Carolyn A. Berry

Affiliated Faculty, NYU Wagner; Associate Professor, NYU Langone School of Medicine

Carolyn Berry

Carolyn Anne Berry holds a PhD in Community Psychology from New York University. Her current research focuses on the health and health care of low-income children and families, and includes both investigator initiated research and program evaluation. She recently concluded a five year grant from the National Institute of Environmental Health Sciences (NIEHS) entitled Social Factors and the Environment in Pediatric Asthma that is investigating racial/ethnic disparities in childhood asthma. She conducting an outcome evaluation of the SchoolFood Plus Initiative, a program designed to enhance the nutrition of children in the NYC public school system. Dr. Berry and Dr. Dennis Smith are in the final stages of a process study of WeCARE, a recently implemented program designed to provide specialized assessments and services to that portion of the public assistance population that is unable to work immediately. That program and study are funded by the NYC Department of Social Services/Human Resources Administration. Dr. Berry is part of a Wagner team working on the national evaluation of "Expecting Success", a demonstration project funded by the Robert Wood Johnson Foundation to address disparities in cardiac health care at 10 hospitals with large volumes of racial and ethnic minorities.

Dr. Berry regularly teaches Program Analysis and Evaluation.


This course serves as an introduction to those evaluation tools most commonly used to assess the performance of publicly funded programs, in both the public and private sector. Topics include developing and assessing program theory, implementation and process assessment, methods of impact evaluation, and efficiency analysis (cost-benefit and cost-effectiveness analysis). The focus is on critical analysis and understanding of both the underlying programs and their evaluations.

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This course serves as an introduction to those evaluation tools most commonly used to assess the performance of publicly funded programs, in both the public and private sector. Topics include developing and assessing program theory, implementation and process assessment, methods of impact evaluation, and efficiency analysis (cost-benefit and cost-effectiveness analysis). The focus is on critical analysis and understanding of both the underlying programs and their evaluations.

Download Syllabus

This course serves as an introduction to those evaluation tools most commonly used to assess the performance of publicly funded programs, in both the public and private sector. Topics include developing and assessing program theory, implementation and process assessment, methods of impact evaluation, and efficiency analysis (cost-benefit and cost-effectiveness analysis). The focus is on critical analysis and understanding of both the underlying programs and their evaluations.

Download Syllabus



Many policy problems require governmental leaders to forge vast networks beyond their own hierarchical institutions. This essay explores the challenges of implementation in a networked institutional setting and incentives to induce coordination between agencies and promote quality implementation. It describes the national evaluation of the Assuring Better Child Health and Development program, a state-based program intended to increase and enhance the delivery of child development services for low-income children through the health care sector, using Medicaid as its primary vehicle. Using qualitative evaluation methods, the authors found that all states implemented programs that addressed their stated goals and made changes in Medicaid policies, regulations, or reimbursement mechanisms. The program catalyzed interagency cooperation and coordination. The authors conclude that even a modest level of external support and technical assistance can stimulate significant programmatic change and interorganizational linkages within public agencies to enhance provision of child development services.



We sought to determine whether low acculturation among Mexican American caregivers protects their children against asthma. Methods. Data were obtained from an observational study of urban pediatric asthma. Dependent variables were children's diagnosed asthma and total (diagnosed plus possible) asthma. Regression models were controlled for caregivers' level of acculturation, education, marital status, depression, life stress, and social support and children's insurance. Results. Caregivers' level of acculturation was associated with children's diagnosed asthma (P=.025) and total asthma (P=.078) in bivariate analyses. In multivariate models, protective effects of caregivers' level of acculturation were mediated by the other covariates. Independent predictors of increased diagnosed asthma included caregivers' life stress (odds ratio [OR]= 1.12, P=.005) and children's insurance, both public (OR=4.71, P=.009) and private (OR = 2.87, P=.071). Only caregiver's life stress predicted increased total asthma (OR = 1.21, P=.001). Conclusions. The protective effect of caregivers' level of acculturation on diagnosed and total asthma for Mexican American children was mediated by social factors, especially caregivers' life stress. Among acculturation measures, foreign birth was more predictive of disease status than was language use or years in country. Increased acculturation among immigrant groups does not appear to lead to greater asthma risk.



We examined racial and ethnic disparities in the total potential burden of asthma in low-income, racially/ethnically heterogeneous Chicago schools, Methods. We used the Brief Pediatric Asthma Screen Plus (BPAS ) and the Spanish BPAS , validated, caregiver-completed respiratory questionnaires, to identify asthma and possible asthma among students in 14 racially/ethnically diverse public elementary schools. Results. Among 11 490 children, we demonstrated a high lifetime prevalence (12.2%) as well as racial and ethnic disparities in diagnosed asthma, but no disparities in prevalences of possible undiagnosed asthma. Possible asthma cases boost the total potential burden of asthma to more than 1 in 3 non-Hispanic Black and Puerto Rican children. Conclusions. There are significant racial and ethnic disparities in diagnosed asthma among inner-city schoolchildren in Chicago. However, possible undiagnosed asthma appears to have similar prevalences across racial/ethnic groups and contributes to a high total potential asthma burden in each group studied. A better understanding of underdiagnosis is needed to address gaps in asthma care and intervention for low-income communities.



