 Research indicates a strong correlation between poverty in childhood and an increased likelihood of incarceration. Youth from low-income backgrounds face multiple risk factors that increase their odds of entering the justice system. Poverty-related challenges such as inadequate education, exposure to violence, limited access to mental health resources and family support contribute to higher rates of school suspensions, dropouts, and behavioral issues, all of which can push these children into the juvenile justice system. According to the New York State Office of Children and Family Services' Juvenile Justice Detention Monitoring Report, a total of 3,854 juvenile detention admissions occurred across New York State in 2023. These youth, typically between the ages of 13 and 21, often enter the system from underserved communities and have experienced significant trauma. The New York State Office of Children and Family Services (OCFS) supervises the treatment and care of court-placed youth, managing residential facilities, and providing them with the support they need to successfully reintegrate into society. Support services include education, employment training, recreation, counseling, mental health services, medical and dental care in both secure and limited secure facilities across the state. The dental needs of these youth are significant and ongoing, particularly in the mid-Hudson and Rochester areas. There are nine residential facilities located in both urban and rural areas of the state. While each facility has its own medical suite staffed by a team of registered nurses and mid-level practitioners, not all facilities have on-site dental suites, and some rely on mobile dental vans for treatment.  Addressing the Gap in Dental Care
Youth placed in OCFS custody are disproportionately minority and often have multiple special needs. They face numerous challenges, not the least of which is a lack of previous access to healthcare. Many arrive with untreated dental issues, from routine decay to more serious conditions, and require significant interventions to bring them to levels of adequate care for their age and developmental level. “Our facilities are tasked with addressing these issues and ensuring that incarcerated youth receive care while they are in custody,” says Dr. Jim Horne, Chief of Medical Services. “Many of them have had poor access to medical and dental care, and it’s common for these teens to be seeing a dentist for the first time in a long time while they are in our care.” Many of the youth are grappling with multiple caries and abscesses, and 3rd molar extractions are often needed. But finding dentists to work with OCFS to treat incarcerated youth is an ongoing challenge that Dr. Horne and his team are working to overcome through outreach to organizations like the New York State Dental Foundation. At each facility, a medical team, including a dentist, is responsible for evaluating new arrivals and providing necessary treatment. Dentists are asked to visit facilities at least twice each month to provide services. This ongoing care includes everything from routine dental exams to more complex treatments such as restorative, surgical, and endodontic procedures. Dr. Horne says that people underestimate the impact that a missing front tooth has on a teenager’s self-esteem. “We work with young people who are still developing, and our goal is to change their trajectory. For dental care, our emphasis is on restoration and education.” So why has it been such a challenge to find dentists to treat these youth? Dr. Horne says a few factors are at play. State dentists working in these facilities will make anywhere from $170,000 to $200,000 a year, which may be lower than those working in private practice. But OCFS offers a streamlined system for dentists who provide care at these facilities, alleviating many of the administrative burdens typically associated with the Medicaid reimbursement process. Dentists are reimbursed directly by OCFS based on standard Medicaid rates, with payment typically processed within a few weeks. “But I think a bigger issue is the stigma around servicing these youth,” says Dr. Horne. “We’re asking a dentist to come to our facility to deliver treatment to kids who may need to be shackled. But providers see patients in a safe environment, and a youth counselor escort is always present. Historically we have not had any cases of a patient becoming physically aggressive during dental treatment.” Dr. Horne cited other challenges in delivering dental care for incarcerated youth, including long wait times for oral surgery. Additionally, the lack of dentists willing to treat at their facilities has created a need to transport youth long distances for their dental care. They may receive treatment in locations more than an hour away, then make the long trip back, in restraints and recovering from a dental procedure. Dentists Play a Vital Role in Rehabilitation Dental care is just one piece of the rehabilitation puzzle for incarcerated youth — but it is a vitally important one. Given the critical need for dental services, there is a growing effort to engage more dentists in providing care to incarcerated youth in New York State. “We are looking for dentists who share our values and understand that providing oral health care contributes to the rehabilitation of these kids,” says Dr. Horne. “Restoring not only their physical health but also their self-esteem and sense of well-being is crucial to their overall rehabilitation. Our dentists are contributing to a broader goal of preparing these youth for reintegration into their communities and to lead healthy and productive lives.” Dental providers who are interested in learning more about employment opportunities with OCFS can directly contact Dr. Jim Horne, Chief of Medical Services, at (518) 474-9560, or search vacancies at https://statejobs.ny.gov.
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