Girls are the fastest
growing segment of the juvenile justice system and the least well served: Girls are the fastest growing segment of the United
States and California Juvenile Justice Systems. Over 641,000 of the nearly two million
youth entering juvenile justice residential facilities nationally each year are
girls. Los Angeles currently is in the top three jurisdictions in the nation in
terms of the number of adolescent girls entering its detention and juvenile
system at enormous cost to the health and economies of its local communities.
This cost extends into the next generation of Californians, since 20% of girls
in the juvenile justice system have been pregnant or are parents of young
Girls Are Different: The Girls Health Screen Study (Acoca and Lexcen,
2009), conducted in San Diego and Santa Cruz and Philadelphia detention
centers, revealed that compared to their male counterparts, girls enter
detention with unique and often more serious physical and mental health
problems and are less likely to receive adequate medical screening, assessment
treatment and aftercare. Girls also tend to enter the juvenile justice system
at a younger age and for less serious offences (like running away from abusive
homes) than boys, and are more likely to have experienced sexual victimization
Girls Health Screen
(GHS) Study Findings: The above GHS
study revealed medical evidence of the sexual victimization of girls in
detention, each of whom received a physical examination by our Nurse
Practitioners and nurses. Forty one per cent had signs of vaginal tearing
possibly due to sexual assault. Additionally, 7 % of girls were currently
pregnant, 8% had tested positive for tuberculosis within the last year, 40%
needed glasses-only 10% had glasses with them- and 36% had been homeless. Further,
our studies revealed there are currently limited medical standards for girls
entering these facilities and no standardized medical screening and assessment
tools for girls other than the Girls Health Screen.
The Health and Justice Connection for
Girls: According to Educate
or Incarcerate (Acoca, 2001), a
study of 1000 girls in the juvenile justice system, access to medical care reduced the
likelihood of recidivism and violent offending among girls at risk by
The Girls Health Screen
and Girls Health Passport: Based on this research, the Girls Health and Justice Institute (a California
non-profit), the Children's Hospital of Philadelphia and the Juvenile Law
Center developed the Girls Health Screen (GHS). The
Girls Health Screen is currently a laptop based, 120 item questionnaire written
in fifth grade language. It has a voice -enhanced function which meaning that
questions can be read aloud to accommodate girls with learning, academic or
language differences. Girls complete the GHS in 15-30 minutes .The GHS is
currently being converted into a web application.
The development and
implementation of the web GHS in Los Angeles is supported by the California
Endowment, Blue Shield of California and Kaiser Family Foundations.
What can the web-based
Girls Health Screen Provide?
1. Provide the GHS
questionnaire (120 questions in simple yes/no questionnaire) in web-based
format in English and Spanish that complies with all statutory requirements for
medical intake for detained juveniles.
2. Provide a flexible
alert system to notify detention medical and correctional staff when girls
report an urgent medical problem on intake such as a life-threatening allergy,
a recent sexual assault or suicidal ideation.
3. Provide facility
medical providers with an immediate record of health and behavioral health
screening information to guide assessment and treatment within the
4. Provide both on-demand
and regular monthly reporting of health data to juvenile correctional
institutions and de-identified data reports to local state and national
research, policy and legislative entities.
5. Provide a
portable medical report upon each girl’s release that can be linked to
community-based healthcare for continued, uninterrupted care.
Does the Girls Health Screen Work in Detention Centers?
- Step One: GHS adopted as standard intake
procedure for girls entering detention
- Step Two: GHS results
used to trigger acute medical responses for girls entering detention
- Step Three: GHS used to
guide medical assessment and treatment planning by existing medical provider
while in detention
- Step Four: GHS used to guide
pre-release planning and post release follow-up
- Step Five: The GHS
becomes the first step in an Electronic Girls Health Passport that allows girls
to “carry” their health information from institutions to their communities and
- GHS complies with Best Practice Guidelines from the
American Academy of Pediatrics, NCCHC, NJDA and ACA.
- GHS helps facilities respond to Federal and State
- GHS raises institutional standard of care by
increasing awareness of medical problems
- Clarifies legal liability by demonstrating that
institution has taken appropriate steps to identify medical needs.
- Streamlines medical intake procedures
- Targets scarce medical resources towards areas of
- Children in placement
considered “family of 1” for purposes of income determination and usually
qualify for Medicaid.
- Medicaid reimburses all
“medically necessary” treatment (also EPSDT) for youth. GHS assists in establishing medical
- Youth in detention
awaiting adjudication generally qualify for Medicaid. GHS provides rapid identification of health problems and may
assist girls to qualify for Medicaid.
- Implement the Girls
Health Screen at intake for 50 girls in Los Angeles County Girls Camps.
- Develop the first
secure web platform and database for juvenile girls in detention so that the
GHS will be web accessible to girls
at intake into the system and contribute to a California and national
database on the medical and
behavioral health needs of girls in
the juvenile justice system.
- Pilot the web-based
GHS in Los Angeles, California. This
will involve the development of support and collaboration of key leaders who
will participate on the GHS Los Angeles Advisory Committee and the completion
of the web platform described above.
- Initiate the First
Electronic Girls Health Passport
which will provide a seamless continuum of medical screening, assessment,
treatment and follow-up linking community health providers and medical
providers in institutions. Currently, there is little communication of medical
needs between juvenile residential institutions and community health providers.
Consequently, expensive medical procedures are often repeated unnecessarily
(such as immunizations) and urgent medical and behavioral health problems such
as injury resulting from sexual assault, head injuries, serious allergies and
substance abuse are often missed. We expect that the Electronic Health Passport
by providing a single standardized medical screening and record-keeping
procedure will remedy this costly and dangerous gap.
are the Benefits to Detention Centers of Using the GHS?
How could the GHS Assist
Facilities to Access Medicaid and Other Funding?
What are the Next for
The Girls Health Screen and Girls Health Passport in Los Angeles?