Deaths in juvenile justice residential facilities

Purpose: To provide the first national description of death in juvenile justice residential facilities. Methods: Data come from recent censuses of all public and private juvenile justice facilities in the United States. Death rates for the custody population are adjusted for length at risk, and are compared to death rates of adolescents in the general population. Multivariate modeling is used to identify facility-level risk factors related to deaths. Results: Adjusting for the number of days at risk, adolescents in juvenile justice facilities have lower risks of death by accident and homicide, but considerably higher risks of death from suicide and illness (200% and 50%, respectively). Facilities with larger Black populations, those that lock sleeping room doors, and facilities designed to screen young persons for future placements all had significantly higher odds of experiencing a death. Conclusions: The higher rates of death from suicide or illness suggest either (a) juvenile justice facilities host very high risk adolescents who would have died on the outside, (b) the facility environment itself increases the risk of death relative to the adolescents' environment outside the facility, particularly in the case of deaths from suicide, (c) placement in a juvenile justice facility may be indicative of a time of crisis in adolescents' lives in terms of physical or mental health and thus the risk of death increases, or most realistically, (d) some combination of the above. That deaths are more likely in facilities with larger Black populations warrants significant future investigation. Finally, the policy of locking sleeping room doors should be seriously evaluated in light of the strong association found with suicide. (c) 2006 Society for Adolescent Medicine. All rights reserved.