**State of New Mexico**

**Strategic Prevention Framework State Incentive Grant (SPF-SIG)**

**State Strategic Plan**

**Prepared by Behavioral Health Services Division, Department of
Health**

**July 21, 2005**

**Introduction**

New Mexico's Strategic Prevention Framework State Incentive Grant: State
Strategic Plan provides a description of how the project will be
implemented. After a brief introduction, it describes the results of the
analysis of state problems and consequences and the process used to
prioritize from among those indicators. Following the summary of data, a
description of New Mexico's allocation strategy and initial
implementation plan is provided.

**Background of New Mexico's Strategic Prevention Framework Project**

New Mexico's Strategic Prevention Framework project is based on its
on-going prevention system development. The SPF SIG comes at an
opportune time for New Mexico, as its first SIG was able to demonstrate
substantial success in reducing risk and preventing use among
adolescents. The prevention system developed by the SSA over the past
decade is prepared to elevate its effectiveness through an infusion of
new assessment and planning strategies to build capacity, implement, and
evaluate effective, evidence-based programs, strategies and practices
that impact community wide indicators.

The SPF SIG project is directed by the Prevention Services Bureau of the
Behavioral Health Services Division of the New Mexico Department of
Health. The SPF SIG Advisory Committee is the Substance Abuse Advisory
Committee of the Interagency Behavioral Health Planning Council, an
overarching group appointed by Governor Bill Richardson to provide
leadership to the State's re-organized behavioral health system. The
Advisory Committee oversees five SAMHSA grants, and has one
subcommittee, the Prevention Advocates, that provides strategic guidance
to the SPF SIG project. Its membership consists of prevention
professionals and advocates from across the New Mexico who volunteer
their time and energy to this effort.

The Prevention Services Bureau directs the project through the
leadership of its Chief, Don Maestas, LISW, with an experienced staff of
program managers. The Bureau contracts for state level evaluation,
coordination, and training services. All contractors of these services
have worked with the state's prevention system for more than five years,
including throughout its first SIG project. Local communities are funded
through contracts to local agencies, coalitions, or fiscal agents who
must provide a closely monitored scope of services during a fiscal year.
Outcome evaluation at the local level is purchased by programs as a
contractual service provided by a professional evaluator.

**State Epi Profile**

The State Epidemiological Workgroup (SEW) has worked since October 2004
to develop the State Epi Profile. The resulting Profile highlights
consequences in several areas that are described in the following
section. The SEW consists of about a dozen epidemiologists from state
departments, the statewide evaluator, staff from the SSA, and is
coordinated by a contracted local firm that plans and directs the work
of the group. The Profile will continue to evolve with the project. It
contains data on consequences and use that are available at the state
and county level, and that are comparable to national indicators. The
major data indicators in the Profile are death data collected annually
by Division of Epidemiology of the Department of Health. In order to
have sufficiently reliable data for most of the State's thirty-three
counties, each major indicator is an aggregate of death data for a
five-year period. All rates provided represent a calculated number per
100,000 people. Those data are then analyzed within the document by
ethnic/racial group, age group, and gender. County rankings of rates are
provided, as are raw numbers and percentage contribution to the overall
state burden (number) per county.

**Problem Statement**

*Indicators Reviewed*

A review of the State Epi Profile will illustrate the range of
indicators considered in planning the prioritization of New Mexico's
substance abuse consequences and related use upon which to focus the
State's SPF project. Ultimately, four groups of indicators have been
selected under which to group all other data. These include as
consequence data:

-   Alcohol-Related Chronic Disease Death, with Alcohol-Related Chronic
    Liver Disease Death as its major component,

-   Alcohol-Related Acute Injury Death, with Alcohol-Related Motor
    Vehicle Crash Deaths as its major component,

-   Smoking-Related Death, and,

-   Drug-Related Death.

New Mexico does not have sufficient data sets for examining what might
be considered "less severe" consequence data across these indicators.
For example, data on drug-related crime is not consistently available at
the county level, and the state level data have been widely described as
unreliable by numerous members of the SEW because of multiple reporting
problems. In addition, the State does not have sufficient data for some
adult use and consequence data from its adult telephone survey, although
it does have reliable data for most youth indicators from its Youth Risk
and Resiliency Survey, which is the bi-annual statewide student survey
for New Mexico, an expanded version of the CDC-developed Youth Risk
Behavior Survey. DWI arrest data are included as one indicator in the
report, but those data are not considered to be indicative of
drinker/driver behavior but instead indicative of enforcement emphasis
at the local level, and to represent not so much a consequence as
perhaps an intervening factor

The SEW agreed early in its process that much of the data that were
ultimately needed for the project were not actually available and that
much of its work over the five years of the SPF would involve developing
strategies to improve the data and its availability. The four groups of
indicators that were identified as comparable as sources for county and
state level data, can all be used for national, state, and county level
comparison. Because of this comparability, the SEW agreed that these
four indicators would provide a suitable starting place as the first
iteration of the project's State Epi Profile.

*Profile of Substance Use Consequences and Use: Highlights*

Consequences of Substance Abuse: Nine of the ten leading causes of death
in New Mexico are at least partially caused by the abuse of alcohol,
tobacco, or other drugs. Ischemic heart disease is the leading cause of
death in New Mexico, followed by chronic lower respiratory disease,
cerebrovascular disease, and lung cancer, all of which are associated
with smoking. Chronic liver disease, motor vehicle accidents, suicide,
and diabetes are leading causes of death that are associated with
alcohol use. While the all-cause death rate varies somewhat by county,
the counties with the highest absolute numbers of deaths are the highly
populated counties of Bernalillo, Doña Ana, Santa Fe, and San Juan.

# Alcohol-Related Death. New Mexico has consistently had the second highest alcohol-related death rate in the United States (after Alaska). Death rates from alcohol-related causes increase with age. American Indians have higher alcohol-related death rates than other ethnicities. McKinley and Cibola counties have extremely high alcohol-related death rates, driven by high rates in the American Indian population. The counties with the most deaths from the five-year period are Bernalillo, McKinley, Doña Ana, Santa Fe, and San Juan. New Mexico has extremely high death rates due to both chronic diseases (33.3 per 100,000) and injuries (23.4 per 100,000) related to alcohol use.

