Investigating Effects of Mentoring for Youth with Assault Injuries: Results of a Randomized-Controlled Trial
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| Title: | Investigating Effects of Mentoring for Youth with Assault Injuries: Results of a Randomized-Controlled Trial |
|---|---|
| Language: | English |
| Authors: | Lindstrom Johnson, S. (ORCID |
| Source: | Prevention Science. Nov 2022 23(8):1414-1425. |
| Availability: | Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ |
| Peer Reviewed: | Y |
| Page Count: | 12 |
| Publication Date: | 2022 |
| Sponsoring Agency: | National Institute on Minority Health and Health Disparities (NIMHD) (DHHS/NIH) |
| Contract Number: | P20MD000198 |
| Document Type: | Journal Articles Reports - Research |
| Descriptors: | Adolescents, Injuries, Violence, Peer Relationship, Prevention, Mentors, Curriculum Evaluation, Behavior Problems |
| DOI: | 10.1007/s11121-022-01406-z |
| ISSN: | 1389-4986 1573-6695 |
| Abstract: | Mentoring is considered an evidence-based practice for violence prevention. This study presents a partial replication of the "Take Charge!" program implemented in partnership with Big Brothers Big Sisters of America (BBBS). One hundred and eighty-eight early adolescents (M age = 12.87; 61.17% male) who were treated for peer-related assault injury in two urban mid-Atlantic emergency departments were randomly assigned to receive a mentor from two BBBS affiliates. Mentors and organization staff were trained in the "Take Charge!" violence prevention curriculum, which had previously shown evidence of efficacy. Intent-to-treat analyses showed statistically significant improvements in conflict avoidance self-efficacy for the intervention group at 9 months and reductions in fighting at 21 months, but an increase in parental report of aggression at 9 months. Complier average causal effect models revealed evidence of an additional effect for reduced problem behavior at 21 months for intervention adolescents who received a mentor. No effects were found for youth-reported aggression, retaliatory attitudes, deviance acceptance, or commitment to learning. Sensitivity analyses suggested increased aggressive behavior for adolescents in the intervention group who did not receive a mentor (i.e., non-compliers). These findings extend the evidence-base for "Take Charge!" as a violence prevention curriculum for youth already engaged in violence to "real-world" implementation settings. However, they also suggest that challenges associated with providing youth with mentors can be consequential and that additional supports may be needed for these youth/parents. |
| Abstractor: | As Provided |
| Entry Date: | 2022 |
| Accession Number: | EJ1352826 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwFiDrC627HmT3-XtQHboxX_AAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDO9HoirBSH6kvqYEIgIBEICBmvGvyU2i00bEBmDRD2NNNFwg3dYfzIHGjUf7bKrv5shmZsk4pUfZHPOLTRVR-YzwFBpJ4o2HDM998-2r3rGtWYvJ5a2morvSJDCNnzVk3wpQr6iSWrwF9mrQqBn-uNa1Gh2u47csvoWgvciPTMSOILemyubUCSnaK1RvCvL7KvTkQqtEtQ0vtPyXUXAirHm8bcKKNYB7RUOBrY0= Text: Availability: 1 Value: <anid>AN0159793922;n9p01nov.22;2022Oct25.05:27;v2.2.500</anid> <title id="AN0159793922-1">Investigating Effects of Mentoring for Youth with Assault Injuries: Results of a Randomized-Controlled Trial </title> <p>Mentoring is considered an evidence-based practice for violence prevention. This study presents a partial replication of the Take Charge! program implemented in partnership with Big Brothers Big Sisters of America (BBBS). One hundred and eighty-eight early adolescents (M age = 12.87; 61.17% male) who were treated for peer-related assault injury in two urban mid-Atlantic emergency departments were randomly assigned to receive a mentor from two BBBS affiliates. Mentors and organization staff were trained in the Take Charge! violence prevention curriculum, which had previously shown evidence of efficacy. Intent-to-treat analyses showed statistically significant improvements in conflict avoidance self-efficacy for the intervention group at 9 months and reductions in fighting at 21 months, but an increase in parental report of aggression at 9 months. Complier average causal effect models revealed evidence of an additional effect for reduced problem behavior at 21 months for intervention adolescents who received a mentor. No effects were found for youth-reported aggression, retaliatory attitudes, deviance acceptance, or commitment to learning. Sensitivity analyses suggested increased aggressive behavior for adolescents in the intervention group who did not receive a mentor (i.e., non-compliers). These findings extend the evidence-base for Take Charge! as a violence prevention curriculum for youth already engaged in violence to "real-world" implementation settings. However, they also suggest that challenges associated with providing youth with mentors can be consequential and that additional supports may be needed for these youth/parents. Clinical trials number: clinicaltrials.gov NCT01770873.</p> <p>Keywords: Violence prevention; Mentoring; Efficacy; Assault injuries; Early adolescents</p> <p>Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s11121-022-01406-z.</p> <p>Mentoring is listed as an effective practice in preventing crime and delinquency and a promising practice for improving education and behavioral health outcomes (Office of Juvenile Justice and Delinquency Prevention, [<reflink idref="bib27" id="ref1">27</reflink>]). Mentoring is thought to improve outcomes through the creation of meaningful relationship with a nonparental adult who can provide social support and positive modeling around socio-emotional, cognitive, and identity development (DuBois et al., [<reflink idref="bib14" id="ref2">14</reflink>]). Big Brothers and Big Sisters of America (BBBS) is the oldest, largest, and best-known community-based mentoring organization in the USA. This paper presents the results of a partnership with two BBBS agencies to augment traditional systems and activities to include a previously evaluated violence prevention curriculum, <emph>Take Charge!</emph>, to meet the needs of youth who had been treated for an assault injury in the emergency department (ED). Meta-analyses consistently identify small to moderate effect sizes for mentoring programs across a variety of outcomes including academic performance, conduct problems, psychological and social functioning, and attitudes/motivations (DuBois et al., [<reflink idref="bib14" id="ref3">14</reflink>]; Raposa et al., [<reflink idref="bib29" id="ref4">29</reflink>], [<reflink idref="bib30" id="ref5">30</reflink>]; Tolan et al., [<reflink idref="bib32" id="ref6">32</reflink>]). These same meta-analyses also find larger effects for programs that serve youth at higher risk. Youth treated for an assault injury in the ED represent an important population for violence prevention efforts given both their increased likelihood for repeat injuries and the possibility that the ED visit could represent a teachable moment (Cunningham et al., [<reflink idref="bib11" id="ref7">11</reflink>]).</p> <hd id="AN0159793922-2">Effectiveness of Mentoring for Violence Prevention</hd> <p>While previous meta-analyses (DuBois et al., [<reflink idref="bib14" id="ref8">14</reflink>]) and funding initiatives focused on populations with risk factors suggested the possibility of increased benefit from mentoring, there is a concern that mentors do not have the skills to support or maintain a relationship with youth with additional behavioral and psychosocial needs (Grossman &amp; Rhodes, [<reflink idref="bib16" id="ref9">16</reflink>]; Tolan et al., [<reflink idref="bib32" id="ref10">32</reflink>]). Tolan et al. ([<reflink idref="bib32" id="ref11">32</reflink>]) focused their meta-analysis on programs that served a sample of youth deemed at-risk for delinquency due to either their own behavior or residence in a high-crime area. They found significant effect sizes for mentoring programs on aggression (<emph>d</emph> = 0.29) and delinquency (<emph>d</emph> = 0.21). Significant heterogeneity was identified in effect sizes, suggesting the need to identify program characteristics predictive of improved outcomes.</p> <p>One particular tension is to what extent mentoring programs should be focused exclusively on relationship-building versus targeted-skills development. A re-analysis of the Raposa et al. ([<reflink idref="bib29" id="ref12">29</reflink>], [<reflink idref="bib30" id="ref13">30</reflink>]) meta-analysis found that programs with a targeted approach had double the effect size of those with non-specific relational approaches (<emph>g</emph> = 0.25 vs. <emph>g</emph> = 0.11; Christenson et al., [<reflink idref="bib8" id="ref14">8</reflink>]). Moderator analyses suggested that the effect of the targeted approach was additionally beneficial for high-risk youth and for academic functioning, psychological symptoms, and social functioning. However, research suggests that adding structure to mentoring programs under more typical conditions of real-world implementation may yield fewer benefits for delinquency reduction than hypothesized (DuBois &amp; Keller, [<reflink idref="bib13" id="ref15">13</reflink>]). This highlights the importance of exploring the benefits of targeted approaches for youth with increased risk for violence when implemented in real-world settings.</p> <hd id="AN0159793922-3">The Take Charge! Program</hd> <p>The <emph>Take Charge!