Module Three

Prevention Program Planning

### Time

The anticipated time for the module is four hours.

### Learning Objectives

Participants will be able to:

-   Describe the 5 steps of SAMHSA's Strategic Prevention Framework

-   Understand the basic components of completing each step

-   Understand where to get additional information on completing the 5
    steps

-   Understand CSAP and NIDA prevention principles

-   Enhance a prevention program using these prevention principles

### Materials and Preparation

1.  Prepare an overhead or LCD projector with the appropriate slides.

2.  Prepare five posters, each labeled with one step of the Strategic
    Prevention Framework.

3.  Be ready to use the following information and worksheets:

    -   **SAMHSA's Strategic Prevention Framework At-A-Glance**

    -   **Defining and Mobilizing the Community**

    -   **Defining the Community**

    -   **Mobilizing the Community**

    -   **Community Readiness Summary**

    -   **Institute of Medicine Continuum of Care**

    -   **School- Family- and Community-based Prevention**

    -   **U, S or I?**

    -   **CSAP Principles of Effective Substance Abuse Prevention**

    -   **Society/Environmental Domain**

    -   **NIDA Prevention Principles**

    -   **Cultural Competence**

> 4\. Use a **video cassette recorder and monitor** to show the video
> ***Environmental Prevention Strategies: Putting Theory into
> Practice.***

[Note to facilitator]{.underline}:

This module provides an overview of a framework for comprehensive
prevention planning. It does not describe all of the tasks and
activities involved in operationalizing the steps in the framework.
Rather the intention of this module is to provide a foundational
overview of the concepts and elements that inform and drive
comprehensive, data-driven prevention planning. Additional trainings on
understanding and implementing the SPF are being developed.

### Format of Facilitator Notes

Trainer instructions are in *italics.* Suggested narrative is in normal
font.

The topic for Module 3 is comprehensive strategic planning. In this
module we will explore a planning framework which uses data to make
informed decisions about what types of interventions are best suited to
address substance abuse and its related problems in a community.

### Integrating the SPF throughout the SAPST

*Module 3 was developed based on SAMHSA/CSAP's Strategic Prevention
Framework and provides an overview of each of the Steps as well as
addressing Cultural Competency and Sustainability. When covering the
module content the facilitator must be diligent in making the
connections between the content covered the previous 2 modules.
Additionally, the facilitator should foreshadow the importance of the
content to the remaining modules. For example, Module 4 addresses SPF
Steps 4-5, Implementation (Step 4) and Monitoring and Evaluation (SPF
Step 5), in detail.*

Slide 1

*Show slide, **Planning for Action**. Review slide.*

Slide 2

*Show slide, **Prevention** **Planning**. Review slide.*

Planning allows us to be intentional and thoughtful and to use our
resources wisely. In this module we will explore how to build an
effective community prevention plan. Although there are various
frameworks for prevention planning, the planning framework used in this
workshop is based on SAMHSA's Strategic Prevention Framework (SPF).
Since the SPF will be used by all SAMHSA grantees and sub-grantees, we
have chosen this framework to include it in this curriculum. In order
for prevention efforts to be effective, it is crucial to plan, to
strategize, and to involve multiple and diverse segments of the
community (e.g. school, family, religious institutions, grass-roots
neighborhood organizations, and busi­nesses) when creating a
comprehensive plan. The steps discussed in this section can assist
prevention planners to do this.

Slide 3

*Show slide 3, **Activity: 7-Up**. The following is an optional activity
to increase participants\' understanding of the need for plan­ning. (5
minutes)*

*Tell participants you want them to join you in an activity called
\"7-UP.\" Then give them the following instructions:*

-   It is very important that you perform well in this activity, so
    listen carefully.

-   There are two instructions for this activity:

1.  There are to be 7 people standing in the room at all times

2.  No one person is to stand for more than 5 seconds at a time

*Do not respond to any questions, but quickly follow these instructions
with:*

-   \"GO!\"

> *Observe, but do not speak with participants. After about a minute,
> call \"time\" and debrief the activity around the following
> questions*:

-   What happened? *(Point out that most people just assumed they
    couldn\'t talk to each other, that some people tried really hard to
    participate and make it work, others exhibited frustration and gave
    up trying, others refused to play at all, and still others may have
    tried to organize the group at some point, with varying degrees of
    success.)*

-   Did the instructions sound clear and specific at first? Did the fact
    that you were told that it was very important that you perform well
    create stress?

-   What would have made it easier for you to be successful?
    *(Communication, an articulated reason for doing the activity, a
    mutually agreed-upon plan, coopera­tion, encouragement, celebration
    of success, etc.)*

-   What does this activity have to do with planning? *(Compare this
    experience with the way many of us do prevention in our communities.
    We know it is very important that we are successful in helping young
    people avoid the use of drugs. There are many people, programs,
    agencies and organizations working hard to prevent adolescent
    substance abuse, and we can get frustrated when our desired outcomes
    are not achieved. A few of us might try working together, but there
    is rarely any overall community plan for prevention that informs
    each of us how our piece \"fits\" into the bigger picture of
    prevention in our community, why we are doing what we\'re doing, how
    we know it is likely to work.)*

Slide 4

*Show slide, **Community Prevention Systems**. Review slide.*

Slide 5

*Show slide, **Focus for Communities**. Review slide.*

SAMHSA/CSAP has issued its definition of "evidence-based strategies"
which should be used to define the third bullet on the slide ("Based on
evidence-based research and empirical data"). The definition as of
January, 2007 is as follows:

Evidence-based Strategies are those which:

-   Appear on a Federal list

-   Appear in a peer-reviewed journal as effective

-   Demonstrate effectiveness based on the three new guidelines for
    evidence issued by CSAP in January, 2007:

    -   Guideline 1: The intervention is based on a solid theory or
        theoretical perspective that has been validated by research;

    -   Guideline 2: The intervention is supported by a documented body
        of knowledge -- a converging accumulation of empirical evidence
        of effectiveness -- generated from similar or related
        interventions that indicate effectiveness; and

    -   Guideline 3: The intervention is judged by a consensus among
        informed experts to be effective based on a combination of
        theory, research, and practice experience. Informed experts may
        include key community prevention leaders, and elders or other
        respected leaders within indigenous cultures.

Examples of consequence related outcomes measured at the population
level include: number of alcohol-related vehicle accidents by white
males ages 21-25 in ABC Community; number of brain injuries that are a
direct result of inhalant use.

Slide 6

*Show slide 6, **How Can We Create a Comprehensive Plan?** Review
slide.*

Slide 7

*Show slide 7, **Focus of the Strategic Prevention Framework**. Review
slide.*

Slide 8

*Show slide 8, **Key Principles of the SPF**. Review slide.*

Public health is community health. It has been said that health care is
vital to all of us some of the time, but public health is vital to all
of us all of the time. The mission of public health is to fulfill
society\'s interest in assuring conditions in which people can be
healthy. The three core public health functions are:

-   The assessment and monitoring of the health of communities and
    populations at risk to identify health problems and priorities

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-   The formulation of public policies designed to solve identified
    local and national health problems and priorities

-   To assure that all populations have access to appropriate and
    cost-effective care, including health promotion and disease
    prevention services, and evaluation of the effectiveness of that
    care.

The Public Health Approach to prevention planning focuses on the
interaction of three elements:

-   *Agent*: ATOD use and consequence of ATOD use

-   *Host*: ATOD users

-   *Environment*: Climate that encourages, discourages or sustains
    substance abuse

Slide 9

*Show slide 9, **Outcomes Based Prevention**. Review slide.*

Slide 10

*Show slide 10, **Outcomes Based Prevention (Graphic)**. Review slide
explaining how the elements on the graphic flow.*

Community is the unit of measure for the SPF. Therefore, changes in
substance abuse and related problems at the community and population
level are the goal. Data is what drives the entire Strategic Prevention
Framework. Assessing community needs involves collecting actual data on
patterns of consumption and the consequences of consumption for a
particular community. Baseline data (current assessment data) shows
where we are starting, as well as where we would like to be (desired
outcomes). Along the way we will measure our progress toward where we
want to be (toward desired outcomes) and exactly how we got there
(process).

Intervening variables are what drive the behaviors, such as risk factors
and protective factors, as well as other factors (e.g. inadequate
enforcement of laws controlling underage access to alcohol). The
programs, policies and practices selected and implemented by a community
will address the intervening variables (such as risk and protective
factors) with the goal of changing substance abuse and related problems
at the community/population level.

Slide 11

*Show slide 11, **SAMHSA's Strategic Prevention Framework**. Give a
brief overview of each step. Refer participants to the **SAMHSA's
Strategic Prevention Framework At-A-Glance** information sheet to follow
along.*

The goals of the SPF are to:

1\) Prevent the onset and reduce the progression of substance abuse

2\) Reduce substance abuse related problems

3\) Build capacity and infrastructure

The SPF planning model consists of 5 steps which connect and loop back
to each other, creating a continuous cycle. Data is used for each step
in a systematic way to make informed decisions about what types of
interventions are best suited to address substance abuse and its related
problems in a community. Through asking questions of assessment data and
mobilizing the community, informed planning decisions can be made
regarding setting priorities, selecting intervention strategies,
appropriating resources, implementing interventions, modifying
interventions as needed, and planning for sustainability throughout the
process. Each step is to be considered in the context of cultural
competency in relation to a specific community. Cultural competency will
dictate how each step is operationalized in a specific community, the
tools and resources that will be used, the types of interventions that
will be implemented, and the types of evaluation procedures and tools
that will be utilized.

*Many facilitators have found it useful to post each step on newsprint
on the wall to refer to throughout the SAPST training, showing where
each section of the curriculum is "anchored" in the 5-step process, and
as a check for understanding of participant learning. The newsprint
poster for each step can be revealed as each Step is discussed.*

Slide 12

*Show slide 12, **Activity: Guided Walk**.*

*Have participants form groups of 8 persons each. Have each group form a
line with their hands on the shoulders of the person in front of them.
Then ask everyone to close their eyes, except for the first person at
the front of each line. Tell the groups they will be led around the room
by the one person with his/her eyes open, while the others follow,
keeping their eyes closed. Explain that you will move around the room
tapping people on the shoulder, which indicates they may open their
eyes. Have groups walk around the room negotiating various obstacles.*

How did the leaders feel to be the only one with their eyes open? How
did others in the group feel when only the leader had his/her eyes open?
How did things changed when others had their eyes open?

*Make sure the point is made that through effective planning everyone
has their eyes open to the process and understands where they are going,
leading to a greater chance of success.*

Slide 13

*Show slide 13, **SAMHSA's Strategic Prevention Framework** (with
Assessment highlighted), and display poster for Step 1.*

Each step feeds into the next, and a continuous cycle is created. The
first step we will review is "Profile population needs, resources, and
readiness to address needs and gaps."

The SPF planning model uses data in a systematic way to make informed
decisions about what types of interventions are best suited to address
substance abuse and its related problems in a community. This first step
is when consumption and consequence data is gathered and analyzed.
Through asking questions of the data available, informed decisions can
be made regarding setting priorities, selecting intervention strategies,
appropriating resources, implementing interventions and modifying these
as needed, and planning for sustainability throughout the process.

