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Since the landmark study of Adverse Childhood Experiences (ACEs; Felitti et al., American Journal of Preventive Medicine, 14(4):245–258, 1998), there has been a significant growth in efforts to address ACEs and their impact on individual health and well-being. Despite this growing awareness, there has been little systematic review of state legislative action regarding variation in focus or scope or of the broader context impacting the introduction and enactment of ACE-related policy efforts. To inform the role of psychologists and related professionals to contribute to these legislative efforts, we conduct a comprehensive mixed-method analysis of all state bills introduced over the past two decades to investigate the use and impact of ACE research in introduced and enacted state legislative language (51 states, N(Total Bills) = 1,212,048, N(ACE Bills) = 425). In addition, these analyses examine congressional office communications (N = 14,916,546 public statements) and voting records (N = 1,163,463 votes) to understand the relationship between legislative members’ public discussion of ACEs and their voting behavior on these bills. We find that legislators’ public discourse is significantly related to ACE-related policymaking above and beyond political affiliation or demographic characteristics. Furthermore, key legislative language related to domestic violence, evidence-based practice, and prevention were significant predictors of whether an ACE-related bill becomes law—above and beyond the political party in power. These analyses highlight the ways in which ACE-related research has informed state policy. Based upon this work, we offer recommendations for researchers and policymakers.

Pediatric primary care providers have an important role in addressing the health effects of trauma, yet routine screening is rare. This study evaluated whether the 10-item Child Trauma Screen (CTS) could identify youth experiencing posttraumatic stress disorder (PTSD) symptoms. Participants were 107 caregiver-youth pairs aged 7 to 17 years old, 55.8% male, and 76.4% Hispanic who were recruited at an urban pediatric primary care clinic. Youth and caregivers separately completed the CTS and the UCLA PTSD Reaction Index for DSM-5 (RI-5) prior to their medical visit. Half of youth experienced at least one type of trauma, and one sixth reported elevated PTSD symptoms. The CTS was highly correlated with the RI-5 on PTSD symptom severity, and correctly classified 85% of youth based on likely PTSD diagnosis. The brief CTS can accurately identify youth suffering from PTSD symptoms, and may be particularly feasible to implement in busy primary care practices.

Youth involved in child welfare services (CWS) are at elevated risk for substance use. CWS involvement may provide an opportunity for intervention to prevent subsequent use; however, little is known about mitigating substance use risk in this population. Using data from the second National Survey of Child and Adolescent Well-Being (NSCAW II), the present study examined individual, psychological, and contextual risk factors (e.g., prior substance use, depression, posttraumatic stress, maltreatment experiences) and protective factors (e.g., caregiver monitoring, peer relationships) following CWS involvement (Wave 1) in relation to alcohol, marijuana, and cocaine use 36 months later (Wave 3). The nationally-representative sample of CWS-involved youth was restricted to individuals who were aged 11 years or older at Wave 1 and had at least a partial interview at Wave 3 (N = 763). Three logistic regression models showed that Wave 1 substance use increased the likelihood of marijuana and cocaine use at Wave 3 [marijuana OR = 1.41 (1.19–1.68); cocaine OR = 1.26 (1.07–1.50)] but not binge alcohol use [OR = 1.44 (0.95–2.19)]. Other risk and protective factors had limited predictive value for Wave 3 substance use. The present findings suggest that initiating substance use prior to or at the time of CWS involvement is a critical risk factor for later substance use. Substance use screening and referral to treatment is imperative for CWS-involved youth.

Children in the child welfare system experience high rates of exposure to potentially traumatic events, which are associated with significant impairments in safety, permanency, and well-being. However, child welfare systems have not routinely screened children for trauma, and little is known about such efforts. This paper describes five statewide and tribal projects to implement trauma screening for children in the child welfare system as part of broader, trauma informed care initiatives. Findings indicate that implementation strategies varied considerably but that screening generally resulted in identification of high rates of trauma exposure, trauma symptoms and service referrals. Further, screening was generally perceived favorably by child welfare workers and mental health professionals. However, wide variations were observed in the number of children screened, suggesting that more research is needed to identify optimal strategies. Lessons learned are described and recommendations made for implementing trauma screening in state or tribal child welfare systems.

