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Based in Allegheny County, a coalition of local stakeholders took note of the region's infant mortality rates, particularly the stark disparities observed by race, and established a vision to reduce infant mortality in the region. The group undertook a multi-faceted effort to (1) develop predictive models of infant mortality risk; (2) evaluate the effectiveness of available interventions; and (3) combine these tools in order to tailor intervention referrals based on maternal risk profiles. With this effort, the coalition sought to address the apparent disconnect between the region's robust maternal and child health care system and relatively poor birth and infant outcomes and racial disparities.The effort started with the integration of data from a variety of sources into an integrated database built specifically for this research effort covering the period 2003 to 2013. With the database, researchers linked each individual's data across multiple data sources, including the Allegheny County Health Department, the University of Pittsburgh Medical Center, the Allegheny County Department of Human Services Data Warehouse, and individual programs. With these data, we used a standard method for comparing outcomes and measuring the racial disparity between Black and white infants that involved calculating a ratio by dividing the rate or percentage for Black infants by the rate or percentage for white infants.Overall, the results showed that between 2003 and 2013 in Allegheny County disparities were more pronounced for infant mortality (3.25) than low birthweight (1.88) or preterm birth (1.49). Among the different potential causes of infant mortality, the most pronounced disparity was for SIDS (1.78). Among maternal health factors, pre-pregnancy obesity and gestational diabetes had the highest infant mortality disparity. The low birthweight disparity was similar and lower than the infant mortality disparity across all of the maternal health factors, while the preterm birth disparity was even lower. For the maternal behavioral and contextual factors, the infant mortality disparity ranged from 1.5 to 2.3.The 11-year span of data reported in the IMPreSIv database and the breadth of intervention data included allowed us to report granular information on birth outcomes within Allegheny County over this time period. The database also allowed us to summarize the various factors associated with the range of birth outcomes and describe the participation rates in the medical and community setting interventions. Against this backdrop of pronounced disparities in birth outcomes across a range of factors, we examined the effectiveness of interventions for women with different risk factors (e.g. substance use disorders) in order to develop a tool to facilitate individualized referrals to the interventions that will help the most for a specific risk profile.

OBJECTIVE To understand how youth PTSD symptoms and externalizing problems emerge and change over time for youth with different profiles of victimization, including polyvictimization. METHOD We conducted a latent class analysis (LCA) to identify empirically derived victimization profiles in a sample of 2,776 youth who participated in an evaluation study. We then conducted growth curve analyses to determine whether these victimization profiles predicted change in the course of PTSD symptoms and externalizing problems over a 1-year time period for youth engaged in a variety of community-based services. RESULTS The LCA revealed three profiles: a low victimization profile defined by relatively low endorsement of victimization across types; a witnessing profile defined by particularly high endorsement of witnessing violence; and a polyvictimization profile defined by high endorsement of multiple types of victimization. We found that overall, despite differing initial levels of PTSD symptoms and externalizing problems, all three groups' symptoms improved over the year, but the polyvictimization class generally showed the steepest decreases, particularly in caregiver-reported PTSD symptoms. CONCLUSION Polyvictimized youth participating in community-based services are at increased risk for developing PTSD and externalizing problems, but symptoms appear to decrease to levels similar to other victimized youth after one year. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Youth exposed to violence, many of whom are from racial/ethnic minority backgrounds, are at high risk for externalizing problems such as aggressive and oppositional behavior, conduct problems, and delinquency. Most interventions target youth with already high levels of such problems, while selective prevention efforts have received less attention. It is important for researchers, policy makers and practitioners to understand how such problems develop and change over time, and how selective prevention may impact externalizing problems. In this study, we examined one-year trajectories of externalizing problems in 883 low-income, ethnic minority youth exposed to violence who participated in randomized controlled trials testing a prevention program for high-risk youth called the Strengthening Families Program. We found three trajectories of externalizing problems: Low Externalizing (43% of the sample had consistently low levels of externalizing symptoms), Persisters (39% of the sample had consistently high levels of externalizing symptoms), and Improvers (18% of the sample had initially high levels of externalizing symptoms that decreased over time). There were demographic differences between the three trajectories with individuals in the Low Externalizing trajectory more likely to be female and younger than those in the other two trajectories and Persisters and Improvers had significantly more problems with baseline internalizing symptoms, family conflict, and parenting behavior compared to the Low Externalizing trajectory. Logistic regressions then tested several predictors of membership in the Persisters trajectory compared to the Improvers trajectory, controlling for all covariates simultaneously. Only baseline parenting behavior and intervention group membership significantly predicted trajectory membership, and these were small and unreliable effects. Thus, children with varying levels of violence exposure, co-occurring emotional/behavioral problems and family issues, and varying demographics (e.g., age and gender) may do equally well over time, but engagement in this type of intervention may increase the likelihood that high levels of externalizing problems are ameliorated over time.

