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The development of evidence-based interventions (EBIs) for the prevention of behavioral health problems is well supported. However, limited data exist on the sustainability of EBIs once initial support has ceased. The current study assessed, at 2 years after initial start-up support: (1) What percent of schools sustained EBI implementation? (2) To what degree did sustaining schools implement the EBI with fidelity? (3) What were the primary reasons for not sustaining the EBI? (4) What theoretical and contextual factors during initial start-up support predicted sustainment of the EBI? The study used process evaluation data from the dissemination of the Botvin "LifeSkills Training" (LST) middle school program in 158 school districts (including 419 schools). Fifty-one percent of districts sustained the EBI and most of these sustaining districts reported following key fidelity guidelines. Primary reasons for discontinuing centered around low teacher or administrative support and turnover. Significant predictors of sustaining LST were higher ratings of LST's complexity, benefit, and compatibility by teachers; more positive perceptions of organizational support from administrators; and smaller proportions of Black students. Results show that EBI sustainment and fidelity of implementation post-initial startup support are feasible, though likely not for all schools. Findings also suggest that cultivating support for the EBI among staff during start-up support may be helpful for sustainment and that social determinants of a school have a complex relationship with EBI sustainment. Future research should explore true causes of differences due to race/ethnicity as well as COVID-19 effects.

As evidence-based interventions (EBIs) become more widely disseminated, fidelity of implementation (FOI) often wanes. This study explores the association between FOI and malleable variables within classrooms that could be targeted to optimize resources without compromising FOI as school-based EBIs are disseminated across real-world settings. We utilized process evaluation data from a national dissemination project of the Botvin "LifeSkills" Training (LST) middle school program, a universal prevention intervention shown to reduce substance use. The sample included 1,626 teachers in 371 schools across 14 states. Hierarchical linear models examined the relationship between observational measures of implementation factors and three domains of fidelity (e.g., adherence, student responsiveness, and quality of delivery). Findings suggest that curriculum modifications, student misbehavior, and shortage of time to implement the LST middle school program were factors most associated with lower FOI. Class size, access to program materials, and whether LST was delivered in a traditional classroom setting that is well-suited for instruction (versus in a less structured environment such as the school cafeteria) are less predictive. In scale-up of classroom-based universal interventions targeting behavioral health outcomes, our findings indicate that carefully vetting modifications, supporting classroom management strategies, and ensuring sufficient class time for implementation of highly interactive EBIs such as LST are important considerations. Since changes to EBIs are inevitable, efforts are needed to guide facilitators in making adjustments that improve program fit without compromising the essential intervention activities deemed necessary to produce desired outcomes.

Pregnancy rates among youth experiencing homelessness are much higher than those of their housed peers, yet limited research exists on this population's abortion experiences. This study examined abortion attitudes, experiences, and decision making through individual interviews with 30 female, male, and gender-fluid youth (ages 18-21 years) experiencing homelessness. Respondents indicated that abortions are common in this population. Many youth also reported they either had, and/or knew of others, who had attempted abortions outside of the formal medical system while experiencing homelessness. Most youth noted that self-inductions resulted from not knowing where or how to access abortions safely, and as many feared stigma, judgment, and violence from family members and serious partners in response to obtaining abortions. Most youth reflected inaccurate perceptions regarding abortion cost, accessibility, and legality. Findings should be considered in developing socially contextualized family planning prevention and outreach efforts among this highly vulnerable youth population.

Purpose: Due to the ethical concern around involuntary treatment, this study sought to investigate if youth participants in wilderness therapy who were transported to the program experienced different rates of change than those not transported. Methods: Multilevel modeling techniques were used to investigate rates of change for youth between transported and nontransported youth over 5 points until 6 months postdischarge. In addition, repeated measures analyses of variance investigated parent reports of change over time across transport status, gender, and diagnosis. Results: The findings showed no differences between transported and nontransported youth in changes over time. Overall, all youth improved significantly with changes maintained postdischarge regardless of transport status. Discussion: This study shows that transporting youth to treatment does not appear to interfere with the treatment outcome; however, more research is needed to understand clients' perception of the transport process.

Background: Outdoor Behavioral Healthcare (OBH) has arisen to fill a gap in mental health treatment. While research shows large positive changes in adolescent self-reports, little is known about predictors of change, longitudinal outcomes, and parent-reports of change. Objective This study sought to identify treatment outcomes up to 18 months post-discharge and predictors of change for parents of adolescent clients in OBH treatment. Methods: Parents of 659 adolescents from four OBH programs were invited to complete questionnaires at intake, discharge, and 6 and 18 months post-discharge. A regression was conducted to examine change during treatment, and a multilevel model to examine trajectories of change post-treatment. Results: OBH participants entered treatment with clinically significant levels of emotional and behavioral dysfunction, made significant change during the program, and discharged within the "normal" range of functioning. Post-discharge scores indicated that clients remained in the "normal" range of functioning 6 and 18 months post-discharge. The regression analysis found that parent intake scores and attachment disorders were predictive of in-treatment change. The MLM found that parent perceptions of treatment gains and adoption status were significant predictors of functioning post-discharge. Conclusions: Results are in-line with previous research suggesting that OBH may be helpful to adolescents experiencing a wide range of presenting problems, and adds new insights as well. Parent-reports parallel the dramatic changes in adolescent self-reports documented throughout OBH literature; data up to 18 months post-treatment shows healthy functioning per the parent perspective; and adoption and attachment appear to play a role in outcome trajectories.

