Original Article
A descriptive study of primary health care practices in Ontario’s youth custody facilities Lisa S Cossy MSc1, Linda T Miller PhD2 LS Cossy, LT Miller. A descriptive study of primary health care practices in Ontario’s youth custody facilities. Paediatr Child Health 2013;18(10):523-528. BACKGROUND: Adolescents admitted to youth custody facilities are often in need of physical and mental health care. OBJECTIVES: To describe primary health care practices in Ontario’s youth custody facilities. METHOD: A questionnaire regarding facility characteristics and primary health care practices was distributed to the directors of all youth custody facilities in Ontario. RESULTS: Most (87.8%) facilities obtained medical histories after the youth arrived, and 92% used health care professionals to perform that assessment. Intake medical examinations were performed on each youth admitted to custody at 94% of all facilities; however, only 57.2% of facilities reported that these examinations were performed by a doctor within 72 h of admission. Performing suicide assessments on all youth at intake was reported by 77.6% of facilities. Continuous health education was provided by 76% of facilities. Facility type and type of management appear to be related to some areas of health services provision. CONCLUSIONS: Youth custody facilities in Ontario are providing primary health care services. Weaknesses are, however, evident, particularly in relation to untimely intake medical examinations, failure to provide continuous health education and failure to conduct suicide assessments on all youth at intake. Future research on barriers to health service provision in Canadian youth custody facilities is recommended. Key Words: Custody facilities; Health care; Health practices; Youth
custody
R
esearch reveals that youth admitted to custodial facilities are often in need of physical, dental and psychological health care (1-3). Several studies have found that these youth have higher rates of health problems compared with the general population of youth (4-6). Many juvenile offenders also acquire injuries and health care problems while in custody due to psychological distress, fights, use of physical restraints and self-inflicted injuries (7-9). In Canada, young people in custody usually range from 12 to 17 years of age (10). There are two types of custody in which a youth can be placed: open custody and secure custody. Secure custody is typically intended for youth who have been found guilty of serious offences or who pose an escape risk. In secure custody facilities, youth are detained by security devices, including fullperimeter fences, electronic surveillance and locked bedroom doors at night; they may also be under constant observation by staff (10,11). Alternatively, a facility is considered to be ‘open’ when there is minimal use of security devices or perimeter
Une étude descriptive des pratiques de soins de première ligne dans les établissements de garde d’adolescents de l’Ontario HISTORIQUE : Les adolescents admis dans des établissements de garde ont souvent besoin de soins physiques et mentaux. OBJECTIFS : Décrire les pratiques de soins de première ligne dans les établissements de garde d’adolescents de l’Ontario. MÉTHODOLOGIE : Les directeurs de tous les établissements de garde d’adolescents de l’Ontario ont reçu un questionnaire sur les caractéristiques de leur établissement et les pratiques de soins de première ligne qui y sont offertes. RÉSULTATS : La plupart des établissements (87,8 %) obtenaient les antécédents médicaux de l’adolescent après son arrivée, et 92 % faisaient appel à des professionnels de la santé pour ce faire. Dans 94 % des établissements, chaque adolescent subissait un examen médical à l’arrivée, mais seulement 57,2 % des directeurs ont déclaré que ces examens étaient effectués par un médecin dans les 72 heures suivant leur admission. Tous les adolescents devaient se soumettre à une évaluation du risque de suicide à leur arrivée dans 77,6 % des établissements. Une formation continue dans le domaine de la santé était assurée dans 76 % des établissements. Le type d’établissement et le type de gestion semblaient liés à certains aspects de la prestation de services de santé. CONCLUSIONS : Les établissements de garde d’adolescents de l’Ontario fournissent des soins de première ligne. Les faiblesses sont toutefois évidentes, notamment en ce qui a trait à l’examen médical effectué trop longtemps après l’admission ainsi qu’au défaut de fournir une formation continue dans le domaine de la santé et de procéder à une évaluation du risque de suicide auprès de tous les adolescents à leur admission. D’autres recherches sont recommandées sur les obstacles à la prestation de services de santé dans les établissements de garde du Canada.