</emph> program is a violence prevention mentoring program, designed for youth ages 10–15 treated in the ED for an assault injury as a result of peer-to-peer violence (Cheng et al., [<reflink idref="bib7" id="ref16">7</reflink>]). The program uses a one-on-one, community-based mentoring model to pair adults to meet with youth over 2 to 6 months and deliver a 6-session violence prevention curriculum as well as engage in relationship-building activities. In addition, parents are offered three home visits focused on parental involvement and monitoring. Core curriculum pieces are based on the Social Cognitive Theory (Bandura, [<reflink idref="bib3" id="ref17">3</reflink>]) and include a focus on situation perception, behavioral capability, outcome expectation, and self-efficacy (see Online Resource A). A randomized-controlled trial of the intervention in an urban mid-Atlantic sample found significant declines for those in the intervention condition relative the control condition in youth report of misdemeanors at 6 months, but not other behavior changes such as 30-day fights and fight injuries or youth or parent report of aggression. The intervention condition relative the control condition also reported increases in conflict avoidance self-efficacy at the 6-month follow-up, but no differential changes in attitudes toward interpersonal violence or retaliation and social competence. When taking into account adherence, an additional effect of youth self-reported reduced aggression was suggested for the high adherence group relative the control condition. This evaluation represents a partial replication of the above study, with a focus on embedding the intervention within existing mentoring agencies.</p> <hd id="AN0159793922-4">This Study</hd> <p>By moving to BBBS as implementer, the current trial of <emph>Take Charge!</emph> makes an important move toward understanding the effectiveness of this targeted mentoring approach. Therefore, it addresses important questions of feasibility for implementation, sustainability, and potential scale-up within existing community-based mentoring organizations. This is critical to do early in the development and evaluation process because promising initial intervention trial results often fail to replicate when interventions are evaluated in more naturalistic settings, apparently at least in part because of inadequate consideration of fit with existing practices and other features of host organizations (i.e., values, staff capacity, training systems; DuBois &amp; Silverthorn, [<reflink idref="bib15" id="ref18">15</reflink>]). This study utilized a randomized-controlled trial design to evaluate the impact of <emph>Take Charge!</emph> 2.0 for youth who had been treated in the ED for peer assault injuries. Youth in two cities were randomly assigned to receive a BBBS mentor who had been trained in the <emph>Take Charge!</emph> curriculum, with additional support before and after the youth was matched with the mentor, compared to usual care. Intervention effects were examined from both an intent-to-treat perspective as well as an as-treated perspective. The latter analysis relied on a complier average causal effect (CACE) framework to understand the impact of <emph>Take Charge!</emph> 2.0 when youth were successfully paired with a mentor, which was not the case for all youth in the intervention condition. Given the above-noted focus on effectiveness, the CACE analysis is a critical addition. Specifically, consideration of these results in combination with those of the intent-to-treat analyses provided an opportunity for insight into the extent to which real-world variations in implementation are a factor in observed effects of the program, thus clarifying the benefits that may accrue if program delivery processes can be improved.</p> <hd id="AN0159793922-5">Method</hd> <p></p> <hd id="AN0159793922-6">Sample</hd> <p>Study participants were 188 adolescents between the ages of 10- and 15-years-old presenting for a peer fight-related injury in two urban, pediatric EDs (Baltimore, MD; Philadelphia, PA) between June 2014 and June 2016 when recruitment was stopped to ensure adequate follow-up time within funding constraints. Most assaults did not involve weapons (84.57%) and only one adolescent was hospitalized as a result of their injury. The aggressors reported by participants were most frequently classmates (41.49%) or acquaintances (24.47%). See Table 1 for sample demographics and a comparison between intervention and control group participants. At baseline, the groups differed significantly only by household income, with more participants in the intervention group reporting income less than $25,000 (<emph>p</emph> ≤ 0.05).</p> <p>Table 1 Demographic characteristics of sample by intervention condition</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" /&gt;&lt;th align="left"&gt;&lt;p&gt;Full sample&lt;/p&gt;&lt;p&gt;(&lt;italic&gt;n&lt;/italic&gt; = 188; %)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Intervention condition&lt;/p&gt;&lt;p&gt;(&lt;italic&gt;n&lt;/italic&gt; = 98; %)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Control condition&lt;/p&gt;&lt;p&gt;(&lt;italic&gt;n&lt;/italic&gt; = 90; %)&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Mean age (SD)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12.87 (1.52)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12.93 (11.55)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12.83 (1.49)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Recruitment site&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Baltimore&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;102 (54.3%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;54 (55.1%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;48 (53.3%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Philadelphia&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;86 (45.7%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;44 (44.9%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;42 (46.7%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Race/ethnicity&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Black&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;178 (94.68%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;95 (96.94%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;83 (92.22%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; White&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 (1.60%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 (1.02%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 (2.22%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Latino/a&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 (1.60%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 (1.02%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 (2.22%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Asian&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 (0.53%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 (1.02%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0 (0%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Multiracial&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 (1.06%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0 (0%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 (2.22%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Other&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 (0.53%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0 (0%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 (1.11%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Gender&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;115 (61.17%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;57 (63.33%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;58 (59.18%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Female&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;73 (38.83%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;33 (36.67%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;40 (42.11%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Parent relationship&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Biological mother&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;163 (86.70%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;86 (87.76%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;77 (85.56%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Biological father&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 (4.26%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4 (4.08%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 (8.89%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Stepfather&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 (0.53%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0 (0%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 (1.11%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Grandmother&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 (4.26%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5 (5.10%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 (8.89%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Other&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 (4.26%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 (3.06%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 (8.89%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Parental education&lt;sup&gt;t&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; High school or less&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;112 (59.57%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;52 (53.06%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;60 (66.66%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Some college or more&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;76 (40.43%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;46 (46.94%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30 (33.33%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Annual family income &amp;#60; $25,000*&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Yes&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;115 (61.17%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;60 (70.59%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;55 (56.12%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; No&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;68 (37.17%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25 (29.41%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;43 (43.89%)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <sups>*</sups> <emph>p</emph> ≤ 0.05; <sups>t</sups><emph>p</emph> ≤ 0.10</p> <hd id="AN0159793922-7">Procedures</hd> <p>Research staff used the ED electronic patient tracking system and medical records to identify potentially eligible families. Families then were contacted by mail/phone to provide information about the study and further assess eligibility. Exclusion criteria included injuries due to child abuse, sexual abuse, sibling fights or other fights involving household members, or fights with police. Adolescents and their parents/guardians had to be able to speak and understand English and have the ability to participate in a mentoring intervention. Specifically, as part of the intervention, participants randomized to receive mentoring were required to complete the BBBS application and interview process. In addition, due to BBBS policies, adolescents had to reside with parents/guardians and the caregiver could not currently be involved in an ongoing custody dispute or Child Protective Services investigation. Participants were enrolled a median of 62 days after the ED visit, which did not differ significantly by intervention status. A study visit, either at home or at the hospital/clinic, was conducted with families in order to obtain written parent/guardian consent and adolescent assent.</p> <p>At study visits, the parent and adolescent completed a separate in-person interview (baseline) and an audio-computer assisted self-interview (ACASI; all visits) questionnaire. The interview collected information about demographics and the circumstances of the injury. The use of headphones for the ACASI questionnaire allowed for the private collection of potentially more sensitive information from participants, including adolescent behaviors and parenting practices. The data collection process took approximately 1 h for the family to complete, with families receiving $30, $40, and $50 as remuneration for their time for baseline, 9-month, and 21-month visits, respectively. Additionally, a research assistant used an electronic abstraction guide to log relevant information from the ED medical record of the target visit. Visits took place either at home or in the clinic based on the preference of the family. Research staff were blind to intervention condition at baseline; only electronic data collection was used for follow-up assessments. Data were available for 149 youth (79%) at 9 months and 148 youth (79%) at 21 months. Attrition did not vary by demographic factors or outcome variables except aggression; youth who reported more aggression at baseline were less likely to be lost to follow-up at 21 months, which was controlled for in all analyses. Attrition was slightly higher at 9- and 21-month time points for the control condition; attrition and differential attrition were within the bounds of acceptability as determined by the What Works Clearinghouse (WWC, [<reflink idref="bib34" id="ref19">34</reflink>]). Details are provided in the CONSORT diagram in Fig. 1.</p> <p>Graph: Fig. 1 Take Charge! 2.0 CONSORT diagram</p> <p>We used a random number generator to determine assignment to intervention or control in blocks of 6 per gender by site. Following the baseline data collection, the research team opened a sealed envelope containing group assignment with the family present and informed them of the services they would receive. Ninety-eight youth were referred to BBBS for pairing with a mentor and ninety were assigned to a comparison group that received usual post-visit care, which included written recommendations and suggestions for follow-up care. While specific services related to prevention of future assault injuries were not assessed for this group, similar receipt of psychological services was reported at follow-up visits for intervention and control youth. Youth referred to BBBS were eligible to be matched with a mentor who had received standard BBBS training as well as additional training on violence prevention. Assuming covariates (e.g., baseline score on the outcome) account for 25% of the variance in the outcome, sample of 160 was estimated to be needed for statistical power of 0.80 to detect an effect size (ES) of 0.39 with alpha = 0.05 (two-tailed). Applying a more liberal criterion of alpha = 0.10 (two-tailed), the minimum detectable effect size was 0.34 (Dong &amp; Maynard, [<reflink idref="bib12" id="ref20">12</reflink>]).</p> <hd id="AN0159793922-8">Intervention</hd> <p>BBBS staff, including those responsible for volunteer recruitment, family enrollment, and match support received a half-day introductory training that provided an overview of <emph>Take Charge!</emph> 2.0 including detailed descriptions of the parent and youth curriculum as well as how BBBS staff were being asked to support implementation. Volunteers recruited to mentor for BBBS, independent of this study, were asked if they wanted to participate in <emph>Take Charge!</emph> 2.0. Once they completed the required application and screening processes of BBBS, which include a criminal background investigation, they were introduced to <emph>Take Charge!</emph> 2.0 during BBBS orientation. After agreeing to participate, they were matched with a <emph>Take Charge!</emph> 2.0 youth following usual BBBS protocols of initially sharing information and with all parties agreeing to the match after an in-person meeting. The mentor then completed an additional training module for <emph>Take Charge!</emph> 2.0 on IMPACT U, the online training site used by BBBS.</p> <p>The mentor training reviewed the 9 sections of the <emph>Take Charge!</emph> curriculum (Cheng et al., [<reflink idref="bib7" id="ref21">7</reflink>]), which consisted of obtaining their consent for participation in research, a <emph>Take Charge!</emph> 2.0 overview, a review of the six <emph>Take Charge!</emph> program units, and a "getting prepared" section. In total, the training was designed to take mentors less than 1 hour to complete. The training was interactive and included videos of example session activities as well as links to additional resources that could be used with the mentee. Mentors continued to have access to this training throughout the course of their involvement with <emph>Take Charge!</emph> 2.0 and were provided with a digital copy of a curriculum guide. The guide included detailed and sometimes scripted information to help mentors complete the needed activities. In addition, the usual monthly contacts with BBBS Match Support Specialists asked about completion of <emph>Take Charge!</emph> 2.0 activities and they provided specific assistance in overcoming barriers.</p> <p>The expectation was that after 1 month of relationship building, the mentor would guide the youth in the 6 violence prevention units over 6 subsequent visits. Each of the 40-min units included discussion of specific objectives, presentation of a problem-solving activity, practice and role-playing skills, and summation of concepts and objectives. Specific topics covered included a discussion of the intervention and goal setting utilizing possible selves (unit 1), recognition of anger triggers and practice in self-regulation (unit 2), problem-solving skills and conflict management (unit 3), weapon safety (unit 4), digital safety and decision-making (unit 5), and a wrap up/review (unit 6). Additionally, parents were invited to participate in three parenting support sessions (Cheng et al., [<reflink idref="bib7" id="ref22">7</reflink>]), with the first session covering the basics of the youth curriculum and delivered by project staff immediately after randomization to the intervention condition. The remaining two parenting intervention sessions were provided by BBBS staff as an additional part of the mentor match process at a time convenient for the family. These sessions involved interactive activities (e.g., role playing and worksheets) and focused on setting parenting expectations around youth behavior and parental monitoring (see Online Resource A). Specific delivery adaptations that differed from the previous trial of <emph>Take Charge</emph> include the use of an online system for training, program support for mentors, delivery of the parenting intervention by the community-based mentoring agency, and the inclusion of technology in the curriculum.</p> <hd id="AN0159793922-9">Measures</hd> <p>Outcome measures assessed behaviors, attitudes, and skills and were collected at all timepoints. We conceptualize attitudes and skills to be important mediators in the pathway to reduced violence involvement; however, they are important secondary outcomes in their own right. Unless otherwise indicated, all measures are youth report.