What Does a ”Prevention Prepared Community” Look Like?

1. What Does a ”Prevention Prepared Community” Look Like? ADAA Management Forum December 13, 2010

2. A “Prevention Prepared Community” will plan and implement a system-oriented, comprehensive prevention structure at the community level • Why a “system-oriented” prevention structure • Seeking community level change • Requires changing community conditions • System partners are critical to environmental strategies that change community conditions

3. Prevention Prepared Community • Why “comprehensive”? • Looks at the potential prevention needs of all community members, along the continuum from non-use through support for recovery • Builds the broad advocacy needed for sustained community change and making the reduction of ATOD use a public policy priority

4. Key Principles and funding trends that support prevention prepared communities • Coalitions and Partnerships – Collaboration is the Key • SAMHSA’s Strategic Prevention Framework (SPF) • ONDCP’s Drug Free Communities (DFC) • SPF and DFC similarities is evidence of a strong SAMHSA and ONDCP Partnership • Maryland will model partnership on the State level through the MSPF initiative

5. Key Principlesof Prevention Prepared Communities • Their prevention/reduction efforts feature strong community participation and leadership in: • Determining community needs • Developing community action plans • Determining strategies to address their particular needs • Implementing evidence based strategies and practices specifically designed for that community • Evaluating and using evaluation findings to continually strengthen community prevention efforts

6. Key Principles (continued) • Communities utilize a structured public health planning process • Structured, such as the SPF process described below • Public Health approach – focused on impacting both the host (the individual) and the environment (community conditions, norms, policies, etc.)

7. Key Principles (continued) • Increased emphasis on the environmental prevention approach • Changing the community conditions that can foster ATOD use and abuse • Targeting and tracking community level change (actual reductions in a community’s level of substance use and consequences) • In concert with more traditional approches that target individual youth and families • Results in a more comprehensive approach addressing individual, family, school and community contributing factors

8. Key Principles (continued) • Implement evidence-based strategies, programs, activities, and policies that: • Have been shown to be effective at producing actual changes in levels of use, consequences and contributing factors • Are strategically matched to community needs and resources

9. Key Principles (continued) • All prevention efforts should be evaluated for their impact on reducing substance use, consequences and contributing factors • Contribute to the body of evidence that shows (finally, conclusively) that Prevention Works • We have generally been unsuccessful in proving this to funders and policy makers • Consequently, prevention remains a low funding and policy priority

10. Key Principles (continued) • Must build advocacy for the field • Community coalitions (not agency staff) advocate for needed laws, policies, resources, etc. that help prevent and reduce substance use and consequences along the entire continuum • Coalitions use the results of the community-driven, evidence-based environmental strategies in their communities as their tools in this advocacy effort

11. Utilizing the MSPF process to build and sustain “prevention prepared communities” that embody these principles • MSPF process objectives: • Build community capacity, though a structured strategic planning process, to identify and effectively address its particular substance abuse and consequence issues • Implement evidence-based, culturally-competent strategies designed to impact conditions in their community that foster ATOD use and consequences

12. MSPF Outcome Objectives • Reduce the misuse of alcohol by youth and young adults in their community, through the attainment of the following objectives: • Reduce the number of underage youth that drink • Reduce the number of youth and young adults that binge drink • Reduce the number of alcohol-realted crashes that involve youth and young adults

13. MSPF Components • Community Mobilization – Mobilze and convene a diverse MSPF planning group comprizing local citizens, policy makers, stakeholders, providers, etc. • Include representatives from the most impacted groups and communities • Include those in treatment and recovery • Include impacted family members and loved ones • Include youth, from non-users to those in treatment and recovery (Find a way to get them involved) • Include those who work with these groups

14. MSPF Components • Needs Assessment – Review community level data to document the nature and extent of underage drinking, youth binge drinking and alcohol related crashes, their contributing factors, and community resources • Agency personnel, particularly treatment providers, can provide key use and consequence data and, as importantly, qualitative information, based on direct observation and experience about the nature of use, trends, contributing factors, etc.

15. MSPF Components • Strategic Planning – Community develops a structured MSPF Strategic Plan for utilizing its MSPF funds and other available resources to address its identified youth and young adult alcohol use and consequence problems • Agency personnel can provide context and great depth to the plan by identifying how their service population is impacted by substance use and how their programs can help the coalition carry out its community change prevention objectives

16. MSPF Components • Implementation – Community coalition researches, selects and implements culturally competent, evidence-based strategies that address the community conditions that foster the misuse of alcohol by youth and young adults • Concrete connections to treatment for youth identified through enhanced enforcement (environmental) activities • Concrete connections to recovery through the provision of family alcohol and drug free activities serving both the recovered person and at-risk children

17. MSPF Components • Evaluation – Contract with an independent Evaluator for outcome evaluation measuring progress in reducing misuse of alcohol by youth and young adults. Also conduct process evaluation to document the processes, activities, people and other resources utilized to attain objectives • Agency personnel will be relied upon to provide key stakeholder input to the process evaluation activities

