Content uploaded by Claire Brindis
Author content
All content in this area was uploaded by Claire Brindis on Dec 03, 2018
Content may be subject to copyright.
Special Article
Opportunity Youth: Insights and
Opportunities for a Public Health
Approach to Reengage Disconnected
Teenagers and Young Adults
Tamar Mendelson, PhD
1
, Kristin Mmari, DrPH
2
, Robert W. Blum, MD
2
,
Richard F. Catalano, PhD
3
, and Claire D. Brindis, DrPH
4
Abstract
Approximately 1 in 9 teenagers and young adults aged 16-24 in the United States is currently disconnected from school and
employment. These disconnected young people (ie, opportunity youth) are not only at high risk for long-term emotional,
behavioral, and health problems, but they also represent a loss of human capital, with high social and economic costs. In this
article, we offer a public health perspective on opportunity youth by describing their distribution in the population and conse-
quences of their disconnection; proposing a conceptual model of the issue based on epidemiological principles, life course
development concepts, and ecological theory; and recommending multisector strategies for preventing disconnection of young
people and reengaging opportunity youth. A public health approach to the problem of opportunity youth would involve
developing and investing in youth monitoring data systems that can be coordinated across multiple sectors, consolidating both the
delivery and funding of services for opportunity youth, developing policies and programs that encourage engagement of young
people, and fostering systematic approaches to the testing and scaling up of preventive and reengagement interventions.
Keywords
conceptual model, disconnection, prevention, reengagement, youth disconnection
Emerging adulthood—the period between the late teens and
early 20s—is a profoundly important developmental stage.
During this time, most young people obtain the education
and training that will provide the foundation for their occu-
pational trajectories during the rest of adulthood.
1
Many
young people, however, do not obtain adequate levels of
these important experiences to support future financial
independence and productive careers. In 2016, nearly
12%of teenagers and young adults aged 16-24 in the United
States were both out of school and out of work.
2
These
young people are commonly referred to as disconnected
youth or opportunity youth. The latter term is preferred by
some because it conveys the notion that engaging this group
in the educational system and the labor force has potential
benefits. Relative to their connected contemporaries,
opportunity youth have a disproportionate share of prob-
lems as they age, including chronic unemployment, pov-
erty, mental health disorders, criminal behaviors,
incarceration, poor health, and early mortality.
3-5
These
alarming disparities between opportunity youth and their
more connected peers represent a public health problem
with serious social, economic, and health implications.
In this article, we view youth disconnection from a public
health perspective, dividing our discussion into 3 sections.
First, we describe the distribution and consequences of youth
disconnection in the United States. Second, we provide a
conceptual model of youth connection and disconnection,
which is grounded in ecological theory, life course develop-
ment concepts, and epidemiological principles. Third, we
offer recommendations for multisector strategies aimed at
reducing and preventing youth disconnection.
1
Department of Mental Health, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA
2
Department of Population, Family, and Reproductive Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3
School of Social Work, University of Washington, Seattle, WA, USA
4
Adolescent and Young Adult Health National Research Center, University
of California, San Francisco, School of Medicine, San Francisco, CA, USA
Corresponding Author:
Kristin Mmari, DrPH, Johns Hopkins Bloomberg School of Public Health,
Department of Population, Family, and Reproductive Health, 615 N Wolfe
St, Room E4620, Baltimore, MD 21205, USA.
Email: kmmari1@jhu.edu
Public Health Re ports
2018, Vol. 133(Supplement 1) 54S-64S
ª2018, Association of Schools and
Programs of Public Health
All rights reserved.
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0033354918799344
journals.sagepub.com/home/phr
Youth Disconnection: Distribution in
the Population and Individual and Social
Consequences
Disconnected youth compose a sizable portion of the US
population of teenagers and young adults aged 16-24. Mea-
sure of America, a project of the Social Science Research
Council, uses data from the American Community Survey
(ACS) to develop detailed reports on disconnected youth.
2
Measure of America reported that the proportion of US teen-
agers and young adults aged 16-24 who were neither
employed nor in school 3 months before each survey
declined from 14.7%in 2010 to 11.7%in 2016. Although
this decline represents a 20%decrease in the percentage of
disconnected youth from 2010 to 2016, an estimated 4.6
million young people were still disconnected in 2016, the
most recent year for which data were available.
2
The 2016 Measure of America data suggested that the
probability of disconnection among young people was
affected by income, race/ethnicity, and residential environ-
ment. Disconnected youth were nearly twice as likely as
connected youth to live in poverty and to receive Medicaid.
2
In communities where the poverty rate was below 6%, about
1 in 14 young people were disconnected; however, in com-
munities where the poverty rate was above 21%, 1 in 5 young
people were disconnected. Racial/ethnic disparities were
striking; youth disconnection occurred in 6.6%of Asian
American, 9.7%of white, 13.7%of Latino, 17.2%of black,
and 25.8%of American Indian/Alaska Native young peo-
ple.
2
The fact that these disparities persisted even when con-
trolling for income suggests that structural racism and
discrimination may also contribute to youth disconnection.
Residential environment disparities were also noted; youth
disconnection was found among 11.3%of young people in
suburban areas, 12.9%in urban areas, and 19.3%in rural
areas. Whereas the national average for youth disconnection
was 11.7%,24%of young people in the rural South were
disconnected. Other factors reportedly related to youth dis-
connection have included poor grades, mental health and
substance use disorders, parental unemployment, exposure
to trauma, and association with socially deviant peers.
3,6
Youth disconnection has consequences, both for each
affected young person and for society. In a longitudinal study
published in 2002, young people who were not in school or
employed for at least 6 months while aged 16-18 were 3 times
more likely than their connected peers to develop depression
and other mental health disorders and 5 times more likely to
have a criminal record, yet one-sixth as likely to obtain a high
school or college degree.
7
In 2012, each disconnected young
person was estimated to cost taxpayers $13890 per year and
approximately $250000 during a lifetime, taking into account
criminal justice expenses, welfare and social service payments,
taxpayer-funded health care costs, and lost tax revenue.
8
The heterogeneity of this population complicates efforts
to understand the unique experiences of or help opportunity
youth. The population encompasses a broad range of young
people, including those in the juvenile justice and foster care
systems, teenage mothers, and homeless young people.
