THE SEXUAL ABUSE
TO PRISON PIPELINE:
THE GIRLS’ STORY
Human Rights Project for Girls
Georgetown Law Center
on Poverty and Inequality
Ms. Foundation for Women

CENTER ON POVERTY and INEQUALITY

Text here	
00report:
authors
of the
Malika Saada Saar, Human Rights Project for Girls
Rebecca Epstein, Georgetown Law Center on Poverty and Inequality
Lindsay Rosenthal, Ms. Foundation for Women
Yasmin Vafa, Human Rights Project for Girls

The authors gratefully wish to acknowledge the following contributors for their
substantive assistance to this report:
Maheen Kaleem, Human Rights Project for Girls, who appeared at just the right moment, with unbending
commitment and vision, to help bring us to the finish line.
Julie F. Kay, Human Rights Attorney, whose human rights expertise, guidance and feedback immeasurably
strengthened this report in service of America’s most vulnerable girls.
Shakira Washington, Consultant, Human Rights Project for Girls, whose brilliant research and writing on
girls at the margins laid the foundation for this paper’s development.
Teresa Younger, President of the Ms. Foundation for Women, whose leadership in supporting Ms. Fellowship during her first months at the Foundation was essential to the completion of this report.

And with thanks for their time and effort in reviewing this paper and providing
invaluable insight:
Mary Bissell, ChildFocus
Peter Edelman, Georgetown Law Center on Poverty and Inequality
Carmen Perez, Campaign for Youth Justice
Liz Ryan, YouthFirst! Initiative
Francine Sherman, Boston College Law School
Dana Shoenberg, Center for Children’s Law and Policy

To obtain a hard copy of this report, please contact:
Center for Poverty and Inequality | Georgetown University Law Center
600 New Jersey Avenue NW #461 | Washington, DC 20001
povertycenter@law.georgetown.edu
Download available at www.law.georgetown.edu/go/poverty

Design Ines Hilde, Georgetown Law Photography Front cover photo and photos on pages 4, 6, 27,
and 34 by © Richard Ross, www.juvenile-in-justice.com. Back cover photo and photos on pages 21 and
45 by © Rebecca Epstein, www.rebeccaepsteinphotography.com. All photos used by permission.

THE SEXUAL ABUSE
TO PRISON PIPELINE:
THE GIRLS’ STORY
Dedicated to the girls

The Nature of This Flower Is to Bloom
Rebellious. Living.
Against the Elemental Crush.
A Song of Color
Blooming
For Deserving Eyes.
Blooming Gloriously
For its Self.

— Alice Walker

Text here	

00

about the authors’ organizations

Human Rights Project for Girls works to make the lives of US young women and girls a human rights
priority. Gendered violence here in the US, like gendered violence abroad, restricts girls’ rights and the
realization of their full potential and dignity. As a national organization of human rights lawyers, Rights4Girls
addresses the conditions of sexual violence, rape, exploitation, and trafficking here in the United States in
the areas of policy, legislation, and law. We advocate for the dignity and personhood of young women and
girls – so that every girl may possess the right to be safe and live a life free of violence and exploitation. See
more at www.rights4girls.org.
The Center on Poverty and Inequality works with policymakers, researchers, practitioners, and advocates to develop effective policies and practices that alleviate poverty and inequality in the United States.
The Center’s areas of anti-poverty work include national, state, and local policy and program recommendations that help marginalized girls, promote effective workforce and education policies and programs for
disconnected youth, and develop policy to combat deep poverty. Its strategies are to partner with Administration agencies and non-profit organizations to host national conferences, produce and widely disseminate
in-depth reports, engage in public speaking, and participate in national coalitions and working groups. See
more at www.law.georgetown.edu/go/poverty.
The Ms. Foundation for Women is the first and largest US women’s foundation. Since our founding in
1972, we have supported grassroots organizations across the country to sustain and amplify the vision and
voice of women who area leading change in their communities, particularly low-income women, women of
color and young women. We focus on three pillars — women’s health, economic justice and safety — in
order to fulfill our mission: to build women’s collective power to realize a nation of justice for all. See more at
www.forwomen.org.

table of contents

Introduction
Girls’ Paths of Sexual Abuse into the Juvenile Justice System

	

4

	6

The Proportion of Girls — Especially Girls of Color — in the
Juvenile Justice System is Increasing.

	

7

Girls in the Juvenile Justice System are Disproportionately
Victims of Sexual Violence.

	

7

Girls’ Behavioral Reaction to Sexual Abuse and Trauma is
Criminalized, Reinforcing the Sexual Abuse to Prison Pipeline.

	

9

The Juvenile Justice System Typically Fails to Address, and
Often Exacerbates, Trauma that Caused Girls to Be There.

	

12

Dismantling the Pipeline: Policy Recommendations to
Reduce Traumatized Girls’ Arrest and Incarceration

	

15

Lived Experience of the Sexual Abuse to Prison Pipeline:
Victims of Sex Trafficking Jailed as Offenders.

	

19

	

20

	

22

	

23

	

24

	

25

Dismantling the Pipeline: Policy Recommendations to
Keep Victims of Sex Trafficking Out of Juvenile Justice
Lived Experience of the Sexual Abuse to Prison Pipeline:
Detention of Girls Who are Status Offenders.
Dismantling the Pipeline: Policy Recommendations to
Decrease the Disproportionate Effect of Status Offense
Enforcement on Girls
In Focus: Dual-System Youth and the Sexual Abuse to
Prison Pipeline.
Dismantling the Pipeline: Policy Recommendations
to Reduce Foster Girls’ Crossing Over into the Juvenile
Justice System

Child Welfare and the Sexual Abuse to Prison Pipeline: Identifying
and Treating Trauma in the Child Welfare System
Dismantling the Pipeline: Policy Recommendations to Improve
the Child Welfare System’s Response to Girls

Conclusion

	27
	

29

	 32

3

4

VIOLENCE AGAINST GIRLS
IS A PAINFULLY AMERICAN
TALE. IT IS A CRISIS OF
NATIONAL PROPORTIONS…

introduction

Violence against girls is a painfully American tale. It is a crisis of national
proportions that cuts across every divide of race, class, and ethnicity. The
facts are staggering: one in four American girls will experience some form of
sexual violence by the age of 18. Fifteen percent of sexual assault and rape
victims are under the age of 12;1 nearly half of all female rape survivors were
victimized before the age of 18.2 And girls between the ages of 16 and 19
are four times more likely than the general population to be victims of rape,
attempted rape, or sexual assault.3
And in a perverse twist of justice, many girls who experience sexual abuse
are routed into the juvenile justice system because of their victimization.
Indeed, sexual abuse is one of the primary predictors of girls’ entry into the
juvenile justice system.4 A particularly glaring example is when girls who are
victims of sex trafficking are arrested on prostitution charges — punished as
perpetrators rather than served and supported as victims and survivors.
Once inside, girls encounter a system that is often ill-equipped to identify
and treat the violence and trauma that lie at the root of victimized girls’
arrests. More harmful still is the significant risk that the punitive environment will re-trigger girls’ trauma and even subject them to new incidents
of sexual victimization, which can exponentially compound the profound
harms inflicted by the original abuse.
This is the girls’ sexual abuse to prison pipeline.
This report exposes the ways in which we criminalize girls — especially girls
of color — who have been sexually and physically abused, and it offers policy
recommendations to dismantle the abuse to prison pipeline. It illustrates the
pipeline with examples, including the detention of girls who are victims of
sex trafficking, girls who run away or become truant because of abuse they
experience, and girls who cross into juvenile justice from the child welfare
system. By illuminating both the problem and potential solutions, we hope to
make the first step toward ending the cycle of victimization-to-imprisonment
for marginalized girls.

5

6

GIRLS’ PATHS OF SEXUAL
ABUSE INTO THE JUVENILE
JUSTICE SYSTEM

girls’ paths of sexual abuse into the juvenile justice system

the proportion of girls — especially
girls of color — in the juvenile justice
system is increasing.

tion of girls’ having violated conventional norms and
stereotypes of feminine behavior,19 even when that
behavior is caused by trauma.20

The rate of girls’ involvement in juvenile justice is
growing disproportionately at key determinative points
in the criminal justice process, including the decision
to arrest and detain girls.5

girls in the juvenile justice system are
disproportionately victims of sexual
violence.

Girls of color are particularly affected by this trend.6
Although rates of overrepresentation vary significantly by jurisdiction,7 the national trends are revealing.
African-American girls constitute 14 percent of the
general population nationally but 33.2 percent of
girls detained and committed.8 Native American girls
are also disproportionately involved in the juvenile
justice system:9 they are 1 percent of the general
youth population but 3.5 percent of detained and
committed girls.10
The disproportionate rates of confinement in residential placements for girls of color are most accurately
revealed when viewed per capita: Native American
girls are in residential placements at a rate of 179 per
100,000; African-American girls at a rate of 123 per
100,000; and Latinas at a rate of 47 per 100,000. By
comparison, 37 per 100,000 of non-Hispanic white
girls are confined.11
According to studies by the Girls Study Group of the
US Department of Justice’s Office of Juvenile Justice and Delinquency Prevention, among others, the
increase in girls’ rate of arrest and incarceration over
the last two decades is not a result of their engaging
in criminal activity at higher rates.14 Nor are they increasingly violent.15 Although the reason has not been
definitively determined, evidence suggests that one
cause is more aggressive enforcement of non-serious
offenses that are rooted in the experience of abuse
and trauma,16 as illustrated by the recent increase in
arrests of girls involved in family-based incidents.17
In fact, the leading cause of arrest for girls are minor
offenses such as misdemeanors, status offenses, outstanding warrants, and technical violations.18 And the
decision to arrest and detain girls in these cases has
been shown often to be based in part on the percep-

Research reveals that girls who are sent into the
juvenile justice system have typically experienced
overwhelmingly high rates of sexual violence.21
Further studies are urgently needed, as virtually no
national data exists to illuminate incarcerated girls’
histories of sexual violence. However, several local
and regional studies paint an informative portrait
of incarcerated girls’ histories of abuse. In a 2006

LGBT/GNC Girls
Youth who identify as lesbian, gay, bisexual, transgender, or gender non-conforming (LGBT/GNC)
are overrepresented in the juvenile justice system.
Although LGBT/GNC youth comprise only 5 to 7
percent of the general population, they represent
13 to 15 percent of youth who come into contact
with the juvenile justice system.12 Recent research
by the National Council on Crime and Delinquency
(NCCD) indicates that LGBT/GNC girls, in particular, are involved in the system at an even higher
rate: a survey of 1,400 girls across seven jurisdictions found that 40 percent of girls in the juvenile
justice system are LGBT/GNC (compared to 14
percent of boys).13

study of girls involved in Oregon’s juvenile justice
system, for example, 93 percent had experienced
sexual or physical abuse; 76 percent had experienced
at least one incident of sexual abuse by the age of 13;
and 63 percent had experienced both physical and
sexual abuse.22
Similarly, in a 2009 study of delinquent girls in South
Carolina, 81 percent reported a history of sexual
violence, and 42 percent reported dating violence.23

7

girls in residential placement by race and ethnicity

Rate per
100,000

non-hispanic white

african american

hispanic

asian

20
40
60
80
100

37

120

47

native american

11

123

140
160
180

179
Adapted from Child Trends DataBank, Juvenile Detention, Indicators on Children and Youth 5 (2013), available at http://www.childtrends.org/wp-content/uploads/2012/05/88_
Juvenile_Detention.

8

girls in juvenile justice

31%
s e x u a l ly a b u s e d

boys in juvenile justice

7%

Girls’ rate of sexual
abuse is 4 times higher
than boys’ in juvenile
justice, and girls’ rate
of complex trauma (five
or more ACEs) is nearly
twice as high.

s e x u a l ly a b u s e d

45% 24%
five or m o r e

ACE s

five or more

ACE s

Source: Michael T. Baglivio et al., US Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, The Prevalence of
Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders, 3 J. Juv. Justice 1, 9 (Spring 2014), available at http://www.journalofjuvjustice.org/
JOJJ0302/JOJJ0302.pdf.

girls’ paths of sexual abuse into the juvenile justice system

Finally, a 1998 study of juvenile-justice-involved girls in
California found that 81 percent of girls had experienced one or more incident of physical or sexual
abuse; 56 percent reported one or more forms of sexual abuse; and 45 percent reported being beaten or
burned at least once.24
But rates of prevalence alone do not fully capture the
severe extent and multiple incidents of girls’ sexual
victimization. In the California study, for example, of
the 56 percent of girls who reported sexual abuse
— which can take many forms — 40 percent of girls
reported being raped or sodomized at least once, and
17 percent reported multiple occurrences of abuse.25
Girls in the Oregon study, meanwhile, reported they
had experienced an average of over four forms of
severe sexual abuse before the age of 12.26
Justice-involved girls also are victimized by sexual
violence at an earlier average age, and for a longer
average duration, than other forms of abuse. The
South Carolina study, for example, found that in
contrast to other forms of violence that peaked during
certain developmental stages, sexual violence was a
risk for girls throughout their lives, though particularly
during adolescence.27 Meanwhile, the California study
found that the age at which girls were “most likely” to
be fondled or molested was five years old;28 and the
Oregon study found that the average age at which at
least one instance of sexual abuse occurred was just
under seven and a half years old.29 These findings are
particularly significant in light of a recent study that
found that traumatic exposure before high school is
an even stronger predictor of girls’ delinquency than

The US Attorney General’s Task Force on Children
Exposed to Violence has concluded that childhood
trauma is associated with involvement in the juvenile
justice system.39 For girls more than for boys, this
connection is strongly rooted in the experience of sexual violence. 40 And the link appears to continue even
after girls are released: a recent study has shown
that sexual abuse is one of the strongest predictors
of whether a girl will be charged again after release;
in fact, it appears to have a greater impact on girls’
re-entry into the system than other risk factors like
behavioral problems and prior justice involvement.41
Yet, significantly, the experience of sexual abuse did
not have the same impact on boys.42 Clearly, sexual
abuse has a uniquely defining impact on juvenile
justice involvement for girls.

GIRLS’ EXPERIENCE OF COMPLEX TRAUMA AND
MULTIPLE INCIDENTS OF VICTIMIZATION
Some studies indicate that girls experience complex and multiple forms of trauma at disproportionate rates. In a 2014 study of the abuse histories of
more than 60,000 youth in Florida’s juvenile justice
system, for example, girls reported having experienced Adverse Childhood Experiences (ACEs)31 at
higher rates than boys in all 10 categories of trauma
and abuse analyzed.32 Nearly half of the girls (45.1
percent) experienced five or more forms of trauma
and abuse, compared to less than one-third (27.4
percent) of boys.33 These findings are consistent with
other research, including a 2010 study of a nationally
representative sample of justice-involved youth, that
show higher rates of complex trauma and multiple
forms of victimization among girls.34

such exposure during high school.

30

Although the precise findings of rates of sexual abuse
vary, all studies find higher rates of victimization for
girls than boys.35 One local study of delinquent youth,
for example, found that the rate of sexual abuse for
justice-involved girls was over four times higher than
for boys. And a 2011 literature review found that
girls’ dramatically higher rate of sexual abuse was the
most consistent finding among nineteen studies
that analyzed the prevalence of trauma by gender.37
Other recent studies have replicated this finding.38

girls’ behavioral reaction to sexual
abuse and trauma is criminalized,
reinforcing the sexual abuse to prison
pipeline.

The most common crimes for which girls are arrested — including running away, substance abuse, and
truancy — are also the most common symptoms of
abuse.43 Indeed, child sexual abuse experts list these

9

girls’ paths of sexual abuse into the juvenile justice system

findings vary, but local and regional studies show alarmingly high rates of abuse
among girls in the juvenile justice system.

SOUTH CAROLINA

10

OREGON

FLORIDA

81%93%84%
42%76%31%
63%41%
O F G I R L S

O F G I R L S

O F G I R L S

victims of sexual violence

sexually or physically
abused

victims of family violence

O F G I R L S

O F G I R L S

O F G I R L S

victims of dating violence

sexually abused

sexually abused

O F G I R L S

O F G I R L S

sexually

Source: Dana D. Dehart, The Ctr. For Child & Family
Studies, Poly-victimization Among Girls in the Juvenile
Justice System: Manifestations & Associations to
Delinquency 12 (Oct. 2009), available at https://www.
ncjrs.gov/pdffiles1/nij/grants/228620.pdf.

&

physically abused

Source: Dana K. Smith, Leslie D. Leve & Patricia
Chamberlain, Adolescent Girls’ Offending and Health
Risking Sexual Behavior: The Predictive Role of Trauma, 11 Child Maltreatment 346, 350 (Nov. 2006).

physically abused

Source: Michael T. Baglivio et al., US Dep’t of Justice,
Office of Justice Programs, Office of Juvenile Justice
& Delinquency Prevention, The Prevalence of Adverse
Childhood Experiences (ACE) in the Lives of Juvenile
Offenders, 3 J. Juv. Justice 1, 9 (Spring 2014), available at http://www.journalofjuvjustice.org/JOJJ0302/
JOJJ0302.pdf.

girls’ paths of sexual abuse into the juvenile justice system

CALIFORNIA

MULTI-STATE STUDY

32%
81%
56% 40% 39%
45% 17%40%
56%
O F G I R L S
sexually or physically
abused

In the California study,
of the girls who had
been sexually abused,
the abuse was severe
and often occurred
multiple times.

O F G I R L S
sexually maltreated

O F G I R L S

O F G I R L S

O F G I R L S

sexually abused

raped/sodomized
at least once

sexually assaulted/raped

O F G I R L S

O F G I R L S O F G I R L S

beaten or burned at least
once

multiple occurrences

physically abused

O F G I R L S
domestically abused

Source: Leslie Acoca, Outside/Inside: The Violation of American Girls at Home, on the Streets, and in the Juvenile
Justice System, 44 Crime & Delinquency 561 (1988), available at http://leslieacoca.org/images/Outside-Inside_-_The_Violation_of_American_Girls_at_Home_-_On_the_Streets_-_and_in_the_Juvenile_Justice_System_by_Leslie_Acoca.pdf.

Source: Carly B. Dierkhising et al., Trauma Histories
Among Justice-Involved Youth: Findings from the National Child Traumatic Stress Network, 4 Eur. J. Psychotraumatology (Jul. 2013), available at http://www.ncbi.nlm.nih.
gov/pmc/articles/PMC3714673/.

