The long and at times sordid history of the juvenile justice system in the United States.

IMPACT: The American Pediatric Society 'Issue of the Year' (2023-2024) has been focused on increasing access to quality healthcare for children who are incarcerated. Addressing the future of youth in the juvenile justice system requires that pediatricians understand the history of how that system has gotten to where it is now. This commentary examines the creation and growth of the United States juvenile justice system since its establishment 125 years ago, so as to guide a way forward.

Perspectives of California Legislators on Institutional Barriers and Facilitators to Non-Partisan Research Evidence Use in State Health Policymaking.

BACKGROUND: Bridging the translational gap between research evidence and health policy in state legislatures requires understanding the institutional barriers and facilitators to non-partisan research evidence use. Previous studies have identified individual-level barriers and facilitators to research evidence use, but limited perspectives exist on institutional factors within legislatures that influence non-partisan research evidence use in health policymaking. OBJECTIVE: We describe the perspectives of California state legislators and legislative staff on institutional barriers and facilitators of non-partisan research evidence use in health policymaking and explore potential solutions for enhancing use. DESIGN: Case study design involving qualitative interviews. PARTICIPANTS: We interviewed 24 California state legislators, legislative office staff, and legislative research staff. APPROACH: Semi-structured recorded interviews were conducted in person or by phone to identify opportunities for enhancing non-partisan research evidence use within state legislatures. We conducted thematic analyses of interview transcripts to identify (1) when research evidence is used during the policymaking process, (2) barriers and facilitators operating at the institutional level, and (3) potential solutions for enhancing evidence use. RESULTS: Institutional barriers to non-partisan research evidence use in health policymaking were grouped into three themes: institutional policies, practices, and priorities. Interviews also revealed institutional-level facilitators of research evidence use, including (1) access and capacity to engage with research evidence, and (2) perceived credibility of research evidence. The most widely supported institutional-level solution for enhancing evidence-based health policymaking in state legislatures involved establishing independent, impartial research entities to provide legislators with trusted evidence to inform decision-making. CONCLUSIONS: Potential institutional-level changes within state legislatures may enhance evidence use in health policymaking, leading to improved health outcomes and lower healthcare costs for states.

Ten Urgent Priorities Based on Lessons Learned From More Than a Half Million Known COVID-19 Cases in US Prisons.

COVID-19 is ravaging US prisons. Prison residents and staff must be prioritized for vaccination, but a rapidly mutating virus and high rates of continued spread require an urgent, coordinated public health response.Based on knowledge accumulated from the pandemic thus far, we have identified 10 pressing public health priorities for responding to COVID-19 in prisons: (1) accelerate population reduction coupled with community reentry support, (2) improve prison ventilation systems, (3) ensure appropriate mask use, (4) limit transfers between facilities, (5) strengthen partnerships between public health departments and prison leadership, (6) introduce or maintain effective occupational health programs, (7) ensure access to advance care planning processes for incarcerated patients and delineation of patient health care rights, (8) strengthen partnerships between prison leadership and incarcerated people, (9) provide emergency mental health support for prison residents and staff, and (10) commit to public accountability and transparency.Dedicated prison leaders cannot accomplish these public health priorities alone. We must mobilize prison leaders, staff, and residents; public health departments; community advocates; and policymakers to work together to address the pandemic's outsized impact in US prisons.

Barriers to Health Care for Latino Youths During Community Reentry After Incarceration: Los Angeles County, California, 2016-2018.

Objectives. To examine barriers to health care for Latino youths during reentry after incarceration.Methods. For this in-depth qualitative study, we conducted 69 semistructured interviews with 22 Latino youths and their parents at 1, 3, and 6 months after incarceration. We performed thematic analysis of interview transcripts, from which a preliminary conceptual model emerged describing barriers to care for Latino youths. We then conducted trajectory analyses of dyadic youth-caregiver pairs to test the conceptual model. We collected longitudinal interviews in Los Angeles County, California, from November 2016 to March 2018.Results. Beyond recognized stressors experienced by youths during reentry, most of which families related to poverty and neighborhood environment, Latino youths also experienced cultural barriers to care (i.e., self-reliance and pride, religiosity and reproductive care as taboo, preference for home remedies, language) as well as barriers to care because of undocumented status (i.e., fear of deportation, job insecurity).Conclusions. Reentry is challenging, and Latino youths face additional barriers to care during reentry related to culture and legal status, but have cultural strengths. Increased access to culturally sensitive, safety-net health care, regardless of immigration status, may reduce health inequalities for Latino youths undergoing reentry.

