"We should be resourcing their liberation:" a qualitative formative study to guide introduction of a systems engineering intervention at a King County, WA juvenile detention center clinic.

BACKGROUND: There are ongoing efforts to eliminate juvenile detention in King County, WA. An essential element of this work is effectively addressing the health needs of youth who are currently detained to improve their wellbeing and reduce further contact with the criminal legal system. This formative study sought to inform adaptation and piloting of an evidence-based systems engineering strategy - the Systems Analysis and Improvement Approach (SAIA) - in a King County juvenile detention center clinic to improve quality and continuity of healthcare services. Our aims were to describe the priority health needs of young people who are involved in Washington's criminal legal system and the current system of healthcare for young people who are detained. METHODS: We conducted nine individual interviews with providers serving youth. We also obtained de-identified quantitative summary reports of quality improvement discussions held between clinic staff and 13 young people who were detained at the time of data collection. Interview transcripts were analyzed using deductive and inductive coding and quantitative data were used to triangulate emergent themes. RESULTS: Providers identified three priority healthcare cascades for detention-based health services-mental health, substance use, and primary healthcare-and reported that care for these concerns is often introduced for the first time in detention. Interviewees classified incarceration itself as a health hazard, highlighting the paradox of resourcing healthcare quality improvement interventions in an inherently harmful setting. Fractured communication and collaboration across detention- and community-based entities drives systems-level inefficiencies, obstructs access to health and social services for marginalized youth, and fragments the continuum of care for young people establishing care plans while detained in King County. 31% of youth self-reported receiving episodic healthcare prior to detention, 15% reported never having medical care prior to entering detention, and 46% had concerns about finding healthcare services upon release to the community. CONCLUSIONS: Systems engineering interventions such as the SAIA may be appropriate and feasible approaches to build systems thinking across and between services, remedy systemic challenges, and ensure necessary information sharing for care continuity. However, more information is needed directly from youth to draw conclusions about effective pathways for healthcare quality improvement.

Elevating the Voices of Girls in Custody for Improved Treatment and Systemic Change in the Juvenile Justice System.

The U.S. juvenile justice system does not meet the needs of girls in custody, and often fails to address girls' symptoms of trauma and high rates of sexual exploitation histories. As the system shifts away from punitive detention to a trauma-informed approach with community-based services, community psychologists and other helping professionals can help center the needs and experiences of girls in custody. As part of a multi-year collaboration, our research team created a confidential youth advisory process in one juvenile detention center (JDC). We acted as liaisons between the girls in custody and JDC administrators, reporting girls' feedback to agencies at monthly meetings. Participant confidentiality, safety, and consent were priorities. The girls' feedback, which was conceptualized within a System Responsiveness and hierarchy of needs framework, led JDC probation and mental health staff to improve services (e.g., better laundry system, longer showers, warmer food), climate (e.g., consistent reward system, confidentiality of grievances), and treatment (e.g., increase focus on gender and culture) to reduce the trauma of incarceration among girls in custody. Girls' feedback also catalyzed systemic change that led to a reduction in the JDC population in favor of wraparound community-based services better suited to meet girls' needs. Implications for community psychology values and the juvenile justice system, including the benefits and challenges of this type of collaboration, are discussed.

Development of a Multi-Session Curriculum Addressing Domestic Minor Sex Trafficking for High-Risk Male Youth.

Males, in particular adolescents and young adults, have been increasingly recognized as involved in domestic minor sex trafficking (DMST). However, there are very sparse resources and organizations that provide prevention, identification, and interventions for boys and young men who are involved in or at-risk for DMST involvement. The objective was to develop and assess an educational curriculum to prevent adolescent male involvement in DMST through a three-pronged educational approach: as victims of sexual exploitation; receiving financial benefit as exploiters; as buyers of sex. Through quality improvement cycles, changes were made to enhance the curriculum by utilizing the outcome measures of participant questionnaires and feedback from a steering committee of clinical experts. Male youth at the state's juvenile detention center were asked to participate in pilot groups, as they were identified as a high-risk population of adolescents to become involved. The curriculum was modified by adding sessions, including additional community guest speakers, and providing a more holistic educational experience that involves trafficking prevention from both a victimization and perpetration standpoint. Our goal is to expand this educational opportunity to be utilized in multiple settings (e.g., schools, hospitals) across the country.