# Alcohol-Related Chronic Disease Death. New Mexico's rate of death due to alcohol-related chronic diseases is more than 2.5 times the national rate. Death rates increase with age. American Indians, both male and female, and Hispanic males have extremely high rates. As with all alcohol-related death, McKinley and Cibola counties have the highest rates in the state. Alcohol-related chronic liver disease (AR-CLD) is the single cause that accounts for the most deaths due to alcohol-related chronic diseases.

-   [AR-CLD.]{.underline} AR-CLD is the principle driver of New Mexico's
    consistently high alcohol-related chronic disease death rate. AR-CLD
    death rates are extremely high among American Indians, both male and
    female, and Hispanic males. The high rates among American Indians
    and Hispanic males between the ages of 35 and 44 represent a
    tremendous burden in terms of years of potential life lost. While
    Bernalillo County has the highest number of deaths due to AR-CLD
    (391 over the years 1999-2003), four counties that stand out for
    their very high rates are McKinley, Cibola, San Miguel, and Rio
    Arriba.

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-   [Alcohol-Related Injury Death]{.underline}. The two highest causes
    of alcohol-related injury death are motor vehicle crashes and
    suicide. Males are more at risk than females. American Indians are
    at higher risk than other ethnicities, among both males and females.
    Hispanic males are more at risk than White Non-Hispanic males.

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-   [Alcohol-Related Motor Vehicle Crash Death (AR-MVC)]{.underline}.
    New Mexico's AR-MVC death rate has decreased dramatically over the
    past 20 years. However, Mew Mexico has the sixth highest AR-MVC
    death rate in the country, and the rate has not improved over the
    last ten years. Both male and female American Indians have elevated
    rates, especially younger males (age 15-44). McKinley, Rio Arriba,
    and San Juan counties have substantial AR-MVC deaths and high rates,
    with McKinley and San Juan county rates driven by the high American
    Indian rate, and the Rio Arriba rate driven by the American Indian
    rate.

-   [Suicide]{.underline}. Suicide is closely associated with alcohol
    and drug abuse. New Mexico's suicide rate has consistently been
    among the highest in the United States. Suicide rates are higher
    among males than among females for all ethnicities and age groups.
    White-Non Hispanic females have a higher suicide rate than females
    of other ethnicities. Among males, White Non-Hispanics and American
    Indians have the highest rates. The heaviest suicide burden falls on
    male American Indians between the ages of 15 and 44.

-   [Smoking-Related Death]{.underline}. New Mexico has historically had
    one of the lowest smoking related death rates in the nation.
    Nonetheless, New Mexico's number of deaths associated with smoking
    is considerably greater than the number associated with alcohol and
    other drugs. Males have higher smoking related death rates than
    females. Among males, Black Non-Hispanics have the highest rates,
    followed by White Non-Hispanics. Among females, White Non-Hispanics
    have the highest rates, followed by Black Non-Hispanics. Sierra,
    Lea, Eddy, Chaves, and Curry counties have the highest
    smoking-related death rates. In each of these counties, the high
    rates are driven by the high rates among White Non-Hispanics.

# Drug-Related Death. New Mexico has historically had the highest drug-related death rate in the nation. Drug overdoses account for more than 80% of drug-related deaths. The most common drugs causing death for the period covered in this report were morphine/heroin, cocaine, alcohol, methadone, and oxycodone. Drug-related death rates are higher for males than for females, however, the percentage of females dying from drug overdose is increasing. The highest rates are among Hispanic males, followed by White Non-Hispanic males. Rio Arriba, Chaves, Bernalillo, and Valencia counties have the highest rates in the state. Bernalillo County bears the highest burden of drug-related death in terms of total numbers of deaths.

[Alcohol, Tobacco, and Other Drug Consumption Behavior]{.underline}

Consumption is important to examine for reasons beyond the fact that
consumption behavior leads to negative consequences. For example, while
binge drinking by youth is a behavior that can lead to death or injury,
it is also a behavior that, if continued into adulthood, may lead to
very serious consequences from chronic drinking. Additionally, those who
have the heaviest consumption are not always those who have the most
serious outcomes. For instance, while Native Americans have the poorest
outcomes for many alcohol-related indicators, it is Hispanics that are
most likely to report binge drinking. Indeed, while New Mexico has some
of the worst alcohol related outcomes, consumption in New Mexico is only
about average compared to national rates.

# Binge Drinking (adult). Binge drinking, defined as drinking 5+ drinks on an occasion is associated with numerous types of injury death, including motor vehicle fatalities, suicide, and homicide. Among adults (age 18 or over) of all ethnicities, binge drinking was more commonly reported by males than females. Among males, Hispanics were more likely to report binge drinking than other ethnicities. Young adults (age 18-24) were more likely than other age groups to report binge drinking.

# 

# Binge Drinking (youth). New Mexico public high school students were more likely to report binge drinking than U.S. high school students. Among New Mexico students, binge drinking was more commonly reported by upper grade students than lower grade students. Hispanics were more likely to report binge drinking than White Non-Hispanic Youth.

# 

# Drinking and Driving (youth). New Mexico high school students were more likely to report driving after drinking alcohol than were U.S. students. Drinking after driving was more common among boys than girls, and was less common among White Non-Hispanic youth than among Hispanic, American-Indian, or Black youth. Eleventh and 12th grade students were more likely to report drinking and driving than 9th and 10th grade students.

-   [Drinking and Driving (adult)]{.underline}. These data have not yet
    been integrated into the State Profile but will be included in the
    next version of the report by the end of the month.

# Drug Use (youth). Marijuana and cocaine use were more prevalent among New Mexico students than among U.S. students. Among boys, marijuana use increased with each grade level. The use of cocaine, methamphetamine, or inhalants was less commonly reported by White Non-Hispanic students than by Hispanics, American Indians, or Blacks. The use of any of these three substances was more common among 12th grade boys than among 9th grade boys.