security (10). Most open custody facilities have fewer restrictions on youths’ movement within the facility and allow access to activities such as escorted community outings (11). Under the Youth Criminal Justice Act, open custody facilities may consist of a community residential centre, a child care institution, a group home, and a forest or wilderness camp (10). The living arrangements in youth custody facilities may vary depending on the type and size of the facility. Small open and secure custody facilities may have single rooms or a mixture of single and double rooms, whereas large secure custody facilities may have cells with bunk beds. All youth custody facilities in Ontario are funded by the provincial government. However, not all youth custody facilities are managed by the provincial government; there are numerous privately operated facilities (12). In Ontario, 7511 youth were admitted to custody (pretrial detention) between 2010 and 2011 (13); however, only 1152 youth received a custodial sentence. A total of 647 youth were sentenced to open custody facilities (517 males and 130 females). Secure
1Health and Rehabilitation Sciences; 2School of Occupational Therapy, University of Western Ontario, London, Ontario Correspondence: Miss Lisa Cossy, University of Western Ontario, Health and Rehabilitation Sciences, Elborn College 1201 Western Road, London, Ontario N6G 1H1. Telephone 519-661-2175, fax 519-661-3730, e-mail [email protected] Accepted for publication July 8, 2013
Paediatr Child Health Vol 18 No 10 December 2013
©2013 Pulsus Group Inc. All rights reserved
523
Cossy and Miller
Table 1 Postintake health care services
TABLE 2 Mental health services
Question*
Question*
Open custody Secure custody All facilities
How soon are postintake medical concerns addressed (n=49)
Open custody
Secure custody
All facilities
Suicide assessments at intake (n=49)
24 h by doctor
17 (50.0)
7 (50.0)
24 (50.0)
Yes
25 (71.4)
13 (92.9)
38 (77.6)
24 h by nurse
1 (2.9)
1 (7.1)
2 (4.2)
No
10 (28.6)
1 (7.1)
11 (22.4)
48 h
3 (8.8)
2 (14.3)
5 (10.4)
72 h
3 (8.8)
1 (7.1)
4 (8.3)
Yes
30 (85.7)
4 to 7 days
2 (5.9)
0 (0)
2 (4.2)
No
5 (14.3)
Doctor’s availability
8 (23.6)
3 (21.5)
11 (22.9)
Medical service providers used for postintake health care (n=49)
Screen for recent/past drug use at intake (n=49) 14 (100.0) 0 (0)
44 (75.5) 5 (24.5)
Access to trained counsellors (n=40) 18 (62.1)
8 (72.7)
Contracted doctors
19 (57.6)
5 (41.7)
25 (55.5)
Always Sometimes
3 (10.3)
2 (18.2)
5 (12.5)
Emergency room
18 (54.5)
11 (91.7)
29 (64.4)
Never
8 (27.6)
1 (9.1)
9 (22.5)
Walk in clinic
20 (60.6)
6 (50.0)
26 (57.8)
Any available doctor
17 (21.2)
4 (33.3)
11 (24.4)
Other medical office
12 (36.4)
2 (16.7)
14 (31.1)
26 (65.0)
Data presented as n (%). *Totals differ because of appropriate skips in questions or nonresponse to questions
Health education classes (n=49) Yes
26 (74.3)
11 (78.6)
37 (75.5)
No
9 (25.7)
3 (21.4)
12 (24.5)
Frequency of health education classes (n=37) Daily
2 (7.7)
0 (0)
3 to 4 times per week
2 (7.7)
0 (0)
Weekly
2 (5.4) 2 (5.4)
10 (38.5)
5 (45.4)
15 (40.5)
Biweekly
2 (7.7)
2 (18.2)
4 (10.8)
Monthly
7 (26.9)
2 (18.2)
9 (24.4)
Quarterly
3 (11.5)
2 (18.2)
5 (13.5)
Health education topics (n=37) Dermatology
5 (19.2)
3 (27.2)
8 (21.6)
Drug use
23 (88.4)
11 (100.0)
34 (91.8)
Exercise and sports
22 (84.6)
10 (90.9)
32 (86.4)
Food and nutrition
21 (80.7)
11 (100.0)
32 (86.4)
Hygiene
26 (100.0)
10 (90.9)
36 (97.2)
Mental health
10 (16.5)
8 (72.7)
24 (64.8)
Parenting classes
12 (46.1)
5 (45.4)
17 (45.9)
Prenatal classes
26 (100.0)
1 (9.0)
Sexual health
26 (100.0)
11 (100.0)
37 (100.0)
4 (15.3)
3 (27.2)
7 (18.9)
Other
6 (16.2)
Data presented as n (%). *Totals differ because of appropriate skips in questions or nonresponse to questions
custody sentences totaled 505 youth (437 males and 68 females) (14). The majority (54.8%) of all youth who received custodial sentences to both open and secure custody facilities spent between one and six months in custody, whereas 65.3% of youth admitted to pretrial detention spent between one and 30 days in custody (14). Despite the evidence of high rates of health issues within this population, health services within many youth custody facilities are often deficient (15,16). Several investigations into youth custody facilities within Ontario have revealed inadequate levels of care. Concerns identified by the youth include unavailability of nonprescription medications on week nights and weekends, dry air that causes nose bleeds, poor food quality and quantity, and lack of access to fresh air (17,18). Information regarding health care practices in youth custody facilities in Canada and Ontario is limited, unlike in the United Kingdom and the United States (US), where such information is available on websites of the departments responsible for juvenile justice services. To increase information regarding this area of Canadian youth justice services, the main purpose of the present study was to describe primary health care services in Ontario’s youth custody facilities. To the best of our knowledge, no studies examining a wide range of primary health care practices in Canadian youth custody facilities have been published. 524
