Running head: HEALTH PERSPECTIVES

Health Perspectives of Finland and the United States on the Effects of Youth
Incarceration
Kimberly Anderson, Mikaeyla Kliethermes, Jennifer Kruse, Linnea Osterman
Missouri State University

Health Perspectives of Finland and the United States on the Effects of Youth
Incarceration
According to the World Health Organization [WHO] (2015), adolescents are from
ages 10 to 19 years old. Depending on the crime, an adolescent can be incarcerated in a
juvenile detention center or in a jail. Incarnation for adolescents include the temporary
and safe custody of juveniles whose alleged conduct is subject to court jurisdiction who
require a restricted environment for their own and the communitys protection while
pending legal action (Bear, n.d.). An incarcerated adolescent is considered a vulnerable
population because the majority of them have barriers to their medical needs. These
barriers include lack of: health insurance, parent involvement, knowledge of medical
needs, and also low socioeconomic status. Many adolescents arrive to incarceration with
communicable diseases, bone fractures, gunshot wounds, and STIs (Morris, 2004).

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Health may be less of a priority due to the psychological and physiological stress
of incarceration or the environment leading up to incarceration. Custody may increase
care for an individuals health by providing an initial screening and evaluation upon
entering the facility, which they may not have had otherwise (Morris, 2004). In
comparison to the less vulnerable population, health is not simply an absence of disease.
According to the World Health Organization, health is defined as a complete state of
physical, mental and social well-being (WHO, 2015). This meaning that all aspects of a
persons mental and physical status, are considered into their state of health. From a
healthcare workers prospective, health is very complex and can involve many
characteristics. Overall, health is a balance and is specific to an individual and their
limitations, as well as how they define fulfillment and well-being.
Concerns for Health Promotion and Disease Prevention
One of the first steps to promoting health is to identify a problem. For youth
who have been incarcerated, homelessness is a common struggle. For example, 30
percent of the population at a large youth shelter in New York had been incarcerated or
arrested at least once previously (Toro et al., 2007). A large portion of the youth that leave
juvenile detention do not have a stable home to return, which may put them at risk for
committing more crimes such as panhandling, sleeping in public, or loitering. Also, it is
evident that some adolescents cannot return home simply due to their crime. For
example, if they live in Section 8 housing and have been charged with crimes such as
domestic violence, they may not legally be allowed to return. For this reason, the US
Department of Housing and Urban Services (HUD) created the Continuum of Care
program to quickly rehouse people affected by homelessness. To further help youth
affected by homelessness, the government created the federal McKinney-Vento

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Education of Homeless Children and Youth Assistance Act It provides students
immediate enrollment into schools, even if they do not have the normally required
documents like proof of residence or immunizations and provides transportation to and
from school (National Center for Homeless Education, 2011). In Finland, the government
has approved a national program called Housing First to reduce homelessness in the
youth population and created a goal to eliminate long-term homelessness by 2015. The
main objective of this project is to increase the number of apartments, availability, and
quality of housing guidance, advice, and support housing (Tuuteri, n.d.).
Homelessness is a key to health; it is estimated that the life expectancy of
someone in the homeless population is between 42 and 52, which is far less than the
average of 78 years of age of the general population (OConnell, 2005). It appears that
the United States is more focused on rapid re-housing, but Finland has an approach to
find permanent housing quickly for homeless youth. Permanent solutions are a better
option, if possible. Finland will also work with adolescents who have bad credit, but there
is not a concrete plan to get the adolescent out of poverty, which created the
homelessness. In the United States, the McKinney-Vento Education of Homeless
Children and Youth Assistance Act helps to get the adolescent an education, which, in
turn, should help decrease poverty and thus decrease homelessness. Finlands rate of
youth homelessness has been increasing in recent years, while the United States has
relatively the same rate (U.S. Interagency Council on Homelessness, 2012).
Another problem facing adolescents who have been incarcerated is
recidivism. Recidivism is the recurrence of criminality in the future. It has been found
that juvenile incarceration increases the probability of incarceration later in life (Juvenile

