The association between type of out-of-home mental health treatment and juvenile justice recidivism for youth with trauma exposure.

BACKGROUND: High rates of mental health disorders and exposure to trauma among the juvenile justice population highlight the importance of understanding whether and how mental health services can help prevent further justice system involvement as well as provide treatment. AIMS: We had two principal questions: Is out-of-home mental health treatment after arrest associated with reduced recidivism among young people who have been exposed to trauma? Are particular types of out-of-home treatment associated with better outcomes? We hypothesised that type of residential setting would affect outcomes among those with histories of serious trauma. METHODS: Primary data sources included Florida Juvenile Justice, Child Welfare and Medicaid data from July 2002 through June 2008. We identified all Florida Juvenile Justice cases with a record of 'severe emotional disturbance'. Two groups were identified - one for whom an arrest was followed within 90 days by out-of-home placement for mental health treatment and the other for whom there was some other out-of-home placement. Generalised estimating equations (GEE) were used to calculate associations with likelihood of re-arrest during a 12 month at risk period. RESULTS: Young people who had experienced severe trauma and were sent to out-of-home treatment settings after conviction for a criminal offence had lower recidivism rates when receiving treatment in foster care than other out-of-home placements, while those with less severe or no trauma histories had lower recidivism rates with any out-of-home placement. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: We believe that this is the first study to have considered how trauma histories may mediate outcomes for young people in out-of-home placements after arrest or conviction for a criminal offence. Findings suggest that case managers and clinicians should consider the trauma histories when making decisions about the appropriate treatment setting in these circumstances. Copyright © 2017 John Wiley & Sons, Ltd.

Disposition of Charges, Out-of-Home Mental Health Treatment, and Juvenile Justice Recidivism.

This study examined whether the disposition of juvenile justice encounters among youth with severe emotional disturbance was associated with the likelihood of recidivism. Court dispositions, such as probation and diversion, as well as Medicaid-funded out-of-home mental health treatment, were compared. Data sources included the Florida Department of Juvenile Justice and Medicaid claims data. Youth receiving probation had the highest recidivism rates. Among youth in out-of-home treatment, those receiving treatment in foster care services had the lowest recidivism rates. Youth placed into a diversion program were less likely to be re-arrested for a felony, whereas youth receiving inpatient psychiatric services were less likely to be re-arrested for a misdemeanor. Mental health treatment may reduce the likelihood of youth continuing on increasing criminal trajectories.

Identifying Potential Care Management Candidates: The Use of Diagnosis-Based Models to Predict 5-Year Health Care Costs.

OBJECTIVE: This article examined individual characteristics associated with having higher costs in a 5-year period to identify patients that may potentially benefit from case management. METHODS: Florida Medicaid claims data from 2005 to 2010 were used to examine the characteristics, diagnoses, and services (in 2005) associated with individual costs in 5 future years (2006-2010). The data were divided into estimation and prediction samples with regression models estimated using diagnoses and service use in 2005 to predict future costs. Predictive power was assessed by applying the model results to the prediction sample and comparing predicted costs to actual costs. RESULTS: Demographics, service use, and diagnosis in 2005 were associated with costs in the following 5 years. Models were predictive of future costs with a significant relationship between the predicted costs and actual costs. CONCLUSION: Diagnosis-based models in conjunction with prior costs can predict future costs. Individuals predicted to have higher costs may be candidates for case management to potentially avoid reduce costs.

The relationship between race/ethnicity and the perceived experience of mental health care.

Although there is a vast amount of literature on differences in the perceived experiences of general health care among different racial/ethnic groups, few studies have examined the relationship between race/ethnicity and perceptions of mental health care. The purpose of this study was to determine whether non-Hispanic African Americans and Hispanics had more negative (or less positive) perceptions of the mental health treatment they receive compared to non-Hispanic Whites. Data were from the 1998-2006 Florida Health Services Surveys. The findings indicated that African Americans and Hispanics were less likely than Whites to have favorable perceptions of the mental health care services they received, even after adjusting for demographic and health status variables. Interventions should be designed to address disparities in mental health treatment and the perceptions of such treatment. (PsycINFO Database Record

Stepped care versus standard trauma-focused cognitive behavioral therapy for young children.

