The nurses and case workers at the facility, however, are less than enthusiastic about the screen. Nurse Veronica Crespin, says she doesn't believe the facility is missing urgent needs under their current system. The medical needs that Acoca identified as urgent, Crespin argued, likely had already been noted in the standard screening procedure. Reylene's burns had been observed, for instance, even though Reylene was evasive about how she got them.

In addition, Acoca's screen takes at least twice as long, she said, and the facility staff is already stretched thin. "Most of the time it's one nurse per shift and there are multiple intakes. It's constant and something is always going on," she says.

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The real problem, Crespin says, is not what goes on inside the facility, where girls have access to medical care and are essentially a captive audience for providers and health educators, but rather what happens one they leave and return to the community. While many of the girls qualify for Medicaid or other forms of insurance, they simply do not seek medical care.

"I'm not sure if it's transportation or non-compliance," Crespin says. "Often they're released with their meds," and then return with the same pack, never having taken them. "We do go over the meds with the family when they're discharged, but sometimes they don't comply," she says.

Roberta Muro, who runs the girls' probation unit, also blames the gap in communication between detention and probation officers, who are in charge of the girls once they leave. "We don't have the mechanisms in place to get permission" for detention to share sensitive health information with the probation team, she explains. And because the detention center is run by the county, while the probation unit is run by the state, getting through the bureaucracy can be difficult.

Without that information, Muro says, probation officers often don't know what to follow up on, or whether the girls need help finding health care in the community. "Maybe she's not going to school because she has issues we don't know about. Maybe detention sent her home with antibiotics, but she can't afford it and no one follows up," Muro explains. "The more we know, the more we can help."

The girls often have insurance but need help using it, she adds. If they have a sore throat, for example, they may not have a primary care provider to visit; instead they may go to an ER "and then get fed up and leave." She says probation officers could help them access care at clinics instead, saving the health care system money in the process.

In most counties and states, the minute a child on Medicaid enters detention, their insurance coverage is suddenly cut off. The costs of any medical services during detention therefore fall entirely to the states. Acoca worries that this creates a disincentive for many facilities to identify health needs. New Mexico, however, has a law that allows kids to keep their Medicaid coverage for the first 60 days in detention. That means the federal government picks up a share of the health costs, since Medicaid is a joint state and federal program.