Leslie Acoca
Health and Justice for Girls

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 children.


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 and trauma.


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 systemaccess to medical care reduced the likelihood of recidivism and violent offending among girls at risk by 72%. 


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.


Funding Partners:

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 institution. 

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.


How 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 medical homes
    • GHS complies with Best Practice Guidelines from the American Academy of Pediatrics, NCCHC, NJDA and ACA.
    • GHS helps facilities respond to Federal and State mandates.
    • 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 greatest need
      • 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 necessity.
      • 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.


What 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?