Investigators and Authors: Brian Bumbarger Mark Greenberg Mark Feinberg Brittany Rhoades Louis Brown

1. Communities That Care 201Pennsylvania’s Prevention ApproachCommonwealth Prevention Alliance ConferenceJune 7, 2012Sandy Hinkle Communities That Care Consultant EPISCenter, PSU

2. Investigators and Authors: Brian Bumbarger Mark Greenberg Mark Feinberg Brittany Rhoades Louis Brown Wayne Osgood Ty Ridenour Damon Jones Jennifer Sartorious Daniel Bontempo Brendan Gomez Richard Puddy Michael Cleveland Collaborative Policy Innovators: Mike Pennington Clay Yeager James Anderson Keith Snyder The EPISCenter and research described here are supported by grants from the Pennsylvania Commission on Crime and Delinquency. Special thanks to the staff of the Office of Juvenile Justice and Delinquency Prevention (OJJDP)

3. Why don’t communities see greater success in prevention? • Chasing money rather than outcomes • No single guiding philosophy (many separate but disconnected efforts) • Little accountability • The lack of good data to drive decision-making and resource allocation • Reliance on untested (or ineffective) programs • Poor implementation quality • Inability to sustain programs Bumbarger, B. and Perkins, D. (2008). After Randomized Trials: Issues related to dissemination of evidence-based interventions. Journal of Children’s Services,3(2), 53-61. Bumbarger, B., Perkins, D., and Greenberg, M. (2009). Taking Effective Prevention to Scale. In B. Doll, W. Pfohl, & J. Yoon (Eds.) Handbook of Youth Prevention Science.  New York: Routledge.

4. To improve outcomes, we must bridge the gap between science and practice • Pennsylvania’s Approach: Createsustained, community-wide public health impact through effective community coalitions using proven-effective programs targeted at strategically identified risk and protective factors

5. Goals of Pennsylvania’s Approach • Prevent dependency, delinquency, and ATOD use to the greatest degree possible (primary prevention) • Intervene effectively with youth for whom primary prevention is not sufficient • Allow communities flexibility to select strategies that best meet local needs • Create community-level infrastructure for strategic prevention planning and coordination • Provide accountability and use scarce resources efficiently ULTIMATELY…. • To “move the needle” on key indicators of (behavioral) health at the POPULATION level

6. From Lists to Improved Public Health: Barriers • Synthesis and translation of research to practice, (and practice to research) • EBP dissemination, selection, and uptake • Ensuring sufficient implementation quality and fidelity • Understanding adaptation and preventing program drift • Measuring and monitoring implementation and outcomes • Policy, systems, and infrastructure barriers • Sustainability in the absence of a prevention infrastructure Bumbarger, B. and Perkins, D. (2008). After Randomized Trials: Issues related to dissemination of evidence-based interventions. Journal of Children’s Services,3(2), 53-61. Bumbarger, B., Perkins, D., and Greenberg, M. (2009). Taking Effective Prevention to Scale. In B. Doll, W. Pfohl, & J. Yoon (Eds.) Handbook of Youth Prevention Science.  New York: Routledge.

7. What is CTC? • An “operating system” to mobilize communities and agency resources • Follows a public health model of preventing poor outcomes by reducing associated risk factors and promoting protective factors • Coalition model that is data-driven and research-based • Follows a specific sequence of steps • Focuses on the use of targeted resources and evidence-based prevention programs

8. The Five Phases of Communities That Care Development

9. Profile population needs, resources, and readiness to address needs and gaps Sustainability & Cultural Competence Monitor, evaluate, sustain, and improve or replace those that fail Mobilize and/or build capacity to address needs Implement evidence-based prevention programs and activities Develop a Comprehensive Strategic Plan SAMHSA’s Strategic Prevention Framework Steps Assessment Evaluation Capacity Planning Implementation

10. SAMHSA in coordination with the Office of National Drug Control Policy (ONDCP) administers approximately 700 Drug Free Communities Programs using the Strategic Prevention Framework. Of those, almost 200 use the Communities that Care Model as a tool to implement the Strategic Prevention Framework.

11. Communities that Care is an effective tool to implement the Drug Free Communities program as well as other SAMHSA Strategic Prevention Programs.

12. Successful CTC’s in Pennsylvania Use a Three Prong Approach • Milestones and Benchmark direction and assessment for readiness. • Selecting Evidence Based Programs based on choosing the right fit and practicality based on their community risk and resource assessment. • Yearly assessment of coalition functioning at the internal level.

