TABLE 1.

Priorities to Protect Children Impacted by the Justice System From COVID-19

Advocacy priorities

Evidence-based downsizing of youth and adult criminal justice population. Smart, rapid decarceration is needed. Prioritization of individuals not deemed a public safety risk or with medical vulnerabilities is recommended. Health experts can contribute medical expertise to inform judicial decision-making and reentry plans.

Infection control standards and care delivery in correctional facilities equal to community standards of care. Needed prevention measures include screening, social distancing, education, access to personal protective equipment, and improving hygiene and disinfection. Quarantining is critical and likely to be challenging. Prompt data reporting is key.

Youth-centered approach to COVID-19 response. Many facilities have ended family visitation, and court processes are delayed. Youth need to be provided with frequent free video or telephone calls to families and legal counsel. Legal rights must be maintained and, to the extent possible, court procedures expedited, not delayed. Quarantine should not resemble solitary confinement; youth in isolation should be provided education, recreation materials, and other privileges, to the extent possible.

Robust medical care, mental health care, education, and rehabilitative programming during the pandemic. Ramped up telehealth and remote learning opportunities should be pursued. Youth wellbeing and rights should be prioritized.

Access to supportive medical care for patients with COVID-19 who are incarcerated. Moderate and severe cases will likely require care in community hospitals.

Clinical priorities

Ambulatory: health providers should consider screening for (1) youth incarceration, (2) parental incarceration, and (3) parental occupational health risk as essential workers in correctional settings. If exposure to a correctional setting is identified or known, providers can address the risks and stressors from the COVID-19 pandemic that add to those already faced by families affected by the justice system.

Ambulatory: as many youth undergo repeat cycles of incarceration, support at-risk youth by increasing surveillance and provide appropriate referrals (mental health, social services) to prevent youth incarceration, even during the pandemic.

Correctional health: providers caring for incarcerated youth in detention should adhere to infection control guidelines, responding to medical and mental health risks.

Hospital settings: recognize that, given the likelihood of outbreak in correctional facilities, incarcerated adolescents may require hospital-level care for COVID-19. Treating providers should be compassionate and treat the patients humanely, as they would any other adolescent.

Hospital settings: understand that the quality and availability of care youth receive in correctional settings may be low (eg, limited overnight nursing or diagnostic equipment). Consider having a lower threshold for initiating a diagnostic evaluation and for admission and a higher threshold for discharge. Facilities are trying to limit movement, so if an incarcerated youth was sent to the emergency department because of COVID-19 or for an unrelated condition, it is likely important.