1. Maine Learning Community: Selecting Strategies February 21, 2007
Maine Office of Substance Abuse (OSA)
Northeast Center for Application of Prevention Technologies (NECAPT)
Hornby Zeller Associates, Inc (HZA)
Maine’s Environmental Substance Abuse Prevention Center (MESAP)
Opening Remarks:
This training was designed with partners to pick up where your assessments leave off
Lots of opportunity for cross sharing
Lots of time within county to work through activities that will help in strategy selection
Provide you with the tools and resources (human and technical) to complete your plan
This is day one and day two will be in March
Opening Activity: What are you hoping to get out of today?
Ask some participants to share aloud
OR have all write expectations down on index cards. Facilitators collect and summarize after State presentation.

2. Learning Objectives
By the end of day one workshop, participants will be able to:
Better understand the Maine SPF-SIG initiative
Follow a process to prioritize intervening variables
Identify effective types of strategies to address intervening variables
Apply criteria to determine “fit” of strategies
Use resources to develop a comprehensive approach

3. Agenda Welcome and Introductions Past, Present, Future…
State update
Grantee check-in
Prioritizing Intervening Variables
Process for prioritizing
Group work
Identifying and Selecting Strategies
Evidence-based interventions
Determining “Fit”
Creating a comprehensive approach

4. ME Office Substance Abuse (OSA) Update
Review state assessment process
Discuss timeline for SPF-SIG
Rebecca will provide slides for this section

5. Common Terms Intervening Variables Consequence and Consumption
(Risk & Protective Factors/
Underlying Conditions)
Consequence
and Consumption
Patterns
Evidence-Based
Interventions
Clarification of language
Goals
Objectives
Strategies

6. Needs Assessment Process
In addition to the needs assessment, communities completed a capacity assessment to assess human technical organizational and financial resources necessary to monitor affected populations
*Maine’s SPF Guide to Assessment and Planning August 2006, Hornby Zeller Associates, Inc.
This is the process that communities are involved in now

7. Needs Assessment Check-in
What new partners or resources did you identify in your community as a result of your assessment efforts?
What has been challenging?
Was there anything that surprised you?
Have tables spend about 5 minutes in small groups to discuss. Determine who will report out, then in large group report out one lesson learned so far
- Ask for volunteers to report out on some interesting lessons learned or surprises
Adapted from*NM Capacity Training, January 25, 2006, Michelle Fry & Paula Feathers, Southwest Center for Applied Prevention Technologies

8. Strategic Plan Elements
Community Vision, Target Areas, Planning Process, Decision Process, and Prioritization (Prioritization – focus of Day One)
Strategies (focus of Day One)
Capacity Building Priorities, Action Plan, Sustainability (focus of Day Two)

9. Intervening Variables Prioritization
ME Logic Models
Intervening Variables and Contributing Factors
Prioritization of Intervening Variables

10. Underage Drinking Logic Model
Consequence
and Consumption
Patterns
Intervening
Variables
Strategies
Access/ Availability
Parental Monitoring
Underage
Drinking
Law Enforcement
Knowledge of
Health Risks
*Access/ Availability – social and retail
Need to define intervening variables and provide as a handout
Advertising
Adult Modeling
School Policies

11. High-Risk Drinking Logic Model
Consequence
and Consumption
Patterns
Intervening
Variables
Strategies
Knowledge
of Health Risks
High-Risk
Drinking
18-25 yr olds
Promotions
& Pricing
Need to define intervening variables and provide as a handout
Retail Sales/
Over-service
Lack of Screening/
Early Intervention

12. Prescription Drug Misuse Logic Model
Consequence
and Consumption
Patterns
Intervening
Variables
Strategies
Knowledge
of Health Risks
Prescription
Drug Misuse
18-25 yr olds
Need to define intervening variables and provide as a handout
Availability

13. Logic Model Table Discussion
Looking at the logic model handouts:
Do the problems and intervening variables seem to be consistent with what you found in your needs assessment?
Is there anything that seems to be missing?

14. Underage Drinking Intervening Variables
Retail Access/Availability
Social Access/Availability
Law Enforcement
Parental Monitoring
Knowledge of Health Risk
Advertising
Adult Modeling
School Policies
SPF is built on the idea that making changes to intervening variables at the community level will cause changes in substance use and related problems.
For example: The above list represents the intervening variables already identified as priorities in Underage Drinking in the State needs assessment
*Maine’s SPF Guide to Assessment and Planning August 2006, Hornby Zeller Associates, Inc.