13. CTC in Pennsylvania • Adopted as a statewide initiative in 1994 • Over 120 communities trained over 16 cycles • 60-70 currently functioning CTC communities • System of assessment & dedicated technical assistance to improve coalition functioning • Over a decade of studying the processes of coalitions • Opportunity to study CTC & EBPs in a long-term large-scale implementation under real-world conditions

14. Pennsylvania’s “Blueprints” Initiative • Followed from earlier CTC initiative that promoted community coalitions/risk & resource assessments • State funding for program startup, after identification of need by local community • Nearly 200 EBP’s funded since 1998 (+~200 through other sources) • Big Brothers/Sisters, LST, SFP 10-14, PATHS, MST, FFT, MTFC, Olweus Bullying Program, TND, Incredible Years, ART

15. Milestones and Benchmarks

16. Defining Milestones and Benchmarks • There are 5 Phases • Phases are divided into Milestones and Benchmarks, each phase includes 4-7 Milestones. • Within each Milestone there are multiple Benchmarks that must be accomplished in order for the Milestone to be achieved. • Each Item is rated on 2 scales with a rating from 1-4; A Benchmark rating (how well) and a challenge rating (how difficult).

18. http//episcenter.psu.edu/sites/default/files/ctc/milestonesandbenchmarks.xlshttp//episcenter.psu.edu/sites/default/files/ctc/milestonesandbenchmarks.xls www.episcenter.psu.edu

19. Selecting EBP

20. Creating Fertile Ground for EBPs Risk-focused Prevention Planning (the Communities That Care model) Collect local data on risk and protective factors Form local coalition of key stakeholders Leads to community synergy and focused resource allocation Re-assess risk and protective factors Use data to identify priorities Select and implement evidence-based program that targets those factors

21. Pennsylvania’s EBP dissemination in 1999…

22. Pennsylvania’s EBP dissemination in 2012…

23. Reducing Youth Problems and Promoting Positive Youth Development: Choosing the best program for your community …...

24. Program Fit Risk and Protective Factors Developmental Stage Targeted Population • Culture and Values • Domains of Influence

25. Program Efficacy Based on the programs record of evaluation… Will you get the improved outcomes you want?

26. Program Feasibility Assess Delivery and Impact Sustainability Sufficient Quality

27. Where does the program fall on the Matrix of Fit & Feasibility vs. Evidence?

28. The Cost-effectiveness of Evidence-based Prevention in Pennsylvania(measured benefits and costs per community and statewide )

29. Where to go for help http://www.nrepp.samhsa.gov/ http://www.colorado.edu/cspv/blueprints/modelprograms.html

30. Coalition Functioning

31. Assessing & Supporting Community Coalitions • Web-based data collection from CTC board members • Provide feedback to sites • Summary Report to TA • TA presents to CTC site • Used for strategic planning

32. Communities That Care Web-Based Survey CTC Web Statewide Report – June 2010 Revision Date: 6/17/10 Sponsored by CTC Research Team, Prevention Research Center Pennsylvania State University 32

33. CTC Domains The areas that were studied in CTC-Web 2010 include the following:     Board Membership Board Leadership Board Relationships CTC Process Barriers Experienced Programs Implemented Technical Assistance Board Work Style 33

34. The research says……………

35. ANOVA: **p<.01 *p<.05

36. Do Coalitions Affect Program Sustainability? Operating Not operating % Grantees off of funding 2 or more years

37. Measuring Population-level Impact • Cross-sectional quasi-experimental study of 98,000 students in 147 communities • Used propensity score matching to minimize potential selection bias • Found youth in CTC communities reported lower rates of risk factors, substance use, and delinquency than youth in similar non-CTC communities (7x as many as by chance) • Communities using EBPs showed better outcomes on twice as many R/P factors and behaviors (14x as many as by chance)

38. 5 year Longitudinal Study of PA Youth % Change of CTC/EBP Youth Over Comparison Group 419 age-grade cohorts over a 5-year period: youth in CTC communities using EBPs had significantly lower rates of delinquency, greater resistance to negative peer influence, stronger school engagement and better academic achievement Feinberg, M.E., Greenberg, M.T., Osgood, W.O., Sartorius, J., Bontempo, D.E. (2010).  Can Community Coalitions Have a Population Level Impact on Adolescent Behavior Problems?  CTC in Pennsylvania, Prevention Science.

39. Other “big picture” lessons… • Some balance between evidence-based practices and practice-based evidence • Find a small number of things that work, and do them well • Operating system to prepare communities, focus efforts, and create fertile ground for EBPs • These also require active TA and attention to fidelity

40. Evidence-based Prevention and Intervention Support Center Prevention Research Center, Penn State University 206 Towers Bldg. University Park, PA 16802 (814) 867-3160 –sah41@psu.edu episcenter@psu.edu www.episcenter.psu.edu Thank You!