7
Yet
these subgroups are often excluded from or underrepresented
in population surveys, including the ACS and Current
Population Survey.
8
Adding to the challenge, youth discon-
nection is usually assessed as if it were binary (ie, discon-
nected or not), when it may actually be better conceptualized
and measured along a continuum. Furthermore, although
some young people (described as chronically disconnected
youth) are consistently out of work and school, others
(described as underattached youth) are only intermittently
disconnected, having either not progressed satisfactorily
through the educational system or not secured consistent,
stable employment. Evidence suggests that various sub-
groups may require different intervention approaches.
8
Another challenge is that the prevailing structural defini-
tion of disconnection (ie, out of school and work) may not
capture the extent to which many young people lack mean-
ingful connections, including positive relationships with
peers, adults, and family. Those enrolled in school (techni-
cally connected) may be homeless or abused and may have
family disruptions or inadequate peer relationships. Thus,
understanding disconnection within not only a structural
context but also social and emotional contexts is crucial to
providing adequate support to opportunity youth.
Conceptual Model of Youth Connection
and Disconnection
To clarify the theoretical underpinnings of youth
disconnection, we propose a conceptual model that draws
from epidemiological principles,
9,10
life course development
concepts,
10,11
and ecological theory (Figure). The model is
informed by the Positive Youth Development Framework,
which views youth development as embedded within family,
school, community, society, culture, and history, and which
promotes strategies that provide opportunities that build on
young people’s strengths.
14-18
This framework assumes plas-
ticity (ie, the capacity for adaptive change), which is espe-
cially relevant during adolescence, a time of dramatic brain
development and emotional growth, both of which provide
opportunities for transformation. The framework also empha-
sizes that positive change can take place within multiple social
contexts (ie, family, peer groups, school, community) and can
be promoted by various people in those contexts.
14,15,18
The conceptual model is built around young people aged
16-24 and their developmental stages. The model depicts a
continuum from connection, to underattachment, to discon-
nection (Figure). The model includes protective factors for
connection and risk factors for disconnection, all of which
potentially affect youth development at multiple ecological
levels, including individual, family, school/friends, commu-
nity, and society/policy. At each developmental stage and
ecological level, risk and protective factors can increase or
decrease disconnection. For example, at the societal level,
structural racism, sexism, and income inequality may limit
Mendelson et al 55S
options for housing, education, and employment and, thus,
increase the likelihood of disconnection.
19
Conversely, access
to supportive adults and services can reduce the likelihood of
disconnection.
3,20
The model additionally incorporates various
interventions, which can also influence youth development.
These interventions may range from promotion of connection,
to prevention of disconnection, to reengagement of those who
are disconnected.
12,13
The model indicates that promotion and
prevention strategies—key components of a public health
approach that are detailed later—as well as reengagement stra-
tegies can be envisioned that target various youth populations,
which, depending on the intervention goals, may include all
young people regardless of risk (universal interventions);
young people with risk factors for disconnection, such as place-
ment in child welfare (selective interventions); and young peo-
ple exhibiting early signs of disconnection, such as missing
numerous school days (indicated interventions).
12,13
Strategies for Preventing or Reducing
Youth Disconnection: Applying a Public
Health Approach
In this next section, we describe promising prevention and
reengagement strategies, and we make recommendations for
how these strategies might be improved or expanded by
using public health tools. Public health tools—including
identifying populations at highest risk for health issues, mon-
itoring protective and risk factors, and implementing
population-based prevention and intervention strategies—
can be used in an intentional and systematic way to reduce
the number of opportunity youth.
So far, the predominant response to youth disconnection
has been the use of reengagement strategies. These strategies
aim to reconnect young people with education or to provide
young people with apprenticeships, other job training, or
employment (Table 1). National reengagement programs,
such as YouthBuild, Job Corps, and Year Up, have demon-
strated measurable (albeit small) benefits for high school gra-
duation rates and wages.
25
Other large-scale initiatives have
broadened the scope and impact of this work. One of these
initiatives is the Aspen Institute’s Opportunity Youth Incen-
tive Fund, an initiative established in 2012 that provides sup-
port to 21 US sites and has 3 goals: (1) reconnecting
opportunity youth to education and employment; (2) catalyz-
ing the adoption of approaches in education and career attain-
ment that lead to family-sustaining careers; and (3) promoting
local, state, and national policies that increase the replication
and scaling up of these approaches.
26
Another reengagement
Figure. Conceptual model of youth connection and disconnection. Disconnected youth are teenagers and young adults aged 16-24 who are
neither in school nor employed.
2
The model is built around developmental stages (continuum: connection to underattachment to discon-
nection) of young people aged 16-24. Protective factors for connection and risk factors for disconnection may affect development at multiple
ecological levels: individual, family, school/friends, community, and society/policy. Promotion of connection, prevention of disconnection, and
reengagement of disconnected youth with school, employment, or key social supports can be used to target young people universally (all young
people), selectively (young people with risk factors), or as indicated (young people showing early signs of disconnection).
12,13
56S Public Health Reports 133(Supplement 1)
project is the 100 000 Opportunities Initiative, which was
launched in 2015 and is the largest employer-led, opportunity
youth–focused coalition in the United States. In this initiative,
the coalition committed to training and hiring 100000 oppor-
tunity youth by 2018. More recently, after surpassing this
original goal 2 years ahead of schedule, it established a new
goal to hire 1 million opportunity youth by 2021.
27
Historically, strategies to prevent youth disconnection
have not received the same level of priority as reengagement
strategies. Yet prevention is at least as important as reen-
gagement; it can reduce the need for costly interventions
later in life, and it can reduce suffering and enhance well-
being among young people.
28
Preventive approaches for
youth disconnection include strengthening connections
within the key contexts in young people’s lives (school, fam-
ily, and community) and promoting academic and career
engagement among young people (Table 2). For example,
a large body of evidence supports the role that universal
preschool education can play in both readiness to learn and
good academic performance, demonstrating a positive long-
term effect on student engagement in school.