BACKGROUND: To compare the effectiveness and cost of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT), a new service delivery method designed to address treatment barriers, to standard TF-CBT among young children who were experiencing posttraumatic stress symptoms (PTSS). METHODS: A total of 53 children (ages 3-7 years) who were experiencing PTSS were randomly assigned (2:1) to receive SC-TF-CBT or TF-CBT. Assessments by a blinded evaluator occurred at screening/baseline, after Step One for SC-TF-CBT, posttreatment, and 3-month follow-up. TRIAL REGISTRATION: ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT01603563. RESULTS: There were comparable improvements over time in PTSS and secondary outcomes in both conditions. Noninferiority of SC-TF-CBT compared to TF-CBT was supported for the primary outcome of PTSS, and the secondary outcomes of severity and internalizing symptoms, but not for externalizing symptoms. There were no statistical differences in comparisons of changes over time from pre- to posttreatment and pre- to 3-month follow-up for posttraumatic stress disorder diagnostic status, treatment response, or remission. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC-TF-CBT compared to TF-CBT. CONCLUSIONS: Although future research is needed, preliminary evidence suggests that SC-TF-CBT is comparable to TF-CBT, and delivery costs are significantly less than standard care. SC-TF-CBT may be a viable service delivery system to address treatment barriers.

Developing Models to Predict Persistent High-Cost Cases in Florida Medicaid.

This paper examined individual characteristics associated with being a high-cost case in multiple years for Medicaid-covered health care services. In addition, the accuracy of models that predict future persistent high-cost cases was examined. Florida Medicaid claims from 2005 to 2010 were used to examine characteristics, diagnoses, and services associated with individual costs being in the top 1% of recipients. Regression models were estimated with diagnoses and service use in a base year used to predict future high-cost cases. Several different perspectives were used that focus on predicting current year high-cost cases based on prior persistence, predicting future persistence of high costs, and a combination of using past persistence to predict future persistence. Average annual costs for persistent high-cost cases were more than $140,000. Overall, models were predictive of future high-cost cases. The receipt of intermediate case facility (mental retardation) services was the strongest predictor of future high-cost cases. Inpatient, outpatient, pharmacy, and nursing home services, along with diagnoses, all provided important information for predicting high-cost cases. Diagnosis-based models in conjunction with prior costs can predict future high-cost cases with a high degree of accuracy. However, given that many high-cost cases reside in intermediate care facilities, it is not clear that such individuals would benefit from intensive case management. Service use patterns in prior years, diagnoses, and prior costs should all be used to identify individuals who may benefit from intensive case management.

Suicide Attempts After Emergency Room Visits: The Effect of Patient Safety Goals.

In 2007 the Joint Commission National Patient Safety Goals included a requirement addressing risks associated with patient suicidality. The rational for this requirement was that suicide has been the most frequently reported sentinel event since the inception of the Sentinel Event Policy in 1996. The Patient Safety Goals on suicide required hospitals implement actions to assess suicide risk, meet client's immediate safety needs and provide information such as a crisis hotline to individuals and family members for crisis situations. This study performed a secondary data analysis to assess the effect of the 2007 Joint Commission Patient Safety Goals on suicide attempts among patients following treatment at hospital emergency rooms among individuals enrolled in the Florida Medicaid program. A difference-in-difference approach compared changes in rates of suicide attempts for individuals with a primary mental health diagnosis and individuals with a physical health diagnosis after emergency room treatment. In the 6 months following treatment, suicide rates declined after implementation of the goals among patients treated for a primary mental health diagnosis, and increased among patients with a poisoning diagnosis, compared to individuals with a physical health diagnosis. The goals were associated with a reduction in suicide attempts after emergency room treatment.

Healthcare costs associated with antiretroviral adherence among medicaid patients.

