Patrick Boyle is the editor of Youth Today, and author of A Father's Place, a parenting column in Maryland's Gazette newspaper chain and on several Web sites. A 24-year newspaper and magazine veteran, Boyle has extensive experience covering youth issues as a reporter for The Watertown Daily Times and The Washington Times, and as a free lancer for the Washington Post, Baltimore Sun, Newsday, Child and Parenting magazines and ABC News, among others. His book, Scouts' Honor: Sexual Abuse in America's Most Trusted Institution, examined child molestation in the Boy Scouts of America. He has also served as senior editor of Car & Travel magazine and spokesman for AAA. He has a Master's degree in journalism from the University of Maryland.

Introduction:

When young people get in trouble with the law, it makes news. But what happens next? Much of the country pays little attention.

Those who work with youth know all too well that the nations juvenile justice system fails both youths and society in numerous ways: From poor conditions and horrendous health care to inappropriate lock-ups and few efforts to help youth re-enter society. But there are efforts around the country to improve conditions and services.

Over the past several years, Youth Today has explored the problems and the solutions. The stories below cover such issues as:

• U.S. Justice Department investigations of state juvenile justice systems. What has Justice found, and is it doing enough to fix the problems?
• Why health care in juvenile justice facilities is often atrocious, and whats being done about it.
• How a group of advocates helped to get the U.S. Supreme Court to overturn the juvenile death penalty.
• Evaluations of juvenile drug courts do they offer any proof of effectiveness?
• Helping youth transition back into society from juvenile detention.
• A shock boot camp that tried to become kinder and gentler.
• Efforts by police to improve their relationships with youth in their communities.

The articles reflect the many of the numerous ever growing issues of concern surrounding juvenile justice. Some of the articles demonstrate dynamics and variables that lead to success of at least part of the mission of particular programs, systems, and approaches. Others identify significant factors that cause or contribute to some programs and systems falling short of their mission considerably, if not entirely. In either case, the articles offer professionals in the juvenile justice system with additional insight, context, perspective, and information which many youth workers may find useful or as an opportunity to reconsider some of the elements of their programs or other work.

Funding limitations, political agendas, and competing priorities will always encompass and impact many of the fundamental issues that often hinder the improvement and progress of juvenile justice systems and related programs. The perpetual challenge is to continuously overcome common obstacles and provide the best programs and services possible to youth in juvenile justice systems across the United States.

—Patrick Boyle

For site visitors who wish to click on a specific article, you can click on the article's title. If you prefer, you may scroll down to read all articles at once.

Behind the Death Penalty Ban
Supreme Court decision caps state-by-state combat by unusual coalition.
By Patrick Boyle

A Critic Joins the System
By Bill Alexander

Juvenile Drugs Courts: Funding Soars, but What Do We Know?
By Jennifer Moore

Transforming America's Juvenile Justice System
By Bart Lubow and Vincent Schiraldi

For Detained Youth, Horrors in California
By Patrick Boyle

Unjust Medicine
Why health care in juvenile justice facilities is often atrocious,
and what's being done about it.
By Martha Shirk

U.S. Justice Department Cuffs Juvenile Corrections
Federal civil rights attorneys increasingly file charges over conditions,
but some watchdogs say they're too soft.
By Ted Gest

Why Are We So Eager to Fear Youth?
By Mike Males

A Kinder, Gentler Shock Program?
STAR claims impressive results with disruptive youth, but some observers
see abuse.
By Bill Alexander

Cops and Kids: Police Turn into Youth Workers, Hoping to Bridge Gaps
By Jamie Meltzer and Patrick Boyle

Turbulent Re-Entry
Programs show promise in cutting recidivism by helping juvenile offenders ease back home, but praise comes faster than money.
By Bill Alexander

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Juvenile Justice Advocacy:
Back From the Doldrums
By Bill Treanor

Promoting best practice in the juvenile justice field has a long, twisted history, with enough triumph and tragedy to concoct a soap opera titled, "Desperate Advocates."

Prior to the passage of the federal legislation in 1974 that set up the Office of Juvenile Justice and Delinquency Prevention (OJJDP), the nation's lockups for teens had all the charm of Abu Ghraib prison. By 1973, a broad national bipartisan consensus had emerged that a thorough root-and-branch reform was needed. Lead by such groups as the National Council of Jewish Women, the YMCA and the National Council on Crime and Delinquency, the 1974 law made progressive reform the law of the land. It virtually mandated the removal of status offenders from lockups and the development of a range of community alternatives. That spawned the proliferation of the youth-serving community based organizations that now dot the country.

Advocacy efforts to implement the law got off to a strong start during the Ford and Carter administrations. They peaked with a multi-million dollar "special emphasis" initiative, championed by OJJDP Administrator Ira Schwartz, which funded dozens of state-level, progressive policy-makers and service-provider coalitions to push for more funding and better services for troubled teens.

In 1981, Schwartz and his advocacy orientation were given the heave-ho by the new Reagan administration.

Over the next quarter century, the parochial interests of most national groups drifted towards obtaining congressional earmarks from OJJDP and elsewhere in the federal budget, while national-level policy advocacy withered.

Schwartz, meanwhile, had founded a peripatetic university-based shop, now known as the Center for Research on Youth and Social Policy (CRYSP) at the University of Pennsylvania. In the youth service field, good intentions are about as useful as guidance from a Chinese fortune cookie. But Schwartz's interest in reviving statewide juvenile justice advocacy found a like-minded partner in Laurie Garduque, program director for research at Chicago's John D. and Catherine T. MacArthur Foundation. Beginning in 1996 - with a total of $200,000 in grants to Penn's CRYSP, Northwestern University's School of Law, Temple University and the Youth Law Center - the foundation began investing in three areas of juvenile justice reform: focusing on better services in Chicago, researching evidence-based best practices and resuscitating state efforts to encourage what the always diplomatic Garduque calls "a more balanced approach."

Through the Research Network on Adolescent Development and Juvenile Justice, chaired by Laurence Steinberg at Temple University (where Schwartz, coincidentally, is now provost), the foundation has invested $11.2 million in research and policy advocacy. The astute MacArthur effort offers a best practice case study in philanthropic grant making on the virtues of longevity and focus, without being over-prescriptive. Schwartz argued for an effort by MacArthur that would be "not just for advocates" but would draw on more established groups, such as the Boy Scouts, Boys & Girls Clubs and others with a less direct stake in juvenile justice reform.