Background: The health and health care needs of non-English-speaking Hispanic families with children are poorly understood, in part because they are often excluded from research owing to language barriers. Instruments that are valid in English and Spanish are necessary to accurately evaluate the magnitude of asthma prevalence and morbidity among Hispanics.

Objective: To establish the sensitivity and specificity of the English and Spanish versions of the asthma portion of the Brief Pediatric Asthma Screen Plus (BPAS ) in a low-income Hispanic population.

Methods: The validation sample consisted of 145 children whose parents completed the BPAS in Spanish and 78 whose parents completed it in English. Bilingual clinicians conducted the examinations on which the clinical assessments were based. We compared the BPAS results with the clinical assessment findings to determine the sensitivity and specificity of the BPAS among Hispanics in terms of identifying children who warrant further medical evaluation for asthma.

Results: The sensitivity and specificity of the asthma portion of the Spanish BPAS were 74% and 86%, respectively. The sensitivity and specificity of the asthma portion of the English BPAS were 61% and 83%, respectively.

Conclusions: The asthma portion of the BPAS , a valid screen for identifying children who are in need of further evaluation for potentially undiagnosed asthma, is valid for low-income Hispanics in Spanish and English. As the Hispanic population continues to grow, it is imperative that researchers have English and Spanish instruments that are valid for this population.



Background: Asthma is the most common disease of childhood, but the recognition and detection remain poor, especially among schoolchildren. There has been an increase in the number of instruments available to detect the risk of asthma earlier in children. We have previously validated a simple, self-reported screen, the Brief Pediatric Asthma Screen (BPAS).

Objective: To develop a new screen for asthma and allergies based on the BPAS (BPAS ) with the intent of keeping the screen brief and simple, while including allergy detection.

Methods: Questions from the BPAS were extensively revised, and questions regarding allergic rhinitis were added. A panel of parents of asthmatic children reviewed and critiqued the questions. The final BPAS was distributed in elementary schools, and a cohort of 129 participated in a validation against the gold standard of evaluation by an expert in asthma.

Results: For asthma the best items were wheeze, persistent cough, night cough, and response to change in air temperature. The simplest scoring, any 1 of the 4 items, yielded the best balance of specificity (73.6%) and sensitivity (73.3%). For allergy, using all six items, having any one or any two of the items had sensitivity of 71.4% and specificity of 77.3%.

Conclusions: The BPAS provides a rapid and valid method for the detection of potential allergy and asthma in schoolchildren. Sensitivity and specificity are acceptable for both asthma and allergies.




This paper describes the development and psychometric properties of the Diabetes Problem-Solving Measure for Adolescents (DPSMA).


The DPSMA is a structured, interview-based questionnaire that examines how adolescents with type 1 diabetes solve diabetes-related self-management problems. Seventeen diabetes-related self-management problem vignettes were derived from a survey of adolescents and their parents. The vignettes were reviewed and finalized by a multidisciplinary team of diabetes experts. A sample of 43 adolescents, 13 to 17 years old, with type 1 diabetes, was used to establish the psychometric properties of the instrument.


The scale demonstrated acceptable internal consistency and interrater reliability. Predicted relationships with scores on concurrently administered measures of adherence, diabetes quality of life, and metabolic control provided support for construct validity.


The results suggest that the DPSMA has acceptable internal consistency, interrater reliability, and construct validity. It may be a useful tool to help healthcare providers understand the diabetes-related problem-solving abilities of their adolescent patients.


The objectives of this study were to establish the validity of the Crisis in Family Systems-Revised, a recently developed measure of contemporary life stressors, using the same validation technique as in the original validation and to provide further evidence of construct validity by assessing its relationship to socioeconomic status and residential location. We conducted 124 in-person interviews with parents in three outpatient pediatric asthma clinics affiliated with an academic medical center. The design was cross-sectional and correlational. Total count of life stressors accounted for 19% of the variance in scores on the Center for Epidemiologic Studies-Depression. Respondents using Medicaid and living in the city experienced more objective stressors, but the proportions of stressors rated as negative or positive (Valence), and ongoing (Chronicity) were fairly constant across subsamples, as was the Difficulty rating. Psychologists and health and mental health services researchers are in need of constructs relevant to contemporary society and its issues and tools to measure these constructs. Life stressors appears to be such a construct and the Crisis in Family Systems-Revised a measure with considerable utility.


Objective: We explored the current state of developmental screens, child development services, mechanisms to fund screens and services, and incentives for adopting new services within managed care organizations serving Medicaid enrolees.

