PEDIATRICS Vol. 119 No. 4 April 2007, pp. e991-e1001 (doi:10.1542/peds.2006-0959)
SPECIAL ARTICLE |
Can Juvenile Justice Detention Facilities Meet the Call of the American Academy of Pediatrics and National Commission on Correctional Health Care? A National Analysis of Current Practices
a Justice, Law, and Crime Policy Program, Department of Public and International Affairs, George Mason University, Manassas, Virginia
b The Lloyd Society, Kensington, Maryland
c Department of Criminology and Criminal Justice, Florida Atlantic University, Davie, Florida
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ABSTRACT |
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 TOP ABSTRACT METHODSRESULTSDISCUSSIONCONCLUSIONSAPPENDIX: GLOSSARY OF FACILITY...REFERENCES |
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OBJECTIVE. Despite the recommendation of the American Academy of Pediatrics, just 53 of the
3500 juvenile justice residential facilities in the United States have received voluntary accreditation for facility health care from the National Commission on Correctional Health Care. This suggests either that facilities do not meet the standards of care or do not seek accreditation. This study describes whether and under what conditions juvenile detention facilities (a narrowly defined subset of all facility types) adhere to some of the standards outlined by the National Commission on Correctional Health Care and promoted by the American Academy of Pediatrics. METHODS. Data from 2 national censuses of juvenile justice residential facilities (n = 726) were used to describe detention facility performance in terms of 10 types of service provision, ranging from health screening to communicable-disease testing. Multivariate models predicting high levels of service provision were estimated.
RESULTS. Juvenile detention centers partially meet some of the minimum standards. Most services can be garnered at some level; however, they tend to be provided on an ad hoc basis for portions of the population rather than systematically for the whole population. Detention centers most likely to provide a higher tier of services tend to be those that have longer average lengths of stay, are larger, and are government owned. There are also geographic and racial differences in quality and scope of health services.
CONCLUSIONS. Juvenile facilities have been provided a single set of standards for a diverse system with tremendous variation across and within facility types. Detention centers are just one specialized type. Very few detention centers meet a minimum standard of care, which suggests that standards are simply not being met (hence the low levels of accreditation). The findings of this study call into question whether detention facilities with little in the way of health care infrastructure can benefit from National Commission on Correctional Health Care standards as they are currently packaged, regardless of whether accreditation is the ultimate goal.
Key Words: juvenile justice • standards • health care • adolescent • JRFC • CJRP
Abbreviations: AAP—American Academy of Pediatrics • NCCHC—National Commission on Correctional Health Care • JJRF—Juvenile Justice Residential Facilities • JRFC—juvenile residential facility census • CJRP—census of juveniles on probation • CPR—cardiopulmonary resuscitation • OR—odds ratio
In 2001, the American Academy of Pediatrics (AAP) Committee on Adolescence published a policy statement entitled "Health Care for Children and Adolescents in the Juvenile Correctional Care System."1 Reviewing the ever-growing body of evidence that shows that young people in the juvenile system are at considerably higher risk for health, mental health, social, family, substance abuse, and other problems, the committee provided 7 recommendations for better securing health care for this underserved population. Among its recommendations was a call for pediatricians who serve this population to adopt the standards advanced by the National Commission for Correctional Health Care (NCCHC).
The NCCHC has developed and published "Standards for Health Services in Juvenile Detention and Confinement Facilities" (most recently updated in 2004).2 This 300-page document is sold on the NCCHC Web site and represents the official position of NCCHC in terms of 9 general areas of health services ranging from governance and administration to medical and legal issues. The standards are designed as evaluation tools for juvenile facilities of all sizes and types and are promoted as a means to increase the quality of health services for young people in the juvenile justice system.2(pviii)
The position adopted by the Committee on Adolescent Health1 implies, and the standards offered by the NCCHC2 state, that health care policy can be applied equally across the spectrum of juvenile justice residential facilities (JJRFs). This may not be a feasible means of designing service delivery. There is tremendous variation within and across JJRF types relevant to a facility's ability to provide health services. Across facility types, JJRFs vary in terms of their fundamental purpose (see Appendix). Facilities also vary substantially within type in terms of structural characteristics (such as ownership, size, length of stay, services offered, and openness to the community), all of which impact their ability to realize a formal system of care.3–5 Therefore, suggesting that a 1-size-fits-all standard of care may be equally applied within and across this vast array of facility types is much the same as suggesting that all hospitals in the United States and the different units found therein should provide the same services at the same standard.
