Communities That Care 201
Pennsylvania’s Prevention Approach
Commonwealth Prevention Alliance Conference
June 7, 2012
Sandy Hinkle
Communities That Care Consultant
EPISCenter, PSU
Investigators and Authors:
Brian Bumbarger
Mark Feinberg
Louis Brown
Ty Ridenour
Jennifer Sartorious
Brendan Gomez
Michael Cleveland
Mark Greenberg
Brittany Rhoades
Wayne Osgood
Damon Jones
Daniel Bontempo
Richard Puddy
Collaborative Policy Innovators:
Mike Pennington
Clay Yeager
James 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 proveneffective 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 level
5
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 evidencebased prevention programs
The Five Phases of Communities That Care Development
Phase 1
Getting Started
Phase 5
Phase 2
Implementing
& Evaluating
the CAT
Organizing,
Introducing,
Involving
CTC
System
Phase 4
Creating a
Community
Action Plan
(CAT)
Phase 3
Developing a
Community
Profile
SAMHSA’s
Strategic Prevention Framework Steps
Assessment
Evaluation
Monitor, evaluate,
sustain, and improve
or replace those that
fail
Profile population
needs, resources, and
readiness to address
needs and gaps
Sustainability &
Cultural Competence
Implement evidencebased prevention
programs and
activities
Implementation
Capacity
Mobilize and/or build
capacity to address needs
Develop a
Comprehensive
Strategic Plan
Planning
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.
U.S. DEPARTMEN T OF HEALTH AND HUMAN SE RVICES
Substance Abuse and Mental Health Serv ices Administration
Center f or SubstanceAbuse Prev ention
www.samhsa.gov
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 HEALTH AND HUMAN SE RVICES
Substance Abuse and Mental Health Serv ices Administration
Center f or SubstanceAbuse Prev ention
www.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 largescale 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 Phases
2. 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
1.11
Designate points
of contact to act
as a catalysts for
the process.
HOW CLOSE HOW
SUPPORT
ACTION DATE
ARE WE?
CHALLENGING DEFINITION
MATERIALS PLAN Y/N ACHIEVED
(1-4)
(1-4)
4= There is a Tools - pp 6
designated
- 8 & 66 single point of 68.
contact in the
community
who
understands
the
Communities
That Care
process and
coordinates
the initial
workgroup.
COMMENTS/
PLANS
www.episcenter.psu.edu
http//episcenter.psu.edu/sites/default/files/
ctc/milestonesandbenchmarks.xls
Selecting EBP
Creating Fertile Ground for EBPs
Risk-focused Prevention Planning
(the Communities That Care model)
Form local coalition
of key stakeholders
Re-assess risk
and protective
factors
Collect local data on
risk and protective
factors
Leads to community
synergy and
focused resource allocation
Select and implement
evidence-based program that
targets those factors
Use data to
identify priorities
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 …...
Risk and Protective
Factors
Program Fit
Developmental Stage
Targeted Population
 Culture and Values
 Domains of
Influence
Program Efficacy
Based on the programs
record of evaluation…
Will you get the improved outcomes you want?
Program Feasibility
Assess Delivery and Impact
Sustainability
Sufficient Quality
Where does the program fall on the Matrix of Fit & Feasibility vs. Evidence?
Fit & Feasibility (F&F)
Strong <-------------- Weak
Evidence
Poor ------------------------------------------------> Good
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
The Cost-effectiveness of
Evidence-based Prevention in Pennsylvania
(measured benefits and costs per community and statewide )
Program
Big Brothers/Sisters
B-C per Avg. Return/ # Programs
youth Community
Statewide
Est. Total
PA Return
$54
$13,500
28
$378,000
$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
$6,541
$872,133
15
$13,082,000
LifeSkills Training
Strength. Families
TOTAL
$317,066,641
Where to go for help
http://www.nrepp.samhsa.gov/
http://www.colorado.edu/cspv/blueprints/modelprograms.html
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
CTC
Web
Communities That Care
Web-Based Survey
Statewide Report – June 2010
Revision Date: 6/17/10
Sponsored by
CTC Research Team, Prevention Research Center
Pennsylvania State University
32
CTC Domains
The areas that were studied in CTC-Web 2010
include the following:
Board
Membership
Board
Relationships
Board Leadership
CTC Process
Programs
Implemented
Board Work
Style
Barriers
Experienced
Technical
Assistance
33
The research says……………
How Do CTC Coalitions Support Prevention?
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
mobilize comm. &
support prevention**
promote EBP*
non-CTC
assist in evaluating
impact**
CTC
ANOVA: **p<.01 *p<.05
Do Coalitions Affect Program Sustainability?
Operating
Not operating
% Grantees off of funding 2 or more years
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)
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
40
33.2
30
20
16.4
10
0
-10.8
-10.8
-10
-20
Delinquency
Negative Peer Influence
Academic Performance
School Engagement
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 Center
Prevention Research Center, Penn State University
206 Towers Bldg.
University Park, PA 16802
(814) 867-3160 –sah41@psu.edu
episcenter@psu.edu
www.episcenter.psu.edu