6

Possible Future Directions

The final panel session of the workshop moved beyond healing to what can be done to reduce and prevent the need for healing. Three presenters, Keenon James, National Organization of Black Law Enforcement Executives; Joe Kelroy, Director, Division of Juvenile Services, Arizona Supreme Court; and Michal Rudnick, Arizona Health Care Cost Containment System, looked at measures that can be taken at the state,

county, and local level to avoid problems before they occur. Moderator Kevin Ahmaad Jenkins, vice-provost postdoctoral fellow at the University of Pennsylvania’s School of Social Policy and Practice, referred to the familiar diagram of three children trying to look over a fence (Figure 6-1). He urged moving beyond equality or equity to justice by removing the cause of the inequity. “Let’s remove the barrier,” he said. “We’re good at showing the problem, continuing to talk about the problem, pointing at the problem, telling the statistics,” he said. But the more important question is “who’s bringing a bulldozer to knock the fence down?”

CREATING A CULTURE OF HOPE

Joe Kelroy, director of the Division of Juvenile Services at the Arizona Supreme Court, reminded workshop participants of the reality of detention, as outlined in a report from the Justice Policy Institute (Holman and Ziedenberg, 2006). Detention:

• Increases recidivism and does not reduce crime.
• Pulls children deeper into the system and slows the natural “aging out of delinquency.” Alternatives are more effective at reducing recidivism and a fraction of the cost.
• Produces depression and makes mentally ill youth worse.
• Increases risk of self-harm (communities have seen two to four times the rate of suicide for detained youth).
• Leads youth with special needs to fail to return to school.
• Impedes later success in the labor market.
• Is not cost effective.
• Has increasingly locked up youth of color at disproportionate rates.

Several initiatives undertaken in Arizona have had a great impact in reducing these outcomes and point toward what could be done in the future, Kelroy observed.

The Kids at Hope program creates a culture of hope for the juveniles and families by transforming juvenile justice from a compliance-driven to a hope-driven culture. The Kids at Hope philosophy and framework has been pushed out to all 15 counties in Arizona, Kelroy said, and all have embraced it, although in different ways. For example, some counties have established centers where law enforcement personnel, teachers, and children can meet in an open setting and receive both assessment and help. The intention is to combine the right child with the right person, in the right place and at the right time.

A Juvenile Detention Alternatives Initiative that started in 2004 is now operating in nine counties, Kelroy observed. In addition, a Crossover Youth Practice Model, which began in 2012, has involved all of Arizona’s counties in considering the protocols applied to dually adjudicated juveniles. Both of those initiatives are focused on disparity issues and on the factors that involve children in both the child welfare and juvenile justice systems. Additionally, an initiative on minor victims of sex trafficking (MVST) has trained all judges, probation officers, and detention officers on the issue. Each county juvenile probation department has an established MVST specialist as a “go-to person” in that county. “If they identify somebody, or if there’s a question about someone, they’re able to look through that lens and hopefully save the life of someone,” Kilroy said.

Arizona’s approach begins with the premise that “all kids are capable of success, no exceptions.” When Kelroy was working as a detention officer in Illinois, sending a child to corrections was considered a negative factor in staff performance reviews, and Kelroy has extended that emphasis in Arizona. Out of 80,000 people in Apache County, for example, fewer than five children were committed. The county closed its detention facility in 2015 and repurposed it as a community center, saving more than one million dollars annually in county funding. Instead of serving one or two children each day, it now serves anywhere from 35 to 50, and a second community center is planned.

Research in Maricopa County had shown that diversion allowing juveniles to avoid entering the court system was disproportionately unavailable to Hispanic, Black, and Native American youth compared with White youth, Kelroy observed. That situation has changed so that opportunities for diversion now have no significant disparities. “We’re hopeful that that movement can grow and go into other communities,” he said. Statewide, Arizona has reduced admissions to detention by 50 percent, with a 35 percent reduction in the average daily population.

Assessment tools are now being used to provide optimal services to juveniles and communities, with the use of data to ensure the validity of these tools. Yuma County, for example, with the development of its Hope Assessment Center, cut recidivism to 11 percent in a 12-month period. Similarly, through multiagency collaborations, Pinal County has reduced group home arrests by 54 percent. Kelroy added, “that’s the courts working with group homes demonstrating how we work with kids in our facilities. The cross training of specific skillsets to workers within the group homes enables them to be better able to address problematic behaviors rather than calling law enforcement.”

