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ED 384 415 AUTHOR TITLE INSTITUTION SPONS AGENCY REPORT NO PUB DATE CONTRACT NOTE AVAILABLE FROM PUB TYPE EDRS PRICE DESCRIPTORS ABSTRACT DOCUMENT RESUME PS 023 220 Thompson, Linda S.; Sheahan, Paula M. Health Care of Incarcerated Youth: State Programs & Initiatives. National Center for Education in Maternal and Child Health, Arlington, VA. Health Resourc_ and Services Administration (DHHS/PHS), Washington, DC. Maternal and Child Health Bureau. ISBN-1-57285-005-1 94 MCU-117007 109p. National Maternal and Child Health Clearinghouse, 8201 Greensboro Drive, Suite 600, McLean, VA 22102 (single copy free). Reports Research/Technical (143) Tests /Evaluation Instruments (160) MFOI/PC05 Plus Postage. *Adolescents; Child Health; Health Conditions; *Health Needs; *Health Services; National Surveys; *Prisoners; Program Attitudes; Program Descriptions; Program Effectiveness; *State Programs; Statewide Planning This report presents the analysis a.7,' results of a survey of states' progress in meeting the goals and objectives of their state action plans on the health care of incarcerated youth. The survey questioned 48 juvenile justice professionals, health care professionals, and university faculty from across the nation concerning state progress toward action plan objectives, barriers to progress, youth health problems, and target population. It found that 1 respondent reported meeting all of the state action plan objectives, 28 respondents reported meeting some of the objectives, and 7 reported meeting none of the objectives The bulk of the report consists of 1- or 2-page listings for each state which outline incarcerated youth health care goals, objectives, program action, community actions, state actions, accomplishments, current initiatives, and contact persons for each state, the District of Columbia, and the Virgin Islands. A copy of a follow-up survey is included. (MOM) *********************************************************************** * Reproductions supplied by EDRS are the best that can be made * from the original document. * ***********************************F*********************************** yeice at tducAtcmii Fromm. and imorovemene EDUCATIONAL RESOURCES INrORMATION CENTER (ERIC) This document has been reproduced as ecorved from the person or organization originating it. Minor changes have been made to Improve reproduction Wake/ Points of view or opinions stated in this document do not necessarily represent OffeCial 0E111 position or pokey Health Care Go of Incarcerated Youth ee a State Programs & Initiatives BEST COPY AVAILABLE Health Care of Ir,arcerated Youth State Programs & Initiatives By Linda S. Thompson, M.S.N., Dr.P.H. and Paula M. Sheahan Supported by the Maternal and Child Health Bureau Health Resources and Services Administration Public Health Services U.S. Department of Health and Human Services Published by the National Center for Education in Maternal and Child Health Arlington, VA 3 Cite as Thompson, I... and Sheahan, P. (1994). Health Care of Incanated )'outh: Slate Programs and Initiatives. Arlington, VA: National Center for Education in Maternal and Child Health. Health Care of incarcerated Youth: State Pmgmms and Initiatives is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. In accordance with accepted publishing standards, the National Center for Education in Maternal and Child Health (NCEMCH) requests acknowledgment. in print, of any information reproduced in another publication. The mission of the National Center for Education in Maternal and Child Health ( NCEMCH ) is to promote and improve the health, education, and well-being of children and families by leading a national effort to collect, develop, and disseminate infor- mation and educational materials on maternal and child health; and by collaborating with public agencies, voluntary and profes- sional organizations, research and training programs. policy centers, and others to advance knowledge in programs, service deliver', and policy development. Established in 1982 at Georgetown University. NCEMCI I is part of the Graduate Public Policy Program. NCEMCH is funded primarily by the U.S. Department of Health and Human Services through its Maternal and Child Health Bureau. Library of Congress Catalog Card Number 9.1-68517 ISBN I-57285-00-5-1 Published by: National Center for Education in Maternal and Child Health 2000 15th Street North, Suite 701 Arlington, Virginia 22201-2617 (703) 524-7802 (703) 5249335 fax Internet: ncemch01@gumedlib.dml.georgetown.edu Single copies of this publication are available at no cost from: Naticmal Maternal and Child Health Clearinghouse 8201 Greensboro Drive, Suite 600 McLean, Virginia 22102 (703) 821-8955, exts. 25,1 or 265 (703) 821-2098 fax This publication has been produced by the National Center for Education in Maternal and Child Health under its cooperative agreement (MCU-117007) with the Maternal and Chilcl Health Bureau. Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services. iii TABLE OF CONTENTS Foreword v SECTION 1 Analysis 1 SECTION 2 State Programs & Initiatives 11 Survey 98 V FOREWORD Health Care of Incarcerated Youth: State Programs and Initiatives is the final report in a series of publications funded by the Maternal and Child Health Bureau (MCHB) addressing the health needs of incarcerated youth. This report presents the results and the analysis of a survey of states' progress in meeting the goals and objectives of their state action plans developed during the 1991 Tri-Regional Workshops on the Health Care of Incarcerated Youth. Significance of the issue. More than 2 million children and adolescents in this country are arrested each year, and more than 600,000 are incarcerated in juvenile or adult correctional facilities. Most of these youth have not committed violent or serious crimes; many are victims of poverty and neglect, suf- fering from undiagnosed or untreated physical and emotional disorders. Many of these young people suffer from physical, psychological, or sexual abuse. These children and adolescents enter the juvenile justice system with a host of health care problems, including respiratory disorders, depression, addiction to alcohol or other drugs, HIV infection, and sexually transmitted diseases. Their involvement in the court system iurther separates them from mainstream health care. Strategies and resources. The Maternal and Child Health Bureau has focused national attention on the health status of incarcerated youth, and has devoted significant resources to improving the health of this vulnerable young population. MCHB has convened national and regional conferences on the health needs of incarcerated youth, has guided collaborative efforts to develop partnerships between juvenile justice and health care professionals, has produced books and other materials informing a range of audi- ences about the health status of incarcerated youth, and continues to fund model demonstration and training programs to improve health care for these youth. Conferences and collaboration. During 1988-89, the Maternal and Child Health Bureau sponsored a two-part national conference entitled "The Forgotten Child in Health Care: Children in the Juvenile Justice System." Held on the east and west coasts, this conference signified the first national approach to defining the health characteristics of incarcerated youth, exploring interrelationships between the roles and responsibilities of Title V professionals and those of juvenile justice professionals, and promoting interdisciplinary collaboration between child advocates and key state policymakers in child health and juvenile justice. Subsequently, the Maternal and Child Health Bureau developed and sponsored three workshops, the 1991 TriRegional Workshops on the Health Care of Incarcerated Youth (held in San Diego, Birmingham, and Philadelphia). These workshops helped to unify interagency collaboration and to promote closer working relationships between juvenile justice professionals and health care specialists within each state. All states were represented at these working meetings and each developed a state action plan. Publications. The reports of these national and regional conferences on incarcerated youth have been published by the National Center for Education in Maternal and Child Health. Based on the east- west national conference, The Forgotten Child in Health Care: Children in the ,Juvenile Justice System (1991) is the first publication in the series. The three regional conferences resulted in the second report, vi Health Care of Incarcerated Youth: Report from the 1991 Tri-Regional Workshops (1991). As noted earlier, Health Care of Incarcerated Youth: State Programs and Initiatives is the third and final report in the series. In addition to this series, the Maternal and Child Health Bureau has funded other publications on the health of incarcerated youth, including Hard Time, Healing Hands: Developing Primary Health Care Services for Incarcerated Youth (1993). This definitive publication addresses a range of health issues affecting incarcerated youth (e.g., violence, alcohol and other drug abuse, chronic illness, mental health, sexually transmiaed diseases), as well as legal issues, training, and financing. Model programs. The Maternal and Child Health Bureau continues to fund a number of projects that focus on the health needs of incarcerated youth. These projects, among the special projects of regional and national significance (SPRANS) funded by MCHB, serve as multidisciplinary demonstration and training programsmodel programs for states and communities attempting to address the health needs of these youth. The programs focus primarily on the needs of young African American males and other minority youth involved with the juvenile justice system. (Young males of color in this country are disproportionately represented in two special populationsthose at risk for serious health problems, and those involved with the juvenile justice system.) A decade of commitment. The Maternal and Child Health Bureau has consistently created and sup- ported strong partnerships between providers of public health services and the juvenile justice system. For more than a decade, MCHB's initiatives have exemplified its commitment to improving the present and future health and well-being of incarcerated youth. It is our hope that state and regional leaders in maternal and child health programs, juvenile justice advisory groups, and juvenile justice agencies will continue to work together to improve the delivery of health services to children and youth in the juve- nile justice system. Audrey H. Nora, M.D., M.P.H. Director, Maternal and Child Health Bureau Assistant Surgeon General hildren and adolescents incarcerated in juvenile jus- tice facilities in this country frequently fail to receive their full entitlement of health care services. The mor- bidities affecting children and adolescentsespecially minority youthoften are not addressed when these youth are incarcerated in juvenile correctional institutions. There may be several root causes for this neglect. First, standards for health care services in correctional settings for these young people have been developed but not widely adopted. Second. health --.:rvices often are provided on a limited basis or by clinicians with minimal training in correctional health and adolescent medicine. Third, service providers are not sensitive to the ( thnic and cultural concerns of the popula- tion. Finally, financing of needed health care in correctional settings is problematic for many jurisdictions. In response to the health care needs of incarcerated youth, the Maternal and Child Health Bureau (MCHB) sponsored a series of national and regional conferences on the health service needs of this vulnerable population. This report is based on responses to a follow-up survey of workshop participants on current state and regional activities to improve the health status of incarcerated youth. We intend this report to serve as a resource and reference guide in planning future health care programs for incarcerated youth. Through a national survey of participants who attended work- shops on the health care of incarcerated youth, respondents reported on their progress in meeting the state action plans developed at the workshops, sources of funding for health care services, current delivery of primary health care services, identified leading health care problems and barriers to the delivery of health care services, and current initiatives aimed at improving the health care of incarcerated youth. 2 HEALTH CARE or INCARCERATED YOU EH Background The Maternal and Child Health Bureau ( ivIcHB). U.S. Department of Health and Human Services (DHI15), convened the Tri- Regional Workshops on the Health Care of Incarcerated Youth to increase aware- ness of the health needs of incarcerated youth and promote interdisciplinary collabo- ration in providing health care to this popu- lation. Held in San Diego, California, Birmingham, Alabama, and Philadelphia, Pennsylvania, in 1991, the workshops brought together representatives of profes- sional and lay organizations; child health and juvenile justice professionals; local, state, and federal governments; and child advocacy groups. At the workshop, work groups were charged with identifying and prioritizing state action plans to improve health care for incarcerated youth. These action plans, published in Health Care of Incarcerated Youth: Report from the 1991 'DI-Regional lVorkshops (1991), were organized into three areas: program level, community level and state level. The quality of primary health care services for incarcerated youth has contin- ued to improve since the 1991 report. In order to ensure that all juvenile justice facili- ties meet minimum standards of practice, the Maternal and Child Health Bureau requested that the National Center for Education in Maternal and Child Health (NCEMCH) pub- lish a report on the progress that states have made in meeting their objectives for improv- ing he health status of incarcerated youth. It is hoped that this report will stimulate interest in and serve as a resource for the planning of future programs to improve the health status of incarcerated youth. Methodology The National Center for Education in Maternal and Child Health staff, in consulta- tion with Maternal and Child Health Bureau staff and consultants, developed a survey designed to record each state's progress toward meeting action objectives, to identify barriers to meeting the objectives, to describe primary health care services and their sources of funding, t( list the leading health care problems of incarcerated youth, and to name current initiatives to improve the health care of incarcerated youth. The questionnaire was designed to obtain descriptive information of current programs and activities (see survey, page 98). Oda/ lef ILI Iry In January 1992, each participant in the tri-regional workshops received a survey. The purpose of the survey was to gather in- depth descriptive data to (1) increase our understanding of the health problems occur- ring within juvenile justice populations and the types of health services available to ANALYSIS 6.31111Hes..._ 11/fira raistram--_1111111111l Figure 1 Survey Respondents by Public Health Region those youth, (2) determine the progress that states have made in meeting action objec- tives for improving health care services, and (3) identify barriers to and incentives for designing health care programs for incarcer- ated youth. Results A total of 48 respondents from every public health service region of the country completed and returned the survey instrument (see Figure 1). For states that did not return a survey, we are including their state action plans developed at the tri-regional work- shops. The largest percentage of respondents were from Regions III and IX (18.8 percent), followed by Regions I, VI, and X (10.4 percent). The largest proportion of the respondents were juvenile justice pro- fessionals (38 percent), followed by maternal and child health professicnals (31 percent), followed by university faculty or 3 staff (17 percent) (see Figure 2). The majority of sur- vey respondents (78 per- cent) reported meeting some of the state action plan objectives (see Figure 3). Close to 20 percent of the respon- dents reported meeting none of the objectives and one respondent reported meeting all of their objectives. Thiny-five percent of respondents cited timing as the number one barrier to meeting state action plan goals and objectives (see Figure 4). The second major harrier reported to meeting their iden- tified goals and objectives was lack of or poor collaboration (24 percent), followed by economic problems within the state (22 percent). Education 1(2.1%) Advocate 2 (4.1%) Figure 2 Survey Respondents by Reported Professional Affiliation (N=48) Unknown 4 (8.3%) Justice 18 (37.6%) University Faculty 8 (18.7%) i0 Maternal and Child Health 16 (31.3%) 4 Figure 3 State Action Plan Objectives Met (N=36) Met No Objectives 7 (19.4%) Met All Objectives 1(2.8%) Met Some Objectives 28 (77.8%) Figure 4 Five Main Barriers to Meeting State Action Plan Objectives (N=37) Number and Percentage of Respondents Citing: Time/Timing: 13 (35%) Lack of/Poor Z.loilaboration: 9 (24%) State Economic Conditions: 8 (22%) Personnel Change: 5 (14%) O Local Economic Conditions: 2 (5%) 0 BEST COPY AVAILABLE HEALTH CARE OF INCARCERATED YOUTH The tri:regional distribution of the level and type of reported goals and objectives met by the respondents reveals that at the program level, all areas focukd on. Increasing collabo- ration/coordination, developing standards for services to youth, increasing training efforts, and establishing statewide networks to review local, state,:and national regulations (see Figure 5). Goals and objectives met by all areas at the community level focused on establishing a coalition of state and private advocacy groups. " .he state level, all areas reported enhancing communication and col- laboration between agencies. When asked to identify the age and sex of the population served, a majority of respondents said that they provided services to youth between the ages of 13 and 15 years (70 percent) (see Figure 6). Sixty-nine percent of the respondents reported providing services to youth ages 16 to 18 years. Only 20 percent of the respondents reported pro- viding services to youth under the age of 10 years. Over 60 percent of the respondents reported providing services to both males and females. The leading reported health care problem among incarcerated youth was sexually trans- mitted diseases (25 percent), followed by sub- stance abuse (21 percent), dental problems (19 percent), and mental health problems (19 percent) (see Figure 7). The primary providers of acute and episodic care to incarcerated youth are family practitioners (see Figure 8). The primary providers of outpatient specialty care are University/Medical School Departments. The most frequently r. ported barrier to providing primary health care services to incarcerated youth was lack of qualified staff or providers (22 percent). The next most frequently reported barrier was difficulty in 11 ANALYSIS Figure 5 Reported Action Objectives Met by Level Program Level Increase collaboration/coordination between agencies. Develop standards for serving youth who are detained and incarcerated. Establish a statewide network to review local, state, and national regulations and recommend change. Community Level Develop reciprocal working relationships between local universities to provide health care services to Incarcerated youth. Develop a network with other state and local agencies. Increase community awareness of the health and social needs of incarcerated youth. State Level Encourage state Advisory Committee to include health issues on their planning agenda. Explore alternate methods of funding programs for youth. Enhance communication and collaborations among agencies. 