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Enhancing medical education: youth in custody

Pediatric Research (2024)Cite this article

Mass incarceration has profound adverse effects on health and is concentrated in discrete communities disproportionately living in low-income neighborhoods. Approximately 48,000 children are held each day in jails, prisons, juvenile facilities, and immigration detention facilities (referred to subsequently as custodial settings) in the United States.1,2 Despite the large number of children held in custody, most medical students, pediatric residents, and fellows do not have direct education experience with youth in custodial settings. Without formal medical education during medical school and post-graduate pediatric training with this unique population and setting, medical students and pediatric trainees (residents, fellows) lack the full spectrum of specialty and subspecialty exposures to make career decisions. Further, many medical schools and pediatrics departments have implemented Diversity, Equity, and Inclusion (DEI) positions, providing a unique opportunity to expand health equity to include children and adolescents held in custodial facilities. The 2023–2024 American Pediatric Society (APS) president’s issue of the year, “Increasing Access to Quality Health Care for Youth in Custody,” calls for medical education on youth in custody as a priority focus for the field of pediatrics.3 We outline a path for elevating and enhancing medical education on youth in custody to resolve our collective blind spot and adequately equip the next generation of pediatricians to care for youth in custody, an essential criteria for achieving health equity.

To our knowledge, national curricular competencies for medical students and pediatric trainees do not include specific training requirements about the care of youth in custody. The degree of clinical exposure among United States medical schools and pediatric trainee programs to custodial settings is highly variable and unmeasured. Our collective impression based on informal surveys with department chairs, APS council, and APS members is that clinical education objectives for medical students and pediatric trainees regarding evidence-based or consensus care for children and adolescents in custody are insufficient for meeting the educational needs of medical students and pediatric trainees expected to provide medical care for this medically fragile and underserved population. While some medical student training, pediatric residency, and pediatric fellowship programs—especially adolescent medicine—provide opportunities for clinical exposure to youth or adults in carceral custody, many do not. In some academic medical centers, the adolescent fellowship programs run the youth carceral care in the local detention facilities. Although many pediatric departments and medical schools have DEI deans and vice-chairs, most academic medical centers and pediatric departments are largely disconnected and unaffiliated with the medical care of youth custodial settings. Difficulties related to jurisdictional differences in delivering health care for children in custody, permissions to enter custodial facilities, access to electronic medical records, and reimbursement models, create significant but solvable barriers impeding optimal health care for youth in custody. These challenges only become magnified when providing educational opportunities for medical students and pediatric trainees.

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References

  1. Sawyer W. & Wagner P. Youth confinement: the whole pie 2023. Prison Policy Initiative, 2023. Accessed 11 January 2024. Available at: https://www.prisonpolicy.org/reports/pie2023.html

  2. US Customs and Border Protection. CBP Releases April 2023 Monthly Operational Update. US Customs and Border Protection. accessed 11 January 2024. Available at: https://www.cbp.gov/newsroom/national-media-release/cbp-releases-april-2023-monthly-operational-update

  3. Barnert E. & DeBaun M. R. Increasing access to quality healthcare for children who are incarcerated: American Pediatric Society issue of the year (2023-2024). Pediatr Res. 2023;https://doi.org/10.1038/s41390-023-02739-3

  4. Owen M. C. & Wallace S. B., Committee on A. Advocacy and collaborative health care for justice-involved youth. Pediatrics. 2020;146. https://doi.org/10.1542/peds.2020-1755

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Authors and Affiliations

  1. Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Elizabeth Barnert

  2. Georgia Department of Juvenile Justice, Atlanta, GA, USA

    Michelle Staples-Horne

  3. Stanford University Schools of Medicine and Education, Palo Alto, CA, USA

    Lisa J. Chamberlain

  4. Vanderbilt University School of Medicine, Nashville, TN, USA

    Michael DeBaun

Authors
  1. Elizabeth Barnert
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  2. Michelle Staples-Horne
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  3. Lisa J. Chamberlain
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  4. Michael DeBaun
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Contributions

Elizabeth Barnert developed the initial draft of the manuscript and led revisions. Michelle Staples-Horne, Lisa J. Chamberlain, and Michael DeBaun contributed to developing the concepts for the manuscript and contributed to revisions.

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Correspondence to Elizabeth Barnert.

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Competing interests

M.D. and his institution sponsor two externally funded research investigator-initiated projects. Global Blood Therapeutics (GBT) will provide funding for the cost of the clinical studies. GBT was not a co-sponsor of either study. M.D. did not receive any compensation for the conduct of these two investigator-initiated observational studies. M.D. is a member of the Global Blood Therapeutics advisory board for a proposed randomized controlled trial for which he receives compensation. M.D. is on the steering committee for a Novartis-sponsored phase II trial to prevent priapism in men. M.D. was a medical advisor in developing the CTX001 Early Economic Model. M.D. provided medical input on the economic model as part of an expert reference group for the Vertex/CRISPR CTX001 Early Economic Model in 2020. M.D. consulted for the Forma Pharmaceutical company about sickle cell disease in 2021 and 2022. E.B. volunteers as Chair of the Juvenile Health Committee of the National Commission on Correctional Health Care and serves on its Board of Directors. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Barnert, E., Staples-Horne, M., Chamberlain, L.J. et al. Enhancing medical education: youth in custody. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03087-6

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