The standard health question at the Bernalillo center about sexual abuse, for instance, is whether a girl has been raped in the past five days. A "yes" to that question could trigger an investigation, but it would do little to identify a history of sexual abuse that occurred earlier and may be a factor in a girls' mental health issues.
When Jessica first entered the facility, brought in by police in handcuffs, she was given basically the same treatment as if she were a boy.
First, she was given a full pat-down to check for contraband, like drugs or weapons. After showering and putting on her uniform, Jessica was given a brief health screening to ensure that she didn't need emergency medical services before being booked. The screen lasts about 15 minutes and is given by the facility's staff nurse in a small room attached to the intake area.
Acoca's Girls Health Screen app, given on an iPad.
The door remains open for security purposes, with guards and new residents passing by. Without privacy, Acoca says, girls are unlikely to reveal important health information, especially when they have previously been victimized.
Jessica was weighed, measured, vital signs taken, and the nurse briefly evaluated her physical and mental state, noting her judgment, affect, speech and mood. Next, she was asked a series of about 35 questions from the facility's medical intake form, including a list of her current medications, whether she had taken alcohol or drugs in the last 24 hours, was feeling suicidal or if she had a history of self-destructive behavior.
There are a handful of questions given only to females: Are you pregnant? If so, have you started prenatal care? What form of birth control do you use?
The Albuquerque facility is among the 15 to 17 percent of the country's 3,500 juvenile justice detention centers that test all girls for pregnancy on admission, according to the 2004 Juvenile Facilities Census. Almost one quarter of facilities do not offer access to obstetric services.
"There are many stories about girls whose pregnancies aren't identified, who then have miscarriages on the unit," Acoca says. "Every teen pregnancy must be considered high risk." A study published in the Western Journal of Medicine in 1995 found that 60 percent of facilities reported at least one obstetric complication.
In some facilities, Acoca says girls are asked questions about sexual assault in front of male residents. "These are girls with a history or rape and assault and their boundaries might not be well established," she explains. In many facilities, she adds, the staff nurses are trained to deal with adult men, not young girls.
The screening process is a missed opportunity, argues Acoca. "Detention may be the only chance [these girls] get to see a doctor, physician's assistant or a nurse who asks them questions about their health," making it an ideal time to provide needed services. It's also a chance to create a health record for the girls that can travel with them outside of the facility, and to link them with clinics and providers in the community when they leave.