67.6% to 74.8% for Medicaid insured adolescents (p�0.195).Tobacco screening rates improved from 35.9% to 52.3% for com-mercially insured adolescents (p�0.001) and from 38.9% to 45.1%for Medicaid insured adolescents (p�0.31). Alcohol screeningrates improved from 29.2% to 44% (p�0.002) for commerciallyinsured adolescents and were 35.8% and 36.5% (p�0.88) amongMedicaid insured adolescents.Conclusions: Continued quality improvement efforts in this re-gion of NY have been associated with increased improvements inreceipt of screening and counseling and greater delivery of confi-dential care to adolescents. Quality improvement interventions area promising strategy for successfully changing primary care pro-viders’ decision support systems and improving systematic contentdelivery of preventive services to both commercial and Medicaidinsured adolescent populations.

PII: S1054-139X(04)00324-6

21.

SERVICE UTILIZATION AND THE LIFE CYCLE OFYOUTH HOMELESSNESSJennifer Carlson, M.D., Eiko Sugano, M.P.H.,Susan G. Millstein, Ph.D., and Colette L. Auerswald, M.D.,Dept. of Pediatrics, University of California, San Francisco, SanFrancisco, California.

Purpose: Homeless youth are often viewed as a homogenouspopulation; however, it appears that they, like housed youth, con-sist of various subpopulations. The objective of this exploratorystudy is to describe differences in service utilization (use of shel-ters, outreach services, medical services, or drug treatment pro-grams) by homeless youth based on their life cycle stage. Thiscycle is defined by four main stages: initiation, stasis, disequilib-rium, and extrication. In initiation, youth are immigrants to thestreet culture from mainstream culture. In stasis, youth are inte-grated into the street economy and share a street ethic. In disequi-librium, youth experience episodes of minor or major disasters thatthreaten their ability to continue to survive on the street. In extri-cation, youth are attempting to leave street life.Methods: Participants were 15 to 23 year old youth who had beenhomeless the two nights prior to being interviewed or had a historyof homelessness in the previous six months. Subjects were re-cruited from pre-determined street venues in three neighborhoodsand two transitional programs. Data were collected using an audiocomputer assisted self-interview (ACASI) questionnaire. Life cy-cle was measured by a five-item measure. Service utilization wasmeasured by four items: specific shelter use, specific outreachprogram use, specific clinic use, and types of services used. Dif-ferences in utilization by life cycle stages were tested using Chi-square analyses. When appropriate, the extrication stage was di-vided into street youth and program youth for further analysis.Program youth were not included in some analyses because of therisk of confounding.Results: The final sample consisted of 175 youth (162 from streetvenues, 13 from program venues). There were no significant dif-ferences between stages for use of shelter, outreach or drug treat-ment program services. There were significant differences betweenstages for health care utilization (p�.01 for use of specific clinicsand p�.02 for use of health care services in general). Furtheranalyses showed that youth in extrication (both on the street and

sampled from programs) were significantly more likely to usehealth services than youth in other stages (p�.002 to p�.041).Analyses of drug treatment program use showed that youth inextrication were significantly more likely to use services thanyouth in stasis (p�.048).Conclusion: We found that the use of health services and drugservices is greatest among youth who are attempting to leave thestreet. These findings suggest that youth attempting to leave thestreet may approach health services for their needs. In addition,health services should be designed to reach out to youth in otherstages of the life cycle.Support: NICHD (K-23, HD 0149003, PI: C. Auerswald); MCHBLEAH Training Project (PI: C. Irwin, Jr.); UCSF REAC and CORAwards (PI: C. Auerswald).

PII: S1054-139X(04)00325-8

22.

TELEMEDICINE AS AN ALTERNATIVE TOIMPROVING HEALTH CARE SERVICES TO YOUTH INSTATE CUSTODYKaren C. Fox, Ph.D., Center for Health Innovation and Com-munity Outreach, University of Tennessee Health Science CenterCollege of Medicine, Memphis, Tennessee.

Purpose: The purpose of this study is to examine the effectivenessof the children in state custody telemedicine program by compar-ing intermediate outcomes in the year prior to the telemedicineintervention with those experienced in the first year of the Tele-health intervention.Methods: Study Design: The study is a pre/post quasi-experimen-tal design.Analyses: Data is gathered for the year prior to telemedicine andthe first year of the intervention.Setting: The target population for this study is adolescents in stateresidential treatment centers.Patients/Participants: 800 subjects are eligible for inclusion ifthey consent to participate in the research.Outcomes measures: The study compares pre/post measures ofaccess to care as measured by utilization of specialty consults,emergency room (ER) visits and inpatient days; timeliness of caredelivery as measured by time from referral to date of service forbehavioral health; and overall costs of care as measured by thecosts of specialty consults, emergency room visits, inpatient days,transportation costs, and personnel time during transportation.Results: Telemedicine appears to significantly improve access tocare. For each 1 % increase in implementation level (defined aspercent of all outpatient visits conducted by telemedicine) outpa-tient visits increased by 1% while emergency room visits de-creased by 7%. Inpatient visits are not significantly impacted.Telemedicine may also improve the timeliness of care for childrenin YDCs. Two of the four YDCs have a significant decrease intime from referral to treatment after the telemedicine intervention,(38% decrease overall) When examining the relationship betweenlevel of telemedicine implementation at the center level and cost,a negative relationship is found for five cost measures in more thanone center.Conclusions: This research shows significant differences betweenYouth Development Centers in terms of increases in visits, costs,timeliness and telemedicine visits. The study also finds that level

121Abstracts / 36 (2005) 111-154