In addition to Pediatrics, publications in other leading medical and public health journals have advocated the targeting of children and adolescents housed in the juvenile justice system for health services.6–10 Yet, there has been no systematic national evaluation of whether facilities are adopting recommended practices or whether the recommended practices have increased the health and well-being of these young people. The most recent attempt to describe facility practices came from an analysis of data derived from a sample of facilities in the late 1980s and early 1990s.11 Those results suggested that just 26% of the facilities in the sample conformed to the service criteria defined in the study. The only contemporary indication available of compliance with suggested standards is whether facilities voluntarily seek and receive accreditation from the NCCHC. Earlier this year, just 53 of the 3500 facilities in the United States were so accredited (accreditation staff at NCCHC, verbal communication, January 18, 2006).
Our study provides a contemporary description of the extent to which JJRFs adhere to the standards published by the NCCHC and identifies predictors of variation in health care provision. Although the NCCHC suggests that their standards be applied equally across the universe of facilities and these census data allow for the description of health care across all facilities, this study focuses on a specific type of juvenile justice facility: detention centers. The basis for this decision is described below; however, in brief, the decision stems from the vast differences within and across facility types that make universal characterizations unwieldy and insensitive to important variations. Ideally, the results of this study will provide a critical context in which to guide correctional health care policy makers and professionals as they prioritize health care–delivery goals in light of the realities of the JJRF system.
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METHODS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSAPPENDIX: GLOSSARY OF FACILITY...REFERENCES |
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Participants
The universe of JJRFs includes everything from group homes and boot camps to residential treatment and long-term secure facilities that resemble adult prison (see Appendix for more description). It is important to recognize that different types of facilities have very different institutional priorities (which range from protecting the community to providing respite and treatment for children in need of services). A gross summary of services across all facilities will mask important differences across facility types. We began our study by evaluating health services in juvenile justice facilities and focused on arguably the most critical stage in the residential system: the detention facilities. Furthermore, by focusing on a single type of facility, we allowed for examination of the within–facility-type variations critical to the successful implementation of health care.
It has been argued that juvenile detention facilities represent an excellent opportunity to intervene with the greatest number of high-risk youth.6 This is because detention centers serve the highest volume of young people and are the gate through which young people enter the JJRF system, thus affording the first (and perhaps only) occasion to provide services in a controlled setting. Providing health care in detention centers is not without substantial complications. Detention centers tend to have shorter lengths of stay, mostly because their purpose is to house young people who are awaiting either adjudication or postdisposition placement into a different type of facility. Despite the challenges of rapid population turnover, these facilities may represent the only chance to identify health needs and coordinate health care for many high-risk young people, including both the young people who proceed to long-term facilities and those who are released back to the community.12–14
Data
The Office of Juvenile Justice and Delinquency Prevention of the US Department of Justice sponsors 2 censuses of all public and private JJRFs in the United States: the juvenile residential facilities census (JRFC)15 and the census of juveniles in residential placement (CJRP).16 To meet the inclusion criteria for these censuses, facilities must house young persons under the age of 21 who have been charged with or adjudicated for an offense and are in the facility because of that offense. The JRFC and CJRP are rotated so that 1 census is conducted every October. The CJRP was introduced in 1997, and the JRFC in 2000. The JRFC collects data on characteristics of the facilities and services provided to young people, including information about health care. The CJRP collects data on each young person housed on a specific reference night in these same facilities (for additional details on the censuses, see refs 3–5 and 12–14).
The health care module of the JRFC was designed, in part, to answer questions about whether and under what conditions basic and specialized health care services are provided to young people. The health care module has been fielded twice, once in 2000 and again in 2004. It provides a unique opportunity to measure whether the policy statements and standards proposed by AAP and NCCHC are practiced. This study uses data from the 2000 and 2004 JRFCs and the 2003 CJRP to describe the scope of health care services.
Methods for the implementation of these censuses are rigorous. Both questionnaires underwent years of iterative pretesting, including cognitive interviewing with facility administrators and service providers and mail-out field testing. Response analyses are conducted on samples of facilities to ensure the ongoing validity of the data. Respondents are guaranteed confidentiality. The census frame is updated yearly. The response rates range from 95% (2003 CJRP) to 96% (2000 and 2004 JRFC).