-   [Drug Use (adult)]{.underline}. County-level estimates of adult drug
    use are not available. However, the National Survey on Drug Use and
    Health (NSDUH) makes state-level estimates available. Estimates are
    for the year 2002. *Marijuana.* New Mexicans have the 12^th^ highest
    rate of past 30-day marijuana use in the nation. 7.4% of New
    Mexicans report marijuana use, while 6.2% nationwide report the
    same. Approximately 39% of NSDUH respondents in New Mexico and
    nationwide perceive a great risk associated with smoking marijuana
    once a month or more often. *Any illicit drug other than marijuana.*
    New Mexican respondents were more likely to report use of any
    illicit drugs other than marijuana than US respondents (NM-4.6%;
    US-3.7%). New Mexico has the fourth highest rate of use of illicit
    drugs other than marijuana in the nation. *Cocaine.* Past year
    cocaine use was reported by 3.1% of New Mexicans, while 2.5% of
    national respondents reported the same. New Mexico has the fourth
    highest rate of self-reported past-year cocaine use in the nation.
    *Drug dependence and abuse.* Drug abuse and dependence are very
    prevalent in New Mexico when compared to the rest of the nation. New
    Mexico had the sixth highest rate of drug dependence in the nation
    (NM- 2.1%; US- 1.9%), and had the highest rate of drug abuse in the
    nation (NM-12.0%; US- 9%)

-   [Smoking (Youth)]{.underline}. The percentage of U.S. high school
    students reporting current smoking (smoking cigarettes within the
    past 30 days) declined from 28.5% in 2001 to 21.9% in 2003. In 2003,
    30.2% of New Mexico high school students reported current smoking.
    This is well above the 2003 US smoking rate, and very close to the
    2001 US smoking rate. New Mexico boys were more likely to report
    smoking than New Mexico girls (31.9% and 27.7%, respectively).
    Current smoking rates increase by grade level among boys, but remain
    relatively stable by grade level among girls. Native American and
    Black students were more likely to be current smokers than were
    Hispanic and White Non-Hispanic students. In three counties, more
    than 40% of students reported current smoking (Mora County-48.7%;
    McKinley County-45.3%; Union County-40.4%).

-   [Smoking (Adult)]{.underline}. In 2002, current smoking was reported
    by 21.2% of New Mexico adults and 23.0% of U.S. adults. New Mexico
    men were more likely to report current smoking than New Mexico women
    (23.3% and 19.3%, respectively). Among both men and women, young
    adults (ages 18-24) were most likely to report smoking (32.3% of men
    and 24.0% of women), while those 65 years old or older were the
    least likely to report smoking (8.6% of men and 13.5% of women).
    This pattern was remarkably different among American Indian men.
    While 64.3% of American Indian men ages 65 and older reported
    smoking, only 14.0% of American Indian men ages 18-24 reported
    smoking. There was not a great deal of variation in smoking rates by
    race ethnicity. American Indians had the lowest smoking rate
    (12.6%), while Blacks had the highest (22.4%). Two counties had
    smoking rates of greater than 40% (Hidalgo County-49.0%; Union
    County 41.8%). An additional four counties had smoking rates of
    greater than 30% (Harding-34.3%; Quay-33.4%; Lea-33.3%;
    Cibola-31.4%).

The profile provided here is a summary, narrative version of the major
patterns that are shown in the detailed State Epi Profile.

**Criteria Used to Prioritize Indicators**

*State Level Priorities: Critical Needs*

The State Level Priorities for New Mexico's SPF have been determined
through a somewhat rigorous prioritization process. A model was
developed from numerous examples and strategies shared with the states
at the series of SEW meetings. New Mexico attended the first of these in
Denver, Colorado during Spring 2005. The criteria selected for New
Mexico's process are familiar from those examples. They include:

-   Severity -- state ranking within nation

-   Severity -- rate per 100,000

-   Burden -- number of persons/size of problem

-   Burden -- economic impact

-   Burden -- social impact

-   Trend Characteristics -- increasing, decreasing, stable, and
    compared to national trend

State level data were provided as collected in the State Epi Profile,
and participants were lead through the report using some of the
indicators so that they could quickly develop a familiarity with the
report and how to use it to find data. Data for the state rate and
number of persons/size of problem was provided in the report. The state
rank in the nation as well as trend characteristics were provided to the
participants verbally, although most of that information is included in
the narrative supporting the report. Each criterion was rated by
participants as either "high," "medium," or "low" on the provided
worksheet (and given 3, 2, or 1 point respectively in the later
scoring). To illustrate the rating process, some examples are provided
for which specific data points were provided in the Profile: New
Mexico's rank nationally for alcohol-related chronic disease death is
2^nd^ -- this was rated as a "high" priority based on the data and
compared to the other three priorities. Similarly, the state's trend
characteristics related to this indicator show that while the national
rate has decreased steadily over the past two decades, New Mexico's has
remained stable over that time, leading to a "high" priority for this
indicator. The state's ranking for tobacco-related death is 46^th^,
consequently this was rated as a "low" priority compared to the other
three areas.

Other criteria, for which the SEW had not provided data, were rated
based upon participants' background knowledge of the problem, including
economic and social impact, and the criteria included as secondary
considerations and described in the next section. The group process took
slightly over an hour each time it was conducted.

The New Mexico Prevention Advocates served as the group to conduct the
prioritization, as per the State's plan, along with the Prevention
Bureau staff (six individuals). A total of twenty-eight people
participated in this process in three separate small group sessions
during June 2005.

*Other Criteria Used in Prioritization*

Further consideration was given to less defined characteristics related
to the consequence data. These include:

-   Preventability/Changeability

-   Capacity/Resources

-   Perceived Gap between Capacity/Resources

-   Readiness/Political Will/Public Concern

For prioritizing on the state level, participants in the process were
asked to use their own background knowledge and understanding of these
problems and their consequences to make a judgment of these four items
relative to what the state priorities should become.

Participants were asked to use their own knowledge of the prevention
research literature to rate, in a relative manner, the preventability of
each consequence, relative to the other three. For example, what is more
preventable or changeable -- chronic alcohol use behaviors, acute/binge
alcohol use behaviors, smoking, or illicit drug use?

Each additional issue was posed in the same manner, asking participants
to use their own background knowledge of the four content areas to
assess their importance on a relative scale as high, medium, or low.

