Juvenile Standards 2015: What’s New?

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The 2015 edition of NCCHC’s Standards for Health Services in Juvenile Detention and Confinement Facilities is the product of a task force of experts representing all disciplines within correctional health care.

The Standards lay the foundation for constitutionally acceptable health services systems and are the basis for NCCHC accreditation, which is a voluntary, ongoing process for continuing improvement. They address nine general areas: governance and administration, safety, personnel and training, health care services and support, patient care and treatment, health promotion, special needs and services, health records and medical-legal issues.

Each entry consists of the standard’s number and name, the standard itself, the compliance indicators, definitions (if any) and the discussion. The standard’s intent remains the first sentence of the discussion. The “optional recommendations” and “performance measures” from 2011 have either been eliminated or incorporated into the discussion.

Each standard is designated as either essential (facilities must meet 100% of those applicable) or important (facilities must meet 85% of those applicable). Four standards that were classified as important in the 2011 manual have been changed to essential in the 2015 edition:
• B-05 Federal Sexual Abuse Regulations
• D-05 Hospital and Specialty Care
• E-13 Discharge Planning
• G-06 Patients With Alcohol and Other Drug Problems

Thirteen standards were renamed or renumbered, and one section was renamed:
• A-08 Communication on Patients With Special Needs is now Communication on Patients’ Health Needs
• B-01 Infection Control Program is now Infection Prevention and Control Program
• B-05 Federal Sexual Assault Reporting Regulations is now Federal Sexual Abuse Regulations
• B-06 Procedure in the Event of Sexual Assault is now Response to Sexual Abuse
• C-01 Credentialing is now Credentials and Privileges
• E-12 Continuity of Care During Incarceration is now Continuity and Coordination of Care During Incarceration
• G-06 Intoxication and Withdrawal is now G-07
• G-07 Care of the Pregnant Juvenile is now G-09 Counseling and Care of the Pregnant and Postpartum Juvenile
• G-08 Juveniles With Alcohol and Other Drug Problems is now G-06 Patients With Alcohol and Other Drug Problems
• G-09 Family Planning Services is now G-08 Contraception and Family Planning Services
• G-10 Aids to Impairment is now Aids to Reduce Effects of Impairment
• H-03 Access to Custody Records is now H-04
• H-04 Management of Health Records is now H-03
• Section E Juvenile Care and Treatment is now Patient Care and Treatment

Some changes to the standards were substantial, others were more subtle. These standards were extensively revised:
• A-03 Medical Autonomy
• A-06 Continuous Quality Improvement Program
• B-03 Patient Safety
• B-06 Response to Sexual Abuse
• C-02 Clinical Performance Enhancement
• C-08 Health Care Liaison
• D-02 Medication Services
• D-05 Hospital and Specialty Care
• E-02 Receiving Screening
• E-04 Health Assessment
• E-07 Nonemergency Health Care Requests and Services
• E-12 Continuity and Coordination of Care During Incarceration
• F-05 Use of Tobacco
• G-01 Chronic Disease Services
• G-07 Intoxication and Withdrawal
• G-08 Contraception and Family Planning Services
• G-09 Counseling and Care of the Pregnant and Postpartum Juvenile
• G-11 Care for the Terminally Ill
• I-02 Emergency Psychotropic Medication
• I-03 Forensic Information

Snapshot of Notable Changes
A few of the notable changes in the 2015 standards are outlined below.

In the Governance and Administration section, A-03 Medical Autonomy introduces a new concept to the standards: Health staff members do not write disciplinary reports. While it is permissible for health staff to write an informational report about an incident, they should not be involved with the determination of disciplinary action as a result of the incident. If juveniles believe that health staff are able to influence discipline, it may discourage their use of the health care system, potentially creating a barrier to access to care.

A-06 Continuous Quality Improvement Program has changed significantly. This standard no longer requires a basic or comprehensive CQI program in which facilities had to conduct one to two process studies and one to two outcome studies per year, depending on their average daily population. Now, all facilities must establish a quality improvement committee. They must continue to study site-specific problems, but the type of study conducted is determined by the health care problem in question.

In the Personnel and Training section, C-02 Clinical Performance Enhancement was broadened to encompass all direct patient care clinicians, including RNs and LPNs. C-08 Health Care Liaison was changed to clarify when a health care liaison is required. A liaison is required when qualified health care professionals are not available for 24 hours, instead of when they are not on-site. A plan must still be in place that tells child care staff what to do when a health situation arises when health staff are not present.

In the Health Care Services and Support section, D-02 Medication Services has a new compliance indicator that focuses on issues of timeliness with medication delivery. The standard requires specific time frames from ordering to delivery, and backup plans if the time frames cannot be met. In D-05 Hospital and Specialty Care, a written agreement with the community hospital or off-site specialty services is no longer required, but it is recommended.

In the Patient Care and Treatment section, several standards have notable changes. E-02 Receiving Screening now requires that all females be offered a test for pregnancy; those who report opiate use are offered the test immediately and others are referred to health staff within 48 hours for testing. Tests for sexually transmitted diseases must be offered upon arrival or within 24 to 48 hours. Additional inquiries are now required on the receiving screening form.

E-04 Health Assessment now requires that all positive findings are reviewed by a treating clinician no matter who conducts the health assessment, and for this standard, a treating clinician is defined as a nurse practitioner, physician assistant or physician. A test for tuberculosis is required unless there is documentation from the health department that the prevalence rate does not warrant it.

E-09 Segregated Juveniles discourages prolonged segregation of more than two to five hours except under documented exceptional circumstances.

E-12 Continuity and Coordination of Care During Incarceration was almost entirely rewritten to be more patient-centered. Compliance indicators require timely care and sharing of treatment plans and testing results with patients.

In the Special Needs and Services section, G-01 Chronic Disease Services now requires clinical protocols for hypertension and sickle cell disease. The requirements for documentation in the health record were changed to include monitoring disease control (poor, fair or good) and patient status (stable, improving or deteriorating), as well as taking appropriate action to improve outcome. G-05 Suicide Prevention Program redefined several terms; for example, “actively suicidal” was changed to “acutely suicidal” and “potentially suicidal” was changed to “nonacutely suicidal.” G-08 Contraception and Family Planning Services has significant changes and also introduces language regarding the availability of contraception.

Finally, in the Medical-Legal Issues section, I-01 Restraint and Seclusion now specifies that health staff should order clinical restraints and seclusion only for patients exhibiting behavior dangerous to self or others as a result of medical or mental illness. I-02 Emergency Psychotropic Medication has additional follow-up care requirements following the use of such intervention.

Complying With the New Standards
Accredited facilities may choose to follow either the 2011 or the 2015 edition of the Standards until May 1, when all programs must be in compliance with the 2015 edition. Facilities that are undergoing surveys before May 2016 and choose to be accredited under the 2011 edition must submit a transition plan to NCCHC by May 1 outlining the changes that will be made to comply with 2015 Standards.

 [This article first appeared in the Winter 2016 issue of CorrectCare.]

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