1. Strategic Prevention Framework 101 November, 2013
Shari Sprong, MA, MS
Aleya Martin, MPH
Health Resources in Action
Intros – Aleya & Shari
- Ask for name, tribe, where they work, have any knowledge or experience with the SPF
Go over agenda (cut lunch and breaks?)
Location of bathrooms
- Guidelines: cellphones, take break if you need it, take responsibility for your own learning, any other pressing?

2. Prevention
"Prevention is an active, assertive process of creating conditions and/or personal attributes that promote the well-being of people.” (William A. Lofquist)
Aleya
Go over quote, highlight:
Both environmental (conditions) and individual (personal attributes)
- SPF is a framework to lead through the process

3. Prevention Continuum Aleya
Up the left side: WHO you are doing it with or for
Under each title: WHAT you do at each level
These need to line up, since they may not be effective if mixed (e.g., a general health promotion curriculum may not be focused enough for someone at higher risk).

4. Behavioral Health Continuum of Care Model
Aleya
Call attention to handout.
Behavioral health – often looking at both mental health and substance abuse, since often co-occurring.
Promoting well-being at each level, just the starting place is different.
Promotion = environment
Institute of Medicine levels define 3 levels of risk, all prior to diagnosis of a disorder:
Universal – general public or a whole population that hasn’t been identified on the basis of individual risk
Selective – target individuals or sub-population whose risk of developing unhealthy behaviors (e.g., substance abuse) is “much higher than average”
Indicated – target high risk individuals identified as having “minimal, but detectable signs or symptoms foreshadowing mental, behavioral or emotional disorder”

5. Key Principles of the SPF
Public Health Approach
Data-Driven Community-Based Strategic Planning Process
Outcomes-Based Prevention
Aleya
PH approach – focus is on a population or community, rather than on individuals
Data-driven Community-based Strategic planning process (steps to take that we will go through today)
Outcomes-based – looking to see that it moves the needle for the community

6. Strategic Prevention Framework Supports Accountability, Capacity, and Effectiveness
Assessment
Profile population needs, resources, and readiness to address needs and gaps
Capacity
Mobilize and/or build capacity to address needs
Planning
Develop a Comprehensive Strategic Plan
Implementation
Implement evidence-based prevention programs and activities
Evaluation
Monitor, evaluate, sustain, and improve or replace those that fail
Shari
Introduce doctor analogy (“Dr. of the community”)
Sustainability and Cultural Competence need to be considered within each component

7. Strategic Prevention Framework Supports Accountability, Capacity, and Effectiveness
Assessment
Profile population needs, resources, and readiness to address needs and gaps
Capacity
Mobilize and/or build capacity to address needs
Planning
Develop a Comprehensive Strategic Plan
Shari
Implementation
Implement evidence-based prevention programs and activities
Evaluation
Monitor, evaluate, sustain, and improve or replace those that fail

8. 1. Assessment Diagnosis:
Needs and risk & protective factors assessment
Resource inventory
Prioritization of community issues
Shari

9. Data Triangle Archival Data Attitudes/Behaviors,
Risk/Protective Factors
Community Perspective, Community Readiness

10. Data Analysis Levels Trends Patterns Establish baseline Over time
By age, gender, race/ethnicity
Shari
Don’t go deep on this, just quick overview.

11. Increase Collaboration – Decrease Duplication
Resource Inventory
Current community resources
Who is being serviced
Overlaps vs. gaps
Increase Collaboration – Decrease Duplication
Shari

12. Prioritization of Community Issues
Synthesize all 3 sources of data and resource inventory
Identify areas of focus (1 – 2)
Craft a problem statement
Drug (or other issue)
Target population
Baseline rate
Shari

13. Risk & Protective Factors
Definition: Characteristics that increase (risk) or decrease (protective) the likelihood of a negative outcome.
Domains:
Community
School
Family
Individual/Peers
Shari
Define
Briefly go over handout in folder.

14. Assessment Activity Shari/Aleya Explain process: Part 1
First take time to read and think through the tasks as individuals, then will go through it as a group and make decisions. You can advocate for your ideas, but need to work together as a group.
Look over all “data” given – town data, parent and student surveys
As a group, decide which drug to focus on first and give 2 – 3 reason/criteria for your selection.
Part 2
As you look over the data, also identify 1-2 risk and 1-2 protective factors for your community that relate to the drug you selected.
These results will be used later as we continue the process.
For processing:
What drug and target group did you select? Anyone else choose these?
Ask a couple of groups “Why?”
What risk and protective factors did you choose?
What did you notice about the process the group went through to make your decision?

