1. Meeting the Challenge of Diverse Settings: The California Experience Jamie Miller, MPH California Department of Health STD Control Branch/CDC

2. Objectives Demonstrate the diversity of ClaSP Share programmatic outcomes

3. Programmatic Challenges and Facilitators

4. Diversity in size County CT morbidity levels County female 15-19 populations County juvenile detention female bookings per year Large = 500+ Medium = 200-499 Small = <200

5. Diversity in Structure & History of Working Relationships County administration Health Departments Probation ClaSP coordinators Health department (health educators, program managers) Probation (medical staff, administrative) Past working relationships Health department & Probation history varied from none to limited projects

6. Diversity in medical care Medical care provider types Health department Probation County medical Outside contractors Hours of medical coverage Range up to 24hrs/7days week

7. Diversity in medical care Protocols Screen at booking Screen before 96 hours Laboratories Type (public health, commercial, hospital) Type test (all NAAT; test manufacturers) Specimen processing (batch 2-3x/wk; daily)

8. Program Facilitators County level Existence of Standardized Protocol Title 15 – rigid interpretation Local protocol adjustments Establishing coordinators and building the team Developing implementation plan together Bridging differences in cultures (safety vs public health) Sharing a common vision about goals of program Educating all staff on purpose and reason for project Communicating with administrators and managers (development & progress)

9. County level cont’d Developing innovative approaches or procedural changes: Screening as standard of care Using custody staff to collect specimens Prioritizing females for exams Using bookee tracking systems to monitor those who have not been screened Revising language in medical care contracts

10. Program Facilitators State level Conducting annual meetings, standing committees & interim workgroups Share data/discuss emerging issues Share best practices Consensus benchmarks for screening Establishing performance-based contracts Site visits for contract adherence and TA Data submission requirements

11. Screening and Treatment Outcomes

12. CT Screening Trends 2003-2006 6022 72686781 7510 % Positive 1693

13. Proportion Screened by Facility Size 2006

14. Test Timing & Treatment Outcomes 2006 Timing of test (booking to specimen collection) 76% of those booked were tested within 1 day of booking Proportion treated 89% of those positive were treated Timing and location of treatment 79% of those treated were treated within 14 days 93% treated while incarcerated

15. Conclusions CT screening and treatment of females in juvenile detention facilities can be accomplished. High levels of coverage and treatment can be attained if: Provide clear definition of expectation Plan for flexibility within and across systems The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention

16. Acknowledgements Alameda – Gay Calhoun Fresno – Shahla Rahmani, Jeannette Sawyer Humboldt – Steve Moore, Stacy Campbell, Maggie Rios Kern – Callie G. Huston Kings – Kathy Mittleider, Maria Soto Orange – Samantha Lutz, Mike Carson Riverside - Barbara Cole, Faith Davis-Bolton, Kevin Meconis Sacramento – Sandra Hand, Alix Gillam, Lena Nguyen San Bernardino – Sharon Jaques, David Perry San Diego – Craig Sturak San Joaquin – Deborah Tyler San Mateo – Cara Silva, Liz Piper, Dianna McDowell Santa Barbara – Ralph Barbosa Santa Clara - Corina Vera, Jerry Klein Santa Cruz – Joan Kaufman, Eddie Bautista Shasta County – Heidi Vert, Jackie Mae Sonoma – Marie Piazza, Kimberly Mahr Stanislaus County – Jessica Montoya This project was supported in part by the Centers for Disease Control and Prevention and the California Department of Public Health.

17. Question & Answers Contact info: Jamie.miller@cdph.ca.gov Jamie.miller@cdph.ca.gov (510) 620-3188