Health and Medicine | Population Health | public health | UW . News Blog
September 22 2022
As King County pursues its goal of “No detention of youthUltimate Elimination of Juvenile Detention in the District University of Washington researchers are working to help address key systemic challenges in how young people approach health care.
With a strategic plan to close a juvenile detention center by 2025, King County needs an increasingly robust system to ensure young people have consistent and accessible services, including health care. This is especially true of juvenile release, the researchers say.
“For many young people involved in the criminal legal system, their first experience in health care as adolescents is in conditions of confinement and trauma,” said Sarah Gimbel, professor of child, family, and population health nursing at the University of Washington School of Nursing. “So while juvenile detention is not an ideal place to get physical and mental health care, it is also critical that we meet children where they are today, address their needs, and improve their chances of continuing to engage in health care services in the community.”
As King County directs investments and puts in place policies that support families and prevent youth participation in the legal system, Gimpel explains, improving support for young people already in detention is critical, especially when they return to their communities from detention.
“You think about the resources and money we’re putting into the incarcerated children, yet very little is being put into the back end to help them get back into their communities,” Gimpel said. “We’ve worked for over a year in a juvenile detention clinic with some really great health workers, but they’re struggling in a system that is set to shut down without a concrete plan for what it looks like.”
Gimbel co-leads a team of UW experts in Implementation of a scientific project To build a health care management system for young detainees. The team includes consultants and experts from local organizations choose 180 And the Community Corridorsin addition to Harborview Medical Center, is working to improve the quality of in-clinic care at King County Children’s and Family Center to better serve and track the health needs of young people.
“Before young people engage with the criminal legal system, they often come from neighborhoods that are under-resourced and under-supported,” said Sean Goode, CEO of CHOOSE180. “The data tells us that a large proportion of the children who live in prisons come from neighborhoods that are far removed from economic justice, health justice, and educational justice, so the disproportionate amount of injustice they experienced before they entered the courtroom is unusual. Then they end up in prison. And, living in these facilities, for the first or probably second time in their lives, they begin to ask questions about their health and well-being.”
The UW team’s systems-building effort is receiving funding from various government and foundation sources, but in the spring Gimbel gave a presentation at the “Dawg Tank” scholarship competition at the UW School of Nursing. She won a $15,000 prize with a plan to enhance the systems approach by creating a navigation function for nurses to help young people manage their own healthcare that would be outside the Justice Center clinic. The nurse will work closely with CHOOSE180.
“Navigating our health care system is very difficult,” said Adi Burgess, a graduate student at the University of Wisconsin working on the Systems project. “When a young person is involved in the criminal legal system, there are usually many other competing priorities and pressures that they and their families face, so navigating health care can be particularly challenging.”
The idea for the Nurse Navigation Project trial came from conversations with community members and service providers about the effects of detention and how to make health care more accessible to young people and families who have been marginalized by current systems.
“We hope that this pioneering nurse in navigation will be part of the movement toward a societal system that does not include detention,” Borges said. “It is an evolving concept that will be directed by community organizations with deep experience in this space.”
Goode adds that these young people face a host of challenges, including that when they leave prison, they also leave care plans that may have been first introduced within those walls.
“For young people who have been forced to live in prisons within those facilities, we have to understand how to make sure they get care when they return to the community,” Good said. “This is where this conversation about nurses’ mobility comes into play. It is an opportunity to imagine a world in which young people immediately have access to ongoing care that allows them to continue their journey toward wellness and wholeness.”
The UW Group has found that deficiencies in health care services in juvenile detention centers, exacerbated by communication and coordination barriers, lead to missed opportunities to address the individual health needs of young people. The group aims to break down walls between isolated services in order to improve communication and make service providers work synergistically.
“My work lies at the intersection of nursing (and health care in general) and systems engineering,” Gimpel said. “I focus on helping frontline health workers do their job better with whatever resources they have. Currently, addressing the complex health needs of young people engaged in the criminal legal system has the potential to improve their well-being, as well as prevent recidivism and support King County’s goal of in not detaining young people.”
“We know for sure that young people, when they engage in their healing journey, are less likely to cause harm,” Good said, “allowing us all to live in the community of our dreams, a community where all young people have the opportunity to thrive, live and love.”
For more information, contact Sarah Gimbel at firstname.lastname@example.org.
Mark(s): Adi Borges • Population Health • Sarah Gimbel • School of Nursing
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