Post on 11-Jan-2016
Communities That Care 201Pennsylvania’s Prevention
Approach
Commonwealth Prevention Alliance ConferenceJune 7, 2012
Sandy Hinkle Communities That Care Consultant
EPISCenter, PSU
Investigators and Authors:
Brian Bumbarger Mark GreenbergMark Feinberg Brittany RhoadesLouis Brown Wayne OsgoodTy Ridenour Damon JonesJennifer Sartorious Daniel BontempoBrendan Gomez Richard PuddyMichael Cleveland
Collaborative Policy Innovators:Mike Pennington Clay YeagerJames Anderson Keith Snyder
The EPISCenter and research described here are supported by grants from the Pennsylvania Commission on Crime and Delinquency. Special thanks to the staff of the Office of Juvenile Justice and Delinquency Prevention (OJJDP)
Why don’t communities see greater success in prevention?
• Chasing money rather than outcomes• No single guiding philosophy (many separate but disconnected
efforts)• Little accountability• The lack of good data to drive decision-making and resource
allocation• Reliance on untested (or ineffective) programs• Poor implementation quality• Inability to sustain programs
Bumbarger, B. and Perkins, D. (2008). After Randomized Trials: Issues related to dissemination of evidence-based interventions. Journal of Children’s Services,3(2), 53-61.
Bumbarger, B., Perkins, D., and Greenberg, M. (2009). Taking Effective Prevention to Scale. In B. Doll, W. Pfohl, & J. Yoon (Eds.) Handbook of Youth Prevention Science. New York: Routledge.
• To improve outcomes, we must bridge the gap between science and practice
• Pennsylvania’s Approach: Create sustained, community-wide public health impact through effective community coalitions using proven-effective programs targeted at strategically identified risk and protective factors
Goals of Pennsylvania’s Approach• Prevent dependency, delinquency, and ATOD use to the greatest degree
possible (primary prevention)
• Intervene effectively with youth for whom primary prevention is not
sufficient
• Allow communities flexibility to select strategies that best meet local needs
• Create community-level infrastructure for strategic
prevention planning and coordination
• Provide accountability and use scarce resources efficiently
ULTIMATELY….
• To “move the needle” on key indicators of (behavioral) health at
the POPULATION level5
From Lists to Improved Public Health: Barriers
• Synthesis and translation of research to practice, (and practice to research)
• EBP dissemination, selection, and uptake• Ensuring sufficient implementation quality and fidelity• Understanding adaptation and preventing program drift • Measuring and monitoring implementation and outcomes• Policy, systems, and infrastructure barriers• Sustainability in the absence of a prevention infrastructure
Bumbarger, B. and Perkins, D. (2008). After Randomized Trials: Issues related to dissemination of evidence-based interventions. Journal of Children’s Services,3(2), 53-61.
Bumbarger, B., Perkins, D., and Greenberg, M. (2009). Taking Effective Prevention to Scale. In B. Doll, W. Pfohl, & J. Yoon (Eds.) Handbook of Youth Prevention Science. New York: Routledge.
What is CTC?
• An “operating system” to mobilize communities and agency resources
• Follows a public health model of preventing poor outcomes by reducing associated risk factors and promoting protective factors
• Coalition model that is data-driven and research-based
• Follows a specific sequence of steps
• Focuses on the use of targeted resources and evidence-based prevention programs
CTC System
Phase 1Getting Started
Phase 2Organizing, Introducing,
Involving
Phase 3Developing a Community
Profile
Phase 4Creating a
Community Action Plan
(CAT)
Phase 5Implementing & Evaluating
the CAT
The Five Phases of Communities That Care Development
SAMHSA’s Strategic Prevention Framework Steps
Sustainability & Cultural Competence
Profile population needs, resources, and readiness to
address needs and gapsMonitor, evaluate,
sustain, and improve or replace those that
fail
Implement evidence-based prevention
programs and activities
Develop a Comprehensive Strategic Plan
Mobilize and/or build capacity to address
needs
Assessment
Capacity
PlanningImplementation
Evaluation
U.S. DEPARTMEN T OF HEA LTH AND HUMAN SE RVICESSubstance Abuse and Mental Health Services AdministrationCenter for Substance Abuse Preventionwww.samhsa.gov
SAMHSA in coordination with the Office of
National Drug Control Policy (ONDCP) administers
approximately 700 Drug Free Communities
Programs using the Strategic Prevention
Framework.
