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1.  Multiple Forensic Interviews During Investigations of Child Sexual Abuse: A Cost-Effectiveness Analysis 
Applied developmental science  2013;17(4):10.1080/10888691.2013.836033.
In cases of suspected child sexual abuse (CSA) some professionals routinely recommend multiple interviews by the same interviewer because any additional details provided might improve decision-making and increase perpetrator convictions. We analyzed alternative policies about child interviewing to estimate the probability that a policy of all children receiving multiple interviews will increase criminal convictions and better protect children. Using decision analysis, we prepared a decision tree reflecting the structure through which a case of possible CSA passes through the health care, welfare, and legal systems with an estimated probability of conviction of the offender. We reviewed the CSA disclosure, criminal justice, and child welfare literature to obtain estimates for the median and range of rates for the steps of disclosure, substantiation, criminal charges, and conviction. Using the R statistical package, our decision analysis model was populated using literature-based estimates. Once the model was populated, we simulated the experiences of 1,000 cases at 250 sets of plausible parameter values representing different hypothetical communities. Multiple interviews increase the likelihood that an offender will be convicted by 6.1% in the average community. Simulations indicate that a policy in which all children seen for a CSA medical evaluation receive multiple interviews would cost an additional $100,000 for each additional conviction. We estimate that approximately 17 additional children would need to be interviewed on more than one occasion to yield one additional conviction. A policy of multiple interviews has implications for the children, for the costs of care, for protecting other children, and for the risk of false prosecution.
doi:10.1080/10888691.2013.836033
PMCID: PMC3825174  PMID: 24244100
2.  Economic Analysis of a Multi-Site Prevention Program: Assessment of Program Costs and Characterizing Site-level Variability 
Programmatic cost analyses of preventive interventions commonly have a number of methodological difficulties. To determine the mean total costs and properly characterize variability, one often has to deal with small sample sizes, skewed distributions, and especially missing data. Standard approaches for dealing with missing data such as multiple imputation may suffer from a small sample size, a lack of appropriate covariates, or too few details around the method used to handle the missing data. In this study, we estimate total programmatic costs for a prevention trial evaluating the Strong African American Families-Teen program. This intervention focuses on the prevention of substance abuse and risky sexual behavior. To account for missing data in the assessment of programmatic costs we compare multiple imputation to probabilistic sensitivity analysis. The latter approach uses collected cost data to create a distribution around each input parameter. We found that with the multiple imputation approach, the mean (95% confidence interval) incremental difference was $2149 ($397, $3901). With the probabilistic sensitivity analysis approach, the incremental difference was $2583 ($778, $4346). Although the true cost of the program is unknown, probabilistic sensitivity analysis may be a more viable alternative for capturing variability in estimates of programmatic costs when dealing with missing data, particularly with small sample sizes and the lack of strong predictor variables. Further, the larger standard errors produced by the probabilistic sensitivity analysis method may signal its ability to capture more of the variability in the data, thus better informing policymakers on the potentially true cost of the intervention.
doi:10.1007/s11121-012-0316-z
PMCID: PMC3638081  PMID: 23299559
cost(s); economic analysis; substance use prevention; youth; African Americans
3.  The Estimated Annual Cost of ADHD to the U.S. Education System 
School mental health  2011;3(3):169-177.
The purpose of this study was to examine and monetize the educational outcomes of students with ADHD. Data were examined from the Pittsburgh ADHD Longitudinal Study (PALS), a follow-up study of children diagnosed with ADHD in childhood and recontacted for follow-up in adolescence and young adulthood. A comprehensive educational history was obtained for all participants from Kindergarten through 12th grade. Annual economic impact was derived from costs incurred through special education placement, grade retention, and disciplinary incidents. Results indicated that, as compared to students without ADHD, students with ADHD incurred a higher annual cost to the U.S. Education system. Specifically, a student with ADHD incurred an average annual incremental cost to society of $5,007, as compared to $318 for students in the comparison group. These results suggest that prevention and intervention strategies are greatly needed to offset the large financial impact of educating youth with ADHD.
doi:10.1007/s12310-011-9057-6
PMCID: PMC4123753  PMID: 25110528
4.  Costs and Effectiveness of the Fast Track Intervention for Antisocial Behavior 
Background
Antisocial behavior is enormously costly to the youth involved, their families, victims, taxpayers and other members of society. These costs are generated by school failure, delinquency and involvement in the juvenile justice system, drug use, health services and other services. For prevention programs to be cost effective, they must reduce these costly behaviors and outcomes.