Reframe the Behaviour: Evaluation of a training intervention to increase capacity in managing detained youth with fetal alcohol spectrum disorder and neurodevelopmental impairments.

The first study to investigate the prevalence of fetal alcohol spectrum disorder (FASD) within an Australian juvenile detention centre has identified the highest known prevalence of FASD among a justice-involved population worldwide. However, there has been limited investigation into the capacity of the custodial workforce to identify and manage young people in Australian detention centres with FASD or other neurodevelopmental impairment (NDI), and no published interventions aiming to develop environments appropriate for those with FASD in justice settings. Using the Template for Intervention Description and Replication checklist, this study describes the conception, implementation and evaluation of a training intervention aiming to upskill the custodial workforce in the management of youth with FASD and NDI; 117 staff participated in the intervention, and 109 completed pre- and post-intervention surveys. Improvements were seen across almost all knowledge and attitude items, and the intervention was considered highly necessary, appropriate and valuable by the workforce.

Negative Impact of the Job: Secondary Trauma Among Juvenile Detention and Juvenile Probation Officers.

The purpose of this article is to extend the existing literature on the workplace experiences of staff who work with juvenile offenders. We do this by assessing the extent of secondary trauma among a sample of juvenile detention officers and juvenile probation officers, and examine whether or not predictors of secondary trauma differ by position. Ordinary least squares (OLS) regression results based on a survey of 298 staff reveal that secondary trauma is relatively low among both juvenile detention officers and juvenile court/probation officers. Additionally, results indicate predictors of secondary trauma differ for each of these job positions. Experiencing threat or harm from offenders increased secondary trauma for detention officers but not for probation/court officers. However, having a higher level of education and input into decision-making decreased secondary trauma for probation/court officers, but not for detention officers. Greater support from coworkers led to decreased secondary trauma for both detention and probation/court officers. Implications for detention and probation agencies include efforts to improve supervisor and coworker support, as well as debriefing sessions after threat of harm incidents have occurred.

Biopsychosocial Causes of Suicide and Suicide Prevention Outcome Studies in Juvenile Detention Facilities: A Review.

To identify various biopsychosocial risk factors associated with suicidality in juvenile detention facilities and the effectiveness of suicide prevention protocols currently in use. Medical literature searches were conducted using databases like Pub Med, Ovid, and Google Scholar to identify studies conducted in and outside of United States. The prevalence of suicide among youth imprisoned at detention facilities has risen. Psychiatric disorders are common among such population, making them vulnerable to suicidal tendencies. Suicide risk screening within first 24 h of admission to the detention facility has shown to lower the risk of suicide. Identification of high risk individuals and their further psychiatric assessment is advocated. Much of work with regards to screening tools and instruments is underway and further study is required to get a better understanding.

Efficacy of an HIV/STI sexual risk-reduction intervention for African American adolescent girls in juvenile detention centers: a randomized controlled trial.

Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13-17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.

Chlamydia screening and positivity in juvenile detention centers, United States, 2009-2011.

An estimated 2.9 million new chlamydia infections occur in the United States each year. Among women, chlamydia can lead to serious adverse outcomes, including pelvic inflammatory disease and infertility. Chlamydia prevalence is highest among females aged 15-19 years. Despite long-standing recommendations directed at young, sexually active females, screening remains sub-optimal. Juvenile detention centers (JDCs) are uniquely situated to screen and treat high-risk adolescents. From 2009-2011, performance measure data on chlamydia screening coverage (proportion of eligible females screened) and positivity (proportion of females tested who were positive) were available from 126 geographically-dispersed JDCs in the United States. These facilities reported screening 55.2% of females entering the facilities (149,923), with a facility-specific median of 66.4% (range: 0-100%). Almost half (44.4%) of facilities had screening coverage levels of 75-100%. This screening resulted in the detection of 12,305 chlamydial infections, for an overall positivity of 14.7% (facility-specific median = 14.9%, range: 0-36.9%). In linear regression analysis, chlamydia positivity was inversely associated with screening coverage: as coverage increased, positivity decreased. The burden of chlamydia in JDCs is substantial; facilities should continue to deliver recommended chlamydia screening and treatment to females and identify mechanisms to increase coverage.

