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Out of sight, out of compliance: USdetained girls’ health justiceLaurie Schaffnera

a Sociology Department, University of Illinois at Chicago, BSB4112, 1007 W. Harrison St.,MC 312, Chicago, IL 60607, USAPublished online: 24 Feb 2014.

To cite this article: Laurie Schaffner (2014): Out of sight, out of compliance: US detained girls’health justice, Contemporary Justice Review: Issues in Criminal, Social, and Restorative Justice,DOI: 10.1080/10282580.2014.883845

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Out of sight, out of compliance: US detained girls’ health justice

Laurie Schaffner*

Sociology Department, University of Illinois at Chicago, BSB 4112, 1007 W. Harrison St.,MC 312, Chicago, IL 60607, USA

(Received 31 July 2012; accepted 19 November 2012)

Due to an overreliance on arrests in the late 1990s, the incarceration of youngwomen in the United States increased dramatically. On any given day in 2010,over 9000 girls were held in residential placement. Largely hidden from publicview, little is known about the health requirements of female adolescentoffenders in US secure custody. Less is known about how those needs are metwhile in detention. Curiously, while most theories regarding female juveniledelinquency draw upon non-criminogenic health-related factors – sexual abuse,family violence, and low self-esteem – their specific legal troubles are rarely, ifever, framed in public health terms. Drawing on original interviews with 100court-involved girls, detainees’ perceptions of their medical, psychological,sexual, and social health concerns are highlighted. The data link court-involvedgirls’ prior health issues to their coming to the attention of juvenile authoritiesas well as demonstrating possible non-compliance with domestic andinternational standards for the health rights of juveniles deprived of their liberty.

Keywords: detained girls; health conditions; delinquency as public healthconcern, correctional health care; children’s rights

Introduction: health care matters and US court-involved girls

In the arbitrary divisions among academic research topics and disciplines, the studyof juvenile delinquency was largely shunted over to the purview of criminal justiceexperts in the mid-1900s. In the last decades of the twentieth century, sub/culturalstudies, critical jurisprudence, and feminist sociology turned their theoretical atten-tion to the politics of youth and trouble, and ideas about normativity and deviance.Due to the surge in incarceration rates in the United States over the same period,public health experts became involved in examining health care issues particular topenal systems, but rarely contributing to the theoretical discussion. The intent ofthis paper is to contribute to these cross-disciplinary conversations with a particularfocus on the plight of court-involved young women.

In 2008, an estimated 633,000 girls under the age of 18 were arrested,representing 30% of all juvenile arrests (Puzzanchera, 2009). Girls under the age of18 comprised 17% of all arrests for the FBI’s Violent Crime Index crimes(Puzzanchera, 2009). An estimated 300,000–600,000 youth cycle through securejuvenile detention centers each year, and on any given day, approximately 27,000youth are held in close to 500 secure juvenile temporary detention facilities across

*Email: scaff@uic.edu

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the nation (Skowyra & Cocozza, 2007). Census counts estimate that over 100,000children are held in all categories of shelter facilities including incarceration incorrectional units (Matson, Bretl, & Wolf, 2000). According to the one-day censuscount of juvenile facilities in the United States in 2010, over 9000 girls aged13–17 were living in public, private, and tribal residential facilities that housejuvenile offenders (accessed November 26, 2012, available at http://ojjdp.gov/ojstatbb/ezacjrp/asp/Age_Sex.asp). This process is racialized: nationally, as morethan half of all girls in custodial placements are of color (Snyder & Sickmund,2006). In addition, evidence mounts revealing that young women presently held injuvenile facilities have severe, chronic, and acute psychological and physical healthcare needs (Acoca & Dedel, 1998; Belknap & Holsinger, 1998; Owen & Bloom,1997; Penn, Esposito, Stein, Lacher-Katz, & Spirito, 2005).

While exact age varies by jurisdiction, most young women adjudicateddelinquent are between 13 and 18 years of age. Nationally, the majority of arrestsof girls are for minor offenses such as truancy, runaway, or curfew, although girlscome into the system at significant rates for drug and violent offenses. Even so,scrutiny of the nature of girls’ ‘minor offenses’ uncovers a devastating picture ofyouth living in urban street economies and illuminates how public health issuessuch as substance dependency, personal violence, and sexual harmdisproportionately influence the lives of this particular population.

Until recently, the mental and medical health concerns of court-involved girlswere largely missing from the public agenda. Most studies of health care in jailsand prisons focus on adults (e.g., Myers, 1999; Stone & Winslade, 1998). A con-siderable body of work now focuses specifically on the penal health care ofwomen, but adult women (e.g., Anderson, 2003; Covington, 1998a; Maeve, 1999;Moe & Ferraro, 2003; Reviere & Young, 2004). Reported sporadically acrosscriminology, public health, and social welfare journals, studies of the healthconditions of detained girls are available chiefly from research published by theNational Commission on Correctional Health Care. Culling these literatures revealsa troubling picture.

For example, 75% of a sample of detained girls in Cook County (IL) exhibiteda prevalence of mental health disorders (Teplin et al., 2006; see also Domalanta,Risser, Roberts, & Risser, 2003). Experts report that youth in detention experiencehigh rates of violence prior to their incarceration (Bell & Jenkins, 1995).Depression and delinquency were linked through research that found that a largeproportion of girls (82%) who suffered from depression had committed crimesagainst persons (Obeidallah & Earls, 1999). According to research conducted byadolescent psychologists, adolescent female offenders suffer tremendous emotionaltrauma (Cauffman, Feldman, Waterman, & Steiner, 2004; Kelly, Martinez, &Medrano, 2005). Girls’ aggression and its correlates are linked in recent work to avariety of subsequent challenges in adolescence, including coming to the attentionof juvenile authorities (Moretti, Odgers, & Jackson, 2004; Underwood, 2003).Increasingly, gender-specific interventions with court-involved girls includeresponses to their unmet emotional and psychological health needs (Bloom, Owen,& Covington, 2003; Covington, 2005; Greene Peters and Associates, 2000;Maniglia, 2006). Understanding connections among factors such as sexual coercion,sexual injury, emotional trauma, poorly attended medical injury and illness, andsubsequent offending becomes salient as the increasing prevalence of medicalneglect, physical and sexual abuse and their chronic and long-term effects are more

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widely known to health specialists, and as arrest and incarceration rates for girlsremain at unprecedented levels.

