The impact of drug court participation on mortality: 15-year outcomes from a randomized controlled trial.

AIM: To test the effects of drug court participation on long-term mortality risk. METHODS: During 1997-98, 235 individuals charged with a non-violent offense were randomly assigned to Baltimore City Drug Treatment Court (BCDTC) or traditional adjudication. Heroin was the predominant substance of choice among the sample. Participant mortality was observed for 15 years following randomization. RESULTS: Over 20% of participants died during the study, at an average age of 46.6 years, and 64.4% of deaths were substance-use related. Survival analyses estimated that neither mortality from any cause nor from substance use-related causes significantly differed between BCDTC and traditional adjudication. CONCLUSIONS: Frequent and premature death among the sample indicates that this is a high-risk population in need of effective substance use treatment. Roughly half of drug treatment courts are now estimated to offer medication assisted treatment (MAT), which is currently the most effective treatment for opioid use disorders. In this study of BCDTC implemented over 15 years ago, only 7% of participants received MAT, which may explain the lack of program impact on mortality. Historical barriers to providing MAT in drug court settings include access, concerns about diversion, negative attitudes, blanket prohibitions, and stigma. Drug treatment courts should implement best practice standards for substance use treatment and overdose prevention, including increased access to MAT and naloxone, and training to reduce stigmatizing language and practice.

Communal schools and teacher victimization.

Despite data showing that teacher victimization is at least as great a problem as student victimization, far less research exists regarding teacher victimization than student victimization and overall school crime, particularly with regard to the application of criminological theory to explain the victimization of teachers. We address this gap by examining the hierarchical relationship between communal school organization and teacher victimization in a nationally representative sample of 37,497 teachers from 7,488 public schools in the United States. Results showed that teacher experienced less victimization in schools that were more communally organized. We discuss these findings and present implications for school-based delinquency prevention.

An evaluation of police officers in schools as a bullying intervention.

Despite existing efforts to prevent bullying, research suggests that bullying remains a serious and common problem across the United States. Therefore, researchers should continuously propose and evaluate alternative policies that may mitigate bullying as a social issue. One such strategy that has been proposed is the use of police officers in schools, best known as School Resource Officers (SROs). The current study evaluated the efficacy of SROs as an intervention against bullying in schools in the United States. Using a longitudinal sample consisting of three years of data from the School Survey on Crime and Safety (n = 480), schools that initiated, discontinued, and continued their use of SROs from one time point to another were compared to a control group of schools. The findings indicate that SROs do not have an effect on bullying in schools. Policy implications of these findings suggest that programs that focus on components such as teaching social and emotional competency skills, improving relationships between students and adults, and creating a positive school environment may be more effective in reducing bullying than a security procedure such as the use of SROs. Alternative programs should be explored to mitigate bullying and improve the well-being of students.

Scaling-Up Evidence-Based Programs Using a Public Funding Stream: a Randomized Trial of Functional Family Therapy for Court-Involved Youth.

The Affordable Care Act expanded access to Medicaid programs and required them to provide essential health benefits, which can include prevention services. This study assesses the costs and benefits to using Medicaid funding to implement a well-known evidence-based program, Functional Family Therapy (FFT), with a sample of juvenile justice-involved youth. The study also provides a rigorous test of FFT accommodated for a contemporary urban population that is gang at risk or gang-involved. One hundred twenty-nine predominantly minority and low income families were randomly assigned to receive an enhanced version of FFT or an alternative family therapy. Data from pre- and post-intervention interviews with youth and parents, court records of contacts with the justice system and residential placements, official records of community services, and the costs of placements and services are summarized. The intervention was implemented with fidelity to the FFT model using Medicaid funding. Treatment and control subjects received a wide range of community and residential services in addition to FFT. A higher percentage of treatment subjects than controls received services following random assignment, but the cost per youth served was lower for treatment than control youth, primarily because control youth were more often placed in residential facilities. Recidivism during the 18-month follow-up period was lower for FFT than for control youth. The combination of cost savings realized from avoiding more costly services and the expected future savings due to recidivism reduction suggest the expanded use of evidence-based practices using public funding streams such as Medicaid is warranted.

Standards of Evidence for Efficacy, Effectiveness, and Scale-up Research in Prevention Science: Next Generation.

A decade ago, the Society of Prevention Research (SPR) endorsed a set of standards for evidence related to research on prevention interventions. These standards (Flay et al., Prevention Science 6:151-175, 2005) were intended in part to increase consistency in reviews of prevention research that often generated disparate lists of effective interventions due to the application of different standards for what was considered to be necessary to demonstrate effectiveness. In 2013, SPR's Board of Directors decided that the field has progressed sufficiently to warrant a review and, if necessary, publication of "the next generation" of standards of evidence. The Board convened a committee to review and update the standards. This article reports on the results of this committee's deliberations, summarizing changes made to the earlier standards and explaining the rationale for each change. The SPR Board of Directors endorses "The Standards of Evidence for Efficacy, Effectiveness, and Scale-up Research in Prevention Science: Next Generation."

Structure and deviancy training in after-school programs.

Evidence regarding the effectiveness of after-school programs (ASPs) for reducing problem behaviors is mixed. Unstructured ASPs may increase antisocial behavior by increasing "deviancy training" opportunities, when peers reinforce deviant attitudes and behaviors. This research analyses approximately 3000 five-minute intervals from 398 observations of activities delivered as part of an ASP in five public middle schools. Analyses of peer and group leader responses to deviant behavior in the context of ASP activities indicated that while peer responses are generally reinforcing, group leaders typically do not respond to deviance. Multi-level analyses of the association between activity structure and deviant behavior indicate that higher levels of structure in the activity as a whole decrease levels of violence and counternormative behavior. As the level of structure in five-minute intervals within the activity increases, the level of violent behavior declines, but violent talk (e.g., threats to commit violence) increases. Implications for after-school programming are discussed.

