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RAE, JF, SHB and PGA declare that they have no competing interests. In the past five years, WVB has received grants/research support from Cephalon, Inc., and has served on speaker panels for Janssen Pharmacuetica and Pfizer, Inc.
All authors have fulfilled conditions required for authorship. RAE was involved in the conception, design, analysis, and drafting of the manuscript. JF was involved in the conception and drafting of the manuscript. PGA was involved in manuscript design and analysis. SHB was involved in the manuscript conception and design. WVB was involved in the design, analysis, and drafting of the manuscript. All authors revised the manuscript for intellectual content and approved the manuscript’s final, submitted version.
The purpose of the current study was to evaluate the impact of a July 2008 Tennessee Court of Appeals opinion that shifted financial responsibility for juvenile court ordered psychiatric evaluations from the State to the County.
We used de-identified administrative data from the Tennessee Department of Mental Health and mid-year population estimates from the U.S. Census Bureau from July 1, 2006 to June 30, 2010, and an interrupted time series design with segmented regression analysis to quantify the impact of the implementation of the Court opinion.
In the study period, there were 2,176 referrals for juvenile court ordered psychiatric evaluations in Tennessee; of these, 74.1% were inpatient evaluations. The Court opinion was associated with a decrease of 9.4 (95% C.I. = 7.9–10.8) inpatient and increase of 1.2 (95% C.I. = 0.4–2.1) outpatient evaluations per 100,000 Tennessee youth aged 12 to 19 years per month.
The Court opinion that shifted financial responsibility for juvenile court ordered psychiatric evaluations from the State to the County was associated with a sudden and significant decrease in inpatient psychiatric evaluations, and more modest increase in outpatient evaluations.