Family, Mental Health, and Placement Outcomes of a Low-cost Preventive Intervention for Youth in Foster Care.

This study assessed secondary outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years within Washington State were recruited and randomly assigned into either the Connecting program (n = 110) or a treatment-as-usual control condition (n = 110). The program included a 10-week sequence of self-directed family activities and DVDs with video clips. Survey data were collected from caregivers and youth at baseline, immediately post-intervention, and at 12 and 24 months post-intervention; placement data was collected from the child welfare department as well. Intention-to-treat analyses focused on 5 classes of secondary outcomes at 24 months post-intervention: caregiver-youth bonding, family climate, youth risk behavior attitudes, youth mental health, and placement stability. There were no intervention effects in the full sample. In subgroup analyses, among older youth (ages 16 - 17) but not younger youth (ages 13 - 15), the Connecting condition (vs. controls) yielded more frequent caregiver-reported bonding communication, bonding activities, warmth, and positive interactions, as well as less favorable youth attitudes towards early initiation of sexual behavior and substance use, and fewer youth self-injurious thoughts. Consistent with the social development model, the divergent outcomes between younger and older youth suggests Connecting's driving mechanisms involve social processes that undergo critical shifts between early and mid-adolescence. Overall, the Connecting program showed promise in older youth for long-term promotion of caregiver-youth bonding, healthy behaviors, and mental health, but did not demonstrate long-term efficacy in facilitating stable or permanent placement of youth in care.

Evaluation of a Brief Foster Parent/ Case Worker Training to Support Relationship Building Skills and Acceptance of LGBTQ+ Youth in Care.

LGTBQ+ youth in foster care need unique support and acceptance; however, few case workers and caregivers receive specialized training. To address this, the Connecting: Sexual Orientation and Gender Identity Expression (SOGIE) eLearning was developed. This evaluation assesses whether attitudes and behavioral intentions regarding LGBTQ+ youth improved as a result of this training. Caregivers and child welfare professionals showed growth in many areas, including how important they felt it was to learn strategies and skills to support LGBTQ+ youth, as well as their confidence to care for LGBTQ+ youth. The Connecting: SOGIE eLearning is a promising tool for child welfare systems.

Two-Year Risk Behavior Outcomes from Connecting, a Prevention Program for Caregivers and Youth in Foster Care.

This study experimentally tested risk behavior outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years from across Washington State were recruited and randomly assigned to either the self-directed program with supplemental support (n = 110) or a treatment as usual control condition (n = 110). Program materials included a workbook with family activities and DVDs with video clips. Over the 10-week program, participants received motivational support contacts to prompt program completion. Survey data were collected from youth and their caregivers at baseline, directly following intervention, then again at 12 and 24 months post-intervention. Intervention effects at 24-month follow-up were found to be moderated by age. Among 16- to 17-year-old youth at follow-up, there was an intervention benefit yielding reduced use of any substance (OR = 0.71, 95% CI [0.54, 0.93], p = 0.01) and nonviolent delinquency (OR = 0.73, 95% CI [0.57, 0.94], p = 0.02). There was no intervention effect among adolescents aged 13 to 15 years for any risk behaviors. This evidence suggests that the developmental timing of a self-directed, family-focused preventive intervention for youth and their caregivers in the foster care system may influence risk behaviors that typically emerge in late adolescence. ClinicalTrials.gov Identifier: NCT03157895.

Methodological Strategies for Prospective Harmonization of Studies: Application to 10 Distinct Outcomes Studies of Preventive Interventions Targeting Opioid Misuse.

The Helping to End Addiction Long-Term (HEAL) Prevention Cooperative (HPC) is rapidly developing 10 distinct evidence-based interventions for implementation in a variety of settings to prevent opioid misuse and opioid use disorder. One HPC objective is to compare intervention impacts on opioid misuse initiation, escalation, severity, and disorder and identify whether any HPC interventions are more effective than others for types of individuals. It provides a rare opportunity to prospectively harmonize measures across distinct outcomes studies. This paper describes the needs, opportunities, strategies, and processes that were used to harmonize HPC data. They are illustrated with a strategy to measure opioid use that spans the spectrum of opioid use experiences (termed involvement) and is composed of common "anchor items" ranging from initiation to symptoms of opioid use disorder. The limitations and opportunities anticipated from this approach to data harmonization are reviewed. Lastly, implications for future research cooperatives and the broader HEAL data ecosystem are discussed.