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Justice Center [JJC], 2015). This relates to health in that it has been found that if there is
an increase in time spent in incarceration as an adolescent, it has been found to make the
mentally ill youth worse and create a greater risk for self-harm. These statistics are varied
greatly between America and Finland, because America has a much greater proportion of
the adolescent population incarcerated (JJC, 2015).
In America, up to 62% of the youth released from juvenile custody are reincarcerated again within three years (Larson, 2013). Comparatively, Finnish prisons
have recidivism rates around 20-30% for three years. Both of the effects of incarceration
on adolescents (worsening mentally illness and self-harm) fall under assessing and
promoting mental health. For Greene County, according to the Juvenile Justice Center,
incarcerated youth are assessed for medical and mental health within one hour of arrival
to the facility. Within 48 hours, the youth is cleared by a psychology counsellor.
Throughout their incarceration, counselling services and Cognitive Behavior Therapy are
available (JJC, 2015). Finland has mental health housing units available for incarcerated
youth to learn to live alone with some support (Larson, 2013).
Since incarceration in youth and recidivism rates are higher in America than in
Finland, the American adolescents are at a greater risk of mental health issues, including
self-harm. The prevalence of self-harm of adolescents in America is approximately 15%
of teens (Hawton, Rodham, & Evans, 2006.). In Finland, a study of adolescents aged 13
to 18 years old found a prevalence of self-injury at 1.8% (Larson, 2013). According to the
statistics on recidivism and self-harm, Finlands health promotion for incarcerated youth
is more effective than Americas.
Rehabilitation

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According to Merriam-Webster, rehabilitation means to restore back to a healthy
condition after an event or illness (2015). In the community, rehabilitation may include
access to education, employment, and health services (World Health Organization
[WHO], 2015). Some of the general vulnerable populations may view rehabilitation as
getting financial services, such Woman Infant Children (WIC) to help with finical
disparities. Social services, such as family support, child care, health care, and temporary
assistance; could also be considered rehabilitation because it is helping people get back to
a healthy level of living (Missouri Department of Social Services, 2015). According to
the WHO, 15% of the worlds population has a disability that limits their activities in life
(2015). These individuals may view rehabilitation as attaining visual, hearing, and
mobility aids through the community to increase their quality of life.
The incarceration of adolescents hopes to give opportunity to the youth to become
constructive citizens in the community, which can be accomplished by rehabilitation
(Amen & Lee, 2012). Many rehabilitation centers are used after incarceration, but it is
important to begin this process during incarceration for adolescents. This should begin
during incarceration because it gives the youth a chance to learn social norms before
going back to an environment that could be promoting criminal behavior. Some
beneficial programs for rehabilitation are vocational training programs and career
education programs. Vocational training allows the teens to learn hands on skills for a
possible career, promote social connectedness in the community, and decrease the
homeless adolescent population. This is valuable because it can influence possible career
paths, how to live independently, and how to earn a living without doing criminal
activities (Amen & Lee, 2012). This is to hopefully give the youth skills and resources to
decrease homelessness upon that population.

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In the United States, juvenile justice centers focus on rehabilitation as the primary
goal (Juvenile Law Center, 2015). However, there is much confrontation about whether
juvenile delinquents should be incarnated in a jail as a punishment or if they should
attend a rehabilitation program instead. Recently in several states, the Juvenile Detention
Alternatives Initiative (JDAI) has been put into place (Teitelman & Linhares, 2013). The
JDAI has a goal to limit the amount of time that teens spend incarcerated and to hopefully
become productive adults during their transition in stages of life. Greene County has had
improved statistical results for juveniles with the implementation of new reforms. These
statistics include a 35% decrease in juvenile admissions and a 30% decrease in the length
of overall length of stay (Teitelman & Linhares, 2013). Greene County is also one of the
first counties in Missouri to establish a Reporting Center, which can be considered a
rehabilitation center. It provides a place for previous juvenile delinquents to come after
school for counseling, activities, and supervision (Teitelman & Linhares, 2013). In the
United States, it is also very common to see rehabilitation programs for drugs, alcohol,
and violence in our youth population.
According to the WHO, 80% of the worlds population lives in low and middleincome countries (WHO, 2015). This means that it is very difficult for rehabilitation to
occur globally. Many people in underdeveloped countries cannot afford rehabilitation
services, which make it hard to attain assistive devices or beneficial programs. Globally
for incarcerated adolescents, rehabilitation is making a troubled teen into a law-abiding
citizen. The hopes of rehabilitation is to prevent teens from committing further crimes
and give them the skills to make choices that do not provide threat to themselves or the
community. Rehabilitation may look different in different countries, but they all want the
same outcome, which is for their youth to become productive citizens.

