1. Out-of-Home Treatment for Youth With Mental Health Needs and Juvenile Justice Involvement Presenter: John Robst, Ph.D. Louis de la Parte Florida Mental Health Institute Department of Economics University of South Florida IZA (Institute for the Study of Labor) - Bonn American Evaluation Association San Antonio, TX November 2010

2. APHA – Philadelphia, PA – 11/10/2009 Disclosures Financial support for this project provided by Agency for Healthcare Administration (AHCA). Financial support for this project provided by Agency for Healthcare Administration (AHCA). This work is joint with Mary Armstrong, PhD and Norin Dollard, PhD This work is joint with Mary Armstrong, PhD and Norin Dollard, PhD 2

3. APHA – Philadelphia, PA – 11/10/2009 Purpose of the study This paper examined juvenile justice (JJ) contacts/recidivism among youth in out-of-home (OOH) treatment. This paper examined juvenile justice (JJ) contacts/recidivism among youth in out-of-home (OOH) treatment. The goal is to determine whether JJ recidivism is less likely when a JJ encounter is followed by OOH treatment. The goal is to determine whether JJ recidivism is less likely when a JJ encounter is followed by OOH treatment. Distinguished between those who have experienced trauma and those who have not. Distinguished between those who have experienced trauma and those who have not. 3

4. APHA – Philadelphia, PA – 11/10/2009 Background Much of the existing research linking OOH and JJ focuses on specific treatment programs (Chamberlain and colleagues, Multidimensional Treatment Foster Care; Lee and Thompson (2008), the Teaching-Family model for group treatment). Much of the existing research linking OOH and JJ focuses on specific treatment programs (Chamberlain and colleagues, Multidimensional Treatment Foster Care; Lee and Thompson (2008), the Teaching-Family model for group treatment). 4

5. APHA – Philadelphia, PA – 11/10/2009 Florida OOH settings OOH settings Therapeutic Foster Care (TFC) Therapeutic Foster Care (TFC) Therapeutic Group Home Care (TGH) Therapeutic Group Home Care (TGH) Statewide Inpatient Psychiatric Program (SIPP) Statewide Inpatient Psychiatric Program (SIPP) 5

6. APHA – Philadelphia, PA – 11/10/2009 Data Florida Medicaid claims data - out-of-home treatment between July 2003 and June 2007. Florida Medicaid claims data - out-of-home treatment between July 2003 and June 2007. Matched with Department of Juvenile Justice data using individual identifiers and deterministic matching. Felony and misdemeanor charges. Matched with Department of Juvenile Justice data using individual identifiers and deterministic matching. Felony and misdemeanor charges. Unit of analysis was the JJ episode; 5,326 JJ encounters among 1,511 youth or 3.5 JJ encounters per youth (sd= 2.6). Unit of analysis was the JJ episode; 5,326 JJ encounters among 1,511 youth or 3.5 JJ encounters per youth (sd= 2.6). 6

7. APHA – Philadelphia, PA – 11/10/2009 Data For each encounter: For each encounter: OOH treatment begin within 90 days after encounter; and before any subsequent encounters OOH treatment begin within 90 days after encounter; and before any subsequent encounters 848 JJ encounters among 711 youth were followed by OOH treatment 848 JJ encounters among 711 youth were followed by OOH treatment Subsequent JJ episode within one year period Subsequent JJ episode within one year period Sixty-one percent of the JJ encounters were followed by a subsequent encounter Sixty-one percent of the JJ encounters were followed by a subsequent encounter 7

8. APHA – Philadelphia, PA – 11/10/2009 Comparison group The comparison group: treatment episodes that did not have out-of-home treatment begin within 90 days of the JJ contact. The comparison group: treatment episodes that did not have out-of-home treatment begin within 90 days of the JJ contact. 4,485 JJ encounters among 1,414 youth were not followed by OOH treatment within 90 days. 4,485 JJ encounters among 1,414 youth were not followed by OOH treatment within 90 days. Comparison group is not a ‘no treatment’ group; may have received treatment in the community, and/or delayed OOH treatment. Comparison group is not a ‘no treatment’ group; may have received treatment in the community, and/or delayed OOH treatment. 8

