Prevention Approaches in the Community

1. Prevention Approaches in the Community Karol L. Kumpfer, Ph.D. Professor, Dept. of Health Promotion and Education University of Utah

2. Objectives • Define coalitions and better understand their need • Review evidence-based community change programs • Cover the PREVENT Model of Community Readiness • Increase understanding of five steps in the Strategic Prevention Framework for community prevention efforts • Discuss community coalition outcomes

3. Definition of a Coalition “A coalition is a formal agreement and collaboration between groups or sectors of a community in which each group retains its identity but all agree to work together toward a common goal of building a safe, healthy, and drug-free community.” - Community Anti-Drug Coalitions of America(CADCA)

4. The Need for Community Coalitions • Community coalitions have become very popular for health promotion and disease prevention. • Community coalitions have been implemented by: • State and local governments • The Henry J. Kaiser Family Foundation

5. The Need for Community Coalitions (cont.) • The Robert Wood Johnson Foundation’s “Fighting Back” coalitions • The National Cancer Institute's COMMIT and ASSIST tobacco and cancer reduction programs • The U.S. Centers for Disease Control and Prevention’s Planned Approach to Community Health (PATCH) health promotion program

6. Executive Office of the President Office of National Drug Control Policy & Substance Abuse and Mental Health Services Administration The U.S. Center for Substance Abuse Prevention (CSAP) funds over 500 community partnerships nationwide. DRUG FREE COMMUNITIES SUPPORT PROGRAM:

7. Evidence-based Community Coalition Models • The Communities That Care (CTC) coalition planning model by Drs. Hawkins and Catalano has standardized needs assessments used by state substance abuse agencies. CTC is the most popular model. • The Midwestern Prevention Program (Pentz) has evidence of effectiveness in NIDA research studies. • Project Northland (Perry) is focused more on alcohol prevention in communities. • Three Communities Prevention Model developed by Holder and associates works for alcohol policy changes in communities.

8. Evidence-based Community Coalition Models • All community coalition models follow a strategic planning model like the PREVENT model (Kumpfer, Whiteside and Wandersman, 1997). • The first step is to determine if your community is ready for a community coalition—a readiness assessment • If any areas are weak, the community needs to address these areas of weakness.

9. Assessing Community Readiness to Start a Coordinated Community Prevention Approach (Kumpfer, et al., 1997) • Seven key factors that must be present: • Problem defined by needs assessment • Recognition of problem by community • Existence of funding sources • Vision/plan • Energy to mobilize/sustain coalition • Networking with stakeholders • Talent/leadership

10. Typical Coalition Steps • Conduct Needs Assessment • Mobilize Members,Resources, Structure/Bylaws • Develop Strategic Plan • Implement Plan and Activities Implement trainings, e-newsletter, brown bags, and annual conference; mini-grant program for direct youth prevention services, police training, enforcement, PSAs, bill boards, radio and TV media, community alcohol free events, etc. • Evaluate

11. Step #1: Profile population needs, resources, and readiness to address needs and gaps Sustainability & Cultural Competence Step #5: Monitor, evaluate, sustain, and improve or replace those that fail Step #2: Mobilize and/or build capacity to address needs Step #4: Implement evidence-based prevention strategies and initiatives Step #3: Develop a Comprehensive Strategic Plan Strategic Prevention Framework Steps

12. Step #1: Readiness and Needs Assessment • Gather archival needs data on risk and protective factors • Treatment needs data • Existing prevention services • Gap analysis • •

13. Step #2: Mobilizing and Recruiting Members • Community Leader to Invite Agencies and Citizens • Community Meeting or Conference • Newspaper Announcements • Information Booths and Brown Bags • Print Media – Ads • Electronic Media • PSAs • Web Site • Child Specific • Newsletter on web site • Television “Kids Corner”

14. Frequent Partners: • Schools (90%) • Law enforcement (85%) • Alcohol and drug prevention agencies (76%) • Parents (72%) • Volunteers (71%) • Treatment providers (70%) • Local governments (67%)

