Sexual Abuse to Prison Pipeline, The Girls' Story, Georgetown Law Center for Poverty and Inequality, 2015
Download original document:
This text is machine-read, and may contain errors. Check the original document to verify accuracy.
THE SEXUAL ABUSE TO PRISON PIPELINE: THE GIRLS’ STORY Human Rights Project for Girls Georgetown Law Center on Poverty and Inequality Ms. Foundation for Women CENTER ON POVERTY and INEQUALITY Text here 00report: authors of the Malika Saada Saar, Human Rights Project for Girls Rebecca Epstein, Georgetown Law Center on Poverty and Inequality Lindsay Rosenthal, Ms. Foundation for Women Yasmin Vafa, Human Rights Project for Girls The authors gratefully wish to acknowledge the following contributors for their substantive assistance to this report: Maheen Kaleem, Human Rights Project for Girls, who appeared at just the right moment, with unbending commitment and vision, to help bring us to the finish line. Julie F. Kay, Human Rights Attorney, whose human rights expertise, guidance and feedback immeasurably strengthened this report in service of America’s most vulnerable girls. Shakira Washington, Consultant, Human Rights Project for Girls, whose brilliant research and writing on girls at the margins laid the foundation for this paper’s development. Teresa Younger, President of the Ms. Foundation for Women, whose leadership in supporting Ms. Fellowship during her first months at the Foundation was essential to the completion of this report. And with thanks for their time and effort in reviewing this paper and providing invaluable insight: Mary Bissell, ChildFocus Peter Edelman, Georgetown Law Center on Poverty and Inequality Carmen Perez, Campaign for Youth Justice Liz Ryan, YouthFirst! Initiative Francine Sherman, Boston College Law School Dana Shoenberg, Center for Children’s Law and Policy To obtain a hard copy of this report, please contact: Center for Poverty and Inequality | Georgetown University Law Center 600 New Jersey Avenue NW #461 | Washington, DC 20001 email@example.com Download available at www.law.georgetown.edu/go/poverty Design Ines Hilde, Georgetown Law Photography Front cover photo and photos on pages 4, 6, 27, and 34 by © Richard Ross, www.juvenile-in-justice.com. Back cover photo and photos on pages 21 and 45 by © Rebecca Epstein, www.rebeccaepsteinphotography.com. All photos used by permission. THE SEXUAL ABUSE TO PRISON PIPELINE: THE GIRLS’ STORY Dedicated to the girls The Nature of This Flower Is to Bloom Rebellious. Living. Against the Elemental Crush. A Song of Color Blooming For Deserving Eyes. Blooming Gloriously For its Self. — Alice Walker Text here 00 about the authors’ organizations Human Rights Project for Girls works to make the lives of US young women and girls a human rights priority. Gendered violence here in the US, like gendered violence abroad, restricts girls’ rights and the realization of their full potential and dignity. As a national organization of human rights lawyers, Rights4Girls addresses the conditions of sexual violence, rape, exploitation, and trafficking here in the United States in the areas of policy, legislation, and law. We advocate for the dignity and personhood of young women and girls – so that every girl may possess the right to be safe and live a life free of violence and exploitation. See more at www.rights4girls.org. The Center on Poverty and Inequality works with policymakers, researchers, practitioners, and advocates to develop effective policies and practices that alleviate poverty and inequality in the United States. The Center’s areas of anti-poverty work include national, state, and local policy and program recommendations that help marginalized girls, promote effective workforce and education policies and programs for disconnected youth, and develop policy to combat deep poverty. Its strategies are to partner with Administration agencies and non-profit organizations to host national conferences, produce and widely disseminate in-depth reports, engage in public speaking, and participate in national coalitions and working groups. See more at www.law.georgetown.edu/go/poverty. The Ms. Foundation for Women is the first and largest US women’s foundation. Since our founding in 1972, we have supported grassroots organizations across the country to sustain and amplify the vision and voice of women who area leading change in their communities, particularly low-income women, women of color and young women. We focus on three pillars — women’s health, economic justice and safety — in order to fulfill our mission: to build women’s collective power to realize a nation of justice for all. See more at www.forwomen.org. table of contents Introduction Girls’ Paths of Sexual Abuse into the Juvenile Justice System 4 6 The Proportion of Girls — Especially Girls of Color — in the Juvenile Justice System is Increasing. 7 Girls in the Juvenile Justice System are Disproportionately Victims of Sexual Violence. 7 Girls’ Behavioral Reaction to Sexual Abuse and Trauma is Criminalized, Reinforcing the Sexual Abuse to Prison Pipeline. 9 The Juvenile Justice System Typically Fails to Address, and Often Exacerbates, Trauma that Caused Girls to Be There. 12 Dismantling the Pipeline: Policy Recommendations to Reduce Traumatized Girls’ Arrest and Incarceration 15 Lived Experience of the Sexual Abuse to Prison Pipeline: Victims of Sex Trafficking Jailed as Offenders. 19 20 22 23 24 25 Dismantling the Pipeline: Policy Recommendations to Keep Victims of Sex Trafficking Out of Juvenile Justice Lived Experience of the Sexual Abuse to Prison Pipeline: Detention of Girls Who are Status Offenders. Dismantling the Pipeline: Policy Recommendations to Decrease the Disproportionate Effect of Status Offense Enforcement on Girls In Focus: Dual-System Youth and the Sexual Abuse to Prison Pipeline. Dismantling the Pipeline: Policy Recommendations to Reduce Foster Girls’ Crossing Over into the Juvenile Justice System Child Welfare and the Sexual Abuse to Prison Pipeline: Identifying and Treating Trauma in the Child Welfare System Dismantling the Pipeline: Policy Recommendations to Improve the Child Welfare System’s Response to Girls Conclusion 27 29 32 3 4 VIOLENCE AGAINST GIRLS IS A PAINFULLY AMERICAN TALE. IT IS A CRISIS OF NATIONAL PROPORTIONS… introduction Violence against girls is a painfully American tale. It is a crisis of national proportions that cuts across every divide of race, class, and ethnicity. The facts are staggering: one in four American girls will experience some form of sexual violence by the age of 18. Fifteen percent of sexual assault and rape victims are under the age of 12;1 nearly half of all female rape survivors were victimized before the age of 18.2 And girls between the ages of 16 and 19 are four times more likely than the general population to be victims of rape, attempted rape, or sexual assault.3 And in a perverse twist of justice, many girls who experience sexual abuse are routed into the juvenile justice system because of their victimization. Indeed, sexual abuse is one of the primary predictors of girls’ entry into the juvenile justice system.4 A particularly glaring example is when girls who are victims of sex trafficking are arrested on prostitution charges — punished as perpetrators rather than served and supported as victims and survivors. Once inside, girls encounter a system that is often ill-equipped to identify and treat the violence and trauma that lie at the root of victimized girls’ arrests. More harmful still is the significant risk that the punitive environment will re-trigger girls’ trauma and even subject them to new incidents of sexual victimization, which can exponentially compound the profound harms inflicted by the original abuse. This is the girls’ sexual abuse to prison pipeline. This report exposes the ways in which we criminalize girls — especially girls of color — who have been sexually and physically abused, and it offers policy recommendations to dismantle the abuse to prison pipeline. It illustrates the pipeline with examples, including the detention of girls who are victims of sex trafficking, girls who run away or become truant because of abuse they experience, and girls who cross into juvenile justice from the child welfare system. By illuminating both the problem and potential solutions, we hope to make the first step toward ending the cycle of victimization-to-imprisonment for marginalized girls. 5 6 GIRLS’ PATHS OF SEXUAL ABUSE INTO THE JUVENILE JUSTICE SYSTEM girls’ paths of sexual abuse into the juvenile justice system the proportion of girls — especially girls of color — in the juvenile justice system is increasing. tion of girls’ having violated conventional norms and stereotypes of feminine behavior,19 even when that behavior is caused by trauma.20 The rate of girls’ involvement in juvenile justice is growing disproportionately at key determinative points in the criminal justice process, including the decision to arrest and detain girls.5 girls in the juvenile justice system are disproportionately victims of sexual violence. Girls of color are particularly affected by this trend.6 Although rates of overrepresentation vary significantly by jurisdiction,7 the national trends are revealing. African-American girls constitute 14 percent of the general population nationally but 33.2 percent of girls detained and committed.8 Native American girls are also disproportionately involved in the juvenile justice system:9 they are 1 percent of the general youth population but 3.5 percent of detained and committed girls.10 The disproportionate rates of confinement in residential placements for girls of color are most accurately revealed when viewed per capita: Native American girls are in residential placements at a rate of 179 per 100,000; African-American girls at a rate of 123 per 100,000; and Latinas at a rate of 47 per 100,000. By comparison, 37 per 100,000 of non-Hispanic white girls are confined.11 According to studies by the Girls Study Group of the US Department of Justice’s Office of Juvenile Justice and Delinquency Prevention, among others, the increase in girls’ rate of arrest and incarceration over the last two decades is not a result of their engaging in criminal activity at higher rates.14 Nor are they increasingly violent.15 Although the reason has not been definitively determined, evidence suggests that one cause is more aggressive enforcement of non-serious offenses that are rooted in the experience of abuse and trauma,16 as illustrated by the recent increase in arrests of girls involved in family-based incidents.17 In fact, the leading cause of arrest for girls are minor offenses such as misdemeanors, status offenses, outstanding warrants, and technical violations.18 And the decision to arrest and detain girls in these cases has been shown often to be based in part on the percep- Research reveals that girls who are sent into the juvenile justice system have typically experienced overwhelmingly high rates of sexual violence.21 Further studies are urgently needed, as virtually no national data exists to illuminate incarcerated girls’ histories of sexual violence. However, several local and regional studies paint an informative portrait of incarcerated girls’ histories of abuse. In a 2006 LGBT/GNC Girls Youth who identify as lesbian, gay, bisexual, transgender, or gender non-conforming (LGBT/GNC) are overrepresented in the juvenile justice system. Although LGBT/GNC youth comprise only 5 to 7 percent of the general population, they represent 13 to 15 percent of youth who come into contact with the juvenile justice system.12 Recent research by the National Council on Crime and Delinquency (NCCD) indicates that LGBT/GNC girls, in particular, are involved in the system at an even higher rate: a survey of 1,400 girls across seven jurisdictions found that 40 percent of girls in the juvenile justice system are LGBT/GNC (compared to 14 percent of boys).13 study of girls involved in Oregon’s juvenile justice system, for example, 93 percent had experienced sexual or physical abuse; 76 percent had experienced at least one incident of sexual abuse by the age of 13; and 63 percent had experienced both physical and sexual abuse.22 Similarly, in a 2009 study of delinquent girls in South Carolina, 81 percent reported a history of sexual violence, and 42 percent reported dating violence.23 7 girls in residential placement by race and ethnicity Rate per 100,000 non-hispanic white african american hispanic asian 20 40 60 80 100 37 120 47 native american 11 123 140 160 180 179 Adapted from Child Trends DataBank, Juvenile Detention, Indicators on Children and Youth 5 (2013), available at http://www.childtrends.org/wp-content/uploads/2012/05/88_ Juvenile_Detention. 8 girls in juvenile justice 31% s e x u a l ly a b u s e d boys in juvenile justice 7% Girls’ rate of sexual abuse is 4 times higher than boys’ in juvenile justice, and girls’ rate of complex trauma (five or more ACEs) is nearly twice as high. s e x u a l ly a b u s e d 45% 24% five or m o r e ACE s five or more ACE s Source: Michael T. Baglivio et al., US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders, 3 J. Juv. Justice 1, 9 (Spring 2014), available at http://www.journalofjuvjustice.org/ JOJJ0302/JOJJ0302.pdf. girls’ paths of sexual abuse into the juvenile justice system Finally, a 1998 study of juvenile-justice-involved girls in California found that 81 percent of girls had experienced one or more incident of physical or sexual abuse; 56 percent reported one or more forms of sexual abuse; and 45 percent reported being beaten or burned at least once.24 But rates of prevalence alone do not fully capture the severe extent and multiple incidents of girls’ sexual victimization. In the California study, for example, of the 56 percent of girls who reported sexual abuse — which can take many forms — 40 percent of girls reported being raped or sodomized at least once, and 17 percent reported multiple occurrences of abuse.25 Girls in the Oregon study, meanwhile, reported they had experienced an average of over four forms of severe sexual abuse before the age of 12.26 Justice-involved girls also are victimized by sexual violence at an earlier average age, and for a longer average duration, than other forms of abuse. The South Carolina study, for example, found that in contrast to other forms of violence that peaked during certain developmental stages, sexual violence was a risk for girls throughout their lives, though particularly during adolescence.27 Meanwhile, the California study found that the age at which girls were “most likely” to be fondled or molested was five years old;28 and the Oregon study found that the average age at which at least one instance of sexual abuse occurred was just under seven and a half years old.29 These findings are particularly significant in light of a recent study that found that traumatic exposure before high school is an even stronger predictor of girls’ delinquency than The US Attorney General’s Task Force on Children Exposed to Violence has concluded that childhood trauma is associated with involvement in the juvenile justice system.39 For girls more than for boys, this connection is strongly rooted in the experience of sexual violence. 40 And the link appears to continue even after girls are released: a recent study has shown that sexual abuse is one of the strongest predictors of whether a girl will be charged again after release; in fact, it appears to have a greater impact on girls’ re-entry into the system than other risk factors like behavioral problems and prior justice involvement.41 Yet, significantly, the experience of sexual abuse did not have the same impact on boys.42 Clearly, sexual abuse has a uniquely defining impact on juvenile justice involvement for girls. GIRLS’ EXPERIENCE OF COMPLEX TRAUMA AND MULTIPLE INCIDENTS OF VICTIMIZATION Some studies indicate that girls experience complex and multiple forms of trauma at disproportionate rates. In a 2014 study of the abuse histories of more than 60,000 youth in Florida’s juvenile justice system, for example, girls reported having experienced Adverse Childhood Experiences (ACEs)31 at higher rates than boys in all 10 categories of trauma and abuse analyzed.32 Nearly half of the girls (45.1 percent) experienced five or more forms of trauma and abuse, compared to less than one-third (27.4 percent) of boys.33 These findings are consistent with other research, including a 2010 study of a nationally representative sample of justice-involved youth, that show higher rates of complex trauma and multiple forms of victimization among girls.34 such exposure during high school. 30 Although the precise findings of rates of sexual abuse vary, all studies find higher rates of victimization for girls than boys.35 One local study of delinquent youth, for example, found that the rate of sexual abuse for justice-involved girls was over four times higher than for boys. And a 2011 literature review found that girls’ dramatically higher rate of sexual abuse was the most consistent finding among nineteen studies that analyzed the prevalence of trauma by gender.37 Other recent studies have replicated this finding.38 girls’ behavioral reaction to sexual abuse and trauma is criminalized, reinforcing the sexual abuse to prison pipeline. The most common crimes for which girls are arrested — including running away, substance abuse, and truancy — are also the most common symptoms of abuse.43 Indeed, child sexual abuse experts list these 9 girls’ paths of sexual abuse into the juvenile justice system findings vary, but local and regional studies show alarmingly high rates of abuse among girls in the juvenile justice system. SOUTH CAROLINA 10 OREGON FLORIDA 81%93%84% 42%76%31% 63%41% O F G I R L S O F G I R L S O F G I R L S victims of sexual violence sexually or physically abused victims of family violence O F G I R L S O F G I R L S O F G I R L S victims of dating violence sexually abused sexually abused O F G I R L S O F G I R L S sexually Source: Dana D. Dehart, The Ctr. For Child & Family Studies, Poly-victimization Among Girls in the Juvenile Justice System: Manifestations & Associations to Delinquency 12 (Oct. 2009), available at https://www. ncjrs.gov/pdffiles1/nij/grants/228620.pdf. & physically abused Source: Dana K. Smith, Leslie D. Leve & Patricia Chamberlain, Adolescent Girls’ Offending and Health Risking Sexual Behavior: The Predictive Role of Trauma, 11 Child Maltreatment 346, 350 (Nov. 2006). physically abused Source: Michael T. Baglivio et al., US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders, 3 J. Juv. Justice 1, 9 (Spring 2014), available at http://www.journalofjuvjustice.org/JOJJ0302/ JOJJ0302.pdf. girls’ paths of sexual abuse into the juvenile justice system CALIFORNIA MULTI-STATE STUDY 32% 81% 56% 40% 39% 45% 17%40% 56% O F G I R L S sexually or physically abused In the California study, of the girls who had been sexually abused, the abuse was severe and often occurred multiple times. O F G I R L S sexually maltreated O F G I R L S O F G I R L S O F G I R L S sexually abused raped/sodomized at least once sexually assaulted/raped O F G I R L S O F G I R L S O F G I R L S beaten or burned at least once multiple occurrences physically abused O F G I R L S domestically abused Source: Leslie Acoca, Outside/Inside: The Violation of American Girls at Home, on the Streets, and in the Juvenile Justice System, 44 Crime & Delinquency 561 (1988), available at http://leslieacoca.org/images/Outside-Inside_-_The_Violation_of_American_Girls_at_Home_-_On_the_Streets_-_and_in_the_Juvenile_Justice_System_by_Leslie_Acoca.pdf. Source: Carly B. Dierkhising et al., Trauma Histories Among Justice-Involved Youth: Findings from the National Child Traumatic Stress Network, 4 Eur. J. Psychotraumatology (Jul. 2013), available at http://www.ncbi.nlm.nih. gov/pmc/articles/PMC3714673/. 