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.