Preventive Care Use Among Justice-Involved and Non-Justice-Involved Youth

• Published in: Pediatrics (Evanston) 2017-11, Vol.140 (5)
• Main Authors: Aalsma, Matthew C, Anderson, Valerie R, Schwartz, Katherine, Ouyang, Fangqian, Tu, Wanzhu, Rosenman, Marc B, Wiehe, Sarah E
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Cohort Studies; Criminal Behavior; Criminal Law - trends; Emergency medical care; Emergency medical services; Emergency Medical Services - trends; Female; Government programs; Health care access; Health problems; Health risks; Health services utilization; Humans; Juvenile Delinquency - trends; Juvenile offenders; Male; Medicaid; Medicaid - trends; Pediatrics; Preventive Medicine - trends; Retrospective Studies; United States - epidemiology; Well being
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2017-1107

Youth involved in the juvenile justice system (ie, arrested youth) are at risk for health problems. Although increasing preventive care use by justice-involved youth (JIY) is 1 approach to improving their well-being, little is known about their access to and use of care. The objective of this study was to determine how rates of well-child (WC) and emergency department visits, as well as public insurance enrollment continuity, differed between youth involved in the justice system and youth who have never been in the system. We hypothesized that JIY would exhibit less frequent WC and more frequent emergency service use than non-justice-involved youth (NJIY). This was a retrospective cohort study of administrative medical and criminal records of all youth (ages 12-18) enrolled in Medicaid in Marion County, Indiana, between January 1, 2004, and December 31, 2011. The sample included 88 647 youth; 20 668 (23%) were involved in the justice system. JIY had lower use rates of WC visits and higher use rates of emergency services in comparison with NJIY. JIY had more and longer gaps in Medicaid coverage compared with NJIY. For all youth sampled, both preventive and emergency services use varied significantly by Medicaid enrollment continuity. JIY experience more and longer gaps in Medicaid coverage, and rely more on emergency services than NJIY. Medicaid enrollment continuity was associated with differences in WC and emergency service use among JIY, with policy implications for improving preventive care for these vulnerable youth.