October 10, 2006

UCSF Pediatrics Resident Behind Juvenile Offenders Health Insurance Law

Mana Golzari

Adolescents in juvenile detention in California now have a better chance of receiving the critical health care services they need upon reemergence from incarceration in large part because of the efforts of a first-year UCSF Pediatrics Department resident. The resident, Mana Golzari, MD, was the impetus behind SB1469, which requires county juvenile detention facilities to enroll eligible youth into MediCal and other state-sponsored health care programs. The legislation was introduced by California State Sen. Gil Cedillo (D-Los Angeles) in March and recently was signed into law by Gov. Arnold Schwarzenegger. The 27-year-old said she hopes the new law, which goes into effect in January 2008, will improve the health status of a segment of the adolescent population with a "disproportionate share of adolescent morbidity and mortality." In other words, they are among the sickest young people in the state. History of Interest in the Health of the Disenfranchised Golzari said she has had a long-standing interest in the health status of the disenfranchised. While a medical student at Stanford University in 2003 Golzari began exploring the difficulties of obtaining MediCal and Public Health Insurance for youth at the Santa Clara County Juvenile Hall. She determined that enrolling youth in MediCal requires the initiative of their parent or guardian, in this instance, the juvenile detention facility. After talking with medical directors of juvenile detention centers statewide she learned that enrolling youth in MediCal wasn't a "part of the protocol" prior to releasing incarcerated youth back into society. So, frustrated by the system, she wrote legislation that would make it a mandatory part of the probation protocol to determine whether youth are eligible for MediCal. The original legislation was introduced by State Assemblyman Joe Coto (D- San Jose). A revised version later was taken up by Cedillo. Golzari also credits support from the medical and legal establishment, including the California Medical Association, American Academy of Pediatrics and the organizations Youth Law and Books Not Bars, in the rapid passage of the legislation. The Poor Health Status of Youth in Juvenile Detention Juvenile offenders face a variety of either untreated or undiagnosed health conditions, from chronic uncontrolled asthma to serious psychiatric conditions, substance abuse, trauma, and high rates of STDs, said Golzari, who also is the lead author of a review article on the health of juvenile offenders published in the June issue of the Journal of Adolescent Health. The article, "The Health Status of Youth in Juvenile Detention Facilities," finds that for these youths, "their time of incarceration often represents their only significant contact with a health care provider outside of an emergency setting." "As such, it is critical that health care providers (within the Juvenile Justice System) utilize the opportunity to treat, educate, and connect these youth with community resources to facilitate their access to health care upon their reemergence into the community," the article states. Other review article authors include Stephen J. Hunt, PhD and Arash Anoshiravani, MD, MPH. The study was funded by grants from the Santa Clara Valley Foundation and an American Association of Pediatrics Child Access to Community Health grant. Numerous studies throughout the years have acknowledged the poor health status of youth in juvenile detention. And recidivist youth are even more likely to exhibit poor health, the article states. "A 1973 survey of 200 youth in detention found that recidivist youth had significantly higher rates of "neuroses" and personality disorders than nonrecidivist youth.... Surveys of youth in detention throughout the 1990s found that recidivist youth were more likely to have a substance abuse disorder than nonrecidivist youth." "My hope is that this law will open a door in order to establish medical homes for these kids once they leave detention, as a means of being able to intervene in their life paths," Golzari said. She said she hopes the legislation will not only support the health needs of incarcerated youth but will also reduce recidivism and incarceration rates. While a definite link between lack of health care services and recidivism has not been drawn several studies "provide a tentative basis for assuming that medical intervention may reduce the rate of incarceration and recidivism." "It has been estimated that between 25 and 75 percent of these youths have a mental health issue that is not being properly addressed. When they're properly treated it can have a revolutionary effect on their lives and potentially prevent them from being imprisoned again and leading a life of crime."

" The health status of youth in juvenile detention facilities "
Mana Golzari, BA, Stephen J. Hunt, PhDc, Arash Anoshiravani, MD, MPH
Journal of Adolescent Health 38(6):776-782, June 2006
Abstract | Full Text | Full Text (PDF)