46-49
The Good
Behavior Game, an example of a classroom-centered
Table 1. Examples of school-, family-, community-, and employer-based programs for the reengagement of disconnected youth
a
Program Name Target Audience Program Description Outcomes
School-based programs
PACE Center
for Girls
Girls aged 11-18 who exhibit multiple
health, safety, and delinquency risk
factors such as poor academic
performance, truancy, risky sexual
behavior, and substance use
PACE operates in 19 nonresidential,
year-round centers across Florida.
Girls attend PACE during school
hours and receive academic and
social services (eg, life skills training,
care planning). Parental engagement,
transition, and follow-up services
are key to PACE. When girls leave
PACE, they are expected to return
to schools to complete their
secondary education.
Results of a randomized controlled
trial are expected in 2018 that will
include examining the impact of the
program on high school completion,
school suspensions, absenteeism,
arrests, and employment stability.
Interim report findings were
included in Treskon et al.
21
Reconnecting
Youth
Adolescents aged 10-12 who are (1)
behind in credits for grade level, (2)
in the top 25th percentile for
absences, (3) have a grade point
average lower than 2.3 OR have a
prior dropout OR have been
referred by school personnel
Evidence-based program intended to
increase school performance,
decrease drug involvement, and
decrease emotional distress via a
75-lesson curriculum, social and
school bonding activities, and a
school crisis response plan.
A qualitative study in an urban high
school setting showed that the
program directly increased personal
control, prolonged exposure to the
program, and increased protective
factors.
22
Employer-based programs
National Guard
Youth
ChalleNGe
Program
Young men and women aged 16-18
who have difficulty completing
traditional high school
Using a military model, a voluntary 17-
month dropout recovery program
helps at-risk young people earn their
high school diploma or GED, enroll
in college or trade school, start a
career, or join the military.
Compared with controls, program
participants were more likely to
obtain their GED, to have earned
college credits (72% vs 56%), to be
employed and earning about 20%
more income, and to report living
on their own. Unfavorable trends
increased the risk of not using birth
control and having tried illegal drugs
other than marijuana.
23
Opportunity
Youth
Service
Initiative
Diverse young people and young adults
aged 18-24 from disadvantaged
backgrounds
The initiative provides young people
with an opportunity to engage in an
environmental service project,
workplace readiness training,
assistance in transition to college,
and professional certifications,
including OSHA.
Results showed that 48% of
participants indicated that they
enrolled in a school, and 52%
indicated that they successfully
obtained employment. Substantial
differences emerged in community
engagement, teamwork, leadership,
self-responsibility, communication,
and grit.
24
Abbreviations: GED, general educational development; OSHA, Occupational Safety and Health Administration.
a
Disconnected (or opportunity) youth are teenagers and young adults aged 16-24 who are neither in school nor employed.
2
Note: Additional evidence-based and promising prevention and reengagement programs can be found at the following websites: https://www.oasas.ny.gov/
prevention/evidence/EBPSList.cfm, https://youth.gov/evidence-innovation/program-directory?keywords¼&field_pd_factors_risks_tid¼413&field_pd_fac
tors_protective_tid¼All, http://goc.maryland.gov/wp-content/uploads/sites/8/2015/10/Program-Models-for-Serving-Opportunity-Youth.pdf
Mendelson et al 57S
Table 2. Examples of school-, family-, community-, and employer-based programs for the prevention of youth disconnection
a
Program Name Target Audience Program Description Outcomes
School-based programs
Good Behavior Game Early elementary grades Classroom-centered universal
prevention program delivered by
teachers in classrooms.
Shown to have short- and long-term
positive effects on problem
behaviors, conduct disorder,
educational outcomes, substance
use, and violence.
29-32
Life Skills Training Students in kindergarten through
12th grade, students in transition,
and parents
Substance abuse prevention
program that builds knowledge
about the dangers of drug use and
promotes healthy alternatives
through personal self-
management skills, general social
skills, and drug and violence
resistance skills.
Reduced tobacco, alcohol, and illicit
drug use and reduced verbal and
physical aggression and
delinquency for intervention
participants relative to controls.
33
Produced $50 benefit for every $1
invested in terms of reduced
corrections costs, welfare and
social services burden, drug
and mental health treatment,
and increased employment and
tax revenue.
34
Family-centered programs
Strengthening Families High-risk families with children in
preschool through age 17
14-session evidence-based program
that provides parent, child, and
family with life skills training.
Parents and children participate in
groups together and separately.
Various randomized controlled trials
evaluating the program reported
positive results in reducing
substance use and delinquency by
improving family
relationships.
35,36
Triple P: Positive
Parenting Program
Parents of children up to age 17,
specialized programs for parents
of children with disabilities, family
issues (separation/divorce),
minority populations
Parenting program designed to
address behavioral and emotional
problems in children and teens.
Based on social learning, cognitive
behavioral theory, and
developmental theory.
Shown to reduce rates of child
abuse, reduce foster care
placements, and decrease
hospitalizations from child abuse
injuries.
37
Reduced problems in children and
improved parental well-being and
parenting skills.
38
Community-based programs
Communities That
Care (CTC)
Young people in grades 5 through
12 in participating communities
CTC is a coalition-based prevention
approach in which researchers
consult with community
stakeholders to identify relevant
risk and protective factors and
implement evidence-based
school, family, and community
preventive interventions to
promote positive youth
development.
Multiple large-scale impact
evaluations have found that CTC
reduces short- and long-term
substance use and delinquent
behaviors.
39-41
CTC was also found to increase
youth-reported protective
factors
42
and to be a cost-
beneficial intervention with a
return of $5.30 per $1 invested
under conservative
assumptions.
43
PROSPER (PROmoting
School-Community
Partnerships to
Enhance Resilience)
Young people through 12th grade PROSPER is a community-university
partnership that delivers
evidence-based school-, family-,
and community-based preventive
interventions with the primary
goal of preventing substance
misuse.
Lower substance misuse was seen in
intervention youth (relative
reduction rates up to
approximately 31%)
44
as well as
reduced conduct problems
45
through 6.5 years after baseline.
Long-term effects, beyond high
school, were observed on
reducing substance misuse.
40
a
Disconnected (or opportunity) youth are teenagers and young adults aged 16-24 who are neither in school nor employed.
