Introduction To Connected Kids Key Goal Connected Kids: Safe Strong Secure is an AAP program designed to support clinicians’ efforts to prevent youth violence by.

Introduction To
Connected Kids
Key Goal
Connected Kids: Safe Strong Secure
is an AAP program designed to
support clinicians’ efforts to prevent
youth violence by promoting the
development of resilient children.
Why Is This Important?
 Violence is a major cause of childhood morbidity
and mortality in the United States.
 Homicide is the 2nd leading cause of death for 13- to
• The leading cause of death for African Americans 13 to 21
years old1
 Increase in community violence during 1990s
• 21st century rates in the United States still among the
highest in the world
Why Is This Important?
 Many parents and pediatricians feel community
violence screening should be routine in well
child care.2-5
 Results from the 1998 and 2003 AAP Periodic
Surveys of Fellows show that a majority of
pediatricians feel unprepared to manage
community violence.2-4
Why Is This Important?
Parents want more doctors to discuss community
Community violence
should ask
Supportive partner
Parent's emotional support
Alcohol/drug use in household
Results from the National Survey of Early Childhood Health
Connected Kids provides…
Tools and strategies to help parents raise
resilient children:
 Educational materials for parents and
 Effective anticipatory guidance
 Developmentally appropriate guidelines
 Easy-to-use Clinical Guide with links to
Development Process
Development of Connected Kids included6:
 Input from parents, clinicians, and other experts
 Testing of program materials in focus groups with
diverse families and clinicians7
 Incorporation of stakeholder feedback
 A broad and respectful approach for all of the
educational materials
 Coordination with other AAP efforts
Connected Kids will:
 Strengthen the connections among children
and youth, their families, and their community
 Reduce risk factors by building resilience8
Presentation Goals
1. Become familiar with the underlying theoretical
model for Connected Kids
2. Review the counseling schedules for Infancy
and Early Childhood, Middle Childhood, and
3. Learn how to prepare a strategy for
implementing this program in your practice
Connected Kids . . .
 Uses an asset-based approach to prevention that:
• Emphasizes the identification and enhancement of
• Enhances clinician-family alliance
 Helps parents with strategies to:
• Promote positive development
• Develop prosocial interpersonal skills
• Obtain support and resources to help raise children
Asset- Versus Risk-based
Approaches to Guidance
• Goal: Help improve child’s
• Goal: Reduce known risks
• Assess family strengths
• Link to community
• Screen for risk factors
• Refer to services
Connected Kids Includes:
Clinical guide
Counseling schedule
Handouts for parents and families
Web site
• This training presentation
• Database of violence prevention materials
• Success stories
Clinical Guide
• This presentation
supplements the clinical
guide, available online at
• Clinical guide contains
• Background information
• Counseling schedule
• Visit-by-visit suggestions
from birth to age 21
Building Blocks
Connected Kids centers on 4 overlapping
themes of anticipatory guidance
• Child’s changing abilities
• Cognitive development of child
• Related parental concerns
 Addresses the importance of
parental supports
 Incorporates the idea that
parents develop along with
the child
 Contributes to the quality of
family life
 Promotes positive parenting
Positive Parenting
Teaching desired behavior begins with a
positive and nurturing foundation9
to do when
your child
How to manage conflict
and teach responsibility
Ways to nurture your
children and prevent misbehavior
Community Connections
 Research underscores the
importance of10:
• Social capital: a measure of the
interconnectedness among people
with their community
• Community connections
 Clinicians can help connect
families to community resources
Physical Safety
 Counseling schedule focuses on
violence and intentional injury
• Complements AAP’s TIPP®
(The Injury Prevention Program)
 Handguns in the home placed in
the context of child development
• Provides objective information to help
families make their own decisions
Connected Kids Counseling
 Lists topics to introduce and reinforce at each visit
 Provides asset-based assessment and anticipatory
guidance for each visit
 Links to use of parent and patient brochures:
• Distributed when a topic is first introduced
• Promote discussion between provider and family
• Give useful information to foster the development of
strong, resilient children
Counseling Schedule
Anatomy of a Brochure
Front Cover
Cover image visually conveys
core message
Designed by Artists for Humanity, a nonprofit arts and entrepreneurship program
for Boston teens.