Implementation quality and positive experiences in after-school programs.

Data collected during an evaluation of a multi-site trial of an enhanced after-school program were used to relate quality of program implementation to student experiences after school. The enhanced after-school program incorporated a drug use and violence prevention component that was shown to be effective in previous research. Building on Durlak and Dupre's (Am J Community Psychol 41:327-350, 2008) dimensions of implementation, we assessed the level of dosage, quality of management and climate, participant responsiveness, and staffing quality achieved at the five program sites. We evaluated how these characteristics co-varied with self-reported positive experiences after-school. The study illustrates how multiple dimensions of program implementation can be measured, and shows that some but not all dimensions of implementation are related to the quality of student after-school experiences. Measures of quality of management and climate, participant responsiveness, and staffing stability were most clearly associated with youth experiences. The importance of measuring multiple dimensions of program implementation in intervention research is discussed.

An experimental evaluation of the All Stars prevention curriculum in a community after school setting.

This study tested the effectiveness of a prevention curriculum, All Stars, as implemented in a year-long school-based after school program and provides an independent replication of the effects of All Stars on targeted mediators and problem behaviors using an experimental methodology. Middle school students (N = 447) who registered for the after school program were randomly assigned to the experimental or control condition. The sample included approximately equal proportions of males and females, was 70% African American, and 59% of the students received subsidized meals at school. All Stars was delivered with reasonable integrity to the program design, although with lower quality than reported in earlier efficacy trials. However, actual student exposure to the program was lower than expected due to low levels of attendance in the after school program. Students who ever attended received an average of 16 h of All Stars instruction. Results showed no differences between the treatment and control students at post-test on any of the outcomes or mediators. Further, no positive effects were found for youths receiving higher dosage, higher quality program delivery, or both. Insufficient time to achieve high quality implementation in the after school context and potential deviancy training are suggested as reasons for the failure to replicate positive program effects.

School predictors of the intensity of implementation of school-based prevention programs: results from a national study.

Research has indicated that the effectiveness of school-based prevention programs is affected by the implementation quality of these programs. As the importance of implementation has become clearer, researchers have begun to examine factors that appear to be related to implementation quality. Data from a nationally representative sample of 544 schools were used to examine structural equation models representing hypothesized relationships among school and program factors and implementation intensity, controlling for exogenous community factors. Significant relationships were found between implementation intensity and several school and program factors, including local program development process, integration into school operations, organizational capacity, principal support, and standardization. Implications of these findings are discussed.

The Baltimore City Drug Treatment Court: 3-year self-report outcome study.

This study reports results from interviews with 157 research participants who were interviewed 3 years after randomization into treatment and control conditions in the evaluation of the Baltimore City Drug Treatment Court. The interviews asked about crime, substance use, welfare, employment, education, mental and physical health, and family and social relationships. Program participants reported less crime and substance use than did controls. Few differences between groups were observed on other outcomes, although treatment cases were less likely than controls to be on the welfare rolls at the time of the interview. Effects differed substantially according to the originating court.

Do after school programs reduce delinquency?

After school programs (ASPs) are popular and receive substantial public funding. Aside from their child-care and supervision value, ASPs often provide youth development and skill-building activities that might reduce delinquent behavior. These possibilities and the observation that arrests for juvenile crime peak between 2 p.m. and 6 p.m. on school days have increased interest in the delinquency prevention potential of ASPs. This study examined effects of participation in ASPs conducted in Maryland during the 1999--2000 school year and the mechanism through which such programs may affect delinquent behavior. Results imply that participation reduced delinquent behavior for middle-school but not for elementary-school-aged youths. This reduction was not achieved by decreasing time spent unsupervised or by increasing involvement in constructive activities, but by increasing intentions not to use drugs and positive peer associations. Effects on these outcomes were strongest in programs that incorporated a high emphasis on social skills and character development.

Challenges in disseminating model programs: a qualitative analysis of the Strengthening Washington DC Families Program.

This article discusses the challenges faced when a popular model program, the Strengthening Families Program, which in the past has been implemented on a smaller scale in single organizations, moves to a larger, multiorganization endeavor. On the basis of 42 interviews conducted with program staff, the results highlight two main themes that address program and organizational characteristics. The themes relate to the cultural relevance of the program, the accessibility of program partners, the organization of program services, and the coordination of program activities. The article also offers a discussion of how to better prepare sites for program delivery. This discussion focuses explicitly on the need for good communication among program partners, extensive community outreach, and the ability to secure additional resources.

Characteristics of effective school-based substance abuse prevention.

This study summarizes, using meta-analytic techniques, results from 94 studies of school-based prevention activities that examined alcohol or other drug use outcomes. It set out to determine what features of school-based substance abuse prevention programs are related to variability in the size of program effects, It asked (1) Which populations (e.g., high risk vs. general population) should be targeted for prevention services? (2) What is the best age or developmental stage for prevention programming? (3) Does program duration matter? and (4) Does the role of the person delivering the service (e.g., teacher, law enforcement officer, peer) matter? The results suggest that targeting middle school aged children and designing programs that can be delivered primarily by peer leaders will increase the effectiveness of school-based substance use prevention programs. The results also imply that such programs need not be lengthy. The evidence related to the targeting issue is sparse, but suggests that, at least for programs teaching social competency skills, targeting higher risk youths may yield stronger effects than targeting the general population. Suggestions for future research are offered.