5 Figure 6 Leading Health Problems of Youth Health Problem STD Substance Abuse Gum/Dental Mental Health Asthma/Respiratory Injuries Lack of Preventive Health AIDS/HIV Dietary Pregnancy/Reproductive 25% 21% 19% 19% 11% 8% 8% Note. Numbers add up to more than 100% because more than one selection per respondent was possible. RFST COPY AVAILABLE 1C Figure 7 Target Population Served, by Age Under 10 years 11 20 Between 10 and 12 years 25 45 Between 13 and 15 years 36 70 Between 16 and 18 years 35 69 Over 18 years 14 25 finding providers "willing to provide health care services" (20 percent) (see Figure 9). Current initiatives aimed at improving the health care of incarcerated youth are catego- rized in the following ways: education and training of professionals, juveniles, and public: health care services: and system reform or change (see Figure 10). The most frequently reported type of initiative was aimed at educa- tion and training, followed by system reform or change. Summary Findings from this report indicate that only one respondent reported meeting all of their goals and objectives planned during the regional workshops. Several barriers were reported that prevented participants from meeting their goals and objectives. These bar- riers included timing, lack of (or poor) collab- oration, and economic problems. Among respondents reporting some success in meet- ing their goals and objectives, areas of success focused on collaboration/coordination, stan- dards development, training, and establishing statewide networks. ! e lo.yputh::. prItnaiy. . Outpatient Ciro Spaaalty Can (rank) (rank) Healtimp plitni4pt clinics . 3 3 Commurilty:Health Centers 3 3 Public4iOSPItn1 ctirtpaUent- Depiiitinents 6 8 Private Hotpltal Outpatient Departments 0 0 PrivatezP.ediatriclans 3 5 Privatetfiarnily or4leneral Practitioners 8 3 Health Maintenace Organizations 0 0 University/Medical School Departments 5 9 Other 1 The population served by juvenile justice agencies included both males and femallts ranging in age from 10 to 18 years. The lead- ing health care problems named were similar to other studies and included sexually trans- mitted diseases, substance abuse, dental problems, arid mental health problems. A significant number of respondents reported health care problems among the juvenile justice population, and close to 50 percent reported barriers to providing health Figure 9 Barriers to Primary Health/Providers Lack of Qualified Staff/Providers 22 Finding Providers Willing to Provide Health Care 20 Access 7 Lack of Comprehensive Health Care 7 Training/Supervision of Staff 7 Location 5 13 liE.ALTII CARE OF INCARCERATED YOUTH care services. The two primary barriers were lack of qualified health care staff, and diffi- culty in finding providers "willing to provide services to the population." Only one region (Region II) failed to report a current initiath e to improve the health status of incarcerated youth. The most frequently reported initiative was the forma- tion of an interagency coup to either evalu- ate or implement programs. Future Directions Children and ado- lescents in the juve- nile justice system are an underserved group in the health care sys- tem. This paucity of health services is particularly unsettling given that these youth are at especially high risk for poor health and neglected medical prob- lems, such as poor nourishment and dental hygiene, learning disorders, and asthma. In addition, delinquent youth are sexually active at a considerably younger age than their nondelinquent peers, putting them at greater risk for sexually transmitted disease and early pregnancy. They are also dispro- portionately more likely to suffer from seri- ous mental health disorders and substance abuse, and to have been victims of child maltreatment and family violence. There have been attempts to improve health care services. For the last five years, the Maternal and Child Health Bureau has devoted considerable time and resources to addressing the particular needs of children in the juvenile justice system through a series of ANALYSIS Figure 10 Type of Initiatives Implemented to Improve the Health Status of Incarcerated Youth Type of Initiatives Implemented 1. Education and Training of Juveniles, Professionals and Public Initiated staff training on health issues Initiated staff training on specific health problems (HIV. violence) Initiated education of juveniles on available health services Initiated education of policymakers and administrators on health needs of incarcerated youth Published journal articles or manual on health issues of incarcerated youth Standardized certification of nursing staff to provide EPSDT screening of incarcerated youth 2. Health Care Services Implemented ways to comply with NCCHC standards Linked with area university to provide health services Implemented specific health service programs (immunization. mental health) 3. System Reform or Change Formed an interagency group to evaluate quality of care or to implement various service programs for incarcerated youth Conducted a needs assessment or study of health problems of incarcerated youth Evaluated the use of medicaid EPSDT funds and various grant programs to improve service Public Health Service Region I II III IV V VI VII VIII IX X 7 BEST COPY AVAILABLE 8 national and regional conferences and publi- cations. MCHB also established as a funding priority demonstration projects to improve the health of incarcerated youth and subsequent- ly funded community-based demonstration programs for youth who are in contact with the juvenile justice system. All of these activi- ties have served to create partnerships between providers of public health services and juvenile corrections. Nevertheless, more atten- tion must be paid to the health and social needs of underserved groups of children and adolescents. This attention should focus On several areas. First, careful scrutiny must he given to the way health care services are organized HEALTH CARE OF INCARCERATED YOUTH services for children and youth in the juve- nile justice system. States should design juvenile justice pro- grammatic strategies that incorporate the public health approach. Programs should follow a continuum of services ranging from primary prevention to supportive and restorative programs. juvenile justice profes- sionals should form interdisciplinary teams that target at-risk children for primary prevention. Federal block grant funding should support programs that teach children social problem-solving skills and ways to cope with or resist peer pressure to engage in anti- social and problem behaviors. States should design multidisciplinary approaches that coordinate services between agencies providing services to chil- dren. Multidisciplinary approaches should integrate youth correctional programs with health. mental health, social service, and educational or vocational programs. All states should adopt strategies to improve the physical and mental health of the juvenile justice population. Many pre- existing physical and mental health prob- lems can be addressed when children and adolescents enter secure detention facilities. Standards of care exist and should be met through working relationships between the juvenile justice system, public health system, and academic medical care centers. I lealth care professional:, should assume a greater share of the responsibility for improving the quality of health care within juvenile justice facilities. This responsibility should include several areas. First is the pro- vision of quality health care services to and delivered to incarcerated children and youth. Next, educational programs prepar- ing health care providers to care for chil- dren and adolescents must include content on high-risk groups. These professionals should receive content on the health issues of incarcerated youth and ways to tailor services to address their needs. Finally, attention must be paid to the need to alter the system of care for underserved children and youth. This would include doing the following: change legislative mandates; expand correctional standards to he perfor- mance or outcome based; enhance coordi- nation of services for children; and enhance and expand community-based services for children and youth. Recommendations Ilere are several recommendations for states to adopt to improve the system of 1.5 ANALI'SIS children and adolescents in correctional facilities. Second is the analysis and evalua- tion of child and adolescent health status and maintenance of health care standards. Next is the education and training of juve- nile justice professionals on child and ado- lescent health care needs, health assessment and disease pi.evention, and health promo- tion programs. The final area of responsi- hiltiy concerns advocacy for appropriate pri- mary prevention and treatment services for at-risk youth; adequate financing; and leg- islative sentencing reform. 9 16 STATE PROGRAMS INITIATWES 17 12 HEALTH CARE OF INCARCERATED YOUTH Alabama Goals Improve the health of adolescents involved with the juvenile justice system. Goals Met: Met Some Goals Objectives 1. Develop communication and teamwork among state and local agencies. 2. Develop communication and teamwork with the private sector. Objectives Met: Met Some Objectives Program Actions 1. Develop Individual Health Care Plan (IHCP), then create a mechanism to monitor and track IHCP. 2. Create an organizational chart that documents options once the juvenile is in the system. 3. Identify the current providers of health care to training schools. 4. Arrange a meeting with the president of state probation office. Program Accomplishments Developed an active coalition of adolescent health services, which is conducting a needs assessment for a statewide report. Community Actions 1. Develop access to community mental health clinics. 2. Develop access to public health clinics. Community Accomplishments Maintained eligibility for Children's Rehabilitation Services (CRS) for incarcerated youth who have a medical diagnosis that meets the program's eligibility criteria (e.g., cerebral palsy, hemophilia). State Actions 1. Develop lines of communication between state agencies including the Department of Youth Services, Children's Rehabilitation Services, Public Health, and Department of Human Resources. 2. Assess health care needs. 3. Make a concerted effort to have all facilities accredited. 4. Name a medical representative to the state advisory committee. State Accomplishments Developed better communication among some state agencies. STATE PROGRAMS & INMATIVES 13 Current Initiatives Children's Rehabilitation Services is offering community-based medical and habilitative services to children with special health needs, its well as coordination and support services to their families. The Children's Hospital at the University of Alabama is negotiating with Medicaid to determine the eligibility of certain segments of this population. Contact Information Patsy Patton State Supervisor Planning/Program Development; Children's Rehabilitation Services 2129 East South Boulevard., P.O. Box 11586 Birmingham, AL 36111 (205) 281-8780 (205) 281-1973 fax Ronald Feinstein, M.D. Director, Division of Adolescent Medicine Department of Pediatrics: Children's Hospital, University of Alabama at Birmingham 1600 7th Avenue South, CHT-157 Birmingham, AL 35233 (205) 934-5262 (205) 934-1150 fax 19 14 HEALTH CARE. OF INCARCERATED YOtTTH Alaska Goals Standardize data collection for all 'UV nile institutions and programs. Goals Met: There was no survey submitted for this state. Objectives 1. Track the Alaskan youth population who are in juvenile services programs. 2. Identify. avoid, and eliminate overlapping of health services. 3. Identify gaps in information within the health delivery system. Objectives Met: No response received. Program Actions No response received. Program Accomplishments: No response received. Community Actions Locate and identify all systems (funding, services, education) that deliver health care to Alaskan youth. Community Accomplishments: No response received, State Actions 1. Educate the Juvenile Justice Advisory Committee about health care issues and needs of incarcerated youth. 2. Educate the Juvenile Justice Advisory Committee about the need to include health care issues as part of the juvenile justice agenda. 3. Identify all common data elements in juvenile institutions and youth services programs. State Accomplishments: No response received. Current Initiatives No response received. Contact Information No survey submitted. ET1 STATE PROGRAMS & INITIATIVES 15 Arizona Goals 1. Establish a network of communication between the personnel in juvenile corrections health services, health departments at the state and county levels, and community agencies. 2. Identify the health needs of the incarcerated youth population and the resources avail- able to meet those needs. Goals Met: Met Some Goals Objectives 1. Initiate contact with appropriate personnel. 2. Provide quality health services to the incarcerated youth population. Objectives Met: Met Some Objectives Program Actions 1. Obtain support from the Arizona Department of Health Services in planning a meeting that will include representatives of this department, county health depart- ments, county juvenile correction health services, and community agencies. 2. Develop a planning committee. 3. Secure financial support. 4. Schedule a date, time, and place for the meeting. S. Review health records and documents that identify physical and mental health needs. Program Accomplishments Established the Arizona Adolescent Health Coalition, which improved communication and collaboration between agencies, groups, and individuals providing service to or working with adolescents; and completed a report on the Status of Adolescent Health in Arizona, including information about incarcerated youth. Community Actions Ensure that community agencies provide information on existing resources. Community Accomplishments Formed subcommittees of the Adolescent Health Advisory Coalition in order to identify the health care needs of adolescents. These subcommittees include: policy, planning, and research; legislation and advocacy; program and evaluation; substance use/abuse; sexuality; physical health; mental health; finance; and education. State Actions Implement the Adolescent Health Risk Appraisal with all new commitments to juvenile corrections. State Accomplishments: No response received. 21 16 HEALTH CARE. OF INCARCERATED YOUTH Current Initiatives The Health Services Bureau, Department of Corrections, is educating new administrative and legislative staff about the health care issues of incarcerated youth. Contact Information Barbara Olsen, R.N. Adolescent I lealth Consultant Arizona Department of I iealth Services 1740 West Adams Street, #200 Phoenix, AZ 85007 (602) 542-1880 Janice H. Piepergerdes, R.N., M.A. Administrator, Health Services Bureau Department of juvenile Corrections P.O. Box 35000 Phoenix, AZ 85069 (602) 869-9050 STATE. PROGRAMS & INITIATIVES Arkansas Goals 1. Improve the quality and continuation of care to incarcerated youth while in juvenile services. Obtain resources for follow-up. 2. Coordinate services for troubled youth (i.e., services that are common to the iltvenile justice, child welfare, and mental health systems). These services will include educa- tion, health, and drug and alcohol services. 3. Improve the quality of services and the continuity of care for incarcerated youth. Goals Met: Met Some Goals Objectives 1. Find/develop a statewide network of health care with coordination of services. 2. Investigate and develop expertise in finding available funding or avenues for funding. 3. Urge coordination between three existing state task forces charged with designing new community-based alternatives. 4. Continue to explore and develop the work initiated by the Juvenile Justice Task Fore'. Objectives Met: Met Some Objectives Program Actions 1. Increase interest and information among the various agencies in an effort to have each agency designate a representative. 2. Seek accreditation with a correctional medical commission and give this information to applicable agencies. 3. Improve recruitment of nurses and doctors who will work to improve the quality of care for incarcerated youth. 4. Work to assure medical reimbursement. 5. Talk with the governor about merging results from three task forces into a comprehen- sive continuum of care for troubled youth. 6. Work with the chairs of the three task forces to merge their plans and funds to develop comprehensive services. 7. Explore other funding avenues (private, state, and federal) for services development. 8. Reconvene the Juvenile justice Task Force to design and implement new services for delinquent youth that include consolidation of youth service facilities, expansion of community alternatives, and regionalization of services for the very serious offender. 9. Expand the membership of the Juvenile Justice Task Force to include representatives from education, health, and drug and alcohol agencies. Program Accomplishments: No response received. Community Actions 1. Work to obtain reimbursement at the county level and to locate services provided free of charge by various agencies. 23 17 18 HEALTH CARE OF INCARCERATED yowl' 2. Seek the involvement of political representatives regarding positive information and feedback in order to form coalitions to apply for grants and avenues of funding. Community Accomplishments: No response received. State Actions 1. Seek input from heads of departments in state agencies to gain their support and invite their expertise. 2. Contact the Department of 1Iea lth to seek support for health services and seek exper- tise concerning possible training resources or supplies that could he provided free of charge. 