Department of Juvenile & Adult Detention Health Clinic

Where is it?
1211 E Alder (off 12th, one block south of Jefferson)

How do I get there?
From UW or CHMC:
By car: Go south over the Mountlake Bridge; continue south on 24th (becomes 23rd) for 3 miles. Turn right on Jefferson (Ezell's Chicken on corner on the right). Turn left on 12th. Go 1 1/2 blocks; turn left into DYS parking lot.
By Shuttle: Take shuttle at UW to Harborview Hospital (9th and Jefferson). Walk east on Jefferson. Turn right on 13th. Go 1 block into parking lot.

From anywhere else:
By car: Take I-5 to James St. exit. Go east on James. Turn right on 12th. Go two blocks and turn left into DYS parking lot.
By bus: Call Metro, 553-3000.

Where do I park?
Park in Visitors' parking area located directly in front of the building. Parking is tight (to say the least) and you may have to wait for a spot to open up. That is okay! Please do not park in the two-hour free street parking, as tickets are given after two hours, and sick call lasts longer than 2 hours.

Please leave your cell phone in the car. No cell phones are allowed inside.

To Reach the Health Clinic:
Enter the building at the main entrance (latte stand next to the door). Proceed through the Security station and take the elevator on your left down to the first floor. Go straight ahead, then veer to the right, and you will arrive at the sally port of Central Services. State your name and destination (Health Clinic) and they will let you pass through, after trading you a Visitor's Pass for your Driver's License. Turn left and go down the hall to the stairs on the left. Go down the stairs, turn left and the Health Clinic (room 033) is on the right before you get to Control Post 1. Welcome! Sick call usually begins at 9:00 am.

Who is my contact person?
You will be working with Dr. Ann Giesel.

Overview:
This is a unique "outpatient" setting, probably different from anything you have experienced before. The first visit is often somewhat overwhelming. The youth are usually cooperative and see us as providers of health care, not as their adversaries. Focus on their concerns, not their offense.

Security:
NEVER leave a youth alone in an exam room or office. If you do, the nursing staff will need to be notified so that they can order a "strip search". Do NOT tell youths the dates of appointments at other facilities.
*** KEEP YOUTH IN YOUR SIGHT AT ALL TIMES! ***
For security reasons, cell phones are not allowed inside the facility.

Background Information:
The Juvenile Detention Center is a facility for youths under 18 years who have been charged with a crime in King County. Most often, they are awaiting court or sentencing. A few youths will serve short sentences at the Detention Center. Capacity: 150-160, new facility completed late fall, 1992. The average length of stay is several days; range is < 24 hrs to months. The detainees are a medically underserved population with increased risk for drug use, STDs, mental health problems, school failure and illiteracy. They include gang members, street kids, and "regular" kids. Youth of color are disproportionately represented. Youth are often anxious or depressed about their court dates, sentencing, and the uncertainty of their situation. The average reading level is at the 4th grade. Many are repeat offenders.

Patient Care:
CODE BLUE: When this is announced on the radio, it is a medical emergency. RN and medical provider go to the designated site with emergency equipment.

Medical:
Health clinic staff performs medical, mental health, and drug and alcohol screens at the time of admission. This includes vital signs, urine dip, and urine chlamydia LCR. Youth, RN, or other staff initiates sick call visits.

Health appraisals are completed on all youths within 7 days of admission unless previously completed within the past six months (per NCCHC standards).
1) Review the admission screen
2) Complete a brief past medical history, review of systems, and physical exam
3) Remember to mention confidentiality and the routine nature of questions at the beginning of the interview.
4) Make sure youth has had vital signs checked and urine dip done (for LE, prot, & glc) Chlamydia LCR is also offered to all.
5) Included in EPSDT is vision and hearing

STD screening is performed by clinicians (PAs and NPs) from the Harborview STD Clinic and by UW medical staff. HIV counseling and anonymous testing are performed by the communicable disease investigator from the Health Department. Do not chart anything about HIV status or testing in the chart.

Hepatitis A & B immunization is offered to all youth through HMC STD Clinic/Health Dept.

Referrals may be made outside the facility prn; discuss with fellow or attending. Medical Chart: Problem List -- note Health Appraisal (EPSDT), Allergies, etc.

Order Sheet -- at the left of the chart (please discuss all orders with preceptor)

Progress Notes, Health Appraisal Forms - red-bordered forms, Labs. Billing/Encounter Forms - Complete form and give to preceptor to sign.

Mental Health Team:
Youth may be referred to the Mental Health Team. Discuss your concerns with the attending. Appropriate referrals would include concerns regarding suicidal ideation, depression, self-mutilation or carving, psychotic behavior, etc. Check progress notes to see if the youth is being followed by mental health. Write referrals on the appropriate form and place in the mental health box. Referrals may also be made to the Drug and Alcohol team.

Laboratory:
In house -- Urine dip for leukocyte esterase, nitrites, protein and glucose, etc.
- Urine pregnancy test
- Occult blood in stool
- KOH, wet mount, gram stain
- Blood glucose chemstrip
- Hematocrit
- Quick strep test
Outside lab -- Cultures for gonorrhea, herpes; chlamydia LCR
- RPR, HIV
- Others as indicated - (CBC, urine C&S etc.)
- Throat culture to R/O Group A strep