11

girls’ paths of sexual abuse into the juvenile justice system

behaviors as warning signs that an adolescent has
been abused and needs therapeutic intervention.44
According to a study conducted by the US Department of Health and Human Services, 46 percent of
runaway and homeless youth report being physically
abused; 38 percent report being emotionally abused,
and 17 percent report being forced into unwanted
sexual activity by a family or household member.45
Research has consistently shown that girls’ problem
behavior, in contrast to that of boys, “commonly
relates to an abusive and traumatizing home life.”46
Self-reports by female offenders support these
findings, in which girls “are significantly more likely
than males to report that victimization was a key
factor leading to their offending.”47

12

A National Child Traumatic Stress Network (NCTSN)
review of literature on trauma and girls’ delinquency
emphasizes the causal role that unaddressed trauma
can play in the criminalization of girls:
[Studies] suggest that if trauma is not resolved,
… result[s may] includ[e] (a) alcohol and drug
use, (b) involvement in violent activity, and
(c) development of mental health problems
such as PTSD. For many of these adolescent
females, there appears to be a link between
the experience of abuse and neglect, the lack
of appropriate treatment, and the behaviors
that led to arrest.48
Yet despite the body of research showing that the
effect of trauma and abuse drives girls into juvenile
justice,49 the system itself typically overlooks the
context of abuse when determining whether to arrest
or charge a girl, often with a minor offense. When law
enforcement views girls as perpetrators, and when
their cases are not dismissed or diverted but sent
deeper into the justice system, the cost is twofold:
girls’ abusers are shielded from accountability, and
the trauma that is the underlying cause of the behavior is not addressed. The choice to punish instead
of support sets in motion a cycle of abuse and
imprisonment that has harmful consequences for
victims of trauma.

the juvenile justice system typically
fails to address, and often exacerbates,
trauma that caused girls to be there.

Although some defend the practice of detaining
victimized girls on the grounds that the system can
provide protection or needed services,50 that justification cannot counterbalance the significant psychological and physical harms created by commitment. In
fact, access to adequate services, if any, is severely
limited; worse, the system’s routine processes can
serve to re-traumatize girls; and, worse still, some
report that they experience new incidents of abuse
while inside.
The NCTSN has noted the unique link between
trauma and mental health for girls: “[S]tudies have
consistently found that among those who are exposed to trauma, females are more likely than males
to develop mental health problems as a result.”51
And, consistent with the link between trauma and
contact with the juvenile justice system, in 2004 the
NCTSN noted overwhelming rates of trauma and
post-traumatic stress disorder (PTSD) among girls in
the system: 70 percent of girls in juvenile justice had
been exposed to some form of trauma and over 65
percent had experienced symptoms of PTSD sometime in their lives, 48.9 percent of whom were experiencing those symptoms at the time of the study.52
Rates of PTSD and other mental health disorders are
consistently higher in girls than their male peers.53 For
example, one study by the National Center for Mental
Health and Juvenile Justice found that approximately
80 percent of females in the juvenile justice system
met the criteria for at least one mental health disorder,
compared to 67 percent of boys.54 Another found that
major depression is four to five times more common
in girls housed in detention and correctional facilities
than in the general community, compared to twice as
common in detained boys than the general community.55 The rate of major depression in detained girls was
29 percent, compared to 11 percent in boys.56

girls’ paths of sexual abuse into the juvenile justice system

Trauma
coping
behaviors
resume
and/or
	
re-entry into
abusive
environment

Release into community with
exacerbated trauma symptoms

Trauma symptoms triggered
and/or new incidents of abuse

girls’ common reactions to

Entry into
Juvenile
Justice

trauma are criminalized and
exacerbated by involvement in
the juvenile justice system,

New arrest
occurs and
cycle repeats
and deepens

leading to a cycle of abuse

(for prostitution,
status offenses,
incorrigible
behavior, etc.)

and imprisonment

13

Sexual Abuse (sex trafficking,
abusive home, poorly supervised
child welfare placement)
Reactive
Behavior

Gender Differences
in Mental Health
Diagnoses

Unaddressed Trauma, Mental
Health, Physical Health Issues

mental health diagnoses among justice-involved youth by gender

67% 80%
of boys

of girls

Source: Jennie L. Shufelt & Joseph J. Cocozza, Nat’l Ctr. for Mental Health and Juvenile Justice, Youth With Mental Health Disorders in the Juvenile Justice System: Results
from a Multi-State Prevalence Study 4 (June 2006), available at http://www.ncmhjj.com/wp-content/uploads/2013/07/7.-PrevalenceRPB.pdf.

girls’ paths of sexual abuse into the juvenile justice system

14

Yet when girls enter the juvenile justice system, mental
health screenings are rarely administered by licensed
professionals, and follow-up assessments and
treatment are frequently inadequate.57 Some studies
have found that this lack of services exists more often
in facilities that serve girls.58 According to a recent
nationwide census conducted by the US Department
of Justice’s Office of Juvenile Justice and Delinquency
Prevention (OJJDP), only approximately half the youth
in the juvenile justice system are placed in a facility
that provides mental health evaluations of all residents.59 Follow-up care is often insufficient even for
youth who do receive evaluations.60 And a significant
majority of juvenile justice youth (88 percent) resides
in facilities in which mental health counselors are not
licensed professionals.61

“I became even more withdrawn and angry. I felt
completely disconnected from my family, from
friends; and the counselors inside offered no support for the real problems I was facing. I felt like
nobody believed that I could actually do something
positive with my life — especially the staff inside
the facilities, who treated me like a case number,
not like a person. At that time what I needed was
to talk to folks about all I had been through, to
feel connected to people — to feel useful, so that I
could find my own direction in life. I needed to heal
from the trauma and to be supported with love and
encouragement.” – NADIYAH SHEREFF

traditional group care setting became pregnant within
two years, the same was true for only 26.9 percent of
those who received the intervention.63
In addition, the juvenile justice system rarely meets
medical needs related to sexual abuse that girls have
experienced, including gynecological and obstetric
care. Although the national prevalence of adolescent
pregnancy among justice-involved girls is unknown,
several local studies have found that a significant
percentage of girls in the juvenile justice system are
or have been pregnant,64 and the risk for adolescent
pregnancy is increased by childhood trauma and sexual abuse.65 In a survey of girls in the juvenile justice
system, The National Crittenton Foundation found
that 49 percent of the young mothers in the study
reported a history of sexual abuse.66
Most juvenile justice facilities are unaccredited and do
not offer specialized services for pregnant girls who
have been sexually abused. Nor are they in compliance with standards of pediatric or reproductive
health care for incarcerated populations established
by the American College of Obstetricians and Gynecologists and other accrediting organizations such
as the National Commission on Correctional Health
Care.67 In one recent national survey by OJJDP, only
18 percent of juvenile justice facilities provided the
basic service of pregnancy testing at entry.68 Moreover, pregnant girls in some juvenile justice facilities
report being shackled, hungry, and without access to
prenatal and parenting education.69

Yet mental health services can yield important and
positive results for girls. A study in Florida that examined girls after release, for example, found that those
who received mental health care services were 37
percent less likely to re-offend, and another found
that two years after release, girls who were provided
a trauma-based intervention had reduced rates of
recidivism compared to girls in generic group care.62
Meanwhile, a recent study in Oregon found that girls
living in out-of-home placements who were provided
with a trauma-based intervention were far less likely
to become pregnant: while 46.9 percent of girls in the

In addition to the insufficient treatment of trauma-related health needs, conditions in juvenile justice systems risk re-traumatizing girls. Routine procedures,
including the use of restraints and strip searches, as
well as the isolating, punitive environment itself, can
be particularly harmful to victims of trauma by triggering their traumatic stress symptoms.70
A 2012 Texas Criminal Justice Coalition study of
incarcerated girls illustrates the issue. In that study,
46 percent of participants reported that the staff,
programs, and treatment in county juvenile justice
facilities did not help them deal with past trauma in

girls’ paths of sexual abuse into the juvenile justice system

their lives; 4 percent said their time in county facilities
did more harm than good in dealing with past trauma.
State facilities fared only marginally better: 30 percent of surveyed girls reported that their time in the
state secure facility was unhelpful in addressing past
trauma. Significantly, 8 percent reported that the state
facility had done them more harm than good.71
Girls in such conditions tend to respond by internalizing their negative experiences, entering into depression or engaging in self-harm. 72 These reactions
can increase the risk of additional harm.73 According
to the National Child Traumatic Stress Network,
“[m]any characteristics of the detention environment
(seclusion, staff insensitivity, loss of privacy) can
exacerbate negative feelings and feelings of loss of
control among girls, resulting in suicide attempts and
self-mutilation.”74 In addition, some girls experience
new incidents of sexual victimization while in the
system.75 Taken together, lack of appropriate care and
re-triggering conditions can lead to a harmful cycle of
trauma that often turns inward.
For girls who are sent into the juvenile justice system because of behavior based on their reaction to
trauma – such as running away from home to escape
an abusive caretaker — detention is an unjust and
harmful practice. These girls are not a threat to public
safety.76 Arresting and detaining them effectively punishes girls for being victims, and it fails to provide the
services necessary to heal and recover. It is simply an
unacceptable response to child sexual abuse.

Dismantling the Pipeline: Policy Recommendations to Reduce Traumatized Girls’ Arrest
and Incarceration.
Strengthen the JJDPA.
Passed in 1974, the Juvenile Justice and Delinquency
Prevention Act (JJDPA) is the single most comprehensive federal legislation that governs conditions of confinement for youth and delinquency prevention. The
JJDPA sets standards for states’ operation of juvenile
justice systems, provides federal funding to
improve the juvenile justice system and to prevent

delinquency, and establishes State Advisory Groups,
among other provisions. The JJDPA, however, has
not been reauthorized since 2002. Reauthorization
of the JJDPA is critical to funding services, innovation, and creating new standards that will reflect over
a decade of research and the development of best
practices to serve the needs of children in the juvenile
justice system.
As part of the reauthorization process, we recommend the following changes to the JJDPA to improve
conditions for girls in the juvenile justice system:
•	

•	

•	

•	

•	

•	

•	

Implement accountability mechanisms to ensure
that states to comply with standards and guidelines for gender-specific services, including issuing annual public reports on progress towards
compliance with standards and guidelines.
Increase funds available to incentivize states to
create gender-specific, trauma-informed prevention and treatment programs and services.
Require at least one State Advisory Group
member to have expertise in gender-specific
issues, such as sexual abuse and domestic child
sex trafficking, as well as knowledge of effective
interventions.
Require states to employ validated, comprehensive screening and assessments to evaluate
all children entering the juvenile justice system
for trauma and to develop appropriate treatment
plans and programming in response to identified
needs.
Require states to screen children at intake for
commercial sexual exploitation and divert identified victims away from the juvenile justice system
whenever possible.
Explicitly prioritize funding for the development of
programs to train law enforcement officers and
other juvenile justice system staff to better identify
and respond to trauma.
Require states to evaluate the effectiveness of
juvenile justice programs that address the needs
of girls; develop plans to remedy identified gaps
and deficiencies; and report on progress annually.

15

girls’ paths of sexual abuse into the juvenile justice system

•	

Require the collection of data on girls in the
juvenile justice system and their outcomes
disaggregated and cross tabulated by race and
ethnicity, including the following information:
→→
The number of victims of commercial
sexual exploitation involved in the juvenile justice system.
→→
The conditions of confinement for girls,
including frequency of solitary confinement or isolation, strip searches, shackling during childbirth, inappropriate use
of restraints, or other practices that may
exacerbate girls’ trauma.
→→
The number of pregnant and parenting
girls in the system and the treatment
they receive, from pregnancy testing
through postpartum care and new-

16

parenting services.
Further the Work of OJJDP’s National Girls
Initiative.
Promising work has been initiated by the OJJDP,
which oversees compliance with the JJDPA. Through
its Girls Study Group and National Girls Initiative (NGI),
OJJDP has elevated a focus on girls in the juvenile
justice system. The current Administrator, Robert
Listenbee, has expressed his strong commitment
to improving the juvenile justice system for girls. We
applaud these efforts and urge that NGI receive the
appropriate funding and support to engage in the
following actions:
•	

•	
•	

•	

Issue regulations interpreting the JJPDA requirements for the creation and implementation of
gender-specific policies and programming.
Assist OJJDP in enforcing JJDPA requirements to
create and implement gender-specific services.
Convene a coalition and seek input from broad,
diverse sources to develop clear guidelines and
best practices for gender-responsive programming and policies.
Develop training and technical assistance for
states seeking to create more gender-responsive
programming and policies.

•	

Identify and develop other sources of federal
funding to support the creation of community-based, gender-responsive, and traumainformed programming such as the Juvenile
Accountability Block Grant Program (JABG)
and the NGI Innovation Awards.

Fully Enforce — and Strengthen — the Prison
Rape Elimination Act.
The Prison Rape Elimination Act (PREA) is a powerful tool that can help prevent abuse against girls in
juvenile justice if effectively enforced. Under the law,
facilities must screen inmates for a history of sexual
abuse and provide appropriate medical and mental
health care within 14 days of intake.77 Youth who
are victimized while in a facility, meanwhile, must
have timely access to emergency medical and crisis
intervention services.78 PREA standards also limit
procedures that are likely to trigger re-traumatization,
such as pat-downs by officers of the opposite sex,
strip searches, and solitary confinement. And the law
requires state facilities to collect data on allegations of
sexual abuse, aggregate the data at least yearly, and
make that data publicly available.79
Although these provisions represent progress, enforcement mechanisms are weak. There is no private
right of action to enforce PREA’s standards. And
while the US Department of Justice may reduce by 5
percent federal grant funds to states that fail to certify
compliance, a state can avoid that penalty as long
as the governor “submits an assurance that such 5
percent will be used only for the purpose of enabling
the state to achieve and certify full compliance with
the standards in future years.”80 No deadline has been
imposed for states to come into compliance.81
PREA would be a more effective means of preventing
and addressing violence against girls in juvenile justice
if amended in the following ways:
•	

Provide for mandatory penalties if states fail to
adopt and comply with federal standards within
a reasonable period.

girls’ paths of sexual abuse into the juvenile justice system

•	
•	

•	

•	

Limit the time that a state can offer an assurance
before funding is cut.
Define the required “timely” crisis intervention
services as within 12 hours of a resident’s filing
a complaint under the law.
If an assault disclosed at intake occurred shortly
before entering the facility (within a week), reduce
the maximum allowable timeframe for states to
provide victims with access to mental health and
medical services to three days from the current
14-day standard.
Require foster homes and congregate care facilities to comply with PREA and federal standards
if they enter into contracts with juvenile justice
agencies.82

Provide Gender-Specific Physical and Mental
Health Care In Justice Settings.
Girls need access to trauma-informed and gender-specific health care — not only to improve their
wellbeing over the long term, but also to reduce the
likelihood of recidivism. 83 The Multidimensional
Treatment Foster Care model is one approach that
has been shown to be effective in reducing recidivism
among girls.84 Juvenile justice systems should ensure
that girls’ mental health needs are adequately identified, assessed, and treated while in the system, and
that girls have access to necessary mental health care
when they re-enter their communities.
Implement Gender-Specific Health Screening and
Assessment.
State and local jurisdictions should require facilities
to implement gender-specific health screening at
intake. The Girls Health Screen (GHS), developed by
Leslie Acoca of the National Girls Health and Justice
Institute, is a helpful model to guide the development
of gender-specific medical triage in juvenile justice
settings.85 Currently, it is the only validated health
screening tool tailored specifically to girls in state
custody,86 and it has been effectively implemented in
juvenile justice facilities in three California counties.87
Comprehensive follow-up assessments can help
inform treatment plans.

Require Facilities to be Accredited for the Provision of Medical Care.
The National Commission on Correctional Health
Care (NCCHC) has promulgated widely accepted
standards for health care in correctional settings.
Compliance, however, is not mandatory, and many
juvenile justice facilities remain unaccredited.88 As
a result, compliance with established standards of
pediatric care is low or non-existent. According to
the American Academy of Pediatrics Committee on
Adolescence, “[D]ata from 2004 showed that overall,
fewer than half of the facilities were compliant with
recommended health screening and assessments.
Few detention facilities met even minimal levels of
care, although better care was seen as the length of
stay increased.”89 Policymakers at the federal, state,
and local level should mandate accreditation.
Provide Comprehensive Reproductive
Health Care.
The juvenile justice system should adopt a coordinated and integrated approach to reproductive
health needs in addressing girls’ high rates of sexual
abuse.90 Most fundamentally, juvenile justice facilities should be required to meet the comprehensive
standards for women’s physical and reproductive
health care developed by the NCCHC91 and adhere
to guidelines like those established by the American
College of Obstetricians and Gynecologists (ACOG),
the American Public Health Association, and the
Juvenile Detention Alternatives Initiative of the Annie
E. Casey Foundation.92 Consistent with a 2011 report
by ACOG’s Committee on Health Care for Underserved Women, for example, protocols should include
mandatory assessment for pregnancy risk at intake
and follow-up pregnancy testing as appropriate. The
shackling of pregnant young women during labor and
delivery should be strictly prohibited.93
In addition, given the unique reproductive health
consequences of trauma and abuse, juvenile justice
systems should work with specialists to integrate
mental health treatment into reproductive health treatment and services.