15. Contributing Factors: Retail Access
Retail Outlet
Density
ID Checks
In Bars/ Restaurants
Retail Access/
Availability
Each intervening variable has different factors associated with it.
For example: under Easy Retail Access, you may find that every convenience store sells alcohol, and there are bars that allow 18 to party 21 to drink w/out a real deterrent for the underage drinkers, alcohol sold all night in liquor stores.
Enforcement of
Minimum Drinking
Legal Age (MDLA)
Hours/ Days of
Retail Sales

16. Youth Alcohol Use Underage Drinking
School
Policy
Social Access
Retail Access
Law
Enforcement
Advertising
Adult Modeling
Parental
Monitoring
- MAKE LIST A HANDOUT of all contributing factors
The rest of the intervening variables have their contributing factors as well.
All of these contribute to the use patterns you have also found in your assessment.
This use, ultimately contributes to the priority problem (underage drinking among high school youth).
Of course all communities will not be able to address all the contributing factors for all intervening variables, therefore communities will need to prioritize the intervening variables most relevant to each community
Youth Alcohol Use
Underage Drinking

17. OSA Prioritization Process
Changeability
High Low
Importance
High
Low
The state went through a prioritization process to determine which intervening variables they included in the state logic model based on these criteria:
Changeability – Do we have the expertise and know how (research knowledge) to change this intervening variable?
Importance – How important is this intervening variable in impacting the problem across the state?
Changeability – Do we have the expertise and research knowledge to change this intervening variable?
Importance – How important is this intervening variable in impacting the problem across the state?

18. Community Prioritization Process
Changeability
High Low
Importance
High
Low
Community can engage in a similar process using slightly different definitions for the criteria:
Changeability – Do we have the capacity (readiness and readiness) to change this intervening variable?
Importance – How important is this intervening variable in impacting the problem in our community?
Changeability – Do we have the capacity (resources and readiness) to change this intervening variable?
Importance – How important is this intervening variable in impacting the problem in our community?

19. Prioritization Activity
Each community group will be assigned one intervening variable (or contributing factor) for underage drinking
Use the data that you have brought and your knowledge of the community to answer the questions in the prioritization table
Come to a consensus on the importance and changeability of that variable (high/low)
Activity – Using the Prioritization handout
In community groups, work through the intervening variable (or a key contributing factor) assigned to your group. Based on your own data and analyses or your knowledge of your community to complete the grid to determine whether importance and changeability are high or low.

20. Underage Drinking Logic Model
Consequence
and Consumption
Patterns
Intervening
Variables
Strategies
Access/ Availability
Parental Monitoring
Underage
Drinking
Law Enforcement
Knowledge of
Health Risks
Advertising
Adult Modeling
School Policies

21. Constructing a Matrix Activity
Changeability
High Low
Importance
High
Low
Then groups will report out and facilitator will complete a giant 2X2 on newsprint with the intervening variables in their designated quadrant.
Using the newsprint 2X2 table facilitator will fill in the quadrants with the intervening variables
Next, the large group will look at the giant 2X2 table and as decision makers in this composite community to determine which intervening variables will become the priorities –
Discuss pros and cons for choosing high importance/ low changeability or low importance/ high changeability
If all are high/high- what other elements would you need to consider to prioritize? Would need to compare/contrast variable to eachother instead of looking only at one.
This process is one that can be replicated with needs assessment and capacity assessment data to prioritize in communities.

22. Logic Model Strategy Consequence and Consumption Patterns Strategy
Intervening
Variable
Strategy
Consequence
and
Consumption
Patterns
Intervening
Variable
Strategy
Strategy
Intervening
Variable

23. Identifying and Selecting Evidence-Based Interventions (EBIs)
Large group:
How are strategies selected? Give examples (what has been done in the past? What know how to do? New interesting program? Connections that we have?)
Why not continue to select strategies in that way?
State wide approach
Based on needs of community/ target audience
Notes:
At this point, you have assessed your needs and resources, know what capacities you have and what resources need to be increased, now you are ready to move into planning and selecting effective strategies. How do you know what to do? There are many programs out there that have shown to be effective with various groups of youth, parents, and communities. Check out the Samhsa website for this information. Remember CSAP also knows that there are many strategies that are “home grown” and occur in various communities around the country. They are trying to cultivate and disseminate these strategies through the process called, NREPP. (brief description)

24. High-Risk Drinking Logic Model
Consequence
and Consumption
Patterns
Intervening
Variables
Strategies
Knowledge
of Health Risks
High-Risk
Drinking
18-25 yr olds
Promotions
& Pricing
Consider this example of high risk drinking
Retail Sales/
Over-service
Lack of Screening/
Early Intervention

25. Strategy Match Low price alcohol specials in bars
Over-service of young adults
Consequence and Consumption:
High-Risk Drinking yr olds
Middle school curriculum
Mentoring Program
If you are trying to impact “intervening variable” and ultimately the “consequence” then strategies must match
These strategies do not match
Ask what intervening variables may the strategies shown impact?