Court-involved girls’ health care needs remain unmet due to several factors.First, in general, children’s problems are often obscured from public view becausethe public may assume that children’s needs are met in the private sphere of thehome and family, i.e., someone else is taking care of them. Second, young womenin juvenile legal systems are children, not adults. The consideration of the healthcare needs in the adult women jail population may be more apparent in mediareports and research agendas, especially since the development of an AIDSpandemic (e.g., Jose-Kampfner, 1995; Maeve, 1999; Richie & Johnsen, 1996). Aschildren, detained young women’s troubles have been discounted as whines andcomplaints (Gaarder, Rodriguez, & Zatz, 2004; see also Bond-Maupin, Maupin, &Leisenring, 2002). A discourse of incompetence, of not knowing what they reallyneed, may do the cultural work that allows their medical plight not to be takenseriously.

Third, court-involved young women are girls, not boys. The majority ofresearch, and thus policy and program development and delivery, targets malejuvenile delinquents (e.g., Battin-Pearson, Thornberry, Hawkins, & Krohn, 1998;Office of Juvenile Justice and Delinquency Prevention [OJJDP], 1993). Incarceratedgirls’ issues are specific to their being female, but tend to be discounted in twoways. The first claims that because they are only a small percentage of the arrestsand are girls (i.e., how much damage can they really do, most serious habitualoffenders are boys), their plight is not really worthy of consideration. Another waywe have missed incarcerated girls’ struggles is that, as girls, because we know thattheir troubles are often of a relational, emotional, or psychological nature (Belknap,2003; Covington, 1998b), historically, they have been discounted as ‘hysterical.’ Inthis discourse, court-involved girls’ troubles are not only minimized, but are aboutthe need for therapy, not about problems related to children’s rights, or poverty,racism, and sexism. Individualistic psychological solutions for quite serious socialproblems are offered (i.e., if only they had better or more services, if only theycould get help with their emotional problems, then the problems of girls would besolved). Besides minimizing the acute psychological damage being done to girlchildren, this framing discounts the very real material challenges faced by youngwomen of color in disadvantaged communities whose survival strategies arecriminalized.

Fourth, attending to incarcerated girls’ health care concerns lies within the pur-view of those charged with punishing the girls. It is plausible that this contradictionaffects the motivation to provide the best resources on their behalf. Fifth, incarcer-ated girls are offenders, not innocents. The public may not be inspired to care foryoung adult criminals as they might be encouraged to act on behalf of innocentdependent children. Because court-involved girls are processed in the delinquencyside of the juvenile and family court system, as opposed to the dependency side,through a discourse of the worthy victim, female offenders may not be consideredas sympathetic as the children in the dependency side of the courtroom. After all,these girl-children could be framed as criminals, and, according to current law andorder policy, should not be made to feel that comfortable anyway. In myriad ways,these elements converge to leave the unique needs and rights of girls processed onthe delinquency side of the family court out of range of popular discourse in gen-eral, and academic research in particular.

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Based on data drawn from extant studies of incarcerated girls and accounts fromoriginal interviews with 100 court-involved girls, I argue that the crisis in the healthcare needs of court-involved girls intertwines with their juvenile court involvement,and that considering their myriad health concerns prepares the ground for fruitfulavenues for understanding young women’s attention from juvenile authorities in thefirst place, as well as contributing to improving health care provision for girls insecure custody. Few large-scale quantitative studies of incarcerated girls’ health careconcerns have been conducted, so we know little about the actual experiences ofcourt-involved girls. We hear even less about what they say in their own wordsabout those experiences.

Health care challenges of incarcerated girls: what we do know

Research on the health of adolescent girls in the general population revealstroubling trends (Louis Harris and Associates, Inc., 1997; Park, Mulye, Adams,Brindis, & Irwin, 2006). Several national surveys report on the health conditions ofyoung people. The National Longitudinal Survey of Adolescent Health (AddHealth) at the University of North Carolina, the National Survey of Adolescent andChild Well-Being (US Department of Health and Human Services), and ChildTrends in Washington DC provide a range of health-related data regarding childrenin the US. Much medical research highlights a range of adolescent health careconcerns. Yet, few sources focus on youth in juvenile detention and even fewerhighlight the particular needs of court-involved girls.

Even so, the unique health needs of young women in the juvenile legal systemare being identified. Differences by gender in need and care have likewise begun tosurface in research protocols (Alemagno, Shaffer-King, & Hammel, 2006; Dembo,Schmeidler, Sue, Borden, & Manning, 1995; Kelly et al., 2005). Because thetypical girl in detention is 16 years old, African-American, Latina, or Native Ameri-can, coming from a no- or low-income family, and likely to have already droppedout of school, it can be surmised that she is more in need of medical and dentalhealth care than her more privileged counterpart, whose parents likely drive theirdaughters to regular medical and dental appointments (see Immarigeon, 2006;Sherman, 2005).

In one of the wealthiest nations on the planet, in 2011, 11% of all childrenremained uninsured in the United States with tenuous access to health careprovision (Cohen & Martinez, 2012; Kenney, Haley, & Tebay, 2003). Public healthfunding is in decline. Nowhere is this more evident than in juvenile detentionhealth facility centers. Little can be systematically documented about actual healthcare delivery in all adolescent facilities nationwide. Of the 1300 juvenile detentionfacilities in the nation, only 37 have been accredited by the National Commissionon Correctional Health Care (Bell, 2003)

Physical, medical, and dental health

Childhood and adolescent injury and disease, when attended to properly andpromptly, might be considered minor or common among youth populations.However, when left untreated, ailments from routine injury or accident can developinto painful episodes of discomfort among a subset of youth who have alreadyexperienced depleted routine health care attention. Among a sample of girls in

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detention in 1996, close to nine in ten (88%) reported having experienced seriousphysical health problems (Acoca & Dedel, 1998). In one assessment of healthissues among adolescents in a detention center, approximately 60 children permonth reported having experienced physical and medical injuries in their lives priorto detention (Moore, 2003). In that study, girls presented at detention health clinicshad common complaints of headaches, stomach pain, colds, skin rashes, acne, andgynecological needs (Moore, 2003). Another medical problem among incarceratedyouth that is of great concern in general to health care providers is the prevalenceof Hepatitis C viral infection. Dramatically high rates of risk factors and infectionare detected among adolescents in detention (Bair et al., 2005; Murray, Richardson,Morishima, Owens, & Gretch, 2003; Thomas, Keene, & Cieslak, 2005). Diseasessuch as asthma, diabetes, and socially transmitted parasitic infections are morecommon among low-income and minority communities than their privileged coun-terparts (Ireson & Hall, 2005; Smith, Hatcher-Ross, Wertheimer, & Kahn, 2005).

