Further complicating service delivery is the fact that step-down and continuing care services rarely follow an index treatment episode. Hence, the chronic nature of the substance use disorder is typically not addressed. Without less intensive step-down services there is a significant risk of relapse and return of substance abuse problems (Alford et al., 1991; Armstrong & Altschuler, 1998; Brown, Meyers, Mott, & Vik 1994; Latimer et al., 2000; Spear & Skala, 1995; Stewart & Brown, 1993; Winters, 1999; Winters et al., 2000). This causes readmissions to treatment, expending the already limited pool of resources.

Community Assessment Centers originated within the U.S. Office of Juvenile Justice and Delinquency Prevention (OJJDP) to address multiple and decentralized points of entry, inadequate assessment practices, scarce resources, system fragmentation, and lack of early intervention among at-risk and delinquent youth (Bilchik, 1995; Oldenettel & Wordes, 2000). There are 67 CACs distributed throughout the United States (e.g., California, Colorado, Florida, Kansas, Maryland, Nebraska) and a formal evaluation of their effectiveness is under way (National Council on Crime and Delinquency, 2003). Four interrelated components make up the CAC. First, these centers serve as a single point of entry (component # 1) into the entire system of care within a target community. All agencies regardless of the service system within which they are embedded (e.g., mental health, substance abuse) triage youth to the CAC. If the youth has been arrested, the arresting officer transports the youth to the CAC, where they are booked prior to being assessed. In other words, CACs function as a centralized intake facility for all sectors of a community's service system. Administration of a standardized screening instrument (e.g., Massachusetts Youth Screening Instrument [MAYSI-2]; Grisso & Barnum, 2000) is followed by a standardized comprehensive assessment (component #2), when indicated (e.g., Comprehensive Adolescent Severity Inventory [CASI]; Meyers, Hagan, et al., in press). Arrested youth also receive a risk assessment so that the level of needed security can be determined. Assessment data are reviewed by an interdisciplinary team comprised of CAC staff and colocated staff from multiple community agencies. The data are stored in an integrated management information system (component #3) for data sharing and performance monitoring and are synthesized into a case plan for ongoing case management (component #4). Colocated staff work with case management staff to minimize the red tape that case managers may face when accessing an array of community services. When implemented as designed, CACs (1) enable identification of issues that impede community youths' ability to function (whether they are in the juvenile justice system or not) so that (2) effective services can be delivered in a coordinated, nonduplicative fashion by systems staff working together for the purpose of (3) improving the functional status of youth (and possibly their families), thereby preventing penetration (or further penetration) into various systems of care (Meyers, 1998, 2000). Although evaluation data are not yet available in

this area, CACs are nonetheless a promising approach to systems change for youth who use, abuse, or are dependent upon substances, regardless of their presenting problem or the system to which they present. Given the obvious potential of this approach, there is clear need for additional research and evaluation and, if effectiveness is shown, for dissemination and community training.

Although there are recent indications that violent crime has decreased among juveniles, youth crime overall is at unacceptably high levels, with younger and more impaired youth being arrested at an increasing rate (Snyder & Sickmund, 1999). As social services are reduced, the juvenile justice system has become the focal point for interventions with many youth. Hence, the justice system has responded by providing a number of innovative programs (Jenson & Howard, 1998; Office of Juvenile Justice and Delinquency Prevention, 1995).

One such program is the juvenile drug court (American University, 1997; Belanko, 2001; Office of Justice Programs Drug Court Clearinghouse and Technical Assistance Project, 1998). Modeled after adult drug court programs, juvenile drug courts (of which there are 167 as of June 2001; American University, 2001) combine identification of a youth's problems with systemic interventions monitored and enforced by the presiding judge. Although the name implies that drug treatment is the sole focus of these courts, juvenile drug courts generally take a multifaceted approach. Educational deficits, family problems, and behavioral difficulties are addressed by staff of local provider agencies who attend weekly meetings, share information, work together, and change intervention plans where indicated. Participating providers serve as a team delivering coordinated, noncompeting services to youth.

Outcome results are still preliminary, but there are a few studies that found reduced recidivism rates and increased time to rearrest among juvenile drug court participants (Belenko, 2001; Meyers, O'Brien, et al., under review). While ad ditional research is needed, juvenile drug courts appear to be a promising systems intervention for substance-abusing juvenile offenders. These courts enact some of the core principles described above for a more effective systems approach to identifying and treating SUDs among adolescents.

CASASTART, originally called the Children at Risk program, was developed by the National Center on Addiction and Substance Abuse (CASA) at Columbia University through foundation and U.S. Department of Justice funding to address service gaps among high-risk 8-to 13-year-olds, their families, and their communities (Murray and Belanko, under review). Similar to the programs discussed above, CASASTART forges a working partnership of schools, law enforcement, and community-based health and social service organizations, and all are housed under one roof. Through intensive case management, a coordinated constellation of eight core services is provided to varying degrees according to the needs of the youth and his or her family: social support; family services; educational services; after-school and summer recreational activities; mentoring; incentives; community policing; and criminal and juvenile justice interventions. Evaluation data illustrate that CASASTART participants were less likely to use or deal drugs, engage in violent crime, or be influenced by negative peers (Harrell, Cavanagh, & Sridharan, 1998). Further, these same youth were more likely to belong to positive peer groups and to advance to the next grade. These data suggest that CASASTART is a promising systems change model that results in positive outcomes among its participants.