Anatomy of a Brochure
 Each brochure addresses
one specific issue
 Content based on all four
building block themes
 Reading level: 2nd to 6th
 Contains concrete
examples for key concepts
Anatomy of a Brochure
Back Cover
 Summarizes topics
 Space provided for:
• Parent/patient guidance
• Follow-up suggestions
• Community resources
• Next appointment
• Practice name and address
Counseling Schedule
Infancy & Early
2 days – 4 years
Middle Childhood
5 – 10 years
11 – 21 years
Counseling Schedule:
2 DAYS to
2 and 4
6 and 9
What Babies Do
Parental Frustration
Parent Mental Health
Parent Support
Child Care
Safe Environment
Parenting Style
Bonding and Attachment
Establishing Routines
Discipline = Teaching
Modeling Behavior
• Early caregiver relationships set the stage for future
• Securely attached young children have an easier time
developing positive, supportive relationships
• Emerging evidence shows that securely attached
young children are found to have more18-25:
Balanced self-concept
Advanced memory processes
Sophisticated grasp of emotion
Positive understanding of friendship
Infancy Counseling
Be on the lookout for families
who are socially isolated or
experiencing family discord.
Who helps you with
your baby?
If there is a gun in
the home, how is it
Is this what you
How much time do
you have off from
Being a new parent
can be exhausting.
How are you doing?
Infancy Brochures
Welcome to the World of Parenting!
Visit: 2 Days to 4 Weeks
 Helps parents understand the
normal development of
 Provides information about
coping skills for parents
 Discusses changes in the ways
parents may now relate as a
How to Use this Tool
• Whenever appropriate, include both parents
in the conversation
• Discuss infant crying and ways to handle it:
• Crying is normal
• Crying upsets parents
• Sometimes, parents just need to let the baby
Helpful Hint!
Support new parents with
positive statements:
I love the way your baby looks at you,
soothes to your voice. You’re doing a
great job!
Parenting Your Infant
Visit: 2 and 4 Months
 Helps parents understand normal
development of 4- to 9-month-old
 Stresses importance of building
family connections
 Discusses 3 problems:
• Colic
• Trouble sleeping
• Clinging to parents
How to Use this Tool
• Reiterate messages about crying and parental
• Emphasize to parents the importance of
having time together without their baby
Helpful Hint!
Support new parents with
positive statements:
Your infant is alert, growing well, and
has a beautiful smile!
How Do Infants Learn?
Visit: 6 and 9 months
 Offers practical suggestions to
parents based on a newborn’s
brain development
• Encourages activities like reading or
singing to promote brain growth
 Helps parents understand that
exploration is a natural
developmental need
How to Use this Tool
• Ask parents about their social connections.
Refer to sections “Others Who Care for Your
Baby” and “Taking Care of Yourself”
• Utilize the “Social Connections” worksheet
from the Clinical Guide
• Talk about child care arrangements
Helpful Hint!
Notice infant’s new behaviors
and parent-child interaction:
Wow, your baby is really interested in
my stethoscope! I like the way she lets
me examine her, but she is always
looking over at you for assurance.
Your Child is on the Move:
Reduce the Risk of Gun Injury
Visit: 6 and 9 months
 Correlates childhood injuries/
deaths due to firearms and
presence of handguns in the home
 Emphasizes that a child’s curiosity
about guns overwhelms any
lessons learned about gun safety
 Provides information needed to
make informed decisions
How to Use this Tool
• Discuss handguns in the context of other
household hazards
• Since some parents may not be in agreement
concerning the presence of handguns in the
home, encourage them to look at the
brochure together to make an informed
Helpful Hints!
• In areas of country with high rates of gun ownership, some
practices offer reduced price or free gun locks
• Be aware of the potential lethality of domestic violence in homes
with handguns
Counseling Schedule:
Early Childhood
12 and 15
Child Development and
and 2 YEARS
Child’s Assets
Guided Participation
3 and 4 YEARS
Peer Playing
Safety in Others’ Homes
Talking About Emotions
Promoting Independence
Early Childhood26-30
 Communication skills allow young children to
sustain bouts of play
 How young children learn to react is greatly
influenced by:
• Parental relationship
• Parental behavior
• Home environment
Early Childhood Counseling
Encourage alternatives to TV,
such as outdoor activity or
“Does your child
have opportunities
to play with other
children this age?”
“Teach your child by
providing positive
reinforcement for
desired behaviors.”
Normal toddler behavior may be
especially difficult for families
with little social support.