Trajectories of Handgun Carrying in Rural Communities From Early Adolescence to Young Adulthood.

Importance: Characterizing patterns of handgun carrying among adolescents and young adults can inform programs to reduce firearm-related harm. Longitudinal patterns of handgun carrying among rural adolescents have not been identified. Objectives: To assess specific points of intervention by characterizing patterns of handgun carrying by youths in rural communities from early adolescence to young adulthood and to quantify how age at initiation, duration, and frequency of carrying differ across identified patterns. Design, Setting, and Participants: This cohort study uses the control group of the community-randomized trial of the Communities That Care prevention system, conducted among public school students in 12 rural communities across 7 states. Participants self-reported their handgun carrying at 10 data collection points from 12 to 26 years of age (2005-2019). Data were analyzed from January to July 2021. Main Outcomes and Measures: Handgun carrying in the past 12 months. Latent class growth analysis was used to estimate handgun carrying trajectories. Results: In this longitudinal rural sample of 2002 students, 1040 (51.9%) were male; 532 (26.6%) were Hispanic, Latino, Latina, or Latinx; 1310 (65.4%) were White; and the highest level of educational attainment of either parent was a high school degree or less for 649 students (32.4%). The prevalence of handgun carrying in the last 12 months ranged from 5.3% (95 of 1795) to 7.4% (146 of 1969) in adolescence and increased during the mid-20s (range, 8.9% [154 of 1722] to 10.9% [185 of 1704] from 23 to 26 years of age). Among the participants who reported handgun carrying at least once between 12 and 26 years of age (n = 601 [30.0%]), 320 (53.2%) reported carrying a handgun in only 1 wave. Latent class growth analysis indicated 6 longitudinal trajectories: never or low probability of carrying (1590 [79.4%]), emerging adulthood carrying (166 [8.3%]), steadily increasing carrying (163 [8.1%]), adolescent carrying (53 [2.6%]), declining carrying (24 [1.2%]), and high probability and persistent carrying (6 [0.3%]). The earliest mean (SD) age at initiation of handgun carrying occurred in both the adolescent and declining carrying groups at the ages of 12.6 (0.9) and 12.5 (0.7) years, respectively. More than 20% of some groups (emerging adulthood [age 26 years: 49 of 154 (31.8%)], steadily increasing [age 26 years: 37 of 131 (28.2%)], declining [age 13 years: 7 of 23 (30.4%)], and high probability and persistent carrying [age 15 years: 3 of 6 (50.0%)]) reported carrying 40 times or more in the past year by the age of 26 years. Conclusions and Relevance: This study found distinct patterns of handgun carrying from adolescence to young adulthood in rural settings. Findings suggest that promoting handgun safety in rural areas should start early. Potential high-risk trajectories, including carrying at high frequencies, should be the focus of future work to explore the antecedents and consequences of handgun carrying in rural areas.

The Usual, Racialized, Suspects: The Consequence of Police Contacts with Black and White Youth on Adult Arrest.

Research on race and policing indicates that Black Americans experience a greater frequency of police contacts, discretionary stops, and police harassment when stops occur. Yet, studies examining the long-term consequences of police contact with young people have not examined whether criminal justice consequences of police contact differ by race. We address this issue by examining whether police encounters with children and adolescents predict arrest in young adulthood and if these effects are the same for Black and White individuals. The paper uses longitudinal survey data from 331 Black and White respondents enrolled in the Seattle Public School District as eighth graders in 2001 and 2002. Our findings indicate that police encounters in childhood increase the risk of arrest in young adulthood for Black but not White respondents. Black respondents who experience contact with the police by the eighth grade have eleven times greater odds of being arrested when they are 20 years old than their White counterparts.

Development and Implementation of Businesses That Care in Zacatecas, Mexico.

