SPF Implementation in Rural Communities

1. SPF Implementation in Rural Communities Catonsville, Maryland February 25, 2011 Matthew Myers, MA CAPT NERT Associate Lourdes M. Vázquez, MSW NERT Training and Technical Assistance Specialist

2. About Today Share with a peer… • One hope you have for today. • One thing you already know about prevention in rural settings.

3. Strategic Prevention Framework

4. Objectives At the end of the workshop participants will have: • Reviewed best practice and research that informs rural, community-level prevention work. • Clarified possible challenges and opportunities particular to rural communities when implementing the first three steps of the SPF. • Identified existing and needed community-level data sources in their rural areas for use in a comprehensive assessment process.

5. Objectives (Cont’d.) • Determined potential strengths and gaps in their local capacity to implement the SPF. • Examined how being in a rural community may impact the planning phase of the SPF. • Identified and prioritized needed assistance at the county level in order to best support community-level prevention.

6. Context: State Priority and Indicators Reduce the misuse of alcohol by youth and young adults in Maryland, as measured by the following indicators: • Reduce the number of youth, ages 12-20, reporting past month alcohol use • Reduce the number of young persons, ages 18-25, reporting past month binge drinking • Reduce the number of alcohol-related crashes involving youth ages 16-25

7. What is Rural?

8. What’s Rural in Maryland? Activity In your small group, review Handout #1 and have a dialogue about: • What would you add or change in the definitions provided to fit your understanding of “rural” in your communities/jurisdictions? • Open dialogue in large group

9. Defining “Rural” http://www.ers.usda.gov/AmberWaves/June08/PDF/RuralAmerica.pdf

10. What is Rural? Approaches: • Rural-urban continuum (Scaramella, 2001). From frontier to rural. • There are degrees of rurality and there is a continuum of acculturation to mainstream America (Slama, 2004). • Rural and urban as dichotomous categories (OMB, U.S. Census) • Dichotomous categories mask hidden heterogeneity in very rural areas (Hall, 2006) • Rural areas are not homogeneous (Slama, 2004).

11. Is Rural Homogeneous? • “While many of the substance abuse problems in rural America are familiar, the patterns of risk, protection, use, cause, and effect are often distinct—reflecting geography, demographics, culture, economy, and resources”.(The Athena Forum, 2010) • “Rural and urban may not necessarily be a dichotomy, nor is rural living necessarily a homogeneous American experience across Maine, Alaska, and Alabama”. (Hall, 2006)

13. Challenges Research also suggests that drug abuse, addiction and its other related consequences are a serious and growing problem in rural areas. While we are actively working to expand our knowledge base on drug abuse and addiction in these communities, providing drug abuse prevention, treatment, and services, and conducting drug abuse research in rural areas are difficult due to issues such as confidentiality, access to services, logistical difficulties, and a limited cadre of researchers and health care providers in rural areas. (NIDA, 1998)

14. Community-Level Assessment from a Rural Perspective

15. Strategic Prevention Framework

16. Community Assessment • What types of problems the community experiences • Who experiences these problems • What capacity exists within the community (currently) to address the problem(s) • Which problems can actually be addressed, given the community capacity

17. Assessing Community-Level Needs • Types of data • Quantitative: Consists of counts, rates or other statistics that document existence or absence of problems, behaviors or occurrences Examples include: • Driving under the influence arrest reports • Drug-use youth surveys • Alcohol-related school suspensions

18. Assessing Community-Level Needs • Types of data • Qualitative: Provides results in descriptions of problems, behaviors, or events • Reflects individual and community perceptions gleaned from: • Focus groups • Stakeholders interviews • Case studies • Testimonials

19. Assessing Risk and Protective Factors • Each substance abuse problem has its own set of risk and protective factors. • Factors driving a problem in one community may differ from factors driving it in another community.

20. Risks in Rural Settings The risk of substance abuse is increased in rural America by geographic isolation, poverty, lack of employment opportunities, lower levels of education, and lack of resources to prevent and treat problems. Education, income, and employment are factors in illicit drug use but not in alcohol abuse. (Van Gundy, 2006)

21. Consumption in Rural Communities (The NSDUH Report, 2004) • Among 12-17 year-olds who received grades of A or B in their last semester, rural youths reported higher rates of past month alcohol use and binge alcohol use than non-rural youths. • Among youths who received grades of C or below in their last semester, rural youths reported a higher rate of binge alcohol use than non-rural youths, though this difference did not reach statistical significance.

