title: Alcohol and juvenile justice contacts: a comparison of fee-for-service and capitated medicaid mental health services.
abstract: OBJECTIVE
  This study examines whether youth with alcohol problems are especially vulnerable to juvenile justice contact when receiving public mental health services in fee-for-service versus capitated managed-care agencies. Capitation is a payment method often accompanying managed care; a fixed fee is paid per person enrolled, for a specific time period and range of services.
  
  
  METHODS
  Youth services were studied in a statewide, quasi-experimental design from July 1994 to June 1997; subjects were 13,365 Medicaid-eligible youth (52% female) aged 10-17. Alcohol problems were measured using a clinician-generated psychiatric diagnosis and a subjective indicator of alcohol symptoms obtained from a psychometrically tested mental health treatment intake form. Analysis methods were hazard/survival rates, log-rank tests and Cox proportional hazards models.
  
  
  RESULTS
  As measured by the presence of symptoms, alcohol-involved youth in capitated managed care were significantly less likely to have contact with the juvenile justice system, in uncontrolled analysis. In controlled analysis, they were also less likely; however, only at the level of a trend.
  
  
  CONCLUSIONS
  Concerns regarding capitated managed mental health care (e.g., substitution of care or "cost-shifting") found no support. There was no evidence of a shifting of alcohol-involved youth receiving mental health services under capitated managed care to the juvenile justice system. If anything, such youth saw their likelihood of juvenile justice involvement decrease.
authors.affiliation: Department of Child Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. scottm@child.cpmc.columbia.edu
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Scott
authors.forename: Lonnie R
authors.initials: LR
authors.lastname: Snowden
authors.forename: Anne M
authors.initials: AM
authors.lastname: Libby
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000191:economics* / Q000453:epidemiology*; D002204:Capitation Fee / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002648:Child; D003120:Colorado / Q000453:epidemiology; D016001:Confidence Intervals; D003416:Criminal Law / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D016016:Proportional Hazards Models