Design: National, cross-sectional mail survey. Survey of 388 Medicaid managed care organizations (MMCO) enrolling children in 1998–99.

Results: Most of the 155 plans that responded provided an array of developmental screenings and services, funded primarily through internal mechanisms or under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) programs. Plan contacts expressed interest in implementing new services, particularly if additional funding was available. The most important motivators included requiring services in the Medicaid contract, enhanced capitation rates, and demonstration that providing child development services would reduce other utilization costs.

Conclusions: If state Medicaid agencies want to enhance the child development services available through health plans, they could initiate steps such as requiring child development services in contracts with plans or providers; revising EPSDT language and engaging in more consistent enforcement; and enhancing capitation rates. More research on effectiveness and benefits of specific developmental screens and services is needed.



Objective. We sought to understand why certain Medicaid managed care organizations (MMCOs) implemented child development services or programs and how they had done so. We also sought to identify barriers and facilitators to successful initiation and implementation of child development programs.

Methods. We conducted 9 key informant interviews and 4 site visits, and performed qualitative analyses to identify major themes across responses.

Results. We identified a small number of MMCOs with child development services. High-level support was crucial for program initiation; physician buy-in, staff support, and strong working relationships with outside health professionals or agencies were principal factors in successful program implementation.

Conclusions. MMCOs that were committed to implementing child development services were successful in doing so, without external funding or regulatory mandate. The results provide valuable strategies for MMCOs interested in developing programs and for researchers and advocates interested in promoting child development services for low-income children. Key words: Medicaid managed care, child development services.




To determine the effects of aspects of residency training on AIDS-related treatment practices. METHOD: The authors conducted a nationwide longitudinal panel study of 394 physicians who graduated in 1989 from six medical schools in New York State. Data were collected during the participants' fourth year of medical school, their third year of residency training, and six years after they had graduated from medical school. Questionnaires sought information about AIDS-related practice behaviors, including avoiding invasive procedures, minimizing contact, emphasizing AIDS prevention and education, and volume of people with AIDS treated. RESULTS: Aspects of residency training had a sustained impact on how the physicians cared for patients with AIDS but not on the numbers of patients they treated. Determinants of treatment practices included aspects of the residency environment (e.g., emphasis on problem solving, student orientation; p < .01), characteristics of the faculty (e.g., commitment to teaching, tolerance of varied viewpoints), cynicism about patient care (p < .001), social biases (homophobia and aversion to intravenous drug users; p < .001), and AIDS-related attitudes (p < .01). CONCLUSIONS: Fundamental changes to residency training, all of which are associated with learner-centered education, can improve physicians' treatment of their patients with HIV and AIDS.



To develop and validate a measure of contemporary life stressors. STUDY SETTING: Three interview studies: Study 1 (pilot), 32 caregivers receiving case management services for a child with chronic illness; Study 2 (validation), 311 caregivers of children receiving general pediatric care at a university clinic; Study 3 (reliability), 17 caregivers of children with a complex medical diagnosis. STUDY DESIGN: Study 1: item development via discussions with case managers; piloted with caregivers. Study 2 examined psychometric properties of the measure and correlated it with the CES-D, a measure of depressive symptomatology and the PRQ85-Part 2, a measure of perceived social support, to establish its convergent construct validity. Study 3 established the test-retest reliability of the measure over two weeks by correlating two administrations of the index. DATA COLLECTION: Face-to-face interviews in homes (Study 1) or in clinic waiting rooms (Studies 2 and 3) and by telephone (Study 3 retest). PRINCIPAL FINDINGS: The CRISYS is a flexible, multidimensional tool that demonstrates strong face, content, and construct validity, and excellent test-retest reliability. The format is easy to use and well accepted by respondents and is suitable for low-income populations. CONCLUSIONS: Researchers will find the CRISYS useful when evaluating the success of a clinical model or a healthcare system, and the effectiveness of an insurance plan or a government program. Clinicians may also find that the CRISYS is an effective screen for family needs.



Few instruments exist for the assessment of adolescent mental health. In order to examine the appropriateness of the Mental Health Inventory (MHI) for use with adolescents, secondary analyses were conducted of the large subsample (n = 953) of adolescents who participated in the community-based Rand Health Insurance Study. The reliability and readability of the MHI were confirmed. Subscales reflecting Psychological Well-Being and Psychological Distress were derived. The MHI, with its adolescent norms, is recommended for the assessment of adolescent mental health, particularly in studies in which comparison to a nonpsychiatric, normative adolescent population is indicated.


Smith, D., Knickman, J., and Berry, C.A.. Managing the demand for emergency service: The New York City EMS. Disaster Management, 6, 151-159.


Berry, C.A. and Weitzman, B.C.. Factors affecting housing comfort among formerly homeless families: Housing quality or individual vulnerabilities?. The Community Psychologist, 26, 27-29

1992 The impact of AIDS and other factors on residency program choice. AIDS and Public Policy, 7, 128-134.