Journal of Correctional Health Care - April 2023 - 94

Journal of Correctional Health Care
Volume 29, Number 2, 2023
ª The Author(s) 2023
DOI: 10.1089/jchc.21.09.0086
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BEST PRACTICES
Prescribing Psychotropic Medications
for Justice-Involved Juveniles
Anthony Tamburello, MD, CCHP,1* Joseph Penn, MD, CCHP,2
Rosa Negron-Mun˜ oz, MD,3 and Kristopher Kaliebe, MD4
Abstract
Psychiatric disorders are exceedingly common in justice-involved youth. Relevant justice systems are varied,
evolving, complex, and underserved. The intent of this article is to highlight the research and best practices
related to managing the psychiatric disorders of justice-involved youths with a particular focus on
pharmacotherapy. We review relevant features of the justice system and related case law, how prescribing
for these individuals varies from both community settings and for incarcerated adults, effective assessment
and medication selection, informed consent, management of nonadherence and medication diversion, and
applied evidence for specific psychiatric problems common in these patients. Psychiatrists caring for
justice-involved youth will benefit from tools, like this article, for training and orientation to provide timely
and effective treatment services and consultation in these settings.
Keywords: prescribing, justice, youth, psychopharmacology, psychiatry
Introduction
The American Academy of Psychiatry and the Law's
2022 Practice Resource for Prescribing in Corrections
was focused on the treatment of incarcerated adults
(Tamburello et al., 2022). That document did not address
justice-involved adolescents and children. Although the
arrest rate has declined by more than half over the past
decade (compare 1,812,930 arrests in 2009), in 2019
there were 696,620 arrests of individuals under the age
of 18 (Office of Juvenile Justice and Delinquency Prevention
[OJJDP], 2009, 2019a).
On any given day in 2018, an average of 37,529 youths
were housed in state, local, or private residential facilities
(OJJDP, 2019c), not counting the fraction of people
under the age of 18 held in adult correctional facilities
(3,400; OJJDP, 2019b). There is a tremendous range of
chronological (from 9 to 20 years old) and developmental
maturity in these individuals.
These systems are varied, evolving, and complex.
They are typically understaffed, underfunded, and underserved.
They have become increasingly privatized and
fragmented, with carve-outs for specialty services like
sexual offenses, mental health, substance use, and firesetting
treatment.
Privatization has led to fewer opportunities for training
psychiatrists within these institutions. Ideally, psychopharmaceuticals
would be prescribed by individuals
with the highest level of training and experience, such
as those with board certification in child and adolescent
psychiatry, with additional training in forensic settings.
1University Correctional Health Care Rutgers University-Robert Wood Johnson Medical School Department of Psychiatry, Piscataway, New Jersey, USA.
2Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Correctional Managed Care Mental Health Services, Conroe, Texas, USA.
Departments of 3Child and Adolescent Psychiatry and 4Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA.
*Address correspondence to: Anthony Tamburello, MD, CCHP, University Correctional Health Care c/o NewJersey Department ofCorrections, Bates Building 2nd Floor, Box 862,
Stuyvesant & Whittlesey Rd, Trenton, NJ 08625, USA, Email: tamburac@ubhc.rutgers.edu
94

Journal of Correctional Health Care - April 2023

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