Barnert Elizabeth S, Perry Raymond, Morris Robert E
Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif; Children's Discovery & Innovation Institute, Mattel Children's Hospital UCLA, Los Angeles, Calif.
Juvenile Court Health Services, Los Angeles County Department of Health Services, Los Angeles, Calif.
Acad Pediatr. 2016 Mar;16(2):99-109. doi: 10.1016/j.acap.2015.09.004. Epub 2015 Sep 26.
Addressing the health status and needs of incarcerated youth represents an issue at the nexus of juvenile justice reform and health care reform. Incarcerated youth face disproportionately higher morbidity and higher mortality compared to the general adolescent population. Dental health, reproductive health, and mental health needs are particularly high, likely as a result of lower access to care, engagement in high-risk behaviors, and underlying health disparities. Violence exposure and injury also contribute to the health disparities seen in this population. Further, juvenile incarceration itself is an important determinant of health. Juvenile incarceration likely correlates with worse health and social functioning across the life course. Correctional health care facilities allow time for providers to address the unmet physical and mental health needs seen in this population. Yet substantial challenges to care delivery in detention facilities exist and quality of care in detention facilities varies widely. Community-based pediatricians can serve a vital role in ensuring continuity of care in the postdetention period and linking youth to services that can potentially prevent juvenile offending. Pediatricians who succeed in understanding and addressing the underlying social contexts of their patients' lives can have tremendous impact in improving the life trajectories of these vulnerable youth. Opportunities exist in clinical care, research, medical education, policy, and advocacy for pediatricians to lead change and improve the health status of youth involved in the juvenile justice system.
关注被监禁青少年的健康状况和需求是少年司法改革与医疗改革交叉领域的一个问题。与普通青少年人群相比，被监禁青少年面临着高得多的发病率和死亡率。牙齿健康、生殖健康和心理健康需求尤其高，这可能是由于获得医疗服务的机会较少、参与高风险行为以及潜在的健康差距所致。接触暴力和受伤也导致了这一人群中出现的健康差距。此外，青少年监禁本身就是健康的一个重要决定因素。青少年监禁可能与整个生命历程中更差的健康状况和社会功能相关。惩教医疗设施为医疗服务提供者提供了时间来解决这一人群中未得到满足的身心健康需求。然而，拘留设施中的医疗服务提供存在重大挑战，拘留设施中的医疗质量差异很大。以社区为基础的儿科医生在确保拘留后时期的连续护理以及将青少年与可能预防青少年犯罪的服务联系起来方面可以发挥至关重要的作用。成功理解并解决患者生活中潜在社会背景的儿科医生在改善这些弱势青少年的生活轨迹方面可以产生巨大影响。在临床护理、研究、医学教育、政策和宣传方面，儿科医生有机会引领变革并改善参与少年司法系统的青少年的健康状况。
