Improving Testing in a Juvenile Detention Facility…a Success Story Beth Butler Infertility Prevention Project Coordinator STD Program Pennsylvania Department of Health

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

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 state’s Department of Public Welfare Office of Children and Youth Services. These facilities are long term and house the young people after youth detention.

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.

Juvenile Justice Sites in PA Elk York Centre Berks Butler Lycoming Pike Bedford Clinton Clearfield Blair Indiana Somerset Luzerne Fayette Perry Bucks Lancaster Mercer Franklin Chester Clarion Schuylkill Cambria Monroe Huntingdon Greene Venango Allegheny Adams Washington Westmoreland Jefferson Mifflin Fulton Dauphin Armstrong Beaver Juniata Union Carbon Lehigh Columbia Snyder Cumberland Lebanon Montgomery Lawrence Tioga Erie Potter Bradford Warren McKean Crawford Wayne Forest Susquehanna Sullivan Wyoming Cameron Lackawanna Northumberland Northampton Delaware Montour Philadelphia Northwest Southwest North Central Northeast South Central Southeast 2.1 - 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

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 CDC’s reporting criteria. The facility examined was Shuman Center in Pittsburgh PA, Allegheny County.

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

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.

CDC’s 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.

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.

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.

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

Quarter by Quarter Data for 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

1st Quarter 2005 vs. 1st Quarter 2006 Data for Shuman Center 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

Females Admitted vs. Screened for Chlamydia by Year at Shuman Center 475 admitted and 70 screened ---- 20% positivity 630 admitted and 93 screened ----- 12.9% positivity 608 admitted and 189 screened ---- 12.6% positivity CY 2003 14 cases identified CY 2004 12 cases identified CY 2005 24 cases identified 1st quarter 2006 12 cases identified

What about the boys??? 1st quarter 2006 data: 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%

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.

Question & Answers

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