Module Three

Prevention Program Planning

### Time {#time .HeadInfSheet}

The anticipated time for the module is 4 hours.

### Learning Objectives {#learning-objectives .HeadInfSheet}

Participants will be able to

-   Describe the five steps of SAMHSA's strategic prevention framework

-   Understand the basic components of completing each step

-   Find additional information on completing the five steps

-   Understand CSAP and NIDA prevention principles

-   Understand the basic components of completing each step

-   Enhance a prevention program using these prevention principles

### 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>

###  {#section .HeadInfSheet .unnumbered}

### 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.

### 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?