2
Note: Additional evidence-based and promising prevention and reengagement programs can be found at the following websites: https://www.oasas.ny.gov/
prevention/evidence/EBPSList.cfm, https://youth.gov/evidence-innovation/program-directory?keywords¼&field_pd_factors_risks_tid¼413&field_pd_fac
tors_protective_tid¼All, http://goc.maryland.gov/wp-content/uploads/sites/8/2015/10/Program-Models-for-Serving-Opportunity-Youth.pdf
58S Public Health Reports 133(Supplement 1)
universal prevention program, was found to reduce conduct
problems, emotional disorders, school suspensions, and spe-
cial education service use, as well as to increase high school
standardized test scores and the odds of high school gradua-
tion and college attendance; and, during early childhood, to
reduce antisocial behaviors, substance use, and violent and
criminal behavior.
29-32
Both Communities That Care and
Promoting School-Community-University Partnerships
to Enhance Resilience (PROSPER) are examples of
community-based strategies to prevent youth disconnection,
each of which has demonstrated positive effects that extend
into young adulthood.
39-45
In these approaches, researchers
provide structured guidelines and support to communities
and help them convene a coalition of agencies, schools, and
community leaders to conduct school-based assessments,
prioritize protective and risk factors, and implement
evidence-based school, family, and community prevention
programs matched to their identified priorities.
To be maximally effective, however, strategies to prevent
disconnection need to be delivered at multiple ecological
levels (ie, family, peers, school, community), during various
developmental stages (infancy through early adulthood), and
across various sectors (eg, education, health). Effective
evidence-based prevention strategies certainly exist,
28
but
many have not measured their effect on youth disconnection,
and most have not been scaled up sufficiently to affect a
broad population. In addition, only a few prevention strate-
gies, such as that reported by Stormshak et al,
50
have been
integrated with reengagement strategies.
To expand on the work already begun and address a prob-
lem as complex as youth disconnection, multisectoral
approaches are needed. Public health strategies should be
well suited to this effort because they can be formulated to
target diverse sectors, to work at multiple ecological levels,
and to engage a wide range of stakeholders and disciplines
concurrently.
51,52
Strategies most likely to succeed will be
those that (1) use coordinated data systems, (2) consolidate
service delivery and blend funding, (3) involve young people
in the design and implementation of interventions, and
(4) undertake systematic approaches to the testing and scal-
ing up of prevention and reengagement interventions.
Coordinated Data Systems
Multiple youth monitoring data systems collect data on edu-
cation, health care, juvenile justice, child welfare, and foster
care. However, because most of these data systems currently
lack interoperability, it is nearly impossible to track oppor-
tunity youth who move in and out of these sectors. Also,
these data systems often fail to gather data elements in con-
sistent ways. The current situation presents an opportunity
for creating policies that incentivize standardized data col-
lection and data sharing. Ultimately, coordinated collection
and integration of data across multiple systems is crucial for
effectively preventing and reducing youth disconnection.
Another challenge is that in many data systems, certain
opportunity youth subgroups (eg, homeless and unstably
housed young people, lesbian/gay/bisexual/transgender/
queer and questioning [LGBTQ] young people) are invisible.
LGBTQ young people are known to be disproportionately
discriminated against and harassed in schools and the work-
place,
53-55
but they are often concealed within the broader
category of opportunity youth because many data systems do
not capture data on sexual orientation or gender identity.
2
Data system consistency, consolidation, and sharing across
various educational, health, and social services should be a
priority. Through new public policies, integrated data sys-
tems could be established that would identify disconnected
youth communities or subgroups to prioritize for prevention
and reengagement efforts.
A related obstacle is the lack of longitudinal data pertain-
ing to opportunity youth. Information about the pathways
that young people may follow into and out of disconnection
is valuable. For example, longitudinal data have shown that
the quality of parental caregiving from age 6 to 42 months is
a predictor of high school dropout rates.
56
Evidence also
indicates that children exhibiting problem behaviors in first
grade or having to repeat first grade had higher high school
dropout rates than children without these issues.
56,57
Some
longitudinal datasets, such as the National Longitudinal Sur-
vey of Youth, the Educational Longitudinal Survey of Youth,
and the National Longitudinal Study of Adolescent Health,
can be useful in broadening the understanding of differences
among chronically disconnected, underattached, and institu-
tionalized young people.
6
Nevertheless, an increase in the
collection and monitoring of youth disconnection risk indi-
cators over time could help ensure that at-risk young people
are identified early and provided with additional supports to
prevent disconnection as they age.
The San Diego Youth Opportunity Pathway Initiative is
an example of how detailed and integrated data can be used
to prioritize prevention and reengagement programs.
26
Beginning in 2013, this collaborative merged data from the
US Census tract with data from the US Department of Health
and Human Services and the San Diego Association of
Governments to create “heat” maps, which display areas
with high concentrations of young people who have various
risk factors for disconnection, including unemployment, teen
births, probation, foster care, and school dropout. Along with
data on levels of existing programming, the maps have been
used by collaborative partners to identify priority neighbor-
hoods and potential entry points for prevention and reen-
gagement efforts. Another example is the Opportunity
Index, created by Opportunity Nation, a cross-sector national
coalition working to expand economic mobility and close the
opportunity gap in the United States. This group has inte-
grated information from various data sources to provide an
annual opportunity score for states and counties throughout
the United States.
58
The opportunity score is based on 20
economic, health, and civic indicators that measure expan-
sion or restriction of access to opportunity for upward
Mendelson et al 59S
mobility, and it can be used to identify the communities that
are most in need of prevention and reengagement efforts. We
recommend that similar types of monitoring systems, which
would collect, merge, and integrate data, preferably across
the life course and at a population level, be implemented
broadly by the communities.
Most data sets either do not include key risk factors (eg,
family trauma) and protective factors (eg, positive relation-
ships with a caring adult) for youth disconnection or do not
monitor these risk and protective factors longitudinally. One
exception is the Communities That Care Youth Survey,
which is administered to young people in grades 6, 8, 10,
and 12 on a population-wide basis and provides data on more
than 20 risk and protective factors.
