Implementation and development of federally-funded systems of care over time.

This study describes development in federally funded systems of care. Data for this study were collected using the System of Care Assessment that rated grantees' enactment of system of care principles in the infrastructure and service delivery domains. Data were collected by trained raters who conducted several site visits over the funding period.

Youth and youth coordinators' perspectives on youth involvement in systems of care.

To increase understanding of the current status of youth involvement in Substance Abuse and Mental Health Services Administration-funded system-of-care communities, focus groups with youth and youth coordinators were conducted as part of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. Using focus group discussions as the primary qualitative data analysis method, these discussions addressed the ways in which youths are involved in their communities, the role of youth coordinators, the challenges that hinder youth participation, and strategies for overcoming these challenges. Discussions revealed that the most common form of youth involvement is through youth groups, and that apart from these groups, youth participation is largely absent.

Single- versus double-layer uterine incision closure and uterine rupture.

Objective: To evaluate whether closure of the uterine incision with one or two layers changes uterine rupture or vaginal birth after cesarean section (VBAC) success rates.

Methods: Subjects with one previous cesarean section by documented transverse uterine incision that attempted VBAC were identified. Exclusion criteria included lack of documentation of the type of closure of the previous uterine incision, multiple gestation, more than one previous cesarean section, and previous scar other than low transverse.

Effect of body mass index and excessive weight gain on success of vaginal birth after cesarean delivery.

Objective: To estimate whether excessive weight gain or obesity are risk factors affecting success for vaginal birth after cesarean (VBAC).

Methods: Patients attempting VBAC were identified by the International Classification of Diseases, 9th Revision, codes "VBAC" and "non-primary C-section" and by reviewing logbooks on labor and delivery. A chart review identified patients attempting VBAC who were eligible for inclusion.

Increased success of trial of labor after previous vaginal birth after cesarean.

Objective: To estimate whether a history of a previous successful vaginal birth after cesarean delivery (VBAC) has an effect on a subsequent VBAC attempt.

Methods: A chart review of cases identified from the International Classification of Diseases, 9th Revision (ICD-9) codes and cases identified in the logbooks on Labor and Delivery yielded 1,216 cases of attempted VBAC from 1996 to 2000. Data gathered from these cases included history of previous successful VBAC.