The universe of facilities in these censuses includes all facility types, ranging from nonsecure group homes to long-term facilities that are secured with razor wire. As discussed above, this study focuses on detention centers (see Appendix for more detail on detention centers). Thus, the data analyzed here represent a census of all juvenile detention centers operating in the United States on the reference days of the census administrations.
Over the 3 census years (2000 JFRC, 2003 CJRP, and 2004 JRFC) there were, on average, 726 juvenile detention facilities that housed 36000 young people on each of the reference days (see Table 1). Put in more global terms, these 726 facilities housed approximately one third of the total daily facility population of 105000 young people in 3500 facilities. Nearly 50% of all detention centers housed <25 young people. The bulk of facilities were government owned and operated (85%). The average length of stay was 37 days, although the average shortest length of stay within these facilities was 1.8 days.
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Analysis
Table 2 describes standards promoted in the NCCHC 1999 and 2004 publications that may be measured with JRFC data. There are 9 major sections of the NCCHC standards. For this study we examined key aspects within 4 of those areas, including such basics as health screening and assessment, to more specialized services and first aid. It should be noted that the standards are often lengthy and are not readily operationalized. The corresponding JRFC coverage is also provided in Table 2. The full JRFC questionnaire is available online.15,16
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The analyses began by describing each of the measurable services in simple frequencies (Tables 3 through 10). To further describe the provision of health care within detention centers, multivariate models were estimated to identify predictors of the scope of health care services provided. The outcome of interest was operationalized in 3 ways. First, a 9-point index that summed all NCCHC-recommended services measurable with JRFC data (with the measure of nonemergency medical requests dropped because every facility had at least 1 mechanism for youth to secure an appointment and because there is no inherent ranking of the different modes for requesting services) was constructed. Within each service area, a score of 1 was assigned for full compliance, 0.5 was assigned for partial compliance, and a 0 was given for not offering the service. Second, a 3-category ordinal scale was developed on the basis of the distribution of the 9-point service to provide relative rankings of facilities in terms of the numbers of services provided as either low, medium, or high (see Table 11). Finally, the 3-category scale was collapsed into a dichotomous variable that distinguished between high and low/medium rankings. The 3 models were estimated by using ordinary least squares, ordinal probit, and logistic regression, respectively.
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Predictor variables were derived from other work on correlates to health care delivery in the JJRF system.17,18 They included the geographic region (the country was divided into 10 regions), facility population size, level of security, ownership status (whether government or private), crowding within the facility, length of stay of residents, average age of young people, percentage of the population that is black/African American, the percentage that is Hispanic, the percentage that is male, and the percentage of residents who had been adjudicated or convicted (in other words, found guilty of a crime). All predictor variables in the final models came from measures in the 2004 JRFC, with the exception of the demographic and length-of-stay measures, which came from the 2003 CJRP.
Results across the models were robust, and only the final reduced logistic model predicting high service ranking is presented here, largely because logistic results are most intuitive and because of the fit with underlying assumption of the model parameters. The outcome in the final model is whether the facility was among the high health care service providers. This is defined as falling into the top tier of all facilities on a 9-point index of service. This translates into a score of >5.5 and, in practical terms, means that a facility met the standards for at least 5 of the recommended services.
Limitations
This study provides limited assessment of the multitude of NCCHC standards. However, the types of health services covered are arguably among the most fundamental, and the work represents a first attempt at modeling facility-level provision of services for this area of health care.
The measures in this study should be viewed strictly as indicators of facility practices. Future work is needed on the extent to which policy and stated practices translate into actual implementation. Furthermore, it is critical to gauge whether the implementation reflects evidence-based recommendations for diagnoses and treatment and to assess whether best practices result in measurable improvement in health. An additional limitation is the lack of measures on the individual health needs of the population served by each facility.
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RESULTS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSAPPENDIX: GLOSSARY OF FACILITY...REFERENCES |
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Table 3 provides a description of health screening practices. The NCCHC recommends that all young people receive a screening immediately on arrival by a trained health screener. Most facilities (98%) report that all young people are "asked questions or administered a form which asks questions about the current status of their physical health."15 Contrary to NCCHC recommendations, more than half of the facilities use staff that are not trained in screening techniques and are not health care professionals to conduct the screening. Nearly all facilities have young people screened within 7 days after arrival. By 2004, the percentage of facilities that screened within 24 hours rose from 68.7% to 75.7%.