59-61
Another exception is
Search Institute’s Developmental Assets Profile,
62
which has
been used in schools and communities since 2005. This sur-
vey measures young people’s internal strengths, external
supports, and growth in these key areas over time. An impor-
tant step toward preventing youth disconnection would be
the development of policies that require schools to perform
longitudinal population-level surveys, starting in early ele-
mentary school and extending through high school or
beyond. These surveys should measure disconnection levels,
risk and protective factors, and their consequences. Data
captured by such surveys could help inform interventions
that are tailored to and responsive to the needs of various
subgroups of opportunity youth.
Another strategy that would help deepen our understand-
ing of the experiences and needs of opportunity youth would
be to integrate data obtained using qualitative and mixed
methods with quantitative data. Interviewing young people
who are either at risk for disconnection or are already dis-
connected would enhance the ability of researchers and pol-
icy makers to view issues from the perspective of young
people. A more frequent use of qualitative methods would
allow comparisons of the experiences of various discon-
nected youth subgroups, including those in rural areas and
urban areas, and those in culturally disadvantaged groups
(eg, immigrant youth) and marginalized groups (eg,
LGBTQ). Qualitative reviews of school policies would be
a way to identify policies that may be contributing to youth
disconnection, either inadvertently or by design. One exam-
ple is the use of “one strike and you’re out” (zero tolerance)
school expulsion policies.
63
These and other school policies
have been criticized for increasing dropout and incarceration
rates, as well as other problems.
63-67
Information obtained
from regular policy analyses would offer the opportunity to
modify such policies that may be placing more students at
risk for disconnection.
Strategies and policies that promote the capture and use of
appropriately detailed, coordinated, and integrated longitu-
dinal data are needed to help various systems and sectors
better align with each other to address youth disconnection.
However, substantial challenges to implementation of
these strategies and policies exist. These challenges
include costs, privacy concerns, technological issues, and
obtaining stakeholder buy-in. Progress in this area will
require collaborative efforts, including making infrastruc-
ture- and data-sharing arrangements, to move the field
forward.
Service Delivery and Funding
Disconnected youth have historically relied on a handful of
public and nonprofit agencies or stand-alone programs in
their communities for the prevention and reengagement ser-
vices they need. These agencies and programs have typically
been supported by a fragmented array of funding sources.
Because of ineffective interagency coordination, information
sharing, and longitudinal follow-up, disconnected youth
have received inadequate attention to their needs, and data
on both the short- and long-term effects of programmatic
efforts have been lacking. Consolidation of prevention and
reengagement services to disconnected youth would help
address some of these deficiencies, and public policy could
be used to help drive and shape this consolidation.
For policies directed at service consolidation to be effec-
tive, however, policy makers need to consider the potential
costs and benefits of the outcomes they are seeking, applying
a return-on-investment approach to any funding commit-
ments that are being considered.
34
For example, funding
could be made dependent on programs providing certain
returns, such as demonstrations of interagency collaboration,
service-system integration, and engagement of young people
in service and system development. Policy makers could also
consider promoting the blending of funding within jurisdic-
tions. An example of this blending of funding is Performance
Partnership Pilots (P3) for Disconnected Youth,
68
which was
reauthorized by Congress in 2015. P3 provides jurisdictions
with the opportunity to test innovative, cost-effective, and
outcome-focused strategies for improving results for discon-
nected youth. It allows jurisdictions to blend their existing
federal discretionary funds across multiple eligible pro-
grams, thus removing barriers to disconnected youth service
delivery across communities. Another example is a new col-
lective effort by national nonprofit organizations and
employers to consolidate $6.5 billion of federal funding, with
the goal of reengaging more than 1 million opportunity youth
in education and employment annually for the next 5 years.
69
Jurisdictions that use blended funding approaches should be
required to provide rigorous impact evaluations of their pro-
grams. The results of these evaluations would then shape
subsequent policy and programmatic efforts.
Another challenge with current service delivery and pro-
gramming for young people is that they are often focused
only on one developmental period (or age group) without
considering the life course implications of disconnection.
Although numerous evidence-based programs exist at vari-
ous grade levels (eg, the Good Behavior Game intervention),
rarely are these programs integrated with programming at the
next grade level. One exception is the Raising Healthy Chil-
dren program, which delivers teacher, parent, and child
60S Public Health Reports 133(Supplement 1)
interventions across primary and secondary school.
70
Origi-
nally tested in primary schools and found to have broad and
lasting effects,
71-73
the primary school intervention was
extended into middle school in a separate trial.
70
Young
people in the intervention group demonstrated increased
school and family connectedness
74
; reduced problems with
mental health, risky sexual behavior, sexually transmitted
infections, and substance use; and other positive outcomes,
including increases in high school graduation rates, number
of years of college attendance, and measures of socioeco-
nomic status.
70-72
Disconnected Youth Involvement
Disconnected youth should be asked to provide input on
research, strategy development, and intervention delivery
efforts. The participation of disconnected youth who are
most marginalized (ie, those who are chronically discon-
nected) should be sought. Young people can provide
important perspectives on intervention feasibility and accept-
ability, which may improve program efficacy. Their involve-
ment also has the potential to provide opportunity youth with
leadership and employment opportunities and positive con-
nections with adults. One strategy involves the use of previ-
ously disconnected youth as mentors or coaches to young
people at risk for leaving school and being disconnected.
An example of this strategy is in Baltimore City, Maryland,
where the Thread Program (https://www.thread.org) pro-
vides a network of supports for high school students at high-
est risk for leaving school early or for gang engagement.
Keys to success in involving disconnected youth include
using specific outreach strategies, providing ongoing training
with useful real-world applications, engaging in retention
efforts, ensuring meaningful representation, and acknowled-
ging input. Trust can be developed by prioritizing the con-
cerns of young people over those of service providers. To
date, the most successful efforts to involve disconnected
youth have provided young people with human and financial
resources and training on how to make meaningful contribu-
tions.
75
That said, more research is needed to ascertain the
most effective ways to engage disconnected youth in
research, strategy, and intervention efforts.
Systematic Intervention Testing and Scaling Up
The United States currently lacks a national public health
policy agenda for, or systematic approach to, the develop-
ment, testing, scaling up, and funding of interventions aimed
at disconnected and at-risk youth. Public policy makers
could help improve each of these processes by developing
policies that provide incentives for programs that use
evidence-based practices and for programs that require sys-
tematic documentation of implementation and outcomes in a
manner that would enable knowledge sharing. Also,
researchers and public health practitioners could work
together to systematically identify, test, and refine the core
components of intervention programs for disconnected
youth.