</p> <hd id="AN0159793922-10">Behaviors</hd> <p>Fighting was assessed by asking "How many times were you in a physical fight with persons other than your brother(s) or sister(s) in the last 30 days?" (Centers for Disease Control and Prevention, [<reflink idref="bib9" id="ref23">9</reflink>]-[<reflink idref="bib9" id="ref24">9</reflink>]). Based on the distribution, responses were truncated at 6. Involvement in problem behavior was assessed using the Going Places Instrument. This measure has 7 open-ended questions that ask how many times in the past 30 days the youth has engaged in various behaviors (e.g., damaged property, hung out with someone who would get into trouble, started a fight; alpha range across times of assessment = 0.78–0.81; Simons-Morton et al., [<reflink idref="bib31" id="ref25">31</reflink>]). Aggression was assessed using the Modified Aggression Scale (Bosworth &amp; Espelage, [<reflink idref="bib5" id="ref26">5</reflink>]), whereby youth are asked the number of times they engaged in 12 aggressive behaviors over the past 30 days including hitting, threatening, yelling, and teasing. Response options include 6 categories ranging from 0 to 5 or more (alpha range = 0.88–0.92). Parent report of aggression was obtained using the Aggression subscale of the Child Behavior Checklist (Achenbach, [<reflink idref="bib1" id="ref27">1</reflink>]), whereby the parent indicates on a three-point scale the truth of 18 statements for the child (e.g., gets into fights, hot temper; alpha range = 0.90–0.91). For all of the multi-item measures, item responses were averaged, with higher scores indicating greater report of involvement.</p> <hd id="AN0159793922-11">Attitudes</hd> <p>Retaliation beliefs were assessed using the 8-item Children's Perception of Environmental Violence scale (Hill &amp; Noblin, [<reflink idref="bib17" id="ref28">17</reflink>]). Items start with the stem "I believe" and are followed by statements such as "if someone hits you, you should hit back" and "if someone hurts you, you should forgive and forget." Items are answered with a 4-point Likert scale from strongly agree to strongly disagree and are reversed coded so that a higher score indicates more retaliatory beliefs. Item responses were averaged (alpha range = 0.79–0.80). Deviance acceptance was assessed using 4 items from the California Healthy Kids Survey (California Healthy Kids Survey, [<reflink idref="bib6" id="ref29">6</reflink>]). These items have a question stem of "How do you feel about someone your age doing the following" and assess smoking, trying marijuana, using marijuana frequently, and carrying a weapon to school. Response options are neither approve nor disapprove, somewhat disapprove, and strongly disapprove. Item responses are reverse coded so that higher scores indicate beliefs more accepting of deviance before being averaged (alpha range = 0.86–0.93). Conflict avoidance self-efficacy was assessed with an 11-item scale, the questions for which ask about the ability to use non-violent strategies to resolve a conflict, avoidance of conflict situations, and involvement in prosocial behaviors (Cheng et al., [<reflink idref="bib7" id="ref30">7</reflink>]). Items are asked on a 4-point Likert scale from strongly agree to strongly disagree and are reverse coded so that higher equals more self-efficacy. Item responses are averaged (alpha range = 0.86–0.90).</p> <hd id="AN0159793922-12">Skills</hd> <p>Social competence was assessed using 8 items from the Developmental Assets Profile (DAP; Benson et al., [<reflink idref="bib4" id="ref31">4</reflink>]). Specifically, youth were asked how true each of the following statements were for them: "build friendships with other people," "accept people who were different than them," and "express their feelings in appropriate ways." Youth responded using a 4-point Likert scale from not at all or rarely to extremely or almost always. Responses were averaged with higher scores indicating greater reported social competence (alpha range = 0.85–0.91). Commitment to learning was assessed similarly using 7 items from the DAP, including "care about school," "actively engaged in learning new things," and "do my homework" (alpha range = 0.87–0.89). Hopes and goals for youth were assessed using 10 items from the Child Trend's Flourishing Youth Project (Lippman et al., [<reflink idref="bib24" id="ref32">24</reflink>]). Three items assessed hope that focused on expectations and excitement about the future, and seven items assessed the existence and importance of goals and strategies to meet them. Responses were made on a 5-point Likert scale from not at all like me to exactly like me, with items reverse coded as needed so that a higher score indicated greater hopes and goals (alpha range = 0.76–0.83).</p> <hd id="AN0159793922-13">Data Analysis</hd> <p></p> <hd id="AN0159793922-14">Intent-to-Treat Analysis</hd> <p>Regression analyses to estimate intervention effects at both 9 and 21 months under the intent-to-treat framework were run in Mplus (Muthén &amp; Muthén, [<reflink idref="bib26" id="ref33">26</reflink>]–[<reflink idref="bib26" id="ref34">26</reflink>]). Baseline differences between intervention and control conditions were found by income &gt; $25,000 a year and parent report of aggression; these were included as control variables in the regression analyses. Youth report of fighting was modeled as a count variable (i.e., negative binomial to account for overdispersion). Scales were computed if 60% of data were present (maximum missing for any scale was <emph>n</emph> = 5 (3.14%); full information maximum likelihood (FIML) was used to allow for the retention of all cases). Standardized mean differences (i.e., difference in model-estimated means for intervention and control groups on the outcome divided by the pooled standard deviation of the measure at the same time point) were used as effect sizes (ES). A package in R was used to calculate effect sizes for count outcomes (Coxe, [<reflink idref="bib10" id="ref35">10</reflink>]); these ES can be interpreted as standardized mean differences.</p> <hd id="AN0159793922-15">CACE</hd> <p>The overall purpose of CACE analysis is to compare compliers in the intervention group with would-be compliers in the control group (Peugh et al., [<reflink idref="bib28" id="ref36">28</reflink>]). The rationale for this analysis is based on a compliance rate greater than 0, but less than 100%, where "compliance" in the present context is receipt of a mentor. Whereas an as-treated analysis would compare these individuals to all individuals in the control group, CACE analysis accounts for the unknown compliance status of those in the control group. The goal is to identify individuals in the control group who would have received the intervention had they been assigned to take it.</p> <hd id="AN0159793922-16">Compliance</hd> <p>Compliance was determined to be successful matching with a BBBS mentor. As compliance generally must be assessed as dichotomous variable, the threshold set for compliance has trade-offs. For this project, setting the compliance threshold to be receipt of a specific number of <emph>Take Charge!</emph> sessions would have resulted in estimates that were not necessarily generalizable to everyday practice in which implementation of interventions may be more fluid (e.g., portions of sessions are delivered). Importantly, defining compliance as receipt of any mentoring also avoids biases that may occur with dosage variables (e.g., number of sessions) for determining compliance (WWC, [<reflink idref="bib34" id="ref37">34</reflink>]). Additionally, determining compliance to have been matched plus receipt of all 3 parent sessions would have resulted in too few compliers.</p> <hd id="AN0159793922-17">Assumptions of CACE</hd> <p>The core assumption for CACE analyses that provides the basis for causal inference is the ignorable treatment assignment assumption, which states that treatment assignment is independent of potential outcomes for each participant conditioned on the baseline covariates (Angrist et al., [<reflink idref="bib2" id="ref38">2</reflink>]). This is satisfied by the presence of random assignment. The assumption of stable unit treatment value states that the outcome of one participant is independent from the outcome of another participant. For <emph>Take Charge!</emph> 2.0, as randomization and delivery of the intervention occurred at the individual level this assumption can be assumed to be met. The monotonicity assumption assumes that there were no defiers (i.e., participants who will do the opposite of the condition to which they are randomized). This assumption mainly concerns contamination; as our compliance threshold was receipt of a <emph>Take Charge</emph>-trained BBBS mentor, individuals who were non-compliers by definition did not have access to the intervention. Although individuals in the control condition did not have access to a BBBS mentor trained in the <emph>Take Charge!</emph> curriculum, 11 (16.66%) reported having an adult mentor through a formal program at 9 months and 4 (5.71%) reported having a mentor at 21 months. Finally, the exclusion restriction states that the effect of being assigned to receive the intervention on the outcome is mediated entirely by compliance status; in other words, for those in the intervention group who are non-compliers (in this case, those not being matched with a BBBS mentor), assignment to the intervention group has no consequences for their outcome.