AANP Member Spotlight: Revising Health Service Guidelines for Youth Who Are Incarcerated
Hear from Jennifer Clifton, DNP, FNP-BC, CCHP-A, FAANP, about her work representing nurse practitioners as a member of the Juvenile Standards Task Force.
Dr. Jennifer Clifton has a passion for exploring research involving adolescent health, particularly that of adolescents within the juvenile correction system. In 2018, Clifton became the first liaison of the American Association of Nurse Practitioners® (AANP) to the National Commission on Correctional Health (NCCHC) Board of Directors. She is also a member of the NCCHC Juvenile Health Committee and has helped spearhead vital research in the area of juvenile health literacy.
For the first time in seven years, NCCHC has revised and updated the Standards for Health Services in Juvenile Detention and Confinement Facilities. Clifton served on the task force that crafted the revision and spoke with AANP about the changes made, how those changes help empower nurse practitioners (NPs) to best serve this patient population and the importance of having NPs at the table where decisions like these are being made.
Q: I’d like to get a sense of your career trajectory from family NP and doctor of nursing practice to serving on the Juvenile Standards Task Force. What were some of the crucial moments along this path?
Jennifer Clifton: I started working in juvenile corrections in 2005. In 2011, I gave my first poster presentation for the NCCHC and spoke to many people there. When I asked them who the NP leaders were at the NCCHC, I was unable to find any. So, I worked my way in.
Eventually, I got invited to be the first NP in the NCCHC’s Juvenile Health Committee, where I now serve as the co-chair of the committee. It is from that group that I was chosen to become a part of the multidisciplinary task force for revising Juvenile Standards as their sole NP representative.
Q: As one of the few NPs to hold the Certified Correctional Health Professional (CCHP) Advanced certification, can you explain your role and how you think NPs can best get involved in this organization in the future?
Clifton: The advanced CCHP certification is for administrators — I believe there are only around 30 individuals who have it. Now, while many can earn their fundamental CCHP certification, up until now specialty certifications in the program only included administrators, registered nurses (RNs), mental health professionals and physicians. There was no room for NPs. That bothered me.
After years of advocacy by myself and other NPs, CCHC administrators agreed to open up an advanced certification track for NPs and PAs. Right now, I am on a task force that is revising the physician certification exam. When we are done with our revisions, they will be grandfathering out the CCHP-Physician exam in favor of a new exam that includes NPs and PAs, as well as physicians.
It is so exciting that NPs are going to be able to get that advanced certification with CCHP soon, so I’m currently encouraging all correctional NPs to get their basic certifications so they may be eligible to take this specialty exam soon after it is implemented.
Q: The issues regarding the health of the nation’s youth who are incarcerated are not always widely documented or understood by patients and providers. What are some of the unique characteristics and challenges for treating this patient population?
Clifton: The most unique challenge to me — that is also a really wonderful opportunity— is the developing adolescent brain. We know now that your brain continues to develop until your mid-20s. Our RNs and NPs see this as an opportunity to be impactful. This fills us with hope, too. Adolescents are capable of learning, changing and growing. It’s a very hopeful environment.
When I presented for the NCCHC back in 2011, I covered a development that I found incredibly interesting. We did a survey in our system of youth who were in prison and found that they scored higher in health literacy than the average teenager. I totally attribute that to the fact that they are around nurses 40 hours per week, and our nurses are so good at working with these kids. That’s an example of how we are making an impact.
Q: The last time the NCCHC Standards for Health Services in Juvenile Detention and Confinement Facilities was updated was in 2015. What changed over the last seven years to necessitate this update?
Clifton: What necessitated it was truly time itself. NCCHC routinely updates these standards around every five years. The places where we really focused a lot of our changes were advanced practice provider roles, anti-racism language and LGBTQ health care. Additionally, we want to update our use of language to reflect that these are not incarcerated youth, but youth who are incarcerated.
We want to acknowledge the full array of youth and adolescents and the various kinds of trauma that can affect them. I just wrote a position statement for NCCHC about trauma-responsive language, and the task force strived to include trauma-responsive language in the updated standards, as well. We want people to start using this language with all our youth, not just those that we know have undergone specific traumatic events. Just being locked up is traumatic for a youth, in and of itself.
Q: While collaborating with this wide variety of health care professionals, what work did you do to ensure the NP role was represented in these updates?
Clifton: Honestly, I didn’t get every change I wanted, but I felt like I made progress. As I was leaving, one of the heads of the task force said, “Well, we’re looking forward to having you back in another five years when we revise the standards again.” My takeaway was, while I might not have gotten everything I want, NPs are welcome at the table, and they are listening to us. They recognize I have something to say and maybe next time I’ll get precisely what I want: full parity with the physicians that work in corrections.
The standards still require physician oversight, but some of the roles previously reserved for physicians are now open to NPs. An example of that is the Quality Improvement (QI) Committee. Traditionally, only a physician could lead the QI Committee. Per the American Nurses Credentialing Center (AANC), one of the essentials of NP education is QI and there’s not a reason in the world an NP cannot lead that committee. The updated standards now state that NPs can lead that committee, so there are incremental changes taking place to help move NPs to practice to the top of their license. It’s a work in progress, but these new standards are certainly an improvement.
Q: We are seeing more and more NPs in leadership roles and serving on task forces like this one. Why do you feel it is so important to have NPs’ voices in these situations?
Clifton: We have a unique perspective and educational background. We can articulate what an NP is and what an NP does to those who still don’t fully grasp what we do, while bringing quality care to people who are incarcerated. Individuals who are incarcerated are a marginalized group who often lack proper medical care. If we can teach more people about the NP role, more NPs would be hired within the carceral system. We could improve the overall health care of this population.
NPs do a lot of health education and prevention care. If we continue to treat the youth with respect by talking to them in a language that they understand instead of talking down to them, they’ll listen and know we are there for them.
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