Effects of capitated mental health services on youth contact with the juvenile justice system.
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.
Scott
Michelle A
MA
Department of Child and Adolescent Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. scottm@child.cpmc.columbia.edu
Snowden
Lonnie
L
Libby
Anne M
AM
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