Paeds · child-safety-and-social-paediatrics
Youth justice and detained young people
Also known as Health of young people in detention · Juvenile justice health · Incarcerated adolescent health · Youth offending and health · Young offenders and developmental vulnerability · Detained youth and equivalence of care
Fellowship-level guide to the health of justice-involved and detained young people: the concentration of neurodisability, mental illness, trauma and substance use behind the gate; the equivalence-of-care principle; the entry-screening pathway; safeguarding, consent and confidentiality in custody; the post-release mortality spike; and the paediatrician's advocacy role across the community-to-detention-to-release arc.
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Red flags
- Treating detention as a security problem, not a health encounter — equivalence of care means the same standard as the community
- Missing neurodisability — FASD, ADHD, intellectual disability and language disorder are the rule, not the exception, in this group
- Overlooking acute suicide or self-harm risk on entry — the first days of custody are the highest-risk window
- Assuming the young person can give fully informed consent without checking comprehension, capacity and literacy
- Confusing the health role with the forensic or investigative role — you treat and advocate; you do not interrogate
- Letting the discharge plan die at the gate — the post-release mortality spike is real, and linkage to care is the preventive intervention
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Ethics, law and professional practice
- Adolescent health and youth justice
- Current 2026 PREP curriculum — Learning goal 9: Clinical assessment and management — vulnerable and marginalised youth
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Professional practice: equivalence of care, consent and confidentiality for detained young people
- Clinical Applications
- Ethics and law in adolescent practice
- Health needs of justice-involved youth and the entry-screening pathway
- Long Cases
- Short Cases
- Communication stations
- 9. Safeguarding vulnerable children and young people
- 2. Professional skills and knowledge: Communication
- 10. Adolescent health and youth-friendly services
- 1. Professional values and behaviours
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Safeguarding, adolescent health and the law
- Communication
- History
- Clinical
- General Pediatrics Content Outline — Domain 4: Child Abuse and Neglect
- General Pediatrics Content Outline — Domain 21: Adolescent Medicine
- General Pediatrics EPA 10: Leading interprofessional teams
- Health equity, equivalence of care and advocacy for justice-involved youth
- Professionalism 1: Professional Behavior and Ethical Principles
- Systems-Based Practice 1: Legal and regulatory requirements in correctional settings
- Systems-Based Practice 2: Coordination of care across systems
- Health Equity 1: Advocacy for marginalised and detained youth
- Professional
- Health Advocate
- Pediatrics: equivalence of care and rights of detained young people
- Collaborator: working with justice, mental health and community agencies
Overview & Definition
Picture a fifteen-year-old remanded in custody overnight for an alleged assault. Before the first hour passes he has disclosed suicidal thoughts, and you are the doctor called to see him. Your job is not to assess his guilt, and it is not to manage the security problem. It is to deliver the same standard of care he would receive in your emergency department, recognise the layers of vulnerability he carries, and act on the acute risk. [1] [16]
Justice-involved youth are young people whose lives have intersected with the youth justice system — from police diversion and community supervision through to sentenced or remand detention. Detention is the most restrictive end of that pathway, but most health needs are shared across the whole spectrum. The paediatric encounter matters wherever the young person sits on it. [1]
The load-bearing principle is equivalence of care: health services for young people in detention must be equivalent in standard, range and quality to those available in the community. Stated in the United Nations Havana Rules and adopted by national bodies, it means the young person does not forfeit the right to evidence-based, timely, confidential health care because a court has ordered their detention. [16]
The second principle is that detention is a screening window. Many of these young people have had erratic contact with health services, and detention is a rare moment of structure where unrecognised illness, disability and risk can be identified and addressed. Used well, it narrows rather than widens the health-equity gap. [10] [16]
References18ShowHide
- [1]Borschmann R, Janca E, Carter A, Willoughby M, Hughes N, Snow K, et al. The health of adolescents in detention: a global scoping review. The Lancet Public Health, 2020.PMID 31954434
- [2]Bower C, Watkins RE, Mutch RC, Marriott R, Freeman J, Kippin NR, et al. Fetal alcohol spectrum disorder and youth justice: a prevalence study among young people sentenced to detention in Western Australia. BMJ Open, 2018.PMID 29440216
- [3]Billstedt E, Anckarsäter H, Wallinius M, Hofvander B Neurodevelopmental disorders in young violent offenders: overlap and background characteristics. Psychiatry Research, 2017.PMID 28285251
- [4]Yohros A Examining the relationship between adverse childhood experiences and juvenile recidivism: a systematic review and meta-analysis. Trauma, Violence & Abuse, 2023.PMID 35166600
- [5]Borschmann R, Coffey C, Moran P, Hearps S, Degenhardt L, Kinner SA, et al. Self-harm in young offenders. Suicide & Life-Threatening Behavior, 2014.PMID 24773535
- [6]Doolan I, Najman JM, Mills R, Cherney A, Strathearn L Does child abuse and neglect explain the overrepresentation of Aboriginal and Torres Strait Islander young people in youth detention? Findings from a birth cohort study. Child Abuse & Neglect, 2013.PMID 23352083
- [7]Balogun T, Troisi C, Swartz MD, Lloyd L, Beyda R Does juvenile detention impact health? Journal of Correctional Health Care, 2018.PMID 29544377
- [8]Vincent GM, Grisso T, Terry A, Banks S Sex and race differences in mental health symptoms in juvenile justice: the MAYSI-2 national meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 2008.PMID 18216730
- [9]McBride AB Editorial: Justice-involved youth — a national state of emergency in children's mental health. Journal of the American Academy of Child and Adolescent Psychiatry, 2024.PMID 37992853
- [10]Balogun T, Troisi C, Swartz MD, Beyda R Juvenile justice-involved youth: preventive health services received prior to detention. Journal of Correctional Health Care, 2021.PMID 34402679
- [11]Casiano H, Bolton SL, Hildahl K, Katz LY, Bolton J, Sareen J A population-based study of the prevalence and correlates of self-harm in juvenile detention. PLoS One, 2016.PMID 26760497
- [12]Kippin NR, Leitão S, Watkins R, Finlay-Jones A, Condon C, Marriott R, et al. Language diversity, language disorder, and fetal alcohol spectrum disorder among youth sentenced to detention in Western Australia. International Journal of Law and Psychiatry, 2018.PMID 30420110
- [13]Moore E, Indig D, Haysom L Traumatic brain injury, mental health, substance use, and offending among incarcerated young people. The Journal of Head Trauma Rehabilitation, 2014.PMID 23656964
- [14]Moore E, Gaskin C, Indig D Childhood maltreatment and post-traumatic stress disorder among incarcerated young offenders. Child Abuse & Neglect, 2013.PMID 23978574
- [15]Barnert E, Sun A, Abrams L, Chung PJ Reproductive health needs of recently incarcerated youth during community reentry: a systematic review. BMJ Sexual & Reproductive Health, 2020.PMID 31722933
- [16]Barnert ES, Perry R, Morris RE Juvenile incarceration and health. Academic Pediatrics, 2016.PMID 26548359
- [17]Borschmann R, Kinner SA Rates and causes of death after release from incarceration among 1 471 526 people in eight high-income and middle-income countries: an individual participant data meta-analysis. The Lancet, 2024.PMID 38614112
- [18]Beaudry G, Yu R, Perry AE, Fazel S Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials. The Lancet Psychiatry, 2021.PMID 34419185