Psychological and emotional health

Mental health problems have surfaced in crisis proportions among detained youth(Levitt, 1999). Rates of mental disorders among incarcerated youth exceed those ofchildren in community studies (Davis, Bean, Schumacher, & Stringer, 1991). Moore(2003) found that in one facility, approximately 40% of the youth in detention wereprescribed psychotropic medications. Court-involved young women experience highrates of emotional and psychological problems: close to 75% of young women in astudy of juveniles in the Cook County system exhibited symptoms for three or morecategories of psychiatric disorders (Teplin et al., 2006). The stressful nature ofsecure custody itself has been documented in adult women (Fogel & Martin, 1992).

A 1995 national survey of 39 juvenile correctional facilities found that detainedyouth have numerous emotional health concerns (Morris et al., 1995). Morris et al.(1995) found that 22% of the youth had considered suicide and 16% had attemptedit. Hayes (2009) studied suicides among youth in juvenile detention and found thattwo-thirds were of youth committed to long-term secure facilities (Hayes, 2009).Matson et al. (2000) report that psychiatric medications accounted for 14% of allmedications prescribed in detention and included antidepressants, stimulants, andantipsychotics.

Cauffman et al. (2004) conclude that large numbers of female juvenile detaineeswere found to have post-traumatic stress disorders. A survey conducted in aPhiladelphia facility of female juvenile detainees, Ambrose and Simkins (1999)produced equally troubling results. Over half (54%) of the sample had beenhospitalized for psychiatric reasons; 81% reported experiencing trauma of some sort(Ambrose & Simkins, 1999). Ambrose and Simkins (1999) were concerned thatyoung women who were actually suffering from Post-Traumatic Stress Disorderhad been misdiagnosed with Oppositional Defiant Disorder – a diagnosis that hasbeen linked to girl’s legal charges of Disorderly Conduct (Ambrose & Simkins,1999; Schaffner, 2006). While psychological and emotional factors such as lowself-esteem or early sexual trauma are almost universally theorized as correlating tolater ‘risky’ adolescent behaviors (Louis Harris and Associates, Inc., 1997; Phillips1998), these considerations have been dismissed by prosecutors, judges, andprobation personnel as excuses and manipulations (Gaarder, Rodriguez, & Zatz,2004; Leban & Szajko, 2004).

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Sex and gender health

Numerous national reports indicate that sexual offenses against children arewidespread (Raghavan, Bogart, Elliott, Vestal, & Schuster, 2004; Runtz & Briere,1986; Stock, Bell, Boyer, & Connell, 1997). It is generally accepted that girls aresexually abused and raped more often than boys (Finkelhor & Baron, 1986). Justless than one half of all non-voluntary sexual experiences among women in thegeneral US population occurred before they were 14 years of age (Moore, Nord, &Peterson, 1989). As girls in general were disproportionately victims of abuse, sotoo were girls in trouble with the law. In one report focused on girls in the Califor-nia juvenile correctional system, 92% reported experiencing sexual, physical, oremotional abuse; many reported combinations of multiple forms of abuse and expe-riencing abuse on multiple occasions (Acoca & Dedel, 1998). Owen and Bloom’s(1997) study of young women in the California Youth Authority found that 85%indicated some type of abuse in their lives.

Gynecological, obstetric, and reproductive health care is crucial to girls’ thrivingin adolescence. The pregnancy rate among detained females was high. Keller(2002) found that over 20% of girls on probation were pregnant or parenting. Morethan 24,000 pregnant girls are arrested each year (HMPRG, 2003). Acoca (2004)examined California detained girls and found that 29% had been pregnant at leastonce and 16% had been pregnant while incarcerated. In addition, girls in correc-tions experience high rates of sexually transmitted infections (Joesoef, Kahn, &Weinstock, 2006). Matson et al. (2000) studied detained youth in a Wisconsin facil-ity and concluded that 24% of the girls reported at least one sexually transmitteddisease . In another study of detained girls, 27% of the sample tested positive forchlamydia and 11% tested positive for gonorrhea (HMPRG, 2003). Among a sam-ple of 1284 adolescent girls incarcerated in California, the chlamydia prevalencewas 12.9% (Chartier et al., 2005). Because 50% of all new HIV infections occur inyouth under 24 and the female rate is rising more rapidly than the male rate ofinfection, it is plausible that court-involved girls are at great risk (HMPRG, 2003).Furthermore, in 2002, out of the 191 pap smears performed in one detention facil-ity, 13% (24) were abnormal (Moore, 2003).

Social health

Factors such as racism, sexism, poverty, poor education, and sub-standard housingaffect court-involved young women’s experiences of health and health careprovision in their family lives. Because of the pernicious effects of thedisproportionate minority representation of girls in the juvenile systems, racialdisparities in young women’s health care delivery reveal the population of youngwomen deprived of their liberty to be suffering inordinately from such medicalissues as obesity, asthma, access to timely health care, assistance with hygiene andexercise, as well as experiencing disproportionate levels of trauma and stress (Bell,2003; HMPRG, 2003). Systemic injustice and racial bias administered by stateagencies against poor African-American families on the dependency side of familycourt have been detailed elsewhere (Roberts, 2002). Poverty and socioeconomicclass status influence girls’ outcomes due to of the lack of opportunity and thinneddown decisional avenues that are generally available to the less advantaged.Poverty, health, and involvement in the juvenile legal system are intertwined fac-tors. Brown and Males (2011) linked poverty statistically to arrest rates of youth in

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California, finding that poverty predicts criminal arrest among youth more than ageor race.

A well-rounded education is widely considered as one of the strongestpredictors of a smooth transition to successful adulthood (i.e., Bowles & Gintis,1976). Nationally, the drop-out rate is approximately 11% (Kaufman & Alt, 2001).This rate is slightly higher for males, and much higher for students of color.Gonzales, Richards, and Seeley (2002) show that approximately 75% of seriousoffenders [meaning male] were habitually truant. However, truancy accounts forover half of all status offenses, and girls represent 58% of all status arrests(Gonzales et al., 2002; Snyder, 2006). We know that juvenile delinquency anddropping out of high school are linked (Sweeten, 2006). In addition, when childrenmiss school for weeks due to illness or injury, it is very difficult to make up thatacademic work.

When young women are without adequate housing, it is plausible that they willhave even more difficulty receiving adequate health care and aftercare. Culhaneet al. (2011) reveal a definite link between homelessness, ill health, and attentionfrom juvenile authorities. The US Department of Education estimates more than800,000 children and youth find themselves with no permanent place to call homefor at least some of each year (Kreisher, 2002). Youth in trouble with the law aremore likely to experience homelessness than other youth (Toro, Dworsky, &Fowler, 2007). Acoca and Dedel (1998) found that girls come into the juvenilesystem from out-of-home placements, foster homes, and the streets indisproportionate amounts.