3. Contact the University of Arkansas Medical Science Center for support and training. State Accomplishments Established a number of work groups through the Division of Children and Family Services, Department of Human Services, that are working with individuals from various disciplines and agencies. Current Initiatives The Administrative Office of the Courts is working to improve internal organi- zation; reorganization is under way and will have an impact on all of the programs and services relevant to this survey. Contact Information Donna L. Gay Coordinator of Juvenile Courts Administrative Office of the Courts, Justice Building 625 Marshall Street Little Rock, AR 72201 (501) 376-6655 (501) 682-6877 fax STATE PROCRAMS & INITIA1TVES 19 California Goals Improve the quality of care for incarcerated youth and obtain better preven- tion and intervention services for all California adolescents. Goals Met: Met Some Goals Objectives 1. Initiate a statewide network of informed individuals working on state regula- tions and national and state standards of care. 2. Develop expertise in finding funding for care. 3. Develop statewide coordination of adolescent health care. Objectives Met: Met Sonic Objectives Program Actions 1. Obtain information about standards and state regulations. 2. Designate a local representative at every facility. 3. Improve recruitment for nurses and doctors who will work to improve the quality Of care. 4. Increase information and interest in accreditation. 5. Work to ensure that eligible youths receive medical reimbursement (Supplemental Security Income, Child I Iea lth and Development Program, Crippled Children's Services, NC 250). Program Accomplishments 1. Convened work group on state regulations and national and state standards of care. 2. Improved recruitment of health care staff. Community Actions 1. Arrange for a representative from all accredited counties to talk about the accreditation process. 2. Form coalitions to apply for grants (intrastate and interstate). 3. Work for Child Health and Development Program reimbursement at the county level. Community Accomplishments Worked for Child Health and Development Program reimbursement at the county level. State Actions 1. Ask that a funded representative from every county or region in California attend the annual juvenile justice meeting. 2. Obtain draft 5 of the Correctional Treatment Regulations for discussion. 3. Seek foundation support (e.g., Robert W. J. Rosenthal). 4. Seek the same staffing level for health care as for probation. 2 20 MAUD CARE. OF INCARCERATED vomit 5. Send a group to Sacramento as advocates for ;ncarcerated youth to meet with Steve Kessler, Dr. Shaw, Iry White, and Senator PcLos ley. 6. Change the name of Maternal and Child Health Services to Mothers, Children, and Adolescents (MCHA) in an effort to encourage active involvement in health care for adolescents. 7. Report results to the regional meeting and federal Maternal and Child Health Bureau program. State Accomplishments Developed State Correctional Treatment Center Regulations. Current Initiatives The Department of Youth Authority is recruiting quality health care staff; recon- stituting committees on infection control, quality assurance, and therapeutics; and instituting an electronic system for medical records (COSTAR). Two articles have been published on the health care of incarcerated youth: Jameson. (1989). The Need for the Development of Professional Ethical Standards for Health Providers. Journal of Adolescent Health Care 10:490; and Costello and Jameson. (1987). Legal and Ethical Rules of Health Care Professionals to Incarcerated Children. Journal of Legal Medicine 8(2):191. Contact Information Dan Palmer, M.D. Chief of Medical Services Department of Youth Authority 4241 Williamsbourgh Drive Sac amento, CA 95823 (916) 427-4870 Elizabeth .jameson, J.D. Youth Law Center 114 Sansome Street, Suite 3820 San Francisco, CA 9 -1104 -3820 (415) 5.43-3379 STATE PROGRAMS & INITIATIVFS Colorado Goals Increase access to Medicaid to meet the health care needs of Colorado's adolescents. Goals Met: Met Some Goals Objectives Obtain Medicaid funds for youth involved in the juvenile justice system by the start of FY 1993. Objectives Met: Met Some Objectives Program Actions Develop a database of the health needs of the target population, and conduct an analysis of the cost savings to the state by obtaining Medicaid funds for this population. Program Accomplishments Determined eligibility requirements to access Medicaid funds for the health care needs of juveniles on parole status. Community Actions Conduct lobbying efforts to gain legislative support for this issue. Community Accomplishments Implemented a plan to access federal funds with Title V funds. State legislators have assured juvenile justice officials of their commitment to support this plan. State Actions 1. Organize a statewide task force to develop strategies for obtaining Medicaid funds. 2. Determine key individuals at the state and local levels. 3. Require the task force to define the mission, goals, objectives, and actions required for completing this project. 4. Interpret the federal requirement that restricts use of Medicaid funds for incarcerated youth. 5. Increase the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) periodicity schedule for annual examinations for adolescents. 6. Adjust state policies in order to assure access to Medicaid for eligible youth. State Accomplishments 1. Organized a statewide task force in order to develop strategies for accessing Medicaid funds. 21 22 HEA..TH CARE OF JNCARCERATED YOUTH 2. Identified key individuals at state and local levels and convened a conference with those individuals to determine strategies for obtaining funds. Current Initiatives The Colorado Division of Youth Services is working on a systematic approach in which the state legislature has mandatory access to available funds (including Title IVE) and, eventually, to Medicaid funds. Contact Information Paul A. Targoff Director of Staff Development and Quality Control Colorado Division of Youth Services 3900 South Carr Street Denver, CO 80235 (303) 987-4616 (303) 987-4610 fax STATE PROGRAMS & INITIATIVES 23 Connecticut Goals Improve the health care of incarcerated youth and of youth who are in after- care in local community placement. Goals Met Met All Goals Objectives Build collaborative relationships between public health, corrections, and juve- nile justice systems. Objectives Met Met Some Objectives Program Actions Plans in this area depend upon the outcome of actions at the state level. Program Accomplishments Initiated discussions with members of the juvenile justice programs. Community Actions Plans in this area depend upon the outcome of actions at the state level. Community Accomplishments Implemented a program whereby school-based health centers serve students returning to the community. At this time, Connecticut has centers in only 11 schools. State Actions 1. Arrange meetings between the Department of Health and Human Services' Maternal and Child Health program and the Department of Children and Youth Services to determine the current status of the health care system in community place- ment facilities. 2. Explore areas in which the Department of Health Services could offer assistance, such as training, consultation, and other forms of assistance. 3. Request that the new commissioner at the Department of Health and Human Services become more actively involved in the State Advisory Committee on juvenile justice and Corrections. 4. Encourage the State Advisory Committee on Juvenile Justice to include health issues on its agenda. State Accomplishments 1. Participated on three subcommittees of the Governor's Justice Advisory Committee. 2. Encouraged the State Advisory Committee on juvenile justice to include health on its agenda. 24 HEALTH CARE OF INCARCERATED YOUTH Current Initiatives Connecticut Department of Health and Human Services current initiative focuses on school-based health centers. Contact Information Lynn Letarte Supervisor, School and Adolescent Health Connecticut Department of Health and Human Services 150 Washington Street Hartford, CT 06106 (203) 566-2057 (203) 566-8401 fax STATE PROGRAMS & INITIAnvFs 25 District of Columbia Goals Improve the health of adolescents involved with the juvenile justice system. Goals Met: There was no survey submitted for this state. Objectives Objectives Met: No response received. Program Actions 1. Secure the commitment of Maternal and Child Health Program staff to fur- ther identify and meet with appropriate juvenile justice authorities in the District of Columbia to identify joint mental health/juvenile justice collaborative efforts. A work- ing group will be formed if feasible. 2. Explore (during negotiations for a health/Medicaid interagency agreement) the issue of including Medicaid coverage for youth in the juvenile justice system, following the experience of Massachusetts and other states. 3. Follow through on preliminary efforts by Maternal and Child Health to ensure ade- quate care for all pregnant women and adolescents in the correctional system in the District of Columbia. 4. Foster collaboration between the Maternal and Child Health staff and Maryland staff on the possibility of pilot testing the Hopkins Intake Assessment and staff training module developed by Dr. Linda Thompson. Program Accomplishments: No response received. Community Actions No response received. Community Accomplishments: NO response received. State Actions Form a mayoral level task force on children, youth, and families. State Accomplishments: No response received. Current Initiatives No response received. Contact Information No survey submitted. 31 tin 26 Florida HEALTH CARE OF INCARCERATED YOUTH Goals Study the issue of adolescents under the age of 19 years being placed in the adult forensic mental health system (if judged either incompetent to proceed or not guilty by reason of insanity). Goals Met: There was no survey submitted for this state. Objectives Identify the following data: (1) number of incarcerated youth in the target pop- ulation; (2) placement history for these adolescents; (3) criminal charges; (4) counties; (5) placement to and within facilities; (6) special treatment received, if any; (7) destination of the youth when they leave the current facility; and (8) loss. Objectives Met: No response received. Program Actions 1. Review data from community forensic programs to locate adolescents. 2. Contact programs that serve this population for further information. Program Accomplishments: No response received. Community Actions Review issue with district forensic coordinators. Community Accomplishments: No response received. State Actions 1 Review the forensic database of current residents and admission trends. 2. Contact each of the forensic hospital administrators regarding their perception of prob- lems, special treatment needs (medical, mental health, and dental), and policies con- cerning this population. 3. Contact the chief jail inspector for information about Florida's laws and handling of adolescents in adult jails. 4. Examine documented data regarding age and demographics in jail. 5. Contact Michael Dale about information related to juveniles being certified into adult prosecution. 6. Review forensic statutes and decide whether the department should pursue revisions to Chapter 916,ES. (similar to the guidelines used by civil hospitals). State Accomplishments: No response received. Current Initiatives No response received. 32 STATE PROGRAMS & INITIATIVES 27 Georgia Goals Improve medical services available to adjudicated youth in Georgia. Goals Met: There was no survey submitted for this state. Objectives Advocate for attention to medical care issues as the state of Georgia begins to reorganize its children and youth services delivery system. Objectives Met: No response received. Program Actions Focus on the Atlanta Youth Detention Center as a starting point: 1. Reexamine medical expenditures in order to reallocate resources and improve benefits. 2. Maintain accreditation according to the standards of the Commission on Correctional Health Care and update procedures as revised standards are published. 3. Explore potential linkages with colleges and universities. 4. Report conference recommendations to the Department of Youth Services management. Program Accomplishments: No response received. Community Actions 1. Disseminate conference findings and other relevant data about the health needs of adjudicated and/or incarcerated youth to local commissions on children and youth. 2. Offer to report on the conference to Department of Youth Services d..3trict directors in order to enhance local level medical care (detention and community programs). Community Accomplishments: No response received. State Actions 1. Summarize results of the conference and provide relevant background infor- mation to the Council of Juvenile Court Judges, the Children and Youth Coordinating Council, the governor's office, relevant division directors (mental health, mental retar- dation, substance abuse, public health), and the Department of Family and Children's Services. 2. Explore untapped resources available statewide through colleges and universities. State Accomplishments: No re ponse received. Current Initiatives No response received. 33 @MI.. 28 Hawaii HEALTH CARE OF INCARCERATED YOUTH Goals 1. Increase community awareness of the health issues of confined youth. 2. Begin statewide networking among juvenile corrections officials, health care providers, and the health planner in Hawaii. Goals Met: Met Some Goals Objectives 1. Create an ongoing task force to examine the health status and needs of con- fined youth in Hawaii and to develop recommendations to better meet their needs. 2. Conduct a state conference on incarcerated youth for both the corrections community and the health community. Objectives Met Did Not Meet Any Objectives Program Actions No response received. Program Accomplishments: No response received. Community Actions No response received. Community Accomplishments 1. Reorganized the long-term juvenile correctional facility within the Office of Youth Services. 2. Began working with this new agency to address the health needs of Hawaii's incarcerated youth. State Actions 1. Contact representatives of the departments of youth services, judiciary, health, and human services, and the University of Hawaii, in order to work together as a task force on incarcerated youth. 2. Contact Kapeolarie Medical Center for Women and Children to ask for their help in sponsoring a statewide conference on incarcerated youth. State Accomplishments 1. Reorganized the long-term juvenile correctional facility within the Office of Youth Services. 2. Began working with this new agency to address the health needs of Hawaii's incarcerated youth. 34 STATE PROGRAMS & INITIATIVES Current Initiatives The University of Hawaii School of Medicine is corresponding with administrators in the Office of Youth Services (the office responsible for the long-term correctional facility for youths in Hawaii) on issues related to the physical and mental health of incarcerated youth. The Office of Youth Services has begun a vigorous campaign to create a community network of services for youth (hut includes health services only in the broadest of Lerms). Contact Information Robert Bidwell, M.D. Assistant Professor, Pediatrics Division of Adolescent Medicine, University o!.: Hawaii School of Medicine 1319 Punahou Street Honolulu, HI 96826 (808) 973-838-7 (808) 949-4232 fax 29 30 Idaho HEALTH CARE OF INCARCERATED YOUTH Goals Coordinate a health care initiative between the bureaus of juvenile justice and maternal and child health. Goals Met: Met All Goals Objectives 1. Encourage participation in education/enlightenment by departments, divi- sions, and bureaus within juvenile justice and maternal and child health programs. 2. Promote and encourage interagency collaboration. 3. Establish communication and collaboration between district health departments and regional juvenile justice systems. Objectives Met: Met Some Objectives Program Actions No response received. Program Accomplishments: No response received. Community Actions 1. Contact the American Academy of Pediatrics Subcommittee for Incarcerated Youth. 2. Assign a maternal and child health representative to regional juvenile justice advisory hoards. 3. Contact county commissioners and legislators to increase their awareness of this issue. 4. Establish linkage/liaison with universities. Community Accomplishments 1. Recommended appointment of a maternal and child health representative to regional juvenile justice advisory hoards. 2. Established the Juvenile Justice Advisory Committee which includes representatives from the Idaho Association of Counties, the Sheriff's Association, state legislators, and others. 3. Established linkage/liaison with North Idaho Junior College, Lewis and Clark State College, Boise State University, Idaho State University, and the College of Southem Idaho. State Actions 1. Conduct a statewide needs assessment through a joint effort between juve- nile justice and maternal and child health programs. 2. Arrange a bureau/division forum. 3. Contact the state's youth commission and governor's office for participation in the forum. 4. Place health care issues on the juvenile justice agenda. STATE PROGRAMS &INITIATIVES 31 State Accomplishments 1. Initiated a statewide needs assessment through a joint effort between juvenile justice and maternal and child health programs. 2. Initiated coordination of a bureau/division forum. 3. Contacted Sharon Hixon, Idaho Commission for Children and Youth, to participate in the forum. 4. Placed health care issues on the juvenile justice agenda. Current Initiatives The Idaho Department of Health and Welfare is constructing Idaho's new Juvenile Detention Center. The health of incarcerated youth will be a component as development progresses. Contact Information Simonne deGlee, M.S., P.N.P. Child Health Program Coordinator Bureau of Maternal & Child Health; Idaho Department of Health and Welfare 450 West State Street, 4th Floor Towers Boise, ID 83720-5450 (208) 334-5957 (208) 334-6581 fax 3/ 32 Illinois HEALTH CARE OF INCARCERATED YOUTH Goals Improve collaborative efforts with the legislature, state agencies, and advisory groups to maximize funding options in order to maintain and improve health care services for incarcerated youth and youth on parole. Goals Met: There was no survey submitted for this state. Objectives Involve superintendents more fully in serving on statewide coordinating groups, including Department of Corrections, Department of Mental Health, Department of Children and Family Services, State Board of Education, and Department of Alcohol and Substance Abuse. Objectives Met: No response received. Program Actions 1. Examine different state systems or case management services. 2. Work with individual superintendents to develop their own coalition (i.e., convene more meetings to address specific issues). 3. Address overcrowding in institutions and ensure that health care services are competi- tive with other scarce resources. Program Accomplishments: No response received. Community Actions 1. Form coalitions to apply for funding. 2. Maintain accreditation status and high health care standards. Community Accomplishments: No response received. State Actions 1. Convene a problem-solving/planning work group with sister agencies. 2. Develop a coordinated case management system. 3. Look at long range planning and become proactive regarding identified needs. 4. Maintain the quality of health care services and improve staff training. State Accomplishments: No response received. Current Initiatives No response received. 