Of those, almost 200 use the Communities that
Care Model as a tool to implement the Strategic
Prevention Framework.
Communities that Care is an effective tool to implement the Drug Free Communities program as well as other SAMHSA Strategic Prevention Programs.
U.S. DEPARTMEN T OF HEA LTH AND HUMAN SE RVICESSubstance Abuse and Mental Health Services AdministrationCenter for Substance Abuse Preventionwww.samhsa.gov
Successful CTC’s in Pennsylvania Use a
Three Prong Approach
• Milestones and Benchmark direction and assessment for readiness.
• Selecting Evidence Based Programs based on choosing the right fit and practicality based on their community risk and resource assessment.
• Yearly assessment of coalition functioning at the internal level.
CTC in Pennsylvania
• Adopted as a statewide initiative in 1994
• Over 120 communities trained over 16 cycles
• 60-70 currently functioning CTC communities
• System of assessment & dedicated technical assistance to improve coalition functioning
• Over a decade of studying the processes of coalitions
• Opportunity to study CTC & EBPs in a long-term large-scale implementation under real-world conditions
Pennsylvania’s “Blueprints” Initiative
• Followed from earlier CTC initiative that promoted community coalitions/risk & resource assessments
• State funding for program startup, after identification of need by local community
• Nearly 200 EBP’s funded since 1998 (+~200 through other sources)
• Big Brothers/Sisters, LST, SFP 10-14, PATHS, MST, FFT, MTFC, Olweus Bullying Program, TND, Incredible Years, ART
Milestones and Benchmarks
Defining Milestones and Benchmarks
1. There are 5 Phases2. Phases are divided into Milestones and
Benchmarks, each phase includes 4-7 Milestones.
3. Within each Milestone there are multiple Benchmarks that must be accomplished in order for the Milestone to be achieved.
4. Each Item is rated on 2 scales with a rating from 1-4; A Benchmark rating (how well) and a challenge rating (how difficult).
Milestone 1.1 Organize the community to begin the Communities That Care Process.
BENCHMARK HOW CLOSE ARE WE? (1-4)
HOW CHALLENGING(1-4)
DEFINITION SUPPORTMATERIALS
ACTIONPLAN Y/N
DATE ACHIEVED
COMMENTS/PLANS
1.11Designate points of contact to act as a catalysts for
the process.
4= There is a designated single point of contact in the community who understands the Communities That Care process and coordinates the initial workgroup.
Tools - pp 6 - 8 & 66 - 68.
http//episcenter.psu.edu/sites/default/files/ctc/milestonesandbenchmarks.xls
www.episcenter.psu.edu
Selecting EBP
Creating Fertile Ground for EBPsRisk-focused Prevention Planning
(the Communities That Care model)
Collect local data on risk
and protective factors
Use data to identify
priorities
Select and implement evidence-based
program that targets those factors
Re-assess risk and
protective factors
Form local coalition of key stakeholders
Leads to community synergy and
focused resource allocation
Pennsylvania’s EBP dissemination in 1999…
Pennsylvania’s EBP dissemination in 2012…
Reducing Youth Problems and Promoting Positive Youth Development:Choosing the best program for your community …...
Program FitRisk and Protective Factors
Developmental Stage
Targeted Population
Culture and Values
Domains of Influence
Program Efficacy
Based on the programsrecord of evaluation…
Will you get the improved outcomes you want?
