Many recent news articles on obese youth and the health concerns that arise from this condition have brought this important subject into the spotlight. One recent quote may serve as an example: “The country is facing an epidemic of childhood obesity. Fifteen percent of children and teens--more than 9 million--are overweight. For kids, that’s double the figure from two decades ago; for teens, it’s triple. As a result of the extra pounds, high blood pressure, high cholesterol and Type II diabetes are being increasingly diagnosed in children.” (Parktakes, FC Park Authority, Winter 06) The school nurses in your community and the nurse at the juvenile detention center and the DJJ Correctional Center will tell you that this is so true. Never before have those of us on the front lines of the juvenile justice system worked with so many diabetic teens on probation or in our care. Have we responded to client health profiles in a conscientious and capable fashion?
This article is a primer on what some say is an affirmative role or responsibility of all DJJ staff to pay at least nominal attention to health and fitness of all clients. Yet some say client health and fitness is “none of our business”. But are we not concerned with more than recidivism reduction? Bob Bermingham, past president of VJJA and current Fairfax Co. Gang Prevention Coordinator, tells us that “Self-image or the lack thereof plays a significant role in how a youth sees himself as part of a community, school or home. Low self-esteem is an issue frequently found in youth who become involved in negative behaviors such as joining gangs.” Other gang experts tell us that preteen and teen involvement in “resilience” building after-school activities build self-esteem and thwart delinquency. These same activities also promote good physical health. Many report through personal observation that weight loss and athletic or fitness activity build the self-esteem that helps teens change or improve their lives. Is that not a part of what we are charged with doing with or for our clients?
Probation officers may be wise to carefully look at school files and physical examinations when childhood obesity appears to be an issue. We tend to pay attention to family substance abuse patterns and to teach clients about increased levels of genetic predisposition. Why should we not make similar “health” observations, supported by an “obesity” comment on a kid’s third grade school physical? Calling attention to a family history of obesity or diabetes in the investigation and report is a good first step. In some social history or predispositional reports, we even see a link, perhaps a fuzzy one, between poor school attendance and years of childhood illness or health excuses for truancy. In some courts, a judge may order a child to wear his or her eyeglasses or to take a prescribed medication if such action is beneficial and fosters better comportment or school attendance. Might the same judge direct some clients with dangerous health profiles (i.e. obesity, substance abuse) to make changes that reduce current or future absences, illnesses and overall risk?
The caseworker’s role in the group home or residential situation is even more compelling. Whenever a child is detained in a juvenile detention center or placed in a group home, there is a clear duty to oversee the total well-being of the ward. State minimum residential standards may prohibit corporal punishment, overzealous exercise programs as a punishment, and the “withholding” of food. But these same standards do not preclude the development of a voluntary health/fitness program that the clients and parents help to develop. If nurse or doctor (or judge) makes such specific recommendations, the ability of the CSU or DJJ program to implement an overall well-being program is even more legitimate. Is it a mild case of malfeasance to knowingly let an ‘unhealthy-obese’ teen reside in the group home program for a year without showing weight loss or health improvements each quarter? Having an inexpensive BMI (body mass index) scale in each group home might be a great first step. Some teen programs use the federal government web site to log or track a youth’s exercise and eating on a daily basis (see www.mypyramidtracker.gov or www.mypyramid.gov). Some real program examples may be helpful:
One such example is Angel M., who successfully completed a group home program for teenage boys on probation in November 2006. When he entered the program in 2005, he was extremely obese and had zero self-esteem. In fact, the probation officer who referred him to residential care said he got his self-esteem from his gang affiliation. He was a very scary 14-year-old, arrested while walking down the street carrying a machete, in search of someone who had made him angry. Fortunately, he didn’t find him. While in the group home, a routine of daily physical activity and healthier menus was implemented for all residents. By the date of Angel’s completion ceremony, he had lost more than 70 pounds, wore a tuxedo to his ceremony, and thanked the judge and all who helped him find a way to live something other than the gang life. He made special mention of the cook for the group home program, who had helped him learn to make better food choices. It was obvious by the smile on his face (and a vastly different self presentation) that he liked himself enough to want something more out of life.
We wonder if you might agree with two predictions: By 2010, the court social history will no longer require the printing of the social security number of parents. This will occur to reduce risk of identity theft. And by 2010, the goals for each client in residential care will require at least an element that addresses the health and fitness of each youth. Your ADVOCATE editors (and Uncle Buck) welcome comments or responses in the form of letters to the editor.
Eric Assur is employed by the 17th Court Service Unit in Arlington. Suggestions for future book reviews can be sent to bookem@vjja.org.
