The opportunities and challenges of multi-site evaluations: lessons from the jail diversion and trauma recovery national cross-site evaluation.

Multi-site evaluations, particularly of federally funded service programs, pose a special set of challenges for program evaluation. Not only are there contextual differences related to project location, there are often relatively few programmatic requirements, which results in variations in program models, target populations and services. The Jail Diversion and Trauma Recovery-Priority to Veterans (JDTR) National Cross-Site Evaluation was tasked with conducting a multi-site evaluation of thirteen grantee programs that varied along multiple domains. This article describes the use of a mixed methods evaluation design to understand the jail diversion programs and client outcomes for veterans with trauma, mental health and/or substance use problems. We discuss the challenges encountered in evaluating diverse programs, the benefits of the evaluation in the face of these challenges, and offer lessons learned for other evaluators undertaking this type of evaluation.

The development and implementation of theory-driven programs capable of addressing poverty-impacted children's health, mental health, and prevention needs: CHAMP and CHAMP+, evidence-informed, family-based interventions to address HIV risk and care.

This article describes a program of prevention and intervention research conducted by the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project; McKay & Paikoff, 2007 ) investigative team. CHAMP refers to a set of theory-driven, evidence-informed, collaboratively designed, family-based approaches meant to address the prevention, health, and mental health needs of poverty-impacted African American and Latino urban youth who are either at risk for HIV exposure or perinatally infected and at high risk for reinfection and possible transmission. CHAMP approaches are informed by theoretical frameworks that incorporate an understanding of the critical influences of multilevel contextual factors on youth risk taking and engagement in protective health behaviors. Highly influential theories include the triadic theory of influence, social action theory, and ecological developmental perspectives. CHAMP program delivery strategies were developed via a highly collaborative process drawing upon community-based participatory research methods in order to enhance cultural and contextual sensitivity of program content and format. The development and preliminary outcomes associated with a family-based intervention for a new population, perinatally HIV-infected youth and their adult caregivers, referred to as CHAMP+, is described to illustrate the integration of theory, existing evidence, and intensive input from consumers and healthcare providers.

Child Maltreatment and Adult Substance Abuse: The Role of Memory.

Child maltreatment is a risk factor for substance abuse in adulthood. This study examines whether memory of maltreatment is a necessary link in the path leading from prospectively measured childhood maltreatment to adult substance use problems. Official Child Protective Services reports and adult retrospective recall of childhood maltreatment were used to predict illegal drug use and alcohol problems in adulthood controlling for covariates. Memory was a necessary link in the path between prospective reports of maltreatment and alcohol problems, and an important link in the path between prospective reports and illegal drug use. Implications for prevention and treatment are discussed.

Long-term outcomes of young adults exposed to maltreatment: the role of educational experiences in promoting resilience to crime and violence in early adulthood.

This study investigates whether positive educational experiences in midadolescence mitigate the impact of exposure to substantiated maltreatment and reduces young adult antisocial behavior. While there is theoretical and empirical support for the mediating or moderating role of educational experiences on maltreatment and antisocial outcomes, few prospective studies exist. In this exploratory study, data are from the Rochester Youth Development Study (RYDS), a longitudinal panel study of 1,000 adolescents. The original sample included 73% males, and 85% African American or Hispanic youth of whom about 20% were maltreated. Measures in this study are from a combination of interview data and official records collected through age 23. Outcomes include self-reported crime and violence, arrest, and partner violence perpetration. Educational variables include midadolescent self-report of high school graduation, educational aspiration, college expectation, school commitment, teacher attachment, self-reported grades, school GPA, attendance, and an additive index of all school assets. Multivariate path analysis controlled for gender, race/ethnicity, poverty, and early antisocial behavior. Path analysis examined whether educational experiences mediated the impact of maltreatment on antisocial outcomes. Although maltreatment was significantly predictive of criminal and violent behaviors, it only was weakly associated with educational experiences. The impact of maltreatment on arrest was weakly mediated (reduced) by educational GPA and by high school graduation. The additive index also mediated the impact of maltreatment on crime and violence. Maltreatment's impact on partner violence was also weakly mediated by school GPA. Interaction terms were used to test for moderation: only one significant effect was found: school GPA protects maltreated youth from perpetration of partner violence as young adults. Although there are few significant effects in a number of models, the research is consistent with a focus on promoting school achievement and completion among urban youth in general, in conjunction with addressing earlier antisocial behavior problems.

Collaboration With Urban Parents to Deliver a Community-Based Youth HIV Prevention Program.

This article draws on the unified theory of behavior change to examine adult community members' participation in a collaborative, community-based HIV prevention program for inner-city youth. Specifically, the impact of a training and mentorship process is examined with a sample of parent facilitators hired to deliver an evidence-based HIV prevention program in Bronx, New York. Findings indicate that the training program impacted four of five key constructs (environmental constraints, habitual behavior, social norms, and self-concept) expected to be related to parents' ability to deliver the program constructs significantly beyond any increase evidenced by the control group (HIV knowledge increased in both groups). Community-level training programs may therefore be an effective medium for increasing caregivers' intention to collaborate in community-based prevention programs.

Youth Substance Use in a Context of Family Homelessness.