In 2016, New York City policymakers came together with federal and private funders to support a program, Connections to Care (C2C), intended to provide quality mental health support within high-risk communities. RAND researchers conducted an evaluation of C2C, examining its implementation across 15 community-based organizations, its impact on access and utilization of mental health care, mental health symptoms, and other outcomes, and its costs.

At least one in five adult New Yorkers is likely to meet the criteria for a mental health diagnosis, yet most do not receive mental health services to treat these problems. Mental health problems, such as depression and anxiety, disproportionately affect historically underserved segments of the population, such as racial/ethnic minority and low-income individuals, and these groups are least likely to receive mental health services. The Connections to Care (C2C) Collaborative developed the C2C program, which integrates mental health support into the work of nonclinical community-based organizations (CBOs) through task shifting; task shifting is an approach extending evidence-informed health care skills to community-based partners under the oversight of trained professionals to expand the health care workforce. This study uses data from interviews, surveys, and CBO-provided progress indicators to describe how C2C has been implemented within and across the 15 CBOs. This study also describes study methods and a description of the baseline sample for the impact evaluation at the time of writing.

In this final chapter we consider the impact of more enlightened ideas about dogs kept as companion animals, new roles for therapy and service dogs, and advances in research methods used to study canine-human interaction. We begin by discussing limitations in common terminology and the need to respect each dog’s requirements for health and fulfillment. Next, we identify ten trends on the horizon that will affect human beings’ attitudes, values, practices, and policies during interactions with dogs. The chapter concludes with observations about the research/practice gap. We argue that, when it comes to human-canine interaction, it is less the case that people know the research and fail to implement it and more the case that the research has not yet “caught up to” practice.

Evaluation of interventions for children exposed to violence is critical for informing dissemination of effective services nationally, but retention rates in such studies are typically low, jeopardizing intent-to-treat analytic approaches. We examine predictors of retention (demographics, violence exposure, child mental health, caregiver demographics, and engagement in intervention) in a large multisite national study of interventions for children exposed to violence. Our analyses found that families were more likely to be retained in the study at 6 months if caregivers rated their own physical health as poor or fair, the child experienced higher levels of maltreatment, or the family was assigned to the intervention group within the study. In models limited to those families in the study's intervention group, only receipt of services was significantly related to study retention. Methods with which to increase retention in family therapy programs for at-risk families are discussed.

Objectives The study tests whether participation in interventions offered by a subset of sites from the National Safe Start Promising Approaches for Children Exposed to Violence initiative improved outcomes for children relative to controls.

Between January 2007 and June 2010, members of the Allegheny County Maternal and Child Health Care Collaborative designed, implemented, and evaluated the Allegheny County Maternal Depression Initiative, a local system-change effort focused on increasing identification, referrals, and engagement in treatment as needed and appropriate for women at high risk for maternal depression. The collaborative was successful in improving key organizational and clinical processes related to the achievement of its aims. This article describes how and why the initiative was created, the processes through which it was implemented and evaluated, and the results and lessons learned. It concludes with recommendations in four areas for practice and policy change designed to expand and sustain the initiative's achievements: improve identification of maternal depression, enhance access to available resources and services, increase engagement in behavioral health treatment, and improve overall system performance.

