Last Updated

08/25/2020

As the novel coronavirus disease 2019 (COVID-19) pandemic continues to evolve, a troubling, but familiar pattern is emerging. Like numerous other medical conditions rooted in the social and environmental determinants of health, COVID-19 is having a disproportionate impact on historically disenfranchised communities. For example, an analysis of data from New York found that “neighborhoods with higher rates of confirmed COVID-19 cases have lower median incomes, and higher shares of residents who are Black or Hispanic.”1 Data in Milwaukee County, Wisconsin, reveal that African American people (who comprise 26% of the population) represent 41% of COVID-19 cases and 55% of deaths (as of April 19, 2020).2 In Louisiana, African American people are 32% of the population but represent­­ 59% of COVID-19 deaths (as of April 19, 2020).3

In response to the disproportionate impact of COVID-19 on poor and racial/ethnic minority communities, child health advocates are now calling for federal, state, and local governments to enact polices that protect and support marginalized individuals and communities. Sally Goza, MD, president of the American Academy of Pediatrics (AAP), writes, “If we are to effectively manage this pandemic, we must understand and acknowledge the unique vulnerabilities some communities face as we propose solutions, treatments, and financial supports. Any plan to flatten the curve must take into account the spread and impact among communities of color and other marginalized groups.”4

Youth involved with the justice system are members of these marginalized and vulnerable populations and are entitled to special consideration in response to the COVID-19 pandemic. As outlined in the recently published AAP policy statement, “Advocacy and Collaborative Health Care for Justice-Involved Youth,”5 youth involved in the justice system are more likely to have unmet medical, mental health, and social needs; more likely to be youth of color; and more likely to have been exposed to adverse childhood experiences (ACEs). Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth, youth with current or past involvement with the child welfare system, and youth with developmental disabilities are a few of the many marginalized populations that are overrepresented in the justice system. Similar to the disproportionate impact of COVID-19 among historically disenfranchised communities, disparities within the juvenile justice system are rooted in inequities in the social and environmental determinants of health and the failure of public policies to adequately address them. As the world grapples with how to respond to the COVID-19 pandemic, the needs and rights of justice-involved youth must be fulfilled.

On any given day, approximately 43,600 people younger than 18 years are held in youth detention facilities across the United States.6 Even under normal circumstances, many detention facilities fail to provide a supportive, developmentally appropriate environment for confined youth. In terms of the physical environment, Sue Burrell of the Youth Law Center writes, “It is fair to say that many look very much like jails for children. The clanging metal doors; paucity of natural light; modular plastic furniture bolted to the floor; cramped cement spaces offered for recreation; scratched metal mirrors; concrete slab beds; stripped isolation rooms; and sterile sleeping cells all contribute to an unfriendly, surreal environment for youth at a critically vulnerable point in their lives.”7 In addition to the traumatic physical environment, confined youth may experience numerous adversities that exacerbate the trauma of confinement. Among other challenges, confined youth may be exposed to physical violence, may be held in isolation or solitary confinement, may have limited contact with family, and may have poor access to education and developmentally appropriate programs.

Recognizing that under normal circumstances, incarcerated and detained youth often experience poor conditions of confinement, juvenile justice advocates have raised concerns that many juvenile detention facilities are not equipped to adequately respond to COVID-19 pandemic. These concerns have been validated by media reports highlighting the experiences of confined youth during the COVID-19 pandemic. For example, there have been reports of confined youth being held in isolation for up to 23 hours a day,8 having limited contact with family, having education classes suspended, and having poor access to soap and personal protective equipment.9-12 There are also concerns about the capacity of detention facilities to stop the transmission of COVID-19 among confined youth. According to the Centers for Disease Control and Prevention (CDC), “correctional and detention facilities can include custody, housing, education, recreation, health care, food service, and workplace components in a single physical setting. The integration of these components presents unique challenges for the control of COVID-19 transmission among incarcerated/detained persons, staff, and visitors.” Detention facilities may struggle to ensure social distancing and may experience supply chain disruptions in obtaining soap, hand sanitizer, personal protective equipment, and cleaning supplies. Collectively, these factors increase the risk of COVID-19 transmission among confined youth. Because of lack of testing and unclear public reporting requirements, the number of confirmed COVID-19 cases among confined youth is unknown. However, there have been several reports of COVID-19 outbreaks at juvenile detention facilities.13-15