15. Frequent Partners (cont.) Other groups • Youth (64%) • Private business (63%) • Government—human services (62%) • Courts/probation (61 %) • Religious organizations (61%) • Government—health services (56%) • Recovering people (55%) • Other concerned citizens (54%)

16. Prospective Partners Infrequent Partners. According to the Robert Wood Johnson Join Together coalition surveys (Join Together, 1993), the following were represented in less than 30 percent of substance abuse coalitions: • Labor organizers • Transportation • Employment services • Public assistance • Alcohol industry and beverage control • Citizen action groups

17. Step #3: Develop Strategic Plan • Review Needs Assessment Data • Determine most changeable and most salient risk factors • Review and select programs and policies that reduce risk • Develop strategic plan (staffing, timelines, budget, evaluation).

18. Step #3: Select an Planning Model with Evidence-based Prevention Programs and Policies Read Reviews of the Research Literature Communities That Care (Hawkins, et al., 2000) Review federal agency web sites on use trends and best practices 1. NIDA “Red Book” www.drugabuse.gov 2. OJJDP Strengthening America’s Families www.strengtheningfamilies.org 3. SAMHSA National Registry -NREPP (2005) www.preventionregistry.org

19. Four Steps for Choosing an Evidence-based Prevention Program • Gather Local Data • Determine Why These High-Risk Individuals Use Drugs • Select the Best Prevention Intervention

20. Where in the Prevention Continuum to Intervene? • First you should decide where in the prevention risk continuum you want to intervene: • Before there are any risk indicators with general population using universal approaches, • Using selective approaches for high-risk groups, or • Using indicated approaches for individuals • manifesting symptoms of use (dropping • grades, isolation, and antisocial behavior).

21. Universal Selective Indicated General population (mixed low, high risk) Targeted Population at High risks Targeted Individuals at High Risk School-based approaches I. Information II. Education curriculums • social inoculation • peer resistance • normative education • life skill training III. School climate change programs • school policies • instructional changes IV. School coalitions • multiple approaches I. Alternative Programs • youth skills training • after school or special class/club • sports or recreation II. Cultural pride & competency III. Peer leadership IV. Tutoring V. Mentoring VI. Children of Alcoholics Groups VII. Trauma & Violence Prevention VIII. Parent-peer groups • alternatives programs • peer leadership • peer counseling • tutoring • mentoring • cultural pride • in-school suspension • student assistance • student crisis line & warm lines • school support group • aftercare group • alternative schools/classes Prevention Matrix The following table provides an overview of Universal, Selective, and Indicated as defined by school-based approaches, family focused approaches, and community based approaches.

22. Universal Selective Indicated • parent education - groups - lectures -curriculums • parent support • parent skills training (1-7 sessions) • family skills training (1-7 sessions) Family-focused approaches • home visits • parent skills training (10+ sessions) • family skills training (7+ sessions) • family case/ manager • parent support groups • family skills training • parent-peer group for troubled youth • parent self-help support group • tough love • family treatment - structural - strategic - functional • family services Community-based approaches • youth clubs • recreation • outdoor challenges • mentoring • tutoring • school homework support • community partners (inner city, housing projects) • public awareness • community mobilization • community coalitions/task forces • school/community partnerships • church sponsored youth groups • rites of passage programs • gang & delinquency prevention • alternative programs • job skill training • job apprentice programs Prevention Matrix (continued)

23. Step 3.2: Which Sites to Focus Upon—School, Family, Community? • Step 3.3: Choosing the Most Effective Approach • (see National Registry of Effective Prevention • Programs and Practices --NREPP • www.samhsa.gov/modelprograms • Additional web-sites include: • 1. Department of Education’s Safe and Drug-free Schools • www.ed.gov 2. Office of Juvenile Justice and Delinquency Prevention BluePrints for Violence Prevention www.colorado.edu/cspv/blueprints 3. International Cochrane Collaboration Review of School Substance Abuse Prevention (Foxcroft, et al., 2003) www.cochranecollaboration.org