Aim
The Fast Track intervention is a 10-year, multi-component prevention program targeting antisocial behavior. The intervention identified children at school entry and provided intervention services over a 10-year period. This study examined the intervention’s impact on outcomes affecting societal costs using data through late adolescence.
Methodology
The intervention is being evaluated through a multi-cohort, multi-site, multi-year randomized control trial of program participants and comparable children and youth in similar schools, and that study provides the data for these analyses. Schools within four sites (Durham, NC; Nashville, TN; Seattle, WA; and rural central Pennsylvania) were selected as high-risk based on crime and poverty statistics of the neighborhoods they served. Within each site, schools were divided into multiple sets matched for demographics (size, percentage free/reduced lunch, ethnic composition); one set within each pair was randomly assigned to the intervention and one to the control condition. Within participating schools, high-risk children were identified using a multiple-gating procedure. For each of three annual cohorts, all kindergarteners (9,594 total) in 54 schools were screened for classroom conduct problems by teachers. Those children scoring in the top 40% within cohort and site were then solicited for the next stage of screening for home behavior problems by the parents, and 91% agreed (n = 3,274). The teacher and parent screening scores were then standardized within site and combined into a sum score. These summed scores represented a total severity-of-risk screen score. Children were selected for inclusion into the study based on this screen score, moving from the highest score downward until desired sample sizes were reached within sites, cohorts, and conditions.
Results and Discussion
The intervention lacked both the breadth and depth of effects on costly outcomes to demonstrate cost-effectiveness or even effectiveness.
Limitations
The outcomes examined here reflect effects observed during measurement windows that are not complete for every outcome. Data are lacking on some potential outcomes, such as the use of mental health services before year 7.
Conclusion and Implications
The most intensive psychosocial intervention ever fielded did not produce meaningful and consistent effects on costly outcomes. The lack of effects through high school suggests that the intervention will not become cost-effective as participants progress through adulthood.
Future Research
Future research should consider alternative approaches to prevention youth violence.
PMCID: PMC3755453  PMID: 21051793
5.  A Person-Centered Examination of Adolescent Religiosity Using Latent Class Analysis 
Empirical studies of religion’s role in society, especially those focused on individuals and analyzing survey data, conceptualize and measure religiosity on a single measure or a summary index of multiple measures. Other concepts, such as “lived religion,” “believing without belonging,” or “fuzzy fidelity,” emphasize what scholars have noted for decades: humans are rarely consistently low, medium, or high across dimensions of religiosity including institutional involvement, private practice, salience, or belief. A method with great promise for identifying population patterns in how individuals combine types and levels of belief, practice, and personal religious salience is latent class analysis. In this paper, we use data from the first wave of the National Study of Youth and Religion’s telephone survey to discuss how to select indicators of religiosity in an informed manner, as well as the implications of the number and types of indicators used for model fit. We identify five latent classes of religiosity among adolescents in the United States and their socio-demographic correlates. Our findings highlight the value of a person-centered approach to understanding how religion is lived by American adolescents.
doi:10.1111/jssr.12001
PMCID: PMC3772788  PMID: 24043905
religiosity; latent class analysis; adolescents
6.  The Effect of the WIC Program on the Health of Newborns 
Health Services Research  2010;45(4):1083-1104.
Objective
To determine the effect of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on birth outcomes.
Data Source
The Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID). The PSID provides extensive data on the income and well-being of a representative sample of U.S. families from 1968 to present. The CDS collects information on the children in PSID families ranging from cognitive, behavioral, and health status to their family and neighborhood environment. The first two waves of the CDS were conducted in 1997 and 2002, respectively. We use information on 3,181 children and their mothers.
Study Design
We use propensity score matching with multiple imputations to examine whether WIC program influences birth outcomes: birth weight, prematurity, maternal report of the infant's health, small for gestational age, and placement in the neonatal intensive care unit. Furthermore, we use a fixed-effects model to examine the above outcomes controlling for mother-specific unobservables.
Principal Findings
After using propensity scores to adjust for confounding factors, WIC shows no statistically significant effects for any of six outcomes. Fixed-effects models, however, reveal some effects that are statistically significant and fairly substantial in size. These involve preterm birth and birth weight.
Conclusions
Overall, the WIC program had moderate effects, but findings were sensitive to the estimation method used.
doi:10.1111/j.1475-6773.2010.01115.x
PMCID: PMC2910570  PMID: 20459450
WIC; birth outcomes; propensity score; multiple imputations; fixed-effects model
7.  Can a Costly Intervention Be Cost-effective? 
Archives of general psychiatry  2006;63(11):1284-1291.
