1. 1 Taking Advances in Prevention Science to Scale to Prevent Drug Misuse and Crime Community-Wide J. David Hawkins Social Development Research Group School of Social Work University of Washington

2. 2 Research Guiding Practice Malleable risk and protective factors identified through longitudinal studies should be targeted by preventive interventions. (Coie et al., 1994; Woolf, 2008; O’Connell, Boat & Warner, 2009)

3. 3 Advances in Prevention Over the past 25 years, controlled trials have identified both ineffective and effective prevention policies and programs.

4. 4 Effective Programs and Policies Have Been Identified in a Wide Range of Areas Effective Programs and Policies Have Been Identified in a Wide Range of Areas 1.Prenatal & Infancy Programs 2.Early Childhood Education 3.Parent Training 4.After-school Recreation 5.Mentoring with Contingent Reinforcement 6.Youth Employment with Education 7.Organizational Change in Schools 8.Classroom Organization, Management, and Instructional Strategies 9.School Behavior Management Strategies 10.Classroom Curricula for Social Competence Promotion 11.Community & School Policies 12.Community Mobilization (Hawkins & Catalano, 2004)

5. 5 Preventive interventions that address shared risk factors for different adolescent health risking behaviors have produced reductions in multiple outcomes, including drug use and crime. (Hawkins et al, 1999; Botvin et al., 2002 ; Flay et al, 2004; Haggerty et al., 2007; Schweinhart et al, 1992; 2005).

6. 6 Lists of Rigorously Tested and Effective Youth Violence and Drug Abuse Prevention Programs and Policies Lists of Rigorously Tested and Effective Youth Violence and Drug Abuse Prevention Programs and Policies Blueprints for Violence Prevention www.colorado.edu/cspv/blueprints/ Communities That Care Prevention Strategies Guide http://preventionplatform.samhsa.gov

7. 7 But… Prevention approaches that do not work or have not been evaluated have been more widely used than those shown to be effective. (Gottfredson & Gottfredson, 2002, Hallfors et al 2001, Ringwalt et al., 2002.)

8. 8 The Challenge How can we take tested and effective prevention programs to scale… while recognizing that communities are different from one another and that people want to have control over what programs they use?

9. 9 Why “community” level? Preventive services are implemented locally. Youths in different communities are exposed to different levels of risk and protection.

10. 10 Distribution of Risk in a City

11. 11 Estimated National Value Peer-Individual Madison Middle School Risk Profile 8 th Grade 2002

12. 12 Peer-Individual Estimated National Value Peer-Individual Nova High School Risk Profile 10 th Grade 2002

13. 13 A Goal for Community Prevention To identify and address those risk factors that are most prevalent and those protective factors that are most suppressed with tested and effective policies and programs.

14. 14 Communities That Care: A Tested and Effective Operating System for Community Wide Prevention CTC is a proven method for mobilizing communities to prevent underage drinking, tobacco use and delinquent behavior. CTC has been tested in a randomized controlled experimental trial involving 12 pairs of matched communities (24 communities) across 7 states from Maine to Washington. CTC’s effects have been independently replicated in a statewide dissemination trial in Pennsylvania.

15. 15 Population Level Effects of CTC Compared with control communities, CTC significantly reduced the incidence of tobacco use, alcohol use and delinquent behavior community wide by end of 8 th grade. Compared with control communities, CTC significantly reduced the prevalence of smokeless tobacco use, current drinking, binge drinking and delinquent behavior community wide in 8 th grade.

16. 16 Communities That Care is owned by the federal government and is available at: http://preventionplatform.samhsa.gov/ CSAP Contact: Patricia Getty, Ph.D. Acting Director, Division of Systems Development Center for Substance Abuse Prevention patricia.getty@samhsa.hhs.gov

17. 17 The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate

18. 18 The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Community readiness assessment. Identification of key individuals, stakeholders, and organizations.

19. 19 The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Training key leaders and board in CTC Building the community coalition.

20. 20 Organizations Represented by CTC Board Members in 12 CTC Communities Business25 Citizen Advocacy 13 Organization Community Coalition11 Community Member 17 Health Agency15 Human Service Agency 43 Juvenile Justice System9 Law Enforcement23 Local Philanthropic 3 Organization Media4 Parent 13 Religious Group21 School104 Substance Abuse 8 Prevention Organization State, Town, City or 20 Municipal Government Youth Member15 Youth Recreation Program24 Other8 Total: 376 Members

21. 21 The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Collect risk/protective factor and outcome data. Collect information on community resources Construct a community profile from the data.

22. 22 Estimated National Value Peer-Individual

23. 23 The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Define outcomes. Prioritize factors to be targeted. Select tested, effective interventions. Create action plan. Develop evaluation plan.

24. 24 Addressing Risk with Effective Action 3-5 Early Childhood Education prenatal-2 Prenatal/Infancy Programs 6-14Family Therapy prenatal-14Parent Training Family Management Problems Developmental PeriodProgram Strategy Factor Addressed

25. 25 Effective Prevention for Parents of Young Adolescents Creating Lasting Connections Family Matters Guiding Good Choices Parents Who Care Parenting Wisely Strengthening Families 10-14

26. 26 The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Form task forces. Identify and train implementers. Sustain collaborative relationships. Evaluate processes and outcomes. Adjust programming.

27. 27 CTC Trainings 1. Key Leader Orientation 2. Community Board Training 3. Community Assessment Training 4. Community Resource Assessment Training 5. Community Planning Training 6. Community Program Implementation Training

28. 28 Assess risk, protection and resources Implement and evaluate tested prevention strategies Increase in priority protective factors Decrease in priority risk factors Increase in positive youth development Reduction in problem behaviors Vision for a healthy community Process Measurable Outcomes 6-9 mos. 1 year 2-5 years 4-10 years Communities that Care Process and Timeline

29. 29 Why Does CTC Work? Complete set of manualized trainings. Process for assessing community readiness. Milestones and Benchmarks that guide communities through the CTC process. Standardized assessment process for community needs assessment. Menu of tested and effective preventive interventions. Training and tools for monitoring implementation fidelity and quality and outcomes.

