Center For Substance Abuse Prevention Research Articles

SAMHSA reinstates CSAP Prevention Fellowship program

One of the substance use disorder (SUD) workforce tools to die during the Trump administration was the CSAP (Center for Substance Abuse Prevention) Prevention Fellowship Program, run by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Lawmakers call for increased funding for SAMHSA

Last month a group of representatives called on the U.S. House Committee on Appropriations to increase funding for the Substance Abuse and Mental Health Services Administration (SAMHSA), in particular, for the Center for Substance Abuse Treatment (CSAT), the Center for Substance Abuse Prevention (CSAP), and the Substance Abuse Prevention and Treatment (SAPT) Block Grant.

Making prevention of substance use or mental illness more professional

It's important for prevention experts to continue their path to professionalization, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP).

SAMHSA prevention manual focusses on ‘professionalization’

It's important for substance use disorder (SUD) prevention experts to continue their path to professionalization, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP). In a report issued this month, SAMHSA listed core competencies needed to work in the field of SUD prevention.

In Case You Haven't Heard…

Good news for substance use prevention and treatment overall in House appropriations: Partnerships for Success (from the Center for Substance Abuse Prevention [CSAP]) grants were restored, and funding for primary prevention was restored. It's likely that the Senate will look at appropriations over the summer. But for many, especially those who are new to Congress, the frame of reference is STR and SOR. They didn't grow up in the system, and they don't understand the complexities, which mean that once money is delivered to the states, it needs to be spent at a local level. “The rollout stunk,” one Washington insider told ADAW recently, referring to the STR process. As we have written many times before, STR was passed by Congress in December 2016, and states had less than two months to get in their applications. The money went out and “stuff appeared,” as our source said. The pressure to get resources out the door, given the opioid crisis mode, was clear. But moving forward — and this is where appropriations come in — it's important to look at the entire substance use problem. STR and SOR are only for opioids. Adding billions of dollars to the budget for opioids when methamphetamine is around the corner and more people are still dying from alcoholism than opioids means that a broader view is needed. The Substance Abuse Prevention and Treatment block grant, in which states decide where they need to spend the money, should come in for more funding. Under House appropriations, it doesn't. Still, the overall topline number increased for the Substance Abuse and Mental Health Services Administration in the House, proposed cuts to the Center for Substance Abuse Prevention were rejected and there was a small increase in funding to combat underage drinking.

President's proposed budget would slash treatment and prevention funding

We had a feeling of déjà vu when the White House sent its proposed budget to Congress last week. Similar to past years, the Office of National Drug Control Policy (ONDCP) would be decimated, moving the $100 million Drug‐Free Communities program to the Center for Substance Abuse Prevention (CSAP) at the Substance Abuse and Mental Health Services Administration (SAMHSA). There's no additional money in the Substance Abuse Prevention and Treatment (SAPT) block grant and cuts to the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, CSAP and SAMHSA's Center for Substance Abuse Treatment.

In Case You Haven't Heard

There are things happening at the Substance Abuse and Mental Health Services Administration (SAMHSA) — probably best summed up as turnover, but considering that the new administration is halfway through its term, it's confusing that there is such little information. Chideha Ohuoha, M.D., M.P.H., announced as director of SAMHSA's Center for Substance Abuse Treatment just weeks ago (we were still waiting to be allowed to interview him), last week got a new position: senior medical officer of the Office of the Chief Medical Officer. At the same time, in a letter to stakeholders obtained by ADAW, he announced that he would retire from the federal government in February. Fran Harding, head of the Center for Substance Abuse Prevention, will be leaving this month — also not officially announced by SAMHSA. Paolo del Vecchio, longtime director of the Center for Mental Health Services, has been replaced by Anita Everett, M.D., who was appointed as chief medical officer at SAMHSA more than two years ago in a restructuring (see ADAW, Aug. 15, 2016). You guessed it — not officially announced. What's going on at the centers? Is there a restructuring? Are directors being replaced? The official response from SAMHSA: “No comment.” Comments from stakeholders in the field? A big sigh with a “who knows?” At least the agency is continuing to administer billions of dollars in new grants, under the plainspoken leadership of Elinore McCance‐Katz, M.D., who has bristled against what she saw as the nonmedical stance of former SAMHSA leadership.

