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Improvements in teen depression might have benefits that extend beyond clinical symptoms, improving peer, family, and school functioning over time.

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Communities are increasingly being required by state and federal funders to achieve outcomes and be accountable, yet are often not provided the guidance or the tools needed to successfully meet this challenge. To improve the likelihood of achieving positive outcomes, the Getting To Outcomes (GTO) intervention (manual, training, technical assistance) is designed to provide the necessary guidance and tools, tailored to community needs, in order to build individual capacity and program performance. GTO is an example of a Prevention Support System intervention, which as conceptualized by the Interactive Systems Framework, plays a key role in bridging the gap between prevention science (Prevention Synthesis and Translation System) and prevention practice (Prevention Delivery System). We evaluated the impact of GTO on individual capacity and program performance using survey- and interview-based methods. We tracked the implementation of GTO and gathered user feedback about its utility and acceptability. The evaluation of GTO suggests that it can build individual capacity and program performance and as such demonstrates that the Prevention Support System can successfully fulfill its intended role. Lessons learned from the implementation of GTO relevant to illuminating the framework are discussed.

Objective. To assess the relative impact of clinical factors versus nonclinical factors--such as postacute care (PAC) supply--in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care. Data Sources and Study Setting. Medicare acute hospital, IRF, and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data. Study Design. We used multinomial logit models to predict PAC use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements. Data Collection/Extraction Methods. A file was constructed linking acute and postacute utilization data for all medicare patients hospitalized in 1999. Principal Findings. PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there. Conclusions. We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes--or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes.Key Words. postacute care, provider supply, Medicare, rehabilatation, nursing homes Postacute care (PAC) was the fastest growing sector of the Medicare program throughout the early to mid-1990s. A number of factors including payment incentives, advances in drug treatments and surgical techniques, and improvements in outpatient care contributed to shorter lengths of stay in acute care hospitals and corresponding increases in PAC use. As more hospitalized patients transfer to PAC, the need to better understand the factors driving such transfers is growing. 413