Robst John, Armstrong Mary, Dollard Norín, Rohrer Lodi
Department of Mental Health Law and Policy, Florida Mental Health Institute, University of South Florida, Tampa, FL 33612, USA.
Crim Behav Ment Health. 2013 Jul;23(3):162-76. doi: 10.1002/cbm.1871.
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.
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.
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.
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.
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.
在佛罗里达州，对于有心理健康需求且需要家庭外治疗的年轻人有三种选择：社区集体之家、寄养家庭和住院集体设施。先前的研究表明，处于集体环境中的年轻人刑事司法结果较差，这可能归因于集体环境中的负面同伴影响。
比较三种环境下青少年在家庭外治疗期间及之后的逮捕率。检验在考虑治疗前特征和安置类型后，治疗期间的逮捕率与治疗后逮捕率独立相关的假设。
利用佛罗里达州医疗补助索赔数据识别2003年至2007年接受家庭外心理健康护理的儿童和青少年。然后将这些数据与佛罗里达州少年司法和执法记录相匹配。倾向得分匹配用于考虑不同治疗环境中青少年之间的观察到的差异。多项逻辑回归模型用于检验逮捕率之间的关系。
在治疗期间及之后，接受治疗性集体家庭护理的青少年未经调整的逮捕率高于精神病住院部或寄养护理中的青少年。治疗期间的逮捕占家庭外治疗后逮捕差异的很大一部分。在考虑治疗期间逮捕率的差异后，治疗环境本身的集体与非集体性质并不是治疗后逮捕的一个强有力的决定因素。
关注集体之家中较高逮捕率的原因，其中可能包括同伴传染和工作人员政策，可能会改善结果。对于没有重大精神疾病的青少年，治疗性寄养护理可能比社区集体护理更好。
