ABSTRACT
Purpose: Adolescents acquire Chlamydia trachomatis with rates in 15-19 y/o females more than 4.8x the adult population and males 2.5x higher. There is growing recognition of the health consequences of untreated sexually transmitted infections (STI) especially for women in juvenile or correctional facilities. The previous study was a retrospective analysis conducted at the only juvenile detention facility in the state of Hawaii from 2014-2017. It revealed high prevalence of STIs, Chlamydia (CT) and Gonorrhea (GC), in both males and females with fewer than half the documented infections being treated prior to discharge, indicating a need for routine and timely testing to allow treatment of those infected as opposed to a presumptive STI treatment. The purpose of this study is to look at the prevalence rate of CT and GC after implementing routine testing and to assess treatment rate upon timely result receipt. Methods: This retrospective analysis was conducted at the only juvenile detention facility in the State of Hawaii from June 1, 2020-May 31, 2021. It documented the prevalence rate of CT and GC after implementing routine testing upon detention. It also looked at the timeliness of treatment and treatment rates as the time frame marked the first year of implementing routine CT and GC urine screen upon detention and sending the screen tests at a commercial lab for timely results. This time frame is unprecedented in the era of the coronavirus pandemic. This study was approved by Hawai‘i DOH Institutional Review Board. Results: Of the 218 admissions, 187 were tested (85%). 14 refused and 17 were under the state's age of consent (15%) prohibiting routine sample collection and testing as ordered by the facility. Of the 187 tests, 75(35%) were females, 143(65%) were males. CT was prevalent in 25% of females and 7% of males. GC was found in 13% of females and 3% of the males. CT-positive tests of females sent to commercial lab were treated timely 80% of the time vs. 60% for the CT-positive tests sent to the state lab. For CT-positive tests of males and GC-positive tests of females and males, the commercial and state labs showed the same timeliness of treatment. Rates of untreated females with CT was 12%, untreated males 25%;untreated females with GC was 11%, all males with GC were treated. The average result time receipt of tests sent to commercial lab was 6 days vs.2 weeks with the state lab. Conclusions: Prevalence rate of CT and GC remained consistently higher in females than males despite females making up only a third of the census. Timely treatment rate was remarkable for tests sent to commercial lab decreasing the number of untreated youths. This avoided presumptive CT and GC treatment, further leaving out the potential for antibiotic resistance, a continuous and growing concern prompting the updates in the CDC STD treatment guidelines in 2021. Sources of Support: None.
ABSTRACT
Purpose: Opioid-related morbidity and mortality have risen in many settings. In particular, the prevalence of opioid misuse in incarcerated youth exceeds that of the general adolescent population and overdose mortality within 2 weeks of release is 129 times higher. In 2016, 1 out of 10 adolescent deaths were opioid-related. In King County, WA, since the onset of the COVID-19 pandemic, the number of opioid-related overdose in youth under the age of 20 increased twofold from 10 in 2019 to 21 in 2020. Despite such trends, most incarcerated individuals who could benefit from treatment do not receive it. Our goal was to implement a quality improvement (QI) project to evaluate the prevalence of opioid misuse in adolescents and improve protocols to support youth with opioid use disorder (OUD) at a juvenile detention center in King County, WA. Methods: From March 2020-April 2021, providers at the Clark Children and Family Justice Center (CFJC) implemented a QI project to improve quality of care for youth with opioid misuse and OUD. We conducted a chart review to determine prevalence of opioid misuse among youth. We reviewed the change in percentage of youth referred for substance misuse after the implementation of 2 change interventions: provider buprenorphine waiver training and the development of an opioid use management and referral protocol. Providers completed buprenorphine waiver training in June 2020. We developed and initiated protocols in September 2020 to screen adolescents for opioid use and withdrawal, support buprenorphine induction and maintenance, provide youth with overdose prevention training and naloxone kit, and improve care coordination to ensure a smooth transition of care for youth with OUD returning to their communities. This project was reviewed by the University of Washington IRB and determined to be “not human subjects research” as defined by federal and state regulations. Results: The prevalence of opioid misuse of youth ages 12-17 at CFJC from September 2020-April 2021 was 16.9% in comparison to 3.6% in the general population in 2016. From March-May 2020, prior to providers completing buprenorphine waiver training, only 60% of youth who reported substance misuse were referred to the CFJC-Health Clinic for consultation by the next available clinic day. From June-August 2020, after providers completed buprenorphine waiver training, 81% of youth who reported substance misuse were referred for consultation. From Sept 2020-April 2021, after implementation of a referral and management protocol for opioid use and withdrawal, almost all (90%) of youth reporting misuse were referred. Conclusions: Similar to previous literature, we found that the prevalence of opioid misuse among adolescents at CFJC was significantly higher than in the general population. Our findings demonstrate that two change interventions of provider buprenorphine training and the development of protocols to facilitate the assessment and management of opioid misuse and OUD increased the rate of youth who received treatment for OUD at CFJC. Further refinement of these guidelines is needed to ensure that all youth admitted to CFJC with opioid misuse and OUD receive timely consultation and support to decrease the rate of opioid-related morbidity and mortality in confined youth. Sources of Support: None.
