Use of outpatient care by juvenile detainees upon community reentry: effects of mental health screening and referral.
OBJECTIVE
This study assessed rates of mental health care utilization among juvenile detainees upon community reentry and examined the impact of a mental health screening and referral program.


METHODS
A pre-post cohort design was used: 24 months before and after implementation of the program. The sample included 7,265 observations from 6,345 participants age 13 to 18 (first cohort, 4,812; second, 2,453). Outcomes included mental health care utilization (30 and 60 days postdetention) and recidivism (three and six months postdetention).


RESULTS
Logistic regression models of utilization at 30 days, controlling for cohort differences with propensity scores, found that males were less likely than females to have a mental health visit (odds ratio [OR]=.54, 95% confidence interval [CI]=.45–.64, p<.01); the likelihood was also lower among black (OR=.52, CI=.44–.62, p<.01) and Hispanic (OR=.12, CI=.07–.22, p<.01) youths, compared with white youths, and among older youths (OR=.53, CI=.50–.57, p<.01) (similar results at 60 days). No overall significant differences between cohorts were found in visits at 30 (first cohort, 14%; second, 16%) and 60 (17% and 19%, respectively) days postrelease. An age interaction with cohort indicated a cohort difference among adolescents in the middle tertile (14.6–16.5 years) in utilization at 30 (first cohort, 12%; second, 17%) and 60 (16% and 21%) days. Compared with the preimplementation cohort, the postimplementation cohort had higher recidivism rates at three (first cohort, 24%; second, 31%) and six (36% and 43%) months.


CONCLUSIONS
Connection to services upon community reentry was poor among detained youths. A screening and referral program was not sufficient to increase utilization rates.
Department of Pediatrics, Indiana University School of Medicine, 410 West 10th St., Suite 1001, Indianapolis, IN 46202, USA. maalsma@iupui.edu
Matthew C
MC
Aalsma
Yan
Y
Tong
Kathleen
K
Lane
Barry
B
Katz
Marc B
MB
Rosenman
D000293:Adolescent; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007604:Juvenile Delinquency / Q000523:psychology / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011329:Prisoners / Q000523:psychology / Q000706:statistics & numerical data; D011330:Prisons; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012737:Sex Factors; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data