Strategic Prevention Framework (SPF): North Carolina Model for Prevention Programming Al Stein-Seroussi, Ph.D. Martha Wa

1. Strategic Prevention Framework (SPF): North Carolina Model for Prevention Programming Al Stein-Seroussi, Ph.D. Martha Waller, Ph.D. Pacific Institute for Research and Evaluation Chapel Hill, NC Addiction Professionals of North Carolina October 26, 2006

2. Workshop Objectives Participants will (I hope) gain understanding of… • SAMHSA Strategic Prevention Framework • National SPF SIG goals • Outcome-Based Prevention • NC SPF SIG Model • SPF in the Community

4. What is the Strategic Prevention Framework? • SAMHSA-wide planning model for prevention • Relevant for substance abuse, mental health promotion, other areas • Consists of 5 basic steps… • Needs Assessment • Capacity Building • Strategic Planning • Implementation of Evidence-Based Programs, Policies, and Practices (EBPPPs) • Evaluation and Monitoring

5. Profile population needs, resources, and readiness to address needs and gaps Cultural Competence & Sustainability 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 Strategic Prevention FrameworkState and Community Levels 1. Assess 2. Build Capacity 5. Monitor, evaluate 3. Plan 4. Implement

6. What is the SPF State Incentive Grant (SIG)? • SAMHSA’s major SPF demonstration • CSAP’s flagship initiative • Five-year cooperative agreements from CSAP • Up to $2.35 million per year for five years • Fund Distribution: • 85% of funds to Communities • 15% of funds for State administration (including needs assessment and evaluation) • Key components • State epi workgroup • State advisory board • Data driven planning to set state/local priorities • Funding mechanism for targeting communities • Must address underage drinking • Outcome-based prevention

7. National SPF-SIG Goals • Prevent onset and reduce the progression of substance abuse, including underage drinking • Reduce substance-related problems in communities • Build prevention capacities/infrastructure at State and community levels Implement a process of infusing data across all SPF steps for improved decision- making

8. SPF SIG Grantees (Cohorts I & II) by CAPT* Region(* SAMHSA/CSAP’s Centers for the Application of Prevention Technologies) HI NH WA ME VT AK MT ND MN OR MA NY ID WI SD RI MI WY CT PA IA NJ NE NV OH IN DE IL WV UT MD CO DC VA MO KS CA KY Guam NC TN Palau OK AZ AR NM SC GA MS AL LA TX FL NOTE: Five State names in black boxes denote Cohort 2 (2005) grantees. Cohort 1 grantees began in 2004. Puerto Rico Western CAPT Southwest CAPT Central CAPT Southeast CAPT Northeast CAPT

9. Who’s Involved Nationally? CSAP Cross-Site Evaluation SEW TA SPF States CAPTs

10. Who’s Involved in N.C.? Governor Easley CAAB Secretary of DHHS Division of MH/DD/SAS SSA Office of Prevention Underage Drinking Liaison Epi Workgroup Liaison Mental Health Liaison State Epidemiological Workgroup (SEW) Contractors Needs Assessment (RTI) Evaluation (PIRE) Targeted Communities Centers for Prevention Resources, LMEs, Providers Targeted Populations

11. Outcome-Based Prevention Substance-Related Consequences and Use Intervening Variables (Risk and Protective Factors/ Causal Factors) Programs, Policies, Practices Aim: to guide relevant and effective prevention strategies by first understanding the prevalence and patterns of problems and the factors that contribute to them.