Eliminating Gaps in Medicaid Coverage During Reentry After Incarceration.

This commentary explores the health and social challenges associated with gaps in Medicaid health insurance coverage for adults and youths exiting the US criminal justice system, and highlights some potential solutions.Because a high proportion of recently incarcerated people come from low-income backgrounds and experience a high burden of disease, the Medicaid program plays an important role in ensuring access to care for this population. However, the Medicaid Inmate Exclusion Policy, or "inmate exclusion," leads to Medicaid being terminated or suspended upon incarceration, often resulting in gaps in Medicaid coverage at release. These coverage gaps interact with individual-level and population-level factors to influence key health and social outcomes associated with recidivism.Ensuring Medicaid coverage upon release is an important, feasible component of structural change to alleviate health inequities and reduce recidivism. High-yield opportunities to ensure continuous coverage exist at the time of Medicaid suspension or termination and during incarceration prior to release.

The Role of Parent Engagement in Overcoming Barriers to Care for Youth Returning Home After Incarceration.

We sought to understand the role of parent engagement in overcoming barriers to care for youth re-entering the community following incarceration. For this mixed methods study, we conducted quantitative surveys on healthcare needs and access with youth (n = 50) at 1-month post-incarceration, and semi-structured interviews with a subset of these youth (n = 27) and their parents (n = 34) at 1, 3, and 6-months post-incarceration (total 94 interviews). Differences by race/ethnicity and gender were assessed using Chi square test of proportions. We performed thematic analysis of interview transcripts to examine the role of parent engagement in influencing youths' access to healthcare during reentry. Most youth were from racial/ethnic minority groups and reported multiple ACEs. Girls, compared to boys, had higher ACE scores (p = 0.03), lower family connectedness (p = 0.03), and worse general health (p = 0.02). Youth-identified barriers to care were often parent-dependent and included lack of: affordable care (22%), transportation (16%), and accompaniment to health visits (14%). Two major themes emerged from the qualitative interviews: (1) parents motivate youth to seek healthcare during reentry and (2) parents facilitate the process of youth seeking healthcare during reentry. Parents are instrumental in linking youth to healthcare during reentry, dispelling prevailing myths that parents of incarcerated youth are inattentive and that youth do not want their help. Efforts that support and enhance parent engagement in access to care during reentry, such as by actively involving parents in pre-release healthcare planning, may create stronger linkages to care.

Fierce Autonomy: How Girls and Young Women Impacted by Commercial Sexual Exploitation Perceive Health and Exercise Agency in Health Care Decision-Making.

Prior research has examined the high health care needs and vulnerabilities faced by survivors of commercial sexual exploitation (CSE), yet their perspectives are frequently absent. We sought to understand the narratives and views of individuals affected by CSE on their bodies, health, and motivations to seek health care treatment. Twenty-one girls and young women ages 15 to 19 years with self-identified histories of CSE participated in the study. All participants had current or prior involvement in the juvenile justice and/or child welfare systems. Data collection included brief questionnaires, followed by semi-structured individual interviews. The interviews took place between March and July 2017 and were analyzed using iterative and inductive techniques, using the shared decision-making model as a guide. "Fierce Autonomy" emerged as a core theme, depicting how past traumas and absence of control led the girls and young women to exercise agency and reclaim autonomy over decisions affecting their health.

Health Needs of Youth in Detention With Limited Justice Involvement.

Although incarcerated youth (i.e., youth sentenced to secure custody) have high health needs, the health of detained youth with limited justice involvement remains poorly understood. Between September 2018 and February 2019, social workers from the Los Angeles County Whole Person Care Juvenile Reentry Aftercare Program (WPC) assessed the health and social needs of youth in pre-trial detention. We partnered with the WPC team to analyze assessments completed by 83 youth participants. Youth were on average 16 years old, most (83%) identified as male, and all were from racial or ethnic minority groups. Participants reported high behavioral health needs, including a high prevalence of prior suicide attempts (16%) and history of substance use (81%). Participants demonstrated a pattern of crisis healthcare utilization. Youth also indicated areas of strength, including personal positive traits, engagement in extracurricular activities, educational achievements, and having multiple sources of social support. The majority of youth (74%) desired vocational training and nearly all (94 %) wanted to return to school after release. Overall, the findings indicate that detained youth with limited involvement in the justice system are a resilient group that have notably higher health risk than same-age peers, signifying a critical opportunity for intervention.