Objective Childhood exposure to trauma, including violence and abuse, is a major public health concern that has resulted in increased efforts to promote trauma-informed child-serving systems. Trauma screening is an important component of such trauma-informed systems, yet widespread use of trauma screening is rare in part due to the lack of brief, validated trauma screening measures for children. We describe development and validation of the Child Trauma Screen (CTS), a 10-item screening measure of trauma exposure and posttraumatic stress disorder (PTSD) symptoms for children consistent with the DSM-5 definition of PTSD. Method Study 1 describes measure development incorporating analysis to derive items based on existing measures from 1,065 children and caregivers together with stakeholder input to finalize item selection. Study 2 describes validation of the CTS with a clinical sample of 74 children and their caregivers. Results Results support the CTS as an empirically derived, reliable measure to screen children for trauma exposure and PTSD symptoms with strong convergent, divergent, and criterion validity. Conclusion The CTS is a promising measure for rapidly and reliably screening children for trauma exposure and PTSD symptoms. Future research is needed to confirm validation and to examine feasibility and utility of its use across various child-serving systems. (PsycINFO Database Record

Multisystemic therapy (MST) was developed to help youth with serious social, emotional, and behavioral problems. Research on the efficacy and effectiveness of MST has shown positive outcomes in different domains of development and functioning among various populations of youth. Nonetheless, even with a large body of literature investigating the treatment effects of MST, few studies have focused on the effectiveness of MST through large-scale dissemination efforts. Utilizing a large sample of youth involved in a statewide dissemination of MST (n = 740; 43% females; 14% Black; 29% Hispanic; 49% White; Mage = 14.9 years), propensity score matching was employed to account for baseline differences between the treatment (n = 577) and comparison (n = 163) groups. Treatment effects were examined based on three outcomes: out-of-home placement, adjudication, and placement in a juvenile training school over a 6-year period. Significant group differences remained after adjusting for baseline differences, with youth who received MST experiencing better outcomes in offending rates than youth who did not have an opportunity to complete MST due to non-clinical or administrative reasons. Survival analyses revealed rates of all three outcomes were approximately 40% lower among the treatment group. Overall, this study adds to the body of literature supporting the long-term effectiveness of MST in reducing offending among high-risk youth. The findings underscore the potential benefits of taking evidence-based programs such as MST to scale to improve the well-being and functioning of high-risk youth. However, strategies to effectively deliver the program in mental health service settings, and to address the specific needs of high-risk youth are necessary.

The 50th anniversary of the Swampscott Conference offers an opportunity to reflect on a community psychology setting, The Consultation Center at Yale, that was formed in response to the 1963 Community Mental Health Act and the 1965 Swampscott Conference. The Center has flourished as a community psychology setting for practice, research, and training for 39 of the 50 years since Swampscott. Its creation and existence over this period offers an opportunity for reflection on the types of settings needed to sustain the field into the future.

This study examined the relation between children's history of exposure to potentially traumatic events (PTEs) and clinical and functional mental health trajectories over a 18-month period among a national sample of youth referred for services in children's behavioral health systems of care (SOCs). Using data from the national evaluation of the Comprehensive Community Mental Health Services program for communities funded from 1997 to 2000, the study sample included 9556 children and their families. Latent growth modeling was used to assess the effect of history of exposure to PTEs on trajectories in a number of behavioral health outcomes during the 3-year period following referral to services, controlling for child demographic characteristics (gender, race, and age). Results revealed that, on average, children in SOCs exhibited significant improvements over time on all four outcome measures. Children with a history of exposure to PTEs had higher rates of internalizing and externalizing problem behaviors and functional impairments and fewer behavioral and emotional strengths at baseline, but experienced improvements in these outcomes at the same rates as children without exposure to a traumatic event. Finally, child race, gender, and age also were associated with differences in behavioral health trajectories among service recipients. Implications for SOCs, including approaches to make them more trauma-informed, are discussed.