12. Substance-Related Consequences and Use Intervening Variables Policies, Programs, Practices

13. Substance-Related Consequences and Use Intervening Variables Policies, Programs, Practices • Overall consumption • Acute, heavy consumption • Consumption in risky situations • Drinking and driving • Smoking around young children • Consumption by high risk groups • Youth, college students, older groups • Pregnant women

14. Substance-Related Consequences and Use Intervening Variables Policies, Programs, Practices • Community Level Factors • Availability of substances (price, retail, social) • Promotion of substances • Social Norms regarding use • Enforcement of Policies and Social Norms • Individual Level Factors • Perceptions of risk and harm • Positive attitude toward drug use

15. Substance-Related Consequences and Use Intervening Variables Policies, Programs, Practices • Must address the targeted consequence • Must address the Risk and Protective Factors/Causal Factors (s) believed to be involved • Must be evidenced-based

16. Match Between Consequence and Intervening VariablesMismatch Between Strategies and Intervening Variables Easy retail access to alcohol by minors Middle school curriculum Alcohol-related traffic crashes Mentoring program Limited law enforcement on roadways

17. Favorable attitudes towards alcohol Middle school curriculum Alcohol-related traffic crashes Peer influence Match Between Strategies and Intervening VariablesMismatch Between Consequence and Intervening Variables

18. Match Between Consequence and Intervening VariablesMatch Between Strategies and Intervening Variables Merchant training and compliance checks Easy retail access to alcohol by minors Alcohol-related traffic crashes Increased police presence on the roads Limited law enforcement on roadways

19. Why Outcomes Based Prevention? • Increases the likelihood of targeting significant problems (data-guided) • Identifies and targets key risk and protective factors/causal factors contributing to consequences/consumption • Links strategies to key risk and protective factors/causal factors and ultimately consequences/consumption • Builds a basis for ongoing monitoring and evaluation activities to track and improve prevention efforts Lead with results, not with programs

20. Profile population needs, resources, and readiness to address needs and gaps Cultural Competence & Sustainability 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 Strategic Prevention FrameworkNorth Carolina Model 1. Assess 2. Build Capacity 5. Monitor, evaluate 3. Plan 4. Implement

21. State Level Needs Assessment • State established SEW (early 2006) • State executed contract with RTI to provide SEW support • SEW identified and reviewed constructs and data elements • SEW assessing and prioritizing substance abuse-related consequence data

22. Organization of NC Consequence Data

23. Epidemiological Dimensions • Prevalence rates (how much?) • Severity of consequence (per unit) • Trends over time (increase? decrease?) • National ranking (high? low?) • Develop epidemiological profile

24. What is an “epidemiological profile”? A document that . . . summarizes the nature, magnitude, and distribution of substance use and related consequences for the State/Jurisdiction, and . . . organizes the data in a manner that facilitates data interpretation and, ultimately, their application

25. Examples of State Level Data

26. Source: National Highway Traffic Safety Administration

27. Source: National Center for Health Statistics- National Vital Statistics System

28. Source: Uniform Crime Reports, Part I Crimes

29. Source:Youth Risk Behavior Surveillance System & Behavioral Risk Surveillance System

30. Source:National Survey on Drug Use and Health

31. Source:Youth Risk Behavior Surveillance System

32. Source:Youth Risk Behavior Surveillance System & Behavioral Risk Surveillance System

33. Source:National Survey on Drug Use and Health

34. Source:National Survey on Drug Use and Health

35. State Level Needs Assessment: Next Steps • SEW will submit priority issues to CAAB, organized by substance (epi profile) • CAAB will review priorities and consider the following: • other funding • political considerations • geographic considerations • evaluability during grant period • CAAB will determine statewide SPF SIG priorities • State will develop and submit required strategic plan to CSAP (to be discussed)

36. State Level Needs Assessment: Next Steps (cont.) • SEW will gather and assess county-level data regarding the state SPF SIG priority • SEW will prioritize communities that should be targeted for funding based on several criteria (e.g., prevalence rates, relative contribution to state rates) and make recommendations to CAAB • CAAB will select communities for funding (mechanism for distributing funds is not yet determined) • Communities will conduct needs assessment

37. Community Level Needs Assessment • Funded communities will asses… • Local variation in priority area by subpopulation • Intervening variables that contribute to the state priority problems in their community (i.e., “Why do we have so much of x?”) • Resources, capacity, and readiness to address the intervening variables and consequences

38. Profile population needs, resources, and readiness to address needs and gaps Cultural Competence & Sustainability 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 1. Assess 2. Build Capacity 5. Monitor, evaluate 3. Plan 4. Implement

