Brittany Raffa, MD

Isolation in juvenile detention centers persists despite ample data demonstrating the traumatizing consequences to youth who often already have been traumatized. I recently visited a detention center as part of my pediatric residency’s advocacy rotation. There, I learned that youth are kept in isolation for several days, with a vague definition by staff on the limit of “several days.” Multiple words were used for confinement, the most stunning and horrific of which was “segregation” – “He got into a fight and was placed in segregation.” While in isolation or segregation – whatever it is called – mental illness and posttraumatic stress disorder are exacerbated. Youth do not participate in school classes, and they are barred from the daily hour of physical activity. In extreme cases, they go from complete isolation one day to complete freedom the next.

The vibe word in the facility I visited was “evidence-based strategies,” stressed by the new administration. But evidence-based strategies do not include isolation. They include educating staff about the pervasive effects of trauma in children. They include communication interventions, conflict resolution, and the implementation of rewards such as extra visitation, computer time, or the use of an adolescent’s own personal hygiene items or clothing. They include knowledge of the adolescent brain, and how the use of isolation in juvenile centers has led to increased suicide rates in those children.

Lindsay M. Hayes, author of the National Center on Institutions and Alternatives’ 2004 report “Juvenile Suicide in Confinement: A National Study,” wrote: ”Although room confinement remains a staple in most juvenile facilities, it is a sanction that can have deadly consequences. … More than 50% of all youths’ suicides in juvenile facilities occurred while young people were isolated alone in their rooms, and … more than 60% of young people who committed suicide in custody had a history of being held in isolation.”

The United Nations has called on all countries to absolutely prohibit solitary confinement for juveniles, as has the American Academy of Child and Adolescent Psychiatry. Thus, extreme isolation should not be another tool for juvenile detention centers.

Currently, 20 states have banned solitary confinement in juvenile detention facilities. The major barriers are from staff, who state it would remove a tool, put staff in danger, and allow youth to run the facilities. None of these has been shown to be true. Some juvenile detention centers have changed the traditional meaning of isolation – youth will have a minimum of 8 hours away from isolation when confined for a day or longer. “During that 8 hours, they have the opportunity to talk to and be in the company of staff,” said Adam Schwartz, a lawyer for the American Civil Liberties Union of Illinois, whose lawsuit drastically limited solitary confinement practices in Illinois’s juvenile detention centers. The policy also requires that inmates in isolation continue to receive education and mental health services.

There is a human dignity that not even detainees deserve to lose. President Obama has discussed this, as has the 2012 Report of the Attorney General’s National Task Force on Children Exposed to Violence, which concluded: “Nowhere is the damaging impact of incarceration on vulnerable children more obvious than when it involves solitary confinement.” I am writing this article to raise awareness about this underreported problem in hopes that new legislation will lead to change that is in the best interest of our children.

Dr. Raffa is in postgraduate year 2 in her pediatric residency at Vanderbilt Children’s Hospital in Nashville, Tenn.

Isolation in juvenile detention centers persists despite ample data demonstrating the traumatizing consequences to youth who often already have been traumatized. I recently visited a detention center as part of my pediatric residency’s advocacy rotation. There, I learned that youth are kept in isolation for several days, with a vague definition by staff on the limit of “several days.” Multiple words were used for confinement, the most stunning and horrific of which was “segregation” – “He got into a fight and was placed in segregation.” While in isolation or segregation – whatever it is called – mental illness and posttraumatic stress disorder are exacerbated. Youth do not participate in school classes, and they are barred from the daily hour of physical activity. In extreme cases, they go from complete isolation one day to complete freedom the next.

The vibe word in the facility I visited was “evidence-based strategies,” stressed by the new administration. But evidence-based strategies do not include isolation. They include educating staff about the pervasive effects of trauma in children. They include communication interventions, conflict resolution, and the implementation of rewards such as extra visitation, computer time, or the use of an adolescent’s own personal hygiene items or clothing. They include knowledge of the adolescent brain, and how the use of isolation in juvenile centers has led to increased suicide rates in those children.

Lindsay M. Hayes, author of the National Center on Institutions and Alternatives’ 2004 report “Juvenile Suicide in Confinement: A National Study,” wrote: ”Although room confinement remains a staple in most juvenile facilities, it is a sanction that can have deadly consequences. … More than 50% of all youths’ suicides in juvenile facilities occurred while young people were isolated alone in their rooms, and … more than 60% of young people who committed suicide in custody had a history of being held in isolation.”