15. But Why? Craft a problem statement (don’t wordsmith now)
The problem is …
But why?
But why here?
Craft a problem statement (don’t wordsmith now)
Drug (or other issue)
Target population
Baseline rate
“But why?” usually relates to risk factors
Be as specific as possible for your community for the “But why here?” Dig as deeply as possible.

16. Strategic Prevention Framework Supports Accountability, Capacity, and Effectiveness
Assessment
Profile population needs, resources, and readiness to address needs and gaps
Capacity
Mobilize and/or build capacity to address needs
Planning
Develop a Comprehensive Strategic Plan
Shari
Capacity building includes mobilizing human and other resources to meet your goals.
Implementation
Implement evidence-based prevention programs and activities
Evaluation
Monitor, evaluate, sustain, and improve or replace those that fail

17. 2. Capacity Building: The ability to mobilize community & resources
Build an inclusive community movement/coalition
Membership
Structure/function
Engage community, include key decision makers & those affected by the problem
Shari
May be tribe, rather than coalition, though may want to develop partnerships with others outside of tribe for effective strategies, data collection, etc.
This is about building a coalition to be able to carry out all of the steps and make the process into a community movement.
Membership includes both who is at the table and what knowledge and skills are represented.
Structure/function includes how the coalition is set up AND the ability of the group to work together, make decisions, etc.
Engage… Remember that your identified target population needs to be at the table, e.g., if you are focused on youth, youth need to be at the table (or at least involved at each step of the way, whether or not they actually sit at coalition meetings). Another example: active users. It’s important that they are NOT just token representatives, but are involved in meaningful participation.

18. Levels of Involvement Shari Trying to create a community movement
Core Leadership
Active Membership
Don’t Attend Meetings, but Give Their Input
Shari
Trying to create a community movement
A coalition is the vehicle where people come together to make decisions in the best interest of the community.
The whole idea is to build ownership in the group and the strategies, since this is the first step towards sustainability.
Some coalitions have a list of variety of ways to participate, even if someone can’t or isn’t interested in attending meetings (e.g., put info about coalition in your agency’s newsletter, put up posters from a social norms campaign in your building [if the target population spends time in your bldg.]).

19. Sample Organizational Chart
Steering Committee
General Membership
Data STAT
Youth Outreach STAT
Parent Outreach STAT

20. Capacity Building Program vs. Coalition Scale Focus
Staff responsibility
Shari
How does this relate to Tribe or Tribal Council?
Scale = “unit of change”
Program looks at change within program participants (relatively small group)
Coalition looks at community-wide change (requires multiple programs/policies to achieve it)
Focus:
-Program – one intervention/strategy and related behavior change
-Coalition – organization and coordination of programs (leading to community level change) – multiple strategies at multiple levels
Staff responsibility:
-Program staff need to run the programs/strategies (people/organizations within the coalition)
-Coalition staff need to coordinate the programs, not in charge of running them. [This is the ideal, but not always reality.]

21. Capacity Building Educate the group Leadership Effective prevention
Cultural competence
Shari
Training and education are critical to promote readiness.
Examples:
Leadership: developing agendas and facilitating successful meetings, elements of strategic planning
Effective prevention: prevention continuum and how to match strategies to the level of prevention where the problem is identified; need for both environmental and individual strategies; what works (evidence-based strategies)
Cultural competence: What groups are in the community but aren’t represented at the table? How might they be approached?

22. Identify and secure resources
Capacity Building
Identify and secure resources
Human resources
Technical resources
Management and evaluation resources
Financial resources
Shari
Human resources = people
Technical Resources = could include TA, technology
All of these are important at different points in SPF.
As a coalition chooses its strategies, it needs to revisit capacity building to determine what’s needed and build it up.

23. Strategic Prevention Framework Supports Accountability, Capacity, and Effectiveness
Assessment
Profile population needs, resources, and readiness to address needs and gaps
Capacity
Mobilize and/or build capacity to address needs
Planning
Develop a Comprehensive Strategic Plan
Implementation
Implement evidence-based prevention programs and activities
Aleya
Evaluation
Monitor, evaluate, sustain, and improve or replace those that fail

24. 3. Planning Multiple strategies in multiple domains Logical
Data- driven

25. Planning What is a Comprehensive Strategic Plan?
Vision & Mission Statements
Problem Statement
Strategic Goals & Objectives
Outcomes
Logic Models
Evidence-Based Strategies
Action Plan & Timeline
Evaluation Plan
Aleya
The output of this process is a document of these components (“medical record”).
Action plan is the operations manual of how to accomplish everything.

