At the Cook County Juvenile Temporary Detention Center, gender matters. It determines where inmates sleep, where they take meals and what they do for gym class. Most importantly, it determines what kind of healthcare they receive while in confinement.
While this used to be problematic for LGBT residents, center officials say a new collaboration between the center and the pediatric department at Stroger Hospital could lead to more pointed and culturally competent care for incarcerated youth across the gender spectrum.
The Same-Gender Loving (SGL) Clinic at the John H. Stroger Jr. Hospital of Cook County opened Feb. 1, providing LGBTQ detained youth with access to affirming care.
This level cultural competency may not always be present in the Juvenile Detention Center, but the staff is becoming more educated all the time, said Dr. Ngozi Ezike, medical director for the center.
Over the past year, detention center staff have undergone hours of training to learn how to place transgender individuals in the way that will be most comfortable for them, rather than the "one-size-fits-all" policy that was in place before.
When youth arrive at the detention center, they receive a medical exam in their first two hours. For the rest of their time, which can be anywhere from a few days to a few years, they receive weekly care at the clinic, staffed by Bell and two other Stroger physicians.
Dr. Margot Bell a senior attending physician in the Division of Adolescent Medicine, conceived of the clinic.
If Bell or Ngozi sees that a youth has a problem that may be better suited for care at the SGL clinic, they can arrange for an appointment back at Stroger. There's a precedent for that, Ngozi said, as inmates have been to the other adolescent clinics in the past. Though youth from the center have not yet been taken to the clinic, both physicians see it as a possibility for the future.
"Dr. Bellshe's almost like a human conduit," said Ezike. "It's very seamless. They'll easily give us an appointment to accommodate our kids from here. That's a pretty strong and well-established connection."
One of the biggest issues with caring for incarcerated transgender youth is sorting out their hormone treatment, said Ezike. The youth in the center are mostly under the age of 18, so they cannot receive hormones without parental consent. Some youth come in already on a hormone treatment that they bought on the street or on the internet, but Ezike cannot continue that treatment without getting guardian consent. If inmates can get parental consent, Ezike could bring them over to the SGL clinic to start or continue on hormones. Beyond hormones, Bell and Ried said they can help youth from the center with LGBT-specific mental health issues.
"Because we still have a presence there, we started having a conversation about partnering to make the whole of the county system more LGBT-friendly in terms of providing care for youth, and that's how we got tied in together," said Bell.