# Presentation: 176038

## SAMHSA CSAPPrevention Fellows TrainingPlanning WorkshopDecember 12-13, 2006 

- Developed by: CSAP Central CAPTKathy Paxton, MSChuck Klevgaard, BSW

## Welcome & Introductions

*Know your neighbor activity*
*Ask the person next to you their name and one little known or outrageous fact about themselves.*
*Share with the person next to you your name and one little known or outrageous fact about themselves.*
*Introduce each other to the large group.*

## Why Are We Here?

- Participant Expectations
- Learning Objectives
- Ground Rules
- Resources

## “Note to Self”

- Sharing what we learned in Reno?
- Flip Chart Exercise
- Group Sharing

## Why Plan?

- Large Group Brainstorming Exercise

## Prevention Planning

- Why create a plan for action?
- Planning allows us to:
- Create an objective profile of our community
- Identify how to focus resources and efforts
- Implement more effective strategies

## BREAK & Networking

## How Can We Create a Comprehensive Plan?

- By using SAMHSA’s Strategic Prevention Framework (SPF), which outlines the elements in a comprehensive planning model

## Key Principles of the Strategic Prevention Framework

- Public health approach
- Strategic planning process
- Data used throughout the process to inform decisions
- Outcome-based prevention

## SAMHSA’s Strategic Prevention FrameworkSupports Accountability, Capacity, and Effectiveness

**Assessment**
**Profile population needs, resources, and readiness to address needs and gaps**

**Evaluation**
**Monitor, evaluate, sustain, and improve or replace those that fail**

**Implementation**
**Implement evidence-based prevention programs and activities**

**Planning**
**Develop a Comprehensive Strategic Plan**

**Capacity**
**Mobilize and/or build capacity to address needs**

## Step 1 - Assessment

- What is Assessment?
- Assessment of substance use and related problems of substance use
- Assessment of resources, gaps, and readiness
- Leads to recommendations regarding community priorities

## Why do an assessment?

- It answers the question, “What is going on in my community?”
- How big and what type of a substance use problem do I have in my community?
- What resources currently exist in my community that address the problem?
- How ready is my community for prevention?

## How do I conduct an assessment?

- Create a needs assessment profile
- Define your community
- Implement a community readiness tool
- Assess available resources and gaps in services

## Questions to Consider

- Has your community used ATOD consequence data in the past as part of its assessment process?
- Is consequence data available?
- How useful is the data?
- How does community readiness impact prevention planning and interventions?

## Step 2 - Capacity: What does it involve?

- Mobilizing resources
- Engaging stakeholders
- Partnerships with the community
- Building coalitions
- Developing readiness
- Focus on cultural competency, sustainability and evaluation

## Step 3 - Develop a Comprehensive Strategic Plan

- What is a Comprehensive Strategic Plan?
- A comprehensive, logical, and data driven plan to address the problems identified in Step 1 using the capacity built or mobilized in Step 2
- Includes a Logic Model
- Includes Strategic Goals, Objectives, and Performance Targets

## How Do I Create a Strategic Plan?

- Include a vision for prevention activities based on:
- Documented needs
- Identified resources and strengths
- Measurable objectives and performance measures
- Baseline data
- Include a long-term strategy to sustain policies, programs, and practices
- Adjust plans as the result of ongoing needs assessment and monitoring

## Step 4 - Implementation: What is it?

- Step-by-step guide on how you will implement your Strategic Plan
- Develop action plans for your intervention
- Develop an evaluation plan

## Step 5 - Evaluate

- What does the Evaluation Step include?
- Process evaluation
- Collect required outcome data
- Review policy, program, and practice effectiveness
- Develop recommendations for quality improvement

## Why Do I Need Evaluation?

- Evaluation is crucial because it tells us:
- What works
- What doesn’t work
- What to improve
- How to improve it

## Two Common Threads Throughout the Strategic Prevention Framework

- Cultural competence and sustainability are at the center of the Strategic Prevention Framework because they are integral to each step of the framework

## Questions/Feedback

## Describe the Program

- Logic Model Defined
- Description of what a program is expected to achieve and how it is expected to work
- A map linking together a project’s goals, activities, services and assumptions

## Benefits of a Logic Model

- Develops understanding
- Helps monitor progress
- Serves as an evaluation framework
- Helps expose assumptions
- Helps restrain over-promising
- Promotes communication

