Journal of Correctional Health Care - April 2023 - 119

JUVENILE DETENTION AND PRIMARY CARE UTILIZATION
119
exchange (HealthIT.gov, 2019). However, additional
investigation is warranted to assure that all PC clinic sites
have been included. This is vital not only for an enhanced
understanding of available resources, but also to support a
continuum of care and health equity for community providers
and patients through linked EHR systems.
Additionally, this study was completed before the onset
of the pandemic, which has had an impact on rates of incarceration
in various parts of the United States. The
home county for this study saw a significant decline in
the rates of juvenile detention (Santa Clara County,
2020). Although the overall trend in decreased detention
is positive, the trends observed in our data were before
the pandemic and reflective of community norms and the
associations between juvenile detention and health care
utilization at that time. However, this may also be a
more accurate reflection of the association due to the extraordinary
disruptions caused by the pandemic.
Reentry into the community is presumed to be a challenging
time for youth and caretakers, with detention,
release, and community reintegration undoubtedly contributing
to prolonged stress. Youth who have been removed
from their communities are reengaging in various environments
within the context of strict programmatic expectations
and sometimes with electronic monitoring devices
(Crump, 2020) tracking their movement. How these transitions
increase medical risks is not fully understood.
Additionally, medical risks may continue to be high due
to ongoing high-risk behaviors, gaps in medical care, primary
mental health needs, a lack of understanding of care
received while detained, and poor coordination between
providers in and out of custody (Barnert et al., 2020).
Also, despite having multiple health needs, youth may
not prioritize health care follow-up or may consider it
less important than competing priorities such as reestablishing
school linkages, employment, coordinating with
mandated programs, and/or behavioral health services
(Barnert et al., 2020; Freudenberg et al., 2007). This
may result in accessing care at later stages of illness or
during heightened need, thus warranting more extensive
interventions or medical admissions for in-hospital care.
The ultimate consequence of what is a complex and
multifactorial issue is that youth who experience juvenile
detention have worse health outcomes when compared to
their non-JJ-involved peers.
Our findings show a high risk of readmission within
30 to 60 days postrelease, indicating that PC follow-up
within 30 days should be prioritized after detention. Additional
areas for future research include evaluation of factors
that prevent youth from seeking care, how behavioral and
medical diagnoses are related to JJ involvement, and how
transitions from detention to the community may impact
medical risks as well as social and medical outcomes.
Also, it is vital that resources be allocated to further
study what qualities and characteristics of PC utilization
or resource availability in a PC office or medical home
may function as protective against JJ involvement. Additional
research is needed to understand the health
needs of JJ-involved youth and expand on the findings
from our study that suggest there may be an association
between PC utilization trends and JJ involvement.
Acknowledgment
Thank you to Dr. Sunshine Pooley for her guidance
regarding statistical tools and her review of the article.
Authors' Contributions
S.A. conceptualized and designed the study. J.W. conceptualized
the study and conducted the analysis. S.A. and
J.W. both interpreted the data, drafted the initial article,
critically reviewed and revised the article, and approved
the final article as submitted. Both authors agree to be
accountable for all aspects of their work.
Author Disclosure Statement
The authors disclosed no conflicts of interest with respect
to the research, authorship, or publication of this article.
Funding Information
The authors received no financial support for the
research, authorship, or publication of this article.
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Journal of Correctional Health Care - April 2023

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