State Immunization Requirements for Juveniles in Detention Facilities

State Immunization Requirements for Juveniles in Detention Facilities Megan Lindley 1, Gail Horlick 1, Abigail Shefer 1, Fred Shaw 2, Margaret Gorji 3 National Immunization Program, CDC 2 Public Health Law Program, CDC 3 Warner, Mayoue, Bates & Nolen, PC 1 March 8, 2007 The findings and conclusions in this presentation have not been formally disseminated by CDC and should not be construed to represent any agency determination or policy.

Background • Laws requiring immunizations for school entry have been shown to improve child & adolescent vaccination coverage in elementary and middle schools. • Little is known about the use of immunization laws in other settings.

Objective • Determine status of laws, regulations, and other legal requirements relating to immunization in juvenile detention facilities

Methods • Legal analysts in CDC’s Public Health Law Program collected statutes and regulations from all 50 states and D. C. – Lexis-Nexis – Public web-based databases • Data collected September 2004 – June 2005 • Legal counsel from each state given opportunity to comment on accuracy, completeness and interpretation of findings

Study Questions • Assessment: Is the facility required to assess immunization status or screen for any vaccine-preventable disease (VPD)? • Administration: – Offer: Is the facility required to offer or make available any vaccine to any resident? – Ensure: Is the facility required to provide, arrange for or make certain that any resident has been vaccinated against any VPD? • Exemptions: medical, religious, philosophical

Results: Correctional Facilities Assess Administer 13 (25%) 18 (35%) Hepatitis B 1* 1 1/1 Routinely rec. (all inmates) 9 3 3/3 Routinely rec. (juvenile detention) 5 16** 16/16 Any immunizations Ensure * If charged with certain crimes, including sex crimes and drug offenses **In 13 states, the law does not refer specifically to juvenile detention facilities, but is written in such a way that it could be interpreted as applying to such facilities.

Results: Exemptions n (%)* Any exemption 8 (50%) Medical exemption 8 (50%) Religious exemption 5 (31%) Philosophical exemption 1 (6%) *Proportion among states with “ensure” laws for juveniles, n=16

Timeline for Compliance n (%) * On admission 3 (19%) Within 7 days of admission 1 (6%) Within 14 days of admission 2 (13%) Within 30 days of admission 5 (31%) Not specified 6 (38%) *Proportion among states with “ensure” laws for juveniles, n=16

Variation in State Requirements • Legal definitions of facilities vary by state – Terminology, ages of ‘juveniles’ (<16, 18, 21) • Departmental responsibility for oversight varies by state – Laws under authority of Corrections/Justice Department, Child/Family Services, Social Services, Health Department, etc. • Broad or unclear statutory language can create difficulties in interpretation – State counsel in different jurisdictions had varying interpretations of laws

Interpretation of Laws • Based on location of statute in code; legal definitions of facilities, occupants – Location: “Family and Youth Services and Juvenile Justice” or “Placement and Detention” – Facilities: “authorized to use locked doors…to prevent children from leaving” or “ 24 -hour living setting [for unrelated] children” or having “legal custody” of children – Occupants: children “adjudicated as delinquent” or “who have committed an offense that is only committable by children” or “habitually truant”

Example • “ Ind. Admin. Code tit. 470, r. 3 -11 -75 requires that the child caring institution […] ensures that each child has received immunizations […] all children must be immunized against routine childhood disease. ‘Child caring institutions’ are defined in Ind. Admin. Code tit. 470, r. 3 -155 as place engaged in (among other things) receiving and caring for dependent children, children in need of services, or delinquent children. ” – Not applicable to juvenile detention centers (response from state counsel)

Use of School Entry Laws • Two states apply school entry requirements to children in juvenile justice system – Texas: Law explicitly states that vaccines required for school entry are also “required for…children admitted, detained, or committed in Texas Department of Criminal Justice…and Texas Youth Commission facilities”. – South Dakota: Program Administrator for Correctional Health Services considers juvenile detention facilities to be certified schools, subject to school entry laws

Conclusions • Less than half the states have laws requiring vaccination of incarcerated juveniles – Few explicitly directed toward detention facilities • State laws vary in terms of who is covered, responsibility for enforcement, and interpretation

Implications • State by state variation may preclude or complicate development of consistent national policy or model legislation • Advocates for vaccination of children in juvenile detention facilities should: – promote awareness of existing state laws – understand how laws are interpreted in their jurisdiction

Questions? Megan C. Lindley, MPH Contractor, Mc. King Consulting Corporation National Center for Immunization & Respiratory Diseases (proposed) 404 -639 -8717 MLindley@cdc. gov