Behavioral health and health care
BETWEEN 1987 AND 1996, the volume of cases handled by the U.S. juvenile justice system increased 49% (Teplin, 2001). During this same period, youth in the general population have experienced increases in behavioral health problems, including both mental health, and substance abuse disorders (Burns 1999 and Cocozza and Skewyra 2000). Not surprisingly there have been reported increases in behavioral health problems in youth served by the juvenile justice system (Cocozza and Skewyra 2000 and Teplin 2001). Currently, there is little available research on the prevalence and types of behavioral health problems among youth in the juvenile justice system. However, some general conclusions can be made regarding prevalence rates (Cocozza and Skewyra 2000; Grisso 2000 and Teplin 2000).
First, it has been estimated that youth in the juvenile justice system experience significantly higher prevalence rates of behavioral disorders than youth in the general population. In fact, it is recognized that the prevalence rates of behavioral disorders in juvenile justice youth is twofold greater than the prevalence rates in the general youth population (Cocozza and Skewyra 2000; Grisso 2000 and Teplin 2000).
Secondly, it is estimated that approximately one out of every five youths in the juvenile justice system has a serious behavioral health disorder resulting in functional impairment that affects family, school, or community activities (Cocozza & Skewyra, 2000). Unfortunately, it is difficult to obtain reliable estimates of the prevalence of serious behavioral health disorders among youth because of varying measures and definitions of serious behavioral illness. However, if the prevalence rates of serious behavioral disorders for youth in the general population is approximately 9% to 13% and researchers have consistently found the prevalence rate of disorders for youth in the juvenile justice system to be twofold greater, it can reasonably be expected that the prevalence rate of serious behavioral health disorders for youth within the juvenile justice system is approximately 18% to 26% (Cocozza and Skewyra 2000; Grisso 2000 and Teplin 2000).
Finally, many of the youth in the juvenile justice system with serious behavioral health problems also experience a substance abuse disorder (Cocozza and Skewyra 2000; Grisso 2000 and Teplin, L., 2000. Held without help: Youth and adults with mental illnesses in jail. NAMI Advocate 22, pp. 21–22.Teplin 2000). Although researchers are only beginning to focus on youth, it has been estimated that approximately 50% of all adolescents receiving behavioral health care in the general population are dually diagnosed with a mental health and substance abuse disorders. It is reasonable to expect that among the juvenile justice system population, the rates may be even greater (Cocozza & Skewyra, 2000).
While increases in behavioral health disorder prevalence rates have occurred, the behavioral health treatment system has experienced sweeping changes as a result of managed behavioral health care (Stroul, Pires, Armstrong & Meyers, 1998). There is a current trend toward contracting with private-sector, for-profit corporations to administer managed behavioral health benefits. Moreover, publicly funded health insurance programs often use some type of carve-out of general medical care programs to finance managed behavioral services (Jellinek & Little, 1998). Changes in financing and delivery of behavioral health care have led to uncertainty regarding access to services for enrollees of managed behavioral health care programs (Stroul et al., 1998).
Currently, there is no available research addressing the impact of managed behavioral health care on juvenile justice youth needing behavioral health services. This study was performed as a component of a larger study examining access to behavioral health care for juvenile justice youth (Thomas, 2002; Thomas, 2004). The purpose of this study was to describe how managed behavioral health care affects youth in the juvenile justice system with behavioral health disorders. This research study was performed by way of a multiple case study (Yin, 1994) consisting of semi-structured interviews of officials in the local, state, and federal juvenile justice system.
Review of literature
There is no available research examining managed behavioral health care’s impact on juvenile justice youth needing behavioral health services. Therefore, this review of literature will describe studies that examine the affect of managed behavioral health care on youth in the general population with behavioral health disorders.
The era of managed care was initiated at a time when the mental health community was only beginning to understand the significance of behavioral health disorders in youth. Under the managed behavioral health care system, the community behavioral health system has been financially underfunded. The resulting inadequacy of the community behavioral health system led to a greater number of youth becoming acutely ill and entering psychiatric inpatient facilities in states of crises (Watkins, 1999). This observation was supported by a comparative descriptive study that investigated children’s and adolescent’s cost and utilization patterns in carve-out plans and compared them with the utilization patterns of adults in these plans. Twelve-month data on utilization and costs of behavioral health care from one managed behavioral health care organization were examined for 176,000 youth in three age groups, birth to 5 years, 6 to 12 years, and 13 to 17 years. Data for 434,000 adults enrolled in the same managed behavioral health plan were also examined. The study found that youth from 13 to 17 years of age were more than twice as likely as adults and about 7 times as likely as children aged 6 to 12 years to use inpatient services. Youth from 13 to 17 years of age also had a slightly higher probability of using outpatient care than adults, while children aged 6 to 12 had lower rates of outpatient care than youth 13 to 17 years of age or adults. When examining the intensity of behavioral health service use, youth 13 to 17 years of age were also more likely than adults and other children to have very high costs of inpatient care. The researchers concluded that youth ages 13 to 17 may benefit most from the elimination of caps on inpatient mental health care costs covered by insurance (Gresenz, Liu, & Sturm, 1998).
Tags: Behavioral health