METHODS
An 81-item questionnaire was distributed via e-mail to the directors of all open and secure youth custody facilities in Ontario. There were 70 youth custody facilities in Ontario when the survey was conducted; 49 of the facilities were open custody facilities and 21 were secure custody facilities. All 70 facilities were invited to participate in the survey. The director of each facility was the intended respondent, and each director was contacted by telephone to discuss participation in the study and to obtain his or her e-mail address. A copy of the survey, the letter of information and instructions for completion and return of the survey were forwarded via e-mail to the facility director. No surveys were distributed to the youth detained in the facilities. The questionnaire was developed from a review of the Canadian Paediatric Society, WHO and United Nations (19) recommendations for the health care of youth in custody, and from a review of reports on health care practices in youth custody in the United Kingdom and the US (20,21). The questionnaire consisted of 79 closed-ended questions and two open-ended questions; it contained 13 sections and requested information on the following domains: facility demographic information; health care oversight and guidelines; health care program; intake assessments; postintake health services provision; privacy and consent issues; staffing information; emergency care; nutrition; health education; physical activity; mental health care; and long-term care. Only items related to program oversight, intake assessment, postintake health services provision, medical staff complement, health education and mental health are reported in the present study. The questions were designed to elicit information about the availability and provision of primary health care services, eg, “After arrival at this facility do the youth undergo a medical evaluation?” “If yes, within what time period after admission are medical evaluations generally performed?” “Is there an ongoing health education program for the youth?” “How often are health education sessions conducted?”. The questions and the response options relating to the data provided in the present study are listed in Tables 1 and 2. The present study was approved by the Research Ethics Committee of the University of Western Ontario (London, Ontario) and Ontario’s Youth Justice Research Committee. Data analysis SPSS version 17.0 (IBM Corporation, USA) was used to analyze the data. Descriptive statistics were used to summarize the presence and prevalence of primary health care practices. χ2 tests were performed to determine whether there were associations among Paediatr Child Health Vol 18 No 10 December 2013
Health care in youth custody facilities
TABLE 3 Characteristics of youth custody facilities
TABLE 4 Intake health care practices
Characteristic*
Question*
Open custody Secure custody All facilities
Type of management (n=49) Government Private
8 (22.9)
7 (50.0)
15 (30.6)
Yes
27 (77.1)
7 (50.0)
34 (69.4)
Not routine
Population type (n=49) All male
Open custody Secure custody All facilities
Medical history at intake (n=49) 30 (85.7)
13 (92.9)
43 (87.8)
5 (14.3)
1 (7.1)
6 (12.2)
13 (100.0)
40 (93.0)
Who takes medical history (n=43) 22 (62.9)
6 (42.9)
28 (57.1)
All female
6 (17.1)
2 (14.3)
8 (16.3)
Male and female
7 (20.0)
6 (42.9)
13 (26.5)
Medical professional
27 (79.0)
Trained other
1 (3.3)
0 (0)
1 (3.3)
Untrained other
2 (6.7)
0 (0)
2 (6.7)
Intake medical examination (n=49)†
Capacity, number of youth (n=41) 6–10
23 (79.3)
1 (8.3)
24 (58.6)
Yes
31 (88.5)
11–19
5 (17.2)
4 (33.3)
9 (22.0)
No
4 (11.5)
20–29
1 (3.5)
2 (16.7)
3 (7.3)
14 (100.0) 0 (0)
45 (91.8) 4 (8.9)
Who performs intake examination (n=49)
30–39
0 (0)
2 (16.7)
2 (4.8)
>40
0 (0)
3 (25.0)
3 (7.3)
24 h
0 (0)
0 (0)
