August 26, 2020
Contact: Ryan Norton
August 25, 2020
SAHM Calls for Action to Protect Justice-Involved Youth
The Society for Adolescent Health and Medicine (SAHM) urges governors, adult and juvenile justice system administrators, courts, and other state and local officials, who have not already done so, to rapidly and significantly reduce the number of youths in juvenile detention and correctional facilities by suspending new admissions and releasing those detained or incarcerated whenever possible in order to mitigate the spread of COVID-19 and the negative effects that may result from periods of medical isolation or quarantine in a confinement setting. SAHM endorses the American Academy of Pediatrics statement on responding to the needs of youth involved in the justice system during the COVID-19 pandemic.
It is estimated that nearly 1,600 incarcerated or detained youth have been infected with COVID-19, in addition to facility staff members. The Centers for Disease Control and Prevention (CDC) warned that shared spaces and close quarters within detention facilities present “unique challenges” for controlling the spread of disease. The guidelines recommended by the CDC to the general public to protect against infection, including social distancing and frequent handwashing, may be difficult to practice in such facilities. Additionally, the daily cycling in and out of staff to and from the community, transfer of youth between facilities, off-site referrals, court, and visitation, present opportunities for COVID-19 to be introduced to a juvenile justice setting.
High rates of serious medical conditions have been documented within populations of incarcerated or detained youth, putting them at increased risk for severe complications or death related to COVID-19. Justice-involved youth are at higher risk for contracting infectious diseases. While data suggest that COVID-19 cases may be less severe in children, these underlying medical conditions have been listed by the CDC and the World Health Organization (WHO) as conditions that may place these youth at higher risk for life-threatening illness due to COVID-19. Additionally, according to the CDC, pregnancy places youth at an increased risk for severe illness from COVID-19 and there may be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19. According to the Survey of Youth in Residential Placement, 9 percent of girls in custody have children (compared with 6 percent of female youth in the general population) and a 2004 national census found that 5 percent of girls in juvenile justice residential placement were pregnant.
To reduce the spread of disease facilities are limiting visitations from family, legal representatives and other community members, as well as limiting in-person school and other regular programming. Some facilities may confine children in their rooms for more than 23 hours a day to limit COVID19 exposure, equivalent to solitary confinement, which increases risk of self-harm and suicidal ideation and can lead to serious mental and physical health problems.
The vast majority of justice-involved youth meet formal criteria for at least one psychiatric disorder and are at higher risk for significant substance use disorders. The fear and uncertainty due to the COVID-19 pandemic and the measures taken by detention facilities to slow the spread of disease may exacerbate pre-existing mental health problems among incarcerated youth and lead to increased trauma.
Now is the time to prioritize the mental and physical health of this vulnerable population of justice-involved youth. Immediate action is needed to protect incarcerated youth from COVID-19 infection and to shelter them from the traumatic impacts of this crisis that may have long lasting consequences for their physical and mental health.
SAHM recommends the following:
- Within the constraints of public safety, reduce new admissions to juvenile detention and correctional facilities to only those youth who absolutely need to be detained;
- Release youth who can be safely cared for in their home communities by:
- Examining all pre- and post-adjudication release processes and mechanisms and employing these as quickly as possible
- Prioritizing youth for release who have underlying health conditions, including pregnancy, which may place them at higher risk for COVID-19 complications
- For youth on probation:
- Eliminate detention or incarceration as an option for technical violations of probation
- Eliminate requirements for in-person meetings with their probation officers and replace with virtual visits or home visits with social distancing
- Suspend all requirements to attend and pay for court and probation-ordered in-person programs, community service and labor
- Connect them to health care in the community
- Create transitional plans for youth released from custody to avoid rushed releases into the community without adequate resources and support:
- Ensure they have a safe and stable place to live
- Evaluate for food insecurity and nutritional needs
- Ensure access to ongoing medical, behavioral and substance abuse care
- Ensure immediate access to Medicaid for eligible youth
- Provide a plan for educational services upon leaving the facility with the local educational agency, which may include providing Wi-Fi access and IT equipment necessary for distance learning
- Include supply of Personal Protective Equipment (PPE) for medically isolated and quarantined youth and family members/guardians upon release
- Involve the parent/guardian in any decision to release a youth who is actively under quarantine or medical isolation for COVID-19 to ensure the parent/guardian is able to safely care for the youth without jeopardizing the health of others in the home
- For those who need to remain in juvenile detention or confinement facilities, provide:
- Access to comprehensive behavioral health care in-person or by telemedicine to include mental health and substance abuse counseling, psychiatric care and medication assisted treatment for drug dependence
- Access to the same or increased frequency of communication with family members and guardians for psychosocial support as compared to pre-COVID operations
- Access to COVID-19 PCR testing if symptoms develop, after significant COVID-19 exposure, and as deemed necessary after admission or prior to release or placement
- Humane quarantine and medical isolation (physical, not social, allowing a and b)
- Prompt release from medical isolation based on CDC guidelines using a time or symptom based criteria (not test based)
- Adequate on-site health care providers and access to comprehensive medical care, which may require telemedicine and referrals to providers in the community
- The necessary PPE, policies and procedures to care for the youth that may become ill
- The consistent and appropriate use of PPE for staff and youth
- A healthy workforce to supervise the youth by promoting or establishing an occupational health program to test staff for COVID-19, track staff exposures and illness, recommend quarantine and medical isolation periods, and provide health education on the prevention of COVID-19
The Society for Adolescent Health and Medicine (SAHM), founded in 1968, is a nonprofit multidisciplinary professional society of 1,200 members committed to the promotion of health, well-being and equity for all adolescents and young adults by supporting adolescent health and medicine professionals through the advancement of clinical practice, care delivery, research, advocacy and professional development. Through education, research, clinical services and advocacy activities, SAHM enhances public and professional awareness of adolescent health issues among families, educators, policy makers, youth-serving organizations, students in the field as well as other health professionals around the world.
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