With funding from MacArthur beginning in 1998, Schwartz turned to Tom McKenna, who had recently retired as executive director of Big Brothers Big Sisters of America (BBBSA). McKenna is much admired for his personal dedication to the youth service field as a whole, not just that of his own employer. He set up shop at Penn and began to laboriously organize what would eventually become the National Network of Statewide Juvenile Justice Advocates. At first, the goal was to strengthen groups in Delaware, Florida, Michigan and Arizona. The early results in building and/or strengthening statewide collaborations were mixed. Florida proved especially difficult and was dropped, while Pennsylvania was added.

The initial effort was modeled on a state-level version of the National Collaboration for Youth, part of what is now the National Human Services Assembly, in which McKenna had been active during his 14-year tenure at BBBSA.

McKenna's work was evaluated by Penn Professor Burt Cohen. Discovering the obvious, Cohen wrote in his 2003 report that he had "one surprise . . . there was much less representation of traditional youth-serving agencies (e.g., YMCA, Salvation Army) than had originally been anticipated." Other funders take note that the evaluation also found "that starting an advocacy collaboration clearly requires some targeted resources, but not an inordinate amount."

Building on earlier national work by the Youth Law Center's Building Blocks for Youth Project, run by Liz Ryan, McKenna tied together some of the most forceful and dedicated state-based advocates. Experienced groups such as the Connecticut Juvenile Justice Alliance, run by Ferdinand Muniz, the Indiana Juvenile Justice Task Force, run by Bill Glick, and the Juvenile Justice Project of Louisiana, run by David Utter, immediately raised the sophistication of the entire network.

As the organizing work by McKenna, in collaboration with Katz's National Assembly, progressed, MacArthur's Garduque could not have been more pleased. The task of "reframing issues in juvenile justice" was making steady progress. "Of course," she notes, "it helps that juvenile crime has fallen." McKenna's network has grown from five states to 28 states in seven years.

McKenna and Garduque are keen to point out that other foundations have played important roles - especially the Annie E. Casey Foundation, where Bart Lebow directs juvenile justice work. Also pitching in are two New York City foundations, the Open Society Institute and the JEHT Foundation. Foundations with a limited geographic focus have also helped, such as the Tow Foundation in Connecticut and The California Wellness Foundation.

As the network grew, several key organizational development issues needed resolution. Penn was from the start a temporary Philadelphia home, and McKenna was a convening figure, not a permanent staffer. Discussions of this nature can be agonizing because of uncertainty about just who is going to pay for a new home and staff. But with MacArthur funding all but certain, two Washington, D.C.-based suitable suitors stepped forward.

One was Voices for America's Children (formerly the National Association of Child Advocates), run by Tamara Copeland. The other suitor was the Coalition for Juvenile Justice (CJJ). The coalition is made up of chairs and other members of the state Juvenile Justice Advisory groups set up under the Juvenile Justice and Delinquency Prevention Act. Compared to Voices (as the group is known), CJJ offered McKenna and company an agency that was single-mindedly focused, for better or worse, on juvenile justice. But it also has an executive director in David Doi who is even more timid than Copeland.

The National Network of Statewide Juvenile Justice Advocates gave the high sign to CJJ, wherein the network will maintain a separate structure and hire a staff person.
In December, MacArthur came through with a $400,000 grant over two years for CJJ and its new partner. Last year MacArthur funded 27 groups to work on juvenile justice, a quarter of them in Illinois. This year the foundation will spend $6.5 million on such efforts.

Since 1984, OJJDP has funded CJJ to provide training and technical assistance and to make policy recommendations to the White House and Congress. Those reports, while hardly influential, were more than the Justice Department under anal-retentive Attorney General John Ashcroft could abide.

Doi and CJJ faced a version of hanging judge syndrome in 2002, when OJJDP administrators used the newly amended Anti-Lobbying Act, and declared that no OJJDP grantee could also advise and lobby the White House and Congress. OJJDP administrator Robert Flores cut CJJ's funding from $669,375 in 2002 to $344,000 in 2003, and set up a duplicative (but equally independent-minded) Federal Juvenile Justice Advisory Committee.

That cut of half its budget put CJJ into what could easily have been a death spiral, eliminating the last even quasi-independent group that keeps a close eye on national juvenile justice policy and spending. But dismay about the performance of Flores and antipathy toward deputy OJJDP Deputy Administrator Bill Woodruff, combined with the Bush administration's relentless budget cutbacks, sparked a rally by supporters to CJJ's cause. In November 2003, the state advisory groups agreed to more than double each state's dues to CJJ from $2,000 to $5,000. Today, 41 states and territories (along with Washington, D.C.) are CJJ dues payers, while the Annie E. Casey Foundation is in its fourth year of a year-to-year $100,000 grant to CJJ. Now those years of work by McKenna are bearing dividends for CJJ.

Says Doi in a decidedly untimid fashion, "Our budgetary health is very, very good." He cites the CJJ 2005 budget projection of $970,000 as his exhibit A, up from this year's $725,000.

"In 2002, 80 percent to 85 percent of our budget came from the federal government," he says. "This year, federal funding was 45 percent and we have more money. We're doing well because of the support of our members and the broader support of national JJ leaders like Mark Soler [Youth Law Center], Patty Puritz [National Juvenile Defender Center, part of the American Bar Association] and Shay Bilchik," president of the Child Welfare League of America.

Will the new partnership between CJJ and the National Network of Statewide Juvenile Justice Advocates be just the tonic the field needs? One veteran advocate involved with both groups is Beth Arnovits, the executive director since 1979 of the Michigan Council on Crime and Delinquency. She characterizes the health of juvenile justice reform as "depressed." For advocates, says Arnovits, "The problem continues to be getting anyone who will fund" aggressive campaigns in the states on behalf of teens in the juvenile justice system. If there were more risk-taking philanthropies with staying power - like MacArthur, Tow and the California Wellness Foundation - the prognosis for ongoing reform would be excellent.

As for McKenna's wagon, now hitched to CJJ, the road ahead is uncertain. For the sake of the over 104,413 juveniles in residential placement (in 2001) and the over 2.26 million arrested each year (in 2002), and for the paying-through-the-nose taxpayer, success is vital.

Contact: CJJ (202) 467-0864, info@juvjustice.org; MacArthur Foundation
(312) 726-8000, www.macfound.org.

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Behind the Death Penalty Ban
Supreme Court decision caps state-by-state combat by
unusual coalition.
By Patrick Boyle

For the past several years, Dr. David Fassler has enjoyed putting his plastic brain through x-ray machines at airports.

