Catherine A Gallagher Anne Douds George Mason University Hepatitis B Vaccination Practices in Juvenile Justice Residential Facilities Catherine A Gallagher Anne Douds George Mason University

The Juvenile Justice Residential Facility Population JJRFs house young people accused of or adjudicated for criminal or delinquent offenses Often also house children in need of services High risk population, high risk time, high risk environment 3,500 JJRFs in the United States 105,000 average daily population Especially important to address gaps in health care Hepatitis B vaccinations are logistically difficult (given high turnover in population and lack of record availability) but critical

Purpose Examine the conditions under which JJRFs provide Hepatitis B vaccination Identify correlates of Hepatitis B vaccination policy and practices Highlight gaps in policy and practice measures Work towards strategic planning to increase coverage

Two data collection instruments

Size Population size All facilities Number of kids 1-25 65.5% 23,183 1-25 65.5% 23,183 26-50 6.9 19,537 51-100 10.3 23,844 101-200 4.9 11,180 200+ 2.3 21,887

Type Detention center 20.6 (715) Training school 6.5 (225) R&D 2.5 (86) Group homes 29.2 (1013) Boot camp 45 (1.3)

Ownership Private 58.8% Tribal .2 State 18.3 County 21.3 Municipality 1.4

JRFC 2004 Hepatitis B Series

23,179 young people placed in 986 facilities not providing hepatitis B vaccination

Overview 23,179 young people placed in 986 facilities NOT providing hepatitis B vaccination 25,333 young people placed in 455 facilities in which ALL young people receive hepatitis B vaccination (practice) Detention centers are less likely than other types of facilities to provide hepatitis B vaccination Facility size positively related to hepatitis B vaccination State owned and operated most likely to provide hepatitis B Many young people in residential facilities receive hepatitis B vaccinations outside the facility

Detention centers are less likely than other types of facilities to provide hep B vaccine

Two Hepatitis B Vaccination Outcomes 1. Policy 65.5% Whether ANY young person receives Hepatitis B vaccinations while assigned a bed at the facility 2. Practice 42.2% Of those suggesting a policy, whether AT LEAST ONE young person received a single dose of Hep B vaccination during a 30-day period

Summary of models Policy Practice Length of Stay 1.003 1.001 Detention -2.22 -1.75 Training 2.03 -1.11 Facility size 1.33 -1.15 2.23 1.42 2.44 1.75 2.08 2.84 3.01 3.72 17.13 14.7 Male -1.004 ------ State 1.64 2.26 City -2.37 2.68 Crowding ----- 1.82 Exams (on) 1.49 1.34 (off) -1.18 -2.00

Results of multivariate models

…a bit more balanced (removed large facility effect)

Policy Location affects Practice One or more Hep B vaccination doses given in 30-day period Inside/Outside 52.8% Inside 73.2 Outside 25.1

440 facilities indicated that “ALL young persons receive doses of hepatitis B vaccine” 55.9% reported that at least one dose had been given in the 30-day reference period This Appears to be a function of facility size but not necessarily length of stay Pre-vaccine serological screening 31.6% reported pre-vaccine serological screening for ALL young people 13.2% did not have pre-vaccine serological screening available 59.6% conducted screening at discretion of health care provider

Conclusions ¼ of JJRF daily population in facilities without provisions for Hepatitis B vaccination Policy 65.5% Practice 42.2% Larger, state-owned facilities had significantly higher odds of both Policy and Practice One interesting exception is the reversal of signs for training schools City owned facilities significantly less likely to report providing Hep B vaccination, but of those providing, City facilities significantly more likely to have evidence of Practice Practice more likely to occur when policy is to give vaccination on-site In analyses not presented, there is evidence of regional effects Additional modeling will assess state-level effects

Available Guidelines for JJRFs NCCHC Recommends vaccination for all young people This is not the reality One-size fits all may be at odds with the amount of time available to give the three-dose series The existing structure of health care in JJRFs Perhaps guidelines could be better tailored to the diverse types of facility OR guidelines based on individual young persons characteristics Some types of facilities need more direction than others