As part of the Global Smart Drinking Goals campaign launched in 2018 in 6 "City Pilots" around the world, the Businesses That Care (BTC; Empresas Que se Cuidan in Spanish) prevention system was developed and implemented in Zacatecas, Mexico. BTC is a private business sector adaptation of the Communities That Care prevention system. BTC is designed to address underage alcohol use through a combination of a company-led prevention system, an adapted family-based prevention program with parents employed at participating companies, and environmental prevention strategies for company employees. BTC was designed to be congruent with other health and safety efforts in the region (e.g., media campaign, road safety, and school prevention efforts). This study presents the feasibility and adoption of the BTC system in Zacatecas. Process implementation measures indicated successful participant recruitment, retention, and adherence to intervention protocols. The first 4 stages of BTC implementation were completed within 14 months, with Stage 5 being interrupted by the COVID-19 pandemic. BTC Prevention Committee members, made up of employees from BTC participating companies, received 9 out of 10 BTC trainings/workshops during this time. Results provide evidence of the acceptability and feasibility for private companies to implement a prevention system approach for reducing youth alcohol use.

Factors Associated With Trajectories of Externalizing Behavior in Preschoolers.

OBJECTIVE: More media exposure and life stressors are associated with higher levels of externalizing behaviors in young children; however, their joint impact on externalizing behavior trajectory is unknown. This study assessed the relationship of stressful life events (SLE), media exposure, and additional demographic and family variables on the trajectory of externalizing behaviors in preschool-aged children. METHODS: Participants were children ages 3 to 5 years from a large, 18-month duration, randomized control trial to reduce inappropriate media exposure. The sample was recruited from community pediatrics' practices. Intervention and control groups were collapsed, with study arm a covariate. Latent growth modeling (LGM) was conducted, with main outcome of externalizing behaviors at 6, 12, and 18 months after study initiation. Primary exposures of interest were total daily media hours, SLE, intimate partner violence, and harsh parenting. RESULTS: Final analyses included 613 children. LGM without covariates revealed a significant decrease in mean externalizing score between baseline and 18 months. LGM with covariates revealed that individuals with more media exposure exhibited more externalizing behaviors and SLE significantly predicted a slower decline in externalizing behaviors. Externalizing behavior at 18 months was significantly predicted by SLE, child age, white non-Hispanic race, and harsh parenting. CONCLUSIONS: Exposure to a greater number of stressful life events appears to slow the age-appropriate decline in externalizing behaviors for preschool-aged children, while harsh parenting and media exposure are associated with more externalizing behavior. Findings highlight the importance of screening and surveillance in primary care and the need for early intervention efforts targeted to these risks.

Proximal Outcomes of Connecting, an Evidence-based, Family-focused Prevention Program for Caregivers of Adolescents in Foster Care.

This study experimentally tested proximal outcomes of Connecting, a low-cost, self-directed, family-based substance-use prevention program for foster families. Families (n = 220) fostering youth age 11 to 15 years were recruited and randomly assigned into the self-administered program with telephone support (n = 110) or a treatment as usual, control condition (n = 110). Program materials included a workbook with family activities and DVDs with video clips. Survey data were collected from youth and their caregivers at baseline and 4 months later. Results indicate 60% were 'very satisfied' with Connecting, and 85% would recommend Connecting to other caregivers. Analyses revealed foster youth in the program (n = 93) were significantly more likely than controls (n = 104) to report improved problem-solving skills (Cohen's d = .13, p = .02), involvement in making family rules (OR = 2.6, p = .02), and caregiver recognition for positive behavior (OR = 3.8, p = .03) at posttest. Improvement was observed in youth report of intervention-specific communications (B = 0.15, p = 0.07) and improved refusal skills (OR = 2.09, p = .06). No significant effects were found on bonding communication, inconsistent discipline, family conflict, monitoring, and antisocial norms about substance use and violence, nor were there significant effects from any caregiver reports on similar measures. This evidence suggests that a self-administered family-focused preventive intervention can positively influence known risk and protective factors for youth in foster care.

Barriers to recruitment, retention and intervention delivery in a randomized trial among patients with firearm injuries.

