The Untapped Power of Community-School Based Prevention

1. Mark T. Greenberg Pennsylvania State University The Untapped Power of Community-School Based Prevention

2. First we must seek out the causes of mental illness … and eradicate them. Here, more than in any other area, "an ounce of prevention is worth more than a pound of cure." For prevention is far more desirable for all concerned. It is far more economical and it is far more likely to be successful. Prevention will require both selected specific programs directed especially at known causes, and the general strengthening of our fundamental community, social welfare, and educational programs which can do much to eliminate or correct the harsh environmental conditions which are often associated with …mental illness. • (Pres. Kennedy, 1963) IEY1SUM

3. Improving Public Health Through Education Poor School Achievement Poor Mental Health Aggression/Violence Early Substance Use Undesired Related Outcomes Underlying Shared Constraints Impulsive Action Emotion Dysregulation Insecure Relations w/ Parent, Teachers, Peers

4. Resilience Factors that create Well-Being for Children • Self-Control/Emotion Regulation • Cognitive Abilities – Problem Solving Skills • Building Attention and Learning Capacity • Healthy relations with peers and adults • Safe, Welcoming, Caring Classrooms

6. Core Challenge Scope of the Problems in “Rural” Populations 30-Day Cigarette Use U.S. Monitoring the Future Study, 2008 U.S. Monitoring the Future Study, 2008—among 8th-12th graders, 30 day cigarette use

7. Three Research and Practice Challenges that could be impacted by Effective Community Coalitions • Implementing Programs with High Quality and Fidelity • Program Integration with Ongoing Programs & Activities • Building Sustainability of Programs, Policies, and Practices

8. Social/Emotional Cognitive Violence Prevention Responding in Peaceful and Positive Ways Interpersonal Cognitive Problem Solving Promoting Alternative Thinking Strategies (PATHS) Increased Social Awareness/Social Problem Solving Making Choices Drug/Alcohol Prevention Life Skills Training Project Alert All Stars It Real Family Focused Intervention Triple P Strengthening Families: 10-14 –Iowa Ecological School Transition Project Child Development Project Good Behavior Game/Mastery Learning Multi-Domain Linking the Interests of Families and Teachers Seattle Social Development Project Incredible Years Effective Universal Programs

9. What has been Accomplished: • The number of empirically validated (EV) preventive interventions and policies has grown substantially • RCTs have been crucial in legitimizing prevention efforts – although many programs still require independent replication • Reviews of these programs are now widely available • The easy work is done!

10. Types of Research

11. A Focus on Type 2 Translational Research is Key to Examining the Process and Outcomes of CCs Type Two Translation is research on factors associated with the adoption and utilization of scientifically validated interventions by service systems. In the real world, translation of science-based practices oftenstumble, largely unguided, toward uneven, incomplete and socially disappointing outcomes.

12. Public Health Impact on Substance Use Requires… Sustained, quality EBIs …greater use of evidence-based interventions (EBIs) …sustained, quality implementation on a large scale EBIs Evaluated- not effective Not Evaluated Rigorously demonstrated, long-term EBI impact is very rare (Foxcroft et al., 2003).

13. What Do We Want? We want programs that are: • Cost Efficient (affordable) • Teachable (broad scale use) • Sustainable (over time, changing events)

14. Effective Programs • Evidence-based programs are most effective when they are implemented with fidelity • Fidelity = the practitioners use all the core intervention components skillfully

15. *Approximately 5,000 6th and 7th grade students @ baseline and follow-up Data from Pentz, Trebow, Hansen, MacKinnon, Dwyer, Johnson, Flay, Daniels, & Cormack

16. Questions About Sustainability and CCs • How can communities institutionalize prevention programming as they do treatment? • What factors can improve the sustainability or “staying power of prevention programming”? • What types of technical assistance do schools, agencies and community leaders need to create systemic change?

18. Creating CC Models to Insure Quality Implementation and Sustainability • Communities That Care • PROSPER

19. Sustainability: Definitions • Continuation of a program or policy following adoption; the last stage of implementation. • The incorporation of a change into everyday behaviors and beliefs. • “Making the change stick.” • “Doing business in a new way”

20. Sustainability is a Process • Sustainability is a process. It requires buy-in from end users and leaders who have had sufficient experience to see the program work effectively in their context. • This requires 4-5 years of implementation. Thus, a long-term plan for training and support is essential to more toward sustainability.

21. Large Scale Diffusion of Research-Based Prevention: The Pennsylvania Experience Investigators: Collaborative Policy Innovators: Mark Feinberg Clay Yaeger Mark Greenberg Mike Pennington

22. Building Community Coalitions In 1992, PA Commission on Crime and Delinquency (PCCD) chose to use the Communities That Care (CTC) model • Developed by David Hawkins and Richard Catalano • Mobilizes local communities by involving “key leaders” • Establishes a prevention board to oversee local prevention assessment, planning and implementation process. • Board develops a long-term prevention plan based on an assessment of risks in the community.

23. Communities That Care Prevention Board members undergo a “six-phase training” on the CTC model: • Key Leader Orientation • Community Board Orientation • Community Assessment Training • Community Resource Assessment Training • Community Planning Training • Community Plan Implementation Training

24. Why CTC? Why PCCD chose the CTC model: • Community readiness – prepares “fertile ground” to support a comprehensive community prevention effort before selecting specific programs. • Programming often selected based on the availability of grant funds – we have money so let’s do a program! • CTC turns this approach on its head – identify a need before choosing a program designed to meet that need. • Make sure that chosen program(s) fits with the risks and strengths of each individual community. • Provides a roadmap to ensure that programming leads to specific, measurable positive outcomes in the community.