17

girls’ paths of sexual abuse into the juvenile justice system

school discipline: girls, violence, and the school to prison pipeline

18

Sasha was raped as a high school student. When
news of the rape was circulated in social media,
she was ridiculed by her classmates, making it
impossible for her to feel safe at school. Sasha
immediately became truant. For six months, Sasha’s mother unsuccessfully appealed to school
district administrators to transfer Sasha to a safer
school environment. In an effort to ensure that
Sasha still received her education, her mother
attempted to home school her, but the school district threatened to refer Sasha to the child welfare
system for keeping her out of school. Because of
her extensive, unaddressed trauma and fear for her
own safety, Sasha refused to go to school and ultimately dropped out. After two years out of school
and without receiving trauma-related services, she
was arrested on petty theft charges. Only after her
arrest was Sasha referred to a therapist who identified her trauma as the cause of her truancy. With
the assistance of an educational advocate, Sasha
applied and was accepted to an alternative school
that provided a small therapeutic setting and a
second chance at graduation.98
Sasha’s story illustrates a common problem. When
schools fail to support girls who are victimized by
gender-based violence and harassment on campus,
girls no longer feel safe and as a result may disengage, become truant, or exhibit challenging behaviors that are rooted in the trauma they have experienced.99 Yet instead of being viewed as victims of
sexual violence, these girls are often disciplined,

Include Trauma-Related Health Treatment in
Re-entry/Aftercare Plans.
As described above, sexual abuse is a unique predictor of recidivism for girls.94 The period immediately
after release is when girls are at the highest risk of
recidivism and serious harm. The original underlying
abuse, for example, may resume; or girls may deal
with unresolved trauma by using coping strategies
that increase girls’ risk of re-entry, such as substance
abuse or running away. To lessen this risk, re-entry
planning should include an attempt to connect
girls with trauma-related health resources in the
community.95

including being suspended, expelled, or referred to
law enforcement.100
In Norman, Oklahoma, for example, after rumors
spread about the rape of three female students by a
male peer, the school reportedly did not act to stop
the repeated harassment of the victims. In fact,
when one of the rape victims swung a heavy book
bag at a student who stated “I hear you like being
raped in the ass,”101 she was suspended along with
the student who harassed her.102
More research should be conducted to study the
rates at which girls experience sexual violence in
school and how schools handle these incidents,
including the services they provide to the victims.103
Meanwhile, school districts should abandon
zero-tolerance disciplinary policies104 for victims
of sexual violence on campus and consider whether a given violation of school policy was caused
by the initial trauma of sexual victimization. As
stated by the Illinois State Board of Education
Ensuring Success in School Task Force, “When
there is a relationship between the survivor’s
behavior and the survivor’s experience of violence
— for example, when students engage in
acts of self-defense — schools need to be flexible
and modify punishment appropriately.”105 This
recommendation reflects the need to recognize
the link between girls’ reactive behaviors and
underlying initial trauma and train staff to respond
accordingly.

Although juvenile justice systems often operate with
limited financial and case management resources to
address issues that may arise after release, Medicaid and CHIP funds can be used to finance some
trauma-related health and mental health services, as
detailed below.96 At a minimum, states should require
juvenile justice systems to assist youth in enrolling in
health care coverage before release to eliminate unnecessary administrative barriers to accessing mental
health and trauma services during this critical time.97
Ideally, every girl released from the juvenile justice
system should have a community provider identified
as part of her aftercare treatment plan.

girls’ paths of sexual abuse into the juvenile justice system

lived experience of the sexual abuse to prison pipeline:
victims of sex trafficking jailed as offenders

“Suffering, isolated, tired and helpless at the age of 15, the concrete box that represented my cell in Zenoff
Hall, the girls’ section the largest of the juvenile facility in Las Vegas, Nevada, seemed no less invasive than
the horror of the streets. As much of a real physical confinement as it was, it wasn’t all too different than the
mental confinement I endured from my pimp. I was interrogated for hours on end, reminded that my opinions
didn’t matter, and locked in like a dog in a kennel. Unless I was saying the answers to the questions that they
wanted to hear, my voice was irrelevant. Skip ahead a few years later, I endured it again in California, only that
time experiencing my seventeenth birthday within the juvenile hall walls.  Both times I was faced with charges
of solicitation and/or prostitution, a crime that as a minor who wasn’t of legal age to consent to sex, couldn’t
seriously be charged to commit. But yet, there I was, facing them. To my agony, I comprehended this as yet
another system that failed me … I was re-traumatized every day in detention while having to be watched, fully
nude, while I showered. No one assessed me or ever even asked me what got me there, no rehabilitation services were offered. I just sat locked in a box while being interrogated and talked-down to.”106

19

— Withelma “T” Ortiz Walker Pettigrew

One of the grimmest examples of the sexual abuseto prison pipeline is the detention of girls who are
bought and sold for sex.
Child sex trafficking* is child sexual abuse. And
it is abuse that is often layered over pre-existing
trauma: children who have been sexually abused
are especially vulnerable to traffickers. Yet many
jurisdictions still view victims of child sex trafficking
as perpetrators. These girls are arrested on charges
of prostitution even though they are too young to
legally consent to sex.108
Although child welfare agencies are charged with
the task of responding to child sexual abuse cases
and have often had previous interactions with
exploited youth, they do not — and in many states,
cannot — function as an alternative to incarceration unless the trafficker is a parent or “caretaker,”
as defined by state law.109 As a result, trafficked
children, who are victims of statutory rape or child
abuse, are sent into the juvenile justice system
— imprisoned as a direct consequence of their
victimization.

A few states have adopted legislation or regulations
to allow child welfare to respond to child sex trafficking victims.110 But even when child welfare systems
can respond to child sex trafficking, too often they
do not.111
In the worst cases, where children are poorly cared
for, the child welfare system inadvertently plays a
part in making girls vulnerable to exploitation. When
girls who grow up in the child welfare system —
especially children who have been placed in
multiple homes — live without stability or safe,
supportive family attachments, it can render them
vulnerable to the manipulation of traffickers who
promise to love and care for them.112 Indeed, some
traffickers purposely troll for youth in certain group
homes because they are aware of this vulnerability.
As one report in California stated:
Exploiters know where foster care group
homes are and they directly recruit girls from
these settings — they prey on the kids they
know are the most vulnerable. Exploiters
also use coercion and threats to force these

*	 Domestic Minor Sex Trafficking: Hearing before the H. Subcomm. on Crime, Terrorism & Homeland Security of the H. Comm. on the Judiciary, 111th Cong. 4 (Sept. 15, 2010) (testimony of
Ernie Allen, President & CEO, Nat’l Ctr. for Missing & Exploited Children).

girls’ paths of sexual abuse into the juvenile justice system

young girls to recruit other youth living in the
group home.113
We know too little about the lives of trafficked girls
and the experiences of girls in child welfare. More
research is urgently needed to learn how many
American girls are trafficked each year, as well as
the percentage of trafficked girls in child welfare,
given their significant abuse histories and unique
vulnerability.

20

Recently enacted legislation may help the child
welfare system support girls in their care who are
trafficked or at-risk and help them avoid crossing
over into juvenile justice: the Preventing Sex Trafficking and Strengthening Families Act. This law requires states to identify, document, and determine
appropriate services for children in the child welfare
system who are victims of sex trafficking or at risk
of becoming victims. It also allows them to track
child victims of sex trafficking under the Adoption
and Foster Care Analysis and Reporting System
before and during their time in foster care. Importantly, the law also requires the child welfare system
to report children who are missing from foster care
placements to law enforcement and the National
Center for Missing and Exploited Children within
24 hours.114 Further guidance is needed to assist
states in collecting data from the child welfare and
juvenile justice systems, identifying and developing appropriate screening tools, and ensuring that
services are gender-specific, trauma-informed, and
culturally competent.

Dismantling the Pipeline: Policy
Recommendations to Keep Victims of
Sex Trafficking Out of Juvenile Justice.
End the Arrest and Detention of Youth for
Prostitution.
State laws and delinquency codes should
define children under the age of 18 who engage
in commercial sex acts as per se victims of trafficking, and they should prohibit the arrest, detention,
and prosecution of children for prostitution, prosti-

tution-related offenses, or other acts related to
their sexual exploitation.
Such laws would be consistent with state laws that
declare minors to be legally incapable of consenting
to sex, as well as federal law, which defines any act
of commercial sex with a person under the age of
18 as a severe form of trafficking in persons.115
Enact Effective and Universal Safe Harbor
Laws.
States that continue to allow the arrest and detention of children on prostitution charges should
enact safe harbor or immunity laws to ensure that
trafficked youth are treated as victims, not perpetrators. Several states have adopted these laws.
The provisions of existing safe harbor laws vary,
but all strive to direct child victims of sex trafficking
into appropriate treatment services and divert them
from juvenile justice involvement.
To be fully effective, safe harbor statutes should at
minimum include the following elements:
•	

Funding mechanism and/or partnership
with child welfare system to ensure provision
of comprehensive services to victims and
appropriate alternatives to arrest, detention,
and prosecution;
•	 Eligibility of all minors under the age of 18;
•	 Eligibility of all victims of sex trafficking,
regardless of whether they enter the system
on prostitution charges;
•	 Immunity from arrest and prosecution when the
charging offense is directly related to the child’s
exploitation and victimization; and
•	 Fully funded court diversion programs when
immunity is not an option.
Diversion programs avoid detention and instead
provide child victims with essential services. Victims
avoid acquiring records and instead may receive
specialized and individualized treatment, including
family support services, essential life skills training, and assistance with job placement, as well as
housing, education, and vocational skills.

girls’ paths of sexual abuse into the juvenile justice system

21

ending violence against girls by ending demand

As with all markets, even illicit ones, sex trafficking
is driven by both supply and demand.117 To date,
most enforcement efforts at the federal and state
levels focus on the victims and the traffickers.
Laws that criminalize the act of sex with minors118
are too rarely enforced in the context of child sex
trafficking. In many cases, child-sex buyers escape
with little or no accountability, despite the traumatic effect of their acts on the victims. To help put
an end to the commercial sexual exploitation of
children, advocates and lawmakers should:
•	

Educate the public on the role of buyers in
perpetuating systematic violence against
underage girls and other vulnerable youth;

•	

Increase training of law enforcement and
prosecutors on investigations and pros-

ecutions of child-sex buyers and redirect
resources to scale up operations against
buyers rather than criminalizing victims;
•	

Instruct federal and state anti-trafficking
task forces throughout the country to target
buyers of child sex in their operations; and

•	

Encourage the use of federal anti-trafficking
statutes and state laws that criminalize
sex with minors to prosecute buyers of underage girls.

A targeted strike against demand from both
a cultural and legal standpoint would weaken
the market for commercially sexually exploited
youth and help combat this form of genderbased violence.

girls’ paths of sexual abuse into the juvenile justice system

lived experience of the sexual abuse to prison pipeline:
detention of girls for status offenses

“I was locked up ten different times within a two year period. Inside juvie I met other girls like myself who
were there for prostitution, running away, and truancy. All of us were from the same neighborhoods, poor
families, and seemed to have the same disposition of trauma, anger mixed with hopelessness. We were not
violent girls. We were girls who were hurting. Being confined to a tiny cement room was one of the hardest
things I have ever had to experience. Being locked up all I could do was reflect on my life but it didn’t seem
to help. I became even more withdrawn and angry.” — Nadiyah Shereff

22

Status offenses such as truancy, running away, or
curfew violations are acts that are unlawful only
when committed by youth. Unlike juvenile delinquent offenses, the acts are defined by the perpetrator’s age.119
Girls are disproportionately involved in the juvenile
justice system for status offenses at critical stages
of the process, including petitions, which initiate a
case; detention; and judicial dispositions that result
in out-of-home placement at residential centers,
foster homes, or correctional facilities.120 In 2011,
for example, girls accounted for 28 percent of all
petitioned delinquency cases, but 41 percent of
petitioned status offense cases.121 Strikingly, girls
comprised only 16 percent of the overall detained
population in 2011, but almost 40 percent of
youth detained for status offenses.122 Finally, girls
accounted for 40 percent of status offense cases
that resulted in out-of-home placement in 2011,
although they were just 12 percent of youth receiving such dispositions overall.123

Status offenses can often be seen more comprehensively when viewed in the context of trauma.
The root cause for committing status offenses is
often tied to abuse, such as running away from an
abusive home or failing to attend school because
a trafficker is forcing a girl to “work.”124 For example, as recently stated in a brief prepared for the
National Child Traumatic Stress Network: “Youth
who have experienced chronic trauma do not believe that the adults around them can or will protect
them, and sometimes they are right. What is interpreted as delinquent behavior or pointless acting
out is often their attempt to assume the burden of
taking care of themselves.”125
Consistently, girls are disproportionately affected
by the enforcement of the status offense of running
away.126 Over the past twenty years, girls have
accounted for approximately 60 percent of runaway
cases.127 It is the only petitioned offense in recent
years other than prostitution for which the majority
of youth offenders are girls.128 Yet running away is
often a response to sexual abuse,129 which contrib-

girls’ paths of sexual abuse into the juvenile justice system

utes to a harmful cycle: when girls with a history of
sexual abuse run away, they are more likely to be
commercially sexually exploited130 or engage in other behavior that increases their risk of involvement
in the juvenile justice system. Research indicates
that, in turn, when a girl returns home after release,
if the juvenile justice system failed to address the
underlying abuse, she remains at high risk of subsequent sexual victimization throughout her life.131
Despite the link to sexual abuse, of all status offenses, runaway cases have most consistently resulted
in detention and out-of-home placement adjudication over the past two decades.132 Greater attention
should be directed at the trauma underlying these
minor offenses and away from detention.

Dismantling the Pipeline: Policy Recommendations to Decrease the Disproportionate Effect of Status Offense Enforcement
on Girls.
Close the Valid Court Order Loophole.
The Juvenile Justice and Delinquency Prevention
Act (JJDPA) prohibits youth from being incarcerated
for status offenses.133 In 1980, however, Congress
created a loophole in that ban: the Valid Court
Order (VCO) exception. The VCO exception allows
children to be detained if they violate court orders
that prohibit them from committing enumerated
status offenses. For example, if a court issues an
order that forbids a girl from running away, she can
be sent into the juvenile justice system under the
VCO exception if she later does so.
The VCO exception undercuts the JJDPA’s core
requirement that youth should not be detained
for status offenses. In 2010, in recognition of the
problem, the National Council of Juvenile and
Family Court Judges, which had originally advocated for the exception, called for the phaseout of the
VCO.134 Some states have voluntarily chosen to do
so, but they remain in the minority.135

Because girls are disproportionately charged with
and detained for status offenses, closing this loophole would particularly benefit girls. We recommend
that all states adopt legislation closing the VCO
loophole, and that the federal government provide
incentives for them to do so in a reauthorized and
strengthened JJDPA.
Provide Law Enforcement Training on Gender
Bias and Gender Stereotyping to Decrease
Girls’ Contact with the Justice System.
The disproportionate effect of the enforcement of
status offenses on girls is part of a broader trend
sometimes referred to as “net widening,” in which
law enforcement policies and practices arrest,
detain, and incarcerate more youth for less serious
offenses.136 Net widening has resulted in an increase in girls’ involvement with the juvenile justice
system over the past twenty years.137
But girls who commit low-level violations and who
do not pose a risk to public safety do not belong in
the justice system138 — especially those whose behavior stems from sexual abuse. Training is required
to understand implicit and structural gender and
racial bias that results in the disproportionate rates
of girls entering the system, and to better recognize
trauma. The National Child Traumatic Stress Network has produced several resources on recognizing trauma in the juvenile justice system, including
bench cards to help judges recognize and respond
to the impact of trauma on children139 and a brief on
trauma among girls in the juvenile justice system.140
Similar guidance should be expanded and deepened to include information about the effect of
gender bias and stereotyping on public systems’
perceptions of and responses to girls’ behavior, as
well as ways to ensure that trauma assessments
are integrated into treatment plans.

23

girls’ paths of sexual abuse into the juvenile justice system

in focus: dual-system youth and the sexual abuse to prison pipeline

Youth who have been involved in both the juvenile
justice and child welfare systems — known as
crossover, dual-system, or dually involved children141 — are some of the most vulnerable children
in state custody,142 and they are disproportionately
female:143 girls comprise one-fifth to one-quarter of
the juvenile justice population, but one-third to one-

24

half of dual-system youth.144 A Los Angeles report,
for example, found that of the first-time juvenile offenders studied who were also involved in the child
welfare system, 37 percent were female, although
girls comprised only 24 percent of first-time offenders who were not involved in child welfare.145

Girls are disproportionately represented in the dually involved youth population.

Youth in Juvenile
Justice: 1/5 to
1/4 are girls.

Dually Involved Youth:
1/3 to 1/2 are Girls.

Source: Denise Herz Et Al., Georgetown Univ., Ctr. for Juvenile Justice Reform, Addressing the Needs of Multi-System Youth: Strengthening the Connection Between Child Welfare
and Juvenile Justice 1 (Mar. 2012), available at http://cjjr.georgetown.edu/wp-content/uploads/2015/03/MultiSystemYouth_March2012.pdf.

girls’ paths of sexual abuse into the juvenile justice system

Research by the National Council on Crime and
Delinquency (NCCD), meanwhile, found that
gender non-conforming girls are especially vulnerable to juvenile justice involvement after contact
with the child welfare system.146 (NCCD’s findings
are consistent with several studies that indicate
that LGB girls and GNC youth are particularly at
risk of juvenile justice involvement and face distinct
safety risks in public systems.147)
The consequences of crossing into the juvenile
justice system are significant. The risk of recidivism
is higher for foster care youth than for their peers.
One study of dual-system youth, conducted two
years after release from juvenile justice, found
that 70 percent had re-entered the justice system,
compared to 34 percent of their peers who had
not had contact with the child welfare system.152
Meanwhile, a significant percentage of dualsystem youth languish in the juvenile justice system for a longer time than their non-childwelfare-involved counterparts, and they are
more likely to be involved in the criminal justice
system as adults.153
Collaboration between the juvenile justice and
child welfare systems can help prevent crossover.
Inter-agency cooperation can improve the development of treatment plans and better inform
judges in deciding whether to detain girls or
divert them from juvenile justice.154 To that end,
some jurisdictions have begun screening for child
welfare involvement at the time of arrest. A helpful
model is the Crossover Youth Practice Model
(CYPM), developed by the Center for Juvenile
Justice Reform at Georgetown University. CYPM
is a dual-system approach that works to reduce
foster youth involvement in the juvenile justice
system, out-of-home-placements, congregate
care placement, and pre-adjudication detention,
as well as increase families’ participation in the
decision-making process.155

Dismantling the Pipeline: Policy Recommendations to Reduce Foster Girls’ Crossing Over Into the Juvenile Justice System.
•	

•	

•	

Implement screenings upon entry into the
child welfare system to identify a history
of trauma.
Develop cross-system collaboration between
the juvenile justice and child welfare systems.
Implement models like CYPM, adding genderresponsive components to improve services
and outcomes for dually involved girls.
Limit providers’ referrals to law enforcement to
manage challenging behaviors.161

25
the crossover pathway for girls of
color

The crossover pathway is especially significant for
African-American youth, who are involved in the
child welfare system at 2.26 times their representation in the general population of children148 and,
once there, are disproportionately likely to become
involved in the juvenile justice system.149 A study of
one county found that 27 percent of African-American girls in juvenile detention had an open child
welfare case compared to 7 percent of youth
overall and 13 percent of African-American boys.150
Research shows that children of color in the
child welfare system face disparities in outcomes
compared to white youth. They are less likely to
be reunited with families, more likely to be placed
in congregate care settings, less likely to exit child
welfare with a permanent family, and face worse
long-term outcomes in academic achievement,
health, and other areas than their white peers.151

girls’ paths of sexual abuse into the juvenile justice system

Girls who have experienced abuse often engage
in challenging and, at times, defiant and disruptive
behavior, which is a common response to trauma.
When foster families and caregivers are not adequately trained to address these behaviors, they
sometimes call law enforcement to control the
children in their care.162 But as described above, the
juvenile justice process is likely to be significantly
harmful and risk re-traumatizing these youth. To
avoid this cycle, providers who apply for contracts
to work with vulnerable children should be required
to demonstrate that they are qualified to address

these trauma-rooted behaviors without resorting to
calling the police except in extreme circumstances.
Meanwhile, child welfare agencies should be required regularly to collect data on provider referrals
to law enforcement based on behavior while in their
care or otherwise related to placement. Such data,
which should be publicly available, should be analyzed to develop policies and practices to improve
providers’ handling of crisis situations and end
unnecessary shunting of child welfare youth into the
juvenile justice system.