BACKGROUND: We discuss barriers to recruitment, retention, and intervention delivery in a randomized controlled trial (RCT) of patients presenting with firearm injuries to a Level 1 trauma center. The intervention was adapted from the Critical Time Intervention and included a six-month period of support in the community after hospital discharge to address recovery goals. This study was one of the first RCTs of a hospital- and community-based intervention provided solely among patients with firearm injuries. MAIN TEXT: Barriers to recruitment included limited staffing, coupled with wide variability in length of stay and admission times, which made it difficult to predict the best time to recruit. At the same time, more acutely affected patients needed more time to stabilize in order to determine whether eligibility criteria were met. Barriers to retention included insufficient patient resources for stable housing, communication and transportation, as well as limited time for patients to meet with study staff to respond to follow-up surveys. These barriers similarly affected intervention delivery as patients who were recruited, but had fewer resources to help with recovery, had lower intervention engagement. These barriers fall within the broader context of system avoidance (e.g., avoiding institutions that keep formal records). Since the patient sample was racially diverse with the majority of patients having prior criminal justice system involvement, this may have precluded active participation from some patients, especially those from communities that have been subject to long and sustained history of trauma and racism. We discuss approaches to overcoming these barriers and the importance of such efforts to further implement and evaluate hospital-based violence intervention programs in the future. CONCLUSION: Developing strategies to overcome barriers to data collection and ongoing participant contact are essential to gathering robust information to understand how well violence prevention programs work and providing the best care possible for people recovering from injuries. TRIAL REGISTRATION: ClinicalTrials.gov NCT02630225 . Registered 12/15/2015.

Helping individuals with firearm injuries: A cluster randomized trial.

BACKGROUND: Patients with firearm injuries are at high risk of subsequent arrest and injury following hospital discharge. We sought to evaluate the effect of a 6-month joint hospital- and community-based low-intensity intervention on risk of arrest and injury among patients with firearm injuries. METHODS: We conducted a cluster randomized controlled trial, enrolling patients with firearm injuries who received treatment at Harborview Medical Center, the level 1 trauma center in Seattle, Washington, were 18 years or older at the time of injury, spoke English, were able to provide consent and a method of contact, and lived in one of the five study counties. The intervention consisted of hospital-based motivational interviewing, followed by a 6-month community-based intervention, and multiagency support. The primary outcome was the risk of subsequent arrest. The main secondary outcome was the risk of death or subsequent injury requiring treatment in the emergency department or hospitalization. RESULTS: Neither assignment to or engagement with the intervention, defined as having at least 1 contact point with the support specialist, was associated with risk of arrest at 2 years post-hospital discharge (relative risk for intervention assignment, 1.15; 95% confidence interval, 0.90-1.48; relative risk for intervention engagement, 1.07; 95% confidence interval, 0.74-2.19). There was similarly no association observed for subsequent injury. CONCLUSIONS: This study represents one of the first randomized controlled trials of a joint hospital- and community-based intervention delivered exclusively among patients with firearm injuries. The intervention was not associated with changes in risk of arrest or injury, a finding most likely due to the low intensity of the program. LEVEL OF EVIDENCE: Care management, level II.

Understanding the intergenerational transmission of substance use and problem behavior: Implications for future research and preventive interventions.

The Constitution of the Iroquois Nation states that we should "look and listen for the welfare of the whole people and have always in view not only the present, but also the coming generations." The excellent intergenerational longitudinal studies represented here help us better understand patterns of behaviors across generations. Collectively, these studies provide a pathway for future research on contexts and trends in substance use, research on age of onset among early generations, and research related to epigenetics to improve prevention interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Fidelity Assessment of a Social Work-Led Intervention Among Patients with Firearm Injuries.

PURPOSE: To support future development and refinement of social work-led intervention programs among patients with firearm injuries and to demonstrate how a fidelity assessment can be used to adjust and refine intervention delivery in an ongoing trial. METHODS: We conducted a fidelity assessment of a randomized controlled trial of a social work-led intervention among patients with a firearm injury. RESULTS: We found that our study intervention was well implemented, meeting 70% of the fidelity assessment score items, however noted lower fidelity with client-based items. DISCUSSION: As a result of fidelity assessment findings, we refined intervention delivery to improve implementation fidelity including beginning to review cases of all patients each month, rather than focusing on patients in crisis. Our fidelity assessment process and findings offer insight into the challenges of implementing an intervention among patients with firearm injuries and highlights the value of monitoring intervention fidelity during an ongoing trial.

Investigating the efficacy of a self-directed parenting intervention to reduce risky behaviors among college students: Study protocol for a multi-arm hybrid type 2 randomized control trial.