OBJECTIVE: This study examines the relationship between family processes and youth substance use debuts among a sample of youth residing in urban family homeless shelters. METHOD: Data regarding shelter experiences, youth and family characteristics, and the use of three substances (i.e., cigarettes, alcohol, and marijuana) were gathered from a sample of youth (11-14 years) and their respective parents residing in an urban family homeless shelter system. Multinomial logistic regression analysis was used to examine the influences on youth substance use. RESULTS: Of the 198 youth included in the statistical analysis, 72% (n=143) reported no substance use debuts, while 18% (n=35) indicated one and 10% (n=20) indicated two to three substance use debuts. Within the final model, greater substance use debut was associated with being older (13-14 vs. 11-12; OR=7.5; 95% CI =1.8-30.9) and stressors exposure (OR=4.8; 95% CI =1.5-14.7). Furthermore, youth of adult caretakers that reported low levels of the three family processes considered were almost four and a half more likely (OR=4.4; 95% CI =1.2-16.5) to have made two to three substance use debuts. CONCLUSIONS: Family processes may be a particularly important intervention target toward reducing the rate of substance use among youth residing in urban family homeless shelters.

Intergenerational continuities and discontinuities in intimate partner violence: a two-generational prospective study.

This study focuses on intergenerational continuity in violent partner relationships. We investigate whether exposure to caregiver intimate partner violence (IPV) during adolescence leads to increased involvement in IPV during early adulthood (age 21-23) and adulthood (age 29-31). We also investigate whether this relationship differs by gender. Although there is theoretical and empirical support for intergenerational continuity of relationship violence, there are few prospective studies of this issue. We use data from the Rochester Youth Development Study (RYDS), a longitudinal study of the development of antisocial behavior in a community sample of 1,000 urban youth followed from age 14 to adulthood. The original sample includes 73% men and 85% African American or Hispanic youth. Measures come from a combination of interviews and official records. The Conflict Tactics Scale (CTS) is used to assess IPV and severe IPV in the youth and parent generations. Analyses controlled for child physical abuse, race/ethnicity as well as parent education, family stability, and poverty. In multivariate models, adolescent exposure to caregiver severe IPV resulted in significantly increased risk of relationship violence in early adulthood (age 21-23). Furthermore, there is an indirect effect of adolescent exposure to severe IPV on later adult involvement in IPV (age 29-31), mediated by involvement in a violent relationship in early adulthood. These results were largely invariant by gender. However, we observed a direct pathway between IPV exposure and adult IPV for women (marginally significant) suggesting that adolescent exposure to caregiver IPV may set in motion women-specific processes.

Impact of adolescent exposure to intimate partner violence on substance use in early adulthood.

OBJECTIVE: Youth exposure to intimate partner violence has been theorized to increase the risk of adverse outcomes in adulthood including substance-use problems. However, the limited research on the association between early exposure to intimate partner violence and later alcohol- or drug-use problems is inconclusive. Using a prospective design, this study investigates whether adolescent exposure to intimate partner violence increases the risk for problem substance use in early adulthood and whether this relationship differs by gender. METHOD: The study uses a subsample (n = 508) of participants from the Rochester Youth Development Study, a longitudinal study of urban, largely minority adolescents that oversampled youth at high risk for antisocial behavior and drug use. Logistic regression analyses were conducted to assess whether adolescent exposure to intimate partner violence predicted increased odds of four indicators of problem substance use in early adulthood, controlling for parental substance use, adolescent maltreatment, and sociodemographic risk factors. RESULTS: Exposure to severe intimate partner violence as an adolescent significantly increased the odds of alcohol-use problems in early adulthood for young women (odds ratio = 5.63, p < .05) but not for young men. Exposure to intimate partner violence did not increase the odds of other substance-use indicators for either gender. CONCLUSIONS: Girls exposed to intimate partner violence may be at increased risk for problems with alcohol use in adulthood and should be a target for prevention and intervention efforts. Overall, however, the association between exposure to intimate partner violence and later substance-use problems is less than anticipated in this high-risk community sample.

It Takes a Village to Deliver and Test Child and Family-Focused Services.

OBJECTIVES: The purpose of this article is to highlight the benefits of collaboration in child focused mental health services research. METHOD: Three unique research projects are described. These projects address the mental health needs of vulnerable, urban, minority children and their families. In each one, service delivery was codesigned, interventions were co-delivered and a team of stakeholders collaboratively tested the impact of each one. RESULTS: The results indicate that the three interventions designed, delivered, and tested are associated with reductions in youth mental health symptoms. CONCLUSION: These interventions are feasible alternatives to traditional individualized outpatient treatment.

Childhood maltreatment and antisocial behavior: comparison of self-reported and substantiated maltreatment.

Although accurate assessment of maltreatment is critical to understanding and interrupting its impact on the life course, comparison of different measurement approaches is rare. The goal of this study is to compare maltreatment reports from official Child Protective Services (CPS) records with retrospectively self-reported measures. Research questions address the prevalence and concordance of each type of measure, their relationship to social disadvantage, and their prediction to four antisocial outcomes in adolescence and early adulthood including arrest, self-reported violence, general offending, and illegal drug use. Data to address this comparison come from the Rochester Youth Development Study (RYDS), a longitudinal panel study of 1,000 adolescents. Findings indicate that self-reported retrospective maltreatment is somewhat more prevalent (29%) than official substantiated maltreatment (21%). Among those with official reports, in young adulthood about half self-reported maltreatment, whereas 37% of those self-reporting have an official report. In general, both sources suggest that maltreatment is associated with a higher prevalence of antisocial behavior. It is not clear that combining sources of information improves prediction.