Exposure to childhood trauma is a major public health concern and is especially prevalent among children in the child welfare system (CWS). State and tribal CWSs are increasingly focusing efforts on identifying and serving children exposed to trauma through the creation of trauma-informed systems. This evaluation of a statewide initiative in Connecticut describes the strategies used to create a trauma-informed CWS, including workforce development, trauma screening, policy change, and improved access to evidence-based trauma-focused treatments during the initial 2-year implementation period. Changes in system readiness and capacity to deliver trauma-informed care were evaluated using stratified random samples of child welfare staff who completed a comprehensive assessment prior to ( N = 223) and 2 years following implementation ( N = 231). Results indicated significant improvements in trauma-informed knowledge, practice, and collaboration across nearly all child welfare domains assessed, suggesting system-wide improvements in readiness and capacity to provide trauma-informed care. Variability across domains was observed, and frontline staff reported greater improvements than supervisors/managers in some domains. Lessons learned and recommendations for implementation and evaluation of trauma-informed care in child welfare and other child-serving systems are discussed.

Purpose Many questions remain about the effectiveness of behavioral health treatments for children in large systems of care, including the use of evidence-based treatments (EBTs). The goals of this study were to 1) describe outcomes of children receiving treatment in a statewide system, overall and separately for demographic groups; 2) describe penetration rates of EBTs and examine outcomes by treatment type and 3) examine moderation of treatment type by demographic group. Methods Participants were 46,399 children receiving behavioral health services at one of 25 outpatient clinics in a state system between 2013 and 2017. Administrative data included child demographic characteristics, treatment type, and problem severity based on the Ohio Scales. Propensity score methods were used to analyze EBT effects compared to no EBT conditions, and interactions with demographic groups. Results The overall pre- to post-treatment effect size across all treatment types was medium (Cohen’s d = 0.49 to 0.51) and similar to prior research. White children showed greater improvements than Black or Hispanic children, 7 to 12-year olds improved more than younger and older children, and females improved more than males. Almost half (47%) of children received cognitive behavioral therapy, and an additional 12.4% received another EBT. Children receiving EBTs showed greater improvement than those not receiving an EBT. The relative benefits of EBTs were mostly consistent across sex, age, and race/ethnicity, but EBTs were associated with some reductions in disparities by race/ethnicity (particularly for Hispanic youth and more modestly for Black youth) and age. Conclusions Outcomes for children receiving behavioral health treatment in a statewide system were modest. EBTs can be disseminated within large systems and have potential for improving overall outcomes for children from diverse backgrounds.

Objectives. We examined patterns of sexual behavior and risk for sexually transmitted infections (STIs) in young adulthood for Black, Hispanic, and White females. Methods. We used a nationally representative sample of 7015 female young adults from wave III of the National Longitudinal Study of Adolescent Health. Sexual risk items assessed behaviors occurring in the previous 6 years and past year to determine classes of sexual risk and links to STIs in young adulthood. Results. Latent class analysis revealed 3 sexual risk classes for Black and Hispanic youths and 4 sexual risk classes for White youths. The moderate and high risk classes had the highest probabilities of risky sexual partners, inconsistent condom use, and early age of sexual initiation, which significantly increased odds for STIs compared with recent abstainers. Conclusions. We found different classes of sexual behavior by race/ethnicity, with Black and Hispanic young women most at risk for STIs in young adulthood. Preventive efforts should target younger adolescents and focus on sexual partner behavior.

