An Alarming Connection Between Justice System Involvement and Child Health

A first-of-its kind study finds that while only 2% of patients at a large children’s hospital are identified with likely personal or family involvement in the justice system, they account for large proportions of some troubling diagnoses

August 6, 2021

(COLUMBUS, Ohio) – Research over the last decade has shown that young people who have been incarcerated can have poorer physical and mental health outcomes than persons who have not been incarcerated, and that youth who have experienced a family member’s incarceration also may experience negative effects.

A new study conducted at Nationwide Children’s Hospital’s Abigail Wexner Research Institute and published in the journal Health & Justice, appears to be the first to use electronic medical records and link children’s personal or family involvement in the correctional system to diagnoses – and the authors say the findings are so alarming they should be a call to action for pediatric providers.

The study looked at the electronic medical records of 2.3 million youth (up to 21 years old) who had received care at Nationwide Children’s between 2006 and 2020. No standard screening for exposure to the justice system was typically employed at Nationwide Children’s during those years. Nevertheless, approximately 2% had a correctional “keyword” in their record indicating probable personal or parental involvement in the correctional system as recorded by a health professional.

That 2% accounted for 66% of all patients with cannabis-related diagnosis over the time period of the study. They also accounted for: 

  • 53.9% of all patients with substance use-related disorders
  • 51.8% of all patients with trauma-related disorders
  • 47.8% of all patients with stress-related disorders
  • 37.6% of all patients with psychotic-related disorders
  • 35.5% of all patients with anemia-related disorders
  • 32.8% of all patients with suicidal-related disorders
  • 17.0% of all developmental-related disorders of speech and language

“We anticipated that the results would show that children with any involvement in the correctional system would have some concerning diagnoses, but the magnitude was a bit shocking,” said Samantha Boch, PhD, RN, a former prison nurse and lead author of the study.

The authors note that many factors other than involvement in the justice system likely contribute to these diagnoses, and those factors may also have led to their parents’ or their own incarceration. But personal or family involvement in the justice system appears to be a signal that the potential for other worrying diagnoses is high.

“We performed this research at our own institution, and our findings need to be confirmed by other researchers and institutions looking at their own patient populations,” said Deena Chisolm, PhD, director of Center for Child Health Equity and Outcomes Research at the Abigail Wexner Research Institute at Nationwide Children's and an author of the study. “What our study shows, though, is that it’s urgent that the pediatric health care system try to identify children who have justice system involvement, and that we proactively pursue interventions to help them.”

Dr. Boch led the study as a post-doctoral fellow in Nationwide Children’s Patient-Centered Pediatric Research Program. She is now an assistant professor at the University of Cincinnati College of Nursing with an affiliate role at Cincinnati Children’s Hospital Medical Center.

About Nationwide Children's Hospital

Named to the Top 10 Honor Roll on U.S. News & World Report’s 2023-24 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital 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 as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs, as well as prioritizing quality and safety, are part of what allows Nationwide Children’s to advance its unique model of care. Nationwide Children’s has a staff of more than 14,000 that provides state-of-the-art wellness, preventive and rehabilitative care and diagnostic treatment during more than 1.7 million patient visits annually. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s physicians train the next generation of pediatricians and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities. More information is available at NationwideChildrens.org.