The Tobacco Settlement Proceeds Act, a referendum passed by Arkansans in the November 2000 election, invests Arkansas' share of the tobacco Master Settlement Agreement funds in seven health-related programs. RAND was contracted to perform a comprehensive evaluation of the progress of the seven programs in fulfilling their missions, as well as the effects of the programs on smoking and other health-related outcomes. This article discusses the Arkansas Tobacco Settlement Commission's activities and its responses to recommendations by RAND in the earlier evaluation reports and documents continued activity and progress by the seven funded programs for 2008 and 2009. The article evaluates the progress of each of the funded programs, including assessing progress in achieving programmatic goals and tracking the programs' activities and indicators. It also updates trends in outcome measures developed to monitor the effects of the funded programs on smoking and other health-related outcomes. Finally, it provides both program-specific and statewide recommendations for future program activities and funding, including ongoing strategic planning, developing evaluation measures, collaboration with other programs, and sustaining funding and growth.

Children's exposure to violence (CEV)-including direct child maltreatment, witnessing domestic violence, and witnessing community and school violence-can have serious consequences, including a variety of psychiatric disorders and behavioral problems, such as posttraumatic stress disorder, depression, and anxiety. Fortunately, research has shown that interventions for CEV can substantially improve children's chances of future social and psychological well-being. Safe Start Promising Approaches (SSPA) was the second phase of a planned four-phase initiative focusing on preventing and reducing the impact of CEV, sponsored by the U.S. Department of Justice's Office of Juvenile Justice and Delinquency Prevention (OJJDP). OJJDP selected 15 program sites across the country that proposed a range of intervention approaches, focused on multiple types of violence, included variations in ages and age-appropriate practices, and would be implemented in different settings. Each site participated in a national evaluation, conducted by the RAND Corporation. The evaluation design involved three components: a process evaluation, an evaluation of training, and an outcomes evaluation. This article presents the results of the first two evaluations. It describes the program and community settings, interventions, and implementations of the 15 SSPA programs for the first two years of implementation (through March 2009), as well as the training evaluation results.

This study examines the impacts arising from neuroscience and mental health research going back 20-25 years, and identifies attributes of the research, researchers or research setting that are associated with translation into patient benefit, in the particular case of schizophrenia. The study combined two methods: forward-tracing case studies to examine where scientific advances of 20 years ago have led to impact today; and backward-tracing perspectives to identify the research antecedents of today's interventions in schizophrenia. These research and impact trails are followed principally in Canada, the UK and the USA. The headline findings are as follows: The case studies and perspectives support the view that mental health research has led to a diverse and beneficial range of academic, health, social and economic impacts over the 20 years since the research was undertaken.Clinical research has had a larger impact on patient care than basic research has over the 20 years since the research was undertaken.Those involved in mental health research who work across boundaries are associated with wider health and social benefits.Committed individuals, motivated by patient need, who effectively champion research agendas and/or translation into practice are key in driving the development and implementation of interventions.This study provides an overview of the methods and presents the full set of findings, with the policy provocations they raise, and an emerging research agenda. It has been written for funders of biomedical and health research and health services, health researchers, and policymakers in those fields. It will also be of interest to those involved in research and impact evaluation.

A number of programs aim to reduce the stigma and discrimination associated with mental illness, and they can include a variety of components such as training, education, media campaigns, and contact with people with mental illness. Stigma and discrimination reduction activities are evaluated in this article, using evidence from an extensive literature review. Specific areas reviewed include relevant theories of stigma and prejudice reduction, what is and is not known about the effectiveness of various approaches to reducing the stigma of mental illness, the kinds of methodologies previously used in evaluating these approaches, and the methodologies that should be employed in the future. The authors also introduce a conceptual model of mental health stigma reduction based on a variety of existing theories and evidence.

A major challenge facing human service programs is the inability to engage people identified or referred for services. This toolkit offers five strategies to increase client recruitment and retention for these programs. It provides techniques, examples, and resources to support the development of a comprehensive program recruitment and retention plan that will address many engagement challenges.