A descriptive study of primary health care practices in Ontario’s youth custody facilities Lisa S Cossy MSc1, Linda T Miller PhD2 LS Cossy, LT Miller. A descriptive study of primary health care practices in Ontario’s youth custody facilities. Paediatr Child Health 2013;18(10):523-528. BACKGROUND: Adolescents admitted to youth custody facilities are often in need of physical and mental health care. OBJECTIVES: To describe primary health care practices in Ontario’s youth custody facilities. METHOD: A questionnaire regarding facility characteristics and primary health care practices was distributed to the directors of all youth custody facilities in Ontario. RESULTS: Most (87.8%) facilities obtained medical histories after the youth arrived, and 92% used health care professionals to perform that assessment. Intake medical examinations were performed on each youth admitted to custody at 94% of all facilities; however, only 57.2% of facilities reported that these examinations were performed by a doctor within 72 h of admission. Performing suicide assessments on all youth at intake was reported by 77.6% of facilities. Continuous health education was provided by 76% of facilities. Facility type and type of management appear to be related to some areas of health services provision. CONCLUSIONS: Youth custody facilities in Ontario are providing primary health care services. Weaknesses are, however, evident, particularly in relation to untimely intake medical examinations, failure to provide continuous health education and failure to conduct suicide assessments on all youth at intake. Future research on barriers to health service provision in Canadian youth custody facilities is recommended. Key Words: Custody facilities; Health care; Health practices; Youth
custody
R
esearch reveals that youth admitted to custodial facilities are often in need of physical, dental and psychological health care (1-3). Several studies have found that these youth have higher rates of health problems compared with the general population of youth (4-6). Many juvenile offenders also acquire injuries and health care problems while in custody due to psychological distress, fights, use of physical restraints and self-inflicted injuries (7-9). In Canada, young people in custody usually range from 12 to 17 years of age (10). There are two types of custody in which a youth can be placed: open custody and secure custody. Secure custody is typically intended for youth who have been found guilty of serious offences or who pose an escape risk. In secure custody facilities, youth are detained by security devices, including fullperimeter fences, electronic surveillance and locked bedroom doors at night; they may also be under constant observation by staff (10,11). Alternatively, a facility is considered to be ‘open’ when there is minimal use of security devices or perimeter
Une étude descriptive des pratiques de soins de première ligne dans les établissements de garde d’adolescents de l’Ontario HISTORIQUE : Les adolescents admis dans des établissements de garde ont souvent besoin de soins physiques et mentaux. OBJECTIFS : Décrire les pratiques de soins de première ligne dans les établissements de garde d’adolescents de l’Ontario. MÉTHODOLOGIE : Les directeurs de tous les établissements de garde d’adolescents de l’Ontario ont reçu un questionnaire sur les caractéristiques de leur établissement et les pratiques de soins de première ligne qui y sont offertes. RÉSULTATS : La plupart des établissements (87,8 %) obtenaient les antécédents médicaux de l’adolescent après son arrivée, et 92 % faisaient appel à des professionnels de la santé pour ce faire. Dans 94 % des établissements, chaque adolescent subissait un examen médical à l’arrivée, mais seulement 57,2 % des directeurs ont déclaré que ces examens étaient effectués par un médecin dans les 72 heures suivant leur admission. Tous les adolescents devaient se soumettre à une évaluation du risque de suicide à leur arrivée dans 77,6 % des établissements. Une formation continue dans le domaine de la santé était assurée dans 76 % des établissements. Le type d’établissement et le type de gestion semblaient liés à certains aspects de la prestation de services de santé. CONCLUSIONS : Les établissements de garde d’adolescents de l’Ontario fournissent des soins de première ligne. Les faiblesses sont toutefois évidentes, notamment en ce qui a trait à l’examen médical effectué trop longtemps après l’admission ainsi qu’au défaut de fournir une formation continue dans le domaine de la santé et de procéder à une évaluation du risque de suicide auprès de tous les adolescents à leur admission. D’autres recherches sont recommandées sur les obstacles à la prestation de services de santé dans les établissements de garde du Canada.