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The design of rehabilitation can be challenging in the case of a young person who
has sustained as a result of the offense the prison. Often the young may not be willing to
accept help and rehabilitation work to do need to see a special effort of a young inspiring.
A closed institution, to bring also become a problem in the provision of services. All
services may not be possible to provide prison. In addition, it must be noted that patients
need for rehabilitation of the Territory of life, which are self-evident.
Young people seek to invest in the rest of the prison if the offense is sufficiently
small. In many cases, a young person may survive a first offense by a fine alone. If the
pursuit of crime, take a look at the persistence of the young may be placed in prison
instead of school at home. There is continuous monitoring so that any criminal intentions
young can possibly be prevented. In addition, he will be offered a social worker services
and tarviettassa services in a psychiatric unit. Together with the young person seeks to
determine what his behavior is due, and if he could somehow change it.
In addition to ordinary prisons, there is also a prison hospital, where prisoners are
placed with serious health deficiencies or they need hospital-level care. Each in an
ordinary prison is a nurse on the spot and at least once a week the opportunity to get a
doctor's appointment. We also have a prison mental hospital which placed severe mental
disorder prisoners. In addition, ordinary prison notified every time a prison mental
hospital when one of the prisoners forced insulation.
Governmental and Nongovernmental Structures that Address Health Concerns
The community health concerns in the United States is addressed through the U.S
Department of Health and Human Services [USDHHS] and the Centers for Disease
Control [CDC]. The USDHHS also established Healthy People 2020, which provides
public health goals for our nation (Harkness & DeMarco, 2016). Community health
concerns are addressed through these programs because many of the goals deal with

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problems that occur in the community setting and not just the acute setting. Adolescent
health is one of the new focus areas of Health People 2020. This goal states that
adolescents should have improved health, healthy development, well-being, and safety
(U.S Department of Health and Human Services, 2014).
The United States health care system works primarily from privately owned
health insurance companies (Harkness & DeMarco, 2016, p. 31). Publically funded
agencies such as Medicare, Medicaid, and the Veterans Health Administration are
exceptions and help with the many Americans that struggle to pay for health care. Over
15% of Americans are completely uninsured, while 35% are underinsured and unable to
pay for appropriate health care (Harkness & DeMarco, 2016, p. 31). The United States is
the highest spending country in the entire world when it comes to health care and health
care services. Non-governmental organizations (NGOs) provide support and promote
health for the American people through their services provided by volunteer and private
donations (Harkness & DeMarco, 2016, p.31). The health care system model that best fits
the United States, is the out-of-pocket model due to our industrialization and our lack of
mass medical care. The model discusses that the United States has the technologies and
the resources to see a doctor at any time as long as you can afford some sort of out-ofpocket cost (Physicians for a National Health Program [PNHP], 2009). A major challenge
that this country is facing is the controversial argument on whether or not health care is a
right or a privilege. The Affordable Care Act was the first step towards having universal
care for all Americans and was put in to place to allow more affordable care to the
American people by lowering premiums and out-of-pocket costs. This reform has faced
many challenges since it was upheld by the Supreme Court in 2012. Many states have