Slide 14

*Show slide 14, **Step 1 -- Assessment**. Review information on slide.*

Assessment in this framework requires us to explore the prevalence of
substance consumption and substance related problems, as well as
resources, gaps, and a community's state of readiness. We want to be
able to drill down to the most specific information available at a
community level about substance abuse rates, consumption patterns, and
substance related problems. Data at the county, town, city,
neighborhood, reservation, and school level is more useful for planning
community interventions than is state level data. By drilling down to
the most specific information possible, we are able to plan for specific
interventions that focus on groups and contexts which are most impacted
by ATOD consumption and consequences, as revealed by the data.

Assessment requires us to explore rates and patterns of ATOD use and
abuse as well as related problems (consequences). Examples:

-   [Prevalence data]{.underline}: refers to "how many/much
    [now]{.underline}," e.g. percentage of 18-24 year old women, by
    ethnicity, who are current users of cocaine; current rates of
    alcohol use among 45-55 year old White males

-   [Incidence data]{.underline}: refers to "how many initiated the
    behavior and when," e.g. percentage of females, by ethnicity, who
    first use alcohol prior to age 10; rates of African American men who
    first use cigarettes prior to age 25

-   [Consequence data]{.underline}: refers to "what happened to how
    many," e.g. percentage of skin burns attributable to cigarette use,
    in people ages 25-35 who use smoking tobacco; the number of motor
    vehicle crashes involving 18-25 year old males, by ethnicity,
    directly attributed to alcohol use; the number of brain injuries
    caused by inhalant use among 8^th^ grade students

Examination of substance consumption and consequence data is an ongoing
process. Communities will need to use the data to make decisions about:
present needs, existing resources that address those needs, the match
between the needs and existing resources, priorities based on gaps
between the identified needs and existing resources, progress achieved,
and priorities for capacities that need to be built or mobilized in the
future to address changing needs.

Slide 15

*Show slide 15, **Why Do We Need to do an Assessment?** Review
information on slide.*

A comprehensive assessment takes the guesswork out of where prevention
efforts should be focused. It provides a complete picture of where your
community is regarding the four questions on the slide. Getting the full
picture means knowing your community's level of readiness, the
prevalence of ATOD use and related problems, intervening variables such
as risk and protective factors, and the resources available in your
community.

Slide 16

*Show slide 16, **How Do I Conduct an Assessment?** Review slide.*

What are the elements that constitute a comprehensive community
assessment?

[Create an Assessment profile]{.underline}

Accurately assess substance abuse related problems using epidemiological
data. Use data on ATOD consumption and consequences to define what the
ATOD related problems are in a community. Measuring progress involves
comparing baseline information about problems with changes in this data
after interventions have been implemented.

Identify the magnitude of the substance abuse problem and where it is
greatest.

What are the nature, extent, and impact of ATOD related problems in a
community? Are there particular places, times, groups of people who seem
to be "driving the data"? The magnitude of burden of particular problems
is an important consideration in the priority setting process for
planning. By addressing those problems that are driving the rates of use
and related consequences, we maximize the potential for achieving
population level outcomes while effectively utilizing limited prevention
resources. When analyzing data, drill down to the most specific
information possible. This can be done by asking "reporter" questions,
such as "Who," "What," "When," "Where," "How," and "Why." For example,
where are the bulk of motor vehicle crashes involving alcohol occurring?
Who is involved in the greatest number of these crashes? When do they
occur? What are the costs of these crashes (legal costs, medical costs,
lost time for work/school, etc.)?

[Define and Mobilize Your Community]{.underline}

*Refer participants to the information sheet* ***Defining and Mobilizing
the Community***.

The defined community is where the 5 SPF steps are applied. The
selection of a focus community should be grounded in data (consequence
data as well as prevalence and incidence data) that indicates a problem
among a specific group of people. A community can be a county, a city, a
town, a neigh­borhood, an ethnic community, a reservation, a military
reserve, an unincorporated area, an area served by social service
agencies, a school district or an individual school. How you define your
community will determine who you will focus on as you work through each
of the planning steps. Your community definition should include
geographic, demographic, cultural, service and organization profiles.

For example, a community could be a core group of middle school boys who
attend three different schools in one school district who are using
marijuana. This would make the school district your community. Or it
could be a county that is experiencing high rates of alcohol abuse among
45 to 55 year old Caucasian women.

*Refer participants to the worksheets **Defining the Community** and
**Mobilizing the Community**. Have participants spend a few minutes
jotting some notes on their worksheet, Defining the Community. Then ask
participants to find a partner and spend 10 minutes discussing who some
of the stakeholders might be in their community, referring to the
worksheet, **Mobilizing the Community.***

[Implement community readiness tool]{.underline}

After the community has been defined and mobilized, we must assess the
extent to which the defined community is ready to implement a substance
abuse prevention plan. Refer to the information sheet, **Community
Readiness Summary**. The information from NIDA on community readiness
came from a review of communities implementing prevention. The review
team identified characteristics impacting effectiveness and organized
them into nine stages. Communities that enjoy higher levels of readiness
implement more effective prevention programs. However, acknowledgement
of a problem is the foundation of readiness, but not the same as
readiness as you will see in a moment when we discuss stages of change.

[Assess available resources and gaps in service]{.underline}

What does the community already have in place to address the identified
ATOD problems? How effective have these resources been?

*Drive home the concept that the data drive the process of selecting
programs, policies, and practices to implement in a community. Reinforce
this concept in each of the steps of the SPF.*

Slide 17

*Show slide 17, **Stages of Change**.*

When considering a community's readiness to implement a substance abuse
prevention plan, The Stages of Change Model, developed by Drs. Carlo
DiClemente and James Prochaska provides a valuable context. The idea is
that change is a process, and that individuals and communities are at
various levels of motivation, or readiness*,* to change. Communities at
different stages of change can benefit from different interventions,
matched to their stage of change. The five stages of change are
pre-contemplation, contemplation, decision/determination, action, and
maintenance. Earlier stages of change correspond to lower levels of
readiness. The slide lists the five stages of change with suggestions
for moving communities to the next level.

*Ask participants how they think this information could be useful in
enhancing their community's level of readiness.*

Slide 18

*Show slide 18, **Questions to Consider**. Use these questions to
stimulate conversation among the participants.*

*Optional additional questions that could be used to stimulate
conversation:*

-   *What seems to influence the prevalence rates of use? (risk and
    protective factors)*

-   *Once you have completed an assessment, how much more refined will
    your target population be?*

-   *Do you anticipate that your target population will change through
    the assessment?*

Slide 19

*Show slide 18, **SAMHSA's Strategic Prevention Framework** (Capacity
highlighted). Review slide and show poster for step 2.*

Each step of the SPF feeds into and loops back to the others, and a
continuous planning cycle is created. Next, we will talk about the
second step, "Mobilize and/or build capacity to address needs."

Slide 20

*Show slide 19, **Step 2 -- Capacity: What is it?** Review slide.*

Capacity means various types and levels of resources that an
organization has at its disposal to meet implementation demands.
Resources include:

-   Human resources (staff or volunteers) with specific skill sets
    needed to carry out your goals and objectives, leadership skills,
    program development, and others

-   Technical resources such as facilities, equipment, and other fixed
    capital

-   Management and evaluation resources

-   Funding

Can your organization or coalition bring about the changes it would like
to make in order to prevent or reduce substance use/abuse? The answer to
that question can be found once capacity is assessed.

Slide 21

*Show slide 20, **Capacity: Why is it Important?** Review slide.*

After using data to determine present needs, we consider the existing
resources to address the identified needs.

Data is used in this step to make objective decisions about:

1\) Whether there is a match between resources and needs. Are the
resources located in the same area where the needs are?

2\) Setting priorities based on the match between the needs and the
resources that currently exist to address these needs

3\) Where capacity to address other needs should be developed

Slide 22

*Show slide 21, **Capacity: What Does it Involve?** Review slide.*

Capacity building is not a single event, but rather an ongoing process
that evolves with the changing needs of your community. You will need to
continually build your human, technical, and financial resources.

Mobilizing resources within your own organization or coalition will help
you begin to assess the match between the needs determined in assessment
step of the SPF and the existing resources at your disposal to meet
these needs. In order to build capacity you first need to know what
resources already exist and what resources are lacking. You also need
broad-based support, a multifaceted approach, and the resources to
effect sustainable substance abuse prevention policies, programs and
practices. Ideally you would assess your own organization's capacity to
address the identified need and then expand to explore the capacity of
resources outside of your organization when crafting a prevention plan.
Increasing community readiness is an important aspect of capacity
building.

Engaging stakeholders, all members of a community who have a vested
interest or stake in the success or failure of the activities/outcomes
of your efforts, is a part of capacity building. Without engaging these
persons through new or existing partnerships or coalitions, it will be
much more difficult to plan for and achieve your goals and outcomes.

To "engage" means to take into one's employment; to promise, to pledge;
to occupy the attention; to interlock so that power is transmitted
(Oxford American Dictionary, 1980). It is not enough to simply publicize
your efforts, you need to actively involve people in a strategic manner
best suited to their skills, abilities, willingness and availability at
a state as well as local community levels.

*The following are optional questions to stimulate discussion about
engaging stakeholders:*

-   How would you know someone is engaged?

-   What are some markers or ways you would know if you have
    successfully engaged key stakeholders?

Engaging/building coalitions is a very useful method of building
capacity within a community. Utilizing the collective skills, resources
and political capital of coalition members in a community-wide,
comprehensive approach can provide the greatest chance for long-term
impact and lasting success.

Developing readiness in your organization, coalition and within the
community to meet the identified needs can be advanced through
education, training and/or technical assistance. These efforts should
move beyond awareness of the issues and include skill-building efforts
related to evaluation and sustainability. Of equal importance is
attention to cultivating a culturally competent approach to prevention
interventions, from assessment through evaluation. Cultural competency
should be achieved by all staff, from support staff to clinical and
service providers to organizational management staff through training
and technical assistance.

Utilizing a comprehensive approach, not focused solely on funding or a
single organization, through assessing and making the best use of the
collected skills, resources, experience and expertise of a group will
enhance and expand those resources that currently exist. Continued
creative collaboration will build sustainable programs and sustainable
outcomes.

Focusing on evaluation also contributes to building capacity. Building
the capacity to evaluate your planning process, your capacity building
activities, your implementations, and your desired outcomes contributes
to your work towards your desired outcomes.

Slide 23

*Show slide 22, **Questions to Consider**. Review slide.*

*Use these questions to stimulate discussion about capacity building.*

Slide 24

*Show slide 23, **SAMHSA's Strategic Prevention Framework (Strategic
Planning highlighted)**. Review slide and display poster of Step 3.*

Now we will turn our attention to developing a comprehensive strategic
plan. This plan will build from your work in steps 1 and 2 of the SPF.

Slide 25

*Show slide, **Step 3: Develop a Comprehensive Strategic Plan**. Review
slide.*

The third step in the Strategic Prevention Framework is to develop a
comprehensive strategic plan. The planning process should produce
strategic goals, objectives, and performance targets, as well as logic
models and in many cases action plans.

Logic models are graphic depictions of a planned intervention. A logic
model should be developed for each planned intervention. If the
intervention is developed by a coalition or other collaborative group,
or if a single organization develops a multi-component intervention, an
overarching logic model should be developed as well as logic models for
each component of the project. Each member organization of the
collaborative should develop logic models for the particular part of the
intervention for which they are responsible. In-depth information on
creating a logic model will be covered in the Evaluation Module of this
curriculum.

