7
Reflections on the Workshop
In the final session of the workshop, roundtable members and other workshop participants reflected on some of the most important ideas and themes that arose over the course of the day.
CONTRASTING PERSPECTIVES
Octavio Martinez, Jr., executive director of the Hogg Foundation for Mental Health and associate vice-president in the Division of Diversity and Community Engagement at The University of Texas at Austin, observed that the United States as a whole is a very individualistic society, but indigenous and ethnic populations have a more collective philosophy. These perspectives are “butting up against each other, and we really haven’t addressed that when it impacts our policies.” The juvenile justice system may want to take a more individualistic approach to a problem, whereas a community wants a more collective approach.
He also commented on what he called “the myth of meritocracy.” People often use the idea of a meritocracy to contend that people fall behind because they have not worked hard enough. Yet racism and other social forces can undercut hard work, which has important implications for public policy. Though U.S. society has largely ignored these issues, he said, they have to be addressed to create and scale up programs across the country to ensure that all communities benefit.
Finally, the United States is a capitalist society. The private sector needs to make a profit, “and there’s nothing wrong with making a good
profit if you do it with integrity,” said Martinez. Americans fund what they value, so if something is not funded, that reveals something about values. The workshop made it clear that Arizona does value its children, and it is funding programs to help them. This needs to happen in the rest of the United States and all its many communities, he said.
He concluded his comments by noting that the Hogg Foundation has created a fellowship program that brings in people with lived experience in lieu of a master ’s degree. “These folks have done an amazing job,” he said. “They worked through a recent Texas legislature on justice issues, and I can’t say how wonderful it was and the impact that they made.” People with lived experience need to be integrally involved in designing and implementing policies, said Martinez, which is “something that we all need to think hard about.”
PARALLELS BETWEEN THE HEALTH CARE AND JUVENILE JUSTICE SYSTEMS
Reginald Tucker-Seeley, Edward J. Schneider Assistant Professor of Gerontology at the University of Southern California, drew attention to the issues that are similar in the health care and juvenile justice systems. In health care, one of the biggest challenges is care coordination as patients navigate their way across care. The same problem occurs as juveniles make their way through the juvenile justice system. In that respect, coordination across systems could help solve similar problems in both systems. Tucker-Seeley, for example, has studied how financial hardship affects health and health behaviors. “It was eye opening for me to see that the fines and fees levied on families as they’re navigating [the juvenile justice] system could potentially cause financial hardship, which then could impact the kinds of health decisions that they’re making,” he said. Another example of the need for cross-system communication involves the complex role of law enforcement, he said. How can the person charged with preventing crime help people get the services they need before a crime occurs?
He also asked whether a process of reconciliation is needed across health care and juvenile justice. Does the criminal justice system need to acknowledge and say that it is sorry for the history of maltreatment and the effect that its actions have had on the health and well-being of communities?
Winston Wong, medical director for Disparities and Quality Initiatives at Kaiser Permanente, called attention to the social determinants of health, such as housing instability, food insecurity, and transportation barriers. The juvenile justice system essentially replicates the injustices embedded in these social institutions, he said. Systemic racism, historical
trauma, and structural discrimination all manifest as sources of trauma that have direct effects on children, and these structural aspects of society are just as much a social determinant of health as whether a child has food on the table.
Michelle Wong, a roundtable fellow and associated health postdoctoral fellow in health services research at the U.S. Department of Veterans Affairs’ (VA’s) Center for the Study of Healthcare Innovation, Implementation, and Policy, advocated creating a large flow diagram so that all the stakeholders in the juvenile justice system can see what happens at each stage, various intervention points, and the places where such factors as systemic racism are affecting this system. Such a diagram could also reveal to policymakers where they can intervene in the system to improve the lives of children and their families. Such a diagram could show that “here are the short-term cure points, when we’re just putting a Band-Aid onto a bigger situation, but here’s the bigger situation.”
Michal Rudnick, project manager at the AHCCCS, cautioned the workshop participants that health care organizations are under pressure from a large number of constituencies, all of which are facing severe problems. “I want to be careful how I say this,” she said, but “there are lots of horrible crises happening. . . . Human nature is to advocate and fight for those people that are closest to us, for our communities. . . . We do the best that we can, and I’ve seen progress in the last 20 years. All we can do is keep moving forward.”