Program Feasibility
Sufficient Quality
Sustainability
Assess Delivery and Impact
Fit & Feasibility (F&F)
Poor ------------------------------------------------> Good
Evidence Strong
<-------------- Weak
Untested or Ineffective & Poor F&F
Untested or Ineffective & some challenges to F&F
Untested or Ineffective but good F&F
Promising Effectiveness but Poor F&F
Promising Effectiveness but some challenges to F&F
Promising Effectiveness & good F&F
Evidence-based but Poor F&F
Evidence-based but some challenges to F&F
Evidence-based & good F&F
Where does the program fall on the Matrix of Fit & Feasibility vs. Evidence?
The Cost-effectiveness of Evidence-based Prevention in Pennsylvania
(measured benefits and costs per community and statewide )
Program B-C per youth
Avg. Return/ Community
# Programs Statewide
Est. Total PA Return
Big Brothers/Sisters $54 $13,500 28 $378,000
LifeSkills Training $808 $161,600 100 $16,160,000
Multi. Treatment Foster Care
$79,331 $475,986 3 $1,427,958
Multisystemic Therapy $16,716 $2,507,400 12 $30,088,800
Functional Family Therapy
$32,707 $12,395,953 11 $136,355,483
Nurse-Family Partnership
$36,878 $4,782,976 25 $119,574,400
Strength. Families $6,541 $872,133 15 $13,082,000
TOTAL $317,066,641
http://www.nrepp.samhsa.gov/http://www.colorado.edu/cspv/blueprints/modelprograms.html
Where to go for help
Coalition Functioning
Assessing & Supporting Community Coalitions
• Web-based data collection from CTC board members
– Provide feedback to sites
– Summary Report to TA
• TA presents to CTC site
• Used for strategic planning
32CTC Research Team, Prevention Research Center
Pennsylvania State University
Sponsored by
Communities That Care
Web-Based Survey
Statewide Report – June 2010Revision Date: 6/17/10
CTCWeb
33
CTC DomainsThe areas that were studied in CTC-Web 2010 include the following:
CTC Process
Board Leadership
Board Work Style
Board Relationship
s
Board Membershi
p
Barriers Experienced
Technical Assistance
Programs Implemented
The research says……………
0
1.5
3
4.5
How Do CTC Coalitions Support Pre-vention?
non-CTC CTC
ANOVA: **p<.01 *p<.05
Do Coalitions Affect Program Sustainability?
% Grantees off of funding 2 or more years
Operating Not operating
Measuring Population-level Impact
• Cross-sectional quasi-experimental study of 98,000 students in 147 communities
• Used propensity score matching to minimize potential selection bias
• Found youth in CTC communities reported lower rates of risk factors, substance use, and delinquency than youth in similar non-CTC communities (7x as many as by chance)
• Communities using EBPs showed better outcomes on twice as many R/P factors and behaviors (14x as many as by chance)
-20
-10
0
10
20
30
40
-10.8
33.2
-10.8
16.4
Delinquency Academic PerformanceNegative Peer Influence School Engagement
5 year Longitudinal Study of PA Youth% Change of CTC/EBP Youth Over
Comparison Group
419 age-grade cohorts over a 5-year period:
youth in CTC communities using EBPs had significantly lower rates of delinquency,
greater resistance to negative peer influence,
stronger school engagement and better academic achievement
Feinberg, M.E., Greenberg, M.T., Osgood, W.O., Sartorius, J., Bontempo, D.E. (2010). Can Community Coalitions Have a Population Level Impact on Adolescent Behavior Problems? CTC in Pennsylvania, Prevention Science.
Other “big picture” lessons…
• Some balance between evidence-based practices and practice-based evidence
• Find a small number of things that work, and do them well
• Operating system to prepare communities, focus efforts, and create fertile ground for EBPs– These also require active TA and attention to fidelity
Thank You!
Evidence-based Prevention and Intervention Support CenterPrevention Research Center, Penn State University
206 Towers Bldg.University Park, PA 16802
(814) 867-3160 –sah41@psu.eduepiscenter@psu.edu
www.episcenter.psu.edu