BACKGROUND: The relationship of antiretroviral therapy (ART) adherence to total healthcare expenditures for Medicaid-insured people living with HIV or AIDS (PLWHA) is not well understood, especially among asymptomatic HIV-positive patients. OBJECTIVE: This study examined Medicaid-insured HIV-positive and AIDS-diagnosed patient groups to determine the association of ART adherence to mean monthly total healthcare expenditures in the 24-month measurement period, controlling for demographic, geographic, insurance, and clinical factors. The present study extends the existing literature by analyzing the relationship of ART adherence to total healthcare costs for asymptomatic HIV-positive patients separately from those patients with AIDS-defining conditions. METHODS: This retrospective study utilized claims data from Florida Medicaid claims from July 2006 through June 2011. All patients (n = 502) were HIV-positive, aged 18-64 years, non-pregnant, and ART naïve for at least 12 months prior to the measurement period. Each patient was categorized, based on medication possession ratios, as adherent (≥90 %) or non-adherent (<90 %), and were divided into two groups: HIV positive (n = 232) and AIDS diagnosed (n = 270). Generalized linear models predicted the mean monthly total expenditures for the non-adherence group versus the adherence group. RESULTS: For the HIV-positive group, the adjusted mean monthly expenditures for the non-adherent group were US$1,291; the adherent group adjusted mean monthly expenditures were US$1,926. The HIV-positive non-adherent group adjusted mean monthly expenditures were significantly less than the adherent group (-40 %, p < 0.001). However, for the AIDS-diagnosed group, there was not a statistically significant association of ART adherence to total healthcare expenditures (p = 0.29). CONCLUSION: The results show that the relationship of ART adherence to healthcare costs is more complex than previously reported.

Step one within stepped care trauma-focused cognitive behavioral therapy for young children: a pilot study.

This pilot study explored the preliminary efficacy, parent acceptability and economic cost of delivering Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy (SC-TF-CBT). Nine young children ages 3-6 years and their parents participated in SC-TF-CBT. Eighty-three percent (5/6) of the children who completed Step One treatment and 55.6 % (5/9) of the intent-to-treat sample responded to Step One. One case relapsed at post-assessment. Treatment gains were maintained at 3-month follow-up. Generally, parents found Step One to be acceptable and were satisfied with treatment. At 3-month follow-up, the cost per unit improvement for posttraumatic stress symptoms and severity ranged from $27.65 to $131.33 for the responders and from $36.12 to $208.11 for the intent-to-treat sample. Further research on stepped care for young children is warranted to examine if this approach is more efficient, accessible and cost-effective than traditional therapy.

Do employers know the quality of health care benefits they provide? Use of HEDIS depression scores for health plans.

OBJECTIVE Dissemination of health quality measures is a necessary ingredient of efforts to harness market-based forces, such as value-based purchasing by employers, to improve health care quality. This study examined reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for depression to firms interested in improving depression care. METHODS During surveys conducted between 2009 and 2011, a sample of 325 employers that were interested in improving depression treatment were asked whether their primary health plan reports HEDIS scores for depression to the National Committee for Quality Assurance (NCQA) and if so, whether they knew the scores. Data about HEDIS reporting by the health plans were collected from the NCQA. RESULTS HEDIS depression scores were reported by the primary health plans of 154 (47%) employers, but only 7% of employers knew their plan's HEDIS scores. Because larger employers were more likely to report knowing the scores, 53% of all employees worked for employers who reported knowing the scores. A number of structural, health benefit, and need characteristics predicted knowledge of HEDIS depression scores by employers. CONCLUSIONS The study demonstrated that motivated employers did not know their depression HEDIS scores even when their plan publicly reported them. Measures of health care quality are not reaching the buyers of insurance products; however, larger employers were more likely to know the HEDIS scores for their health plan, suggesting that value-based purchasing may have some ability to affect health care quality.

The impact of emotional disturbances on the arrest trajectories of youth as they transition into young adulthood.

This article identifies the arrest trajectories of youth from ages 12 through 24 years old and tests hypotheses derived from Moffitt's developmental taxonomic theory of crime concerning the impact of various emotional disturbances on the specific trajectories of the youth involved. The study uses exclusively administrative data sets and includes a gender and racially diverse sample of 10,360 youth (30.7% females) who were arrested at least once between ages 12 and 24 in the early 2000s. Latent class growth analysis was employed in order to identify distinct arrest trajectories of youth in the sample. Multinomial logistic regression was used to identify diagnostic and other characteristics associated with membership in the specific trajectories predicted by Moffitt's theory. Five trajectory classes were identified, 3 of which were consistent with taxonomic theory including high and classic adolescence limited trajectory classes and a "snared adolescence limited class" described more recently by Moffitt. The distribution of youth among the 5 classes was very different for those with and without emotional disturbances. Youth with emotional disturbances in their late adolescent years were more likely to fall into the high arrest trajectory class and much less likely to fall into the low arrest trajectory class. Compared to youth without an emotional disturbance, youth with psychotic disorders were more than twice as likely to fall into the high as into the low arrest trajectory class. Youth with disruptive behavior disorders were more than twice as likely to fall into the high and intermediate classes as into the low trajectory class. Anxiety and depressive disorders were not associated with significantly greater likelihood of falling into any one of the trajectory classes. Youth in the snared adolescence limited class were more likely than those in the classic adolescence limited class to be male, black versus white and in the foster care enrollment category lending some support to Moffitt's conceptualization of this class as an adolescence limited class composed of youth who are snared by involvement in the criminal justice and or social services systems. Implications of these results for public policy and the study of adolescence are discussed.