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opted out of its services which has left gaps in the vulnerability groups in certain parts of
the country (U.S. Department of Health and Human Services, 2015).
The health care system in Finland differs greatly from the United States in many
ways. Finland provides universal health care for all permanent residents, private
insurance can also be purchased if needed (Kela, 2015). Funding for health care is
through taxation, including state funding, municipal taxation, National Health Insurance,
employer contributions, and patient fees which are of low and reasonable cost (Kela,
2015). The National Health Insurance Model represents this health care system since the
citizens pay into a government-run insurance program that pays for their universal health
care. The model describes benefit of this type of system due to the reduced cost and a less
complicated administrative involvement, unlike the United States. Since the insurance
companies in Finland do not sell for profit, there is no financial motives to deny patients
claims (PNHP, 2009).
Youth who are detained or incarcerated in correctional facilities represent a
medically underserved population at high risk for a variety of medical and emotional
disorders (National Commission on Correctional Health Care [NCCHC], 2015). After
1984, all federal funding for health care of incarcerated youth was stopped and shifted to
local governments in the United States. Due to the decline of federal funding the quality
of health care provided to this population has decreased considerably (NCCHC, 2015).
Adolescents who are incarcerated are usually among the most poor and socially
disadvantaged which causes them to be more vulnerable due to their lack of access to
care (NCCHC, 2015). Allen Criger, a Workforce Development Specialist and a Police
Services Representative who works with this population at the Evening Reporting Center
of Greene County, informed me that in the state of Missouri, every adolescent is granted

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Medicaid services once they have become incarcerated. This allows them to have easier
access to health care and treatments when needed. He also explained that usually if there
is anything wrong they will go to the Emergency Department due to the availability and
affordability of the ED with Medicaid services, unless their parents are covered and can
afford doctors visits. The Affordable Care Act (ACA) has opened doors for incarcerated
youth by expanding such Medicaid services and establishing insurance exchanges to lowincome families (NCCH, 2015). Medicaid is a governmental organization that aids in the
health promotion of incarcerated youths in America, there are also non-governmental
organizations that provide their services to this vulnerability group. The Evening
Reporting Center (ERC) is a local governmental organization for Greene County. It is an
after school program where previously incarcerated youth are court ordered while they
await their court dates. It is a four-week program where the youth are required to go
through classes that are designed to be therapeutic, educational, and allow for character
building for at-risk teens that will hopefully impact them in a positive way. Health
education is taught by the Greene County Health Department, or nursing students from
Missouri State University. This health education includes, sex education, over the counter
medications, substance abuse, first aid, nutrition, and other important subjects. The ERC
is a very important resource to many juveniles who are in a very vulnerable point in their
lives, and empowerment to make smart choices is essential and necessary. This
organization strives to help them with these decisions and hopefully keep them out of
incarceration in the future. The challenges that these organizations have in providing
these services, is their inability to access them once in the system. To solve this problem,
the justice system should work more closely with non-profit, non-governmental

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organizations to provide services to juveniles while incarcerated. This could hopefully
provide support and knowledge for when they are released into the world.
Once juveniles are released from detention their health disparities still exist, and
due to court costs and legal fees, may be even more prevalent. A non-governmental
organization that can aid in the support of this group is the Adolescent Health Working
Group. This American organization is guided towards advocating for policies and reforms
that will allow for adolescents to access health care more easily (Adolescent Health
Working Group [AHWG], 2015). They also have events and training for health care
providers, so that they can more effectively serve the youth in their community. Other
non-profit organizations such as the Salvation Army can help this population by
providing them with clothes, food, rehabilitation and much more. They work specifically
with youth in their afterschool programs that can facilitate a safe place for youth to learn
in a constructive environment (The Salvation Army, 2015). This program provides
recreational activities along with educational programs to stimulate and learning and
rehabilitation. This is especially important for adolescents who have been incarcerated
because they are easily influenced by their peers and environment. Providing a secure and
nurturing environment is essential to their progress.
In Finland, health care services are primarily the responsibility of the state
and run by the social services. If necessary, a municipal entity to purchase services from
the private sector. Of course, there is a need to work very comprehensive private sector,
but the prisons are in Finland, maintained by the state, so they are mainly used for
operating under the authority of the State health care services. In Finland, the same model
as the other Nordic countries followed. All health care services are available to everyone
in Finland. General health care funded by tax-funded. The patient becomes payable only

