National Girls Health Screen Project

Stoneleigh Fellow: Leslie Acoca, 2007-2010

Leslie Acoca has spent her career working with and studying issues related to women and girls in the adult and juvenile prison systems. She has an undergraduate degree from Yale University and masters degrees in counseling and psychology from University of San Francisco- Lone Mountain. She lectures nationally and has written extensively on health and juvenile justice issues, including presentations and publications for the National Council on Crime and Delinquency, the New Jersey Juvenile Justice Commission, the California Department of Corrections, and the Child Welfare League of America. She is, most recently, the founder and executive director of "In Our Daughters' Hands, Inc.", a California organization dedicated to promoting the physical and mental health of girls, particularly those who have entered or are at risk of entering the juvenile justice and child welfare systems.

Project Abstract

Girls have become the fastest growing segment of the juvenile justice population. Despite the overall drop in juvenile crime, data show an increase in both the number and percentage of girls in the juvenile justice system. A majority of girls in this population suffer from one or more serious health or mental health problems. Yet, there are neither medical standards to guide the screening, assessment, and treatment of these problems, nor comprehensive, specific data on the particular health care needs of these girls. Because detention facilities have traditionally served male detainees who have different health needs than their female counterparts, particularly in regard to reproductive health and incidence of sexual abuse, overall, appropriate services designed to meet girls' needs are lacking.

A disproportionate number of these girls are minority youth from low-income families with limited access to health care. This project helps meet a critical need in this population and earlier studies indicate that providing medical care to this population can prevent further justice involvement.  The applicant's 2001 study of girls in the Florida juvenile justice system revealed that girls who had entered the system at least once who had access to physical health care were over 72 percent less likely to re-enter the system or to commit serious and violent crimes.

In addition to preventing further justice involvement, addressing the health needs of girls in the justice system is important for several other reasons.  First, many states require juvenile justice facilities to attend to the medical needs of children in custody (adult inmates' right to medical care is guaranteed under the Eighth Amendment to the U.S. Constitution against cruel and unusual punishment). Second, humanitarian concerns prompt society to respond to the basic needs of vulnerable members. Third, major public health concerns regarding infectious and communicable diseases are addressed in treating this population of young people who have an elevated risk of having hepatitis, tuberculosis, and HIV/AIDS.

To address these problems, and working in collaboration with the Juvenile Law Center in Philadelphia, Leslie Acoca initiated the National Girls Health Screen Project (NGHSP). This three-phase, collaborative, cross-system project addresses the health care needs of girls aged 10-17 who have been detained. The project is currently underway at the Youth Study Center in Philadelphia and in California (where Acoca is based). Having completed phase one of the research, she is funded through a Stoneleigh Foundation Fellowship to complete the research and disseminate the findings.

Acoca has two primary collaborators in Pennsylvania: Robert Schwartz, Esq., of the sponsoring organization, the Juvenile Law Center; and Dr. Donald Schwarz, Chief of Adolescent Medicine at Children's Hospital of Philadelphia (CHOP). Frances Lexcen, Forensic Psychologist at the University of Washington, serves as senior researcher for the project facilitating data collection and analysis.

Project Goals

While the immediate goal of this project is to identify and prioritize the health problems of girls as they enter detention, the over-arching, long-term goal is to improve the health of girls in the juvenile justice system. Moreover, in the absence of any national medical standards, other, longer-term goals include the development of policies governing health screening, assessment and treatment of adolescent girls in the juvenile justice system; improvement of practice in juvenile detention facilities by providing assessments and treatment; impact on community health through the treatment of communicable diseases; and, ultimately increase in the girls' potential to lead healthy lives. Acoca also envisions the health screen project working in the child welfare system and systems serving homeless youth.

Specificall, the project seeks to:

  • Provide a research-based foundation for the development of medical standards in juvenile correctional settings; and, to
  • Develop legislation to support and monitor the delivery of health services for adolescent girls in the juvenile justice system

Project Method

Phase 1: Research.

In this phase, Acoca and her collaborators designed two tools necessary to assess the health needs of girls aged 10-17 detained in juvenile detention: (1) the Girls Health Screen (GHS) instrument and (2) a physical examination protocol to validate the screening tool. Acoca led the research team that developed the GHS, which is the first gender-responsive, research-based medical screening instrument for this population. The GHS instrument is a series of questions about physical and mental health administered by computer when a girl is admitted to a detention center. In order to develop the questions, the research team reviewed medical case files at the sites' detention centers (in Philadelphia, San Diego, and Santa Cruz). Wording of the GHS is age-appropriate, culturally sensitive, and suitable for girls with different learning abilities and different levels of literacy.

The physical exam to validate the screen was designed by Dr. Donald Schwarz of CHOP. This exam, conducted by the usual health care personnel at each site (typically nurses or nurse practitioners), is linked to items on the screening instrument and where possible, provides more than one validating physical examination or laboratory finding for each screening questionnaire response.

Phase 2: Validation.

This phase involves validating the GHS, which is currently being administered to 600 girls entering three detention facilities (in Philadelphia, San Diego, and Santa Cruz). Upon entering a facility, girls sit down in front of a laptop computer and answer on the computer a series of medical questions designed to identify and prioritize their medical needs. The results of the screen then lead facility staff to take whatever steps are necessary to meet her health needs. After they are screened, each girl receives a physical examination (developed in Phase 1 by CHOP's Dr. Donald Schwarz), which is designed to validate whether or not physical and mental health issues addressed in the computerized screening tool successfully identify the needs of the girls.

Phase 3: Dissemination.

During the final phase the researchers will build a national database on the health needs of girls in the juvenile justice system, and undertake a process of disseminating the findings to inform policy and practice across the country. In addition, the applicant will be working to develop partnerships for delivery of the information generated by the GHS to child and youth serving systems and ultimately to the girls themselves and their health providers. Publication of the work target both the juvenile justice and health systems. Dissemination will involve producing and distributing the GHS to agencies and facilities serving girls in the system. Acoca hopes to make this possible at minimal expense by relying on grant funding for disseminating the screening tool.