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| Passing the screen test |
| By Ann Coppola, News Reporter |
| Published: 02/25/2008 |
In correctional medicine, if you ask what conditions inmates should be medically screened for before they enter a facility, the simple answer is there is no simple answer. Going down a one-size-fits-all checklist sounds like an easy way to prevent a flu, cold or other bug from getting past the gates. Realistically, when you start to consider all of the addictions, chronic illnesses, and short-term sicknesses that exist in our communities, the idea becomes not only impractical but impossible.Even though the task seems overwhelming, making a plan to decide when certain tests are performed, and for which individuals those tests are appropriate, can be accomplished in an organized and efficient way. Corrections.com spoke with Dr. John May, Chief Medical Officer of Armor Correctional Health Services, to sort out the intake challenge, and learn about the newest developments in correctional medical assessments. Corrections.com: What medical conditions should inmates be screened for at intake? John May: Well, there is no single checklist of conditions to screen for. It depends on the prevalence of certain conditions in certain communities, on the size and infrastructure of the facility, and on the risk factors of the inmates who are coming in. You should screen for conditions that will impact the facility, for which reasonable interventions exist, and for which a scientifically proven and practical-to-implement test is available. CC: So how can a facility figure out and prioritize which screenings are appropriate? JM: There are three main areas each facility ought to be screening for. First are conditions that would immediately impact the facility, either the other inmates or staff. This also includes any urgent health needs of the detainees. Communicable diseases like tuberculosis and MRSA, are good examples of things to screen for that would immediately put the whole facility at risk. These screenings are easy to achieve in almost any setting. None require lab tests, just a careful medical history obtained through some questions and visual observation. The next layer of screening would be for inmates’ health needs which have public health implications or risks. If this can’t be done at intake it can be done within the first fourteen days of their being in the facility. Inmates need to know if they have HIV, sexually transmitted infections like gonorrhea, Chlamydia, and syphilis, or if they are pregnant. The education is important both for their health and for the public health. The purpose of these screening tests is to identify conditions for which an early intervention is helpful. The third area is for health conditions that will have a long term impact on an inmate’s health. If the inmate is at risk for a long term condition and they are going to be at the facility for a longer time, it is generally appropriate to screen. These conditions include cancer, high cholesterol and hepatitis. CC: What about the cost of the tests? Can most facilities afford to perform screenings in all three of these areas? JM: Many facilities are doing at least some or all of these. They ought to be done and can be done without causing great disruption to the facility. The screenings are cost effective because, for example, if you don’t screen for Chlamydia it can turn into pelvic inflammatory disease. That can be avoided. You can also identify cervical cancer at an earlier state with a screening. These tests are not costly, but missing early interventions for these conditions ultimately is. CC: Can you discuss some of the newer developments with medical screenings? JM: Even though it’s not a medical condition, screening for the risk of a gunshot wound is a concept that’s been developing for awhile, and corrections is in a very good position to identify those at highest risk. The leading cause of death in African-American men aged 18 to 24 is gun violence. In a large number of jails as high as one in four male inmates have been shot at least once. There are different screening tools and interventions that can be done upon an inmate’s release for the risk of a gunshot wound. Some risk factors include a previous gunshot wound, easy access to a gun, inmates with gang related tattoos, and having witnessed a shooting at an early age. We can reduce rates of homicide by providing counseling and case management to these individuals. CC: When you talk to other doctors and nurses in the field, what concerns do they have about screening inmates? JM: When I spoke [at the American Correctional Association’s winter conference], some of the comments I heard from the audience was that the justification for different screenings is not always clear. Some people say that, for example, with a Chlamydia test they don’t understand why they have to do it or the science behind it. It’s important to know why certain tests are appropriate for identifying certain conditions, and how it will protect the facility and the public. Related Resources: Learn the NCCHC standards on screening Report studies health screenings in a county jail NIJ update on mental health screening |
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