Beleaguered, chaotic, or depleted family life can be stressful even for familiesthat have an array of symbolic, material, and social resources available to themsuch as wide kinship connections in various relatives’ homes around the nation,funds for children to travel between families, health insurance includingpsychological services, sexual harassment-free and vibrant schools, and the like(Roman, 2006). But for young women further impeded in their developmentbecause of their involvement in the juvenile legal system, family depletion can bedevastating.

Design and methodology

The problem and research questions

Girls’ delinquency has been linked to a number of health-related factors – sexualabuse, depression, and family violence. Little is known about how court-involvedyoung women characterize these experiences. This project began with multipleintentions: to ascertain health care needs of incarcerated girls; to gather incarceratedgirls’ perceptions of these concerns in their own words; to notice pathways, if any,between health care concerns prior to incarceration with girls’ subsequent attentionfrom correctional authorities; and to stimulate thinking about court-involved girls’legal problems as public health issues. Research questions included:

� How do incarcerated young women talk about their health concerns, bothpre-existing and during their time in the juvenile legal system?

� In what ways/Do prior health concerns affect girls’ court involvement?� What are incarcerated young women’s impressions of health care provision inthe juvenile legal system?

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In addition to these life and health history narratives, data from case file reviews,observations of girls’ interactions with juvenile corrections and health personnel,and tours at medical centers in the facilities were collected. These four sets of datawere approached as an empirically rich foundation from which to interpret thesocial implications of relationships among variables such as health care concerns;health care provision; girls’ perceptions of their troubles with the law; and girls’impressions of both their health and care inside secure settings. I was particularlyinterested in a data-driven understanding of gender-specific analyses of girls’involvement with juvenile authorities and its implication as a public health concern(in addition to/in place of a penal or correctional issue).

Methods

Findings from extant quantitative analyses and original qualitative data werecollected. Statistics released from the Office of Juvenile Justice and DelinquencyPrevention (OJJDP) at the Department of Justice to present national trends injuvenile arrests and incarceration were also assessed. The qualitative data werecollected between 1994 and 2000 in three Massachusetts, California, and Colorado.Between 2001 and 2005, I observed and interviewed juveniles in facilities andcommunity-based organizations in Illinois. Overall, data were drawn frominterviews, observations, participations, trainings, tours, and case file reviews.

Location of study

Because the focus of this study was approached nationally, the research was notbounded by one locale and used multi-site data collection procedures. Facilitieswere selected based upon several criteria: location in terms of being in states thathad specific and meaningful events in the history of their juvenile legal systems,located in proximity to where I lived and worked, and in terms of ability to gainaccess. I conducted 15 interviews in two facilities in Massachusetts, a state that hadexperienced significant reforms in its youth delinquency system; 104 interviews in25 facilities in California, a state with one of the highest incarceration rates in thenation; seven interviews in two facilities in Colorado, the location of a particularlylarge, long-term residence for girls, generally considered by experts as successful;and 27 interviews in five facilities in Illinois, the state with the first juvenile legalsystem in the nation and one of the first gender-specific programs for girls. Formalinterviews and ethnographic notes were collected in the following settings: deten-tion halls, long-term secure residential facilities, adolescent mental health andpsychiatric facilities, and out-of-home placement group homes for court-involvedyouth, all locations where girls were being formally treated in juvenile corrections.

Access

Once participants were identified as young women formally processed in thedelinquency side of the juvenile court system, they self-selected on the basis ofavailability and willingness. I usually began by addressing an entire unit in eachfacility both in English and Spanish, explaining the project and inviting youngwomen to join the research as a participant. I then individually met with youngwomen who indicated interest in participating in an interview. These confidential

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interviews were conducted with informed written parental/legal guardian consentand written juvenile assent. To protect confidentiality, identifiable details of youthwere altered slightly. Whenever possible, a life-history approach to the interviewswas deployed; open-ended questions guided by semi-structured conversations tookplace in private interview rooms and averaged two hours in length.

Protocol

The 38-page youth interview protocol probed for a range of experiences andresources. Details were sought regarding their family background and relationships;their own and family involvement in legal system; educational history; drug andalcohol use/dependency; history and nature of physical, sexual, or emotional harm;experiences with medical, dental, and psychological health care; gynecological andobstetric health care; and sexual practices, identities, and preferences. The interviewprotocol concluded with a discussion of interests, strengths, and areas that theyoung women believed might stimulate resiliency.

Sample

The final sample consisted of 100 girls who were interviewed with the sameinstrument, allowing for reliable comparisons across interviews. The reasons forarrest, detention, or court-processing of the young women in the final sampleincluded 4% for sexually related offenses (although 14% of the sample admitted toever having participated in a sexual economy); 6% for minor or status offenses;24% for property offenses; 29% drug or alcohol charges; and 37% for charges forviolent offenses. Tables 1 through 3 display sample demographics and health careconcerns.

Girls’ ages ranged from 13 to 18 years of age, their average age was 15.3 yearsold, and the modal age was 15 years old – 26% of the total sample were 15 yearsof age (see Table 1).

Because I invited young women to participate in Spanish if they preferred, 35%of the sample self-identified as Latina, Chicana, or Hispanic. This subgroupincluded children who said their families were from El Salvador, Guatemala,Mexico, Nicaragua, and Puerto Rico.

Thirty-seven percent of the young women in the final sample identified asAfrican-American and 13% claimed White or European American heritage(see Table 2).

Table 1. Ages of youth participants.

Age Frequency

13 614 2315 2616 2317 2018 2Total 100

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Table 3 displays the myriad health concerns of the young women in this study.A total of 15% of the young women in this study were pregnant or parenting; 53%said they had been sexually harmed before entering the system. Thirty-three percenthad been told by an adult that they needed psychological counseling, and 24% hadalready been hospitalized for a prior medical condition. The young women’s narra-tives about these experiences and concerns are shared throughout this discussion.

Coding

I conducted a quantitative content analysis of the qualitative data (interviews andobservations) to derive the prevalence of primary themes (types of health care

Table 2. Self-reported racial/ethnic backgrounds of youth participants.

Background %

African-American 37Latina 35White/European 13African-American and Latina 5Asian American 4Native American Indian 3African-American and Asian American 2Asian American and Latina 1TOTAL 100

Table 3. Self-reported health experiences of youth participants.

Health concernPercent reporting (of

N = 100)a

Anemia 13Asthma 31At least one parent deceased 12Backaches 20Emotional abuse 71Epilepsy/seizures 3First consensual sexual experience prior to age 14 37Hospitalization for serious medical condition (burn, fall, beating,rape, and miscarriage)

24

Headaches 25Hepatitis 2Lice, scabies, or crabs 29Not yet received gynecological exam since detention 66Physical abuse 53Pregnant or parenting 15Prescribed psychotropic medication 13Scars (injury, knife, and gunshot) 22Serious head injury (‘Ever had…?’) 10Sexual harm (rape, molestation, and incest) 53Sexually transmitted infections (gonorrhea or Chlamydia) 39Told that they needed psychological help 33Toothaches 26Urinary tract infections 17Vaginal yeast infections 25

aConcerns were not mutually exclusive, therefore totals do not add up to 100%.

