The California Experience

1. The California Experience Jamie Miller, MPH California Department of Health STD Control Branch 2006 CDC National STD Prevention Conference May 7-11, 2006

2. What About California Correctional Facilities? • 59 halls in 51 counties in California • 2003 - 117,000 total bookings • 18% females • Department of Corrections and Rehabilitation • Corrections Standards Authority (old BOC)

3. Program and Procedures Standards • Title 15 Program and Procedures Standards - minimum standards for juvenile facilities • Article 8 Health Services • Section 1430 – Intake Health Screening • Immediately upon entry to facility • Section 1432 – Health Appraisal/Medical Exam • Within 96 hours

4. Title 15 Standards/Guidelines2003 Addition • “Juveniles are also at significant risk for sexually transmitted diseases, such as chlamydia. Consultation with the local health officer regarding current recommendations for screening is recommended. Screening while in custody will benefit the individual as well as persons in the community with whom the minor will interact after release.”

5. Juvenile Justice Survey (1998) • Self-administered questionnaire survey of Juvenile Justice Medical Administrators • Assessing screening and treatment practices • Response Rate - 75% (39/52) • Findings • STD testing at sick call most common practice • For those few sites reporting CT screening policies, overall coverage was 41% for females.

6. “Get Tested” Program • “Get Tested” program (1999-2002) • Community based screening • Multiple counties/venues • Findings • High prevalence of CT in juvenile justice • Second highest population

7. So, what did we do? • Identified available funding • CSPS and IPP • Identified state project manager • Developed project design • Created and sent out to local STD Controllers request for proposals • Developed contractual scope of work • data dictionary, quarterly communication reports, annual reports

8. Chlamydia Screening Project (ClaSP) Overarching Goal Provide routine chlamydia screening for high risk adolescents with a prevalence of >5% in juvenile justice facilities through partnerships between juvenile justice and local health department STD control programs

9. What Did We Want to Accomplish? • Long term - to decrease the female prevalence of chlamydia in juvenile justice facilities by 20% • Short term • Assess the yield of chlamydia screening • Assess the timing of screening after booking • Assist the state in determining the feasibility of candidate STD national performance measures

10. Who Could Apply? • Application process – informal long-term • County contracts • Selection criteria: • Collaboration among: • county health department • local juvenile justice or probation • Population - 250,000 15-19 year old females • Juvenile justice census (bookings) of at least 50 female detainees per year • Excluded SF and LA

11. Activities • Provide CT screening and treatment to all females booked • Provide screening at booking or as close to booking as possible • Ensure rapid notification of positive test results • Provide appropriate and expedient treatment • Ensure follow up and referral for those testing positive who are released prior to treatment

12. Who, What, When, Where and How? • Number of counties funded • 2003 - 15 (18 facilities) • 2005 - 17 (22 facilities) • Urine tests by NAATS • Testing performed by county public health laboratories • Medical services provided by county health, county probation medical or through contracts • Informed consent via • Medical blanket • Specific service (verbal or written)

13. How Diverse Were We?

14. What About the Size of the Facility? • Classified counties based on county annual booking averages • Large (N=11) • 500 or more females booked per year • Medium (N=4) • 200 – 499 females booked per year • Small (N=2) • Less than 200 females booked per year

15. So, what did we learn? • Developing and nurturing collaboration • Bring juvenile justice managers and medical staff in early • Educate them re purpose of screening • Moving timing of screening • from medical assessment to intake/booking • Systematizing screening • screen all (high proportion sexually active) • educational materials

16. Screening Results 7652 6728 6614

17. Proportion of Booked Females Screened by Days from Booking

18. So, what helped us? • Had state standards for medical care • Received federal funding • Identified project contacts (county & state) • Held annual meetings & interim workgroups • Share data/discuss emerging issues • Share best practices • Established performanced-based contracts • Site visits for contract adherence and TA • Data submission requirements

19. Next Steps • Continue to provide technical assistance to improve screening coverage in lower performing sites • Identify additional funds as necessary • Monitor contracts to ensure optimal performance

20. Acknowledgements ClaSP Project Participants by County: Alameda – Gay Calhoun, Sue Chen, Adrienne Hanson; Humboldt – Steve Moore, Stacy Campbell, Maggie Rios; Kern – Callie G. Huston; Kings – Nicole Geha, Gloria Littman, Barbara Van Baren; Orange – Lydia Mikhail, Samantha Lutz, Mike Carson; Riverside – Faith-Davis-Bolton, Kevin Meconis, Barbara Cole; Sacramento – Olivia Kasiyre, Karen Tait, Gwen Morrisey, Alix Gillam, Angelica Velasquez, Angel Carrillo; San Bernardino – Heather Cockerill, Marshare Penny, Becky Nanyonjo, Steve Nozaki; San Joaquin – Deborah Tyler; San Mateo – Jim Olsen, Liz Piper, Sarah Cottrell; Santa Barbara – Elizabeth Scarcelli Snyder, Ralph Barbosa; Santa Clara - Corina Vera, Jerry Klein; Santa Cruz – Sharon Crowley; Shasta County – Elaine Best, Heidi Vert, Jackie Mae, Susan Hobson, Dixie Wolfe, Melissa Janulewicz; Sonoma – Jim Stafford, Marie Piazza, Sandy Rigney, Kim Caldaway, Ryan McClane, Alan Powell, Kimberly Mahr; Stanislaus County – Maribel Lopez, Jessica Montoya This project was supported in part by the Centers for Disease Control and Prevention and the California Department of Health Services.