Community Determinants of Substance Abuse Treatment Referrals from Juvenile Courts: Do Rural Youths Have Equal Access?

Abstract

Many youths in juvenile justice are in need of substance use services, yet referral to services is often inadequate. This study examines the ecological factors related to substance use service referrals made through Tennessee's juvenile courts. A series of hierarchical binomial logistic models indicated that individual-level factors accounted for 31% of the variance among courts in referral rates. Community and court factors accounted for an additional 16% of the variance. Youths were more likely to be referred if they had a higher need, were white, were male, were adjudicated in communities that had a higher service density, and appeared in courts that had good relationships and frequent contact with mental health providers. Controlling for individual need, youths in rural areas tended to have lower referral rates; however, this relationship was mediated by the frequency of contact and the quality of relations between the court and mental health providers and county average socioeconomic status.

KEYWORDS:

• adolescence
• behavioral health care
• community
• disparities
• hierarchical logistic modeling
• juvenile justice
• racial and ethnic differences
• rural
• service referral
• substance use services

This research was supported by grants from the National Institute of Mental Health (RO1 MH-70680) and National Institute on Drug Abuse (R21 DA017682). The authors would like to express their gratitude to Dr. Carolyn Breda of Vanderbilt University for providing the court and referral data for this study, to Dr. Thomas Smith of Vanderbilt University for technical assistance, and to Dr. Ana Maria Brannan for her generous comments on earlier versions of this paper.

Notes

∗p < .05, ∗∗p < .10.

^a Variable is reverse scored; higher scores = less contact.

^a Variable is reverse scored; higher scores = less contact.