The impact of Behavioral Health Overlay Services (BHOS) policy on health and behavior among justice involved youth

Introduction: Youth involved with the juvenile justice system have elevated rates of mental health issues (Hazen et al., 2004).  Additionally, a majority of these youth have a co-occurring substance use problem (Schubert et al., 2011). The failure to provide behavioral health services to address these needs may contribute to continued delinquency and, later, adult criminality.  Therefore, ensuring provision of  assessment and comprehensive treatment of behavioral health problems for justice involved youth is essential for breaking this cycle and produce healthier young people. Behavioral Health Overlay Services (BHOS) were developed under the Florida Medicaid Community Mental Health Services Program to allow providers the financial structural flexibility to address mental health, substance abuse, and other co-occurring treatment needs of youth placed in Department of Juvenile Justice (DJJ) facilities. Therefore, the goal of this study is to examine outcomes for justice involved youth who received the array of services covered under BHOS.

Methods: Data obtained from the Florida Child Welfare Information System and Medicaid claims database included 8,705 youth who were placed in DJJ facilities during fiscal years 2006 and 2007.  About 68% of the sample was male with an average age of 16 (SD = 1.93).Youth who received BHO services and those who did not were matched using the propensity score method (Rosenbaum & Rubin, 1984). Outcomes included placement in a State Inpatient Psychiatric program (SIPP), involuntary mental health examination, and arrests. Logistic regression was used to examine the effect of various predictors on youth outcomes.

Results: Results from multivariate logistic regression indicated that being in a group that did not receive BHOS was associated with negative outcomes. Youth who did not receive BHOS were almost 3 times more likely to be placed in SIPP (OR = 2.8, p < .05), 39% more likely to have involuntary mental health examinations, and 6 times more likely (OR = 6.45, p < .05) to recidivate after release from DJJ. 

Conclusions: Results of this study underscore the importance of financial and structural flexibility in provision behavioral health services for youth involved in multiple systems, such as juvenile justice and mental health systems. Interventions that address the needs of youth placed in DJJ should include extending eligibility for BHOS for all justice involved youth and broadening the array of services and supports. Collaboration between systems is also warranted to enhance effective communication and to respond more effectively to the issues of youth involved in multiple systems.