Strategies & Principles ofCommunity Based PreventionCommunity Based Prevention

Kevin P. Haggerty, Ph.D.Director

Social Development Research Group,

School of Social Work

haggerty@uw.edu

Objectives

• What are the key principles guiding prevention efforts?– Risk Factors

– Protective Factors– Protective Factors

– Evidence Based Programs

• How can communities use the research base for prevention?– Communities that Care

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4

Community Prevention Guidedby Prevention Science

• Community owned and operated• Data Driven: Ongoing monitoring of risk and

protective factors –use your surveys

• Evidence Based: adoption of effective programs– Evaluations of unproven programs are required and – Evaluations of unproven programs are required and

supported.

• Outcome Focused: reductions in community levels of adolescent risk taking behavior

• Sustainable• Sound Investment

35 Years of Research Advances

1. We know what predicts many negative developmental outcomes as well as behavioral health.

2. We know what works to change those 2. We know what works to change those predictors and prevent behavioral problems in our youth.– Experimental trials have identified over 50 effective

interventions for promoting behavioral health and preventing negative developmental outcomes.

King County Best Startskingcounty.gov.beststarts

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InterventionsInterventions

Program Implementation and Evaluation

Prevention SciencePrevention ScienceFrameworkFramework

Define the Problem

Identify Riskand ProtectiveFactors

Problem Response

Community

Risk Factors for Adolescent Problems

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Family

School

Individual/Peer

Protective Factors

Individual Characteristics– High Intelligence– Resilient Temperament– Competencies and Skills – Competencies and Skills

In each social domain (family, school, peer group and neighborhood)– Prosocial Opportunities– Reinforcement for Prosocial Involvement– Bonding– Healthy Beliefs and Clear Standards

The Social Development Model—Five elements of Protection

Different communities havedifferent risk/protective profiles

In su f fic ie nt n umbe r ofst u de n ts in th is are a.

Neighborhood #2

12John A. Pollard , P h.D. Dev elopmental Res earch and Pr ogram s

No s tu den tsin t his a re a .

Neighborhood #1 Neighborhood #3

Peer-Individual

Types of Risk may Vary by Community or School

50%

60%

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High School B Risk Profile

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1. In every sphere

2. Same factors predict many well-being outcomes

3. Addressing one can impact many outcomes

Five key points about risk andprotective factors?

FamilySchool

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impact many outcomes

4. Operate in the same way across gender, race and ethnic, socio economic and regions

5. More protection = Fewer problemsMore risk = More problems

Individual/Peer

Community

Evidence Based Programs: Whatbenefits do proven programs offer?

1. Improve child well-being at a population level

2. Stronger and more consistent positive outcomes for children and positive outcomes for children and youth in the community

3. Strong ethical argument – avoid potential harmful effects

4. Potential cost savings to taxpayers and society 16

Evidence Based Program Examples: Risk focused programs address variety

of outcomes

Strong African American Families

Prevention is a wise use of publicfunding

PROGRAM

COST ($) BENEFIT ($) BENEFIT MINUS

COST

BENEFIT FOR

EVERY DOLLAR

SPENT

EARLY CHILDHOOD EDUCATION $7,420 $26,480 $19,060 $3.60

READING RECOVERY $1,895 $22,781 $13,181 $9.82

LIFE SKILLS TRAINING $34 $1,415 $1,382 $35.66

From Lee, S., Aos, S., Drake, E., Pennucci, A., Miller, M. and Anderson, L.(2012). Return on investment: Evidence-based options to improve statewide outcomes, April 2012 update. Olympia: Washington State Institute for Public Policy. Documents ID: 12-04-1201

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LIFE SKILLS TRAINING $34 $1,415 $1,382 $35.66

PROJECT TOWARD NO DRUG

ABUSE

$14 $123 $109 $8.61

SEATTLE SOCIAL DEVELOPMENT

PROJECT

$2,959 $6,237 $3,249 $2.11

GOOD BEHAVIOR GAME $150 $14,508 $14,358 $96.80

D.A.R.E $99 0 $-99 0

How does a program earn thedistinction of being proven?