Slide 26

*Show slide, **Why Do I Need a Strategic Plan?** Review slide.*

Your strategic plan outlines what will be done over time to create
change in your community, including planning for future capacity needs,
interventions/services and infrastructure development to support the
interventions.

Your plan is grounded in data and should begin with a theory of change,
from which an intervention will be developed and a logic model built.
Your theory of change describes the rationale for believing that your
selected strategies and evidence-based programs, policies and/or
practices will result in your desired changes, or outcomes, in the
substance related problems of your focus population.

Slide 27

*Show slide, **Institute of Medicine Prevention Classification** Review
slide.*

The Institute of Medicine (IOM) has proposed another way to
conceptualize prevention. *Refer participants to the **Institute of
Medicine Continuum of Care** information sheet and briefly explain the
continuum from prevention through treatment and maintenance. Use the
information sheet to guide you in your explanations.*

Universal strategies address the entire population. Selective strategies
focus on subsets, or subgroups of the population exposed to greater
levels of risk. Indicated strategies are designed to prevent the onset
of substance abuse in individuals who have initiated the use of alcohol
or other drugs of first use.

*Refer participants to their information sheet, **School-, Family- and
Community-Based Prevention Strategies. ***These are some examples of
universal, selective, and indicated strategies that NIDA has shown can
be effective in reducing substance abuse when implemented in schools,
families, or communities.

*Optional Activity*: Now you have an opportunity to apply your newly
acquired knowledge by classifying prevention strategies as universal,
selective, or indicated. *Refer them to their work sheet, **U, S or
I?*** Assign the appropriate classification to each example by checking
the box in the appropriate column*. Using the **U, S or I? Answer
Sheet** at the end of this section, review the correct answers.*

Questions to consider when crafting this plan:

-   Is it truly comprehensive?

-   Have you looked at all the appropriate data? Were all the
    appropriate people involved in the process?

-   Have you considered all the angles?

-   Does the plan, as written, make sense to someone who had no input?

Slide 28

*Show slide, **How do I Create a Strategic Plan?** Review slide.*

There are some suggested standards for developing a strategic plan to
achieve measurable outcomes. Start with an articulated vision. Be
deliberate.

Design a plan that contains programs, policies and/or practices that:

-   Is directly responsive to your assessment of needs and resources

-   Is built upon a theory of change

-   Is comprised of elements and activities related to the theory of
    change

-   Can demonstrate positive outcomes in different settings over time

Creating, monitoring, evaluating, and adjusting a strategic plan over
time ensures that it is a dynamic tool that supports both sustainability
and responsiveness to changing issues, data, priorities, and resources.

Slide 29

*Show slide, **Questions to Consider**. Review slide.*

*Use these questions to stimulate discussion on strategic planning.*

Slide 30

*Show slide, **SAMHSA's Strategic Prevention Framework** (Implementation
highlighted). Review slide and display poster of step 4.*

With our comprehensive strategic plan in place, we will focus on
selecting and implementing evidence-based prevention programs and
activities to address our priority substance abuse consumption and
consequence problems identified in Step 1 of the SPF. We will use our
resources and capacities identified in Step 2 to support implementation
of these evidence-based prevention programs and activities.

Slide 31

*Show slide, **Step 4- Implementation: What is it?** Review slide.*

This step involves taking action as guided by the strategic plan
developed in Step 3 of the SPF. In Step 4, you develop detailed action
plans for each component of your intervention, ensuring cultural
competency and fidelity of implementation of programs and activities.
Balancing fidelity and adaptation involves maintaining the core
components of a program or strategy while making necessary adaptations
for your focus population. Often program developers can guide the
development of planned adaptations. In Step 4, you will also begin the
final development of a detailed evaluation plan that includes evaluating
adaptations as well as evaluating process and outcome measures and
ongoing monitoring of implementation fidelity.

Slide 32

> There are a number of recognized scientifically defensible prevention
> principles that communities can use to guide the design and
> implementation of programs that work. Refer to the Information Sheets,
> **CSAP Principles of Substance Abuse Prevention** and **NIDA
> Prevention Principles**. We will be looking at these two sets of
> prevention principles, one from CSAP and one from NIDA.
>
> Show the slide, **CSAP Principles of Substance Abuse Preven­tion**.
>
> These principles are divided into six domains, or areas of influence:
> individual, family, peer, school, community, and
> society-environmental. CSAP identified these principles as common
> elements of effective programs. They can guide preventionists in
> developing innovative programs and strengthening existing programs in
> these domains. They are a set of useful implementation guides.

Slide 33

> *Show the slide, **Individual Domain**.*
>
> Prevention interventions implemented at the individual level seek to
> change knowledge of and attitudes toward substances and substance
> abuse with the ultimate goal of influencing individual behavior.
> Effective individual-level substance abuse prevention programs
> incorporate some common principles.
>
> *Review these principles as listed on the slide.*

Slide 34

> *Show the slide, **Family Domain.***
>
> Prevention interventions implemented at the family level seek to
> reduce family risk factors and increase bonding to family, healthy
> family beliefs and clear expectations. Common principles of effective
> family-level substance abuse prevention programs are listed on the
> slide.

Slide 35

> *Show the slide, **Peer Domain**.*
>
> Prevention interventions implemented at the peer level attempt to
> involve peers in prevention education, provide accurate perceptions of
> peer involvement with substances, and support non-using peer networks
> and activities. Common principles of effective peer-level substance
> abuse prevention programs are listed on the slide.

Slide 36

> *Show the slide, **School Domain**.*
>
> Prevention interventions implemented at the school level seek to
> increase students' bonding with school, support academic achievement,
> and create positive school climates. Common principles of effective
> school-level substance abuse prevention programs are listed on the
> slide.

Slide 37

> *Show the slide, **Community Domain**.*
>
> Prevention interventions implemented at the community level endeavor
> to increase young people's bonding to community and address community
> norms favorable to substance use. Common principles of effective
> community-level substance abuse prevention programs are listed on the
> slide.

Slide 38

> *Show the slide, **Society/Environmental Domain**, and refer
> participants to the information sheet, **Society/Environmental
> Domain**.*
>
> Prevention interventions implemented at the society/environmental
> domain address norms favorable toward substance use and abuse,
> policies enabling use and abuse, lack of enforcement of laws designed
> to prevent use and abuse, and utilize strategies focus on the
> environment as a whole. Common principles of effective
> society/environmental prevention strategies are listed on the slide.

Slides 39, 40, and 41

> *Show the slides, **NIDA Prevention Principles**, and refer to the
> corresponding information sheet. Discuss the principles using the
> information sheet as your guide.*
>
> *Prepare for this section by reading the corresponding information
> sheets and preparing a short overview lecture on each principle. You
> can find more information on the prevention principles at
> <http://modelprograms/samhsa.gov/pdfts/pubs_Principles.pdf>, at
> <http://www.nida.nih.gov/Prevention/principles.html> and at
> [http://modelprograms.samhsa.gov](http://modelprograms.samhsa.gov/) ,
> click on "Publications," then "CSAP\'s Guides to Science-based
> Practices," then "Principles of Substance Abuse Prevention."*

*More information on the NIDA Prevention Principles can be found by
reading, "Prevention Drug Use Among Children and Adolescents: A
Research-based Guide for Parents, Educators, and Community Leaders,\"
located at <http://www.nida.nih.gov/Prevention/Prevopen.html>.*

Slide 42

*Have participants work in table groups. They are now ready to apply the
information they have been learning about the principles. Show the
slide, **Enhancing Prevention Programs**.*

As a group, select a prevention program or activity with which you are
familiar. Determine in which domain the pro­gram takes place. Review the
information sheets, **Principles of Substance Abuse Preven­tion,
Society/Environmental Domain,** **NIDA Prevention Principles,** and
**Environmental Strategies.** Make recommendations to enhance the
program, based on the find­ings presented in the information sheets.

*After about 30 minutes, ask a few groups to present any interesting
enhancements they came up with.*

You can use these findings as guidelines to enhance existing prevention
programs. This can be especially useful when communities are not looking
to implement a new program. They can also be useful when communities are
unable to find an evidence-based practice which matches their needs. In
this case, the findings can be used to modify or develop a program.

Slide 43

We will now view a video **Environmental Prevention Strategies: Putting
Theory** **into Practice**. This video has been selected to highlight
environmental strategies which are attracting much interest and have
been shown to be very effective in reducing and preventing substance
abuse.

*Show the video (24 minutes).*

Slide 44

*Show slide, **Fidelity and Adaptation**. Review slide.*

Balancing fidelity of implementation of a program or strategy while
adapting it for special populations involves maintaining the core
components of the program or strategy which are responsible for
achieving its outcomes, while making cultural adaptations that will
enhance the program with a particular population. Program developers are
important resources in our efforts to maintain high program fidelity
while making necessary adaptations to increase their appropriateness.
Evaluating adaptations will reveal their appropriateness and
effectiveness.

Slide 45

*Show slide, **Implementation Planning: Why?** Review slide.*

Implementation of a prevention intervention is a dynamic process. It can
be easy to drift from your intended plan as you implement it over time.
Action plans should be maps with the best route to reach your
destination clearly marked. They provide a reference tool for ensuring
that you are able to follow the best route, adjusting as necessary to
accommodate unexpected detours along the way, and marking progress
towards your destination.

When you were planning for a particular intervention, you were also
planning the necessary capacity to support and sustain it. You may need
to build capacity to provide the infrastructure for your activities
before they can begin. You may need to develop the human, technical or
financial resources necessary to support your activity or program. As
program needs change over time, capacity needs evolve. The planning
process is not stagnant; rather it is a continuing cycle that builds
upon itself.

Slide 46

*Show slide, **Questions to Consider**. Review slide.*

*Use these questions to stimulate discussion on selecting and
implementing evidence-based practices, policies and programs.*

Slide 47

*Show slide, **SAMHSA's Strategic Prevention Framework** (Monitor and
Evaluate highlighted). Review slide and display poster of step 5.*

Next we turn our attention to monitoring, evaluating, sustaining, and
improving or replacing those programs/strategies that fail.

Slide 48

*Show slide, **Step 5: Monitor, Evaluate, Sustain, and Improve...**
Review slide.*

This step builds off steps 1 through 4 of the SPF. Evaluation actually
begins with our work in step 1 as we gather baseline assessment data,
resource data, and data on community readiness. It continues with our
work in step 2 as we assess the human, technical, financial, and
organizational capacities. Our logic models, developed in step 3,
provide the basis for our evaluation plan, and implementing
interventions in step 4 involves gathering process and fidelity data
that will be used in step 5, evaluation. Evaluation also includes
gathering outcome data to assess program effectiveness and suggest areas
of improvement.

Module 4 of this curriculum will explore this final step in more detail.

Slide 49

*Show slide, **Why Do I Need Evaluation?** Review slide.*

Evaluation allows us to report our short-term outcomes in a timely
manner. If we are realizing our anticipated outcomes, that's great. If,
on the other hand, our anticipated outcomes are not forthcoming, we can
use our evaluation data to design adaptations and adjustments. Process
evaluation allows timely insight into possible issues involving fidelity
and adaptation of implementation. Evaluation also enables us to assess
our long-term outcomes in order to determine if we are making progress
toward our ultimate goals.