Objectives
To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact.
Design
Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study.
Results
Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria.
Conclusions
Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations.
doi:10.1001/archpsyc.63.11.1284
PMCID: PMC2753445  PMID: 17088509
8.  Myths, Presumptions, and Facts about Obesity 
The New England journal of medicine  2013;368(5):446-454.
BACKGROUND
Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.
METHODS
Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations.
RESULTS
We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations.
CONCLUSIONS
False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.)
doi:10.1056/NEJMsa1208051
PMCID: PMC3606061  PMID: 23363498
9.  Systems Science and Childhood Obesity: A Systematic Review and New Directions 
Journal of Obesity  2013;2013:129193.
As a public health problem, childhood obesity operates at multiple levels, ranging from individual health behaviors to school and community characteristics to public policies. Examining obesity, particularly childhood obesity, from any single perspective is likely to fail, and systems science methods offer a possible solution. We systematically reviewed studies that examined the causes and/or consequences of obesity from a systems science perspective. The 21 included studies addressed four general areas of systems science in obesity: (1) translating interventions to a large scale, (2) the effect of obesity on other health or economic outcomes, (3) the effect of geography on obesity, and (4) the effect of social networks on obesity. In general, little research addresses obesity from a true, integrated systems science perspective, and the available research infrequently focuses on children. This shortcoming limits the ability of that research to inform public policy. However, we believe that the largely incremental approaches used in current systems science lay a foundation for future work and present a model demonstrating the system of childhood obesity. Systems science perspective and related methods are particularly promising in understanding the link between childhood obesity and adult outcomes. Systems models emphasize the evolution of agents and their interactions; such evolution is particularly salient in the context of a developing child.
doi:10.1155/2013/129193
PMCID: PMC3655564  PMID: 23710344
10.  Service Use Patterns for Adolescents with ADHD and Comorbid Conduct Disorder 
Service use patterns and costs of youth diagnosed with attention-deficit/hyperactivity disorder (ADHD) and comorbid conduct disorder (CD) were assessed across adolescence (ages 12 through 17). Featured service sectors include mental health, school services, and the juvenile justice system. Data are provided by three cohorts from the Fast Track evaluation and are based on parent report. Diagnostic groups are identified through a structured assessment. Results show that public costs for youth with ADHD exceed $40,000 per child on average over a 6-year period, more than doubling service expenditures for a non-ADHD group. Public costs for children with comorbid ADHD and CD double the costs of those with ADHD alone. Varying patterns by service sector, diagnosis, and across time indicate different needs for youth with different conditions and at different ages and can provide important information for prevention and treatment researchers.
doi:10.1007/s11414-008-9133-3
PMCID: PMC3534729  PMID: 18618263
11.  Issues in the Economic Evaluation of Prevention Programs 
Applied developmental science  2003;7(2):76-86.
Economic analysis plays an increasingly important role in prevention research. In this article, we describe one form of economic analysis, a cost analysis. Such an analysis captures not only the direct costs of an intervention but also its impact on the broader social costs of the illness or problem targeted. The key question is whether the direct costs are offset by reductions in the other, morbidity-related costs, such as the use of expensive services. We begin by describing how economists think about costs. We then outline the steps involved in calculating the costs of delivering an intervention, including both implicit and explicit costs. Next we examine methods for estimating the morbidity-related costs of the illness or problem targeted by the intervention. Finally, we identify the challenges one faces when conducting such an analysis. Throughout the article, we illustrate key points using our experiences with evaluating the Fast Track intervention, a multiyear, multicomponent intervention targeted to children at risk of emotional and behavioral problems.
doi:10.1207/S1532480XADS0702_4
PMCID: PMC2836594  PMID: 20228955
12.  Alternative Methods for Handling Attrition 
Evaluation review  2004;28(5):434-464.
Using data from the evaluation of the Fast Track intervention, this article illustrates three methods for handling attrition. Multiple imputation and ignorable maximum likelihood estimation produce estimates that are similar to those based on listwise-deleted data. A panel selection model that allows for selective dropout reveals that highly aggressive boys accumulate in the treatment group over time and produces a larger estimate of treatment effect. In contrast, this model produces a smaller treatment effect for girls. The article's conclusion discusses the strengths and weaknesses of the alternative approaches and outlines ways in which researchers might improve their handling of attrition.
doi:10.1177/0193841X04264662
PMCID: PMC2765229  PMID: 15358906
attrition; imputation; selection models; nonresponse
13.  Duration of Lactation and Incidence of Maternal Hypertension: A Longitudinal Cohort Study 
American Journal of Epidemiology  2011;174(10):1147-1158.