security (10). Most open custody facilities have fewer restrictions on youths’ movement within the facility and allow access to activities such as escorted community outings (11). Under the Youth Criminal Justice Act, open custody facilities may consist of a community residential centre, a child care institution, a group home, and a forest or wilderness camp (10). The living arrangements in youth custody facilities may vary depending on the type and size of the facility. Small open and secure custody facilities may have single rooms or a mixture of single and double rooms, whereas large secure custody facilities may have cells with bunk beds. All youth custody facilities in Ontario are funded by the provincial government. However, not all youth custody facilities are managed by the provincial government; there are numerous privately operated facilities (12). In Ontario, 7511 youth were admitted to custody (pretrial detention) between 2010 and 2011 (13); however, only 1152 youth received a custodial sentence. A total of 647 youth were sentenced to open custody facilities (517 males and 130 females). Secure
1Health and Rehabilitation Sciences; 2School of Occupational Therapy, University of Western Ontario, London, Ontario Correspondence: Miss Lisa Cossy, University of Western Ontario, Health and Rehabilitation Sciences, Elborn College 1201 Western Road, London, Ontario N6G 1H1. Telephone 519-661-2175, fax 519-661-3730, e-mail [email protected] Accepted for publication July 8, 2013
Paediatr Child Health Vol 18 No 10 December 2013
©2013 Pulsus Group Inc. All rights reserved
523
Cossy and Miller
Table 1 Postintake health care services
TABLE 2 Mental health services
Question*
Question*
Open custody Secure custody All facilities
How soon are postintake medical concerns addressed (n=49)
Open custody
Secure custody
All facilities
Suicide assessments at intake (n=49)
24 h by doctor
17 (50.0)
7 (50.0)
24 (50.0)
Yes
25 (71.4)
13 (92.9)
38 (77.6)
24 h by nurse
1 (2.9)
1 (7.1)
2 (4.2)
No
10 (28.6)
1 (7.1)
11 (22.4)
48 h
3 (8.8)
2 (14.3)
5 (10.4)
72 h
3 (8.8)
1 (7.1)
4 (8.3)
Yes
30 (85.7)
4 to 7 days
2 (5.9)
0 (0)
2 (4.2)
No
5 (14.3)
Doctor’s availability
8 (23.6)
3 (21.5)
11 (22.9)
Medical service providers used for postintake health care (n=49)
Screen for recent/past drug use at intake (n=49) 14 (100.0) 0 (0)
44 (75.5) 5 (24.5)
Access to trained counsellors (n=40) 18 (62.1)
8 (72.7)
Contracted doctors
19 (57.6)
5 (41.7)
25 (55.5)
Always Sometimes
3 (10.3)
2 (18.2)
5 (12.5)
Emergency room
18 (54.5)
11 (91.7)
29 (64.4)
Never
8 (27.6)
1 (9.1)
9 (22.5)
Walk in clinic
20 (60.6)
6 (50.0)
26 (57.8)
Any available doctor
17 (21.2)
4 (33.3)
11 (24.4)
Other medical office
12 (36.4)
2 (16.7)
14 (31.1)
26 (65.0)
Data presented as n (%). *Totals differ because of appropriate skips in questions or nonresponse to questions
Health education classes (n=49) Yes
26 (74.3)
11 (78.6)
37 (75.5)
No
9 (25.7)
3 (21.4)
12 (24.5)
Frequency of health education classes (n=37) Daily
2 (7.7)
0 (0)
3 to 4 times per week
2 (7.7)
0 (0)
Weekly
2 (5.4) 2 (5.4)
10 (38.5)
5 (45.4)
15 (40.5)
Biweekly
2 (7.7)
2 (18.2)
4 (10.8)
Monthly
7 (26.9)
2 (18.2)
9 (24.4)
Quarterly
3 (11.5)
2 (18.2)
5 (13.5)
Health education topics (n=37) Dermatology
5 (19.2)
3 (27.2)
8 (21.6)
Drug use
23 (88.4)
11 (100.0)
34 (91.8)
Exercise and sports
22 (84.6)
10 (90.9)
32 (86.4)
Food and nutrition
21 (80.7)
11 (100.0)
32 (86.4)
Hygiene
26 (100.0)
10 (90.9)
36 (97.2)
Mental health
10 (16.5)
8 (72.7)
24 (64.8)
Parenting classes
12 (46.1)
5 (45.4)
17 (45.9)
Prenatal classes
26 (100.0)
1 (9.0)
Sexual health
26 (100.0)
11 (100.0)
37 (100.0)
4 (15.3)
3 (27.2)
7 (18.9)
Other
6 (16.2)
Data presented as n (%). *Totals differ because of appropriate skips in questions or nonresponse to questions
custody sentences totaled 505 youth (437 males and 68 females) (14). The majority (54.8%) of all youth who received custodial sentences to both open and secure custody facilities spent between one and six months in custody, whereas 65.3% of youth admitted to pretrial detention spent between one and 30 days in custody (14). Despite the evidence of high rates of health issues within this population, health services within many youth custody facilities are often deficient (15,16). Several investigations into youth custody facilities within Ontario have revealed inadequate levels of care. Concerns identified by the youth include unavailability of nonprescription medications on week nights and weekends, dry air that causes nose bleeds, poor