“She really pays
attention when we
talk; does she
understand when
you speak to her?”
“What do you think your
child does best? What does
he enjoy doing?”
Early Childhood Brochures
Teaching Good Behavior:
Tips on How to Discipline
Visit: 12 and 15 Months
 Describes the basics of a behavioral
approach to parenting toddlers
• Positive reinforcement for desired
• Limit setting
 Advises parents about effective
alternatives to corporal punishment
How to Use this Tool
• Start conversations about toddler behavior with
gentle inquiries
• “Your child is growing and developing well.
Have tantrums started? How do you handle
• “What is your child doing new since last visit?
What do you want to change?”
• Endorse the core message: a simple approach
for teaching toddlers how to behave well
Helpful Hint!
Be on the lookout for children with difficult
temperaments, families who are socially
isolated, and families experiencing discord
Playing is How Toddlers Learn
Visit: 18 Months and 2 Years
Helps parents understand normal
toddler behavior and advises them
how to
• Provide a stimulating environment
during this period of major brain
• Understand the natural curiosity and
exploration of toddlers
How to Use this Tool
• Discuss normal toddler play behavior
• Provide parents with guidance on the types
of toys that stimulate imagination
• Help parents identify places where they can
meet other toddlers and their parents
Helpful Hints!
• Check in with parents about how
their family relationships are faring
• Support toddler’s parents with
positive statements:
What a delightful child you have!
He is really curious about the
world. This is great to see!
Pulling the Plug on TV Violence
Visit: 18 Months and 2 Years
 Provides information about the
influence of TV violence on
 Offers tips for parents
• Set limits on TV time
• Know what children are watching
• Watch programs with children
• Do not put TV in a child’s room
How to Use this Tool
• Identify alternatives to TV, such as toys that
use imagination or outdoor play when possible
• Recognize that alternatives can be
challenging, as TV often provides free in-home
child care for families who cannot afford
organized activities or who live in unsafe areas
Helpful Hint!
Ask the child:
What’s your favorite TV show?
The child’s response often indicates the kind of TV programs being
watched, which provides a topic to open discussion with parents
Young Children Learn A Lot When They
Visit: 18 Months and 2 Years
 Introduces the importance of
peer playing
 Includes tips on how to make
play opportunities successful
 Assists parents in solving
common difficulties, such as
aggression and rejection
How to Use this Tool
• Ask if child has opportunities to play with
other children of the same age
• Use parent’s answer to discuss how the child
plays or how to find other children
• Help parents problem solve any play or
playmate issues
Helpful Hint!
Try to notice something about what
children are wearing, the toys they
bring, or their behavior:
I see you really like trucks.
Do you and your friends play
with trucks a lot?
Counseling Schedule:
Middle Childhood
Establishing Routines and
Setting Limits
Teaching Behavior
Out-of-School Time
School Connections
Alcohol and Drugs
Interpersonal Skills
Child Mental Health
School Performance
Middle Childhood
 Rapid development of knowledge and skills
characterizes middle childhood
 Routines and limits will help children feel loved and
secure during this time of transition31,32
 Children learn by watching and interacting with
parents, other adults, and other children
• Parents can consciously model and expect respectful
Middle Childhood
 Play is another way children learn social skills35
• Many parents have concerns regarding safety and
supervision for after-school activities
 Schools can have a significant impact on
preventing violence36,37
• Besides academics, children learn how to function in
• Parental involvement with schools improves their
children’s experience and attachment
Middle Childhood
Counseling for the Parent
Do you have rules or
limits with respect to
TV, video games, and
computer time?
Are you involved in
any school-related
Who is your
child’s best
Children grow and develop
within a context of family,
school, and community.
How does your child
help around the
Is your child happy
most of the time or
Middle Childhood
Counseling for the Child
Have you been in
any pushing or
shoving fights?
What happens
when you and
your friends argue
or disagree?
What do you do
for fun?
School-age children need
to be active participants in
learning how to avoid and
react to conflict.
What do you like
best about school?
If you see someone
being bullied, what
do you do?
Middle Childhood Brochures
Growing Independence: Tips for
Parents of Young Children
Visit: 5 Years
 Emphasizes importance of
beginning parent-child
communication about peer
relationships early
 Teaches parents how to:
• Listen to children
• Help children assume more
independence and responsibilities
How to Use this Tool
• Address parents’ fears about children’s
safety in the outside world
• Ask about how the child is doing in school
and address any behavioral or emotional
Helpful Hints!