</p> <hd id="AN0159793922-18">Estimation of CACE</hd> <p>We used maximum likelihood (ML), which is not sensitive to violations in parametric assumptions (Jo, [<reflink idref="bib18" id="ref39">18</reflink>]). To do this, we incorporated the Mixture Modeling feature in Mplus (Muthén &amp; Muthén, [<reflink idref="bib26" id="ref40">26</reflink>]–[<reflink idref="bib26" id="ref41">26</reflink>]). In this framework, compliance status is defined as a dichotomous latent variable (i.e., compliers and non-compliers). Compliance class membership is completely observed in the treatment group whereas it is completely unobserved in the control group. The unknown compliance status of individuals in the control group is handled as missing data via the EM algorithm. High starting values were used and the optimization history examined to ensure that the best log-likelihood was replicated.</p> <p>Income and parent report of aggression at baseline were included as covariates as these were significantly different between the intervention and control group. Including predictors of compliance can improve precision in predicting compliance classes, and therefore increase the power to detect CACE effects (Jo et al., [<reflink idref="bib20" id="ref42">20</reflink>]). Youth perception of the severity of their injury was found to be the only predictor associated with being matched with a BBBS mentor in a previous study (see Lennon et al., [<reflink idref="bib22" id="ref43">22</reflink>]) and included in the models. Due to the co-occurrence of non-compliance and missing data (i.e., youth in the intervention condition who were not matched with a mentor were also more likely to be lost to follow-up), analyses accounted for the possibility of missing not at random by conducting sensitivity analyses (i.e., Response Exclusion Restriction analysis; Jo et al., [<reflink idref="bib21" id="ref44">21</reflink>]). Additional sensitivity analyses relaxed the exclusion restriction (i.e., no effect of assignment to condition for non-compliers). These analyses are important as they account for both possible effects due to contamination (i.e., youth in the control group receiving a mentor) as well as demoralization (i.e., youth in the intervention condition not receiving a BBBS mentor; Jo, [<reflink idref="bib19" id="ref45">19</reflink>]). Effect sizes were calculated like the ITT analyses.</p> <hd id="AN0159793922-19">Results</hd> <p>Tables 2 and 3 present descriptive, ITT, and CACE results. Fifty percent of youth in the intervention group (<emph>n</emph> = 49) were matched with a mentor and on average matches lasted 14.04 (SD 8.24) months at the time of data collection cessation (June 2017; 24 matches still active). For these youth, mentors reported conducting an average of 8.04 of the 21 discrete intervention activities (SD 5.66; range 3–21). Parents received an average of 1.99 (SD 0.81) sessions.</p> <p>Table 2 Descriptive statistics for outcomes by intervention condition</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;Outcome&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="3"&gt;&lt;p&gt;Full sample&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="3"&gt;&lt;p&gt;Intervention condition&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="3"&gt;&lt;p&gt;Control condition&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Baseline&lt;/p&gt;&lt;p&gt;&lt;italic&gt;M&lt;/italic&gt; (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;9 mo&lt;/p&gt;&lt;p&gt;&lt;italic&gt;M&lt;/italic&gt; (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;21 mo&lt;/p&gt;&lt;p&gt;&lt;italic&gt;M&lt;/italic&gt; (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Baseline&lt;/p&gt;&lt;p&gt;&lt;italic&gt;M&lt;/italic&gt; (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;9 mo&lt;/p&gt;&lt;p&gt;&lt;italic&gt;M&lt;/italic&gt; (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;21 mo&lt;/p&gt;&lt;p&gt;&lt;italic&gt;M&lt;/italic&gt; (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Baseline&lt;/p&gt;&lt;p&gt;&lt;italic&gt;M&lt;/italic&gt; (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;9 mo&lt;/p&gt;&lt;p&gt;&lt;italic&gt;M&lt;/italic&gt; (SD)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;21 mo&lt;/p&gt;&lt;p&gt;&lt;italic&gt;M&lt;/italic&gt; (SD)&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="10"&gt;&lt;p&gt;Behaviors&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Fighting&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.80 (1.56)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.49 (1.18)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.28 (0.83)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.69 (1.49)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.46 (1.15)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.14 (0.48)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.92 (1.64)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.52 (1.24)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.42 (1.08)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Problem behavior&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.89 (2.17)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.01 (2.48)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.87 (2.19)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.87 (2.23)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.14 (2.92)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.98 (2.45)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.91 (2.11)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.85 (1.82)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.75 (1.86)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Aggression&amp;#8212;youth&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.77 (1.03)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.68 (0.92)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.64 (0.91)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.74 (1.03)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.67 (0.97)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.68 (0.99)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.79 (1.03)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.69 (0.86)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.60 (0.82)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Aggression&amp;#8212;parent&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.43 (0.38)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.42 (0.35)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.41 (0.37)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.37 (0.31)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.41 (0.35)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.42 (0.40)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.49 (0.43)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.43 (0.36)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.41 (0.33)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="10"&gt;&lt;p&gt;Attitudes&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Retaliation&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.66 (0.65)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.20 (0.37)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.20 (0.40)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.23 (0.49)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.19 (0.38)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.17 (0.38)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.25 (0.40)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.22 (0.36)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.23 (0.43)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Deviance acceptance&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.67 (0.78)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.62 (0.75)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.76 (0.73)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.72 (0.78)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.58 (0.76)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.68 (0.71)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.61 (0.77)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.66 (0.75)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.85 (0.76)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Conflict avoidance self-efficacy&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.12 (0.57)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.25 (0.56)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.26 (0.53)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.16 (0.61)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.37 (0.57)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.22 (0.58)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.09 (0.53)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.10 (0.52)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.30 (0.46)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="10"&gt;&lt;p&gt;Skills&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Social competence&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.01 (0.68)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.94 (0.67)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.96 (0.75)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.05 (0.67)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.00 (0.66)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.91 (0.73)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.96 (0.68)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.87 (0.67)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.91 (0.73)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Commitment to learning&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.01 (0.74)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.94 (0.72)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.94 (0.74)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.02 (0.77)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.92 (0.78)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.97 (0.75)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.00 (0.71)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.95 (0.65)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.90 (0.73)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Hopes and goals&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.87 (0.58)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.95 (0.55)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.96 (0.60)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.89 (0.59)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.00 (0.54)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.96 (0.64)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.84 (0.58)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.88 (0.57)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.96 (0.56)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>Table 3 ITT and CACE analysis</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;Outcome&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="2"&gt;&lt;p&gt;ITT&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="2"&gt;&lt;p&gt;CACE&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;9 months&lt;/p&gt;&lt;p&gt;&lt;italic&gt;B&lt;/italic&gt; (SE)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;21 months&lt;/p&gt;&lt;p&gt;&lt;italic&gt;B&lt;/italic&gt; (SE)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;9 months&lt;/p&gt;&lt;p&gt;&lt;italic&gt;B&lt;/italic&gt; (SE)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;21 months&lt;/p&gt;&lt;p&gt;&lt;italic&gt;B&lt;/italic&gt; (SE)&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" colspan="5"&gt;&lt;p&gt;Behaviors&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Fighting&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.10 (0.39)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 1.40 (0.46)***&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&lt;sup&gt;a&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 1.87 (0.63)**&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Problem behavior&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.41 (0.42)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.26 (0.38)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 1.15 (0.78)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 2.21 (1.23)*&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Aggression&amp;#8212;youth&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.05 (0.16)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.10 (0.16)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.30 (0.35)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.26 (0.33)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Aggression&amp;#8212;parent&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.08 (0.04)*&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.06 (0.05)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.10 (0.05)&lt;sup&gt;t&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.07 (0.10)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="5"&gt;&lt;p&gt;Attitudes&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Retaliation&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.11 (0.11)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.08 (0.11)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.24 (0.24)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.32 (0.26)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Deviance acceptance&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.02 (0.13)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.18 (0.12)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.26 (0.27)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.15 (0.34)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Conflict avoidance self-efficacy&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.24 (0.09)**&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.09 (0.09)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.36 (0.16)*&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.09 (0.13)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" colspan="5"&gt;&lt;p&gt;Skills&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Social competence&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.08 (0.12)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.06 (0.13)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.34 (0.19)&lt;sup&gt;t&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.11 (0.29)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Commitment to learning&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.05 (0.12)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.05 (0.13)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.05 (0.25)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.28 (0.28)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Hopes and goals&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.10 (0.09)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.02 (0.10)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;0.48 (0.27)&lt;sup&gt;t&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt; &amp;#8722; 0.00 (0.15)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>All analyses controlled for baseline parent report of aggression and income and youth report of the severity of their injury <sups>***</sups><emph>p</emph> ≤ 0.001; **<emph>p</emph> ≤ 0.01; *<emph>p</emph> ≤ 0.05; <sups>t</sups><emph>p</emph> ≤ 0.10 <sups>a</sups>The 9-month CACE analysis for fighting would not converge <sups>b</sups>Due to the use of a negative binomial distribution, this coefficient is interpreted as the log count of number of fights</p> <hd id="AN0159793922-20">ITT Estimates</hd> <p>Regression analyses show that, relative to the control group, the intervention group reported significantly greater conflict self-efficacy at 9 months (ES 0.43; <emph>p</emph> ≤ 0.01) and significantly fewer fights at 21 months (ES − 0.26; <emph>p</emph> ≤ 0.001). Additionally, relative to the intervention group, the control group reported lower levels of parent-reported aggression at 9 months (ES − 0.23; <emph>p</emph> ≤ 0.05). No significant effects were found for youth-reported problem behavior, aggression, retaliatory attitudes, deviance acceptance, social competence, commitment to learning, or hopes and goals.</p> <hd id="AN0159793922-21">CACE Estimates</hd> <p>CACE models also found significantly greater conflict self-efficacy at 9 months (ES 0.64; <emph>p</emph> ≤ 0.05) and significantly fewer fights at 21 months (ES − 0.42; <emph>p</emph> ≤ 0.01) for compliers in the <emph>Take Charge!</emph> condition relative to would-be compliers in the control group. Additionally, CACE analysis showed an estimated effect on problem behavior at 21 months, in the direction of relatively less problem behavior for compliers in the <emph>Take Charge!</emph> condition (ES − 1.01; <emph>p</emph> ≤ 0.05). Greater social competence as well as hopes and goals for <emph>Take Charge!</emph> compliers at 9 months trended toward significance (ES 0.51 and 0.87, respectively; <emph>p</emph> ≤ 0.10). On the other hand, paralleling ITT results, would-be compliers in the control group showed a trend toward less parent report of aggression at 9 months relative to <emph>Take Charge!</emph> compliers (ES 0.29; <emph>p</emph> ≤ 0.10). No significant effects were evident for youth-reported aggression, retaliatory attitudes, deviance acceptance, or commitment to learning. There were trends (<emph>p</emph> &lt; 0.10) in the direction of increased social competence and hopes and goals for compliers in the intervention group relative to would-be compliers in the control group.</p> <hd id="AN0159793922-22">Sensitivity Analyses</hd> <p>Results of additional models with alternative parameterizations can be found in Online Resource B. When accounting for missingness not at random, the only finding that changed from the base model was an additional significant effect for less problem behavior at 9 months (ES − 0.65; <emph>p</emph> ≤ 0.05) for compliers in the intervention group relative to would-be compliers in the control group. This model parameterization relaxes the assumption that there is no difference between the intervention and control group in missing data and explicitly models missingness. When relaxing the exclusion restriction (i.e., no effect for non-compliers), differences in the direction of negative effects for non-compliers in the intervention group were identified at both 9 and 21 months, particularly for behavioral measures. Relative to would-be non-compliers in the control group, non-compliers in the intervention condition (i.e., randomized to intervention group but not matched with a mentor) had significantly higher scores on the measures of problem behavior and both youth- and parent-reported aggression at 9 months (ES 0.14, 0.23, and 0.31, respectively, <emph>p</emph> ≤ 0.05); differences in the same direction also were evident at 21 months for problem behavior (ES 0.26, <emph>p</emph> ≤ 0.05) and youth-reported aggression (ES 0.37, <emph>p</emph> ≤ 0.01). This model parameterization relaxes the exclusion restriction which states that there is no effect for non-compliers.