171 41111/fir/ STATE PROGRAMS & INTTIATIVES Iowa Goals 1. Create an information exchange between maternal and child health institu- tions and state incarcerated youth centers. 2. Determine juvenile justice funding status by May 1991. 3. Share information by fall 1991. Goals Met: Met Some Goals Objectives 1. Include a status report in the state maternal and child health newsletter by fall 1991. 2. Amend or expand juvenile justice funds to target the health issues of incarcerated youth by December 1991. 3. Write SAP# (if necessary) into the Maternal Child Health Block Grant application to be developed for 1992. 4. Continue to develop lines of communication, both instate and with other states. Objectives Met: Met Some Objectives Program Actions 1. Become informed about state standards, American Correctional Association standards, and National Commission on Correctional Health Care standards by March 1991. 2. Develop contacts for information by March 1991. 3. Reach a collaborative agreement by February 1, 1992. 4. Distribute findings by fall 1991. Program Accomplishments The state team conducted a survey to determine the practices or procedures of the various facilities housing incarcerated youth. Written items for a manual were requested along with a narrative of unmet needs faced by programs. This was to lead to an infor- mation exchange, and some information on the issues has been provided to certain facilities. Community Actions 1. Become informed about state standards, American Correctional Association standards, and National Commission on Correctional Health Care standards by March 1991. 2. Develop contacts for information by March 1991. 3. Reach a collaborative agreement by February 1, 1992. 4. Distribute findings by fall 1991. Community Accomplishments Information has been provided by the Iowa Coalition for Comprehensive School Health, the Iowa Department of Public Health, and others to illustrate model community linkages. 33 Fro 3J 34 11111111M1111111111111111111111111111011111111 HEALTH CARE OF INCARCERATED YOUTH Follow-up has not been conducted to determine whether this information has generated action at the community level. State Actions 1. Invite health and incarcerated youth staff to participate, by January 1, 1992, in a collaborative effort with the following groups: Iowa Coalition for Comprehensive School Health Education; Iowa Public Health Association; Iowa Association of Physical Education, Recreation and Dance; Smoke Free 2000; Governor's Council on Physical Fitness and Sports; and Iowa Peer Helper Association. 2. Include an article on this issue in the state maternal and child health newsletter by fall 1991. 3. Design and write an agreement based on a possible pilot program by spring 1992. 4. Submit this to the information clearinghouse by spring 1992. State Accomplishments The state initiated a survey on practices at various facilities for incarcerated youth and has disseminated some of the resulting information. The state has also encouraged vari- ous state organizations to consider the needs of incarcerated youth. Current Initiatives The Iowa Department of Public Health has developed a questionnaire to gain a perspective on 'he health care needs of incarcerated youth. This was a significant help in establishing a dialogue with detention centers, the boys state training school, and the Iowa Juvenile Home. The state Teen Line number for health information and referral was shared with facilities. An adolescent health manual entitled AdolescenceA Continuum: From Childhood to Adulthood is being developed and distributed. Contact Information Tim A. Lane, M.A. Adolescent Health Consultant Lukas Building/State Capitol Des Moines, IA 50319-0057 (515) 281-7833 STATE. PROGRAMS & INITIATIVES 35 Kansas Goals Improve health. care services delivered to incarcerated youth in the state of Kansas. Goals Met: Met Some Goals Objectives Develop an interagency plan for implementing improved health care services for incarcerated youth by January 1, 1992. Objectives Met: Met Some Objectives Program Actions 1. Participate in the development of state standards for the health care of children. 2. Develop a monitoring protocol for health services delivered to incarcerated youth. Program Accomplishments There has been frequent collaboration, by telephone and or -site inspection, concerning health care issues. Maternal and child health consultation se.vices have been provided to Youth and Screening Centers. There has also been participation in developing and coor- dinating standards for child health. Community Actions 1. Initiate health care training programs for staff and youth in institutions. 2. Maximize funding for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) when delivering health care services to incarcerated youth. Community Accomplishments Staff and youth health education programs have been initiated and developed within the community. Cerified nurses are providing EPSDT screenings. State Actions 1. Schedule bimonthly meetings between the Kansas Department of Health and Environment, Division of Family Health, and the Kansas Department of Social and Rehabilitative Youth Services to develop a plan for integrating health care initiatives for each agency. 2. Ensure that health care initiatives for incarcerated youth meet the Healthy People 2000 objectives. 3. Begin negotiations with the university to integrate/share services in social work, medi- cine. nursing, and psychology. 4. Explore funding resources for health care services delivered to incarcerated youth. Oil 36 HEALTH CARE. OF INCARCERATED YOU State Accomplishments The state has ensured that health care initiatives for incarcerated youth meet the Healthy People 2000 objectives. The state has also explored funding resources for health care services for incarcerated youth, and has submitted a grant proposal to improve these services Current Initiatives The Kansas Department of Health and Environment, Child Health and Juvenile Offenders, is standardizing the certification for nurses who provide EPSDT services. The department's nurse consultants are collaborating/consulting with nurses in the Youth Centers and Screening Unit. The state submitted a grant proposal to the federal Maternal and Child Health Bureau to improve health care and services for incarcerated youth. Collaboration/coordination is under way between state agencies and private/public sectors to provide preventive and primary health care services. Contact information Linda Ladehoff, M.N., A.R.N.P. Pediatric Nurse Consultant Kansas Department of Health and Environment, Child Health and Juvenile Offenders 900 Southwest Jackson, Room 1005 Topeka, KS 66612-1290 (913) 296-7433 (913) 296-6231 fax STATE. PROGRAMS & INITIATIVES 37 Kentucky Goals Provide quality health care to securely detained juveniles in Kentucky. Goals Met: There was no survey submitted for this state. Objectives Assess current health care in juvenile detention centers and juvenile holding facilities. Objectives Met: No response received. Program Actions No response received. Program Accomplishments: No response received. Community Actions No response received. Community Accomplishments: No response received. State Actions 1. Questionnaires will be sent to directors of two juvenile detention centers and 11 juvenile holding facilities to ascertain the services provided, service providers, available financing, and standards followed. 2. Data will be compiled and reported to the interagency committee on juvenile detention. State Accomplishments: No response received. Current Initiatives No response received. Contact Information No survey was submitted. wipmlp mow. 43 38 HEALTH CARE OF INCARCERATED YOUTH Louisiana Goals Improve the quality of care for incarcerated youth. Goals Met: Met Some Goals Objectives 1. Develop statewide coordination and consistency in adolescent care. 2. Develop a network of health care providers for the provision of services. 3. Reevaluate the ability to compete with the private sector in the hiring of nurses. Objectives Met: Met Some Objectives Program Actions 1. Improve recruitment of health care workers to increase the quality of care. 2. Obtain information about accreditation. 3. Obtain information about standards and state regulations. Program Accomplishments: No response received. Community Actions 1. Develop a reciprocal working relationship between local universities and institutions to provide or expand services. 2. Develop a network with other state and local agencies and private providers to com- plement present services and provide a comprehensive system of care. Community Accomplishments: No response received. State Actions 1. Complete a comprehensive self-study to determine needs for prevention, intervention, and follow-up of adjudicated youth. Examine present status and future needs. 2. Complete a review of the literature to determine standards of care that meet the identified needs. 3. Explore and pursue alternate funding sources. State Accomplishments: No response received. Current Initiatives The Juvenile Reception and Diagnostic Center is conducting a self-evaluation to prepare to meet the necessary requirements for accreditation by the American Corrections Association as a first step toward providing a good basic level of care. STATE PROGRAMS & irirnAinvFs 111111111111111!. 39 Contact Information Barbara M. Gagneaux Director, Nursing Services Juvenile Reception and Diagnostic Center Post Office Box 116 Baton Rouge, LA 70714 (504) 774-7720 40 Maine HEALTH CARE OF INCARCERATED YOUTH Goals Improve the health of youth who are incarcerated. Goals Met: Met Some Goals Objectives 1. Identify the unmet health care needs of this population. 2. Establish a coalition of state and private groups to address the health care needs of incarcerated youth. Objectives Met: Met Some Objectives Program Actions 1. Identify the current methods of providing health care services in Maine, including assessment, treatment, and preventive activities, by (a) contacting personnel at the Maine Youth Center and identifying the ways in which health care is being pro- vided; (b) identifying standards and protocols used; and (c) identifying state qualifica- tions and continuing education needs. 2. Develop a plan to address and identify needs. Program Accomplishments 1. Met with the director of the health care facility for the Maine Youth Center. 2. Identified the standards and protocols used. On the day of admission, the center's registered nurse conducts health screening, including a physical examination, medical history, suicide ideation, and mental health status. A visit with the physician is sched- uled within a week, and a psychiatric evaluation is provided for all youth who are committed or referred by the court. A substance abuse assessment is made, and hear- ing, vision, speech, and language screening is conducted. The American Academy of Pediatrics standards of care are used. 3. Identified areas that require continuing education efforts including parenting classes and childbirth education for pregnant and parenting youth. 4. Developed a plan to address and identify needs; the Division of Maternal and Child Health planned to conduct an out-of-school health needs assessment and survey this population the following year. Community Actions No response received. Community Accomplishments: No response received. State Actions Contact the following groups to encourage coalition building: Juvenile justice Advisory Committee; Maine Chapter of the American Academy of Pediatrics; Department of Mental Health and Mental Retardation; Substance Abuse; Bureaus of Health (Maternal tin STATE PROGRAMS & INITIATIVES and Child Health, AIDS, Sexually Transmitted Diseases, Dental, and Disease Control); and Medicaid. State Accomplishments: No response received. Current Initiatives No response received. Contact Information DeEtte Hall Director, Teen & Young Adult Health Program Department of Human Services; Division of Maternal & Child Health State House Station 11 Augusta, ME 04333 (207) 287-5361 (207) 287-4172 fax 41 mipmeip 4140, 4 y1 42 HEALTH CARE OF INCARCERATED YOUTH Maryland Goals Improve the health of adolescents involved with the juvenile justice system. Goals Met: Met Some Goals Objectives No response received. Objectives Met: Did Not Meet Any Objectives Program Actions No response received. Program Accomplishments The Instrument for Adolescent Health Status Measurement has been used by nurses and nonprofessional staff in the Division of Juvenile Services, and has been reviewed for use in the community. Community Actions 1. Present to the Secretary for Children, Youth and Family the Instrument for Adolescent Health Status Measurement and the training module for youth workers (developed through a previous grant from the Maternal and Child Health Bureau). Pilot test the assessment tool in at least one state juvenile justice facility to focus atten- tion on the issue of systems change. 2. Explore with District of Columbia staff the possibility of pilot testing the Instrument for Adolescent Health Status Measurement in one of the District of Columbia's facilities. Share the project materials with the District of Columbia Public Health staff. 3. Reexamine the issue of Medicaid coverage as Maryland moves ahead with its commit- ment to privatization and to instate community-based juvenile justice residential treat- ment services. 4. Consider Maryland's preliminary efforts to implement the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) expanded service provision, mandated by the Omnibus Budget and Reconciliation Act of 1989, as a way to maximize federal support for needed specialized services such as mental health for the population in the juve- nile justice system. 5. Examine the Instrument for Adolescent Health Status Measurement as a way to facili- tate continuity of information for this population as it moves from residential to com- munity based to aftercare status. Community Accomplishments The Instrument for Adolescent Health Status Measurement is currently being utilized. State Actions No response received. STATE PROGRAMS & INITIATIVES State Accomplishments Issues concerning Medicaid coverage have been reexamined. Current Initiatives The Maryland State Department of health and Niental Hygiene has provided continued availability to the Division of juvenile Services. Contact Information Genie L. Wessel Consultant School/Adolescent Health; Maryland State Dept of Health and Nlental Hygiene 201 West Preston Street, Room 321A Baltimore, MI) 21201 (301) 225-6748 Marianne E. Felice, M.D. Chief, Division of Adolescent Medicine Department of Pediatrics; tniversity of Nlarvland 31 S. Green Street, 3rd Floor Baltimore, MI) 21201 (410) 328-4195 (410) 328-0131 fax 43 44 Massachusetts HEALTH CARE OF INCARCERATED YOUTH Goals Improve the quality of health and mental health care for youth placed in the custody of the Department of Youth Services. Goals Met: Did Not Meet Any Goals Objectives Strengthen collaboration between the Department of Youth Services and the Department of Public Health, the Maternal and Child Health staff, the staff of the Children's Division of the Massachusetts Department of Mental Health, and private providers. Objectives Met: Did Not Meet Any Objectives Program Actions 1. Include health maintenance goals in the Department of Youth Services plans for youth who are returning home. 2. Improve follow-up of juveniles released from detention by referring to Maternal and Child Health-funded programs or-other health programs. 3. Improve mental health consultation services for the Department of Youth Services concerning staff/juvenile interactions. 4. Improve the value of mental health treatment recommendations through providing better training for mental health professionals on the methods of operation and the capacity of various programs. Program Accomplishments: No response received. Community Actions Raise awareness (among coalitions that advocate for or deliver adolescent health services) concerning health care issues for juveniles in the Department of Youth Services system. Community Accomplishments: No response received. State Actions 1. Identify existing interagency groups that deal with children's issues, and place the Department of Youth Services on the agenda. This may he the Adolescent Health Council. Add the Department of Youth Services providers to the group. 2. Explore accreditation. 3. Explore the possibility of Medicaid funding beyond health services to include actual reimbursement for program costs. 4. Ask the Department of Public Health to provide a complete listing of its funded ado- lescent services to the Department of Youth Services. STATE. PROGRAMS & INITIATIVES 45 5. Ask the Department of Youth Services to provide a reciprocal complete list of its fund- ed adolescent services to the Department of Public Health. State Accomplishments: No response received. Current Initiatives The Massachusetts Department of Youth Services is collaborating with Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, including issues related to managed care. Contact Information Gary Shostak, M.P.H. I./ Director of Health Services M.A. Dept of Youth Services: Fort Point Place 27-43 Wormwood Street Boston, MA 02210 (617) 727-7575 (617) 951-2409 fax 46 HEALTH CARE OF INCARCERATED YOUTH Michigan Goals Improve communication about the health issues of incarcerated youth. Goals Met: There was no survey submitted for this state. Objectives 1. Identify key resource persons in juvenile justice and comprehensive health at the state level. 2. Develop a mechanism for discussion of issues among state agencies. Objectives Met: No response received. Program Actions 1. Analyze the current status of resources for health with respect to standards for incarcerated youth. 2. Provide materials on the number and location of incarcerated youth and those in the juvenile justice system. 3. Recommend measures for health needs that are currently unmet, and the costs to pro- vide optimum care. 4. Advocate within the state agency for services needed at the local level. Program Accomplishments: No response received. Community Actions 1. Provide reports at the state level on health issues and resources, and suggest ways to resolve or coordinate services locally. 2. Inform the state about local alliances that are successful in meeting health care needs. Community AcComplishments: No response received. State Actions 1. Schedule a discussion topic by the state interagency Adolescent Health Steering Committee at the Michigan Department of Public Health to increase aware- ness of status and issues over the next year. 2. Include regular participation on the steering committee, by November 1, 1991, of a representative of the state agency with primary responsibility for juvenile justice. 3. Explore the possibility of incorporating the health needs of youth in the juvenile justice system within the plans for health care delivery for children in the state. State Accomplishments: No response received. Current Initiatives No response received. 