Timely Help for Troubled Youth: The HomeCare Program Integrates Services, Reduces Recidivism Rate

Article excerpt

Most of the youth involved in the juvenile justice system meet the criteria for a mental health disorder, substance use disorder, or both (1). However, the juvenile justice system traditionally has not provided mental health interventions and mental health providers are not always equipped to deal with the juvenile justice population. Similarly, Bonham noted that the line between adolescent behaviors associated with mental illness and delinquent behaviors may be blurred (2).

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The HomeCare Program was developed in 2003, following a federal consent decree mandating improved mental health services for juvenile justice youth being discharged from detention centers throughout Connecticut (3) At that time, the state of Connecticut awarded funding to the University of Connecticut School of Medicine to establish child/adolescent psychiatric clinics in federally qualified health centers (FQHCs) to address the need for psychiatric prescribers.

The original intent of the HomeCare Program was to provide continuity of care for youth needing medication while in detention and timely access to follow-up care after release. Previously, detention psychiatrists were reluctant to start or change prescription medications for youth in detention because they feared the youth would lose access to timely care upon release. With waits for community child psychiatry appointments ranging from weeks to months, even for those children who entered detention with an existing prescriber, this concern often resulted in a lack of medication treatment during detention or extended detention periods for youth awaiting release into services.

Today, the HomeCare Program provides a psychiatric bridging service that seamlessly transitions youth from juvenile detention to a psychiatric provider in their home community who can coordinate care that meets individual and family needs. To do this effectively, the HomeCare Program uses a collaborative approach, bringing the best models of academic and community care to this complex population. By providing ready access to community psychiatry providers, the program helps youth avoid extended stays in detention. At the same time, it prevents a relapse of psychiatric symptoms due to abrupt discontinuation of psychotropic medication started during detention. This intervention is especially valuable in the initial days after release when youth are at increased risk of re-offending. Based in both FQHCs and mental health clinics throughout Connecticut, the HomeCare Program reflects a developed and implemented model of referral, treatment, and community collaboration within the juvenile justice system.

HomeCare patient demographics

Male                        61%

Female                      39%

African American            24%

Bi-racial                    5%

Caucasian                   24%

Hispanic                    47%

Other                      < 1%

Care within the community

All referrals to the HomeCare Program must come from juvenile probation, juvenile parole, or adult probation officers. When a referral is made, the HomeCare Program obtains information on current and past medications, prior treatment episodes, reasons for court involvement, and collateral psychiatric evaluations or information. This information, along with direct input from the child's probation officer, allows for a needs-based triage process. Priority is given to individuals who have been detained or incarcerated or those completing a court-ordered inpatient psychiatric evaluation. Each clinic is set up to minimize the time between referral and initial appointment. Traditionally, this time has averaged between six and eight weeks, but averages just 17 days through the HomeCare Program. Using the licensed advanced practice registered nurse (APN)/child psychiatrist collaborative model of care, the intake and psychiatric evaluation are conducted simultaneously to minimize any wait for prescription renewals. …