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MEDIAL HOMES FOR DETAINED YOUTHRebecca Monk Beyda, MD, MS, Titilola B. Balogun, MBBS, MPH, Nicole Trojan, MS, Mona A. Eissa, MD, MPH, PhD
A Balanced Approach to Juvenile Justice Harris County Juvenile Probation Department
Boston University School of Medicine asks all individuals involved in the development and presentation of Continuing Medical Education (CME) activities to disclose all relationships with commercial interests. This information is disclosed to CME activity participants. Boston University School of Medicine has procedures to resolve apparent conflicts of interest. In addition, presenters are asked to disclose when any discussion of unapproved use of pharmaceuticals and devices is being discussed.
I, Rebecca M. Beyda, have no commercial relationships to disclose.
DETAINED YOUTH
Chlamydia (females)
Tooth decay Illegal drug use Any mental health disorder
0%
10%
20%
30%
40%
50%
60%
70%
80%90%
15%
50%
85%
67%
Health needs of youth in the Juvenile Justice System
Committee on Adolescence. Health Care for Youth in the Juvenile Justice System. Pediatrics. 2011; 128;1219
AAP MEDICAL HOME
Accessible Compassionate Culturally Effective
Continuous Comprehensive Family Centered
Coordinated
PURPOSE
1. Identify barriers to health care for detained youth
2. Identify available medical homes in needed areas
3. Connect youth with medical homes upon release from the juvenile justice center and post-adjudication facilities
METHODS: NEEDS ASSESSMENT
Surveys• Detained youth• Guardians
Focus Groups
• Detained youth• Guardians
Community Mapping
Topics assessed
• Health insurance• Type of insurance• Medical home• Medical needs• Mental health needs• Barriers to care
• Good/bad health care experiences
RESULTS: SURVEYYouth Baseline Characteristics n=368
Age (years) 15 (11-17)Gender Male 297 (82%) Female 67 (18%)Ethnicity Black 187 (52%) Hispanic 108 (30%) White 65 (18%)Parental marital status Married 112 (37%) Never married 95 (32%) Other 94 (31%) Language spoken at home English 272 (80%) Spanish 67 (20%)
RESULTS: SURVEY
Possess Insurance Possess Medicaid Endorse having a Medical Home
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
75%67%
58%Youth n=368
Guardian n=97
Survey results from detained youth and their guardians Jan – July 2014
RESULTS: FOCUS GROUPS
YOUTHBARRIERS
Transportation
Money
Fear
Location PARENTBARRIERS
Transportation
Insurance
Youth refusal
Inconvenient hours BARRIERS
Transportation
Insurance
Fear/Refusal
Location/Hours
RESULTS: COMUNITY MAPPINGMedical Homes Included:
• Met most AAP criteria• Cared for teen patients• Screened for substance
use/abuse• Offered reproductive
services
TRANSITION OF CARE
Discharge Summary
• Parent• Faxed to PCP
Referral Form
• Medical staff• Probation
officers
LIMITATIONS• Surveys – Selection bias• Youth electing to take the survey may be healthier• Guardians contacted may be more involved with youth
• Focus groups• All youth focus groups were young men• Young women may have identified different barriers
• Community mapping• May not have included all teen medical homes
CONCLUSIONS:
• Surveys• The majority of detained youth report having health insurance• 40% of detained youth lack a medical home
• Focus Groups• Transportation and insurance are perceived barriers to care• Youth report fear as a barrier to care• Guardians report youth refusal as a barrier to care
• Community Mapping• Certain areas of need lack medical homes• More mental health screening and services are needed
NEXT STEPS:
Data analy
sis
• Survey results• Disseminate information
Partnershi
p
• Area teen clinics• Juvenile justice center
Coalition
• Engage community partners• Formation of coalition
THANK YOU
Medical Providers
• Laura Benjamins, MD, MPH
• Michelle Barratt, MD, MPH
• Mona Eissa, MD, MPH, PhD
Juvenile Justice Center
• IRB Committee• Medical Staff• Nicole Trojan,
MS
UT School of Public Health
• Titilola Balogun, MBBS, MPH,
• Martin Nguyen, MPH,
• Dixie Sasu• Vanessa
Nicholson, MPH
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