Improving Testing in a Juvenile Detention Facility

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Improving Testing in a Juvenile Detention
Facilitya Success Story

• Beth Butler
• Infertility Prevention Project Coordinator
• STD Program
• Pennsylvania Department of Health

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Acknowledgements

• Without the efforts of the following
  individuals this project would not have been so
  successful
• Therese Defazio, Shuman Juvenile Detention
  Center
• Tera Matson, Shuman Juvenile Detention Center
• Linda Schombert, Allegheny County Health
  Department
• Nancy Fenton, Allegheny County Health Department
• Judy Schumacher, Allegheny County Health
  Department
• Dr. Harold Wiesenfeld, Allegheny County Health
  Department
• Stephen Kowalewski, PA Department of Health

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Juvenile Justice System in Pennsylvania

• There are 22 facilities in 23 counties in
  Pennsylvania, exclusive of Philadelphia.
• There are 598 spaces available in Pennsylvania
  for youths to be served in juvenile detention.
• Approximately 17 of the approximately 37,000
  juvenile cases in Pennsylvania are female.
• Post Juvenile Detention There are 3 youth
  development centers and 2 youth forestry camps
  run by the states Department of Public Welfare
  Office of Children and Youth Services. These
  facilities are long term and house the young
  people after youth detention.

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Juvenile Detention Standards in PA

• 42 Pa.C.S. 6301 et seq. Standards Governing the
  use of Secure Detention under the Juvenile Act
  provides programs of supervision, care, and
  rehabilitation which are consistent with the
  protection of the community, based on the
  offenses committed, and enable the children to
  become responsible citizens.
• Juvenile Detention Program Standards establish
  minimum standards for youth who are placed in
  detention an initial health screen is to be
  completed within one hour of admission and a
  complete medical examination (STD screening is
  listed at component) within 48 hours of admission.

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Juvenile Justice Sites in PA
All juvenile detention facilities throughout
Pennsylvania are county run
The capacity in the facilities range from 8 to
48---exclusive of Allegheny County with 130 and
Philadelphia with 105
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The Performance Measure

• The 2005 CSPS Performance Measure requires STD
  Programs to examine screening practices in large
  juvenile justice facilities that have 500
  bookings annually. One facility in Pennsylvania
  met CDCs reporting criteria.
• The facility examined was Shuman Center in
  Pittsburgh PA, Allegheny County.

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A first look at Shuman Center

• 2003
• 475 females admitted
• 70 females screened for chlamydia
• 14.7 screened
• 14 positive for chlamydia
• 20.0 positivity

• 2004
• 630 females admitted
• 93 females screened for chlamydia
• 14.8 screened
• 12 positive for chlamydia
• 12.9 positivity

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What was going on at Shuman .

• All males admitted to Shuman Center were tested
  with a leukocyte esterase test (LET). If the LET
  was positive, the males were tested for chlamydia
  and gonorrhea.
• All females were offered a pelvic exam including
  STD testing for chlamydia and gonorrhea. A
  majority of the young women declined testing.
• Females received LETs if there was a suspicion of
  a urinary tract infection.
• The Allegheny County Health Department laboratory
  provided the testing for Shuman Center . Cervical
  and urethral specimens were collected. Amplified
  technology was utilized.

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CDCs Performance Measure

• The performance measure required the PA STD
  Program to look at the female chlamydia screening
  numbers for Shuman Center.
• Upon review, the percentage of young women tested
  was low and positivity was high.
• Goals and objectives were put into place to
  improve screening practices at Shuman Center to
  screen more female admittees.

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The Response..

• The numbers screened were admittedly low because
  the young women did not consent to pelvic
  examinations.
• The availability of urine chlamydia testing for
  females and males would improve screening
  compliance.
• Because of a commitment of the medical staff at
  Shuman Center and STD Program Staff at the
  Allegheny County Health Department the ball was
  rolling to provide urine testing at Shuman Center.

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Change was rather quick

• Shuman Center began utilizing amplified urine
  based screening for female and male admittees
  September 2005.
• Specimen analysis is done at the Allegheny County
  Health Department Laboratory.

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1st half 2005 vs. 2nd half 2005Data for Shuman
Center

• 1st Half 2005
• 304 females admitted
• 59 females screened for chlamydia
• 19.4 screened
• 5 positive for chlamydia
• 8.5 positivity

• 2nd Half 2005
• 284 females admitted
• 127 females screened for chlamydia
• 44.7 screened
• 19 positive for chlamydia
• 15.0 positivity

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Quarter by Quarter Datafor Chlamydia for Shuman
Center
Urine testing began Sept 2005
1st qtr 2005 21.8 screened 2nd qtr 2005
10.8 screened 3rd qtr 2005 38.3 screened 4th
qtr 2005 55.0 screened 1st qtr 2006 73.6
screened
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1st Quarter 2005 vs. 1st Quarter 2006Data for
Shuman Center

• 1st Quarter 2005
• 174 females admitted
• 38 tested for chlamydia
• 21.8 tested
• 2 positive cases of chlamydia found
• 5.3 positivity

• 1st Quarter 2006
• 148 females admitted
• 109 tested for chlamydia
• 73.6 tested
• 12 positive cases of chlamydia found
• 11.0 positivity

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Females Admitted vs. Screened for Chlamydia by
Year at Shuman Center
CY 2003 14 cases identified CY 2004 12 cases
identified CY 2005 24 cases identified 1st
quarter 2006 12 cases identified
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What about the boys???

• Boys were not routinely tested for chlamydia
  before September 2005 because of the leukocyte
  esterase testing.
• More males have been screened with chlamydia
  urine testing.
• 1st quarter 2005 data
• Males admitted 765
• Males screened for CT 101
• (13.2 screened)
• Male CT cases identified 19
• Male positivity 18.8

1st quarter 2006 data Males admitted
741 Males screened for CT 494
(66.7 screened) Male CT cases
identified 28 Male positivity 5.7
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Beyond Shuman Center.

• The PA STD Program has established relationships
  in county juvenile justice facilities throughout
  PA.
• Many juvenile justice facilities provide family
  planning services to females in their facilities.
• The PA STD Program provides testing in
  approximately 8 juvenile justice facilities and
  positivity is similar to that found at Shuman.
• Because of the increased interest and commitment
  to screening, data is now being analyzed to look
  at ages, races, crime committed, and length of
  stay for juveniles at Shuman with chlamydia
  infection.

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Question Answers
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We Hold the Key

• Have the desire to increase screening
• Want to acknowledge the importance of screening
• Can find a way to get it done