Reducing Binge Drinking in Adolescents through Implementation of the Strategic Prevention Framework

The Strategic Prevention Framework (SPF) is a conceptual model that supports coalition-driven efforts to address underage drinking and related consequences. Although the SPF has been promoted by the U.S. Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention and implemented in multiple U.S. states and territories, there is limited research on the SPF's effectiveness on improving targeted outcomes and associated influencing factors. The present quasi-experimental study examines the effects of SPF implementation on binge drinking and enforcement of existing underage drinking laws as an influencing factor. The intervention group encompassed 11 school districts that were implementing the SPF with local prevention coalitions across eight Kansas communities. The comparison group consisted of 14 school districts that were matched based on demographic variables. The intervention districts collectively facilitated 137 community-level changes, including new or modified programs, policies, and practices. SPF implementation supported significant improvements in binge drinking and enforcement outcomes over time (p<.001), although there were no significant differences in improvements between the intervention and matched comparison groups (p>.05). Overall, the findings provide a basis for guiding future research and community-based prevention practice in implementing and evaluating the SPF.

Screening, Brief Intervention, and Referral to Treatment Education for Emergency Nurses in 5 Hospitals: Implementation Steps and Hurdles

The World Health Organization reported that mental and substance use disorders will surpass all physical diseases by 2020. 1 World Health Organization Promoting mental health: concepts, emerging evidence, practice. http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf Google Scholar More than 23.5 million individuals (9.4%) aged 12 years or older have been identified as needing treatment for substance use problems, yet only 2.3 million (<10%) received care. 2 Leading change: a plan for SAMHSA’s roles and actions 2011–2014. http://store.samhsa.gov/product/SMA11-4629 Google Scholar , 3 Office of Applied Studies. Results from the 2008 national survey on drug use and health: national findings. NSDUH Series H-36, HHS Publication No. SMA 09–4434. Substance Abuse and Mental Health Services Administration Web site. http://www.oas.samhsa.gov. Published 2009. Accessed May 9, 2014. Google Scholar Furthermore, the total estimated societal costs of substance abuse in the United States amount to approximately $510.8 billion annually. 2 Leading change: a plan for SAMHSA’s roles and actions 2011–2014. http://store.samhsa.gov/product/SMA11-4629 Google Scholar , 4 Miller T Hendrie D Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, Rockville, MD2009 Google Scholar Such alarming statistics regarding alcohol and other drug (AOD) problems are compounded by the untold deleterious impact of substance misuse on the lives of individuals, families, communities, and society. Excessive alcohol use accounted for approximately 88,000 deaths per year from 2006 to 2010 and accounted for 1 in 10 deaths among adults aged 20 to 64 years. 5 CDC features, data & statistics Alcohol deaths. http://www.cdc.gov/features/alcohol-deaths Google Scholar This impact has garnered the attention of health professionals who are escalating assessment skills and services to individuals regarding harmful AOD use. 6 Hankin A Daugherty M Bethea A Haley L The emergency department as a prevention site: a demographic analysis of substance use among ED patients. Drug Alcohol Depend. 2013; 130: 230-233 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar , 7 Ong-Flaherty C Screening, brief intervention, and referral to treatment: a nursing perspective. J Emerg Nurs. 2012; 38: 54-56 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 8 Désy P Perhats C Alcohol screening, brief intervention, and referral in the emergency department: an implementation study. J Emerg Nurs. 2008; 34: 11-19 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar , 9 Désy P Howard PK Perhats C Li S Alcohol screening, brief intervention, and referral to treatment conducted by emergency nurses: an impact evaluation. J Emerg Nurs. 2010; 36: 538-545 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar , 10 Barnard S Implementing an SBIRT (screening, brief intervention, and referral to treatment) program in the emergency department: challenges and rewards. J Emerg Nurs. 2009; 35: 561-563 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 11 Vadlamudi RS Adams S Hogan B Wu T Wahid Z Nurses’ attitudes, beliefs, and confidence levels regarding care for those who abuse alcohol: impact of educational intervention. Nurse Educ Pract. 2008; 8: 290-298 Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar , 12 Gonzalez Castro F Garginkel J Critical issues in the development of culturally relevant substance abuse treatments for specific minority groups. Alcohol Clin Exp Res. 2003; 27: 1381-1388 Crossref PubMed Scopus (42) Google Scholar Irene Kane is Associate Professor of Nursing, University of Pittsburgh School of Nursing, Pittsburgh, PA. Ann M. Mitchell is Professor of Nursing, University of Pittsburgh School of Nursing, Pittsburgh, PA. James Aiello is Project Associate, Institute for Research, Education and Training in Addictions, Pittsburgh, PA. Holly Hagle is Director, National SBIRT Addiction Technology and Transfer Center and Institute for Research, Education and Training in Addictions, Pittsburgh, PA. Dawn Lindsay is Director of Evaluation Services, Institute for Research, Education and Training in Addictions, Pittsburgh, PA. Kimberly S. Talcott is ELITE and SBIRT Project Manager, University of Pittsburgh School of Nursing, Pittsburgh, PA. Lynn Boucek is SBIRT Project Associate, University of Pittsburgh School of Nursing, Pittsburgh, PA.