The United Nations has called on all countries to absolutely prohibit solitary confinement for juveniles, as has the American Academy of Child and Adolescent Psychiatry. Thus, extreme isolation should not be another tool for juvenile detention centers.

Currently, 20 states have banned solitary confinement in juvenile detention facilities. The major barriers are from staff, who state it would remove a tool, put staff in danger, and allow youth to run the facilities. None of these has been shown to be true. Some juvenile detention centers have changed the traditional meaning of isolation – youth will have a minimum of 8 hours away from isolation when confined for a day or longer. “During that 8 hours, they have the opportunity to talk to and be in the company of staff,” said Adam Schwartz, a lawyer for the American Civil Liberties Union of Illinois, whose lawsuit drastically limited solitary confinement practices in Illinois’s juvenile detention centers. The policy also requires that inmates in isolation continue to receive education and mental health services.

There is a human dignity that not even detainees deserve to lose. President Obama has discussed this, as has the 2012 Report of the Attorney General’s National Task Force on Children Exposed to Violence, which concluded: “Nowhere is the damaging impact of incarceration on vulnerable children more obvious than when it involves solitary confinement.” I am writing this article to raise awareness about this underreported problem in hopes that new legislation will lead to change that is in the best interest of our children.

Dr. Raffa is in postgraduate year 2 in her pediatric residency at Vanderbilt Children’s Hospital in Nashville, Tenn.

Isolation in juvenile detention centers persists despite ample data demonstrating the traumatizing consequences to youth who often already have been traumatized. I recently visited a detention center as part of my pediatric residency’s advocacy rotation. There, I learned that youth are kept in isolation for several days, with a vague definition by staff on the limit of “several days.” Multiple words were used for confinement, the most stunning and horrific of which was “segregation” – “He got into a fight and was placed in segregation.” While in isolation or segregation – whatever it is called – mental illness and posttraumatic stress disorder are exacerbated. Youth do not participate in school classes, and they are barred from the daily hour of physical activity. In extreme cases, they go from complete isolation one day to complete freedom the next.

The vibe word in the facility I visited was “evidence-based strategies,” stressed by the new administration. But evidence-based strategies do not include isolation. They include educating staff about the pervasive effects of trauma in children. They include communication interventions, conflict resolution, and the implementation of rewards such as extra visitation, computer time, or the use of an adolescent’s own personal hygiene items or clothing. They include knowledge of the adolescent brain, and how the use of isolation in juvenile centers has led to increased suicide rates in those children.

Lindsay M. Hayes, author of the National Center on Institutions and Alternatives’ 2004 report “Juvenile Suicide in Confinement: A National Study,” wrote: ”Although room confinement remains a staple in most juvenile facilities, it is a sanction that can have deadly consequences. … More than 50% of all youths’ suicides in juvenile facilities occurred while young people were isolated alone in their rooms, and … more than 60% of young people who committed suicide in custody had a history of being held in isolation.”

The United Nations has called on all countries to absolutely prohibit solitary confinement for juveniles, as has the American Academy of Child and Adolescent Psychiatry. Thus, extreme isolation should not be another tool for juvenile detention centers.

Currently, 20 states have banned solitary confinement in juvenile detention facilities. The major barriers are from staff, who state it would remove a tool, put staff in danger, and allow youth to run the facilities. None of these has been shown to be true. Some juvenile detention centers have changed the traditional meaning of isolation – youth will have a minimum of 8 hours away from isolation when confined for a day or longer. “During that 8 hours, they have the opportunity to talk to and be in the company of staff,” said Adam Schwartz, a lawyer for the American Civil Liberties Union of Illinois, whose lawsuit drastically limited solitary confinement practices in Illinois’s juvenile detention centers. The policy also requires that inmates in isolation continue to receive education and mental health services.

There is a human dignity that not even detainees deserve to lose. President Obama has discussed this, as has the 2012 Report of the Attorney General’s National Task Force on Children Exposed to Violence, which concluded: “Nowhere is the damaging impact of incarceration on vulnerable children more obvious than when it involves solitary confinement.” I am writing this article to raise awareness about this underreported problem in hopes that new legislation will lead to change that is in the best interest of our children.

Dr. Raffa is in postgraduate year 2 in her pediatric residency at Vanderbilt Children’s Hospital in Nashville, Tenn.