Objective: This study examined whether fathers' prebirth pregnancy intentions were associated with fathers' involvement with his child 15 months later. Method: Propensity score matching was used to assess the effects of fathers' pregnancy intentions (self-reported before the birth of the child) on three measures of father involvement (residency with child, engagement in caregiving activities, and engagement in social cognitive play) in a large sample of young, diverse, and low-income fathers (N = 2,008). Results: In this sample matched on sociodemographic and interpersonal factors, fathers reporting an intended pregnancy had significantly higher levels of social and cognitive play with their child, compared to fathers reporting an unintended pregnancy. However, intentions were not significantly associated with fathers' residency with child or caregiving activities. Conclusion: Results suggest that fathers' pregnancy intentions are predictive of certain types of father involvement and emphasize the importance of controlling for factors associated with both fathers' intentions and involvement. [ABSTRACT FROM AUTHOR]

Purpose: This quasi-experimental pilot study evaluated the preliminary efficacy of training designed to increase child welfare workers' (N = 156) knowledge, attitudes, and behaviors related to communicating with youth involved in the child welfare system about sexual and reproductive health (SRH). Method: Preintervention and 3-month follow-up survey data were collected from intervention participants (n = 69) who registered for a sexual health training and comparison participants (n = 87) who registered for other child welfare trainings. Results: Participants in the SRH training showed more positive behavioral beliefs, self-efficacy, and knowledge of SRH compared to date- and region-matched comparison participants at the 3-month follow-up; there was no difference between the groups on intentions or past month communication with clients regarding SRH. Conclusion: Findings suggest that although SRH training may be effective in changing child welfare workers' attitudes about SRH, additional efforts may be needed to alter intentions and behaviors. [ABSTRACT FROM AUTHOR]

As interest grows in programs that improve prison inmates' behavior and psychosocial well-being, any such interventions must be rigorously examined and their underlying mechanisms for change must be understood. This pilot study examined the use of prison-based dog training programs across Washington State Department of Corrections facilities for their impacts on inmates' infraction rates. The study also compared levels of empathy, self-efficacy, and anxiety between program participants and nonparticipants. Findings indicated that prison dog program participants' infraction rates improved and that participants had lower levels of anxiety than nonparticipants. [ABSTRACT FROM AUTHOR]

Youth experiencing homelessness are a vulnerable population with increased behavioural health risks. Social networks are a consistent correlate of youths' substance use behaviours. However, less is known about the reciprocal relationships among these constructs. This study classified youth experiencing homelessness according to their social support network type (e.g. instrumental, emotional, service) and composition (e.g. family, peers, service staff) and linked their membership in these social network classes to sociodemographic and substance use characteristics. Four waves of cross‐sectional data were collected between October 2011 and June 2013 from youth experiencing homelessness, ages 14–29, at three drop‐in centres in Los Angeles, CA (N = 1,046). This study employed latent class analysis to identify subgroups of youth experiencing homelessness according to the type and composition of their social support networks. Multinomial logistic regression analyses were then conducted to identify the sociodemographic and substance use characteristics associated with social support network class membership. Five latent classes of youths' social support networks were identified: (a) high staff emotional and service support; (b) high home‐based peer and family emotional, service and instrumental support; (c) moderate street‐ and home‐based peer emotional support; (d) low or no support and (e) high home‐based peer and family emotional and instrumental support. Multinomial logistic regression models indicated that race/ethnicity, gender, sexual orientation, literal homelessness, former foster care experience, depression, heroin and marijuana use were significant correlates of social support network class membership. Results indicate distinct classes of social support networks among youth experiencing homelessness, with certain sociodemographic and substance use characteristics implicated in youths' social networks. [ABSTRACT FROM AUTHOR]

Homeless youth become pregnant or involved in pregnancies at high rates. There are many ways by which unintended pregnancies may be prevented, including the use of condoms and other contraceptives. However, there is a dearth of research regarding contraceptive use among this vulnerable youth population, and especially through lenses that consider homeless youths' diverse gender identities, expressions, and sexualities. This study qualitatively explores homeless youths' attitudes and experiences regarding condom and other contraceptive use. Data were obtained from interviews with 30 youth experiencing homelessness, ages 18-21. Youth reported inconsistent use of condoms and other contraceptives, which youth often attributed to their perceptions of contraceptive inaccessibility and exorbitant cost. Most youth also did not know where to obtain contraceptive information and services, and reported transportation barriers and fear of being stigmatized in health care settings, particularly in relation to their gender identities and sexualities. Findings suggest that reproductive and sexual health information and services are urgently needed by all homeless young people, and from low-barrier, non-judgmental, and empathetic sources. [ABSTRACT FROM AUTHOR]

This study explores rates of early pregnancy and parenthood among a sample of young adults (N = 215), ages 18–22, with a history of foster care. The study also compares the educational attainment, financial resources, and homelessness experiences of young adults who became parents to those who did not. By age 21, 49% of the young women became pregnant, and 33% of young men reported getting someone pregnant. Over a quarter of participants experienced parenthood, which was associated with lower educational attainment, less employment, not having a checking or savings account, and a history of homelessness. Gender moderated the association between parenthood and employment such that males who were parents were more likely than female parents to be employed. Given that these young adults were at risk of early pregnancy and parenthood regardless of emancipation status and across several racial/ethnic groups, the results suggest a need for early pregnancy prevention efforts for all youth with child welfare involvement as well as improving resources and support for those who become young parents. [ABSTRACT FROM AUTHOR]

This study reports preliminary permanency findings of the Fostering Healthy Futures for Teens program, a 30-week mentoring intervention for maltreated teenagers with open child welfare cases. Participants included 245 8th and 9th graders who were randomized to intervention or control conditions. The program evidenced high rates of engagement and satisfaction. There were few statistically significant differences between intervention/control groups on baseline risk factors, yet, after controlling for covariates, intervention youth had 7 times the odds of attaining permanency at long-term follow-up. [ABSTRACT FROM AUTHOR]