1. Improving Testing in a Juvenile Detention Facility…a Success Story
Beth Butler
Infertility Prevention Project Coordinator
STD Program
Pennsylvania Department of Health

2. Acknowledgements
Without the efforts of the following individuals this project would not have been so successful:
Therese Defazio, Shuman Juvenile Detention Center
Tera Matson, Shuman Juvenile Detention Center
Linda Schombert, Allegheny County Health Department
Nancy Fenton, Allegheny County Health Department
Judy Schumacher, Allegheny County Health Department
Dr. Harold Wiesenfeld, Allegheny County Health Department
Stephen Kowalewski, PA Department of Health

3. Juvenile Justice System in Pennsylvania
There are 22 facilities in 23 counties in Pennsylvania, exclusive of Philadelphia.
There are 598 spaces available in Pennsylvania for youths to be served in juvenile detention.
Approximately 17% of the approximately 37,000 juvenile cases in Pennsylvania are female.
Post Juvenile Detention: There are 3 youth development centers and 2 youth forestry camps run by the state’s Department of Public Welfare Office of Children and Youth Services. These facilities are long term and house the young people after youth detention.

4. Juvenile Detention Standards in PA
42 Pa.C.S. §6301 et seq. Standards Governing the use of Secure Detention under the Juvenile Act provides programs of supervision, care, and rehabilitation which are consistent with the protection of the community, based on the offenses committed, and enable the children to become responsible citizens.
Juvenile Detention Program Standards establish minimum standards for youth who are placed in detention: an initial health screen is to be completed within one hour of admission and a complete medical examination (STD screening is listed at component) within 48 hours of admission.

5. Juvenile Justice Sites in PA
Elk
York
Centre
Berks
Butler
Lycoming
Pike
Bedford
Clinton
Clearfield
Blair
Indiana
Somerset
Luzerne
Fayette
Perry
Bucks
Lancaster
Mercer
Franklin
Chester
Clarion
Schuylkill
Cambria
Monroe
Huntingdon
Greene
Venango
Allegheny
Adams
Washington
Westmoreland
Jefferson
Mifflin
Fulton
Dauphin
Armstrong
Beaver
Juniata
Union
Carbon
Lehigh
Columbia
Snyder
Cumberland
Lebanon
Montgomery
Lawrence
Tioga
Erie
Potter
Bradford
Warren
McKean
Crawford
Wayne
Forest
Susquehanna
Sullivan
Wyoming
Cameron
Lackawanna
Northumberland
Northampton
Delaware
Montour
Philadelphia
Northwest
Southwest
North Central
Northeast
South Central
Southeast
2.1 -
All juvenile detention facilities throughout Pennsylvania are county run
The capacity in the facilities range from 8 to 48---exclusive of Allegheny County with 130 and Philadelphia with 105

6. The Performance Measure
The 2005 CSPS Performance Measure requires STD Programs to examine screening practices in large juvenile justice facilities that have 500+ bookings annually. One facility in Pennsylvania met CDC’s reporting criteria.
The facility examined was Shuman Center in Pittsburgh PA, Allegheny County.

7. A first look at Shuman Center
2003
475 females admitted
70 females screened for chlamydia
14.7% screened
14 positive for chlamydia
20.0% positivity
2004
630 females admitted
93 females screened for chlamydia
14.8% screened
12 positive for chlamydia
12.9% positivity

8. What was going on at Shuman ….
All males admitted to Shuman Center were tested with a leukocyte esterase test (LET). If the LET was positive, the males were tested for chlamydia and gonorrhea.
All females were offered a pelvic exam including STD testing for chlamydia and gonorrhea. A majority of the young women declined testing.
Females received LETs if there was a suspicion of a urinary tract infection.
The Allegheny County Health Department laboratory provided the testing for Shuman Center . Cervical and urethral specimens were collected. Amplified technology was utilized.

9. CDC’s Performance Measure…
The performance measure required the PA STD Program to look at the female chlamydia screening numbers for Shuman Center.
Upon review, the percentage of young women tested was low and positivity was high.
Goals and objectives were put into place to improve screening practices at Shuman Center to screen more female admittees.

10. The Response…..
The numbers screened were admittedly low because the young women did not consent to pelvic examinations.
The availability of urine chlamydia testing for females and males would improve screening compliance.
Because of a commitment of the medical staff at Shuman Center and STD Program Staff at the Allegheny County Health Department the ball was rolling to provide urine testing at Shuman Center.

11. Change was rather quick…
Shuman Center began utilizing amplified urine based screening for female and male admittees September 2005.
Specimen analysis is done at the Allegheny County Health Department Laboratory.

12. 1st half 2005 vs. 2nd half 2005 Data for Shuman Center
304 females admitted
59 females screened for chlamydia
19.4% screened
5 positive for chlamydia
8.5% positivity
2nd Half 2005
284 females admitted
127 females screened for chlamydia
44.7% screened
19 positive for chlamydia
15.0% positivity

13. Quarter by Quarter Data for Chlamydia for Shuman Center
Urine testing began Sept 2005
1st qtr % screened 2nd qtr % screened
3rd qtr % screened 4th qtr % screened
1st qtr % screened

14. 1st Quarter 2005 vs. 1st Quarter 2006 Data for Shuman Center
174 females admitted
38 tested for chlamydia
21.8% tested
2 positive cases of chlamydia found
5.3% positivity
1st Quarter 2006
148 females admitted
109 tested for chlamydia
73.6% tested
12 positive cases of chlamydia found
11.0% positivity

15. Females Admitted vs. Screened for Chlamydia by Year at Shuman Center
475 admitted and 70 screened % positivity
630 admitted and 93 screened % positivity
608 admitted and 189 screened % positivity
CY cases identified CY cases identified
CY cases identified 1st quarter cases identified

16. What about the boys??? 1st quarter 2006 data:
Boys were not routinely tested for chlamydia before September 2005 because of the leukocyte esterase testing.
More males have been screened with chlamydia urine testing.
1st quarter 2005 data:
Males admitted: 765
Males screened for CT: 101
(13.2% screened)
Male CT cases identified: 19
Male positivity: 18.8%
1st quarter 2006 data:
Males admitted: 741
Males screened for CT: 494
(66.7% screened)
Male CT cases identified: 28
Male positivity: 5.7%

17. Beyond Shuman Center….
The PA STD Program has established relationships in county juvenile justice facilities throughout PA.
Many juvenile justice facilities provide family planning services to females in their facilities.
The PA STD Program provides testing in approximately 8 juvenile justice facilities and positivity is similar to that found at Shuman.
Because of the increased interest and commitment to screening, data is now being analyzed to look at ages, races, crime committed, and length of stay for juveniles at Shuman with chlamydia infection.

18. Question & Answers

19. We Hold the Key Have the desire to increase screening
Want to acknowledge the importance of screening
Can find a way to get it done