39. State Level Capacity Building Throughout the SPF SIG, NC will take the lead in developing prevention capacity at the state and local levels through…. • Funding Centers for Prevention Resources (CPRs) • Training CPRs, LMEs, and providers on SPF model • Cultural competence

40. Community Level Capacity Building If funded communities lack capacity and/or readiness to address the state priority then they must build the capacity and readiness through… • coalition building • getting buy-in from community leaders (political, religious, law enforcement, educators, media, business, health, etc.) • recruiting prevention providers • hiring & training staff • creating needed infrastructure • sharing information & data • developing cultural competence • getting to know and understand their community

41. Profile population needs, resources, and readiness to address needs and gaps Cultural Competence & Sustainability 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 1. Assess 2. Build Capacity 5. Monitor, evaluate 3. Plan 4. Implement

42. State Level Strategic Plan • State must submit strategic plan to CSAP (after CAAB approves priority issues) • Strategic plan must include an assessment of… • Substance abuse related problems • Substance abuse related systems in place • Criteria and rational for determining priorities • Description of the SPF SIG prior

43. State Level Strategic Plan con’t. • Capacity Building • Areas that need strengthening • State and community-level activities to build capacity • Role of the SEW workgroup after the initial needs assessment • Plans for Ongoing and Future Activities • State plan for how to allocate SPF SIG fund • Community-based activities that SPF SIG funds will support • The approach to allocating funds in detail • The implications of the allocation approach

44. State Level Strategic Plan con’t. • Implementation • The approach N.C. will take in implementing state level capacity and infrastructure activities as well as community level SPF SIG policies, programs, and practices • How the state will support the work of the communities • Evaluation • State-level surveillance, monitoring, and evaluation activities we anticipate implementing • Processes and outcomes we expect to track and how we plan to do it • What we expect to be able to change • How will we ensure that communities will collect required data and how it will be submitted to the state and CSAP

45. Community Level Strategic Plan • Vision for prevention at the community level • Consideration of the state’s prevention priorities and how they affect community (e.g., subgroups) • Logic model that connects consequence to consumption and intervening variables at the community level • Statement of community resources, capacity, and readiness to address priority area • Appropriate EBPPPs for addressing priorities at the community level • Discussion of how community will implement culturally appropriate practices • Methods for monitoring process and outcomes at the community level • Sustainability plan • Realistic timeline

46. Profile population needs, resources, and readiness to address needs and gaps Cultural Competence & Sustainability 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 1. Assess 2. Build Capacity 5. Monitor, evaluate 3. Plan 4. Implement

47. Implementing EBPPPs • Program intensity (planned vs. actual) • Number, length and frequency of sessions • All topics covered? • Program content • Sessions delivered in same order? • Materials or handouts same as planned? • Other variations in program delivery? • Program location (planned vs. actual) • Program recipients (planned vs. actual) • Characteristics of program recipients • Number of program recipients • Program deliverer • Staff, instructors as planned? • Characteristics • Training • Deliverer/recipient ratio • Other aspects of the program as implemented that differed from the program as planned?

48. Profile population needs, resources, and readiness to address needs and gaps Cultural Competence & Sustainability 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 1. Assess 2. Build Capacity 5. Monitor, evaluate 3. Plan 4. Implement

49. State LevelMonitoring/Evaluation To enhance state and sub-state capacity to collect, analyze, interpret, and use data to monitor their program outcomes • Process and outcomes data at the state and community level • Community-level outcomes that relate to the state priority • If possible, comparisons will be made with communities not receiving SPF SIG funds • Yearly subgroup analyses will be conducted • Time series analyses will be conducted • Feedback will be provided to communities with the intention of sharing progress and sparking discussion of successes and setbacks

50. Community Level Monitoring/Evaluation • Measures appropriate for local, state priorities and federal outcomes • Outcome data collection procedures developed • Fidelity data collection procedures developed • Evaluation capacity developed • Plans for implementing local evaluation procedures developed • Plans for feedback from evaluation to community developed • Community plans for using evaluative feedback in future prevention programming • Process for monitoring implementation of 5 SPF steps