11 girls’ paths of sexual abuse into the juvenile justice system behaviors as warning signs that an adolescent has been abused and needs therapeutic intervention.44 According to a study conducted by the US Department of Health and Human Services, 46 percent of runaway and homeless youth report being physically abused; 38 percent report being emotionally abused, and 17 percent report being forced into unwanted sexual activity by a family or household member.45 Research has consistently shown that girls’ problem behavior, in contrast to that of boys, “commonly relates to an abusive and traumatizing home life.”46 Self-reports by female offenders support these findings, in which girls “are significantly more likely than males to report that victimization was a key factor leading to their offending.”47 12 A National Child Traumatic Stress Network (NCTSN) review of literature on trauma and girls’ delinquency emphasizes the causal role that unaddressed trauma can play in the criminalization of girls: [Studies] suggest that if trauma is not resolved, … result[s may] includ[e] (a) alcohol and drug use, (b) involvement in violent activity, and (c) development of mental health problems such as PTSD. For many of these adolescent females, there appears to be a link between the experience of abuse and neglect, the lack of appropriate treatment, and the behaviors that led to arrest.48 Yet despite the body of research showing that the effect of trauma and abuse drives girls into juvenile justice,49 the system itself typically overlooks the context of abuse when determining whether to arrest or charge a girl, often with a minor offense. When law enforcement views girls as perpetrators, and when their cases are not dismissed or diverted but sent deeper into the justice system, the cost is twofold: girls’ abusers are shielded from accountability, and the trauma that is the underlying cause of the behavior is not addressed. The choice to punish instead of support sets in motion a cycle of abuse and imprisonment that has harmful consequences for victims of trauma. the juvenile justice system typically fails to address, and often exacerbates, trauma that caused girls to be there. Although some defend the practice of detaining victimized girls on the grounds that the system can provide protection or needed services,50 that justification cannot counterbalance the significant psychological and physical harms created by commitment. In fact, access to adequate services, if any, is severely limited; worse, the system’s routine processes can serve to re-traumatize girls; and, worse still, some report that they experience new incidents of abuse while inside. The NCTSN has noted the unique link between trauma and mental health for girls: “[S]tudies have consistently found that among those who are exposed to trauma, females are more likely than males to develop mental health problems as a result.”51 And, consistent with the link between trauma and contact with the juvenile justice system, in 2004 the NCTSN noted overwhelming rates of trauma and post-traumatic stress disorder (PTSD) among girls in the system: 70 percent of girls in juvenile justice had been exposed to some form of trauma and over 65 percent had experienced symptoms of PTSD sometime in their lives, 48.9 percent of whom were experiencing those symptoms at the time of the study.52 Rates of PTSD and other mental health disorders are consistently higher in girls than their male peers.53 For example, one study by the National Center for Mental Health and Juvenile Justice found that approximately 80 percent of females in the juvenile justice system met the criteria for at least one mental health disorder, compared to 67 percent of boys.54 Another found that major depression is four to five times more common in girls housed in detention and correctional facilities than in the general community, compared to twice as common in detained boys than the general community.55 The rate of major depression in detained girls was 29 percent, compared to 11 percent in boys.56 girls’ paths of sexual abuse into the juvenile justice system Trauma coping behaviors resume and/or re-entry into abusive environment Release into community with exacerbated trauma symptoms Trauma symptoms triggered and/or new incidents of abuse girls’ common reactions to Entry into Juvenile Justice trauma are criminalized and exacerbated by involvement in the juvenile justice system, New arrest occurs and cycle repeats and deepens leading to a cycle of abuse (for prostitution, status offenses, incorrigible behavior, etc.) and imprisonment 13 Sexual Abuse (sex trafficking, abusive home, poorly supervised child welfare placement) Reactive Behavior Gender Differences in Mental Health Diagnoses Unaddressed Trauma, Mental Health, Physical Health Issues mental health diagnoses among justice-involved youth by gender 67% 80% of boys of girls Source: Jennie L. Shufelt & Joseph J. Cocozza, Nat’l Ctr. for Mental Health and Juvenile Justice, Youth With Mental Health Disorders in the Juvenile Justice System: Results from a Multi-State Prevalence Study 4 (June 2006), available at http://www.ncmhjj.com/wp-content/uploads/2013/07/7.-PrevalenceRPB.pdf. girls’ paths of sexual abuse into the juvenile justice system 14 Yet when girls enter the juvenile justice system, mental health screenings are rarely administered by licensed professionals, and follow-up assessments and treatment are frequently inadequate.57 Some studies have found that this lack of services exists more often in facilities that serve girls.58 According to a recent nationwide census conducted by the US Department of Justice’s Office of Juvenile Justice and Delinquency Prevention (OJJDP), only approximately half the youth in the juvenile justice system are placed in a facility that provides mental health evaluations of all residents.59 Follow-up care is often insufficient even for youth who do receive evaluations.60 And a significant majority of juvenile justice youth (88 percent) resides in facilities in which mental health counselors are not licensed professionals.61 “I became even more withdrawn and angry. I felt completely disconnected from my family, from friends; and the counselors inside offered no support for the real problems I was facing. I felt like nobody believed that I could actually do something positive with my life — especially the staff inside the facilities, who treated me like a case number, not like a person. At that time what I needed was to talk to folks about all I had been through, to feel connected to people — to feel useful, so that I could find my own direction in life. I needed to heal from the trauma and to be supported with love and encouragement.” – NADIYAH SHEREFF traditional group care setting became pregnant within two years, the same was true for only 26.9 percent of those who received the intervention.63 In addition, the juvenile justice system rarely meets medical needs related to sexual abuse that girls have experienced, including gynecological and obstetric care. Although the national prevalence of adolescent pregnancy among justice-involved girls is unknown, several local studies have found that a significant percentage of girls in the juvenile justice system are or have been pregnant,64 and the risk for adolescent pregnancy is increased by childhood trauma and sexual abuse.65 In a survey of girls in the juvenile justice system, The National Crittenton Foundation found that 49 percent of the young mothers in the study reported a history of sexual abuse.66 Most juvenile justice facilities are unaccredited and do not offer specialized services for pregnant girls who have been sexually abused. Nor are they in compliance with standards of pediatric or reproductive health care for incarcerated populations established by the American College of Obstetricians and Gynecologists and other accrediting organizations such as the National Commission on Correctional Health Care.67 In one recent national survey by OJJDP, only 18 percent of juvenile justice facilities provided the basic service of pregnancy testing at entry.68 Moreover, pregnant girls in some juvenile justice facilities report being shackled, hungry, and without access to prenatal and parenting education.69 Yet mental health services can yield important and positive results for girls. A study in Florida that examined girls after release, for example, found that those who received mental health care services were 37 percent less likely to re-offend, and another found that two years after release, girls who were provided a trauma-based intervention had reduced rates of recidivism compared to girls in generic group care.62 Meanwhile, a recent study in Oregon found that girls living in out-of-home placements who were provided with a trauma-based intervention were far less likely to become pregnant: while 46.9 percent of girls in the In addition to the insufficient treatment of trauma-related health needs, conditions in juvenile justice systems risk re-traumatizing girls. Routine procedures, including the use of restraints and strip searches, as well as the isolating, punitive environment itself, can be particularly harmful to victims of trauma by triggering their traumatic stress symptoms.70 A 2012 Texas Criminal Justice Coalition study of incarcerated girls illustrates the issue. In that study, 46 percent of participants reported that the staff, programs, and treatment in county juvenile justice facilities did not help them deal with past trauma in girls’ paths of sexual abuse into the juvenile justice system their lives; 4 percent said their time in county facilities did more harm than good in dealing with past trauma. State facilities fared only marginally better: 30 percent of surveyed girls reported that their time in the state secure facility was unhelpful in addressing past trauma. Significantly, 8 percent reported that the state facility had done them more harm than good.71 Girls in such conditions tend to respond by internalizing their negative experiences, entering into depression or engaging in self-harm. 72 These reactions can increase the risk of additional harm.73 According to the National Child Traumatic Stress Network, “[m]any characteristics of the detention environment (seclusion, staff insensitivity, loss of privacy) can exacerbate negative feelings and feelings of loss of control among girls, resulting in suicide attempts and self-mutilation.”74 In addition, some girls experience new incidents of sexual victimization while in the system.75 Taken together, lack of appropriate care and re-triggering conditions can lead to a harmful cycle of trauma that often turns inward. For girls who are sent into the juvenile justice system because of behavior based on their reaction to trauma – such as running away from home to escape an abusive caretaker — detention is an unjust and harmful practice. These girls are not a threat to public safety.76 Arresting and detaining them effectively punishes girls for being victims, and it fails to provide the services necessary to heal and recover. It is simply an unacceptable response to child sexual abuse. Dismantling the Pipeline: Policy Recommendations to Reduce Traumatized Girls’ Arrest and Incarceration. Strengthen the JJDPA. Passed in 1974, the Juvenile Justice and Delinquency Prevention Act (JJDPA) is the single most comprehensive federal legislation that governs conditions of confinement for youth and delinquency prevention. The JJDPA sets standards for states’ operation of juvenile justice systems, provides federal funding to improve the juvenile justice system and to prevent delinquency, and establishes State Advisory Groups, among other provisions. The JJDPA, however, has not been reauthorized since 2002. Reauthorization of the JJDPA is critical to funding services, innovation, and creating new standards that will reflect over a decade of research and the development of best practices to serve the needs of children in the juvenile justice system. As part of the reauthorization process, we recommend the following changes to the JJDPA to improve conditions for girls in the juvenile justice system: • • • • • • • Implement accountability mechanisms to ensure that states to comply with standards and guidelines for gender-specific services, including issuing annual public reports on progress towards compliance with standards and guidelines. Increase funds available to incentivize states to create gender-specific, trauma-informed prevention and treatment programs and services. Require at least one State Advisory Group member to have expertise in gender-specific issues, such as sexual abuse and domestic child sex trafficking, as well as knowledge of effective interventions. Require states to employ validated, comprehensive screening and assessments to evaluate all children entering the juvenile justice system for trauma and to develop appropriate treatment plans and programming in response to identified needs. Require states to screen children at intake for commercial sexual exploitation and divert identified victims away from the juvenile justice system whenever possible. Explicitly prioritize funding for the development of programs to train law enforcement officers and other juvenile justice system staff to better identify and respond to trauma. Require states to evaluate the effectiveness of juvenile justice programs that address the needs of girls; develop plans to remedy identified gaps and deficiencies; and report on progress annually. 15 girls’ paths of sexual abuse into the juvenile justice system • Require the collection of data on girls in the juvenile justice system and their outcomes disaggregated and cross tabulated by race and ethnicity, including the following information: →→ The number of victims of commercial sexual exploitation involved in the juvenile justice system. →→ The conditions of confinement for girls, including frequency of solitary confinement or isolation, strip searches, shackling during childbirth, inappropriate use of restraints, or other practices that may exacerbate girls’ trauma. →→ The number of pregnant and parenting girls in the system and the treatment they receive, from pregnancy testing through postpartum care and new- 16 parenting services. Further the Work of OJJDP’s National Girls Initiative. Promising work has been initiated by the OJJDP, which oversees compliance with the JJDPA. Through its Girls Study Group and National Girls Initiative (NGI), OJJDP has elevated a focus on girls in the juvenile justice system. The current Administrator, Robert Listenbee, has expressed his strong commitment to improving the juvenile justice system for girls. We applaud these efforts and urge that NGI receive the appropriate funding and support to engage in the following actions: • • • • Issue regulations interpreting the JJPDA requirements for the creation and implementation of gender-specific policies and programming. Assist OJJDP in enforcing JJDPA requirements to create and implement gender-specific services. Convene a coalition and seek input from broad, diverse sources to develop clear guidelines and best practices for gender-responsive programming and policies. Develop training and technical assistance for states seeking to create more gender-responsive programming and policies. • Identify and develop other sources of federal funding to support the creation of community-based, gender-responsive, and traumainformed programming such as the Juvenile Accountability Block Grant Program (JABG) and the NGI Innovation Awards. Fully Enforce — and Strengthen — the Prison Rape Elimination Act. The Prison Rape Elimination Act (PREA) is a powerful tool that can help prevent abuse against girls in juvenile justice if effectively enforced. Under the law, facilities must screen inmates for a history of sexual abuse and provide appropriate medical and mental health care within 14 days of intake.77 Youth who are victimized while in a facility, meanwhile, must have timely access to emergency medical and crisis intervention services.78 PREA standards also limit procedures that are likely to trigger re-traumatization, such as pat-downs by officers of the opposite sex, strip searches, and solitary confinement. And the law requires state facilities to collect data on allegations of sexual abuse, aggregate the data at least yearly, and make that data publicly available.79 Although these provisions represent progress, enforcement mechanisms are weak. There is no private right of action to enforce PREA’s standards. And while the US Department of Justice may reduce by 5 percent federal grant funds to states that fail to certify compliance, a state can avoid that penalty as long as the governor “submits an assurance that such 5 percent will be used only for the purpose of enabling the state to achieve and certify full compliance with the standards in future years.”80 No deadline has been imposed for states to come into compliance.81 PREA would be a more effective means of preventing and addressing violence against girls in juvenile justice if amended in the following ways: • Provide for mandatory penalties if states fail to adopt and comply with federal standards within a reasonable period. girls’ paths of sexual abuse into the juvenile justice system • • • • Limit the time that a state can offer an assurance before funding is cut. Define the required “timely” crisis intervention services as within 12 hours of a resident’s filing a complaint under the law. If an assault disclosed at intake occurred shortly before entering the facility (within a week), reduce the maximum allowable timeframe for states to provide victims with access to mental health and medical services to three days from the current 14-day standard. Require foster homes and congregate care facilities to comply with PREA and federal standards if they enter into contracts with juvenile justice agencies.82 Provide Gender-Specific Physical and Mental Health Care In Justice Settings. Girls need access to trauma-informed and gender-specific health care — not only to improve their wellbeing over the long term, but also to reduce the likelihood of recidivism. 