Author: Jerry Higgins
When C.A. Dillon Youth Development Center in Butner was closed in 2016 as part of the 2014 Juvenile Justice Strategic Plan, youths housed at Dillon were relocated into the newly reopened Edgecombe Youth Development Center.
Once the former C.A. Dillon YDC campus re-opened in February 2020 as a juvenile detention center, the need for pediatric medicine providers to assist juvenile justice health care in a central location was great. Shortages for nurses and medical providers were no different than in community health care nationally, and the Juvenile Justice section did not have enough medical personnel to provide the necessary medical care at the newly re-opened Dillon location.
Prior to Dillon’s reopening, there were discussions between Juvenile Justice Health Services Director Dale Floyd and Dr. Richard Chung, a pediatrician at Duke Health System, as Duke had shown interest in providing primary health care services to juveniles. There were discussions about both Duke and UNC Health joining forces and providing services at Dillon. Dr. Chung and Duke Pediatric Cardiologist Dr. Anthony Milazzo helped bring UNC into the planning discussions and facilitated the services now in place at Dillon.
“We spoke with pediatricians at Duke more than two-plus years ago and they were interested in providing health care to juveniles,” Floyd said. “Initially it was a shared program with UNC. Ultimately, the timing wasn’t right for Duke, but we are so grateful for their involvement and partnership.”
In November 2020, UNC Pediatrics became the sole partner for Juvenile Justice health care at Dillon JDC. And, what a partnership it has been.
“We are thrilled with how it has been going,” said Dr. Martha Perry, the medical director of the UNC Children’s Primary Care Clinic and associate program director for the UNC Pediatrics Residency Program. “The state was looking for providers with adolescent medical experience to support the growing need. We have relations with multiple departments (with UNC Health) who can meet our needs through our work. When JJ partners with an institution, it has access to the entire institution, which helps increase the resources in place.”
Physicians and residents from UNC Pediatrics are on site at Dillon weekly to address any medical issues – both physical and mental – the juveniles may have. They get the same type of care they’d get if they went to a doctor’s office.
Most juveniles who obtain care at Dillon may never have received the type of complete head-to-toe physical and mental health observations and examinations during their adolescence. Many do not have a medical home. Dental care is provided based on emergent need while they are at the facility.
Three physicians and a nurse practitioner rotate weekly to run the on-site clinic and coordinate care with facility nurse Ebony Crutchfield. The residents who serve the facility are paired with a designated physician, but Dr. Perry said the residents are very capable to provide quality full-time care for the juveniles. However, should there be an illness or other situation that needs additional consultation, the physicians can contact specialists within the UNC health care system.
Shortly after the partnership began, the COVID-19 pandemic took hold. Juvenile Justice used UNC’s experience as a front-line provider and research institution on COVID-19-related illnesses for assistance in the treatment required to stop the virus.
While it is not a primary part of the care provided, the ability to use telehealth technology exists if necessary. While the state prison system uses telehealth extensively with UNC specialists in order to keep offenders at their facilities for appointments when they can to preserve security, the need for telehealth in the Juvenile Justice facilities has primarily been in the realm of psychiatric services. At Dillon, telehealth has not been implemented at this time, according to Dr. Perry and Floyd.
“We have been using telehealth for psychiatric clinics for several years and it is very critical,” Floyd said. “We could include it at Dillon for other specialty services as situations and needs arise. I know it has been a lifesaver for psychiatric services at Cabarrus and other locations. Telehealth could be used in every situation where it is difficult to find a provider, so no juvenile has a deficit in care.”