**Planning Using a Focused Approach**
***Activity***

## Logic Model Puzzle Activity:

**Among 15 to 24 year olds**

**Low or discount PRICING of alcohol**

**Easy RETAIL ACCESS to Alcohol for youth**

**Easy SOCIAL ACCESS to Alcohol**

**Media Advocacy to Increase Community Concern about Underage Drinking**

**Restrictions on alcohol advertising in youth markets**

**SOCIAL NORMS accepting and/or encouraging  youth drinking**

**PROMOTION of alcohol use (advertising, movies, music, etc)**

**Low ENFORCEMENT of alcohol laws **

**Young Adult DRINKING AND DRIVING**

**Social Event Monitoring and Enforcement**

**Bans on alcohol price  promotions and happy hours **

**Enforce underage retail sales laws**

**Causal **
**Factors**

**Strategies**
**(Examples)**

**Substance-Related Consequences**

**Substance**
**Use**
**(consumption)**

**Logic Model Puzzle Activity:**
**Reducing Alcohol-Related Youth Traffic Fatalities**

**Low PERCEIVED RISK of alcohol use **

**Underage  BINGE DRINKING**

**Young Adult**
**BINGE DRINKING**

**Underage**
**DRINKING AND DRIVING**

## Logic Model Puzzle ActivityCommunity LevelUtilize the ConsequenceAlcohol Marijuana Related School ProblemsIdentify Causal Factors/ Intervening VariablesStrategies

## Consumption Patterns

- Consumption Patterns

## Consequences

## Consequences

## Community Example:

**Causal **
**Factors**

**Strategies**
**(Examples)**

**Substance-Related Consequences**

**Substance**
**Use**
**(consumption)**

**Community Example:**
**Linking Causal Factors to Data : Literature Search**

**Young Adult DRINKING AND Drugging Before Class**

**Underage  Drinking**

**Young Adult**
**Marijuana Use**

**Underage**
**BINGE DRINKING**

**High rate of alcohol / drug related school problems**
**(Grades**
**Absence**
**Suspensions)**

**Linking Violence and Substance Abuse Prevention to Academic Success**
- _[http://www.k12coordinator.org/onlinece/onlineevents/linking/id57.htm](http://www.k12coordinator.org/onlinece/onlineevents/linking/id57.htm)__ _

- 1   Adapted from Devaney, B., et al. (1993). *Evaluating the effects of school health interventions on school performance: Design report.* Princeton, NJ: Mathematica Policy Research, Inc., p. 1.
- 2   Adapted from Devaney, B., et al. (1993). *Evaluating the effects of school health interventions on school performance: Design report.* Princeton, NJ: Mathematica Policy Research, Inc., p. 8-9.
- 3    Learning First Alliance. (2001). *Every Child Learning: Safe and Supportive Schools. *Baltimore, MD: Association for Supervision and Curriculum Development. Available online at _[http://](http://www.learningfirst.org/)__[www.learningfirst.org](http://www.learningfirst.org/)_.
- 4   Kellam, S.G. (August 6, 2001). *The seamless integration of evidence-based education and prevention in schools. *Presentation at the National Technical Assistance Meeting of the Safe and Drug-Free Schools Program, United States Department of Education, Washington, DC.

## Community Example:

**Causal **
**Factors**

**Strategies**
**(Examples)**

**Substance-Related Consequences**

**Substance**
**Use**
**(consumption)**

**Community Example:**
**Identifying Strategies That Impact Use and Causal Factors**

**Young Adult DRINKING AND Drugging Before Class**

**Underage  Drinking**

**Young Adult**
**Marijuana Use**

**Underage**
**BINGE DRINKING**

**High rate of alcohol / drug related school problems**
**(Grades**
**Absence**
**Suspensions)**

**Linking Violence and Substance Abuse Prevention to Academic Success**
- _[http://www.k12coordinator.org/onlinece/onlineevents/linking/id57.htm](http://www.k12coordinator.org/onlinece/onlineevents/linking/id57.htm)__ _

- _[Strategies](file:///focusachieve.pdf)_

## Slide 33

| Concept  | Definition |
| --- | --- |
| Individual Factors | Individual characteristics that influence behavior, such as knowledge, attitudes, beliefs, and personality traits  |
| Interpersonal Factors  | Interpersonal processes, and primary groups including family, friends, peers, that provide social identity, support, and role definition  |
| Institutional Factors  | Rules, regulations, policies, and informal structures which may constrain or promote recommended behaviors  |
| Community Factors  | Social networks and norms that exist as formal or informal arrangements among individuals, groups, and organizations  |
| Public Policy  | Local, state, federal policies and laws that regulate or support healthy actions and practices for disease prevention, early detection, control and management  |

## Tobacco Use / Why Did So Many Quit ?

- Norms

- Policy

- Information

- Skills

- Motivation

- Price

## Seat Belts

- Norms

- Enforcement

- Information

- Skills

- Motivation

- Laws

## Assessing Causal Factors and Planning 

- Collect available data on causal factors
- Examine causal factors for the resources present and the gaps resources
- Prioritize causal factors based on several criteria such as need, high capacity and community readiness
- Determine areas where you may need to build capacity and or readiness in addressing a causal factors

## Selecting Strategies 

- Must address the problem identified
- Must address the causal factor(s) believed to be involved
- Should consider current and future capacity

## Selecting Prevention Strategies

_**Key Questions**_
- How will the selected strategies address the causal factors identified in the assessment process?
- Are the strategies evidence-based?
- What other strategies/programs exist in your community to address the identified problem?
- Can the strategies selected achieve your desired outcomes?

## