A Minimum Age for California's Juvenile Legal System: Lessons on Collaborative Research to Drive Legislative Change.

THE PROBLEM: Most U.S. states lack a minimum age of juvenile legal jurisdiction, which leaves young children vulnerable to a harsh, punitive system that causes lifelong adverse health and social outcomes. However, partnership between academics, advocates, and policymakers can catalyze legislative change to set minimum ages. PURPOSE OF ARTICLE: We, an academic pediatrician and social worker, describe our stakeholder-policymaker-academic partnered research that led to the passage of California Senate Bill 439, which excludes children under age 12 from eligibility for juvenile legal prosecution. To stimulate future efforts, we also describe how the initial partnership led to a national coalition through which we are partnering with stakeholders across the United States to influence minimum age laws nationwide. KEY POINTS: Stakeholder-policymaker-academic partners can contribute synergistically in the research-to-policymaking process. CONCLUSIONS: Through a stakeholder-policymaker-academic partnership, we were able to influence the passage of a minimum age law for the juvenile legal system in California. Lessons learned in this collaboration can be applied by researchers across disciplines who wish to influence policy.

Credible messenger mentoring to promote the health of youth involved in the juvenile legal system: A narrative review.

This narrative review examines the literature on credible messenger mentoring (CMM) as an intervention to promote the health and well-being of youth involved in the juvenile legal system. In the CMM model, individuals with shared life experiences (e.g., from the same neighborhoods or marginalized communities, with former gang or incarceration history) serve as mentors, leveraging their own history of transformation to engage youth involved in the juvenile legal system and promote individual and community change. CMM is an increasingly popular approach for working with youth involved in the juvenile legal system, yet the state of the research on this intervention is unclear. This article provides a narrative review of existing research on CMM to understand what is known, and unknown, about the intervention. Results find an emerging, but incomplete body of evidence supporting the impact of CMM for youth involved in the juvenile legal system, and for adult mentors. Qualitative and observational findings provide stronger support for the model, while quantitative findings provide more mixed evidence, indicating that CMM may be a promising life course health intervention, yet needs more empirical study. Findings from this review underscore the value of integrating community-informed evidence in the evaluation of health interventions. Future research can inform contemporary interest in the CMM approach and guide implementation and measurement standards for optimizing intervention delivery with youth involved in the juvenile legal system.

"It was there when I came home": young adults and jail reentry in the context of COVID-19.

In this study, the authors explore how young adults navigated the dual challenges of the COVID-19 pandemic and jail reentry in a large urban environment. Fifteen young adults (aged 18-25) participated in up to nine monthly semi-structured interviews to discuss their experiences of reentry during the height of the COVID-19 pandemic (i.e., spring and summer 2020). Participants held mixed attitudes and beliefs about COVID-19. Several participants viewed the pandemic as a hoax, while others took the pandemic more seriously, particularly if their friends and family members had contracted the virus. Yet nearly all participants viewed the pandemic as having a relatively minimal impact on their lives compared to the weight of their reentry challenges and probation requirements. Young adults described COVID-19 stay-at-home orders as limiting their exposure to negative influences and facilitating compliance with probation requirements. However, resource closures due to COVID-19, including schools, employment programs, and social services presented barriers to reentry success. The authors draw upon these findings to pose implications for interventions supporting young adult reentry. Supplementary Information: The online version contains supplementary material available at 10.1007/s12103-022-09683-8.

United States Youth Arrest and Health Across the Life Course: A Nationally Representative Longitudinal Study.

BACKGROUND: Youth are arrested at high rates in the United States; however, long-term health effects of arrest remain unmeasured. We sought to describe the sociodemographic characteristics and health of adults who were arrested at various ages among a nationally representative sample. METHODS: Using the National Longitudinal Study of Adolescent to Adult Health, we describe sociodemographics and health status in adolescence (Wave I, ages 12-21) and adulthood (Wave V, ages 32-42) for people first arrested at age younger than 14 years, 14 to 17 years, and 18 to 24 years, compared to never arrested adults. Health measures included physical health (general health, mobility/functional limitations, death), mental health (depressive symptoms, suicidal thoughts), and clinical biomarkers (hypertension, diabetes). We estimate associations between age of first arrest and health using covariate adjusted regressions. RESULTS: Among the sample of 10,641 adults, 28.5% had experienced arrest before age 25. Individuals first arrested as children (ie, age <14) were disproportionately Black, compared to White. Compared to individuals never arrested, people arrested before age 25 had more depressive symptoms and higher rates of suicidal thoughts during adolescence. Arrest before age 25 was associated with worse self-reported health, higher rates of functional limitations, more depressive symptoms, and greater mortality by adulthood (ages 32-42). CONCLUSIONS: Arrest before age 25 was associated with worse physical and mental health--and even death in adulthood. Child arrest was disproportionately experienced by Black children. Reducing arrests of youth may be associated with improved health across the life course, particularly among Black youth, thereby promoting health equity.

