An alarming connection between justice system involvement and child health

Research over the last decade has shown that young people who have been incarcerated can have poorer physical and mental health outcomes than persons who have not been incarcerated, and that youth who have experienced a family member’s incarceration also may experience negative effects.

A new study conducted at Nationwide Children’s Hospital’s Abigail Wexner Research Institute and published in the journal Health & Justice, appears to be the first to use electronic medical records and link children’s personal or family involvement in the correctional system to diagnoses—and the authors say the findings are so alarming they should be a call to action for pediatric providers.

The study looked at the electronic medical records of 2.3 million youth (up to 21 years old) who had received care at Nationwide Children’s between 2006 and 2020. No standard screening for exposure to the justice system was typically employed at Nationwide Children’s during those years. Nevertheless, approximately 2% had a correctional “keyword” in their record indicating probable personal or parental involvement in the correctional system as recorded by a health professional.

That 2% accounted for 66% of allpatients with cannabis-related diagnosis over the time period of the study. They also accounted for:

53.9% of all patients with substance use-related disorders
51.8% of all patients with trauma-related disorders
47.8% of all patients with stress-related disorders
37.6% of all patients with psychotic-related disorders
35.5% of all patients with anemia-related disorders
32.8% of all patients with suicidal-related disorders
17.0% of all developmental-related disorders of speech and language

“We anticipated that the results would show that children with any involvement in the correctional system would have some concerning diagnoses, but the magnitude was a bit shocking,” said Samantha Boch, Ph.D., RN, a former prison nurse and lead author of the study.

The authors note that many factors other than involvement in the justice system likely contribute to these diagnoses, and those factors may also have led to their parents’ or their own incarceration. But personal or family involvement in the justice system appears to be a signal that the potential for other worrying diagnoses is high.

“We performed this research at our own institution, and our findings need to be confirmed by other researchers and institutions looking at their own patient populations,” said Deena Chisolm, Ph.D., director of Center for Child Health Equity and Outcomes Research at the Abigail Wexner Research Institute at Nationwide Children’s and an author of the study. “What our study shows, though, is that it’s urgent that the pediatric health care system try to identify children who have justice system involvement, and that we proactively pursue interventions to help them.”

Dr. Boch led the study as a post-doctoral fellow in Nationwide Children’s Patient-Centered Pediatric Research Program. She is now an assistant professor at the University of Cincinnati College of Nursing with an affiliate role at Cincinnati Children’s Hospital Medical Center.