Within Arizona as a whole over the past 25 years, referrals have dropped from as high as 90,000 to under 34,000 annually, Kelroy pointed out. The number of detention centers has gone from 14 to 10, and Department of Juvenile Corrections facilities house fewer than 200 juveniles on an average day. Kelroy noted that the most restrictive options are the most expensive, move children toward the deep end of the system, and disproportionately affect minority youth. The least restrictive options, in contrast, are far less expensive, keep children in their homes and connected to their communities, and produce better outcomes.

Delinquent juvenile behavior does not necessarily lead to criminal behavior in adulthood, Kelroy said. Even juveniles with sexually abusive behaviors have a recidivism rate of less than 5 percent. Regarding minor victims of sex trafficking, children are not prostitutes, said Kelroy, they are victims. Judges, probation officers, and detention officers need to learn that juveniles do not engage in prostitution by choice. Nor is it true that

juveniles in detention and corrections facilities are necessarily dangerous. Nationally, more than three-quarters are there for technical and status offenses, drug crimes, property offenses, and public order offenses.

“We have a lot of work to do,” Kelroy concluded. But the leadership of judges is critical, he said, because they can convene people. “We have to have their voices at the table.”

ENSURING THE CONTINUITY OF HEALTH CARE

Michal Rudnick, project manager at the Arizona Health Care Cost Containment System (AHCCCS), focused on issues related to access to health care for juveniles involved in the juvenile justice system. The AHCCCS is the Medicaid agency in Arizona and serves 1.9 million members in the state. The AHCCCS “doesn’t always get a great rap,” said Rudnick. “We’re a government agency, and government agencies can tend to run slowly.” But the leaders of the agency are committed to listening to the community and to responding to the community’s needs with innovative actions, she added.

As mentioned earlier in the workshop, when a child is detained for criminal reasons, federal law dictates that access to health benefits be suspended. The AHCCCS has done everything that it can to assist youth in this situation, Rudnick said, “and we continue to be committed to doing that.” For youth as well as adults, the “very real and unfortunate situation” is that jails and prisons are becoming health care facilities. Judges see the same people over and over and point out that access to Medicaid is what they need to get health care and be successfully reintegrated into the community. Medicare administrators “are not experts on criminal justice,” Rudnick said, “but we certainly do have the ability to influence policies that can impact getting those health providers and health plans to serve our citizens, whether they’re incarcerated or not.”

One step her agency has taken is to arrange for Medicaid applications to be submitted while people are still in prison, which is a practice followed by some but not all other states. That avoids a period of at least 45 days, “in the best-case scenario,” before someone released from prison can get back on the program. “Within 24 hours of their release, we reinstate their benefit, so they’ll have Medicaid coverage available if they need to go into any sort of care. They’re able to access those services almost immediately, and that’s huge.” Also, people going to prison who did not have Medicaid coverage are able to submit an application through an online portal, resulting in coverage within 24 hours of release.

Rudnick also described a program targeted toward the adult population that serves families and children as well. Arizona has established 13 health homes that provide medical services, including behavioral health

services, to people on probation or parole. People who are served by these health homes receive employment, housing, and food supports and are offered medication assisted treatment if they have a substance use disorder. It is an incentive-based program, where health care providers have 17 milestones and core components that they must meet to be paid, such as being able to provide the approved medication-assisted treatment drugs when needed, providing family support, and partnering with probation departments. Arizona has invested $300 million in these 13 clinics, “and I want to see more,” said Rudnick.

AVOIDING INVOLVEMENT WITH THE JUVENILE JUSTICE SYSTEM

Just a few weeks before the workshop, a 6-year-old in Orlando, Florida, was handcuffed and taken to a juvenile jail for kicking and punching school employees during a temper tantrum. “If you’re 6 years old, you’re in the first grade, you haven’t even received your first report card, but you’ve started down that school-to-prison pipeline,” said Keenon James, deputy director of the National Organization of Black Law Enforcement Executives. An incident like the one in Orlando is not a public safety problem, said James. It is a community problem.

