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September 22, 2022
UW health care systems professionals are establishing a “nurse navigation” site to help children in the criminal justice system access health care.Joshua Trejo / Pixabay
As King County seeks to reach its goal, “Zero juvenile detention” — which will finally eliminate the practice of juvenile detention in counties — University of Washington researchers are working to help solve major problems in how youth engage with health care.
With a strategic plan to close its juvenile detention center by 2025, King County needs an increasingly robust system to ensure youth have access to consistent and accessible services, including health care. This is especially true when youth are released from prison, the researchers say.
“For many youth involved in the criminal justice system, their first health care experience as an adolescent is incarceration and trauma,” said Sarah Gimbel, professor of child, family and public health nursing at the UW School of Nursing. “So while juvenile detention is a less-than-ideal condition for access to physical and mental health services, it’s critical that we’re meeting kids where they are today, addressing their needs, and improving opportunities for health engagement. Care services in the community.”
As King County directs investments and creates policies that support families and prevent youth from becoming involved in the law system, Gimbel said it is critical to improve support for incarcerated youth, especially as they reenter their communities from incarceration.
“You think about the resources and money we put into incarcerating kids, and very little is put into helping them get back into their communities,” Gimbel said. “We’ve been working with amazing frontline health workers at the youth detention clinic for over a year now, but they’re struggling in a system that seems to be closing without a concrete plan in place.”
Gimbel has been leading a team of UW experts together Applied science project Building a system to manage health care for incarcerated youth. The team includes consultants and experts from local organizations Select 180 And Community corridorsIn addition to Harborview Medical Center, the King County Children and Family Justice Center is improving the quality of care at the clinic to better serve and address the health needs of youth.
“Before youth are involved in the criminal justice system, they often come from underserved and underserved neighborhoods,” said Sean Goode, executive director of CHOOSE180. The data indicates that a significant number of incarcerated children come from neighborhoods far removed from economic justice, health justice, educational justice, and the disproportionate violence they experience before entering the courtroom is unusual. Then they end up incarcerated and living in these institutions, and perhaps for the first or second time in their lives, they start asking questions about their health and safety.
The UW team’s system-building effort has funding from a variety of state and foundation sources, but in the spring, Gimbel performed well in the UW School of Nursing’s “Dawg Tank” grant contest. She won a $15,000 award for planning to increase the systems approach by creating a nurse navigation site to help youth manage health care outside of the justice center’s clinic. The nurse works 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 justice system, many priorities and stressors are placed on them and their families, so navigating health care can be especially challenging.
The nurse-navigation project was designed to pilot conversations with community members and service providers about the impact of incarceration and how to improve access to health care for youth and families marginalized by the current system.
“Our hope is that this nurse exploration pilot can be part of the movement toward a community-based system that does not include incarceration,” Borges said. “It’s a concept driven by community organizations with deep experience in this space.”
Goode said when these young people leave prison, they face a variety of challenges, including leaving the care plans they first met within those walls.
“And for the youth who are forced to live in those institutions, we need to make sure how they are cared for when they return to the community,” Goode said. “This is where the discussion around nursing navigation comes in. It’s an opportunity to imagine a world where young people have immediate access to ongoing care that allows them to continue their journey to health and wholeness.
The UW team found that inefficiencies in health care delivery in youth detention centers, exacerbated by communication and coordination barriers, miss opportunities to address youth’s individual health needs. The group aims to break down walls between sid services to improve communication and enable providers to work in a coordinated manner.
“My work sits at the intersection of nursing (and health care in general) and systems engineering,” says Gimbel. “I focus on helping frontline health professionals do their jobs better with whatever resources are available. And now, addressing the complex health needs of youth involved in the criminal justice system has the potential to improve their safety, prevent recidivism, and support King County’s goal of zero youth incarceration.
“We know for sure that when young people are engaged in their healing journey, they are much less likely to be harmed,” said Good, “which allows us to live in the community we all dream of, where all young people have the opportunity to thrive, live and love.”
For more information, contact Sarah Gimbel at sgimbel@uw.edu.
account(s) Eddie Borges • Public health • Sarah Gimbel • School of Nursing
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