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really a small proportion of treatment. Everyone is entitled to public health care services,
both at work and dig in the vast majority of the prison population.
Finnish health care has received much praise from well-functioning organization.
Many other countries verrataren, so Finland is doing relatively well. Abroad, many
people may be left without care because it is expensive. In Finland, for this practice is not
possible. Everyone is entitled to receive the best possible care regardless of income or
status. Every patient is equally valuable and entitled to receive the necessary care.
The purpose of KASTE is to promote and develop the Finnish health care.
Services are expected to be the most customer-oriented and thus each product to ensure
the best possible treatment. According to the current kompens have focused on the
following: I. Risk groups inclusion, well-being and health; II. Reform of children, young
people and families with services; III. Reform of services for the elderly; IV. The service
and regeneration of basic services; V. Information and Information Systems; and VI.
Management support service structure and well-being (Occupational Health).
Each inmate will be made within two weeks of health mapping out his basic state
of health. In addition, long-term prisoners is carried out every two years to the Health
Check. Prisons are trying to keep each prisoner's state of health care and all information
entered in the prison register your patient information.
Youth inmates are entitled to all the same health care services as ordinary citizens.
They use basic health services, and if applicable to them, can also be arranged specialist
services. Long-term prisoners (length of pre-trial detention for more than half a year) will
also receive dental care. In dental care, to treat ailments that are considered essential to
basic health. Prisoners also have the opportunity to mental health services. Each of the
prison health care professional is trained in mental health for the detection of problems.
Inmates also have the right to access substance abuse treatment if it is deemed necessary.

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Prisoners also get glasses if they need to states on medical grounds. All of these services
are funded by the government and are free of charge to prisoners.
Nursing Theory Related to Incarcerated Youth
Incarcerated youth are at a high risk for many diseases and health disparities. To
promote optimal health in these individuals it is in great importance for the nurse to
preform primary, secondary and tertiary prevention techniques. Betty Neumans Systems
Model focuses on the three levels of prevention. She believed that this system allowed for
the retention, attainment, and maintenance of patients wellness (Petiprin, 2015). Primary
prevention is focused on education; providing information to this vulnerability group
about ways to prevent illness is the number one way to empower them to take control of
their own health. Important education topics for this vulnerability group would be effects
of substance abuse, sexually transmitted diseases, and the importance of nutrition and
exercise. The ERC provides all of these educational services and much more to juveniles
in their program. It is important for them to understand the effects of their choices and the
choices of their peers; this health education may even deter them from preforming
criminal acts in the future, therefore reducing their risk for injury and disease.
Secondary prevention is focused on screening, early detection, and early
treatment. It is defined as an effort to diminish the effects of illness or injury once it has
begun (Harkness & DeMarco, 2016, p.90). This effort is usually carried out in psychiatric
screenings in juvenile detentions to determine high-risk behaviors such as aggression and
violence, which may indicate that they will offend again. Studies show that 70% of
juveniles in detention centers are suffering from at least one mental disorder (Childrens
Defense Fund [CDF], 2012). The importance of secondary prevention in these cases are
extreme; the earlier the detection and treatment of a mental disorder, the sooner a child
can gain control of their life. The Childrens Defense Fund is an NGO that supports this

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level of prevention a great deal by providing programs to needy children that fund health
screenings to detect disease, mental illness, neglect, and abuse of all kinds to children of
all kinds. Their mission is to ensure the health and safety of children across the United
States, especially those in poverty, minorities, and with disabilities (CDF, 2012).
The third and final level of prevention is tertiary prevention. This level is focused
on treatment and rehabilitation. This level is important for juveniles struggling with
long-term health problems such as addiction, hepatitis, or HIV/AIDS. Most likely
juveniles will not have a lot of knowledge about these diseases and the effects of their
decisions on their bodies, so certain therapies should be provided. In a sense, juvenile
facilities are a form of rehabilitation for criminal action. This rehabilitation needs to be
continued outside of the detention center to ensure progress is made and health is
encouraged. For example, if an adolescent is arrested for abusing drugs and serves his
time, that addiction will probably continue as soon as they are returned to their original
environment. Tertiary prevention is necessary to try and prevent re-offense and further
harm to the health and body. Since youths are still developing and maturing rehabilitation
is key to their growth, it can provide them with what they need to make more empowered
and knowledgeable choices in their lives.
When contrasting the two countries, Finland has an increased access to healthcare
and decreased percentage of youth incarcerated. Both Finland and the United States are
striving toward better outcomes through government and nongovernmental organizations
for this vulnerable population through health promotion and prevention. Based on the
statistics provided, the effects of incarceration is less detrimental to the youth in Finland
in comparison to the United States.

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