food quality and quantity, and lack of access to fresh air (17,18). Information regarding health care practices in youth custody facilities in Canada and Ontario is limited, unlike in the United Kingdom and the United States (US), where such information is available on websites of the departments responsible for juvenile justice services. To increase information regarding this area of Canadian youth justice services, the main purpose of the present study was to describe primary health care services in Ontario’s youth custody facilities. To the best of our knowledge, no studies examining a wide range of primary health care practices in Canadian youth custody facilities have been published. 524
METHODS
An 81-item questionnaire was distributed via e-mail to the directors of all open and secure youth custody facilities in Ontario. There were 70 youth custody facilities in Ontario when the survey was conducted; 49 of the facilities were open custody facilities and 21 were secure custody facilities. All 70 facilities were invited to participate in the survey. The director of each facility was the intended respondent, and each director was contacted by telephone to discuss participation in the study and to obtain his or her e-mail address. A copy of the survey, the letter of information and instructions for completion and return of the survey were forwarded via e-mail to the facility director. No surveys were distributed to the youth detained in the facilities. The questionnaire was developed from a review of the Canadian Paediatric Society, WHO and United Nations (19) recommendations for the health care of youth in custody, and from a review of reports on health care practices in youth custody in the United Kingdom and the US (20,21). The questionnaire consisted of 79 closed-ended questions and two open-ended questions; it contained 13 sections and requested information on the following domains: facility demographic information; health care oversight and guidelines; health care program; intake assessments; postintake health services provision; privacy and consent issues; staffing information; emergency care; nutrition; health education; physical activity; mental health care; and long-term care. Only items related to program oversight, intake assessment, postintake health services provision, medical staff complement, health education and mental health are reported in the present study. The questions were designed to elicit information about the availability and provision of primary health care services, eg, “After arrival at this facility do the youth undergo a medical evaluation?” “If yes, within what time period after admission are medical evaluations generally performed?” “Is there an ongoing health education program for the youth?” “How often are health education sessions conducted?”. The questions and the response options relating to the data provided in the present study are listed in Tables 1 and 2. The present study was approved by the Research Ethics Committee of the University of Western Ontario (London, Ontario) and Ontario’s Youth Justice Research Committee. Data analysis SPSS version 17.0 (IBM Corporation, USA) was used to analyze the data. Descriptive statistics were used to summarize the presence and prevalence of primary health care practices. χ2 tests were performed to determine whether there were associations among Paediatr Child Health Vol 18 No 10 December 2013
Health care in youth custody facilities
TABLE 3 Characteristics of youth custody facilities
TABLE 4 Intake health care practices
Characteristic*
Question*
Open custody Secure custody All facilities
Type of management (n=49) Government Private
8 (22.9)
7 (50.0)
15 (30.6)
Yes
27 (77.1)
7 (50.0)
34 (69.4)
Not routine
Population type (n=49) All male
Open custody Secure custody All facilities
Medical history at intake (n=49) 30 (85.7)
13 (92.9)
43 (87.8)
5 (14.3)
1 (7.1)
6 (12.2)
13 (100.0)
40 (93.0)
Who takes medical history (n=43) 22 (62.9)
6 (42.9)
28 (57.1)
All female
6 (17.1)
2 (14.3)
8 (16.3)
Male and female
7 (20.0)
6 (42.9)
13 (26.5)
Medical professional
27 (79.0)
Trained other
1 (3.3)
0 (0)
1 (3.3)
Untrained other
2 (6.7)
0 (0)
2 (6.7)
Intake medical examination (n=49)†
Capacity, number of youth (n=41) 6–10
23 (79.3)
1 (8.3)
24 (58.6)
Yes
31 (88.5)
11–19
5 (17.2)
4 (33.3)
9 (22.0)
No
4 (11.5)
20–29
1 (3.5)
2 (16.7)
3 (7.3)
14 (100.0) 0 (0)
45 (91.8) 4 (8.9)
Who performs intake examination (n=49)
30–39
0 (0)
2 (16.7)
2 (4.8)
>40
0 (0)
3 (25.0)
3 (7.3)
24 h
0 (0)
0 (0)
