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Trauma among Chicago’s Court-Involved Youth

Paula Satariano
July 19, 2017
Juvenile justice (JJ) populations experience high levels of trauma that have been found to impact their capacity to access healthcare and lead healthy lives. In response, Health & Medicine Policy Research Group’s Court-Involved Youth Project began to collaborate with the Illinois ACES Response Collaborative on policy development and program recommendations for justice-involved youth. On Monday, June 26th, the Project held a Healthcare Connections Workshop in Chicago’s south side, at Access Learning & Discovery Center to examine the evidence of barriers facing justice-involved youth in accessing health care. Many barriers were found to be rooted in trauma, poverty, violence, and other social determinants of health.

For almost three hours, youth in after care and on probation, after care specialists, probation leaders, Cook County Juvenile Temporary Detention Centers (JTDC) caseworkers, Illinois Department of Juvenile Justice (DJJ), and other JJ staff and community healthcare providers convened to look at data on the barriers to justice-involved youth accessing healthcare, and to come up with solutions. Staff members from Health & Medicine, including members from the Illinois ACES Response Collaborative like myself, co-facilitated tabletop discussions and guided brainstorming sessions on best solutions.

Barriers
After viewing the findings from previously completed focus groups with justice-involved youth (on the barriers to healthcare access), I facilitated a small table-top group discussion on participants’ reactions to the data. Topics of barriers ranged from Transportation, Safety of Youth, Trust of Healthcare Providers and Community Clinics, Prioritization of Healthcare, and Mental & Behavioral Healthcare. From these conversations, three main themes emerged:
  • DISTRUST of the system, health care providers, and social workers from past negative experiences and historical trauma (including intergenerational trauma).
  • SERVICE Availability was not in close proximity to justice-involved youth most in need, representing disparities in access to care.
  • TRANSPORTATION policies did not adequately consider youths’ safety including their inability to cross gang lines, nor did it consider transparency in what was expected of justice-involved youth during transportation (i.e., not needing to divulge confidential health information to JJ staff).

Solutions
Again in small groups, each group was assigned one major issue (i.e., comfort of the physical space, connections from JJ settings into community settings, etc.) and we all began brainstorming how to work through the issue from different perspectives--youth, JJ staff, and providers. I helped facilitate our groups discussion, and guided the development of 1) a recommendation guide to achieve desired solutions, and 2) a list of potential barriers to achieving our desired solutions. I found that many of these items could be transferred to projects or policies meant to address the needs of individuals with high ACEs accessing care.

Recommendation Guide:
  1. Provide reliable, safe transportation for justice-involved youth
  2. Offer Trauma-Informed Care training for JJ staff
  3. Offer paperwork/appointment support
  4. Develop/distribute educational resources to justice-involved youth and families
  5. Build trust in hospital systems among justice-involved youth (JJ staffs’ accompaniment of justice-involved youth to appointments may provide support in navigating health care system, and build young people’s self-efficacy)
  6. Develop individual youth agency
  7. 7Streamline/standardize communication strategy to reduce instances of justice-involved youth “falling through the cracks” outside of justice system and miscommunication between providers, youth and families, and JJ staff

Potential Barriers:
  1. Time needed by parents or guardians to make appointments and take JJ youth to services
  2. Push-back from staff from completing additional trainings (on Trauma-Informed Care)
  3. Discomfort among justice-involved youth with After Care staff communicating with parent/guardian about results
  4. Reckless behavior among justice-involved youth following positive HIV status, or other sexually transmitted disease
  5. Current laws preventing After Care staff or other JJ staff from providing support to justice-involved youth in securing appointments and joining youth in health care visits

Next Steps
At the end of the workshop, we met as a large group to discuss future goals and other opportunities that may help reduce justice-involved youth’s barriers to accessing health care. Youth advocated in support of the need to address safety in transportation, particularly in regards to avoiding gang lines, and the need to improve trust in the system. One young person mentioned their interest in including their mother in After Care communications, which directly contradicted what was assumed by After Care staff. These interactions exemplified the benefits of redistributing power to include justice-involved youth in the development of future programs and policies that will be directly impacting their lives and wellbeing. The inclusion of justice-involved youth (as well as all youth who have lived trauma or other adverse life experiences) in these processes, from program development, to implementation, to evaluation, may increase the overall impact and sustainability of the program and policy, thereby reducing costs and improving the life trajectory of all engaged youth.