Health care standards for youth in custodial facilities

Question 1

What percentage of youth in custodial facilities require medical or mental health care?

Answer 1

23-50%

Question 2

What health policy should be in place?

Answer 2

Staff member to oversee the health program
Does not need to be a HCP
Should be an advisory committee

Question 3

What is the policy re: intake assessment?

Answer 3

All youth should be medically evaluated within 72h of admission

Question 4

What should be done for youth with history of recent substance use?

Answer 4

Assess for signs and symptoms of withdrawal

Youth withdrawing from regular benzodiazepine require a medically supervised treatment setting

Question 5

What are the guidelines for longer-term placements?

Answer 5

1. A recent medical history and physical examination have been performed and recorded.
2. The medical and mental health history from the family has been obtained and recorded.
3. Any investigations and assessments that were ordered have been performed and the results have been reviewed.
4. A plan for both short- and long-term health goals has been established and detailed on the youth’s chart so that further evaluation will be carried out, either in the community on discharge or in any other institution to which the youth is transferred. This will reduce duplication and ensure that the assessment is done. These plans should be communicated to the youth and could involve family members as the youth consents.
5. The youth has been involved in any plans concerning his/her health and that consent and confidentiality issues have been respected. Any plans or decisions made about the youth’s health and health care have been discussed with him/her and he/she has agreed to them. Health care professionals and case managers should ensure that consent to gather information about the youth is obtained, and that consent to any part of the plan or any health intervention is not forced on the youth by any staff member or anyone outside the facility. Every effort should be made to protect the confidentiality of the youth’s health record.

Question 6

What are the guidelines for emergency care?

Answer 6

1. All facilities have a clearly detailed 24 h, seven-day-a-week emergency care plan that is fully understood by all staff.
2. Someone trained in first aid, CPR, and management of violence should be present at all times
3. A list of 24h resources should be posted

Question 7

What are the guidelines for continuing health assessment?

Answer 7

1. All previous medical, psychological, educational, psychiatric and laboratory evaluations should be available to assist with the current or future health care of the youth.
2. A complete and confidential history, including psychiatric symptoms, sexual behaviour, substance abuse and history of physical/sexual abuse should be included in the youth’s assessment.
3. Complete dental and medical examinations, including a genital examination where appropriate, should be performed once explanations have been given to the youth and consent has been obtained.
4. If recommended, hearing, visual screening and laboratory evaluations should be arranged.
5. Assessments of cognitive ability and any specific learning disabilities should be organized when appropriate.
6. Immunizations should be updated according to provincial guidelines (with youth and parental consent where required).
7. All youths should receive appropriate anticipatory guidance, including the following:
   a) education on healthy eating, an active lifestyle and additional treatment as needed;
   b) explanation of and counselling on the consequences of high-risk sexual behaviours, such as hepatitis, unplanned pregnancy, HIV and other sexually transmitted infections (this information should be detailed and appropriate to the youth’s cognitive ability); and
   c) ongoing counselling on contraceptives and safer sex (this should be offered to all youths, without judgment of their sexual orientation or practices).