</p> <hd id="AN0159793922-23">Discussion</hd> <p>This study presents an evaluation of a randomized-controlled trial of a violence prevention curriculum embedded in two BBBS organizations to support the needs of youth treated in the ED for peer assault injuries. Intent-to-treat analyses showed evidence of statistically significant effects of random assignment to <emph>Take Charge!</emph> on two of the 10 outcome measures at 9 months (improved conflict avoidance self-efficacy but also greater parent-reported aggression) and one of the same 10 measures at 21 months (reduced fighting). Complier average causal effect models indicated reduced problem behavior at 21 months for those receiving a mentor through the intervention relative to their counterparts in the control group as well as differences in the direction of negative effects for those not receiving a mentor again relative to their control group counterparts. These findings extend the evidence base for the <emph>Take Charge!</emph> curriculum as a violence prevention curriculum for youth already engaged in violence and raise important issues for consideration when moving programs to "real-world" settings.</p> <p>This study presents a replication study of <emph>Take Charge!</emph> (Cheng et al., [<reflink idref="bib7" id="ref46">7</reflink>]) and shows some consistency of impact despite a different implementation model. Specifically, consistent findings were found for improvements in conflict avoidance self-efficacy in the short term (i.e., 6–9 months) as well as decreases in problem behavior. An additional finding of decreased fighting was identified at 21 months for this study, which was not evident in the original study that had follow-up only at 6 months. A further difference is that parents in the current study reported greater aggression for intervention youth at 9 months, although sensitivity analyses suggest this might have been driven by intervention youth who did not receive mentoring. Taken as a whole, the findings across the two studies suggest that mentoring programs tailored to the needs of youth who are treated for assault injuries can be beneficial for building protective factors associated with reducing violent behaviors. This complements the existing meta-analysis of studies of mentoring for youth at-risk of delinquency, which found effect sizes of 0.11 for aggression and 0.21 for delinquency (Tolan et al., [<reflink idref="bib32" id="ref47">32</reflink>]). Unlike previous meta-analyses that have found consistent positive findings for social and psychological outcomes (i.e., Tolan et al., [<reflink idref="bib32" id="ref48">32</reflink>]; Christenson et al., [<reflink idref="bib8" id="ref49">8</reflink>]), in this study the evidence of significant intervention effects was primarily for outcomes related to violent behaviors, although CACE analyses did identify trends toward improvements in social competence and hopes and goals. This may reflect the curricular nature of the intervention, which while addressing a call for "targeting specific mechanisms underlying particular youth difficulties" (Raposa et al., [<reflink idref="bib29" id="ref50">29</reflink>], [<reflink idref="bib30" id="ref51">30</reflink>], p. 438), may reduce impacts on outcomes thought to be supported by social support and modeling (DuBois et al., [<reflink idref="bib14" id="ref52">14</reflink>]).</p> <p>The CACE analyses allow for examination of the estimated impact of <emph>Take Charge!</emph> 2.0 conditional upon receipt of mentoring. This is a meaningful distinction as an important component of this trial was embedding it within BBBS, and like other organizations, they are focused on the impact on individuals who receive services. In this study, there was a mentor match rate of 50%, similar to BBBS's usual match rate. Although data for comparison are limited, previous studies of BBBS and other mentoring programs in the USA (Grossman &amp; Rhodes, [<reflink idref="bib16" id="ref53">16</reflink>]) also have reported sizable percentages of youth assigned to receive mentoring not being matched with a mentor by study end point. This includes the previous trial of <emph>Take Charge!</emph> in which 54% of youth received the intervention as intended (Cheng et al., [<reflink idref="bib7" id="ref54">7</reflink>]). An added complication may be the importance placed on match-fit in programs such as BBBS, with mentors, mentees, and their parents allowed to indicate personal preferences. Although available evidence indicates that match-fit is important, with DuBois et al. ([<reflink idref="bib14" id="ref55">14</reflink>]) finding stronger effects for programs that pair mentors/mentees taking into account similarity of interests and racial/ethnic match pairs, other findings point to the importance of the content of the interactions between mentors and mentees (Tolan et al., [<reflink idref="bib32" id="ref56">32</reflink>]).</p> <p>The negative effects that were suggested by the CACE sensitivity analyses, such that youth in the intervention group who did not receive a mentor tended to fare less well particularly in the area of aggressive behavior than their projected counterparts in the control group, point to the possible importance of striking a balance between a preference and relationship driven match and ensuring that youth are not disillusioned and harmed by not receiving a mentor. Similar evidence of harm has been reported for matches that end early (Grossman &amp; Rhodes, [<reflink idref="bib16" id="ref57">16</reflink>]). The present findings may indicate a demoralization effect and a need for parents/youth to seek other compensatory forms of support. However, they also may indicate a lack of a desire for those not matched for the intervention or for behavior change (Tromp et al., [<reflink idref="bib33" id="ref58">33</reflink>]), particularly given that the main reason BBBS agencies reported lack of match was difficulty contacting or engaging youth and/or families. Previous analyses of data from the present trial indicated that <emph>Take Charge!</emph> 2.0 youth who were matched with a BBBS mentor did not differ based on demographic or family characteristics, with the only difference being relatively greater perceptions of severity of their injury (Lennon et al., [<reflink idref="bib22" id="ref59">22</reflink>]). However, reported severity of injury was not associated with any of the outcomes in the CACE sensitivity analyses, not supporting a selection argument (e.g., less motivation to avoid future aggressive behavior among those not matched due to less severe injuries). Further investigation of possible negative effects of not receiving a mentor is therefore an important future research direction.</p> <hd id="AN0159793922-24">Limitations and Next Steps</hd> <p>Limitations of this study include its relatively small sample size, particularly for the CACE analysis which further divided the sample, the fact that it took place in only two BBBS agencies in urban areas of the mid-Atlantic, and limited availability of information about implementation of intervention sessions. Additionally, the 9-month attrition rates only met the liberal WWC standard. Sensitivity analyses did not indicate differential attrition based on youth aggression at baseline. Nevertheless, especially in view of the evidence of negative effects provided by the CACE analysis being predominantly at 9 months, there clearly is a need to further investigate predictors of attrition and their potential implications for findings in trials such as this one that are conducted in real-world settings and thus likely to experience varying degrees of loss to follow-up.</p> <p>The present findings suggest that, for youth referred to mentoring programs, it is important to compare outcomes of those who are matched with a mentor to those who are not. Although, the findings suggesting possible harmful effects of not receiving mentoring despite program referral, in the absence of other comparable research these findings should be viewed as preliminary. Because this study was designed to be a replication study, multiple different outcomes were assessed; this increased the likelihood of false positives (i.e., type 1 error). Consistency of the present findings regarding positive effects of <emph>Take Charge!</emph> with the earlier, efficacy trial, however, supports their validity and suggests that the program can be of benefit to youth in the context of implementation challenges (DuBois &amp; Silverthorn, [<reflink idref="bib15" id="ref60">15</reflink>]). While testing mediation of program impact was beyond the scope of this article, evidence for changes in attitudes and skills at 9 months suggests this may be an important avenue for future research and critical to understand mechanisms of impact for mentoring interventions (Tolan et al., [<reflink idref="bib32" id="ref61">32</reflink>]).