Children may be exposed to numerous types of traumatic events that can negatively affect their development. The scope to which studies have examined an array of events among young children has been limited, thereby restricting our understanding of exposure and its relationship to behavioral functioning. The current cross-sectional study describes traumatic event exposure in detail and its relationship to behavioral health among an at-risk sample of young children (N = 184), under 6 years of age, upon enrollment into an early childhood, family-based, mental health system of care. Caregivers completed home-based semistructured interviews that covered children's exposure to 24 different types of traumatic events and behavioral and emotional functioning. Findings indicated that nearly 72% of young children experienced 1 or more types of traumatic events. Multiple regression model results showed that exposure was significantly associated with greater behavioral and emotional challenges with children's age, gender, race/ethnicity, household income, and caregiver's education in the model. These findings highlight the prevalence of traumatic exposures among an at-risk sample of young children in a system of care and suggest that this exposure is associated with behavioral and emotional challenges at a young age.

Background Adolescence is a critical developmental period when tobacco use is initiated and progression to regular smoking occurs. Another growing concern is the mounting evidence of ethnic/racial disparities in the smoking rates and adverse health consequences related to smoking. To reduce ethnic/racial disparities in smoking behaviors, understanding the protective influences against smoking behaviors among minority adolescents is important. Therefore, we examined the role of ethnic pride and parental disapproval of smoking on a wide range of smoking behaviors in ethnic/racial minority and White adolescents attending a suburban high school in Connecticut.

The present study examined how exposure to traumatic events affects children with severe emotional disturbance who are being served in a school-based system of care. Multilevel growth curve models were used to examine the relationships between a child’s history of traumatic events (physical abuse, sexual abuse, or domestic violence) and behavioral and emotional strengths, internalizing problem behaviors, and externalizing problem behaviors over 18 months. Results indicate that children receiving services ( N = 134) exhibited increased emotional and behavioral strengths and decreased internalizing and externalizing problem behaviors from enrollment to 18-month follow-up. Children with a history of traumatic events improved more slowly than children without such a history on both strengths and internalizing problem behaviors, even after controlling for dosage of services received and other characteristics previously found to predict outcomes. Gender was also related to improvement in internalizing symptoms. Results highlight the continued need to assess the impact of exposure to traumatic events for children served in a system of care.

Parental knowledge is defined as parental awareness and information about a child's activities, whereabouts, and associations that is obtained through parental monitoring, parental solicitation, or self-disclosure. Increased parental knowledge is generally associated with lower adolescent substance use; however, the influence of various contextual factors, such as adolescent gender and grade level is not well understood, particularly for different racial or ethnic groups. In the present study, we used Hierarchical Generalized Linear Modeling (HGLM) analyses to examine the longitudinal relationship of parental knowledge to adolescent substance use in the context of adolescent gender and grade level among 207 urban African American adolescents in grades 6-11. Results indicated that increased parental knowledge is associated with a concurrent lower likelihood of substance use across all types of substances examined (alcohol, tobacco, marijuana, other drug use, and any drug use), but it did not predict changes in substance use one year later for the entire sample. However, analyses by gender and grade level showed that for boys and middle school youth, parental knowledge was a protective factor for increases in substance use across one year. Findings are discussed in terms of their implications for prevention and health promotion interventions for adolescent substance use among African American youth.

Patterns of substance use are examined in a sample of over 1,200 youth in a non-metropolitan region of New England. Self-reported history and frequency of alcohol, tobacco, marijuana, inhalants, pain medications, and other hard drug use was assessed for 9th and 10th grade students. Latent class analyses identified four patterns of substance use: non-users (22%), alcohol experimenters (38%), occasional polysubstance users (29%), and frequent polysubstance users (10%). Contextual risk and protective factors in the individual, family, peer, and community domains predicted substance use patterns. Youth report of peer substance use had the largest effects on substance use class membership. Other individual characteristics (e.g., gender, antisocial behavior, academic performance, perceived harm from use), family characteristics (e.g., parental drinking, parental disapproval of youth use), and community characteristics (e.g., availability of substances) demonstrated consistent effects on substance use classes. Implications for prevention are discussed from a social-ecological perspective.