And evaluation provides information we can use to communicate with our
key stakeholders, thus supporting sustainability.

Slide 50

*Show slide, **How Do I Accomplish This Step?** Review slide.*

Once evaluation data is collected and analyzed, we use our evaluation
results to improve our strategic plan and our implementation of
evidence-based practices. An in-depth discussion of evaluation will
occur in the Evaluation Module of this curriculum.

Slide 51

*Show slide, **Two Common Threads**. Review slide.*

Slide 52

*Show slide, **SAMHSA's Strategic Prevention Framework**. Review slide.*

Sustainability and cultural competence are at the center of the SPF,
indicating that we are to incorporate principles of cultural competence
and sustainability as we address each step. Cultural competency and
sustainability underpin the planning model. Being intentional in the
planning process regarding each of these elements is crucial in
developing a prevention intervention that is suited to and accepted by
your focus community.

Slide 53

*Show slide, **The SPF and Cultural Competence**. Review slide*.

Cultural competence means that our assessment processes, measures and
tools; our organizational structures; our strategic plans; the
interventions we select to implement the materials and methods employed
in that implementation; and our evaluation measures and processes help
to eliminate disparities, honor and respect individual and group
differences, and assure quality.

Attention to the needs, styles, values and beliefs of the various
cultures with whom we work is crucial to developing prevention plans
that utilize strategies that are appropriate and effective for
particular groups of people on which we are focusing our efforts.

Slide 54

*Show slide and refer participants to information sheet, **Cultural
Competence**. Review slide.*

Cultural competence is a bit like mercury -- you know it's there, you
can see it, but it can be hard to get a grip on and examine. Cultural
competence is not measured only by the number of cultural competency
trainings program staff have participated in (though that can be a part
of fostering culturally competent systems, agencies and professionals).
The Lewin Group, 2002 identified the following seven domains that
reflect cultural competence:

-   *Organizational Values*: Are mid- and high-level staff responsible
    for coordinating cultural competence activities that are reflected
    in the agency's business and program plan and is funding provided to
    support their efforts?

-   *Governance:* Do formal cultural competence-related policies exist
    regarding personnel, board development, communication and
    community/client input?

-   *Planning and Monitoring/Evaluation:* Is client satisfaction
    regarding cultural competence-related planning sought in the
    development, integration and implementation of cultural competency
    plans?

-   *Communication:* Do staff/professionals demonstrate effective
    communication with diverse groups? Does the agency engage in two way
    communication with the community from which its clients come?

-   *Staff Development:* Is there investment (monitory and other) in
    cultural competence training for staff at all levels of the agency?
    Are staff evaluations conducted in a culturally competent manner?

-   *Organizational Infrastructure:* Is the overall budgetary allocation
    and investment in cultural competence activities aligned with the
    strategic plan? Are formal and informal alliances/links maintained
    with the community and other partners to address cultural competence
    issues?

-   *Services/Interventions:* Are tailored outreach and community
    education initiatives fostered? Do focused prevention plans reflect
    cultural competence related factors?

Slide 55

*Show slide, **The SPF and Sustainability**. Review slide.*

Sustainability is "the *process* of ensuring an adaptive and effective
substance abuse prevention system that achieves long term results that
benefit a focus population" (Johnson, Hays, Center, and Daley, 2004).

Attention to sustainability involves focusing on characteristics of the
infrastructure that need to be sustained in order to continue to meet
the needs of a target population with effective prevention
interventions. It also means focusing on ensuring sustainability of
outcomes over time.

Slide 56

*Show slide, **Elements of Sustainability**. Review slide.*

These elements should be included in a comprehensive sustainability
approach, one that will support your community's ability to continue to
maintain the population level outcomes resulting from the preventions
strategies implemented.

Structures and formal linkages should be established and maintained to
sustain the innovative policies, programs and practices that lead to
your community's desired outcomes. An administrative office or function
that is responsible for the policy, program or practice can nurture
these linkages both within and among organizations.

Champions and leadership actions help to sustain the intervention. How
do internal (within the organization) champions support the policy,
program or practice communicate or demonstrate their support to sustain
the policy, program or practice? Who might be an example of an internal
champion? How do external (outside the organization) champions who
support the policy, program or practice communicate or demonstrate their
support to sustain the policy, program or practice? Who might be an
example of an internal champion?

Resources are needed to sustain the intervention. Actions must be taken
to recruit and utilize staff, volunteers, technical resources, and funds
to support the policy, program or practice.

Administrative policies and procedures assist in sustaining the
intervention. Internal and external policies must be developed and
implemented to sustain the policy, program or practice. What might be
some examples of internal and external policies?

-   Internal: Staff development policies

-   External: Legislation at local level that supports the intervention

Expertise is needed to sustain the intervention. Actions must be taken
to recruit and utilize staff with the necessary expertise and skills to
support the policy, program or practice.

Finally, ownership is needed among the intervention's stakeholders. To
what extent are the needs of the stakeholders being met by the program,
policy or practice? How are program and evaluation results disseminated
to stakeholders? What is the level of commitment of stakeholders to the
outcomes of the intervention?

Slide 57

*Show slide, **How Can the SPF Steps be Completed?** Review slide.*

The SPF requires a detailed process and a significant amount of work.
This work could be shared among several workgroups, such as the three
noted here.

Slide 58

*Show slide, **The Strategic Prevention Framework Principles** (first of
2 slides). Review slide.*

There are eight principles upon which the SPF is built.

[Prevention is a Continuum]{.underline} -- Prevention extends from
deterring diseases and behaviors that contribute to them to slowing the
onset and severity of illnesses when they do arise.

[Prevention is Prevention is Prevention]{.underline} -- The mechanisms
of prevention are the same whether the focus is on changing social,
environmental or biological factors.

[Successful Prevention Decreases Risk Factors and Enhances Protective
Factors]{.underline} -- The same risk factors affect many health issues
-- from depression and substance use to delinquency and school drop-out.
Other factors can protect against these problems. The goal: to reduce
risk factors and enhance protective factors that can compromise health
and wellness.

[Prevention Requires Adoption of Known Effective Prevention Practices
Within a Framework That Works]{.underline} -- Research and experience
have produced highly effective prevention programs to reduce risk
factors and promote protective factors.

Slide 59

*Show slide, **SPF Principles (second of 2 slides)**. Review slide.*

[Systems of Prevention Services Work Better Than Service
Silos]{.underline} -- The best prevention results form partnerships;
without collaboration, even the best prevention efforts will not
leverage collective resources and can miss achieving their potential.

[Common Data Sets Across Service Systems Can Help Asses Prevention
Efficacy and Promote Accountability]{.underline} -- Solid evaluation can
help assess program effectiveness and the value of engagement across
service systems.

[Recognizes the importance of States and Communities]{.underline}**-**
Coordinating funding and developing infrastructure helps achieve
outcomes at the state and community levels.

[Comprehensively address Substance Abuse]{.underline} - Utilizing
multiple strategies across multiple sectors with both public and private
resources is wise.

Slide 60

*Show slide, **Case Studies**. Review slide.*

*Have the case study groups from Module 2 apply the steps of the SPF to
their sample community by following the directions on the slide. Remind
participants that in applying the SPF in real communities, a thorough
needs assessment will drive the selection of priority risk and
protective factors. For the purposes of this activity, their case study
groups will simply select a program that addresses a risk factor evident
in their community profile; reinforce that they will NEVER do this when
implementing the SPF in actuality.*

Slide 61

*Show slide, **Planning for Action**. Review slide and begin the closing
discussion.*

*Elicit discussion on the following types of questions:*

-   How do you think the SPF process would benefit your own community?

-   Has anyone used this or a similar process in your community? Which
    steps were the most help­ful? Which ones were the biggest challenges?

-   Which steps of the planning process do you think are the ones most
    often neglected by commu­nities?

-   Why do you think they are neglected?

-   Why is it important that all the steps be followed thoroughly?

-   What are some things you can do to assure that the process is
    followed in your own communities?

Slide 62

*Show slide, **Prevention Planning**. Review slide.*

Slide 63

*Show slide, **Prevention Planning**. Review slide.*

### Slide 64 {#slide-64 .HeadInfSheet}

*Show slide, Questions and Answers. Answer any questions participants
have.*

### INFORMATION SHEET {#information-sheet .HeadInfSheet}

# SAMHSA's Strategic Prevention Framework 

## At-a-Glance 

  ----------------------------------------------------------------------------------
  Step 1            Step 2           Step 3          Step 4           Step 5
  ----------------- ---------------- --------------- ---------------- --------------
  **Profile         **Mobilize and   **Develop a     **Implement      **Monitor,
  population needs, build capacity   comprehensive   evidence-based   evaluate,
  resources, and    to address       strategic       prevention       sustain, and
  readiness to      needs.**         plan.**         programs,        improve or
  address needs and                                  policies, and    replace those
  gaps.**                                            practices.**     that fail.**

  Conduct a needs   Create and       Select          Develop action   Collect and
  assessment.       maintain         policies,       plans for        analyze
                    partnerships.    programs, and   implementing     evaluation
                                     practices to    policies,        data.
                                     implement.      programs, and    
                                                     practices.       

  Assess your       Convene key      Develop logic   Implement        Write
  community's       stakeholders,    model and       policies,        evaluation
  readiness for     coalitions, and  evaluation      programs, and    report.
  prevention.       service          plan.           practices.       
                    providers to                                      
                    plan and                                          
                    implement Steps                                   
                    3 and 4.                                          

  Develop clear,    Plan and         Create a        Implement        Recommend
  concise, and      implement        comprehensive   strategic plan.  quality
  data-driven       strategies to    strategic plan,                  improvements
  problem           improve your     including                        based on
  statements.       community's      strategic                        evaluation
                    readiness.       goals,                           data.
                                     objectives, and                  
                                     performance                      
                                     targets.                         

  Assess            Mobilize                                          
  organizational,   financial and                                     
  fiscal, and       organizational                                    
  leadership        resources.                                        
  capacity.                                                           

  Assess resources                                                    
  and service gaps.                                                   
  ----------------------------------------------------------------------------------

### INFORMATION SHEET {#information-sheet-1 .HeadInfSheet}

# Defining and Mobilizing the Community

## Defining the Community

Before we can address Step 1 of the planning process, we need to define
what we mean by "community." The community definition will determine
where we will apply the five steps for building a successful prevention
plan. A community can be a county, a city, a town, a neighborhood, a
reservation, a military reserve, an unincorporated area, a
social-service catchment area, a school district, or even an individual
school. Once you've defined your community, you can assess its
readiness, risk and protective factors, and resources; then you can
select programs for it. Your community definition should include
geographic, demographic, cultural, service, and organization profiles.
Defining your community will also help you identify whom to include in
the planning process.

## Mobilizing the Community

Mobilizing the community means engaging all sectors of the defined
community in a community-wide prevention plan. This involves identifying
existing community coalitions, engaging formal and informal leaders from
your demographic and cultural profiles, and involving services and
organizations active in the community.

