An integrated framework for serving at-risk youth based on a review of studies of drug use, delinquency, teen pregnancy, runaway youth, school dropouts and other problem behaviors projects a sequence of increasing risk of serious problems measured by four stages: (1) risk antecedents such as poverty and family dysfunction which are correlated with poor outcomes, although many such youth do not experience poor outcomes; (2) risk markers such as poor school performance or involvement with child protective services which are early indicators that an individual youth is experiencing problems; (3) problem behaviors which are early manifestations of deviance, and (4) outcomes in the form of serious drug abuse, criminal involvement, and dropping out of school. Within this framework, the Children at Risk Program focuses on youth who exhibit risk markers as well as risk antecedents (stages 1 and 2) and provides intensive interventions to prevent the onset of problem behaviors and outcomes (stages 3 and 4). Neighborhood and school activities are combined with intensive outreach, assessment, and follow-up by CAR case managers to link youth and family members to needed services. Incentives, recreational programs, and family events are used to engage hard-to-reach clients. Baseline data from interviews with 325 CAR participants and their caregivers will be presented on neighborhood, family, peer group, and individual risk indicators. The efforts in five cities to develop integrated service delivery systems to meet the needs of this client population will be discussed in light of the first year service referral and utilization patterns.