26. Strategy Match Low price alcohol specials in bars
Over-service of young adults
Consequence: Underage Drinking
Consumption: Underage and Young adult binge drinking
Policy to limit drink specials
Responsible Server Education

27. Selecting Best Fit Prevention Interventions
Identify
Types of
Strategies
Select Specific
Programs,
Practices
& Policies
Ensure
Effectiveness
Best Fit
Prevention
Interventions
Demonstrate Evidence of Effectiveness
Demonstrate Practical Fit
Demonstrate Conceptual Fit
Relevant?
Practical?
Effective?

28. Conceptual Fit A “Good Conceptual Fit” intervention should:
Fit into community logic model
Drive positive outcomes in identified substance abuse problems
Address the community’s intervening variables
Be based on evidence-based principles for target population
Target multiple opportunities for intervention
If question to ask yourself is “Is the type of strategy relevant”?

29. Types of Strategies Policy Enforcement Communication Collaboration
Education
Define strategies
Small group activity – with one of the 3 logic models, begin thinking through potential types of strategies that may conceptually fit

30. Practical Fit for Community
Feasible given a community’s resources, capacities, and readiness to act
Add to or reinforce prevention strategies in the community—synergism and layering
Consider community climate
Meet cultural needs of target population
Sustainable in community
Saturation
Next criteria is practical fit – Can your organization do this in your community?

31. Practical Fit Activity
Assess how well the strategy practically fits your community:
Does your coalition have the staff and funding needed?
Do you have the necessary community contacts needed (police, leaders, etc.)?
Will the community support this strategy?
Does strategy reflect our community’s culture?
Could this strategy be sustained?
Activity – Use prescription drug use logic model*********
All groups will be given a strategy that addresses the same intervening variable. Assuming that you have decided to address [intervening variable] and the strategy your group has been assigned conceptually meets your need – fits into your logic model. Is that strategy practical?
Groups will answer the discussion questions to determine how well that strategy would fit in their community.
Ask groups to briefly report out on how practical the strategy could be for their community
Back up activity – ask tables to discuss which questions do they find themselves asking the most often regarding strategy selection in general
Make a handout

32. Prescription Drug Misuse Logic Model
Types of
Strategies
Consequence
and Consumption
Patterns
Intervening
Variables
Knowledge
of Health Risks
Prescription
Drug Misuse
18-25 yr olds
Need to define intervening variables and provide as a handout
Availability

33. Effectiveness Definition of Evidence-Based Interventions
Finding Evidence-Based Interventions
Creating a Comprehensive Approach

34. Paradigm Shift
From picking off lists to thinking critically about needs
From categorical labels to ratings along a continuum
From relying on strength of evidence alone to assessing the relative importance of strength of evidence in a broader context
From stand-alone intervention selections to comprehensive community plans
CSAP process to expand the field of potential strategies
Expert Workgroup on Evidence-Based Programming
Convene nationally recognized prevention researchers—diverse theoretical backgrounds and perspectives
Develop recommendations and guidelines for prevention planners—SPF SIG Program
Need broad array of evidence-based interventions, and
Flexibility to choose options that fit community circumstances

35. What is Evidence-Based?
Included on Federal lists or registries of evidence-based interventions
Reported (with positive effects) in peer-reviewed journals, or
3) Documented evidence of effectiveness based on guidelines developed by SAMHSA/CSAP
Workgroup decided on guidelines to assist in process of identifying strategies (not a new list) …

36. What is Evidence-Based? (con’t)
Guidelines for Documenting Effectiveness
Based in solid theory validated by research
Supported by a documented body of knowledge generated from similar or related effective intervention
Judged by informed experts to be effective
Informed experts could include state level group OR key community prevention leaders and/ or elders, or other respected learders within indigenous cultures.

37. How do you find Evidence-Based Interventions?
Federal Registries
CAPT Resources
Experts in the field (NIAAA, NIDA)
Research
This info will also be a handout

