1. 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

2. 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

3. 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

4. Two data collection instruments

5. Size Population size All facilities Number of kids 1-25 65.5% 23,183
% ,183
,537
,844
,180
,887

6. 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)

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

8. JRFC 2004 Hepatitis B Series

9. 23,179 young people placed in 986 facilities not providing hepatitis B vaccination

10. 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

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

12. 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

13. Summary of models Policy Practice Length of Stay 1.003 1.001
Detention
Training
Facility size
Male
State
City
Crowding
Exams (on)
(off)

14. Results of multivariate models

15. …a bit more balanced (removed large facility effect)

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

17. 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

18. 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

19. 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