Implementation of Canada's youth justice minimum age of 12: implications for children in Canada and globally.

Youth justice minimum age thresholds vary widely and are garnering increased global attention. In 1984, legislation in Canada excluded all children under age 12 from its youth justice system, yet few studies have examined implementation of the statute. We interviewed 22 experts across Canada to understand how the law functions and to guide responses in Canada and other nations. We used an inductive, thematic analysis process. Experts reported that excluding children under 12 from Canada's youth justice system has been effective in eliminating juvenile legal processing for children under 12, and promoting responses that identify and address the root causes of children's disruptive behavior outside of the legal system. Experts noted that addressing key gaps in funding and community service provision can reduce service variation by geography, race or ethnicity, socio-economic status, and ability or disability status and can enhance youths' success. Canada's experience suggests that for optimal implementation, minimum age laws should be coupled with robust funding and sufficient service provision to achieve racial justice and health equity.

Applying a Health Development Lens to Canada's Youth Justice Minimum Age Law.

OBJECTIVES: We applied a Life Course Health Development (LCHD) framework to examine experts' views on Canada's youth justice minimum age law of 12, which excludes children aged 11 and under from the youth justice system. METHODS: We interviewed 21 experts across Canada to understand their views on Canada's youth justice minimum age of 12. The 7 principles of the LCHD model (health development, unfolding, complexity, timing, plasticity, thriving, harmony) were used as a guiding framework for qualitative data analysis to understand the extent to which Canada's approach aligns with developmental science. RESULTS: Although the LCHD framework was not directly discussed in the interviews, the 7 LCHD framework concepts emerged in the analyses and correlated with 7 justice principles, which we refer to as "LCHD Child Justice Principles." Child involvement in the youth justice system was considered to be developmentally inappropriate, with alternative systems and approaches regarded as better suited to support children and address root causes of disruptive behaviors, so that all children could reach their potential and thrive. CONCLUSIONS: Canada's approach to its minimum age law aligns with the LCHD framework, indicating that Canada's approach adheres to concepts of developmental science. Intentionally applying LCHD-based interventions may be useful in reducing law enforcement contact of adolescents in Canada, and of children and adolescents in the United States, which currently lacks a minimum age law.

Technology-Based Interventions to Promote the HIV Preexposure Prophylaxis (PrEP) Care Continuum: Protocol for a Systematic Review.

BACKGROUND: Preexposure prophylaxis (PrEP) is a promising biomedical intervention for HIV prevention. Researchers have proposed the PrEP care continuum to guide and evaluate PrEP implementation programs. Technology-based interventions (TBIs) have been widely used in HIV prevention and treatment programs, including for the promotion of the PrEP care continuum. The rapid development of new interventions using technology and electronic health methods emphasizes the need for a review of the effectiveness of these TBIs. OBJECTIVE: The aim of this systematic review is to summarize the effectiveness and acceptability of TBIs used to promote the HIV PrEP care continuum. METHODS: We will conduct a systematic literature search in PubMed, Embase, MEDLINE, PsycINFO, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Only intervention studies (ie, studies meeting the criteria of randomized controlled trials or quasi-experimental studies) evaluating the effectiveness of TBIs will be included. We will search the National Institutes of Health Research Portfolio Online Reporting Tools (NIH RePORT) for interventions involving PrEP. At least 2 reviewers will independently screen and select the studies, extract the data, and evaluate the quality of the studies, and discrepancies will be resolved by a senior author. We will provide a narrative synthesis of the included studies and present details about the study populations, interventions, and PrEP-related outcomes of significance. RESULTS: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021249562). As of August 2021, we have completed the initial search and identified 1213 records. Study screening and data extracting are in progress. We expect the results to be ready by summer 2022. CONCLUSIONS: The findings of this review will summarize successful experiences and lessons learned from the existing literature and therefore inform the design and implementation of intervention studies for PrEP care promotion. TRIAL REGISTRATION: PROSPERO CRD42021249562; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249562. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33045.

