Katherine Schwartz

A Statewide Collaboration to Initiate Mental Health Screening and Assess Services for Detained Youths in Indiana

OBJECTIVES We describe a statewide effort to implement detention-based mental health screening and assess follow-up services offered to detained youths in Indiana. METHODS A total of 25,265 detention stays (15,461 unique youths) occurred between January 1, 2008, and December 31, 2011, across 16 detention centers participating in the Indiana Juvenile Mental Health Screening Project. We collected screening results and reports of detention-based follow-up mental health services and referrals from justice system records. RESULTS Approximately 21% of youths screened positive for mental health issues requiring follow-up. A positive screen significantly predicted that youths would receive a follow-up mental health service or referral while detained or upon detention center discharge, compared with youths who did not screen positive (61% vs 39%). Logistic regression models indicated that a positive screen was associated with (1) contact with a mental health clinician within 24 hours of detention center intake and (2) a mental health referral upon discharge. White youths were more likely than minorities to receive both follow-up services. CONCLUSIONS Future statewide efforts to improve the mental health of detained youths should incorporate standards for providing appropriate follow-up services in detention centers.

Trends in Use and Cost of Second-Generation Antipsychotics Among Children and Teens in Indiana Medicaid, 2004-2012.

OBJECTIVE To replicate and extend a study by the Agency for Healthcare Research and Quality (AHRQ) and Rutgers on antipsychotic use among youths in Medicaid, the authors analyzed Indiana Medicaid claims from 2004 to 2012, extending the earlier study by focusing on second-generation antipsychotics, including both fee-for-service (FFS) and non-FFS patients, and analyzing cost trends. METHODS The authors evaluated the impact of several Indiana Medicaid policy changes on medication utilization and cost among children enrolled for at least one month during 2004-2012 (N=683,716-793,637), using an exhaustive antipsychotic list to search the database. RESULTS Annual utilization rates for antipsychotics were 2%-3% but were much higher among foster children (10%-15%). Policies implemented in 2007 or later were associated with a significant plateauing of utilization in 2008-2012. CONCLUSIONS Growth of second-generation antipsychotic utilization and costs was similar to trends described in the AHRQ-Rutgers study. Several containment strategies appeared effective in addressing these trends.

Motivating compliance: Juvenile probation officer strategies and skills

ABSTRACT Juvenile probation officers aim to improve youth compliance with probation conditions, but questions remain about how officers motivate youth. The study’s purpose was to determine which officer-reported probation strategies (client-centered vs. confrontational) were associated with their use of evidence-based motivational interviewing skills. Officers (N = 221) from 18 Indiana counties demonstrated motivational interviewing skills by responding to scenarios depicting issues common to youth probationers. Results of a hierarchical multiple regression analysis indicated that, while officer endorsement of client-centered strategies was not associated with differential use of motivational interviewing skills, officers endorsing confrontational strategies were less likely to demonstrate motivational interviewing skills.