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. Method: 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. J. Am. Acad. Child Adolesc. Psychiatry, 2002, 41 (12):1462-1469.