At an airport in Wyoming, he recalls, a security agent spotted "the very lifelike" model while scanning Fassler's carry-on bag, turned to a colleague and said, "I think I found what you lost."

Fassler was carrying his brain back from the state legislature, where his testimony about adolescent brain development helped convince lawmakers last year to ban executions of juveniles convicted of murder.

The Vermont psychiatrist was among dozens of doctors, lawyers and youth advocates who traveled the country to campaign against the juvenile death penalty - a campaign that culminated last month with victory at the U.S. Supreme Court.
"It's the biggest [juvenile justice] decision of the last 30 years," says Marsha Levick, legal director of the Philadelphia-based Juvenile Law Center.

That decision resulted from work by countless people and scores of organizations, including the pleadings of a lone professor 20 years ago and kicking into high gear with a meeting of allies in Chicago 15 years later. While the victory cannot be attributed to any single group, one of the most influential efforts was an unusual alliance of physicians, lawyers, child advocates and death penalty foes who coordinated a campaign that blended science, politics, legal strategies, religious beliefs, public opinion and public relations.

Ultimately, the victory rested on convincing one judge that, with about 70 people sitting on death rows for crimes they committed as juveniles, carrying out that penalty was so unusual that it should be declared unconstitutional. That's what the court did last month, in its 5-4 ruling in Roper v. Simmons.

Turning Point

In retrospect, says the man hailed as the founder of the movement to abolish the juvenile death penalty, "I was incredibly naïve."

Victor Streib, a law professor at Ohio Northern University, was studying juvenile homicides around 1980 when he "stumbled across this rare practice" of juvenile executions. His research spurred him to write and speak out against that practice. He spent much of the 1980s traveling to state legislatures, presenting scientific evidence about adolescent brain development in hopes of getting lawmakers to ban juvenile executions.

"I thought I could walk in and tell people the research, and they'd say, 'Voila!,' " he says. But the academician hadn't accounted for politics. "A number of legislators said they couldn't vote for that because they would be seen as voting against the death penalty," he recalls. "Politically, they couldn't support me, even though they agreed with me."

Several legislatures, such as Oregon's, did ban the practice. But Streib felt like "this lonely voice."

Then "a confluence of events and trends," as Miami lawyer Stephen Harper puts it, brought Streib lots of company.

In 1988, the U.S. Supreme Court (in Thompson v. Oklahoma) banned executions of juveniles who were under 16 when they committed their crimes. In 1989, it rejected an effort (in Stanford v. Kentucky) to ban executions of anyone who was under 18 at the time of the crime.

Over the next decade, more lawyers, researchers and youth advocates got involved in juvenile death penalty cases and in combating the national move to punish more juvenile offenders as adults. Law Professor Steven Drizin, supervising attorney at Northwestern University's Children and Family Justice Center, organized commemorations of the 100th anniversary of juvenile court in 1999, focusing on the rehabilitative concept of the court.

That same year, Harper, coordinator of capital litigation at the Miami-Dade Public Defenders Office, got a call from the American Bar Association (ABA). The ABA caller said five juveniles were scheduled for execution the following year, and wanted help in mounting a concerted effort to stop the practice. Harper had headed the public defenders' juvenile division and helped to create the public defenders' Juvenile Sentencing Advocacy Project.

The ABA called other attorneys and researchers as well, setting off a series of discussions and activities that led to what Drizin calls "the turning point."
With action picking up in various parts of the country but no formal network for the actors to coordinate, the ABA convened a brainstorming meeting among the major players in late 2000. Among the 15 or so people gathered at Northwestern's Children and Family Justice Center in Chicago were Drizin; Streib; Harper; Robert Schwartz, executive director of the Juvenile Law Center; Patricia Puritz, director of the ABA's juvenile justice center; and people from Amnesty International and Human Rights Watch.

The consensus: The time was right to push for an end to the juvenile death penalty.
They planned to make changes in state legislatures, state courts and public opinion. "Our goal," Harper says, "was to end the juvenile death penalty state by state, jury by jury, kid by kid."

The Chicago participants launched a loosely centralized effort to build a coalition among groups that stood on the same side of the issue, albeit sometimes for different reasons. Their Juvenile Death Penalty Initiative (JDPI) included the American Bar Association, Drizin's Children and Family Justice Center, the Florida Justice Institute and the Project for the Advancement of Human Rights Law.

Harper, the initiative's director, says one key to success was getting "the scientific/medical community talking with the child advocacy community."
Initiative members and supporters searched for states that seemed most ripe for change. For example, Drizin says that if a state had abolished the death penalty for the mentally retarded, advocates hoped they could use evidence about brain development to win a ban on executing juveniles as well.

They tried to find groups within each state to push for legislative change, with JDPI members providing support, such as death penalty information and connections to the perhaps most important weapon: doctors.

Observe the Frontal Lobes

While banning juvenile executions is largely a moral issue for child advocates, the legislative strategy was to make the debate not about morality - especially the hot-button issue of the death penalty - but about science. Brain imaging technology had vastly improved the ability of scientists to pinpoint brain development and activity, and to see how much different adolescent brains were from those of adults.
Among other things, they found that areas governing impulse control and judgment are the last to develop, and are not fully functional until adulthood.

"Psychiatrists have long known and appreciated that the brains of adolescents function in fundamentally different ways than the brains of adults," Fassler says. "Now we had actual research evidence that could explain this phenomenon."

That new evidence prompted several medical societies to take a step that some of them shy away from: issuing formal stands on matters of public policy.

The trend had started before the Chicago meeting, when an Arizona psychiatrist, Mark Wellek, convinced the American Society of Adolescent Psychiatry to adopt a policy in October 2000 against the execution of anyone for crimes committed before age 18. Wellek, who had long been interested in the issue, was then president of the society.
He then helped convince the American Psychiatric Association (APA) to take the same stand. Fassler, an officer of the APA, then helped to get a similar policy passed by the American Medical Association (AMA).

"That was a big one," Fassler says. The 250,000-member AMA is considered a politically conservative group, and it "avoids taking positions on social issues," Fassler notes. Its action "was a signal that mainstream American medicine felt that there was sufficient scientific evidence to support this argument."

There were numerous signals that mainstream America agreed as well. For instance, more and more religious bodies, such as the U.S. Conference of Catholic Bishops and the United Methodist Church, were stepping up their public statements against the practice.

