2. This training was developed under the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for the Application of Prevention Technologies contract. Reference #277-08-0218. For training use only. 2

3. Session 2 Agenda 1. Review Key Concepts from Day 1 2. Strategic Prevention Framework Step 1: Assessment Step 2: Capacity 3

4. Session 2 Learning Objectives Describe how to assess substance use and related problems Describe how to assess risk and protective factors that contribute to the identified substance use and related problems. Describe how to assess a community’s readiness and resources to address its problems. 4

5. Review: Public Health Questions What? Substance abuse and other behavioral health problems Who?The population that is the focus of the intervention(s) When? Developmental stage of the focus population Where? Contexts that influence health Why? Risk and protective factors How? Strategic Prevention Framework 5

6. ACTIVITY – SPF in Action  Get into small groups with 3-4 people.  Identify an activity in your everyday life or work that incorporates ALL five steps of the SPF.  Write down what you did for each of the five steps: 1.Assessment 2.Capacity 3.Planning 4.Implementation 5.Evaluation  Discuss responses with the large group. 6

7. Step 1: Assessment 7

8. What to Assess The existing resources and readiness of the community to address them The risk and protective factors that influence them The nature and extent of substance use behavior and related problems 8

9. Our Road Map – Logic Model Risk and Protective Factors Behaviors and Related Problems Resources and Readiness Interventions 9

10. Examples of Substance Use Behaviors  Overall consumption  Acute/heavy consumption Binge Drinking  Consumption in risky situations Drinking and Driving Smoking around young children  Consumption by populations/groups Youth, college students, older adults Pregnant women 10

11. TOBACCOALCOHOL ILLICIT DRUG IllnessLung cancer Heart disease Lung disease Reproductive health Fetal effects Cirrhosis Cancer Heart disease Fetal effects Overdose HIV Fetal effects InjuryBurnsMotor vehicle crashes Suicide Homicide Motor vehicle crashes Suicide Other Crime Work/School Crime Work/School Examples of Substance-Related Problems 11

12. What is Epidemiology? EpidemiologyDistributionPersonPlaceTimeDeterminantsRiskProtection Information Sheet 2.1: Key Concepts for Step 1 12

13. Health Disparities Difference in health Adverse impact on groups of people Social, economic, environmental disadvantages What are “health disparities”? 13

14.  In 2008, more than twice as many people who were poor needed and received treatment for a substance use problem compared to those with a high income.  Males have suicide rates almost four times as high as females.  African American women over the age of 40 have lower rates of breast cancer than non-Hispanic white women. But they are more likely to die from breast cancer.  Current alcohol use among youth aged 18-20 is almost 50%, even though alcohol consumption is illegal under age 21. Did You Know…? 14

15. Understanding the Nature of the Behaviors and Related Problems  What are the behaviors and related problems?  How often are they occurring?  Where are they occurring?  Which populations experience them most? Assessment Questions: 15

16. Types of Data Shows how often an event/ behavior occurs or to what degree it exists Explains why people behave or feel the way they do Information Sheet 2.2: Types of Data Information Sheet 2.3: Pros & Cons of Data Collection Methods QuantitativeQualitative 16

17. On a scale from 1-4 (1 is low, 4 is high), how comfortable are you with working with data? If you are 3-4, what do you like about working with data? If you are 1-2 what is it that concerns you or is a barrier? Have you worked with any of this data before as part of your job? If so, have you worked with any of these data sources and which ones? Do you know of any challenges to getting this data in the communities where you work? National/State Government websites Survey-specific websites State Depts./data warehouse State Epi Workgroup Local Health Dept.Hospitals/ClinicsPolice Dept.Schools/CollegesTribal Examples of Data Sources Information Sheet 2.4: Data Sources 17

18. ACTIVITY Looking at Data- Worksheet 2.5: Activity – Looking at Data  Get into small groups.  Refer to Worksheet 2.5: Activity –Looking at Data and answer the following questions about the data charts: o What conclusions can you draw from looking at the data? o What additional questions do you have after examining the data? o What additional data might you want to collect and review?  Discuss responses with the large group. 18

19. Tips to Remember about Data Examine different kinds of data Look for relationships and patterns Be aware that data gaps exist Not all data is equal 19

20. Examining Data: Make Comparisons Information Sheet 2.6: Tips for Examining Data 20 COMPARE DATA Now vs. past Population group vs. population group Community vs. state or other community

21. Overcoming Barriers: How to Choose What to Address PROBLEM Magnitude – Is it the largest one? Time trend – Is it getting worse over time? Severity – How severe is it? Comparison – How does it compare? 21