Attain strong evidence of

positive program outcomes

Produce indicators

of positive

• Conduct evaluation with random assignment

• Conduct evaluation with random assignment Ensure

Obtain evidence of

positive program

outcomes

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Develop a strong

program design

• Carry out evaluation with a comparison group

• Conduct regression analysis (quasi-experimental design )

• Perform multiple pre- and post -evaluations

• Meta-analysis

• Carry out evaluation with a comparison group

• Conduct regression analysis (quasi-experimental design )

• Perform multiple pre- and post -evaluations

• Meta-analysis

positive outcomes

assignment (experimental design)

• Carry out multiple evaluations with strong comparison group (quasi-experimental design)

assignment (experimental design)

• Carry out multiple evaluations with strong comparison group (quasi-experimental design)

• Conduct pre- and post-intervention evaluation

• Conduct pre- and post-intervention evaluation

• Evaluate program quality and process

• Establish continuous improvement system

• Evaluate program quality and process

• Establish continuous improvement system

Ensure fidelity of

Implement-ation

• Create logic model and replication materials

• Create logic model and replication materials

What are the essential characteristics of a proven program?

Impact Evaluation Quality

Positive impact on child well-being outcomes

Absence of any negative effects

One randomized controlled trial OR a quasi-

experimental trial without design flaws

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System Readiness

Intervention Specificity

Population of focus is clearly defined

Risk and protective factors that a program seeks to change is identifiable

Training materials are available

Information on the financial and human resources are

required

Cost-benefit analysis

Evidence Based Programs….Where to Turnhttp://www.colorado.edu/cspv/blueprints/

Why Universal Programming?

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The Challenge

How can we take tested and effective

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effective prevention programs to scale?

What Has NOT Worked in Community Based Preventive Trials ?

Providing resources to support community

coalitions without a structure or process to ensure

• clearly defined, focused, and manageable goals based in data, with corresponding high-quality data sources to data, with corresponding high-quality data sources to monitor progress;

• use of tested and effective programs, with careful attention to monitoring of implementation quality and fidelity;

• evaluation of program impacts on outcomes meaningful to the community(Hallfors et al. (2002); Klerman et al. (2005); Merzel & D'Afflitti, (2003).

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What Has Worked in Community-Based Prevention Trials?

• Preventive interventions focused on malleable community level risk / protective factors. factors.

• Strategies that build local partnerships or coalitions to promote use of tested and effective programs to address community

prevention needs.

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Examples

• Communities Mobilizing for Change on Alcohol- Wagenaar

• Community Trials Intervention to Reduce High Risk Drinking- Holder

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High Risk Drinking- Holder

• Project Northland- Perry

• Midwestern Prevention Project –Pentz

• PROSPER-Spoth/Greenberg

• Communities that Care— Hawkins, et al.

Common Elements ofCollective Impact

• Common Agenda

• Shared Measurement System• Shared Measurement System

• Mutually Reinforcing Activities

• Continuous Communications

• Backbone Support Organizations

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Kania & Kramer, 2011

Communities Communities That Care That Care Develops Capacity toDevelops Capacity to

Build a coalition of diverse stakeholders to achieve collective impact.

Assess and prioritize for action- risk, protection, and behavioral health outcomes.

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outcomes.

Strengthen protection and address priority risks with effective preventive interventions.

Sustain high fidelity implementation of preventive interventions to reach all those targeted.

CTC Overview Video

Measure to ensure success~ Are fewer teens drinking? ~ Fewer committing violent acts?