25. PA Communities That Care First CTC Funding Announcement Released in 1994 • Eight CTC Sites were Funded! • Some Rural, Some Urban Created State-Wide Technical Assistance Structure • Divided state into five regions, each with a dedicated Regional Strategic Consultant (RSC) to work proactively with sites From 1995 - 2002 PCCD funded the start-up of 127 CTC Sites throughout Pennsylvania.

26. Longitudinal Study • Used Pennsylvania Youth Survey data from 2001, 2003 and 2005 • Over 231,000 student self-reports • Stronger design because the earlier waves of data act as a control, allowing examination of within-unit change over time • Because surveys were anonymous, examined change in school/grade cohorts across time

27. Longitudinal Sample

28. CTC vs. non-CTCRisk and Protective Factors

29. CTC vs. non-CTCATOD Use a Frequency of Use statistics are based on a 2-level hierarchical model

30. Communities that Care Over 2/3 of CTC sites that received PCCD start-up funding remain active and functioning. • PCCD has created an infrastructure to build and support local coalitions and to ensure they continue to be effective. • Created structure and uniformity in function for all sites assuring that all sites follow the same logic model.

31. PA Communities That Care Four factors predicted sustainability • Quality of Board Functioning (Culture and Leadership) • Fidelity of CTC Implementation • Management of Changing Board Membership • Effective Sustainability Planning • Rural Areas More Likely to Succeed

32. Program Selection by Type

33. Program Classification

34. Program Sustainability 76% Percent n=41 grantees off of funding 2 or more years

35. Coalition Connection And Sustainability Grantees off of funding 2 or more years

36. Summary:Sustainability 2-years Post-funding • School-based prevention programs can be sustained! • Connection to a local prevention coalition, community and school leader support were associated with sustainability

37. Can we Use Existing Community Systems? CTC Creates a New System Can we work with Existing Community Systems to Create a “Home” for Prevention and its Coordination in Communities? The Cooperative Extension System!!!! Eureka!

38. The PROSPER Project: Promoting School-Community Partnerships to Enhance Reslience Richard Spoth, Cleve Redmond, Mark Greenberg, Mark Feinberg And Many Others!!!!

39. PROSPER: a model for the diffusion and support of evidence-based prevention(Promoting School-community-university Partnerships to Enhance Resilience)

40. PROSPER RCT • 28 communities, randomly assigned to intervention or delayed wait-list control (14 each – 7 per state) • All Rural School Districts • Approximately 11,000 youth across two cohorts • Each community selected 1 family-focused and 1 school-based EBI from a menu • Provided two years of funding for each program, match for year three, then only team support

41. Local Community Teams Extension Agent, Public School Staff, Social Service Agency Representatives, Parent/Youth Representatives Prevention Coordinator Team– Extension Prevention Coordinators University/State-Level Team University Researchers, Extension Program Directors The Three -Tiered Partnership Model

42. Making Use of Existing InfrastructuresExtension Linked with the Public School Systems • Cooperative Extension System • Largest informal education system in the world • Over 3,150 agents in nearly every county • Science with practice orientation • Horizontal/vertical linkages for effective implementation • Public School System • Universal system reaching nearly all children • States have networks for programming support • Increasing emphasis on accountability/empirical orientation

43. The Core Components: Fundamentals of PROSPER • A community-level PROSPER team • A three-tiered partnership structure with proactive technical assistance and ties to a land-grant university • Utilization of evidence based programs for middle school youth and families chosen from a menu • High quality program implementation • Evaluation of program impact & process

44. PROSPER Partnership Goals • Positive Youth Development & Strong Families • Prevention of Risky Youth Behaviors • Quality administration of programs • Building Sustainability Extension Personnel Public School Personnel Prevention Researchers Community Citizens

45. Findings • Families can be effectively recruited to join these programs • PROSPER sites can implement programs with effectiveness • Significant outcomes are shown for both families and teens

46. Community 8thGrade Data

47. PROSPER Substance Initiation Results ─Diverging Trajectories of Marijuana Use Through 4½ Years Past Baseline Source: Spoth, Redmond, Greenberg, Shin, et al. (2009). Addressing addiction with community health partnerships and evidence-based intervention: Substance use outcomes 4½ years past baseline. Manuscript in preparation.

48. PROSPER Sustainability Model Purpose: Improved Child and Family Outcomes Goal 1: Sustaining Growth & Quality of Programming Goal 2: Sustaining Well-Functioning Teams • Evidence-based Family Program • Delivery to increasing percentage of families • Quality implementation • Evidence-based School Program • Delivery to all 7th graders • Quality implementation • Effective External Relationships • Strong ties with schools/aligned community organizations • Effective communications • Effective Internal Relationships • Strategic teams with strong participation • Productive meetings Objectives Resource Generation for Programs Program Quality Management/ Planning Strengthening Partnerships with Schools/ Other Organizations Strategic Communication Planning Planning for Recognitions and Rewards Monitoring Team Structure & Roles & Participation Conducting Effective, Regular Meetings Community/ School Positioning Strategies

49. Sustainability Status • All teams and family programs sustained; 12 of 14 school programs sustained • Combination of short-term and stable funding sources • Teams have institutionalized monitoring of implementation quality/fidelity • Teams continue to use Sustainability Planning Model to guide action plans • Several teams have expanded into neighboring communities

50. At Year 5, Teams Sustainability Planning related to • Quality of Board Functioning (Culture and Leadership) • Orientation of New Team Members • Members see more Benefits than Costs in Participation