Hidden talents in harsh environments.

Although early-life adversity can undermine healthy development, children growing up in harsh environments may develop intact, or even enhanced, skills for solving problems in high-adversity contexts (i.e., "hidden talents"). Here we situate the hidden talents model within a larger interdisciplinary framework. Summarizing theory and research on hidden talents, we propose that stress-adapted skills represent a form of adaptive intelligence that enables individuals to function within the constraints of harsh, unpredictable environments. We discuss the alignment of the hidden talents model with current knowledge about human brain development following early adversity; examine potential applications of this perspective to multiple sectors concerned with youth from harsh environments, including education, social services, and juvenile justice; and compare the hidden talents model with contemporary developmental resilience models. We conclude that the hidden talents approach offers exciting new directions for research on developmental adaptations to childhood adversity, with translational implications for leveraging stress-adapted skills to more effectively tailor education, jobs, and interventions to fit the needs and potentials of individuals from a diverse range of life circumstances. This approach affords a well-rounded view of people who live with adversity that avoids stigma and communicates a novel, distinctive, and strength-based message.

Addressing Child Mental Health by Creating a National Minimum Age for Juvenile Justice Jurisdiction.

In August 2020, in the midst of a national conversation about racism in the United States, news of a Black eight-year-old boy being arrested for sitting improperly in the school cafeteria spread through the country.1 Body-camera footage showed police attempting to place the boy in handcuffs that slipped from his wrists before they took him to a juvenile detention facility where he was charged with felony battery. The boy's mother and lawyer reported that following arrest, he experienced somatic and trauma symptoms, including headaches, nightmares, and insomnia. His story, and the attention it garnered, illustrate the importance of the growing movement to establish a national minimum age of juvenile justice jurisdiction-an age below which a child cannot be prosecuted in juvenile court. We call upon child and adolescent psychiatrists to join this movement as a critical tool for promoting mental health and racial equity for children.

Collaborative Responses to Commercial Sexual Exploitation as a Model of Smart Decarceration.

Historically, youths who are affected by commercial sexual exploitation (CSE) in the United States have been implicated as perpetrators of crime and overrepresented in the juvenile justice system. As an intriguing example of the "smart decarceration" social work grand challenge, policy and practice initiatives have converged to decriminalize cisgender girls and young women experiencing CSE by reframing them as victims of exploitation rather than as criminals. To date, these efforts have largely focused on gender-specific programming for cisgender girls and young women. In this article, the authors describe how federal, state, and local policy and practice innovations have supported reframing CSE as a form of child maltreatment and rerouted girls and young women from the juvenile justice system to specialized services. Using Los Angeles County as a case example, the authors detail how innovative prevention, intervention, and aftercare programs can serve as models of smart decarceration for CSE-affected cisgender girls and young women with the potential to address the needs of youths with diverse gender and sexual identities.

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.

Pathways to Civic Engagement Among Urban Youth of Color.