26
the role of group homes

the role of law enforcement

Poorly supervised group homes and other congregate care facilities that do not implement specialized
protections and trauma-informed treatment supports
can play a significant role in the sexual abuse to
prison pipeline. According to one study, girls with a
history of sexual abuse are more likely to be placed
in a group home or congregate care facility.156 Placement in congregate care, in turn, doubles the risk of
juvenile justice involvement for girls – though it does
not have the same effect on boys.157 Preliminary
research suggests that the reason for this increased
risk of juvenile justice involvement for girls is unsafe
living conditions in congregate care, including a
higher risk of sexual abuse and physical abuse by
staff and other youth.158 This abuse may lead girls in
these placements to develop coping strategies that
increase their risk of justice involvement, as described in this report.

Youth in foster care sometimes enter the juvenile justice system because their residential
placements do not adequately address the behavioral challenges common among girls who
have experienced severe abuse, and instead
rely on law enforcement to control the behavior
of youth in their custody.159 At least one-third of
arrests for crossover youth are related to their
child welfare placement. In most cases, the
arrest is the result of an incident that occurred
within the youth’s group home.160

27

CHILD WELFARE AND THE
SEXUAL ABUSE TO PRISON
PIPELINE: IDENTIFYING AND
TREATING TRAUMA IN THE
CHILD WELFARE SYSTEM

child welfare and the sexual abuse to prison pipeline

Child welfare systems can act as a leading force
in helping prevent and respond to girls’ trauma.
Although it is challenging for underfunded and
overburdened child welfare systems to fully accommodate the needs of girls struggling with complex
needs, failing to do so carries consequences that
are significant and enduring.

28

Histories of sexual abuse appear to be vastly underreported in the system, given the surprisingly low rate
(9 percent) of child welfare cases that are initiated
based on sexual abuse allegations.163 One reason for
the low rate may be that child welfare cases focus on
the actions of the caretaker. This practice excludes
incidents in which girls are sexually abused by others.
To address the needs of all girls who are victims of
sexual abuse, regardless of the perpetrator, the child
welfare system should screen all youth for a history of
sexual abuse at entry, irrespective of the reason their
case was initiated.
Each year, approximately 190,000 girls live in foster
care, but little research has been collected on their
histories of sexual abuse or their outcomes.164 In one
of the few studies to examine the issue, 54 percent of
foster care girls reported a history of sexual abuse.165
In addition, girls who had experienced sexual abuse
fared worse in the system than other girls in foster
care: they changed placements twice as often; they
were more likely to have been placed in a restrictive
placement or congregate care setting (64 percent vs.
35 percent);166 they were more likely to exhibit mental
health symptoms (37 percent vs. 18 percent);167 and
they were almost twice as likely to have been involved
in the juvenile justice system (41 percent vs. 24
percent).168 Another study similarly found that sexual abuse significantly increased the risk of multiple
placements and adoption disruptions.169 Meanwhile,
as previously mentioned, sex trafficking of girls in
foster care is clearly an issue, though its prevalence
is unknown.
The primary mission of the child welfare system, of
course, is to care for children who have experienced

abuse, violence, or neglect. Some jurisdictions have
made important progress by implementing traumainformed care. But these efforts are not yet sufficiently uniform or widespread. States can do more
to improve systems’ identification and assessment of
trauma and abuse, enhance the provision of services,
and build stronger partnerships with other public systems that play key roles in serving traumatized girls,
including schools and the mental health field. According to research by the National Child Traumatic Stress
Network (NCTSN), significant work lies ahead:
Despite the extraordinary number of children
in foster care who have experienced traumatic
events and are exhibiting traumatic stress symptoms, and the growing body of science about
efficacious treatments for child traumatic stress,
few child welfare agencies across the nation
integrate trauma knowledge into their practices,
policy, training, performance standards, or assessment and have evidence-based trauma-specific interventions available in their community or
their service continuum, including mental health
contract portfolios.170
In a 2005 study conducted in 11 geographically diverse jurisdictions, NCTSN conducted interviews with
staff who serve traumatized youth, including the child
welfare system, dependency and family courts, foster
care agencies, mental health agencies, and schools,
and found the following:
•	

•	

•	

Child welfare workers seldom receive in-depth
information about a child’s trauma history when
a child is first referred to them by another agency
or system.
Many agencies do not conduct a standardized
post-traumatic stress assessment with a child
who has experienced maltreatment and has been
referred to the child welfare system.
Fewer than half of those interviewed trained staff
on available evidence-based treatments for child
traumatic stress.

child welfare and the sexual abuse to prison pipeline

•	
•	

Over a third of those interviewed conducted no
staff trainings on assessment of child trauma.
About a third of those interviewed said that they
never make referrals to a treatment provider or
placement based on use of evidence-based
practices; another third said they rarely did so.171

In light of the substantial harms inflicted by sexual
abuse, it is critical to ensure that child welfare systems
fully assess children’s histories of trauma and abuse
and develop comprehensive supports, protocols, and
protections when incidents of abuse are disclosed
about youth in their care. Although it will be complex
and challenging work that will require collaboration
among the health system, child welfare system, and
juvenile justice system, as well as a recognition of the
significant overlap in the populations of children they
serve, this urgent issue must be addressed to better
serve girls and steer them away from the juvenile
justice system.172

Dismantling the Pipeline: Policy Recommendations to Improve the Child Welfare System’s
Response to Girls.
Improve the Child Welfare System’s Identification
of Victims of Abuse and Implement a Gender-Responsive Approach to Victims of Abuse.
•	 Develop and implement high-quality trainings
for staff on how to prevent, identify, assess, and
respond to children who enter the system with
a history of sexual abuse, including commercial
sexual exploitation. Promising training has been
developed by the National Child Traumatic Stress
Network.173
•	 Extensively train foster parents and kinship caregivers on the risks of sex trafficking and how to
mitigate them. For those girls who already have a
history of being trafficked, and who may continue
to maintain a connection to their former traffickers, specially trained foster homes should be
considered, akin to therapeutic foster placements
and specialized foster placements for pregnant
and parenting teens.174

•	

Implement system-wide gender-responsive protocols for trauma screening and assessment of
girls to identify urgent needs relating to violence
and abuse.
•	 Administer an immediate and thorough assessment when abuse is identified by a qualified
mental health professional.
•	 Implement mechanisms to ensure that all caregivers receive updated results of mental health
assessments to ensure appropriate treatment.
•	 Coordinate meetings with girls’ teams of professionals and other caregivers to discuss the
assessment as the baseline for developing an
effective treatment plan consistent with practices
developed by the National Child Traumatic Stress
Network, including referrals out of the system to
provide appropriate services where necessary.
•	 Use culturally appropriate, evidence-based
assessment tools and treatment plans to
address traumatic stress and associated
mental health symptoms.
•	 Increase federal child welfare funding to support
the most effective strategies for girls and
their families and create federal standards for
gender-specific child welfare practices.
The two primary sources of federal financing for child
welfare services, Title IV-E and Title IV-B of the Social
Security Act,175 are significantly underfunded. Congress should increase funding to these programs to
better serve children. As part of this effort, it should
incentivize states to decrease overreliance on group
homes that are unstable and that fail to address girls’
complex needs; instead, it should emphasize placing
more youth in family-like settings and therapeutic
foster care and providing services at home, consistent with research that shows these methods so
serve foster youth most effectively.176 Finally, it should
incentivize states to provide front-line child welfare
workers with professional training on best practices in
trauma-informed approaches.

29

child welfare and the sexual abuse to prison pipeline

Use Medicaid Funds to Improve Quality
Care and Trauma-Related Services for
Girls in Child Welfare.
Medicaid is currently underutilized as a tool to help
youth who have experienced trauma. Medicaid funds
can be better used to cover the cost of certain trauma-related services needed by abused and neglected girls in state custody, including multi-systemic
therapy and functional family therapy, two of the most
commonly recommended evidence-based treatment
services for system-involved youth.

177

Improve the Use of Medicaid to Cover the Cost of

30

Trauma-Related Care.
Federal law requires Medicaid agencies to assess and
improve the delivery of services for children in foster
care.178 A 2013 guidance letter issued by the US Department of Health and Human Services (HHS) offers
assistance to states to use Medicaid more effectively
to cover the cost of trauma-related care, as well as
design Medicaid treatment strategies for children and
youth who have experienced trauma.179 Recommended strategies include using Medicaid funds to cover
evidence-based screening and assessment practices,
as well as home and community-based services for
children exposed to trauma.
Fully Utilize Medicaid’s Early Periodic Screening,
Diagnostic and Treatment Benefit (EPSDT).
The EPSDT applies to children enrolled in Medicaid,
particularly those who have experienced trauma and
require specialized health services as a result. This
benefit covers services that physicians determine are
medically necessary “to correct or ameliorate any
physical and mental illness or conditions,”180 even if
the conditions are not included in the state’s Medicaid
plan.181 As such, it can cover many services that are
commonly needed by children in state custody who
have experienced trauma, such as cognitive behavioral therapy, crisis management services, peer support,
family therapy, and targeted case management.182
Many states do not maximize use of this benefit, particularly for children with mental health needs.183

Use Medicaid to Connect Child-Welfare-Involved
Children with Integrated Health Care Practices.
For a variety of reasons — including periods of
homelessness and running away, frequent placement changes, and involvement in the juvenile justice
system — girls in foster care often lack consistent
access to the coordinated health services they need
to recover from trauma and abuse.
Through the Affordable Care Act, the Center for
Medicare and Medicaid Innovation (CMMI) has
invested in integrated care models that “emphasize a
person-centered, continuous, coordinated and comprehensive care” approach to health care.184 These
models provide critical trauma-informed primary care
for people with complex medical needs, including
children in the child welfare system.185
An example of an integrated care model is the medical home. Medical homes are comprised of interdisciplinary teams of providers who develop individualized,
coordinated plans 186 for people with chronic health
conditions.187 The medical home model is especially
well-suited for girls who have suffered abuse, because they address needs holistically, including mental and physical health and social service needs. They
can also serve mobile or hard-to-reach populations.
The American Pediatric Association has developed
tools to help medical providers understand how
this model can address the health needs of children
exposed to violence,188 including training on medical
issues associated with violence exposure, screening
tools, and methods to engage families in violence
prevention.189
Invest in Creating Safe and Supportive
Group Homes with Specialized Services
for Teenage Girls.
Although family preservation is often a desirable
outcome, there will always be girls for whom staying
in a family or relative placement is not a safe option because of intra-familial abuse or other harmful
environmental factors. Currently, there are not enough

child welfare and the sexual abuse to prison pipeline

family foster care options or adoptive parents to
serve all children who need them. Identification of
and investment in group homes that provide quality,
specialized services to youth should be increased,
while group homes that do not should be phased
out. Youth themselves should be consulted in making
these assessments and help identify improvements to
better meet their needs.

youth, and children with disabilities. Child welfare
agencies and courts should prohibit refusals to serve
youth based on their immutable characteristics and
ban the practice of cherry-picking the most cooperative youth, which tends to exclude children who have
experienced the most severe abuse and are in greatest need of services, increasing their risk of juvenile
justice involvement.

To complement these efforts, child welfare systems
should ensure that effective and meaningful complaint procedures are in place to allow girls to seek
protection and immediate placement changes when
they feel unsafe. Federal standards of abuse or
maltreatment of children in foster care are too limited
to adequately address girls’ experiences and concerns,190 as revealed in a qualitative study on girls’
reports of abuse in foster care placements.191 At a
minimum, all service providers should be required
to demonstrate comprehensive child abuse prevention practices before receiving accreditation or grant
funding. For group homes, these practices should be
similar in scope to the PREA standards for juvenile

Prohibit Child Welfare Agencies and Providers from
Discharging Runaway Girls.
Currently, child welfare systems can discharge youth
who are on runaway status, and providers are not
always required to hold beds for runaway youth,
which contributes to placement instability and service
disruption after a runaway child is located. Yet chronic
episodes of running away are often indicative of violence and abuse, which, if untreated, increase these
youths’ risk of harm and arrest. While these cases
may be challenging to manage, effective strategies
should be developed to continue to serve these vulnerable girls.

justice facilities.
Implement Policies that Improve Responses to
the Behavior of Foster Youth Who Have Experienced Trauma and Abuse.
In recognition of the challenging trauma-rooted
behaviors that child welfare children often exhibit,
the system contracts with specialized providers that
can provide therapeutic interventions and help children heal. When these providers fail to manage the
trauma-related behavioral challenges they have been
hired to handle, they should not punish the girls in
their care by calling on law enforcement except as a
last resort, as detailed above.
Implement “No Eject, No Reject” Policies to Prevent
Discrimination and Guard Against “Cherry-picking”
of Youth Among Child Welfare Providers.
Under-funding and a shortage of beds leaves certain
groups of children at particular risk, including older
youth, pregnant and parenting youth, LGBT/GNC

Require Continuing Crisis De-escalation Training for
All Providers in the Child Welfare System to Help
Staff Effectively Manage Trauma-rooted Behavior.
Providing regular training and ongoing professional
development support to front-line staff is critical to ensuring the well-being of youth in custody and ending
the abuse to prison pipeline.

31

32

CONCLUSION

conclusion

Girls’ high rates of sexual abuse and their increased involvement in the juvenile
justice system is not a coincidence. There is a direct correlation. Research has
illuminated the link between girls’ trauma and the ever-widening law enforcement
net in which girls are caught, most often on minor offenses. 
There is much work to do.
We still do not know enough about this pipeline for girls. Research typically excludes girls from study samples, data is often not disaggregated by gender, race,
and ethnicity, and public agencies do not collect information about trauma and
gender-specific issues. The real and distinct lives of girls, especially when their
lives play out at the intersection of race and gender, remain invisible.
And when we lack the most basic information about girls’ unique needs and what
is happening in their lives, especially against the backdrop of high rates of sexual
violence, the battle to develop effective strategies for their health is an uphill one.
We must take action to learn more about the systemic criminalization of victimized
girls, who are disproportionately girls of color.  In the context of the emerging and
significant debate on the criminalization of boys of color, our report is a definitive
call to recognize the harm that is girls’ experience. We hope that this report will
fuel new conversations and a sense of urgency to recognize and remedy the unjust
and injurious response to victims and survivors of sexual abuse.

33

34

ENDNOTES

endnotes

1.	

2.	
3.	

4.	

5.	

6.	

7.	

8.	

David Finkelhor, Gerald Hotaling, I.A. Lewis & Christine Smith, Sexual
Abuse in a National Survey of Adult Men and Women: Prevalence,
Characteristics, and Risk Factors, 14 Child Abuse & Neglect 1, 19-28
(1990); US Dep’t of Justice, Bureau of Justice Statistics, Sex Offenses and
Offenders (Jan. 1997).
White House Council on Women & Girls, Rape and Sexual Assault: A Renewed
Call to Action 1 (Jan. 2014), available at https://www.whitehouse.gov/
sites/default/files/docs/sexual_assault_report_1-21-14.pdf.
Callie Marie Rennison, US Dep’t of Justice, Office of Justice Programs,
Bureau of Justice Statistics , National Crime Victimization Survey: Criminal
Victimization 2000, Changes 1999-2000 with Trends 1993-2000, Table
2, at 6 (June 2001), available at http://www.bjs.gov/content/pub/pdf/
cv00.pdf.
Emily G. Marston, Mike A. Russell, Ingrid Obsuth & Gillian K. Watson,
Dealing With Double Jeopardy: Mental Health Disorders Among
Girls in the Juvenile Justice System, in Delinquent Girls: Contexts,
Relationships, and Adaptation 105, 122 (Shari Miller, Leslie D. Leve &
Patricia K. Kerig eds., 2012); Selby M. Conrad, Nicole Placella, Marina
Tolou-Shams, Christie J. Rizzo & Larry K. Brown, Gender Differences
in Recidivism Rates for Juvenile Justice Youth: The Impact of Sexual
Abuse, 38 Law & Hum. Behav. 4, 305, 309-310 (Aug. 2014) (“Childhood sexual abuse (CSA) is a potent risk factor for delinquency and
subsequent juvenile justice involvement, especially for young women
(Chesney–Lind, 1997; Gavazzi et al., 2006; Hubbard & Pratt, 2002).”);
Stephanie Hawkins Anderson, Girls in the Juvenile Justice System:
The Causes and Correlates of Girls’ Involvement, in Delinquent Girls:
Contexts, Relationships, and Adaptation, supra at 44.
Francine T. Sherman, Richard A. Mendel & Angela Irvine, Annie E. Casey
Found., Making Detention Reform Work for Girls: A Guide to Juvenile
Detention Reform 5-6 (Apr. 2013), available at http://www.aecf.org/m/
resourcedoc/AECF-MakingDetentionReformWorkforGirls-2013.pdf;
Francine T. Sherman, Annie E. Casey Found., Detention Reform and Girls:
Challenges and Solutions 10 (2005) available at http://www.aecf.org/m/
resourcedoc/AECF-DetentionReformAndGirls-2005.pdf.
Poor data collection on Latina youth in the juvenile justice system has
made it difficult to quantify their representation in national statistics.
Because many jurisdictions do not fully disaggregate data by race and
ethnicity, the proportion of Latina youth involved in the system tends
to be under-identified and likely inflates the numbers of white youth.
Asian youth are similarly inaccurately identified. See Nat’l Council on
Crime & Delinquency, Racial and Ethnic Disparities in the US Criminal Justice
System, available at http://www.nccdglobal.org/sites/default/files/
publication_pdf/created-equal.pdf (last visited May 31, 2015); see
also Reform Trends: Counting Latino Youth, Juvenile Justice Information
Exchange, http://jjie.org/hub/racial-ethnic-fairness/reform-trends/ (last
visited May 25, 2015).
The W. Haywood Burns Institute for Juvenile Justice Fairness and Equity,
Unbalanced Juvenile Justice, 2011 detention rates for all youth of
color per 100,000 youth, http://data.burnsinstitute.org/#comparison=2&placement=1&races=2,3,4,5,6&offenses=5,2,8,1,9,11,10&year=2011&view=map (last visited May 25, 2015).
Melissa Sickmund, Anthony (T.J.) Sladky, Wei Kang & Charles Puzzanchera, US Dep’t of Justice, Nat’l Ctr. for Juv. Justice, Easy Access to
the Census of Juveniles in Residential Placement: 1997-2013, http://
www.ojjdp.gov/ojstatbb/ezacjrp/ (last visited May 24, 2015); Annie E.
Casey Found., KIDS COUNT Data Center, Child Population by Race and
Age Group (2013), http://datacenter.kidscount.org/data/tables/8446child-population-by-race-and-age-group?loc=1&loct=1#detailed/1/
any/false/36/13,66,67,68,69,70,71,12|/17077,17078 (last updated
Feb. 2015). For these purposes, detention is defined as being held
in a residential juvenile facility before arraignment or adjudication or
awaiting placement or transfer. Commitment refers to youth who are
assigned to live in residential placements after adjudication. See Melissa Sickmund, Anthony (T.J.) Sladky, Wei Kang & Charles Puzzanchera,
US Dep’t of Justice, Nat’l Ctr. for Juv. Justice, Glossary, Easy Access
to the Census of Juveniles in Residential Placement, http://www.ojjdp.gov/

9.	