24. Step #4: Implement Strategic Plan • Monitor progress (benchmarks) • Evaluate • Sustain (develop funding plan). • Improve

25. Step #5: Evaluate Model ProgramOr Policy • Annual Incidence and Prevalence Survey or other Local Data • Changes in Risk and Protective Factors • Direct Services Evaluations using standardized instruments

26. Evalation: How Well o Coalitions Work • Results of the Largest • Community Coalition Evaluation • Conducted on CSAP Community • Coalitions

27. 5 Location of the 251 Partnerships 2 3 4 5 1 22 6 5 13 7 3 7 1 5 6 1 6 11 1 6 1 4 1 2 1 3 9 26 2 5 5 5 3 5 8 5 8 1 1 3 4 2 13 10 2 1 1 SAMHSA-CSAP Community Partnership Program

28. 1994-95 1996 Total Adults Tenth graders Eighth graders Total: 14,807 12,092 26,899 12,842 13,042 25,884 14,151 16,539 30,690 41,800 41,673 83,473 Annual Site Visits to 24 Partnerships • Annual Site Visit Reports (N=24) • Composite Reports (N=24) A Rigorous National Evaluation Age Groups Surveyed in the 24 Partnerships and 24 Comparison Communities

29. Involvement in Drug Prevention Activities 12 12 3 9 6 Vote for Issue B Red Ribbon Days • • SAMHSA-CSAP Less Likelihood of Illicit Drug Use DISAPPROVAL OF DRUGS In the Past Month Community Partnership Neighborhood Perceived Safe From Drugs Adults are Less Likely to Use Illicit Drugs When: • Living in partnership communities, • Participating in drug prevention activities, • Living in neighborhoods safe from drugs, and • Disapproving of drug use.

30. Inclusive and Broad-based Membership Strong Core of Partners Comprehensive Vision Shared Vision Decentralized Units High Number of Prevention Contact Hours Avoidance or Resolution of Severe Conflict Reasonable Staff Turnover Outcome Evaluation Results:Characteristics of Successful Partnerships

31. Adults 10th Graders 8th Graders 32 28 12 11 30 26 28 10 26 24 9 Adjusted Prevalence Rates (%) 24 8 22 22 7 20 20 6 p036* p005* p025* 0 0 0 t1 t2 t1 t2 t1 t2 Partnership Communities Comparison Communities *one-tailed 30 Day Illicit Drug UseMALES

32. Adults 10th Graders 8th Graders 48 34 66 32 64 30 46 Adjusted Prevalence Rates (%) 62 28 26 60 p030* 0 44 p005* Partnership Communities 0 0 t1 t2 t1 t2 t1 t2 Comparison Communities *one-tailed 30 Day Alcohol UseMALES

33. Adults 10th Graders 8th Graders 24 24 6 22 22 5 Adjusted Prevalence Rates (%) 20 20 18 18 4 p026* 1 0 0 0 Partnership Communities Comparison Communities t1 t2 t1 t2 t1 t2 *one-tailed 30 Day Illicit Drug UseFEMALES

34. 8thGraders Adults 10th Graders 46 42 32 30 44 40 Adjusted Prevalence Rates (%) 28 42 38 26 0 0 40 Partnership Communities Comparison Communities 0 t1 t2 t1 t2 t2 t1 30 Day Alcohol UseFEMALES

35. Why Did Community CoalitionsReduce Substance Abuse in Males But Not in Females? We can only speculate: • Boys are more impacted by Community Environment (laws, policies, enforcement, norms) • Girls are more impacted by family and social, peer influence • Most used school based approaches teach knowledge and social skills that can increase drug use in girls.

36. Summary • Defined coalitions and reviewed their need • Reviewed evidence-based community change programs • Covered the PREVENT Model of Community Readiness • Increased understanding of the five steps in the Strategic Prevention Framework for community prevention efforts • Discussed community coalition outcomes