83 The Multidimensional Treatment Foster Care model is one approach that has been shown to be effective in reducing recidivism among girls.84 Juvenile justice systems should ensure that girls’ mental health needs are adequately identified, assessed, and treated while in the system, and that girls have access to necessary mental health care when they re-enter their communities. Implement Gender-Specific Health Screening and Assessment. State and local jurisdictions should require facilities to implement gender-specific health screening at intake. The Girls Health Screen (GHS), developed by Leslie Acoca of the National Girls Health and Justice Institute, is a helpful model to guide the development of gender-specific medical triage in juvenile justice settings.85 Currently, it is the only validated health screening tool tailored specifically to girls in state custody,86 and it has been effectively implemented in juvenile justice facilities in three California counties.87 Comprehensive follow-up assessments can help inform treatment plans. Require Facilities to be Accredited for the Provision of Medical Care. The National Commission on Correctional Health Care (NCCHC) has promulgated widely accepted standards for health care in correctional settings. Compliance, however, is not mandatory, and many juvenile justice facilities remain unaccredited.88 As a result, compliance with established standards of pediatric care is low or non-existent. According to the American Academy of Pediatrics Committee on Adolescence, “[D]ata from 2004 showed that overall, fewer than half of the facilities were compliant with recommended health screening and assessments. Few detention facilities met even minimal levels of care, although better care was seen as the length of stay increased.”89 Policymakers at the federal, state, and local level should mandate accreditation. Provide Comprehensive Reproductive Health Care. The juvenile justice system should adopt a coordinated and integrated approach to reproductive health needs in addressing girls’ high rates of sexual abuse.90 Most fundamentally, juvenile justice facilities should be required to meet the comprehensive standards for women’s physical and reproductive health care developed by the NCCHC91 and adhere to guidelines like those established by the American College of Obstetricians and Gynecologists (ACOG), the American Public Health Association, and the Juvenile Detention Alternatives Initiative of the Annie E. Casey Foundation.92 Consistent with a 2011 report by ACOG’s Committee on Health Care for Underserved Women, for example, protocols should include mandatory assessment for pregnancy risk at intake and follow-up pregnancy testing as appropriate. The shackling of pregnant young women during labor and delivery should be strictly prohibited.93 In addition, given the unique reproductive health consequences of trauma and abuse, juvenile justice systems should work with specialists to integrate mental health treatment into reproductive health treatment and services. 17 girls’ paths of sexual abuse into the juvenile justice system school discipline: girls, violence, and the school to prison pipeline 18 Sasha was raped as a high school student. When news of the rape was circulated in social media, she was ridiculed by her classmates, making it impossible for her to feel safe at school. Sasha immediately became truant. For six months, Sasha’s mother unsuccessfully appealed to school district administrators to transfer Sasha to a safer school environment. In an effort to ensure that Sasha still received her education, her mother attempted to home school her, but the school district threatened to refer Sasha to the child welfare system for keeping her out of school. Because of her extensive, unaddressed trauma and fear for her own safety, Sasha refused to go to school and ultimately dropped out. After two years out of school and without receiving trauma-related services, she was arrested on petty theft charges. Only after her arrest was Sasha referred to a therapist who identified her trauma as the cause of her truancy. With the assistance of an educational advocate, Sasha applied and was accepted to an alternative school that provided a small therapeutic setting and a second chance at graduation.98 Sasha’s story illustrates a common problem. When schools fail to support girls who are victimized by gender-based violence and harassment on campus, girls no longer feel safe and as a result may disengage, become truant, or exhibit challenging behaviors that are rooted in the trauma they have experienced.99 Yet instead of being viewed as victims of sexual violence, these girls are often disciplined, Include Trauma-Related Health Treatment in Re-entry/Aftercare Plans. As described above, sexual abuse is a unique predictor of recidivism for girls.94 The period immediately after release is when girls are at the highest risk of recidivism and serious harm. The original underlying abuse, for example, may resume; or girls may deal with unresolved trauma by using coping strategies that increase girls’ risk of re-entry, such as substance abuse or running away. To lessen this risk, re-entry planning should include an attempt to connect girls with trauma-related health resources in the community.95 including being suspended, expelled, or referred to law enforcement.100 In Norman, Oklahoma, for example, after rumors spread about the rape of three female students by a male peer, the school reportedly did not act to stop the repeated harassment of the victims. In fact, when one of the rape victims swung a heavy book bag at a student who stated “I hear you like being raped in the ass,”101 she was suspended along with the student who harassed her.102 More research should be conducted to study the rates at which girls experience sexual violence in school and how schools handle these incidents, including the services they provide to the victims.103 Meanwhile, school districts should abandon zero-tolerance disciplinary policies104 for victims of sexual violence on campus and consider whether a given violation of school policy was caused by the initial trauma of sexual victimization. As stated by the Illinois State Board of Education Ensuring Success in School Task Force, “When there is a relationship between the survivor’s behavior and the survivor’s experience of violence — for example, when students engage in acts of self-defense — schools need to be flexible and modify punishment appropriately.”105 This recommendation reflects the need to recognize the link between girls’ reactive behaviors and underlying initial trauma and train staff to respond accordingly. Although juvenile justice systems often operate with limited financial and case management resources to address issues that may arise after release, Medicaid and CHIP funds can be used to finance some trauma-related health and mental health services, as detailed below.96 At a minimum, states should require juvenile justice systems to assist youth in enrolling in health care coverage before release to eliminate unnecessary administrative barriers to accessing mental health and trauma services during this critical time.97 Ideally, every girl released from the juvenile justice system should have a community provider identified as part of her aftercare treatment plan. girls’ paths of sexual abuse into the juvenile justice system lived experience of the sexual abuse to prison pipeline: victims of sex trafficking jailed as offenders “Suffering, isolated, tired and helpless at the age of 15, the concrete box that represented my cell in Zenoff Hall, the girls’ section the largest of the juvenile facility in Las Vegas, Nevada, seemed no less invasive than the horror of the streets. As much of a real physical confinement as it was, it wasn’t all too different than the mental confinement I endured from my pimp. I was interrogated for hours on end, reminded that my opinions didn’t matter, and locked in like a dog in a kennel. Unless I was saying the answers to the questions that they wanted to hear, my voice was irrelevant. Skip ahead a few years later, I endured it again in California, only that time experiencing my seventeenth birthday within the juvenile hall walls. Both times I was faced with charges of solicitation and/or prostitution, a crime that as a minor who wasn’t of legal age to consent to sex, couldn’t seriously be charged to commit. But yet, there I was, facing them. To my agony, I comprehended this as yet another system that failed me … I was re-traumatized every day in detention while having to be watched, fully nude, while I showered. No one assessed me or ever even asked me what got me there, no rehabilitation services were offered. I just sat locked in a box while being interrogated and talked-down to.”106 19 — Withelma “T” Ortiz Walker Pettigrew One of the grimmest examples of the sexual abuseto prison pipeline is the detention of girls who are bought and sold for sex. Child sex trafficking* is child sexual abuse. And it is abuse that is often layered over pre-existing trauma: children who have been sexually abused are especially vulnerable to traffickers. Yet many jurisdictions still view victims of child sex trafficking as perpetrators. These girls are arrested on charges of prostitution even though they are too young to legally consent to sex.108 Although child welfare agencies are charged with the task of responding to child sexual abuse cases and have often had previous interactions with exploited youth, they do not — and in many states, cannot — function as an alternative to incarceration unless the trafficker is a parent or “caretaker,” as defined by state law.109 As a result, trafficked children, who are victims of statutory rape or child abuse, are sent into the juvenile justice system — imprisoned as a direct consequence of their victimization. A few states have adopted legislation or regulations to allow child welfare to respond to child sex trafficking victims.110 But even when child welfare systems can respond to child sex trafficking, too often they do not.111 In the worst cases, where children are poorly cared for, the child welfare system inadvertently plays a part in making girls vulnerable to exploitation. When girls who grow up in the child welfare system — especially children who have been placed in multiple homes — live without stability or safe, supportive family attachments, it can render them vulnerable to the manipulation of traffickers who promise to love and care for them.112 Indeed, some traffickers purposely troll for youth in certain group homes because they are aware of this vulnerability. As one report in California stated: Exploiters know where foster care group homes are and they directly recruit girls from these settings — they prey on the kids they know are the most vulnerable. Exploiters also use coercion and threats to force these * Domestic Minor Sex Trafficking: Hearing before the H. Subcomm. on Crime, Terrorism & Homeland Security of the H. Comm. on the Judiciary, 111th Cong. 4 (Sept. 15, 2010) (testimony of Ernie Allen, President & CEO, Nat’l Ctr. for Missing & Exploited Children). girls’ paths of sexual abuse into the juvenile justice system young girls to recruit other youth living in the group home.113 We know too little about the lives of trafficked girls and the experiences of girls in child welfare. More research is urgently needed to learn how many American girls are trafficked each year, as well as the percentage of trafficked girls in child welfare, given their significant abuse histories and unique vulnerability. 20 Recently enacted legislation may help the child welfare system support girls in their care who are trafficked or at-risk and help them avoid crossing over into juvenile justice: the Preventing Sex Trafficking and Strengthening Families Act. This law requires states to identify, document, and determine appropriate services for children in the child welfare system who are victims of sex trafficking or at risk of becoming victims. It also allows them to track child victims of sex trafficking under the Adoption and Foster Care Analysis and Reporting System before and during their time in foster care. Importantly, the law also requires the child welfare system to report children who are missing from foster care placements to law enforcement and the National Center for Missing and Exploited Children within 24 hours.114 Further guidance is needed to assist states in collecting data from the child welfare and juvenile justice systems, identifying and developing appropriate screening tools, and ensuring that services are gender-specific, trauma-informed, and culturally competent. Dismantling the Pipeline: Policy Recommendations to Keep Victims of Sex Trafficking Out of Juvenile Justice. End the Arrest and Detention of Youth for Prostitution. State laws and delinquency codes should define children under the age of 18 who engage in commercial sex acts as per se victims of trafficking, and they should prohibit the arrest, detention, and prosecution of children for prostitution, prosti- tution-related offenses, or other acts related to their sexual exploitation. Such laws would be consistent with state laws that declare minors to be legally incapable of consenting to sex, as well as federal law, which defines any act of commercial sex with a person under the age of 18 as a severe form of trafficking in persons.115 Enact Effective and Universal Safe Harbor Laws. States that continue to allow the arrest and detention of children on prostitution charges should enact safe harbor or immunity laws to ensure that trafficked youth are treated as victims, not perpetrators. Several states have adopted these laws. The provisions of existing safe harbor laws vary, but all strive to direct child victims of sex trafficking into appropriate treatment services and divert them from juvenile justice involvement. To be fully effective, safe harbor statutes should at minimum include the following elements: • Funding mechanism and/or partnership with child welfare system to ensure provision of comprehensive services to victims and appropriate alternatives to arrest, detention, and prosecution; • Eligibility of all minors under the age of 18; • Eligibility of all victims of sex trafficking, regardless of whether they enter the system on prostitution charges; • Immunity from arrest and prosecution when the charging offense is directly related to the child’s exploitation and victimization; and • Fully funded court diversion programs when immunity is not an option. Diversion programs avoid detention and instead provide child victims with essential services. Victims avoid acquiring records and instead may receive specialized and individualized treatment, including family support services, essential life skills training, and assistance with job placement, as well as housing, education, and vocational skills. girls’ paths of sexual abuse into the juvenile justice system 21 ending violence against girls by ending demand As with all markets, even illicit ones, sex trafficking is driven by both supply and demand.117 To date, most enforcement efforts at the federal and state levels focus on the victims and the traffickers. Laws that criminalize the act of sex with minors118 are too rarely enforced in the context of child sex trafficking. In many cases, child-sex buyers escape with little or no accountability, despite the traumatic effect of their acts on the victims. To help put an end to the commercial sexual exploitation of children, advocates and lawmakers should: • Educate the public on the role of buyers in perpetuating systematic violence against underage girls and other vulnerable youth; • Increase training of law enforcement and prosecutors on investigations and pros- ecutions of child-sex buyers and redirect resources to scale up operations against buyers rather than criminalizing victims; • Instruct federal and state anti-trafficking task forces throughout the country to target buyers of child sex in their operations; and • Encourage the use of federal anti-trafficking statutes and state laws that criminalize sex with minors to prosecute buyers of underage girls. A targeted strike against demand from both a cultural and legal standpoint would weaken the market for commercially sexually exploited youth and help combat this form of genderbased violence. girls’ paths of sexual abuse into the juvenile justice system lived experience of the sexual abuse to prison pipeline: detention of girls for status offenses “I was locked up ten different times within a two year period. Inside juvie I met other girls like myself who were there for prostitution, running away, and truancy. All of us were from the same neighborhoods, poor families, and seemed to have the same disposition of trauma, anger mixed with hopelessness. We were not violent girls. We were girls who were hurting. Being confined to a tiny cement room was one of the hardest things I have ever had to experience. Being locked up all I could do was reflect on my life but it didn’t seem to help. I became even more withdrawn and angry.” — Nadiyah Shereff 22 Status offenses such as truancy, running away, or curfew violations are acts that are unlawful only when committed by youth. Unlike juvenile delinquent offenses, the acts are defined by the perpetrator’s age.119 Girls are disproportionately involved in the juvenile justice system for status offenses at critical stages of the process, including petitions, which initiate a case; detention; and judicial dispositions that result in out-of-home placement at residential centers, foster homes, or correctional facilities.120 In 2011, for example, girls accounted for 28 percent of all petitioned delinquency cases, but 41 percent of petitioned status offense cases.121 Strikingly, girls comprised only 16 percent of the overall detained population in 2011, but almost 40 percent of youth detained for status offenses.122 Finally, girls accounted for 40 percent of status offense cases that resulted in out-of-home placement in 2011, although they were just 12 percent of youth receiving such dispositions overall.123 Status offenses can often be seen more comprehensively when viewed in the context of trauma. The root cause for committing status offenses is often tied to abuse, such as running away from an abusive home or failing to attend school because a trafficker is forcing a girl to “work.”124 For example, as recently stated in a brief prepared for the National Child Traumatic Stress Network: “Youth who have experienced chronic trauma do not believe that the adults around them can or will protect them, and sometimes they are right. What is interpreted as delinquent behavior or pointless acting out is often their attempt to assume the burden of taking care of themselves.”125 Consistently, girls are disproportionately affected by the enforcement of the status offense of running away.126 Over the past twenty years, girls have accounted for approximately 60 percent of runaway cases.127 It is the only petitioned offense in recent years other than prostitution for which the majority of youth offenders are girls.128 Yet running away is often a response to sexual abuse,129 which contrib- girls’ paths of sexual abuse into the juvenile justice system utes to a harmful cycle: when girls with a history of sexual abuse run away, they are more likely to be commercially sexually exploited130 or engage in other behavior that increases their risk of involvement in the juvenile justice system. Research indicates that, in turn, when a girl returns home after release, if the juvenile justice system failed to address the underlying abuse, she remains at high risk of subsequent sexual victimization throughout her life.131 Despite the link to sexual abuse, of all status offenses, runaway cases have most consistently resulted in detention and out-of-home placement adjudication over the past two decades.132 Greater attention should be directed at the trauma underlying these minor offenses and away from detention. Dismantling the Pipeline: Policy Recommendations to Decrease the Disproportionate Effect of Status Offense Enforcement on Girls. Close the Valid Court Order Loophole. The Juvenile Justice and Delinquency Prevention Act (JJDPA) prohibits youth from being incarcerated for status offenses.133 In 1980, however, Congress created a loophole in that ban: the Valid Court Order (VCO) exception. The VCO exception allows children to be detained if they violate court orders that prohibit them from committing enumerated status offenses. For example, if a court issues an order that forbids a girl from running away, she can be sent into the juvenile justice system under the VCO exception if she later does so. The VCO exception undercuts the JJDPA’s core requirement that youth should not be detained for status offenses. In 2010, in recognition of the problem, the National Council of Juvenile and Family Court Judges, which had originally advocated for the exception, called for the phaseout of the VCO.134 Some states have voluntarily chosen to do so, but they remain in the minority.135 Because girls are disproportionately charged with and detained for status offenses, closing this loophole would particularly benefit girls. We recommend that all states adopt legislation closing the VCO loophole, and that the federal government provide incentives for them to do so in a reauthorized and strengthened JJDPA. Provide Law Enforcement Training on Gender Bias and Gender Stereotyping to Decrease Girls’ Contact with the Justice System. The disproportionate effect of the enforcement of status offenses on girls is part of a broader trend sometimes referred to as “net widening,” in which law enforcement policies and practices arrest, detain, and incarcerate more youth for less serious offenses.136 Net widening has resulted in an increase in girls’ involvement with the juvenile justice system over the past twenty years.137 But girls who commit low-level violations and who do not pose a risk to public safety do not belong in the justice system138 — especially those whose behavior stems from sexual abuse. Training is required to understand implicit and structural gender and racial bias that results in the disproportionate rates of girls entering the system, and to better recognize trauma. The National Child Traumatic Stress Network has produced several resources on recognizing trauma in the juvenile justice system, including bench cards to help judges recognize and respond to the impact of trauma on children139 and a brief on trauma among girls in the juvenile justice system.140 Similar guidance should be expanded and deepened to include information about the effect of gender bias and stereotyping on public systems’ perceptions of and responses to girls’ behavior, as well as ways to ensure that trauma assessments are integrated into treatment plans. 