10.	

11.	

12.	

13.	

14.	

15.	

16.	

ojstatbb/ezacjrp/asp/glossary.asp (last visited May 24, 2015).
Christopher Hartney, Nat’l Council on Crime & Delinquency, Native American
Youth and the Juvenile Justice System 3 (Mar.2008), available at http://
www.juvenile.utah.gov/DMC/Available%20Studies/2008%20Focus%20
Native%20American%20Youth-NCCD.pdf; Nat’l Council on Crime &
Delinquency, Center for Girls & Women, Getting the Facts Straight about
Girls in the Juvenile Justice System 7 (Feb. 2009), available at http://www.
nccdglobal.org/sites/default/files/publication_pdf/fact-sheet-girlsin-juvenile-justice.pdf; see also Oregon Comm. on Children and Families,
Disproportionate Minority Contact in Oregon’s Juvenile Justice System:
Identification and Assessment Report 20-26 (May 2012), available at http://
www.oregon.gov/oya/dmcsummit/2014/Materials/OregonDMCReport2012FINAL.pdf
Sickmund, supra note 8; Annie E. Casey Found., KIDS COUNT Data
Center, Child Population by Race and Age Group (2013), available
at http://datacenter.kidscount.org/data/tables/8446-child-population-by-race-and-age-group?loc=1&loct=1#detailed/1/any/fal
se/36/13,66,67,68,69,70,71,12|/17077,17078 (last updated Feb.
2015).
Child Trends Data Bank, Juvenile Detention 5, available at http://www.
childtrends.org/wp-content/uploads/2012/05/88_Juvenile_Detention.
pdf (last updated Sep. 2013). Per capita rates of youth involved in
juvenile justice can more clearly reveal disproportionate rates than
the percentage proportion of youth involved with the justice system.
According to the Office of Juvenile Justice and Delinquency Prevention,
the latter method can mask disparities. See US Dep’t of Justice, Office
of Justice Programs, Office of Juvenile Justice & Delinquency Prevention,
Disproportionate Minority Contact 6-7, available at http://www.ojjdp.gov/
mpg/litreviews/Disproportionate_Minority_Contact.pdf (last visited May
25, 2015).
Catherine Hanssens, Aisha C. Moodie-Mills, Andrea J. Ritchie, Dean Spade
& Urvashi Vaid, A Roadmap for Change: Federal Policy Recommendations for
Addressing the Criminalization of LGBT People and People living with HIV 37
(May 2014), available at https://web.law.columbia.edu/sites/default/
files/microsites/gender-sexuality/files/roadmap_for_change_full_report.pdf.
Angela Irvine, Time to Expand the Lens on Girls in the Juvenile Justice
System, NCCD Blog (Mar. 26, 2015), http://www.nccdglobal.org/
blog/time-to-expand-the-lens-on-girls-in-the-juvenile-justice-system;
Angela Irvine, LGBT/GNC Youth in Juvenile Justice, NCCD Blog (Mar.
13, 2015), http://www.nccdglobal.org/blog/lgbtgnc-youth-in-juvenile-justice.
Margaret Zahn, Stephanie Hawkins, Janet Chiancone & Ariel Whitworth, US
Dep’t of Justice, Girls Study Group: Understanding Girls’ Delinquency 3
(Oct. 2008), available at https://www.ncjrs.gov/pdffiles1/ojjdp/223434.
pdf; Am. Bar Ass’n & Nat’l Bar Ass’n, Justice By Gender: The Lack of
Appropriate Prevention, Diversion, and Treatment Alternatives for Girls
in the Juvenile Justice System, 9 Wm. & Mary J. Women & L. 1, 73, 79
(2002), available at http://scholarship.law.wm.edu/cgi/viewcontent.
cgi?article=1182&context=wmjowl; Anne L. Stahl & Phyllis Coontz,
Juvenile Assault Arrestees and Their Incidents: Same and Opposite
Gender Relationships, in Delinquent Girls: Contexts, Relationships, and
Adaptation, supra note 4 (“[O]ur analyses lend support to prior claims
that the increases we see in juveniles entering the justice system may
be partially due to changes in laws and police protocol. Variations in
gendered patterns of simple assault arrests may reflect changes in the
way that police respond to behaviors that always existed, as well as
changes in public tolerance toward those behaviors.”).
Margaret Zahn, Susan Brumbaugh, Darrell Steffensmeier, Barry C .Feld,
Merry Morash, Meda Chesney-Lind, Jody Miller, Allison Ann Payne, Denise C.
Gottfredson & Candace Kruttschnitt, US Dep’t of Justice, Girls Study Group:
Understanding Girls’ Delinquency, Violence by Teenage Girls: Trends and
Context 6-7 (May 2008), available at https://www.ncjrs.gov/pdffiles1/
ojjdp/218905.pdf.
Zahn, supra note 14, at 3-4; Schwartz, supra note 4 at 20-21; See also
Kerig, supra note 4, at 121, 134-135; Am. Bar Ass’n & Nat’l Bar Ass’n,

35

endnotes

17.	

18.	
19.	

36

20.	

21.	

22.	
23.	

24.	

25.	
26.	
27.	
28.	
29.	
30.	

Justice By Gender: The Lack of Appropriate Prevention, Diversion, and
Treatment Alternatives for Girls in the Juvenile Justice System, supra
note 14.
Jennifer Schwartz & Darrell Steffensmeier, Stability and Change in
Girls’ Delinquency and the Gender Gap: Trends in Violence and Alcohol
Offending Across Multiple Sources of Evidence, in Delinquent Girls:
Context, Relationships and Adaptation, supra note 4, at 5-6 (“Policy shifts
toward stretched definitions of what constitutes law-violating behavior
… leads to enhanced sanctioning for aggressive conduct among youth
overall but even more so among girls who tend to commit the milder,
less serious forms of physical attacks or threats.”); Zahn, supra note
15, at 6 (“Because arrests for assault increased without corresponding
increases in arrests for homicide or robbery, these analysts attribute
the increases in assault arrests to changes in law enforcement policies,
such as responses to domestic violence, rather than to actual increases
in assaults”).
Sherman, Detention Reform and Girls: Challenges and Solutions, supra note
5, at 29-34; Sherman, Making Detention Reform Work for Girls: A Guide to
Juvenile Detention Reform, supra note 5, at 7.
Jyoti Nanda, Blind Discretion: Girls of Color & Delinquency in the Juvenile Justice System, 59 UCLA L. Rev. 1502, 1529-1530 (2012); Tina
L. Freiburger & Alison S. Burke, Status Offenders in the Juvenile Court:
The Effects of Gender, Race, and Ethnicity on the Adjudication Decision,
9 Youth Violence & Juvenile Justice 4, 352, 354 (2011); Patricia K. Kerig
& Stephen P. Becker, Trauma and Girls Delinquency, in Delinquent Girls:
Contexts, Relationships, Adaptations, supra note 4, at 120; see also Coalition for Juvenile Justice, SOS Project, Emerging Issues Policy Series, Issue
No. 1 3-4 (2013), available at http://juvjustice.org/sites/default/files/
resource-files/SOS%20Project%20-%20Girls,%20Status%20Offenses%20and%20the%20Need%20for%20a%20Less%20Punitive%20
and%20More%20Empowering%20Approach.pdf.
Sherman, Making Detention Reform Work: A Guide to Juvenile Detention
Reform, supra note 5, at 19; Margaret Zahn, Stephanie Hawkins, Janet
Chiancone & Ariel Whitworth, US Dep’t of Justice, Girls Study Group:
Understanding Girls’ Delinquency, supra note 14, at 3; Dana K. Smith,
Leslie D. Leve & Patricia Chamberlain, Adolescent Girls’ Offending and
Health Risking Sexual Behavior: The Predictive Role of Trauma, 11 Child
Maltreatment 4, 346,346-347 (Nov. 2006).
Margaret Zahn, Stephanie Hawkins, Janet Chiancone & Ariel Whitworth, US
Dep’t Of Justice, Girls Study Group: Understanding Girls’ Delinquency, supra
note 14, at 4; Patricia K. Kerig & Stephen P. Becker, Trauma and Girls’
Delinquency, in Delinquent Girls: Context, Relationships And Adaptation,
supra note 4, at 121-134.
Dana K. Smith, Leslie D. Leve & Patricia Chamberlain, Adolescent Girls’
Offending and Health Risking Sexual Behavior: The Predictive Role of
Trauma, supra note 20, at 350.
Dana D. Dehart, The Ctr. for Child & Family Studies, Poly-victimization
Among Girls in the Juvenile Justice System: Manifestations & Associations to
Delinquency 12 (Oct. 2009), available at https://www.ncjrs.gov/pdffiles1/
nij/grants/228620.pdf.
Leslie Acoca, Outside/Inside: The Violation of American Girls at Home,
on the Streets, and in the Juvenile Justice System, 44 Crime & Delinquency 4, 561, 566 (1988), available at http://leslieacoca.org/images/
Outside-Inside_-_The_Violation_of_American_Girls_at_Home_-_On_
the_Streets_-_and_in_the_Juvenile_Justice_System_by_Leslie_Acoca.pdf.
Id. at 567.
Patricia Chamberlain & Kevin J. Moore, Chaos And Trauma In The Lives
Of Adolescent Females With Antisocial Behavior And Delinquency, 6
Journal of Aggression, Maltreatment, and Trauma 1, 79, at 92 (2002).
Dana D. Dehart, supra note 23, at 32.
Acoca, supra note 24, at 567.
Chamberlain, supra note 26, at 92.
Mary C. Marsiglio, Krista M. Chronister, Brandon Gibson & Leslie D.
Leve, Examining the Link Between Traumatic Events and Delinquency
Among Juvenile Delinquent Girls: A Longitudinal Study. 7 J. Child and

31.	

32.	
33.	

34.	

35.	

36.	
37.	
38.	

Adolescent Trauma 4, 217, 224-225 (Dec. 2014), available at http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC4286894/ (“Study results
point to a prospective predictive relationship between previous trauma
event exposure and future delinquency for pre-high school entry girls
only. For older girls, results suggest that previous trauma experiences were predictive of future trauma experiences, but not future
delinquency.
The Adverse Childhood Experiences (ACEs) study conducted by Dr.
Felitti with Kaiser Permanente and the Centers for Disease Control
revealed that the higher a child’s ACE score – that is, the greater
then number of adverse childhood experiences, including sexual and
physical abuse — the greater her risk of mental and physical health
problems throughout her life. V.J. Felitti et al., Relationship of Childhood
Abuse and Household Dysfunction to Many of the Leading Causes of
Death in Adults: The Adverse Childhood Experiences Study, 14 Am.
Journal of Preventive Medicine 4, 245 (1998). The ten categories of
ACES used in recent studies of youth in the juvenile justice system
include emotional abuse, physical abuse, sexual abuse, emotional
neglect, physical neglect, family violence, household substance abuse,
household mental illness, parental separation or divorce, and having an
incarcerated household member. The experience of childhood trauma
has been proven to lead to many negative long-term health consequences and juvenile justice involvement. See, e.g., Michael T. Baglivio
et al., US Dep’t of Justice, Office of Justice Programs, Office of Juvenile
Justice & Delinquency Prevention, The Prevalence of Adverse Childhood Experience (ACE) in the Lives of Juvenile Offenders, 3 J. of Juv.
Justice 2, 11 (Spring 2014), available at http://www.journalofjuvjustice.
org/JOJJ0302/JOJJ0302.pdf (“ACES not only increase the chances
of involvement in the juvenile justice system but the risk of re-offense.
A focused effort on early identification of ACEs, and intervention for
ACEs with a goal of improving youth life circumstances and preventing
criminal behavior may reduce likelihood and costs related to juvenile
criminal activities.”).
Baglivio, The Prevalence of Adverse Childhood Experience (ACE) in the
Lives of Juvenile Offenders, supra note 31, at 9 (Fig. 1).
Id.; See also Karen Baynes-Dunning & Karen Worthington, Responding
to the Needs of Adolescent Girls in Foster Care, XX Geo. J. Poverty
L. & Pol’y 2, 324 (2013), available at http://karenworthington.com/
uploads/2/8/3/9/2839680/adolescent_girls_in_foster_care.pdf (analyzing the three primary data sets on child maltreatment and finding
that sexual abuse was the driving factor of girls experiencing higher
overall maltreatment rates as compared to their male peers).
The Florida study replicated the finding of several other studies,
including Erin M. Espinosa, Jon R. Sorenson, & Molly A. Lopez, Youth
Pathways to Placement: The Influence of Gender, Mental Health Need
and Trauma on Confinement in the Juvenile Justice System, 42 J. Youth
& Adolescent Dev. 1824, 1830 (2013); Julian D. Ford et al., Poly-Victimization and Risk of Posttraumatic, Depressive, and Substance Use
Disorders and Involvement in Delinquency in a National Sample of
Adolescents, 46 J. Adolescent Health 545, 548 (2010); Dehart, supra
note 23, at 11-12.
Kerig, supra note 4, at 134 (citing Abram 2002; Belknap and Holsinger
2006; Dembo 1998; Ford 2008; Johansson and Kempf-Leonard 2009;
Kerig 2009, 2010; Lawyer 2006; McCabe 2002; Taylor 2008; Wood
2002; Yoshinaga 2004).
Other forms of abuse occurred in less disproportionate rates. Baglivio,
supra note 31, at 4.
Kerig, supra note 4, at 134.
See Carly B. Dierkhising et al., Trauma Histories Among Justice-Involved Youth: Findings from the National Child Traumatic Stress Network, 4 Eur. J. Psychotraumatology (Jul. 2013), available at http://www.
ejpt.net/index.php/ejpt to http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3714673/ (last visited May 18 2015); Selby M. Conrad, Nicole
Placella, Marina Tolou-Shams, Christie J. Rizzo, and Larry K. Brown,
Gender Differences in Recidivism Rates for Juvenile Justice Youth: The
Impact of Sexual Abuse, supra note 4, at 310.

endnotes

39.	 Robert L. Listenbee, Jr., et al., US Dep’t of Justice, Office of Justice
Programs, Office of Juvenile Justice & Delinquency Prevention, Report of the
Attorney General’s National Task Force On Children Exposed to Violence
21 (Dec. 12, 2012), available at http://www.justice.gov/defendingchildhood/cev-rpt-full.pdf.(“The vast majority of children involved in the
juvenile justice system have survived exposure to violence and are
living with the trauma of those experiences.”).
40.	 Smith, supra note 20, at 350; see also Anderson, Girls in the Juvenile
Justice System: The Causes and Correlates of Girls’ Involvement, in Delinquent Girls: Contexts, Relationships, and Adaptation, supra note, 4 at 44.
41.	 Conrad, supra note 4, at 309-10.
42.	 Id. (“Childhood sexual abuse (CSA) is a potent risk factor for delinquency and subsequent juvenile justice involvement, especially for young
women (Chesney–Lind, 1997; Gavazzi et al., 2006; Hubbard & Pratt,
2002)”); see also Anderson, supra note 4, at 44.
43.	 See Coal. for Juvenile Justice, SOS Project Girls, Status Offenses, and
the Need for a Less Punitive and More Empowering Approach, supra note
19, at 3.
44.	 Tip Sheet: Warning Signs of Possible Sexual Abuse in a Child’s Behaviors, Stop it Now!, http://www.stopitnow.org/ohc-content/tip-sheet-7
(last visited May 25, 2015).
45.	 Nat’l Coal. for the Homeless, Fact Sheet: Homeless Youth 1 (June 2008),
available at http://www.nationalhomeless.org/factsheets/youth.pdf (citing US Dep’t of Health & Human Servs., National Evaluation of Runaway
and Homeless Youth (1997)).
46.	 Kerig, supra note 4, at 121 (citing R. Dembo et al., Gender Differences
in Service Needs Among Youth Entering a Juvenile Assessment Center:
A Replication Study, 2 J. Corr. Healthcare 191, 121 (1995)).
47.	 Anderson, supra note 4, at 44 (citing Dixon 2004, Breslau 1991; Cauffman 1998; Hoyt and Scherer 1998; Rivera and Widon 1990)).
48.	 Marianne Hennessey, Julian D. Ford, Karen Mahoney, Susan J. Ko &
Christine Siegfried, Nat’l Child Traumatic Stress Network, Trauma Among
Girls in the Juvenile Justice System 4 (2004), available at http://www.
nctsn.org/nctsn_assets/pdfs/edu_materials/trauma_among_girls_in_
jjsys.pdf.
49.	 E.g. Delinquent Girls: Contexts Relationships and Adaptation, supra note
4.; Margaret Zahn et al., US Dep’t of Justice, Office of Justice Programs,
Office of Juvenile Justice & Delinquency Prevention, Causes and Correlates
of Girls Delinquency (Apr. 2010), available at https://www.ncjrs.gov/
pdffiles1/ojjdp/226358.pdf.
50.	 See Francine T. Sherman, Justice for Girls: Are We Making Progress,
59 UCLA L. Rev 1584, 1602-1612 (2012), available at http://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?article=1870&context=lsfp;
See also Shared Hope Int’l, JuST Response State Systems Mapping Report
14 (2015), available at http://issuu.com/julianbach/docs/just_response_mapping_report_digita?e=5039581/12008488 (“States
assert several reasons for considering alternatives to immunity laws.
Many feel they do not have safe placement alternatives to detention. In
states where child protective services is unable to investigate juvenile
sex trafficking because laws bringing these cases within their mandate
are not in place, a juvenile justice response may be the only system
option available to intervene in the minor’s exploitation. In states that
employ a diversion response, the option to charge trafficked children
with delinquency for prostitution offenses allows the court to mandate
participation in a trauma-informed diversion program that may encourage victims overcoming trauma bonds to be more cooperative in their
treatment plan. However, while detention may guarantee separation
from traffickers, it does not necessarily guarantee safety and rarely
offers trauma-informed services.”)
51.	 Hennessey, supra note 48, at 4.
52.	 Id.
53.	 See Kerig, supra note 4, at 120, 134 (“One reason to hypothesize that
PTSD is differentially related to girls’ delinquency is that PTSD, in general, is a gender-linked disorder. Across samples and ages, a well-replicated finding is that women and girls are more likely to be diagnosed
with PTSD than men and boys, even in the context of exposure to the
same traumatic event (citing Tolin and Foa (2006).”).