RAND researchers' model of the child welfare system shows that increasing prevention while also increasing treatment improves system experience and long-term outcomes while paying for itself by reducing lifetime child welfare system costs.

To provide objective analyses about the effects of prevention and treatment programs on child welfare outcomes, RAND researchers built a quantitative model that simulated how children enter and flow through the nation's child welfare system. They then used the model to project how different policy options (preventive services, family preservation treatment efforts, kinship care treatment efforts, and a policy package that combined preventive services and kinship care) would affect a child's pathway through the system, costs, and outcomes in early adulthood. This study is the first attempt to integrate maltreatment risk, detection, pathways through the system, and consequences in a comprehensive quantitative model that can be used to simulate the impact of policy changes. This research suggests that expanding both prevention and treatment is needed to achieve the desired policy objectives: Combining options that intervene at different points in the system and increasing both prevention and treatment generates stronger effects than would any single option. The simulation model identifies ways to increase both targeted prevention and treatment while achieving multiple objectives: reducing maltreatment and the number of children entering the system, improving a child's experience moving through the system, and improving outcomes in young adulthood. These objectives can all be met while also reducing total child welfare system costs. A policy package combining expanded prevention and kinship supports pays for itself: There is a net cost reduction in the range of 3 to 7 percent of total spending (or approximately $5.2 billion to $10.5 billion saved against the current baseline of $155.9 billion) for a cohort of children born over a five-year period.

Rather than forcing a choice between expanding and enhancing either prevention or treatment plans, the child welfare system could find better results by focusing a balance of effort on improving both.

Children's exposure to violence is common and can lead to mental health problems and delinquent behaviors. Because many interventions have focused on specific violence types or symptoms and been difficult to implement in real-world settings, the evidence base is still emerging. The Office of Juvenile Justice and Delinquency Prevention's Safe Start Promising Approaches (SSPA) initiative focused on preventing and reducing the impact of children's exposure to violence through interventions in ten diverse communities. The evaluation examined the effectiveness of the SSPA interventions to address issues for children and families exposed to violence. The ten sites were diverse in their intervention approaches, types of violence exposure targeted, and implementation settings. To evaluate each approach's effectiveness in reducing violence's harmful effects, RAND researchers partnered with the community-based sites to develop a rigorous controlled evaluation design for each intervention, with either a randomized control group or a comparison group selected on similar characteristics. The longitudinal analyses found that families in both the intervention and comparison groups had positive gains on many outcomes, but there was no evidence that the intervention groups improved more. Among those who received Safe Start services, one site produced large, significant improvements in posttraumatic stress disorder symptoms, and another site produced medium, significant effects on several outcomes (child self-control, posttraumatic stress disorder, and behavior; caregiver depression; and family conflict). Although the initiative added to knowledge about how to address the problem, there was no clear case for using a particular intervention to help these children and their families.

In the United States, many health care systems function independently from one another. Increasing coordination across systems has the potential to vastly improve services and patient outcomes, yet implementing these changes can be challenging, requiring increased communication, interaction, and coordination across systems that typically function independently. Parental depression is one health issue that could benefit greatly from a comprehensive systems approach. The Helping Families Raise Healthy Children initiative is a cross-system quality improvement initiative aimed at improving identification and treatment of families faced with the dual challenge of caregiver depression and early childhood developmental delays. Four main techniques were used to foster and sustain cross-system collaboration and communication: cross-system trainings, regular meetings of collaborative partners, a cross-system learning collaborative for service providers, and two cross-system facilitators. The initiative achieved successful cross-system collaboration, suggesting that these methods may be used in other initiatives to foster similar types of collaboration across systems.