Sustainability of State-Level Substance Abuse Prevention Infrastructure After the Completion of the SPF SIG.

Recent national substance abuse prevention efforts that have been disseminated at the state level have provided fertile ground for addressing the dearth of systematic research on state-level substance abuse prevention infrastructure. The Strategic Prevention Framework State Incentive Grant Program (SPF SIG), a national public health initiative sponsored by the US Substance Abuse and Mental Health Services Administration and its Center for Substance Abuse Prevention, is one such effort, providing an opportunity to examine state-level substance abuse prevention infrastructure across the country. The aims of the SPF SIG initiative include reducing substance abuse and its related problems, as well as enhancing state and local prevention infrastructure and capacity. In this article, we describe the status of state-level substance abuse prevention infrastructure and capacity 1 year after the first 26 funded states ended their projects, based on follow-up interviews with state prevention decision-makers. We found that, in five of the six prevention domains we measured, prevention infrastructure capacity increased during the 12-month period after the grants ended. The evidence for further SPF capacity development even after the conclusion of the grants suggests that states recognized the benefits of using the SPF and took deliberate steps to sustain and enhance the integration of this framework into their state prevention systems. In addition, the findings suggest that state agencies and organizations can benefit from time-limited resources aimed at increasing their capacity and that such efforts can have a lasting impact on measures of state prevention system capacity.

State Systems Change in Prevention Resource Management

Federally funded initiatives have provided resources to develop comprehensive substance abuse prevention strategies. Historically, most awards were made directly to communities. Beginning in 1997, the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP) signaled a new direction. The State Incentive Grant (SIG) program saw grants awarded to states and territories who then distributed money to communities to support prevention program implementation. A primary goal of the SIG program was statewide coordination of prevention service delivery and resource mobilization. Over seven years, 40 states and US territories received SIG awards. The SIG program was based on the assumption that systems change, in the form of improved state-level coordination and resource mobilization, would result in improved community-level prevention and, ultimately, in improved substance use outcomes. Coordination was defined as collaborative efforts of state-level agencies and individuals with control over prevention resources that resulted in a plan for addressing substance use problems and populations at risk. Resource mobilization was defined as the leveraging and/or redirection of resources to support implementation of effective prevention strategies. A cross-site evaluation of the systems changegoals included a content analysis of grantees’ report documents and ratings of grantee accomplishments along a scale of milestones leading to institutionalization. A majority of grantees (68 percent) achieved at least the first milestone in coordination and resource mobilization categories and they achieved more coordination milestones than resource mobilization milestones. Results are discussed in relation to the role of prevention systems change in achieving desired substance use–related outcomes.