• Let the child know that secrets are
not OK
• Discuss child sexual abuse during
or after examination of the child’s
I’m here with your mother so
it’s OK. No adult should ever
tell you to keep a secret from
your parents.
Bullying: It’s Not OK
Visit: 6 Years
 Provides guidance for parents of
victims, bullies, and bystanders
 Victims may seek medical
attention, but the poorest future
outcomes are among bullies
 Schools can prevent bullying
using proven interventions
How to Use this Tool
• Place brochure in the waiting room; it may
be of interest to both parents and children
• Discuss specific strategies with those
families whose children are being bullied
• Use brochure as a guide when speaking to
community groups
Helpful Hint!
Ask the child:
Have you ever been in any pushing
or shoving fights?
If the answer is yes, it is important to determine the child’s role.
Drug Abuse Prevention Starts With
Visit: 8 Years
 Discusses connection between a
teen’s use and abuse of drugs
and/or alcohol and:
• Parent behavior and attitudes
• Media influences
• Communication
 Addresses parental role in
modeling and maintaining open
How to Use this Tool
• Encourage parents to talk with and listen to
their children
• For parents who smoke, discuss the ease of
starting and the difficulties of quitting;
address other substance abuse problems if
• Have substance abuse resources on hand
Helpful Hint!
Start conversations about drug
abuse with the recent news:
Did you hear about _____ being
charged with _____? What do you
think about that?
Friends Are Important: Tips for Parents
Visit: 8 Years
 Focuses on importance of peer
• Encourages parents to get to know their
child’s friends
 Provides guidance on monitoring
behaviors to prevent unsafe
 Reiterates Connected Kids theme of
clear, consistent, and positive
How to Use this Tool
• Encourage parents to know their child’s
whereabouts and talk about expectations for
staying in touch
• Encourage parents to help their child develop
a sense of belonging through prosocial youth
groups and community-based organizations
Helpful Hints!
• Address friendships and community activities while discussing
school progress and promoting physical activity
• Ask parent: “Who is your child’s best friend?” to initiate discussion
Everybody Gets Mad: Helping
Your Child Cope With Conflict
Visit: 10 Years
 Developed for parents of pre- and
early adolescents
 Describes the physiology of anger
and offers strategies to avoid
fighting when angry
 Guides parents in teaching their
children how to respond to
How to Use this Tool
• Introduce the topic with general questions
such as “Are there a lot of fights at
school?” or “What happens when you get
• Discuss the body’s physical response to
anger and how to stay calm
Helpful Hints!
• Ask patients who avoid fights if they have hints for other kids
• Consider the possibility of abuse, exposure to violence, or history
of ADHD or minimal brain trauma in children who have difficulty
dealing with anger
Counseling Schedule:
Early Adolescence
11 to 14
Family Time Together
Peer Relationships
Support System
Staying Safe
Teen Mental Health
Conflict Resolution Skills
Healthy Dating
Gaining Independence
Early Adolescence
 Independence is an overarching characteristic
of the early teen years
 Becoming independent means being more
responsible for one’s own safety
 Help teens stay safe by teaching them how to
avoid violence through good communication
 Effective communication is the common thread
for the Connected Kids early adolescence
Early Adolescence
 Talk with teens and parents about activities that
help families stay connected; many teens are
unsure about family relationships40
 Parents influence their teen children; discuss
parental use of alcohol, tobacco, and other drugs
 Involving adults from outside the family has a
positive effect on teen development41
 Encourage teens to get involved in their
communities; it is one of the best ways to help
them stay safe42
Early Adolescence
 Teens with friends engaged in risky behaviors
are more likely to imitate these behaviors43
 Conversely, friends involved in constructive,
prosocial activities encourage healthy and safe
 Teen dating violence affects approximately 1 in
8 high school students. Discuss healthy dating
with both teens and their parents44
 Youth who have a variety of ways to solve
conflicts are less likely to be hurt in a fight or
Early Adolescence
Use this mnemonic as
the basis for assessing
an adolescent’s risk for
involvement in violence.
See the Connected Kids
Clinical Guide for more
Early Adolescence
Counseling for Parents
What do you think
of your teenager’s
How are you
monitoring your
What kind of
activities does
your child enjoy?
