Juvenile facilities face unique health care challenges due to high rates of communicable diseases, mental health issues, substance abuse problems, and poor community health among incarcerated youth. Initial health screenings are important but quality varies between short-term detention facilities and long-term state institutions. Maintaining confidentiality, providing dental, medical and nutritional services, and controlling infectious diseases are ongoing issues. Female juveniles in particular have elevated needs due to high risks of sexual victimization, mental health problems, and substance abuse.

1. CHAPTER TWELVE
Correctional Health Care

2. Juvenile Health Care
• Youth held in juvenile facilities have elevated rates of communicable
diseases, high levels of mental disorders or learning difficulties,
involvement in substance abuse, and poor histories of community
health care
• These factors shape the type of medical and mental health care that
these youth require when they are incarcerated
• Milwaukee has high rates of chronic illnesses, including asthma, high
rates of previous hospitalization, surgery, medication use, and some
level of violent victimization
• Oregon youth have been reported to have very high levels of chronic
illnesses (77%), mental health disorders (87%), substance abuse
issues (77%), and past suicide attempts (33%)
• In Washington States, those in county facilities had higher rates of
emergency room visits, a greater number of acute health issues, and
more suicide watches than those in state facilities
• Conversely, juveniles in state institutions were more likely to have
chronic health needs, such as dentistry, dermatology, or nutrition

3. Juvenile Health Care
• An initial medical assessment is critical in order to identify communicable diseases
and also to check if the juvenile is under the influence, putting them at higher risk
for overdose or poisoning
• Newly admitted youth also need to be checked for injuries or existing health
problems
• The American Correctional Association (ACA) sets a one hour standard timeframe
for intake assessments; staff conducting these evaluations should have
comprehensive training in suicide assessment and medical care
• The quality of health screening often depends on the type of facility to which the
juvenile is placed
• Most youth stay for only a few days in juvenile detention and this fact influence the
types of health care they receive
• Health assessment in state correctional facilities tend to be more comprehensive
because youth will be there much longer; therefore, they are often screened for
communicable diseases, chronic health conditions, and pregnancy
• 68% of facilities reported providing physical health examinations to all youth; larger
facilities tend to provide more extensive health screening and assessments

4. Juvenile Health Care
• A greater number of facilities test all youth for tuberculosis (46%)
compared to pregnancy (16%), sexually transmitted infections (14%),
hepatitis B (10%) or HIV (4%)
• One issue that facilities face in that youth in confinement may
exaggerate their health care conditions or needs and because of this,
correctional officers may fail to investigate any complaints of pain or
distress
• Correctional officers may also fail to abide by treatment plans, follow-
up on medical advice or ensure that youth receive their medications
• A nutritionally sound diet is an important component for all individuals
– improper diets can lead to health problems, exacerbate existing
medical conditions, and may be associated with acting-out behaviors
• Youth with chronic illnesses such as diabetes, prenatal care, or
obesity may require special diets
• Correctional food is notorious for being unhealthy – high in fat and
starch content

5. Juvenile Health Care
• 12% of admitted youth were obese at intake and after three
months of confinement, the percentage of obese or overweight
juveniles increased to two-thirds
• Juveniles often resist efforts to increase their hygiene
• Access to daily recreation, exercise, and fresh air is important
and idleness often results in higher rates of misconduct
• Incarcerated juveniles tend to have high rates of asthma,
hypertension, diabetes, tuberculosis, and dental problems
• They also exhibit higher rates of risk behaviors, including
alcohol and tobacco use, assaultive behavior, gang
membership, and sexual activity
• Providing effective health care services for incarcerated youth
may also contribute to success in the community once they are
released

6. Health Care Challenges Within Juvenile Corrections
Confidentiality
• In some cases, health care providers are not legally able to disclose to other
facility staff or parents about the health status of the juveniles in their care
• Staff members who disclose the confidential health information of inmates without
proper authorization may be placing themselves in jeopardy of being sued or
prosecuted
• Facilities must develop comprehensive information systems that track health-
related issues that medical staff can have access to
Dental Care
• Many youth fear dental exams, have poor dental hygiene, and may ignore what
appear to be minor dental problems
• Dental emergencies such as impacted wisdom teeth or injuries resulting from
recreational activities, unintentional causes, or assaults also occur behind bars
• It is important that juveniles receive some preventative care and, if possible,
health education about proper dental care

7. Health Care Challenges Within Juvenile Corrections
Medical Care Expenditures
• Providing appropriate correctional health care for juveniles is costly,
especially with unpredictable costs such as emergency care,
dentistry, and prescriptions
• A single case of HIV/AIDS represents a cost of $13,900 to $36,500 for
medication per year
• Juvenile correctional facilities must provide comprehensive health
care treatment that tackles the problems of chronic medical
conditions, past injuries, psychological problems, and dental and
optometric services
• At a minimum, facilities must treat the most obvious or emergent
conditions, bring immunizations up-to-date, and provide educational
information about risk behaviors affecting the minor
• Telemedicine, or the use of telephones, internet services, or television
conferences, allows specialized health care professionals to assist in
the diagnosis of patients without having to transport the youth has
decreased costs associated with transportation of youth but has
significantly increased overall medical costs

8. Health Care Challenges Within Juvenile Corrections
Blood Borne Pathogens and Infectious Diseases
• Controlling the spread of blood borne pathogens and infectious diseases is a key
issue in the operation of youth facilities
• Communicable diseases such as sexually transmitted infections, HIV/AIDS, and
hepatitis must be detected and treated
• The likelihood of transmission is increased because inmates are usually housed
in close quarters
• Engaging in consensual sex, assaults, and rape increase the risk of transmitting
diseases
• AIDS education can increase juveniles’ willingness to be tested and increase their
levels of fear about the disease, but education does not appear to significantly
impact decision-making to engage in risk behaviors
• Females experience significantly higher rates of Chlamydia and gonorrhea than
males; each tested positive for both over 50% of the time
• Incarcerated juveniles have lower hepatitis infection rates than the adult
population
• Staff members receive orientation training about blood borne pathogen

9. Specific Health Needs of Female Juveniles
• Females present unique health challenges for the juvenile justice
system
• Correctional health care has typically been delivered on models
created for male populations
• Incarcerated juveniles have high percentages of sexually transmitted
infections, past pregnancies, suicide attempts, anorexia, bulimia,
depression, and substance abuse
• Females are more likely to suffer from coexisting disorders and are 15
times more likely to have been the victim of unwanted sexual
advances
• Detained females were found to have the following family problems:
mental health (21%), alcohol abuse (27%), drugs (26%), and criminal
justice system involvement (58%)
• A vast majority of female detainees experienced a major trauma, such
as witnessing a death or being threatened with a weapon
• High percentages also reported having mental health or substance
abuse problems and being sexually active