Creating Healthy Opportunities: Conversations with Adolescent Health Experts

Transcription

1 Creatig Healthy Opportuities: Coversatios with Adolescet Health Experts A Iterview with Shay Bilchik, JD, Coducted by Kare Brow A Project of the Parters i Program Plaig for Adolescet Health (PIPPAH) Iitiative

2 Creatig Healthy Opportuities: Coversatios with Adolescet Health Experts Author ad Iterviewee Biographies Kare Brow Kare Brow is a public radio reporter ad freelace writer who specializes i health care. Her work frequetly appears o NPR ad i atioal magazies ad ewspapers. She has also produced several radio documetaries o metal health topics, icludig childhood bipolar disorder, sibligs of the metally ill, ad post-traumatic stress disorder. She has wo umerous atioal awards, icludig the Edward R. Murrow Award ad Daiel Schorr Jouralism Prize, as well as jouralism fellowships, most recetly the Kaiser Media Fellowship i Health. Her work is featured olie at Shay Bilchik, JD Shay Bilchik is the fouder ad Director of the Ceter for Juveile Justice Reform at Georgetow Uiversity s Public Policy Istitute i Washigto, DC. The Ceter s purpose is to focus the atio s public agecy leaders, across systems of care ad levels of govermet, o the key compoets of a strog juveile justice reform ageda. This work is carried out through the dissemiatio of papers o key topics, the sposorship of symposia, ad a Certificate Program at Georgetow providig public agecy leaders with short, but itesive study, ad ogoig support i their reform efforts. Prior to joiig the Istitute o March 1, 2007, Mr. Bilchik was the Presidet ad CEO of the Child Welfare League of America, a positio he held from February of Shay led CWLA i its advocacy o behalf of childre through his public speakig, testimoy, ad published articles, as well as collaborative work with other orgaizatios. Prior to his teure at CWLA, Shay headed up the Office of Juveile Justice ad Deliquecy Prevetio (OJJDP) i the U.S. Departmet of Justice, where he advocated for ad supported a balaced ad multi-systems approach to attackig juveile crime ad addressig child victimizatio. Before comig to the atio s capital, Mr. Bilchik was a Assistat State Attorey i Miami, Florida from , where he served as a trial lawyer, juveile divisio chief, ad Chief Assistat State Attorey. Mr. Bilchik eared his B.S. ad J.D. degrees from the Uiversity of Florida. Ackowledgemets Creatig Healthy Opportuities: Coversatios with Adolescet Health Experts, was commissioed by the Parters i Program Plaig for Adolescet Health (PIPPAH) iitiative of the Materal ad Child Health Bureau (MCHB), Health Resources ad Services Admiistratio (HRSA). The views preseted are those of the iterviewees ad do ot ecessarily represet the views of the MCHB, HRSA, or ay idividual PIPPAH gratee. Copyright 2010, PIPPAH gratees. PIPPAH gratees iclude the followig orgaizatios: America Academy of Pediatrics America Bar Associatio Ceter o Childre ad the Law America College of Prevetive Medicie CityMatCH, Board of Regets, Uiversity of Nebraska Medical Ceter Healthy Tee Network Natioal Associatio of Couty ad City Health Officials Natioal Coferece of State Legislatures Natioal Istitute for Health Care Maagemet (NIHCM) Foudatio This iterview is a excerpt from the series Creatig Healthy Opportuities: Coversatios with Adolescet Health Experts. The series icludes iterviews with Agela Diaz, MD, MPH, Shay Bilchik, JD, Richard Kreipe, MD, Jae Brow, PhD, ad Abigail Eglish, JD.