Address parents’ concerns
about safety while still
helping them encourage
their teen’s independence
How do you
negotiate rules of
What most concerns
you about your
teenager’s safety?
Early Adolescence
Counseling for Youth
Whom do you turn
to for advice and
What do you do
to stay safe?
What after-school
activities are you
involved with?
With independence comes
the responsibility for staying
Whom do you go to
for help if you’re
having trouble in
your relationship?
What do you and
your friends like to
Early Adolescence
Talking With Your Teen: Tips for
Early Adolescence
 Describes typical teen behaviors
and feelings and emphasizes
parent-child communication as
independence increases
 Teaches parents how to:
• establish reasonable limits
• encourage safety as independence
How to Use this Tool
• Initiate discussion at puberty by asking,“I’m
sure there are many other changes going on
that you can’t see with your eyes, aren’t
• Speak with parents regarding concerns
about their child’s puberty
Helpful Hints!
• Having both teens and parents read this brochure may
encourage better communication between parent and child
• Ask parents to think about their own adolescence and how they
behaved and coped at this age
Staying Cool When Things Heat Up
Early Adolescence
 Encourages teens to think about
ways to resolve conflicts other
than fighting
 Discusses the role bystanders
play in promoting violent
How to Use this Tool
• Use different approaches based on violence
• “You’re very healthy, but I’m worried about
all the fights you’re getting into.”
• “Your exam looks good and I’m also glad to
hear that you haven’t been getting into a lot
of fights.”
Helpful Hints!
• Some clinicians leave this brochure in the waiting room for
patients to read beforehand
• It may help to let patients know that this information came from
other teenagers.
Expect Respect: Healthy Relationships
Early Adolescence
 Discusses healthy relationships and
ways to recognize and prevent
partner violence
 Teens are still experimenting with
intimate relationships and may be
more open to improving the quality
of their relationships
 While designed for all teenagers, it
had the most resonance with young
female teens in focus groups.
How to Use this Tool
• Introduce when teens show an interest in
relationships, dating, and sexual behavior
• Discuss healthy relationships along with
physical concerns such as sexually
transmitted diseases
• Can be used with sex education courses in
Helpful Hints!
At the end of an exam, say:
Today we have discussed some of the
physical issues of intimate
relationships, but the emotional
issues are just as important.
Teen Dating Violence: Tips for Parents
Early Adolescence
 Discusses parental response
when partner abuse is suspected
 The main concern for parents is
their child’s happiness and
welfare, not pointing out what is
wrong with the abusive partner
How to Use this Tool
• Encourage parents to:
• empathize with what their child is
• support their child in finding and maintaining
non-abusive, healthy relationships
Helpful Hint!
Give this brochure to parents at the same time Expect
Respect: Healthy Relationships is given to teenagers
Counseling Schedule:
Middle Adolescence
15 – 17
Plans for the Future
Firearms and Suicide
Middle Adolescence
 There is a direct link between assets and
the risk for violence and future success46
 Identify and support a teen’s:
functional abilities
positive relationships with others
connections to groups, role models, and
Middle Adolescence
 A key in helping teens avoid violence is to
teach them how to:
• assess risk and make an immediate decision
• think about the long-term consequences of that
Middle Adolescence
Counseling for Parents
If you have guns,
how do you store
How is your teen
getting along with
Do you talk about
future plans?
Help parents with the
teen’s dilemma of quick
decisions and long-term
How do you stay in
touch with your
What non-school
activities is your teen
involved with?
Middle Adolescence
Counseling for Youth
Do you have
somebody to talk
to when you feel
What do you want
to do after high
school graduation?
What do you like best
about yourself?
Teens are living in the
moment, but need to think
about the future.
Can you get a gun if
you want to?
How do you get along
with your friends?
Middle Adolescence
Teen Suicide and Guns
Middle Adolescence
 Discusses the risks of guns in
the home and the link to
completed teen suicides
 Objectively discusses guns and
gun storage
How to Use this Tool
• Use on an individual basis to support
• Can be distributed to schools and
community groups
• Parents of teens with mood disorders may
benefit from this along with the brochure
Help Stop Teenage Suicide
Helpful Hints!
Use current events:
Did you hear about the teen who killed
himself last month? I’m talking about
this with all of my teenage patients.
