PONE-D-22-29610Health of Children who experienced Australian Immigration DetentionPLOS ONE

Dear Dr. Tosif,

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Summary of the revision and overall impression

The study tackles an important public health problem, the impact of held detention on the health and wellbeing of children and adolescents. This cross-sectional study used medical records from the Royal Children´s Hospital Immigrant Health Service, with the aim of describing the physical and mental health status of children who experienced held detention in Australia. One of the main strengths of the study is the data sources used (e.g., clinical records). For me, the strength of these type of data sources is that it can be seen as a more objective measure of health outcomes, when compared to self-reporting, which is a methodology often used in studies examining health outcomes of migrant populations. I would only suggest the authors to make a stronger case for the gap in the literature regarding the impact of detention centers on children’s health, by highlighting the methodology used. There are studies, mainly carried out in the United States, about the impact of detention centers on children´s health. However, as mentioned above, most use self-reported measures to evaluate the impact.

Major and minor issues

a) Major issues

- No major issues.

b) Minor issues:

1. General comments:

- I recommend language editing of the manuscript. The ideas presented in some paragraphs can be made clearer for the readers with minor language editing of the manuscript.

2. Introduction:

- It would be helpful for readers who are not familiarized with the Australian immigration system to have a better understanding in the introduction of the referral process to the Royal Children´s Hospital Immigrant Health Service. Why do children get referred to these health services? Are all children in detention receiving health services in this hospital or only those children who are referred by the immigration system? If this is the case, why some children get referred and why some children do not get referred to these health services? What are the criteria being used?

- It would also be helpful to know more about the differences between the Immigration Detention Centers on Australian mainland and the offshore Regional Processing Centers in Nauru and Manus Island, Papua New Guinea. What are the characteristics and processes that make these detention centers different from each other?

3. Methods:

- It would be useful for readers if authors described why they decided to analyze the health outcomes separately for the Immigration Detention Centers on Australian mainland and the offshore Regional Processing Centers in Nauru and Manus Island. This could be tied to the introduction suggestion of describing how are these immigration detention centers different.

4. Results:

- Include a statement like “results not shown in tables” for those results who are not included in the descriptive tables.

- I would suggest to only include the percentages in the parentheses, not both the percentages and the number of participants. Maybe just leave the n´s when the total n is different from what is previously stated in that paragraph. For example, delete here: “Almost half (43%, n=120/277) the cohort had sleep difficulties, 27% (n=76/277) reported nightmares and 10% (n=28/277) of children had engaged in self-harm”. But keep it here: “Attachment issues with severe functional impact were diagnosed in 53% (n = 16/31) of infants born in detention….”.

5. Discussion

- It is not clear in the manuscript at which point during the detention process children receive medical care in the Royal Children´s Hospital Immigrant Health Service. A section in the discussion about this would be helpful to readers to understand if the health outcomes are associated to their stay in the immigration detention centers or if they are a result of the migration process. For instance, if children are being evaluated in their first week after arrival to the detention centers, are the nutritional deficiencies associated to reduced access to nutritious food in the detention centers or are they associated to food insecurity in their countries of origin and during the migration process (e.g., before their arrival to the detention centers). I believe that integrating this into the discussion, and/or in the results section, could strengthen the argument the authors are making.

- Discuss the differences found when comparing health outcomes between the Immigration Detention Centers on Australian mainland and the offshore Regional Processing Centers in Nauru and Manus Island, Papua New Guinea. Why are some health outcomes more prevalent in Nauru vs. the Australian mainland detention centers, and vice versa? Are the conditions in these centers different? Could these conditions be impacting differently the health of children and families being detained?

- Discuss how generalizable are the study findings, based on the methodology implemented. Are these results generalizable only to participants in the study? Could the results be generalizable to other children held in detention in Australia or other parts of the world and why or why not?

6. Figures

- For Figure 1, I would suggest including axis captions for both the x and y axis, as well as a descriptive title.

Reviewer #2: A relevant issue about the health impact of detention on migrant children is addressed. Unfortunately, this situation is becoming more frequent in different parts of the world.

However, the following is recommended:

1) In the introduction more precisely the differences between the two places of detention and the reasons for these differences.

2) Include literature on the impact of detention on children's health in other countries, places, etc. To have a reference point of the results found in this investigation.

Method

3) Describe more the processes used for the selection of information.

4) Explain more clearly how mental health problems were detected, who was the specialist who made the diagnosis, with what criteria, etc.

5) The same comment for diagnoses of developmental disorders

6) Explain with greater precision the processes for the analysis of the information, not only the statistical analyzes used.

Discussion

7) The information in the following paragraphs should be considered as a hypothesis, since this information was not included in the results.

“Our experience working with children and families in detention also highlights challenges to service access and care. Visits from the Melbourne IDC to RCH required advance notification and confirmation of appointments, transport bookings, security approvals and security clearance (pat downs, bag checks upon exit and re-entry). Despite a captive population, appointments were often missed (or children attended late) due to logistical and coordination difficulties, reducing time available for clinical care. When children did attend RCH, multiple security guards would accompany families and maintain line of sight at all times, waiting outside the clinic doors during medical review.

Parents were often incapacitated by their own mental illness, contributing to challenges in

assessing and providing healthcare for these children. Most visits were completed with

interpreting assistance, and there was secondary psychological impact for RCH

interpreters, administrative and clinical staff, and at times, for transport and security staff.

High turnover of immigration case managers, individual detention healthcare providers,

immigration security staff, child protection staff, and subsequently, community-based

case managers, also affected care delivery through loss of continuity, multi-layered

bureaucracy and consequent communication issues"

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Review_PONE-D-22-29610.pdf

Health of Children who experienced Australian Immigration Detention

PONE-D-22-29610R1

Dear Dr. Shidan Tosif,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Cesar Infante Xibille, Ph.D

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Authors have responded to previously sent comments and made the corresponding changes. I have no additional comments.

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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