22. ACTIVITY Choosing the Problem Worksheet 2.7: Activity - Choosing the Problem  Get in your same small groups.  Refer to Worksheet 2.7: Activity – Choosing the Problem and answer the following questions about the data charts on marijuana: o What conclusions can you draw from looking at the data? o What additional data might you want to collect and review?  Compare the marijuana and alcohol data. Answer these questions: o What conclusions can you draw from looking at both of these data? o Which problem would you select and why? o Was there any additional information that you would have liked to see?  Discuss responses with the large group. 22

23. Logic Model – Next Stop on Our Road Map Risk and Protective Factors Behaviors and Related Problems Resources and Readiness Interventions 23

24. Examples of Evidence-Based Risk Factors for Underage Drinking Low perception of harm of alcohol use Social norms that accept underage drinking Easy retail access Low enforcement of alcohol laws Easy social access Low or insufficient parental monitoring Information Sheet 2.8: Examples of Data to Collect 24

25. ACTIVITY – Match Up Worksheet 2.9: Activity – Match Up  Get in small groups.  Refer to Worksheet 2.9: Activity – Match Up: o From List 1, select three risk factors for underage drinking. Write these on your chart. o From List 2, determine which data indicators fit with each of the risk factors you selected. Write these on your chart. o From List 3, identify the source for the data. Write this on your chart.  Assign someone to report the groups’ answers. 25

26. Logic Model – Where We Are Now Underage Drinking Risk – Easy Social Access Risk – Parental Monitoring Protective – School Engagement Risk and Protective Factors Interventions Behaviors and Related Problems Risk – Social Access Risk – Perception of Harm 26

27. Step 2: Capacity 27

28. Assessing Capacity CAPACITY RESOURCES READINESS 28

29. Resources I am a resource We have expertise in evaluation Our mission is about health and well-being I’ve been working in the community on prevention for over 20 years I am Native American and know my community well 29

30. ACTIVITY – Identifying Resources  On your own, identify a community where you work or live.  Determine the community resources—human, fiscal, and organizational—that are connected to underage drinking.  Write these resources down on separate sticky notes.  Put the sticky notes on the appropriate paper on the wall: “Human Resources,” “Fiscal Resources,” or “Organizational Resources.” 30

31. Community Readiness Information Sheet 2.10: Assessing Capacity How ready is a community… To accept that a substance use problem needs to change? To take action to change the problem? 31

32. ACTIVITY – High/Low  For the community you identified in the previous activity, determine its level of resources and readiness to address underage drinking according to the following four scenarios: o High resources, high readiness o High resources, low readiness o Low resources, high readiness o Low resources, low readiness  Find a partner and take turns sharing which scenario accurately describes your community and why. 32

33. CASE STUDY ACTIVITY – Determining Resources and Readiness  Get into case study groups.  Review the information on resources and readiness for the case.  Use the information provided in the case to determine the resources, resources gaps, and readiness to address underage drinking.  Record answers in the chart on Worksheet 2.11: Case Study Activity – Determining Resources and Readiness. Worksheet 2.11: Case Study Activity – Determining Resources and Readiness 33

34. Strategic Prevention Framework 34

35. Session 2 Learning Objectives Describe how to assess substance use and related problems, and the risk and protective factors that contribute to them Explain how health disparities relate to prevention Describe how to assess a community’s readiness and resources to address its problems 35

36. Questions or comments? 36

37. References 1 Friis, R.H. & Sellers, T.A. (2009). Epidemiology for public health practice (4 th ed.). Sudbury, MA: Jones & Bartlett Publishers, LLC. 2 U.S. Department of Health and Human Services, Healthy People 2020 (n.d.). Disparities. Retrieved from http://www.healthypeople.gov/2020/about/disparitiesAbout.aspx 3 U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2011). National Healthcare Disparities Report, 2010. AHRQ Publication No. 11-0005. Rockville, MD: Author. pp.103. Retrieved from http://www.ahrq.gov/qual/nhdr10/nhdr10.pdf 4 U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2011). National Healthcare Disparities Report, 2010. (AHRQ Publication No. 11-0005). Rockville, MD: Author. pp.101. Retrieved from http://www.ahrq.gov/qual/nhdr10/nhdr10.pdf 5 American Cancer Society. (2011). Breast Cancer Facts & Figures 2011-2012. Atlanta, GA: Author. pp.4. Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-030975.pdf 6 Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings (Office of Applied Studies, NSDUH Series H-38A, HHS Publication No. SMA 10-4586Findings). Rockville, MD: Author. pp.30. 37