Pediatrics in the community: rattling the bars for change: medical homes for youth exiting juvenile detention.

In 2003, Mana Golzari was a medical student at Stanford working at a juvenile detention medical center. She was struck by the poor health status of the incarcerated youth. Nationally, more than 2 million children and adolescents pass through juvenile detention each year, and they have substantially higher morbidity than their nonincarcerated peers. (1) Despite a 2001 American Academy of Pediatrics policy statement recommending establishment of a medical home before release and although it is mandated that incarcerated youth receive medical care, such services often are discontinued on the youth’s discharge back into the community. (2)(3) Dr Golzari realized that the released youths were not being enrolled into public medical insurance programs for which they were eligible. To address this barrier, Dr Golzari met in August 2005 with the legislative staff of representative Joe Coto, her state assembly member. She provided background research to support legislation ensuring Medicaid enrollment for eligible youth prior to release from detention. She worked with the staff to author a bill. It languished in committee, but they did not give up, instead developing support from the unions of parole officers and social workers, and teamed with California Senator Gil Cedillo’s office to introduce Senate Bill (SB) 1469. Dr Golzari worked continuously to broaden the coalition supporting SB 1469 with endorsements from psychologists, legal advocates, medical associations, and other stakeholders. She testified at legislative hearings about her first-hand experiences. She led letter-writing campaigns on behalf of pediatricians and sent Governor Schwarzenegger supporting materials, including a costbenefit analysis. As a resident since 2006 in the University of California at San Francisco Pediatric Leadership for the Underserved (PLUS) program, she has remained active on this issue. SB 1469 was passed into law in October 2006 and went into effect January 2008. In discussing her successful effort, Dr Golzari said, “I hope that conveying some of the nitty-gritty details about the legislative process will help other pediatricians meet with their local lawmakers to effect system change for overlooked pediatric patient populations like youth in detention.” Along with faculty collaborator Dr Anda Kuo, Dr Golzari has now established a partnership between San Francisco juvenile hall and her residency program and is working to establish a model system by which teens exiting detention have an initial appointment scheduled with a physician prior to release. They also have created a “Youth in Detention” curriculum to disseminate best practices for this population and are conducting a study assessing medical care utilization patterns of recently released youth. (Mana Golzari, MD, University of California, San Francisco, San Francisco, Calif.)