The result will be the formation of a community coalition, if one is not
already active, or the formation of a subcommittee from an already
existing committee or board. Membership may include representatives for
young people and parents, cultural groups, law enforcement, juvenile
justice, education, civic and faith organizations, social services, and
government. Pulling together diverse members with a range of knowledge
and skills creates an effective network for accessing diverse
populations and increasing awareness of the substance abuse problem. A
strategy to periodically reenergize the group with new members should be
built into the group process. This coalition or subcommittee will
encourage collaboration and oversee the five-step planning process to
ensure shared decision making and community ownership of the vision,
process, and programs selected for implementation.

### WORKSHEET {#worksheet .HeadInfSheet}

# Defining the Community 

## Community definition:

## Describe your identified community.

Geographic boundaries:

Demographics:

Cultural groups:

Major service providers:

Major organizations:

### WORKSHEET {#worksheet-1 .HeadInfSheet}

# Mobilizing the Community 

## Identify groups and individuals within the community.

Existing coalitions:

Key community leaders:

Interested youth and parents:

Cultural leaders:

Law enforcement representatives:

Juvenile Justice representatives:

School representatives:

Civic and faith organization representatives:

Social services:

Government representatives:

### INFORMATION SHEET: Community Readiness Summary {#information-sheet-community-readiness-summary .HeadInfSheet}

  ------------------------ ---------------------------------------------------
  Stage and Name           

  **1. Community           Substance abuse is generally not recognized by the
  Tolerance/No Knowledge** community or leaders as a problem. "It's just the
                           way things are" is a common attitude. Community
                           norms may encourage or tolerate the behavior in
                           social context. Substance abuse may be attributed
                           to certain age, sex, racial, or class groups.

  **2. Denial**            There is some recognition by at least some members
                           of the community that the behavior is a problem,
                           but little or no recognition that it is a local
                           problem. Attitudes may include "It's not my
                           problem" or "We can't do anything about it."

  **3. Vague Awareness**   There is a general feeling among some in the
                           community that there is a local problem and that
                           something ought to be done, but there is little
                           motivation to do anything. Knowledge about the
                           problem is limited. No identifiable leadership
                           exists, or leadership is not encouraged.

  **4. Preplanning**       There is clear recognition by many that there is a
                           local problem and something needs to be done. There
                           is general information about local problems and
                           some discussion. There may be leaders and a
                           committee to address the problem, but no real
                           planning or clear idea of how to progress.

  **5. Preparation**       The community has begun planning and is focused on
                           practical details. There is general information
                           about local problems and about the pros and cons of
                           prevention programs, but this information may not
                           be based on formally collected data. Leadership is
                           active and energetic. Decisions are being made and
                           resources (time, money, people, etc.) are being
                           sought and allocated.

  **6. Initiation**        Data are collected that justify a prevention
                           program. Decisions may be based on stereotypes
                           rather than data. Action has just begun. Staff is
                           being trained. Leaders are enthusiastic as few
                           problems or limitations have occurred.

  **7.                     Several planned efforts are underway and supported
  Institutionalization/\   by community decision makers. Programs and
  Stabilization**          activities are seen as stable, and staff is trained
                           and experienced. Few see the need for change or
                           expansion. Evaluation may be limited, although some
                           data are routinely gathered.

  **8. Confirmation/\      Efforts and activities are in place and community
  Expansion**              members are participating. Programs have been
                           evaluated and modified. Leaders support expanding
                           funding and program scope. Data are regularly
                           collected and used to drive planning.

  **9.                     The community has detailed, sophisticated knowledge
  Professionalization**    of prevalence and risk and protective factors.
                           Universal, selective, and indicated efforts are in
                           place for a variety of focus populations. Staff is
                           well trained and experienced. Effective evaluation
                           is routine and used to modify activities. Community
                           involvement is high.
  ------------------------ ---------------------------------------------------

# Strategies to Increase Readiness

## Stage 1: Community Tolerance/No Knowledge

Strategies:

-   Small-group and one-on-one discussions with community leaders to
    identify perceived benefits of substance abuse and how norms
    reinforce use

-   Small-group and one-on-one discussions with community leaders on the
    health, psychological, and social costs of substance abuse to change
    perceptions among those most likely to be part of the group that
    begins development of programs

## Stage 2: Denial

Strategies:

-   Educational outreach programs to community leaders and community
    groups interested in sponsoring local programs focusing on the
    health, psychological, and social costs of substance abuse

-   Use of local incidents in one-on-one discussions and educational
    outreach programs that illustrate harmful consequences of substance
    abuse

## Stage 3: Vague Awareness

Strategies:

-   Educational outreach programs on national and State prevalence rates
    of substance abuse and prevalence rates in communities with similar
    characteristics, including use of local incidents that illustrate
    harmful consequences of substance abuse

-   Local media campaigns that emphasize consequences of substance abuse

## Stage 4: Preplanning

> Strategies:

-   Educational outreach programs to community leaders and sponsorship
    groups that communicate the prevalence rates and correlates or
    causes of substance abuse

-   Educational outreach programs that introduce the concept of
    prevention and illustrate specific prevention programs adopted by
    communities with similar profiles

-   Local media campaigns emphasizing the consequences of substance
    abuse and ways of reducing demand for illicit substances through
    prevention programming

## Stage 5: Preparation

Strategies:

-   Educational outreach programs open to the general public on specific
    types of prevention programs, their goals, and how they can be
    implemented

-   Educational outreach programs for community leaders and local
    sponsorship groups on prevention programs, goals, staff
    requirements, and other startup aspects of programming

-   A local media campaign describing the benefits of prevention
    programs for reducing consequences of substance abuse

## Stage 6: Initiation

Strategies:

-   In-service educational training for program staff (paid and
    volunteer) on the consequences, correlates, and causes of substance
    abuse and the nature of the problem in the local community

-   Publicity efforts associated with the kickoff of the program

-   A special meeting with community leaders and local sponsorship
    groups to provide an update and review of initial program activities

## Stage 7: Institutionalization/Stabilization

Strategies:

-   In-service educational programs on the evaluation process, new
    trends in substance abuse, and new initiatives in prevention
    programming, with trainers either brought in from the outside or
    with staff members sent to programs sponsored by professional
    societies

-   Periodic review meetings and special recognition events for local
    supporters of the prevention program

-   Local publicity efforts associated with review meetings and
    recognition events

## Stage 8: Confirmation/Expansion

Strategies:

-   In-service educational programs on the evaluation process, new
    trends in substance abuse, and new initiatives in prevention
    programming, with trainers either brought in from the outside or
    with staff members sent to programs sponsored by professional
    societies

-   Periodic review meetings and special recognition events for local
    supporters of the prevention program

-   Presentation of results of research and evaluation activities of the
    prevention program to the public through local media and public
    meetings

## Stage 9: Professionalization

Strategies:

-   Continued in-service training of staff

-   Continued assessment of new drug-related problems and reassessment
    of targeted groups within community

-   Continued evaluation of program effort

-   Continued update on program activities and results provided to
    community leaders and local sponsorship groups, and periodic stories
    through local media and public meetings

-   National Institute on Drug Abuse. (1997). *Community readiness for
    drug abuse prevention: Issues, tips and tools.* Rockville, MD:
    National Institute on Drug Abuse.

For a tool to assess community readiness, please refer to the following
Web site:

<http://captus.samhsa.gov/western/resources/bp/step1/crassess.cfm>

For more information and tools on prevention planning, please refer to
the following Web site:
<http://captus.samhsa.gov/western/resources/bp/index.cfm>

### INFORMATION SHEET {#information-sheet-2 .HeadInfSheet}

# Institute of Medicine Continuum of Care

![](media/image1.jpeg){width="5.997222222222222in"
height="2.9763888888888888in"}

**Institute of Medicine Continuum of Care -- Prevention Definitions**

**Universal**

Universal prevention strategies address the entire population (e.g.
national, local community, school, grade, neighborhood, pregnant women,
gender groups, elderly, etc.) with messages, policies and programs aimed
at preventing or delaying the abuse of alcohol, tobacco and other drugs.
The mission of universal prevention is to deter the onset of substance
abuse by providing all individuals the information and skills necessary
to prevent the problem. All members of the population are seen to share
the same general risk for substance abuse, although risk levels may vary
greatly between individuals. Universal prevention is delivered to large
groups without any prior screening for risk. The entire population is
assessed as capable of benefiting from prevention.

**Selective**

Selective prevention strategies focus on subsets of the total population
that are deemed to be exposed to greater levels of risk for substance
abuse by virtue of their membership in a particular population segment
(e.g. children of substance abusers, students who are failing
academically, or those exposed to other risk factors.) Risk groups may
be identified on the basis of biological, psychological, social, or
environmental risk factors known to be associated with substance abuse
(IOM 1994) and focused sub-groups may be defined by age, gender, family
history, place of residence, such as high drug-use or low-income
neighborhoods, etc. Selective prevention focuses on the entire subgroup
regardless of the degree of risk of any individuals within the group.
One individual in the subgroup may be at low personal risk for substance
abuse, while another person in the same subgroup my already be abusing
substances. The selective prevention strategy is presented to the entire
subgroup because the subgroup as a whole is at higher risk for substance
abuse than the general population. An individual's personal risk is not
specifically assessed or identified and is based solely on a presumption
given his or her membership in the higher risk subgroup.

**Indicated**

Indicated prevention strategies are designed to prevent the onset of
substance abuse in individuals who do not meet the DSM-IV criteria for
addiction, but who are showing early danger signs, such as falling
grades and consumption of alcohol or other drugs. The mission of
indicated prevention is to identify individuals who are exhibiting early
signs of substance abuse and other problem behaviors associated with
substance abuse and to focus on them with special programs. The
individuals are exhibiting substance abuse-like behavior, but at a
subclinical level (IOM 1994)

