Issue: Lack of Mandatory Policies to Meet Sexual Health Needs

1. Comprehensive, LBGTQ-Inclusive Sexual Health Care for Youth in State Custody as a Human Right: The Teen SENSE Initiative The Center for HIV Law and PolicyAdrian Guzman, J.D., M.P.H.

2. Issue: Lack of Mandatory Policies to Meet Sexual Health Needs • Consensus: Comprehensive Sexual Health Care of Youth in State Care is a • State obligation: Necessary for the health and well-being of youth • Opportunity: Unique opportunity to reach high-risk youth and provide them with sexual medical care and sexuality education to promote self-awareness and long-term health • Despite this consensus policies are: • Inconsistent • Vague • Unofficial, ad hoc, and optional • No focused efforts to change public policy on this issue on a large scale

3. The Teen SENSE Initiative • Goal: Nationwide state mandates and standards for the provision of comprehensive sexual health care for youth in state custody • Multidisciplinary coalition to create model policies and standards and to lead advocacy for comprehensive, LGBTQ-inclusive: • Sexual health care • Sexual health education • Staff training to ensure competence that includes the rights and needs of LGBTQ youth • Legal framework establishing affirmative right of adolescents to comprehensive sexual health care • Local implementation efforts engaging policy makers and agency heads

4. Redefining Sexual Health Care • Sexual Health Care that • Meets the full range of sexual health needs of youth in state facilities • Inclusive of all sexual orientations and gender identities • Sexual Health Education that is • Comprehensive, scientifically sound • Inclusive of needs of all sexual orientations and gender identities • Culturally appropriate • Staff training • To understand, respect, and respond to the health and safety needs of all youth regardless of sexual orientation and gender identity • Rights-based: Youth Rights Road Map • Demonstrates urgency and an unmet affirmative right • Demonstrates need for mandated, consistent standards • Fills critical resource gap, useful for broad range of advocates

5. Cultivating Local Leadership • Local engagement and leadership is necessary for change • Local interdisciplinary network with a common goal and strategy • Youth participation • CHLP role: • Providing framework for national initiative-policy and standards lead • Organizing a national advisory board • Organizing and mobilizing local actors • Providing legal expertise • Current status: • Breakthroughs with Juvenile Justice Coalition, ACS • Roundtable meetings with local leaders; multi-state networks • Groundwork for collaboration on sexual health education and staff training • New national partners

6. Model Standards First set of Teen SENSE Model Standards released in January 2012: Model Sexual Health Care Standards for Youth in State Custody Model Sexual Health Education Standards for Youth in State Custody Model Staff Training Standards: Focusing on the Needs of LGBTQ Youth Endorsed by over 20 agencies, organizations, and universities across the United States

7. Model Policies First set of Teen SENSE Model Policies outlining the elements of essential sexual health services released in April 2012 Model Policy: Sexual Health Care for Youth in State Custody Model Policy: Sexual Health Education for Youth in State Custody Model Policy: Training for Youth Facility Staff: Ensuring Competence that Includes the Rights and Needs of LGBTQ Youth

8. Conclusions and Lessons Drawn (1) • There is both an obligation and an opportunity to meet the needs of disproportionately affected communities by focusing policy advocacy efforts on the institutions in which they are disproportionately represented • Focus on immediate and long-term sexual health of communities • Address the multiple factors that compound risk • Consider and redefine the role these institutions play in heightening or reducing risk • Interaction of legal analyses and policy advocacy is vital • Establishment of legal entitlements can be an important motivating carrot or stick

9. Conclusions and Lessons Drawn (2) • Interdisciplinary collaborations are necessary to address the multiple factors affecting the long-term health of communities • Multidisciplinary teams of experts in intersecting fields must collaborate to develop model policies and strategies • Coordinating expertise and strategy can enable these teams to bring state agency heads to the table to make voluntary changes • Creating standards and frameworks that can be used locally, nationally, and internationally

10. Conclusions and Lessons Drawn (3) • Redefine sexual health care and the way it is understood by consumers, providers, and policymakers • A comprehensive view of sexual health care that is rights-based and recognizes the importance of social, cultural, environmental, and economic factors • Provide best policies by recognizing and tapping into the vital factors that shape the health of individuals and communities • Characterize sexuality education and a safe, respectful environment as part of an essential right to health care • Provide strategic advantages • National initiatives work best when local implementation is undertaken by local leaders • Create model policies and strategies that can be adapted to other jurisdictions with similar systems and institutions • Local actors sharing resources create strong networks for change

11. Challenges Ahead • Changing state bureaucracies that are largely hidden from public scrutiny, defensive, homophobic, and sex-phobic • Systemic change may depend on the voluntary actions of slow-moving, conservative, politically driven bureaucracies • Optimally balancing the “carrots” with “sticks” • Funding for projects that are long-term, and in which change is incremental, is scarce • Cultivating local leadership with limited funding • Making progress at a pace that is commensurate with the crisis requires significant investment • Collaborators are overburdened and under-funded, and ability to dedicate significant efforts without new funding is circumscribed • Applying human rights framework in US-based advocacy

12. Teen SENSE is possible through a founding grant for the Teen SENSE initiative from the M.A.C. AIDS Fund and with additional support from The Arcus Foundations Gay and Lesbian Fund Broadway Cares/Equity Fights AIDS, and the Elton John AIDS Foundation.