Getting child advocates involved was sometimes more difficult. In some states, Harper says, "there were many in child advocacy work who said, 'I agree with you completely, but if I get involved with you in this effort, I will lose whatever limited political capital we have' " in their state legislatures. "I understand," he says.
Most of the groundwork appears to have been coordinated by legal advocates and death penalty foes. National youth advocacy groups, such as the Child Welfare League of America and the Children's Defense Fund, issued policy briefs against the juvenile death penalty, sent letters to government officials on behalf of people on death row and joined the amicus briefs in the case that the Supreme Court decided last month.

Leading the charge in the states were groups like the South Dakota Peace and Justice Center, a faith-based nonprofit whose efforts included getting high school and college students to write to legislators and hold rallies. The South Dakota Coalition for Children, the state affiliate of Voices for America's Children, lobbied legislators.
The JDPI helped to connect the local organizations with medical experts like Wellek and Fassler. Having doctors testify and represent organizations like the APA brought clout that youth advocates and death penalty foes couldn't muster.

"When a medical doctor or a psychiatrist testifies in front of a legislature, they get a level of respect that advocates generally will not get," Drizin says. "They're talking about hard science. … Legislators stand up and listen."

"The brains of adolescents function in fundamentally different ways than the brains of adults," Fassler told Wyoming legislators in February 2004, pointing out sections of the brain on his plastic model.

Doctors also participated in media campaigns organized by the ABA, which included briefings for reporters about the latest research on brain development. That led to significant coverage about how the teenage brain differs from the adult brain. The ABA also posted juvenile death penalty facts and resources on its website, which helped to spread information quickly among advocates and journalists.

(The primary ABA lawyers involved in the effort now operate a separate nonprofit, the National Juvenile Defender Center, but no one was available for comment last month.)
Then the U.S. Supreme Court dropped a decision called Atkins in everyone's lap.

The Atkins Effect

The Supreme Court does not rule by public opinion. But it considers evolving public standards of what is acceptable and what is not.

In 1989, the court refused to declare the execution of mentally retarded people to be unconstitutional. But in 2002, the court reversed itself. In Atkins v. Virginia, the court cited changing national standards, noting that since 1989, the number of states that had the death penalty but barred its imposition on the mentally retarded had risen from two to 18.

For those seeking to ban the execution of juveniles, the Atkins reasoning looked identical to their arguments: less legal culpability due to brain development, and changing national standards as reflected in state laws.

"It wasn't until the Atkins case came out that we realized that perhaps this might go to the Supreme Court," Harper says.

That same year, confronted with Stanford v. Kentucky again, the court declined to hear a juvenile death penalty case. The four dissenting justices - John Paul Stevens, David H. Souter, Ruth Bader Ginsburg and Stephen G. Breyer - wrote a stinging minority opinion that said executing juveniles is "a relic of the past and is inconsistent with evolving standards of decency."

How many states would have to reverse themselves to get the court to change its stance? "We wanted to have as many, if not more, states in the aggregate than the court did in Atkins," Drizin says.

They were moving toward that goal when another court decision shook the ground.

A Surprising Decision

Even by the standards of convicted murderers, Christopher Simmons was not the person one would pick as an example of why juveniles should not be executed. In 1993, when he was 17, Simmons and a 15-year-old friend murdered a woman with premeditation, just for fun. They broke into her home in Fenton, Mo., bound her hands and feet, drove to a bridge and threw her in a river. She drowned. The boys took $6.
Simmons got the death penalty, while his accomplice got life in prison.

In 2003, the Missouri Supreme Court overturned Simmons' sentence. Most striking was the court's reasoning: It used the Atkins decision to declare that the death penalty was unconstitutional for anyone under 18. Observers had expected the court to rule on the grounds of state law, but the court essentially made a constitutional ruling that the U.S. Supreme Court had rejected. The ABA called such a decision by a state court "virtually unheard of."

"We were a bit taken by surprise," Drizin says. "It was pretty apparent that this would be a case that would catch the Supreme Court's attention. It was a throw down the gauntlet kind of decision."

The court agreed in January 2004 to hear the case. It was not the case that death penalty foes would have chosen to take to the high court.

"It drove me crazy," Streib says. "Most of us expected the Supreme Court to smack them down with the back of their hand."

What's more, Harper says, "We thought we needed to get more states on board before it went to the court. We thought at some level that this was premature."
The concerted efforts since 2000 had yielded complete victories only in Indiana, South Dakota and Wyoming. Montana had acted in 1999. That meant that since 1989, seven states had banned juvenile executions: four through legislation, one (Washington) through a state court ruling, and two (New York and Kansas) when they re-established their death penalties in the 1990s.

So out of 38 states with the death penalty, 18 prohibited it for juvenile offenders, up from 11 at the time of the court's 1989 refusal to ban executions of 16- and 17-year-olds. That equaled the number that barred the execution of the mentally retarded at the time of the Atkins decision, but was less than half of all death penalty states.
The advocates felt they were making progress. In several states, bills had passed through committees, through one house of a legislature, or, in New Hampshire, through both houses, only to be vetoed by the governor. When the court agreed to hear Simmons, legislation was pending in about a half-dozen states.

There was an upside to the sudden trip to the Supreme Court: In the midst of the campaign, Harper had undergone treatment for brain cancer. "He was the inspirational center for many of us," Drizin says. "Part of our mission was to try to make this happen before Steve's brain cancer returned."

Lots of Friends

The Supreme Court would hear oral arguments in October 2004. The JDPI was not directly involved. While the state of Missouri and the attorney for Simmons prepared their legal briefs, the initiative's members were among many lawyers and physicians around the country who worked on amicus ("friend of the court") briefs supporting the death penalty ban. That's where the change in public opinion, and the work of countless advocates over the years, really showed.

"The thing that impressed us was … the huge number of groups that were interested in filing petitions" in support of the death penalty opponents, Harper says. "It was like boom, boom, boom, boom. There was this wave."

When Levick of the Juvenile Law Center in Philadelphia helped to write a brief to be signed by youth advocacy organizations, 52 signed on. They ranged from the Child Welfare League of America and Voices for America's Children to the Office of the Child Advocate in Connecticut and the Children's Action Alliance in Arizona.

Pulling together co-signers exposed a touchy issue: The arguments against the death penalty contended that juveniles have diminished capacity for rational decision-making, just the opposite of what youth advocates argue when pressing for youth rights. That, The New Republic reported last month, is why the American Civil Liberties Union wouldn't join that brief. (It joined another.)