In general, the group discussed each indicator as it was considered in
turn. There was much more discussion about "other criteria" -- those
criteria dependent upon personal knowledge, experience, and informed
opinion -- than about the data-established "primary criteria." The
responses from participants were totaled and averaged by the SEW
coordinator, and the results reported here for the first time.

*Resources*

Resource data is being collected and assembled by the SEW as part of a
telephone and e-mail survey to community level stakeholders in each
county. It will be used to support local funding decisions, and then
used during the capacity building period, after awards have been made,
to help create community-wide action plans that leverage all of the
available resources in the community.

*Readiness*

Readiness data is also being collected which will also be used in the
capacity building phase of the project to work with communities to help
focus their efforts and create broad understanding of intervening
variables/causal factors.

These data are also collected in this process at the county level.

**Final SPF SIG Priorities**

*State Priorities*

Twenty-eight individuals with strong professional substance abuse
backgrounds completed the prioritization process, including the State's
Underage Drinking Program single contact and the State's DEA Demand
Reduction Officer. Ten items were ranked by each participant on a scale
of high (assigned three points), medium (assigned two points), and low
(one point). Each indicator could be assigned a maximum score of thirty
points by each participant. The following are the results of aggregating
and averaging the rating scores:

-   Alcohol-Related Chronic Disease Death Score: 25.2

-   Alcohol-Related Injury Death Score: 25.0

-   Drug-Related Death Score: 21.4

-   Smoking-Related Death Score: 18.8

The rating scores were consistent across participants, showing little
variation in the priority assigned by different individuals
participating in the process. As is evident from these results, a
consensus in this prioritization process developed in the numeric scores
that identified two indicators as possible priorities for the SPF SIG,
Alcohol-Related Chronic Disease Death and Alcohol-Related Injury Death.

The four criteria items with data provided from the State Epi Profile
and during the prioritization process by the participating
epidemiologist include:

-   Severity -- state ranking within nation

-   Severity -- rate per 100,000

-   Burden -- number of persons/size of problem

-   Trend Characteristics -- increasing, decreasing, stable, and
    compared to national trend

When only these four criteria were examined alone, the following
ratings, listed in descending order, resulted (a maximum of twelve
points could be assigned):

-   Alcohol-Related Chronic Disease Death Score: 10.8

-   Alcohol-Related Injury Death Score: 10.7

-   Drug-Related Death Score: 8.7

-   Smoking-Related Death Score: 7.1

As is apparent from these two sets of ranking results, the same two
indicators were ranked highest, with very similar scores, and the
relative numeric spread was consistent among the two different methods
of calculations.

The five-year span of the project limits the potential impact on chronic
disease death rates and the life-long consumption patterns that cause
New Mexico's high rates of death. On the other hand, alcohol-related
injury death rates, and the related consumption patterns, especially
binge drinking, that contribute to these rates, are more readily
impacted in a shorter time frame. Consequently, the State will focus on
Alcohol-Related Injury Death, which in New Mexico is primarily the
result of DWI crashes. New Mexico already has a broad policy focus on
DWI, and this is a very opportune moment to help focus on that indicator
with effective and comprehensive community-wide planning to prevent DWI.
In addition, there has substantial encouragement from CSAP to focus on
underage drinking, which is a major contributor to binge drinking and
DWI problems in the state.

New Mexico will focus its SPF SIG project on Alcohol-Related Injury
Death, and further prioritize this consequence as DWI, which is by far
the leading contributor to this indicator in New Mexico. An examination
of the data contained in the State's Epi Profile shows that Motor
Vehicle death rates are particularly high among those aged 15 to 24,
with more than a quarter of all of these deaths striking this age
category in every ethnic group. Therefore the primary focus of these DWI
prevention efforts will be on individuals in the 15 to 24 year old age
group, which suffers an inordinate burden due to the risky drinking
patterns of underage youth and young adults.

Each subrecipient community will study and assess the usage patterns
related to alcohol-related motor vehicle crashes among 15 to 24 year
olds in their community as part of the competitive proposal process.
This will be followed by a much more extensive assessment process that
will occur during the early award period, where numerous local factors
will be studied and assessed related to these problem usage behaviors
and their consequences.

The final decision to choose this SPF SIG priority was made, after
review of the priority scoring results and discussion with staff and
project leadership, was made by the Project Director, Don Maestas, Chief
of the Prevention Services Bureau. This decision was approved by the SSA
prior to finalization of this report.

*Allocation Plan for SPF SIG Funds*

New Mexico's SPF SIG funds will be allocated by a competitive Request
for Proposal (RFP) process that follows the state's procurement code. An
RFP will be issued during July upon approval of this plan by CSAP.
Proposals from communities will be due four weeks later, and a thorough
review process that scores proposals will be conducted to determine the
communities and projects to be funded by the initiative. With an
efficient award process, New Mexico will award funds for projects to
begin by late September. Eight to ten SPF Implementation grants will be
awarded, with award amounts ranging from \$100,000 to \$200,000,
depending upon quality of proposal and projected size of the population
to be addressed by the initiative. While these awards can only be made
for one year at a time under New Mexico's procurement code, the
procurement code allows them to be renewed based on satisfactory
performance for up to a total of four years, after which time a new
competitive RFP process must occur. With satisfactory performance, it is
anticipated that the amount of these awards would remain consistent over
the four-year period. Five to seven smaller capacity-building grant
awards, ranging from \$25,000 to \$50,000, will be offered to applicant
communities that exhibit high need but low capacity to implement a
rigorous community-wide problem-focused operation plan. These smaller
capacity building grant awards will focus on the first three SPF steps
\-- assessment, planning, and capacity building, providing an
opportunity for these communities to participate in training and
technical assistance activities for a year. They will be expected to
support the cost of data assessment activities lead by an external
evaluator as part of their funding. The evaluator will be an active
participant in all aspects of the project including assessment, capacity
building, implementation and evaluation. If these projects are
successful in creating capacity, they will have the opportunity to
implement rigorous strategies and evaluate their program success in the
second year of community level funding. These successful programs will
receive higher awards equivalent to those in the first cohort of
implementation grants. A portion of the available funding will be held
in reserve for these communities pending their progress during the first
year of the community award phase of New Mexico's SPF SIG. Should some
of these programs not succeed in meeting expectations and receiving full
implementation grants, the remaining, un-obligated funds will be awarded
to other community applicants through a new competitive funding process.

