Faculty Bibliography

PURPOSE: Relatively little is known about the prevalence of traumatic brain injury (TBI) among adolescents who come into contact with the criminal justice system. METHODS: We undertook screening for TBI among newly admitted adolescents in the New York City jail system using a validated TBI screening tool. A convenience sample of 300 male and 84 female screenings was examined. RESULTS: Screening revealed that 50% of male and 49% of female adolescents enter jail with a history of TBI. Incidence of TBI was assessed using patient health records, and revealed an incidence of 3,107 TBI per 100,000 person-years. CONCLUSIONS: Elevated prevalence and incidence of TBI among incarcerated adolescents may relate to criminal justice involvement as well as friction in jail. Given the large representation of violence as a cause of TBI among our patients, we have begun focus groups with them to elicit meaningful strategies for living with and avoiding TBI.

OBJECTIVES: We sought to better understand acts of self-harm among inmates in correctional institutions. METHODS: We analyzed data from medical records on 244 699 incarcerations in the New York City jail system from January 1, 2010, through January 31, 2013. RESULTS: In 1303 (0.05%) of these incarcerations, 2182 acts of self-harm were committed, (103 potentially fatal and 7 fatal). Although only 7.3% of admissions included any solitary confinement, 53.3% of acts of self-harm and 45.0% of acts of potentially fatal self-harm occurred within this group. After we controlled for gender, age, race/ethnicity, serious mental illness, and length of stay, we found self-harm to be associated significantly with being in solitary confinement at least once, serious mental illness, being aged 18 years or younger, and being Latino or White, regardless of gender. CONCLUSIONS: These self-harm predictors are consistent with our clinical impressions as jail health service managers. Because of this concern, the New York City jail system has modified its practices to direct inmates with mental illness who violate jail rules to more clinical settings and eliminate solitary confinement for those with serious mental illness.

Chronic health conditions are overrepresented among jail or prison inmates but often go untreated during incarceration and following release. We describe the Bronx Transitions Clinic, a partnership between a community-based organization and an academic medical center, which facilitates connections to medical care for formerly incarcerated people.

Correctional health systems represent some of the largest health systems in the United States, caring for patients with high rates of morbidity and mortality. The poorly understood realm of correctional health care represents a missed opportunity to integrate care for these patients with care provided by community health providers. Three aims are integral to effective correctional health: patient safety, population health, and human rights. Patient safety and population health are well-defined aims in community health care systems and emerging in correctional settings. Dual loyalty and other unique challenges in correctional settings make the human rights aim absolutely essential for promoting correctional health.