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concerns). One of the research questions was to discover what participants’ con-cerns were and how many of them shared those same concerns. Because I wasinterested in not only what their experiences were, but when they occurred, I alsocoded for temporal divisions in their narratives (prior/current/ongoing).

This research project was not designed for definitive theory-proofing, forexample, that a certain type or number of young women’s health experiences willpredict their pathways into the juvenile legal system. One intention was however,to provoke thinking about the intertwining factors such as lack of adequateattention to childhood injury, then missing school, then dropping out of school, andthen coming to the attention of authorities. In that vein, the following presentationof study participants’ perceptions is organized temporally: health concerns prior toincarceration and experiences while in detention settings. Prevalence data andtiming are noted along with archetypical excerpts from participants’ interviews.

Findings: unhealed wounds

The data from secure units reveal that girls related health care concerns wereexperienced prior to legal system involvement. As girl children, before ever havingapproached a juvenile facility, participants’ reported serious, chronic, and acutehealth care experiences. Young women easily recounted details of their health histo-ries of injuries, illness, accidents, and abuse. However, accounts of their healthexperiences typically were woven throughout jumbled narratives of various otheraspects of their lives with parents, siblings, school, friends – and bouts with troublewith juvenile authorities.

My mom was always working. She worked at night, she was never home. I got leftalone a lot when I was little. My mom is a nurse at an old folk’s home and my daddoes grassroots organizing for some kind of non-profit thing. Well, I just wanted tobe bad – that’s all why I’m in here. I saw my brother be bad and he got hella atten-tion for it. I was the little one, always put to the side. My mom worked at night and Inever saw her … Maybe if I woulda had the same 4th grade teacher I never wouldagot in trouble. She helped me and took me places.

Well, my mom was reaching out for help because I was bad and ran away to my aun-tie house. When I came home, she told police that I pushed her … OK when I was in6th grade I had a bad accident. I got in the hospital because a crock-pot fell on meand I got burned real bad [shows scar on arm]. I missed so much school from beingsick, I finally just quit. Let me tell you, I now went to so many schools I don’t evenknow how many. Schools jus’ come and go! (15 year old participant)

This young woman began the interview by saying, ‘I don’t remember anythingbefore 4th grade. I have no memory there.’ She was unable to meet my eyes duringthe interview. She talked about how, because she was ‘sick,’ she ‘missed so muchschool.’ Now, a so-called school drop-out, she sits in a tiny room in a detentionfacility accused of a crime. Over half of the young women in my sample of juve-nile detainees had already dropped out of school. Reasons that girls give for drop-ping out are often characterized in self-blaming or passively termed factors such as‘family problems,’ ‘falling behind,’ and ‘losing interest’ (see, e.g., Orenstein,1995). Listening closely to these narratives uncovers missed crucial factors such aspoorly attended health problems that predated those events.

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Many of the respondents had ‘bad accidents,’ injuries and unhealed woundsfrom a variety of physical incidences but, as in the case of the young womanabove, the healing process may not have been supervised by an adult who couldhelp them keep up with other, ongoing life events such as school homework. Thus,being sick or ill or in pain began to affect other aspects of life such as school orloving family relations.

Another participant related an account of her health experiences.

My mom’s [17 year old] ex-boyfriend hit her in the head with a golf club. But shewas already in a car wreck like 10 years ago and she can’t walk good. She is handi-capped, she talks and walks funny. I just met my dad when I was 11. He’s servingtime now but I don’t know what for.

OK, I got pregnant in 4th grade and had my baby when I was 12! My son is alreadyso smart! He playin’ on the computer; he can name things. He already beat me inNintendo!

But the thing is, in my family they treat everybody wrong. My brother hit me in thehead with a stick, and my sister said I deserved it! They hadda take me outta there ina ambulance. I hate my brother and sister. I hate a lot of people. I hate the boy whoraped me – I want to kill them. Everybody who saw my brother do that and didn’thelp. My mind is full of hate.

When I got arrested, it was for selling dope. I hadda get some money to feed mybaby! It’s fast money, I don’t have no time to be hangin’ at no Burger King forchump change. (16 year old participant)

Here is a young woman who was raised by a mother with an abusive boyfriend;first met her father at age 11 which was one year before she gave birth to her ownchild; was physically attacked by her brother, and reports having been raped. Narra-tives such as this exemplify many of the experiences of the study participants. It isnot the case that her health problems caused her to sell drugs, but that her experi-ences with injury and lack of care cannot be separated from understanding heridentity-formation, her sense of self, her sense of worth, her knowledge and abilityfor self-care, her sense of her future. Having to spend a good proportion of hertime making sense of having witnessing her mother be attacked and healing frombeing beaten and raped herself must play some role in her lack of knowledge aboutand access to wider opportunities and choices.

Girls were able to identify their unique medical health needs, and those weresevere. Thirteen percent reported that they were anemic. Two young women saidthey had been treated for hepatitis, three for epilepsy or seizures of some kind. Inthis sample of incarcerated girls, 20% of the young women complained of back-aches, 25% said they had headaches, and 26% had experienced toothaches. One inten had experienced a serious head injury at some time in their life. Almostone-fourth (24%) reported hospitalizations for a condition or injury such as a burn,a fall, a beating, being raped, and having a miscarriage. Twenty-two displayed scarsfrom both injuries and accidents, including gunshot and knife wounds. Over half(53%) reported having been physically mistreated.

In terms of emotional assaults, almost three-fourths (71%) had been told by acaregiver that they ‘were worthless,’ ‘should commit suicide,’ or ‘should not have

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been born.’ One young woman said, ‘I was a trick baby,’ another young womanrecounted, ‘I don’t know who my daddy is, my mama said he was aone-night-stand.’ One third had been told by somebody that they thought they hadpsychological problems that needed treatment. Thirteen percent had already beenprescribed psychotropic medications such as Prozac, Paxil, and Lithium.

One young woman who was being adjudicated delinquent for prostitution,itself a public health crisis, reported that she required Ritalin for ‘Attention Span.’