9. APHA – Philadelphia, PA – 11/10/2009 Trauma Trauma was defined using two data sources. Trauma was defined using two data sources. Medicaid claims - trauma diagnosis (post-traumatic stress disorder, reactive attachment disorder, acute stress disorder or a v-code related to abuse). Medicaid claims - trauma diagnosis (post-traumatic stress disorder, reactive attachment disorder, acute stress disorder or a v-code related to abuse). Child welfare administrative data - substantiated sexual, emotional, or physical abuse in the study period. Child welfare administrative data - substantiated sexual, emotional, or physical abuse in the study period. 9

10. APHA – Philadelphia, PA – 11/10/2009 Methods Generalized estimating equations (GEE) were used to estimate associations between individual characteristics and the likelihood of JJ recidivism. Generalized estimating equations (GEE) were used to estimate associations between individual characteristics and the likelihood of JJ recidivism. GEE can accommodate repeated measures/observations on individuals by appropriately computing the standard errors GEE can accommodate repeated measures/observations on individuals by appropriately computing the standard errors Dichotomous dependent variable (JJ recidivism) calls for a logistic distribution. Dichotomous dependent variable (JJ recidivism) calls for a logistic distribution. 10

11. APHA – Philadelphia, PA – 11/10/2009 Delinquency rates Number of JJ encountersAllTrauma No trauma 1-232.0%30.2%34.1% 3-531.2%30.0%32.5% 6-817.9%17.7%18.1% 9+18.9%22.1%15.3% Observations 1,551 827 724 11

12. APHA – Philadelphia, PA – 11/10/2009 JJ Recidivism TraumaNo trauma Obs.MeanStd errorObs.MeanStd error JJ recidivism 2,82662.6%0.012,50059.9%0.01 Days until recidivism 1,77094.62.21,49898.92.35 OOH Episode 2,82617.6%0.012,50014.0%0.01 SIPP49852.6%0.0235066.3%0.03 TFC49825.9%0.0235014.3%0.02 TGC49821.5%0.0235019.4%0.02 Days until OOH episode 49837.71.1235040.61.32 12

13. APHA – Philadelphia, PA – 11/10/2009 JJ recidivism and OOH treatment TraumaNo trauma Obs.MeanStd errorObs.MeanStd error No OOH treatment after JJ contact Recidivsm2,32863.9%0.012,15060.8%0.01 Days until recidivism 1,48895.82.31,30996.72.35 OOH treatment after JJ contact Recidivism49856.6%0.0235054.0%0.03 Days until recidivism 28288.65.69189113.97.31 Days until OOH episode 49837.71.1235040.61.31 13

14. APHA – Philadelphia, PA – 11/10/2009 GEE results 14 Trauma historyNo trauma history CoefStd err p value CoefStd err p value SIPP -0.1600.1640.330-0.4040.1590.011 TFC -0.8070.215<0.001-0.4350.3310.190 TGH -0.2120.2520.400-0.3840.2940.192 Other variables: felony, # JJ contacts, demographics (age, gender, race), year

15. APHA – Philadelphia, PA – 11/10/2009 Discussion The finding that out-of-home mental health treatment, in general, contributes to reductions in adverse outcomes for justice-involved youth with trauma histories, provides greater impetus to implement and have available as post-discharge options, community-based evidence-based practices that are known to be effective with justice-involved youth with mental health issues. The finding that out-of-home mental health treatment, in general, contributes to reductions in adverse outcomes for justice-involved youth with trauma histories, provides greater impetus to implement and have available as post-discharge options, community-based evidence-based practices that are known to be effective with justice-involved youth with mental health issues. 15

16. APHA – Philadelphia, PA – 11/10/2009 Limitations Administrative data – may lead to biased results; inflated (unobserved factors) or conservative (didn’t have JJ detention) Administrative data – may lead to biased results; inflated (unobserved factors) or conservative (didn’t have JJ detention) Descriptive analysis – more rigorous analysis required to draw causal implications Descriptive analysis – more rigorous analysis required to draw causal implications 16