Proposals for funding will be scored on a 100-point scale for their
response. To support proposals that focus on communities and populations
with critical need, an additional ten points will be awarded to
proposals through a weighting process that assigns additional points for
applications from applicants within counties with critical need, and up
to an additional ten points will be awarded for a selected critical need
population focus (described further in the following section). To
emphasize matching resources to need, the State will also award an
additional five points to counties whose resources are lower per capita
than their critical need would suggest is appropriate.

The competitive funding process is open to all communities. However,
through the awarding of additional points in the scoring process to
critical need areas, New Mexico will be using an allocation planning
model that resources critical need geographic areas and critical need
population groups to address the State-identified priority problem.

*Priorities for Local Funding*

Priorities for local funding will be based on the state priority as
previously described. The State's selected priority of alcohol-related
motor vehicle crashes among 15 to 24 year olds will be required as the
over-arching focus, and subrecipients will be required to identify and
implement strategies focused on addressing the intervening variables
that lead to this consequence. Community initiatives will be required to
address these problem behaviors with evidence-based programs, strategies
and practices.

Within New Mexico's communities, applications to address the State's
priority indicator from counties with a critical need to reduce
alcohol-related motor vehicle death will be encouraged through the
assignment of additional points in the proposal scoring process.
Applicants from the top one third of counties with highest
Alcohol-Related Motor Vehicle Crash Death rates or the top one third of
counties with the highest number of Alcohol-Related Motor Vehicle Crash
deaths, based on data presented in the New Mexico State Epi Profile,
will be given preference through assignment of ten additional points to
the proposal score.

In addition, consequences described in the Profile indicate that Native
American males suffer an inordinately high rate of death from
Alcohol-Related Motor Vehicle Crashes, while Hispanic males suffer the
highest number of deaths statewide. Proposals representing broad
community initiatives that specifically focus on these particular
population groups will be assigned up to ten additional points in a
similar manner, depending upon the clarity of that focus as determined
in the proposal review process.

Other priorities to be scored in the review process include: a proposed
community-wide impact on the selected indicator(s); a broad range of
collaborators representing the major segments of the community who may
reasonably impact the problem when working together; a flexible,
problem-focused planning model that can successfully identify and
address intervening variables and causal factors; a preliminary plan to
address multiple intervening variables and causal factors across several
domains, including a substantial emphasis on environmental strategies;
sufficient capacity identified in the proposal to implement rigorous,
evidence-based initiatives; a plan to leverage other initiatives to
maximize outcomes across the community; a proposed work-plan that
identifies several intermediate outcomes that may reasonably impact the
problem and related indicators; a sound plan to identify and measure
baseline and periodic indicators that may impact the problem;
demonstration of "readiness to act" within the context of broad,
community-wide problems that must be addressed comprehensively in order
to expect measurable change.

Finally, a per capita evidence-based prevention "funding index," that
includes state directed substance abuse prevention funding from the SSA,
from the state's Underage Drinking Program authority, from DWI
prevention programs funded by the state, and from Drug Free Communities
funds, will be developed and applied to the counties. Those counties
with whose resources are lower than would be expected, based on their
need, will receive an additional five points in the proposal scoring
process. To operationalize this process, counties will be ranked by the
per capita expenditure of prevention resources available in the county
and the listing divided into quartiles. Those counties whose ranked
critical need in alcohol-related injury death is not in an equivalent
quartile representing resources, will have the additional five points
added to their score.

Communities with high need but low capacity will be integrated into this
initiative through a sustained capacity-building program. These
communities will receive smaller SPF capacity-building grants to
participate in a range of training, technical assistance, and
coalition-building programs. In the second funding year some of these
communities will be sufficiently prepared to successfully receive SPF
implementation funding.

A simple grid can illustrate the range of quality in responses to the
RFP as well as the range of responses that the State must be prepared to
make, whether in funding or in provision of technical assistance:

+-------------+-------------+-------------+-------------+-------------+
| **P         |             |             |             |             |
| rioritizing |             |             |             |             |
| Local       |             |             |             |             |
| Funding     |             |             |             |             |
| Based on    |             |             |             |             |
| Potential   |             |             |             |             |
| of          |             |             |             |             |
| Results**   |             |             |             |             |
|             |             |             |             |             |
| **Deci      |             |             |             |             |
| sion-Making |             |             |             |             |
| Matrix**    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
|             | **NEED**    | **          | *           | **          |
|             |             | RESOURCES** | *CAPACITY** | READINESS** |
+-------------+-------------+-------------+-------------+-------------+
| HIGH        |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| MEDIUM      |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| LOW         |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+

*Decision Making Process*

A broad based review team will score proposals, with three readers
reviewing each proposal. A rigorous review of each proposal will be
undertaken by the entire review team to create consensus within the team
that the best proposals, meeting the criteria described above, are in
fact rated as such. The proposals will be ranked in order of average
score and the top scoring proposals will be recommended for funding. The
Project Director will review the recommendations and present to the SSA
and members of the Substance Abuse Committee of the Behavioral Health
Planning Council, and to CSAP. Pending feedback and consent, awards will
be made in September.

**Integration with State Underage Drinking Initiatives**

New Mexico's SSA and Underage Drinking Coordinator have worked closely
throughout the SPF planning process. Through collaborative planning and
inter-agency partnering, the Enforcing Underage Drinking Laws (EUDL) RFP
process will be designed to complement the SPF SIG initiatives and not
duplicate or contradict the process or distribution of resources.
Initiatives will be required to leverage involvement across the
community to impact community level indicators. New initiatives funded
under the SPF will be required in the first and then in each successive
funding period to integrate their underage drinking program components
addressing DWI prevention with others operating in the community.

