An Alarming Connection Between Justice System Involvement and Child Health

An Alarming Connection Between Justice System Involvement and Child Health 1024 575 Jeb Phillips

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.

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.

But a new study conducted at the Abigail Wexner Research Institute at Nationwide Children’s Hospital 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.

“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 published in the journal Health & Justice.

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.

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 a 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

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 is currently refining these investigations using electronic medical record data from Cincinnati Children’s, in addition to garnering input and perspectives of families affected by incarceration.

“Because the United States has maintained the highest rates of incarceration in the world for several decades, we can no longer stall efforts to better understand and mitigate the social, health, and economic consequences on youth who are affected,” she said.


Boch S, Sezgin E, Ruch D, Kelleher K, Chisolm D, Lin S. Unjust: the health records of youth with personal/family justice involvement in a large pediatric health system. Health & Justice. 2021 Aug 1. [Epub]

About the author

Jeb is the Managing Editor, Executive Communications, in the Department of Marketing and Public Relations at Nationwide Children's Hospital. He contributes feature stories and research news to PediatricsOnline, the hospital’s electronic newsletter for physicians and other health care providers, and to Pediatrics Nationwide. He has served as a communications specialist at the Center for Injury Research and Policy at The Research Institute and came to Nationwide Children’s after 14-year career as daily newspaper reporter, most recently at The Columbus Dispatch.