Other amicus briefs were filed on behalf of medical and scientific organizations, 30 religious organizations, and dozens of foreign nations and bar associations.
The scientific evidence, so powerful in state legislatures, would be of less use in the Supreme Court. "I don't think the brain research has any impact at all on the constitutional issue," Streib notes.

There seemed to be little that could change the minds of seven of the nine justices. Four had written the dissenting opinion in 2002 that called the juvenile death penalty "a relic of the past." In the Atkins case, Justices William H. Rehnquist, Antonin Scalia and Clarence Thomas had dissented from the majority opinion banning the execution of the mentally retarded; they were unlikely to grant such a ban to 16- and 17-year-olds.

The key to victory was convincing either Justice Sandra Day O'Connor or Justice Anthony M. Kennedy that since the court last considered the juvenile death penalty in 1989, national and even world opinion had changed so much that there was a consensus against it. (See "Supreme Court Torn Over Executing Juveniles," October 2004, under archives at www.youthtoday.org/youthtoday.)

"What's notable is how robust this consensus is," Seth Waxman, the attorney for Simmons, told the court on the morning of Oct. 13, 2004. He stressed the consistent movement of states banning the juvenile death penalty, and noted that almost every country in the world bans it as well.

Missouri Solicitor James R. Layton argued that the changes in state laws were too few and recent to demonstrate a permanent national trend.

Justice O'Connor spoke only to note that the number of states banning juvenile executions equaled the number that banned executions of the mentally retarded at the time of the Atkins decision.

Kennedy asked several questions, and seemed torn. He wondered how much international standards should influence the United States. "World opinion is against this," he said to Layton. "Does that have any bearing on whether it's unusual?"
After the hearing, observers agreed that Kennedy was struggling with the issue. O'Connor's lone statement offered slight hope to the death penalty foes.
When the decision was released last month, Waxman had convinced one of the swing judges: Kennedy.

Kennedy even wrote the majority opinion, which focused on the trend since the late 1980s: more states banning juvenile executions, no state reversing itself after banning them, and only a few of those that kept it on the books actually carrying it out. He also noted, "The overwhelming weight of international opinion against the juvenile death penalty is not controlling here, but provides respected and significant confirmation" for the decision.

Some of the advocates felt especially happy for Harper. "One of the main motivating factors for a lot of people was to have this be part of Steve's legacy," Drizin says. "Hopefully … he will be with us for years to come.

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A Critic Joins the System
By Bill Alexander

After 20 years of slugging it out with police, prosecutors and bureaucrats, juvenile justice reformer Vincent Schiraldi has joined their ranks.

If you're going to meaningfully fix juvenile justice in America, you've got to go inside," says Schiraldi, 46, after being nominated by Washington Mayor Anthony Williams (D) last month to head the city's troubled juvenile justice system.

The married father of two teenagers has been trying to improve juvenile justice for more than a decade. A graduate of the State University of New York at Binghamton, Schiraldi went to work in 1980 for the New York State Division for Youth as a live-in house parent at a group home for delinquent boys. It was there, he says, that he first witnessed institutional "cynicism" among youth workers in the form of negative case management styles and overzealous security. "Books were considered contraband and confiscated," he recalls.

Disillusioned, he quit. He soon got approval from Jerome Williams, founder of the National Center on Institutions and Alternatives (NCIA), to open a regional office in San Francisco.

In 1985, he and Dan Macallair co-founded the nonprofit Center on Juvenile and Criminal Justice (CJCJ), which later absorbed the NCIA office Schiraldi had opened. CJCJ focused primarily on reducing juvenile incarceration through technical assistance and model programs in cities such as Washington.

The Justice Policy Institute' (JPI) was born in 1997 as a policy development and research arm of CJCJ. Five years later, JPI split off on its own. Schiraldi ran JPI in Washington, while Macallair ran CJCJ in California.

JPI's focus has included commissioning studies and serving as a quotable think tank, with a stated goal of "ending society's reliance on incarceration." As executive director,* Schiraldi has criticized and offered alternatives to such practices as disproportionate minority confinement, lengthy jail stays and trying children as adults.

"It's a miracle they would hire me," Schiraldi says. "I've never run a large bureaucracy." Mindful of his image as a bureaucrat-hating dragon slayer, he says he never considered the agencies he battled over the years to be "complete enemies."

Priding himself on being a "community worker," Schiraldi says he will bring a sense of "urgency and alarm" to blow out the "institutional lethargy and indifference" that hobbles juvenile justice agencies nationwide.

Vinny's View

Alarm is the right word for the Washington juvenile justice system and its Oak Hill juvenile jail - so plagued with mismanagement and allegations of inmate abuse that the agency was nearly placed under court receivership last year. A special arbiter has been appointed to deal with the class-action lawsuit against the city over conditions at Oak Hill. Some 400 youngsters come under the agency's domain.

Schiraldi will be the first director of the city's new Department , of Youth Rehabilitation Services, which replaces the agency that oversaw Oak Hill. If confirmed by the city council, Schiraldi will earn $140,000 a year, and leap from overseeing a $1 million budget and seven staffers at JPI to a $6 1'million budget and a staff of 592 with the city.

"A couple of zeros may be added [to the budget], but it's still the same brain making the same decisions on how to reduce recidivism and improve resident treatment," he says.

Macallair, whose CJCJ maintains offices in San Francisco and Oakland, Calif., says Schiraldi "brings a passion for fixing the system to his job that separates him from someone with a conventional outlook."

That outlook began taking shape 30 years ago. Back in 1970s Brooklyn, N.Y., the adolescent Schiraldi and his homeboys kept busy with pranks and brushes with the law that included drinking on the street and minor vandalism.

"But the Italian and Polish police didn't arrest us, unless we were doing something really bad," recalls Schiraldi. "They talked to us, then shooed us away."

He says police rarely exhibit such concern and helpfulness when dealing with minority youth. In Washington, he notes, "96 percent [of the juveniles in detention] are African-American and 1 percent to 4 percent are Latino. The excellence of the [D.C.] juvenile system kicks into gear when white kid is arrested. They rarely incarcerated, and they are given the attention they deserve.

Schiraldi: Vows to erase the "institutional lethargy and indifference" that typifies juvenile justice system.

"He's way, way out of the box," says Bart Lubow, director of the Annie E. Casey Foundation Program for High Risk Youth at Their Families. "Vinny has spent his career battling broken systems. I applaud the District for the boldness in selecting him."

