Melbourne Rotary 7 April 2010

1. Melbourne Rotary7 April 2010 Communities that Care Evaluation Richard F. Catalano, Ph.D Bartley Dobb Professor for the Study and Prevention of Violence Director, Social Development Research Group School of Social Work University of Washington www.sdrg.org

2. Communities That Care Ltda partnership between the Rotary Club of Melbourne , the Royal Children’s Hospital & the University of Washingtonwww.wch.org.au/ctc john.toumbourou@deakin.edu.au

3. Prevention Science Framework Program Implementation and Evaluation Interventions Identify Risk and Protective Factors Define the Problem Response Problem

4. Prevention Science Research Advances Etiology/Epidemiology of Problem Behaviors • Identify risk and protective factors that predict problem behaviors and describe their distribution in populations. Efficacy Trials • Design and test preventive interventions to interrupt causal processes that lead to youth problems.

5. Risk Factors Substance Abuse Delinquency Teen Pregnancy School Drop-Out Violence Depression & Anxiety Community Availability of Drugs   Availability of Firearms   Community Laws and Norms Favorable Toward Drug Use, Firearms, and Crime    Media Portrayals of Violence  Transitions and Mobility     Low Neighborhood Attachment and Community Disorganization    Extreme Economic Deprivation      Risk Factors forAdolescent Problem Behaviors

6. Family School Individual/Peer

7. Protective Factors Individual Characteristics • High Intelligence • Resilient Temperament • Competencies and Skills In each social domain (family, school, peer group and neighborhood) • Positive Opportunities • Reinforcement for Positive Involvement • Bonding • Healthy Beliefs and Clear Standards

8. Prevalence of 30 Day Alcohol Use by Number of Risk and Protective Factors

9. Prevalence of “Attacked to Hurt”By Number of Risk and Protective Factors

10. Prevalence of Other Problemsby Number of Risk Factors Bond, Thomas, Toumbourou, Patton, and Catalano, 2000

11. Number of School Building Level Risk Factors and Probability of Meeting Achievement Test Standard (10th Grade Students) Arthur et al., 2006

12. Epidemiology • Different neighborhoods have different profiles of risk, protection, and outcomes.

13. Distribution of Risk in a City

14. Prevention Science Research Advances Etiology/Epidemiology of Problem Behaviors • Identify risk and protective factors that predict problem behaviors and describe their distribution in populations. Efficacy Trials • Design and test preventive interventions to interrupt causal processes that lead to youth problems.

15. Prenatal & Infancy Programs Early Childhood Education Parent Training After-school Recreation Mentoring with Contingent Reinforcement Youth Employment with Education Organizational Change in Schools Classroom Organization, Management, and Instructional Strategies School Behavior Management Strategies Classroom Curricula for Social Competence Promotion Community & School Policies Community Mobilization Wide Ranging Approaches Have Been Found To Be Effective (Hawkins & Catalano, 2004)

16. Selected Benefit Cost Findings Early Childhood Education$17,202$7,301$9,901 Nurse Family Partnership$26,298$9,118$17,180 Life Skills Training$746$29$717 Seattle Soc. Dev. Project$14,246$4,590$9,837 Guiding Good Choices$7,605$687$6,918 Multi-D Treat. Foster Care $26,748$2,459 $24,290 Intensive Juv. Supervision $0$1,482 -$1,482 Big Brothers/Sisters (all costs) $4,058$4,010$48 (taxpayer costs only)$4,058$1,283$2,775 Steve Aos, Associate Director Washington State Institute for Public Policy saos@wsipp.wa.gov www.wa.gov/wsipp

17. But… • Prevention approaches that do not work or have not been evaluated have been more widely used than those shown to be effective. (Gottfredson et al 2000, Hallfors et al 2000, Hantman et al 2000, Mendel et al 2000, Silvia et al 1997; Smith et al 2002)

18. Communities that Care Model for Achieving the Vision of Science Informing Practice Provides the education, skills and tools to build community capacity to change youth outcomes through choosing and implementing tested, effective programs matched to their needs

19. The Communities That Care Operating System Get Started Creating Communities That Care Implement and Evaluate Get Organized Develop a Profile Create a Plan • Community readiness assessment. • Identification of key individuals, stakeholders, and organizations.

20. The Communities That Care Operating System Get Started Creating Communities That Care Implement and Evaluate Get Organized Develop a Profile Create a Plan • Training key leaders and board in CTC • Building the community coalition.

21. The Communities That Care Tools for Decision Making Get Started Creating Communities That Care Implement and Evaluate Get Organized Develop a Profile Create a Plan • Collect risk/protective factor and outcome data. • Construct a community profile from the data.

22. The CTC Youth Survey Tool Helps Match Need to Tested, Effective Programs • Identifies levels of 21 risk and 9 protective factors and academic and behavioral outcomes • Guides planners to select tested, effective actions • Monitors the effects of chosen actions

23. The Communities That Care Tools for Decision Making Get Started Creating Communities That Care Implement and Evaluate Get Organized Develop a Profile Create a Plan • Define outcomes. • Prioritize risk factors to be targeted. • Select tested, effective interventions. • Create action plan. • Develop evaluation plan.