3 Creatig Healthy Opportuities: Coversatios with Adolescet Health Experts Profile: Shay Bilchik Fouder ad Director, Ceter for Juveile Justice Reform at Georgetow Uiversity Public Policy Istitute If you do t kow that the family with whom you are workig had three other childre i the system i the last three years who had all bee abused ad eglected, he says, ad ow you re disposig of a case i the juveile justice system where the youg perso has committed their first deliquet act, how are you goig to possibly order the services that youg perso ad family [are] goig to eed? Whe a youg perso is brought hadcuffed to a juveile detetio ceter, people ofte caot see beyod the crime the youth has bee accused of committig. Most fid it hard to look at the factors that first put a child o a path to deliquecy, from educatioal resources i the commuity, to health services available i the eighborhood, to the age of the parets whe the youth was bor. Shay Bilchik, a logtime child welfare ad juveile justice professioal, is a exceptio. By uderstadig that juveile deliquecy is ofte a result of life circumstaces over which that youg perso has little or o cotrol, Bilchik believes advocates ad policy makers ca better focus their efforts ad develop strategies that will help the ext youg perso live a healthy, safe, ad fulfillig life ad stay out of the crimial justice system. I thik oe of the mai challeges today is the lack of equity across our society for the 40 millio adolescets i terms of the opportuities they have for positive youth developmet, says Bilchik. [For more iformatio about positive youth developmet, see box page 5.] Bilchik has dedicated his professioal life to reformig the juveile justice system ad addressig the societal factors that feed ito it. Bilchik headed the Office of Juveile Justice ad Deliquecy Prevetio (OJJDP) uder Presidet Clito. He wet o to become Presidet/CEO of the Child Welfare League of America, ad ow rus the Ceter for Juveile Justice Reform at Georgetow Uiversity s Public Policy Istitute. His reformist outlook bega durig his early career as a iter i the Public Defeder s Office i cetral Florida ad the as a prosecutor i Miami workig mostly i the juveile court. Whe he looked ito the backgroud of the youg defedats his agecy represeted, he foud a umber of worrisome iflueces ad missed opportuities. I could trace back ito their early childhood years either experiece with the child welfare or the juveile justice system, Bilchik says. It was my first real eye opeer that there was a very log path that a lot of offeders i our crimial justice system had followed. It was t that they tured to crime as adults but rather there was a developmetal path that could be studied ad uderstood. Amog Bilchik s early actios as a Assistat State s Attorey was to focus o diversio, a cocept that aims to keep youg people who get i trouble for mior ifractios out of the justice system etirely. Our realizatio was that if we could keep kids out of the system, that we d likely be doig better [for them] i the log ru tha if we brought them ito it, he said. Ad if that approach does ot work for a particular child or offese, the ext challege would be to keep youth from peetratig too deeply ito the system. Bilchik would try to keep youg people i the least restrictive settig possible ad keep them away from adult offeders to improve their chaces of itegratig back ito the commuity oce released. Bilchik also bega to sped time i commuities to see how youg people were livig. He would accompay social workers, public health urses, police officers, ad others ito housig projects, schools, ad homes. He also wet alog o public health urse visits to teeage Creatig Healthy Opportuities: Coversatios with Adolescet Health Experts 1

4 parets. From those visits, he bega to uderstad more about the roots of crimial behavior, especially amog youth livig i poverty. What would be most helpful to prevet deliquecy would be to make sure [youth] have a opportuity for educatio, after school programs, ad for cultural advacemet, he says. Their schools should be well staffed with teachers who are excited about teachig ad have good teacher to studet ratios. Ad whe [adolescets] are lookig for geeral health prevetio i which urses made regular home visits to tee parets. The practitioers would cousel the ew parets about healthrelated behaviors, icludig the effects of paretal smokig or drug use o fetuses ad babies; they would help the youg parets maage their ager ad depressio i order to reduce child abuse; ad they would try to steer the mothers ad fathers ito a better life course through educatio ad skills-buildig. That itesive itervetio, Bilchik says, reduced abuse ad eglect for example, where they may feel ivolved, respected, ad icluded i a way they did ot feel i maistream istitutios. They will look to gags who will give