Never or curtailed lactation has been associated with an increased risk for incident hypertension, but the effect of exclusive breastfeeding is unknown. The authors conducted an observational cohort study of 55,636 parous women in the US Nurses’ Health Study II. From 1991 to 2005, participants reported 8,861 cases of incident hypertension during 660,880 person-years of follow-up. Never or curtailed lactation was associated with an increased risk of incident hypertension. Compared with women who breastfed their first child for ≥12 months, women who did not breastfeed were more likely to develop hypertension (hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.18, 1.36), adjusting for family history and lifestyle covariates. Women who never breastfed were more likely to develop hypertension than women who exclusively breastfed their first child for ≥6 months (HR = 1.29, 95% CI: 1.20, 1.40). The authors found similar results for women who had never breastfed compared with those who had breastfed each child for an average of ≥12 months (HR = 1.22, 95% CI: 1.13, 1.32). In conclusion, never or curtailed lactation was associated with an increased risk of incident maternal hypertension, compared with the recommended ≥6 months of exclusive or ≥12 months of total lactation per child, in a large cohort of parous women.
doi:10.1093/aje/kwr227
PMCID: PMC3246687  PMID: 21997568
breast feeding; hypertension; lactation; oxytocin; parity; pregnancy; prolactin; women
14.  Treatment for ADHD: Is More Complex Treatment Cost-Effective for More Complex Cases? 
Health Services Research  2007;42(1 Pt 1):165-182.
Objective
To determine the cost-effectiveness of three alternative high-quality treatments for attention deficit hyperactivity disorder (ADHD) relative to community care (CC) and to determine whether cost-effectiveness varies with the presence of comorbid disorders.
Data Sources/Collection
The study included 579 children ages 7–9.9 with diagnosed ADHD at six sites. Data for the study were distilled from administrative data and from interviews with parents, including estimates of the child's functional impairment. These analyses focus on changes in functional impairment over 14 months.
Study Design
The study involved a large clinical trial that randomized participants to one of four arms: routine CC, intensive medication management (MedMgt), multicomponent behavioral treatment, and a combination of behavioral treatment and medication.
Principal Findings
We assessed the cost-effectiveness of the alternatives using costs measured from a payer perspective. The preferred cost-effective treatment varies as a function of the child's comorbidity and of the policy maker's willingness to pay. For pure (no comorbidity) ADHD, high-quality MedMgt appears likely to be cost-effective at all levels of willingness to pay. In contrast, for some comorbid conditions, willingness to pay is critical: the policy maker with low willingness to pay likely will judge MedMgt most cost-effective. On the other hand, a policy maker willing to pay more now in expectation of future costs savings (involving, for example, juvenile justice), will recognize that the most cost-effective choice for comorbid conditions likely involves behavior therapy, with or without medication.
Conclusions
Analyses of costs and effectiveness of treatment for ADHD must consider the role of comorbidities.
doi:10.1111/j.1475-6773.2006.00599.x
PMCID: PMC1955245  PMID: 17355587
Cost-effectiveness; ADHD; conduct disorder; anxiety; children
15.  Racial Differences in Parental Reports of Attention-Deficit/Hyperactivity Disorder Behaviors 
Objective
Accurate assessment of racial disparities in attention-deficit/hyperactivity disorder (ADHD) depends on measurement that is equally valid for all groups. This study examines differences among African American and white children in ADHD measurement with a widely used parental report instrument, the Diagnostic Interview Schedule for Children (DISC).
Methods
Data come from 1070 children in the Fast Track Project, a longitudinal study of predominantly low-income children at risk of emotional and/or behavioral problems. Item Response Theory (IRT) methodology is used to determine whether ADHD screening items provide comparable information for African American and white children or whether differential item function (DIF) exists. IRT scores and race/ethnicity are entered in logistic regression models predicting use of ADHD medication.
Results
Seven of 39 DISC items performed differently among African Americans and whites. In most cases, parents of white children were more likely to endorse these items than were parents of African American children at comparable underlying levels of children’s hyperactivity. When items exhibiting differential functioning were deleted, race disparities predicting underlying need as indicated by ADHD medication use decreased and were no longer statistically significant.