Arrests among youth after out-of-home mental health treatment: comparisons across community and residential treatment settings.

BACKGROUND: There are three options in Florida for young people with mental health needs who require out-of-home treatment: community-based group homes, foster families and inpatient group facilities. Prior research has suggested that young people in group settings have poorer criminal justice outcomes, perhaps attributable to negative peer effects in group environments. AIMS: To compare arrest rates during and after out-of-home treatment for youth across the three settings. To test the hypothesis that arrest rates during treatment are independently related to arrest rates after treatment, after allowing for pre-treatment characteristics and placement type. METHODS: Florida Medicaid claims data were used to identify children and adolescents in out-of-home mental health care from 2003-2007. These were then matched with Florida Department of Juvenile Justice and Law Enforcement records. Propensity score matching was used to allow for observed differences between youth in different treatment settings. Multinomial logistic regression models were used to test relationships between arrest rates. RESULTS: Unadjusted arrest rates for youth in therapeutic group home care were higher than in psychiatric inpatient units or foster care during and after treatment. Arrests during the treatment episode accounted for a substantial proportion of the difference in arrests after out-of-home treatment. After accounting for differences in arrest rates during treatment, the group versus non-group nature of the treatment setting per se was not a strong determinant of arrest after the treatment episode. CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: Attention to the causes of higher arrest rates in group homes, which may include peer contagion and staff policies, could improve outcomes. For youths without a major psychiatric disorder, therapeutic foster care may be better than community-based group care.

The impact of mental health services on arrests of offenders with a serious mental illness.

This study examines the impact of mental health services on arrests of offenders with a serious mental Illness (SMI) by assessing changes in associations between receipt of outpatient and emergency room/inpatient services and arrests one, two, and three quarters later. A variety of data sets were used for identifying 3,769 offenders who were in the Pinellas County Florida jail between 7/1/2003 and 6/30/ 2004, and 7,755 offenders who were in the Harris County Texas jail between 10/1/2005 and 9/30/2006. Arrests, out-patient and emergency room/inpatient services were assigned to one of 16 ninety-day periods between 7/1/2002 and 6/10/2006 in Pinellas County and one of 12 such periods between 10/1/2004 and 9/15/2007 in Harris County. Generalized estimating equations were used. Covariates were age, gender, race, diagnosis, and homelessness. The results were also adjusted for exposure to arrests. In Pinellas County, outpatient services significantly reduced the risks of arrests 1 quarter later by 17% (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.78-0.87, p < .001), two quarters later by 11% (OR = 0.89, 95% CI: 0.84-0.94, p < .001), and three quarters later by 9% (OR = 0.91, 95% CI: 0.86-0.96, p = .001). In Harris County, these services reduced the risk of arrest 1 quarter later by 5% (OR = 0.95, 95% CI: 0.91-0.99, p = .028), but not two and three quarters later. In Pinellas County, ER/inpatient services increased the risk of arrests by 22% (OR = 1.23, 95% CI: 1.15-1.30, p < .001), 8% (OR = 1.08, 95% CI: 1.02-1.15, p = .010) and 11% (OR = 1.11, 95% CI: 1.02-1.16, p = .001) one, two, and three quarters later. In Harris County, these services increased the risk of arrest only 1 quarter later (OR = 1.16, 95% CI: 1.11-1.22, p < .001). Results suggest that service receipt and its timing may have had some impact on the arrests of adults with a SMI and criminal justice involvement.

Changes in antipsychotic medication use after implementation of a Medicaid mental health carve-out in the US.