Parent and Provider Perspectives on Recently Incarcerated Youths' Access to Healthcare During Community Reentry.

Incarcerated youth have numerous healthcare needs, yet access to healthcare following community reentry is limited. Healthcare and juvenile justice providers, along with parents, strongly influence access to care for youth undergoing reentry. However, their perspectives are often missing from the literature. We examined parent and provider perspectives on youths' access to healthcare during community reentry. We conducted 72 longitudinal interviews with parents of youth undergoing reentry (n= 34 parents) and cross-sectional interviews with health and juvenile justice providers (n=20 providers). We performed inductive analysis of interview transcripts to identify the major themes related to access to healthcare during reentry. Respondents identified key leverage points that influence access to healthcare along the spectrum of individual, community, and policy-level factors. Parent and provider perspectives demonstrated substantial overlap, strongly concurring on the essential role of parents in linking youth to care and the external factors that limit parents' ability to connect youth to care. However, providers discussed parents not buying-in to treatment plans as a barrier to care, and parents uniquely described feeling powerless when their children were not motivated to receive care. Parents and providers agreed on priority solutions for improving care access during reentry. Immediate solutions centered on: 1) increasing reliability and continuity of providers, 2) providing free or low-cost transportation to healthcare visits, and 3) eliminating gaps in Medicaid coverage post-incarceration. Findings also signal the broader need to pursue strategies that increase family engagement in healthcare during reentry. In doing so, health and juvenile justice providers can partner with parents to overcome barriers to healthcare for youth during reentry.

Key Population Health Outcomes for Children with Medical Complexity: A Systematic Review.

INTRODUCTION: Despite the significant healthcare policy and program implications, a summary measure of health for children with medical complexity (CMC) has not been identified. It is unclear whether existing population health approaches apply to CMC. We conducted a systematic review of the existing peer-reviewed research literature on CMC to describe the health outcomes currently measured for CMC. METHODS: We searched MEDLINE and PsycINFO by linking combinations of key words from three groups of concepts: (1) pediatric, (2) medical complexity, and (3) chronicity or severity. Study eligibility criteria were research studies including CMC with any outcome reported. Data on the outcomes were systematically extracted. Iterative content analysis organized outcomes into conceptual domains and sub-domains. RESULTS: Our search yielded 3853 articles. After exclusion criteria were applied, 517 articles remained for data extraction. Five distinct outcome domains and twenty-four sub-domains emerged. Specifically, 50% of the articles studied healthcare access and use; 43% family well-being; 39% child health and well-being; 38% healthcare quality; and 25% adaptive functioning. Notably lacking were articles examining routine child health promotion as well as child mental health and outcomes related to family functioning. CONCLUSIONS: Key health domains for CMC exist. Adaptations of existing sets of metrics and additional tools are needed to fully represent and measure population health for CMC. This approach may guide policies and programs to improve care for CMC.

Exploring Mental Health and Substance use Treatment Needs of Commercially Sexually Exploited Youth Participating in a Specialty Juvenile Court.

The study sought to: (1) describe the mental health and substance use profiles among participants of a specialty trafficking court program (the Succeed Though Achievement and Resilience Court); (2) describe youths' mental health and substance use treatment prior to participating in the program; and (3) examine whether abuse influences report of mental health problems and/or substance use. Retrospective case review of court files was performed on commercially sexually exploited youth who volunteered to participate in the court from 2012 to 2014 (N = 184). All participants were female. Mental health problems and report of substance use was high among this population. Substance use differed at statistically significant levels between youth with a documented abuse history compared to those with no abuse history. Substance use also differed by report of mental health problems. Unexpected findings included the high rate of hospitalization for mental health problems and relatively low substance use treatment prior to STAR Court participation. Opportunities for improvement in critical points of contact to identify commercially sexually exploited youth and address their health needs are discussed.