52 STATE PROGRAMS & INITIATIVES Minnesota Goals Develop interstate collaboration for specialized services between the Department of Correction and the Department of Mental Health. Goals Met: Met Some Goals Objectives Develop culturally competent drug and alcohol treatment programs for Native Americans (who comprise 15 percent of the state's juvenile population). Objectives Met: Met Some Objectives Program Actions I. Provide culturally specific programs at one site to serve the Native American populations of Minnesota, Wisconsin, North Dakota, South Dakota, and Indiana. 2. Recruit and train Native American counselors to provide care and treatment and to serve as role models within the community. Program Accomplishments: No response received. Community Actions Provide resources such as buildings and other capital equipment within the Native American community. Community Accomplishments Provided resources within the Native American community and a reasonable model for the state as a whole. State Actions 1. Provide funding sources through the Office of Drug Policy, Bureau of Indian Affairs, and the Department of Corrections. 2. Encourage participation of other states through development of interstate compact agreements. State Accomplishments: No response received. Current Initiatives The Hannepin County Medical Center has obtained an increased commitment from the University of Minnesota's Department of Pediatrics to provide educational time for the study of the health problems of incarcerated youth. The quality assurance compo- nent of data selection has been improved. 53 47 [ircH ulp 4111141. Vat vs* 48 HEALTH CARE OF INCARCERATED YOUTH Contact Information George R. Noren, M.D. Medical Director Juvenile Justice Department; Hannepin County Medical Center 701 Park Avenue South Minneapolis, MN 55415 (612) 347-2680 (612) 347-2438 fax 54 STATE PROGRAMS 8 INITIATIVES Mississippi 49 1CM111110111111111116110111=1111111 Goals Improve the quality of health care for youth who are incarcerated. Goals Met: There was no survey submitted for this state. Objectives Develop a network among health care professionals, public officials, legislators, administrators, and community leaders to address the importance of health care for incarcerated youth. Objectives Met: No response received. Program Actions 1. Obtain information about state standards and state regulations. 2. Obtain and disseminate information on national standards to appropriate persons. 3. Inform health officials and others about accreditation requirements. 4. Work to ensure that primary health care is provided to youth who are incarcerated. 5. Report and disseminate information from this conference to the director of the Department of Human Services. Program Accomplishments: No response received. Community Actions 1. Involve youth health care advocates in issues related to incarcerated youth. 2. Inform community leaders, church groups, and nonprofit organizations about the health care issues of incarcerated youth. Community Accomplishments: No response received. State Actions 1. Involve the state advisory group in health care for incarcerated youth. 2. Inform heads of administration about standards. 3. Inform the state's Attorney General about liability when minimal health for incarcerated youth are not met. 4. Include training at a statewide conference of court personnel who deal the juvenile justice system. State Accomplishments: No response received. care standards with youth in Current initiatives No response received. 55 50 HEALTH CARE OF INCARCERATED YOUTH Missouri Goals Bring definitive, comprehensive health care services to Missouri's high-risk and incarcerated youth in accord with the American Medical Association and American Corrections Association standards. Goals Met: Met Some Goals Objectives Develop an interagency plan by February 1992 for coordinated efforts between detention and placement facilities and child care agencies around the state with respect to minimal comprehensive health care standards. Objectives Met: Met Some Objectives Program Actions Develop information and education services for the following critical areas that affect the health of youth: parenting skills (for youth and parents of youth), single moth- ers and prenatal care, abused children, nutritional standards, substance abuse, sexually transmitted diseases, and dental health. Program Accomplishments: Each facility/program operated by the Division of Youth Services is developing local pro- cedures to meet the National Commission for Correctional Health Care standards. Community Actions 1. Obtain the assistance and participation of local university campuses. 2. Coordinate efforts with local public health officials. Community Accomplishments: No response received. State Actions 1. Contact the director of the State Department of Public Health to ascertain the current status of programs and to avoid duplication of effort: (a) Designate a chief or director of state services to youth (if no one is currently serving in that capacity); (h) check the status of the state standards to ensure compliance with those recommended by the American Medical Association and the American Corrections Association; and (c) provide health services education and counseling. 2. Check with Missouri's Juvenile Justice Association and tap into the information exchange between the state's youth facilities. State Accomplishments The Division of Youth Services has (E/eloped a comprehensive policy and procedures manual based on the National Commission on Correctional Health Care standards, and is implementing these policies and procedures in residential facilities and day treatment programs. 5ti Fri STATE PROGRAMS & INITIATIVES Current Initiatives The Division of Youth Services is (1) implementing training for staff and students concerning HIV/AIDS; (2) implementing a training program to certify certain staff in all Division of Youth Services programs as medication aides, and (3) planning a quality assurance program utilizing existing medical staff. The juvenile Detention Center is developing a close working relationship with the City Department of Public Health including collaboration of presentations, discussions, and group programs regarding sexually transmitted diseases, lead poisoning, and AIDS. In addition the Detention Center is establishing in-house dental services. They obtained donated and state surplus dental equipment and contracted services of dentists. They are also developing in-house policy on HIV; AIDS and the training of supervisory registered nurses. Contact Information Mark D. Steward Director Division Of Youth Services P.O. Box 447 _Jefferson City, MO 65102-0447 (314) 751-3324 Ronald L. Pohl& Superintendent of Detention 22nd Judicial Circuit of Missouri 3847 Enright Avenue St. Louis, MO 63108 (314) 531-3600 (314) 531-1248 fax 5r 51 1.* lap ay Ow I* II* 52 Montana HEALTH CARE OF INCARCERATED YOUTH Goals Enhanc° or develop a mental health service delivery system for the incarcerated youth population. Goals Met: There was no survey submitted for this state. Objectives 1. Use existing services and eliminate duplication of services where possible. 2. Develop minimal (baseline) medical and psychological standards. 3. Enhance mental health/substance abuse needs assessment for the incarcerated youth population. Objectives Met: No response received. Program Actions Identify program voids and determine the fiscal and geographical potential for resolving them. Program Accomplishments: No response received. Community Actions Raise awareness about the health needs of incarcerated youth in order to develop a community constituency for support and advocacy. Community Accomplishments: No response received. State Actions 1. Use an interagency coordinated network for relevant state services for incarcerated youth. 2. Develop interagency agreements to ensure cooperation. 3. Intensively pursue university internship programs. State Accomplishments: No response received. Current Initiatives No response received. Contact Information No survey submitted. 56 mit STATE. PROGRAMS & INITIATIVES 53 Nebraska Goals Develop an effective interface between the Nebraska Department of Health and the Nebraska Juvenile Justice System. Goals Met: Did Not Meet Any Goals Objectives 1. Provide health education by February 1992. 2. Provide HIV testing and counseling by February 1992. 3. Ensure that health care for incarcerated youth meets the Healthy People 2000 objectives by February 1992. Objectives Met: Did Not Meet Any Objectives Program Actions 1. Contact Department of Health personnel (Centers for Disease Control and Prevention and county health departments); designate subjects to be covered (what, when, where, and how); and designate teaching methods and teachers. 2. Contact the Nebraska Department of Health to arrange for nurses in Geneva and Kearney to draw blood and provide HIV testing and counseling, and establish confi- dentiality requirements. 3. Develop interagency relationships with maternal and child health programs to set up health screening and education, including immunizations, testing for sexually transmit- ted diseases, and issues concerning sex education, teenage pregnancy, smoking, family planning, and violence prevention. Apply for grant funding. Program Accomplishments: No response received. Community Actions No response received. Community Accomplishments: No response received. State Actions Develop an interagency planning committee including state and community representatives. State Accomplishments: No response received. Current Initiatives No response received. 5" 54 IMMINNOWil HEALTH CARE OF INCARCERATED YOUTH Contact Information Elizabeth R. Westover, R.N. Child and Adolescent Nurse Specialist Department of Health; 301 Centennial Mall South Lincoln, NE 68509 (402) 471-0197 (402) 471-0383 fax STATE PROGRAMS & INITIATIVES 55 Nevada Goals Improve the health care and medical follow-up systems for Nevada's incarcerated youth. Goals Met: Met Some Goals Objectives Form an interagency work group to address the health care needs of this population. Objectives Met: Met Some Objectives Program Actions 1. Designate the Department of Youth Services as the lead agency to coordi- nate the work group. 2. Ensure participation by correction facility nurses in community health nurse traininglworkshops conducted by the state Health Division. Program Accomplishments Enhanced communication by adding the list of youth facility nurses to the Health Division mailing lists. Community Actions 1. Increase communication between facility nurses, community health nurses. and community health centers located in local population centers. 2. Promote the involvement of the Office of Rural Health. Community Accomplishments Contracted for a part-time medical care professional for the youth detention facility. State Actions 1. Form a work group by the Youth Services Division with representation from the state Health Division's maternal and child health program. 2. Promote ties with the Governor's Juvenile justice Advisory Group. Governor's Advisory Council on Youth, and Governor's Maternal and Child Health Advisory Board. State Accomplishments Contracted for a part-time medical care professional for the youth detention facility. Current Initiatives No response received. 61 56 HEALTH CARE OF INCARCERATED YOUTH Contact Information Daniel Prince Chief of Planning and Programs Nevada Youth Services 505 E King Street, Suite 101 Carson City, NV 89710 (702) 687-5982 Launa Ritch Health Educator Nevada State Health Division 505 East King St., Room 205 Carson City, NV 89710 (702) 687-4885 Karen Mowery, R.N., B.S.N. Corrections Nurse Nevada Youth Training Center P.O. Box 469 Elko, NV 89801 (702) 738-7182 62 STATE PROGRAMS & INITIATIVES 57 New Hampshire Goals Improve the availability of comprehensive medical/dental care for the popula- tion served by the Division for Children and Youth Services. Goals Met: Met Some Goals Objectives 1. Provide standards developed by the National Commission on Correctional Health Care to the Ann Norris Youth Development Center and the Scott McLain Youth Service Center. 2. Meet with the National Commission on Correctional Health Care to develop sensitivity concerning medical issues and the need for advocacy. 3. Explore with the Department of Health Services the possibility of collaborative efforts to change Medicaid eligibility. 4. Include medical issues in training and new staff orientation. Objectives Met: Met Some Objectives Program Actions 1. Collaborate with Vermont on the health care of incarcerated youth. 2. Encourage the Juvc ife Justice Advisory Committee to increase community sensitivity to medical issues of incarcerated youth. Program Accomplishments 1. Supplied National Commission on Correctional Health Care standards to youth devel- opment center and youth services center medical staff. 2. Addressed Medicaid eligibility issues. 3. Added a .omponent on medical issues to the staff training curriculum and new staff orientation. Community Actions 1. Locate key contact persons in maternal and child health within the state. 2. Apply for additional funding for medical care. 3. Seek authority and funding for screening/diagnosis and immunization. Community Accomplishments 1. Sought additional funding for medical care. 2. Simplified the ancillary payment system. State Actions No response received. State Accomplishments 1. Sought additional funding for medical care. 63 58 2. Simplified the ancillary payment system. IIFALTH CARE OF INCARCERATED 'MINH Current Initiatives The Division of Children and youth Services is updating health care and med- ical regulations to bring them into compliance with standards for accreditation. Issues concerning sexually transmitted diseases, I IIV infection, and general health awareness are being addressed on intake and through education within the programs and life skills classes. Through training, staff are becoming more aware of the importance of health issues. Contact Information John J. Sheridan Administrator, Bureau of Residential Services Division for Children and Youth Services 45 South Fruit Street Concord, NI I 03301 (603) 271-5945 STATE PROGRAMS & INITIATIVES 59 New Jersey Goals Improve quality of health care for all youngsters served by the Division of Juvenile Services, Department of Corrections. Goals Met: Met Some Goals Objectives 1. Obtain a Memorandum of Understanding between Department of Health and Department of Corrections, juvenile Division. 2. Develop expertise in finding funding for care. Identify the staff members who will be sources of information. Objectives Met: Met Some Objectives Program Actions 1. Obtain information regarding heaith care standards for Division of Juvenile Services population with special emphasis on standards used in Massachusetts. 2. Set up meetings between Juvenile Division and State Department of Health representa- tives to explore cooperative ventures. 3. Work to get eligible youths on medical reimbursement and identify related administra- tive costs jointly with State Department of Health and Division of Juvenile Services. 4. Explore resources with state colleges and universities, including University of Medicine and Dentistry. S. Identify existing resources (including federal, state, regional, and local). Program Accomplishments 1. Obtained information regarding health care standards for Division of Juvenile Services, Department of Corrections (DJS) population with special emphasis on standards used in Massachusetts. "). Recommended actions for 1992 included State Department of Health (SDOH) staff pur- suing the identification of appropriate standards. 3. Preliminary review of Medicaid reimbursement standards indicated barriers based on federal definition of "institution" and state budget restrictions. This issue, among others, is being examined by the Governor's Action Group. -+. Scheduled orientation meeting to orient Department of Corrections (DOC) personnel to existing accessible health services. Obtained national standards on health care for sentenced youth. Community Actions 1. Form coalitions for interested parties and advocate for improved health care for Division of Juvenile Services. 2. Link Division of juvenile Services clients with school based youth services in their community. 3. Develop substance abuse awareness sources to prevent alcohol and drug problems. 6 60 HEALTH CARE OF INCARCERATED YOUTH Community Accomplishments 1. Worked to get eligible youth on medical reimbursement. Identified related administra- tive costs. 2. Participated in cross-service system coalitions to advocate for justice-involved children's needs, including case assessment review teams and county inter-agency coordinating councils to review cases and class-level issues concerning the service needs of "multi- agency" youth. 3. Linked DJS clients with school-based youth services programs in their community. 4. Convened a preliminary meeting between DOC and DHS staff. 5. Considerable progress was made in expanding access of DJS programs to the Substance Abuse Awareness Initiative (SARI). This comprehensive early intervention campaign for justice-involved youth transient across service systems includes provision of a standardized Substance Abuse Awareness curriculum, social influence strategies, staff development and a health media campaign. 6. Jointly (DJS and SDO1D explored resources with state colleges and universities includ- ing the University of Medicine and Dentistry, in New jersey. 7. Case Assessment Review Teams and County Inter Agency Coordinating Councils reviewed case and class-level issues concerning needs of sentenced youth. 8. An early intervention campaign for youth involved in the justice system, Substance Abuse Awareness Initiative, has been developed and in-serviced with DJS staff. State Actions 1. Involve State Interagency Coordinators Committees in an attempt to use resources of agencies outside Division of juvenile Services to improve standards for Division of Juvenile Services. 2. Develop expertise in finding funding for care. Identify the staff members who will he the sources of information. 3. Work to get eligible youth on medical reimbursement and identify related administra- tive costs jointly with State Department of Health and Division of Juvenile Services. 4. Explore resources with state colleges and universities, including University of Medicine and Dentistry. 5. Identify existing resources, (including federal, state, regional and local). 6. Bring to the attention of state legislators and the governor's office the need for changes in Medicaid reimbursement practices and regulations including changes in federal and state regulations. 7. Develop a working relationship between Division of Juvenile Services and the agency adminstering Title XIX (Medicaid) with an objective to increase eligibility and access for Division of juvenile Services clients. State Accomplishments 1. Convened a Governor's Action Group on juvenile Justice which was chaired by the Attorney General. Participation included the Commissioners of Health, Human Services, Education, Corrections, Labor, Community Affairs and the Public Advocate. The group's mandate focused on justice-involved youth and the development of com- munity-based services for them through a variety of cost-effective strategies. 