38. Definition of Peer-Reviewed Journals
Scientific journals in which submissions are reviewed and selected for publication by panels of experts in the field
In the case of proposed publications, an editor sends advance copies of an author's work or ideas to researchers or scholars who are experts in the field (known as "referees" or "reviewers"), normally by or through a web-based manuscript processing system. Usually, there are two or three referees. These referees each return an evaluation of the work to the editor, including suggestions for improvement. Typically, most of the referees' comments are eventually seen by the author. Scientific journals observe this convention universally. The editor, usually themselves understanding the field of the manuscript (although not in as much depth as the referees who are specialists), then evaluates the referees' comments, their own opinion of the manuscript, and the context of the scope of the journal or level of the book and readership, before passing a decision back to the author(s), usually with the referees' comments.
Referees' evaluations usually include an explicit recommendation of what to do with the manuscript or proposal, often chosen from a menu provided by the journal or funding agency. Most recommendations are along the lines of the following: to unconditionally accept the manuscript or proposal, to accept it in the event that its authors improve it in certain ways, to reject it, but encourage revision and invite resubmission, to reject it outright.
During this process, the role of the referees is advisory, and the editor is under no formal obligation to accept the opinions of the referees. Furthermore, in scientific publication, the referees do not act as a group, do not communicate with each other, and typically are not aware of each other's identities. There is usually no requirement that the referees achieve consensus. Thus the group dynamics are substantially different from that of a jury. In situations where the referees disagree about the quality of a work, there are a number of strategies for reaching a decision.
When an editor receives very positive and very negative reviews for the same manuscript, the editor often will solicit one or more additional reviews as a tie-breaker. As another strategy in the case of ties, editors may invite authors to reply to a referee's criticisms and permit a compelling rebuttal to break the tie. If an editor does not feel confident to weigh the persuasiveness of a rebuttal, the editor may solicit a response from the referee who made the original criticism. In rare instances, an editor will convey communications back and forth between authors and a referee, in effect allowing them to debate a point. Even in these cases, however, editors do not allow referees to confer with each other, and the goal of the process is explicitly not to reach consensus or to convince anyone to change their opinions. Some medical journals, however (usually following the open access model), have begun posting on the Internet the pre-publication history of each individual article, from the original submission to reviewers' reports, authors' comments, and revised manuscripts.
Traditionally reviewers would remain anonymous to the authors, but this is slowly changing. In some academic fields most journals now offer the reviewer the option of remaining anonymous or not, or a referee may opt to sign a review, thereby relinquishing anonymity. Published papers sometimes contain, in the acknowledgements section, thanks to anonymous or named referees who helped improve the paper.
Johns Hopkins School of Public Health

39. Using Peer-Reviewed Journals
Questions to consider when matching your community (conceptual fit, practical fit, effectiveness):
Was the program, practice, or policy implemented in a similar geographic area?
Was effectiveness documented in similar subgroups (such as race/ethnicity, sexual orientation, high school dropouts, age, gender)?
Does strategy show effectiveness in impacting your selected intervening variable(s)?
Does the study adequately rule out competing explanations for the findings?

40. How to Find Articles Google Scholar http://scholar.google.com/
Google scholar allows you to search for books and journal articles

41. Google Scholar Results
For example if you are interested in the research that supports responsible beverage service, you can go to this website type in “responsible beverage service” and you will come up with 329 articles that talk about this program
When seeing the number of results you can think about defining your search even more, for example search responsible beverage service in bars.
Also keep in mind that the first articles to appear are usually the most relevant, so consider looking through the first 20 articles to find what you need.

42. Developing a Comprehensive Approach
Use multiple interconnected strategies in order to reach community level change
Multiple strategies will complement and reinforce each other
Consider number of people impacted in each strategy

43. Ecological Model
Target multiple domains or contexts across the lifespan

44. Underage Drinking Logic Model
Consequence
and Consumption
Patterns
Intervening
Variables
Strategies
Social Host
Liability Policy
Underage
Drinking
Social Access/
Availability
???
Let’s address social access to alcohol contributing to underage drinking
Community needs assessment identified that youth were accessing alcohol through parents and community decided to work toward having the town implement a social host liability policy.
Small group discussion: What are some complementary strategies?
???
???

45. Underage Drinking Logic Model
Consequence
and Consumption
Patterns
Intervening
Variables
Strategies
Social Host
Liability Policy
Enforcement of social
Host liability policy
Underage
Drinking
Social Access/
Availability
Let’s address social access to alcohol contributing to underage drinking
Here are some examples of complementary strategies
Communication:
Social Marketing
Campaign
Collaboration:
Police and Community
Parent groups

46. Reach of Strategies How many people will your interventions impact?
Which sectors of the community will be impacted by your efforts?
What dosage of the interventions will target audience experience?
Saturation of your area – Instead of lots of strategies around one small group but moving toward population level change need to impact various sectors of community and reach many people
Population level change – community level change (community defined)
underage population in your community
not 6th graders in one school
Tool in binder to assess reach of all your strategies.

47. Summary of Things to Consider
Conceptual fit
Practical fit
Effectiveness
Comprehensive approach
Reach
There are lots of things to consider here is a summary.

48. Maine Learning Community: Implementing and Sustaining Efforts
March 26, 2007 Augusta, ME
Agenda
Implementation core components
Environmental strategies
Building capacity
Sustainability & funding sources
OSA will have opportunity to suggest what communities can do before then to prepare