Implement system

Communities Communities That Care That Care Process to OutcomesProcess to Outcomes

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Approx. 1 year to plan & implement

Achieve outcomes~ Lower risk: 2-5 years~ Higher protection: 2-5 years~ Lower rates of problem

behavior: 4-10 years

Number of CTC communities implementing effective programs

2004-2008Program 2004-05 2005-06 2006-07 2007-08

Sch

oo

l-B

ased

All Stars Core 1 1 1 1Life Skills Training (LST) 2 4* 5* 5*Lion’s Quest SFA (LQ-SFA) 2 3 3 3Project Alert - 1 1 1Olweus Bullying Prevention Program - 2* 2* 2*Towards No Drug Abuse (TNDA) - - - 2Class Action - - - 1*Program Development Evaluation Training 1 1 - -Program Development Evaluation Training 1 1 - -

Sel

ecti

veA

fter

sch

oo

l

Participate and Learn Skills (PALS) 1 1 1 2Big Brothers/Big Sisters 2 2 2 1Stay SMART 3 3 1 1Tutoring 4 6 6 7Valued Youth 1 1 1 -

Fam

ily

Fo

cuse

d

Strengthening Families 10-14 2 3 3 2Guiding Good Choices 6 7* 8* 7Parents Who Care 1 1 - -Family Matters 1 1 2 2Parenting Wisely - 1 1 2

Total number of programs 27 38 37 39

31*Some funded locally

(Fagan et al., 2009)

Adoption of Science-Based

Prevention

Community Collaboration for

Prevention

Appropriate Selection & Implementation of

Tested, Effective Prevention Programs

CTC Logic Model

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CTC Coalition Functioning &

Capacity

Community Norms

Social Development

Strategy

Community Support for Prevention

Positive Youth Outcomes

Decreased Risk & Enhanced Protection

CTC Capacity Building and

Technical Assistance

Communities That Care =Powerful Results

• 33% tobacco

• 32% alcohol

• 25% delinquent

A large trial of Communities That Care produced reductions in drug use and delinquency compared to control communities

• 25% delinquent behavior

(Hawkins et al. 2009; 2014)

Sustained Effects One Year after Intervention Funding Ended

• In the panel, compared to controls, 10th graders from CTC communities had:– Lower levels of targeted risk factors.

– Less initiation of delinquent behavior, alcohol use, and cigarette use.alcohol use, and cigarette use.

– Lower prevalence of past-month cigarette use.

– Lower prevalence of past-year delinquency

– Lower prevalence of past-year violence.

Hawkins et al., 2012, Archives of Pediatrics and Adolescent Medicine

Is the benefit worth the cost of CTC?

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Yes!

Communities That Care is Cost-Beneficial –even when effect sizes are reduced by 50%

For every $1 spent $4.23 return on investment

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For every $1 spent $4.23 return on investment~ Low risk of negative investment return

Largest share of benefits was from delinquency prevention

Findings sustained from 8th through 12th grade

The Social Development Model—Five elements of Protection

8th Grade ProtectionCTC vs Controls (standardized means)

COMMUNITY SCHOOL FAMILY PEER/INDIVIDUAL

p=0.021

38Control

CTCKim, Hawkins et al., under review

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A Future Guided by PreventionScience Principles

• Community owned and operated• Data Driven: Ongoing monitoring of risk and

protective factors –use your surveys

• Evidence Based: adoption of effective programs– Evaluations of unproven programs are required and – Evaluations of unproven programs are required and

supported.

• Outcome Focused: reductions in community levels of adolescent risk taking behavior

• Sustainable• Sound Investment

The eCTC ImplementationSupport System

• CTC workshops are locally facilitated and streamed as communities are ready for them in an accessible format.

• Web streamed workshops allow flexibility in scheduling the CTC workshops, refresher workshops, and training for new community leaders and coalition members.

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ConclusionsPrevention Science Advances

• Behavior problems are significant causes of adolescent morbidity and mortality

• Risk and protective factors that predict behavior problems are potential targets for intervention

• There is sufficient evidence from controlled trials that policies • There is sufficient evidence from controlled trials that policies and programs can prevent adolescent behavior problems

• Community based prevention should include a combination of locally prioritized and chosen efficacious preventive policies and programs

• CTC achieved intervention fidelity and impact at scale

www.communitiesthatcare.net

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Kevin P. Haggerty, Ph.D.Director of Research

School of Social Workhaggerty@uw.edu