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Timely help for troubled youth

March 1, 2010
by Geraldine S. Pearson, PhD, PMH-CNS, APRN, Josephine M. Hawke, PhD, Edith Dundon, MS, RN, CPNP, and Beth Muller, PMH-CNS, APRN
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The HomeCare Program integrates services, reduces recidivism rate

Most of the youth involved in the juvenile justice system meet the criteria for a mental health disorder, substance use disorder, or both1. 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 blurred2.

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 Connecticut3. 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. If needed, referred HomeCare patients can receive a renewal of their psychotropic medication on the first day of their evaluation. Every effort is made to ensure continuity of care so patients are never without medication.

Care within the clinic

The HomeCare program is focused on short-term medication management and psychiatric case management, rather than traditional psychiatric treatment models that rely heavily on individual, family, and group psychotherapy. Most youth involved in the HomeCare Program receive some type of community service or psychotherapy service, including multisystemic therapy, mentoring, or other in-home interventions. What they do not have is a provider who can manage the psychiatric medication that optimizes their ability to “make use” of therapy services. The HomeCare program is focused on meeting an immediate need for medication management to ensure that there is no interruption in this level of care. The HomeCare Program also focuses on strengths-based and culturally sensitive case management and medication management. This involves understanding the particular needs of the adolescent and family referred for care and then working to meet those needs in a non-punitive manner.

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