2. Initiated preliminary steps toward developing a formal memorandum of agreement regarding health care services for youth residing in DjS Community Programs. Initiated preliminary discussions with several medical schools and the Department of Human Services office responsible for Medicaid funds have taken place in order to identify funding for care. 66 STATE PROGRAMS & INITIATIVES 61 3. Convened a subcommittee of the Family Net Inter-Agency Coordinating Council to develop a funding stream analysis in order to maximize blended funding and joint planning for our joint populations. 4. Exploration of the needed changes in Medicaid reimbursement practices issues is being accomplished by the Governor's Cabinet Action Group. The federal Office for Juvenile Justice and Delinquency Prevention has granted the American Correctional Association funds to train states in funding strategies for justice-involved juveniles including Medicaid fund retrieval. New Jersey has requested and been granted partici- pation in this training. 5. Formed Governor's Cabinet Action Group and plan on exploring ways to use resources of agencies outside DJS to improve standards for DJS clients. 6. Contacted the state university to provide training to providers and health services to clients. A method of payment has yet to be decided. Current Initiatives New Jersey Department of Health current initiatives include preventive child health services; pediatric primary care projects; Sudden Infant Death Syndrome Resource Center; dental health services, including Save Our Smiles Fluoride Mouthrinse Program and Baby Bottle Tooth Decay Cup Project; and New Jersey Child Health Regional Network. Contact Information Catherine Lucas Program Development Specialist Office of Policy Analysis & Planning New Jersey State Department of Corrections CN 863 Trenton, NJ 08625 (609) 292-9424 (609) 633-2112 fax Margaret Gregory, M.D., F.A.A.P. Coordinator, Child Health Program New Jersey State Department of Health 363 West State Street Trenton, NJ 08625 (609) 292-5616 (602) 292-3580 fax 4111411, Imik yip 62 HEALTH CARE OF INCARCERATED YOUTH New Mexico Goals Improve the quality of health care for incarcerated youth. Goals Met: Met Some Goals Objectives 1. Develop collaborative working relationships with persons involved in child health care. 2. Develop better coordinated health care delivery for incarcerated youth. 3. Increase awareness of the need for quality health care for incarcerated youth. Objectives Met: Met Some Objectives Program Actions 1. Educate juvenile justice health care professionals and legislators concerning the health care needs of incarcerated youth. 2. Identify state, local, and university personnel who are (or should be) involved in health care for incarcerated youth and meet to begin the process of collaboration. Program Accomplishments: No response received. Community Actions 1. Obtain the participation of counties in developing and implementing deten- tion standards, and work with associations of counties. 2. Obtain the participation of counties in a statewide detention study, including a study of health care services and needs in local detention facilities. Community Accomplishments 1. Increased awareness of the need for quality health care for incarcerated youth. 2. Began to develop collaborative working relationships. State Actions 1. Develop a working relationship between the health department (maternal and child health staff), New Mexico Youth Authority, and the university medical school concerning health care for incarcerated youth. 2. Incorporate input from health care professionals into state advisory committees and the New Mexico Youth Authority. 3. Meet with medical school representatives to discuss access to grant funds. 4. Develop statewide detention standards that include health care. 5. Conduct a study of juvenile detention including health care needs. 6. Develop collaborative efforts among state agencies, the university, the Indian Health Service, Bureau of Indian Affairs, and Native American jurisdictions regarding health care for incarcerated Native American youth. 66 STATE PROGRAMS & INITIATIVES 63 State Accomplishments 1. Increased awareness of the need for quality health care for incarcerated youth. 2. Began to develop collaborative working relationships to identify persons who should be involved in this process. Current Initiatives The Office of Juvenile Justice Program, New Mexico Youth Authority, received grant funds from the Office of Substance Abuse Prevention for improved treatment. These funds are being used to provide substance abuse treatment to youth in reintegra- tion centers. The University of New Mexico Family Practice Center is placit.e. medical trainees in juvenile correctional facilities. Contact Information Richard Lindahl Juvenile Justice Specialist Office of Juvenile Justice Program: New Mexico Youth Authority 435 St. Michaels Drive Santa Fe, NM 87501 (505) 827-7545 (505) 827-7522 fax 69 fie. Owdow wool* 64 HEALTH CARE OF INCARCERATED YOUTH New York Goals Improve the quality and access of health, education, and social services for incarcerated youth. Goals Met: There was no survey submitted for this state. Objectives 1. Develop a network of state agencies to work collaboratively on a statewide plan for adolescent health services. 2. Identify funding resources. 3. Establish a statewide network for monitoring services on an ongoing basis. Objectives Met: No response received. Program Actions 1. Establish a statewide network to review local, state, and national regulations and make recommendations for change. Include representatives from health, social services, and education. 2. Develop a referral/follow-up mechanism for youth after discharge from the criminal justice or juvenile justice system. 3. Develop a curriculum that specifically addresses the health care needs of youth in the criminal justice system. 4. Provide training, education, and technical assistance to staff working in youth facilities. 5. Develop an evaluation mechanism for monitoring program effectiveness. 6. Increase recruitment of qualified health personnel. Program Accomplishments: No response received. Community Actions 1. Establish a community advisory committee. 2. Form coalitions and advocacy groups to seek alternative resources and to lobby for new legislation. 3. Increase community awareness and linkage with other community-based health and human service organizations. Community Accomplishments: No response received. State Actions 1. Request additional funds to ensure provision of quality health care services. 2. Identify a state liaison to work with the various correctional systems. 3. Assess the adequacy of state-allocated funds for incarcerated youth health services (compared to funds for other youth services throughout the state). State Accomplishments: No response received. U STATE PROGRAMS & INITIATIVES 65 Current Initiatives No response received. Contact Information No survey received. 71 66 HEALTH CARE OF INCARCERATED YOUTH North Carolina Goals Increase medical and mental health services available to incarcerated youth. Goals Met: There was no survey submitted for this state. Objectives 1. Make known the health needs of juveniles at the time they are detained. 2. Strengthen linkages between agencies serving juveniles and area mental health agencies/primary- care providers. Objectives Met: No response received. Program Actions 1. Identify gaps in the comprehensive health care program. 2. Identify a desirable holistic health profile for each youth. 3. Establish a feedback mechanism to provide updates on missing resources to the com- munity and the state. Program Accomplishments: No response received. Community Actions 1. Assess linkages that may already exist at the community level. 2. Amend community-based alternatives and juvenile justice indicators to include health statistics on juveniles. Community Accomplishments: No response received. State Actions 1. Compile health statistics on _retained and incarcerated youth. Set up a system for routine data collection. 2. Publicize the health needs of the target group within the health community (pediatri- cians, medical schools, and others). 3. Develop a health care plan with policy statements. State Accomplishments: No response received. Current Initiatives No response received. Contact Information No survey received. STATE PROGRAMS & INITIATIVES 67 North Dakota Goals Begin collaboration between the North Dakota Division of Juvenile Services and the North Dakota Division of Maternal and Child Health. Goals Met: Met All Goals Objectives Ensure that division directors/representatives hold quarterly meetings to improve coordination and integration of services. Objectives Met: Met All Objectives F'rogram Actions 1. Initiate assessments of the health care offered in individual agencies/institutions. 2. Review existing educational and nutritional services. 3. Share training expertise. Program Accomplishments Assessed level of health care offered in individual agencies/institutions. Community Actions 1. Develop collaboration with the local public health agency, the juvenile com- munity, private facilities, and juvenile probation staff. 2. Ascertain whether local medical and nursing schools can assist in providing shared learning experiences through preceptorships. 3. Improve utilization of staff to avoid duplication of services. Community Accomplishments Established collaboration with the public health agency, the juvenile community, private facilities, and juvenile probation staff. State Actions 1. Share services offered by the state health department with individual juvenile facilities. 2. Investigate ways to improve utilization of Medicaid funds for incarcerated youth. State Accomplishments Scheduled routine meetings between Maternal and Child Health and Juvenile Services Division directors to discuss ways to improve coordination and integration of services. Current Initiatives No response received. 73 68 HEALTH CARE OF INCARCERATED YOU'D.' Contact Information Vonnie Ereth Community Health Nurse State Department of Health 221 N. Fifth, P.O. Box 5503 Bismarck, ND 58502 (701) 222-6512 7 4 STATE PROGRAMS & INITIAITVES 69 Ohio Goals Establish comprehensive health care services for all incarcerated youth. Goals Met: Met Some Goals Objectives Identify specific issues. Objectives Met: Met Some Objectives Program Actions Follow the results of state actions: (1) secure funding; (2) look for qualified staff to implement actions; (3) develop quality assurance/monitoring; (4) develop a managed care system; and (5) provide ongoing education/awareness activities around the state for different disciplines. Program Accomplishments Provided ongoing education/awareness activities in different disciplines at the state level. The Ohio Department of Health held five educational/awareness opportunities (a state- wide conference called "Sharing Days" and four Regional Child Health Workshops) to promote the Children's Health Issues Program, an initiative to address health-related problems of incarcerated youth. Community Actions 1. Follow the results of state actions. 2. Participate in a conference task force (see below). Community Accomplishments: No response received. State Actions 1. Hold a pt obletn-solving conference hosted by the governor's office to raise issues and deal with problems. Invite key administrators and policymakers from the Department of Youth Services, juvenile justice system, state association leadership, Department of Youth Services Superintendents (correction facilities), state association of child advocates, Ohio Legal Rights/Attorney General's office, legislators, Ohio Department of Education-Division of Special Education, Department of Health, County Health Care Association, the state Academy of Pediatrics and Family Practice, Department of Alcohol and Drug Addiction Services, Department of Mental Health, and Department of Human Services. 2. Secure funding sources for the conference (grants, host agencies, Robert Wood Johnson Foundation, other foundations, state agencies, state auditor's office, Ohio Juvenile Justice Department. maternal and child health). 3. State the reasons for convening the meeting in compelling terms. 4. Develop a problem-solving and planning task force/work group after the initial confer- ence to continue to work on specific issues and to ensure ongoing coordination. 75 70 HEALTH CARE OF INCARCERATED YOUTH 5. Develop a policy for implementation at the local level. 6. Hold regional meetings for education/awareness and information sharing at state and local levels. 7. Develop procedures for access to better care. 8. Coordinate provision of specialized care. State Accomplishments 1. Developed a policy for implementation at the local level. z. Established a memorandum of understanding between the Ohio Department of Health, Ohio Department of Rehabilitation and Corrections, and Ohio Department of Youth Services. 3. Developed procedures for access to better care. 4. Held discussions between Ohio Department of Health and Ohio Department of Youth Services personnel concerning new procedures. (No formal proposals or procedures have been introduced to date.) 5. Established, under the leadership of the Ohio Department of Youth Services, a Statewide Networking Meeting on Offenders with Mental Retardation/Developmental Disabilities. The group, which seeks to recommend appropriate programming and services for this special population, includes participants from concerned state, city, county, and private agencies. The Ohio Department of Health participates in and strongly supports the efforts of the group, which has been meeting during the past two years. Current Initiatives The Children's Health Issues Program initiative promotes communication and cooperation between the criminal justice and health care systems in the state of Ohio through teaching, communication, and information sharing at confinement facilities. The project informs prerelease incarcerated parents, adults, and youth about available health clinics in their local communities that will serve their children and other family members. Parents are encouraged to access public health clinics after discharge. Incarcerated per- sons and their family members often lack knowledge of basic health care principles; many incarcerated adults and adjudicated youth lack information about community resources that can provide preventive health care services for their children. Compounding this problem is a lack of coordination among state health, correctional, and social service agencies which are designated to meet the needs of the incarcerated population. To promote better cooperation, a memorandum of understanding established a program policy that brought together three state agencies to improve preventive health care for children and to maximize limited resources. Contact Information Penny Madry Bureau of Maternal and Child Health. Ohio Department of Health 246 N. High Street. 6th Floor P.O. Box 0118 Columbus. OH 43266-0118 (614) 644-5332 (614) 644-9850 fax 76 mipwip FF yip yip STATE PROGRAMS & INMATINTS 71 Oklahoma Goals Develop a system of health care for children and adolescents in the juvenile justice system. Goals Met: There was no survey submitted for this state. Objectives 1. Identify the ways that health needs are being met in the juvenile justice system by June 1992. 2. Develop and implement a comprehensive system of health care by June 1993 for those in the juvenile justice system. Objectives Met: No response received. Program Actions 1. Identify appropriate tools to assess problems. 2. Identify key people to participate in a meeting (see below). 3. Explore funding sources. Program Accomplishments: No response received. Community Actions 1. Continue development of the subcommittee on child and adolescent health issues. 2. Involve the Planning and Coordinating Council (1729) to instruct district and regional planners to amend the institute. Community Accomplishments: No response received. State Actions 1. Convene a group to analyze existing systems by September 1991. Groups should include the chief examiner, chair of the Permanency Planning Task Force, Department of Mental Health, Child Services, Department of Health, Oklahoma State Department of Health, Juvenile Bureaus, Council for Juvenile Justice, and the Planning and Coordinating Council (1729). 2. Develop a plan of action according to the committee's recommendations. State Accomplishments: NO response received. Current Initiatives No response received. 77 mow. *11,41ow yip =lip 72 HEALTH CARE OF INCARCERATED YOUTH Oregon Goals Establish statewide standards equivalent to those of the National Commission on Health Care for Correctional Facilities. Goals Met: Met Some Goals Objectives 1. Establish coordination betv.een Juvenile Justice Programs and the Health Division. 2. Ensure countywide implementation of coordination. Objectives Met: Met Some Objectives Program Actions 1. Implement the changes necessary to comply with established standards and guidelines. 2. Maintain standards on a daily basis for monitoring purposes. Program Accomplishments 1. Initiated formal collaboration between the State Commission on Children and Families and the Health Division. 2. Identified specific work groups to assist in developing special programs. Community Actions 1. Implement standards and guidelines established by the State Commission on Children and Families and the Health Division. 2. Identify training and technical assistance needs. 3. Establish coordination between juvenile departments and county health departments. 4. Involve county health officials and juvenile departments and directors of associations. Community Accomplishments 1. Initiated coordination between juvenile departments and county health departments. 2. Appointed a local health administrator to the state advisory group. 3. Began monitoring juvenile detention facilities with the assistance of local health departments. State Actions 1. Delineate the roles between the Health Division and the State Commission on Children and Families. 2. Adopt standards and guidelines through the administrative rules process. 3. Establish a work group. 4. Mandate that the state Health Division include monitoring of juvenile detention facili- ties in its county reviews. -I. Establish provisions for technical assistance, including training and financial resources. STATE PROGRAMS & INITIATIVES 73 11111111111111111111111111111.1111111111111111111111 State Accomplishments 1. Incorporated health care issues as part of the juvenile justice agenda. 2. Began to identify common data elements in youth institutions and youth services programs. 