In the case of the 6-year-old girl, the charges were dropped and she was returned to her grandmother. But “the trauma inflicted on that young girl and those classmates and the school and the community as a whole is not simply going to go away because on paper the charges are gone,” he said. “I can imagine it as a parent getting a phone call that my 6-year-old is being processed at a juvenile detention facility, the trauma is there.” James also noted that the girl was returned to her grandmother, not to her mother and father. “I know that the mother was absent from the home due to an addiction problem. What else has that child experienced in her short life that we’ve now complicated by an unnecessary arrest? . . . How do we work as a community to address these issues?”

As did Rudnick, James observed that in some communities, the only medical attention someone can get is when they go to jail or prison. He described working at a detention center with someone who was impossible to calm down. Finally, the man asked James, “Please sir, can you tell me how long it’s going to be before I can get to the dentist? I really need this tooth pulled. That’s the only reason I’m here.” Yet going to jail means that someone has a record that will follow that person and cause further problems.

James said that police departments routinely encounter situations where families are reaching out for help. For example, parents might seek

help with a child, but nothing can be done until the child is involved in a traumatic incident. “We have to look at what we’re putting in place, how we’re investing in our communities, not just to put cameras on corners and scanners with police departments, but how are we investing in the mental health needs of our community. . . . How do we move toward getting help in our communities that’s not based on being a criminal and not putting you in the juvenile system?”

Programs that work in one place may not work in another. Of the 18,000 law enforcement agencies in the United States, 12,000 have fewer than 50 officers, James pointed out. Programs may need to be scaled not up but down to address the problems in a local community. He also called attention to the shifting and often uncertain demands placed on law enforcement personnel. As an example, he mentioned the problem of preventing e-cigarette use by children. Passing a law gives officers another tool to stop an individual, and this tool may be directed disproportionately toward communities of color. “It’s like putting somebody in a choke hold over loose cigarettes. It makes no sense.”

Communities can work with law enforcement to keep children out of the juvenile justice system rather than helping them once they are involved in the system. For example, they can help maintain order in schools by building relationships with students. “There’s a lot that the students know,” James said. “They know who’s having a problem at home. They know if a child is coming to school without clean clothes, that’s an indication of things that may be going on at home.”

Communities already contain many of the solutions to the problems they face. From the law enforcement perspective, the goal may be not to make an arrest but to connect someone with the solutions available in a community. “We’re trying to figure out how we get ahead, how we keep individuals out of the system?” One key to community policing is to be proactive, he said. “What does my community need? How do I empower them? How do I not make it a crime to be poor? How do I make it possible for a mother or father who is reaching out for assistance to get that help? How do I help that grandmother who was probably ready to retire but now is raising a 6-year-old?”

Solutions are complicated, but they exist. Communities cannot arrest their way out of such problems, James said. Rather, law enforcement can help by getting services to an individual before a crime is committed. Returning to Jenkins’ metaphor, James, too, called for a bulldozer. “Knock down the fence that says you have to commit a crime to get help. Knock down that fence and put the boxes there so that we can step up to help each other.”

POLICIES WITH IMMEDIATE IMPACT

In response to a question about specific policy changes that would have an immediate impact, Rudnick again cited the suspension of children from Medicaid when they enter the juvenile justice system. Perhaps through state funding, grant funding, or a change in policy at the state level, children and adults could continue to be covered when they became incarcerated. In actuality, health plans do continue to work with people in jail and prisons who have complex health needs. But “there are ways to push the limits, and I’m all about doing that.”

Kelroy emphasized the need for law enforcement personnel to have communications with young people reinforce the right type of behavior. Communicating on the basis of strengths and successes is much more effective than communicating on the basis of failures, he noted. “We get much better outcomes and behavior change from strength-based comments versus you did this wrong.” He also advised adding well-being to the mission of child welfare and juvenile justice departments. Detention centers are not equipped to deal with acute or chronic mental health issues. Rather, a continuum of care is needed to provide for special needs.

James, too, emphasized mental health. Today, a person essentially needs to be a threat to themselves or to the community before they get the mental health services they need. Law enforcement officers know when individuals need help and when they are not in a criminal situation. But the legal requirement that people be a threat to themselves or the community limits what they can do. “We need to eliminate that, address it in policy, so that we can get those resources to our community.” Getting access to mental health services would help address many of what are today seen as public safety concerns.

Finally, James pointed to the need to acknowledge and move beyond mistakes. When a driver misses a turn in a car, the GPS system does not blame the driver for not following directions. Rather, it calculates a new route to a destination. Similarly, young people need the tools to get back on track toward success, he said.