Conclusions
Perceptions of ADHD-related symptoms among parents of African American children appear to differ in important ways from those of parents of white children, and screening instruments relying on parent report may yield different results for African American and white children with similar underlying treatment needs. Gathering information from additional sources including teachers and school counselors can provide a more complete picture of the behavioral functioning and therapeutic needs of children in all race/ethnic groups.
doi:10.1097/DBP.0b013e31811ff8b8
PMCID: PMC3396128  PMID: 18049317
attention-deficit/hyperactivity disorder; screening tests; disparities; African Americans; children’s mental health
16.  Oppositional Defiant Disorder toward Adults and Oppositional Defiant Disorder toward Peers: Initial Evidence for Two Separate Constructs 
Psychological assessment  2006;18(4):439-443.
Confirmatory factor analysis of 25 items on the Child and Adolescent Disruptive Behavior Inventory (CADBI v.2.3) was conducted on teacher ratings of 824 kindergarten children and replicated on 534 children. Model fit was improved when correcting for two method effects: (a) adjacent items, and (b) identical behaviors (e.g., argues with adults, argues with peers). The results showed that the 25 items load on three distinct but correlated factors: Hyperactivity, Oppositional to Adults, and Oppositional to Peers. These more refined constructs from the CADBI may be useful for practitioners in identifying children who are at risk and for helping define appropriate contexts in which to intervene. The CADBI and analytic procedures also may contribute to future psychoeducational research on the development of problem behavior.
doi:10.1037/1040-3590.18.4.439
PMCID: PMC2255569  PMID: 17154765
Children; Measurement; Oppositional Defiant Disorder; Factor Analysis
17.  A Spoonful of Math Helps the Medicine Go Down: An Illustration of How Healthcare can Benefit from Mathematical Modeling and Analysis 
Objectives
A recent joint report from the Institute of Medicine and the National Academy of Engineering, highlights the benefits of--indeed, the need for--mathematical analysis of healthcare delivery. Tools for such analysis have been developed over decades by researchers in Operations Research (OR). An OR perspective typically frames a complex problem in terms of its essential mathematical structure. This article illustrates the use and value of the tools of operations research in healthcare. It reviews one OR tool, queueing theory, and provides an illustration involving a hypothetical drug treatment facility.
Method
Queueing Theory (QT) is the study of waiting lines. The theory is useful in that it provides solutions to problems of waiting and its relationship to key characteristics of healthcare systems. More generally, it illustrates the strengths of modeling in healthcare and service delivery.
Queueing theory offers insights that initially may be hidden. For example, a queueing model allows one to incorporate randomness, which is inherent in the actual system, into the mathematical analysis. As a result of this randomness, these systems often perform much worse than one might have guessed based on deterministic conditions. Poor performance is reflected in longer lines, longer waits, and lower levels of server utilization.
As an illustration, we specify a queueing model of a representative drug treatment facility. The analysis of this model provides mathematical expressions for some of the key performance measures, such as average waiting time for admission.
Results
We calculate average occupancy in the facility and its relationship to system characteristics. For example, when the facility has 28 beds, the average wait for admission is 4 days. We also explore the relationship between arrival rate at the facility, the capacity of the facility, and waiting times.
Conclusions
One key aspect of the healthcare system is its complexity, and policy makers want to design and reform the system in a way that affects competing goals. OR methodologies, particularly queueing theory, can be very useful in gaining deeper understanding of this complexity and exploring the potential effects of proposed changes on the system without making any actual changes.
doi:10.1186/1471-2288-10-60
PMCID: PMC2914732  PMID: 20573235
18.  Early Identification of Children At Risk for Costly Mental Health Service Use 
Children and adolescents with serious and persistent conduct problems often require large public expenditures. Successfully diverting one high risk child from unfortunate outcomes may result in a net savings to society of nearly $2 million, not to mention improving the life of that child and his or her family. This figure highlights the potential of prevention, which often rests on the ability to identify these children at a young age. This study examined the ability of a short conduct-problems screening procedure to predict future need for mental health assistance, special education services, and the juvenile justice system during elementary school ages. The screen was based on teacher and parent report of child behavioral habits in kindergarten, and was used to identify children as either at risk or not at risk for behavioral problems. Service outcomes were derived from a service-use assessment administered to parents at the end of the sixth grade, while special education information was gathered through a survey of school records. Study participants (463 kindergarten children; 54% male, 44% African American) were from economically disadvantaged neighborhoods in four diverse communities across the United States. Results indicated that, while controlling for demographic background variables, the risk indicator strongly predicted which children would require services related to conduct disorder or behavioral/emotional problems. Additional analyses revealed that the dichotomous high risk indicator was nearly as strong as the continuous screening variable in predicting the service-use outcomes, and that the screening of both parents and teachers may not be necessary for determining risk status.