BACKGROUND: Early adulthood is a critical developmental period when many youth transition from living at home to the relative autonomy of college. This transition results in increased opportunity for positive growth and identity development - and for risky substance use and sexual behaviors. Parents continue to influence young adult behavior even from a distance; however, few studies have rigorously tested parent-college student interventions. METHODS: This multi-arm hybrid type 2 trial tests the short- and long-term efficacy of a self-directed handbook for parents of first-year college students. In the summer before college, parent-student dyads are randomly assigned to one of three conditions: control, Parent Handbook, or Parent Handbook Plus. Handbook parents receive encouragement via phone calls to read the handbook and complete activities with their student before leaving for college. Handbook Plus parents also receive booster messages targeted at risky or stressful times. Participants complete surveys of intervention-targeted knowledge, attitudes, and behaviors at baseline and four months after baseline. Students complete three additional surveys at nine, 16, and 21 months after baseline. Dyads in the intervention conditions also reported on handbook utilization, perceived usefulness, and engagement with intervention materials. DISCUSSION: Self-directed family interventions may be a feasible strategy for involving parents of college students. This trial aimed to determine: 1) the efficacy of a self-directed handbook intervention for parents of first-year college students, including whether the addition of periodic booster messages enhanced efficacy; and 2) how variations in handbook utilization, perceived usefulness, and engagement were linked to student outcomes.

Supporting LGBTQ+ Foster Teens: Development of a Relationship-Focused, Self-Guided Curriculum for Foster Families.

LGBTQ+ youth are over-represented in the foster care system. Child welfare systems across the country have been struggling with how to make their systems work better for the LGBTQ+ youth they serve. One strategy is developing foster caregiver trainings that bolster caregivers' knowledge and support of LGBTQ+ youth in their care. This study has three aims: (1) to provide an overview of a module designed to support relationship building between LGBTQ+ youth in foster care and their caregivers, (2) to describe the theater testing procedure used to assess usability of the developed module with foster caregivers and adults, and (3) to share the results of the theater test. Overall, participants provided positive usability feedback about the module activities, as well as a wide variety of recommendations for strengthening the content for widespread use. Participants felt the module should be directed specifically toward caregiver skill development rather than toward both caregiver and youth support. This module represents one example of how materials focused on building foster caregivers' knowledge and support have the potential to help LGBTQ+ teens who are overrepresented in the foster care system.

Parents' Perceptions of Adolescent Exposure to Marijuana Following Legalization in Washington State.

OBJECTIVE: Parents in Washington State face new challenges related to the non-medical marijuana legislation that was passed in 2012. We asked parent focus group participants about changes they have observed in their environment, how their children are exposed to marijuana, and how this exposure might affect youth marijuana use. METHOD: We conducted 6 focus groups with parents of youth ages 8 to 15 (N = 54). Parents were recruited from the Seattle Social Development Project, a multi-ethnic, longitudinal panel study that originated in Seattle in 1985. Thematic content analysis was used to analyze qualitative data. RESULTS: Parents agreed that they did not want their children using marijuana, and were concerned that their children were exposed to marijuana more often and in many different contexts. Parents said they now need to monitor their children's environment more carefully, especially the other adults that spend time around their children. Edible marijuana products were particularly concerning for parents, as they offer a new set of challenges for parents in monitoring their children's exposure to and use of marijuana. Parents were concerned that marijuana exposure would increase risk of marijuana use in adolescents. CONCLUSIONS: Parents' experiences in Washington State provide valuable lessons for social work practitioners, policymakers and those developing preventive interventions. Prevention efforts and public health messaging should begin before legalization takes effect to support parents in preparing for changes in their social and physical environments, and should seek to incorporate parenting strategies to monitor and intervene when children are exposed to marijuana.

Parenting Practices in the Context of Legal Marijuana: Voices from Seattle Parents.

