1. 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 Approach to Juvenile Justice Harris County Juvenile Probation Department

2. 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.

3. D ETAINED Y OUTH Committee on Adolescence. Health Care for Youth in the Juvenile Justice System. Pediatrics. 2011; 128;1219

4. AAP M EDICAL H OME AccessibleCompassionate Culturally Effective Continuous Comprehensive Family Centered Coordinated

5. P URPOSE 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

6. M ETHODS : N EEDS A SSESSMENT 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

7. R ESULTS : S URVEY Youth Baseline Characteristics n=368 Age (years)15 (11-17) Gender Male297 (82%) Female 67 (18%) Ethnicity Black187 (52%) Hispanic108 (30%) White 65 (18%) Parental marital status Married112 (37%) Never married 95 (32%) Other 94 (31%) Language spoken at home English272 (80%) Spanish 67 (20%)

8. R ESULTS : S URVEY Survey results from detained youth and their guardians Jan – July 2014

9. R ESULTS : F OCUS G ROUPS YOUTH BARRIERS Transportation MoneyFearLocation PARENT BARRIERS Transportation InsuranceYouth refusal Inconvenient hours BARRIERS Transportation InsuranceFear/Refusal Location/Hours

10. R ESULTS : C OMMUNITY M APPING

11. R ESULTS : C OMUNITY M APPING Medical Homes Included: Met most AAP criteria Cared for teen patients Screened for substance use/abuse Offered reproductive services

13. T RANSITION OF C ARE Discharge Summary Parent Faxed to PCP Referral Form Medical staff Probation officers

14. L IMITATIONS 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

15. C ONCLUSIONS : 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

16. N EXT S TEPS : Data analysis Survey results Disseminate information Partnership Area teen clinics Juvenile justice center Coalition Engage community partners Formation of coalition

17. T HANK Y OU 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