76
The results of this work could then be used to
inform future efforts to implement and scale up effective
interventions.
As part of this effort, realistic measures of success should
be identified. These measures should be developed based on
the understanding of pathways into and out of youth discon-
nection. Development of these outcome indicators would
allow for the consistent monitoring of intervention and ini-
tiative outcomes and of the progress of target populations.
Both intermediate outcome indicators (eg, active engage-
ment with adults, tutors, or other support people) and
longer-term outcome indicators (eg, school graduation,
post–high school training, education enrollment) need to be
specified, refined, and tracked over time.
Public Health Implications
The societal and economic costs of failing to address the
needs of disconnected youth in the United States are high,
both for this generation of young people and for their chil-
dren. These costs include the loss of human resources to
compete in a global economy, increased demands for public
assistance, mass incarceration, drug abuse and opioid epi-
demics, and massive health service delivery costs.
3,6
The
moral case for preventing and reducing youth disconnection
is equally compelling. Most disconnected youth grow up in
impoverished households and are the victims of failed
schools, failed neighborhoods, and failed child welfare sys-
tems. Their poor emotional, behavioral, and health outcomes
are therefore not surprising.
66
Now, more than ever, we must
use the tools of public health—coordinated data systems,
consolidated services and funding, population engagement,
and systematic evaluation and scaling up—to expand the
work already begun for this population.
Authors’ Note
Drs Mendelson and Mmari, listed in alphabetical order, contributed
equally to this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: This
article was produced with the support of the Bloomberg American
Health Initiative, which is funded by a grant from the Bloomberg
Philanthropies.
References
1. Arnett JJ. Emerging adulthood. A theory of development from
the late teens through the twenties. Am Psychol. 2000;55(5):
469-480.
2. Burd-Sharps S, Lewis K. More Than a Million Reasons for
Hope: Youth Disconnection in America Today. Brooklyn,
Mendelson et al 61S
NY: Measure of America of the Social Science Research Coun-
cil; 2018.
3. Hair EC, Moore KA, Ling TJ, McPhee-Baker C, Brown BV.
Youth who are disconnected and those who then reconnect:
assessing the influence of family, programs, peers and commu-
nities. Child Trends Research Brief. 2009. https://www.child
trends.org/wp-content/uploads/2013/04/8.pdf. Accessed Sep-
tember 11, 2018.
4. Fernandes-Alcantara AL. Disconnected Youth: A Look at 16 to
24 Year Olds Who Are Not Working or in School. Washington,
DC: Congressional Research Service; 2015.
5. Sissons P, Jones K. Lost in Transition? The Changing Labour
Market and Young People Not in Employment, Education, or
Training. Lancashire, England: The Work Foundation; 2012.
6. Wald M, Martinez T. Connected by 25: Improving the Life
Chances of the Country’s Most Vulnerable 14-24 Year Olds.
Menlo Park, CA: William and Flora Hewlett Foundation; 2003.
7. Bynner J, Parsons S. Social exclusion and the transition from
school to work: the case of young people not in education,
employment, or training (NEET). J Voc Behav. 2002;60(2):
289-309.
8. Belfield CR, Levin HM, Rosen R. The economic value of
opportunity youth. 2012. https://files.eric.ed.gov/fulltext/
ED528650.pdf. Accessed September 11, 2018.
9. Lilienfeld AM, Lilienfeld DE. Foundations of Epidemiology.
2nd ed. New York: Oxford University Press; 1980.
10. Kellam SG, Koretz D, Moscicki EK. Core elements of devel-
opmental epidemiologically based prevention research. Am
J Community Psychol. 1999;27(4):463-482.
11. Kellam SG, Rebok GW. Building developmental and etiologi-
cal theory through developmental epidemiologically based pre-
ventive intervention trials. In: McCord J, Tremblay RE, eds.
Preventing Antisocial Behavior: Interventions From Birth
Through Adolescence. New York: Guilford Press; 1992:
162-195.
12. Institute of Medicine. Preventing Mental, Emotional, and
Behavioral Disorders Among Young People: Progress and
Possibilities. Washington, DC: National Academies Press;
2009.
13. Mrazek PJ, Haggerty RJ, eds. Reducing Risks for Mental Dis-
orders: Frontiers for Preventive Intervention Research.
Washington, DC: National Academy Press; 1994.
14. Lerner RM, Lerner JV, Almerigi JB, et al. Positive youth devel-
opment, participation in community youth development pro-
grams, and community contributions of fifth-grade adolescents:
findings from the first wave of the 4-H Study of Positive Youth
Development. JEarlyAdolesc. 2005;25(1):17-71.
15. Benson PL, Scales PC, Hamilton SF, Sesma A Jr. Positive
youth development: theory, research, and applications. In:
Damon W, Lerner RM, eds. Handbook of Child Psychology:
Theoretical Models of Human Development. Vol 1, 6th ed.
New York: John Wiley & Sons; 2006:894-941.
16. Catalano RF, Toumbourou JW, Hawkins JD. Positive youth
development in the United States: history, efficacy, and links
to moral and character education. In: Nucci L, Narvaez D,
Krettenauer T, eds. Handbook of Moral and Character Educa-
tion. 2nd ed. New York: Routledge; 2014:423-440.
17. Roth JL, Brooks-Gunn J. What exactly is a youth development
program? Answers from research and practice. Appl Dev Sci.
2003;7(2):94-111.
18. Taylor RD, Oberle E, Durlak JA, Weissberg RP. Promoting
positive youth development through school-based social and
emotional learning interventions: a meta-analysis of follow-
up effects. Child Dev. 2017;88(4):1156-1171.
19. Matthew DB, Rodrigue E, Reeves RV. Time for Justice: Tack-
ling Race Inequalities in Health and Housing. Washington,
DC: Brookings Institution; 2016.
20. Bridgeland JM, Milano JA. Opportunity Road: The Promise
and Challenge of America’s Forgotten Youth. Washington,
DC: Civic Enterprises and America’s Promise Alliance; 2012.
21. Treskon L, Millenky M, Freedman L. Helping Girls Get Back
on Track: An Implementation Study of the PACE Center for
Girls. Washington, DC: MDRC and the Social Innovation
Fund; 2017.