Millions of children each year are exposed to violence in their homes, schools, and communities as both witnesses and victims. As a result, evidence-based programs for children and adolescents who have been exposed to traumatic events (CEV-EBPs) have been widely disseminated but rarely evaluated in their real-world applications. One crucial aspect of conducting such evaluations is finding appropriate measures that can be of use both to the practitioner and to the researcher. This review aims to provide guidance to the field by first identifying any gaps in the availability of psychometrically tested measures for certain outcome domains and age ranges and then recommending the measures that are most appropriate for use by both researchers and practitioners. Interviews with content experts in the measurement of trauma symptoms and parent-child relationships were conducted to identify the key outcome domains for measurement that are critical to the evaluation of CEV-EBPs and the criteria for dual-use measures, defined as measures that are useful to both researchers and practitioners. A database of 46 relevant measures was created by compiling measures from existing repositories and conducting a focused literature review. Our review of these measures found that existing repositories had few measures of depression, a major gap that should be addressed. Further, there were few measures for young children ages 0-3 years (n = 15) and only a handful of measures (n = 9) had both a child and parent version of the measure. Overall, although the different repositories that currently exist are helpful, researchers and practitioners would benefit from having a single reputable source (e.g., a centralized repository or item bank) to access when searching for measures to use in evaluating CEV-EBPs. Such a tool would hold promising to narrow the current gap between research and practice in the field of children's exposure to violence.

This case study highlights the challenges and solutions for implementing an evidence-based program and associated evaluation in child welfare. The program is designed to support the mental health needs of youth in foster care in school settings. The intervention is unique, not only in the application of an evidence-based program to child welfare, which many scholars and practitioners point out is all too rare, but also because the intervention requires multiple system integration. In detailing the process, we hope to contribute to a growing body of literature documenting the integration of science and practice through the dissemination and implementation of evidence-based programs.

Youth suicide is a national public health priority, with policymakers highlighting schools as an ideal setting in which to deliver suicide prevention programs. Over the past decade, the number of schools implementing such programs has grown substantially, yet little is known about how successfully such programs are being implemented. This study examines the implementation of a district-wide suicide prevention program through key informant interviews with school personnel. Schools with higher rates of implementing district protocols for at-risk students had an organized system to respond to at-risk students, a process for effectively responding to students who were at-risk for suicide, and strong administrative support. In contrast, schools that had lower rates of implementing district protocols relied on a handful of individuals for suicide prevention activities and had limited administrative support. Attention to organizational factors leading to successful implementation of school-based suicide prevention programs may enhance the role of schools in national adolescent suicide prevention efforts.

Objective The aim of this study was to examine the trajectory of cases through four systems: child protection, law enforcement, the dependency courts, and the criminal courts. Method This study focused on a county selected from a 41-county telephone survey conducted for the National Incidence Study of Child Abuse and Neglect (NIS-3). For this analysis prospective samples were drawn from law enforcement (n = 225) and the county child protection (CPS) agency (n = 225) and followed through in-depth case tracking across all agencies and through both the dependency and criminal court systems. Results The percentage of CPS cases opened in dependency court was similar to prior studies (29%), but the acceptance and prosecution rates were much higher—92% of the cases referred from CPS, including many cases of physical abuse. Compared to referrals from CPS to law enforcement (93%), few cases were referred from law enforcement to CPS (17%). Anecdotally, case referral patterns appeared to be influenced by communication patterns and mutual positive regard, regardless of the collaborative protocols in place. One of the most instructive findings was the degree of difficulty in tracking cases across organizations and the types of obstacles that impeded success. Disorganization was not an issue, rather internal structures set up to facilitate intra-organizational processing were the same structures that actually impeded cross-organizational case finding. Conclusions It is not sufficient to rely on the existence of multi-disciplinary teams or Child Advocacy Centers to ensure collaboration. More attention to daily tasks and activities as well as the nature and quality of communication is warranted. On the technical side, use of common case identifiers on cases that are cross-referred is strongly recommended. Future studies should broaden the scope of inquiry to include the consequences of all case trajectories, rather than solely focusing on the justice system.

