STD service availability and barriers for juvenile offenders: An organizational and staff perspective

Adolescent offenders are at high risk for sexually transmitted diseases (STDs). To reduce incidence and prevalence, routine surveillance and linkage to prevention and treatment are needed, and intervening with high-risk subgroups such as juvenile offenders. Many are initially processed through Juvenile Assessment Centers prior to being released to the community, providing a unique opportunity for STD testing, prevention, and treatment. However, there is limited knowledge about barriers to accessing STD services for juvenile offenders, and perspectives of STD service provider staff. We examine STD services availability for juvenile offenders and staff perceptions about STD risk in that population, and identify structural and organizational factors influencing access to STD services. Thirty-eight semi-structured interviews were conducted with staff of all adolescent STD and juvenile justice service providers (10 directors and 28 other staff) in a metropolitan southeast county. Responses were coded and analyzed using Atlas.ti. Ninety percent of the respondents cited STD education as a service need for juvenile offenders, but a number of other needs were cited. Individual, organizational, and community barriers included: lack of STD education, financial resources, parent resistance, and organizational characteristics. Several thematic domains emerged including Resources (e.g., need for free treatment, financial constraints), Service Availability (e.g., transportation, youth awareness), Attitudes (e.g., stigma, confidentiality concerns), and Parental Concerns. STD services are greatly needed for juvenile offenders, but programs face many barriers to effective services implementation. Our findings suggest that increasing access to prevention and treatment for high-risk youths requires overcoming a number of structural, organizational, and outreach obstacles.