23 girls’ paths of sexual abuse into the juvenile justice system in focus: dual-system youth and the sexual abuse to prison pipeline Youth who have been involved in both the juvenile justice and child welfare systems — known as crossover, dual-system, or dually involved children141 — are some of the most vulnerable children in state custody,142 and they are disproportionately female:143 girls comprise one-fifth to one-quarter of the juvenile justice population, but one-third to one- 24 half of dual-system youth.144 A Los Angeles report, for example, found that of the first-time juvenile offenders studied who were also involved in the child welfare system, 37 percent were female, although girls comprised only 24 percent of first-time offenders who were not involved in child welfare.145 Girls are disproportionately represented in the dually involved youth population. Youth in Juvenile Justice: 1/5 to 1/4 are girls. Dually Involved Youth: 1/3 to 1/2 are Girls. Source: Denise Herz Et Al., Georgetown Univ., Ctr. for Juvenile Justice Reform, Addressing the Needs of Multi-System Youth: Strengthening the Connection Between Child Welfare and Juvenile Justice 1 (Mar. 2012), available at http://cjjr.georgetown.edu/wp-content/uploads/2015/03/MultiSystemYouth_March2012.pdf. girls’ paths of sexual abuse into the juvenile justice system Research by the National Council on Crime and Delinquency (NCCD), meanwhile, found that gender non-conforming girls are especially vulnerable to juvenile justice involvement after contact with the child welfare system.146 (NCCD’s findings are consistent with several studies that indicate that LGB girls and GNC youth are particularly at risk of juvenile justice involvement and face distinct safety risks in public systems.147) The consequences of crossing into the juvenile justice system are significant. The risk of recidivism is higher for foster care youth than for their peers. One study of dual-system youth, conducted two years after release from juvenile justice, found that 70 percent had re-entered the justice system, compared to 34 percent of their peers who had not had contact with the child welfare system.152 Meanwhile, a significant percentage of dualsystem youth languish in the juvenile justice system for a longer time than their non-childwelfare-involved counterparts, and they are more likely to be involved in the criminal justice system as adults.153 Collaboration between the juvenile justice and child welfare systems can help prevent crossover. Inter-agency cooperation can improve the development of treatment plans and better inform judges in deciding whether to detain girls or divert them from juvenile justice.154 To that end, some jurisdictions have begun screening for child welfare involvement at the time of arrest. A helpful model is the Crossover Youth Practice Model (CYPM), developed by the Center for Juvenile Justice Reform at Georgetown University. CYPM is a dual-system approach that works to reduce foster youth involvement in the juvenile justice system, out-of-home-placements, congregate care placement, and pre-adjudication detention, as well as increase families’ participation in the decision-making process.155 Dismantling the Pipeline: Policy Recommendations to Reduce Foster Girls’ Crossing Over Into the Juvenile Justice System. • • • Implement screenings upon entry into the child welfare system to identify a history of trauma. Develop cross-system collaboration between the juvenile justice and child welfare systems. Implement models like CYPM, adding genderresponsive components to improve services and outcomes for dually involved girls. Limit providers’ referrals to law enforcement to manage challenging behaviors.161 25 the crossover pathway for girls of color The crossover pathway is especially significant for African-American youth, who are involved in the child welfare system at 2.26 times their representation in the general population of children148 and, once there, are disproportionately likely to become involved in the juvenile justice system.149 A study of one county found that 27 percent of African-American girls in juvenile detention had an open child welfare case compared to 7 percent of youth overall and 13 percent of African-American boys.150 Research shows that children of color in the child welfare system face disparities in outcomes compared to white youth. They are less likely to be reunited with families, more likely to be placed in congregate care settings, less likely to exit child welfare with a permanent family, and face worse long-term outcomes in academic achievement, health, and other areas than their white peers.151 girls’ paths of sexual abuse into the juvenile justice system Girls who have experienced abuse often engage in challenging and, at times, defiant and disruptive behavior, which is a common response to trauma. When foster families and caregivers are not adequately trained to address these behaviors, they sometimes call law enforcement to control the children in their care.162 But as described above, the juvenile justice process is likely to be significantly harmful and risk re-traumatizing these youth. To avoid this cycle, providers who apply for contracts to work with vulnerable children should be required to demonstrate that they are qualified to address these trauma-rooted behaviors without resorting to calling the police except in extreme circumstances. Meanwhile, child welfare agencies should be required regularly to collect data on provider referrals to law enforcement based on behavior while in their care or otherwise related to placement. Such data, which should be publicly available, should be analyzed to develop policies and practices to improve providers’ handling of crisis situations and end unnecessary shunting of child welfare youth into the juvenile justice system. 26 the role of group homes the role of law enforcement Poorly supervised group homes and other congregate care facilities that do not implement specialized protections and trauma-informed treatment supports can play a significant role in the sexual abuse to prison pipeline. According to one study, girls with a history of sexual abuse are more likely to be placed in a group home or congregate care facility.156 Placement in congregate care, in turn, doubles the risk of juvenile justice involvement for girls – though it does not have the same effect on boys.157 Preliminary research suggests that the reason for this increased risk of juvenile justice involvement for girls is unsafe living conditions in congregate care, including a higher risk of sexual abuse and physical abuse by staff and other youth.158 This abuse may lead girls in these placements to develop coping strategies that increase their risk of justice involvement, as described in this report. Youth in foster care sometimes enter the juvenile justice system because their residential placements do not adequately address the behavioral challenges common among girls who have experienced severe abuse, and instead rely on law enforcement to control the behavior of youth in their custody.159 At least one-third of arrests for crossover youth are related to their child welfare placement. In most cases, the arrest is the result of an incident that occurred within the youth’s group home.160 27 CHILD WELFARE AND THE SEXUAL ABUSE TO PRISON PIPELINE: IDENTIFYING AND TREATING TRAUMA IN THE CHILD WELFARE SYSTEM child welfare and the sexual abuse to prison pipeline Child welfare systems can act as a leading force in helping prevent and respond to girls’ trauma. Although it is challenging for underfunded and overburdened child welfare systems to fully accommodate the needs of girls struggling with complex needs, failing to do so carries consequences that are significant and enduring. 28 Histories of sexual abuse appear to be vastly underreported in the system, given the surprisingly low rate (9 percent) of child welfare cases that are initiated based on sexual abuse allegations.163 One reason for the low rate may be that child welfare cases focus on the actions of the caretaker. This practice excludes incidents in which girls are sexually abused by others. To address the needs of all girls who are victims of sexual abuse, regardless of the perpetrator, the child welfare system should screen all youth for a history of sexual abuse at entry, irrespective of the reason their case was initiated. Each year, approximately 190,000 girls live in foster care, but little research has been collected on their histories of sexual abuse or their outcomes.164 In one of the few studies to examine the issue, 54 percent of foster care girls reported a history of sexual abuse.165 In addition, girls who had experienced sexual abuse fared worse in the system than other girls in foster care: they changed placements twice as often; they were more likely to have been placed in a restrictive placement or congregate care setting (64 percent vs. 35 percent);166 they were more likely to exhibit mental health symptoms (37 percent vs. 18 percent);167 and they were almost twice as likely to have been involved in the juvenile justice system (41 percent vs. 24 percent).168 Another study similarly found that sexual abuse significantly increased the risk of multiple placements and adoption disruptions.169 Meanwhile, as previously mentioned, sex trafficking of girls in foster care is clearly an issue, though its prevalence is unknown. The primary mission of the child welfare system, of course, is to care for children who have experienced abuse, violence, or neglect. Some jurisdictions have made important progress by implementing traumainformed care. But these efforts are not yet sufficiently uniform or widespread. States can do more to improve systems’ identification and assessment of trauma and abuse, enhance the provision of services, and build stronger partnerships with other public systems that play key roles in serving traumatized girls, including schools and the mental health field. According to research by the National Child Traumatic Stress Network (NCTSN), significant work lies ahead: Despite the extraordinary number of children in foster care who have experienced traumatic events and are exhibiting traumatic stress symptoms, and the growing body of science about efficacious treatments for child traumatic stress, few child welfare agencies across the nation integrate trauma knowledge into their practices, policy, training, performance standards, or assessment and have evidence-based trauma-specific interventions available in their community or their service continuum, including mental health contract portfolios.170 In a 2005 study conducted in 11 geographically diverse jurisdictions, NCTSN conducted interviews with staff who serve traumatized youth, including the child welfare system, dependency and family courts, foster care agencies, mental health agencies, and schools, and found the following: • • • Child welfare workers seldom receive in-depth information about a child’s trauma history when a child is first referred to them by another agency or system. Many agencies do not conduct a standardized post-traumatic stress assessment with a child who has experienced maltreatment and has been referred to the child welfare system. Fewer than half of those interviewed trained staff on available evidence-based treatments for child traumatic stress. child welfare and the sexual abuse to prison pipeline • • Over a third of those interviewed conducted no staff trainings on assessment of child trauma. About a third of those interviewed said that they never make referrals to a treatment provider or placement based on use of evidence-based practices; another third said they rarely did so.171 In light of the substantial harms inflicted by sexual abuse, it is critical to ensure that child welfare systems fully assess children’s histories of trauma and abuse and develop comprehensive supports, protocols, and protections when incidents of abuse are disclosed about youth in their care. Although it will be complex and challenging work that will require collaboration among the health system, child welfare system, and juvenile justice system, as well as a recognition of the significant overlap in the populations of children they serve, this urgent issue must be addressed to better serve girls and steer them away from the juvenile justice system.172 Dismantling the Pipeline: Policy Recommendations to Improve the Child Welfare System’s Response to Girls. Improve the Child Welfare System’s Identification of Victims of Abuse and Implement a Gender-Responsive Approach to Victims of Abuse. • Develop and implement high-quality trainings for staff on how to prevent, identify, assess, and respond to children who enter the system with a history of sexual abuse, including commercial sexual exploitation. Promising training has been developed by the National Child Traumatic Stress Network.173 • Extensively train foster parents and kinship caregivers on the risks of sex trafficking and how to mitigate them. For those girls who already have a history of being trafficked, and who may continue to maintain a connection to their former traffickers, specially trained foster homes should be considered, akin to therapeutic foster placements and specialized foster placements for pregnant and parenting teens.174 • Implement system-wide gender-responsive protocols for trauma screening and assessment of girls to identify urgent needs relating to violence and abuse. • Administer an immediate and thorough assessment when abuse is identified by a qualified mental health professional. • Implement mechanisms to ensure that all caregivers receive updated results of mental health assessments to ensure appropriate treatment. • Coordinate meetings with girls’ teams of professionals and other caregivers to discuss the assessment as the baseline for developing an effective treatment plan consistent with practices developed by the National Child Traumatic Stress Network, including referrals out of the system to provide appropriate services where necessary. • Use culturally appropriate, evidence-based assessment tools and treatment plans to address traumatic stress and associated mental health symptoms. • Increase federal child welfare funding to support the most effective strategies for girls and their families and create federal standards for gender-specific child welfare practices. The two primary sources of federal financing for child welfare services, Title IV-E and Title IV-B of the Social Security Act,175 are significantly underfunded. Congress should increase funding to these programs to better serve children. As part of this effort, it should incentivize states to decrease overreliance on group homes that are unstable and that fail to address girls’ complex needs; instead, it should emphasize placing more youth in family-like settings and therapeutic foster care and providing services at home, consistent with research that shows these methods so serve foster youth most effectively.176 Finally, it should incentivize states to provide front-line child welfare workers with professional training on best practices in trauma-informed approaches. 29 child welfare and the sexual abuse to prison pipeline Use Medicaid Funds to Improve Quality Care and Trauma-Related Services for Girls in Child Welfare. Medicaid is currently underutilized as a tool to help youth who have experienced trauma. Medicaid funds can be better used to cover the cost of certain trauma-related services needed by abused and neglected girls in state custody, including multi-systemic therapy and functional family therapy, two of the most commonly recommended evidence-based treatment services for system-involved youth. 