Beginning in 1996, the Robert Wood Johnson Foundation embarked on an ambitious effort to test new approaches to ameliorating health and safety problems for young people in America's economically distressed cities. This initiative grew out of concerns at the Foundation that despite the many successful programs that they had funded, and the millions of dollars they (and others) had spent, long term improvement on a range of health and safety indicators had not been realized for populations in urban areas. While some of these problems seemed intractable, the Foundation felt that new approaches might be more successful if local leaders were given greater flexibility and a longer time frame in which to work on such problems. Finally, the Foundation's challenge was to improve the health and safety of children and youth citywide, nor only in a single neighborhood. In 1996, the Foundation funded eight cities to engage in a two year planning process; five of these cities were funded for eight years to implement their plans, beginning in 1998. These five cities are Baltimore, Detroit, Oakland, Philadelphia and Richmond. They were each given approximately $1 million for each year of implementation.

While the Foundation was committed to giving local leaders a fair amount of discretion over choosing the health and safety problems most pressing in their city, and on the strategies they would use to address these problems, the Foundation did lay out some guidelines for the initiative in the five sites. The initiative was to be "data driven" and strategies were to make use of "best practices"; that is, sites were to look at a variety of administrative, survey and other data to choose the problems on which to work and to use, to the best of their ability, empirically tested strategies to address the problems. They were to build a collaborative planning process and base of leadership - pulling in civic leadership from a variety of sectors, including business, philanthropy, non-profits and government, as well as community residents. Sites were encouraged to bring together affluent and non-affluent areas, even those outside municipal boundaries, in order to forge a more viable political base for reform. Direct services to young people were not to be funded, except if testing new pilot approaches, and instead, the cities were asked to change public and private systems to support change and leverage new resources. They were told they would have to show measurable improvement in citywide statistics on health and safety problems. Finally, they were instructed to develop a strong communications plan - to mobilize community support for their efforts.

To evaluate the progress and outcomes of the initiatives, the national evaluation team has used a theory of change approach and has identified a group of nine cities to serve as a basis of comparison against which to assess the progress of the sites. Five different methods of data collection are being used for this evaluation. They are: annual site visits to each site and participation in national meetings for the initiative; key informant interviews with a broad group of civic leaders in the UHI and comparison cities every other year; a telephone household survey of adults and youth every three years; an analysis of federal, state and city public spending on youth in each of the UHI cities every three years; and an analysis of trends in health and safety outcomes in the UHI and comparison cities from 1992 until the end of the initiative.

The national evaluation team is conducting interviews with 6-10 community, city and regional leaders to assess the progress of the initiative in meeting some of its systems change goals. Investigators are charting the ways in which these leaders describe their relationships with other agencies and institutions, the ways in which they describe the city and region's attention to problems facing children and youth in their area, and obstacles to and opportunities for improving the health and safety of young people in their areas. This method seeks to capture the change the initiative hopes to create in the way institutions and agencies work together.

The national evaluation team is conducting, with other researchers at Princeton and Columbia Universities, a multi-wave cross-sectional telephone household survey of parents and young people to assess the ways in which young people are using their time, the ways in which they interact with adults, and the perceptions of the institutions and organizations with which young people interact. Two waves of this survey were conducted in the fall/spring of 98/99 and the fall spring of 01/02; the third wave was conducted in the fall/spring of 04/05. The survey helps to gauge how successful program cities are in engaging young people and in altering their perceptions of how the city or region responds to their needs. The national evaluation has shared the survey data with local evaluators and has presented the findings to each of the site directors. SRBI, a New York based research organization, administers the survey.

The national evaluation includes an analysis of public expenditures — federal, state, and local — in the sites to determine the ways in which these dollars are used to address the health and safety needs of young people. This analysis, performed three times over the course of the implementation phase, will provide one measure of how the initiative is successful at a citywide scale, and how the initiative stimulates change in the way city government responds to the needs of young people. This analysis will be useful both for tracking progress and as a tool for the sites to use in bringing about systems reform.

The national evaluation team is tracking a set of health and safety measures that reflect the priorities of the sites, as well as other social and economic measures that allow the national evaluation team to understand the context in which these initiatives are working. Many of the sites describe health and safety outcome measures as targets, but also describe economic or social changes that can be measured and which are an integral part of their vision. The national evaluators analyze trends in these measures over time, and describe their findings in regular reports to the sites and to the Foundation. These measures are also included in comprehensive reports developed by the national evaluation team at three-year intervals. The national evaluation team provides technical assistance and support to the sites in tracking and understanding additional measures, and in interpreting the results of the data analysis done by the national team.

The National Evaluation of the UHI disseminates findings on topics related to the health and safety of young people in a number of peer-reviewed journals, at national conferences, and in other forums for scholars.

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