The Social Determinants of Justice: Disability, Employment, and the Justice System Connection

October 11, 2023

Challenges in areas ranging from education to the environment, gender to governance, health to housing don’t exist in a vacuum. Each month, Abt experts from two disciplines explore ideas for tackling these challenges in our monthly podcast, The Intersect. Sign up for monthly e-mail notifications here. Catch up with previous episodes here.

Abhorrent racial disparities in America’s criminal justice system are well-documented, but less covered is the over-representation of people with disabilities. Drs. Jennifer Bronson and Hassan Enayati discuss how supports from elementary school through the hiring process can help mitigate the links between disability and employment opportunities as social determinants of justice.

Read the Transcript

Eric Tischler: Hi, and welcome to The Intersect. I'm Eric Tischler. Abt Global tackles complex challenges around the world, ranging from improving health and education to assessing the impact of environmental changes. For any given problem, we bring multiple perspectives to the table. We thought it would be enlightening—and maybe even fun—to pair up colleagues from different disciplines so they can share their ideas and perhaps spark new thinking about how we solve these challenges. Today we're joined by two of those colleagues, Drs. Jennifer Bronson and Hassan Enayati.

Jennifer is a medical sociologist who conducts complex quantitative, qualitative, and evaluation studies designed to improve the health and safety of individuals and communities. She focuses on criminal justice and behavioral health research. Hassan is a labor economist who uses applied microeconomics to examine employment and compensation questions on disability policy, employer disability practices, school-to-work transitions, performance and incentive pay, and involvement with the criminal justice system. Welcome!

Dr. Jennifer Bronson: Thank you. Thank you for having us.

Dr. Hassan Enayati: Same here. Thank you very much.

Eric: Youth and young adults with disabilities face unique and often difficult challenges when transitioning to the workforce. Compared with their peers without disabilities, they have poorer educational employment and independent living outcomes. These create barriers to improving their economic wellbeing, which can lead to disproportionate involvement with the justice system, and this negative relationship can become cyclical. So how can we reduce contact with the justice system and improve outcomes when involvement is unavoidable?

Hassan, let's start with you. How are we defining disability?

Hassan: That's a great question. So, the starting point for me when defining disability is to recognize that disability is a function of social and physical environments and is not innate to the person. The extent of disability that a person experiences hinges on the individual's limitations and the environment in which they live. One of the most thought-provoking analogies I've come across when thinking about the role of environment and disability is the experience of humans in space. While an astronaut may not experience any disabilities on earth once in space, they need a wide range of devices and systems to accommodate nearly all of their activities.

Eric: So, in the context of involvement with the criminal justice system, how do you see that lack of systemic support playing out on the ground? (No pun intended.)

Hassan: I think the way that I think about that is the barriers that intersect or that influence the experience of a disability. And so, one of the most common ones I think people first think about would be the physical barrier. So, does a building have a ramp so that someone with a disability can gain access to the building? Other ones that I think are quite common that are experienced by people if you attend Zoom meetings or Teams calls would be communication supports. So, things like captioning on a video or in print where you would talk about braille.

Then there are two other types of barriers that I'd like to talk about that are not, certainly not exhaustive of the list, but one would be the attitudinal barriers. So those are things like stereotyping, stigma, discrimination. But then the last one, which I think most directly connects to justice involvement would be social factors. And by that, we really mean social determinants of health. So, where someone is born, raised, and where they live. And so, these factors are strongly correlated with justice involvement and also very much influence the experience of individuals with disabilities as they live their daily lives.

Eric: So, in addition to housing and where people live, you want to identify a few other maybe social terms of health that can affect that interaction with the justice system?

Hassan: Some examples of social determinants of health relevant in this context would be employment opportunities. And so that's actually a key factor that many people don't necessarily immediately think of as a determinant of health would be are you able to find work? But studies repeatedly demonstrate that the ability to have work and even more so meaningful work is a key determinant of health.

Eric: Okay, great. Thank you. And so Jennifer, let's segue to you. How does this align with what you're seeing in terms of your work with the justice system?

Jennifer: It's very similar, and I take a social determinants of health model as well when I think about people who are in the criminal justice system, those at risk for it as well as communities. And what's interesting about the social determinants of health, when you're going to talk about disabilities as well as criminal justice is criminal justice itself is a social determinant of health. So that involvement alone, whether it's experiences with police or incarceration, can put you at risk for developing a disability, a chronic health condition, or for one that's already existing, to not have the right treatment to be able to accommodate and support it.

