1. PREGNANT AND INCARCERATED: Meeting the Needs of Pregnant Juveniles
Department of Public Health – County of Los Angeles
Maternal, Child, and Adolescent Health Services
PROBATION-PRENATAL OUTREACH PROJECT
(“P-POP”)
PREGNANT AND INCARCERATED: Meeting the Needs of Pregnant Juveniles
Introduction
Olga Lederer, RN
Shanica Davis RN,
Rene Rothrock, RN,

2. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) OBJECTIVES
Identify, assess, and link pregnant minors within Los Angeles County (CA) detention facilities to case management programs, upon discharge.
Identify lessons learned in collaborating with the Dept. of Probation, Dept. of Health Services, and the Dept. of Public Health to provide outreach to detained pregnant minors.
Define the role of the Liaison Public Health Nurse (LPHN).

3. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) BACKGROUND / HISTORY
The incarcerated pregnant teens
Highest of high-risk mothers
The most vulnerable and the most dysfunctional
Outreach to pregnant “minors” in the Juvenile Halls and Camps started in 1997
History and Overview
Home visitation program that provides case management to high risk pregnant women and their children
Outreach began in 1997 after the collaboration of the Juvenile Courts Health Services Nursing Director Ruth Munoz, the PCG PHN Coordinator, the Director of Prenatal Health Programs and the Medical Director of ______________.
We began to target our highest risk population which were in the Juvenile Hall system (JHS)
4 PHN's visited JHS to identify clients
PHN’s had difficulty accessing detained Juveniles because of :
Each facility required specific authorizations to allow the nurses into the halls and camps
Client schedules within the halls for school, clinic appts, mental health counceling, dental services or court appearances would make the girls inaccessable
Lack of probation staff to bring the girls to see the nurse
NFP/PCG Program administration (Jeanne Smart and Cindy Chow) set out to formalize our program interventions and access to clients within the halls and camps.
What was the benefit of having an LPHN?
Establishing an LPHN in the halls and camps benefitted both our program and Probation by increasing our access to the girls, I could now go to where they were instead of having to wait for an officer to bring the girls to me, and for Probation we lessened the manpower necessary to escort these girls to see the Nurse. Another benefit to probation was that now these girls were being educated about their pregnancy and what “ danger signs” to report for immediate medical treatment, so hopefully there would be less emergency medical calls for the probation officers in the middle of the night.
An Liaison PHN (I was hired ) was hired in___January 05_______ to work within the halls and camps.
Luckily for our program, Probation had identified individuals (Hania Cardenas- community probation and Jeanette Aguirre- Halls & Camps) to pilot a program where by only specific probation officers would manage pregnant and parenting minors, these ladies became our biggest advocates and pathway into the halls and camps. Probation Department is responsible for the children in detention and the management of the day to day operations. Having the authorization of the chief (Paul Higga) to implement our program within the halls and camps was critical.
Juvenile Health Services Nursing Administration also played a key role and assisted in the coordination of meetings and the process of referrals by the nursing staff.

4. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) CHALLENGES
Each facility functioned differently
Unpredictable client schedules
Constant client movement between facilities
Lack of formal relationship between Department of Public Health (DPH) and Department of Probation
Lack of information sharing between large “County” Departments
History and Overview
Home visitation program that provides case management to high risk pregnant women and their children
Outreach began in 1997 after the collaboration of the Juvenile Courts Health Services Nursing Director Ruth Munoz, the PCG PHN Coordinator, the Director of Prenatal Health Programs and the Medical Director of ______________.
We began to target our highest risk population which were in the Juvenile Hall system (JHS)
4 PHN's visited JHS to identify clients
PHN’s had difficulty accessing detained Juveniles because of :
Each facility required specific authorizations to allow the nurses into the halls and camps
Client schedules within the halls for school, clinic appts, mental health counceling, dental services or court appearances would make the girls inaccessable
Lack of probation staff to bring the girls to see the nurse
NFP/PCG Program administration (Jeanne Smart and Cindy Chow) set out to formalize our program interventions and access to clients within the halls and camps.
What was the benefit of having an LPHN?
Establishing an LPHN in the halls and camps benefitted both our program and Probation by increasing our access to the girls, I could now go to where they were instead of having to wait for an officer to bring the girls to me, and for Probation we lessened the manpower necessary to escort these girls to see the Nurse. Another benefit to probation was that now these girls were being educated about their pregnancy and what “ danger signs” to report for immediate medical treatment, so hopefully there would be less emergency medical calls for the probation officers in the middle of the night.
An Liaison PHN (I was hired ) was hired in___January 05_______ to work within the halls and camps.
Luckily for our program, Probation had identified individuals (Hania Cardenas- community probation and Jeanette Aguirre- Halls & Camps) to pilot a program where by only specific probation officers would manage pregnant and parenting minors, these ladies became our biggest advocates and pathway into the halls and camps. Probation Department is responsible for the children in detention and the management of the day to day operations. Having the authorization of the chief (Paul Higga) to implement our program within the halls and camps was critical.
Juvenile Health Services Nursing Administration also played a key role and assisted in the coordination of meetings and the process of referrals by the nursing staff.
APHA Notes_
“Writing of the MOU to clearly define roles, provisions for the LPHN
HIPPA regulations and laws protecting minor rights and privacy delayed the gathering of information or access to computer systems

5. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) ASSESSMENT/DEMOGRAPHICS
Total admission for = 21,580
Total female minor admission = 4,759 (22%)
On any given day pregnant minors are housed in the Juvenile Halls
All pregnant minors must be assessed at the Juvenile Halls
From July 2005-July 2007, 283 (68%) of 461 pregnant minors have been assessed 178 (63%) have been referred to case management services
Largest population is hispanic, then african american, then caucasian

6. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) FINDINGS
Detained pregnant minors lack knowledge on pregnancy related health education
Detained pregnant minors have limited awareness and/or access to resources and programs available to them once released from Juvenile Halls or Camps.
Limited Support Systems

7. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) P-POP IMPLEMENTATION
The P-POP project was implemented with the collaboration of the Department of Public Health, Probation, and Department of Health Services(DHS)
Role of the Liaison Public Health Nurse (LPHN) is to:
Identify pregnant minors within the probation system of halls and camps
Provide health assessment and health education
Refer clients to Nurse Family Partnership(NFP)/Prenatal Care Guidance(PCG) and to other programs upon release from detention centers
Assessment :
General health - History and physical
Prenatal assessment-validating the pregnancy, knowledge base, birth control methods, STD information
psychosocial – home, gang involvement
Mental health status and/or substance abuse issues
Linkage / Referral
Frequency: at least once and prn
This population is at high risk for poor birth outcomes, multiple prenatal complications, and high incidence of STDs.
They are released back to the community or placement facilities without linkages to resources for prenatal care or parenting skills
In the last 3 months we received 50 referrals 1/1-3/30/06
Of the 50 we found that
12% had a dx of depression/2% had dx of anxiety
16% had active drug and/or ETOH abuse problems, 4% had been smoking while pregnant
These were only the referrals sent by the nursing staff from the Juvenile hall Admitting areas. After face to face contact and/or review of the medical records these numbers increase.
We have been unable to obtain data from Probation on this kind of data, nor does the Mental Health unit within the Juvenile Health facilities have information available to us.

8. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) P-POP GOALS
All pregnant minors will have increased knowledge on pregnancy related information and issues.
Identify all pregnant minors within the detention facilities
At least 60% of the detained pregnant minors will be interviewed & educated by LPHN
Pregnant minors, upon release, will be referred to NFP/PCG or other case management programs
At least 50% of the clients that were interviewed by LPHN will be referred to NFP/PCG program.
Pregnant minors, upon release, will receive information on resources that are available within the their local communities.

9. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) PRELIMINARY EVALUATION
LPHN has established relationships with various departments within the facilities, (probation, nursing, mental health, medical records, religious leaders)
LPHN established a system to identify all pregnant minors within the facilities.
Manual data collection was initiated and shared with probation and nursing departments 
July 2005-July 2007
Program
Referred
Pending/Enrolled
Percent Enrolled
NFP 98 21
21%
PCG 78 13
17%

10. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) PRELIMINARY EVALUATION
Major challenge was locating those clients or getting them to respond after they were released.

11. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) PRELIMINARY EVALUATION
98/178 clients (55%) were referred to NFP, and 21 (21%) were pending/enrolled in NFP.
Goal is to see how many clients will complete the NFP program and if the results mirror NFP-LA results.

12. PROBATION-PRENATAL OUTREACH PROJECT (“P-POP”) LESSONS LEARNED
Access to key stakeholders in the process of P-POP implementation
MOU- detail roles and resources that will be provided
Hire someone familiar with the system that will be collaborating in the process to help with implementation
Understanding the mission, vision and objectives of the stakeholder/departments/agencies will assist in the success of implementation of the program