BACKGROUND: Many Medicaid programmes now offer behavioural healthcare through managed care organizations. Medicaid programmes are concerned about carve-outs because the use of non-included services may rise, limiting the efficiencies anticipated with the implementation of managed care. There also exist concerns that patients with serious mental illness may receive reduced care through managed care and consequently have poorer outcomes. OBJECTIVE: This study examined prescription drug utilization among Medicaid recipients with the implementation of a mental health carve-out plan in Florida. In particular, this study examined short-run changes in the utilization of antipsychotic medications among individuals diagnosed with schizophrenia or episodic mood disorders with the implementation of Prepaid Mental Health Plans (PMHPs) in Florida Medicaid. METHODS: This study used Medicaid data from 38 counties in Florida that implemented the PMHP programme in 2005 and 2006. The sample was limited to individuals aged≤64 years who were continuously enrolled in Medicaid. Individuals were required to have at least two diagnoses of schizophrenia, episodic mood disorders, delusional disorders or other nonorganic disorders (three-digit International Classification of Diseases, Ninth Revision [ICD-9] code of 295-298). Five different outcome measures were examined on a monthly basis for the 6 months pre- and post-PMHP implementation: penetration; adherence; Medicaid expenditures for antipsychotics; polypharmacy (multiple antipsychotic medications); and whether dosing was within guidelines. Generalized estimating equations were used to estimate associations between individual and insurance characteristics, and the outcome variables. The analyses were conducted using SAS procedure GENMOD. Empirical (robust) standard errors were calculated to account for repeated observations on the same individual. RESULTS: There were 153,720 monthly observations for the 12,810 people in the sample. Seventy-four percent of the sample was aged between 21 and 54 years, while 65% were female, 30% White, 14% Black and 44% Hispanic. The large proportion of Hispanics stems from the introduction of the PMHP programme in Dade County (Miami). The results indicate the implementation of the PMHP was associated with increased penetration, but reduced adherence, polypharmacy and expenditures by the Medicaid agency. There was no change in the likelihood of prescriptions being written within recommended dosage ranges. CONCLUSION: The introduction of the PMHP was associated with short-run changes in medication utilization among individuals with serious mental illness.

Comparing methods for identifying future high-cost mental health cases in Medicaid.

OBJECTIVE: This article examines methods for identifying future high-cost cases of Medicaid-covered mental health care services. METHODS: Florida Medicaid claims data are used to compare methods based on prior cost, and concurrent and prospective diagnosis-based models. Individuals with prior year expenditures in the top decile or with predicted expenditures in the top decile from the diagnosis-based models were expected to be high-cost individuals. RESULTS: Individuals in the top decile of prior year costs averaged $13,684 (U.S. dollars) in costs in the following year with 50% remaining in the top decile of spending. Individuals classified as high cost by diagnosis-based models averaged $10,935 to $10,974, with 34% meeting the criteria for a high-cost case in the following year. CONCLUSION: In contrast to research on high-costs cases for physical health care, prior cost was superior to diagnosis-based models at identifying future high cases for mental health care.

After out-of-home mental health treatment: atypical antipsychotic medication use and the probability of returning to treatment.

Florida Medicaid claims data were used to assess antipsychotic medication use among children after therapeutic out-of-home mental health treatment. Fifty percent of youth received antipsychotics after the treatment episode, but differences exist across age, gender, and racial groups. Utilization was higher among males and youth ages 6-12, while blacks were less likely to be prescribed antipsychotics than whites. Youth receiving antipsychotics were less likely to return to out-of-home treatment within 6 months. However, among youth receiving antipsychotic medications, a higher medication possession ratio was not associated with the likelihood of returning to treatment. Such patterns require further investigation to determine whether they indicate inadequate treatment for some youth.

Association of involuntary psychiatric examination with probability of arrest of people with serious mental illness.

OBJECTIVE: This study examined the association between the occurrence of an involuntary psychiatric examination under Florida civil commitment law and the probability of arrest during the next quarter. METHODS: County criminal justice records and several statewide and local health and social service data sets were used to identify inmates with a serious mental illness who spent at least one day in the Pinellas County jail between July 1, 2003, and June 30, 2004. These same data sets were combined with statewide arrest and prison records to identify the criminal justice and health and social services histories of these individuals from July 1, 2002, to June 10, 2006, with the four-year period divided into 16 periods of 90 days. The main analysis used individual fixed-effects models to examine the relationship between involuntary examinations and subsequent probability of arrest. RESULTS: There were 3,728 inmates with serious mental illness in the sample, with 40% (N = 1,485) having at least one involuntary examination during the four-year period. Individuals who experienced an involuntary examination during the four years were arrested in 34% (N = 1,038) of the quarters after an examination and in 27% (N = 3,786) of the quarters not preceded by an involuntary examination. Individual fixed-effects models found a significant positive relationship between the receipt of an involuntary examination in one period and the likelihood of arrests, felony arrests, and misdemeanor arrests in the next period. CONCLUSIONS: Involuntary psychiatric examinations were associated with increased risk of arrest. Thus an involuntary examination was a significant signal that individuals with serious mental illness were at risk for criminal behavior and arrest.