Effects of the Strategic Prevention Framework State Incentives Grant (SPF SIG) on State Prevention Infrastructure in 26 States

The Strategic Prevention Framework State Incentive Grant (SPF SIG) program is a national public health initiative sponsored by the U.S. Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention to prevent substance abuse and its consequences. State grantees used a data-driven planning model to allocate resources to 450 communities, which in turn launched over 2,200 intervention strategies to target prevention priorities in their respective populations. An additional goal was to build prevention capacity and infrastructure at the state and community levels. This paper addresses whether the state infrastructure goal was achieved, and what contextual and implementation factors were associated with success. The findings are consistent with claims that, overall, the SPF SIG program met its goal of increasing prevention capacity and infrastructure across multiple infrastructure domains, though the mediating effects of implementation were evident only in the evaluation/monitoring domain. The results also show that an initiative like the SPF SIG, which could easily have been compartmentalized within the states, has the potential to permeate more broadly throughout state prevention systems.

Preventing Substance Abuse and HIV/AIDS among Urban Minority Youth: Evidence from a University-Community Partnership

Purpose: To assess whether evidence-based prevention protocols could positively influence substance abuse and HIV/AIDS knowledge and reduce sexual risk-taking behaviors among urban minority youth. Design: Pretest-posttest design. Setting: Four urban high schools and five summer camp programs located in the North-eastern United States. Subjects: A total of 653 African American and Hispanic/Latino youth, ranging in ages from 13 to 18. Intervention: The intervention for this study incorporated elements from the following evidence-based protocols that have been endorsed by the U.S. Centers for Disease Control and Prevention (CDC) and the Center for Substance Abuse Prevention (CSAP): Be Proud! Be Responsible!; CASASTART!; Focus on Youth; and Street Smart. Sessions were comprised of six, 50-minute modules that incorporated role-plays, discussions, and multimedia formats to actively educate and engage youth in prevention activities. Measures: This study used the National Minority Substance Abuse / HIV Prevention Initiative Cohort 7 Youth Questionnaire., which was developed by CSAP to be used as part of a national cross site evaluation of all Minority AIDS Initiative (MAI) funded programs throughout the United States. Sexual risk behavior served as our outcome variable, with the following ten predictors being assessed for the study: disapproval / alcohol use, school importance, delinquency/crime, disapproval / tobacco use, disapproval / marijuana use, illicit drug use, stress- related alcohol and drug use, HIV/AIDS knowledge, HIV/AIDS testing, and negative peer attitudes. Analysis: Principal components, multiple imputation, and mulitivariate regression analyses were systematically employed to develop a parsimonious model that included ten predictors of sexual risk. Results: Changes in pre and posttest measures revealed that participants who were at heightened risk were also more inclined to get tested for HIV/AIDS after receiving the intervention (95% confidence level). At posttest, an increase in HIV/AIDS knowledge seemed to have a buffering effect against risky sexual behaviors. Additionally, participants who thought of school more favorably were less likely to engage in sexual risk taking behaviors at posttest (95% confidence level). Conclusion: A combination of evidence-based prevention curricula can help transform knowledge into positive behavioral change.

The Interactive Systems Framework Applied to the Strategic Prevention Framework: The Rhode Island Experience

The Interactive Systems Framework for Dissemination and Implementation (ISF) was introduced as a heuristic systems level model to help bridge the gap between research and practice (Wandersman et al., in Am J Commun Psychol 41:171-181, 2008). This model describes three interacting systems with distinct functions that (1) distill knowledge to develop innovations; (2) provide supportive training and technical assistance for dissemination to; (3) a prevention delivery system responsible for implementation in the field. The Strategic Prevention Framework (SPF) is a major prevention innovation launched by the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Administration (SAMHSA). The SPF offers a structured, sequential, data-driven approach that explicitly targets environmental conditions in the community and aims for change in substance use and problems at the population level. This paper describes how the ISF was applied to the challenges of implementing the SPF in 14 Rhode Island communities, with a focus on the development of a new Training and Technical Assistance Resources Center to support SPF efforts. More specifically, we (1) describe each of the three ISF interacting systems as they evolved in Rhode Island; (2) articulate the lines of communication between the three systems; and (3) examine selected evaluation data to understand relationships between training and technical assistance and SPF implementation and outcomes.