18. MSPF Components • Cultural Competence – Knowledge and skills that enable planners to understand and appreciate cultural differences and similarities within, among and between groups. A culturally competent intervention is one that demonstrates sensitivity to and understanding of cultural differences in intervention design, implementation and evaluation

19. MSPF Components • Cultural Competence • A principal reason that many interventions fail to reach their intended audiences and attain their objectives is that the interventions are not culturally competent; they didn’t involve those most involved in and/or impacted by the problem in the planning, implementation and/or evaluation processes • Treatment and recovery services providers can be extremely instrumental in helping the coalition to access and secure the input of those in treatment and recovery and their impacted family members

20. MSPF Components • Sustainability – Each MSPF community will be required to include a sustainability plan as part of its MSPF Strategy to ensure that they begin thinking about sustaining their efforts from the beginning of the planning process. MSPF funding will end and the prevention prepared community must be able to sustain its coalition and community prevention activities • Agency partners that have been actively involved in the MSPF process and have contributed to its success will be more invested in helping sustain the coaltion and its community prevention efforts

21. What Does a ”Prevention Prepared Community” Look Like? What A Loaded Question!

22. What Does a “Prevention Prepared Community” Look Like? In a perfect world (Community), there would be no drug misuse or abuse…. HOWEVER, TO GET THERE, LET’S THINK ENVIRONMENTAL!

23. The Six CSAP Strategies The Center of Substance Abuse Prevention (CSAP) has created six strategies that can form a comprehensive prevention program. Integration of theories and strategies are an important consideration when implementing substance abuse prevention programs.

24. The Six CSAP Strategies • Information Dissemination • Prevention Education • Alternative Activities • Community-Based Processes • Environmental Approaches • Problem Identification and Referral

25. Community-Based Processes This strategy aims to enhance the ability of the community to provide more effective prevention and treatment services for substance abuse disorders.

26. Community-Based Processes Activities in this strategy include the following: organizing, planning, enhancing efficiency and effectiveness of services implementation, interagency collaboration, coalition building, and networking.

27. Environmental Approaches This strategy seeks to establish or change community standards, codes, and attitudes, thereby influencing the incidence and prevalence of substance abuse in the general population.

28. Environmental Approaches Examples of methods used in this strategy include the establishment and review of drug policies in schools, technical assistance to communities to maximize local enforcement procedures, the review and modification of alcohol and tobacco advertising practices, and product pricing strategies.

29. What Does a “Prevention Prepared Community” Look Like? The Community Anti-Drug Coalitions of America (CADCA) adopted seven methods that can bring about community change.

30. Seven Strategies to Affect Community Change • Provide Information • Enhance Skills • Provide Support • Enhance Access/Reduce Barriers • Change Consequences • Change Physical Design • Modify/Change Policies

31. Seven Strategies to Affect Community Change The first three of the seven strategies focus on impacting individuals and by themselves will not achieve measurable change in substance abuse rates in your community.

32. Seven Strategies to Affect Community Change However, the last four strategies are environmental in nature and when utilized in a multi-strategy plan can form the basis of a comprehensive approach along with the first three.

33. Provide Information This strategy includes town hall meetings, Web sites, billboard campaigns, and Public Services Announcements (PSA). This strategy adds to the community’s knowledge of local efforts, but in isolation would not create long-term change.

34. Enhance Skills This strategy includes media advocacy, youth training on refusal skills, parenting classes and training local treatment professionals in prevention concepts. Parenting classes can complement environmental strategies when social host issues are uncovered.

35. Provide Support Support includes substance-free activities for youth, support groups and clubs. If a community determines through its assessment process that many youth are cited for underage drinking during certain hours, substance-free activities can be offered during those times.

36. Enhance Access/Reduce Barriers Environmental strategies often are associated with modifying settings to reduce risk through the implementation of policy, however, systems change to increase the ease of utilization also can be viewed as a population-focused approach. Make access to the basic services community members require a priority.

37. Change Consequences-Incentives and Disincentives Environmental strategies generally include consequences (incentives and disincentives). For a policy to be effective after adoption, active and consistent enforcement of incentives (rewards) or disincentives (penalties) must be swift and appropriate.

38. Change Physical Design The risk associated with specific environments can be reduced through changing the design of the setting. Because substance abuse problems have a close nexus with crime and violence, a coalition working on environmental strategies naturally would urge law enforcement to target specific settings where AOD sales and use are visible.

39. Change or Modify Policies Policies are concrete tools used to reduce risk or to modify settings in ways that benefit the public’s health. They can be formal or informal and are designed to structure community norms, which effect behaviors.

40. The SPF and Environmental Strategies No “cookie cutter” response to environmental strategies exist. You cannot select a “model” program (i.e. Communities Mobilizing for Change Against Alcohol or Challenging College Alcohol Abuse) and hope it will work in your community.

41. The SPF and Environmental Strategies The Maryland Alcohol and Drug Abuse Administration (ADAA) is asking you to utilize the MSPF to assist your community coalition in developing the infrastructure needed for community-based, public health approaches that can lead to effective and sustainable reductions in ATOD use and abuse.

42. So, What Does A “Prevention Prepared Community” Look Like? A Community that can show population level outcomes in reductions for substance use throughout the targeted area.