Objectives This study examined risk of maltreatment among children exiting foster care using a statewide sample of children reunified between 2001 and 2004 in Rhode Island. The objectives were: (1) to compare rates of maltreatment following parental reunification for youth in care as a result of maltreatment with those in care for other reasons; and (2) to assess the effects of child, family, and case characteristics on rates of re-maltreatment among children placed in foster care due to maltreatment. Method A longitudinal dataset of all reunified cases was matched with state records of substantiated Child Protective Service (CPS) investigations. Two Cox proportional hazards models were tested. The first model compared rates of subsequent maltreatment for two groups: children in foster care as a result of maltreatment, and those in care for other reasons. The second model investigated the effects of child, family, and case characteristics on re-maltreatment rates for those in care as a result of maltreatment. Results Children in foster care due to maltreatment were significantly more likely to be maltreated following reunification. Among children in foster care due to maltreatment, factors that raised risk for re-maltreatment included a previous foster care placement, exiting care from a non-relative foster home, and removal due to neglect. Older adolescents had lower rates of re-maltreatment than infants. Child neglect was the primary type of recurrent maltreatment that occurred following reunification. Conclusions Supports are needed for families about to be reunified, particularly when the removal was prompted by incidents of abuse or neglect. Incidents of neglect are particularly likely and appropriate services should specifically target factors contributing to neglect. Cases involving youth with a history of repeated foster care placement or in which non-relative placements are utilized may need additional supports. Practice implications This study suggests that services should be developed to minimize the risk for recurrent maltreatment following reunification. Services would be most useful for high-risk cases prior to reunification and during the first year following reunification. Understanding the risks associated with maltreatment will help guide development of appropriate interventions.

Purpose Positive youth development (PYD) emphasizes a strengths-based approach to the promotion of positive outcomes for adolescents. After-school programs provide a unique opportunity to implement PYD approaches and to address adolescent risk factors for negative outcomes, such as unsupervised out-of-school time. This study examines the effectiveness of an after-school program delivered in urban settings on the prevention of adolescent substance use. Methods A total of 304 adolescents participated in the study: 149 in the intervention group and 155 in a control group. A comprehensive PYD intervention that included delivery of an 18-session curriculum previously found to be effective in preventing substance use in school settings was adapted for use in urban after-school settings. The intervention emphasizes adolescents' use of effective decision-making skills to prevent drug use. Assessments of substance use attitudes and behaviors were conducted at program entry, program completion, and at the 1-year follow-up to program entry. Propensity scores were computed and entered in the analyses to control for any pretest differences between intervention and control groups. Hierarchical linear modeling (HLM) analyses were conducted to assess program effectiveness. Results The results demonstrate that adolescents receiving the intervention were significantly more likely to view drugs as harmful at program exit, and exhibited significantly lower increases in alcohol, marijuana, other drug use, and any drug use 1 year after beginning the program. Conclusions A PYD intervention developed for use in an urban after-school setting is effective in preventing adolescent substance use.

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption.

Introduction This study examines child, family, and case characteristics that impact rates of re-referral to Child Protective Services (CPS) using data on all closed CPS investigations for the state of Rhode Island between 2001 and 2004. Method A longitudinal dataset of all referrals to CPS was created using state submissions to the National Child Abuse and Neglect Data System (NCANDS). After excluding children whose initial CPS investigation resulted in removal from the home, a Cox proportional hazards model was tested to examine factors impacting the likelihood of re-referral. Results Consistent with other research in this area, the initial 6-month period following case disposition is the period of greatest risk of re-referral. Approximately 13% of cases experienced a recurrent allegation during the first 6-month period; an additional 14% experienced a re-referral over the following 12-month period; 7% during the next 12-month period. Family poverty was the strongest predictor of re-referral, though a number of child and case characteristics were significantly related to recurrence. Cases that were substantiated at index were significantly less likely to result in a new allegation, though substantiated cases of physical abuse or those receiving post-investigation services were at higher risk. Conclusions Children from families facing multiple stressors (e.g., low SES, parental substance abuse child disability) are at highest risk of re-referral to CPS and may benefit from the development of preventive services targeted immediately following case closings within CPS.