30. 30 What Does CTC Achieve? Creates a stable infrastructure for prevention in the community. Creates synergy across preventive interventions and efficient use of prevention resources. Helps communities use epidemiological data to prioritize risk and protective factors for preventive action. Increases use of tested and effective preventive interventions. Extends the impact of prevention beyond individual programs and their direct recipients to the broader community – achieves population level outcomes.

31. 31 Ingredients of CTC Success Identified through Research Local CTC board functioning is key to CTC effectiveness, the fidelity of evidence-based programs implemented through CTC, and sustainability of prevention effort. CTC board functioning is dependent on adequate training and ongoing technical assistance. Regular evaluation and feedback to local sites assists the joint work of TA providers and CTC boards in maintaining high-quality site functioning and program fidelity.

32. 32 Communities That Care CYDS Publications Arthur, M.W., Briney, J.S., Hawkins, J.D., Abbott, R.D., Brooke-Weiss, B. &. Catalano, R.F. (2007). Measuring community risk and protection using the Communities That Care Youth Survey. Evaluation and Program Planning, 30, 197-211. Brooke-Weiss, B., Haggerty, K. P., Fagan, A. A., Hawkins, J. D., & Cady, R. (2008). Creating community change to improve youth development: The Communities That Care (CTC) system. The Prevention Researcher 15(2), 21-24. Brown, EC, Hawkins, JD, Arthur, MW, Briney, JS, & Abbott, RD (2007). Effects of Communities That Care on prevention services systems: Findings from the Community Youth Development Study at 1.5 years. Prevention Science. 8, 180-191. Brown, EC, Hawkins, JD, Arthur, M W, Abbott, RD, & Van Horn, ML (2008). Multilevel analysis of a measure of community prevention collaboration. American Journal of Community Psychology, 41, 115-126. Fagan, A. A., Hanson, K., Hawkins, J. D., & Arthur, M. W. (2008). Implementing effective community- based prevention programs in the Community Youth Development Study. Youth Violence and Juvenile Justice, 6, 256-278. Fagan, A. A., Hanson, K., Hawkins, J. D., & Arthur, M. W. (2008). Bridging science to practice: Achieving prevention program implementation fidelity in the Community Youth Development Study. American Journal of Community Psychology, 41, 235-249.

33. 33 Communities That Care CYDS Publications Fagan, A. A., Hawkins, J. D., & Catalano, R. F. (2008). Using community epidemiologic data to improve social settings: The Communities That Care prevention system. In M. Shinn & H. Yoshikawa (Eds.), Toward positive youth development: Transforming schools and community programs. New York: Oxford University Press. Fagan, AA, Brooke-Weiss, B, Cady, R, Hawkins, JD (in press). If at first you don't succeed…keep trying: Strategies to enhance coalition/school partnerships to implement school-based prevention programming. Australian and New Zealand Journal of Criminology. Fagan, A.A., Van Horn, M.L., Hawkins, J.D., & Arthur, M.W. (2007). Using community and family risk and protective factors for community-based prevention planning. Journal of Community Psychology, 35(4), 535-555. Hawkins, JD (2006). Science, social work, prevention: Finding the intersections. Social Work Research, 30(3), 137-152. Hawkins, JD, Oesterle, S, Brown, EC, Arthur, MW, Abbott, RD, Fagan, AA, Catalano, RF (in press). Results of a type 2 translational research trial to prevent adolescent drug use and delinquency: A test of Communities That Care. Archives of Pediatrics and Adolescent Medicine. Hawkins, J. D., Catalano, R. F., Arthur, M. W., Egan, E., Brown, E. C., Abbott, R. D., & Murray, D. M. (2008). Testing Communities That Care: The rationale, design and behavioral baseline equivalence of the Community Youth Development Study. Prevention Science, 9(3), 178-190.

34. 34 Communities That Care CYDS Publications Hawkins, J.D., Brown, E.C., Oesterle, S., Arthur, M.W., Abbott, R.D., & Catalano, R.F. (2008). Early effects of Communities That Care on targeted risks and initiation of delinquent behavior and substance use. Journal of Adolescent Health. Jonkman, H. B., Haggerty, K. P., Steketee, M., Fagan, A. A., Hanson, K., & Hawkins, J. D. (2008). Communities That Care, core elements and context: Research of implementation in two countries. Social Development Issues, 30, 42-57. Murray, D.M., Van Horn, M.L., Hawkins, J.D., & Arthur, M.W. (2006). Analysis strategies for a community trial to reduce adolescent ATOD use: A comparison of random coefficient and ANOVA/ANCOVA models. Contemporary Clinical Trials. 27, 188-206. Quinby, R.K., Fagan, A.A., Hanson, K., Brooke-Weiss, B., Arthur, M.W., & Hawkins, J.D. (2008). Installing the Communities That Care prevention system: Implementation progress and fidelity in a randomized controlled trial. Journal of Community Psychology, 36, 313-332. Van Horn, M.L., Fagan, A.A., Jaki, T., Brown, E.C., Hawkins, J.D., Arthur, M.W., Abbott, R.D., & Catalano, R.F. (2008). The use of mixture models to evaluate differential intervention effects in group randomized trials. Multivariate Behavioral Research, 43, 289-326.

35. 35 Taking Advances in Prevention Science to Scale to Prevent Drug Misuse and Crime Community Wide J. David Hawkins Social Development Research Group School of Social Work University of Washington