them skills, albeit egative skills such as committig crimes, ad who will give them the opportuity to use those skills ad who will give them recogitio for their achievemets. They will tur the positive youth developmet frame 180 degrees i a egative way, but use the same costruct. Would t it be better, he says, for commuity leaders to step i istead ad I could trace back ito [crimial defedats ] early childhood years either experiece with the child welfare or the juveile justice system. It was my first real eye opeer that there was a very log path that a lot of offeders i our crimial justice system had followed. It was t that they tured to crime as adults but rather there was a developmetal path that could be studied ad uderstood. or health care, they should be able to fid it withi their commuity. If we provide youg people these opportuities ad the stage to use their ewfoud skills ad get recogitio for them, we ve really moved way dow the path i terms of reducig deliquecy ad gettig better outcomes for our youg people. From a policy perspective, Bilchik believes program admiistrators, legislators, ad advocates eed to both create opportuities for youg people, such as metorig, tutorig, or arts programs, ad provide wrap-aroud services to esure that youg people get the help they eed i a way that promotes their success. It has to be i a eviromet where [adolescets] are surrouded by adults who will support that type of positive youth developmet, he says. They ca t be put i the vacuum-like eviromet that a program provides ad the come back home agai to parets ad other adults who will ot support them. There also eeds to be a focus o the family ad ways to stregthe the home to which the youg perso will retur after completio of the program. Bilchik is a great believer i itervetio with tee parets, both for the sake of the youg parets, but also for their babies, who are less likely to grow up deliquet if their parets are give strog supports. Bilchik supported a program while at OJJDP, the Nurse Family Partership (NFP), committed by the youg tee moms who were ivolved i the program by 50 percet. It was cost effective, so for every dollar spet, several dollars were saved i log-term costs. Fiftee years later, it also reduced the deliquecy populatio by 50 percet for the childre of the families that took part i the program. What s more, he says, a study released by the Robi Hood Foudatio foud that the NFP program helped delay the tee mothers secod births, which was show to have a impact o the future priso populatio. Accordig to the study, the childre of older mothers are less likely to egage i the kid of egative behavior that leads them ito the crimial justice system. (For more iformatio about NFP, visit If you ve got parets who are t prepared to urture you, who have created a chaotic eviromet i the home where there s ot the stability that you eed; you have a higher risk of edig up i the juveile justice system ad evetually ito the adult crimial justice system, he says. Bilchik says commuities that ivest i programs that support families i the home will likely see log-term rewards ad those that do ot will ecouter the opposite. Without positive ifluece from resposible adults, he says, youg people will seek, ad fid, support i much less savory eviromets, o street corers, use what we already kow about how the adolescet brai works to help at-risk kids stay out of trouble? We all kow the way adolescets i our ow homes rebel ad detach, but if you combie that with the brai developmet research we have ow, we see that durig the same period of rebellig ad idepedece-seekig, adolescets have a limited ability to resist peer pressure. I thik that is what s happeig with a lot of youg people i today s society. They re goig through ormal adolescet developmet, but they re experiecig it i a eviromet that makes it hard to stay o the right side of the law, he says, highlightig the particular challeges facig teeagers who have bee abused, eglected, or raised i foster care as a result of abuse or eglect or otherwise bee exposed to dysfuctioal commuities or families. I do t wat to suggest that youg people ot be held accoutable for their behavior, but I thik we as a society ad as adults eed to uderstad what that pathway looks like, ad feels like, i the societal eviromet i which it takes place ad the cosider those factors as we determie a appropriate sactio. We have a resposibility to make sure our families ad commuities are oes that ca actually support adolescet developmet i a healthy way. Bilchik says this positive approach to deliquecy prevetio has bee a 2 Profile: Shay Bilchik, JD

