*PROSPER Partnerships:
Toward Evidence-Based Intervention for
Youth, Family and Community IMPACT
Richard Spoth
Partnerships in Prevention Science Institute
Congressional Educational Briefing
June 12, 2006
*Funded by the National Institute on Drug Abuse
Map for Today’s
Presentation
1. A Partnership Path to Positive Impact




Challenges to Youth, Family, Community Impact
Opportunities for Impact
IMPACT Framework
Illustrations of Long-term Impact
2. The PROSPER Partnership Model, Successes
to Date
3. Proposed Multistate Network, Anticipated
Benefits
1. A Partnership Path to Youth, Family &
Community Impact:
Challenges, Opportunities, Illustrations
The Challenge—Impact Requires a Larger “Piece”
of Sustained, Quality, Evidence-Based Interventions
(EBIs) with General Community Populations
EBIs
Sustained, quality EBIs
Evaluatednot effective
Not Evaluated
… and rigorously demonstrated, long-term
EBI impact is very rare
Seizing an Opportunity for Impact—
Linking Public Education Dissemination Systems
Reaching Every U.S. Community
• Public School System
 Universal system reaching nearly
all children
 Increasing emphasis on
accountability/evidence orientation
 Cooperative Extension System in Land Grant
Universities
 Largest informal education system in the world
 Over 3,150 agents in nearly every county in the U.S.
 Science with practice orientation
IMPACT Framework—
Basic Science with Practice Tasks
Implant intervention science in stable public education
dissemination systems, linked with other resource systems
Maintain systems-level support for science with practice
Partner with communities strategically, offering
proactive technical assistance
Advance intervention evidence-base
Conduct high quality implementation/
Land Grant
University
Extension
System
participant engagement
Public
School
System
SchoolCommunityUniversity
Partnerships
Tailor toward sustainability of
partnerships and EBIs, planned early
Source: Spoth et al. (2006). Society for Prevention Research 14 th Annual Meeting.
Other
Service/
Resource
Systems
What is evidence-based—
how do we know what works?
• Society for Prevention Research Standards of Evidence
 Design allows strongest possible statement about intervention
“causing” outcome (e.g., randomized, controlled); also
 Specific statement about what outcomes, with whom
 Specific description of intervention and outcome measures
 Quality, timing of measurement
 Sample clearly specified
 Sound statistical analyses, with attention to practical value
and duration of effects
• Specific to phase of prevention research
• Applies to partnership-based interventions
• See www.preventionresearch.org
Illustration of Long-Term Impact—Reduced Meth
Use 4-6 Years Past Baseline
Specific results to be announced when released by
the journal publishing them.
Illustration of Long-Term Impact—Lifetime
Marijuana Use Through 6 Years Past Baseline
Trajectory for ISFP Condition
Trajectory for Control Condition
First Time Proportion
0.4
0.3
0.2
0.1
0
0 m o.
(Pretest)
6 m o.
(Posttest)
18 m o.
Grade 7
30 m o.
Grade 8
48 m o.
Grade 10
72 m o.
Grade 12
See Spoth, Redmond, Shin, & Azevedo (2004). Brief family intervention effects on adolescent substance initiation: School-level
curvilinear growth curve analyses six years following baseline. Journal of Consulting and Clinical Psychology, 72, 535-542.
Other Positive Long-Term Outcomes
from Randomized, Controlled Studies
•
•
•
•
•
•
•
•
•
↑ Parent and Youth Skills
↑ Academic Success
↓ Tobacco/Cigarette Initiation
↓ Alcohol Initiation
↓ Drunkenness
↓ Multi-substance Use
↓ Inhalant Use
↓ Aggression/Conduct Problems
↓ Diagnosable Disorders
*Case Study of “Billy” or “Betty”:
Costs of Life Trajectory of Early Substance
Use and Problem Behaviors
Level of Problem Behaviors
Resident home expenses
Medicaid
Special education
State hospital
Legal (estimated)
Total
Early Childhood
$50,000
$110,000
$28,000
$128,000
$20,000
$336,000
Young Adulthood
*Illustrative case history and cost projections from Dennis Embry (PAXIS Institute).
Illustration of Potential Economic Impact
Partnership-Based Strengthening Families Program:
Benefit-Cost Ratios Under Different Assumptions
$11.34
13
Dollars Returned
11
$9.60
$7.86
9
7
5
3
1
*Actual Study
conditions
1 more case
prevented/100
1 less case
prevented/100
*Estimated $9.60 returned for each dollar invested
under actual study conditions.
Source: Spoth, Guyll, & Day (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, 219-228.
