Shairi R. Turner, MD, MPH

Shairi R. Turner, MD, MPH

2001-2002

Medical Consultant, Florida Department of Health, Tallahassee, FL

Dr. Shairi Turner is an Internist and a Pediatrician.  Her career focus is to make Florida a national leader in Trauma Informed Practices.  She has presented extensively on the neurobiological impact of trauma with the National Association of State Mental Health Program Directors and the National Center for Trauma Informed Care.  She was instrumental in helping Florida achieve recognition from the Centers for Disease Control as a state where child maltreatment is acknowledged as a public health concern.  She believes that by adequately acknowledging and addressing the impact of trauma in the lives of individuals, there can be a national paradigm shift around the treatment of physical and mental health conditions.

Currently she is a Medical Consultant with the Division of Disability Determinations with the Florida Department of Health.  From September 2009 to June 2011 she was the Deputy Secretary for Health and the Director of the Office of Minority Health for the Florida Department of Health.  In these positions she supervised the Divisions of Family Health Services, Disease Control, Environmental Health, Emergency Medical Operations, the Bureau of Laboratories, the Bureau of Statewide Pharmaceutical Services, the Bureau of Health Statistics and Assessments, the Office of Public Health Nursing, 67 County Health Departments and the Office of Minority Health. 

In 2005, she was named as the first Chief Medical Director in the eleven-year history of the Florida Department of Juvenile Justice. During these four years, Dr. Turner established and directed the Office of Health Services, with a staff of thirteen employees.  The Office was responsible for assisting the Department with the provision and oversight of quality medical, mental health, substance abuse and developmental disability services. 

During her tenure with the Department of Juvenile Justice, Dr. Turner’s focus also included the impact of childhood trauma (physical, sexual and emotional abuse) on youth involved in the juvenile justice system, as well as the importance of gender specific services designed to meet the unique needs of girls in the system.  She has given numerous presentations on issues relating to health/mental health care in the juvenile justice setting. 

Prior to her relocation to Tallahassee, Dr. Turner completed the two-year Yerby Post-Doctoral Research fellowship at the Harvard School of Public Health in the Harvard Injury Control Research Center and Youth Violence Prevention Center.  While there, Dr. Turner’s primary interests and research focused on the relationship between mental illness, substance abuse and the disproportionate number of minority adolescents in the U.S. juvenile justice system.

Dr. Turner completed the four year Harvard Combined Internal Medicine and Pediatrics Residency Program at the Massachusetts General Hospital and the Children's Hospital of Boston in 2000.  From 2001 to 2002, she was a Commonwealth Fund/Harvard University Fellow in Minority Health Policy and earned a Master of Public Health from the Harvard School of Public Health with a concentration in Health Policy and Management.

The native of New York City earned an undergraduate degree in Biology from Stanford University in 1991. In 1996, she received the Doctor of Medicine degree from Case Western University School of Medicine in Cleveland, Ohio and was inducted into the Alpha Omega Alpha Honors Medical Society.

2003

Substance Abuse Policies: Implications for Minority Adolescents in the Department of Youth Services

Abstract:

Assess the extent of substance use, specifically by minorities in the Department of Youth Services (DYS) in the State of Massachusetts, and aid in the redevelopment of policies that improve interventions and treatment in the DYS Day Reporting Centers.

Background:

In the United States, illegal drug and alcohol use by adolescents have been a serious problem for nearly four decades.  Based on self-reporting, the rates of illicit drug use by American adolescents peaked in the early eighties at 66%, declined until the early nineties, then after a steady rise has leveled at approximately 54%.  Over the past 26 years, the drug of choice for teenagers has been marijuana.  Although other more addictive and lethal drugs have entered the market during this time period, the perceived lower health risks of marijuana continue to make it more widely used.  Alarmingly 80% of today’s teens have consumed alcohol and 51% have done so before the age of 13.