22. Thompson EA, Eggert LL, Herting JR. Mediating effects of an
indicated prevention program for reducing youth depression
and suicide risk behaviors. Suicide Life Threat Behav. 2000;
30(3):252-271.
23. Millenky M, Bloom D, Muller-Ravett S, Broadus J. Staying on
Course: Three-Year Results of the National Guard Youth Chal-
lenge Evaluation. Washington, DC: MDRC; 2011.
24. Duerden M, Edwards M, Peterson T. 2013 PLSC Evaluation
Report. Washington, DC: Public Land Service Corps; 2013.
25. Treskon L. What Works for Disconnected Young People: A
Scan of the Evidence. Washington, DC: MDRC; 2016.
26. Allen L, Miles M, Steinberg AM. Achieving collective impact
for opportunity youth. Stanford Soc Innov Rev. 2014;12(4):
20-22.
27. 100,000 Opportunities Initiative. 100,000 Opportunities Initia-
tive homepage. 2018. 100kopportunities.org. Accessed
September 11, 2018.
28. Catalano RF, Fagan AA, Gavin LE, et al. Worldwide applica-
tion of the prevention science research base in adolescent
health. Lancet. 2012;379(9826):1653-1664.
29. Ialongo NS, Poduska JM, Werthamer L, Kellam SG. The distal
impact of two first-grade preventive interventions on conduct
problems and disorder in early adolescence. JEmotBehav
Disord. 2001;9(3):146-160.
30. Petras H, Kellam SG, Brown CH, Muthen BO, Ialongo NS,
Poduska JM. Developmental epidemiological courses leading
to antisocial personality disorder and violent and criminal
behavior: effects by young adulthood of a universal preventive
intervention in first- and second-grade classrooms. Drug Alco-
hol Depend. 2008;95(suppl 1):S45-S59.
31. Bradshaw CP, Zmuda JH, Kellam SG, Ialongo NS. Longitudi-
nal impact of two universal preventive interventions in first
grade on educational outcomes in high school. J Educ Psychol.
2009;101(4):926-937.
32. Ialongo NS, Werthamer L, Kellam SG, Hendricks Brown CH,
Wang S, Lin Y. Proximal impact of two first-grade preventive
interventions on the early risk behaviors for later substance
62S Public Health Reports 133(Supplement 1)
abuse, depression, and antisocial behavior. Am J Community
Psychol. 1999;27(5):599-641.
33. Botvin GJ, Griffin KW, Nichols TD. Preventing youth violence
and delinquency through a universal school-based prevention
approach. Prev Sci. 2006;7(4):403-408.
34. Lee S, Aos S, Drake E, Pennucci A, Miller M, Anderson L.
Return on Investment: Evidence-Based Options to Improve
Statewide Outcomes. Olympia, WA: Washington State Institute
for Public Policy; 2012.
35. Kumpfer KL, Alvarado R, Whiteside HO. Family-based inter-
ventions for substance use and misuse prevention. Subst Use
Misuse. 2003;38(11-13):1759-1787.
36. Kumpfer KL, Fowler MA. Parenting skills and family support
programs for drug-abusing mothers. Semin Fetal Neonatal
Med. 2007;12(2):134-142.
37. Prinz RJ, Sanders MR, Shapiro CJ, Whitaker DJ, Lutzker JR.
Population-based prevention of child maltreatment: the U.S.
Triple P system population trial. Prev Sci. 2009;10(1):1-12.
38. Nowak C, Heinrichs N. A comprehensive meta-analysis of
Triple P-Positive Parenting Program using hierarchical linear
modeling: effectiveness and moderating variables. Clin Child
Fam Psychol Rev. 2008;11(3):114-144.
39. Oesterle S, Hawkins JD, Kuklinksi MR, et al. Effects of Com-
munities That Care on males’ and females’ drug use and delin-
quency 9 years after baseline in a community-randomized trial.
Am J Community Psychol. 2015;56(3-4):217-228.
40. Spoth RL, Redmond C, Shin C, Greenberg M, Feinberg M,
Schainker L. PROSPER community-university partnership
delivery system effects on substance misuse through 6 1/2 years
past baseline from a cluster randomized controlled intervention
trial [published erratum appears in Prev Med. 2014;69:36].
Prev Med. 2013;56(3-4):190-196.
41. Rhew IC, Hawkins JD, Murray DM, et al. Evaluation of
community-level effects of Communities That Care on adoles-
cent drug use and delinquency using a repeated cross-sectional
design. Prev Sci. 2016;17(2):177-187.
42. Hawkins JD, Oesterle S, Brown EC, Abbott RD, Catalano RF.
Youth problem behaviors 8 years after implementing the Com-
munities That Care prevention system: a community-
randomized trial. JAMA Pediatr. 2014;168(2):122-129.
43. Kim BK, Gloppen KM, Rhew IC, Oesterle S, Hawkins JD.
Effects of Communities That Care prevention system on youth
reports of protective factors. Prev Sci. 2015;16(5):652-662.
44. Kuklinski MR, Briney JS, Hawkins JD, Catalano RF. Cost-
benefit analysis of Communities That Care outcomes at eighth
grade. Prev Sci. 2013;13(2):150-161.
45. Spoth RL, Trudeau LS, Redmond C, et al. PROSPER partner-
ship delivery system: effects on adolescent conduct problem
behavior outcomes through 6.5 years past baseline. J Adolesc.
2015;45:44-55.
46. Campbell FA, Ramey CT, Pungello E, Sparling J, Miller-John-
son S. Early childhood education: young adult outcomes from
the Abecedarian Project. Appl Dev Sci. 2002;6(1):42-57.
47. Schweinhart LJ, Barnes HV, Weikart DP. Significant Benefits.
The High/Scope Perry Preschool Study Through Age 27.
No. 10. Ypsilanti, MI: High/Scope; 1993.
48. Reynolds AJ, Temple JA, Robertson DL, Mann EA. Long-term
effects of an early childhood intervention on educational
achievement and juvenile arrest: a 15-year follow-up of low-
income children in public schools [published erratum appears
in JAMA. 2001;286(9):1026]. JAMA. 2001;285(18):2939-2946.