A similar analysis of health assessment practices in juvenile detention centers (see Table 4) reveals that far fewer young people receive a health assessment. In 2004, just 51.1% of all facilities had all young people receive a health assessment, and 11.2% did not conduct health assessments. For the purposes of the JRFC, health assessments are defined for the respondent as involving "a nurse, nurse practitioner, doctor or physician assistant examining such things as eyes, ears, nose, throat, blood pressure, and pulse; collecting blood; or taking medical histories."15 By 2004 one quarter of all facilities conducted health assessments within 24 hours after arrival.
Table 5 shows the extent to which detention facilities were in compliance with NCCHC recommendations on screening and health assessments. Most facilities (58%) were in partial compliance with screening standards, but they largely failed to meet standards on the training of the screener. Another 40% were in full compliance. A noticeable improvement was found between the years 2000 and 2004 on meeting the health assessment standard. However, there was a modest increase in noncompliance.
Table 6 shows the extent to which detention facilities provide specialized services. The NCCHC standards suggest that all young people receive an oral health examination and that all girls/young women receive a gynecologic examination. The NCCHC standards (both 1999 and 2004) make no mention of vision or eye examinations, although they are included among the services covered in Table 6. Few facilities made vision, dental, or gynecologic (in facilities housing female residents) services available to all young people (between 13% and 18% across service areas in 2004). Nearly 30% do not provide a vision examination (by either an ophthalmologist or optometrist), and 18.3% fail to provide any of its female population with a gynecologic examination. A large proportion of facilities providing these services do so outside the facility (ie, through local providers in the community).
The NCCHC 2004 standards stated that "All juveniles have the opportunity daily to request health care. Their requests are documented and reviewed for immediacy of need and the intervention required. Sick call and providers' clinics are conducted on a timely basis and in a clinical setting by qualified health care professionals"2(p72) (emphasis in the original). As shown in Table 7, facilities have a variety of mechanisms in place for young people with medical complaints to request care. All facilities had some means for requesting care. It is difficult to place a value on the type of mechanism available, although most in 2004 had upward of 2 methods for accessing care.
Facilities are encouraged to provide opportunities for "recreational exercise." Table 8 indicates that 10% of all detention centers do not offer voluntary opportunities for exercise; however, almost 70% require an average of 1 hour of exercise every day of the week. Exercise was defined in the JRFC as large-muscle activity, including group sports, running, aerobics, and weight training.
An evaluation of communicable-disease–detection practices and pregnancy testing is provided in Table 9. The NCCHC has suggested that young people entering juvenile residential facilities be tested for tuberculosis because of the high-risk nature of the correctional environment for the spreading of the disease and increased risk of drug-resistant forms in this population. Just 42% of all detention centers test all young people on arrival. Ten percent provide no testing, and 44% test as necessary.
The NCCHC standards suggest testing for sexually transmitted and blood-borne diseases, most likely in light of the disproportionately high rate of occurrence in this population and the emerging co-occurrence of these diseases. Few facilities test all young people for HIV (4.3%), although more of them claimed to test all young people for various other sexually transmitted diseases (18.5%). A more common practice is to test at the discretion of a health care professional.
Facilities that house girls/young women seem to be encouraged to determine if they are pregnant during the initial health screening. It seems to be more of an inquiry process rather than a pregnancy test that is recommended. Nonetheless, 18% of facilities that hold girls/young women reported testing all of them for pregnancy. Fifteen (2.4%) facilities that house girls/young women do not provide any pregnancy testing, even when requested by the resident herself.
The NCCHC standards recommend that child care workers who work with juveniles be able to provide cardiopulmonary resuscitation (CPR) and for qualified health care professionals to participate in "continuing education programs." The JRFC data reveal (see Table 10) that 85% of facilities have basic first aid service and CPR-trained staff members available during normal weekday business/operating hours inside the facility, as well as after hours and on weekends. Very few facilities do not have either basic first aid (0.3%) or CPR-trained staff members (1.7%).
Table 11 provides some bivariate analyses of the relationship between some of the independent variables (facility characteristics) and the 3-category collapsed version of the 9-point index of service provision. The results of the final reduced logistic model are presented in Table 12. Recall that the outcome in this model is whether the facility was among the high health care service providers, in other words, they scored >5.5 on the 9-point index.
