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Introduction and Overview1
On September 26, 2019, the Roundtable on the Promotion of Health Equity of the National Academies of Sciences, Engineering, and Medicine held a workshop in Flagstaff, Arizona, on the impact that juvenile justice system involvement has on the health and well-being of adolescents, families, and communities of color. The roundtable has a unique role as a convener of the nation’s experts in health disparities and health equity. It works to promote health equity and the elimination of health disparities by increasing the visibility and understanding of inequities in health and health care among racial and ethnic populations; examining research, policy, and community-centered programs; and catalyzing the emergence of new leaders, partners, and stakeholders.
The Arizona workshop was the last in a series of three centered on the intersection of health equity with the criminal justice system. The first, held in Philadelphia, Pennsylvania, focused on incarceration as a structural determinant of health (NASEM, 2019). The second, held in Washington, DC, examined interactions between race, ethnicity, and drug control laws and policies and the criminal justice system (NASEM, 2022). The Arizona workshop featured panels of nationally and locally
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1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the rapporteurs as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.
recognized experts in justice and health, along with a luncheon session featuring young adults speaking about their experiences in the justice system. As Julie Baldwin, director of the Center for Health Equity Research at Northern Arizona University and chair of the workshop planning committee, said during the workshop’s opening session, “We see this as a critical launching point for dialogue and action around this topic, both locally and nationally.”2 The workshop was sponsored by the Aetna Foundation, the Arizona Biomedical Research Centre, the California Wellness Foundation, The Colorado Trust, the Health Resources and Services Administration, the Hogg Foundation, Merck & Co., Inc., the Moore Foundation, the NARBHA Institute, Northern Arizona University Center for Health Equity Research, and the U.S. Department of Veterans Affairs’ Office of Health Equity.
The objectives of the workshop were:
- Describe what we know today, and what the research tells us, about how involvement with the juvenile justice system affects health outcomes for youth, families, and communities.
- Examine the programs and policies that are successful in all aspects of involvement with the juvenile justice system (pre-involvement, involvement, and post-involvement).
- Explore what needs to be done to improve all aspects of encounters with the juvenile justice system.
Northern Arizona University (NAU) has a strong history of community-engaged research and service and works closely with local justice systems in Northern Arizona, observed the university’s provost and vice president for academic affairs, Diane Stearns, in the workshop’s opening session. Several of the university’s faculty and staff have been involved in the Criminal Justice Coordinating Council in Coconino County, where the university is located, and have worked closely with the local detention center on a project to address health disparities. The university has an active department of criminology and criminal justice, and with the generous support of the NARBHA Institute (formerly known as the Northern Arizona Regional Behavioral Health Authority) it recently hired a new endowed chair in criminal justice and behavioral health. “We’re very
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2 The workshop planning committee consisted of Julie A. Baldwin, Northern Arizona University; Mark Carroll, the NARBHA Institute; Toorjo Ghose, University of Pennsylvania; Kathi Grasso, legal and policy independent consultant; Kevin Ahmaad Jenkins, University of Pennsylvania; Octavio N. Martinez, Jr., Hogg Foundation for Mental Health; Linda Teplin, Northwestern University; and Winston F. Wong, Kaiser Permanente.
committed at NAU to all of these issues, and we’re thankful to have this opportunity to bring everyone together today,” said Stearns.
OVERVIEW OF THE WORKSHOP PROCEEDINGS
In the first session of the workshop (Chapter 2), two speakers provided a national and state context for discussion of the consequences of juvenile justice system involvement on the health and well-being of adolescents, families, and communities of color. Many inequities persist among racial and ethnic groups on measures of health and well-being, and these inequities contribute to and are exacerbated by involvement in the juvenile justice system, the presenters pointed out. At the same time, a variety of actions can help reduce the associations between inequities, physical and behavioral health, and juvenile justice involvement, and greater collaboration among interacting societal institutions could promote and advance these actions.
Four presenters in the second session of the workshop (Chapter 3) turned directly to the effects on individuals, families, and communities of involvement with the juvenile justice system. Reports on juvenile justice facilities have found high rates of violence, abuse, isolation, restraint, suicide, and crowding, along with a lack of access to appropriate health care, mental health services, and suicide screening and to basic services and education. These conditions can interrupt a child’s education, disrupt social connections, alienate loved ones, and limit opportunities for employment and college admission. Speakers discussed alternatives to court involvement and confinement, enhanced and evidence-based programming, alternatives to out-of-home placements, and gender-responsive and culturally tailored interventions and programming that can help move responses past the individual level toward programmatic, systemic, and policy solutions.
The luncheon session at the workshop (Chapter 4) focused on the juvenile justice system in Coconino County, where the workshop took place. It featured a panel of youth, parents, and professionals who all have had direct experience with the juvenile justice system in the county. The youth panelists noted that they could not have resolved the problems they faced without the support of the county’s juvenile justice system, a message that was reinforced by the parents on the panel. The professionals, including several probation officers, observed that watching youth realize their potential gives the officers the energy they needed to continue working in a broken system.
A panel on alternatives to detention (Chapter 5) also featured two speakers with direct experience of the juvenile justice system. One, who was incarcerated as a teenager and went on to earn a law degree, pointed
out that youth need developmentally appropriate responses to their behaviors that are rooted in health and positive development, not just punishment. The other, a tribal judge in California, observed that tribal justice programs provide an alternative to traditional probation and social service departments, enabling children to stay in their communities and out of detention.
The final panel of the workshop (Chapter 6) considered the progress that could be made by instituting the reforms discussed earlier in the day. Transforming juvenile justice from a compliance-driven to a hope-driven culture could further reduce the negative outcomes associated with juvenile justice system involvement. Collaboration with the health care system could extend Medicaid coverage to families and children in detention, which would help them reintegrate into the community. Law enforcement personnel could contribute as well by forgoing arrests and instead connecting youth with solutions available in a community.
In the workshop’s final session (Chapter 7), members of the roundtable and other workshop participants commented on ideas and themes that had arisen over the course of the day, covering such topics as the philosophies that shape societal institutions, the links between the health care and juvenile justice systems, research gaps that could be filled, and the need to look upstream in the lives of young people to prevent crises before they occur. The workshop statement of task can be found in Appendix A; the workshop agenda is in Appendix B; and the speaker biographies are in Appendix C.