2. PROSPER (Promoting School-community-university
Partnerships to Enhance Resilience):
Model and Successes to Date
PROSPER Study Aims*
• Evaluate the effectiveness of partnership
implementation of evidence-based interventions (EBIs)
on youth and family outcomes
• Learn what factors are most important in partnership
effectiveness, quality
implementation and
sustainability
*Funded by the National Institute on Drug
Abuse—Collaboration with Pennsylvania
State University (Mark Greenberg, PI and
Karen Bierman, Co-PI)
PROSPER Organizational Structure
Local Community Teams
Extension Agent, Public School Staff,
Social Service Agency Representatives, Parent/Youth Representatives
Prevention Coordinator Team
Extension Prevention Coordinators
University/State-Level Team
University Researchers, Extension Program Directors
Phases of PROSPER Implementation
• Phase 1: Organization—team formation/planning
• Phase 2: Initial operations—program
implementation
– Teams selected one of three evidence-based, familyfocused programs for 6th graders
– Teams selected one of three evidence-based school
programs for 7th graders
• Phase 3: Early sustainability planning/
institutionalization within Extension
• Phase 4: Ongoing Operations and Sustainability
PROSPER Success—
Implementation Quality
• Literature: Typical implementation adherence
ranges from 42%-86%
– In PROSPER, based on ratings by trained
observers:
 Average 91% adherence for familyfocused EBI
 Average 90% adherence for school-based
EBIs
Source: Spoth, Guyll, Lillehoj, Redmond, & Greenberg (In press). PROSPER study of evidence-based
intervention implementation quality by community-university partnerships. Journal of Community Psychology .
PROSPER Success—
Positive Outcomes for Families
At 1½ Years Past Baseline:
• More consistent
discipline
• Less harsh discipline
• Better family cohesion
• Better mother-child
relations
PROSPER Success—
Substance-related Outcomes for
7th Graders at 1½ Years Past Baseline
Past Year User Rates
Intervention
Control
.06
.05
.04
.03
.02
.01
.00
Marijuana Use**
Inhalant Use**
**p <0.01
Source: Spoth, Redmond, Shin, Greenberg, Clair, & Feinberg (2006). Substance use outcomes at 1½ years past
baseline from the PROSPER community-university partnership trail.
Another PROSPER Success—
Initial Sustainability
• 100% of PROSPER teams obtained
external funding, within a year of
starting the early sustainability phase!
• Funds were obtained from a variety of
sources – state, city, business, religious
and service organizations, and private
individuals.
3. Proposed Multistate Partnership
IMPACT Network and Benefits
Multistate Partnership IMPACT Network
• Step-by-step expansion of partnership network
• Twofold purpose of multistate network
 To replicate the PROSPER Model for “real
world” dissemination of evidence-based
interventions (EBIs) in early-adopter states
 To conduct multisite process and outcome
evaluations or prevention trials, to learn
more about how to achieve large-scale
community IMPACT
Potential Benefits of Network for
Partnership-Based EBIs on a Larger Scale
• To Our Fund of Knowledge
– Expanding knowledge of interventions producing long-term
positive outcomes and economic benefits
– Potential for learning from multistate research network about
optimal dissemination of evidence-based interventions
– To Schools and Communities
– Reduced substance use problems among youth
– Reduced youth behavior problems in school and community
settings
• To Youth and Families
– Enhanced parenting and youth life skills
– Increased family cohesion and well-being
What Could Be…
Scaling up Evidence-Based Interventions
Through Partnership Networks
• Consider the empirically-demonstrated return
from one set of NIDA-funded projects
• Imagine this on a larger scale
Improved economic benefits from federally-funded
projects
–Prevention “stock” is blue chip
–Evidence-based prevention interventions
fiscally wise
Improved health and well-being of youth, families
and communities—making a “real world” difference
Imagine…
IMPACT!
Acknowledgement of
Our Partners in Research
Investigators/Collaborators
R. Spoth (Director), C. Redmond & C. Shin (Associate Directors),
T. Backer, K. Bierman, G. Botvin, G. Brody, S. Clair,
T. Dishion, M. Greenberg, D. Hawkins,
K. Kavanagh, K. Kumpfer, C. Mincemoyer,
V. Molgaard, V. Murry, D. Perkins, J. A. Stout
Associated Faculty/Scientists
K. Azevedo, J. Epstein, M. Feinberg, K. Griffin,
M. Guyll, K. Haggerty, S. Huck, R. Kosterman,
C. Lillehoj, S. Madon, A. Mason, J. Melby, M. Michaels,
T. Nichols, K. Randall, L. Schainker,
T. Tsushima, L. Trudeau, J. Welsh, S. Yoo
Prevention Coordinators
E. Berrena, M. Bode, B. Bumbarger, E. Hanlon
K. James, J. Meek, A. Santiago, C. Tomaschik
And, again, thank you for this
opportunity…
Questions?
For more information please visit our websites at...
www.ppsi.iastate.edu
or
www.prevention.psu.edu
Also see www.preventionresearch.org for the Society for
Prevention Research Standards of Evidence Guidelines.