24. School A

27. Classroom Curricula for Social/ Emotional Competence Promotion Tested, Effective Programs • The Life Skills Training Program (Botvin et al., 1995) • Project Alert Drug Prevention Curriculum (Ellickson et al., 1993; Ellickson and Bell, 1990) • Alcohol Misuse Prevention (Maggs et al., 1998) • Towards No Drug Use (Sussman et al. 2003; 2003)

28. School A

30. Classroom Organization, Management, and Instructional Tested, Effective Strategies • The Good Behavior Game (Kellam and Rebok, 1992) • Seattle Social Development Project(Hawkins et al., 1999; 2005; 2008) • Behavioral Intervention for Middle School Students (Bry, 1982) • Cooperative Learning Programs (Slavin, 1983) • Tutoring Programs (Coie et al., 1984; Greenwood et al., 1993) • Success for All (Slavin et al., 1990)

31. The Communities That Care Tools for Accountability Get Started Creating Communities That Care Implement and Evaluate Get Organized Develop a Profile Create a Plan • Form task forces. • Identify and train implementers. • Sustain collaborative relationships. • Evaluate processes and outcomes for programs annually. • Evaluate community outcomes every two years. • Adjust programming.

32. Community Youth Development Study A 24 Community Randomized Trial of CTC PI: J. David Hawkins Co-PI: Richard F. Catalano Funded in 2003 by: National Institute on Drug Abuse Center for Substance Abuse Prevention National Cancer Institute National Institute on Child Health and Development National Institute on Mental Health

33. Communities That CareTheory of Change CTC Training and Technical Assistance Adoption of Science-based Prevention Framework (Brown et al, 2007) Collaboration Regarding Prevention Issues Appropriate Choice and Implementation of Tested, Effective Prevention Programs & Adoption of Social Development Strategy as Community’s Way of Bringing Up Children (Quinby et al, 2008; Fagan et al., 2008, Hawkins et al., 2008) Decreased Risk and Enhanced Protection 2 years post initiation Positive Youth Outcomes 3+ years post initiation

34. Effects of CTC on Onset of Drug Use and Delinquency • Onset of substance use and delinquency between grade 6 and 8: • Alcohol use* • Cigarette smoking* • Smokeless tobacco use* • Marijuana use • Other illicit drug use • Delinquent behavior* • Among 5th grade students who had not yet initiated. *=Significant at p<.05 Hawkins et al., 2009

35. Effects of CTC on Current Drug Use and Delinquency in the Panel • Alcohol use* • Binge drinking* • Tobacco Use* • Delinquency* *=significant at p<.05 Hawkins et al., 2009

36. Prevalence of Binge Drinking in Past Two Weeks In Panel In Control and CTC Communities Percentage 9.0 p < .05 5.7 1.3 ns 1.0 Note. Observed rates averaged across 40 imputations. ns = nonsignificant. N = 4407. Hawkins et al., 2009

37. Mean Number of Different Delinquent Behaviors Committed by Panel in Past Year In CTC and Control Communities Number 1.13 p< .01 .78 .36 ns .31 Note. Observed means averaged across 40 imputations. ns = nonsignificant. N = 4407 Hawkins et al., 2009

38. Summary and Implications There is evidence that we can advance public health in our communities by using CTC to: • Promote the collection of data on levels of risk and protection to focus community action on elevated risks. • Engage in community efforts to strengthen protection and reduce risks. • Sponsor, endorse and use tested and effective prevention programs. • Deliver effective programs with fidelity

39. Communities That Care has been pioneered in Australia

40. Bunbury Ballarat Mornington

41. Communities That Care LTDAccomplishments • CTC Survey Victoria Wide (1999, 2009) • Establishment of CTC Ltd (support from the Rotary Club of Melbourne, the Baker Foundation, Perpetual Trustees, VicHealth, the Brockhoff Foundation, the Victorian Community Support Fund and others) • Selection of demonstration sites-2002 • Evaluation of demonstration sites in process with promising findings

42. Communities That Care LTDWhat Can You Do Now? • Continue Rotary Club link • Help identify new communities that need CTC • Support the CTC evaluation trial • Support implementation of tested, effective programs • Encourage investment in prevention

43. Communities That Care Ltda partnership between the Rotary Club of Melbourne , the Royal Children’s Hospital & the University of Washingtonwww.wch.org.au/ctc john.toumbourou@deakin.edu.au

44. Communities That Care:Quasi-Experimental Effectiveness Trial in Pennsylvania Investigators: Collaborative Policy Innovators: Mark Feinberg Mike Pennington Mark Greenberg Clay Yeager Louis Brown Damon Jones

45. Summary of Findings • Overall, CTC communities showed lower levels of risk factors, substance abuse, and delinquency (7x as many as chance) • Even greater impact where evidence-based prevention programs were used (11x)