Given the CSAP encouragement to consider targeting underage drinking as
a priority, the emphasis on this behavior and addressing it within the
context of preventing Alcohol-Related Injury Deaths and DWI will be
supported. All of these funded projects, targeting underage drinking as
the "use" leading to binge drinking, DWI, injury, and death, will
participate in all state sponsored underage drinking initiatives,
trainings, town halls, and related events and all of these projects will
utilize the same theoretical logic models.

**SPF SIG Activities in Communities**

*Assessment*

Communities applying for competitive SPF funding through the RFP process
will conduct an initial needs assessment in response to the RFP. Upon
award of funding, those successful communities will enter an extensive
assessment process designed to develop a more specific, local analysis
of the funded priority consequence, and related problem usage patterns
and behaviors. Local evaluators will be required as a component of each
project, and will participate with local communities in the collection
and development of these more detailed data sets where they are
available, and the identification of gaps in data for future data
development and collection at the local level. These efforts will be
designed and supported by the state level evaluator, Behavioral
Assessment, Inc., who is under contract to perform the evaluation of the
State's SPF SIG, inclusive of the collection of baseline data and the
creation of a program logic model that integrates assessment and
baseline data collection into the overall program capacity of each SPF
subrecipient. Data collection, including problem assessment data,
baseline data, and outcome data at the program and community level, will
be conducted by local evaluators under the direction of the state level
evaluation team.

The SEW and state level evaluator will work together to develop
recommendations for data sets to be sought at the local level for reach
priority, including further usage data. The SEW will also support state
level work to create collection strategies where possible for all
communities. Several statewide workshops will be held during the first
month after funding to initiate this process.

*Planning*

Local projects will also participate in the development of a set of
intervening variables, causal factors, and risk and protective factors
that contribute to the data on use. This will lead to an extended period
of planning, which for the first cohort of local projects will be ninety
days, inclusive of assessment and capacity building. This planning
period will develop more sophisticated logic models for creating
evidence-based strategies that will address a broad range of intervening
variables and causal factors. It will include local planning to create
broad collaborative working processes and coalitions across communities,
counties, or tribal areas to collectively focus on one particular
problem. Evaluators will be expected to participate in designing and
leading, with local stakeholders, the data-driven community planning
processes, in a role that is very participatory.

*Capacity*

Capacity building activities will be supported during the first quarter
following award of funds. These will include numerous training and
technical assistance offerings provided by the State to support
expansion of local capacity to address one of the two priorities
addressed by SPF funding. Particular courses to be offered will be
selected from the following, which are already provided in New Mexico's
prevention training system but which will be "customized" to meet the
higher expectations of SPF, then provided to focus on New Mexico's first
cohort of local SPF subrecipients. The monthly meetings of
subrecipients, coordinated by Coop Consulting, Inc. under the direction
of the Project Director Don Maestas, will assess training needs of
subrecipients as a group, and individually. Training resources will be
allocated by the Prevention Services Bureau through its training
contractor. Trainings will be provided to the extent that funding can be
directed to support these activities. Mr. Maestas will ensure that
needed training is provided to subrecipients. The Prevention Bureau will
supervise the scope of work for its training provider to ensure
allocation of resources to support the SPF.

-   Prevention Generalist Training

-   Problem-Focused Planning

-   Cultural Competency: Working in Traditional, Minority, and Immigrant
    Communities

-   Data Collection/Needs Assessment

-   Using Logic Models for Planning

-   Coalition Building

-   Evidence-Based Environmental Strategies

-   Using GIS Software

-   Media and Social Marketing

-   Advocacy and Public Policy

-   Alcohol Merchant Education

These trainings will be evaluated to determine their effectiveness
through a contract with an external evaluator. That evaluator will
assess the impact of these trainings on workplace performance and
improved program effectiveness within the community. Increases in
workforce competencies will be the primary measure of this
effectiveness.

Subrecipients will participate in monthly daylong workshops for at least
the first year of the project. This workshop process will support
on-going quality improvement efforts and planning. Each workshop will
include a focus on assessment, planning, capacity, and evaluation.
Eventually implementation issues will also become a focus where a sort
of "best practice laboratory" is created. These sessions will include
subrecipients and other stakeholders and "experts" from New Mexico who
can contribute to the enrichment of all of these activities. In
addition, the subrecipients of the smaller, capacity building awards,
referred to in the previous "Allocation Plan for SPF SIG funds," will
participate in the training activities and monthly workshops described.

These trainings are and will be available to state staff, policy makers
etc., throughout the duration of the project in order to build capacity
at the local as at the state level.

*Implementation*

Implementation will begin based on local planning progress sometime near
the end of the initial ninety days of the grant period, which will have
focused on detailed assessment, planning and capacity building
activities. The State expects that the SPF activities will be provided
by a "collective" of organizations at the local level. The may be a
collaborative arrangement that may function as a traditional coalition,
or it may function as a flexible arrangement of groups who come and go
as needed in the implementation of targeted initiatives aimed at
particular problem behaviors. One of these organizations will be
expected to convene these local stakeholders and serve as a lead agency,
and either serve as or arrange for a fiscal agent for the five-year
project.

All activities will be evidence-based, whether programs, practices, or
strategies. An on-going emphasis will be place on coalition building and
environmental strategies. Local projects will be required to collaborate
with policy makers from local units of government, law enforcement
leaders from their communities, and other leaders and policy makers to
increase their ability to provide effective, multi-domain approaches to
problem behaviors. At the end of the initial ninety-day grant period,
each subrecipient project will submit an implementation plan that
summarizes the work of the period and lays out a logical process and
timeline to implement evidence-based activities, expand influence,
assess progress, improve quality of efforts, and reach the prioritized
community-wide objectives. This plan, and the included evidence-based
initiatives, must be approved by the Project Director before full
project implementation may begin.

*Evaluation*

Evaluation will be provided by local evaluators who are required as a
condition of the award to be a part of the project team. They will
assist in the assessment stage described above. Significantly for the
SPF, they will identify and collect baseline and later follow-up data to
evaluate progress towards objectives developed in the planning phase
above. They will practice on-going "empowerment" and participatory
evaluation that supports frequent reflection upon progress, design of
initiatives, planning effectiveness, etc. Under the direction of the
statewide evaluator, they will collect data for the state's evaluation
and lead the collection effort of the required national cross-site
evaluation data. Evaluators of the smaller, capacity-building projects
will only collect the cross-site evaluation data during the first
capacity-building year.