Intimate partner violence (IPV) victimization, substance misuse, and depression are highly prevalent among female caregivers involved with child protective services (CPS). Understanding heterogeneity in the occurrence of these problems is essential to improving pathways to intervention for women in this population. Latent class analysis was employed to determine whether there exist homogeneous subgroups of female caregivers who experience different patterns of IPV victimization, substance misuse, and depression. A restricted three-class solution best fit the data, suggesting high risk, moderate risk, and no risk subgroups. A substantial number of female caregivers comprise the high-risk subgroup (33%) in which caregivers reported very high rates of IPV victimization, substance misuse, and depression. Only a very small proportion comprised the no-risk subgroup (9%). Findings emphasize the heterogeneity among subgroups of female caregivers based on these risk factors, which may have implications for practitioners, such as CPS caseworkers, and researchers alike.

Risk assessments allow child and youth services to identify children who are at risk for maltreatment (e.g., abuse, neglect) and help determine the restrictiveness of placements or need for services among youth entering a child welfare system. Despite the use of instruments by many agencies within the U.S. to determine the appropriate placements for youth, research has shown that placement decisions are often influenced by factors such as gender, age, and severity of social–emotional and behavior problems. This study examined ratings of risk across multiple domains using a structured assessment tool used by caseworkers in the Rhode Island child welfare system. The relationship between ratings of risk and placement restrictiveness was also examined. Risk levels varied across placement settings. Multivariate analyses revealed that lower caseworker ratings of parent risk and higher ratings of youth risk were associated with more restrictive placements for youth. Implications for the child welfare system are discussed.

This longitudinal study examines characteristics associated with the timing of three potential foster care outcomes—reunification, adoption, and running away from care (i.e., AWOL). Cox regression modeling was used to identify child and case characteristics associated with each outcome for a statewide sample of children entering care in Rhode Island following implementation of the Adoption and Safe Families Act (ASFA). Results revealed strong differences in both the rates and patterns of exits from care across discharge categories. Risk for reunification began almost immediately upon entry to care and generally decreased over time (despite a sharp spike in rates at the 10- to 12-month period), while risk for adoption was initially low and began to escalate at about the 9-month mark. AWOL rates were lower than those of reunification and adoption, and remained relatively stable over time. A number of child and case characteristics were associated with likelihood of exiting foster care. In many cases, the characteristics operated differently depending on exit type, though in other instances there was consistency indicating that some risk factors are likely to be associated with delays in achieving permanency (e.g., removal due to sexual abuse, presence of child emotional/behavioral disorder). Implications of these findings for child welfare research and practice are discussed.

Systems of care provide comprehensive services to children with emotional and behavioral disorders through a network of local agencies and providers that function as a multi-agency case review team. A primary objective in any system of care is to provide individuals with access to appropriate services. In the present study, access is defined as services received relative to those recommended by a multi-agency review team and barriers to services identified by that team. These indicators, which provide a system-level assessment of service access and function as a proxy for the development of the system of care, fill a gap in the existing literature for more system-level indicators of outcome. A total of 2073 children and youth are assessed upon entry into Rhode Island's behavioral health system of care and then followed for three months to determine the extent of services received relative to those recommended as well as barriers to services identified at service entry. Multi-agency reviews are conducted over an 8-year-period through three phases of system of care implementation-early in the establishment of the system of care, at the midpoint of implementation after substantial funding was received for service enhancements, and after full implementation of the system of care philosophy. The results indicate that, as a system of care matures, access increases significantly on both of these indicators, and that more and different types of children are served and agencies are involved in the system of care. The results are discussed for their implications for assessing systems of care through establishment of system-level empirical benchmarks of service system development.