22. Risk Factors in Rural Communities (The NSDUH Report, 2004) • Rural 12-17 year-old youths were less likely to perceive great risk from having 4-5 drinks of alcohol nearly every day than those who lived in non-rural areas. • Youths in rural areas: • Were less likely than youths in non-rural areas to strongly disapprove of someone their own age having one or more drinks nearly every day; or • Reported that their parents would strongly disapprove if he or she were to have one or more drinks nearly every day

23. Activity Worksheet # 1: Small Group: What information and data do you already have about your rural communities in these five areas? • Demographics • Sub-populations • Consumption and Consequences • Risk and protective Factors • Readiness for Change • Post it on the wall • Gallery walk: Identify what information and data is missing? • Large group summary

24. Mobilizing Capacity from a Rural Perspective

25. Strategic Prevention Framework

26. What is Capacity? • Types and levels of resources needed to address identified needs and to maintain a prevention system • Ability of agencies and organizations to work collaboratively to achieve and sustain targeted reductions in substance abuse behaviors

27. Types of Capacities • Human • Technical • Financial • Structural • Cultural

28. Human Capacities

29. Technical Capacities

30. Structural Capacities

31. Cultural Capacity

32. Which Capacity is Missing?

33. From the Rural Perspective… • Small group dialogue • As you view these different types of capacity, which seem most likely to be stronger and which weaker in rural settings? • Large group dialogue

34. Assessing Community Readiness • Community readiness • Willingness to engage in and support prevention efforts

35. Assessing Community Readiness • Guidance from the State SPF leadership on what will be needed to assess readiness • Some readiness assessment tools • How can we use these with our rural communities? • Additional information we would like to capture, and how

36. Community Readiness Assessment Tools • Community Readiness Model • Tri-Ethnic Center • Prevention Platform • Center for Substance Abuse Prevention • Community Prevention Readiness Index • Community Partner Institute • Community Key Leader Survey • Goodman and Wandersman • Community Readiness Survey • Minnesota Institute of Public Health

37. Assessing Community Readiness Small Group Activity: • What are the challenges and opportunities for assessing readiness at the rural communities level? Large Group Dialogue: • Sample challenges • Brainstorm possible solutions

38. Building Coalition Leadership Capacity, and Issues of Governance

39. Governance Governance is the process of making and carrying out decisions. Effective governance incorporates a variety of decision-making and implementation practices by a wide range of people, organizations, and institutions beyond government. (Rural Policy Research Institute)

40. Activity • Divide into three working groups • Each group will review an article excerpt on coalition development and/or governance • Each personwill collect key points he/she wants to remember when working with rural communities. • Each person will share key points with small group. • Each group will distill TOP FIVE Pointers • Post on chart

41. Activity (Cont’d.) In large group Discussion of TOP FIVE POINTERS selected by each small group

42. Planning from a Rural Perspective

43. Strategic Prevention Framework

44. Planning Tasks • Prioritize risk factors (intervening variables) that will address local priority problems • Select evidence-based strategies • Identify measurable outcomes for each intervention • Complete a logic model

45. Activity As we review the following slides, reflect on how planning in your rural communities may be more or less difficult.

46. Fit Issues – Evidence-Based Strategies

47. Conceptual Fit The intervention • Addresses the community’s risk or protective factors • Drives positive outcomes in identified substance abuse problems • Is based on evidence-based strategies for the target population • Fits in the community logic model

48. Practical Fit Is the strategy a fit for your community? • Does your community have the staff and funding needed? • Do you have the necessary community contacts needed (police, leaders, etc.)? • Will the community support this strategy? • Does strategy reflect the community’s culture? • Could this strategy be sustained?

49. Strength of Evidence Where does the strategy fit along the continuum of evidence from weak to strong? • Has it been included on Federal lists or registries of evidence-based interventions? • Has it been reported with positive results in peer-reviewed journals?

50. Evidence-Based Strategies • CSAP’s Guidance Document “Identifying & Selecting Evidence Based Interventions” (revised 2009) defines evidence-based interventions • SPF SIG requires that all strategies funded meet criteria established in the CSAP guidance document