Substance Abuse Prevention and Treatment within the Criminal Justice System: An Overview of the Issues

Many nurses, especially those in addictions, work directly in the prison system and or relate to inmates before or after institutionalization for criminal activity. This connection led to the theme of the 2009 Annual Education Conference held in Albuquerque, New Mexico, entitled "Substance Abuse Prevention and Treatment: Working with the Criminal Justice Systems." The conference was partially funded through an award from the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (grant # SP015963) and focused on identifying the special risk factors for and barriers to the treatment of addictions for those who enter the criminal justice system. The conference, presented in collaboration with the American Association of Nurse Attorneys (AANA) highlighted the tremendous need for more access to addictions and mental health providers in the criminal justice system. Papers presented at that conference confirmed that nurses can make a real difference in the health of inmates, especially those of us engaged in addictions and mental health practices, and inspired this specially focused edition of the Journal of Addictions Nursing. The purpose of this editorial is to provide an overview of the addictions problems affecting individuals under supervision in the criminal justice system, barriers to treatment within this system, and the cost-benefits of evidence based treatment.

Religiosity and Health Behavior— What Does Research Tell Us?

This article is based on the AAHPERD Research Consortium Scholar Lecture delivered at the 2010 AAHPERD National Convention in Indianapolis, Indiana. Dr. Young's various projects are five-time winners of the U.S. Department of Health & Human Services Award for Outstanding Work in Community Health Promotion. His drug education program, Keep A Clear Mind, authored with Chudley Werch, is a winner of the Center for Substance Abuse Prevention's (CSAP) Exemplary Program Award. It has also been promoted as a Model Program by CSAP, the Substance Abuse and Mental Health Services Administration, and the Office of Juvenile Justice and Delinquency Prevention, and is on the National Registry of Effective Programs. He has received a number of other awards from professional organizations and institutions.

Designing HIV Prevention Interventions for Urban American Indians: Evolution of the Don't Forget Us Program

American Indians and Alaska Natives (AIs/ANs) face health disparities across a variety of diseases and pathologies, a reality that some have argued can be linked to the multiple harms and injustices systematically perpetrated against the population (Jones, 2006). In 2006, it was estimated that over 4 million Americans identified their race as AI/AN, either alone or in combination with another race (U.S. Census Bureau, 2006b). Most AIs/ANs live outside of tribal areas (Ogunwole, 2006), and significant health disparities between AIs/ ANs and the general population have been documented in urban areas and throughout the country (Castor et al., 2006). Although the Indian Health Service (IHS) funds a number of urban programs, these programs represent a miniscule portion of the IHS budget (Castor et al., 2006; Forquera, 2001). HIV/AIDS is a problem of growing concern in AI/AN communities (Vernon J Vernon & Jumper-Thurman, 2005), sociocultural factors that stigmatize risk behaviors and perpetuate silence (Vernon & Jumper-Thurman, 2005), and socioeconomic disadvantage and poverty (Ogunwole, 2006; U.S. Census Bureau, 2007; Vernon & Jumper-Thurman, 2005). AIs/ANs are also disproportionately likely to engage in certain behaviors that place them at risk for HIV transmission. For example, they are significantly more likely to report past-year alcohol or drug use disorders compared with the other racial groups (Substance Abuse and Mental Health Services Administration [SAMHSA], 2007). Another issue is that HIV/AIDS surveillance may underestimate the burden of the disease on the AI/AN population due to racial misclassification (Bertolli, Lee, Sullivan, & the AI/AN Race/ Ethnicity DataValidationWorkgroup, 2007; Bertolli et al., 2004). In urban areas where they are a small minority, AIs/ANs may be especially susceptible to being misclassified as another race in HIV/AIDS statistics. Urban AIs/ANs may benefit from culturally tailored HIV/AIDS prevention services that have a firm grounding in local data. The Don't Forget Us program represents such an effort. The Don't Forget Us program began in 2006 with funding from the Center for Substance Abuse Prevention (CSAP) to deliver substance abuse, HIV/AIDS, and hepatitis prevention services to the urban-dwelling AI population in Baltimore, Maryland. AIs represent a very small minority in the city, constituting only 0.75 percent of Baltimore's total population (U.S. Census Bureau, 2006a). As such, comparatively little was known about the local population regarding characteristics and health risk behaviors. Anecdotal evidence from a local community program funded by the IHS suggested that AIs in the target area experienced numerous risks for substance abuse, HIV/AIDS, and hepatitis. The available local-level census and neighborhood data (Baltimore Neighborhood Indicators Alliance, 2006) indicated that AIs in the city were fragmented, although a few neighborhoods did have larger concentrations of the population. DEVELOPMENT OF THE DON'T FORGET US PROGRAM Strategic Prevention Framework In designing prevention services for the urban AI population, we used SAMHSA'S Strategic Prevention Framework (SPF) to focus our efforts. The SPF provides a road map for prevention program planning and consists of five broad steps: (1) Assess the needs of the target population; (2) build capacity to address needs; (3) develop a strategic plan; (4) implement effective programs, policies, and practices; and (5) evaluate (CSAP, 2007). …

