HSMP 576: Advanced Health Policy

Stacie Balkaran

HSMP 576: Advanced Health Policy

April 25, 2017

Background.

The impetus for the expansion of rehabilitative services in youth correctional facilities in Oregon is clear when looking at the health disparities between incarcerated and non-incarcerated youth. For this discussion, I would like to focus upon one particular service: comprehensive sexuality education. Oregon Youth Authority (OYA) states in a health care services brief that “OYA medical professionals stress prevention” and “discuss safe sex” (p. 2). However, looking at the data, one can see despite these apparent efforts sexual health disparities continue to persist. These disparities have a cumulative impact when the relationship between sexual health and drug use, for example, is observed. Indeed, “incarcerated female adolescents with a diagnosed STI who reported inconsistent condom use had over twice the odds of methamphetamine use compared with consistent condom users” (OHA, p. 6).

I am proposing that Oregon’s Human Sexuality Education Rule (OAR Rule 581-022-1440) be adopted, in some form, by the OYA in its youth correctional facilities. With lower incidence rates than the general population of birth control and condom use; higher incidence rates of sexual abuse; and earlier ages of sexual debut than the general population seen in correctional youth, the need for comprehensive and innovative sexual health programming is urgent (OHA, p. 3). The note for innovation and creativity is an important one since many juvenile offenders do not regularly attend school—the programming should be multifarious in its educational approach (p. 7). The purpose of this discussion is to figure out the details here, such as details surrounding who should fund this programming (OYA, OHA, Department of Corrections (DOC), or other).

Questions

1.  Given that OYA uses its own medical staff to not only teach educational programming, but also to provide medical care to incarcerated youth, is there a potential issue of dual loyalty for these medical providers? If yes, how do we possibly combat this?

2.  The forces surrounding sexual health in correctional youth are so varied and inter-sectoral: gang violence, substance abuse, sexual trauma and violence, the foster care system, and more are at all play here. How do we make sexuality education feel relevant to these youth when they are in a position that is simultaneously and cumulatively affected by these situations?

3.  I will pose the same question I ended the background with: Who should fund this? With the idea in mind that the funder will have different priorities depending on who it is, e.g. the DOC will have different priorities and paradigms than the OHA will have concerning the way sexual health is viewed, taught, and treated.

Readings (3) – Sent out by Dr. Wallace. The longest one (“Sexual Abuse to Prison Pipeline”) is expected to be skimmed for the overall gist.