Mark Carroll, chief health officer at the NARBHA Institute, pointed out that the triple aim of health care relates to head, heart, and wallet. All three need to be aligned to fix the problems involved with juvenile justice as well. “There is a tremendous amount of heart in this room,” he said. “Perhaps the roundtable can help us understand how we can stay engaged. We can bring the head and the wallet along to be aligning with that heart.”
RESEARCH NEEDS
Kevin Ahmaad Jenkins, roundtable fellow and vice-provost postdoctoral fellow at the University of Pennsylvania’s School of Social Policy and Practice, observed that research has a tendency to pathologize people and communities. Racism and not race is the risk factor, he said. For example, if one of three Black men is jailed, two of three are not. Researchers could broaden the focus of their work by promoting the idea of collegiality, by inviting others to participate in their research, and by looking outside the box for new ideas and new people who can contribute. “I want us to be much more meaningful about what we’re doing and what we’re putting our weight behind,” said Jenkins.
Kendall Campbell, associate dean for diversity and inclusion at the Brody School of Medicine at East Carolina University, noted that a breakdown of the decreasing incarceration rates and drug arrests in recent years along racial and ethnic lines would provide useful information to analyze community contributions and responses to problems. He also pointed to the observation made during the workshop that the criminal justice system is not one big system but a variety of systems that interact with each other. Because so many separate systems exist, communication may not be good between the parts. Finally, he proposed that “convening a session of grandmothers” could provide valuable information on building and rebuilding community.
David Byers, administrative director of the Courts in Arizona, asked for much better ways to get research results and other information from one scholarly field to another. “We don’t read your journals, and I suspect you don’t read our journals,” he said. “We have to find a better way to take the knowledge that’s being learned in your fields and get it to us and to people who can make changes in the system.” Even a straightforward directory of who is doing what at a university could help information move across disciplinary and professional borders, he said.
Catherine Gallagher, professor at George Mason University, remarked on the inevitable tension between talking about real people and converting their experiences into numbers. She pointed out, for example, that failure is a luxury that racism has denied many people, a human reality that is impossible to capture in numbers. “If we don’t allow people to fail once or twice or three times, if we just let them fail one time on a road that may not have been their path to begin with, we’re doing great harm.” Though the needs of children are complex, many people can see crises coming, and those warning signs can be dealt with informally, safely, and in the best interests of a child. “Let’s intervene before there’s a crisis,” said Gallagher, “we’re not doing that for all kids.” She also called attention to how and why juvenile facilities are used in the ways that they are. Parallels could even be drawn with asylums, which raises issues associated with “not speaking the language of what we want to do.”
In addition, Gallagher urged reframing what is considered progress or a goal. “The goal isn’t to become a perfect kid, according to rules that they never establish or ascribe to. Rather it is to get through the day without hurting themselves, or without getting hurt by somebody else, or just going to school.” These can be hard wins for children, and recognizing that fact means reframing individualized goals.
Finally, Gallagher urged that consideration be given to changing the names of buildings and other institutions from “community corrections” to “community connections.” “Why emphasize that something has gone
wrong? Failure can be a good thing,” she said. “We can make bad things good, but we can make bad things much worse.”
LOOKING FARTHER UPSTREAM
Shreya Kangovi, executive director of the Penn Center for Community Health Workers at the University of Pennsylvania, noted that she hears every day about the consequences of structural violence done to groups and individuals, whether that consists of locking people up or children killing themselves in solitary confinement or people getting sick and dying. Even the work on social determinants of health is downstream from the perpetration of structural violence, she said. She cited a need for empathy interventions that, for example, reduce implicit bias, greed, and racism. “If we can help people kick a cocaine addiction, we could probably convince people to be a little less selfish,” she said. “Until we solve those root cause problems, we are just going in circles.” Even such policy reforms as funding public schools at the state level rather than the local level would reduce inequity, she noted.
Ernest Moy, executive director of the Office of Health Equity at the VA, also called attention to upstream factors. To a medical provider, a referral occurs after a diagnosis has been made. Is there a way to screen students for risk factors and intervene before an act is committed that will involve them in the juvenile justice system? He also pointed to the many impressive things Arizona has done to reform its juvenile justice system and asked whether funding is the only barrier to spreading such reforms or whether other barriers are involved and whether and how the roundtable can be involved in overcoming these barriers.
Finally, Julie Baldwin thanked the workshop participants for their ideas and questions. The roundtable “will be taking a lot of this information and trying to synthesize it and thinking about next steps,” she said. “We thank all of you very much for your dedication to these important issues and for thinking about our youth and young adults.”
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