177 Improve the Use of Medicaid to Cover the Cost of 30 Trauma-Related Care. Federal law requires Medicaid agencies to assess and improve the delivery of services for children in foster care.178 A 2013 guidance letter issued by the US Department of Health and Human Services (HHS) offers assistance to states to use Medicaid more effectively to cover the cost of trauma-related care, as well as design Medicaid treatment strategies for children and youth who have experienced trauma.179 Recommended strategies include using Medicaid funds to cover evidence-based screening and assessment practices, as well as home and community-based services for children exposed to trauma. Fully Utilize Medicaid’s Early Periodic Screening, Diagnostic and Treatment Benefit (EPSDT). The EPSDT applies to children enrolled in Medicaid, particularly those who have experienced trauma and require specialized health services as a result. This benefit covers services that physicians determine are medically necessary “to correct or ameliorate any physical and mental illness or conditions,”180 even if the conditions are not included in the state’s Medicaid plan.181 As such, it can cover many services that are commonly needed by children in state custody who have experienced trauma, such as cognitive behavioral therapy, crisis management services, peer support, family therapy, and targeted case management.182 Many states do not maximize use of this benefit, particularly for children with mental health needs.183 Use Medicaid to Connect Child-Welfare-Involved Children with Integrated Health Care Practices. For a variety of reasons — including periods of homelessness and running away, frequent placement changes, and involvement in the juvenile justice system — girls in foster care often lack consistent access to the coordinated health services they need to recover from trauma and abuse. Through the Affordable Care Act, the Center for Medicare and Medicaid Innovation (CMMI) has invested in integrated care models that “emphasize a person-centered, continuous, coordinated and comprehensive care” approach to health care.184 These models provide critical trauma-informed primary care for people with complex medical needs, including children in the child welfare system.185 An example of an integrated care model is the medical home. Medical homes are comprised of interdisciplinary teams of providers who develop individualized, coordinated plans 186 for people with chronic health conditions.187 The medical home model is especially well-suited for girls who have suffered abuse, because they address needs holistically, including mental and physical health and social service needs. They can also serve mobile or hard-to-reach populations. The American Pediatric Association has developed tools to help medical providers understand how this model can address the health needs of children exposed to violence,188 including training on medical issues associated with violence exposure, screening tools, and methods to engage families in violence prevention.189 Invest in Creating Safe and Supportive Group Homes with Specialized Services for Teenage Girls. Although family preservation is often a desirable outcome, there will always be girls for whom staying in a family or relative placement is not a safe option because of intra-familial abuse or other harmful environmental factors. Currently, there are not enough child welfare and the sexual abuse to prison pipeline family foster care options or adoptive parents to serve all children who need them. Identification of and investment in group homes that provide quality, specialized services to youth should be increased, while group homes that do not should be phased out. Youth themselves should be consulted in making these assessments and help identify improvements to better meet their needs. youth, and children with disabilities. Child welfare agencies and courts should prohibit refusals to serve youth based on their immutable characteristics and ban the practice of cherry-picking the most cooperative youth, which tends to exclude children who have experienced the most severe abuse and are in greatest need of services, increasing their risk of juvenile justice involvement. To complement these efforts, child welfare systems should ensure that effective and meaningful complaint procedures are in place to allow girls to seek protection and immediate placement changes when they feel unsafe. Federal standards of abuse or maltreatment of children in foster care are too limited to adequately address girls’ experiences and concerns,190 as revealed in a qualitative study on girls’ reports of abuse in foster care placements.191 At a minimum, all service providers should be required to demonstrate comprehensive child abuse prevention practices before receiving accreditation or grant funding. For group homes, these practices should be similar in scope to the PREA standards for juvenile Prohibit Child Welfare Agencies and Providers from Discharging Runaway Girls. Currently, child welfare systems can discharge youth who are on runaway status, and providers are not always required to hold beds for runaway youth, which contributes to placement instability and service disruption after a runaway child is located. Yet chronic episodes of running away are often indicative of violence and abuse, which, if untreated, increase these youths’ risk of harm and arrest. While these cases may be challenging to manage, effective strategies should be developed to continue to serve these vulnerable girls. justice facilities. Implement Policies that Improve Responses to the Behavior of Foster Youth Who Have Experienced Trauma and Abuse. In recognition of the challenging trauma-rooted behaviors that child welfare children often exhibit, the system contracts with specialized providers that can provide therapeutic interventions and help children heal. When these providers fail to manage the trauma-related behavioral challenges they have been hired to handle, they should not punish the girls in their care by calling on law enforcement except as a last resort, as detailed above. Implement “No Eject, No Reject” Policies to Prevent Discrimination and Guard Against “Cherry-picking” of Youth Among Child Welfare Providers. Under-funding and a shortage of beds leaves certain groups of children at particular risk, including older youth, pregnant and parenting youth, LGBT/GNC Require Continuing Crisis De-escalation Training for All Providers in the Child Welfare System to Help Staff Effectively Manage Trauma-rooted Behavior. Providing regular training and ongoing professional development support to front-line staff is critical to ensuring the well-being of youth in custody and ending the abuse to prison pipeline. 31 32 CONCLUSION conclusion Girls’ high rates of sexual abuse and their increased involvement in the juvenile justice system is not a coincidence. There is a direct correlation. Research has illuminated the link between girls’ trauma and the ever-widening law enforcement net in which girls are caught, most often on minor offenses. There is much work to do. We still do not know enough about this pipeline for girls. Research typically excludes girls from study samples, data is often not disaggregated by gender, race, and ethnicity, and public agencies do not collect information about trauma and gender-specific issues. The real and distinct lives of girls, especially when their lives play out at the intersection of race and gender, remain invisible. And when we lack the most basic information about girls’ unique needs and what is happening in their lives, especially against the backdrop of high rates of sexual violence, the battle to develop effective strategies for their health is an uphill one. We must take action to learn more about the systemic criminalization of victimized girls, who are disproportionately girls of color. In the context of the emerging and significant debate on the criminalization of boys of color, our report is a definitive call to recognize the harm that is girls’ experience. We hope that this report will fuel new conversations and a sense of urgency to recognize and remedy the unjust and injurious response to victims and survivors of sexual abuse. 33 34 ENDNOTES endnotes 1. 2. 3. 4. 5. 6. 7. 8. David Finkelhor, Gerald Hotaling, I.A. Lewis & Christine Smith, Sexual Abuse in a National Survey of Adult Men and Women: Prevalence, Characteristics, and Risk Factors, 14 Child Abuse & Neglect 1, 19-28 (1990); US Dep’t of Justice, Bureau of Justice Statistics, Sex Offenses and Offenders (Jan. 1997). White House Council on Women & Girls, Rape and Sexual Assault: A Renewed Call to Action 1 (Jan. 2014), available at https://www.whitehouse.gov/ sites/default/files/docs/sexual_assault_report_1-21-14.pdf. Callie Marie Rennison, US Dep’t of Justice, Office of Justice Programs, Bureau of Justice Statistics , National Crime Victimization Survey: Criminal Victimization 2000, Changes 1999-2000 with Trends 1993-2000, Table 2, at 6 (June 2001), available at http://www.bjs.gov/content/pub/pdf/ cv00.pdf. Emily G. Marston, Mike A. Russell, Ingrid Obsuth & Gillian K. Watson, Dealing With Double Jeopardy: Mental Health Disorders Among Girls in the Juvenile Justice System, in Delinquent Girls: Contexts, Relationships, and Adaptation 105, 122 (Shari Miller, Leslie D. Leve & Patricia K. Kerig eds., 2012); Selby M. Conrad, Nicole Placella, Marina Tolou-Shams, Christie J. Rizzo & Larry K. Brown, Gender Differences in Recidivism Rates for Juvenile Justice Youth: The Impact of Sexual Abuse, 38 Law & Hum. Behav. 4, 305, 309-310 (Aug. 2014) (“Childhood sexual abuse (CSA) is a potent risk factor for delinquency and subsequent juvenile justice involvement, especially for young women (Chesney–Lind, 1997; Gavazzi et al., 2006; Hubbard & Pratt, 2002).”); Stephanie Hawkins Anderson, Girls in the Juvenile Justice System: The Causes and Correlates of Girls’ Involvement, in Delinquent Girls: Contexts, Relationships, and Adaptation, supra at 44. Francine T. Sherman, Richard A. Mendel & Angela Irvine, Annie E. Casey Found., Making Detention Reform Work for Girls: A Guide to Juvenile Detention Reform 5-6 (Apr. 2013), available at http://www.aecf.org/m/ resourcedoc/AECF-MakingDetentionReformWorkforGirls-2013.pdf; Francine T. Sherman, Annie E. Casey Found., Detention Reform and Girls: Challenges and Solutions 10 (2005) available at http://www.aecf.org/m/ resourcedoc/AECF-DetentionReformAndGirls-2005.pdf. Poor data collection on Latina youth in the juvenile justice system has made it difficult to quantify their representation in national statistics. Because many jurisdictions do not fully disaggregate data by race and ethnicity, the proportion of Latina youth involved in the system tends to be under-identified and likely inflates the numbers of white youth. Asian youth are similarly inaccurately identified. See Nat’l Council on Crime & Delinquency, Racial and Ethnic Disparities in the US Criminal Justice System, available at http://www.nccdglobal.org/sites/default/files/ publication_pdf/created-equal.pdf (last visited May 31, 2015); see also Reform Trends: Counting Latino Youth, Juvenile Justice Information Exchange, http://jjie.org/hub/racial-ethnic-fairness/reform-trends/ (last visited May 25, 2015). The W. Haywood Burns Institute for Juvenile Justice Fairness and Equity, Unbalanced Juvenile Justice, 2011 detention rates for all youth of color per 100,000 youth, http://data.burnsinstitute.org/#comparison=2&placement=1&races=2,3,4,5,6&offenses=5,2,8,1,9,11,10&year=2011&view=map (last visited May 25, 2015). Melissa Sickmund, Anthony (T.J.) Sladky, Wei Kang & Charles Puzzanchera, US Dep’t of Justice, Nat’l Ctr. for Juv. Justice, Easy Access to the Census of Juveniles in Residential Placement: 1997-2013, http:// www.ojjdp.gov/ojstatbb/ezacjrp/ (last visited May 24, 2015); Annie E. Casey Found., KIDS COUNT Data Center, Child Population by Race and Age Group (2013), http://datacenter.kidscount.org/data/tables/8446child-population-by-race-and-age-group?loc=1&loct=1#detailed/1/ any/false/36/13,66,67,68,69,70,71,12|/17077,17078 (last updated Feb. 2015). For these purposes, detention is defined as being held in a residential juvenile facility before arraignment or adjudication or awaiting placement or transfer. Commitment refers to youth who are assigned to live in residential placements after adjudication. See Melissa Sickmund, Anthony (T.J.) Sladky, Wei Kang & Charles Puzzanchera, US Dep’t of Justice, Nat’l Ctr. for Juv. Justice, Glossary, Easy Access to the Census of Juveniles in Residential Placement, http://www.ojjdp.gov/ 9. 10. 11. 12. 13. 14. 15. 16. ojstatbb/ezacjrp/asp/glossary.asp (last visited May 24, 2015). Christopher Hartney, Nat’l Council on Crime & Delinquency, Native American Youth and the Juvenile Justice System 3 (Mar.2008), available at http:// www.juvenile.utah.gov/DMC/Available%20Studies/2008%20Focus%20 Native%20American%20Youth-NCCD.pdf; Nat’l Council on Crime & Delinquency, Center for Girls & Women, Getting the Facts Straight about Girls in the Juvenile Justice System 7 (Feb. 2009), available at http://www. nccdglobal.org/sites/default/files/publication_pdf/fact-sheet-girlsin-juvenile-justice.pdf; see also Oregon Comm. on Children and Families, Disproportionate Minority Contact in Oregon’s Juvenile Justice System: Identification and Assessment Report 20-26 (May 2012), available at http:// www.oregon.gov/oya/dmcsummit/2014/Materials/OregonDMCReport2012FINAL.pdf Sickmund, supra note 8; Annie E. Casey Found., KIDS COUNT Data Center, Child Population by Race and Age Group (2013), available at http://datacenter.kidscount.org/data/tables/8446-child-population-by-race-and-age-group?loc=1&loct=1#detailed/1/any/fal se/36/13,66,67,68,69,70,71,12|/17077,17078 (last updated Feb. 2015). Child Trends Data Bank, Juvenile Detention 5, available at http://www. childtrends.org/wp-content/uploads/2012/05/88_Juvenile_Detention. pdf (last updated Sep. 2013). Per capita rates of youth involved in juvenile justice can more clearly reveal disproportionate rates than the percentage proportion of youth involved with the justice system. According to the Office of Juvenile Justice and Delinquency Prevention, the latter method can mask disparities. See US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, Disproportionate Minority Contact 6-7, available at http://www.ojjdp.gov/ mpg/litreviews/Disproportionate_Minority_Contact.pdf (last visited May 25, 2015). Catherine Hanssens, Aisha C. Moodie-Mills, Andrea J. Ritchie, Dean Spade & Urvashi Vaid, A Roadmap for Change: Federal Policy Recommendations for Addressing the Criminalization of LGBT People and People living with HIV 37 (May 2014), available at https://web.law.columbia.edu/sites/default/ files/microsites/gender-sexuality/files/roadmap_for_change_full_report.pdf. Angela Irvine, Time to Expand the Lens on Girls in the Juvenile Justice System, NCCD Blog (Mar. 26, 2015), http://www.nccdglobal.org/ blog/time-to-expand-the-lens-on-girls-in-the-juvenile-justice-system; Angela Irvine, LGBT/GNC Youth in Juvenile Justice, NCCD Blog (Mar. 13, 2015), http://www.nccdglobal.org/blog/lgbtgnc-youth-in-juvenile-justice. Margaret Zahn, Stephanie Hawkins, Janet Chiancone & Ariel Whitworth, US Dep’t of Justice, Girls Study Group: Understanding Girls’ Delinquency 3 (Oct. 2008), available at https://www.ncjrs.gov/pdffiles1/ojjdp/223434. pdf; Am. Bar Ass’n & Nat’l Bar Ass’n, Justice By Gender: The Lack of Appropriate Prevention, Diversion, and Treatment Alternatives for Girls in the Juvenile Justice System, 9 Wm. & Mary J. Women & L. 1, 73, 79 (2002), available at http://scholarship.law.wm.edu/cgi/viewcontent. cgi?article=1182&context=wmjowl; Anne L. Stahl & Phyllis Coontz, Juvenile Assault Arrestees and Their Incidents: Same and Opposite Gender Relationships, in Delinquent Girls: Contexts, Relationships, and Adaptation, supra note 4 (“[O]ur analyses lend support to prior claims that the increases we see in juveniles entering the justice system may be partially due to changes in laws and police protocol. Variations in gendered patterns of simple assault arrests may reflect changes in the way that police respond to behaviors that always existed, as well as changes in public tolerance toward those behaviors.”). Margaret Zahn, Susan Brumbaugh, Darrell Steffensmeier, Barry C .Feld, Merry Morash, Meda Chesney-Lind, Jody Miller, Allison Ann Payne, Denise C. Gottfredson & Candace Kruttschnitt, US Dep’t of Justice, Girls Study Group: Understanding Girls’ Delinquency, Violence by Teenage Girls: Trends and Context 6-7 (May 2008), available at https://www.ncjrs.gov/pdffiles1/ ojjdp/218905.pdf. Zahn, supra note 14, at 3-4; Schwartz, supra note 4 at 20-21; See also Kerig, supra note 4, at 121, 134-135; Am. Bar Ass’n & Nat’l Bar Ass’n, 35 endnotes 17. 18. 19. 36 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. Justice By Gender: The Lack of Appropriate Prevention, Diversion, and Treatment Alternatives for Girls in the Juvenile Justice System, supra note 14. Jennifer Schwartz & Darrell Steffensmeier, Stability and Change in Girls’ Delinquency and the Gender Gap: Trends in Violence and Alcohol Offending Across Multiple Sources of Evidence, in Delinquent Girls: Context, Relationships and Adaptation, supra note 4, at 5-6 (“Policy shifts toward stretched definitions of what constitutes law-violating behavior … leads to enhanced sanctioning for aggressive conduct among youth overall but even more so among girls who tend to commit the milder, less serious forms of physical attacks or threats.”); Zahn, supra note 15, at 6 (“Because arrests for assault increased without corresponding increases in arrests for homicide or robbery, these analysts attribute the increases in assault arrests to changes in law enforcement policies, such as responses to domestic violence, rather than to actual increases in assaults”). Sherman, Detention Reform and Girls: Challenges and Solutions, supra note 5, at 29-34; Sherman, Making Detention Reform Work for Girls: A Guide to Juvenile Detention Reform, supra note 5, at 7. Jyoti Nanda, Blind Discretion: Girls of Color & Delinquency in the Juvenile Justice System, 59 UCLA L. Rev. 1502, 1529-1530 (2012); Tina L. Freiburger & Alison S. Burke, Status Offenders in the Juvenile Court: The Effects of Gender, Race, and Ethnicity on the Adjudication Decision, 9 Youth Violence & Juvenile Justice 4, 352, 354 (2011); Patricia K. Kerig & Stephen P. Becker, Trauma and Girls Delinquency, in Delinquent Girls: Contexts, Relationships, Adaptations, supra note 4, at 120; see also Coalition for Juvenile Justice, SOS Project, Emerging Issues Policy Series, Issue No. 1 3-4 (2013), available at http://juvjustice.org/sites/default/files/ resource-files/SOS%20Project%20-%20Girls,%20Status%20Offenses%20and%20the%20Need%20for%20a%20Less%20Punitive%20 and%20More%20Empowering%20Approach.pdf. Sherman, Making Detention Reform Work: A Guide to Juvenile Detention Reform, supra note 5, at 19; Margaret Zahn, Stephanie Hawkins, Janet Chiancone & Ariel Whitworth, US Dep’t of Justice, Girls Study Group: Understanding Girls’ Delinquency, supra note 14, at 3; Dana K. Smith, Leslie D. Leve & Patricia Chamberlain, Adolescent Girls’ Offending and Health Risking Sexual Behavior: The Predictive Role of Trauma, 11 Child Maltreatment 4, 346,346-347 (Nov. 2006). Margaret Zahn, Stephanie Hawkins, Janet Chiancone & Ariel Whitworth, US Dep’t Of Justice, Girls Study Group: Understanding Girls’ Delinquency, supra note 14, at 4; Patricia K. Kerig & Stephen P. Becker, Trauma and Girls’ Delinquency, in Delinquent Girls: Context, Relationships And Adaptation, supra note 4, at 121-134. Dana K. Smith, Leslie D. Leve & Patricia Chamberlain, Adolescent Girls’ Offending and Health Risking Sexual Behavior: The Predictive Role of Trauma, supra note 20, at 350. Dana D. Dehart, The Ctr. for Child & Family Studies, Poly-victimization Among Girls in the Juvenile Justice System: Manifestations & Associations to Delinquency 12 (Oct. 2009), available at https://www.ncjrs.gov/pdffiles1/ nij/grants/228620.pdf. Leslie Acoca, Outside/Inside: The Violation of American Girls at Home, on the Streets, and in the Juvenile Justice System, 44 Crime & Delinquency 4, 561, 566 (1988), available at http://leslieacoca.org/images/ Outside-Inside_-_The_Violation_of_American_Girls_at_Home_-_On_ the_Streets_-_and_in_the_Juvenile_Justice_System_by_Leslie_Acoca.pdf. Id. at 567. Patricia Chamberlain & Kevin J. Moore, Chaos And Trauma In The Lives Of Adolescent Females With Antisocial Behavior And Delinquency, 6 Journal of Aggression, Maltreatment, and Trauma 1, 79, at 92 (2002). Dana D. Dehart, supra note 23, at 32. Acoca, supra note 24, at 567. Chamberlain, supra note 26, at 92. Mary C. Marsiglio, Krista M. Chronister, Brandon Gibson & Leslie D. Leve, Examining the Link Between Traumatic Events and Delinquency Among Juvenile Delinquent Girls: A Longitudinal Study. 