Developing a Data Resource to Support State Substance Abuse Prevention Planning: Approaches Used in Implementing CSAP's Strategic Prevention Framework

A number of data collection systems designed to monitor selected substance abuse behaviors and consequences are in place in the United States. Some of these systems provide only national-level data, while others provide data disaggregated by state and in some cases by sub-state units such as counties or communities. Less progress has been made in identifying a key set of epidemiologic indicators across the three major substance categories (i.e., alcohol, tobacco, and illicit drugs), and assembling them in a manner designed to effectively support substance abuse prevention planning at the state and local levels. A recent federal initiative funded by the U.S. Center for Substance Abuse Prevention (CSAP) seeks to accelerate progress in this area through its Strategic Prevention Framework (SPF). The framework is intended to stimulate the prudent use of available data, and the development of additional data resources, for: 1) identifying statewide priorities for substance abuse prevention, 2) informing resource allocation decisions, 3) monitoring state and local trends in substance abuse and related consequences, and 4) evaluating state and local prevention efforts. This article describes the underlying rationale and issues considered in developing the database, some of the challenges and limitations in applying the data to prevention planning processes, and current strategies employed by CSAP to guide states and communities in effectively using the data in their substance abuse prevention planning and monitoring efforts.

Challenges in Applying Indigenous Evaluation Practices in Mainstream Grant Programs to Indigenous Communities

Abstract: How can indigenous evaluators implement culturally competent models in First Nations communities while ensuring that government grant evaluation requirements are met? Through describing the challenges in one tribal community in the United States, this article will discuss how American Indian/Alaska Native substance abuse prevention programs are evaluating the implementation and outcomes of Strategic Prevention Framework grants from the federal government’s Center for Substance Abuse Prevention. Requirements for implementing evidence-based programs normed on other populations and for evaluating data based on quantitative methods add to the challenge. Throughout the process, much is being learned that it is hoped will strengthen indigenous grantees and increase the cultural competence of government evaluation requirements.

Quality of Provider–Participant Relationships and Enhancement of Adolescent Social Skills

This study adds to the limited research on the potential importance of the quality of the relationship between adult prevention service providers and youth participants in enhancing social skills and strengthening prevention outcomes. Study subjects were drawn from seven prevention programs funded under a Youth Mentoring Initiative by the Center for Substance Abuse Prevention in the Substance Abuse and Mental Health Services Administration. These programs maintain a relationship-based service focus but use a variety of one-on-one, group, volunteer, and paid staff service formats. Study results showed that youth who perceived a higher level of trust, mutuality and empathy in their relationship with providers experienced significantly greater improvements in social skills (i.e., cooperation, self-control, assertiveness, and empathy) than program participants who perceived a lower quality relationship with adult providers. These findings underscore the importance of recruitment, training and supervisory practices that promote staff and volunteer skills in achieving high quality relationships with youth participants regardless of the specific intervention strategy. Editors' Strategic Implications: Practitioners and policymakers should review the authors' findings about the importance of individual adult skills in building protective mentoring relationships. The impact of relationship quality, rather than setting, suggests that the scope of effective prevention practice can be broadened beyond the confines of formal prevention programming to any place in which caring and skilled adults interact with youth.