*Allocation of Funds to Support these Activities, including Funding
Mechanism*

Funding will be provided in the form of New Mexico's traditional
procurement process, which allows a monthly drawdown of grant funds for
the grant period. Funds for training activities are already allocated
through contract to The LifeLink, the State's prevention training
provider. Contractual funds are also provided to Coop Consulting, Inc.,
the provider of much of the State's centralized SPF planning and SEW
activities, and to Behavioral Assessment Inc., the project's state level
evaluator. Costs of travel and per diem to support subrecipient
participation in the monthly workshops in support of capacity building
will be included as part of the subrecipient contracts. Staff costs are
already covered within the New Mexico Department of Health.

*Community Implementation*

Community level implementation will be strategically planned during the
initial 90-day assessment, planning and capacity building period in
which all funded projects will participate. Detailed implementation
plans will address specific use and problem patterns that are identified
during this period. This implementation will be facilitated by the
on-going technical assistance and training program that will be
supported at the state level. This process will also support the
evolving picture of what constitutes a comprehensive set of intervening
variables and causal factors that contribute to particular prioritized
problems and consequences. New Mexico is confident that the learning
that occurs in this state supported process can contribute to the
national knowledge base of what will work at a local level, as a broad
"package" of on-going activities, to reduce consequences and usage.

*Implications*

These approaches will support targeted, flexible and reflective
assessment and planning processes that will enrich and sustain long-term
community wide collaborative approaches to reducing consequences and
usage patterns that contribute to those consequences. The envisioned
approaches will allow for on-going assessment of effectiveness and
impact, and create projects that are rapidly responsive to new data and
improved practice. The potential for using technology such as GIS
mapping that can be updated frequently to pinpoint geographic "hot
spots" and similar strategies to target peaks in usage that contribute
to problem behaviors is promising, and these kinds of strategies will be
applied across the range of community based projects.

Another implication of this process is the obvious demand for an
ever-increasing knowledge base of evidence-based approaches to working
in this kind of community collaborative manner which such a specific
problem focus. Another important component that will be demanded of the
project is the development of a strong peer technical assistance and
mentoring process as it will be impossible for state staff and their
limited pool of consultants and external resources to work continuously
with local community programs. One way the State proposes to answer this
need is to create a strong network of local evaluators who will function
as "empowerment evaluation" coaches, leading to strong program
self-assessment and quality improvement processes.

**Other Resources**

*Training Resources Directed Toward Assessment, Planning, and Capacity
Building Phase*

The resources of the State's Prevention Training System will be directed
toward the initial 90-day Assessment, Planning, and Capacity Building
phase of the project. Those include the courses listed previously:
Prevention Generalist Training; Problem-Focused Planning; Cultural
Competency: Working in Traditional, Minority, and Immigrant Communities;
Data Collection/Needs Assessment; Using Logic Models for Planning;
Coalition Building; Evidence-Based Environmental Strategies; Using GIS
Software; Media and Social Marketing; Advocacy and Public Policy; and
Alcohol Merchant Education.

These are current curriculum-based training programs that will be more
focused for this cohort of subrecipients and delivered in a concentrated
period of time to enhance existing capacity and to support more
comprehensive and targeted local strategic plans.

*Evaluation and Monitoring*

State level evaluation activities will be conducted by the State's
evaluation contractor, Behavioral Assessment, Inc. Their work will
involve identifying and collecting common outcome indicators that will
be measured across programs and aggregated at the state level. Local
evaluators with each project will complete that primary data collection
activity and submit to the state level evaluator.

Behavioral Assessment, Inc., will also direct evaluation training and
capacity enhancement activities with local evaluators to support the use
of an integrated empowerment evaluation approach with each local
project. This approach will result in assessment and data driven
planning processes that are more objective than the norm and that have
rigorous approaches to identifying local indicators of progress built
into the initial community plan. This will support monitoring activities
that will be provided by state program managers from the Behavioral
Health Services Division. This will provide a much more intensive
monitoring and technical assistance framework that will permit a rapid
response to problems that are identified within local community
initiatives or across the project as a whole. Monthly workshops to
develop effective assessment, capacity, planning, and implementation
activities and to provide a context for progress monitoring will be
coordinated by Coop Consulting, Inc. and project staff of the SSA.
Behavioral Assessment, Inc. and Coop Consulting, Inc. have contracts to
perform these activities on behalf of the project. The Project Director,
Don Maestas, will work closely with all components of the initiative to
create realistic work plans and timetables to reach project objectives.

*Statewide Epidemiological Workgroup*

The SEW will function throughout the project, meeting monthly to review
progress and address on-going data issues. It will update the new State
Epi Profile as soon as appropriate data are available. Its role after
awards are made will focus on identifying indicators that will support
effective project evaluation and measurement of change in indicators at
the state and community level. It is anticipated that alcohol-related
traffic crashes will be reduced in participating communities. It is also
assumed that by including a focus on communities with a large number of
the prioritized consequence data will result in an eventual impact upon
the statewide rates for these problems. The SEW will identify specific
measures that can be effectively collected to help assess these
indicators. Data on traffic accidents are collected routinely by the
Traffic Safety Bureau of the State's Transportation Department. Data are
collected bi-annually on underage drinking through the State's statewide
student survey, the Youth Risk and Resiliency Survey. These will be key
sources for data on community level changes in the prioritized
consequences. An adult telephone survey is also conducted by the State,
which will be utilized to collect related adult usage data. The SEW will
develop strategies to obtain and use these data to support the effective
measurement of state and community level change. These and other data
that may be identified later as appropriate for inclusion will be
aggregated and developed by the SEW at the state and county level.
Policy recommendations will be made for further data collection,
regarding indicators, frequency, collection strategies, and populations
to be sampled and assessed. Recommendations for funding enhanced data
collection activities, and for sustaining the work done by the project
will be made as appropriate. On-going surveillance and monitoring will
continue throughout the project, to include at least all of the
indicators already provided in the State's Profile.