Objectives: Characteristics of the child victim, perpetrator, and maltreatment incident were used to examine predictors of court involvement in cases of serious child maltreatment. Method: Cases were drawn from those reported to: child protective services (n = 225), sheriff's office ( n = 225), prosecutor's office ( n = 60), and dependency court ( n = 65). Logistic regression was used to calculate predicted probabilities of criminal court involvement and dependency court involvement Results: Cases involving female victims were more likely to be filed in criminal court, and sexual abuse had the highest likelihood of prosecution. Cases involving male perpetrators, older perpetrators, and multiple victims were more likely to be filed for prosecution. Physical neglect was the most common type of maltreatment to result in dependency court filings. Perpetrator gender had opposite effects in the two systems. Conclusion: Tracking cases even in the same jurisdiction is confounded by the lack of common identifiers across the agencies involved.

Summarizes findings from an evaluation of a set of California initiatives to help reduce mental health stigma and discrimination, prevent suicide, and improve student mental health.

To develop prevention and intervention programs for children exposed to violence, it is necessary to understand what factors might help alleviate the negative effects of violence exposure. In this study, we sought to test whether relationships exist between certain protective factors and subsequent adjustment and to examine whether violence re-exposure contributed to changes in outcomes over time. The analyses revealed that caregiver reports of both child self-control and the quality of the parent–child relationship were related to changes in child posttraumatic stress disorder (PTSD) symptoms and behavior problems. Furthermore, children experiencing more categories of violence re-exposure had increased behavior problems at follow-up compared to those without re-exposure. These findings advance our understanding of the relationship between these protective factors and outcomes for children exposed to violence and suggest that intervening to bolster these protective factors could improve outcomes.

Children today spend the majority of their time indoors, watching television, playing video games, and using the computer. As screen time has increased, unstructured playtime in the outdoors has decreased. Louv (Childhood’s future, Doubleday, New York, 2005) coined the phrase “nature-deficit disorder” (NDD), referring to the alienation from nature in the lives of today’s wired generation. Not only does the loss of children’s outdoor play and contact with the natural world negatively impact the growth and development of the whole child and their acquisition of knowledge, it also sets the stage for a continuing loss of the natural environment. As educators seek to develop citizens with environmental ethics, in the early childhood years they must first develop children’s love of nature. Likewise, as educators aim to develop citizens who protect animals, teaching children to have affinity for animals, both wildlife and companion animals, is the foundation.

The Helping Families Raise Healthy Children initiative addressed depression among parents of children with early childhood developmental delays, aligning the early intervention and behavioral health systems with a focus on relationship-based care.

The study explores whether and how lifetime violence exposure is related to a set of negative symptoms: child internalizing and externalizing behavior problems, child trauma symptoms, and parenting stress. Using a large sample of violence-exposed children recruited to participate in intervention research, the study employs different methods of measuring that exposure. These include total frequency of all lifetime exposure, total frequency of lifetime exposure by broad category (i.e., assault, maltreatment, sexual abuse, and witnessing violence), and polyvictimization defined as exposure to multiple violence categories. The results indicate that only polyvictimization, constructed as a dichotomous variable indicating two or more categories of lifetime exposure, emerged as a consistent predictor of negative symptoms. The total lifetime frequency of all violence exposure was not associated with negative symptoms, after controlling for the influence of polyvictimization. Likewise, in the presence of a dichotomous polyvictimization indicator the total lifetime frequency of exposure to a particular violence category was unrelated to symptoms overall, with the exception of trauma symptoms and experiences of sexual abuse. Taken together, these findings suggest that total lifetime exposure is not particularly important to negative symptoms, nor is any particular category of exposure after controlling for polyvictimization, with the single exception of sexual abuse and trauma symptoms. Instead, it is the mix of exposure experiences that predict negative impacts on children in this sample. Further research is needed to continue to explore and test these issues.

