1. Communities That Care 201 Pennsylvania’s Prevention Approach Communities That Care 201 Pennsylvania’s Prevention Approach Commonwealth Prevention Alliance Conference June 7, 2012 Sandy Hinkle Communities That Care Consultant EPISCenter, PSU

2. Investigators and Authors: Brian Bumbarger Mark Greenberg Mark Feinberg Brittany Rhoades Louis Brown Wayne Osgood Ty Ridenour Damon Jones Jennifer Sartorious Daniel Bontempo Brendan Gomez Richard Puddy Michael Cleveland Collaborative Policy Innovators: Mike Pennington Clay Yeager James AndersonKeith 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)

3. 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.

4. 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 proven- effective programs targeted at strategically identified risk and protective factors

5. 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

6. 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.

7. 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 evidence- based prevention programs

8. CTC System Phase 1 Getting Started Phase 2 Organizing, Introducing, Involving Phase 3 Developing a Community Profile Phase 4 Creating a Community Action Plan (CAT) Phase 5 Implementing & Evaluating the CAT The Five Phases of Communities That Care Development

9. SAMHSA’s Strategic Prevention Framework Steps Sustainability & Cultural Competence Profile population needs, resources, and readiness to address needs and gaps Monitor, evaluate, sustain, and improve or replace those that fail Implement evidence- based prevention programs and activities Develop a Comprehensive Strategic Plan Mobilize and/or build capacity to address needs Assessment Capacity Planning Implementation Evaluation

10. 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.

11. Communities that Care is an effective tool to implement the Drug Free Communities program as well as other SAMHSA Strategic Prevention Programs.

12. 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.

13. 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 large- scale implementation under real-world conditions

14. 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

15. Milestones and Benchmarks

16. 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).

17. Milestone 1.1 Organize the community to begin the Communities That Care Process. BENCHMARK HOW CLOSE ARE WE? (1-4) HOW CHALLENGING (1-4) DEFINITION SUPPORT MATERIALS ACTION PLAN Y/N DATE ACHIEVED COMMENTS/ PLANS 1.11 Designate points of contact to act as a catalysts for the process. 4= There is a designated single point of contact in the community who understands the Communities That Care process and coordinates the initial workgroup. Tools - pp 6 - 8 & 66 - 68.

18. http//episcenter.psu.edu/sites/default/files/ ctc/milestonesandbenchmarks.xls www.episcenter.psu.edu

19. Selecting EBP

20. Creating Fertile Ground for EBPs Risk-focused Prevention Planning (the Communities That Care model) Collect local data on risk and protective factors Use data to identify priorities Select and implement evidence-based program that targets those factors Re-assess risk and protective factors Form local coalition of key stakeholders Leads to community synergy and focused resource allocation

21. Pennsylvania’s EBP dissemination in 1999…

22. Pennsylvania’s EBP dissemination in 2012…

23. Reducing Youth Problems and Promoting Positive Youth Development: Choosing the best program for your community …...

24. Program Fit Risk and Protective Factors Developmental Stage Targeted Population  Culture and Values  Domains of Influence

25. Program Efficacy Based on the programs record of evaluation… Will you get the improved outcomes you want?

26. Program Feasibility Sufficient Quality Sustainability Assess Delivery and Impact

27. Fit & Feasibility (F&F) Poor ------------------------------------------------> Good Evidence Strong <-------------- Weak 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 Where does the program fall on the Matrix of Fit & Feasibility vs. Evidence?

28. The Cost-effectiveness of Evidence-based Prevention in Pennsylvania (measured benefits and costs per community and statewide ) ProgramB-C per youth Avg. Return/ Community # Programs Statewide Est. Total PA Return Big Brothers/Sisters$54$13,50028$378,000 LifeSkills Training$808$161,600100$16,160,000 Multi. Treatment Foster Care $79,331$475,9863$1,427,958 Multisystemic Therapy$16,716$2,507,40012$30,088,800 Functional Family Therapy $32,707$12,395,95311$136,355,483 Nurse-Family Partnership $36,878$4,782,97625$119,574,400 Strength. Families$6,541$872,13315$13,082,000 TOTAL $317,066,641

29. http://www.nrepp.samhsa.gov/ http://www.colorado.edu/cspv/blueprints/modelprograms.html Where to go for help

30. Coalition Functioning

31. 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

32. 32 CTC Research Team, Prevention Research Center Pennsylvania State University Sponsored by Communities That Care Web-Based Survey Statewide Report – June 2010 Revision Date: 6/17/10 CTC Web

33. 33 CTC Domains The areas that were studied in CTC-Web 2010 include the following: CTC Process Board Leadership Board Work Style Board Relationships Board Membership Barriers Experienced Technical Assistance Programs Implemented

34. The research says……………

35. ANOVA: **p<.01 *p<.05

36. Do Coalitions Affect Program Sustainability? % Grantees off of funding 2 or more years Operating Not operating

37. 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)

38. 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 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.

39. 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

40. 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