7 J. Child and 31. 32. 33. 34. 35. 36. 37. 38. Adolescent Trauma 4, 217, 224-225 (Dec. 2014), available at http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC4286894/ (“Study results point to a prospective predictive relationship between previous trauma event exposure and future delinquency for pre-high school entry girls only. For older girls, results suggest that previous trauma experiences were predictive of future trauma experiences, but not future delinquency. The Adverse Childhood Experiences (ACEs) study conducted by Dr. Felitti with Kaiser Permanente and the Centers for Disease Control revealed that the higher a child’s ACE score – that is, the greater then number of adverse childhood experiences, including sexual and physical abuse — the greater her risk of mental and physical health problems throughout her life. V.J. Felitti et al., Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences Study, 14 Am. Journal of Preventive Medicine 4, 245 (1998). The ten categories of ACES used in recent studies of youth in the juvenile justice system include emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, family violence, household substance abuse, household mental illness, parental separation or divorce, and having an incarcerated household member. The experience of childhood trauma has been proven to lead to many negative long-term health consequences and juvenile justice involvement. See, e.g., Michael T. Baglivio et al., US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, The Prevalence of Adverse Childhood Experience (ACE) in the Lives of Juvenile Offenders, 3 J. of Juv. Justice 2, 11 (Spring 2014), available at http://www.journalofjuvjustice. org/JOJJ0302/JOJJ0302.pdf (“ACES not only increase the chances of involvement in the juvenile justice system but the risk of re-offense. A focused effort on early identification of ACEs, and intervention for ACEs with a goal of improving youth life circumstances and preventing criminal behavior may reduce likelihood and costs related to juvenile criminal activities.”). Baglivio, The Prevalence of Adverse Childhood Experience (ACE) in the Lives of Juvenile Offenders, supra note 31, at 9 (Fig. 1). Id.; See also Karen Baynes-Dunning & Karen Worthington, Responding to the Needs of Adolescent Girls in Foster Care, XX Geo. J. Poverty L. & Pol’y 2, 324 (2013), available at http://karenworthington.com/ uploads/2/8/3/9/2839680/adolescent_girls_in_foster_care.pdf (analyzing the three primary data sets on child maltreatment and finding that sexual abuse was the driving factor of girls experiencing higher overall maltreatment rates as compared to their male peers). The Florida study replicated the finding of several other studies, including Erin M. Espinosa, Jon R. Sorenson, & Molly A. Lopez, Youth Pathways to Placement: The Influence of Gender, Mental Health Need and Trauma on Confinement in the Juvenile Justice System, 42 J. Youth & Adolescent Dev. 1824, 1830 (2013); Julian D. Ford et al., Poly-Victimization and Risk of Posttraumatic, Depressive, and Substance Use Disorders and Involvement in Delinquency in a National Sample of Adolescents, 46 J. Adolescent Health 545, 548 (2010); Dehart, supra note 23, at 11-12. Kerig, supra note 4, at 134 (citing Abram 2002; Belknap and Holsinger 2006; Dembo 1998; Ford 2008; Johansson and Kempf-Leonard 2009; Kerig 2009, 2010; Lawyer 2006; McCabe 2002; Taylor 2008; Wood 2002; Yoshinaga 2004). Other forms of abuse occurred in less disproportionate rates. Baglivio, supra note 31, at 4. Kerig, supra note 4, at 134. See Carly B. Dierkhising et al., Trauma Histories Among Justice-Involved Youth: Findings from the National Child Traumatic Stress Network, 4 Eur. J. Psychotraumatology (Jul. 2013), available at http://www. ejpt.net/index.php/ejpt to http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3714673/ (last visited May 18 2015); Selby M. Conrad, Nicole Placella, Marina Tolou-Shams, Christie J. Rizzo, and Larry K. Brown, Gender Differences in Recidivism Rates for Juvenile Justice Youth: The Impact of Sexual Abuse, supra note 4, at 310. endnotes 39. Robert L. Listenbee, Jr., et al., US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, Report of the Attorney General’s National Task Force On Children Exposed to Violence 21 (Dec. 12, 2012), available at http://www.justice.gov/defendingchildhood/cev-rpt-full.pdf.(“The vast majority of children involved in the juvenile justice system have survived exposure to violence and are living with the trauma of those experiences.”). 40. Smith, supra note 20, at 350; see also Anderson, Girls in the Juvenile Justice System: The Causes and Correlates of Girls’ Involvement, in Delinquent Girls: Contexts, Relationships, and Adaptation, supra note, 4 at 44. 41. Conrad, supra note 4, at 309-10. 42. Id. (“Childhood sexual abuse (CSA) is a potent risk factor for delinquency and subsequent juvenile justice involvement, especially for young women (Chesney–Lind, 1997; Gavazzi et al., 2006; Hubbard & Pratt, 2002)”); see also Anderson, supra note 4, at 44. 43. See Coal. for Juvenile Justice, SOS Project Girls, Status Offenses, and the Need for a Less Punitive and More Empowering Approach, supra note 19, at 3. 44. Tip Sheet: Warning Signs of Possible Sexual Abuse in a Child’s Behaviors, Stop it Now!, http://www.stopitnow.org/ohc-content/tip-sheet-7 (last visited May 25, 2015). 45. Nat’l Coal. for the Homeless, Fact Sheet: Homeless Youth 1 (June 2008), available at http://www.nationalhomeless.org/factsheets/youth.pdf (citing US Dep’t of Health & Human Servs., National Evaluation of Runaway and Homeless Youth (1997)). 46. Kerig, supra note 4, at 121 (citing R. Dembo et al., Gender Differences in Service Needs Among Youth Entering a Juvenile Assessment Center: A Replication Study, 2 J. Corr. Healthcare 191, 121 (1995)). 47. Anderson, supra note 4, at 44 (citing Dixon 2004, Breslau 1991; Cauffman 1998; Hoyt and Scherer 1998; Rivera and Widon 1990)). 48. Marianne Hennessey, Julian D. Ford, Karen Mahoney, Susan J. Ko & Christine Siegfried, Nat’l Child Traumatic Stress Network, Trauma Among Girls in the Juvenile Justice System 4 (2004), available at http://www. nctsn.org/nctsn_assets/pdfs/edu_materials/trauma_among_girls_in_ jjsys.pdf. 49. E.g. Delinquent Girls: Contexts Relationships and Adaptation, supra note 4.; Margaret Zahn et al., US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, Causes and Correlates of Girls Delinquency (Apr. 2010), available at https://www.ncjrs.gov/ pdffiles1/ojjdp/226358.pdf. 50. See Francine T. Sherman, Justice for Girls: Are We Making Progress, 59 UCLA L. Rev 1584, 1602-1612 (2012), available at http://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?article=1870&context=lsfp; See also Shared Hope Int’l, JuST Response State Systems Mapping Report 14 (2015), available at http://issuu.com/julianbach/docs/just_response_mapping_report_digita?e=5039581/12008488 (“States assert several reasons for considering alternatives to immunity laws. Many feel they do not have safe placement alternatives to detention. In states where child protective services is unable to investigate juvenile sex trafficking because laws bringing these cases within their mandate are not in place, a juvenile justice response may be the only system option available to intervene in the minor’s exploitation. In states that employ a diversion response, the option to charge trafficked children with delinquency for prostitution offenses allows the court to mandate participation in a trauma-informed diversion program that may encourage victims overcoming trauma bonds to be more cooperative in their treatment plan. However, while detention may guarantee separation from traffickers, it does not necessarily guarantee safety and rarely offers trauma-informed services.”) 51. Hennessey, supra note 48, at 4. 52. Id. 53. See Kerig, supra note 4, at 120, 134 (“One reason to hypothesize that PTSD is differentially related to girls’ delinquency is that PTSD, in general, is a gender-linked disorder. Across samples and ages, a well-replicated finding is that women and girls are more likely to be diagnosed with PTSD than men and boys, even in the context of exposure to the same traumatic event (citing Tolin and Foa (2006).”). 54. Jennie L. Shufelt & Joseph J. Cocozza, Nat’l Ctr. for Mental Health & Juvenile Justice, Youth with Mental Health Disorders in the Juvenile Justice System: Results from a Multi-State Prevalence Study 4 (June 2006), available at http://www.ncmhjj.com/wp-content/uploads/2013/07/7.-PrevalenceRPB.pdf. 55. Anderson, supra note 4, at 45 (citing Costello 2003, 2006). 56. Id. 57. Andrea J. Sedlak & Karla S. McPherson, US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, Youth’s Needs and Services: Findings from the Survey of Youth in Residential Placement 8 (Apr. 2010), available at https://www.ncjrs.gov/pdffiles1/ ojjdp/227728.pdf. 58. Emily G. Marston et al., Dealing with Double Jeopardy: Mental Health Disorders Among Girls in the Juvenile Justice System, in Delinquent Girls: Contexts, Relationships, and Adaptation, supra note 4, at 106 (citing Acoca (1999), Vermeiren (2006)). 59. Sedlak, supra note 57, at 2 (Apr. 2010), available at https://www.ncjrs. gov/pdffiles1/ojjdp/227728.pdf; see also Sarah Hockenberry, Melissa Sickmund & Anthony Sladky, Nat’l Ctr. for Juv. Justice, Service Provisions by Number of Locked and Unlocked Publicly and Operated Facilities by State, 2010 (2013), available at http://www.ojjdp.gov/pubs/241134.pdf. (analysis of OJJDP’s Juveniles in Residential Facility Census (2010)). 60. See Sedlak, supra note 57, at 8. 61. Id. at 9. 62. Leslie Acoca, Nat’l Council on Crime & Delinquency, Educate or Incarcerate? Girls In Florida and Duval Country Juvenile Justice Systems 45 (Nov. 2000), available at http://leslieacoca.org/images/Educate_or_Incarcerate_-_Girls_in_the_Florida_and_Duval_County_Juvenile_Justice_Systems_by_Leslie_Acoca.pdf; Patricia Chamberlain, Leslie D. Leve & David S. DeGarmo, Multidimensional Treatment Foster Care for Girls in Juvenile Justice: Two-Year Follow up of a Randomized Clinical Trial, 75 J. Consulting & Clinical Psychol. 1, 192-193 (2007), available at http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC1995088/. 63. David C.R. Kerr, Leslie D. Leve, & Patricia Chamberlain, Pregnancy Rates Among Juvenile Justice Girls in Two RCTS of Multidimensional Treatment Foster Care, 77 J. Consulting & Clinical Psychol. 3, 588 (June 2009). 64. See Vanessa Patino, Lawanda Ravoira & Angela Wolf, Nat’l Council on Crime and Delinquency, A Rallying Cry for Change: Charting a New Direction in the State of Florida’s Response to Girls in the Juvenile Justice System 51 (July 2006), available athttp://www.nccdglobal.org/sites/default/files/publication_pdf/cry-for-change.pdf (finding that approximately one-third of their sample experienced a pregnancy); Cindy S. Lederman, Gayle A. Dakof, Maria A. Larrea, & Hua Li, Characteristics of Adolescent Female in Juvenile Detention, 27 Int’l. J.L. & Psychiatry 321, 326 (2004) (finding that 32 percent of their sample had ever been pregnant); R. Alan Williams, & Helen M. Hollis, Health Beliefs and Reported Symptoms Among a Sample of Incarcerated Adolescent Females, 24 J. Adolescent Health 1, 21, 24 (1999) (finding that 37 percent had been pregnant); Leslie Acoca, Are Those Cookies for Me or My Baby? Understanding Detained and Incarcerated Teen Mothers and Their Children, 55 Juv. & Fam. Ct. J. 65, 67 (2004) (finding that in a study of 1,000 girls in California, 29 percent had been pregnant at least once; 16 percent were pregnant while incarcerated; the average age of delivery was 14; 23 percent had a miscarriage and 29 percent had been placed in physical restraints). 65. Jennie G. Noll & Chad E. Shenk, Teen Birth Rates in Sexually Abused and Neglected Females, 131 Pediatrics 4, 1181, 1185 (Apr. 2013), available at http://pediatrics.aappublications.org/content/ early/2013/03/18/peds.2012-3072.full.pdf+html (“The current set of results indicates that maltreatment, specifically sexual abuse and neglect during adolescence, significantly increased the risk of teen childbirth by 2.74-fold and 3.14-fold, respectively.”). 66. The Nat’l Crittenton Found., Summary of Results: Crittenton Adverse Childhood Experiences (ACE) Pilot 6 (Oct. 24, 2012), available at http://www. nationalcrittenton.org/wp-content/uploads/2015/03/ACEresults.pdf. 37 endnotes 38 67. See Am. Acad. of Pediatrics, Comm. on Adolescence, Policy Statement: Health Care for Youth in the Juvenile Justice System, 128 Pediatrics 1219, 1223 (2011), available at http://pediatrics.aappublications. org/content/128/6/1219.full.pdf+html; Catherine A. Gallagher, Adam Dobrin, & Anne S Douds, A National Overview of Reproductive Health Care Services for Girls in Juvenile Justice Residential Facilities, 17 Women’s Health Issues 217 (2007); On shackling, see Am. Coll. of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women, Health care for Pregnant and Postpartum Incarcerated Women and Adolescent Females, Comm. Op. No. 511, at 3 (Nov. 2011, reaff’d 2013), available at http://www.acog.org/-/media/Committee-Opinions/ Committee-on-Health-Care-for-Underserved-Women/co511.pdf?dmc=1&ts=20150526T0232572323 (“Despite progress, 36 states and the Immigration and Customs Enforcement agency of the Department of Homeland Security, which detains individuals who are in violation of civil immigration laws pending deportation, fail to limit the use of restraints on pregnant women during transportation, labor and delivery, and postpartum recuperation.”). 68. Nat’l Conference of State Legs., Medicaid For Juvenile Justice-Involved Children: Juvenile Justice Guidebook for Legislatures 7, available at http:// www.ncsl.org/documents/cj/jjguidebook-medicaid.pdf. 69. Leslie Acoca, Are Those Cookies for Me or My Baby? Understanding Detained and Incarcerated Teen Mothers and Their Children, supra note 64, at 68-72. 70. Maxine Harris & Roger D. Fallot, Envisioning a Trauma-Informed Service System: A Vital Paradigm Shift, in Using Trauma Theory to Design Service Systems 3, 3 (Maxine Harris & Roger D. Fallot, eds., 2001). 71. Tex. Criminal Justice Coal., Girls’ Experiences in the Texas Juvenile Justice System 5 (Oct. 2012), available at http://www.texascjc.org/sites/ default/files/uploads/Girls%20Experiences%20in%20the%20TX%20 JJ%20System%20%28Oct%202012%29.pdf. 72. Stephanie Hawkins Anderson, Girls in the Juvenile Justice System: The Causes and Correlates of Girls’ Involvement, in Delinquent Girls: Contexts, Relationships, and Adaptation, supra note 4, at 44 (“Girls tend to endure more trauma internally (e.g. depression, suicidal ideation/ behaviors, disordered eating) before they respond overtly”) (internal citations omitted)). 73. Hennessey, supra note 48, at 5. 74. Id.; Patricia K. Kerig & Julian D. Ford, Nat’l Child Traumatic Stress Network, Trauma Among Girls in the Juvenile Justice System 7 (2014), available at http://www.nctsn.org/sites/default/files/assets/pdfs/trauma_among_ girls_in_the_jj_system_2014.pdf. 75. For analysis of substantiated cases of sexual assault in juvenile justice facilities see Howard N. Snyder & Melissa Sickmund, US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, Juvenile Offenders and Victims (2006), available at http://www. ojjdp.gov/ojstatbb/nr2006/downloads/chapter7.pdf; For survey data on sexual assault in juvenile justice facilities see Allen Beck, David Cantor, John Hartge, & Tim Smith, US Dep’t of Justice, Office of Justice Programs, Bureau of Justice Statistics, Sexual Victimization in Juvenile Facilities Reported by Youth 2012 (June 2013), available at http://www.bjs.gov/content/ pub/pdf/svjfry12.pdf. 76. Mark Levin & Derek Cohen, Tex. Pub. Policy Found., Kids Doing Time for What’s not a Crime: the Over-Incarceration of Status-Offenders 2 (Mar. 2014), available at file:///C:/Users/MaheenKaleem/Downloads/ Kids_Doing_Time_for_Whats_Not_a_Crime__The_OverIncarceration_of_Status_Offenders.pdf (“This stemmed from the overuse of incarceration to handle nonviolent, minor offenses like running away and truancy. Such punishments have proven to be costlier than alternatives, are largely ineffective at (and, in some cases, counterproductive to) enhancing public safety, and are detrimental to the youth’s development.”); See Coal. for Juvenile Justice, SOS Project Girls, Status Offenses, and the Need for a Less Punitive and More Empowering Approach, supra note 19, at 3 (“Girls are being incarcerated for their own protection, not because of any safety threat they pose to the community.”). 77. Prison Rape Elimination Act (PREA) Juvenile Facility Standards, 28 C.F.R. § 115.381 (2012) Medical and mental health screenings; history of sexual abuse. 78. Prison Rape Elimination Act Juvenile Facility Standards, 28 C.F.R. § 115.382 (2012) (Access to emergency medical and mental health services); 28 C.F.R. § 115.383. (Ongoing medical and mental health care for sexual abuse victims and abusers). 79. Prison Rape Elimination Act, 42 USC. § 15603(a)(1) (2012) (“The Bureau of Justice Statistics of the Department of Justice shall carry out, for each calendar year, a comprehensive statistical review and analysis of the incidence and effects of prison rape.”); see also PREA Essentials: Data Collection and Review, National PREA Resource Center, http://www. prearesourcecenter.org/training-technical-assistance/prea-essentials (last visited May 25, 2015). 80. Audit and Compliance, National PREA Resource Center, http://www. prearesourcecenter.org/faq/audit-and-compliance (Last Updated Mar. 14, 2013). 81. See Frequently Asked Questions, Nat’l PREA Resource Center, “Is there a limit to the number of years that a state can submit an Assurance without a reduction in Department of Justice (DOJ) grant funding?”, available at http://www.prearesourcecenter.org/faq#n2233 (Last updated May 16, 2014) (“During the initial three year audit cycle, which ends on August 19, 2016, DOJ is not imposing a specific date by which states that submit Assurances throughout that audit cycle must come into compliance with the National PREA Standards or face a reduction in DOJ grant funding. If necessary, additional guidance will be provided by DOJ as the end of the initial three year audit cycle approaches.”). 82. Frequently Asked Questions: Applicability of Standards to Individual Settings, (Items 6 and 7), Nat’l PREA Resource Center, http://www. prearesourcecenter.org/faq (Item 6 Last Updated Jul. 9, 2013) (Item 7 Last Updated Feb. 7, 2013). 83. See E. Michael Foster, Amir Qaseem & Tim Connor, Can Better Mental Health Services Reduce the Risk of Juvenile Justice System Involvement? 94 Am. J. Pub. Health 859 (2004); Stephen P. Becker, Patricia K. Kerig, Ji-Young Lim & Rebecca N. Ezechukwu, Predictors of Recidivism among Delinquent Youth: Interrelations Among Ethnicity, Gender, Age, Mental Health Problems, and Posttraumatic Stress, 5 J. Child & Adolescent Trauma 2, 145 (2012); see also Acoca, supra note 62, at 45. 