M EDIAL H OMES FOR D ETAINED Y OUTH Rebecca Monk Beyda, MD, MS, Titilola B. Balogun, MBBS, MPH, Nicole Trojan, MS, Mona A. Eissa, MD, MPH, PhD A Balanced.

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: COMMUNITY MAPPING

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