As King County seeks to reach its goal of “” — ultimately eliminating the practice of juvenile detention in the county —����Ӱ�Ӵ�ý researchers are working to help address major systemic challenges in how young people engage with health care.

With a strategic plan to close the juvenile detention center by 2025, King County needs an increasingly robust system to ensure youth are getting consistent and accessible services, including health care. This is especially true upon release from juvenile detention, the researchers say.��

“For many youth involved in the criminal legal system, their first health care experience as an adolescent is in a setting of confinement and trauma,” said Sarah Gimbel, a professor of child, family and population health nursing in the UW School of Nursing. “So, while juvenile detention is a less than ideal setting for getting physical and mental health care, it is also critical that we are meeting kids where they are today, addressing their needs, and improving the chances that they will continue to engage in health care services in the community.”

While King County guides investments and creates policies that support families and prevent youth involvement in the legal system, Gimbel explains, improving support for youth who are already detained is critical, especially as they reenter their communities from detention.��

“You think about the resources and money that we put into incarcerating kids, and yet so little is put on the back end to help them move back into their communities,” Gimbel said. “We’ve been working for over a year in the juvenile detention clinic with some really amazing frontline health workers, but they are struggling in a system that is scheduled to close down without a concrete plan for what that looks like.”

Gimbel has been co-leading a team of UW experts in an to build a system for managing health care for youth who are detained. The team, which includes advisers and experts from the local organizations and , in addition to Harborview Medical Center, are improving the quality of care in the clinic at the King County Children and Family Justice Center to better serve and track the health needs of young people.

“Prior to young people engaging with the criminal legal system, they’re often coming from neighborhoods that are under-resourced and under-supported,” said Sean Goode, executive director of CHOOSE180. “The data tells us that a large percentage of the children who are living incarcerated are coming from neighborhoods that are farthest away from economic justice, health justice, educational justice, and so the sheer amount of disproportionate injustices they’ve experienced prior to walking into a courtroom are extraordinary. Then they end up incarcerated, living in these facilities, and for likely the first or second time in their lives, they begin to be asked questions about their health and well-being.”

The UW team’s systems-building effort has funding from various state and foundation sources, but in the spring Gimbel made a pitch at the UW School of Nursing’s “Dawg Tank” grant competition. She won the $15,000 award with a plan to augment the systems approach with the creation of a nurse navigation position to help young people manage their healthcare that will be outside of the justice center’s clinic. The nurse will work closely with CHOOSE180.��

“Navigating our health care system is very difficult,” said Addy Borges, a UW graduate student working on the systems project. “When a young person is involved in the criminal legal system, there are usually many other competing priorities and stressors facing them and their families, so navigating health care can be particularly challenging.”

The idea to try the nurse-navigation project came from conversations with community members and service providers about the effects of detention and how to make health care accessible for youth and families who have been marginalized by the current systems.��

“Our hope is that this nurse navigation pilot can be part of the movement toward a community-based system that does not involve detention,” Borges said. “It is an evolving concept that will be guided by community organizations that have deep experience in this space.”��

Goode adds that these youth are faced with a confluence of challenges, including that when they leave incarceration, they are also leaving the care plans that may have been introduced for the first time within those walls.��

“And for the young people who have been forced to live incarcerated inside those facilities, we have to figure out how we make sure they have care when they exit back into the community,” Goode said. “That’s where this conversation around nurse navigation comes into play. It’s an opportunity to imagine a world where young people more immediately have access to a continuation of care that allows them to continue their journey toward wellness and wholeness.”

The UW group has found that inefficiencies in health care services in juvenile detention centers, exacerbated by communication and coordination barriers, result in missed opportunities to address the individual health needs of youth. The group aims to break down walls between siloed services in order to improve communication and make providers work synergistically.

“My work sits at the intersection of nursing (and health care in general) and systems engineering,” Gimbel said. “I focus on helping frontline health workers do their work better with whatever resources they have. And right now, addressing the complex health needs of youth engaged in the criminal legal system has the potential to improve their well-being, as well as prevent recidivism and support King County’s goal of zero youth detention.”

“We know with certainty that young people, when they’re engaged in their healing journey, are far less likely to cause harm,” said Goode, “which allows us all to live in the community we dream of, a community where all young people have the opportunity to thrive, live and love.”

For more information, contact Sarah Gimbel at sgimbel@uw.edu.��

Gimbel, an implementation scientist at the UW School of Nursing, tested her hypothesis and found that smartphone applications, or apps, have the potential to improve efforts to combat HIV/AIDS and other diseases both in the African subcontinent and around the world. By designing software for mobile devices, Gimbel believes that will empower nurses by putting cutting-edge tools into their hands.

“I want to get nurses more engaged in the process of analyzing and using their data,” said Gimbel, who holds an adjunct appointment in the Department of Global Health.

Nurses provide care but also collect data. If they can be actively engaged in using that data, it can lead to improvements in data quality and, ultimately, better health outcomes, Gimbel said.

In a paper published in the September issue of Current HIV/AIDS Reports, Gimbel and her co-authors evaluated the current use of mobile phones and tablets in HIV-related care in low- and middle-income countries around the world. The use of this new technology in the health care system is also known as “mHealth.”

The authors found that a larger selection of phone applications, or apps, are needed to improve the tremendous resources that have been provided to improve HIV/AIDS prevention, care and treatment. And the applications must be designed to be used by huge volumes of users, in other words, to scale.

“Scientists, researchers and practitioners increasingly are borrowing tools from engineering and bringing them to the intersection of quality improvement and health,” Gimbel said.

Leveraging existing health resources – including smartphones – will help nurses work better and smarter, Gimbel said. Nearly 100 percent of the world’s population lives within reach of a cellphone signal, and many nurses in developing economies are able to afford a smartphone. Smartphones can run apps to collect and transmit data of all kinds, from patient adherence information to monitoring drug protocols, and more.

Gimbel and her team focused on HIV/AIDS as opposed to other chronic conditions due to its burden and the amount of resources that have been invested to fight the pandemic. “It’s our laboratory to understand how to make chronic care systems work. So HIV is our testing ground,” Gimbel said. “It has a lot of commonalities with other chronic diseases.”

Now, Gimbel argues, academics and industry must work collaboratively to develop scalable solutions for mHealth innovations to combat HIV and other diseases.

Co-authors include Nami Kawakyu, Hallie Dau and Jennifer A. Unger, all of the UW.

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For more information, contact Gimbel at sgimbel@uw.edu or 206-616-5064.