26. Planning
Design comprehensive interventions to impact risk and protective factors
Substance- Related Problems
Risk and Protective Factors
Evidence Based Strategies

27. Planning Comprehensive strategies include: - Programs - Policies
- Practices
Strategies should be evidence-based (from entire body of prevention research)
Federal Model Program List
Peer-reviewed journal with proven effectiveness
Documented effectiveness
Aleya
Use MassCALL2 example for “documented effectiveness”

28. Planning
Logic Model: Logical connection between the problem, the Risk & Protective Factors and Strategies Implemented
RELATED PROBLEMS
SUBSTANCE USE
RISK & PROTECTIVE FACTORS
STRATEGIES
High Rate of Youth Alcohol-Related Crashes
High Rates of Binge Drinking
Early Initiation of Alcohol Use
Community-based recreation opportunities
Social Norms Encouraging Binge Drinking
Media campaign in school to correct perceptions of ‘normal’ consumption
High Rates of Drinking and Driving
Little Enforcement of Drinking and Driving
Enforcement Checkpoints

29. Planning Activity Shari/Aleya Have same small groups choose strategies
Discuss what data you wish you had before you make a decision about your strategies and list it on worksheet.
Just for the purposes of this activity, make up the statistics you need for your decision and write them down.
Read through the sample strategies and make your selections of 2 – 3 strategies and write them down.
Process just the “Why?” question.

30. Strategic Prevention Framework Supports Accountability, Capacity, and Effectiveness
Assessment
Profile population needs, resources, and readiness to address needs and gaps
Capacity
Mobilize and/or build capacity to address needs
Planning
Develop a Comprehensive Strategic Plan
Aleya
This is the heart of what the coalition is all about – doing what you’ve planned.
Implementation
Implement evidence-based prevention programs and activities
Evaluation
Monitor, evaluate, sustain, and improve or replace those that fail

31. 4. Implementation Putting your plans into practice
Multiple strategies in multiple domains
Fidelity
Staffing
Aleya
Implementation is when you get your treatment, e.g., take pills = community gets its “treatment” = strategies
Variety of “treatments” (multiple strategies…)
Need to be sure to take or do the right amount, at the right intervals = fidelity
If you need to make adaptations, go to developer, if possible, or at least to an evaluator to help figure out what might be changed without adversely affecting the results.
Fidelity to program, but also fidelity to the strategic plan. May have to make some changes along the way (e.g., crisis in comm’ty), but don’t let it pull plans completely off track.
Also need to make sure it is working and, if not, go back to doctor = evaluate and go back to decision making group to decide what to do. Be sure to involve group in decision-making process (and funder, if it’s a big change).
Need sufficient staffing for both the programs/strategies and for the coordination of the strategies.
Role of coalition coordinator may change – before leading planning process, now coordinating all of the organizations/people involved in implementation, but not in charge of doing each strategy.

32. Implementation Role of Coalition Oversight of work
Mutual accountability
Monitoring
Aleya
Relevant to Tribe/Tribal Council?
Coalition staff might go and collect info, observe what is happening and report to coalition, but coalition is responsible for oversight and making and decisions that need to happen. If you skip that, you’ll lose their feeling of ownership…sustainability.
Remember the differences between program and coalition.
Make sure the strategies are following the vision/mission.
Accountable to each other (each person/organization who has a role needs to fulfill that role) and to the community.
Monitoring fidelity.
Leveraging resources.