Through civic engagement, adolescents can increase community vitality, challenge injustices, and address social problems. Positive youth development (PYD) theory and research has generated knowledge of ecological assets (resources and supports in everyday environments) that foster youth civic engagement. Yet, assets and opportunities are not equally available to all youth. Youth of color in urban high-poverty neighborhoods merit more concerted attention in research on civic development to inform theory, policy, and practice. A primary goal of this monograph is to broaden academic and public discourse about what civic engagement looks like and how it develops for urban youth of color who live in high-poverty neighborhoods. We conducted one time, face-to-face interviews and brief quantitative surveys with 87 youth of color (90% Black and Black multiracial; 59.8% male; ages 12-19) recruited from five youth centers in Rochester, New York, from 2015 to 2016. Interviews elicited youth's perspectives on how they define and experience civic engagement, community problems, connections and discussions to community, and adult supports. We used an inductive qualitative methodology. In Chapter I, we review what is known about civic engagement among urban youth of color. We lay out evidence for ecological assets that support youth civic engagement, aligned with a PYD perspective, and articulate ways to expand beyond PYD to understand youth empowerment and urban contexts. In Chapter II, we summarize national and local contexts that may shape the experiences of urban youth of color in our study. To set the stage for the empirical chapters that follow, we describe our sample, study design, and methodology. In Chapter III, we examine how urban youth of color in Rochester experience community violence and discuss the implications of these experiences for civic development. Youth articulated violence as a serious community problem and powerfully discussed frequent, personal, direct and indirect exposures to violence. Due to fear and lack of safety, some youth strategically disconnected from community and relationships and experienced disempowerment. Others reacted to violence with a tendency toward self-protection. For some, community violence was a catalyst for civic action. In Chapter IV, we investigate how youth defined and experienced civic engagement. Youth's civic participation spanned helping community, engaging politically, participating in school or community organizations, engaging in social and leisure activities, and taking personal responsibility. Youth's civic actions were largely informal and localized. Some civic participation was contextualized as a response to community violence, such as intervening to protect peers from harm. Some youth were not civically engaged. In Chapter V, we map out what civic empowerment looks like for these youth and how civic empowerment links to civic action. Supporting prior theory, we found evidence for emotional, relational, and cognitive dimensions of civic empowerment and experiences of civic disempowerment. Emotional empowerment was most closely aligned with civic action, although any expressions of civic empowerment suggest youth are developing building blocks for civic participation. In Chapter VI, we investigate ecological assets that support youth's civic development. Safe community spaces such as youth centers provided familiarity and comfort, opportunities to forge connections with others, and places to help and be helped. Adults supported youth by enabling youth to feel heard, not judging them, serving as role models, and offering guidance and support. Youth were equally articulate about how adults fail to support or empower them. We conclude that some assets generally support positive development and others specifically foster civic development. In Chapter VII, we integrate findings across chapters into a conceptual model of four distinct pathways of civic development. We systematically examined differences among youth who are disengaged, personally responsible, safely engaged, and broadly engaged. All pathways are adaptive, and youth found different ways to navigate community violence and other adversities. As summarized in Chapter VIII, our study informs theory and future research on civic engagement among urban youth of color in contexts of adversity. We put forward four important elements needed for theory of civic development to be relevant for urban youth of color. Then we offer policy and practice recommendations: (a) investment in safe spaces and violence-reduction policies should be a top priority; (b) youth should be involved in decision-making about solutions to issues of concern to them; (c) civic engagement programs and opportunities should center on local issues and allow for multiple forms of engagement; (d) all youth should be heard and taken seriously by the adults in their lives.

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.

Physical Health, Medical Care Access, and Medical Insurance Coverage of Youth Returning Home After Incarceration: A Systematic Review.

Youth reentry following incarceration is a subject of active health care policy innovation and debate. We systematically searched PubMed, CINAHL, Cochrane Library, and Google Scholar for research articles on physical health status or medical care access related to youth reentry (i.e., children and adolescents under 18 years of age). A total of 2,187 articles were identified in the search. After applying exclusion criteria, 10 articles remained. Those included covered general physical health (four articles), medical insurance coverage (five), noninsurance barriers to care and care utilization (five), and reentry youths' prioritization of needs (four). Despite vulnerable health status, the literature on youths' physical health status and medical care access during reentry is sparse, signifying a disconnect in research priorities. The findings suggest that intervention trials on youth reentry and health are needed and that that policy makers should be concerned with Medicaid policy reform.

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.

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.

Behavioral health treatment "Buy-in" among adolescent females with histories of commercial sexual exploitation.

BACKGROUND: Adolescent females with histories of commercial sexual exploitation (CSE) have high mental health and substance use treatment needs, yet little is known about their perspectives regarding behavioral health and behavioral health treatment. OBJECTIVE: We sought to understand the attitudes of adolescent females with histories of CSE regarding behavioral health to identify factors influencing "buy-in" to behavioral healthcare. PARTICIPANTS AND SETTING: Participants included 21 adolescent females, affiliated with our partner organizations (two group homes, a service agency, and a juvenile specialty court), who reported having exchanged sex for something of value. METHODS: In-depth qualitative interviews explored participants' perspectives towards behavioral health. We conducted thematic analysis to identify themes concerning behavioral health. RESULTS: Participants provided insightful definitions of "mental health" that included positive and negative aspects of emotional and cognitive states (e.g. "being happy with yourself" and "not thinking suicidal"), indicating intensified mental health challenges and resilience. Substance use was viewed as a coping mechanism for childhood trauma and their exploitation. Trusted relationships with providers and navigable health systems that encourage autonomy were key to promoting "buy-in" and thus engagement in behavioral health treatment. A conceptual model emerged illustrating factors leading to treatment engagement. CONCLUSION: Adolescent females with histories of CSE constitute a vulnerable population with high levels of trauma as well as unmet mental health and addiction treatment needs. The delivery of trauma-focused, behavioral healthcare centered on patient-provider trust and shared-decision making that encourages client autonomy should be prioritized.