PMCID: PMC2774114  PMID: 12458763
prevention; behavioral disorders; service utilization
19.  Preventing Serious Conduct Problems in School-Age Youths: The Fast Track Program 
Children with early-starting conduct Problems have a very poor prognosis and exact a high cost to society. The Fast Track project is a multisite, collaborative research project investigating the efficacy of a comprehensive, long-term, multicomponent intervention designed to prevent the development of serious conduct problems in high-risk children. In this article, we (a) provide an overview of the development model that serves as the conceptual foundation for the Fast Track intervention and describe its integration into the intervention model; (b) outline the research design and intervention model, with an emphasis on the elementary school phase of the intervention; and (c) summarize findings to dale concerning intervention outcomes. We then provide a case illustration, and conclude with a discussion of guidelines for practitioners who work with children with conduct problems.
doi:10.1016/j.cbpra.2007.04.002
PMCID: PMC2771935  PMID: 19890487
20.  Parenting in Context: Impact of Neighborhood Poverty, Residential Stability, Public Services, Social Networks, and Danger on Parental Behaviors 
This prospective longitudinal study examined the unique and combined effects of neighborhood characteristics on parental behaviors in the context of more distal and more proximal influences. With a sample of 368 mothers from high-risk communities in 4 parts of the United States, this study examined relations between race (African American or European American), locality (urban or rural), neighborhood characteristics, family context, and child problem behaviors, and parental warmth, appropriate and consistent discipline, and harsh interactions. Analyses testing increasingly proximal influences on parenting revealed that initial race differences in warmth and consistent discipline disappeared when neighborhood influences were considered. Although generally culture and context did not moderate other relations found between neighborhood characteristics, family context, and child behaviors, the few interactions found highlight the complex influences on parenting.
doi:10.1111/j.1741-3737.2001.00941.x
PMCID: PMC2760988  PMID: 19829752
neighborhood; parenting; race
21.  A Descriptive Study of School Discipline Referrals in First Grade 
Psychology in the schools  2007;44(4):333-350.
School discipline referrals (SDRs) may be useful in the early detection and monitoring of disruptive behavior problems to inform prevention efforts in the school setting, yet little is known about the nature and validity of SDRs in the early grades. For this descriptive study, SDR data were collected on a sample of first grade students who were at risk for developing disruptive behavior problems (n = 186) and a universal sample (n = 531) from 20 schools. Most SDRs were given for physical aggression and the predominant consequence was time out. As expected, boys and at-risk students were more likely to receive an SDR and to have more SDRs than were girls and the universal sample. A large difference between schools regarding the delivery of SDRs was found. A zero-inflated Poisson model clustered by school tested the prediction of school-level variables. Students in schools that had a systematic way of tracking SDRs were more likely to receive one. Also, schools with more low-income students and larger class sizes gave fewer SDRs. SDRs predicted teacher ratings, and to a lesser extent, parent ratings of disruptive behavior at the end of first grade. Practitioners and researchers must examine school-level influences whenever first grade discipline referrals are used to measure problem behavior for the purpose of planning and evaluating interventions.
doi:10.1002/pits.20226
PMCID: PMC1828691  PMID: 17372623
22.  Measuring Time Costs in Interventions Designed to Reduce Behavior Problems Among Children and Youth 
The economic evaluation of psychosocial interventions is a growing area of research. Though time costs are central to the economist’s understanding of social costs, these costs generally have been ignored by prevention scientists. This article highlights the need to measure such costs and then reviews the principles economists use in valuing time. It then considers the specific time costs that often arise in interventions designed to reduce behavior problems among children and youth. These include classroom time devoted to program activities, the time of parents or other caregivers, the time of teachers (outside of the classroom), and the time of volunteers. We consider the economic principles that govern how economists value these inputs and then apply these principles to data from an evaluation of a prominent intervention in the field, the Incredible Years Program. We find that the time costs are potentially rather large and consider the implications for public policy of ignoring them.
doi:10.1007/s10464-007-9125-0
PMCID: PMC1935433  PMID: 17592769
Costs‐and Cost‐Analysis; Health‐Care‐Costs; Behavior‐Problems; Mental‐Health‐Services; School‐Based‐Intervention; Parent‐Training

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