Connecting With Your Community
Middle Adolescence
 Teenagers who are involved in
their communities are less likely
to be involved with:
• alcohol
• drugs
• violence
• promiscuous sexual activity
How to Use this Tool
• As relationships with their parents become
more complex, additional adult role models
become more important for teens
• Support teens in finding adults in the
community who believe in and support
Helpful Hints!
• Schools and community groups can help find opportunities that
meet the interests and talents of young adults
• It may be beneficial for clinics to develop a resource guide for
teens about local community groups
Counseling Schedule:
Late Adolescence
18 – 21
Transition to
Negotiating a New
(Post High School)
Late Adolescence
 Transitioning to independence is a gradual
 Bringing closure to this process is essential
 Many older teenagers are likely to be moving out
of the home to:
• higher education
• their own living situation
• an entirely new community
 This is exciting and stressful for both teen and
Late Adolescence
Counseling for Youth
What are your plans
down the road?
Do you plan to
move out of your
parents’ home?
Can I help with
getting you where
you want to go?
Support patients with the
transition to becoming a young
Whom do you talk
to about your
future plans?
How do you feel about
moving out?
Late Adolescence
Help Stop Teenage Suicide
Late Adolescence
 Talks about common myths, gives
the warning signs, and stresses
that many teen suicides occur
with little forethought
 Designed for teens, parents, and
other caregivers
How to Use this Tool
• Use with patients with mental health issues,
especially mood or conduct disorders, that
often develop during these years
• Stress link between presence of a handgun
and increased likelihood of lethal suicide
Helpful Hint!
• Teens who think they may be gay, lesbian, bisexual, or transgender
are at an increased risk for suicide; help them and their families
find additional support
Next Stop Adulthood: Tips for Parents
Late Adolescence
 Teens are renegotiating parental
relationships as they transition
into adult responsibilities
 Helps parents let go while
encouraging teens to seek
guidance from their parents
How to Use this Tool
• Use as a catalyst to discuss increasing
• Teens who are already in trouble may need
a social worker to help better understand
and implement these concepts
Helpful Hints!
• It is helpful to discuss employment, community service, sports,
clubs, and other pursuits
• Teenagers need positive engagement with their outside
community in order to thrive!
Ideas for Optimal Use
While implementing Connected Kids with an
individual family depends on a family’s starting
point—and the family’s interest in our input—we
can begin to consider some strategies for
implementation in the following areas:
Intake Forms
Educational Materials
Practice Changes
Community Connections
Intake Forms
 Use the Bright Futures Pediatric Intake Form
• Introduce Connected Kids in a cover letter to families
 Use information gathered to prioritize issues for
families and tailor the program
 As your relationship with a family evolves, it may
become easier to discuss sensitive topics
 Use the information gathered at every visit
 Be sensitive to issues that might be difficult
for a particular family
 Include both statistics and stories
 Prioritize topics covered on the families’
 Use the adolescent brochures to facilitate
new ways for parents and teens to talk
Educational Materials
 Use brochures to introduce sensitive topics,
such as domestic violence
 Encourage the parent to share the information
with other adults caring for the child
 Ask support staff to help distribute materials
while patients are waiting to be seen
Educational Materials
 Personalize the brochures:
• Circling or underlining a passage increases the
likelihood that your advice will be followed
• Write down family-specific information in the box on
the back cover during the visit
 Suggest placing it on the refrigerator so the
cover image can be a reminder of what to do
 Encourage parents/patients to write questions
in the box on the back while they are waiting
Practice Changes
 Involve all office staff; receptionists observe how
parents and children interact
 Use the Counseling Schedule from the Clinical
Guide to document when you have introduced and
reinforced topics
 Talk with colleagues about how they have
successfully implemented Connected Kids
Community Connections
 Become familiar with programs in your
 If resources do not exist, advocate for services
 Get involved:
• Join coalitions working to rid the community of
Speak to community and school groups
Talk with the local media
In Summary
All children deserve to grow up:
We can help families achieve these
Centers for Disease Control and Prevention. Web-based Injury Statistics Query and
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Howard Spivak, MD
Robert Sege, MD, PhD
Elizabeth Hatmaker-Flanigan, MS
Bonnie Kozial
Vincent Licenziato
Kimberly Bardy, MPH
This project was supported by Grant No. 2001-JN-FX-0011 awarded by the Office of Juvenile
Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice.
Points of view or opinions in this document are those of the author and do not necessarily
represent the official position or policies of the U.S. Department of Justice.

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