We examined child psychiatric diagnoses, behavioral problems, overall symptom impairment, global psychological functioning, intellectual ability, and adaptive behavior in 83 sibling pairs whose mothers were diagnosed with a serious mental disorder. Sibling pairs were assessed for the extent to which they converged on the presence or absence of risk on each adverse outcome and then examined under conditions of high vs. low/moderate family stress. Consistent with the study hypotheses, we found that on each outcome assessed there was evidence for sibling convergence of risk. In addition, family stress was found to significantly moderate sibling risk convergence. The results are discussed in terms of their implications for understanding sibling convergence of risk in these families and for clinical and preventive intervention.

Using Cox regression modeling, this longitudinal study examines child and case characteristics associated with changes in placement among 5,909 Rhode Island children in foster care. Results suggest that half of all children experience at least one placement change while in care. Infants change placements least, and risk increases with child age. Emergency shelter settings have the highest risk of placement change, followed by nonrelative settings, group home settings, and relative foster care. The reasons for removal from the home and the history of previous placements also predict placement changes, as do the interactions between foster care setting and some child characteristics.

Caring for a relative with a chronic illness is an increasingly common experience among families. Although a great deal of evidence links caregiving with adverse health outcomes, the mechanism of this relationship is unclear. One potential mediating factor that has received relatively little research attention is the health behavior patterns of caregivers. The goals of the present paper are to (a) provide a selected review and analysis of the published literature that examines caregiver health behavior, (b) highlight examples of caregiver interventions that include a health behavior component, (c) discuss self care as an appropriate framework for advancing the caregiver literature, and (d) offer recommendations for future research and for the design and evaluation of self care interventions for caregivers.

The present study examines the impact of child and family risk factors on service access for youth and families in a school-based system of care. Regression analyses examined the relationships between risk factors and services recommended, services received, and dosage of services received. Logistic regression analyses examined the relationship between risk factors and whether or not youth received specific types of services within the system of care. Results revealed that youth with a personal or family history of substance use had more services recommended than youth without these risk factors, while youth with a family history of substance use received more services. Youth with a history of substance use received a significantly higher dosage of services overall. Finally, history of family mental illness was associated with receiving mental health and operational services (e.g., family advocacy, emergency funds). Implications and limitations are discussed.

This study examined family, school, and community factors and the relationships to racial-ethnic attitudes and academic achievement among 98 African American fourth-grade children. It has been posited that young people who feel better about their racial-ethnic background have better behavioral and academic outcomes, yet there is a need for more empirical tests of this premise. Psychometric information is reported on measures of parent, teacher, and child racial-ethnic attitudes. Path analysis was used to investigate ecological variables potentially related to children's racial-ethnic attitudes and achievement. Parental education and level of racial-ethnic pride were correlated and both were related to children's achievement though in the final path model, only the path from parental education level was statistically significant. Children whose teachers exhibited higher levels of racial-ethnic trust and perceived fewer barriers due to race and ethnicity evidenced more trust and optimism as well. Children living in communities with higher proportions of college-educated residents also exhibited more positive racial-ethnic attitudes. For children, higher racial-ethnic pride was related to higher achievement measured by grades and standardized test scores, while racial distrust and perception of barriers due to race were related to reduced performance. This study suggests that family, school, and community are all important factors related to children's racial-ethnic attitudes and also to their academic achievement.

The evaluation of prevention and health promotion programs is one component of the broader field of evaluation research or social program evaluation. Evaluation research applies the practices and principles of social research to assess the conceptualization, design, implementation, effectiveness, and efficiency of social interventions (Rossi & Freeman, 1993). Prevention program evaluation is one component of evaluation research that draws on knowledge and traditions from several disciplines and fields of study, including public health, psychology, sociology, education, social work, social policy, and public administration.