The COVID-19 pandemic presents unique challenges to the health and well-being of youth involved with the justice system. As federal, state, and local governments work to respond to the COVID-19 pandemic, actions must be taken to protect the health and well-being of vulnerable youth and promote resilience in justice-involved youth. Juvenile justice systems should take action to (1) reduce the transmission of COVID-19 in juvenile justice facilities, and (2) mitigate the negative effects of practices that may be required to reduce the transmission. To further these goals, the AAP recommends juvenile justice agencies:

  • Develop and publish COVID-19 response plans and ensure data regarding suspected and confirmed cases are publicly available, stratified by demographic characteristics (e.g., race/ethnicity, sex, sexual orientation/gender identity), so that we are able to identify persons most at risk. Ensure all staff members are trained on the implementation of the response plans.

  • Ensure that youth and families are notified of suspected and confirmed cases in a timely manner.

  • Release youth who can be safely cared for in their home communities.

    • Create transition plans for youth released from custody that ensure their basic needs, including health insurance coverage, are met.

  • Within the constraints of public safety, reduce new admissions to juvenile detention facilities and increase the use of diversion strategies.

  • Provide emergency funding to expand community-based services and supports for youth diverted or released from detention facilities.

  • The COVID-19 pandemic is disrupting the global economy and causing significant financial strain for many families. As outlined in the AAP policy statement,5 the juvenile justice system may impose numerous fines and fees on justice-involved youth and their families. As federal, state, and local governments take action to mitigate the economic impact of COVID-19, special consideration should be given to costs associated with the juvenile justice system, and the assessment and collection of all fines and fees levied on justice-involved youth and their families should be suspended.

  • For youth who remain in confinement:

    • In accordance with guidelines from UNICEF and the World Health Organization, ensure that the human rights of confined youth are fully respected and fulfilled.17,18

    • Ensure appropriate access to physical, reproductive, and mental health care to youth in custody.

    • Ensure that facilities follow CDC guidance on management of COVID-19 in correctional and detention facilities.16

    • Provide adequate sanitation supplies for facilities and personal protective equipment for health care providers, staff, and youth.

    • Provide youth with written and verbal communication about COVID-19, including information about everyday preventive behaviors within the confines of detention facilities.

    • Ensure that youth have the same access to distance learning materials as nonconfined youth.

    • Ensure access to developmentally appropriate programming.

    • Allow youth to have frequent contact with family and/or individual supports with regular access to free phone calls or video chats.

    • Limit the use of isolation, particularly cells designated for administrative isolation and solitary confinement. If youth must be held in isolation for medical purposes, ensure access to personal belongings, education materials, reading materials, and other programming materials. Youth held in isolation should have regular, free access to contact family or designated support individuals by phone or video chats.

    • Ensure timely access to legal counsel and court hearings.

REFERENCES

  1. NYU Furman Center. COVID-19 Cases in New York City, a Neighborhood-Level Analysis. April 10, 2020. Available at: https://furmancenter.org/thestoop/entry/covid-19-cases-in-new-york-city-a-neighborhood-level-analysis. Accessed on 04/19/2020.

  2. Milwaukee County COVID-19 Dashboard. Available at: https://county.milwaukee.gov/EN/COVID-19. Accessed on 04/19/2020.

  3. Louisiana Department of Public Health. Available at: https://county.milwaukee.gov/EN/COVID-19. Accessed on 04/19/2020/

  4. American Academy of Pediatrics. Available at: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/covid-19-message-from-aap-president-sally-goza-md-faap/. Accessed on 04/19/2020.

  5. American Academy of Pediatrics Policy Statement Advocacy and Collaborative Health Care for Justice-Involved Youth. 2020.