33. Strategic Prevention Framework Supports Accountability, Capacity, and Effectiveness
Assessment
Profile population needs, resources, and readiness to address needs and gaps
Capacity
Mobilize and/or build capacity to address needs
Planning
Develop a Comprehensive Strategic Plan
Shari
Implementation
Implement evidence-based prevention programs and activities
Evaluation
Monitor, evaluate, sustain, and improve or replace those that fail

34. Monitor progress and impact on selected change indicators
5. Evaluation
Monitor progress and impact
on selected change indicators
Community is unit of analysis – not the individual
Trends over time
Use evaluation results to realign strategies, as needed
Shari
“Population Outcomes” (move the needle for the community) vs program outcomes (results for just the program participants)
What are the trends and how do they compare to state/US trends?
Very important to actually use the results to guide future planning – that’s why the SPF is in a circle, not a line

35. Measuring Community Outcomes[1
Logic Model Template
Theory of Change
Problem Statement
Strategies
Activities
Outcomes
Problem
But why?
But why here?
Short Term
Intermediate
Long-Term
Shari
Distribute blank and sample templates
1st three columns from “But why?” activity
Add strategies selected to address R&P Factors, other issues
Difference between Strategies and Activities: e.g., a strategy might be to decrease the number of sales of alcohol to minors and the activities might include distributing materials to sellers, doing compliance checks, etc.
S-T Outcomes often address what is identified in “But why here?” and Intermediate Outcomes address the “But why?” issues.
If time, use one of their examples from Assessment and Planning activities.

36. High Rates of Alcohol Related Crashes among HS students 10/year
Logic Model Template
Theory of Change
Alcohol related crashes among HS youth will decrease by decreasing the binge drinking rates among athletes and other youth and decreasing the high rates of drinking and driving.
Problem Statement
Strategies
Activities
Outcomes
Problem
But why?
But why here?
Short Term
Intermediate
Long-Term
High Rates of Alcohol Related Crashes among HS students
10/year
High Rates of Binge Drinking among HS students
23%
High Rates of Drinking and Driving among HS drivers
17%
Early Initiation first Use
30% used before 13
Limited Activities in town for HS youth to get to using public transportation
Collaborate with Transportation Department to increase access to public transportation to HS activities
Meet with interfaith youth group to provide field trips with access to activities outside of town
5 bus routes changed
5 field trips coordinated on weekends to out of town destinations
Increase access to exisiting activities for HS youth (nondriving)
Youth are involved in meaningful activities
Decrease in % of HS youth who report initiating use before age 13
30% to 25%
Decrease
Binge Drinking Rate from 23% to 15%
Decrease rates of Drinking and Driving
17% to 10%
ULTIMATE
Reduce number of alcohol related crashes by 50% (5/year)
Social Norms Encourage Binge Drinking
90% students believe most athletes binge drink
Vocal minority of Athletea regularly boast about weekend drinking
Implement Atlas and Athena EBS
Social Norms Marketing Campaign at High School
3 sports teams selected to pilot Atlas and Athena curriculum
Design Social Norms media campaign based on youth survey data and athletes norms
10 senior level captains and coaches hold after practice A&A sessions reaching 60 JV athletes
Accurate athlete binge drinking norms communicated via positive majority messages saturating school and reaching 80% of students.
High School misperception of athletes binge drinking rates decreases to 70%
90% to 70%
Little Enforcement of Drinking and Driving
10 or fewer arrests of youth for DUI/year
No checkpoints for DUI during high risk times for youth on weekends
Meet and Strategize with Chief of Police to increase DUI check points
Police agree to DUI checkpoints 2 Saturday evenings per month
At least 2 DUI checkpoints /month on weekends occur
10% increase in number of arrests for youth DUI
Shari
Logic Model Template
Theory of Change
Alcohol related crashes among HS youth will decrease by decreasing the binge drinking rates among athletes and other youth and decreasing the high rates of drinking and driving.
Problem Statement
Strategies
Activities
Outcomes
Problem
But why?
But why here?
Short Term
Intermediate
Long-Term
High Rates of Alcohol Related Crashes among HS students
10/year
High Rates of Binge Drinking among HS students
23%
High Rates of Drinking and Driving among HS drivers
17%
Early Initiation first Use
30% used before 13
Limited Activities in town for HS youth to gain access via public transportation
Collaborate with Transportation Department to increase access to public transportation to HS activities
Meet with interfaith youth group to provide field trips with access to activities outside of town
5 bus routes changed
5 field trips coordinated on weekends to out of town destinations
Increase access to exisiting activities for HS youth (nondriving)
Youth are involved in meaningful activities
Decrease in % of HS youth who report initiating use before age 13
30% to 25%
Decrease
Binge Drinking Rate from 23% to 15%
Decrease rates of Drinking and Driving
17% to 10%
ULTIMATE
Reduce number of alcohol related crashes by 50% (5/year)
Social Norms Encourage Binge Drinking
90% students believe most athletes binge drink
Vocal minority of Athletea regularly boast about weekend drinking
Implement Atlas and Athena EBS
Social Norms Marketing Campaign at High School
3 sports teams selected to pilot Atlas and Athena curriculum
Design Social Norms media campaign based on youth survey data and athletes norms
10 senior level captains and coaches hold after practice A&A sessions reaching 60 JV athletes
Accurate athlete binge drinking norms communicated via positive majority messages saturating school and reaching 80% of students.
High School misperception of athletes binge drinking rates decreases to 70%
90% to 70%
Little Enforcement of Drinking and Driving
10 or fewer arrests of youth for DUI/year
No checkpoints for DUI during high risk times for youth on weekends
Meet and Strategize with Chief of Police to increase DUI check points
Police agree to DUI checkpoints 2 Saturday evenings per month
At least 2 DUI checkpoints /month on weekends occur
10% increase in number of arrests for youth DUI
The long-term outcomes are affected not by any single strategy but by ALL of the strategies and activities.