3. Developed a process for planning that will include local health officials. Current Initiatives The current initiatives of the State Commission on Children and Families are the Girls and Young \\omen's Project, Minority 'Muth Initiative, and Teen Pregnancy Benchmark. Contact Information Gina \X:bod Manager. Juvenile Justice Programs State Commission on Children and Families 800 N.E. Oregon Street, Suite 550, No. 13 Portland. OR 97232 (503) 373-1283 (503) 378-8395 fax 7 74 HEALTH CARE OF INCARCERATED YOUTH Pennsylvania Goals Improve the health of adolescents involved with the juvenile justice system. Goals Met: Met Some Goals Objectives Objectives Met: No response received. Program Actions No response received. Program Accomplishments: No response received. Community Actions No response received. Community Accomplishments: No response received. State Actions No response received. State Accomplishments: No response received. Current Initiatives University of Pittsburgh Graduate School of Public Health has worked with the Allegheny County juvenile Court Detention Center on the pilot project to implement violence prevention strategies with residents and to implement the staff training program. The detention center has also established an information-sharing link with the Education Development Center, Inc., in Massachusetts, concerning adaptation of curriculum materials for use in the Department of Health. Contact Information Kenneth Jams, M.S.W., Ph.D. Assistant Professor of Public Health Social Work Graduate School of Public Health; 222 Parran Hall University of Pittsburgh Pittsburgh, PA 15261 (412) 624-3102 (412) 624-3146 fax wip Islipalp STATE PROGRAMS & INITIATIVES 75 Puerto Rico Goals Improve primary services at residential facilities and secure other services from health agencies or programs. Goals Met: There was no survey submitted for this territory. Objectives 1. Actualize service evaluations by health experts. 2. Establish a coordination system that facilitates exchange of information and services. Objectives Met: No response received. Program Actions 1. Petition the health department to evaluate health services at residential facilities. 2. Prepare a corrective action plan based on the recommendations. 3. Allocate the resources to implement the corrective action plan. Program Accomplishments: No response received. Community Actions No response received. Community Accomplishments: No response received. State Actions 1. Ask the health and welfare council at the governor's office to appoint a task force to discuss the special health needs and possible service alternatives for incarcer- ated youth. All related agencies and programs should be repre.Fented. 2. Promote discussion and decision making on (a) who should provide the services; (b) who should fund them; (c) how they should he funded; and (d) what they should include. 3. Contact funding experts to explore funding possibilities for special projects. 4. Contact the Heath Commissions of the Senate and the House of Representatives to share information on the subject. State Accomplishmei,is: No response received. Current Initiatives No response received. fin SY 76 HEALTH CARE OF INCARCERATED YOUTH Rhode Island Goals Improve health care for all incarcerated youth. Goals Met: Met All Goals Objectives 1. Provide information and education to improve communication between the juvenile corrections system and the courts. 2. Improve the mental health status of incarcerated youth. with emphasis on substance abuse 'drug dealing. 3. Improve education for staff and residents who require medical staff accreditation by the National Commission on Correctional Health Care. Objectives Met: Met All Objectives Program Actions 1. Arrange a meeting between the courts and the juvenile -zorrections staff. 2. Continue program monitoring by the Medical Advisory Committee. 3. Establish a subcommittee of the Medical Advisory Committee to concentrate on health and substance abuse. 4. Improve dental care for incarcerated youth by increasing their access to dentists. Program Accomplishments 1. Established better cooperation between the Rhode Island Family Court and the juvenile corrections system. The court is more aware of the necessity for reviewing health care with the Department for Children. Youth. and Families. 2. Developed more community-related education programs. Community Actions 1. Enhance public relations within the community. 2. Study the environment from which the youth come and to which they return. 3. Continue medical care fOr the youth after their release. a. Involve parents in policy and program decisions. Community Accomplishments 1. Established better cooperation between the Rhode Island Family Court and the juvenile corrections system. The court is more aware of the necessity for reviewing health care with the Department for Children, Youth, and Families. 2. Developed more community-related education programs. State Actions 1. Offer education about mental health child advocacy services. 2. Hold informational meetings. 3. Enhance public relations. t. Address staffing needs for medical nursing. 82 STATE PROGRAMS & INITIATIVES State Accomplishments Accomplishments I. Established better cooperation het en the Rhode Island Family Court and the juvenile corrections system. The court is more aware of the necessity for reviewing health care with the Department for Children, Youth, and Families. 2. Developed more community-related education programs. Current Initiatives The Rhode Island Family Court is attempting through law-related education programs to inform juveniles about all of the various health services available (type. name, address, hours). Contact Information Jeremiah S. Jeremiah, Jr. Chief Judge of Family Court Rhode Island Family Court One Dorrance Plaza Providence, RI 02903 (401) 277-3310 77 83 78 South Carolina HEALTH CARE OF INCARCERAT'D Yef r7H Goals 1. Exert an impact on the probable consent negotiations between the plantiff s attorney and the Department of Youth Services. 2. Develop and implement health care standards for the new regional detention centers that are required by state law after January 1, 1991. Goals Met: There was no survey submitted for this state. Objectives 1. Seek to involve health service agencies in a coordinated effort to provide assistance and counsel to the Department of Youth Services and the Attorney General's office. 2. Formulate an overall state plan, county by county, and provide direct consultation services to clusters of counties to address the mandated removal of jails and lockups by January 1, 1992. Objectives Met: No response received. Program Actions Provide data from the Tri-Regional Workshop on Health Care of Incarcerated Youth to appropriate representatives at the Department of Youth Services and offer assistance in developing revised health care standards. Program Accomplishments: No response received. Community Actions 1. Engage the services of consultants by May 15, 1991, and adopt a state plan within three months. 2. Provide local plans for county government approval within six months. Community Accomplishments: No response received. State Actions Monitot the progress of the Department of Youth Services consent agreement and coordinate the state agencies that will be assisting local jurisdictions in establishing health care clinics for regional detention centers. State Accomplishments: No response received. Current Initiatives No response received. STATE PROGRAMS & INITIATIVES 111.1.1.11.110.1.13K South Dakota Goals Improve the health care services for youth in South Dakota's juvenile correc- tion facilities. Goals Met: Met Some Goals Objectives 1. Conduct a self-assessment of facility compliance with the American Corrections Association or National Commission on Correctional Health Care standards by July 1, 1992. 2. Begin to address deficiencies identified in the self-assessment through interagency collaboration with the Department of Corrections, Department of Health, Department of Human Services, and other appropriate agencies. Objectives Met: Met Some Objectives Program Actions Design and implement a health standards compliance assessment by juvenile facilities with the assistance of the Department of Corrections (Office of the Secretary). Program Accomplishments Developed and began to implement health poiicies at all three juvenile facilities, based on the American Corrections Association standards. Community Actions No response received. Community Accomplishments: No response received. 79 State Actions Identify the issue of health care for incarcerated youth as a high priority so that appropriate resources are allocated to addressing the issue. State Accomplishments Established communication links with the Department of Corrections and Department of Human Services. The Department of Corrections must continue to identify needs prior to seeking assistance from the other departmei Current Initiatives The Department of Corrections and the Policy Development Committee are working on health policies and procedures. The Department of Corrections is also work- ing on HIV/AIDS policy for juvenile corrections institutions. 85 80 HEALTH CARE OF INC.ARC-ERATED YOUTH Contact Information Kevin McLain Special Assistant Department of Corrections 523 E Capitol, Suite 405 Pierre, SD 57501 (605) 77::-3478 86 STATE PROGRAMS & INTIIATINTS Tennessee 81 Goals Develop a methodology for continuing all health care delivery while youth are in custody at both local and state levels. Goals Met: Met Some Goals Objectives Share medical, psychological, and behavioral records. Objectives Met: Met Some Objectives Program Actions 1. Share examples of medical clearance screening forms as v.II as medical protocols between state and local facilities. 2. Select three local courts and one state facility to serve as a model for one year. and expand the model to include other courts at the end of this period. 3. Develop forms and protocols to fill identified gaps. A. Target Williamson, Davidson, and Giles counties. Program Accomplishments Developed new forms and protocols. Community Actions 1. Review and redesign forms and protocols. with assistance from the health department, to meet the recognized need for consistent documentation that will benefit incarcerated youth. 2. Expand utilization of local public and private health care providers in order to decrease the per capita health costs for incarcerated youth. Community Accomplishments Implemented the new Children's Plan which enabled the Division of Youth Services to obtain more funding to share medical information and provide continuing health care. State Actions 1. Expand initiatives to include two additional regions of the state, thus includ- ing all 29 local detention centers and four state training schools at the end of the trial program. 2. Continue the Youth Advisory Board which comprises 15 state agencies. State Accomplishments Received additional funding that allowed the Division of Youth Services to benefit from Medicaid support for ongoing health care delivery services. 8?` 82 HEALTH CARE OF INCARCERATED YOUTH Current Initiatives The current initiatives of the Division of Youth Services include providing hepatitis screening for all youth upon entry. A comprehensive AIDS education program is required for every youth during the period of incarceration, and a vigorous immunization program is being pursued with the cooperation of the local health department. Contact Information Mary Yunker Health Administrator Division of Youth Services; Tennessee Department of Youth Development 2601 Brittan Court Nashville, TN 37206 (615) 741-1384 STATE PROGRAMS & orrnATIvEs 83 Texas Goals Improve the quality of health care services for detained and incarcerated youth. Goals Met: Met Some Goals Objectives Improve access to mental health services and substance abuse treatment and education/vocational training for detained and incarcerated youth. Objectives Met: Met Some Objectives Program Actions 1. Determine to what extent the University of Texas Health Science Center at San Antonio program initiative meets the standards set forth by the National Commission on Correctional Health Care. 2. Continue to provide adequate health care for detained and incarcerated youth. Program Accomplishments 1. Provided access to medical care for incarcerated youth by utilizing physicians from the University of Texas Health Science Center at San Antonio, Department of Pediatrics, Division of Community Pediatrics and Adolescent Medicine. Incarcerated youth are examined and treated during medical call on a daily basis. Adjudicated youth on probation receive health care on an outpatient basis as needed via university health clinics. Psychosocial services and substance abuse treatment are provided to the youth by allied health professionals who are faculty members at the health science center or under contract to provide services. 2. Accomplished several improvements in the quality and quantity of health care services for detained youth, including development of a reproductive health and sexually transmitted diseases health clinic within the facility. 3. Initiated planning for coordination of primary care and substance abuse treatment services between detention and incarceration facilities. Community Actions 1. Encourage similar agencies to maintain contact with each other by meeting quarterly and developing a newsletter. 2. Encourage concerned agencies to prticipate in a community consortium sponsored by the Texas Juvenile Justice Coalition. Community Accomplishments Developed a community consortium to deal with multiproblem cases. This group of service providers includes representatives from state, local, county. and city governments, as well as caregivers and representatives of educational agencies. 89 1 84 IMALTH CARE OF INCARCERATED YOUTH State Actions I. Promote leadership of the Texas Juvenile Justice Coalition by the advisory agency for juvenile matters. 2. Identify statewide efforts directed toward juvenile justice matters and compile a list of resource agencies. 3. Reaffirm existing relationships with state legislators in order to keep informed of current issues and maintain high visibility. 4. Utilize the Texas Juvenile Justice Coalition as a clearinghouse for information concern- ing the juvenile justice system. State Accomplishments Coordinated consortiums in different areas of the state, with assistance from the Texas Juvenile Justice Coalition. The University of Texas Health Science Center at San Antonio, in association with this project, has brought to light the need for partnerships between academic institutions: and state, local, and county agencies that deliver services to incarcerated youth. Current Initiatives The program initiatives of the University of Texas Health Science Center at San Antonio, Department of Pediatrics, are described in the paper by Setzer. Scott. Bath, et al. (1992) in the Journal ()flail and Prison Health. A mental health aftercare component is being added to the program. Contact Information Jakim Balli. M.S.W. Research Instructor UTI-ISC at San Antonio; Department of Pediatrics 7703 Floyd Curl Drive San Antonio, TX 78284-7818 (512) 692-3641 (512) 692-3650 fax Jean R. Setzer, Ph.D. Planner. Evaluator Integrated Community-based Primary Care and Dnig Abuse Treatment; Bexar County Juvenile Detention Center 7703 Floyd Curl Drive San Antonio, TX 78284-7818 (512) 692-3641 (512) 692-3650 fax STATE PROGRAMS & INITIATIVES Utah Goals Improve coordination of health care services provided to incarcerated youth within the state. Goals Met: There was no survey submitted for this state. Objectives Use the current computerized juvenile information system to develop a health care tracking system component by accomplishing the following: 1. Meet with Division of Youth Corrections research, evaluation, and planning staff to discuss the design of a plan for medical information. 2. Determine the type of health care services information to be maintained. 3. Meet with legal advisors for the state Attorney General's office to discuss legal concerns. 4. Determine budget needs and revenue sources. 5. Design a research component to consider (a) the effectiveness of the system in reduc- ing duplication of services; (h) improved coordination of services; (c) improved data collection; and (d) identification of unmet health care needs. 6. Provide training on data entry to Division of Youth Corrections and health staff. Objectives Met: No response received. Program Actions No response received. Program Accomplishments: No response received. Community Actions No response received. Community Accomplishments: No response received. State Actions No response received. State Accomplishments: No response received. Current Initiatives No response received. Contact Information No survey received. 91 85 86 HEALTH CARE OF INCARCERATED YOUTH Virgin Islands Goals Develop an information network to ensure that incarcerated youth receive proper health care services. Goals Met: There was no survey submitted for this territory. Objectives 1. Create a task force including representation from juvenile justice, health care, government, private enterprise, community organizations and advocacy groups, education, and the media. 2. Increase public awareness through dissemination of information, especially through media sources (radio, television, newspaper). Objectives Met: No response received. Program Actions 1. Ensure understanding of a common mission for all involved in the task force. 2. Create linkage by identifying contacts within regions. 3. Gather information about standards and the accreditation program. 4. Gather information about all possible funding sources. 5. Devise strategies for improving working conditions and training programs for health care and juvenile justice personnel. Program Accomplishments: No response received. Community Actions 1. Use media to impress upon the comma 'ity the magnitude of the problem, which includes: (a) lack of good health care; (h) minority over-representation in the juvenile justice system; (c) inadequate juvenile justice facilities; (d) reduced accest, to other services (isolation); and (e) understanding of the world of the troubled youth. Community Accomplishments: No response received. State Actions 1. Educate the governor's office, legislators, and other government officials about the task force, its functions, and its recommendations. 2. Gain access to all possible state funding sources. 3. Establish ongoing linkage through national and regional meetings to gather and share new information and to discover programs that have worked in other areas. State Accomplishments: No response received. 92 ITTi STATE PROGRAMS & INITIATIVES 87 Current Initiatives No response received. Contact information No survey received. 93 88 HEALTH CARE OF INCARCERATED YOUTH Virginia Goals Improve the health care of incarcerated youth. Goals Met: Met All Goals Objectives No response received. Objectives Met: No response received. Program Actions 1. Attempt to place a youth services representative on the Governor's Task Force on Children's Health. 2. Increase and systematize the use of local (county) health department staff to provide relevant health education programs and materials to clients in juvenile justice facilities. Attempt to implement this effort as a formal activity at the state level. 3. Reexamine the Medicaid coverage issue for the population, especially as the state moves to more community-based treatment programs. The state is renegotiating the interagency agreement with agencies resronsible for mental health, youth and family service, and education, as well as with other agencies. 4. Use the interagency consortium approach to identify a flexible pool of resources (found in a study mandated by the legislature). 