When teenagers are arrested, it does not bode well for their general mental or physical health. In fact, while we presume these teens will be less apt to access their medical homes once in the juvenile justice system, or instead end up in the emergency department or worse in the hospital more so than a teen who has not been arrested, these presumptions have not been proven at least until this week when we share two studies that shed light on health care utilization by teens in the juvenile justice system.
The first study by Winkelman et al. (10.1542/peds.2017-1144) provides a cross-sectional analysis of a national sample of teens adjusting for key confounders to compare ED and hospital visits for those with and without involvement in the juvenile justice system. The sample size was quite large in this study (97,976 without involvement and 1375 with a past year arrest, 2450 with past year probation/parole, and 1324 with past year juvenile detention). Even after adjusting for confounders, those in the justice system had more ED visits and hospitalizations than those who did not.
Given the findings of this study, what might you expect from those in the juvenile justice system in terms of accessing their primary care providers and their medical home? Aalsma et al. (10.1542/peds.2017-1107) looked at this side of the juvenile justice equation by examining a retrospective cohort of 88, 647 youth of which 20, 668 (23%) were in the justice system to see if justice-involved youth had less frequent primary care and again more frequent ED utilization. As you might imagine, utilization was lower in justice-involved youth with higher ED visits and vice versa in those who had never been arrested. In addition, the justice-involved teens had longer periods of being off Medicaid than those who had never had a criminal record. What can be done about this and just how serious is this problem? We asked public health and policy expert Dr. Deena Chisolm from Nationwide Children’s Hospital to judge this study wisely and share her perspective in an accompanying editorial (10.1542/peds.2017-2800). We hope you will be a jury of peers for these two studies and commentary so that you can do justice to gaining a better understanding of how much more we can do to build strengths and resiliencies in this group of teens who can benefit greatly from being key members of our medical homes.