**Crosscutting Issues**

*Cultural Competence*

Cultural competence will be a major component of New Mexico's SPF
project. New Mexico traditionally emphasizes a strong focus on culture,
broadly defined. Each community will self-identify the cultural issues
important to the prioritized indicators and problem behaviors that are a
focus of this project. These normally include ethnicity or race,
language, income or class issues, historical community versus
"new-comer" issues, and other issues specific to individual communities
and commonly identified as local cultural issues that lead to specific
behaviors, norms, and practices. Local programs will be expected to
provide the following analysis in their proposal for funding, based upon
culturally competent assessment and data collection strategies and
practices, and then to develop it in greater detail throughout the
project:

Provide and document evidence of local, culturally defined causes and
correlates of the identified problem (underage drinking or DWI),
including:

> 1\) Cultural norms, beliefs, and practices toward use and behavior
>
> 2\) How culture shapes community norms toward use and behavior
>
> 3\) How culture shapes illness and addiction
>
> 4\) How culture defines health

Programs must also provide logically derived plans to:

> 1\) Change culturally based community norms
>
> 2\) Reduce/prevent use and problem behavior

Questions to be addressed throughout the project include:

> 1\) Are there specific cultural practices toward health that will be
> enhanced by the initiative?
>
> 2\) How will the initiative address community and cultural norms?

*Sustainability*

Sustainability in New Mexico is viewed as resources and practices
devoted to maintaining and enhancing our constantly developing
prevention system. As we move forward with the implementation of the
Strategic Prevention Framework we are constantly thinking about
sustainability. In our minds we began to pursue sustainability at the
onset of this project. Our past experience with sustainability has been
very successful, as we have seen our general fund dollars increase with
the loss of our original State Incentive Grant and our practices
maintained and enhanced well beyond the end of the grant. This was
possible due to the fact that we integrated our learnings into our
entire prevention system, i.e., subrecipient requirements, including
evidence based prevention programming, are accepted and required of all
sub-recipients. The SPF SIG is well on its way to becoming the standard
for New Mexico's prevention system, including state and local levels. We
began educating our partners at both the local and state levels soon
after receiving the grant and we will continue with formal training
courses offered through our contractor. Equally important is the actual
implementation of the SPF SIG framework into every aspect of our system.
New Mexico's success in producing significant outcomes can be traced
back to implementation and constant development and improvement of our
overall prevention system.

In addition to activities intended to support subrecipients such as
training and ongoing

technical assistance, we have already began working at the state level
to educate state

staff, state partners, policy makers, etc on the implementation of this
project. Staff has

attended trainings and we are continuously providing information as the
project is being implemented. We began educating our state partners and
policy makers beginning last October through a variety of venues
including face-to-face briefings on the intent of the grant, and two
federal visits. These visits and information shared was vitally
important to

the implementation of this project as helped set the context,
importance, and opportunities of the SPF SIG.

Sustainability at the local level is an ongoing endeavor, which began
several years ago as New Mexico implemented our first five-year plan and
continued with the implementation of our second five-year plan and will
continue as we implement our third five-year plan. Each plan has taken
our "Prevention System" to the next level in their abilities to
implement evidence-based prevention programming. One of our primary
goals throughout this process has been the development of a state of the
art Prevention System, which we know will never be attained but will
always be pursued. As a result of this continued emphasis on creating
the best possible system, New Mexico's prevention programs are some of
the best in the nation and as a result they have been able to leverage
additional resources from a variety of sources at the local, state and
federal levels. New Mexico's Prevention System emphasizes the importance
of every aspect of the system. And because of this emphasis
sustainability as evidenced by the continued development of our local
programs has been successful to date. We will be continuously address
sustainability as the project is implemented and demonstrates success.
Forums of community leaders and stakeholders who participate in
successful local initiatives will be held beginning in the second year
of the project, allowing for sufficient time to explore possible
sustainability strategies in each community.

**Challenges**

The major challenge faced in developing a need based allocation strategy
has been the fear in small communities, especially Native American
communities, that by using county level indicator data, they will not be
eligible to participate in the project. While the State is relying on
county level data to establish a framework to examine indicators, there
is no implied intent to fund at the county level. Describing this
apparent contradiction to local advocates has been an on-going
challenge. A challenge to the project as it is implemented will be
developing effective data collection strategies that represent smaller
communities accurately.

A major challenge is the necessary allocation of state staff and
contracting resources to provide meaningful guidance and technical
assistance to evolving projects. Project leadership that constantly
enhances its knowledge and uses an expanding number of effective
resources such as the CAPT's is essential to the success of New Mexico's
SPF. On-going development of staff skills and other leadership resources
is essential. Working with other state level resources such as New
Mexico's Alcohol Issues Consortium, local "experts" from the DWI field,
local evaluators and trainers, policy leaders, law enforcement
officials, the State's Underage Drinking Coordinator and DEA Demand
Reduction Coordinator is equally essential to reach the potential that
is possible for this project. Simply assessing the possible
contributions from all of these stakeholders and allocating these
resources will be a major challenge in and of itself. Many of these
stakeholders have other resources that are available to them, and these
will be sought and managed within this context.

An additional challenge is seeding the productive development of
sufficient capacity and readiness in communities where they do not now
exist to assess, plan, implement and evaluate complex initiatives. This
part of the State's plan will continue to be developed so that it will
meet with success during the project period. The number of communities
selected to participate in this level of the project is likely to be
smaller so that additional oversight and monitoring can occur that will
create the likelihood of success.

**Projected Milestones**

mid-August 2005: Issue Request for Proposals (RFP)

mid-September: Receive proposals

late-September: Review and score proposals, panel recommends awards

early October: Negotiate contracts

mid-October: Finalize contracts

late-October : Projects begin Assessment, Planning, and Capacity
enhancement phase

November - January: Multiple Training Activities

November 2005 -- September 2006: Monthly Subrecipient Workshops

November 2005 -- February 2006: Collection of community baseline data

March 2006 -- September 2006: On-going collection of local outcome
evaluation data

**Appendix**

*Prioritization of Data Indicators at the State Level* Worksheet

*New Mexico State Epi Profile*