So, what we're seeing is we see that children in the juvenile justice system with special education backgrounds or disabilities or overrepresented, we also see this carried out in adult populations. So for example, about 40 percent of adults who are in jail and about 30 percent of adults in prison report that they have a disability, and only about 10 percent of adults in the general community are saying the same. So we've got a group of people who are kind of disproportionately overrepresented in correctional facilities, jails and prisons who are reporting that they have disabilities, chronic health needs, and they need the support and accommodation.

Eric: Okay, thanks. I think you said justice involvement can create disabilities. Did I hear you correctly?

Jennifer: In kind of correctional health and in research, I always want to stop short of causality and cause and effect, but I think it's also pretty safe to say based on what decades of data and research show that incarceration definitely does not improve a person's health. And in fact, those that have health conditions are not getting the treatment that they need in prisons and jails. And this is documented, so it may not be direct cause, but there's definitely a connections, correlations that are strong and established.

Eric: Okay. And let me ask you both about a social determinant of health that I don't think you've mentioned, which would be race, right? Do we want to talk about what's representation in terms of both disabilities and what we know with the justice ... I know with the justice system that there's a disproportionate representation by race. I'm not sure about disability. Hassan or Jennifer, I don't know if either of you want to comment on that.

Jennifer: Yes, that is a, I think, key overarching thing. Anytime you talk about the criminal justice system and who's in it, racism has to be kind of front and foremost in that conversation just because of the centuries of structural and systemic inequality that we have that have really negatively impacted Black Americans. And in general, with health as well, you also see patterns of health disparities between Black and white children, Black and white adults that extends to disabilities. I know there's disparities in special education labeling and identification, with Black children more likely to be identified as developmentally disabled, intellectually disabled compared to their white peers.

So, it's definitely a factor both in disability identification, disability treatment and services, disability outcomes and special education as well as the criminal justice system as a whole.

Eric: Right. And so, ramping up then as we talk about how do you reach the point of involvement with the justice system and then how does that identification or misidentification or stigma amplify that misrepresentation?

Jennifer: So, I think stereotypes and discrimination do play a big factor in this, and it comes from a couple different points. Racism, again being a key one, but then also just misunderstanding of what mental health looks like, what a behavioral health crisis looks like, what autism looks like, what dementia looks like in the context of the community. When there's some sort of event that warrants law enforcement response, what does that look like? You have law enforcement coming in with predetermined biases as well, inadequate training and responding to health because that's not really their line of work in many ways. They're public safety, not health professionals.

Eric: So, the supports aren't there. On the front of the criminal justice system, like you just said, they're law enforcement, not public health.

Jennifer: Right.

Eric: So right there, that first point of contact, maybe there's a disconnect.

Hassan: Something that I might point to though is we do observe racial gaps on many fronts really at very early ages. So whether we're talking about youth development, there are studies that look at preschool and kindergarten and youth and find systematic differences for children by their race and ethnicity that advances all the way through their formal schooling years. And then there are studies that have looked at how prepared are youth for the labor market as they exit high school. And those studies, again, they find systematic differences by race and ethnicity. So these things, I think they build upon one another. We do observe large gaps in the employment rate of young adults with disabilities by race. And I think that that differences in opportunities can result in different life choices, but I don't want to make a causal claim there.

Eric: I think this is back to social determinants of health because we know that from early age there are health disparities which will lead to behavioral health issues, challenges, and then combine that with racism and you get to greater justice involvement. You both mentioned employment, presumably that's a driver both in front of and on the backside of incarceration terms of recidivism. You want to talk about that a little bit?

Jennifer: Yeah, and I think Hassan's points about kind of these disparities and youth job readiness and youth job placements by race and disability, I think we can trace some of that back to inequality and education. That alone is a social determinant of both health and incarceration, but then special education placements where we know Black youth are less likely to get their needs met, more likely to have disciplinary actions, and this kind of almost just pushes them into the system a little bit.

Eric: Right.

Jennifer: So, it's America, we all need to work, and that includes people with disabilities, people who may have a criminal record, people who are coming out of jail or prison and may have had their employment interrupted in need of some skills development. Safe affordable housing is probably the biggest predictor of recidivism, and that connects back to employment and your ability to have gainful sustainable employment. Now some people think, oh, you have a disability, just go get disability social security. But that is not easy and it kind of shows there's a lack of understanding about the paperwork. You often need a lawyer to help you navigate that paperwork, to submit it. And somebody with a justice background more likely than not, may be coming from a background, a lower economic status, and they're not going to have those resources. They're going to have to get a job until they can get more of that employment.