In light of the growing trend toward formalized research mentorship for effectively transmitting the values, standards, and practices of science from one generation of researchers to the next, this article provides the results of an exploratory study. It reports on research mentorship in the context of interdisciplinary geriatric research based on experiences with the RAND/Hartford Program for Building Interdisciplinary Geriatric Research Centers. At the end of the 2-year funding period, staff from the RAND Coordinating Center conducted 60- to 90-minute open-ended telephone interviews with the co-directors of the seven centers. Questions focused on interdisciplinary mentorship activities, barriers to implementing these activities, and strategies for overcoming them, as well as a self-assessment tool with regard to programs, policies, and structures across five domains, developed to encourage research mentorship. In addition, the mentees at the centers were surveyed to assess their experiences with interdisciplinary mentoring and the center. According to the interviewees, some barriers to successful interdisciplinary mentoring included the mentor's lack of time, structural support, and the lack of a clear definition of interdisciplinary research. Most centers had formal policies in place for mentor identification and limited policies on mentor incentives. Mentees uniformly reported their relationships with their mentors as positive. More than 50% of mentees reported having a primary mentor from within their discipline and had more contact with their primary mentor than their secondary mentors. Further research is needed to understand the complexity of institutional levers that emerging programs might employ to encourage and support research mentorship.

Objectives. We assessed the effect of Master Settlement Agreement (MSA) spending on smoking disparities in Arkansas, which distinguished itself from other states by investing all of its MSA funds in health-related programs. Methods. In 1996–2009 data from the Behavioral Risk Factor Surveillance System, we specified multivariate logistic models to examine gender and racial/ethnic disparities in smoking rates within Arkansas (a pre–post analysis) and between Arkansas and its 6 neighboring states. Results. Before the MSA programs started in 2001, male Arkansans smoked more than did female Arkansans (P Conclusions. MSA-funded programs were more effective in some segments of the Arkansas population than in others. Policymakers should consider targeting future MSA tobacco control programs to populations most resistant to change.

A number of programs aim to reduce the stigma and discrimination associated with mental illness, and they can include a variety of components such as training, education, media campaigns, and contact with people with mental illness. Stigma and discrimination reduction activities are evaluated in this article, using evidence from an extensive literature review. Specific areas reviewed include relevant theories of stigma and prejudice reduction, what is and is not known about the effectiveness of various approaches to reducing the stigma of mental illness, the kinds of methodologies previously used in evaluating these approaches, and the methodologies that should be employed in the future. The authors also introduce a conceptual model of mental health stigma reduction based on a variety of existing theories and evidence.

Depression among pregnant and postpartum women (i.e., perinatal depression) is the number one complication of childbirth. The Allegheny County Maternal Depression Initiative aimed to bridge gaps between physical and behavioral health care and improve the capacity of local systems of care for identifying and treating women at high risk for perinatal depression. To achieve these goals, the collaborative adopted a community-based model of systems change focused on women enrolled in the local Medicaid managed care system. Although the systems change protocol included a number of strategies for enhancing communication at all levels of care, variations in health information technology (HIT) capacities and/or capabilities across initiative partners frequently prevented optimal implementation of these strategies. Here, we present an overview of the results of the initiative, share insights from the collaborative regarding how HIT could have improved those results, and offer recommendations related to ways to effectively leverage HIT to integrate physical and behavioral health care.

RAND's evaluation of Safe Start Promising Approaches identified program successes and challenges in implementing programs for children exposed to violence. The evaluation results, though largely inconclusive, can inform similar efforts going forward.

Summarizes results of RAND's evaluation of the progress and impact of Arkansas' antismoking and health programs established with its share of tobacco settlement funds.

Discusses the large disparities between boys and men of color in California compared with their white counterparts across four broad domains — socioeconomic, health, safety, and ready to learn.

The study identifies some of the greatest disparities for boys and men of color relative to their white counterparts across specific socioeconomic, health, safety, and school readiness indicators in California and provides information about different strategies for reducing the disparities — including effective programs, practices, and policies — that can begin making an important difference in changing the life course of boys and men of color.

