Please cite this article in press as: Sanders, J., et al. Multiple Service Use: The impact of consistency in service quality for vulnerable youth. Child Abuse & Neglect (2013), http://dx.doi.org/10.1016/j.chiabu.2013.10.024 ARTICLE IN PRESS G Model CHIABU-2682; No. of Pages 11 Child Abuse & Neglect xxx (2013) xxx–xxx Contents lists available at ScienceDirect Child Abuse & Neglect Multiple Service Use: The impact of consistency in service quality for vulnerable youth Jackie Sanders a,* , Robyn Munford a , Linda Liebenberg b , Michael Ungar b a Practice Research and Professional Development Hub, Massey University, Private Bag 11 222, Palmerston North, New Zealand b Resilience Research Centre, Dalhousie University, P.O. Box 15000, Halifax, NS B3H 4R2, Canada a r t i c l e i n f o Article history: Received 17 July 2013 Received in revised form 23 October 2013 Accepted 30 October 2013 Available online xxx Keywords: Service consistency Risk Resilience Outcomes Positive youth development a b s t r a c t Little is known about the way in which variations in service quality influence outcomes when youth are clients of more than one service system. This article reports on a study of 1,210 adolescents (aged 13–17 years), half were concurrent clients of two or more services and half were not involved in two or more services. Youth completed a self-report ques- tionnaire administered by a trained interviewer. It was hypothesized that youth reporting two positive service experiences would report lower risks, higher resilience, and better outcomes than youth reporting inconsistent or two negative service experiences and that their resilience, risks, and outcomes would be similar to those of youth not involved in two or more services. MANCOVA was used to determine the relationship among service quality and resilience, risk, and outcomes with four covariates that assessed family and neighbor- hood environments, history of abuse and neglect, and chronic need. Results indicate that service quality had an effect on resilience, risks, and outcomes. These relationships were mediated quite strongly by the influence of the risks youth faced in their neighborhoods and to a lesser extent by the other three covariates. Of the three dependent variables, risk appeared to be the most consistently influenced by all the covariates, and it also differen- tiated service experience groups. Results point to the importance of services developing strategies to effectively address risks confronted by youth and also to ensure that when more than one service is involved with youth, consistency in service delivery is achieved. © 2013 Elsevier Ltd. All rights reserved. Introduction Little attention has been given to the combined impact of interventions from multiple service systems (e.g., child welfare, mental health, special education, juvenile corrections) on vulnerable youth despite the fact that youth with the most complex needs and the highest risks are typically clients of more than one service system (Ungar, Liebenberg, Dudding, Armstrong, & Van de Vijver, 2013). Berzin (2010) makes a case for more attention to be paid to the complex nature of the transition through adolescence for youth who are clients in multiple service systems. She also argues for research that reaches “beyond system classifications toward broader definitions of risk that more adequately portray youth experience” (p. 487). Others have drawn attention to the fact that youth concurrently involved in more than one service system face heightened risks across a broad spectrum of developmental outcomes and generally do not achieve better outcomes despite the larger volume of services they receive (Garland, Aarons, Brown, Wood, & Hough, 2003; Haapasalo, 2000; Harpaz-Rotem, Berkowitz, Marans, Murphy, & Rosenheck, 2008; Hazen, Hough, Landsverk, & Wood, 2004; Kroll et al., 2002; Loeber, Farrington, Stouthamer-Loeber, & Van Kammen, 1998). * Corresponding author. 0145-2134/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.chiabu.2013.10.024