The Effect of a Group Physical Activity Program on Behavior of Incarcerated Youth.

Behavioral health challenges are more prevalent in incarcerated youth than in the general youth population. Questions remain regarding whether physical activity programs can reduce behavioral health challenges in incarcerated youth. Data were available for 1,285 youths incarcerated between January 2017 and December 2018. The structured exercise program was implemented in January 2018. Primary outcomes were numbers of use of force (UoF) and of program modifications (PMs) indicative of delinquent behavior in pre- and post-exercise implementation periods. Rates per 1,000 person-days for UoF (10.0 in 2017 vs. 7.4 in 2018) and for PMs (36.7 vs. 22.9) were statistically different. For youths incarcerated both years, rates per 1,000 person-days for UoF (12.3 vs. 7.9), and for PMs (43.3 vs. 23.5) were statistically different. There was a reduction in behavior modifications in incarcerated youths after implementing the exercise program, but further studies are needed to confirm these results.

Juvenile Detention and Primary Care Utilization: Are They Related?

There is little information on the health care utilization habits of juvenile justice-involved youth. We evaluated whether health care utilization trends after discharge from a juvenile detention facility are associated with a decreased risk of future detention. A retrospective chart review was conducted for youth admitted to a juvenile detention facility from November 1, 2017, to October 31, 2018. Youth who accessed primary care (PC) appeared less likely to be readmitted to juvenile detention compared to those who did not access PC, with the greatest increase in readmissions occurring between days 30 and 60 and slowing after day 90. PC access and health care utilization may be associated with a decreased risk of future detention; however, additional research is needed to further explore this potential linkage.

Racial disparities in youth pretrial detention: a retrospective cohort study grounded in critical race theory.

BACKGROUND AND METHOD: Pretrial detention makes up 75% of juvenile detention admissions and contributes to the disproportionate contact of minoritized youth in the juvenile carceral system. Given that prior evidence largely examines differences between Black and white youth, this study expands research on disproportionate contact in the pretrial detention setting to Hispanic/Latinx, Indigenous, and Asian youth. With a sample of over 44,000 juvenile cases in a northwest state, we used a generalized linear mixed model to estimate the effect of individual level characteristics while accounting for the random effect of differences at the county level. Additionally, we utilized Critical Race Theory (CRT) in formulating our theoretical model and predictions and apply CRT in our analysis and discussion of our results. In doing so we hope to build upon its application in public health discourse for naming and deconstructing processes that lead to unjust social and health stratification. RESULTS: After factoring in gender, age, crime severity, previous offenses, and variation between counties, our analyses show that Black, Hispanic/Latinx, and American Indian/Alaskan Native youth are more likely to experience pretrial detention than white youth. The likelihood of pretrial detention for Asian youth and for youth identified as "Other" or "Unknown" was not significantly different from white youth. CONCLUSIONS: As the iatrogenic effects of detention are disproportionately imposed upon youth of color-particularly Black, Indigenous, and Hispanic/Latinx youth-the disparities present in our study reveal further evidence of institutional racism. In this way, we can see how this carceral process operates as a mechanism of racialized social stratification as put forth by CRT. Considering implications for policy or further research, persistent disparity highlights an enduring need for building or strengthening diversion programs and alternatives to the carceral system, with emphasis on those that are culturally responsive.

Naloxone Knowledge and Attitudes of Juvenile Residents in a Detention Setting.

The opioid epidemic in the United States is financially, physically, and emotionally costly. Juvenile residents in detention settings witness overdose through personal opioid use or that of family or friends. Educational programming was developed for residents in a juvenile temporary detention center to increase knowledge of opioid overdose and nonopioid misuse. Using pre-post group surveys, we evaluated knowledge of opioid overdose, naloxone, and attitudes. Most residents recognized opioids and other substances by name, felt comfortable in their ability to recognize opioid overdose symptoms, and knew how to assist. Youth residents may be less likely to use opioids and more likely to become first responders in an overdose situation. However, some would not intervene or call for help. Instead, a potential conflict for themselves was perceived.

Physical Activity and Social Behaviors of Incarcerated Youth Participating in a Sport-Leadership Program.