37. Strategic Prevention Framework
Aleya

38. Meets the Needs of the People With
Cultural Competence
Meets the Needs of the People With
Whom You Are Working
Eliminates service & participation disparities
Improves effectiveness & quality of programs, policies and practices
Aleya
Includes age, gender, race/ethnicity, abilities, SES status, etc.
Make sure the target population is involved in a meaningful way
Use culturally competent methods at each stage of the process
For example, if you decide to collect information through a written survey, how might that NOT be culturally competent? How might you need to adapt your plan?
How could you keep cultural competence in mind in each stage of the SPF process?

39. Sustain outcomes, not programs
Sustainability
Sustain outcomes, not programs
Think sustainability from the beginning
Look to community resources to sustain outcomes
Sustain prevention by making it everyone’s job
Aleya
There are multiple ways to institutionalize the work of the coalition
Sustain OUTCOMES, not necessarily programs or even the coalition (though often it supports the outcomes)
Get people involved and invested early on – they’re more likely to be motivated to find ways to sustain the work.
How could you integrate sustainability into each stage?
Examples:
Assessment – develop methods for collecting data that are easy to repeat and teach people how to do it; develop partnerships with people who already collect data that could be useful
Capacity Building – develop a cadre of coalition members who can train new members in various topics/skills
Planning – reach out to a wide group of people, including sectors that are not traditionally public health partners, and involve them from the beginning
Implementation – involve members in the strategies related to their sector
Evaluation – involve members in elements of evaluation (collecting follow-up data, data analysis, presenting results to coalition and public)

40. Bringing It Home
How can you start doing some of this now, to prepare you for future funding opportunities?
Shari/Aleya
Partnership development
Data collection (figuring out what data, from where)

41. Contact Information
Aleya Martin
Health Resources in Action (HRiA)
x533
95 Berkeley Street
Boston, MA 02116
Shari Sprong
x502

43. Steps Required to Implement the SPF
Assessment:
Create and maintain coalitions and partnerships
Assess community needs and resources
Analyze problems and goals
Develop a framework or model of change
Capacity:
Increase participation and membership
Build leadership
Enhance cultural competence
Improve organizational management and development
Explain that there are a number of steps to complete within each component
It’s not a linear process and may be working on more than one component simultaneously
Briefly go through steps under Assessment and Capacity
Explain that we will go over each component in some detail, although today will definitely be an overview of the whole process

44. Steps Required to Implement the SPF
Planning:
Develop strategic and action plans
Implementation
Develop interventions
Advocate for change
Influence policy development
Write grant applications for funding
Evaluation
Evaluation initiatives
Sustain projects and initiatives
Continue with steps for Planning, Implementation, and Evaluation
Any questions?
Moving on to take a closer look at the first component, Assessment

45. Community-Based Strategy School-Based Strategy Family-Based Strategy
Measuring Community Outcomes
Inputs
Outputs
Short Term
Outcomes
Program 1
Community-Based Strategy
Intermediate
Outcomes
Program 2
Long Term
Outcomes
Program 1
School-Based Strategy
Program 2
Program Impact
Inputs ($,Time, Resources)
Outputs (Numbers – Served &Programs )
Short Term Outcomes – Knowledge, Attitudes/Beliefs, Skills, Risk & Protective Factors
Comprehensive Strategy Impact
Intermediate Outcomes – Risk & Protective Factors
Long Term Outcomes – Behavior Changes (original problem)
Program 1
Family-Based Strategy
Program 2