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Juvenile Drugs Courts:
Funding Soars, but What Do We Know?
By Jennifer Moore

It's been 10 years since the nation's fledgling juvenile drug courts began receiving federal funds to rehabilitate teen drug abusers. But despite federal investments of more than $1 billion over the past decade and an explosion in the number of such courts to nearly 300 in 2003, little rigorous research has been conducted on their effectiveness.

In a new report, Juvenile Drug Courts and Teen Substance Abuse (Urban Institute Press, 2004), Urban Institute researchers Jeffrey A. Butts and John Roman examine the history, mission, operations and evaluation of juvenile drug courts to find out what's known about their ability to reduce drug use and recidivism.

In the mid-1990s - when arrest rates for juvenile drug violations more than doubled - state and local jurisdictions began creating juvenile drug courts (JDCs), based largely on the anecdotal success of adult drug courts established in the late 1980s. Both adult and juvenile drug courts combine treatment with close supervision and the leverage of judicial authority to change the behavior of users.

Butts and Roman suggest that when federal drug court funds became available to juvenile courts in 1995, some jurisdictions saw an opportunity to provide increased resources to troubled youth caught up in a juvenile justice system that had become more punitive. "This was an earnest endeavor to get services to kids," Roman says.

Since then, however, juvenile drug courts have evolved with widely varying characteristics, largely through uncontrolled innovations. "No one encourages them to think theoretically," Butts says. "They careen back and forth between ideas."

At they same time, the programs have been scrutinized mainly by a "haphazard program of inadequate and potentially redundant evaluations" that have failed to clearly define their components, document their impact or prove their success, the researchers write. "It doesn't take much to evaluate a program" to the satisfaction of funders, Butts says. "JDCs pretty much just have to check off a box that says, 'We've been evaluated.' "

But in a departure from the usual researchers' cry for more research, Butts and Roman assert that less will produce more.

They argue that the current system requiring JDCs to arrange for an evaluation at the conclusion of each three- to four-year federal funding cycle produces limited data and provides little evidence on whether and how the courts work. Like many youth programs, the courts are asked to justify their continuation by producing proof of positive results. For JDCs, the renewal of their federal funding depends upon it.

"That's when the professor from the local university is called in and presented with a shoebox full of data," Butts says. "The easiest thing to do is to compare recidivism among youth who graduated from the drug court program versus those who dropped out or terminated from the program. That's why, when you look at these evaluations, you see something like '90 percent of program graduates were arrest-free 12 months later.' Of course they are, because you've taken all of the likely recidivists out of the equation."

The authors describe this type of impact evaluation as based on a "black box" model, in which drug use and arrest rates are measured before, during and after the offender passes through the "black box" of drug court. Such limited evaluations create myriad problems. Most lack a basic cause-and-effect hypothesis of how involvement in drug court might affect behavior. Most are designed to be nonexperimental or weakly quasi-experimental - that is, they don't randomly assign participants to treatment and control groups, thus limiting their ability to minimize the effects of unobserved factors (like the characteristics of participants) on outcomes. Finally, "black box" evaluations fail to break the processes of the court into components that can be observed and studied individually.

Unfortunately, as many youth workers well know, the thoroughness of evaluations is often sacrificed to accommodate time and financial constraints. In an effort to fill the void of scientifically based research, several practitioner and research groups, including the National Drug Court Institute and the RAND Corp., have compiled best-practice guidelines that list operational features considered by some as key to the success of JDCs. These may help courts that are starting from scratch, but don't provide enough evidence upon which to build a conceptual framework for effective programs.

In their study, Butts and Roman suggest a framework to direct researchers' attention to the important ingredients of program operations, encourage the formulation and testing of viable hypotheses, and suggest useful measurement approaches and data collection techniques.

They conclude that federal money could best be spent on targeted efforts to establish evidence-based operational principles for JDCs through the use of these or similar frameworks, and that a system of independent accreditation based on the implementation of those principles might become the basis for funding renewal.
"The danger in that," Butts says, "is that people will buy into the concept of accreditation instead of evaluation, or that the accreditation process will become politicized."

Steven Belenko, a senior scientist at the Treatment Research Institute at the University of Pennsylvania and an advisory committee member of the National Evaluation of Juvenile Drug Courts, says most JDCs aren't ready for accreditation. "Many have 10 to 15 clients. Almost none have 100 clients, which is the minimum you need to do a decent evaluation," he says.

Belenko agrees that the next step is to fund a small number of JDC programs to be tested by a rigorous experimental design.

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Transforming America's Juvenile
Justice System
By Bart Lubow and Vincent Schiraldi

Over the past five years, public scandals about the way young people are treated in America's juvenile justice facilities have erupted in state after state.

This year, two teenage boys incarcerated in the same cell in a California youth institution were found hanged, in apparent suicides. A month later, experts retained by the state found that juveniles were incarcerated in abominable conditions, with youths attending classes while confined in cages, feces spread on the walls of some youths' cells and extraordinarily high levels of violence.

In Maryland, the U.S. Justice Department strongly criticized conditions in the state's juvenile justice facilities, citing beatings of youth by staff, along with inadequate mental health care and educational programming and chronic overcrowding in antiquated facilities. The in-custody death of youths in Florida, Louisiana and South Dakota have all precipitated calls for reform in those states and, in some cases, have resulted in facilities closing.

For those of us with years of experience in juvenile justice, these short-lived periods of concern are all too familiar. Too often, institutional cycles are characterized by scandal, earnest cries for reform, temporary concern over conditions, gradual entropy and, once again, scandal.

There have been exceptions. In the 1970s, all of the large, locked facilities in Massachusetts were closed under the leadership of Department of Youth Services Commissioner Jerome Miller, and the youth were funneled into community-based programs. Follow-up studies by Harvard University and the National Council on Crime and Delinquency found that graduates of Miller's community-based system were half as likely to matriculate into adult prisons as were youth who went through the previous, institution-based system.

Juvenile justice watchers were disappointed, however, when a model that produced such outcomes failed to spread far and wide.

Likewise, in the 1980s Missouri closed its large training school, relying instead on small, home-like facilities for youth who needed to be held in secure confinement, and on a network of day-treatment programs for youth who could safely be placed in the community. The results of the "Missouri model," promoted under the leadership of Youth Services Director Mark Steward, are impressive. Only 8 percent of youth released from Missouri's facilities in 1999 were sentenced to adult incarceration within three years of release. The figure for Maryland is 30 percent.