### INFORMATION SHEET {#information-sheet-3 .HeadInfSheet}

# Prevention Strategies for the School, Family, and Community

+------------+------------------+------------------+------------------+
| SITE OF    | UNIVERSAL        | SELECTIVE        | INDICATED        |
| IN         |                  |                  |                  |
| TERVENTION |                  |                  |                  |
+------------+------------------+------------------+------------------+
| >          | **Information    | **Alternative    | **Alternative    |
| **School** | and education:** | programs:**      | programs:**      |
|            |                  |                  |                  |
|            | -   media        | -   skills       | -   mentoring    |
|            |     campaigns    |     training     |                  |
|            |                  |                  | **Peer           |
|            | -   health       | -   after-school | leadership and   |
|            |     education    |     activities   | resistance**     |
|            |     curricula    |                  |                  |
|            |                  | -   mentoring    | **Parent-peer    |
|            | -   school       |                  | groups Peer      |
|            |     assemblies   | -   special      | counseling:**    |
|            |                  |     clubs        |                  |
|            | **Competency     |                  | -   student      |
|            | skills           | **Competency     |     crisis hot   |
|            | training:**      | skills           |     line         |
|            |                  | training:**      |                  |
|            | -   social       |                  | **In-school      |
|            |     influence    | -   cultural     | suspension**     |
|            |                  |     pride        |                  |
|            | -   normative    |                  | **Alternative    |
|            |     education    | -   tutoring     | classes and      |
|            |                  |                  | schools:**       |
|            | -   social       | **Peer           |                  |
|            |     skills       | leadership**     | -   vocational   |
|            |     training     |                  |     training     |
|            |     **School     | **Parent-peer    |                  |
|            |                  | groups**         | -   employment   |
|            |   improvement:** |                  |                  |
|            |                  |                  |                  |
|            | -                |                  |                  |
|            |   organizational |                  |                  |
|            |     changes      |                  |                  |
|            |                  |                  |                  |
|            | -   school       |                  |                  |
|            |     policies     |                  |                  |
|            |                  |                  |                  |
|            | -                |                  |                  |
|            |    instructional |                  |                  |
|            |     strategies   |                  |                  |
+------------+------------------+------------------+------------------+
| >          | **Parent         | > **Parenting    | > **Family       |
| **Family** | education:**     | > skills         | > skills         |
|            |                  | > training**     | > training**     |
|            | -                | >                | >                |
|            | prenatal/infancy | > **Family       | > **Parent-peer  |
|            |                  | > skills         | > groups for     |
|            | -   early        | > training**     | > troubled       |
|            |     childhood    | >                | > youth**        |
|            |                  | > **Family case  | >                |
|            | -                | > management**   | > **Parent       |
|            |  adolescent/teen | >                | > self-help      |
|            |                  | > **Parent       | > groups**       |
|            | **Parent         | > support        | >                |
|            | involvement      | > groups**       | > **Family       |
|            | programs**       |                  | > therapy**      |
|            |                  |                  |                  |
|            | **Parenting      |                  |                  |
|            | skills           |                  |                  |
|            | training**       |                  |                  |
+------------+------------------+------------------+------------------+
| > **C      | > **Public       | > **Alternative  | > **Alternative  |
| ommunity** | > awareness      | > programs:**    | > programs:**    |
|            | > campaigns**    |                  |                  |
|            | >                | -   youth clubs  | -   rites of     |
|            | > **Information  |                  |     passage      |
|            | >                | -   mentoring    |     programs     |
|            | clearinghouses** |                  |                  |
|            | >                | > **Tutoring:**  | -   gang and     |
|            | > **Community    |                  |     delinquency  |
|            | > coalitions**   | -   community    |     prevention   |
|            | >                |     service      |                  |
|            | > **Health       |                  | > **Skills       |
|            | > policy         |                  | > training:**    |
|            | > changes**      |                  |                  |
|            | >                |                  | -   job          |
|            | > **Community    |                  |                  |
|            | > policing       |                  |  apprenticeships |
|            | > Laws**         |                  |                  |
+------------+------------------+------------------+------------------+

### WORKSHEET {#worksheet-2 .HeadInfSheet}

# U, S, or I?

Assign the appropriate Institute of Medicine (IOM)
classification---universal (U), selective (S), or indicated (I)---to
each example.

  ------------------------------- ------------- ------------ ------------
                                  UNIVERSAL     SELECTIVE    INDICATED

  1\. Student assistance groups                              
  for children whose lives are                               
  affected by a drug user                                    

  2\. Red-ribbon campaigns                                   

  3\. After-school programs for                              
  children in very low-income                                
  housing communities                                        

  4\. Peer- and media-resistance                             
  campaigns delivered through                                
  schools                                                    

  5\. Strengthening-families                                 
  programs implemented through                               
  community congregations                                    

  6\. Personal-growth curriculum                             
  for young people already                                   
  involved in destructive                                    
  behaviors                                                  

  7\. Clean and sober after-prom                             
  parties                                                    

  8\. Student assistance groups                              
  for young people identified as                             
  drug users                                                 

  9\. Drug education for                                     
  adolescents in juvenile                                    
  detention                                                  

  10\. Life skills training in                               
  school                                                     
  ------------------------------- ------------- ------------ ------------

National Institute on Drug Abuse. (1997). *Drug abuse prevention: what
works.* Rockville, MD: National Institute on Drug Abuse.

### WORKSHEET {#worksheet-3 .HeadInfSheet}

# U, S, or I?---Answer Sheet

Assign the appropriate Institute of Medicine (IOM)
classification---universal (U), selective (S), or indicated (I)---to
each example.

  ------------------------------- ------------- ------------ ------------
                                  UNIVERSAL     SELECTIVE    INDICATED

  1\. Student assistance groups                 **X**        
  for children whose lives are                               
  affected by a drug user                                    

  2\. Red-ribbon campaigns        **X**                      

  3\. After-school programs for                 **X**        
  children in very low-income                                
  housing communities                                        

  4\. Peer- and media-resistance  **X**                      
  campaigns delivered through                                
  schools                                                    

  5\. Strengthening-families      **X**                      
  programs implemented through                               
  community congregations                                    

  6\. Personal-growth curriculum                             **X**
  for young people already                                   
  involved in destructive                                    
  behaviors                                                  

  7\. Clean and sober after-prom  **X**                      
  parties                                                    

  8\. Student assistance groups                              **X**
  for young people identified as                             
  drug users                                                 

  9\. Drug education for                                     **X**
  adolescents in juvenile                                    
  detention                                                  

  10\. Life skills training in    **X**                      
  school                                                     
  ------------------------------- ------------- ------------ ------------

National Institute on Drug Abuse. (1997). *Drug abuse prevention: what
works.* Rockville, MD: National Institute on Drug Abuse.

INFORMATION SHEET

### INFORMATION SHEET {#information-sheet-4 .HeadInfSheet}

# CSAP Principles of Effective Substance Abuse Prevention 

This section provides a brief listing of the scientifically defensible
principles that can help service providers design and implement programs
that work. More information on the principles can be found at
http://modelprograms.samhsa.gov/pdfts/pubs_Principles.pdf and at
<http://www.nida.nih.gov/Prevention/principles.html>. You can also find
information by going to
[http://modelprograms.samhsa.gov](http://modelprograms.samhsa.gov/) and
clicking on "Publications," then "CSAP's guides to science-based
practices," then "Principles of substance abuse prevention."

## Individual Domain

> Prevention interventions implemented at the individual level seek to
> change knowledge of and attitudes toward substances and substance
> abuse with the ultimate goal of influencing individual behavior.
> Effective individual-level substance abuse prevention programs
> incorporate some common principles, listed below.

-   Build social and personal skills.

-   Design culturally sensitive interventions.

-   Cite immediate consequences.

-   Combine information dissemination and media campaigns with other
    interventions.

-   Provide positive alternatives to help young people in high-risk
    environments develop personal and social skills in a natural and
    effective way.

-   Recognize that relationships exist between substance use and a
    variety of other adolescent health problems.

-   Incorporate problem identification and referral into prevention
    programs.

-   Provide transportation to prevention and treatment programs.

## Family Domain

> Prevention interventions implemented at the family level seek to
> reduce family risk factors and increase bonding to family, healthy
> family beliefs and clear expectations. Common principles of effective
> family-level substance abuse prevention programs are listed below.

-   Target the entire family.

-   Help develop bonds among parents in programs; provide meals,
    transportation, and small gifts; sponsor family outings; and ensure
    cultural sensitivity.

-   Help minority families respond to cultural and racial issues.

-   Develop parenting skills.

-   Emphasize family bonding.

-   Offer sessions where parents and young people learn and practice
    skills.

-   Train parents to both listen and interact.

-   Train parents to use positive and consistent discipline techniques.

-   Promote new skills in family communication through interactive
    techniques.

-   Employ strategies to overcome parental resistance to family-based
    programs.

-   Improve parenting skills and child behavior with intensive support.

-   Improve family functioning through family therapy when indicated.

-   Explore alternative community sponsors and sites for schools.

-   Provide videotaped training and educational activities.

## Peer Domain

> Prevention interventions implemented at the peer level attempt to
> involve peers in prevention education, provide accurate perceptions of
> peer involvement with substances, and support non-using peer networks
> and activities. Common principles of effective peer-level substance
> abuse prevention programs are listed below.

-   Structure alternative activities and supervise alternative events.
    Incorporate opportunities to build social and personal skills.

-   Design intensive alternative programs that include a variety of
    approaches and a substantial time commitment.

-   Communicate peer norms against use of alcohol and illicit drugs.

-   Involve young people in the development of alternative programs.

-   Involve young people in peer-led interventions or interventions with
    peer-led components.

-   Counter the effects of deviant norms and behaviors by creating an
    environment for young people with behavior problems to interact with
    nonproblematic young people.

## School Domain

Prevention interventions implemented at the school level seek to
increase students' bonding with school, support academic achievement,
and create positive school climates. Common principles of effective
school-level substance abuse prevention programs are listed below.

-   Avoid relying solely on knowledge-oriented interventions designed to
    supply information about negative consequences.

-   Correct misconceptions about the prevalence of use in conj unction
    with other\
    educational approaches.

-   Involve young people in peer-led interventions or interventions with
    peer-led components.

-   Give students opportunities to practice newly acquired skills
    through interactive\
    approaches.

-   Help young people retain skills through booster sessions.

-   Involve parents in school-based approaches.

-   Communicate a commitment to substance abuse prevention in school
    policies.

## Community Domain

> Prevention interventions implemented at the community level endeavor
> to increase young people's bonding to community and address community
> norms favorable to substance use. Common principles of effective
> community-level substance abuse prevention programs are listed below.

-   Develop integrated, comprehensive prevention strategies rather than
    one-time\
    community-based events.

-   Control the environment around schools and other areas where young
    people gather.

-   Provide structured time with adults through mentoring.

-   Increase positive attitudes by providing opportunities for community
    service.

-   Achieve greater results with highly involved mentors.

-   Emphasize the costs to employers of workers' substance use and
    abuse.

-   Communicate a clear company policy on substance abuse.

-   Include representatives from every organization that plays a role in
    fulfilling coalition\
    objectives.

-   Retain active coalition members by providing meaningful rewards.

-   Define specific goals and assign specific responsibility for their
    achievement to\
    subcommittees and task forces.

-   Ensure planning and clear understanding for coalition effectiveness.

-   Set outcome-based objectives.

-   Support a large number of prevention activities.

-   Organize at the neighborhood level.

-   Assess progress from an outcome-based perspective and make
    adjustments to plan-of-action to meet goals.

-   Involve paid coalition staff members as resource providers and
    facilitators rather than as direct community organizers.

## Society/Environmental Domain

> Prevention interventions implemented at the society/environmental
> domain address norms favorable toward substance use and abuse,
> policies enabling use and abuse, lack of enforcement of laws designed
> to prevent use and abuse, and utilize strategies focus on the
> environment as a whole. Common principles of effective
> society/environmental prevention strategies are listed below.

-   Develop community awareness and media efforts.

-   Use mass media appropriately.

-   Set objectives for each media message delivered.

-   Avoid the use of authority figures.

-   Broadcast messages frequently over an extended period.

-   Broadcast messages through multiple channels when the target
    audience is likely to be\
    viewing or listening.

-   Disseminate information about the hazards of a product or industry
    that promotes it.

-   Promote placement of more conspicuous labels.

-   Promote restrictions on tobacco use in public places and private
    workplaces.

-   Support clean indoor air laws.

-   Combine beverage server training with law enforcement.

-   Increase beverage servers' legal liability.

-   Increase the price of alcohol and tobacco through excise taxes.

-   Increase m minimum purchase age for alcohol to 21.

-   Limit the location and density of retail alcohol outlets.

-   Employ neighborhood antidrug strategies.

-   Enforce minimum-purchase-age laws using undercover buying
    operations.

-   Use community groups to provide positive and negative feedback to
    merchants.