5. Continue use by juvenile justice health programs of relevant portions of the John Hopkins University training manual for health assessments. Program Accomplishments Began to use the Johns Hopkins University training manual. Community Actions No response received. Community Accomplishments: No response received. State Actions No response received. State Accomplishments Placed a representative from the Department of youth and Family Services on the Governor's Task Force on Child Health. Current Initiatives No response received. 94 ROI STATE PROGRAMS & INITIATIVES Contact Information Patricia N. Reams, M.D. Chief Physician Department of Youth and Family Services P.O. Box 3AG Richmond, VA 23208-1108 (804) 746-2135 Mary M. Carpenter Maternal and Child Health Social Work Director Virginia Department of Health P.O. Box 2448 Richmond. VA 23218 (804) 786-7367 90 HEALTH CARE OF INCARCERATED YOUTH Washington Goals Improve collaboration and communication between the systems in this state that have an impact on the care of incarcerated youth, including Child Protective Services, Maternal and Child Health, Bureau of Alcohol and Substance Abuse, juvenile justice system, and Department of Family and Youth Services. Goals Met: Met Some Goals Objectives 1. Introduce/identify the health representative from the Juvenile Justice Advisory Committee to other health professionals in the system. 2. Increase communication among systems, including county detention and state facilities, maternal and child health, mental health, medical systems, and drug and alcohol treat- ment systems. Objectives Met: Met Some Objectives Program Actions 1. Increase awareness of national standards at the county and state level. 2. Ensure that national standards are made available to key people in the systems noted above. 3. Improve collaboration between internal systems including the legal, medical, mental health, drug and alcohol, and corrections systems. Program Accomplishments 1. Contacted several state MCH adolescent health care directors. 2. Explored funding options using Medicaid funding for "off campus" medical consulta- tions; decided on a plan to use the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program and funding. 3. Initiated uniform recordkeeping which improved communication. Community Actions No response received. Community Accomplishments 1. Presented at the annual Juvenile Rehabilitation Conference on Health Care. 2. Contacted MCH programs for pregnant teens through the University Adolescent Program. State Actions 1. Improve coordination between the eastern and western areas of the state concerning implem ntation of national standards which will he discussed at the annual state meeting. 2. Increase attendance by members of the identified systems at the annual Division of Juvenile Rehabilitation conference. 3. Hold a meeting at which health care providers from Maternal and Child Health and the Department of Youth Services can share information about their respective systems. &III STATE PROGRAMS & INITIATIVES State Accomplishments 1. Met with the staff of the Governor's Juvenile Advisory Committee to discuss the possi- bility of having a health representative on the committee. 2. Met with the Medical Director of rke State Division of Juvenile Rehabilitation to discuss collaboration with local public hea.:h and MCH providers. 3. Publicized/advocated for the incarcerated youth publication (Hard Time, Healing Hands: Developing Primary Health Care Services for Incarcerated Youth) at appropriate meetings. 4. Increased attendance by members of different provider groups at the annual Division of Juvenile Rehabilitation conference. 5. Held a meeting at which health care providers from Maternal and Child Health and the Division of Children, Youth, and Family Services shared information about their respective systems. 6. Wrote a chapter in Hard Time, Healing Hands: Developing Primary Health Care Services fir Incarcerated Youth, recommending practical ways of contacting and utiliz- ing more MCI I services. Current Initiatives Parent-Child Health Services, Bureau of Parent and Child Health, has worked to coordinate with the Division of Juvenile Rehabilitation to improve services for adoles- cents in the state juvenile justice system. A major initiative is to provide training to public health nurses so that they can perform the EPSDT screening and bill for reimbursement of services under Title XIX of the Medicaid provisions. Once this training is established, access to health services for adolescents in the detention syste,i: will improve. The University of Washington, Department of Pediatrics, is presently serving three of five state institutions. (Those not served have logistics problems.) Contact Information Judy Schoder, R.N., M.N. Public Health Nurse Consultant Parent-Child Health Services; Bureau of Parent & Child Health P.O. Box 47885 Olympia, WA 98504-7885 (206) 586-1255 Robert W. Deisher, M.D. Department of Pediatrics; Child velopment Center, WJ-10 University of Washington School of Medicine Seattle, WA 98105 (206) 685-1274 James W. Owens, M.D., M.P.H. Medical Director Division of Juvenile Rehabilitation; Echo Glen Children's Center 33010 S.E. 99th St. Snoqualmie, WA 98065 (206) 888-9797 91 9 92 West Virginia HEALTH CARE OF INCARCERATED YOUTH Goals Improve the health care of incarcerated youth. Goals Met: Met Some Goals Objectives No response received. Objectives Met: Met Some Objectives Program Actions 1. Continue staff-level meetings between child health and juvenile justice staff members (initiated at the triregional workshop). 2. Contact recently formed Governor's Task Force on Children, Youth, and Families at the next scheduled meeting to include within the plan the special health needs of youth in the state's juvenile justice facilities, in order to have a flexible funding pool for children's early intervention services in the state. 3. Pursue, through the efforts of the state's juvenile justice authorities, the adoption of model health standards for incarcerated youth as developed by the National Commission on Correctional Health Care; the health department will advocate for this initiative and provide technical assistance as appropriate. 4. Explore possible collaboration between juvenile justice and health staff members in order to develop staff training and orientation for new juvenile justice facility nursing personnel by realistically addressing the specific needs of these staff members as well as issues such as staff burnout and the skills needed to deal effectively with this population. 5. Provide assistance through the health department to improve the admission/health history process for youth committed to juvenile justice facilities. Program Accomplishments 1. Continued to hold meetings between Department of Health and Human Resources staff and the corrections staff. 2. Contacted members of the Governor's Task Force on Children, Youth, and Families, informed them of the problems encountered in dealing with the health care issues of incarcerated youth, and asked their assistance in lobbying for a revision in the current Medicaid exclusion law. 3. Asked state authorities to adopt health care standards and to provide appropriate training. 4. Worked with the Department of Health and Human Resources to improve access to health records. 5. Coordinated activities between the Division of Maternal and Child Health, the deten- tion centers, and the Department of Human Services. Improved communication flow between agencies. 6. Met with key personnel at the detention centers and correction facilities and discussed concerns about health care issues, clarified roles and responsibilities, and offered assistance in obtaining materials. 9ti STATE PROGRAMS & INITIATTVFS 93 Community Actions No response received. Community Accomplishments 1. Adopted the National Commission on Correctional Health Care standards for health services in juvenile confinement facilities. 2. Wrote numerous letters to state officials and politicians to inform them of the problems encountered and the ways in which they could assist. 3. Presented a five-part series on adolescent health care to the staff at the Davis Center correctional facility. 4. Helped detention centers become familiar with the health system staff members who might assist in developing their health programs. S. Shared copies of handbooks on health care for child care workers with the directors of three state-operated detention centers; these handbooks will be used in staff training. State Actions No response received. State Accomplishments 1. Discussed the need for health staff to attend in-service education with state officials. 2. Discussed with supervisor the State Action Plan developed at the workshop. Current Initiatives The Davis Center-Division of Corrections is informing all staff (officers, teach- ers, cooks, other staff members) about the role of health care in addressing the needs and problems of the juveniles served by the Davis Center. In addition, the Handbook on Adolescent Health, published by the Maryland Department of Health and Mental Hygiene (1989) is being used as a curriculum guide. The Davis Center plans to implement an immunization program, and has been stressing health education for staff and residents on issues such as sexually transmitted diseases, AIDS, vital signs, basic first aid, and infant care. The Department of Health and Human Services reported that each facility director is working to locate health care professionals including physicians, nurse practitioners, and other professionals to establish an on-site clinic at each facility. The facility directors also have worked with staff from Maternal and Child Health to obtain equipment and supplies for their facilities. Contact Information Diane L. Hinkle Registered Nurse Davis Center-Division of Corrections Blackwater Falls Road Davis, WV 26260 (304) 259-5241 99 94 HEALTH CARE. OF INCARCERATED YOUTH Jeanne Matics Director Pediatric Program Division of Maternal & Child Health; West Virginia Department of Health and Human Resources 1411 Virginia Street East Charleston, WV 25301 (304) 348-5388 Susan C. Salmons Program Specialist West Virginia Department of Health and Human Resources; Office of Social Services 3135 16th Street Road Huntington, WV 25701-9985 (304) 528-5800 STATE PROGRAMS & INITIA11VES Wisconsin Goals Develop a plan to imixove total health care services, including medical and mental health services, for youth in correctional institutions; these services currently are provided by two separate agencies. Goals Met: Met Some Goals Objectives 1. Implement collaboration among the Corrections, Social Services, and Health Departments concerning medical and mental health services in order to develop an action plan to improve these services. 2. Combine health and mental health records into one record. Objectives Met: Met Some Objectives Program Actions 1. Obtain information on standards for combining health and mental health records. 2. Convene a meeting of identified staff in each department (at division and bureau levels) to discuss the fragmentation of health system funding and service delivery in correctional institutions. Develop an action plan to address these issues. 3. Meet with the secretaries of the appropriate departments to obtain their endorsement of the plan. Program Accomplishments 1. Acquired information on the standards for combining health and mental health records. 2. Convened a meeting of identified staff in each department at the division and bureau levels to discuss fragmentation of health system funding and service delivery in correc- tional institutions. Community Actions Involve private agencies that provide aftercare in efforts to advocate for improved institutional services. Community Accomplishments: No response received. State Actions Involve key legislators in efforts to initiate appropriate legislation (if necessary). State Accomplishments: No response received. 95 101 96 HEALTH CARE. OF INCARCERATED YOUTH Current Initiatives The Wisconsin Bureau of Correctional Health is recruiting and hiring quality staff, identifying staff training needs, and educating juveniles about health issues. Contact information Gloria J. Thomas Assistant Chief, Nursing and Auxiliary Services Wisconsin Bureau of Correctional Health 149 E .Wilson Street Madison, WI 53707-7925 (608) 267-1731 (608) 267-0923 fax Armond H. Start, M.D., M.P.H. Associate Professor HS-Med, Rm 3839; Family Clinic/Wingra Center 777 S. Mills Street Madison, WI 53715 (608) 263-1326 (608) 263-5813 fax 102 STATE PROGRAMS & mirrunvEs Wyoming 97 1111111111111111MIIIIIININE Goals Coordinate resources and services between the Department of Family Services and the Department of Health. Goals Met: No response received. Objectives 1. Review current activities in children's institutions and health programs affect- ing youth. 2. Determine coordinated desired outcomes. Objectives Met: No response received. Program Actions 1. Link programs in the Department Of Family Services with programs in the Department of Health. 2. Identify those who have specific responsibilities for the health care of incarcerated Youth, and define ways to work cooperatively. Program Accomplishments: No response received. Community Actions Develop networks with residential and group homes, regional mental health units, and public health providers. Community Accomplishments: No response received. State Actions Convene a workshop/meeting that will include department directors, superin- tendents, and state program managers. State Accomplishments: No response received. Current Initiatives No response received. Contact Information No survey submitted. 103 98 HEALTH CARE OF INCARCERATED YOUTH iv(1113 Maternal and Child Health Bureau FOLLOW-UP SURVEY TO THE TRI-REGIONAL WORKSHOP ON THE HEALTH CARE OF INCARCERATED YOUTH This survey is a follow-up to the Tri-Regional Workshops on the Health Care of Incarcerated Youth which were funded by the Maternal and Child Health Bureau (MCHB). Your responses, along with all of the other responses to this survey, will he compiled into a report by the National Center for Education in Maternal and Child Health in conjunction with MCHB. You will be sent a copy of the report when it is. completed. Your cooperation in providing this information will contribute to the development of an information database which will be used by MCHB as a basis for allocation of resources to this critically underserved population. Name of Program: Address: City: State: Zip: Person who completed questionnaire: Name: Position: Address: City: State: Telephone: Fax: ( Date Completed: Instructions for completing this survey: Answer only those elements that apply to your program. Information documented should reflect data on all children within your program whether adjudicated or not who fall within the purview of the juvenile justice system. If you have any questions when complet- ing the this survey, please call Paula Sheahan at NCEMCH, (703) 524-7802. Please return this survey by March 13, 1992, in the enclosed envelope to Paula Sheahan, NCEMCH, 2000 15th Street North, Suite 701, Arlington, VA 22201-2617, Fax: (703) 524-9335. 1. State Action Plans developed at regional meeting Please refer to your State Action Plan located in the Health Care of Incarcerated Youth: Report from the 7'ri-Regional Workshops, pages 159-248. A. Did you meet the goals stated in your State Action Plan? [ I Met All Goals Met Some Goals i Did Not Meet Any Goals SURVEY 99 B. What harriers were encountered in meeting these goals? Rank 1 as the most frequently occurring harrier. Please list only one barrier per line. Barrier C. Did you meet the objectives stated in your State Action Plan? Li Met All Goals Ll Met Some Goals Li Did Not Meet Any Goals Rank 1 2 3 4 5 D. What barriers were encountered in meeting these objectives. Rank 1 as the most frequently occurring barrier. Please list only one barrier per line. Barrier Rank 1 2 3 4 5 E. What actions or objectives stated in your State Action Plan have been accomplished at the program level? F. What actions or objectives stated in your State Action Plan have been accomplished at the community level? 100 HEALTH (ARE OP INCARCERATED YOUTH G. What actions or objectives stated in your State Action Plan have been accomplished at the state level? 2. Sources of Funding A. What were the principal sources of funds dedicated to the health care of children in the juvenile jus- tice system in Calendar Year '91? Please estimate the proponion that came from each source below. (If this information is not known, Check here: Percent Mt TO7AL = WO% Source ql Funds Grants, awards from the State (e.g., MCI-I Block Grant, general state funds) City, county, or other local government funds Direct Federal revenues (e.g., SPRANS projects, 330 funds, federal grants) Third party reimbursement (e.g., private or other insurance, Medicaid) Private sources (e.g., foundations, donations, corporate contributions, parents) Other (please specify: 3. Primary Health Care Services A. Describe your target population of children (check all that apply): Age: L.' under 10 ! i 10-12 13-15 16-18 I ! over 18 Sex: I. male r female Other information describing your population: B. List in rank order of importance the five (5) leading health problems faced by children In the juvenile justice system. Please list only one problem per line. Rank 1 as the most important. Problemi Rank 3 SI IRVEY 101 C. Providers of Primary Health Care Services to juvenile Justice Population Who are the principal providers of primary (acute episodic and health super\ :,ion) and specialty care (outpatient treatment and follow up of significant problems identified) to children in your target populatio Please rank them according to which provider serves the most children in your target pop- ulation (1=serves the most, 2=second most, 3=third most, etc.) Health Department Clinics Community Health Centers Public Hosp Outpatient Depts Private Hosp Outpatient Depts Private Pediatricians Private Family or General Practice Health Maintenance Orgs IlniversityiMedical School Depts Other: Outpatient Prinuity Care ,Specialty Care ( rank) ( rank) 1). Barriers in the Current System of Primary Health Care List in rank order of frequency, the five leading barriers to providing primary health care to children in the juvenile justice system. Rank I as the most frequently occurring barrier. Please list only one barrier per line. Barrier Rank 2 3 4 5 E. Please describe your current initiatives aimed at improving the health care of children served by your organization. In addition, please submit products or materials (i.e., pamphlets, publications, posters) or attach copies of proposals or reports which describe your programs. f `1 102 HEALTH CARE OF INCARCERATED YOUTH 4. Anything Else? Is there anything else you would like to tell us about the health care of children in the juvenile justice system in your state? Attach additional sheets of paper as necessary. Thank you for taking the time to participate in this survey. We hope that the results of the survey will prove useful to you in your efforts to serve children in the juvenile justice system. g Ntticincil drid ( fuld I wr. Ncit 1(11 dti(ln ti in iv(H13 ISBN 0 0'D