Oh, I quit school when I was 15 – it wasn’t really workin’ for me up in that school. Igot kicked out of Belmont Creek Spring’s Academy. I have a learning disability – Ihave Attention Span [sic]. I usually take Ritalin, but I don’t got any in here. I needfor my Mom to bring me my stuff, but, … My mom is so mad at me … My wholefamily thing is all fucked up. You see, I’m adopted. My big sister is 19 and my littlebrother is adopted, too. What happened is, I got mad and left my mom’s house andwent to Oakland. I had a friend there and that’s where I met Jimmy.

Jimmy is her [29 year old] boyfriend.

I prefer to live with my boyfriend. He loves me, he is always there for me. He is notmy pimp, but he understands me. I got the idea about prostitution when I met him inRichmond. It was cool down there and then, … well, … I spent five days in OaklandDowntown [adult detention facility]. (16 year old participant)

Prior to entering the juvenile legal system, this young woman had dropped out ofschool and been diagnosed with a mental health problem, one which may have hadsomething to do with her dropping out of school. According to her, things weregoing pretty well: she fell in love and learned how to make money. To someexperts, she made bad choices (Cornish & Clarke, 1998). However, I argue thathaving a learning disability, a boyfriend-cum-pimp who was almost twice her age,and not being in school could point in another theoretical direction – one that takesmental health into consideration as central.

Reproductive education, gynecological care, and sexually transmitted infectionsare of great concern to this population of young women. From inside securesettings, 47% reported that by age thirteen, they had already had their first consen-sual sexual experience. Only 16% of the young women were abstinent, or had nothad heterosexual intercourse. Over half (53%) reported having been harmed sexu-ally, including rape, molestation, and incest. They reported 39 cases of gonorrheaand chlamydia. Seventeen cases of urinary tract infections were recorded; 25% ofthe young women said that they had had yeast infections. Fifteen percent hadchildren in this sample, while the pregnancy rate among teenage girls in the US ingeneral is about 8% (Alan Guttmacher Institute, 2004).

Harmed and injured, many young women complained of inadequate healingattention and support, and of falling behind in other aspects of their adolescentdevelopment: their education, the emotional growth, their socializing skills, theirability to (and attitude about) work – all before coming to the attention of juvenilecourt authorities. A focus on the health experiences of disenfranchised youngwomen shuffling through secure public facilities reveals other dilemmas.

Findings: the ‘complainer’s list’

Narratives from young women locked inside secure settings reveal missedopportunities for providing public health education. Participants expressed a range

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of concerns in their assessment of health needs during their stay in detention,beyond simply the medical including access to clean air, fresh water, familiar andappetizing food, as well as to activities that might distract or bring them peace ofmind, such as sports or art. ‘The food up in here is nasty!’ was a common refrain.Girls complained of stomachaches and, in one facility, many reported that the waterfrom the fountain tasted ‘weird.’ In another facility, there was a malfunction withthe ventilation and air ducts, and it was actually difficult to breathe. At one pointin an interview, a staff official opened the door to our tiny windowless interviewroom and sprayed air freshener at us, as if it were a suitable replacement for freshair. But instead of using these conversations to develop awareness about self-careor learning to articulate health concerns as rights issues, or even as simple momentsof public health information dissemination, many respondents unhealed healthissues were constituted by system staff as lies, complaints, or security hassles(see also Morris, 2004).

Seemingly innocuous aches and pains can grow into tremendous moments ofdiscomfort for young women who cannot simply ask a family member to bringthem an aspirin or other minor medications. In one facility, the medical careenvironment was actually hostile towards detainees. In order to be seen by a nurse,girls had to sign ‘The Complainer’s List.’ Detention staff, shouting:

OK! ALL YOU WHINERS COME ON OUT HERE AND LINE UP! COME ON!YOU’VE GOT 10 MINUTES!

As a few hapless residents straggled into the line, a nurse began to ask detaineesnames and queried each one, loudly, ‘What’s your problem today?’ Later, girlsconfided, ‘I’d rather suffer with an itch than have to be tellin’ her my business outin front of everybody like that.’ Other young women were ruthless – commentsoverheard included: ‘Ooh, she got a nasty snatch!’ among young women in line,with no adult intervention guiding them towards more respectful behavior.

Court-involved young women, including pre-trial detainees, are regularlytransported to medical facilities outside detention centers and consistently reporthumiliation and embarrassment at this treatment. One participant recounted howshe was transported to a nearby public hospital shackled and in her county-issuedkhakis, stamped ‘PROPERTY OF COUNTY JUVENILE CORRECTIONS.’ Shewas indignant at the memory of it:

I have never been so humiliated in my life. I had to go through the doctor’s officewaiting room – in front of all these people – in handcuffs! They were all looking atme like I was a monster or something. People pulled their kids and moved away fromme! I’m NEVER going to the doctor’s here again! I’d rather die first! (14 year oldparticipant)

For various reasons, girls are held in custody before hearings where next steps inthe system would be determined. Some health complaints were prior, others wereongoing. In this study, 31% of the young women said that they had asthma.Experiences with lice, scabies, and crabs were reported by 29%, yet few lined upfor medical attention.

Young women recounted a variety of illnesses, and were often told bydetention staff that the symptoms were unimportant, or were minimized into adismissive, pop-psychology diagnosis of stress.

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I first got my period when I’m 11 years old. It always comes down regular. I told herthat I didn’t get it since I been in here, and she told me it’s ‘cause I’m ‘stressed out.’I’ve asked a ton of times to get someone to help me up in here – especially in themiddle of the night. (15 year old participant)

I was taking drugs and my sister slit her wrists and got a lot of attention for it. Shedid it for her boyfriend and I thought it was really stupid. But then I did it and every-body just got mad at me. I did it when my mom told me I was worth nothing – I slitmy wrists. The lady in here says I don’t need nothin’ for it, though. (16 year old par-ticipant)

I fainted at school and my mom watched me close to find out why I fainted. Shecaught me throwing up in the bathroom. She rented movies about it to show me. I’msupposed to take some medicine, but they don’t got it up in here. They jus’ told meto chill out. (14 year old participant)

My biggest problem is – I’m stressin’! I don’t know where my baby at! When I gotarrested, he was with my boyfriend, but then they told me my boyfriend got lockedup too! I can’t make a phone call, they won’t tell me where my baby at! I’m not sure,he might be with my mom, but I hope he ain’t with my boyfriend’s mom, she’s crazy!(15 year old participant)

Here, young women described absence of menses, suicide attempts, and bulimia– possibly life-threatening ailments, none attended to by officials. Besides violat-ing several United Nations Conventions for the care of children and the rights ofchildren deprived of their liberty, inadequate attention to their concerns equals theinfliction of emotional and psychological harm to girls in lock-up. Being in atraumatic situation of not knowing the whereabouts of one’s child must be psy-chologically disturbing, as the young woman in the above quote attempted toarticulate. Considered by the young women as health issues that were acute anddeserving of attention, these ailments were not only not screened by healthexperts, but the interactions themselves formed missed opportunities for conversa-tions about health concerns as a conduit to talking about the importance of takingtheir lives seriously and learning how to ask for what they need in ways thatmight better be heard, among other possible empowering activities.