-   Employ more frequent enforcement operations.

-   Implement "use and lose" laws.

-   Enact deterrence laws and policies for impaired driving.

-   Enforce impaired-driving laws.

-   Combine sobriety checkpoints with passive breath sensors.

-   Revoke licenses for impaired driving.

-   Immobilize or impound the vehicle of those convicted of impaired
    driving.

-   Target underage drivers with impaired-driving policies.

## References:

Brounstein, P. & Gardner, S. (2001). *Principles of substance abuse
prevention.* Rockville, MD: Substance Abuse and Mental Health Services
Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP),
Division of Knowledge Development and Evaluation.

### INFORMATION SHEET {#information-sheet-5 .HeadInfSheet}

# Society/Environmental Domain

+----------------+-----------------------------------------------------+
| ## Environmen  | One way to categorize prevention strategies is to   |
| tal Strategies | consider those that attempt to alter the            |
|                | environment in which individual children grow,      |
|                | learn, and mature (individualized environments) and |
|                | those that attempt to alter environments in which   |
|                | all children encounter threats to their health,     |
|                | including illicit drugs, alcohol, and tobacco       |
|                | (shared environment) (Klitzner, 1998).              |
|                |                                                     |
|                | Generally, strategies targeting the individualized  |
|                | environment seek to socialize, instruct, guide, and |
|                | counsel children in ways that increase their        |
|                | resistance to health risks. Specific programs may   |
|                | teach parenting skills to parents or life skills to |
|                | children, educate parents and children about health |
|                | risks, or provide specialized services to young     |
|                | people at high risk. All of these individualized    |
|                | strategies seek to prepare and assist individual    |
|                | children in coping with a world that presents       |
|                | myriad temptations and potential threats to their   |
|                | health and well-being (Klitzner, 1998).             |
|                |                                                     |
|                | The limitations of individualized approaches have   |
|                | led to increased emphasis on the shared             |
|                | environment, the world in which children face and   |
|                | cope with health threats. The shared environment    |
|                | can be a neighborhood, town, city, state, or the    |
|                | nation as a whole. Properly designed and managed,   |
|                | the shared environment can support healthy behavior |
|                | and thwart risky behavior for all children,         |
|                | regardless of how well prepared they may be by      |
|                | their individualized environments (Klitzner, 1998). |
|                |                                                     |
|                | Environmental strategies have been found to be more |
|                | efficient because they affect every member of a     |
|                | target population. Training store clerks to check   |
|                | ID reduces the availability of tobacco and alcohol  |
|                | for all neighborhood young people regardless        |
|                | whether they are aware that these strategies are    |
|                | being implemented. Environmental strategies also    |
|                | produce more rapid results. Enforcement of the      |
|                | minimum alcohol purchase age can produce more or    |
|                | less immediate reductions in youth alcohol use.     |
|                | Environmental strategies can also enhance the       |
|                | prevention efforts of many communities that already |
|                | have a number of programs aimed at the              |
|                | individualized environment (Klitzner, 1998).        |
+----------------+-----------------------------------------------------+
| ## Environme   | The following are environmental strategies that     |
| ntal Strategie | have been evaluated and found to be effective:      |
| s -- continued |                                                     |
|                | ## Price Interventions                              |
|                |                                                     |
|                | -   Increasing the price of alcohol and tobacco     |
|                |     through excise taxes is an effective strategy   |
|                |     for reducing consumption---both the prevalence  |
|                |     of use and the amount consumed. It can also     |
|                |     reduce various alcohol-related problems,        |
|                |     including motor vehicle fatalities, driving     |
|                |     while intoxicated, rapes, robberies, cirrhosis  |
|                |     mortality, suicide, and cancer death rates      |
|                |     (Sloan, Reilly, & Schenzler, 1994).             |
|                |                                                     |
|                | ## Minimum-Purchase-Age Interventions               |
|                |                                                     |
|                | -   Increasing the minimum purchase age for alcohol |
|                |     to 21 has been effective in decreasing alcohol  |
|                |     use among young people, particularly beer       |
|                |     consumption. It is associated with reductions   |
|                |     in other alcohol-related problems, including    |
|                |     alcohol-related traffic crashes, suicide,       |
|                |     deaths resulting from pedestrian injuries,      |
|                |     other unintentional injuries, youth homicide,   |
|                |     and vandalism. Outcomes related to              |
|                |     minimum-purchase-age laws for tobacco are not   |
|                |     known because such laws have only recently      |
|                |     begun to be enforced.                           |
|                |                                                     |
|                | -   Enforcement of minimum-purchase-age laws        |
|                |     against selling alcohol and tobacco to minors   |
|                |     through the use of undercover buying operations |
|                |     (also known as "decoy" or "sting" operations)   |
|                |     can substantially increase the proportion of    |
|                |     retailers who comply with such laws. Undercover |
|                |     buying operations conducted by community groups |
|                |     that provide positive and negative feedback to  |
|                |     merchants are also effective in increasing      |
|                |     retailer compliance, as are more frequent       |
|                |     enforcement operations.                         |
|                |                                                     |
|                | -   "Use and lose" laws, which allow for the        |
|                |     suspension of the driver's license of a person  |
|                |     under 21 years of age following a conviction of |
|                |     any alcohol or other drug violation (e.g., use, |
|                |     possession, or attempt to purchase with or      |
|                |     without false identification), are an effective |
|                |     means for increasing compliance with            |
|                |     minimum-purchase-age laws among young people.   |
|                |     Penalties should be swift, certain, and         |
|                |     meaningful. Penalties should not be too harsh,  |
|                |     however, since severity is not related to their |
|                |     effectiveness and, if too severe, law           |
|                |     enforcement and judicial officers may refuse to |
|                |     apply them.                                     |
|                |                                                     |
|                | -   Community awareness and media efforts can be    |
|                |     effective tools for increasing perceptions      |
|                |     regarding the likelihood of                     |
+----------------+-----------------------------------------------------+
| ## Environme   | apprehension and punishment and can increase        |
| ntal Strategie | retailer compliance. They also offer a means for    |
| s -- continued | changing social norms to be less tolerant of        |
|                | alcohol and tobacco sales to and use by minors, and |
|                | for decreasing the costs of law enforcement         |
|                | operations.                                         |
|                |                                                     |
|                | ## Deterrence Interventions                         |
|                |                                                     |
|                | -   Deterrence laws and policies for impaired       |
|                |     driving have been effective in reducing the     |
|                |     number of alcohol-related traffic crashes and   |
|                |     fatalities among the general population and     |
|                |     particularly among young people. Reducing the   |
|                |     legal blood-alcohol-content (BAC) limit to .08  |
|                |     or lower has been shown to reduce the level of  |
|                |     impaired driving and alcohol-related crashes.   |
|                |                                                     |
|                | -   Enforcement of impaired-driving laws is         |
|                |     important to deterrence because it increases    |
|                |     the public's perceptions of the risks of being  |
|                |     caught and punished for driving under the       |
|                |     influence of alcohol.                           |
|                |                                                     |
|                | -   Law enforcement efforts to detect and arrest    |
|                |     drinking drivers include sobriety checkpoints,  |
|                |     which do not result in high levels of detection |
|                |     of drinking drivers, and passive breath         |
|                |     sensors, which allow police officers to test a  |
|                |     driver's breath without probable cause and      |
|                |     substantially increase the effectiveness of     |
|                |     sobriety checkpoints.                           |
+----------------+-----------------------------------------------------+
| ##             | -   Administrative license revocation, which allows |
|                |     for confiscation of the driver's license by the |
|                |     arresting officer if a person is arrested with  |
|                |     an illegal BAC or if the driver refuses to be   |
|                |     tested, has been shown to reduce the number of  |
|                |     fatal traffic crashes and recidivism among      |
|                |     driving-under-the-influence offenders. Actions  |
|                |     against vehicles and tags have been mostly      |
|                |     applied to multiple offenders, with some        |
|                |     preliminary evidence that they can lead to      |
|                |     significant decreases in recidivism and overall |
|                |     impaired driving.                               |
+----------------+-----------------------------------------------------+
| ##             | -   Impaired-driving policies targeting underage    |
|                |     drivers (particularly zero tolerance laws       |
|                |     setting BAC limits at .00 to .02 percent for    |
|                |     young people) and graduated driving privileges, |
|                |     in which a variety of driving restrictions are  |
|                |     gradually lifted as the driver gains experience |
|                |     (and maturity), have been shown to              |
|                |     significantly reduce traffic deaths among young |
|                |     people.                                         |
+----------------+-----------------------------------------------------+
| ## Environme   | ## Intervention                                     |
| ntal Strategie | s Addressing Location and Density of Retail Outlets |
| s -- continued |                                                     |
|                | -   Limitations on the location and density of      |
|                |     retail outlets may help contribute to           |
|                |     reductions in alcohol consumption, traffic      |
|                |     crashes, and certain other alcohol-related      |
|                |     problems, including cirrhosis mortality,        |
|                |     suicide, and assaults. With respect to illicit  |
|                |     drugs, neighborhood antidrug strategies, such   |
|                |     as citizen surveillance and the use of civil    |
|                |     remedies---particularly nuisance abatement      |
|                |     programs, can be effective in dislocating       |
|                |     dealers and reducing the number and density of  |
|                |     retail drug markets and possibly other crimes   |
|                |     and signs of physical disorder within small     |
|                |     geographical areas.                             |
|                |                                                     |
|                | ## Restrictions on Use                              |
|                |                                                     |
|                | -   Restrictions on use in public places and        |
|                |     private workplaces (also known as "clean indoor |
|                |     air laws") have been shown to be effective in   |
|                |     curtailing cigarette sales and tobacco use      |
|                |     among adults and young people. Additional       |
|                |     benefits of clean indoor air laws are that they |
|                |     reduce nonsmokers' exposure to cigarette smoke, |
|                |     and they help to alter norms regarding the      |
|                |     social acceptability of smoking. The effects of |
|                |     restrictions on alcohol use have not been       |
|                |     systematically evaluated.                       |
|                |                                                     |
|                | ## Server-Oriented Interventions                    |
|                |                                                     |
|                | -   With respect to alcohol, server training        |
|                |     programs have been found to affect beliefs and  |
|                |     knowledge, with mixed findings regarding        |
|                |     impacts on server practices and traffic safety. |
|                |                                                     |
|                | -   Retailer education for tobacco merchants has    |
|                |     led to relatively small, short-term reductions  |
|                |     in sales to minors.                             |
|                |                                                     |
|                | -   When server training is combined with           |
|                |     enforcement of laws (against service to         |
|                |     intoxicated patrons, against sales to minors),  |
|                |     training programs are much more effective in    |
|                |     producing changes in both selling and serving   |
|                |     practices.                                      |
+----------------+-----------------------------------------------------+
| ## Environme   | -   Education and training programs are important   |
| ntal Strategie |     in teaching servers about laws, the penalties   |
| s -- continued |     for violation, recognition of signs of          |
|                |     intoxication and false identification, and ways |
|                |     to refuse sales, but they generally are not     |
|                |     sufficient when used alone to produce           |
|                |     substantial and sustained shifts in compliance  |
|                |     with laws.                                      |
+----------------+-----------------------------------------------------+
| ##             | ## Counter-Advertising                              |
|                |                                                     |
|                | -   Counter-advertising campaigns that disseminate  |
|                |     information about the hazards of a product or   |
|                |     the industry that promotes it may help reduce   |
|                |     cigarette sales and tobacco consumption. The    |
|                |     limited research on alcohol warning labels      |
|                |     suggests that they may affect awareness,        |
|                |     attitudes, and intentions regarding drinking    |
|                |     but do not appear to have had a major influence |
|                |     on behavior. Studies have suggested that more   |
|                |     conspicuous labels would have a greater effect  |
|                |     on awareness and behavior.                      |
+----------------+-----------------------------------------------------+

## References:

Brounstein, P., Zweig, J., & Gardner, S. (1998, December) *Science-based
practices in substance abuse prevention: A guide.* Center for Substance
Abuse Prevention, Division of Knowledge Development and Evaluation.

