For the past 25 years, the American Academy of Pediatrics has been involved in the promotion and maintenance of high standards of health care for children and adolescents in juvenile detention facilities. It is the position of the Academy that society assumes an obligation to provide care for the physical and mental health needs of youths who have been removed from their homes and placed in residential facilities. Both the Academy and many individual pediatricians have, therefore, become advocates for improved care for these unfortunate young people. SCOPE OF THE PROBLEM Each year approximately one-half million children and adolescents are admitted to juvenile detention facilities, and an additional one-half million are kept in adult jails or lock-ups, according to the National Commission on Correctional Health Care. Of these, more than 80% are boys. The health care needs of this population are great; more than 50% of all youths entering detention facilities have health-related problems. The most frequently identified problems among detained youths include alcohol and drug abuse, depression and suicidal behavior, physical and sexual abuse, learning disability, and sexually transmitted disease. In view of these multiple problems, health programs in detention facilities must be broad and comprehensive. There are more than 1000 publicly operated state and local juvenile detention, correctional, and shelter facilities in the United States. These may be classified as short-term (usually housing juveniles awaiting adjudication and placement) and longterm (postadjudication and placement). Juveniles detained pending adjudication, disposition, or placement stay in custody an average of 12 days; those committed by court authorities stay an average of 163 days. These figures do not take into account the nearly 500 000 juveniles who are detamed in adult jails and lock-ups for brief but varying periods. The practice of detaining youths in adult jails should be discouraged.
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