When surveyed, minority adolescents (particularly African American youth), report substantially lower rates of alcohol use when compared to Caucasians. Hispanic youth have rates of alcohol use which are closer to those of Caucasians.  The rate of marijuana use among all youths is essentially the same (25-29%) but African American youth are much less likely than Caucasians and Hispanics to use drugs other than Marijuana.

With persistent drug use at earlier and earlier ages, many adolescents become involved with criminal activities, crimes of drug possession or crimes related to drug use.  In fact, data reveals that there is a direct correlation between substance abuse, delinquency, violent behavior and arrest.    Despite lower rates of substance use, minority adolescents are processed through all levels of the criminal justice system in numbers greater than their white counterparts.   This trend continues into adulthood where the number of drug offense admissions to U.S. prisons has increased disproportionately for African American men.

Methods:

This project was designed to assist the Department of Youth Services (DYS), the juvenile justice system in the State of Massachusetts, in re-developing its substance abuse policy.   An extensive review of the literature centered on substance use among adolescents, substance use among minority adolescents, and substance use in the juvenile justice system.  The review also covered multiple substance abuse policy recommendations including those made by the Office of Juvenile Justice and Delinquency Prevention, and compared successful existing juvenile intervention programs.

Secondary analysis was performed on the quantitative data of an anonymous survey done March 2000 of 1470 youths in DYS detentions centers and Day Reporting Centers.  The data was examined to determine the rates of substance abuse among minority adolescents and to identify differences in their substance abuse preferences.  Quarterly data from the Day Reporting Centers was analyzed to determine actual urine drug test results by site.

The existing substance abuse policy was reviewed.  It was determined that given the numerous sites in Massachusetts, the Dorchester DRC- the Dorchester Community Network Center, would be the principle focus of this project. This site was comprised predominantly of African American and Latino youth.  Personal interviews were conducted with the Director of Substance Abuse Services, the Metro Area Substance Abuse Policy specialist, the Program Director and Assistant Director for the Dorchester DRC and the Substance Abuse clinician for the Dorchester DRC.  The interviews concentrated on the implementation of the current policy and the adequacy of the substance abuse interventions and treatments.

Results:

The anonymous survey done in March of 2000 revealed that the primary drug of choice for all adolescents in the Department of Youth Services was marijuana at almost equal rates between Blacks (49.8%), Hispanics (53.3%) and Caucasian (46.9%) youth with significantly less use by Asians (26%).  However, the use of alcohol as a primary drug was the greatest amongst Asians (21.9%) and then Caucasian (11.9%) and Hispanic (10.3%) youth and least amongst Black youth (7.1%).  However Black youth were least likely to report that their drug or alcohol use was a problem when compared to the other youth.

The analysis of the quarterly random drug testing data revealed that marijuana was the drug detected most frequently.  One of the limitations of the urine test is its inability to detect alcohol use in all but those who were intoxicated at the time of the test.  The types of drugs used by adolescents of different races and ethnicities at each site could not be analyzed since it was not specified when the actual tests were obtained.

The personal interviews revealed much of the challenges faced when attempting to treat adolescents who do not view substance use as a problem.

Recommendations:

Given the unique issues faced in treating the adolescent substance abusers and the different etiologies for substance use amongst minorities when compared to non-minorities, the following recommendations were proposed for the Department of Youth Services:

  •     Place race/ethnicity identifiers on the drug tests to track the trends of use between groups at each site
  •     Establish a database for the tracking of interventions, treatment and follow-up for all adolescents with positive drug tests
  •     Require cultural competency and diversity training for the staff and clinicians
  •     Develop curriculums focused specifically on marijuana and alcohol for those adolescents who do not wish to abstain
  •     Mandate the separation and accessibility of substance abuse histories from the sealed criminal records at the time of a youth’s release from DYS.
  •     Develop written policies with community outpatient substance abuse treatment centers
  •     Increase formal communication between case managers and community treatment centers
  •     Cultivate faith based collaboration within the communities

Faculty Preceptor:

Boyles, Director of Substance Abuse Services, Department of Youth Services, Boston, MA