</p> <p>None of the outcomes assessed in this study were blind to treatment condition and therefore all are subject to social desirability bias. Additionally, the majority of outcome measures were youth report. Greater use of multi-informant measures and other, non-reactive sources of data on outcomes (e.g., return visits to EDs, arrest data) would be helpful in future research. An additional limitation is the inability to separate the actual mentoring from the parent component of the intervention. This difficulty is not uncommon in the field, as mentoring is often provided as part of a multi-component intervention (Tolan et al., [<reflink idref="bib32" id="ref62">32</reflink>]). Additionally, a few youth assigned to the control group reported receipt of program-based mentoring which, while not unusual (see Wheeler et al., [<reflink idref="bib35" id="ref63">35</reflink>]), is nonetheless an issue deserving of further attention in future research. Finally, the study was somewhat underpowered for detecting effects of magnitude similar to those reported for broadly similar mentoring programs in past research (DuBois et al., [<reflink idref="bib14" id="ref64">14</reflink>]). As such, where significant effects are not evident, the potential for type II error (i.e., an undetected effect) should be kept in mind.</p> <hd id="AN0159793922-25">Strengths and Implications</hd> <p>The foregoing limitations notwithstanding, this study adds to a needed body of rigorous research on mentoring that includes randomization, longitudinal follow-up, and comprehensive assessment of youth outcomes (DuBois &amp; Silverthorn, [<reflink idref="bib15" id="ref65">15</reflink>]). Additionally, due to its focus on moving to BBBS as implementer, the study has greater external validity for generalization to real-world contexts of implementation than efficacy trials in which researchers exert primary control over implementation (DuBois &amp; Keller, [<reflink idref="bib13" id="ref66">13</reflink>]).</p> <p>This study also makes an important contribution as it demonstrates the possibility of beneficial integration of a violence prevention curriculum (Cheng et al., [<reflink idref="bib7" id="ref67">7</reflink>]) into the largest and most well-known community-based mentoring organization in the USA. Intervention components were tailored to fit within the BBBS model of mentor training, matching, and support, thus offering the opportunity for scalability. However, as other practice-based research has suggested (Marchand et al., [<reflink idref="bib25" id="ref68">25</reflink>]), this involves trade-offs; a particular challenging one for this study was the ability to find mentors for all youth randomized to the intervention condition. Additionally, potential tensions are inherent in placing mentors in a role that requires striking a balance between engaging in activities that support the development of a meaningful relationship and those dictated by a curriculum (Raposa et al., [<reflink idref="bib29" id="ref69">29</reflink>], [<reflink idref="bib30" id="ref70">30</reflink>]). Despite this, the <emph>Take Charge!</emph> demonstrates promise for a targeted mentoring approach for youth with assault injuries. More generally, findings also support the conceptualization of injury resulting from violence as a possible teachable moment for some youth as well as the viability of the ED as a site to identify and connect youth to violence prevention resources (Lindstrom Johnson et al., [<reflink idref="bib23" id="ref71">23</reflink>]).</p> <hd id="AN0159793922-26">Funding</hd> <p>This research was supported by the National Institute on Minority Health and Health Disparities (grant P20MD000198). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH).</p> <hd id="AN0159793922-27">Declarations</hd> <p></p> <hd id="AN0159793922-28">Ethics Approval</hd> <p>All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Johns Hopkins University (NA_000075613) and Children's Hospital of Philadelphia (13–010723) IRB. A Certificate of Confidentiality was obtained from NIH.</p> <hd id="AN0159793922-29">Consent to Participate</hd> <p>Consent was obtained from parents and mentors and assent from children.</p> <hd id="AN0159793922-30">Conflict of Interest</hd> <p>David DuBois is the Chair of the BBBS Research Advisory Council, which is a non-paid position. The remaining authors declare that they have no conflicts of interest.</p> <hd id="AN0159793922-31">Supplementary Information</hd> <p>Below is the link to the electronic supplementary material.</p> <p>Graph: Supplementary file1 (DOCX 17 KB)</p> <hd id="AN0159793922-32">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0159793922-33"> <title> References </title> <blist> <bibl id="bib1" idref="ref27" type="bt">1</bibl> <bibtext> Achenbach TMMaruish ME. The Child Behavior Checklist and related instruments. The use of psychological testing for treatment planning and outcomes assessment. 1999; Lawrence Erlbaum Associates Publishers: 429-466</bibtext> </blist> <blist> <bibl id="bib2" idref="ref38" type="bt">2</bibl> <bibtext> Angrist JD, Imbens GW, Rubin DB. Identification of causal effects using instrumental variables. 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| Items | – Name: Title Label: Title Group: Ti Data: Investigating Effects of Mentoring for Youth with Assault Injuries: Results of a Randomized-Controlled Trial – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Lindstrom+Johnson%2C+S%2E%22">Lindstrom Johnson, S.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-4550-1162">0000-0002-4550-1162</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jones%2C+V%2E%22">Jones, V.</searchLink><br /><searchLink fieldCode="AR" term="%22Ryan%2C+L%2E%22">Ryan, L.</searchLink><br /><searchLink fieldCode="AR" term="%22DuBois%2C+D%2E+L%2E%22">DuBois, D. L.</searchLink><br /><searchLink fieldCode="AR" term="%22Fein%2C+J%2E+A%2E%22">Fein, J. A.</searchLink><br /><searchLink fieldCode="AR" term="%22Cheng%2C+T%2E+L%2E%22">Cheng, T. L.</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Prevention+Science%22"><i>Prevention Science</i></searchLink>. Nov 2022 23(8):1414-1425. – Name: Avail Label: Availability Group: Avail Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 12 – Name: DatePubCY Label: Publication Date Group: Date Data: 2022 – Name: SourceSuprt Label: Sponsoring Agency Group: SrcSuprt Data: National Institute on Minority Health and Health Disparities (NIMHD) (DHHS/NIH) – Name: NumberContract Label: Contract Number Group: NumCntrct Data: P20MD000198 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Injuries%22">Injuries</searchLink><br /><searchLink fieldCode="DE" term="%22Violence%22">Violence</searchLink><br /><searchLink fieldCode="DE" term="%22Peer+Relationship%22">Peer Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Mentors%22">Mentors</searchLink><br /><searchLink fieldCode="DE" term="%22Curriculum+Evaluation%22">Curriculum Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1007/s11121-022-01406-z – Name: ISSN Label: ISSN Group: ISSN Data: 1389-4986<br />1573-6695 – Name: Abstract Label: Abstract Group: Ab Data: Mentoring is considered an evidence-based practice for violence prevention. This study presents a partial replication of the "Take Charge!" program implemented in partnership with Big Brothers Big Sisters of America (BBBS). One hundred and eighty-eight early adolescents (M age = 12.87; 61.17% male) who were treated for peer-related assault injury in two urban mid-Atlantic emergency departments were randomly assigned to receive a mentor from two BBBS affiliates. Mentors and organization staff were trained in the "Take Charge!" violence prevention curriculum, which had previously shown evidence of efficacy. Intent-to-treat analyses showed statistically significant improvements in conflict avoidance self-efficacy for the intervention group at 9 months and reductions in fighting at 21 months, but an increase in parental report of aggression at 9 months. Complier average causal effect models revealed evidence of an additional effect for reduced problem behavior at 21 months for intervention adolescents who received a mentor. No effects were found for youth-reported aggression, retaliatory attitudes, deviance acceptance, or commitment to learning. Sensitivity analyses suggested increased aggressive behavior for adolescents in the intervention group who did not receive a mentor (i.e., non-compliers). These findings extend the evidence-base for "Take Charge!" as a violence prevention curriculum for youth already engaged in violence to "real-world" implementation settings. However, they also suggest that challenges associated with providing youth with mentors can be consequential and that additional supports may be needed for these youth/parents. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2022 – Name: AN Label: Accession Number Group: ID Data: EJ1352826 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s11121-022-01406-z Languages: – Text: English PhysicalDescription: Pagination: PageCount: 12 StartPage: 1414 Subjects: – SubjectFull: Adolescents Type: general – SubjectFull: Injuries Type: general – SubjectFull: Violence Type: general – SubjectFull: Peer Relationship Type: general – SubjectFull: Prevention Type: general – SubjectFull: Mentors Type: general – SubjectFull: Curriculum Evaluation Type: general – SubjectFull: Behavior Problems Type: general Titles: – TitleFull: Investigating Effects of Mentoring for Youth with Assault Injuries: Results of a Randomized-Controlled Trial Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Lindstrom Johnson, S. – PersonEntity: Name: NameFull: Jones, V. – PersonEntity: Name: NameFull: Ryan, L. – PersonEntity: Name: NameFull: DuBois, D. L. – PersonEntity: Name: NameFull: Fein, J. A. – PersonEntity: Name: NameFull: Cheng, T. L. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 11 Type: published Y: 2022 Identifiers: – Type: issn-print Value: 1389-4986 – Type: issn-electronic Value: 1573-6695 Numbering: – Type: volume Value: 23 – Type: issue Value: 8 Titles: – TitleFull: Prevention Science Type: main |
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