5 uphill battle, especially over the last two decades whe zero tolerace has bee the domiat attitude, at the expese of positive youth developmet. Youg offeders have ofte bee throw ito the justice system for mior ifractios, i may cases, he says, more for the sake of the commuity who does ot wat them aroud, tha for the youth themselves. As a result, youg people are immediately stigmatized ad cosidered boud for a life of crime, which ofte becomes a selffulfillig prophecy. Oce it s o their record ad they ve bee labeled i their commuity, i their family, i their peer group, i their school as a trouble maker, as a deliquet, as a kid who wet ito the juveile justice system, it s hard to remove that tag, Bilchik says. I thik we eed to avoid such stigmatizatio as much as we ca. For istace, schools should thik twice before sedig youg people to the juveile detetio ceter for mior misbehavior, forcig the parets to travel to what may be a distat ad itimidatig locatio, fill out paperwork, ad the take the child home. That is likely to lead to great tesio i the family, he says, whe it is behavior that does t really require a arrest, like a jostlig i the school hallway, maybe eve a puch back ad forth that traditioally has bee hadled by a school couselor or a school pricipal sittig the kids dow ad sayig, Okay, we re goig to work this out. Oce a youg perso does ed up i the justice system, Bilchik wats them to get as much educatio, health screeig, ad emotioal support as possible with a eye toward both rehabilitatio ad teachig cosequeces. Whe they get out, oe of the best ways to stop the cycle of deliquecy, he says, is to welcome them immediately back ito the school system. However, he says there has bee resistace to this, especially sice the passage of the No Child Left Behid Act, which Bilchik believes gives a icetive to school systems to expel troubled youth rather tha work with them. If some of these kids who are gettig ito trouble are borderlie academic performers, you ow have aother layer of cocer i the school. Admiistrators say, I do t really wat him back because he s a potetial trouble maker ad he is t goig to cotribute to my scores. Shay Bilchik, o ways to improve the foster care system: Improve support of the child welfare ad protectio workforce through traiig, supervisio, higher salaries ad additioal tools to help them do their job Put resources ito recruitig ad retaiig foster families Provide more behavioral health ad educatio services for childre i foster care Icrease support for youg people after they age out of the foster care system Exhibit a stroger commitmet to family ad youth egagemet icludig the use of family-fidig techology ad methodologies But that s a sad commetary o the barriers we put i the way of our youg people whe they do get ivolved i some misbehavior. Bilchik cotiues, The road we seem to be followig is the oe govered by the zero tolerace metality. This meas we re turig youg people away from the positive youth developmet pathway, which absolutely has to iclude egagemet with school ad a academic future. Eve simple access to health care ca set a youg perso o a safer path. He says youth eed to be able to fid doctors ad commuity cliics i their eighborhoods, they eed a way to pay for the health care (through Medicaid, CHIP, or free cliics), ad the providers eed to kow how to iteract effectively with the adolescets. Somethig as simple as regular eye exams ca prevet a declie i school performace that evetually leads to disruptive behavior. Couselig about reproductive health ca prevet uwated pregacies. Metal health screeigs ca lead to effective treatmet for small or serious problems, problems that may have otherwise bee mistake for willful disobediece, a precursor to eterig the juveile justice system. By teachig healthy behaviors, reiforcig youth stregths, ad followig a positive youth developmet model, providers ca help set youg people o a path that bypasses the legal system altogether. It all comes dow to whether you have a provider who is takig the time to talk to a adolescet ad explore what s goig o i their life, Bilchik says. There may be a tip from the paret or a issue that is relatively obvious such as cuttig or a eatig disorder. However, it may be somethig more subtle such as axiety that has rise up i a child s life. O a more sociological level, Bilchik believes providers eed to be made aware of the racial disparities that are glarig i the juveile justice system but that may origiate elsewhere. He says the data clearly show that a disproportioately large umber of youth of color ed up havig cotact with the juveile justice ad/or foster care systems compared to whites. He says that is partly a result of the lack of commuity supports ad opportuities as well as high levels of poverty i may miority commuities. But he maitais it is also a result of decisios that are made i largescale systems from law eforcemet ad itake workers to schools ad courts. As a result, he says it is likely that miority youth are puished more harshly tha whites, especially for low-grade misbehavior. At every step a decisio is made, more ad more kids of color are peetratig deeper ito the system. It is a matter of how those decisios are made ad what to do about addressig structural, istitutioal, or idividual bias or racism that Creatig Healthy Opportuities: Coversatios with Adolescet Health Experts 3