OBJECTIVES: This study examined marijuana-related parenting attitudes, behaviors, and challenges in the context of nonmedical marijuana legalization in Washington State. METHOD: Qualitative data were collected via 6 focus groups with a total of 54 parents of preteen and teenage children, following the opening of the first marijuana retail store in Seattle in 2014. A structured interview protocol was used to ask parents about their marijuana-related parenting behaviors and about information, skills, or strategies that parents might find helpful while raising children in a state where nonmedical marijuana use is legal for adults. Transcripts were analyzed using thematic content analysis with NVivo software. RESULTS: Findings indicate that most parents talked to their children about marijuana, communicating rules and information about the effects of the drug. Although most parents felt that marijuana use by underage youth was not acceptable, many recognized that it was something teens would likely experiment with. Most parents set guidelines about marijuana in their households, but several faced challenges monitoring their children's behavior (e.g., use of edibles), imposing consequences when children used marijuana, reconciling societal and personal norms, and deciding whether or not to disclose their own use. Parents expressed that they would benefit from learning strategies to deal with these challenges, including factual information and parenting skills, through programs offered in schools or community settings. CONCLUSIONS: Results have implications for future research that seeks to inform prevention program development and shape policies attuned to the needs of parents.

Firearm-related behaviors following firearm injury: changes in ownership, carrying and storage.

Individuals who sustain nonfatal gunshot wound (GSW) injuries are at substantially increased risk of subsequent firearm injury. There is a dearth of literature examining what, if any, firearm-related behavior changes occur among adults as a result of GSW injuries. Using survey data on firearm-related behaviors from an ongoing randomized controlled trial, we sought to describe changes in reported firearm-related behaviors among GSW patients following their injury. Our results suggest that patients with a GSW, especially firearm owners, may change their firearm-related behaviors following injury, some by increasing firearm-related safety and others by increasing frequency of behaviors that may place them at increased risk of subsequent injury. This study highlights the need for further examination of firearm-related behavior change among GSW patients and development of interventions to promote firearm safety among this population.

Effectiveness of Facebook Groups to Boost Participation in a Parenting Intervention.

Although family-based prevention programs have been shown to be effective at reducing adolescent substance use, it is often difficult and costly to recruit and retain parents in programs administered in person. The current study tested whether program engagement and parenting practices could be improved by offering parents in a self-directed family program access to a private Facebook group. Parents of middle school children (N = 103) were recruited through paid Facebook ads to a 5-week self-directed teen substance use prevention program to be completed at home together by parents and their children. Two thirds of parents (N = 72) were randomly assigned to a moderated private Facebook group that provided a forum for parents in the study to interact with each other, and one third (N = 31) were randomized to use the intervention materials without additional support. Relatively few parents participated in the Facebook group and most did not find the experience useful. However, satisfaction with the program assessed 3 months after program completion was high among all parents and most parents engaged with the materials, irrespective of Facebook group assignment. Overall, parents reported significantly lower conflict and more household rules 6 months post-intervention compared to baseline. Parenting practices did not change more among those assigned to the Facebook group than among parents who used the materials on their own. The current findings suggest that providing opportunities for parents to interact online while participating in a self-directed family intervention may not help to increase engagement or improvements in parenting practices, particularly when few parents engage with each other.

Predicting School Suspension Risk from Eighth through Tenth Grade Using the Strengths and Difficulties Questionnaire.

The current study examined (1) if the Strengths and Difficulties Questionnaire (SDQ) would yield alternative factor structures related to either symptoms or strengths with early adolescent students when an exploratory factor analysis (EFA) is used; (2) which scales best predicted suspensions of typically developing early adolescents; and (3) what cut-off scores were useful for identifying youth at risk for suspensions. The current study included 321 parent-student dyads, who were followed from the middle of eighth grade until the end of tenth grade. A symptoms-based EFA yielded three factors: Misbehavior, Isolation, and Agitation. A strength-based EFA yielded three factors, as, well: Emotional, Social, and Moral competence. Logistic regression path analyses were used to predict risk of any suspension at the end of eighth, ninth, and tenth grades. The predictor variables were the original SDQ Conduct Problems and Hyperactivity scales in one model, the Misbehavior and Agitation scales in a second model, and the Emotional and Moral competence scales in the third model. Only the Misbehavior scale consistently predicted suspensions across each grade (b = .27, OR = 1.32, p < .001; b = .15, OR = 1.18, p = .029; b = .17, OR = 1.18, p = .029, respectively). For the Misbehavior scale, cut-off scores were established that reflected the 75th and 90th percentile; however, each cut-off demonstrated strengths and weaknesses for identifying at-risk students. The expectation of screening to identify youth at-risk for suspensions, a complex school discipline decision, is discussed.