Factors related to criminal justice expenditure trajectories for adults with serious mental illness.

BACKGROUND: Criminal careers have been extensively studied in general population sample, but less is known about such patterns among people with major mental illness, and where so, criminal justice expenditure has not been taken into account. AIMS: Our aim was to examine criminal justice system expenditure over time in one Florida county. Our main research question was whether treatment for mental disorders was related to a change in criminal offending and expenditure trajectory. METHODS: We used the Pinellas County (Florida) Criminal Justice Information System to identify individuals under age 65 arrested between July 2003 and June 2004. Archival medical service, social and homeless services data were used to identify individuals with a serious mental illness. A two-step analysis was used to examine the data: first, we identified groups of people with similar patterns of criminal justice expenditures over 4 years (July 2002 to June 2006); second, we evaluated their demographic characteristics, diagnosis and treatment as potential predictors of group membership. RESULTS: Three thousand seven hundred sixty-nine people with serious mental illness were identified in the Pinellas County jail population. Their average length of stay in jail was 151 days and in prison was 48 days. The trajectory analysis identified three groups of individuals with distinct trajectories of criminal justice expenditures: those with low stable, those with initially high but decreasing and those with initially high and sustained or increasing. Mental health treatment, whether acute or sustained, voluntary or mandatory, was associated with membership of the low stable group. CONCLUSION: Review of criminal justice expenditure over time on individuals with major mental disorder may provide important indicators of unmet need for mental health services. Furthermore, it seems probable that improved provision of such services for them could reduce recidivism as well as improving health. Interventions may also be better focused if criminal justice expenditure trajectories are examined; programmes targeting re-offending as well as specific mental health problems may be most effective.

Risperidone long-acting therapy prescribing patterns and their impact on early discontinuation of treatment in a large Medicaid population.

OBJECTIVE: Medicaid claims were examined to determine whether utilization of risperidone long-acting therapy (LAT) was consistent with manufacturer's prescribing information recommendations and what factors were associated with early discontinuation. METHOD: Florida Medicaid claims between July 1, 2003, and June 30, 2007, were used. Recipient demographics and diagnoses, provision of oral antipsychotic supplementation during the first 21 days, number of injections received, medication possession ratio, and augmentation/polypharmacy after the first 21 days were assessed. Logistic regression was used to identify factors associated with early discontinuation of risperidone LAT. RESULTS: There were 3,364 individuals who received 4,546 episodes of risperidone LAT. Most recipients were between 18 and 64 years and had schizophrenia or schizoaffective disorder. Median episode length was 106 days. Median number of injections was 5. Supplementation with oral antipsychotic during the first 21 days was provided in 48% of episodes. Mean dosages were 25 mg or less for 28% of episodes and greater than 75 mg for 7% of episodes. Augmentation/polypharmacy after the first 21 days occurred in 43% of episodes. Early risperidone LAT discontinuation was associated with absence of oral supplementation during the first 21 days (P < .001), low (P = .045) or high (P < .001) initial doses of risperidone LAT, prior inpatient treatment (P < .001), having a substance use disorder (P = .001), and being male (P = .036). CONCLUSIONS: Prescribing practices for risperidone LAT were compared with the recommended protocol. Risperidone LAT was typically used with recommended age and diagnostic groups. However, important discrepancies were identified that could have reduced perceived effectiveness and tolerability of risperidone LAT. Early discontinuation was less likely when the recommendations in the manufacturer's prescribing information regarding dosage and supplementation with oral antipsychotics were followed.

Mental health services expenditures among children placed in out-of-home care.

This study examined Florida Medicaid mental health expenditures for children in out-of-home care. Child welfare and Medicaid administrative databases were analyzed using two-part models to identify characteristics associated with expenditures. Mental health expenditures were higher for older children, boys, children who were abused or lost their caregivers, or with a longer length of stay in out-of-home care. In contrast, African American children were less likely to have positive expenditures than White children, but among youth with positive expenditures, African Americans had higher expenditures. In addition, among youth with positive expenditures, substance use and affective disorders were associated with higher expenditures.