About 20 years ago, Leslie Acoca was sitting in a California courtroom, waiting to testify as an expert witness in court.
What she saw changed the course of her life.
That day, Acoca watched a young woman, barely five feet tall and eight and a half months pregnant, waddle into the courtroom, fully shackled.
As the pregnant woman sat down at the defense table, Acoca watched the chains dig into her swollen belly.
It wasn’t even Acoca’s turn to speak, but she stood up and asked the judge why the girl was in chains.
“She’s a flight risk,’” she remembers the judge telling her. After Acoca continued to protest, she was ejected from the courtroom.
But that experience helped inspire Acoca’s work with a population that is often overlooked: girls and young women in the juvenile justice system.
A tool that Acoca helped develop for girls and young women locked up in Los Angeles County’s juvenile halls and camps has helped draw attention to their health and mental health needs.
Health issues are especially critical for girls in the justice system. Research has found that across all measures girls in the justice system report being victimized more than boys. When it comes to sexual abuse, the gap widens even further—girls reported sexual abuse 4.4 times more often than boys.
Meanwhile, according to a recent report from the National Women’s Law Center, the proportion of girls and young women in juvenile justice system has increased over the past 15 years at all levels, including incarceration and probation supervision. Acoca calls girls the “fastest growing segment of the juvenile justice population.”
Yet most yet services in the juvenile justice system are still designed for boys, according to Acoca.
“There’s no one asking the right questions of girls,” Acoca said. “They’re really medically invisible in the system, not to mention socially and economically invisible. Philanthropy will give some funds to men and boys, but a much smaller amount of funding goes to girls. The interventions that do go to girls are very soft interventions for the most part.”
Acoca formed the National Girls Health and Justice Institute to make sure that the life-threatening health needs of girls are not overlooked. Working with the Children’s Hospital of Philadelphia, the Juvenile Law Center and other partners, she helped develop the Girls Health Screen, the first evidence-based tool aimed at identifying the health issues and trauma faced by girls and young women in the justice system.
From 2012 to 2016, the Girls Health Screen was piloted at Camp Scudder (now known as Camp Scott) and included a partnership with L.A. County’s Department of Health Services, Department of Mental Health and the Probation Department.
With its successful deployment at Scudder, the screen will now be rolled out later this month at Barry J. Nidorf Juvenile Hall, followed by the county’s two other juvenile halls. Between 180 and 200 girls are held in L.A. County’s juvenile detention facilities on any given day, according to the county.
Administered to girls when they first enter the camp, the health screen consists of 117 questions written in a fourth-grade reading level using a web-based format. The answers to health and trauma screen are automatically transmitted to doctors, nurses and health professionals in the facilities.
Over the course of the five-year pilot phase, 331 girls ages 11 to 17 were confidentially screened. Research collected by Acoca revealed some distressing numbers.
More than 21 percent of girls at Camp Scudder had been homeless within the past year, more than 30 percent had lived in a foster care or group home and 74 percent reported having been suspended or expelled from school. Almost 30 percent had witnessed a recent violent act like a murder or other serious traumatic incident. Twenty percent of girls reported having been pregnant at least once and six percent reported having been pregnant when they entered the camp.
“We’re taking about major public health issues that are going unidentified and untreated,” Acoca said. “Our first goal is to identify life-threatening problems, get them help for those problems, create a medical record for those problems and then hook them up with services both inside facilities and outside in their community.”
For Acoca, who also served as director of the Women and Girls’ Institute at the National Council on Crime and Delinquency, a common theme of her work has been to confront the ways in which health issues can help drive the entry of girls into the juvenile justice system.
She recalls the case of a teenage girl at L.A.’s Central Juvenile Hall who was viewed as having terrible behavioral issues because she wouldn’t sit down in her chair at school. It was only later that staff there realized that her problems stemmed from the mental and physical trauma of repeated rape and abuse.
Acoca hopes that the screen can identify serious health issues like these beyond just L.A County. A relatively cheap investment in early intervention could make a big impact for the health and well-being of girls and young in the justice system.
“We could come very close to zero incarceration of girls if we streamlined their access to health and trauma care, measured it and delivered services early, when girls need them most,” Acoca said. “[But] if you don’t ask the right questions, you’re not going to get the right answers.”