Public health experts recognize that as little as 10-20% of our individual health may be attributed to treatments received from the health care system. Meanwhile, the contexts in which we live and our health behaviors have the greatest influence over our health outcomes. These factors are commonly referred to as social determinants of health, and they have a tremendous impact on the short- and long-term health of individuals, families, and communities.
The U.S. criminal justice system has not traditionally considered social determinants of health in legal and programmatic decision-making. Court systems are rarely equipped to alleviate the social determinants that may lead to an individual’s court contact or contribute to their recidivism. This applies to juvenile courts as well, despite general knowledge about the important role families, surrounding support systems and neighborhood contexts play in the long-term health and well-being of youth. Housing stability, in particular, is a critical asset for supporting youth emotional and physical health, but is rarely addressed as part of court services.
More than half of all youth homelessness is directly preceded by a family conflict resulting in the youth running away or being told to leave the home. Additionally, both housing instability and justice involvement are particularly acute for LGBTQ+ youth, who comprise 20-40% of the homeless youth population, often as a result of caregivers rejecting their sexual orientation.
Multiple intersecting risks exist for youth experiencing homelessness and justice involvement. Youth who are unstably housed for extended periods of time are more likely than their housed peers to engage in various survival behaviors, such as theft, selling or consuming drugs, or trading sex for money, shelter or material goods. As engagement in these behaviors increases, so does the likelihood that youth will come in contact with the justice system. It is important to distinguish such survival behaviors from academic and policy frameworks that view criminal behaviors as primarily driven by deficits in critical thinking and problem-solving.
Need for cross-sector, youth-focused partnerships
Juvenile courts have neither the capacity nor the mandate to operate as frontline social service agencies. However, the persistent intersection of housing instability and court involvement calls for better coordination between courts and social service agencies that focus on housing and other social determinants of health.
Our team had the opportunity to initiate a community co-design project to develop such a model. Housing Stability for Youth iN Courts (HSYNC) is a cross-system program designed to improve the identification and referral of court-involved youth facing housing instability, along with their families, to effective community-based services. The model consists of four core components:
- Universal screening using routine data flags the court already collects, with referrals to a community navigator
- Triaged assessment to identify the level of services indicated by youth and family need
- Tailored referrals to evidence-based family resource programs and local social services
- Follow up and re-evaluation of needs
Without addressing the fundamental need of secure and stable housing, efforts to make substantive and long-lasting progress in the lives of court-involved youth will be limited at best. Recognizing the comprehensive needs of youth is critical, as is limiting the role of the court in addressing all these needs. We need more cross-system referral models that do not place youth under legal obligation to engage in services, but nonetheless make these services available and accessible.
By adopting universal screening using routine data collection measures already in place, courts are able to identify needs without having to take on the workforce challenge of retraining probation and court staff as housing and prevention experts, or to develop and implement new assessment tools. Using routinely collected data also allows courts to check whether eligible youth (i.e., those identified by the routine data flags) are actually being referred to the community navigator without needing to build new data infrastructure.
The triage tool used by the community navigator was developed to accommodate real-life variation in need. It guides the referral process from prevention to second- and third-tier intervention programs. This process ensures that services and resources are allocated as effectively and appropriately as possible, whereby those most in need are offered a greater menu of services.
One of the glaring findings of the project, so far, is that communities lack a centralized resource for information about where to find effective family support services within a geographical region (in our case, at the county level). Existing service referral systems, such as 211, do not provide: 1) the level of service (e.g., length, group vs. family offerings, etc.) or 2) whether the program is research-informed.
The hope with the HYSNC model is to effectively engage families in prevention-related activities before a youth faces housing instability or homelessness. Consequently, it is critical to connect families to prevention services that use strategies known to be effective in strengthening family cohesion and climate, in addition to addressing housing and other social determinants of justice involvement.
These improvements do not need to be expensive. Most counties will have at least some services that can be classified as family-based prevention and intervention programs. The challenge lies in connecting these services to the youth and families who can benefit from them the most, namely court-involved youth and their caregivers.
In asking juvenile court staff to make minor modifications to their current practice, we hope to see significant and positive returns in youth and family outcomes. By proactively linking court-involved youth and their families to community services, our hope is that these youth will not only be diverted from future housing instability and homelessness, but from future exposure to the criminal justice system as well.
Lars Almquist, M.A., is a Ph.D. student in the Department of Health Services at the University of Washington’s School of Public Health. His research interests focus on violent conflict as a determinant of individual and population health, as well as the utilization of public health interventions to strengthen community resilience, reduce retaliatory violence and enhance criminal justice reforms.
Sarah Cusworth Walker, Ph.D., is a research associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine, as well as the director of the Evidence-Based Practice Institute and the co-director of the Center for the Study of Justice Effectiveness. She has been the principal investigator of 20-plus research studies focused on juvenile justice reform and received a 2013 MacArthur Foundation Champions for Change Award for her work in investigating how to make evidence-based programming locally and culturally credible.