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It is clear that even within the universe of detention facilities, there is variation in the conditions under which relatively high levels of service are provided (see Table 12). First, there is a geographic variation. Compared with those elsewhere in the country, facilities in both New England and the west were >2 times as likely to be in the top tier of service levels. The size of the facility also significantly predicted higher service provision. With each 1 person increase in facility population size, the odds of providing high service levels increased by 1%. Similarly, the longer the facility houses young people the more likely it is that higher levels of health care services are provided (odds ratio [OR]: 1.01). Facilities housing higher percentages of black/African American young people were significantly more likely to report higher service provision (OR: 1.02). Finally, privately owned (as compared with government-owned) facilities had significantly lower odds of reporting high service provision (OR: 0.42).
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSAPPENDIX: GLOSSARY OF FACILITY...REFERENCES |
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This study provides a national description and analysis of basic health care service provision in a subset of juvenile residential facilities: juvenile detention centers. Using some of the minimum standards suggested by the NCCHC and promoted by the AAP as the basis for evaluation, the results of this study can be taken as both good and bad news. Nearly all detention centers are providing at least a minimum amount of health care. This largely comes in the form of some manner of intake health screening and assessment, optional exercise, and CPR availability around the clock. It remains important to note, however, that some facilities do not provide even these fundamental services.
The most notable weaknesses in service provision include the lack of training of the intake health care screener and the strikingly low levels of vision, dental, and gynecologic services. Although most facilities require recreational exercise, 10% of these detention facilities fail to provide any opportunity for voluntary large-muscle exercise (these facilities housed 1903 young people on the reference day).
Perhaps more alarming is the low level of full population testing for infectious and communicable diseases. The majority of facilities report that testing is conducted for some young people as "deemed necessary by a nurse or doctor." In the general population, testing as recommended by physicians is certainly appropriate, however, in light of the growing evidence of high rates of infection in the correctional population; along with the ease of transmission within facilities and the limited time window for providing health services, testing the entire population may better serve the public health of these young people. It could also benefit the workers within the facility and the population in their home communities. Likewise, it may be best to test all girls/young women to determine if they are pregnant. The follow-up care is certainly problematic and, no doubt, presents significant challenges, especially for those who leave the facility before services can be offered. Rather than offering standards that cannot be met, guidance on how to handle these cases in the form of standards would likely be welcomed.
There are reasonable structural correlates of meeting minimum standards of care. Larger facilities and facilities that hold young people for longer average lengths of stay are more likely to have a broad service portfolio. This reflects the reality that large facilities are more likely to have a health care infrastructure and systematic means of processing health needs, and facilities that hold young people for longer periods of time have more opportunity to provide services. That smaller, shorter-length-of-stay facilities are not meeting minimum standards of care should be worrying. Young people in these facilities are no less in need of basic services and are equally as likely to return to the community with communicable, preventable, and treatable conditions and diseases. It is reasonable to conclude that these facilities are more likely to garner services in a piecemeal fashion. Although this may be the most creative use of available resources, the lack of systematic care should be addressed. Similarly, private facilities are notably less likely to provide fuller ranges of services. Because young people in private detention centers have not been shown to be systematically different from those in public facilities, they should, by definition, require the same level of care.
Although black/African American and Hispanic youth are demonstrably underserved in the larger community, the results from this study reveal a potentially different pattern within detention centers in terms of having access to health care services, at least at the facility level. Facilities with better service portfolios were linked to higher percentages of black/African American young people in their population. Although it cannot be determined with these data that these young people are actually being served within the facilities, it certainly warrants additional investigation, because it is in striking contrast to use of services in the community.* Despite the underrepresentation of female residents and the overrepresentation of Hispanic residents, effects were not found for either of them in terms of the scope of services provided. There is, however, a low level of gynecologic services for facilities that house girls/young women, and this gap in service provision needs to be a priority. Finally, there is significant regional variation. It may be that facilities in different regions offer more services because they are of higher quality; alternatively, it could be attributed to a difference in the quality and availability of health care in the community. Yet again, it could be because of the general health status of the population served by each facility.