6 may exist, Bilchik says. So I wat to do traiig with various people, law eforcemet, itake workers, detetio workers, prosecutors, public defeders, case workers, parole workers, probatio workers, o what biases we may brig to our work ad how to offset them so we make more culturally competet, equitable, ad race ad ethically eutral decisios. But I also wat to make sure that we have programs ad structures i place that look at where there may be disparities i treatmet ad what we ca do structurally to address it. I thik that whe you do your work i this maer, you are egaged i crosssystems field buildig, Bilchik says. You are buildig a field of professioal workers who thik outside of their ow disciplie. That takes time to truly build ad it will ebb ad flow as you ru ito better or worse ecoomic times durig which time people ted to be more protective of resources, turf, ad cotrol. Moreover, he says it requires a certai elighteed self-iterest by stakeholders. They may have to let go of some of their case i the juveile justice system where the youg perso has committed their first deliquet act, how are you goig to possibly order the services that youg perso ad family [are] goig to eed? Similarly, he says, why ot coordiate iformatio betwee the schools ad the foster care system, or betwee caseworkers ad the police departmet? I d like to see a worker i the child welfare system come ito work i the morig, tur o their computer ad see a alert if oe of their cliets has bee I thik oe of the mai challeges today is the lack of equity across our society for the 40 millio adolescets i terms of the opportuities they have for positive youth developmet. All of this poits to Bilchik s overarchig paradigm of puttig resources ito prevetig deliquecy ad keepig adolescets out of the crimial justice system, i order for more youg people, ad, by extesio, adults, to become cotributig members of society. Implemetig this paradigm o the scale it requires, he admits, could well take a social movemet, ad for that to happe, he cites four critical compoets: political leaders willig ad able to speak out o the eed for prevetio programs; educatio for the commuity about the eed for strog programs; the availability of staff ad ifrastructure to set up programs i a commuity; ad fudig to carry them out. Istead of ay oe group lauchig this movemet, he prefers what he calls a multi-systems approach gatherig represetatives from differet disciplies ad istitutios, from the child welfare departmet ad the schools to the local police departmet ad state legislature. Some states have created childre s cabiets made up of represetatives from multiple govermetal departmets icludig public health, trasitioal assistace, substace abuse ad prevetio, or educatio, amog others. programmatic territory, ad eve some cotrol over fudig, i order to create a pool of moey ad staff ready to istitute commuity-wide chages. He says there is precedet for this model, such as a grat program he helped lauch as part of the Clito admiistratio that required collaboratio. We asked for the schools, the justice system, ad the health system i a local commuity to come together ad joitly apply for this moey, showig how they would work i a coordiated fashio to reduce school violece. Ad today, almost 10 years later, that program, called Safe Schools/Healthy Studets has fuded over a billio dollars worth of local programmig. It [moved] from the Clito to the Bush admiistratio ad the evaluatios show that there have bee effective multisystem strategies joitly fuded across systems of care that were implemeted as a result [of the fudig]. We eed to shout this stuff from the moutai tops. By the same toke, he says, differet istitutios should also be ecouraged to share iformatio whe it might help a youg perso. For istace, a judge is better positioed to had dow a setece or a alterative to setecig if he kows somethig about the defedat s history i the child welfare or foster care system ad has full access to educatio records. If you do t kow that the family with whom you are workig had three other childre i the system i the last three years who had all bee abused ad eglected, he says, ad ow you re disposig of a arrested the ight before, he says. Bilchik has cosidered re-eterig govermet to put these ideas ito practice, but he ultimately decided he could do as much good i the oprofit sector. Oe of his mai goals at the Ceter for Juveile Justice Reform at Georgetow Uiversity is to trai ad ispire the ext geeratio of leaders, i ad out of govermet, who ca take the positive youth developmet approach back to their commuities to improve outcomes for youg people. I m talkig about the couty commissioers, the directors of Childre ad Family Services ad Juveile Justice, the city coucilors, the state legislators. Those are leaders who ca impact appropriatios, ca impact state law, ad ca set the stage to do this work i a more meaigful way. With a uified approach to prevet deliquecy ad reform the juveile justice system, he says, it is possible to make America a safer ad stroger place for the ext geeratio to grow up i, ad by doig so, future geeratios will be stroger ad healthier. 4 Profile: Shay Bilchik, JD