49. Reynolds AJ, Temple JA, Ou SR, Arteaga IA, White BA.
School-based early childhood education and age-28 well-
being: effects by timing, dosage, and subgroups. Science.
2011;333(6040):360-364.
50. Stormshak EA, Fosco GM, Dishion TJ. Implementing interven-
tions with families in schools to increase youth school engage-
ment: the family check-up model. School Ment Health. 2010;
2(2):82-92.
51. American Public Health Association. 10 essential public health
services. 2018. https://www.apha.org/about-apha/centers-and-
programs/quality-improvement-initiatives/10-essential-public-
health-services. Accessed September 11, 2018.
52. Institute of Medicine. The Future of the Public’s Health in the
21st Century. Washington, DC: National Academies Press;
2003.
53. Sears D, Mallory C. Documented Evidence of Employment
Discrimination and Its Effects on LGBT People. Los Angeles:
The Williams Institute; 2011.
54. Almeida J, Johnson RM, Corliss HL, Molnar BE, Azrael D.
Emotional distress among LGBT youth: the influence of per-
ceived discrimination based on sexual orientation. J Youth Ado-
lesc. 2009;38:1001-1014.
55. Kosciw JG, Greytak EA, Giga NM, Villenas C, Danischewski
DJ. The 2015 National School Climate Survey: The Experi-
ences of Lesbian, Gay, Bisexual, Transgender, and Queer
Youth in Our Nation’s Schools. New York: GLSEN; 2016.
56. Montes G, Lehmann C. Who Will Drop Out From School? Key
Predictors From the Literature. Rochester, NY: Children’s
Institute; 2004.
57. Jimerson SB, Egeland B, Sroufe LA, Carlson B. A prospective
longitudinal study of high school dropouts, examining multiple
predictors across development. J School Psychol. 2000;38:
525-549.
58. Opportunity Nation. The Opportunity Index. https://opportuni
tynation.org/opportunity-index. Accessed September 11, 2018.
59. Arthur MW, Hawkins JD, Pollard JA, Catalano RF, Baglioni
AJ Jr. Measuring risk and protective factors for substance use,
delinquency, and other adolescent problem behaviors: the
Communities That Care Youth Survey. Eval Rev. 2002;26(6):
575-601.
60. Glaser RR, Van Horn ML, Arthur MW, Hawkins JD, Catalano
RF. Measurement properties of the Communities That Care
®
Youth Survey across demographic groups. J Quant Criminol.
2005;21(1):73-102.
61. Briney JS, Brown EC, Hawkins JD, Arthur MW. Predictive
validity of established cut points for risk and protective factor
scales from the Communities That Care Youth Survey. J Prim
Prev. 2012;33(5-6):249-258.
62. Search Institute. Developmental Assets Profile. 2018. https://
www.search-institute.org/surveys/choosing-a-survey/dap.
Accessed September 11, 2018.
Mendelson et al 63S
63. Smith ML. A generation at risk: the ties between zero tolerance
policies and the school-to-prison pipeline. McNair Scholars
Res J. 2015;8(1):125-141.
64. Curtis AJ. Tracing the school-to-prison pipeline from zero-
tolerance policies to juvenile justice dispositions. Georgetown
Law J. 2014;102:1251-1277.
65. Matthew S, Ferber T. Opportunity Youth Playbook: A Guide to
Reconnecting Boys and Young Men of Color to Education and
Employment. Washington, DC: Opportunity Youth Network
and the Forum for Youth Investment; 2016.
66. Hemphill SA, Herrenkohl TI, Plenty SM, Toumbourou JW,
Catalano RF, McMorris BJ. Pathways from school suspension
to adolescent nonviolent antisocial behavior in students in Vic-
toria, Australia and Washington State, United States. J Com-
munity Psychol. 2012;40(3):301-318.
67. Hemphill SA, Toumbourou JW, Herrenkohl TI, McMorris
BJ, Catalano RF. The effect of school suspensions and
arrests on subsequent adolescent antisocial behavior in
Australia and the United States. JAdolescHealth. 2006;
39(5):736-744.
68. The Forum for Youth Investment. PerformancePartnership
Pilots (P3) Hub. 2018. http://forumfyi.org/P3. Accessed Sep-
tember 11, 2018.
69. Bridgeland JM, Ingram ES, Atwell M. A Bridge to Reconnec-
tion: A Plan for Reconnecting One Million Opportunity Youth
Each Year Through Federal Funding Streams. Washington,
DC: Forum for Youth Investment, Jobs for the Future; 2016.
70. Brown EC, Catalano RF, Fleming CB, Haggerty KP, Abbot
RD. Adolescent substance use outcomes in the Raising Healthy
Children project: a two-part latent growth curve analysis.
J Consult Clin Psychol. 2005;73(4):699-710.
71. Hawkins JD, Guo J, Hill KG, Battin-Pearson S, Abbot RD. Long-
term effects of the Seattle Social Development Intervention on
school bonding trajectories. Appl Dev Sci. 2001;5(4):225-236.
72. Hawkins JD, Kosterman R, Catalano RF, Hill KG, Abbot RD.
Promoting positive adult functioning through social develop-
ment intervention in childhood: long-term effects from the
Seattle Social Development Project [published erratum appears
in Arch Pediatr Adolesc Med. 2005;159(5):469]. Arch Pediatr
Adolesc Med. 2005;159(1):25-31.
73. Hawkins JD, Kosterman R, Catalano RF, Hill KG, Abbot RD.
Effects of social development intervention in childhood 15 years
later. Arch Pediatr Adolesc Med. 2008;162(12):1133-1141.
74. Catalano RF, Haggerty KP, Oesterle S, Fleming CB, Hawkins
JD. The importance of bonding to school for healthy develop-
ment: findings from the Social Development Research Group.
J Sch Health. 2004;74(7):252-261.
75. Patton GC, Sawyer SM, Santelli JH, et al. Our future: a Lancet
commission on adolescent health and well-being. Lancet. 2016;
387:2423-2478.
76. Blase K, Fixsen D. Core Intervention Components: Identify-
ing and Operationalizing What Makes Programs Work.
Washington, DC: US Department of Health and Human Ser-
vices; 2013.
64S Public Health Reports 133(Supplement 1)
