy in handcuffs that slipped from his wrists before they took him to a juvenile detention facility where he was charged with felony battery. The boy's mother and lawyer reported that following arrest, he experienced somatic and trauma symptoms, including headaches, nightmares, and insomnia. His story, and the attention it garnered, illustrate the importance of the growing movement to establish a national minimum age of juvenile justice jurisdiction-an age below which a child cannot be prosecuted in juvenile court. We call upon child and adolescent psychiatrists to join this movement as a critical tool for promoting mental health and racial equity for children.

Unjust: the health records of youth with personal/family justice involvement in a large pediatric health system

BACKGROUND

Mass incarceration has had an undeniable toll on childhood poverty and inequality, however, little is known about the consequences on pediatric health. The purpose of this study was to identify and describe the health of pediatric patients with probable personal or family history involvement with the correctional system.

METHODS

A descriptive study was conducted using electronic health record data of 2.3 million youth (ages 0-21 years) who received care in a large Midwestern hospital-based institution from February 2006-2020. We employed a correctional-related keyword search (e.g. jail, prison, probation, parole) to locate youth with probable personal or family history involvement. Health characteristics were measured as clinician diagnostic codes.

RESULTS

Two percent of the total pediatric population had a correctional keyword in the medical chart (N = 51,855). This 2% made up 66% of all patients with cannabis-related diagnoses, 52% of all patients with trauma-related diagnoses, 48% of all stress-related diagnoses, 38% of all patients with psychotic disorder diagnoses, and 33% of all suicidal-related disorders within this institution's electronic health record database - among other highly concerning findings.

CONCLUSIONS

We captured an alarming health profile that warrants further investigation and validation methods to better address the gaps in our clinical understanding of youth with personal or family history involvement with the correctional system. We can do better in identifying, and supporting families affected by the correctional system.

Executions and Police Conflicts Involving Children, Adolescents and Young Adults

Police violence in the United States represents a pressing public health crisis impacting youth, particularly youth of color. This article reviews the recent epidemiology of police executions and conflicts involving children, adolescents, and young adults. The roles of social determinants of health and centuries-long history of white supremacy and racism as root causes of adverse policing are emphasized. The article summarizes the evidence as to how direct and vicarious experiences of police violence impact youth academic, behavioral, and health outcomes. Recommendations are provided for pediatricians to address this public health crisis through clinical practice, education, advocacy, and research.