From there, then you kind of get a double whammy. It's very difficult to do manual and physical labor depending on what kind of disability you have. It may be the only job many people can get to include restaurant work, and then you've got a criminal record, a misdemeanor, a felony, and that's going to bar you from some employment. Sometimes you can't even get through the door. Sometimes all you can take is under-the-table work. And again, that work is likely not going to be the most accommodating for somebody dealing with a disability. So you're really going to get into this cycle of just negative outcomes that feed into each other and really become kind of involved.

Eric: I want to talk about breaking the cycle for a second, but first, let's talk for a minute, like you just said, getting housing, you need support, getting employment. For people who are already in the justice system and coming out, what can we do to help support them to help break that cycle on the backend?

Jennifer: Specific to people with disabilities who are leaving the system, they need a warm handoff to the community, which could include bridge medication, appointments with community providers, community providers who understand the justice population, but setting them up for a continuity of care when they get to the community is one thing that they really need. And then also job supports same thing, trying to get them into social services.

Hassan: I would add onto that the things that employers can do, I would point to two things. So, one would be the policy shift of Ban the Box. And so, this was a policy that included rules about when employers could use information about an individual's criminal record in the hiring and search process. And the intent of Ban the Box was to reduce the racial differences in the ability to find work after exiting the justice system. These differences really stem from the racial differences in participation in the justice system.

Ban the Box, despite being designed to improve the racial gaps, in fact, heightened them. Best evidence from the research in that area demonstrates that with the absence of information on justice involvement, employers relied on what's called statistical discrimination, which just means that they took the group average. And so the way to think about this is employers said, well, my Black candidates are more likely to be justice involved, and so I'm going to treat all of them, not really all of them, but I'm going to weigh the scale as if they all have some higher risk of criminal justice involvement. And so at the end of the day, the individuals that most benefited from Ban the Box were white men with a criminal justice background, whereas Black men without a criminal justice background, were actually hindered on the labor market.

Now, the second thing that I think employers could do that applies both to individual disabilities and individuals with justice involvement is focusing on the skills needed for the job. Not everyone needs to be the CEO, not everyone needs to be enthusiastic and captivating in their communication. And so, really, assessing what are the key roles and responsibilities that you need from a particular position. And then designing the recruiting process to identify those skills. And so that not only will help you identify if perhaps certain criminal justice backgrounds are too high of a risk for a particular role—and then that's not one that you want to target—but it would also open the door so that you're just not making blanket statements that bringing on someone with criminal justice involvement brings on too much risk to our organization. I think there's a way to be much more thoughtful about that approach.

Eric: Jennifer, were there any other on the backend, any other supports you would want to mention?

Jennifer: Yeah. I think coming from a public health point of view, prevention is vital. And for this, it looks like keeping people out of the criminal justice system to begin with. We know that, since 2015, a quarter of people who've been shot and killed by police were known to have a mental illness. And that's a pretty staggering proportion. So doing more on the backend, whether that involves police training, greater community awareness, that has talked about de-stigmatization, that is key. And this as well, we still got this kind of notion that people with mental illness or certain disabilities are dangerous or violent, and that's statistically not true. So doing more on the prevention community side to one, keep people out of the system, and two, get them the right supports, accommodations, diagnoses, identifications, that work for that person, and then getting them their kind of care plans.

Eric: Hassan, how about you in terms of ways to break the cycle and prevent that involvement?

Hassan: One thing I would point to is the cliff that many youth and their parents' experience as they exit the high school experience where they have rights and clear access to many supports that allow them to have accommodations in the classroom or services within their community. And then as they exit the secondary school system and enter into early adulthood, they experience this cliff where they lose that access, where it's no longer just kind of a part of a system, and they don't have to do that much to get those services.

Now, typically, the responsibility is on the individual to go out and seek all those services, which can be really quite complex to navigate. And so one common solution that's been seen in many recent demonstrations that are testing out new interventions to support youth as they transition is the role of case management as they move through that transitionary period. So, it's not really a new service that is the silver bullet to solve the problem, it's really just somebody who understands a very complex system and can help the individual navigate going and getting the services that they need.

Eric: Well, at least we're not talking about having to reinvent the wheel or smelt a new silver bullet as the case may be. We're talking about extending services that already exist, but once again, we see that the social determinants of health, you don't get to cherry-pick them, they're all interrelated. But I'm really glad that the two of you are working on these aspects of it. Thank you both for joining me.

Jennifer: Thank you.

Hassan: Thank you.

Eric: And thank you for joining us at The Intersect.