54.	 Jennie L. Shufelt & Joseph J. Cocozza, Nat’l Ctr. for Mental Health &
Juvenile Justice, Youth with Mental Health Disorders in the Juvenile Justice
System: Results from a Multi-State Prevalence Study 4 (June 2006), available at http://www.ncmhjj.com/wp-content/uploads/2013/07/7.-PrevalenceRPB.pdf.
55.	 Anderson, supra note 4, at 45 (citing Costello 2003, 2006).
56.	 Id.
57.	 Andrea J. Sedlak & Karla S. McPherson, US Dep’t of Justice, Office of
Justice Programs, Office of Juvenile Justice & Delinquency Prevention,
Youth’s Needs and Services: Findings from the Survey of Youth in Residential
Placement 8 (Apr. 2010), available at https://www.ncjrs.gov/pdffiles1/
ojjdp/227728.pdf.
58.	 Emily G. Marston et al., Dealing with Double Jeopardy: Mental Health
Disorders Among Girls in the Juvenile Justice System, in Delinquent
Girls: Contexts, Relationships, and Adaptation, supra note 4, at 106 (citing
Acoca (1999), Vermeiren (2006)).
59.	 Sedlak, supra note 57, at 2 (Apr. 2010), available at https://www.ncjrs.
gov/pdffiles1/ojjdp/227728.pdf; see also Sarah Hockenberry, Melissa
Sickmund & Anthony Sladky, Nat’l Ctr. for Juv. Justice, Service Provisions
by Number of Locked and Unlocked Publicly and Operated Facilities by State,
2010 (2013), available at http://www.ojjdp.gov/pubs/241134.pdf.
(analysis of OJJDP’s Juveniles in Residential Facility Census (2010)).
60.	 See Sedlak, supra note 57, at 8.
61.	 Id. at 9.
62.	 Leslie Acoca, Nat’l Council on Crime & Delinquency, Educate or Incarcerate?
Girls In Florida and Duval Country Juvenile Justice Systems 45 (Nov. 2000),
available at http://leslieacoca.org/images/Educate_or_Incarcerate_-_Girls_in_the_Florida_and_Duval_County_Juvenile_Justice_Systems_by_Leslie_Acoca.pdf; Patricia Chamberlain, Leslie D. Leve &
David S. DeGarmo, Multidimensional Treatment Foster Care for Girls in
Juvenile Justice: Two-Year Follow up of a Randomized Clinical Trial, 75
J. Consulting & Clinical Psychol. 1, 192-193 (2007), available at http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC1995088/.
63.	 David C.R. Kerr, Leslie D. Leve, & Patricia Chamberlain, Pregnancy
Rates Among Juvenile Justice Girls in Two RCTS of Multidimensional
Treatment Foster Care, 77 J. Consulting & Clinical Psychol. 3, 588
(June 2009).
64.	 See Vanessa Patino, Lawanda Ravoira & Angela Wolf, Nat’l Council on Crime
and Delinquency, A Rallying Cry for Change: Charting a New Direction in the
State of Florida’s Response to Girls in the Juvenile Justice System 51 (July
2006), available athttp://www.nccdglobal.org/sites/default/files/publication_pdf/cry-for-change.pdf (finding that approximately one-third of
their sample experienced a pregnancy); Cindy S. Lederman, Gayle A.
Dakof, Maria A. Larrea, & Hua Li, Characteristics of Adolescent Female
in Juvenile Detention, 27 Int’l. J.L. & Psychiatry 321, 326 (2004) (finding that 32 percent of their sample had ever been pregnant); R. Alan
Williams, & Helen M. Hollis, Health Beliefs and Reported Symptoms
Among a Sample of Incarcerated Adolescent Females, 24 J. Adolescent
Health 1, 21, 24 (1999) (finding that 37 percent had been pregnant);
Leslie Acoca, Are Those Cookies for Me or My Baby? Understanding
Detained and Incarcerated Teen Mothers and Their Children, 55 Juv.
& Fam. Ct. J. 65, 67 (2004) (finding that in a study of 1,000 girls in
California, 29 percent had been pregnant at least once; 16 percent
were pregnant while incarcerated; the average age of delivery was
14; 23 percent had a miscarriage and 29 percent had been placed in
physical restraints).
65.	 Jennie G. Noll & Chad E. Shenk, Teen Birth Rates in Sexually
Abused and Neglected Females, 131 Pediatrics 4, 1181, 1185 (Apr.
2013), available at http://pediatrics.aappublications.org/content/
early/2013/03/18/peds.2012-3072.full.pdf+html (“The current set
of results indicates that maltreatment, specifically sexual abuse and
neglect during adolescence, significantly increased the risk of teen
childbirth by 2.74-fold and 3.14-fold, respectively.”).
66.	 The Nat’l Crittenton Found., Summary of Results: Crittenton Adverse Childhood Experiences (ACE) Pilot 6 (Oct. 24, 2012), available at http://www.
nationalcrittenton.org/wp-content/uploads/2015/03/ACEresults.pdf.

37

endnotes

38

67.	 See Am. Acad. of Pediatrics, Comm. on Adolescence, Policy Statement:
Health Care for Youth in the Juvenile Justice System, 128 Pediatrics
1219, 1223 (2011), available at http://pediatrics.aappublications.
org/content/128/6/1219.full.pdf+html; Catherine A. Gallagher, Adam
Dobrin, & Anne S Douds, A National Overview of Reproductive Health
Care Services for Girls in Juvenile Justice Residential Facilities, 17
Women’s Health Issues 217 (2007); On shackling, see Am. Coll. of
Obstetricians and Gynecologists, Committee on Health Care for Underserved
Women, Health care for Pregnant and Postpartum Incarcerated Women
and Adolescent Females, Comm. Op. No. 511, at 3 (Nov. 2011, reaff’d
2013), available at http://www.acog.org/-/media/Committee-Opinions/
Committee-on-Health-Care-for-Underserved-Women/co511.pdf?dmc=1&ts=20150526T0232572323 (“Despite progress, 36 states and
the Immigration and Customs Enforcement agency of the Department
of Homeland Security, which detains individuals who are in violation
of civil immigration laws pending deportation, fail to limit the use of
restraints on pregnant women during transportation, labor and delivery,
and postpartum recuperation.”).
68.	 Nat’l Conference of State Legs., Medicaid For Juvenile Justice-Involved
Children: Juvenile Justice Guidebook for Legislatures 7, available at http://
www.ncsl.org/documents/cj/jjguidebook-medicaid.pdf.
69.	 Leslie Acoca, Are Those Cookies for Me or My Baby? Understanding
Detained and Incarcerated Teen Mothers and Their Children, supra note
64, at 68-72.
70.	 Maxine Harris & Roger D. Fallot, Envisioning a Trauma-Informed Service
System: A Vital Paradigm Shift, in Using Trauma Theory to Design Service
Systems 3, 3 (Maxine Harris & Roger D. Fallot, eds., 2001).
71.	 Tex. Criminal Justice Coal., Girls’ Experiences in the Texas Juvenile Justice
System 5 (Oct. 2012), available at http://www.texascjc.org/sites/
default/files/uploads/Girls%20Experiences%20in%20the%20TX%20
JJ%20System%20%28Oct%202012%29.pdf.
72.	 Stephanie Hawkins Anderson, Girls in the Juvenile Justice System:
The Causes and Correlates of Girls’ Involvement, in Delinquent Girls:
Contexts, Relationships, and Adaptation, supra note 4, at 44 (“Girls tend
to endure more trauma internally (e.g. depression, suicidal ideation/
behaviors, disordered eating) before they respond overtly”) (internal
citations omitted)).
73.	 Hennessey, supra note 48, at 5.
74.	 Id.; Patricia K. Kerig & Julian D. Ford, Nat’l Child Traumatic Stress Network,
Trauma Among Girls in the Juvenile Justice System 7 (2014), available at
http://www.nctsn.org/sites/default/files/assets/pdfs/trauma_among_
girls_in_the_jj_system_2014.pdf.
75.	 For analysis of substantiated cases of sexual assault in juvenile
justice facilities see Howard N. Snyder & Melissa Sickmund, US Dep’t of
Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency
Prevention, Juvenile Offenders and Victims (2006), available at http://www.
ojjdp.gov/ojstatbb/nr2006/downloads/chapter7.pdf; For survey data on
sexual assault in juvenile justice facilities see Allen Beck, David Cantor,
John Hartge, & Tim Smith, US Dep’t of Justice, Office of Justice Programs,
Bureau of Justice Statistics, Sexual Victimization in Juvenile Facilities Reported
by Youth 2012 (June 2013), available at http://www.bjs.gov/content/
pub/pdf/svjfry12.pdf.
76.	 Mark Levin & Derek Cohen, Tex. Pub. Policy Found., Kids Doing Time for
What’s not a Crime: the Over-Incarceration of Status-Offenders 2 (Mar.
2014), available at file:///C:/Users/MaheenKaleem/Downloads/
Kids_Doing_Time_for_Whats_Not_a_Crime__The_OverIncarceration_of_Status_Offenders.pdf (“This stemmed from the overuse of incarceration to handle nonviolent, minor offenses like running away and
truancy. Such punishments have proven to be costlier than alternatives,
are largely ineffective at (and, in some cases, counterproductive to)
enhancing public safety, and are detrimental to the youth’s development.”); See Coal. for Juvenile Justice, SOS Project Girls, Status Offenses,
and the Need for a Less Punitive and More Empowering Approach, supra note
19, at 3 (“Girls are being incarcerated for their own protection, not
because of any safety threat they pose to the community.”).
77.	 Prison Rape Elimination Act (PREA) Juvenile Facility Standards, 28 C.F.R.
§ 115.381 (2012) Medical and mental health screenings; history of
sexual abuse.

78.	 Prison Rape Elimination Act Juvenile Facility Standards, 28 C.F.R. § 115.382
(2012) (Access to emergency medical and mental health services); 28
C.F.R. § 115.383. (Ongoing medical and mental health care for sexual
abuse victims and abusers).
79.	 Prison Rape Elimination Act, 42 USC. § 15603(a)(1) (2012) (“The
Bureau of Justice Statistics of the Department of Justice shall carry out,
for each calendar year, a comprehensive statistical review and analysis
of the incidence and effects of prison rape.”); see also PREA Essentials:
Data Collection and Review, National PREA Resource Center, http://www.
prearesourcecenter.org/training-technical-assistance/prea-essentials
(last visited May 25, 2015).
80.	 Audit and Compliance, National PREA Resource Center, http://www.
prearesourcecenter.org/faq/audit-and-compliance (Last Updated Mar.
14, 2013).
81.	 See Frequently Asked Questions, Nat’l PREA Resource Center, “Is there
a limit to the number of years that a state can submit an Assurance
without a reduction in Department of Justice (DOJ) grant funding?”,
available at http://www.prearesourcecenter.org/faq#n2233 (Last
updated May 16, 2014) (“During the initial three year audit cycle, which
ends on August 19, 2016, DOJ is not imposing a specific date by which
states that submit Assurances throughout that audit cycle must come
into compliance with the National PREA Standards or face a reduction
in DOJ grant funding.  If necessary, additional guidance will be provided
by DOJ as the end of the initial three year audit cycle approaches.”).
82.	 Frequently Asked Questions: Applicability of Standards to Individual
Settings, (Items 6 and 7), Nat’l PREA Resource Center, http://www.
prearesourcecenter.org/faq (Item 6 Last Updated Jul. 9, 2013) (Item 7
Last Updated Feb. 7, 2013).
83.	 See E. Michael Foster, Amir Qaseem & Tim Connor, Can Better Mental
Health Services Reduce the Risk of Juvenile Justice System Involvement? 94 Am. J. Pub. Health 859 (2004); Stephen P. Becker, Patricia K.
Kerig, Ji-Young Lim & Rebecca N. Ezechukwu, Predictors of Recidivism
among Delinquent Youth: Interrelations Among Ethnicity, Gender, Age,
Mental Health Problems, and Posttraumatic Stress, 5 J. Child & Adolescent Trauma 2, 145 (2012); see also Acoca, supra note 62, at 45.
84.	 Patricia Chamberlain, Leslie D. Leve & David S. DeGarmo, Multidimensional Treatment Foster Care for Girls in the Juvenile Justice System:
2-Year Follow-up of a Randomized Clinical Trial, supra note 62, at 190.
85.	 Mana Golzari, Cynthia J. Mollen & Leslie Acoca, The Girls’ Health
Screen Pilot Study: A Screening Instrument for Girls in the Juvenile
Detention System, 11 J. Evidence-Based Soc. Work 480-483 (2014);
Leslie Acoca, The Girls Health Screen, Girls Health and Justice Institute,
available at http://www.girlshealthandjustice.org/programs/girlshealth-screen/ (last visited May 25, 2015); see also Acoca and Lexcen,
Development of the Girls’ Health Screen: Technical Report (2009), available
at http://stoneleighfoundation.org/sites/default/files/GHS2%20Technical%20Report%20For%20Web.pdf.
86.	 The screen, which takes between 11 and 13 minutes to administer,
can identify health conditions that typical intake exams may miss, as
it is administered privately via a computerized questionnaire, written
at a fourth grade reading level, and available in English and Spanish.
Girls may also choose to have the questions read to them through
headphones. Based on a triage model, the screen identifies health
needs according to a color-coded urgency scale, which allows medical
providers to quickly and easily pinpoint urgent conditions requiring
immediate treatment, such active suicidal ideation, lack of required
medication, or incidents of sexual assault experienced just before
entering the facility. All girls receive physical exams and referrals when
concerns are identified. Girls Health Screen, Girls Health and Justice
Initiative, supra note 85 ; Leslie Acoca, Jessica Stephens & Amanda Van Fleet,
The Kaiser Family Found., Health Coverage and Care for Youth in the Juvenile
Justice System: The Role of Medicaid and CHIP 11 (May 2014), available
at http://kaiserfamilyfoundation.files.wordpress.com/2014/05/8591health-coverage-and-care-for-youth-in-the-juvenile-justice-system.pdf.
87.	 Acoca, supra note 86, at 11.
88.	 Id. at 5.

endnotes

89.	 See Am. Acad. of Pediatrics, Comm. on Adolescence, Policy Statement:
Health Care for Youth in the Juvenile Justice System supra note 67, at
1228.
90.	 Id. at 1231-1232; See also Anita G. Hufft, Supporting Psychosocial
Adaptation for the Pregnant Adolescent in Corrections, 29 MCN Am. J.
Matern. Child Nurs. 122-127 (2004); The Nat’l Campaign to Prevent Teen
& Unplanned Pregnancy & Georgia Campaign for Adolescent Power Potential,
Help Me to Succeed: A Guide for Supporting Youth in Foster Care to Prevent
Teen Pregnancy, available at http://thenationalcampaign.org/sites/default/files/resource-primary-download/help-me-succeed.pdf.
91.	 Nat’l Comm’n for Corr. Health Care, Standards for Health Servs. in Juvenile
Detention & Confinement Facilities (2004); Nat’l Comm’n on Corr. Health
Care, Standards for Health Servs. in Jails (2008); Nat’l Comm’n on Corr.
Health Care, Standards for Health Servs. in Prisons (2008), available at
http://www.ncchc.org/standards-resources; on shackling, see Am. Coll.
of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women, Health care for Pregnant & Postpartum Incarcerated Women &
Adolescent Females, supra note 67, at 3.
92.	 Am. Civil Liberties Union, State Standards for Pregnancy-Related Health
Care and Abortion for Women in Prison, available at https://www.aclu.
org/maps/state-standards-pregnancy-related-health-care-and-abortion-women-prison-map#NATstandards (last visited May 25, 2015);
Annie E. Casey Found., Juvenile Detention Alternatives Initiative, A Guide to
Juvenile Detention Reform: Juvenile Detention Facility Assessment (2014),
available at http://www.aecf.org/m/resourcedoc/aecf-juveniledetentionfacilityassessment-2014.pdf#page=103.
93.	 Am. Coll. of Obstetricians and Gynecologists, Committee on Health Care for
Underserved Women, Health care for Pregnant & Postpartum Incarcerated
Women & Adolescent Females, Comm. Op. No. 511, supra note 67; Annie
E. Casey Found., Juvenile Detention Alternatives Initiative, A Guide to Juvenile
Detention Reform: Juvenile Detention Facility Assessment, supra note 92,
at 175.
94.	 Selby M. Conrad, Nicole Placella, Marina Tolou-Shams, Christie J. Rizzo
& Larry K. Brown, Gender Differences in Recidivism Rates for Juvenile
Justice Youth: The Impact of Sexual Abuse, supra note 4, at 309-310.
95.	 See Emily G. Marston et al., in Delinquent Girls: Contexts, Relationships,
and Adaptation, supra note, at 114 (“Collaboration between juvenile
justice and community mental health systems may be a necessity, in
order to supply sufficient numbers of clinical professionals who can
effectively address the treatment needs of incarcerated adolescent
female populations . . . [T]o maintain treatment gains made in the
juvenile justice facility, empirically supported aftercare programs are
necessary to facilitate these high-risk adolescent females’ successful
reentry into the community.”).
96.	 42 U.S.C. § 1396d(h)(1) (2012).
97.	 The MacArthur Foundation has outlined several strategies states can
employ to accomplish this goal. Sarabeth Zemel, Kimm Mooney, Diane Justice & Katie Baudouin, John and Catharine T. MacArthur Found., Nat’l Acad.
for State Health Policy, Facilitating Access to Health Coverage for Juvenile
Justice Involved Youth 7 (Dec. 2013), available at http://www.nashp.org/
sites/default/files/Facilitating_Access_to_Health_Care_Coverage.pdf.
For example, states may do the following:
1) suspend, rather than terminate, Medicaid eligibility to enable
coverage to be reinstated as quickly as possible on release from
a juvenile justice facility;
2) implement “continuous eligibility,” which allows children who
enter and leave a juvenile detention facility within a 12-month
period to maintain eligibility upon reentry into the community;
3) adopt a policy of “presumptive eligibility,” which permits
qualified providers to make temporary eligibility determinations
for Medicaid before a final determination has been made by the
Medicaid agency thereby enabling youth to immediately access
health services without waiting for official approval; or

98.	
99.	
100.	