Moreover, recent visitors to Missouri from other states have marveled at the differences between these sites and their states' facilities: how the youth are engaged, alert and interactive, compared with the sullen, frightened personas common among their institutional populations.

Which once again raises the question: Why isn't this model being replicated throughout the country?

One reason is that juvenile justice policy-making is still suffering from the effects of the demonization of young people during the 1990s, when Princeton University Professor John DiIulio captured the prevailing political mood by warning about a wave of "superpredator" adolescents. The racial and socioeconomic makeup of America's incarcerated youth surely also helps those in power ignore juvenile justice generally, or, when confronted with a public scandal, enact piecemeal solutions to endemic problems. These factors, coupled with the belief that kids in my state are irrevocably different from Missouri youth, hinders the widespread adoption of juvenile justice reforms that make sense by any standard of measurement.

Finally, most policy-makers and youth correctional officials have simply never seen a juvenile justice system that is not dominated by the 19th century training school model. Since the Annie E. Casey Foundation began funding Missouri as a "model" youth corrections site two years ago, numerous delegations of elected officials and juvenile justice practitioners have toured the state's system. Following one such tour, the Maryland Legislature passed a bill requiring that all facilities in Maryland be reduced to no larger than 48 beds. Policy-makers in Louisiana and California are discussing "Missouri-style" reforms in their states.

As elected officials from California to Maryland, from Louisiana to South Dakota and points between endeavor to reform their state's juvenile justice systems, they should avoid cosmetic fixes designed merely to get them past today's embarrassing headlines. Instead, they should confidently set a course that rids their states of harmful youth prisons, replacing their systems with community programs for those who don't need to be locked up, and small, rehabilitative facilities for those who do.

Bart Lubow (blubow@aecf.org) is a senior associate at the Annie E. Casey Foundation. Vincent Schiraldi (vschiraldi@justicepolicy.org) is executive director of the Justice Policy Institute.

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For Detained Youth, Horrors in California
By Patrick Boyle

The infamous California Youth Authority (CYA) has again been exposed as a virtual torture chamber for convicted youth, but this time advocates for kids believe the situation will improve.

That's because of scathing reports that say detained juveniles are routinely locked in cages, are overmedicated and actually come out in worse mental health than when they went in. State officials have vowed to make changes at CYA facilities, and change actually seems likely, as the reports were produced for the state attorney general because of a lawsuit against the state.

"I expect to get a consent decree out of this in the near future," said Donald Specter, an attorney for the Prison Law Office, a nonprofit that is one of the plaintiffs in the lawsuit.

Reports about horrible conditions in juvenile detention are nothing new. But juvenile justice experts such as John O'Toole, director of the Oakland-based National Center for Youth Law, expect these reports to show the value of litigation in forcing reforms.

The CYA holds about 4,400 young people up to age 25 who have been sentenced for serious and violent crimes.

The lawsuit (Farrell v. Harper) prompted the attorney general to ask several national experts to investigate conditions and produce a series of reports, which have been released in stages since last year. Among the findings:

During classes and counseling sessions, youths are often kept in small cages, so that they were isolated from one another and the staff; the "wards live in constant fear of physical and sexual violence from CYA staff and other wards"; and "The vast majority of youths who have mental health needs are made worse instead of improved by the correctional environment."

CYA officials have called the findings "substantially correct" and promised changes, as have the attorney general and several state legislators. "They're abolishing the use of the cages," Specter says.

He says he and attorneys for the state are on the verge of an agreement to settle the lawsuit. He expects a wide range of stipulations for improving conditions.

Those stipulations will include better staff training and the hiring of more staff, Specter says. "I don't think they're trained properly or enough," he says. The training would include use of de-escalation techniques with youth who are acting up.

While Specter says some CYA staff members are "obviously malicious," he recalls that when he toured CYA facilities a couple of years ago, "I was struck by how many of the staff wanted help. … They went into this not for punitive reasons, but to help kids. …

"They just haven't been given the resources, the training, the administrative structure or the staffing that's needed."

"There's a long way to go," but improvements are on the way, predicts O'Toole of the youth law center. "The CYA has been a horrible place for a very long time."

Contact: California Youth Authority (916) 262-1473, www.cya.ca.gov; Prison Law Office (415) 457-9144, www.prisonlaw.com

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Unjust Medicine
Why health care in juvenile justice facilities is often atrocious, and what's being done about it.
By Martha Shirk

By all accounts, 17-year-old Omar Paisley died an excruciating death.

For three days, Omar lay on a concrete bunk, weeping and moaning and begging for help. "Ain't nothing wrong with his ass," a licensed practical nurse proclaimed after a cursory examination.

By the time the nurse agreed to summon an ambulance, Omar was delusional. By the time the ambulance was actually called, Omar was dead of a ruptured appendix. No one who watched him die even tried to resuscitate him.

Omar's death would be tragic in any setting. The fact that it occurred while he was locked up in the state-run Miami-Dade Regional Juvenile Detention Center was indefensible, a grand jury concluded after a nine-month investigation. "We were appalled at the utter lack of humanity demonstrated by many of the detention workers charged with the safety and care of our youth," the grand jury declared in an investigative report.

Omar's death in June 2003 brought attention to the quality of health care in juvenile justice facilities, a topic that historically has received little scrutiny. A grand jury, a select legislative committee and a state inspector general have investigated the staff missteps that preceded Omar's death, along with the general state of the medical care that the Florida Department of Juvenile Justice provides to the 52,000 youths admitted to secure detention each year.

Omar's death has also spurred a bout of self-examination at other juvenile institutions around the country. "We all worry about something like that happening on our watch," said one detention facility doctor, who asked not to be identified.

From October 1999 through September 2000, the latest period for which data are available, 47 youth died while in custody in the United States. No one knows how many deaths could have been prevented with better medical care. But Earl Dunlap, executive director of the National Juvenile Detention Association (NJDA), says: "I can say to you with no equivocation that health care in juvenile detention and corrections, as a whole, is extremelyinadequate." Although many juvenile facilities around the country provide exemplary health care, evidence is mounting that many others do not:

• Less than a year before Omar died, state quality control inspectors had labeled health care at Miami-Dade as "minimal." Many detainees never received physicals, recordkeeping was haphazard, and requests for care were often ignored, the inspectors reported. In 2000, a girl suffered a miscarriage and went more than a day without medical attention, despite severe bleeding and acute pain. At the time, the center's policy gave staff up to 72 hours to respond to a request for medical assistance.