Research illustrates that participation in physical activity is advantageous to overall health. Incarcerated populations are one subset that would benefit most from consistent engagement in physical activity, yet little is known about programs created to fulfill this need. The purpose of this study was to determine activity levels and social behaviors of incarcerated adolescent males during a structured sport-leadership program. Participants were 23 incarcerated males. The System for Observing Children's Activity and Relationships during Play was employed to evaluate activity and social behaviors. A major finding of this study demonstrated that incarcerated youth engaged in moderate to vigorous physical activity for a large portion of the sport-leadership programming time (50.6%). In this study, prosocial (11.7%) and antisocial (7.1%) interactions mirrored those observed in residential summer camps, on playgrounds, and during recess.

Juvenile Justice, Technology and Family Separation: A Call to Prioritize Access to Family-Based Telehealth Treatment for Justice-Involved Adolescents' Mental Health and Well-Being.

Separating children from families has deleterious effects on children's mental health and well-being, which is highly relevant for youth in juvenile detention and other out-of-home residential placements. Despite growth in the evidence of family-based interventions in mitigating adverse behavioral health outcomes for justice involved adolescents (JIA), gaps remain in intervention dissemination for JIA; this particularly true for those leveraging digital health technologies, a need that has intensified with the COVID-19 pandemic. Use of digital health technologies for JIAs is pressing to address structural barriers in maintaining JIA-family connections, but also to improve treatment access for detained JIAs. Court systems' capacity to support use of digital health tools, such as telehealth, appear promising. Data on the use of tele-conferencing in U.S. juvenile and family courts were collected from 456 juvenile justice professionals as part of a larger study on judicial decision making. Results suggest overwhelming adoption of video-conferencing for court hearings with only 40% of respondents reporting family court use prior to the onset of COVID-19, but majority (91%) now reporting its routine use. Youth participate from a range of settings, including detention, other residential placement, community-based behavioral health and in-home settings. The COVID-19 pandemic has created a shift in the uptake of video-conferencing platforms that could hold promise for future larger scale use across the juvenile justice system. Findings underscore feasibility and acceptability of technology requirements in key settings that should be leveraged for broad scale implementation of empirically supported family-based interventions to advance behavioral health equity for JIA.

Effectiveness of social-therapeutic treatment for serious offenders in juvenile detention: A quasi-experimental study of recidivism.

Due to legislative changes in Germany, there has been an increasing expansion of social-therapeutic facilities for juvenile offenders over the past 15 years. Social therapy comprises an eclectic mix of psychotherapeutic, educational, vocational, and recreational measures in a milieu-therapeutic setting to reduce recidivism of high-risk violent and sexual offenders. This study examined the effectiveness of social-therapeutic treatment on post-release recidivism among juvenile offenders. The sample included male offenders (n = 111) of the juvenile detention center in Berlin, Germany, aged 14-22 years, who were convicted of a violent (94%) or sexual offense (6%). Seventy-three subjects admitted to the social-therapeutic unit were compared to an offense-parallelized control group (n = 38) from the regular units using a propensity score based matching procedure. Initially, the groups did not differ with respect to risk (i.e., Level of Service Inventory - Revised) or risk-related characteristics (e.g., age). Subsequent Cox regression analyses revealed no average treatment effect on recidivism. Since the results indicated that the control group was not untreated, differential treatment effects were examined in a second step. School and vocational trainings had an effect on recidivism. The findings are discussed in light of the challenges in evaluating legally mandated offender treatment.

Mental Health Care of Detained Youth Within Juvenile Detention Facilities.

Mental health treatment of juvenile offenders and undocumented immigrant youth in detention provides a unique opportunity for treatment providers. Although the work may be challenging, the clinical needs and opportunities for early and meaningful interventions are significant. One of the best clinical experiences a psychiatrist can have is working with extremely high-risk youth to help them find safer and better developmental pathways. Few settings can offer such an opportunity to leverage clinical skills to improve the lives and futures of children and adolescents as are afforded to those professionals lucky enough to work in juvenile justice settings.

Increasing Praise Delivery Within Dorms of a Juvenile Justice Facility.