However, any health service may not necessarily be good enough. Besidesdeserving privacy and respect, respondents talked about the need for gender-appro-priate, culturally specific assistance. One African-American participant wasremoved from her mother’s home when she was 11 years old because, sheexplained, ‘My mom bit me and then put a pillow over my face.’ She ran awayfrom her group home after she had been raped by her uncle. This detainee wasquite sophisticated by the time she agreed to this interview:

I try not to be prejudiced or anything, but these blonde-haired blue-eyed therapists – Idon’t trust them. My counselor was young and pregnant. I didn’t want to tell her stuff– I didn’t want to freak her out. (17 year old participant)

The reasons girls listed for being stressed spanned a range of experiences.Across the nation, in the varied secure institutions, bathing and showering were

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locations of considerable tension for some adolescent girls. Even so, bathing andshowering movements typically were conducted in groups with no shower doors orcurtains. In all facilities observed in this study, detainees were hustled in and out ofshowers quickly, allowed approximately five minutes for bathing. Only the leastexpensive, county-issue hygiene and beauty products were offered – practically apunishment of its own for adolescent girls. In one facility, I witnessed girls being‘allowed’ to use their dirty panties for washcloths during their five-minute showers.

Gynecological care is legally mandated for wards of the state (see Table 5).But young women complained about being harangued to ‘use the patch’ or ‘get theshots’ for reproductive protection. ‘We know these white people don’t want ushavin’ babies,’ one participant retorted when I asked her about reproductive control.These comments reveal that incarcerated girls are actively engaged with debatesover their sexual and reproductive choices.

One pregnant detainee was assigned a room without a toilet, but needed tourinate frequently. The facility required that two adult security guards be on theUnit when residents were allowed out of their rooms, to use the bathrooms, forexample. When this young woman needed to leave her room to use the bathroom,

Table 4. Summary of health care needs of incarcerated girls.

Area of concern Challenge/consideration

Medical/physicalhealth

Medical examinations and care that include a sensitive focus on HIV,obesity, asthma, and diabetes.Dental and oral care, including full examinations, X-rays, cleaning, andorthodontic referrals.Eye examinations, including filling corrective lens prescriptions.Skin care including dermatological care of facial acne, rashes, andsocially transmitted parasites.

Psychologicalhealth

Psychological assessment that focuses on gender and adolescence,trauma, and aftercare.Mental health assessment that includes a critical perspective of theover-prescribing of psychotropic and behavioral medications, withfollow-up aftercare.Drug and alcohol dependency assessment, intervention, detoxificationopportunities, harm reduction resources, education, counseling,rehabilitation, and long-term follow-up aftercare.Validation of anger, safe expression of anger, and challenges withemotional literacy.

Gender/sexualhealth

Coercion-free reproductive rights counseling, including access to frank,confidential discussions of contraceptive, abortion, adoption, andparenting options.Pre-natal, pregnancy, and obstetric care.Gynecological care including follow-up test results for sexuallytransmitted infections and aftercare.Sexual health assessment that includes sexual trauma history andsensitivity to sexual minority rights and needs.

Social health Parental, family, and caregiver homelessness, inadequate housing.Parental, family, and caregiver poverty and unemployment.Parental, family, and caregiver alcoholism and substance dependency.Physical abuse/personal violence.Lack of safe access to on-demand health care without fear of policereprisal.Lack of community-based treatment facilities for young women.

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the guard, left alone on the graveyard shift, handed her a bucket to use inside hercell. Logistically, for security reasons, this was the ‘correct’ decision. At the sametime, it was in direct conflict with the human rights of children in confinement.Young women’s gynecological health needs were great, yet two-thirds claimed thatthey had not had a gynecological examination since being taken into custody.

Another psychologically related consideration that several young women raisedwas that they were not allowed to visit with their children while in detention, norwere they allowed to visit with minor siblings. On the one hand, some explainedthat they would not want their babies ‘to see me up in here.’ On the other, though,girls worried and expressed distress over not being able to care for their dependentchildren and younger siblings while in detention. Limited visits, email, andtelephone privileges, while crucial security considerations, curtailed the care workfor which the female juvenile detainees felt acutely responsible.

For some, their treatment in the detention facility was their first visit to adentist. I overheard one young woman asking the dentist, ‘Can I bring my sister inhere too?’ to which the dentist replied, ‘No, honey, this is a jail, we don’t wantyou to bring your baby sister in here.’

Based on data from extant research and the qualitative results in this study,typical health care challenges of detained female adolescents include a range ofunmet needs. As displayed in

Table 4, detained girls concerns include a range of considerations of theirphysical, medical, psychological, sexual, and social health. What the table organizesis not that the needs are surprising, but that they are many. Not one respondent waswithout health need. For the majority, entire sections of concerns had not beenattended to at all (i.e., gynecological examinations). It is absurd to expect anything,let alone conforming behavior, from young women wandering in dangerous situa-tions with headaches, unattended infections, barely healed wounds and injuries whothen contend with the full brunt of the law condemning their survival methods.

Discussion: reframing girls’ delinquency as girls’ medical neglect

Gender-specific explanations for girls’ involvement with juvenile authorities oftenbegin by detailing how marginalized girls’ experiences with health problems suchas stress, violence, abuse, and depression are intertwined with their troubles withthe law. For example, a girl defies curfew or becomes truant for running away fromhome to escape sexual, physical, or emotional abuse. The danger is that this dis-course can be turned into a dismissive, minimalizing framing of girls’ very real andserious health concerns. Probation personnel, line staff, and court actors can dis-count these crises as ‘girls are just being too being emotional, relational, or stressedout’ – or worse, the fallout from the young women’s experiences becomes linkedto explaining why they are delinquents. The narratives recounted in this researchdo point to how health concerns interlink with other family and personal issues,but this only highlights the need for a considered concentration on these healthneeds, not a sort of fashioning of their health problems into predictive of theirdelinquency.

Several insights provided by the data collection advance a comprehension ofthe role that health care concerns can play in court-involved girls’ lives. One,noticing the many ways that life narratives of girls in secure custody center aroundcritical public health concerns (a young woman rushed to a hospital because her

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brother beat her; a young woman raped by her uncle and runs away from her grouphome) demonstrates how medical and mental health intervention prior to theirtrouble with the law could help shape respondent’s focus on healing. A variety ofgirl-specific ‘Girl Talk’ groups have been organized to successfully raise theseissues with detained girls (Schaffner, 2006).