### INFORMATION SHEET {#information-sheet-6 .HeadInfSheet}

# NIDA Prevention Principles

+----------------+-----------------------------------------------------+
| #              | These principles are intended to help parents,      |
| # NIDA Prevent | educators, and community leaders think about, plan  |
| ion Principles | for, and deliver research-based drug abuse          |
|                | prevention programs at the community level. The     |
|                | references following each principle are             |
|                | representative of current research.                 |
+----------------+-----------------------------------------------------+
| ##             | **PRINCIPLE 1-** Prevention programs should enhance |
|  Risk and Prot | protective factors and reverse or reduce risk       |
| ective Factors | factors.                                            |
|                |                                                     |
|                | -   The risk of becoming a drug abuser corresponds  |
|                |     to the relationship among the number and type   |
|                |     of risk factors (e.g., deviant attitudes and    |
|                |     behaviors) and protective factors               |
|                |     (e.g., parental support).                       |
|                |                                                     |
|                | -   The potential impact of specific risk and       |
|                |     protective factors changes with age. For        |
|                |     example, risk factors within the family have    |
|                |     greater impact on a younger child, while        |
|                |     association with drug-abusing peers may be a    |
|                |     more significant risk factor for an adolescent. |
|                |                                                     |
|                | -   Early intervention for risk factors (e.g.,      |
|                |     aggressive behavior and poor self-control)      |
|                |     often has a greater impact than later           |
|                |     intervention by steering a child's life path    |
|                |     (trajectory) away from problems and toward      |
|                |     positive behaviors.                             |
|                |                                                     |
|                | -   While risk and protective factors can affect    |
|                |     people of all groups, these factors can have a  |
|                |     different effect depending on a person's age,   |
|                |     gender, ethnicity, culture, and environment.    |
+----------------+-----------------------------------------------------+
| ##             | **PRINCIPLE 2-** Prevention programs should address |
|                | all forms of drug abuse, alone or in combination,   |
|                | including the underage use of legal drugs (e.g.,    |
|                | tobacco or alcohol); the use of illegal drugs       |
|                | (e.g., marijuana or heroin); and the inappropriate  |
|                | use of legally obtained substances (e.g.,           |
|                | inhalants), prescription medications, or            |
|                | over-the-counter drugs.                             |
|                |                                                     |
|                | **PRINCIPLE 3-** Prevention programs should address |
|                | the type of drug abuse problem in the local         |
|                | community, target modifiable risk factors, and      |
|                | strengthen identified protective factors.           |
|                |                                                     |
|                | **PRINCIPLE 4-** Prevention programs should be      |
|                | tailored to address risks specific to population or |
|                | audience characteristics, such as age, gender, and  |
|                | ethnicity, to improve program effectiveness.        |
+----------------+-----------------------------------------------------+
| ## Preve       | ## Family Programs                                  |
| ntion Planning |                                                     |
|                | **PRINCIPLE 5-** Family-based prevention programs   |
|                | should enhance family bonding and relationships and |
|                | improve parenting skills; provide practice in       |
|                | developing, discussing, and enforcing family        |
|                | policies on substance abuse; and provide training   |
|                | in drug education and information. Family bonding   |
|                | is the bedrock of the relationship between parents  |
|                | and children. Bonding can be strengthened through   |
|                | skills training in parent supportiveness of         |
|                | children, parent-child communication, and parental  |
|                | involvement.                                        |
|                |                                                     |
|                | -   Parental monitoring and supervision are         |
|                |     critical for drug abuse prevention. These       |
|                |     skills can be enhanced with training in setting |
|                |     rules; using techniques for monitoring          |
|                |     activities; praising appropriate behavior; and  |
|                |     applying moderate, consistent discipline that   |
|                |     enforces defined family rules.                  |
|                |                                                     |
|                | -   Drug education and information for parents or   |
|                |     caregivers reinforces what children are         |
|                |     learning about the harmful effects of drugs and |
|                |     opens opportunities for family discussions      |
|                |     about the abuse of legal and illegal            |
|                |     substances.                                     |
|                |                                                     |
|                | -   Brief, family-focused interventions for the     |
|                |     general population can positively change        |
|                |     specific parenting behavior that can reduce     |
|                |     later risks of drug abuse.                      |
+----------------+-----------------------------------------------------+
| ##             | ## School Programs                                  |
|                |                                                     |
|                | **PRINCIPLE 6-** Prevention programs can be         |
|                | designed to intervene as early as preschool to      |
|                | address risk factors for drug abuse, such as        |
|                | aggressive behavior, poor social skills, and        |
|                | academic difficulties.                              |
|                |                                                     |
|                | **PRINCIPLE 7-** Prevention programs for elementary |
|                | school children should target improving academic    |
|                | and social-emotional learning to address risk       |
|                | factors for drug abuse, such as early aggression,   |
|                | academic failure, and school dropout. Education     |
|                | should focus on the following skills:               |
|                |                                                     |
|                | -   self-control                                    |
|                |                                                     |
|                | -   emotional awareness                             |
|                |                                                     |
|                | -   communication                                   |
|                |                                                     |
|                | -   social problem-solving                          |
|                |                                                     |
|                | -   academic support, especially in reading         |
+----------------+-----------------------------------------------------+
| ## Prev        | **PRINCIPLE 8-** Prevention programs for students   |
| ention Plannin | in middle, junior high, and high school should      |
| g -- continued | increase academic and social competence by          |
|                | strengthening the following:                        |
|                |                                                     |
|                | -   study habits and academic support               |
+----------------+-----------------------------------------------------+
| ##             | -   communication                                   |
|                |                                                     |
|                | -   peer relationships                              |
|                |                                                     |
|                | -   self-efficacy and assertiveness                 |
|                |                                                     |
|                | -   drug resistance skills                          |
|                |                                                     |
|                | -   antidrug attitudes                              |
|                |                                                     |
|                | -   personal commitments against drug abuse         |
+----------------+-----------------------------------------------------+
| ##             | ## Community Programs                               |
|                |                                                     |
|                | **PRINCIPLE 9-** Prevention programs aimed at       |
|                | general populations at key transition points, such  |
|                | as transition to middle school, can produce         |
|                | beneficial effects even among high-risk families    |
|                | and children. Such interventions do not single out  |
|                | risk populations and therefore reduce labeling and  |
|                | promote bonding to school and community.            |
|                |                                                     |
|                | **PRINCIPLE 10-** Community prevention programs     |
|                | that combine two or more effective programs, such   |
|                | as family-based and school-based programs, can be   |
|                | more effective than a single program alone.         |
|                |                                                     |
|                | **PRINCIPLE 11-** Community prevention programs     |
|                | reaching populations in multiple                    |
|                | settings---schools, clubs, faith-based              |
|                | organizations, and the media---are most effective   |
|                | when they present consistent, community-wide        |
|                | messages in each setting.                           |
+----------------+-----------------------------------------------------+
| ##             | **PRINCIPLE 12-** When communities adapt programs   |
|  Prevention Pr | to match their needs, community norms, or differing |
| ogram Delivery | cultural requirements, they should retain the       |
|                | following core elements of the original             |
|                | research-based intervention:                        |
|                |                                                     |
|                | -   Structure (how the program is organized and     |
|                |     constructed)                                    |
|                |                                                     |
|                | -   Content (the information, skills, and           |
|                |     strategies of the program)                      |
|                |                                                     |
|                | -   Delivery (how the program is adapted,           |
|                |     implemented, and evaluated)                     |
|                |                                                     |
|                | **PRINCIPLE 13-** Prevention programs should be     |
|                | long term, with repeated intervention (i.e.,        |
|                | booster programs) to reinforce the original         |
|                | prevention goals. Research shows that the benefits  |
|                | from middle-school prevention programs diminish     |
|                | without follow-up programs in high school.          |
+----------------+-----------------------------------------------------+
| #              | **PRINCIPLE 14-** Prevention programs should        |
| # Prevention P | include teacher training on good classroom          |
| rogram Deliver | management practices, such as rewarding appropriate |
| y -- continued | student behavior. Such techniques help to foster    |
|                | students' positive behavior, achievement, academic  |
|                | motivation, and school bonding.                     |
|                |                                                     |
|                | **PRINCIPLE 15-** Prevention programs are most      |
|                | effective when they employ interactive techniques,  |
|                | such as peer discussion groups and parent           |
|                | role-playing, that allow for active involvement in  |
|                | learning about drug abuse and reinforcing skills.   |
|                |                                                     |
|                | **PRINCIPLE 16-** Research-based prevention         |
|                | programs can be cost effective. Like earlier        |
|                | research, recent research shows that each dollar    |
|                | invested in prevention can save up to \$10 in       |
|                | treatment for alcohol or other substance abuse.     |
+----------------+-----------------------------------------------------+

## References:

National Institute on Drug Abuse (NIDA). October 2003. (2nd ed.)
*Preventing drug abuse among children and adolescents: A research-based
guide.* Rockville, MD: U.S. Department of Health and Human Services.

### INFORMATION SHEET {#information-sheet-7 .HeadInfSheet}

# Cultural Competence

Cultural competence is a bit like mercury -- you know it's there, you
can see it, but it can be hard to get a grip on and examine. Cultural
competence is not measured only by the number of cultural competency
trainings program staff have participated in (though that can be a part
of fostering culturally competent systems, agencies and professionals).
The Lewin Group, 2002 identified the following seven domains that
reflect cultural competence:

-   *Organizational Values*: Are mid- and high-level staff responsible
    for coordinating cultural competence activities that are reflected
    in the agency's business and program plan and is funding provided to
    support their efforts?

-   *Governance:* Do formal cultural competence-related policies exist
    regarding personnel, board development, communication and
    community/client input?

-   *Planning and Monitoring/Evaluation:* Is client satisfaction
    regarding cultural competence-related planning sought in the
    development, integration and implementation of cultural competency
    plans?

-   *Communication:* Do staff/professionals demonstrate effective
    communication with diverse groups? Does the agency engage in two way
    communication with the community from which its clients come?

-   *Staff Development:* Is there investment (monitory and other) in
    cultural competence training for staff at all levels of the agency?
    Are staff evaluations conducted in a culturally competent manner?

-   *Organizational Infrastructure:* Is the overall budgetary allocation
    and investment in cultural competence activities aligned with the
    strategic plan? Are formal and informal alliances/links maintained
    with the community and other partners to address cultural competence
    issues?

-   *Services/Interventions:* Are tailored outreach and community
    education initiatives fostered? Do focused prevention plans reflect
    cultural competence related factors?