Researchers have shown that adolescents in residential treatment facilities benefit from behavior-analytic intervention. However, it remains unclear whether practitioners can apply behavioral interventions to increase staff members' appropriate interactions with residents within a juvenile justice facility. In Study 1, researchers compared direct measures of staff behavior in three target dorms (D1, D2, and D3) containing high levels of resident disruptive behavior to a dorm (D4) with consistently low levels of resident disruptive behavior. Results indicated that staff members in the target dorms engaged in significantly higher rates of reprimands and negative statements than in D4. In Study 2, researchers used didactic and video instruction to train staff members in D1, D2, and D3 to increase contingent and noncontingent praise delivery. Results indicated praise delivery by staff members increased slightly in each target dorm. In Study 3, researchers first evaluated the extent to which measures of staff members' and residents' behaviors improved following training within each dorm. Subsequently, researchers compared the post-training behavioral measures from D1, D2 and D3 to D4 to determine the extent to which staff behavior in the training dorms was distinguishable from D4. Results of Study 3 indicated that one or more staff behaviors improved in each training dorm. Nevertheless, residents' disruptive behavior was unchanged in each target dorm. In addition, staff members' behavior in each target dorm continued to be distinguishable from staff members' behavior in D4 on most behavioral measures.

The Impact of Quality Improvement Measures in the Management of Asthma Patients in Juvenile Detention Facilities.

Asthma is a serious chronic lung disease with a significant economic burden. The population of the San Bernardino County Juvenile Detention and Assessment Centers have higher odds of asthma as compared to the general population. Research has shown that a significant number of patients with a prior history of asthma were misdiagnosed. A protocol using objective testing, along with the detailed patient's history, was successfully implemented to verify the diagnosis and guide more effective medical care. After the implementation of those steps, the prevalence of asthma was found to be lower with the new protocol, from 18.1% in the pre-protocol period to 11.2% in the post-protocol period. This decrease resulted in an associated reduction in both direct and indirect healthcare costs and more efficient medical care.

Assessment of suicide probability and related factors in male incarcerated adolescents; a sample of reformatory center in Turkey.

OBJECTIVE: Suicidal behavior in adolescents is an important public health problem, and it ranks first among the causes of prison deaths in incarcerated adolescents(IAs). The aim of this study is to determine the probability of suicide and associated risk factors in IAs. METHOD: Seventy-one male adolescents in a reformatory center were contrasted with a matched group of 71 male adolescent with no psychiatric disorder and no criminal record. Suicidal probability and psychiatric symptomatology were assessed with the Suicide Probability Scale, SA-45 Questionnaire, respectively. RESULTS: It was determined that the probability of suicide was higher in IAs, and depression and hostility symptoms, the presence of another individual involved in delinquency in family had predictive effects. It was also found that there was a positive correlation between the probability of suicide and the number of delinquencies, the number of incarceration, and a negative correlation between attending to school or work while in reformatory and being visited by relatives while in reformatory. CONCLUSIONS: The results suggest that when assessing suicide risk for IAS, it may be useful to pay attention to those with symptoms of depression or hostility, those with multiple delinquencies or entrance to reformatory, and those who have family members involved in delinquency.

Increasing Chlamydia and Gonorrhea Infections among Female Juveniles: The Need for Collaboration to Improve Treatment.

BACKGROUND:  Youth in juvenile detention centers are at a high risk for sexually transmitted disease (STD). The current study assesses the trends of chlamydia and gonorrhea (GC) infections and treatment among females within a single county's juvenile correctional facilities. METHODS: This is a retrospective review of aggregate data of female adolescents between 12 and 18 years old who underwent STD screening from 2009 to 2016 in San Bernardino County. RESULTS: Chlamydia infections among adolescent females increased from 11.8% in 2009 to 17.0% in 2016 (p = 0.0002), and GC infections increased from 1.3% in 2009 to 6.0% in 2016 (p < 0.0001). Treatment rates of chlamydia were stable, ranging from 66.7% to 70.8% of positive female adolescents were treated between 2009 and 2016 (p=0.1752). The treatment rate for GC increased from 33% in 2009 to 78.3% in 2016, but annual trends were not statistically significant (p=0.8419). CONCLUSIONS: Chlamydia and GC infections among female adolescents discovered during routine screening upon booking into a county juvenile detention system increased over the study time period. Effective collaboration between public health and various community organizations is needed to improve awareness and prevention of STDs amongst at-risk adolescents.