Online Health Records Benefit Teens in Juvenile Justice System

Teens who get in trouble with the law often have serious untreated health problems, such as asthma, sexually transmitted infections, mental illnesses or substance abuse. But a strong collaborative relationship between Packard Children’s and the local juvenile justice system is helping physicians improve the health of high-risk adolescents, both in our backyard and on a larger scale.

“These young people are marginalized, considered delinquent,” said Dr. Arash Anoshiravani, the medical director of the Santa Clara County Juvenile Custody Institutions, an adolescent medicine specialist at Packard Children’s and a clinical assistant professor of adolescent medicine at Stanford. “They’re not very engaged in their own health, and they have poor access to health-care systems.”

Too often, the only time these high-risk teens see a doctor is when they’re incarcerated in juvenile hall. Anoshiravani and his colleagues are making the most of that opportunity by helping incarcerated teens get good care for immediate health problems, researching how to improve their health after juvenile hall, and educating physicians-in-training about their needs.

“We’re lucky that we have all the resources of the Santa Clara Valley Health and Hospital system and also the resources of Packard Children’s and Stanford Hospitals,” Anoshiravani said. One recent patient, he recalled, required specialized treatment in Packard Children’s pediatric intensive care unit for a rare liver disorder. Others benefit from Anoshiravani’s ability to inform his treatment decisions by reviewing records of care they received at Packard Children’s in early childhood.

A bigger challenge is figuring out how to help young offenders improve their health after they leave juvenile hall. Both the Packard Children’s and Santa Clara Valley Medical Center’s Teen Health Vans, mobile clinics that offer free care to local uninsured youth, already provide front-line care, but more is needed. Online health records could be a key tool, new research shows. In a study published in Pediatrics Oct. 22, Anoshiravani and colleagues found that incarcerated teens have high rates of Internet access when they are not in juvenile hall, contradicting older findings of low Internet use among underserved groups. And teens in juvenile hall, who often lead unstable lives, were enthusiastic about the idea of accessing their medical histories online instead of via easily-lost pieces of paper. Next, the team plans to develop and pilot-test online medical records that could give high-risk teens more continuity in their medical care.

“If you don’t engage with this patient population, you would never know what issues matter to them,” Anoshiravani said. The health-records study is a good example of turning these teens’ pressing concerns into a plan to help, he added. “Thinking about ways the research community can make a difference on a broader level is really satisfying.”

Finally, a long-established collaboration between Santa Clara County’s juvenile hall, Packard Children’s Hospital and the Stanford University School of Medicine attracts medical students, residents and adolescent medicine fellows to this type of community medicine. “They get to see the other side of medicine, hearing our patients’ life stories and seeing how our social environment affects people’s health,” Anoshiravani said. “I like to think of our patients as the teachers.”