• At the California Youth Authority, several teams of outside experts reported last year that health care was "not commensurate with community standards of care" and that the agency's mental health services actually made most youths worse. Youths sometimes waited two weeks for treatment of fractures. At one facility, narcotic pain medication was never prescribed, even for excruciating conditions.

• For two years, Connecticut's attorney general and its appointed child advocate have been pressing for improvements in health care and other services at the new state-operated Connecticut Juvenile Training Facility. After violence erupted in May, they called for a team of juvenile justice and mental health experts to oversee the facility. "We are gravely concerned that we have reached a point where something catastrophic is going to occur," they said.

• Louisiana is reinventing its health care system for juvenile inmates as a result of a settlement reached in 2002 of civil rights lawsuits challenging conditions of care. The suits, filed in 1998, alleged a pattern of diffident or cruel care, particularly for residents with mental problems, who were sometimes hog-tied or isolated rather than being offered treatment.

• Cook County, Ill., is working on a plan to improve health care at its detention center, the nation's largest, after the settlement in 2002 of a lawsuit alleging that youth had difficulty accessing medical and mental health care and other services.

Injuries, Addictions and STDs

As a group, teens are generally healthy. But that's not as true of the 330,000 who spend time in detention and the 100,000 who are sentenced to correctional institutions each year.

The Coalition for Juvenile Justice says that 50 to 75 percent of those youth have diagnosable mental disorders, and up to half of those also abuse drugs. A national survey of detention facilities in 1994 found the rate of gonorrhea to be 152 times greater among confined males and 42 times greater among confined females than among unconfined youth. A study published in Pediatrics in 1985 reported injury rates five times the rates for youth on the outside. Each month, nearly 1,000 incarcerated youth commit "suicidal acts," says Physicians for Human Rights. The National Center on Institutions and Alternatives says that 108 killed themselves between 1995 and 1999.

In short, teens in detention and correctional facilities have "significant medical, dental and psychological problems," says Dr. Robert E. Morris, a pediatrician who has years of experience caring for confined youth in Los Angeles and, most recently, Louisiana. Aside from the moral and legal obligations to care for locked-up youth, Morris says, self-interest provides another compelling reason: A youth is less amenable to rehabilitation if he's battling physical or mental illness.

"If we are going to try to rehabilitate these kids, we need to provide both medical and psychiatric services," says Morris, who teaches at the medical school at the University of California at Los Angeles. "Otherwise it's not likely that they're going to get better."

But at many juvenile facilities around the country, the health care that's provided rarely rises above the level of "mom and pop-type care," says David W. Roush, former chairman of the National Commission on Correctional Health Care and head of the National Juvenile Detention Association's Center for Research and Professional Development.

"In a typical 50- to 75-bed juvenile facility operated by a county, you might find a part-time nurse who's there for maybe 20 hours a week," says Roush, who has observed health care in about 200 facilities. "There will be a part-time physician, who comes in two or three hours a week. A fever probably isn't going to be viewed as a concern until it hits 102. Of course, in some situations, that's pushing the envelope, and you've made a bad decision."

Some facilities strive to provide a high level of care. At the Santa Clara County juvenile detention center in San Jose, Calif., Medical Director Dr. Jerry R. Klein says he strives to "provide the preventive health care that most kids would get if they had their own private physician, which many of these kids don't."

While a youth is in custody, Klein and his staff make sure his or her immunizations are up to date. They screen for sexually transmitted diseases and provide advice about contraception. A dentist provides routine dental care, and each youth gets a mental health assessment and follow-up treatment if needed. Detainees get "all of those things that we would hope that all of our adolescents would get," Klein says.

More often than he would like, Klein discovers undiagnosed conditions that, left undetected, might cause serious health problems. He says he has diagnosed "everything from chromosome disorders to hypertension to thyroid disease to diabetes."

Because of poverty or chaos at home, many detained youth have a history of inadequate care. It's not uncommon for a teen to report that he last saw a physician for his pre-kindergarten physical. Many have never seen a dentist.

Barriers to High-Quality Care

A major barrier to improving care in juvenile facilities is the ban on the use of Medicaid funds to treat inmates, both juveniles and adults, which leaves counties and states to pay the whole bill. "You wind up with health care competing with all the other institutional needs, like security and guards' salaries," notes Sue Burrell, an attorney in San Francisco with the Youth Law Center, a public interest law firm. "Unfortunately, it sometimes takes a tragedy to get everyone's attention."

In fact, it was the death of a detained youth from pneumonia in 1981 that prompted Santa Clara County to beef up its medical services. Sixteen years later, after a near-suicide left a 14-year-old detainee in a persistent vegetative state, major improvements were made in mental health services for detainees.

In addition to inadequate funds, another barrier to good care is the desire of politicians to avoid being seen as coddling criminals. "We've often heard from juvenile administrators that they don't want Cadillac health care, that Chevy health care is just fine," Morris says.

The uneven quality of personnel also poses problems. "Several different types of people end up in correctional medicine," Morris notes. "Some really love it and do a great job. Some discover immediately that they don't like it and get out. And then some people don't like it and stay on and get broken down and don't do a good job. It's very difficult to attract good people on the cheap."

Another problem is the correctional culture, particularly if medical personnel view themselves as agents of the jailers, as Morris says they did in Louisiana, until recently. "The medical people need to understand that their job is care and not detention," says Morris, who served as medical director for Louisiana's juvenile system after the lawsuits were settled. "They need to worry about how the kid is doing and not about keeping the guards happy."

Klein, in San Jose, thinks Santa Clara County's setup is ideal, with the health professionals who care for detained juveniles employed by Valley Medical Center, the county-run hospital, rather than by the detention center. "The way I look at it is I work for the kids who are here," he said. "By being employed by an outside agency rather than probation, the services I provide are in the best interests of the minors. In situations where one is employed by the probation department or the correctional facility, one has a potential dual allegiance."

Lax Oversight

No federal regulations dictate the level of health care that must be provided in juvenile facilities. The last time the federal government even examined the issue was

in 1992, in its Conditions of Confinement study. That study reported that almost half of detainees lacked daily access to a doctor or nurse.

Are conditions better or worse today? "Although a decade old, many of the findings associated with health care continue to exist," says Dunlap of NJDA. "Particularly in the last four years, youth in confinement have become less and less a priority, and along with that comes an erosion of adequate conditions of confinement."

In fact, just one year after the federal report was issued, critics complained that it had overstated the quality of health care because state and local budget cuts had caused staff reductions,