7 Positive Youth Developmet By Kristi Ware What is Positive Youth Developmet? A positive youth developmet (PYD) model creates programs for youth focused o costructive assets that ca be developed rather tha egative behaviors that should be avoided. What are the mai attributes of Positive Youth Developmet? Focus o stregths, rather tha problems or risk factors. Youth voice ad true egagemet of youth as leaders, parters, ad cotributors, ot simply cliets, ad givig them key roles i actios or orgaizatios. Focus o relatioships betwee adults ad youth as a essetial outcome. Ivolvemet of all commuity members ot just those with specific ties to youth. A log term approach that recogizes the importace of ogoig, positive opportuities ad relatioships to help youg people succeed as adults. What does Positive Youth Developmet look like? PYD emphasizes positive outcomes: Traditioal: Programs geared towards prevetio ted to focus o commo egative outcomes i the lives of teeagers drug use, pregacy, suicide, homelessess, ad truacy. PYD: While prevetio is still a desirable outcome, these programs focus o highlightig the positive thigs that youth ca accomplish. For example, programs may ecourage youth to take o leadership roles, voluteer i the commuity, or explore their abilities i the arts. These programs focus o highlightig ad developig qualities that youth already possess motivatio, compassio, ad creativity. PYD ivolves all youth i the commuity: Traditioal: These programs ted to target youth that have bee idetified as havig risk factors. Examples iclude programs aimed at youth i foster care or youth who have bee truat or ivolved i the juveile justice system. PYD: Programs that are available to all youth promote positive social iteractio, ecourage leadership, ad give youth a chace to feel as though they belog. These programs ot oly help youth develop cofidece ad social competecy, but they also avoid some of the harmful stigmatizatio that ca occur i traditioal programs. PYD eables resiliecy by providig a etwork of support: Traditioal: Frequetly programs for youth have bee ru by just oe stakeholder i the commuity, for example, D.A.R.E., a program ru by local law eforcemet desiged to prevet tee drug use. PYD: These programs aim to make youth more resiliet by providig them with a commuity-wide support etwork. The programs are ot ru by oe etity, but ivolve collaboratio betwee schools, law eforcemet, busiesses, ad private citizes. For example, a commuity could create a youg etrepreeurs program that utilizes the support of schools, local busiesses, ad private citizes ad is aimed at ecouragig youth to recogize their stregths ad iterests. What does the research say? A 1998 review of evaluatios of positive youth developmet programs foud that may of these programs were able to demostrate positive chages i youth behavior, icludig sigificat improvemets i iterpersoal skills, quality of peer ad adult relatioships, self-cotrol, problem solvig, cogitive competecies, self-efficacy, commitmet to schoolig, ad academic achievemet. The programs also led to reductios i uhealthy behaviors icludig aggressio, risky sexual activities, drug ad alcohol use, smokig, ad violece. Sources ad Resources: Barto, William H. ad Jeffrey A. Butts, Buildig o Stregth: Positive Youth Developmet i Juveile Justice Programs, Chapi Hall Ceter for Childre, 2008, available at TABLE%20Chapi%20Hall%20Buildig%20o%20 Stregth_Fial.pdf (last visited 7/10/09). Ferber, Thaddeus, Elizabeth Gaies ad Christi Goodma, Stregtheig Youth Policy: Natioal Coferece of State Legislatures Research ad Policy Report, Positive Youth Developmet: State Strategies, October, 2005, available at youth_developmet.pdf (last visited 7/8/2009). Positive Youth Developmet Resource Maual, ACT for Youth Ceter of Excellece, available at (last visited 7/8/09). Restuccia, Da ad Adrew Budy, Positive Youth Developmet: A Literature Review, August 2003, available at Positive_Youth_Dev.pdf (last visited 7/8/09). Schwartz, Robert G, Juveile Justice ad Positive Youth Developmet, available at ppv/publicatios/assets/74_sup/ydv_7.pdf (last visited 7/8/2009). Creatig Healthy Opportuities: Coversatios with Adolescet Health Experts 5