Nationwide Children’s Hospital (NCH) is one of America’s largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity - serving as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. NCH has been consistently ranked in the Top 10 Best Children’s Hospitals in the nation by US News and World Reports and Top 10 in National Institutes of Health-funding free standing pediatric research facilities. NCH has a staff of more than 14,000 that provides state-of-the-art wellness, preventive and rehabilitative care and diagnostic treatment. The institution provides care for more than 1.5 million patient visits annually from all 50 states and over 45 countries. The hospital-based system includes a network of primary care centers, behavioral health clinics, urgent care clinics, two emergency departments and 527 inpatient beds on the main campus, plus 146 offsite inpatient beds as part of its neonatal network. NCH faculty and physicians are embedded within the College of Medicine at The Ohio State University and train the next generation of pediatricians and pediatric specialists. Importantly, NCH’s Adolescent Medicine team staffs the medical clinic on-site ad serves detained youth at the Franklin County Juvenile Intervention Center (JIC), another name for the local juvenile jail in Columbus, Ohio. The JIC annually detains more than 600 youth, typically holding approximately 100 teenagers on any given day.
In 2020, NCH developed an anti-racism plan entitled Stand Against Racism and Stand for Health Equity, and a Social Justice Initiatives (SJI) department with goals of better supporting youth who are incarcerated or who have incarcerated parents. Our SJI department has supported NCH in bringing electronic health record keeping into the JIC, implementing care coordination for incarcerated youth, expanding the preventative medicine treatment provided in the JIC, and identifying opportunities to further improve health and wellness outcomes for youth who are incarcerated or at risk of incarceration. To date, SJI has spurred changes in care and practice for children of incarcerated parents and justice-involved youth. SJI has paired up with multiple community agencies such as Juvenile Justice Coalition, CoHEAR, and Unlocking Futures to build capacity, develop programming, and support youth. In 2022, the SJI department hosted its first UPenn student who researched various government policies designed to reduce the negative impact of parental incarceration on children and families.
While the primary organization served will be NCH and specifically the SJI, the student will also have the opportunity to participate and receive guidance from the Health-Justice Lab of the University of Cincinnati co-led by a forensic nurse scientist, Dr. Samantha Boch, PhD, RN. A previous corrections nurse, Dr. Boch’s scholarship to date has focused on mass incarceration and pediatric health, supported by federal agencies, and has mentored dozens of students on projects related to health-justice. Dr. Boch will assist the Social Justice Initiatives as needed throughout the project.
The primary research question driving this project is: Who cares for and about the health of detained youth in jail?
Health care services and their structures in local juvenile detention centers (or jails) vary widely across the country. Some counties hire medical providers and staff clinics directly; others contract with pediatric healthcare systems including children’s hospitals; others contract with private agencies. Because Medicaid benefits are suspended when youth are incarcerated (even pre-adjudication), funding systems for financing physical and mental health treatment or other specialty services such as dental and reproductive health care for incarcerated youth are vastly limited, and also varies widely by county and state. There is also little known about whether these facilities have electronic medical record keeping and whether there is continuity of care upon release. Currently there is not a national clearinghouse on what services and treatments are available for youth incarcerated on the local level, best practices, funding opportunities, and very few opportunities for collaboration and learning across different jail facilities.
For more context on specific health challenges faced by currently and formerly incarcerated youth, please see Juvenile Incarceration and Health - Barnart et al. (2016) (https://www.sciencedirect.com/science/article/pii/S1876285915002843)
In collaboration with NCH, UC Health-Justice Lab, health providers (pediatricians), and youth services providers– the project design will include surveying and benchmarking various juvenile detention facilities across the USA to learn what treatment standards are in use, what are funding streams used to support healthcare for incarcerated youth, how specialty needs are met (such as dental or vision care), what mental health treatment is available, and provide recommendations for best practices for children’s hospitals providing care in juvenile detention facilities.
Stakeholders include community-based pediatric providers, local and state government officials, jail service providers, detained youth, and their families. The student will collaborate with internal and external stakeholders to design interview tools and key benchmarks.
A successful project will include an overview of the most frequently-used structures for delivering and funding health services to incarcerated youth, an index of healthcare and correctional facilities contacted (minimum: 4 Ohio, 12 nationwide) , summaries of best practices for providing care and improving outcomes for incarcerated youth, and recommendations for NCH to improve its service delivery and/or increase funding support for treatment for incarcerated youth.
The student will develop at least one manuscript to be submitted for publication in a peer-reviewed journal. Success will also be co-defined by the graduate student – and we will be flexible about what the student defines as success for them. The student will also prepare an abstract or poster for consideration at a conference or an internal presentation within Nationwide Children’s Hospital or University of Cincinnati.
An August wrap up is fine; also fine if the student hopes to complete their project earlier. We are having a health equity conference on-site in April that may be an interesting on-site experience for the student.
