The practice of using restrictive housing for youths who are incarcerated should be stopped or reduced and clear guidelines established for when it cannot be avoided, says a new AAP-endorsed position statement.
Restrictive housing refers to several types of housing status, often used interchangeably with seclusion, isolation or segregation. The term can describe administrative or disciplinary segregation, as well as protective custody. Solitary confinement is the most extreme form of isolation.
The statement Restrictive Housing in Juvenile Correctional Settings (https://bit.ly/3EJgaXd) from the National Commission on Correctional Health Care (NCCHC) asserts that such housing arrangements should never be used as a disciplinary or punitive measure, as a response to a minor infraction or because of staffing shortages, administrative convenience or for retaliation.
Specific steps to take when a youth must be placed in restrictive housing are outlined in the position statement and include obtaining prior medical clearance, proper documentation and monitoring.
Practice has continued
Earlier (2016) NCCHC recommendations stated that “juveniles, mentally ill individuals and pregnant women should be excluded from solitary confinement of any duration.” But the practice of placing juveniles in solitary confinement and broader forms of restrictive housing still occur today, according to the NCCHC.
The statement cites a 2015 survey showing 47% of juvenile justice systems reported locking youths in some form of isolation for more than four hours at a time.
“Given the widespread use of restrictive housing and the well-understood negative health impacts of these practices, it is imperative that juvenile correctional facilities work to reduce or eliminate the use of restrictive housing and establish clear protocols for the rare instances when isolation is deemed essential (e.g., medical necessity) to ensure safety for youth,” the statement reads.
Developmental, safety concerns
“Restrictive housing, unless necessary for medical isolation, is not developmentally appropriate or a safe, effective way to care for youth in correctional settings,” said AAP Committee on Adolescence Chair Elizabeth M. Alderman, M.D., FSAHM, FAAP.
She noted that the NCCHC position statement augments the 2020 AAP policy statement Advocacy and Collaborative Health Care for Justice-Involved Youth (https://pediatrics.aappublications.org/content/146/1/e20201755). That policy opposes solitary confinement for juveniles in correctional facilities and “provides important guidance for all professionals working with youth in juvenile correction settings,” Dr. Alderman said.
Restrictive housing should be the last alternative after trying other behavioral management strategies, said Paula Braverman, M.D., FSAHM, FAAP, the AAP liaison to the NCCHC board of representatives and former chair of the AAP Committee on Adolescence.
“Because of the negative psychological impact of restrictive housing, there has been an emphasis on implementing trauma-informed and developmentally appropriate behavioral management strategies to try to avoid isolated room confinement for adolescents,” she said.
If restricted housing is implemented, Dr. Braverman added, “ongoing reassessment is critical to ensure that the youth remains safe and not isolated any longer than absolutely necessary.”
Medical isolation
Separate recommendations in the statement cover the monitoring of youths in medical isolation for infection-control purposes, such as to protect against contagious diseases like COVID-19.
In these scenarios, the NCCHC statement calls for the least restrictive setting as possible, continuous re-evaluation and close monitoring to ensure there are no negative medical or psychological consequences. Isolated youths should have access to as much programming and family and medical provider contact as possible, while meeting infection prevention and control standards.
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