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AGGARWAL AND WILL
Based on the scale of juvenile incarceration in the
United States, pediatricians and other primary care (PC)
clinicians are likely to provide medical care to youth
who have touched custody and corrections environments.
Although medical personnel and physicians have been
encouraged to function as community advocates for justice
reform in the context of physical and mental health
impacts, there is limited knowledge about how engagement
with the medical system may improve certain outcomes,
medical and nonmedical, for justice-involved
youth.
For adults, evidence demonstrates that enhanced PC
for those released from prison can reduce reincarceration
and may shorten time spent in correctional facilities
(Wang et al., 2019). Studies have also shown that specialized
care for incarcerated adults with chronic diseases
such as HIV can decrease recidivism (Sheu et al.,
2002). However, for JJ-involved youth, although there
is information that links intensive aftercare programs
and some mental health services with decreased recidivism
( James et al., 2013), there is still little data on
how PC utilization may influence juvenile detention.
Additionally, there is no evidence-based standard for
medical follow-up that is known to be more or less protective
for the continuation of care or the prevention of
repeat detention in this population.
According to the American Academy of Pediatrics:
A medical home represents an approach to pediatric
health care in which a trusted physician partners with
the family to establish regular ongoing care. Through
this partnership, the primary health care professional
can help the family and patient access and coordinate
specialty care, other health care services, educational services,
in and out of home care, family support, and other
public and private community services that are important
to the overall health of the child and family. (HealthyChildren.org,
2015, para. 2)
The medical home is vital for addressing medical
needs but can also function as a conduit for other essential
care. Referral for resources such as mental health
linkages, engagement with school systems for evaluations
such as individualized educational plans, and connection
to county agencies such as those that provide
housing, food, or other child and family services may
be essential components that function as protective for
vulnerable populations. There is some evidence that
demonstrates that a medical home with comprehensive
care for chronically ill pediatric populations may improve
health outcomes, decrease costs (Mosquera et al., 2014),
and impact the health-related quality of life for caregivers
of teenagers with special health needs (Chavez et al.,
2018).
It is unknown if having PC access and a medical home
reduces the risks of readmission to a JJ facility. However,
due to evolving electronic health records (EHRs) with a
growing network of linked partners, it is possible to better
examine trends of health care utilization in this at-risk
population.
The aim of this descriptive study is to quantify teen PC
utilization after juvenile detention using the data available
in the EHR and examine whether youth who engage
in PC within 90 days after release from detention are less
likely to experience readmission. By gathering accurate
information on health care utilization trends and exploring
barriers to and facilitators of medical care utilization,
informed programmatic decisions can be made with
evidence-based interventions to facilitate care coordination
in and out of detention.
Materials and Methods
We completed a retrospective cohort study of youth (ages
12-18 years) using the EHR and the EHR automatic data
exchange for youth with at least one admission to a
California juvenile detention facility from November 1,
2017, to October 31, 2018, with approval from the
Santa Clara Valley Medical Center institutional review
board. This time period was selected because the county
juvenile facility, one of the first in the country to transition
to the Epic EHR, went live on this system in October
2016.
Each youth detention results in a unique medical
admission created within the EHR. Discharge date corresponds
with the youth's release date. EHR partners with
linked systems can send encounter data, thus allowing
for a composition of clinical encounters from multiple
hospital systems in the patient's record. The first admission
during the study period was considered the youth's
source encounter.
All data regarding medical visits and JJ admissions
for the year before and after the source encounter were
extracted, creating the study period for the individual.
All available nonmental health clinic and hospital data,
including location and specialty, were compiled for inperson
clinic visits that occurred during periods of nondetention.
Behavioral health and psychiatry visits were
excluded from the study due to EHR privacy restrictions
and inability to validate whether these visits were completed.
Available medical and behavioral diagnoses
from problem lists were based on active problems at
the time of data extraction. Individual diagnoses were
grouped into larger categories based on key terms. Emergency
department and urgent care visits were considered
acute care (AC) visits.
Results
During the study period, of the 706 youth in the study,
230 had at least one PC visit, 346 had at least one
AC visit, and 282 had neither PC or AC visits. Among
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Journal of Correctional Health Care - April 2023
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