Alcohol and juvenile justice contacts: a comparison of fee-for-service and capitated medicaid mental health services.
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.
Scott
Michelle A
MA
Department of Child Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. scottm@child.cpmc.columbia.edu
Snowden
Lonnie R
LR
Libby
Anne M
AM
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