101.	

102.	

103.	

104.	

105.	

106.	

107.	

108.	

4) implement special enrollment procedures, such as by requiring juvenile justice staff to fill out Medicaid applications for every
youth leaving custody.
Telephone Interview with Educational Advocate (Jan. 27, 2015).
Zahn, supra note 15, at 12.
Nat’l Women’s Law Ctr., The Next Generation of Title IX: Harassment and
Bullying Based on Sex 2 (June 2012), available at http://www.nwlc.org/
sites/default/files/pdfs/nwlcharassbullying_titleixfactsheet.pdf; Am. Ass’n
of Univ. Women Educ. Found., Hostile Hallways: Bullying, Teasing, and Sexual
Harassment in School 37-38 (2001), available at http://www.aauw.org/
files/2013/02/hostile-hallways-bullying-teasing-and-sexual-harassment-in-school.pdf (On student’s self-reported reactions to the high
prevalence of sexual harassment in school).
Rebecca Chance, A Demand for Justice in Norman OK After Three
Students Were Raped and Bullied Out of School, The Flounce, (Dec. 4,
2014), http://theflounce.com/demand-justice-norman-ok-three-students-raped-bullied-school/.
Rebecca Klein, Hundreds of Students Protest Norman High School Over
Alleged Bullying of Rape Victims, Huffington Post (Nov. 24, 2014),http://
www.huffingtonpost.com/2014/11/24/norman-high-schoolprotest_n_6214222.html.
See generally Am. Ass’n of Univ. Women Educ. Found., Hostile Hallways:
Bullying, Teasing, and Sexual Harassment in School, supra note 100; see
also Sexual Violence Prevention Strategies, Centers for Disease Control
and Prevention, http://www.cdc.gov/violenceprevention/sexualviolence/
prevention.html (last visited May 30, 2015).
Zero-tolerance policies refer to school disciplinary policies that assign
specific, predetermined punishments to certain behaviors regardless of
the context in which the behavior occurred. Advocates have criticized
these policies for being overly harsh reactions to student misbehavior
that have not necessarily resulted in deterrence or reduction in violent
or illegal activity on school campuses. Christopher Boccanfuso & Megan
Kuhfeld, Evidence-Based, Nonpunitive Alternatives to Zero Tolerance 1-2
(Mar. 2011), available at http://www.childtrends.org/wp-content/uploads/2011/03/Child_Trends-2011_03_01_RB_AltToZeroTolerance.
pdf.
Ill. State Bd. of Educ. Ensuring Success in School Task Force, Final Report
to the Illinois General Assembly 32 (June 2010), available at http://
povertylaw.org/sites/default/files/webfiles/final-essa-task-force-reportwith-appendix%20(1).pdf.
Hearing: Innocence for Sale: Domestic Minor Sex Trafficking, Before the
Subcomm. On Crime, Terrorism, Homeland Sec., and Investigations,
H. Comm. On the Judiciary, 113th Cong. (Mar. 26, 2014) (testimony
by Withelma “T” Ortiz Walker Pettigrew), available at (http://judiciary.
house.gov/_cache/files/2ad6a4b5-09d7-41c1-90dd-44dec1dbfc69/
ortiz-pettigrew-testimony.pdf.
See Linda Smith, Samantha Vardaman & Melissa Snow, Shared Hope
International, The Nat’l Report on Domestic Child Sex Trafficking: America’s
Prostituted Children 30-32 (2009), available at http://sharedhope.org/
wp-content/uploads/2012/09/SHI_National_Report_on_DMST_2009.
pdf; Melissa Farley, Prostitution, Trafficking, and Cultural Amnesia: What We
Must Not Know in Order To Keep the Business of Sexual Exploitation Running
Smoothly 102-103 (2006), available at http://www.prostitutionresearch.
com/Farley%202006%20-%20Prosituttion,%20Trafficking%20
and%20Cultural%20Amnesia.pdf; Victims of sexual abuse are also
28 times more likely to be arrested for prostitution as adults than
their peers. Francine T. Sherman & Lisa Goldblatt Grace, The System
Response to the Commercial Sexual Exploitation of Girls, in Juvenile
Justice: Advancing Research, Policy and Practice 336 (Francine T. Sherman
& Francine H. Jacobs eds., 2011) (citing Cathy Spatz Widom, US Dep’t of
Justice, Office of Justice Programs, Victims of Childhood Sexual Abuse —
Later Criminal Consequences 5 (March 1995), available at https://ncjrs.
gov/pdffiles/abuse.pdf.).
Francine T. Sherman, Justice for Girls, Are We Making Progress?, supra
note 50, at 1611 (2012). If an adult engages in sexual activity with

39

endnotes

109.	

110.	

111.	

40

112.	

113.	

114.	
115.	
116.	

117.	
118.	

119.	

120.	

someone under the statutorily defined age of consent, it is considered
statutory rape. In most states, the age of consent is at least 16. Global
Justice Initiative, Legal Age of Consent for Marriage and Sex for the 50
United States (2011), available at https://globaljusticeinitiative.files.
wordpress.com/2011/12/united-states-age-of-consent-table11.pdf.
However, only a handful of states have legislation with provisions that
ensure that minors are immune from prosecution for prostitution or
prostitution-related offenses, leaving most children vulnerable to arrests
on prostitution or prostitution-related charges. Shared Hope Int’l, JuST
Response Mapping Report, supra note 50, at 11.
Shared Hope Int’l, State Survey Laws: Factors Affecting Child Protective Services Involvement in Commercial Sexual Exploitation of Minors Cases (2014),
available at http://sharedhope.org/wp-content/uploads/2014/06/
Shared-Hope-State-law-survey_CPSInvolvement_through-8.1.pdf.
Id.; US Dep’t of Health and Human Servs., Admin. For Children & Families,
Child Welfare Information Gateway, State Statutes: Current Through June
2014 2, available at https://www.childwelfare.gov/pubPDFs/define.
pdf (Seven states define human trafficking as a form of sexual abuse
in their child welfare laws and four states define human trafficking as a
form of physical abuse).
Shared Hope Int’l & Casey Family Programs, Traffic Stop: A Discussion about
Child Welfare and Judicial Strategies for Preventing Juvenile Sex Trafficking
and Helping Its Survivors 18-21 (2014), available at http://sharedhope.
org/wp-content/uploads/2014/08/Traffic-Stop-FINAL.pdf.
Hearing: Innocence for Sale: Domestic Minor Sex Trafficking, Before the
Subcomm. On Crime, Terrorism, Homeland Sec., and Investigations,
H. Comm. On the Judiciary, 113th Cong. (Mar. 26, 2014) (testimony
by Withelma “T” Ortiz Walker Pettigrew), supra note 106 (“Like me,
any youth in foster care becomes accustomed to adapting to multiple
moves from home to home which allows us to easily then adapt when
traffickers/pimps/exploiters move us multiple times, from hotel to hotel,
city to city, and/or state to state. For myself, as unfortunate as it is to
say, the most consistent relationship I ever had in care was with my
pimp and his family.”).
Kate Walker, California Child Welfare Council, Ending the Commercial
Exploitation of Children: A Call for a Multisystem Collaboration in California
18-19 (2013), available at http://www.youthlaw.org/fileadmin/ncyl/
youthlaw/publications/Ending-CSEC-A-Call-for-Multi-System_Collaboration-in-CA.pdf.
Preventing Sex Trafficking and Strengthening Families Act, P.L. 113183 (2014).
22 U.S. C. § 7102(9)(A) (2015).
At least 28 states that have passed legislation that seeks to treat victims of domestic child sex trafficking as victims and divert them away
from the juvenile justice system. Nat’l Conference of State Legs., Human
Trafficking Overview, http://www.ncsl.org/research/civil-and-criminal-justice/human-trafficking-overview.aspx#Safe Harbor (last visited May
26, 2015). At least 5 states have pending legislation. At the time of the
writing of this paper, at least two of the states with pending legislation
have passed safe harbor bills. Shared Hope Int’l, JuST Response Mapping
Report, supra note 50, at 8.
Shared Hope Int’l, Demanding Justice 4 (2014), available at http://sharedhope.org/wp-content/uploads/2014/08/Demanding_Justice_Report_2014.pdf.
18 U.S. C. § 1591 (2012). Indeed, the courts have held that “[t]he
unambiguous text of §1591 makes no distinction between suppliers
and purchasers of commercial sex acts with children.” United States v.
Jungers, 702 F.3d 1066, 1072 (8th Cir. 2013).
Jessica R. Kendall, Am. Bar Ass’n Div. for Pub. Educ., Juvenile Status
Offenses: Treatment and Early Intervention, Technical Assistance Bulletin No.
29, 1 (2007), available at http://www.americanbar.org/content/dam/
aba/migrated/publiced/tab29.authcheckdam.pdf.
Sarah Hockenberry & Charles Puzzanchera, Nat’l Ctr. for Juvenile Justice,
Juvenile Court Statistics 2011, Chapter 4: National Estimates of Petitioned
Status Offense Cases, 71 (2011), available at http://www.ncjj.org/pdf/
jcsreports/jcs2011.pdf.; Sickmund, supra note 8.

121.	 Hockenberry, supra note 120, at 12, 71 (“Males were involved in 72%
of the delinquency cases handled by juvenile courts in 2011”) and
71(“Males accounted for 59% of the total petitioned status offense
caseload in 2011.”).
122.	 Melissa Sickmund, Anthony (T.J.) Sladky, Wei Kang & Charles
Puzzanchera, US Dep’t of Justice, Nat’l Ctr. for Juvenile Justice, Easy
Access to the Census of Juveniles in Residential Placement, Offense
Profile of Detained Residents by Sex and Race/Ethnicity for United
States 2011, available at http://www.ojjdp.gov/ojstatbb/ezacjrp/asp/
Offense_Detained.asp (In 2011, girls were only 16.2% of detained
residents, but were 36.8% of youth detained for a status offense).
123.	 Id. (In 2011, girls were only 12.3% of total number of juveniles committed to residential placements, but they were 40.3% of youth committed
for a status offense).
124.	 Id. at 3-4. See also Francine T. Sherman, Richard A. Mendel, & Angela Irvine,
Annie E. Casey Found., Making Detention Reform Work for Girls: A Guide
to Juvenile Detention Reform, supra note 5, at 11-12; US Dep’t of Educ.,
Office of Safe and Healthy Students, Human Trafficking in America’s Schools
5-8 (2015), available at https://safesupportivelearning.ed.gov/sites/
default/files/HumanTraffickinginAmericasSchools.pdf; US Dep’t of Educ.,
Office of Safe and Drug-Free Schools, available at http://files.eric.ed.gov/
fulltext/ED498514.pdf (2007).
125.	 Sue Burrell, Nat’l Ctr. for Child and Traumatic Stress, Trauma and the Environment of Care in Juvenile Institutions 3 (2013), available at http://www.
njjn.org/uploads/digital-library/NCTSN_trauma-and-environment-of-juvenile-care-institutions_Sue-Burrell_September-2013.pdf.
126.	 Hockenberry, supra note 120, at 71; See also, Sydney McKinney, Vera Institute of Justice, Status Offense Reform Center, Runaway Youth: A Research
Brief 1-2 (May 28, 2014), available at http://www.statusoffensereform.
org/wp-content/uploads/2014/05/Running-Away_Final.pdf.
127.	 Sydney McKinney, Vera Institute of Justice, Status Offense Reform Center,
Runaway Youth: A Research Brief, supra note 126 at 1-2.
128.	 Francine T. Sherman, Justice for Girls: Are We Making Progress?, supra
note 50, at 12 (“In 2009, girls made up 55 percent of youth arrested
for running away; prostitution was the only other crime for which girls
made up the majority of arrests.”); supra note 119, at 1.
129.	 Jody M. Greene, et al., US Dep’t of Health and Human Servs., Admin. On
Children, Youth, and Families, Sexual Abuse Among Homeless Adolescents:
Prevalence, Correlates, and Sequelae ES-2 (2002), available at http://
www.acf.hhs.gov/sites/default/files/opre/sex_abuse_hmless.pdf;
Kimberly A. Tyler, Dan R. Hoyt & Les B. Whitbeck, The Effects of Early
Sexual Abuse on Later Sexual Victimization Among Female Homeless
and Runaway Adolescents, 15 J. Interpersonal Violence 246 (Mar.
2000), available at http://digitalcommons.unl.edu/cgi/viewcontent.
cgi?article=1031&context=sociologyfacpub; Kimberly A. Tyler, Kellie J.
Hagewen & Lisa A. Melander, Risk Factors for Running Away Among
a General Population Sample of Males and Females, 43 Youth & Soc’y
583, 598 (Jun. 2011); Sanna J. Thompson, Kimberly Bender & Jihye
Kim, Family Factors as Predictors of Depression Among Runaway
Youth: Do Males and Females Differ? 28 Child & Adolescent Soc. Work
35, 44-45 (2011).
130.	 Sydney McKinney, Vera Institute of Justice, Status Offense Reform Center,
Runaway Youth: A Research Brief, supra note 126, at 2.
131.	 Lisa Thrane, Kevin Yoder & Xiaojin Chen, The Influence of Running
Away on the Risk of Female Sexual Assault in the Subsequent Year, 26
Violence & Victims 825 (2011).
132.	 Sarah Hockenberry & Charles Puzzanchera, Nat’l Ctr. for Juvenile Justice,
Juvenile Court Statistics 2011, Chapter 4: National Estimates of Petitioned
Status Offense Cases, supra note 120, at 81, 85.
133.	 See 42 U.S.C. §§ 5633(a)(11)-(13), (22) (2012).
134.	 Nat’l Council of Juv. and Fam. Ct. Judges, Resolution Supporting Reauthorization of JJDP Act and Elimination of VCO Exception, available at http://
www.ncjfcj.org/sites/default/files/vcoresolution3-10.pdf; See also
Gary Gately, New Report Finds Incarceration for ‘Status Offenses’ Still
Widespread, Juvenile Justice Information Exchange (Apr. 10, 2015), http://
jjie.org/new-report-finds-incarceration-for-status-offenses-still-wide-

endnotes

135.	

136.	

137.	
138.	
139.	

140.	
141.	

142.	

143.	
144.	
145.	

spread/108565/ (recommending against detention for status offense
behaviors). For a history of the valid court order exception, see Barry
C. Field, Violent Girls or Relabeled Status Offenders?: An Alternative
Interpretation of the Data, 55 Crime & Delinquency 243, 243-246 (2009).
According to the Office of Juvenile Justice and Delinquency Prevention,
27 states plus the District of Columbia still use the VCO exception. US
Dep’t of Justice, Office of Justice Programs, Office of Juvenile Justice & Delinquency Prevention, http://www.ojjdp.gov/compliance/FY2013-FY%20
2014VCO-state.pdf; see also Coal. for Juvenile Justice, SOS Project,
Status Offenses: A National Survey 8 (2015), available at http://www.
juvjustice.org/sites/default/files/resource-files/Status%20Offenses%20
-%20A%20National%20Survey%20-FINAL%20-%20WEB.pdf.
Jennifer Schwartz & Darrell Steffensmeier, Stability and Change in
Girls’ Delinquency and the Gender Gap: Trends in Violence and Alcohol
Offending Across Multiple Sources of Evidence, in Delinquent Girls:
Context, Relationships and Adaptation, supra note 4, at 5 (“Policy shifts
toward stretched definitions of what constitutes law-violating behavior .
. . leads to enhanced sanctioning for aggressive conduct among youth
overall but even more so among girls who tend to commit the milder,
less serious forms of physical attacks or threats.”) (internal citations
omitted). One example of net-widening is ending the practice of
“up-charging,” in which girls who have committed a status offense are
instead charged with misdemeanor offenses to evade the restrictions of
the JJDPA. Barry C. Feld, Violent Girls or Relabeled Status Offenders?:
An Alternative Interpretation of the Data, supra note 134, at 253.
Feld, supra note 134, at 253.
See generally Kerig, supra note 74.
Nat’l Child Traumatic Stress Network & Nat’l Council of Juv. And Fam. Ct.
Judges, NCTSN Bench Card for the Trauma-Informed Judge, available at
http://www.nctsn.org/sites/default/files/assets/pdfs/judge_bench_
cards_final.pdf (last visted May 27, 2015); see also Resources for
Justice Professionals, Law Enforcement and First Responders, For
Juvenile Justice Professionals/Law Enforcement/First Responders, Nat’l
Child Traumatic Stress Network, http://www.nctsn.org/category/products/
juvenile-justice-professionalslaw-enforcementfirst-responders (last
visited May 27, 2015).
Patricia K. Kerig & Julian D. Ford, Nat’l Child Traumatic Stress Network,
Trauma Among Girls in the Juvenile Justice System, supra note 74.
Many children are involved in both the juvenile justice and child welfare
systems; these children are known by a variety of terms, including
“crossover,” “dual system,” “dual- involved,” or “dually-adjudicated”
youth. The broadest term for these children is “crossover youth,” which
refers to all youth who have experienced child abuse or maltreatment
and engaged in delinquency, whether or not they are ever known to
child protective services or the juvenile justice system According to
that definition, “crossover youth” would encompass all children who
enter the abuse-to-prison-pipeline. Denise Herz et al., Georgetown Univ.,
Ctr. for Juvenile Justice Reform, Addressing the Needs of Multi-System
Youth: Strengthening the Connection Between Child Welfare and Juvenile
Just. 1 (2012), available at http://cjjr.georgetown.edu/wp-content/
uploads/2015/03/MultiSystemYouth_March2012.pdf.
Shay Bilchik & Judge Michael Nash, Child Welfare and Juvenile Justice:
Two Sides of the Same Coin, Juvenile and Family Justice Today 17-18
(Fall 2008), available at http://cjjr.georgetown.edu/pdfs/Fall%2008%20
NCJFCJ%20Today%20feature.pdf.
Id. at 17; Herz, supra note 141, at 2 (stating that majority are male but
the proportion of females among cross-over youth is much higher than
proportion of females in general delinquency).
Herz, supra note 141, at 16-17.
Joseph P. Ryan & Denise C. Herz, Crossover Youth and Juvenile Justice
Processing in Los Angeles County, Ctr. for Families, Children & The
Courts Research Update 4 (Dec. 2008), available at http://www.courts.
ca.gov/documents/AB129-CrossoverResearchUpdate.pdf. See also
Kerig, supra note 4, at 134; Jennifer L. Woolard, Crossing Over: Girls at
the Intersection of Juvenile Justice, Criminal Justice, and Child Welfare,
in Delinquent Girls: Context, Relationships, and Adaptation, supra note 4,

146.	

