What’s New in the 2011 Juvenile Standards

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Don’t be overwhelmed by the new Standards for Health Services in Juvenile Detention and Confinement Facilities—this article will break it down for you into the most need-to-know changes.

Some standards were renumbered or combined (e.g., ectoparasite control is now addressed under Y-B-01 Infection Control Program) and there are subtle changes throughout, but here we will focus solely on the most substantive. By no means will we address every change here, so read through all of the 2011 standards to ensure you are familiar with them. The first step to compliance will be walking through the new standards with your staff and, for each standard that applies to your facility, incorporating all of its compliance indicators into your policy and procedure manual. Speaking of Policies and Procedures (Y-A-05), a new compliance indicator requires the responsible physician to also sign the manual.

Two New Standards
Everyone should be aware of the two new standards: Y-B-03 Patient Safety and Y-B-04 Staff Safety. These standards, classified as important, encompass what we already do to ensure patient and staff safety by instituting nonpunitive error reporting systems, preventing near-miss and adverse clinical events and ensuring that juveniles and staff alike are in a safe and healthy environment.

Chronic Disease Services
Designated an important standard previously, Chronic Disease Services (Y-G-01) has been changed to essential; therefore, compliance is required in order to achieve accreditation. This is a key fact to keep in mind due to the substantial changes to the standard. You will note the addition of major mental illness and seizure disorder to the list of chronic diseases, and compliance indicators now include the appropriate elements of treatment plans. Staff should now maintain a list of patients with chronic diseases and be sure to update patient problem lists with such diagnoses.

Continuous Quality Improvement
The 2011 juvenile standards introduce exciting changes to Continuous Quality Improvement Program (Y-A-06). Depending on the average daily population, facilities will implement basic or comprehensive CQI programs, which will include annual process and outcome CQI studies in which a problem is identified, a study is completed, a plan is developed and implemented, results are monitored and tracked, and improvement is demonstrated or the problem is restudied. The new compliance indicators represent a significant change to the requirements of the standard. Remember that an outcome study assesses whether expected outcomes of patient care were achieved; in other words, outcome studies examine whether patients are improving under the care provided. Note that the responsible physician should be involved in the CQI program through means such as identification of thresholds, problem solving or interpreting data. Annual reviews of the effectiveness of the program will be required.

Suicide Prevention Program
Changes to monitoring potentially suicidal juveniles (Y-G-05 Suicide Prevention Program) will be a central concept for staff training. Whereas actively suicidal juveniles should be placed on constant observation, potentially suicidal juveniles should be monitored on an irregular schedule with no more than 15 minutes between checks. If, however, the potentially suicidal juvenile is isolated, constant observation is required. The new compliance indicators describe what a suicide prevention program should do in a bit more detail. Treatment has been added to the key components of a suicide prevention plan and, of course, treatment plans addressing suicidal ideation and its reoccurrence should be developed, and patient follow-up should occur as clinically indicated.

Continuity of Care
Additions to Y-E-12 Continuity of Care During Incarceration include the timely clinician review of findings with the patient. Treatment plans should be used to guide treatment for episodes of illness and include the elements noted in the new compliance indicators; clinicians should use diagnostic and treatment results to modify the treatment plans as appropriate. Pay attention to the new compliance indicators addressing a juvenile’s return from an emergency room visit or hospitalization. Physicians’ clinical chart reviews should be of sufficient number and frequency to ensure that clinically appropriate care is ordered and implemented by on-site health staff. This activity was moved from the 2004 Y-A-06 standard and its purpose is a bit different here, which we will discuss in a future column.

Procedure in the Event of a Juvenile Death
The Procedure in the Event of a Juvenile Death (Y-A-10) standard now includes two pieces to accompany the clinical mortality review: administrative review and, in the event of a suicide, a psychological autopsy. These three activities are the requirements of a death review under this standard and should be reflected in your policy.

Health Training for Child Care Staff
Please be aware that child care staff who work with juveniles should receive health-related training at least every two years (Y-C-04 Health Training for Child Care Staff). This time frame is new. While it is expected that 100% of the child care staff who work with juveniles are trained in all of the areas described in the standard, compliance now requires that at least 85% of the staff present on each shift are current in their health-related training. This indicator has been revised, as it previously required 100%. The prevention of heat-related illness has been added to the training that child care workers assigned to outside programs (e.g., Outward Bound programs, forestry camps and routine outdoor recreation) should have.

New Frequency Requirements and More

• Under Y-A-04 Administrative Meetings and Reports, documented health staff meetings should occur at least monthly (a new compliance indicator) and statistical reports will now be required quarterly rather than annually.

• The frequency of consulting pharmacist inspections has been increased to quarterly, from every six months, and all off-site locations should be included (Y-D-01 Pharmaceutical Operations).

• Inventories of items subject to abuse (e.g., needles, syringes and other sharps) are now required daily, rather than monthly, under Y-D-03 Clinic Space, Equipment, and Supplies.

• Another notable addition is that of inquiry to employers, state boards and the National Practitioner Data Bank as part of the credentialing process (Y-C-01 Credentialing).

• The Medication Services standard, Y-D-02, now states that juveniles entering the facility on prescription medication should continue to receive the medication in a timely fashion as prescribed, or acceptable alternate medications should be provided as clinically indicated.

• It is worth mentioning that under Y-D-04 Diagnostic Services, stool blood testing kits are no longer required to be kept on site.

• Finally, a notable change occurred in Y-E-04 Health Assessment, where gynecological assessment is now required during the initial health assessment as clinically indicated, rather than for every female youth.

We will go into more detail on revised standards in future articles and Q&A columns. Feel free to send your questions as you are preparing to transition to the 2011 edition.

 [This article first appeared in the Spring 2011 issue of CorrectCare.]

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