title: Effects of capitated mental health services on youth contact with the juvenile justice system.
abstract: OBJECTIVE
  To evaluate the association between Medicaid mental health capitation and youth's involvement with the juvenile justice system.
  
  
  METHODS
  A longitudinal, quasi-experimental pre/post design was used. Using administrative databases, juvenile justice contact, defined as any detention or commitment, was assessed for 13,365 Medicaid-eligible youths, aged 10-17 years, who received public mental health services over a 3-year period (1994-1997) in the state of Colorado.
  
  
  RESULTS
  There was no significant effect of financing when secular time was controlled for (interaction financing x time: hazard rate = 0.92, p =.62). The main effects model demonstrates a significant secular trend with juvenile justice contacts decreasing over time for both types of financing (hazard rate = 0.80, p =.002) and a significant effect of financing with eventually capitated sites having higher rates of juvenile justice contact compared with sites that remained fee-for-service (hazard rate = 1.24, p =. 009). Multivariate analyses controlled for demographics, mental health and substance use diagnoses, and other risk factors for juvenile justice contact.
  
  
  CONCLUSIONS
  After adjustment for secular trends, capitation was not associated with a reduction in juvenile justice contact. Nonetheless, these findings provide evidence that capitation did not increase the risk of juvenile justice contact.
authors.affiliation: Department of Child and Adolescent Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. scottm@child.cpmc.columbia.edu
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Scott
authors.forename: Lonnie
authors.initials: L
authors.lastname: Snowden
authors.forename: Anne M
authors.initials: AM
authors.lastname: Libby
mesh_terms: D000293:Adolescent; D002204:Capitation Fee / Q000706:statistics & numerical data*; D002648:Child; D003120:Colorado; D003430:Cross-Sectional Studies; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D015994:Incidence; D007604:Juvenile Delinquency / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000191:economics*; D008605:Mental Health Services / Q000191:economics*; D015999:Multivariate Analysis