ABSTRACT
Background: On the backdrop of the Royal Commission into the Protection and Detention of Children in the Northern Territory, an adolescent forensic psychiatry service was commenced at Don Dale Youth Detention Centre in 2020. Objectives: To discuss the service set up, the model of care, along with the successes and challenges facing the service. Findings: A narrative and chronological review of the service is presented. The immediate and longterm challenges are discussed, including staff retention, competing political priorities, increasing numbers of young people in detention, new bail laws and Covid-related issues. Conclusion: Despite improved access to specialist mental health care for young people in detention in the Northern Territory, there are multiple barriers to overcome before adequate care can be achieved.
ABSTRACT
Purpose of Study A prior study conducted at a large, Southwestern juvenile detention facility in 2019 revealed that only 33.5% of youth reporting oral sex and 25.9% of youth reporting anal sex were tested for extragenital sexually transmitted infections (STIs). Since many extragenital infections are asymptomatic, testing is crucial for diagnosis and treatment. For the past year and a half, the COVID-19 pandemic has created new challenges for medical care, especially in detention centers where large numbers of youth reside close together. While several studies have found recent decreased rates of STI screening, little is known about how the pandemic affected screening for extragenital STIs for juvenile justice involved youth. Methods Used A retrospective chart review from March 1, 2020 to June 31, 2021 was conducted;only youth seen by a physician for an intake physical exam were included. During the intake physical exam, youth are asked if they have ever put their tongue or mouth on someone's penis, vagina or anus and if anyone has put their penis in their anus. The answers to these questions determine which youth are eligible for screening of extragenital infections. The answers to these intake screening questions, the completion of extragenital testing, and lab results were input into an excel spreadsheet. This data was analyzed using Excel. This study was approved by the University of Texas Health Science Center and the Juvenile Justice Center internal review boards. Summary of Results A total of 574 youth were seen for their intake physical by a physician during this time. 86% were male, the mean age was 15.4 (range 11-17), and 48.6% were black. Of these youth, 224 (39%) reported performing oral sex and 128 of those youth (57%) were tested for oropharyngeal STIs. 7 had unsatisfactory samples, while 1 (0.78%) had oral gonorrhea and 1 (0.78%) had oral chlamydia. There were 20 (3.48%) of all youth attesting to having received anal sex. Of these, 4 (20%) were tested for anal STIs and all were negative for anal gonorrhea or chlamydia. Conclusions The testing for oropharyngeal STIs significantly increased despite the COVID-19 pandemic, from 33.5% to 57%. However, the testing for rectal STIs decreased from 25.9% to 20%. While the prevalence of extragenital STIs at our facility also decreased during the pandemic, it is still necessary to continue testing since many extragenital STIS are largely asymptomatic. As providers offer more testing, it will be important for them to appropriately educate patients and decrease stigma of extragenital testing so that screening rates can improve. (Figure Presented).