84. Patricia Chamberlain, Leslie D. Leve & David S. DeGarmo, Multidimensional Treatment Foster Care for Girls in the Juvenile Justice System: 2-Year Follow-up of a Randomized Clinical Trial, supra note 62, at 190. 85. Mana Golzari, Cynthia J. Mollen & Leslie Acoca, The Girls’ Health Screen Pilot Study: A Screening Instrument for Girls in the Juvenile Detention System, 11 J. Evidence-Based Soc. Work 480-483 (2014); Leslie Acoca, The Girls Health Screen, Girls Health and Justice Institute, available at http://www.girlshealthandjustice.org/programs/girlshealth-screen/ (last visited May 25, 2015); see also Acoca and Lexcen, Development of the Girls’ Health Screen: Technical Report (2009), available at http://stoneleighfoundation.org/sites/default/files/GHS2%20Technical%20Report%20For%20Web.pdf. 86. The screen, which takes between 11 and 13 minutes to administer, can identify health conditions that typical intake exams may miss, as it is administered privately via a computerized questionnaire, written at a fourth grade reading level, and available in English and Spanish. Girls may also choose to have the questions read to them through headphones. Based on a triage model, the screen identifies health needs according to a color-coded urgency scale, which allows medical providers to quickly and easily pinpoint urgent conditions requiring immediate treatment, such active suicidal ideation, lack of required medication, or incidents of sexual assault experienced just before entering the facility. All girls receive physical exams and referrals when concerns are identified. Girls Health Screen, Girls Health and Justice Initiative, supra note 85 ; Leslie Acoca, Jessica Stephens & Amanda Van Fleet, The Kaiser Family Found., Health Coverage and Care for Youth in the Juvenile Justice System: The Role of Medicaid and CHIP 11 (May 2014), available at http://kaiserfamilyfoundation.files.wordpress.com/2014/05/8591health-coverage-and-care-for-youth-in-the-juvenile-justice-system.pdf. 87. Acoca, supra note 86, at 11. 88. Id. at 5. endnotes 89. See Am. Acad. of Pediatrics, Comm. on Adolescence, Policy Statement: Health Care for Youth in the Juvenile Justice System supra note 67, at 1228. 90. Id. at 1231-1232; See also Anita G. Hufft, Supporting Psychosocial Adaptation for the Pregnant Adolescent in Corrections, 29 MCN Am. J. Matern. Child Nurs. 122-127 (2004); The Nat’l Campaign to Prevent Teen & Unplanned Pregnancy & Georgia Campaign for Adolescent Power Potential, Help Me to Succeed: A Guide for Supporting Youth in Foster Care to Prevent Teen Pregnancy, available at http://thenationalcampaign.org/sites/default/files/resource-primary-download/help-me-succeed.pdf. 91. Nat’l Comm’n for Corr. Health Care, Standards for Health Servs. in Juvenile Detention & Confinement Facilities (2004); Nat’l Comm’n on Corr. Health Care, Standards for Health Servs. in Jails (2008); Nat’l Comm’n on Corr. Health Care, Standards for Health Servs. in Prisons (2008), available at http://www.ncchc.org/standards-resources; on shackling, see Am. Coll. of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women, Health care for Pregnant & Postpartum Incarcerated Women & Adolescent Females, supra note 67, at 3. 92. Am. Civil Liberties Union, State Standards for Pregnancy-Related Health Care and Abortion for Women in Prison, available at https://www.aclu. org/maps/state-standards-pregnancy-related-health-care-and-abortion-women-prison-map#NATstandards (last visited May 25, 2015); Annie E. Casey Found., Juvenile Detention Alternatives Initiative, A Guide to Juvenile Detention Reform: Juvenile Detention Facility Assessment (2014), available at http://www.aecf.org/m/resourcedoc/aecf-juveniledetentionfacilityassessment-2014.pdf#page=103. 93. Am. Coll. of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women, Health care for Pregnant & Postpartum Incarcerated Women & Adolescent Females, Comm. Op. No. 511, supra note 67; Annie E. Casey Found., Juvenile Detention Alternatives Initiative, A Guide to Juvenile Detention Reform: Juvenile Detention Facility Assessment, supra note 92, at 175. 94. Selby M. Conrad, Nicole Placella, Marina Tolou-Shams, Christie J. Rizzo & Larry K. Brown, Gender Differences in Recidivism Rates for Juvenile Justice Youth: The Impact of Sexual Abuse, supra note 4, at 309-310. 95. See Emily G. Marston et al., in Delinquent Girls: Contexts, Relationships, and Adaptation, supra note, at 114 (“Collaboration between juvenile justice and community mental health systems may be a necessity, in order to supply sufficient numbers of clinical professionals who can effectively address the treatment needs of incarcerated adolescent female populations . . . [T]o maintain treatment gains made in the juvenile justice facility, empirically supported aftercare programs are necessary to facilitate these high-risk adolescent females’ successful reentry into the community.”). 96. 42 U.S.C. § 1396d(h)(1) (2012). 97. The MacArthur Foundation has outlined several strategies states can employ to accomplish this goal. Sarabeth Zemel, Kimm Mooney, Diane Justice & Katie Baudouin, John and Catharine T. MacArthur Found., Nat’l Acad. for State Health Policy, Facilitating Access to Health Coverage for Juvenile Justice Involved Youth 7 (Dec. 2013), available at http://www.nashp.org/ sites/default/files/Facilitating_Access_to_Health_Care_Coverage.pdf. For example, states may do the following: 1) suspend, rather than terminate, Medicaid eligibility to enable coverage to be reinstated as quickly as possible on release from a juvenile justice facility; 2) implement “continuous eligibility,” which allows children who enter and leave a juvenile detention facility within a 12-month period to maintain eligibility upon reentry into the community; 3) adopt a policy of “presumptive eligibility,” which permits qualified providers to make temporary eligibility determinations for Medicaid before a final determination has been made by the Medicaid agency thereby enabling youth to immediately access health services without waiting for official approval; or 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 4) implement special enrollment procedures, such as by requiring juvenile justice staff to fill out Medicaid applications for every youth leaving custody. Telephone Interview with Educational Advocate (Jan. 27, 2015). Zahn, supra note 15, at 12. Nat’l Women’s Law Ctr., The Next Generation of Title IX: Harassment and Bullying Based on Sex 2 (June 2012), available at http://www.nwlc.org/ sites/default/files/pdfs/nwlcharassbullying_titleixfactsheet.pdf; Am. Ass’n of Univ. Women Educ. Found., Hostile Hallways: Bullying, Teasing, and Sexual Harassment in School 37-38 (2001), available at http://www.aauw.org/ files/2013/02/hostile-hallways-bullying-teasing-and-sexual-harassment-in-school.pdf (On student’s self-reported reactions to the high prevalence of sexual harassment in school). Rebecca Chance, A Demand for Justice in Norman OK After Three Students Were Raped and Bullied Out of School, The Flounce, (Dec. 4, 2014), http://theflounce.com/demand-justice-norman-ok-three-students-raped-bullied-school/. Rebecca Klein, Hundreds of Students Protest Norman High School Over Alleged Bullying of Rape Victims, Huffington Post (Nov. 24, 2014),http:// www.huffingtonpost.com/2014/11/24/norman-high-schoolprotest_n_6214222.html. See generally Am. Ass’n of Univ. Women Educ. Found., Hostile Hallways: Bullying, Teasing, and Sexual Harassment in School, supra note 100; see also Sexual Violence Prevention Strategies, Centers for Disease Control and Prevention, http://www.cdc.gov/violenceprevention/sexualviolence/ prevention.html (last visited May 30, 2015). Zero-tolerance policies refer to school disciplinary policies that assign specific, predetermined punishments to certain behaviors regardless of the context in which the behavior occurred. Advocates have criticized these policies for being overly harsh reactions to student misbehavior that have not necessarily resulted in deterrence or reduction in violent or illegal activity on school campuses. Christopher Boccanfuso & Megan Kuhfeld, Evidence-Based, Nonpunitive Alternatives to Zero Tolerance 1-2 (Mar. 2011), available at http://www.childtrends.org/wp-content/uploads/2011/03/Child_Trends-2011_03_01_RB_AltToZeroTolerance. pdf. Ill. State Bd. of Educ. Ensuring Success in School Task Force, Final Report to the Illinois General Assembly 32 (June 2010), available at http:// povertylaw.org/sites/default/files/webfiles/final-essa-task-force-reportwith-appendix%20(1).pdf. Hearing: Innocence for Sale: Domestic Minor Sex Trafficking, Before the Subcomm. On Crime, Terrorism, Homeland Sec., and Investigations, H. Comm. On the Judiciary, 113th Cong. (Mar. 26, 2014) (testimony by Withelma “T” Ortiz Walker Pettigrew), available at (http://judiciary. house.gov/_cache/files/2ad6a4b5-09d7-41c1-90dd-44dec1dbfc69/ ortiz-pettigrew-testimony.pdf. See Linda Smith, Samantha Vardaman & Melissa Snow, Shared Hope International, The Nat’l Report on Domestic Child Sex Trafficking: America’s Prostituted Children 30-32 (2009), available at http://sharedhope.org/ wp-content/uploads/2012/09/SHI_National_Report_on_DMST_2009. pdf; Melissa Farley, Prostitution, Trafficking, and Cultural Amnesia: What We Must Not Know in Order To Keep the Business of Sexual Exploitation Running Smoothly 102-103 (2006), available at http://www.prostitutionresearch. com/Farley%202006%20-%20Prosituttion,%20Trafficking%20 and%20Cultural%20Amnesia.pdf; Victims of sexual abuse are also 28 times more likely to be arrested for prostitution as adults than their peers. Francine T. Sherman & Lisa Goldblatt Grace, The System Response to the Commercial Sexual Exploitation of Girls, in Juvenile Justice: Advancing Research, Policy and Practice 336 (Francine T. Sherman & Francine H. Jacobs eds., 2011) (citing Cathy Spatz Widom, US Dep’t of Justice, Office of Justice Programs, Victims of Childhood Sexual Abuse — Later Criminal Consequences 5 (March 1995), available at https://ncjrs. gov/pdffiles/abuse.pdf.). Francine T. Sherman, Justice for Girls, Are We Making Progress?, supra note 50, at 1611 (2012). If an adult engages in sexual activity with 39 endnotes 109. 110. 111. 40 112. 113. 114. 115. 116. 117. 118. 119. 120. someone under the statutorily defined age of consent, it is considered statutory rape. In most states, the age of consent is at least 16. Global Justice Initiative, Legal Age of Consent for Marriage and Sex for the 50 United States (2011), available at https://globaljusticeinitiative.files. wordpress.com/2011/12/united-states-age-of-consent-table11.pdf. However, only a handful of states have legislation with provisions that ensure that minors are immune from prosecution for prostitution or prostitution-related offenses, leaving most children vulnerable to arrests on prostitution or prostitution-related charges. Shared Hope Int’l, JuST Response Mapping Report, supra note 50, at 11. Shared Hope Int’l, State Survey Laws: Factors Affecting Child Protective Services Involvement in Commercial Sexual Exploitation of Minors Cases (2014), available at http://sharedhope.org/wp-content/uploads/2014/06/ Shared-Hope-State-law-survey_CPSInvolvement_through-8.1.pdf. Id.; US Dep’t of Health and Human Servs., Admin. For Children & Families, Child Welfare Information Gateway, State Statutes: Current Through June 2014 2, available at https://www.childwelfare.gov/pubPDFs/define. pdf (Seven states define human trafficking as a form of sexual abuse in their child welfare laws and four states define human trafficking as a form of physical abuse). Shared Hope Int’l & Casey Family Programs, Traffic Stop: A Discussion about Child Welfare and Judicial Strategies for Preventing Juvenile Sex Trafficking and Helping Its Survivors 18-21 (2014), available at http://sharedhope. org/wp-content/uploads/2014/08/Traffic-Stop-FINAL.pdf. Hearing: Innocence for Sale: Domestic Minor Sex Trafficking, Before the Subcomm. On Crime, Terrorism, Homeland Sec., and Investigations, H. Comm. On the Judiciary, 113th Cong. (Mar. 26, 2014) (testimony by Withelma “T” Ortiz Walker Pettigrew), supra note 106 (“Like me, any youth in foster care becomes accustomed to adapting to multiple moves from home to home which allows us to easily then adapt when traffickers/pimps/exploiters move us multiple times, from hotel to hotel, city to city, and/or state to state. For myself, as unfortunate as it is to say, the most consistent relationship I ever had in care was with my pimp and his family.”). Kate Walker, California Child Welfare Council, Ending the Commercial Exploitation of Children: A Call for a Multisystem Collaboration in California 18-19 (2013), available at http://www.youthlaw.org/fileadmin/ncyl/ youthlaw/publications/Ending-CSEC-A-Call-for-Multi-System_Collaboration-in-CA.pdf. Preventing Sex Trafficking and Strengthening Families Act, P.L. 113183 (2014). 22 U.S. C. § 7102(9)(A) (2015). At least 28 states that have passed legislation that seeks to treat victims of domestic child sex trafficking as victims and divert them away from the juvenile justice system. Nat’l Conference of State Legs., Human Trafficking Overview, http://www.ncsl.org/research/civil-and-criminal-justice/human-trafficking-overview.aspx#Safe Harbor (last visited May 26, 2015). At least 5 states have pending legislation. At the time of the writing of this paper, at least two of the states with pending legislation have passed safe harbor bills. Shared Hope Int’l, JuST Response Mapping Report, supra note 50, at 8. Shared Hope Int’l, Demanding Justice 4 (2014), available at http://sharedhope.org/wp-content/uploads/2014/08/Demanding_Justice_Report_2014.pdf. 18 U.S. C. § 1591 (2012). Indeed, the courts have held that “[t]he unambiguous text of §1591 makes no distinction between suppliers and purchasers of commercial sex acts with children.” United States v. Jungers, 702 F.3d 1066, 1072 (8th Cir. 2013). Jessica R. Kendall, Am. Bar Ass’n Div. for Pub. Educ., Juvenile Status Offenses: Treatment and Early Intervention, Technical Assistance Bulletin No. 29, 1 (2007), available at http://www.americanbar.org/content/dam/ aba/migrated/publiced/tab29.authcheckdam.pdf. Sarah Hockenberry & Charles Puzzanchera, Nat’l Ctr. for Juvenile Justice, Juvenile Court Statistics 2011, Chapter 4: National Estimates of Petitioned Status Offense Cases, 71 (2011), available at http://www.ncjj.org/pdf/ jcsreports/jcs2011.pdf.; Sickmund, supra note 8. 121. Hockenberry, supra note 120, at 12, 71 (“Males were involved in 72% of the delinquency cases handled by juvenile courts in 2011”) and 71(“Males accounted for 59% of the total petitioned status offense caseload in 2011.”). 122. Melissa Sickmund, Anthony (T.J.) Sladky, Wei Kang & Charles Puzzanchera, US Dep’t of Justice, Nat’l Ctr. for Juvenile Justice, Easy Access to the Census of Juveniles in Residential Placement, Offense Profile of Detained Residents by Sex and Race/Ethnicity for United States 2011, available at http://www.ojjdp.gov/ojstatbb/ezacjrp/asp/ Offense_Detained.asp (In 2011, girls were only 16.2% of detained residents, but were 36.8% of youth detained for a status offense). 123. Id. (In 2011, girls were only 12.3% of total number of juveniles committed to residential placements, but they were 40.3% of youth committed for a status offense). 124. Id. at 3-4. See also Francine T. Sherman, Richard A. Mendel, & Angela Irvine, Annie E. Casey Found., Making Detention Reform Work for Girls: A Guide to Juvenile Detention Reform, supra note 5, at 11-12; US Dep’t of Educ., Office of Safe and Healthy Students, Human Trafficking in America’s Schools 5-8 (2015), available at https://safesupportivelearning.ed.gov/sites/ default/files/HumanTraffickinginAmericasSchools.pdf; US Dep’t of Educ., Office of Safe and Drug-Free Schools, available at http://files.eric.ed.gov/ fulltext/ED498514.pdf (2007). 125. Sue Burrell, Nat’l Ctr. for Child and Traumatic Stress, Trauma and the Environment of Care in Juvenile Institutions 3 (2013), available at http://www. njjn.org/uploads/digital-library/NCTSN_trauma-and-environment-of-juvenile-care-institutions_Sue-Burrell_September-2013.pdf. 126. Hockenberry, supra note 120, at 71; See also, Sydney McKinney, Vera Institute of Justice, Status Offense Reform Center, Runaway Youth: A Research Brief 1-2 (May 28, 2014), available at http://www.statusoffensereform. org/wp-content/uploads/2014/05/Running-Away_Final.pdf. 127. Sydney McKinney, Vera Institute of Justice, Status Offense Reform Center, Runaway Youth: A Research Brief, supra note 126 at 1-2. 128. Francine T. Sherman, Justice for Girls: Are We Making Progress?, supra note 50, at 12 (“In 2009, girls made up 55 percent of youth arrested for running away; prostitution was the only other crime for which girls made up the majority of arrests.”); supra note 119, at 1. 129. Jody M. Greene, et al., US Dep’t of Health and Human Servs., Admin. On Children, Youth, and Families, Sexual Abuse Among Homeless Adolescents: Prevalence, Correlates, and Sequelae ES-2 (2002), available at http:// www.acf.hhs.gov/sites/default/files/opre/sex_abuse_hmless.pdf; Kimberly A. Tyler, Dan R. Hoyt & Les B. Whitbeck, The Effects of Early Sexual Abuse on Later Sexual Victimization Among Female Homeless and Runaway Adolescents, 15 J. Interpersonal Violence 246 (Mar. 2000), available at http://digitalcommons.unl.edu/cgi/viewcontent. cgi?article=1031&context=sociologyfacpub; Kimberly A. Tyler, Kellie J. Hagewen & Lisa A. Melander, Risk Factors for Running Away Among a General Population Sample of Males and Females, 43 Youth & Soc’y 583, 598 (Jun. 2011); Sanna J. Thompson, Kimberly Bender & Jihye Kim, Family Factors as Predictors of Depression Among Runaway Youth: Do Males and Females Differ? 28 Child & Adolescent Soc. Work 35, 44-45 (2011). 130. Sydney McKinney, Vera Institute of Justice, Status Offense Reform Center, Runaway Youth: A Research Brief, supra note 126, at 2. 131. Lisa Thrane, Kevin Yoder & Xiaojin Chen, The Influence of Running Away on the Risk of Female Sexual Assault in the Subsequent Year, 26 Violence & Victims 825 (2011). 132. Sarah Hockenberry & Charles Puzzanchera, Nat’l Ctr. for Juvenile Justice, Juvenile Court Statistics 2011, Chapter 4: National Estimates of Petitioned Status Offense Cases, supra note 120, at 81, 85. 133. See 42 U.S.C. §§ 5633(a)(11)-(13), (22) (2012). 134. Nat’l Council of Juv. and Fam. Ct. Judges, Resolution Supporting Reauthorization of JJDP Act and Elimination of VCO Exception, available at http:// www.ncjfcj.org/sites/default/files/vcoresolution3-10.pdf; See also Gary Gately, New Report Finds Incarceration for ‘Status Offenses’ Still Widespread, Juvenile Justice Information Exchange (Apr. 10, 2015), http:// jjie.org/new-report-finds-incarceration-for-status-offenses-still-wide- endnotes 135. 136. 137. 138. 139. 140. 141. 142. 143. 144. 