Using grounded theory to develop a theory of change for a violence intervention program.

Hospital-based violence intervention programs (HVIP) are critical to interrupting the cycle of violence. These interventions are considered "complex" in that they have many mechanisms of change and related outcomes. Few HVIPs clearly identify the underlying mechanisms of intervention and explicitly link those with key outcomes however, limiting the field's ability to know what works best and for whom. To develop a program theory of change for these "complex interventions," a non-linear, robust methodology that is grounded in the lived experience of those delivering and receiving services is needed. To aid researchers, evaluators, students, and program developers, we describe the use of Grounded Theory as a methodology to enhance the development of complex interventions, illuminating a non-linear approach that engages key stakeholders. To illustrate application, we describe a case example of The Antifragility Initiative, a HVIP in Cleveland, Ohio. The development of the program theory of change was conducted in four phases: (1) review of existing program documents, (2) semi-structured interviews with program developers (n = 6), (3) a focus group with program stakeholders (n = 8), and (4) interviews with caregivers and youth (n = 8). Each phase informed the next and culminated in a theoretical narrative and visual model of the Antifragility Initiative. Together, the theoretical narrative and visual model identify the underlying mechanisms that can promote change by the program.

Using integrated data to examine the effects of summer youth employment program completion on educational and criminal justice system outcomes: Evidence from Cuyahoga County, Ohio.

The current study builds the evidence base on the effects of Summer Youth Employment Programs (SYEP) both geographically and methodologically by linking SYEP participant records to a comprehensive integrated longitudinal database to better understand programmatic impacts on youth who completed participation in an SYEP in Cleveland, Ohio. The study matches SYEP participants and unselected applicants on various observed covariates using the Child Household Integrated Longitudinal Data (CHILD) System and relies upon propensity score matching techniques to estimate program completion impacts on educational and criminal justice system involvement outcomes. SYEP completion is associated with a lower prevalence of juvenile offense filings and incarceration events, better school attendance, and improved graduation rates 1-2 years following program participation.

Experiences of Adversity and Validity of Baseline Concussion Testing.

CONTEXT: Neurocognitive testing is a critical tool in management of sports-related concussions. Adversity during childhood and adolescence effects cognitive tasks, behavioral outcomes, and academic performance. Adversity may be important in baseline concussion test validity as well; however, the effect of these experiences is not well understood. OBJECTIVE: This study examined the relationship between individual-level experiences of adversity and baseline test validity of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Program. We hypothesized that experiences of poverty, maltreatment, or extreme neighborhood deprivation would be associated with lower odds of baseline test validity. DESIGN: Case-Control Study. SETTING: XXX. PARTICIPANTS: This study included 6,495 student-athletes born between 1995 and 2005 who completed a baseline ImPACT test between 10 and 18 years old and could be identified in the Child-Household Integrated Longitudinal Data (CHILD) System, a comprehensive data system with demographic and social service usage outcomes for children in XXX. MAIN OUTCOME MEASURES: Baseline concussion test validity was determined using the ImPACT program's built-in validity measure. Experiences of adversity occurring in the sensitive developmental periods of early childhood and adolescence were key independent variables. RESULTS: Our findings suggest that social mobility may play an important role in baseline validity. Youth with upward social mobility (poverty or neighborhood deprivation in early childhood only) were not significantly different than youth without such experiences (OR=0.91, p=0.74). Youth with persistent adversity across childhood or downward social mobility (poverty or high neighborhood deprivation in adolescence only) had 50-72% lower odds of achieving a valid baseline test (persistent poverty: OR=0.59, p=0.05; adolescent poverty only: OR=0.50, p=0.004; adolescent neighborhood deprivation only: OR=0.28, p<1.0e-4). Maltreatment had no significant effect on test validity. CONCLUSION: These findings suggest certain patterns of adversity may predispose youth to invalid baseline testing scores, potentially increasing their risk of inaccurate injury management and poor outcomes.

Identifying Risk Factors and Advancing Services for Violently Injured Low-Income Black Youth.

Violent exposure among low-income, Black youth has reached alarming rates. Using administrative data that centers racial equity to understand risk factors and aid in prevention is a promising approach to address this complex problem. Medical records were linked to a comprehensive county-level integrated data system using a case-control design. Chi-square tests, T-tests, and multivariate logistic regression assessed for between and within group differences among (1) youth who presented to an emergency department (N = 429) with an assault or gunshot wound (GSW) and a matched sample of non-injured youth (N = 5000); and, (2) youth with GSW injuries (N = 71) compared to assault injuries (N = 358). Injured youth present with greater early adversity, trauma, and prolonged poverty compared to non-injured peers. Youth with GSW injuries differ from assault in several key ways. An ecosystem of care is needed to address the multifaceted causes of Black youth's severe violence exposure that are rooted in systemic racism and poverty. Integrated data using a racial equity lens can help to illuminate opportunities in this ecosystem of care.