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CONCLUSIONS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSAPPENDIX: GLOSSARY OF FACILITY...REFERENCES |
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This exercise suggests several recommendations. First, the universal standards promulgated by the NCCHC may be more useful if they were to consider the variation in priorities and purpose across and structural variation within the different types of facilities. The findings presented here speak directly to the latter issue: Even within a narrowly defined subset of all facilities, there is significant natural structural variation related to whether health care is provided. It could be argued that this structural variation is unrelated to the need to provide health care and what attitudinal priority facility administrators place on health services. Just as a large emergency department that serves an urban area should have different operational goals than a rural emergency department that serves an elderly population, so too should small and large detention centers.
Second, there is no doubt that young people who enter detention centers are underserved and at greater risk for health problems. The wisdom, however, of trying to provide a full portfolio of care (such as that recommended in the current NCCHC standards) remains debatable in this type of facility. Detention centers are legally required to address urgent health problems and any health services ordered by the court, but beyond this, it is unclear what their obligation should be.20 From a public health perspective, it would seem to be an ideal place for intervention, if not only because of the sheer volume of high-risk young people served. Health professionals who work with this population and experts in the risks that these young people face need first to reach a consensus on what time-dependent priorities these type of facilities should achieve. Such a consensus must be built within the current parameters of the legal and organizational structures of the juvenile justice system. If standards were developed that reflected time-dependent algorithms of care, perhaps detention centers, particularly those with little or no infrastructure, could have the guidance needed to provide a higher and more effective system of care.
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APPENDIX: GLOSSARY OF FACILITY TYPES |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSAPPENDIX: GLOSSARY OF FACILITY...REFERENCES |
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- Detention center—the juvenile equivalent to adult jail; tends to be the first facility encountered by young people entering the system; typically houses young people who are awaiting adjudication or postdisposition placement in another JJRF; houses young people charged with all types of offenses, from status (ie, runaway, truant) to murder; highly variable but shorter length of stay than other types of facilities; tends to have higher levels of security (eg, razor wire and multiple locked doors) because of flight risk and uncertainties of population classification; most often owned and operated by local governments, but a substantial proportion are privately owned.
- Reception or diagnostic center—facility designed to diagnose and classify young people who are typically adjudicated delinquent, placed in the legal custody of the state, and are awaiting assignment to a long-term facility pending results of screening and classification; houses young people charged with all types of offenses; short but less-variable length of stay; tends toward higher security levels; most often owned by state governments, although a number are also locally and privately owned and operated.
- Group home/halfway house—small, community-based facility or house with low levels of security designed to house adjudicated young people for longer periods of time, typically to provide transition back to the community; many are privately owned and operated.
- Boot camps/ranch, forestry camp, wilderness or marine program or farm—shorter length-of-stay facility with intense programming for adjudicated youth; most often locally or privately owned and operated; low physical security, high staff security, and often operated in rural, sparsely populated areas.
- Training school/long-term secure facility—the juvenile equivalent to adult prison; facility designed to house large numbers of adjudicated youth who are remanded to state custody for long periods of time in a high-security facility, typically secured with razor wire, multiple locked ports, and high staff security; typically a state-level facility, but many are owned or operated by private companies.
- Residential treatment center—longer-stay facility that provides specialized treatment services (eg, substance abuse, mental health, sex offender therapy, etc) for adjudicated youth; security tends to be lower to midlevel with an emphasis on staff security; most often privately owned and operated, with smaller- to midsized populations.
- Shelter—typically an alternative to detention for court-involved young people with lesser charges or with charges but substantial family and social concerns identified by other agencies; facility also houses young people in child welfare and foster care systems; locally operated and often privately owned; many local jurisdictions do not have this type of facility available or combine these young people with those in detention; low physical security; longer stays than in detention.
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FOOTNOTES |
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Accepted Oct 23, 2006.
Address correspondence to Catherine A. Gallagher, PhD, The Lloyd Society, 3102 Ferndale St, Kensington, MD 20895. E-mail: cgallag4@gmu.edu or E-mail: catherinegallagher{at}thelloydsociety.org
The authors have indicated they have no financial relationships relevant to this article to disclose.
* Although the 2001 AAP policy statement (citing Snyder and Sickmund19) reports that black/African American youth make up 45% of the facility population (and just 15% of the general population), the current analyses find that 38% of the full facility and 36% of the detention population is black/African American. 
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REFERENCES |
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