Think, Ask, Act: The Intersectionality of Mental and Reproductive Health for Judicially Involved Girls.

Danielle Smith, a 16-year-old African-American girl newly detained at juvenile hall, presents for psychiatric evaluation. She describes a history of sexual abuse by her foster father and 2 years of commercial sexual exploitation after running away at 14 years of age. Scarcely more than 100 pounds, she endorses drug use, primarily marijuana, and notes prior use of cocaine and methamphetamine, provided by her trafficker (described as her "boyfriend"). She has a timid smile and uses music and journaling as her refuge. Danielle is unclear about past psychiatric diagnoses but does recall receiving medication from a psychiatrist while in foster care and expresses interest in resuming treatment. Girls in the juvenile justice system are a vulnerable population with overlapping substance use, reproductive, and mental health care needs. The conceptual framework of "intersectionality" is useful to better understand the multiplicity of biopsychosocial needs of girls involved in the justice system. Intersectionality is defined as "a theoretical framework for understanding how multiple social identities (ie, race, gender, and sexual orientation) intersect at the micro level of individual experience to reflect systems of oppression (ie, racism, sexism, classism) at the macro level." In this article, we propose the pragmatic application of the concept of intersectionality to better conceptualize the high unmet health needs of these youth. We conclude by providing recommendations for meeting their needs using the proposed "think, ask, act" approach.