Dataset Information

Scaling Up a Multifaceted Violence Prevention Package: County-Level Impact of the North Carolina Youth Violence Prevention Center.

ABSTRACT:

Objective

Multifaceted approaches to youth-violence prevention package evidence-based programs into initiatives that yield large-scale impact. This study assessed the impact of a package of evidence-based violence prevention programs, implemented as part of the North Carolina Youth Violence Prevention Center, on county-level violence indicators.

Method

Using growth-curve modeling, the target county was compared to all other counties in North Carolina and a comparison county.

Results

Results reveal downward trends on several county-level indicators (i.e., undisciplined/delinquent complaints, total delinquent complaints, juvenile arrests-aggravated assaults, and short-term suspensions) throughout the intervention period. However, statistical tests were unable to confirm that intervention-period scores on youth-violence indicators were significantly different than expected scores given the relationship between pretest and intervention-period scores in other North Carolina counties.

Conclusions

Although additional administrative data points are needed to support the hypotheses, this study provides preliminary evidence of the effectiveness of North Carolina Youth Violence Prevention Center interventions.

SUBMITTER: Smokowski PR

PROVIDER: S-EPMC5396956 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Scaling Up a Multifaceted Violence Prevention Package: County-Level Impact of the North Carolina Youth Violence Prevention Center.

Smokowski Paul R PR Cotter Katie L KL Guo Shenyang S Evans Caroline Bill Robertson CBR

Journal of the Society for Social Work and Research 20170126 1

<h4>Objective</h4>Multifaceted approaches to youth-violence prevention package evidence-based programs into initiatives that yield large-scale impact. This study assessed the impact of a package of evidence-based violence prevention programs, implemented as part of the North Carolina Youth Violence Prevention Center, on county-level violence indicators.<h4>Method</h4>Using growth-curve modeling, the target county was compared to all other counties in North Carolina and a comparison county.<h4>Re ...[more]

PMID: 28435538

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Project description:ObjectiveYouth depression is increasing and is associated with adverse concurrent and long-term outcomes. Understanding receipt of depression treatment and outcomes is critical for population-level efforts to address youth depression. This study aimed to understand treatment patterns and their association with depression-related outcomes.MethodNorth Carolina Medicaid claims were used to conduct a retrospective cohort study of treatment and depression-related outcomes in pediatric Medicaid beneficiaries. The sample included 34,623 youth ages 5 to 21 years with an incident depression diagnosis. Psychotherapy and antidepressant medication were assessed for 6 months following diagnosis. Depression-related outcomes including suicidal or self-harming behaviors, emergency department use, and psychiatric hospitalization were analyzed using Cox proportional hazards models to calculate hazard ratios.ResultsAmong youth with depression, 86% received treatment (39% psychotherapy, 16% medication, 31% combined), but few youth received guideline-recommended treatment duration. At 6 and 18 months, youth who received combined treatment had higher risk of adverse outcomes compared with the other groups. The untreated group had lower risk of outcomes other than all-cause emergency department visits. Single-session psychotherapy and inconsistent medication fills were also associated with poor outcomes; however, more psychotherapy sessions were associated with lower risk of all-cause emergency department visits.ConclusionThese data show that the majority of youth who received depression treatment had suboptimal adherence to recommended guidelines. Youth who received combined treatment (both medication and therapy) had more adverse depression outcomes. As claims records do not include clinical data, the effect of treatment type, dose, depression severity, or a combination of these factors cannot be readily disentangled; therefore, these findings do not support a conclusion that combined treatment leads to poor outcomes. Rather, it is possible that youth with a more severe clinical profile are more likely to be prescribed combined treatment or to have poor adherence and thus worse outcomes. Understanding how to improve adherence in real-world settings is needed. Results suggest that many youth continue to struggle despite receipt of mental health care, indicating a call for enhancing existing treatment strategies. Research should aim to better understand population-level care for depression and to promote receipt of and adherence to recommended treatment duration across modalities.Diversity & inclusion statementOne or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Project description:We sought to examine how the impact of revocable behavioral interventions, e.g., shelter-in-place, varies throughout an epidemic, as well as the role that the proportion of susceptible individuals had on an intervention's impact. We estimated the theoretical impacts of start day, length, and intensity of interventions on disease transmission and illustrated them on COVID-19 dynamics in Wake County, North Carolina, to inform how interventions can be most effective. We used a Susceptible, Exposed, Infectious, and Recovered (SEIR) model to estimate epidemic curves with modifications to the disease transmission parameter (β). We designed modifications to simulate events likely to increase transmission (e.g., long weekends, holiday seasons) or behavioral interventions likely to decrease it (e.g., shelter-in-place, masking). We compared the resultant curves' shape, timing, and cumulative case count to baseline and across other modified curves. Interventions led to changes in COVID-19 dynamics, including moving the peak's location, height, and width. The proportion susceptible, at the start day, strongly influenced their impact. Early interventions shifted the curve, while interventions near the peak modified shape and case count. For some scenarios, in which the transmission parameter was decreased, the final cumulative count increased over baseline. We showed that the timing of revocable interventions has a strong impact on their effect. The same intervention applied at different time points, corresponding to different proportions of susceptibility, resulted in qualitatively differential effects. Accurate estimation of the proportion susceptible is critical for understanding an intervention's impact. The findings presented here provide evidence of the importance of estimating the proportion of the population that is susceptible when predicting the impact of behavioral infection control interventions. Greater emphasis should be placed on the estimation of this epidemic component in intervention design and decision-making. Our results are generic and are applicable to other infectious disease epidemics, as well as to future waves of the current COVID-19 epidemic. Developed into a publicly available tool that allows users to modify the parameters to estimate impacts of different interventions, these models could aid in evaluating behavioral intervention options prior to their use and in predicting case increases from specific events.

Dataset Information

Scaling Up a Multifaceted Violence Prevention Package: County-Level Impact of the North Carolina Youth Violence Prevention Center.

Objective

Method

Results

Conclusions

Publications

Scaling Up a Multifaceted Violence Prevention Package: County-Level Impact of the North Carolina Youth Violence Prevention Center.

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