PROSPER: Lessons Learned About
Evidence-Based Practice in the
Real World
Janet A. Welsh, Ph.D.
Prevention Research Center
The Challenge
• Evidence based practices (EBP’s) to reduce
disorder and promote public health currently
exist, but are underutilized in community
settings
• Even when EBP’s are adopted, they are often
not sustained and rarely implemented with
quality
The Questions
Can EBP’s be infused into community settings
where they are consistently implemented with
high quality and sustained?
AND
If so, does this do anybody any good?
PROSPER 101
PROSPER began in 2002 as a joint endeavor between Penn State
and Iowa State University
PROSPER innovation included using the the Cooperative
Extension System (CES) at Penn State and Iowa State to diffuse
evidence-based prevention programs throughout those two
states. Extension became the linking agent between
communities implementing programs and prevention
researchers at universities with expertise in implementation
science
Design
• RCT, with 28 communities across two
states, randomized to intervention or
control conditions
• 7 intervention and 7 comparison
communities per state
• Data collected from 2 cohorts of 6th
grade youth (2003 & 2004), for an
N=11,000
• Intervention communities received the
following:
– Evidence based family program (SFP:10-14)
– Evidence based school program (3 choices)
– Ongoing, proactive technical assistance
(prevention coordinators)
– Full financial support for 2 years, followed by a
gradual withdrawal of funding
– Implementation monitoring & feedback
Data Collection
All youth were administered a survey that
assessed the following:
– Substance use patterns for multiple substances
– Substance use attitudes, perceptions, beliefs
– Problem behaviors (i.e., delinquency)
– School bonding
– Peer influences
– Parental monitoring
– Parent-child relationship quality & communication
• A subset of cohort II youth (N=1200)
participated in more intensive assessment,
including:
– Parent-child observation
– Parent interviews
– Youth interviews
– Analysis of school records
• Data were first collected in the Fall and Spring
of 6th grade, and annually thereafter until
students graduated from high school
• Cohort II subsample was followed into their
young adult years (ongoing!)
• PROSPER focused initially on substance use
prevention with middle school students.
• Communities were initially offered a menu of
evidence-based prevention programs, including:
–
–
–
–
–
SFP: 10-14
Guiding Good Choices
Project Alert
Life Skills Training
All Stars
• Later, PROSPER sites were offered the option
to add an elementary school program as well,
and in PA several sites selected the PATHS
program
How Does PROSPER Work?
• Each PROSPER community has a local team,
which is a coalition made up of local
stakeholders. Teams have about 8-10 people on
them and can include (but are not limited to) the
following:
–
–
–
–
–
Public school representative
Mental health agency representative
Substance use agency representative
Parent representative
Youth representative (2 or more)
PROSPER Trademarks
• The use of high quality, evidence-based programs
• Ongoing monitoring to assure high levels of
implementation quality
• Ongoing technical assistance to promote
sustainability
• Using data to inform decision-making about
prevention programming & local priorities
What Do PROSPER Teams Do?
• PROSPER teams are responsible for all aspects of
EBI implementation in their communities. This
includes:
–
–
–
–
–
–
SFP recruitment
Hiring, training, and supervision of SFP facilitators
Implementation quality monitoring
Publicity and marketing for PROSPER
Resource generation to support programs
Communicating with stakeholders about PROSPER’s
impacts in the community
• Teams meet about once per month
• Local CES educator serves as the team leader,
but all members participate
• Teams receive TA as needed from Prevention
Coordinators
• PROSPER Team activities are very focused around
the following issues:
– High-quality implementation of EBI’s
• Training of facilitators
• Recruitment of families
• Monitoring of programming quality
– Revenue generation for programming
– Communication with school personnel and
community stakeholders
Sustainability Strategies
• PROSPER sites received full funding f0r all team
activities, programming and TA for the first two
years
• For the next 2 years, they received partial support
• For the past 6 years, they have all fully sustained
their programming using resources they have
generated locally
Pennsylvania Funds Distribution
$250,000.00
•
$33,665.73
$200,000.00
$22,418.55
$68,265.43
$150,000.00
$24,348.15
$25,140.95
$100,000.00
$189,762.83
$145,870.87
$3,833.03
$108,773.61
$107,703.58
$87,512.78
$50,000.00
$65,179.70
$0.00
AY0405
AY0506
AY0607
AY0708
Total Funds
InKind Dollars
AY0809
AY0910
Where do sustainability funds come
from?
• Local Sources: Businesses, school district, team
fundraisers
– Community yard sale
– 4-H Milkshake sale
– Car washes
• County Sources: Collaboration with local organizations
interested in prevention, including
– United Way
– Children & Youth Services
– Mental health or substance abuse prevention agencies
• Foundations:
– Blue Ribbon
– Huffman Family Trust
– Carlisle Health & Wellness
• Local Congressional leaders:
– WAM – discretionary funds
• Federal Sources:
– CYFAR – U.S. Department of Agriculture
• State Sources
– PCCD
– Weed & Seed
Sustainability: Lessons Learned
• Every community’s experience is unique, but
the one thing they all have in common is the
need to plan for sustainability in advance
– Seek expertise in marketing, branding, and
community positioning
Know Your Stakeholders!
In order to sustain your programs, you need to
mobilize your stakeholders and understand what
is important to them.
•
•
•
•
•
School District?
Substance use agency?
Local Businesses?
Local Police?
Children and Youth Services?
Sometimes stakeholders want personal
testimonials, other times they want hard data
Longitudinal Outcome Data for SFP
1
First Time Proprotion
Trajectory for ISFP Condition
Trajectory for Control Condition
0.8
0.6
0.4
0.2
0
0 months
6 months
18 months
30 months
48 months
72 months
(Pretest)
(Posttest)
(Grade 7)
(Grade 8)
(Grade 10)
(Grade 12)
“How to listen together to
solve problems, knowing to follow
through with consequences to
teach them (not understanding
what my child is going through)”
MONEY TALKS
Results—
Delayed Onset of Alcohol Use Leads to Cost Savings
Partnership-Based Strengthening Families Program:
Benefit-Cost Ratios Under Different Assumptions
13
Dollars Returned
11
$11.34
$9.60
$7.86
9
7
5
3
1
*Actual Study
conditions
1 more case
prevented/100
1 less case
prevented/100
*Study Data indicate $9.60 returned for each dollar invested under actual study conditions
Source: Spoth, R., Guyll, M., & Day, S. X. (2002). Universal family-focused interventions in alcohol-use disorder prevention:
Cost-effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63(2), 219-228.
• Have a variety of materials available –
prepare for the 1-minute, 5-minute, and 15
minute presentation
• Do you have an elevator speech?
Please visit our websites at...
www.prevention.psu.edu
www.ppsi.iastate.edu