  6. OJJDP Statistical Briefing Book. Online. Available at: https://www.ojjdp.gov/ojstatbb/corrections/qa08201.asp?qaDate=2017. Accessed on 04/19/2020.

  7. Burrell, S. (2013). Trauma and the Environment of Care in Juvenile Institutions. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress. Available at: https://www.nctsn.org/sites/default/files/resources//trauma_and_environment_of_care_in_juvenile_institutions.pdf. Accessed on 04/19/2020.

  8. Banks, Gabreille. Reports: Children are in 231/2 hour-a-day lock up at Harris County juvenile facility amid COVID-19. Houston Chronicle. Available at: https://www.houstonchronicle.com/news/houston-texas/houston/article/Reports-Children-are-in-23-hour-a-day-lockup-15187249.php. Accessed on 04/10/2020.

  9. Green, E. ‘Pacing and Praying’ Jailed Youth Seek Release as Virus Spreads. The New York Times. Available at: https://www.nytimes.com/2020/04/14/us/politics/coronavirus-juvenile-detention.html Accessed on 04/18/2020.

  10. Kingkade, T. ‘I’m Scared for my child’: Coronavirus hits Louisiana juvenile detention centers. NBC News. Available at: https://www.nbcnews.com/news/us-news/i-m-scared-my-child-coronavirus-hits-louisiana-juvenile-detention-n1182756. Accessed on 04/15/2020.

  11. Hager, E. “I want to See my Child.” Juvenile Lockups Cut visits over COVID-19 Fears. The Marshall Project. Available at: https://www.themarshallproject.org/2020/03/23/i-want-to-see-my-child-juvenile-lockups-cut-visits-over-covid-19-fears. Accessed on 04/12/20.

  12. Jackson, P. Maryland’s highest court rejects plea to release juveniles amid coronavirus threat, hints major announcement is coming ‘shortly.’ The Baltimore Sun. Available at: https://www.baltimoresun.com/coronavirus/bs-md-youth-test-positive-juvenile-detention-center-20200410-2r5c2lvhwzesznkeic3sjemz5i-story.html. Accessed on 0415/2020.

  13. Virginia Department of Juvenile Justice. Available at: http://www.djj.virginia.gov/pdf/admin/Newsroom/News/041720%20Bon%20Air%20JCC%20Residents%20Get%2024-Hour%20Medical%20Care.pdf. Accessed on 40/19/2020.

  14. State of Louisiana Office of Juvenile Justice. Available at: https://ojj.la.gov/ojj-covid-19-information/. Accessed on 04/19/2020.

  15. Florida Department of Juvenile Justice. Available at: http://www.djj.state.fl.us/news/press-releases/press-release-detail/2020/04/17/Update-from-DJJ-Regarding-COVID-4-17-20. Accessed on 04/19/2020.

  16. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) Guidance for Correction and Detention Facilities. Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/guidance-correctional-detention.html. Accessed on 04/18/2020.

  17. The Alliance for Child Protection in Humanitarian Action – UNICEF. Technical Note: COVID-19 and Children Deprived of their Liberty. Available at: https://alliancecpha.org/en/system/tdf/library/attachments/covid-19_and_children_deprived_of_their_liberty_v1_lowres_0.pdf?file=1&type=node&id=37576. Accessed on April 29, 2020.

  18. World Health Organization. Preparedness, prevention and control of COVID-19 in prisons and other places of detention. Interim Guidance. Available at: http://www.euro.who.int/__data/assets/pdf_file/0019/434026/Preparedness-prevention-and-control-of-COVID-19-in-prisons.pdf. Accessed on April 29, 2020.


Interim Guidance Disclaimer:
 The COVID-19 clinical interim guidance provided here has been updated based on current evidence and information available at the time of publishing. Guidance will be regularly reviewed with regards to the evolving nature of the pandemic and emerging evidence. All interim guidance will be presumed to expire on December 31, 2022 unless otherwise specified.

Last Updated

08/25/2020

Source

American Academy of Pediatrics