The purpose of this article is to assist institutions in advancing their efforts to support research mentorship. The authors begin by describing how institutions can shape the key domains of research mentorship: (1) the criteria for selecting mentors, (2) incentives for motivating faculty to serve effectively as mentors, (3) factors that facilitate the mentor–mentee relationship, (4) factors that strengthen a mentee’s ability to conduct research responsibly, and (5) factors that contribute to the professional development of both mentees and mentors. On the basis of a conceptual analysis of these domains as currently documented in the literature, as well as their collective experience examining mentoring programs at a range of academic medicine institutions and departments, the authors provide a framework that leaders of institutions and/or departments can adapt for use as a tool to document and monitor policies for guiding the mentorship process, the programs/activities through which these policies are implemented, and the structures that are responsible for maintaining policies and implementing programs. The authors provide an example of how one hypothetical institution might use the self-assessment tool to track its policies, programs, and structures across the key domains of research mentorship and, on the basis of this information, identify a range of potential actions to strengthen its research mentoring efforts. The authors conclude with a brief discussion of the limitations of the self-assessment tool, the potential drawbacks and benefits of the overall approach, and proposed next steps for research in this area.

The objective of this work was to describe and assess the potential impact of the Agency for Healthcare Research and Quality’s, AHRQ’s, children’s health activities. Using AHRQ databases and publications lists and generic search engines, we developed a comprehensive list of AHRQ’s funded children’s health activities (1990–2005) and related publications (1996–2002). We conducted bibliometric analyses and used Stryer’s (2000) approach to categorize their potential impact. We found that AHRQ’s child health portfolio has changed over time with an increase in activities related to patient safety and health information technology, reflecting trends at AHRQ as a whole. Further, AHRQ has contributed a substantial body of new knowledge as a result of its funding for children’s health activities. The bibliometric analysis suggests that AHRQ’s children’s health activities have successfully disseminated research findings and new knowledge through the published literature. Most of the publications present research findings that can be building blocks early in the translation continuum rather than findings that directly inform policy or change clinical practice. Through its funding of children’s health activities, AHRQ has contributed new knowledge that has been disseminated effectively in the published literature. However, while AHRQ has successfully engaged the child health services research community, efforts to broaden into policy, practice and patient arenas have been less successful.

Objectives This research explores the relationship between hypothesized protective factors and outcomes for children investigated for maltreatment. Methods Using data from the National Survey on Child and Adolescent Well-Being (NSCAW), we ran logistic regression models to examine the relationship between hypothesized protective factors (social competence, adaptive functioning skills, and peer relationships) and outcomes (externalizing behavior, internalizing behavior, reading competence). Results For each hypothesized protective factor, we found variation in individual scores and sample mean scores at the lower end of the scales, indicating that these children fare worse than most children. However, many children experienced large changes in their individual scores over time suggesting that children can and do improve on these hypothesized protective factors. In examining the relationship between hypothesized protective factors and outcomes, children with higher levels of social competence were significantly more likely to be in the normal range for both externalizing and internalizing behaviors. Children with higher mean adaptive functioning skills were more likely to be in the normal range for both externalizing behavior and reading competence. The positive nature of the child's peer relationships was also related to externalizing behavior and reading competence. Conclusions Overall, our analyses support the idea that social competence, adaptive functioning skills, and peer relationships are related to outcomes for children investigated for maltreatment. While further research is needed to establish a causal link, this work identifies three individual-level hypothesized protective factors as potential sources of variation in outcomes. Practice implications To prevent or alleviate the harmful consequences maltreatment, it is necessary to understand factors that help children move beyond poor outcomes. Our analyses suggest that a strong relationship exists between a child's social competence, adaptive functioning skills and positive peer relationships and select outcomes three years after being investigated for maltreatment. With these individual-level protective factors related to more positive outcomes, it suggests that intervening to increase protective factors could improve outcomes for maltreated and at-risk children.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care. Veterans usually receive care within 14 days of their desired appointment date, but wait times vary considerably across VA facilities. VA has long played a national leadership role in measuring the quality of health care. The assessment showed that VA health care quality was as good or better on most measures compared with other health systems, but quality performance lagged at some VA facilities. VA will require more resources and capabilities to meet a projected increase in veterans' demand for VA care over the next five years. Options for increasing capacity include accelerated hiring, full nurse practice authority, and expanded use of telehealth.