Health

UW systems experts put health of kids at the center as King County seeks to reach ‘zero youth detention’

September 22, 2022

UW healthcare systems experts are establishing a “nurse navigation” position to help kids in the criminal legal system get healthcare.Jossué Trejo/Pixabay

As King County seeks to reach its goal of “zero youth detention” — ultimately eliminating the practice of juvenile detention in the county —University of Washington researchers are working to help address major systemic challenges in how young people engage with health care.

With a strategic plan to close the juvenile detention center by 2025, King County needs an increasingly robust system to ensure youth are getting consistent and accessible services, including health care. This is especially true upon release from juvenile detention, the researchers say. 

“For many youth involved in the criminal legal system, their first health care experience as an adolescent is in a setting of confinement and trauma,” said Sarah Gimbel, a professor of child, family and population health nursing in the UW School of Nursing. “So, while juvenile detention is a less than ideal setting for getting physical and mental health care, it is also critical that we are meeting kids where they are today, addressing their needs, and improving the chances that they will continue to engage in health care services in the community.”

While King County guides investments and creates policies that support families and prevent youth involvement in the legal system, Gimbel explains, improving support for youth who are already detained is critical, especially as they reenter their communities from detention. 

“You think about the resources and money that we put into incarcerating kids, and yet so little is put on the back end to help them move back into their communities,” Gimbel said. “We’ve been working for over a year in the juvenile detention clinic with some really amazing frontline health workers, but they are struggling in a system that is scheduled to close down without a concrete plan for what that looks like.”

Gimbel has been co-leading a team of UW experts in an implementation science project to build a system for managing health care for youth who are detained. The team, which includes advisers and experts from the local organizations CHOOSE180 and Community Passageways, in addition to Harborview Medical Center, are improving the quality of care in the clinic at the King County Children and Family Justice Center to better serve and track the health needs of young people.

“Prior to young people engaging with the criminal legal system, they’re often coming from neighborhoods that are under-resourced and under-supported,” said Sean Goode, executive director of CHOOSE180. “The data tells us that a large percentage of the children who are living incarcerated are coming from neighborhoods that are farthest away from economic justice, health justice, educational justice, and so the sheer amount of disproportionate injustices they’ve experienced prior to walking into a courtroom are extraordinary. Then they end up incarcerated, living in these facilities, and for likely the first or second time in their lives, they begin to be asked questions about their health and well-being.”

The UW team’s systems-building effort has funding from various state and foundation sources, but in the spring Gimbel made a pitch at the UW School of Nursing’s “Dawg Tank” grant competition. She won the $15,000 award with a plan to augment the systems approach with the creation of a nurse navigation position to help young people manage their healthcare that will be outside of the justice center’s clinic. The nurse will work closely with CHOOSE180. 

“Navigating our health care system is very difficult,” said Addy Borges, a UW graduate student working on the systems project. “When a young person is involved in the criminal legal system, there are usually many other competing priorities and stressors facing them and their families, so navigating health care can be particularly challenging.”

The idea to try the nurse-navigation project came from conversations with community members and service providers about the effects of detention and how to make health care accessible for youth and families who have been marginalized by the current systems. 

“Our hope is that this nurse navigation pilot can be part of the movement toward a community-based system that does not involve detention,” Borges said. “It is an evolving concept that will be guided by community organizations that have deep experience in this space.” 

Goode adds that these youth are faced with a confluence of challenges, including that when they leave incarceration, they are also leaving the care plans that may have been introduced for the first time within those walls. 

“And for the young people who have been forced to live incarcerated inside those facilities, we have to figure out how we make sure they have care when they exit back into the community,” Goode said. “That’s where this conversation around nurse navigation comes into play. It’s an opportunity to imagine a world where young people more immediately have access to a continuation of care that allows them to continue their journey toward wellness and wholeness.”

The UW group has found that inefficiencies in health care services in juvenile detention centers, exacerbated by communication and coordination barriers, result in missed opportunities to address the individual health needs of youth. The group aims to break down walls between siloed services in order to improve communication and make providers work synergistically.

“My work sits at the intersection of nursing (and health care in general) and systems engineering,” Gimbel said. “I focus on helping frontline health workers do their work better with whatever resources they have. And right now, addressing the complex health needs of youth 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 zero youth detention.”

“We know with certainty that young people, when they’re engaged in their healing journey, are far less likely to cause harm,” said Goode, “which allows us all to live in the community we dream of, a community where all young people have the opportunity to thrive, live and love.”

For more information, contact Sarah Gimbel at sgimbel@uw.edu. 

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