Second, expressions of the unattended effects of physical injury and trauma layhidden within the accounts of young women. The majority had already left schoolbefore getting into trouble with the law. For example, one girl is burned badenough to be hospitalized and subsequently falls behind in school – enough to wantto quit school. Criminologists note that dropping out of school is a typical factor inthe lives of juvenile delinquents while education experts build typologies of reasons

Table 5. Examples of extant policies and standards addressing health care in securejuvenile facilities.

International The Universal Declaration of Human Rights: Adopted and proclaimed byGeneral Assembly Resolution 217 A (III) of 10 December 1948. UnitedNations, New York and Geneva.International Covenant on Civil and Political Rights. 1976. Office of the HighCommissioner for Human Rights, United Nations, New York and Geneva.Standard Minimum Rules for the Treatment of Prisoners. 1977. Office of theHigh Commissioner for Human Rights, United Nations, New York andGeneva.United Nations Standard Minimum Rules for the Administration of JuvenileJustice (‘The Beijing Rules’), 1985. Office of the High Commissioner forHuman Rights, United Nations, New York and Geneva.Convention on the Rights of the Child: Adopted and Opened for Signature,Ratification and Accession by General Assembly Resolution 44/25 of 20November 1989. United Nations, New York and Geneva.United Nations Guidelines for the Prevention of Juvenile Delinquency (‘TheRiyadh Guidelines’). 1990. Office of the High Commissioner for HumanRights, United Nations, New York and Geneva.United Nations Rules for the Protection of Juveniles Deprived of theirLiberty: Adopted by General Assembly Resolution 45/113 of 14 December1990. United Nations, New York and Geneva.Basic Principles for the Treatment of Prisoners: Adopted and Proclaimed byGeneral Assembly resolution 45/111 of 14 December 1990, United Nations,New York and Geneva.Guidelines for Action on Children in the Criminal Justice System:Recommended by Economic and Social Council (Resolution 1997/30 of 21July 1997). United Nations, New York and Geneva.

National Policies and Procedures: Juvenile Community Residential Facilities. 1990.Alexandria, VA: American Correctional Association.Policies and Procedures: Juvenile Detention Facilities. 1992. Alexandria, VA:American Correctional Association.Juvenile Justice Standards, 1996. Chicago, IL: American Bar Association.Standards for Juvenile Health Services in Juvenile Detention andConfinement Facilities. 2004. Chicago, IL: National Commission onCorrectional Health Care.

State Illinois State Administrative Code. 1988. Springfield, IL.State of Illinois Unified Code of Corrections (730 ILCS 5/ch. III Articles 7and 9). 2002. Springfield, IL.Minimum Standards for Juvenile Facilities: State of California. 2003.California Department of Corrections and Rehabilitation, Sacramento, CA.

Note: Compiled in collaboration with the Chicago-based Health and Medicine Policy Research Group.

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for not completing high school. Nuanced details in the accounts of the youngwomen in this study outline a theory that health concerns in the lives of troubledchildren contribute to their coming to the attention of juvenile authorities.

Finally, respondents articulated their criticisms of the health care provision inthe juvenile legal system. This ability for critical thinking points to the possibilitythat public health educational methods may provide opportunities to enlist troubledyoung women themselves in conceptualizing how to improve their lives and senseof purpose.

Several institutional considerations must be taken into account when discussingcorrectional health care delivery. Tennyson (2003) argues that penal medical care isnot inexpensive – while the need is strong, the price is steep. It may be thatphilosophically, detained girls are not seen as worthy victims deserving of publicattention and medical care. Logistically, continued adequate health care must beseamless to be effective. For example, girls’ stays in these correctional facilities canvary from one overnight to several years. It was common for youths’ medical filesand ongoing prescriptions not to arrive with them to detention facilities, placingthem at increased risk of health complications.

From local county agencies to international accords, authorities are mandatedin almost every aspect of the custody situation to attend to the medical needs,health, and comfort of children in confinement (see Table 5). It is not the case thatadequate care is not mandated.

The United Nations Convention on the Rights of the Child (1989) and otherUN documents clearly outline minimum standards for children deprived of theirliberty. Table 5 lists nine examples of international documents that mandate specifichealth care treatment for detained youth. Several national professional associationsrecommend policies and procedures to address juvenile health care in residentialsettings, Table 5 lists four examples. While every state has some form of legalrequirements for minimum standards, Table 5 lists only three examples. Indeed,some of the legal mandates for the health care of detained juveniles are regulatedat the county jurisdictional level.

But one institutional factor cannot be overemphasized when considering healthcare to incarcerated adolescents – that of the security mandate under whichdetention operates. Security concerns often take precedence over even residents’health care. Ensuring the safety and continued custody of residents is the toppriority of the business of corrections. Unfortunately, security concerns may be atodds with health care delivery in locked facilities. For example, while five-minuteshowers may be considered necessary by wary personnel, they may be seen asdemeaning and insufficient by young women wards, adding to their sense of stressand frustration in lock-up. The incident with the bucket used as a toilet, clearly ahuman rights violation, underlines how this tension between security concerns andhealth care delivery surfaced in the young women detainees’ narratives.

Conclusion: healing, not punishing

Examining the formal social control of young women through a public health lensprovides a new focus when analyzing girls’ troubles with the law. Many of thehealth care needs of court-involved young women such as sexual abuse have beennoted in detail by previous researchers. However, locating them as public healthissues, rather than as criminogenic factors, opens up new ways of seeing and

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addressing them. Bringing the voices and realities of young women to the fore ofour discussions about public health needs of detained populations alters the focusof policy and scholarship. Sociological inquiry that encompasses the bleak healthcare experiences of young women points to the need to decriminalize their survivalstrategies and to desist in the overreliance of arrest, incarceration, and punishmentof young women who are righteously struggling to negotiate their troubledadolescence, including managing their own health care. Secure detention halls forjuveniles must be brought into compliance with international and local statutes. Thereality for thousands of girls who are processed in these juvenile facilities acrossthe nation each year is that the facilities could become locations where the publichealth crisis of court-involved girls would be addressed and the healing of girls inthe juvenile legal system could begin.

AcknowledgementsThis work would not have been possible without funding from the Woodrow WilsonFoundation, a Fulbright-Garcia Robles Fellowship, support from the University of Illinois atChicago Office of Social Science Research, and the collaboration of the Chicago, IllinoisHealth and Medicine Policy Research Group. The author would also like to acknowledgethe support of Maria Krysan, Erica Meiners, Beth Richie, Barbara Risman, Gayatri Reddy,and the young women who bravely shared their insights with her.

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