145. spread/108565/ (recommending against detention for status offense behaviors). For a history of the valid court order exception, see Barry C. Field, Violent Girls or Relabeled Status Offenders?: An Alternative Interpretation of the Data, 55 Crime & Delinquency 243, 243-246 (2009). According to the Office of Juvenile Justice and Delinquency Prevention, 27 states plus the District of Columbia still use the VCO exception. US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, http://www.ojjdp.gov/compliance/FY2013-FY%20 2014VCO-state.pdf; see also Coal. for Juvenile Justice, SOS Project, Status Offenses: A National Survey 8 (2015), available at http://www. juvjustice.org/sites/default/files/resource-files/Status%20Offenses%20 -%20A%20National%20Survey%20-FINAL%20-%20WEB.pdf. Jennifer Schwartz & Darrell Steffensmeier, Stability and Change in Girls’ Delinquency and the Gender Gap: Trends in Violence and Alcohol Offending Across Multiple Sources of Evidence, in Delinquent Girls: Context, Relationships and Adaptation, supra note 4, at 5 (“Policy shifts toward stretched definitions of what constitutes law-violating behavior . . . leads to enhanced sanctioning for aggressive conduct among youth overall but even more so among girls who tend to commit the milder, less serious forms of physical attacks or threats.”) (internal citations omitted). One example of net-widening is ending the practice of “up-charging,” in which girls who have committed a status offense are instead charged with misdemeanor offenses to evade the restrictions of the JJDPA. Barry C. Feld, Violent Girls or Relabeled Status Offenders?: An Alternative Interpretation of the Data, supra note 134, at 253. Feld, supra note 134, at 253. See generally Kerig, supra note 74. Nat’l Child Traumatic Stress Network & Nat’l Council of Juv. And Fam. Ct. Judges, NCTSN Bench Card for the Trauma-Informed Judge, available at http://www.nctsn.org/sites/default/files/assets/pdfs/judge_bench_ cards_final.pdf (last visted May 27, 2015); see also Resources for Justice Professionals, Law Enforcement and First Responders, For Juvenile Justice Professionals/Law Enforcement/First Responders, Nat’l Child Traumatic Stress Network, http://www.nctsn.org/category/products/ juvenile-justice-professionalslaw-enforcementfirst-responders (last visited May 27, 2015). Patricia K. Kerig & Julian D. Ford, Nat’l Child Traumatic Stress Network, Trauma Among Girls in the Juvenile Justice System, supra note 74. Many children are involved in both the juvenile justice and child welfare systems; these children are known by a variety of terms, including “crossover,” “dual system,” “dual- involved,” or “dually-adjudicated” youth. The broadest term for these children is “crossover youth,” which refers to all youth who have experienced child abuse or maltreatment and engaged in delinquency, whether or not they are ever known to child protective services or the juvenile justice system According to that definition, “crossover youth” would encompass all children who enter the abuse-to-prison-pipeline. Denise Herz et al., Georgetown Univ., Ctr. for Juvenile Justice Reform, Addressing the Needs of Multi-System Youth: Strengthening the Connection Between Child Welfare and Juvenile Just. 1 (2012), available at http://cjjr.georgetown.edu/wp-content/ uploads/2015/03/MultiSystemYouth_March2012.pdf. Shay Bilchik & Judge Michael Nash, Child Welfare and Juvenile Justice: Two Sides of the Same Coin, Juvenile and Family Justice Today 17-18 (Fall 2008), available at http://cjjr.georgetown.edu/pdfs/Fall%2008%20 NCJFCJ%20Today%20feature.pdf. Id. at 17; Herz, supra note 141, at 2 (stating that majority are male but the proportion of females among cross-over youth is much higher than proportion of females in general delinquency). Herz, supra note 141, at 16-17. Joseph P. Ryan & Denise C. Herz, Crossover Youth and Juvenile Justice Processing in Los Angeles County, Ctr. for Families, Children & The Courts Research Update 4 (Dec. 2008), available at http://www.courts. ca.gov/documents/AB129-CrossoverResearchUpdate.pdf. See also Kerig, supra note 4, at 134; Jennifer L. Woolard, Crossing Over: Girls at the Intersection of Juvenile Justice, Criminal Justice, and Child Welfare, in Delinquent Girls: Context, Relationships, and Adaptation, supra note 4, 146. 147. 148. 149. 150. 151. 152. 153. 154. 155. 156. 157. at 34 (comparing the child welfare and non-child welfare samples, the child welfare sample was more likely to be female, younger, African American and Hispanic. Thirty seven percent of the crossover sample was female, compared to 24% of non-child welfare youth). Irvine, supra note 13 (“While 14% of gender-conforming girls in the juvenile justice system were previously removed from their homes by social workers, 40% of GNC girls were previously removed. While 6% of gender-conforming girls in the juvenile justice system were placed in group homes because someone was hurting them, 24% of GNC girls had this experience.”). See, e.g., K. Majd, J. Marksamer, and C. Reyes, Hidden Injustice: Lesbian, Gay, Bisexual and Transgender Youth in Juvenile Courts 94 (Fall 2009), available at http://www.equityproject.org/pdfs/hidden_injustice.pdf; Hannah Brückner and Kathryn E. W. Himmelstein, Criminal-Justice and School Sanctions Against Nonheterosexual Youth: A National Longitudinal Study, 127 Pediatrics 49-57 (2011), available at http://pediatrics. aappublications.org/content/early/2010/12/06/peds.2009-2306.full. pdf+html (first published online on Dec. 6, 2010). John D. & Catherine T. MacArthur Found., Models for Change, Is there a Link Between Child Welfare and Disproportionate Minority Contact in Juvenile Justice? 2 (Dec. 2011), available at http://www.naco.org/programs/ csd/Documents/Criminal%20Justice/Juvenile%20Justice%20Page/ Dual%20Status%20Youth/06%20Knowledge_Brief_Is_There_a_Link_ between_Child_Welfare_and_Disproportionate_Minority_Contact_in_ Juvenile_Justice.pdf. Georgetown Univ., Ctr. for Juvenile Justice Reform, Crossover Youth Practice Model 93 (2010), available at http://cjjr.georgetown.edu/wp-content/ uploads/2014/12/cypm.pdf (listing characteristics of crossover youth and stating that two studies found that “African American youth are overrepresented in the crossover numbers relative to the general population, child welfare referrals, and juvenile justice referrals”); see Denise Herz & Joseph P. Ryan, Georgetown Univ., Ctr. for Juvenile Justice Reform, Building Multisystem Approaches in Child Welfare and Juvenile Justice (2008); Michelle L. Saeturn & Janay R. Swain, Exploring Characteristics and Outcomes of 241.1 Youth in Alameda County (2009); John D. & Catherine T. MacArthur Found., Models for Change, Is there a Link Between Child Welfare and Disproportionate Minority Contact in Juvenile Justice?, supra note 148, at 3. John D. & Catherine T. MacArthur Found., Models for Change, Is there a Link Between Child Welfare and Disproportionate Minority Contact in Juvenile Justice? supra note 148, at 3. Patrick McCarthy, Annie E. Casey Found., The Alliance for Racial Equity in Child Welfare — Yesterday, Today and Tomorrow, in Disparities and Disproportionality in Child Welfare: Analysis of the Research v (Dec. 2011), available at http://www.cssp.org/publications/child-welfare/ alliance/Disparities-and-Disproportionality-in-Child-Welfare_An-Analysis-of-the-Research-December-2011.pdf. Herz, supra note 141, at 17. Robert F. Kennedy Nat’l Resource Ctr. For Juvenile Justice, Models for Change Resource Ctr. P’ship, From Conversation to Collaboration How Child Welfare and Juvenile Justice Agencies Can Work Together to Improve Outcomes for Dual Status Youth 3 (May 8, 2014), available at http://www. modelsforchange.net/publications/539. See e.g., Dylan Conger & Timothy Ross, Vera Institute of Justice, Reducing the Foster Care Bias in Juvenile Detention Decisions: The Impact of Project Confirm (June 2001), available at http://www.vera.org/sites/default/ files/resources/downloads/Foster_care_bias.pdf; Herz, supra note 141, at 23-24. Georgetown Univ., Ctr. for Juvenile Justice Reform, Crossover Youth Practice Model, supra note 149, at 4-5. Tonya Edmond, Wendy Auslander, Diane E. Elze, Curtis McMillen & Ron Thompson, Differences Between Sexually Abused and Non-Sexually Abused Adolescent Girls in Foster Care, 11 J. Child Sex Abuse 83 (2002). Sara Goodkind, Jefferey J. Shook, Kevin H. Kim, Ryan T. Pohlig & David J. Herring, From Child Welfare to Juvenile Justice: Race, Gender, and 41 endnotes 158. 159. 160. 161. 162. 163. 42 164. 165. 166. 167. 168. 169. 170. 171. 172. System Experiences , 11 Youth Violence & Juvenile Just. 249, 264. (Jul. 2013) (“Analyses of placement sample indicate that congregate care placement is associated with an increased likelihood of justice involvement. These analyses reveal an even more pronounced gender difference with regard to its effects; congregate care doubles the likelihood of juvenile justice involvement for girls but has very little effect on that of boys.”). Madelyn Freundlich, Rosemary J. Avery & Deborah Padgett, Care or Scare: The Safety of Youth in Congregate Care in New York City, 31 Child Abuse & Neglect 2 173, 184 (Feb. 2007). Herz, supra note 141, at 20.; see also Georgetown Univ. Ctr. for Juvenile Justice Reform, Crossover Youth Practice Model, supra note 149, at 89 (citing the absence of de-escalation techniques and procedures in congregate care placements and reliance on law enforcement to resolve incidence; inexperienced staff; and absence of appropriate behavioral modification techniques for the population at hand as a possible contributor to crossover from congregate care). Georgetown Univ., Ctr. for Juvenile Just. Reform, Crossover Youth Practice Model, supra note 149, at 94. Baynes-Dunning & Worthington, supra note 33, at 346-347. Id.; see e.g., Nat’l Child Traumatic Stress Network, Child Welfare Trauma Training Toolkit (2013), available at http://www.nctsn.org/products/ child-welfare-trauma-training-toolkit-2008. US Dep’t of Health and Human Servs., Admin. Of Children and Families, Admin. Of Children, Youth and Families, Children’s Bureau, Child Maltreatment 2012 Summary xi (2013), available at http://www.acf.hhs.gov/sites/default/ files/cb/cm2012.pdf#page=31; see Annie E. Casey Found., KIDS COUNT Data Center, Children Who Are Confirmed by Child Protective Services as Victims of Maltreatment by Maltreatment Type (2007-2011), available at http://datacenter.kidscount.org/data/tables/6222-children-who-areconfirmed-by-child-protective-services-as-victims-of-maltreatmentby-maltreatment-type?loc=1&loct=2#detailed/1/any/fase/867,133,3 8,35,18/3885,3886,3887,3888,3889,3890,872/12951,12950 (last updated Jun. 2014). Blace A. Nalavanya, Scott D. Ryan, Jeanne A. Howard & Susan Livingston Smith, Preadoptive Child Sexual Abuse as a Predictor of Moves in Care, Adoption Disruptions, and Inconsistent Adoptive Parent Commitment, 32 Child Abuse & Neglect 1084, 1085 (2008), available at http://www.researchgate.net/profile/Blace_Nalavany/ publication/23500259_Preadoptive_child_sexual_abuse_as_a_predictor_of_moves_in_care_adoption_disruptions_and_inconsistent_ adoptive_parent_commitment/links/0deec52f398c795d3c000000.pdf (describing the paucity of research on outcomes for children in foster care with child sexual abuse history). Edmond, supra note 156, at 84 (2002). Id. at 83-84. Id. at 84. Id. at 87. Nalavanya, supra note 164. Nat’l Child Traumatic Stress Network, Using Trauma-Informed Child Welfare Practice to Improve Placement Stability Breakthrough Series Collaborative: Executive Summary 1 (Jun. 2013) available at http://www.nctsn.org/sites/ default/files/assets/pdfs/using_ticwp_bsc_executivesummary.pdf. Nicole Taylor & Christine B. Siegfried, Nat’l Child Traumatic Stress Network, Helping Children in the Child Welfare System Health from Trauma: A Systems Integration Approach 1-2 (2005), available at http://www.nctsn.org/ nctsn_assets/pdfs/promising_practices/A_Systems_Integration_Approach.pdf. See Ctr. for Health Care Strategies, Identifying Opportunities to Improve Children’s Behavioral Health Care: An Analysis of Medicaid Utilization and Expenditures (Dec. 2013), available at http://www.chcs.org/media/Identifying-Opportunities-to-Improve-Childrens-Behavioral-Health-Care2. pdf(Describing ways to improve behavioral health services for children on Medicaid who, as the authors note, are often involved with juvenile justice and child welfare systems). 173. See Nat’l Child Traumatic Stress Network, Child Welfare Trauma Training Toolkit (2013), supra note 162. 174. The Administration of Children and Families issued guidance encouraging states to train foster parents on child trafficking. US Dep’t of Health and Human Servs., Admin. For Children, Youth and Families (ACYF), Guidance to States and Services on Addressing Human Trafficking of Children and Youth in the United States (2013), available at https://www.acf.hhs.gov/sites/ default/files/cb/acyf_human_trafficking_guidance.pdf (last visited May 27, 2015); Some states have instituted trainings.. For example, the Connecticut Department of Children and Families Human Anti-Trafficking Response Team partners with two non-profits, Love 146 and My Life My Choice, to host trainings for law enforcement, service providers, group home providers, foster parents, kinship caregivers , others who may interact with foster youth or children vulnerable to trafficking. See, Conn. Dep’t of Children and Fam. HART (Human Anti-Trafficking Response Team), http://www.ct.gov/dcf/cwp/view.asp?a=4743&Q=562246 (last visited May 11, 2015), Love146, https://love146.org/ (last visited May 11, 2015), http://www.fightingexploitation.org/ (last visited May 11, 2015); Supervisor Mark Ridley-Thomas, Preventing Child Sex Trafficking in Foster Care, Supervisor Mark-Ridley Thomas, Children and Family Services, Human Trafficking (Apr. 10, 2014), available at http:// ridley-thomas.lacounty.gov/humanservices/index.php/sex-traffickingin-foster-care/; Ohio Child Welfare Training Program (OCWTP), available at http://ocwtp.net/human%20trafficking%20-%20caregivers.html (last visited May 27, 2015); Tenn. Dep’t of Human Servs., Human Trafficking Services Coordination and Service Delivery Plan 29 (2013), available at https:// www.tn.gov/humanserv/adfam/TDHS-2013-HT-Plan.pdf. 175. Title IV-E emphasizes child removal and out-of-home services, rather than family preservation and in-home services, which experts have shown to achieve better outcomes for children’s welfare. Title IV-B is the only federal funding source available for family preservation services. Letter from Dep’t of Health and Human Servs. Admin. for Children & Families, Ctrs. For Medicare & Medicaid Servs. & Substance Abuse & Mental Health Servs. to State Medicaid Directors on Trauma-Informed Treatment 6-7 (Jul. 11, 2013), available at http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-13-07-11.pdf. 176. Magellan Health Services Children’s Services Task Force, Perspectives on Residential and Community-Based Treatment for Youth and Families 2 (2008), available at http://www.mtfc.com/2008%20Magellan%20RTC%20 White%20Paper.pdf; Laura W. Boyd, State Policy Advocacy and Reform Ctr., Therapeutic Foster Care: Exceptional Care for Complex, Trauma-Impacted Youth in Foster Care 10 (Jul. 2013), available at https://childwelfaresparc.files.wordpress.com/2013/07/therapeutic-foster-care-exceptional-care-for-complex-trauma-impacted-youth-in-foster-care.pdf (“When TFC is conducted according to best practices, it demonstrates positive outcomes and cost savings for this highly fragile population of youth.”); Eva Klain & Amanda R. White, ABA Ctr. on Children and the Law, Implementing Trauma-Informed Practices in Child Welfare 10 (Nov. 2013), available at http://childwelfaresparc.org/wp-content/uploads/2013/11/ Implementing-Trauma-Informed-Practices.pdf. 177. Sarabeth Zemel, Kimm Mooney, Diane Justice & Katie Baudouin, John & Catharine T. MacArthur Found., Nat’l Acad. for State Health Policy, Facilitating Access to Health Coverage for Juvenile Justice Involved Youth, supra note 96, at 8. 178. 42 U.S.C. 622(b)(15)(A) (2012); Info. Mem. from US Dep’t of Health and Human Servs., Admin. on Children, Youth and Families, Information Memorandum, ACYF-CB-IM-11-06 (Oct. 6, 2011). 179. Letter from Dep’t of Health and Human Servs. Admin. for Children & Families, Ctrs. For Medicare & Medicaid Servs. & Substance Abuse & Mental Health Servs. to State Medicaid Director’s on Trauma-Informed Treatment, supra note 175. 180. 42 U.S.C. 1396d(r)(5) (2012). 181. US Dep’t of Health and Human Servs., Ctr. For Medicare & Medicaid Services, EPSDT- A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents 9 (Jun. 2014), available at http://www.medicaid.gov/ endnotes 182. 183. 184. 185. 186. 187. 188. medicaid-chip-program-information/by-topics/benefits/downloads/epsdt_coverage_guide.pdf; Early and Periodic Screening, Diagnostic, and Treatment . U.S. Dep’t of Health and Human Servs., Ctr. For Medicare & Medicaid Services, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html (last visited May 27, 2015). Letter from US Dep’t of Health and Human Servs. Admin. for Children & Families, supra note 175, at 11. Wayne Turner, Early Periodic Screening and Diagnosis and Treatment (EPSDT), Nat’l Health Law Program, 18 Health Advocate (Oct. 2013), available at http://www.healthlaw.org/issues/child-and-adolescent-health/epsdt/health-advocate-epsdt#.VWZws89Vikp. Letter from Directors of US Dep’t of Health and Human Services, Ctr. for Medicare & Medicaid Services & Ctr. for Medicaid & CHIP Services to State Medicaid Directors Regarding Policy Considerations for Integrated Care Models 1 (Jul. 10, 2012), available at http://www.medicaid.gov/ Federal-Policy-Guidance/downloads/SMD-12-002.pdf. Kamala D. Allen & Taylor Hendricks, Ctr. For Health Care Strategies, Medicaid and Children in Foster Care 7-9 (Mar. 2013), available at https:// childwelfaresparc.files.wordpress.com/2013/03/medicaid-and-children-in-foster-care.pdf. Melinda K. Abrams, Rachel Nuzum, Stephanie Mika & Georgette Lawlor, The Commonwealth Fund, Realizing Health Reform’s Potential: How the Affordable Care Act Will Strengthen Primary Care and Benefit Patients 8-10 (2011), available at http://www.commonwealthfund.org/publications/ issue-briefs/2011/jan/strengthen-primary-care. Id. at 10. Medical Homes for Children and Adolescents Exposed to Violence: About the Project, Am. Acad. of Pediatrics, available at http://www. aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Medical-Home-for-Children-and-Adolescents-Exposed-to-Violence/Pages/ Medical-Home-for-Children-and-Adolescents-Exposed-to-Violence. aspx (last visited May 27, 2015). 189. Am. Acad. of Pediatrics, Preventing Sexual Violence: An Educational Toolkit for Health Care Professionals, available at http://www2.aap.org/pubserv/ PSVpreview/pages/tools.html (last visited May 27, 2015). 190. See Baynes-Dunning & Worthington, supra note 33, at 344 (“Federal benchmarks require systems to monitor and address maltreatment that occurs after youth are in the child welfare system, but the definition of incidents that are tracked for that purpose is so limited that it does not capture the range of daily activities that girls may consider abusive towards them. Thus, systems should clearly define what actions by whom are considered incidents of “re-abuse” or repeat maltreatment for purposes of federal reporting, and what actions not meeting this definition still need to be addressed and tracked for system quality improvement.”). 191. Freundlich, supra note 158. 43 This report was made possible by the generous support of The Annie E. Casey Foundation, the JPB Foundation, the Moriah Fund, and the Overbrook Foundation. The views expressed in this report are the authors’ alone and do not necessarily reflect the opinions of these foundations. Published by CENTER ON POVERTY and INEQUALITY 600 New Jersey Avenue NW | Washington, D.C. 20001 www.law.georgetown.edu/go/poverty