The California Experience

1
The California Experience

• Jamie Miller, MPH
• California Department of Health
• STD Control Branch
• 2006 CDC National STD Prevention Conference
• May 7-11, 2006

2
What About California Correctional Facilities?

• 59 halls in 51 counties in California
• 2003 - 117,000 total bookings
• 18 females
• Department of Corrections and Rehabilitation
• Corrections Standards Authority (old BOC)

3
Program and Procedures Standards

• Title 15 Program and Procedures Standards -
  minimum standards for juvenile facilities
• Article 8 Health Services
• Section 1430 Intake Health Screening
• Immediately upon entry to facility
• Section 1432 Health Appraisal/Medical Exam
• Within 96 hours

4
Title 15 Standards/Guidelines2003 Addition

• Juveniles are also at significant risk for
  sexually transmitted diseases, such as chlamydia.
  Consultation with the local health officer
  regarding current recommendations for screening
  is recommended. Screening while in custody will
  benefit the individual as well as persons in the
  community with whom the minor will interact after
  release.

5
Juvenile Justice Survey (1998)

• Self-administered questionnaire survey of
  Juvenile Justice Medical Administrators
• Assessing screening and treatment practices
• Response Rate - 75 (39/52)
• Findings
• STD testing at sick call most common practice
• For those few sites reporting CT screening
  policies, overall coverage was 41 for females.

6
Get Tested Program

• Get Tested program (1999-2002)
• Community based screening
• Multiple counties/venues
• Findings
• High prevalence of CT in juvenile justice
• Second highest population

7
So, what did we do?

• Identified available funding
• CSPS and IPP
• Identified state project manager
• Developed project design
• Created and sent out to local STD Controllers
  request for proposals
• Developed contractual scope of work
• data dictionary, quarterly communication reports,
  annual reports

8
Chlamydia Screening Project (ClaSP)

• Overarching Goal
• Provide routine chlamydia screening for high
• risk adolescents with a prevalence of gt5 in
• juvenile justice facilities through partnerships
• between juvenile justice and local health
• department STD control programs

9
What Did We Want to Accomplish?

• Long term - to decrease the female prevalence of
  chlamydia in juvenile justice facilities by 20
• Short term
• Assess the yield of chlamydia screening
• Assess the timing of screening after booking
• Assist the state in determining the feasibility
  of candidate STD national performance measures

10
Who Could Apply?

• Application process informal long-term
• County contracts
• Selection criteria
• Collaboration among
• county health department
• local juvenile justice or probation
• Population - 250,000 15-19 year old females
• Juvenile justice census (bookings) of at least 50
  female detainees per year
• Excluded SF and LA

11
Activities

• Provide CT screening and treatment to all females
  booked
• Provide screening at booking or as close to
  booking as possible
• Ensure rapid notification of positive test
  results
• Provide appropriate and expedient treatment
• Ensure follow up and referral for those testing
  positive who are released prior to treatment

12
Who, What, When, Where and How?

• Number of counties funded
• 2003 - 15 (18 facilities)
• 2005 - 17 (22 facilities)
• Urine tests by NAATS
• Testing performed by county public health
  laboratories
• Medical services provided by county health,
  county probation medical or through contracts
• Informed consent via
• Medical blanket
• Specific service (verbal or written)

13
How Diverse Were We?
14
What About the Size of the Facility?

• Classified counties based on county annual
  booking averages
• Large (N11)
• 500 or more females booked per year
• Medium (N4)
• 200 499 females booked per year
• Small (N2)
• Less than 200 females booked per year

15
So, what did we learn?

• Developing and nurturing collaboration
• Bring juvenile justice managers and medical staff
  in early
• Educate them re purpose of screening
• Moving timing of screening
• from medical assessment to intake/booking
• Systematizing screening
• screen all (high proportion sexually active)
• educational materials

16
Screening Results
7652
6728
6614
17
Proportion of Booked Females Screened by Days
from Booking
18
So, what helped us?

• Had state standards for medical care
• Received federal funding
• Identified project contacts (county state)
• Held annual meetings interim workgroups
• Share data/discuss emerging issues
• Share best practices
• Established performanced-based contracts
• Site visits for contract adherence and TA
• Data submission requirements

19
Next Steps

• Continue to provide technical assistance to
  improve screening coverage in lower performing
  sites
• Identify additional funds as necessary
• Monitor contracts to ensure optimal performance

20
Acknowledgements
ClaSP Project Participants by County Alameda
Gay Calhoun, Sue Chen, Adrienne Hanson Humboldt
Steve Moore, Stacy Campbell, Maggie Rios Kern
Callie G. Huston Kings Nicole Geha, Gloria
Littman, Barbara Van Baren Orange Lydia
Mikhail, Samantha Lutz, Mike Carson Riverside
Faith-Davis-Bolton, Kevin Meconis, Barbara Cole
Sacramento Olivia Kasiyre, Karen Tait, Gwen
Morrisey, Alix Gillam, Angelica Velasquez, Angel
Carrillo San Bernardino Heather Cockerill,
Marshare Penny, Becky Nanyonjo, Steve Nozaki San
Joaquin Deborah Tyler San Mateo Jim Olsen,
Liz Piper, Sarah Cottrell Santa Barbara
Elizabeth Scarcelli Snyder, Ralph Barbosa Santa
Clara - Corina Vera, Jerry Klein Santa Cruz
Sharon Crowley Shasta County Elaine Best,
Heidi Vert, Jackie Mae, Susan Hobson, Dixie
Wolfe, Melissa Janulewicz Sonoma Jim Stafford,
Marie Piazza, Sandy Rigney, Kim Caldaway, Ryan
McClane, Alan Powell, Kimberly Mahr Stanislaus
County Maribel Lopez, Jessica Montoya This
project was supported in part by the Centers for
Disease Control and Prevention and the California
Department of Health Services.