147.	

148.	

149.	

150.	
151.	

152.	
153.	

154.	

155.	
156.	

157.	

at 34 (comparing the child welfare and non-child welfare samples, the
child welfare sample was more likely to be female, younger, African
American and Hispanic. Thirty seven percent of the crossover sample
was female, compared to 24% of non-child welfare youth).
Irvine, supra note 13 (“While 14% of gender-conforming girls in the
juvenile justice system were previously removed from their homes by
social workers, 40% of GNC girls were previously removed. While 6%
of gender-conforming girls in the juvenile justice system were placed in
group homes because someone was hurting them, 24% of GNC girls
had this experience.”).
See, e.g., K. Majd, J. Marksamer, and C. Reyes, Hidden Injustice: Lesbian,
Gay, Bisexual and Transgender Youth in Juvenile Courts 94 (Fall 2009),
available at http://www.equityproject.org/pdfs/hidden_injustice.pdf;
Hannah Brückner and Kathryn E. W. Himmelstein, Criminal-Justice and
School Sanctions Against Nonheterosexual Youth: A National Longitudinal Study, 127 Pediatrics 49-57 (2011), available at http://pediatrics.
aappublications.org/content/early/2010/12/06/peds.2009-2306.full.
pdf+html (first published online on Dec. 6, 2010).
John D. & Catherine T. MacArthur Found., Models for Change, Is there a
Link Between Child Welfare and Disproportionate Minority Contact in Juvenile
Justice? 2 (Dec. 2011), available at http://www.naco.org/programs/
csd/Documents/Criminal%20Justice/Juvenile%20Justice%20Page/
Dual%20Status%20Youth/06%20Knowledge_Brief_Is_There_a_Link_
between_Child_Welfare_and_Disproportionate_Minority_Contact_in_
Juvenile_Justice.pdf.
Georgetown Univ., Ctr. for Juvenile Justice Reform, Crossover Youth Practice
Model 93 (2010), available at http://cjjr.georgetown.edu/wp-content/
uploads/2014/12/cypm.pdf (listing characteristics of crossover youth
and stating that two studies found that “African American youth are
overrepresented in the crossover numbers relative to the general
population, child welfare referrals, and juvenile justice referrals”); see
Denise Herz & Joseph P. Ryan, Georgetown Univ., Ctr. for Juvenile Justice
Reform, Building Multisystem Approaches in Child Welfare and Juvenile Justice
(2008); Michelle L. Saeturn & Janay R. Swain, Exploring Characteristics and
Outcomes of 241.1 Youth in Alameda County (2009); John D. & Catherine T.
MacArthur Found., Models for Change, Is there a Link Between Child Welfare
and Disproportionate Minority Contact in Juvenile Justice?, supra note 148,
at 3.
John D. & Catherine T. MacArthur Found., Models for Change, Is there a
Link Between Child Welfare and Disproportionate Minority Contact in Juvenile
Justice? supra note 148, at 3.
Patrick McCarthy, Annie E. Casey Found., The Alliance for Racial Equity
in Child Welfare — Yesterday, Today and Tomorrow, in Disparities and
Disproportionality in Child Welfare: Analysis of the Research v (Dec.
2011), available at http://www.cssp.org/publications/child-welfare/
alliance/Disparities-and-Disproportionality-in-Child-Welfare_An-Analysis-of-the-Research-December-2011.pdf.
Herz, supra note 141, at 17.
Robert F. Kennedy Nat’l Resource Ctr. For Juvenile Justice, Models for
Change Resource Ctr. P’ship, From Conversation to Collaboration How
Child Welfare and Juvenile Justice Agencies Can Work Together to Improve
Outcomes for Dual Status Youth 3 (May 8, 2014), available at http://www.
modelsforchange.net/publications/539.
See e.g., Dylan Conger & Timothy Ross, Vera Institute of Justice, Reducing
the Foster Care Bias in Juvenile Detention Decisions: The Impact of Project
Confirm (June 2001), available at http://www.vera.org/sites/default/
files/resources/downloads/Foster_care_bias.pdf; Herz, supra note 141,
at 23-24.
Georgetown Univ., Ctr. for Juvenile Justice Reform, Crossover Youth Practice
Model, supra note 149, at 4-5.
Tonya Edmond, Wendy Auslander, Diane E. Elze, Curtis McMillen &
Ron Thompson, Differences Between Sexually Abused and Non-Sexually Abused Adolescent Girls in Foster Care, 11 J. Child Sex Abuse 83
(2002).
Sara Goodkind, Jefferey J. Shook, Kevin H. Kim, Ryan T. Pohlig & David
J. Herring, From Child Welfare to Juvenile Justice: Race, Gender, and

41

endnotes

158.	
159.	

160.	
161.	
162.	
163.	

42

164.	

165.	
166.	
167.	
168.	
169.	
170.	

171.	

172.	

System Experiences , 11 Youth Violence & Juvenile Just. 249, 264.
(Jul. 2013) (“Analyses of placement sample indicate that congregate
care placement is associated with an increased likelihood of justice
involvement. These analyses reveal an even more pronounced gender
difference with regard to its effects; congregate care doubles the
likelihood of juvenile justice involvement for girls but has very little
effect on that of boys.”).
Madelyn Freundlich, Rosemary J. Avery & Deborah Padgett, Care or
Scare: The Safety of Youth in Congregate Care in New York City, 31
Child Abuse & Neglect 2 173, 184 (Feb. 2007).
Herz, supra note 141, at 20.; see also Georgetown Univ. Ctr. for Juvenile
Justice Reform, Crossover Youth Practice Model, supra note 149, at 89
(citing the absence of de-escalation techniques and procedures in congregate care placements and reliance on law enforcement to resolve
incidence; inexperienced staff; and absence of appropriate behavioral
modification techniques for the population at hand as a possible
contributor to crossover from congregate care).
Georgetown Univ., Ctr. for Juvenile Just. Reform, Crossover Youth Practice
Model, supra note 149, at 94.
Baynes-Dunning & Worthington, supra note 33, at 346-347.
Id.; see e.g., Nat’l Child Traumatic Stress Network, Child Welfare Trauma
Training Toolkit (2013), available at http://www.nctsn.org/products/
child-welfare-trauma-training-toolkit-2008.
US Dep’t of Health and Human Servs., Admin. Of Children and Families, Admin.
Of Children, Youth and Families, Children’s Bureau, Child Maltreatment 2012
Summary xi (2013), available at http://www.acf.hhs.gov/sites/default/
files/cb/cm2012.pdf#page=31; see Annie E. Casey Found., KIDS COUNT
Data Center, Children Who Are Confirmed by Child Protective Services as
Victims of Maltreatment by Maltreatment Type (2007-2011), available at
http://datacenter.kidscount.org/data/tables/6222-children-who-areconfirmed-by-child-protective-services-as-victims-of-maltreatmentby-maltreatment-type?loc=1&loct=2#detailed/1/any/fase/867,133,3
8,35,18/3885,3886,3887,3888,3889,3890,872/12951,12950 (last
updated Jun. 2014).
Blace A. Nalavanya, Scott D. Ryan, Jeanne A. Howard & Susan
Livingston Smith, Preadoptive Child Sexual Abuse as a Predictor
of Moves in Care, Adoption Disruptions, and Inconsistent Adoptive
Parent Commitment, 32 Child Abuse & Neglect 1084, 1085 (2008),
available at http://www.researchgate.net/profile/Blace_Nalavany/
publication/23500259_Preadoptive_child_sexual_abuse_as_a_predictor_of_moves_in_care_adoption_disruptions_and_inconsistent_
adoptive_parent_commitment/links/0deec52f398c795d3c000000.pdf
(describing the paucity of research on outcomes for children in foster
care with child sexual abuse history).
Edmond, supra note 156, at 84 (2002).
Id. at 83-84.
Id. at 84.
Id. at 87.
Nalavanya, supra note 164.
Nat’l Child Traumatic Stress Network, Using Trauma-Informed Child Welfare
Practice to Improve Placement Stability Breakthrough Series Collaborative:
Executive Summary 1 (Jun. 2013) available at http://www.nctsn.org/sites/
default/files/assets/pdfs/using_ticwp_bsc_executivesummary.pdf.
Nicole Taylor & Christine B. Siegfried, Nat’l Child Traumatic Stress Network,
Helping Children in the Child Welfare System Health from Trauma: A Systems
Integration Approach 1-2 (2005), available at http://www.nctsn.org/
nctsn_assets/pdfs/promising_practices/A_Systems_Integration_Approach.pdf.
See Ctr. for Health Care Strategies, Identifying Opportunities to Improve
Children’s Behavioral Health Care: An Analysis of Medicaid Utilization and
Expenditures (Dec. 2013), available at http://www.chcs.org/media/Identifying-Opportunities-to-Improve-Childrens-Behavioral-Health-Care2.
pdf(Describing ways to improve behavioral health services for children
on Medicaid who, as the authors note, are often involved with juvenile
justice and child welfare systems).

173.	 See Nat’l Child Traumatic Stress Network, Child Welfare Trauma Training
Toolkit (2013), supra note 162.
174.	 The Administration of Children and Families issued guidance encouraging states to train foster parents on child trafficking. US Dep’t of Health
and Human Servs., Admin. For Children, Youth and Families (ACYF), Guidance
to States and Services on Addressing Human Trafficking of Children and Youth
in the United States (2013), available at https://www.acf.hhs.gov/sites/
default/files/cb/acyf_human_trafficking_guidance.pdf (last visited May
27, 2015); Some states have instituted trainings.. For example, the
Connecticut Department of Children and Families Human Anti-Trafficking Response Team partners with two non-profits, Love 146 and My
Life My Choice, to host trainings for law enforcement, service providers,
group home providers, foster parents, kinship caregivers , others who
may interact with foster youth or children vulnerable to trafficking. See,
Conn. Dep’t of Children and Fam. HART (Human Anti-Trafficking Response
Team), http://www.ct.gov/dcf/cwp/view.asp?a=4743&Q=562246
(last visited May 11, 2015), Love146, https://love146.org/ (last visited
May 11, 2015), http://www.fightingexploitation.org/ (last visited May
11, 2015); Supervisor Mark Ridley-Thomas, Preventing Child Sex
Trafficking in Foster Care, Supervisor Mark-Ridley Thomas, Children and
Family Services, Human Trafficking (Apr. 10, 2014), available at http://
ridley-thomas.lacounty.gov/humanservices/index.php/sex-traffickingin-foster-care/; Ohio Child Welfare Training Program (OCWTP), available
at http://ocwtp.net/human%20trafficking%20-%20caregivers.html (last
visited May 27, 2015); Tenn. Dep’t of Human Servs., Human Trafficking Services Coordination and Service Delivery Plan 29 (2013), available at https://
www.tn.gov/humanserv/adfam/TDHS-2013-HT-Plan.pdf.
175.	 Title IV-E emphasizes child removal and out-of-home services, rather
than family preservation and in-home services, which experts have
shown to achieve better outcomes for children’s welfare. Title IV-B is
the only federal funding source available for family preservation services. Letter from Dep’t of Health and Human Servs. Admin. for Children &
Families, Ctrs. For Medicare & Medicaid Servs. & Substance Abuse & Mental
Health Servs. to State Medicaid Directors on Trauma-Informed Treatment 6-7
(Jul. 11, 2013), available at http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-13-07-11.pdf.
176.	 Magellan Health Services Children’s Services Task Force, Perspectives on
Residential and Community-Based Treatment for Youth and Families 2 (2008),
available at http://www.mtfc.com/2008%20Magellan%20RTC%20
White%20Paper.pdf; Laura W. Boyd, State Policy Advocacy and Reform
Ctr., Therapeutic Foster Care: Exceptional Care for Complex, Trauma-Impacted Youth in Foster Care 10 (Jul. 2013), available at https://childwelfaresparc.files.wordpress.com/2013/07/therapeutic-foster-care-exceptional-care-for-complex-trauma-impacted-youth-in-foster-care.pdf
(“When TFC is conducted according to best practices, it demonstrates
positive outcomes and cost savings for this highly fragile population of
youth.”); Eva Klain & Amanda R. White, ABA Ctr. on Children and the Law,
Implementing Trauma-Informed Practices in Child Welfare 10 (Nov. 2013),
available at http://childwelfaresparc.org/wp-content/uploads/2013/11/
Implementing-Trauma-Informed-Practices.pdf.
177.	 Sarabeth Zemel, Kimm Mooney, Diane Justice & Katie Baudouin, John & Catharine T. MacArthur Found., Nat’l Acad. for State Health Policy, Facilitating
Access to Health Coverage for Juvenile Justice Involved Youth, supra note
96, at 8.
178.	 42 U.S.C. 622(b)(15)(A) (2012); Info. Mem. from US Dep’t of Health and
Human Servs., Admin. on Children, Youth and Families, Information Memorandum, ACYF-CB-IM-11-06 (Oct. 6, 2011).
179.	 Letter from Dep’t of Health and Human Servs. Admin. for Children & Families,
Ctrs. For Medicare & Medicaid Servs. & Substance Abuse & Mental Health
Servs. to State Medicaid Director’s on Trauma-Informed Treatment, supra
note 175.
180.	 42 U.S.C. 1396d(r)(5) (2012).
181.	 US Dep’t of Health and Human Servs., Ctr. For Medicare & Medicaid Services,
EPSDT- A Guide for States: Coverage in the Medicaid Benefit for Children
and Adolescents 9 (Jun. 2014), available at http://www.medicaid.gov/

endnotes

182.	
183.	

184.	

185.	

186.	

187.	
188.	

medicaid-chip-program-information/by-topics/benefits/downloads/epsdt_coverage_guide.pdf; Early and Periodic Screening, Diagnostic, and
Treatment . U.S. Dep’t of Health and Human Servs., Ctr. For Medicare &
Medicaid Services, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html (last visited May 27, 2015).
Letter from US Dep’t of Health and Human Servs. Admin. for Children &
Families, supra note 175, at 11.
Wayne Turner, Early Periodic Screening and Diagnosis and Treatment
(EPSDT), Nat’l Health Law Program, 18 Health Advocate (Oct. 2013),
available at http://www.healthlaw.org/issues/child-and-adolescent-health/epsdt/health-advocate-epsdt#.VWZws89Vikp.
Letter from Directors of US Dep’t of Health and Human Services, Ctr. for
Medicare & Medicaid Services & Ctr. for Medicaid & CHIP Services to
State Medicaid Directors Regarding Policy Considerations for Integrated
Care Models 1 (Jul. 10, 2012), available at http://www.medicaid.gov/
Federal-Policy-Guidance/downloads/SMD-12-002.pdf.
Kamala D. Allen & Taylor Hendricks, Ctr. For Health Care Strategies,
Medicaid and Children in Foster Care 7-9 (Mar. 2013), available at https://
childwelfaresparc.files.wordpress.com/2013/03/medicaid-and-children-in-foster-care.pdf.
Melinda K. Abrams, Rachel Nuzum, Stephanie Mika & Georgette Lawlor,
The Commonwealth Fund, Realizing Health Reform’s Potential: How the
Affordable Care Act Will Strengthen Primary Care and Benefit Patients 8-10
(2011), available at http://www.commonwealthfund.org/publications/
issue-briefs/2011/jan/strengthen-primary-care.
Id. at 10.
Medical Homes for Children and Adolescents Exposed to Violence:

About the Project, Am. Acad. of Pediatrics, available at http://www.
aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Medical-Home-for-Children-and-Adolescents-Exposed-to-Violence/Pages/
Medical-Home-for-Children-and-Adolescents-Exposed-to-Violence.
aspx (last visited May 27, 2015).
189.	 Am. Acad. of Pediatrics, Preventing Sexual Violence: An Educational Toolkit
for Health Care Professionals, available at http://www2.aap.org/pubserv/
PSVpreview/pages/tools.html (last visited May 27, 2015).
190.	 See Baynes-Dunning & Worthington, supra note 33, at 344 (“Federal
benchmarks require systems to monitor and address maltreatment that
occurs after youth are in the child welfare system, but the definition
of incidents that are tracked for that purpose is so limited that it does
not capture the range of daily activities that girls may consider abusive
towards them. Thus, systems should clearly define what actions by
whom are considered incidents of “re-abuse” or repeat maltreatment
for purposes of federal reporting, and what actions not meeting this
definition still need to be addressed and tracked for system quality
improvement.”).
191.	 Freundlich, supra note 158.

43

This report was made possible by the generous support of The Annie E. Casey
Foundation, the JPB Foundation, the Moriah Fund, and the Overbrook Foundation. The views expressed in this report are the authors’ alone and do not
necessarily reflect the opinions of these foundations.

Published by
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