Changes in federal law will permit West Virginia and other states to use Medicaid dollars to pay for health care services for incarcerated youths beginning Jan. 1.

In addition to helping kids get physical and dental health care, the new rules should give them needed resources to address mental and behavioral health challenges stemming from childhood trauma.

Elizabeth Crouch, associate professor of health services policy and management at the University of South Carolina, said mitigating adverse childhood experiences is a growing part of efforts to keep rural children out of the juvenile justice system and detention.

"A fifth of rural children are diagnosed with developmental behavioral mental health disorders," Crouch pointed out. "Rural children are more likely to be diagnosed with developmental behavioral disorders, such as ADHD, than their urban counterparts."

About 45% of West Virginia children experience adverse childhood experiences, a rate five points higher than the national average. The Medicaid coverage for youth in detention includes physical, dental and behavioral health screenings and case management services.

States are also taking into account neurocognitive research showing teen brains do not fully develop until the mid-20s. Crouch noted arrests of young people have dropped by more than 80% since the mid-1990s, as a greater understanding of childhood trauma has increased the number of alternatives to detention. Still, she acknowledged the challenges for rural kids are formidable.

"What we have found is that rural children have been disproportionately living in homes affected by current substance use or mental illness," Crouch explained. "Rural children have experienced much higher rates of opioid use."

Despite declining arrests and detention rates, young people of color are still far more likely than white youth to be held in juvenile facilities, according to The Sentencing Project.

An audit by Allegheny County reveals most public defenders face excessive caseloads and a lack of resources, putting clients at a disadvantage.

It showed 36 of 42 trial attorneys carry caseloads above the national average.

Robert Perkins, attorney for the Allegheny Lawyers Initiative for Justice, said the state has a history of underfunding public defenders, allowing only $100,000 per county annually. But he added it is the first time the county controller's office has reviewed public defense, focusing on areas of improvement in a neglected system.

"On average, your typical public defender, trial lawyer has two or three times as many cases as they should," Perkins pointed out. "You can be the best lawyer in the world. If you have triple the caseload that you should per national standards, then you can't do a good job for every client. You end up having to pick and choose."

Perkins noted while the American Bar Association outlines 10 key principles for an effective public defense system, the recent audit only examined one for both the Public Defender and court-appointed counsel systems. He argued a deeper review would have shown both fall short of most bar association standards. The study also found the court-run indigent defense system violates standards.

Sarah Linder Marx, senior deputy of public outreach and staff development for the Allegheny County Office of the Public Defender, said she is concerned the audit implied clients must meet requirements beyond those outlined in the Public Defender Act to qualify for a public defender attorney. Specifically, she emphasized the audit suggested stricter income verification measures.

Under the Public Defender Act, individuals qualify based on income eligibility and sign an affidavit confirming their income falls below the poverty line percentage indicating indigence.

"In practice, we would be asking people who are already extremely vulnerable to get us documentation that may not even exist for them," Linder Marx stressed. "We don't have software or access to government documents like other government agencies do to verify income like that."

Linder Marx's office also recommended implementing new case management software would greatly improve the ability to manage workloads and provide opportunities for analysis. The current case management software is dated and inadequate, often creating more work.


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An Illinois documentary takes a deep dive into the Illinois Prisoner Review Board and the politics that influence its decision-making through one man's fight for a second chance.

"In their Hands" follows the life of Ronnie Carrasquillo, who was charged with murdering a plainclothes Chicago police officer in 1976. He was 18 years old when a judge sentenced him to 200 to 600 years in prison. Despite earning a bachelor's degree in theology and creating a committee with other prisoners focused on education and rehabilitation, Carrasquillo was denied parole more than 30 times.

"Every year I went to the parole board, they said, 'You're the same guy, you're still the same gang kid, you're still the same gang leader,'" Carrasquillo recounted. "So they can evolve, but they want to marginalize me and hold me in that position that 'you're still this.' So I used to say, 'I'm the oldest 18-year-old that you know.'"

Carrasquillo spent nearly 50 years in prison before finally being released at age 65 in 2023. An appellate court ruled his sentence was excessive and his profuse parole denial unfair. The film is available on all PBS digital platforms.

Carrasquillo grew up in Chicago during a time where racial violence and street gangs were prevalent. Along with highlighting the factors leading to Carrasquillo's crime, the documentary offers a snapshot of the kinds of extreme sentences young people receive that lead to mass incarceration.

Dan Protess, producer and director of the documentary, said he used Carrasquillo's story to expose the systemic issues in the criminal legal system, including how officials prioritize economic interests over rehabilitation.

"Who are these parole board members?" Protess asked. "What are the political considerations in their appointment? Who in Springfield, the state's capital, is looking over their shoulders? And what other parties might be able to influence them in their decision-making?"

Protess added he hopes the film draws attention to the parole process he believes often gets overlooked, and the great need for reform.

According to state law, the review board consists of 15 people appointed by the governor and the Senate, who must have five years of experience in areas ranging from law and policing to medicine and social work. At least six must also have juvenile experience and no more than eight members may be of the same political party.


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A bill pending in the West Virginia Legislature would increase the length of penalties for "serious" felony convictions, but critics have said it would contribute to prison overpopulation.

The state Senate passed Senate Bill 136 by an overwhelming margin last week. The House of Delegates has yet to consider the measure.

Kenneth Matthews, West Virginia economic justice associate for the American Friends Service Committee, said extending the minimum time prisoners must serve before a parole hearing would pack the prisons with more people waiting for a conditional release.

"Increasing penalties for offenses will create an increase in the prison population that's already overpopulated and create an increase in the aging (prison) population in the state, which is also overpopulated," Matthews outlined.

West Virginia's overall jail population in 2024 was about 11,000, with an incarceration rate of 674 per 100,000 residents, considerably higher than the national average of 614.

According to the Prison Policy Initiative, the state's 10 regional jails were initially built to hold 2,883 people -- but they house more than 4,400 people on any given day. The bill's Republican backers, who have a legislative supermajority, said state law is not stern enough on serious offenders.

Matthews countered the numbers do not back up their position.

"West Virginia is already kind of tough on crime," Matthews pointed out. "We're not the lowest in terms of sentencing and penalties in the country or even in our area, and we're not like an outlier in terms of lower penalties for certain offenses."

He added proposed sentences of 40-60 years for murder before people are eligible for parole would significantly expand the number of older, less-dangerous members of the prison population.

"They have a geriatric wing there and they have actually instituted a job, called the orderly, where their whole job is to push individuals around on wheelchairs and take care of their needs throughout the facility," Matthews emphasized.


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