Our Vision – A Case Study

Esperanza: A Case History Illustrating How the Girls Health & Justice Institute’s Programs and Services Will Transform Health Screening, Assessment and Treatment for Girls in Detention.

The “Before” version of our case study is a composite drawn from our interviews with several young women entering detention centers in the Eastern and Western regions of the country. The “After” version represents our projection of how differently this same young woman and her medical needs will be addressed once the web-based version of the validated Girls Health Screen© (GHS) becomes the standard medical intake for all girls entering United States detention facilities. We expect that the GHS and our other programs and services will guide medical evaluation and treatment procedures for detained girls in detention and afterwards in their home communities.

Before the Girls Health Screen©:

Imagine you are Esperanza, a 14-year-old Hispanic girl running away from home to get away from your Mom’s boyfriend who has been sexually abusing you for years. You have an older boyfriend because sex feels so familiar and you drink and use drugs to help with your pain and confusion. You are not feeling good physically, you are hot and have pain in your stomach and lower back. When you get really upset, like today, it’s hard to breathe but no one has filled your asthma inhaler prescription recently.

First, you run to your boyfriend’s house but his family won’t let you stay with them. Later, you start drinking and hanging out in the local park, but a cop notices your beer container, picks you up, handcuffs you and drives you to juvenile hall. You are scared and angry that an adult man has the power to restrain your hands and push you into his car.

When you get to Juvie you pass through an entry bay and several locked doors. Once inside, you are asked to step into the center of a small rectangle drawn on the linoleum floor with yellow paint. You are told to place your cuffed hands in front of you against the wall and step out of your shoes. In this posture a male correctional officer asks you six questions about your health, including whether you have any gunshot wounds, are high or intoxicated, have been sexually assaulted or feel like killing yourself. You feel dizzy, sick and terrified
so you answer that you “don’t know.” There are other kids, boys, sitting in the hallway looking at you. You feel very embarrassed and ashamed.

You tell the officer that you feel hot and that you have sharp pains in your back and stomach. You hear him talk to a woman officer about whether or not you are faking your health complaints or whether you need to be taken to the medical unit or hospital. They decide that since the liquid staining your pants is clear that you don’t need to go to the hospital, and besides, accompanying you to the hospital would mean taking an officer off duty, further understaffing the facility. You hear the two officers complain about how much more “difficult” girls are than boys and how girls are more likely to lie. You are given oversized sweats and shoes with no laces and locked alone in a single cell for the night.

The next morning at 6 am, an officer unlocks the metal door and tells you to get up for breakfast. You cannot move, you have a bad headache and your whole body is aching. You wait another three hours for the Juvie nurse to arrive. By that time, your pants and lower body are covered with blood. The nurse tells you that you are having a miscarriage and you are transported in cuffs to a local hospital where you are kept overnight for observation. You need a transfusion, that takes time because your blood type, B, common among Hispanics, is fairly rare in the general population. You don’t want your Mom or her boyfriend to find out about your pregnancy, so you stay alone feeling overwhelmingly depressed that you have lost your baby and scared that you might die.

The next day you are returned to Juvie and have a fifteen-minute physical with the nurse. Your exam is not very different from the physical exam given to the other girls or boys. You tell the nurse that you don’t have your asthma inhaler and that you have been drinking and using drugs a lot. The nurse tells you to get your asthma meds when you get home and to watch out for the signs of a pelvic infection. The nurse tells you that unfortunately there are no drug treatment programs for girls so that you will have to find a self-help group if you want to stop using. No one asks you how you feel about losing your baby or who your doctor is at home.

After the Girls Health Screen© is implemented:

You, Esperanza, will come through the Juvie intake bay and be led immediately to a small room off the intake hallway where you will see an ipad and headphones secured to a desk. There, the intake officer will explain the purpose of the Girls Health Screen© (to help the facility understand and attend your health problems) and how to use the ipad version of the Girls Health Screen questionnaire. Once you activate the device and place the headset on your head you will see medical questions about many areas of your life appear on the screen. You will hear the questions read aloud to you in Spanish or English, in case you have trouble reading. You will answer the questions because they are asked in a private setting in words you understand and seem like they describe problems relevant to your body and your life. You are fourteen and quick with technology so you finish the GHS in 12 minutes.

Once you complete the GHS, your answers will be immediately and automatically scored electronically. Your scored questionnaire will show the facility medical providers several answers in the red zone triggering immediate medical attention, such as the clear discharge you are experiencing, your fever and your need for asthma medication. Answers that indicate more chronic problems such as substance use will appear in orange and problems that require medical advocacy such as lack of a medical home or insurance in the community will appear in green.

Instead of going to a cell for the night you will be examined within one hour by the facility nurse or doctor. After your exam, a female officer will be taken off one of the units to escort you to the local hospital, which will also receive the results of your GHS and your physical exam. In the emergency room, it will be determined that you are pregnant and beginning to miscarry. You will be given medication, which successfully arrests the miscarriage and prevents infection.

At the hospital, staff will also learn that you are supposed to carry an inhaler with you at all times. The hospital pharmacy will provide you with an inhaler to take back to the facility. The physician will notice your reported drug use and ask you when you last used to make sure that you are not suffering from an overdose or that your drinking is not causing immediate harm to your baby.

The next day, when you return to detention, you will be taken directly to the nurse who will perform a 45-minute physical examination and medical/social history that is informed by data from the GHS and the ER. The nurse will address your urgent physical health needs including all medications you usually take, your allergies, your mental distress over your high risk pregnancy as well as your substance use history, and your family and social history, which includes victimization. A report is filed with child protective services about the long-term sexual abuse you have suffered from your Mom’s boyfriend.

Finally, you will be asked what kinds of family, health and mother/child resources you would like to access once you return home. You and the nurse will develop a plan for your long-term medical care and an Electronic Health Passport or web based personal health record in preparation for your release home. Your Health Passport information will be sent directly to your community health provider. Also, your health data, stripped of all personal identifiers so that your anonymity and confidentiality is protected, will become part of a national database on girls’ health.