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Reflections on Juvenile Services, COVID-19, and Quality Improvement

By Brent Gibson, MD, MPH, CCHP-P
Managing Director, NCCHC Resources

I recently had a unique opportunity to spend several days within a large, statewide juvenile detention system. I was a member of a team of NCCHC Resources consultants providing technical assistance and conducting a comprehensive review of health care operations throughout the state juvenile system.

During our visit, I was struck by the great emphasis this state places on the welfare of its youth and reminded of the range of services provided by juvenile justice systems. Far more than just a jail for kids who commit serious offenses, these systems provide vital links between troubled and disadvantaged youth and a brighter future as members of society. Their hard-working leaders and staff are persevering to provide needed mentoring, education, behavioral health services, and clinical health care to a particularly vulnerable – and important – population.

With an emphasis on rehabilitation rather than detention, this system offers programs and services including a full-service on-site high school (complete with a principal and staff) offering a regular community school diploma, competitive league sports, mentoring and tutoring for both life and academic skills, a safe and supportive living environment for those with long-term housing needs, and short-term living arrangements for youth having problems with parents or foster care. They also provide detention services for the rare youth who may be a true threat to others.

I was once again impressed by everything that confinement and detentions facilities are having to manage during the COVID-19 pandemic. What I saw was in large part very encouraging. Despite enormous challenges, the juvenile justice system was performing at a high level, with great attention to uninterrupted care during the crisis, and staff were using appropriate measures to reduce the risk of transmission of disease. I was very happy to see the staff wearing masks and social distancing. Hand sanitizer was abundant.

To compound the challenges this system is facing, youth are spread across a vast geographic area which, especially during inclement weather, makes travel and transport hazardous. With the pandemic in the mix, staff and their families are affected, and in some cases, unable to come to work. Despite this, the facilities continue to serve their youth, providing a safe haven for many with no other safe place to go.

During this visit, I also saw opportunities for improvement, and I am reminded that every system and every facility, no matter how high-performing, can always do even better. By asking for our assistance in assessing quality and coordination of care, this system is taking a forward-looking and preventive approach, ensuring that assigned services meet demand, are provided by the appropriate mix of staff, and are linked and coordinated in delivery. Our challenge, in partnership, is to support innovative local solutions that are at the same time coordinated and monitored centrally. I am confident we will be successful together.

If your facility is interested in a a similar assessment, please contact us at info@ncchcresources.org.

One final word, which, as a physician, I feel it’s important to emphasize: Face coverings are a simple, inexpensive, and effective infection control measure that have become needlessly controversial. Wear a face covering when around other people and wear it properly. In the correctional health world, this includes patients, staff, and visitors–with very limited exceptions–in all jails, prisons, and juvenile detention facilities.

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