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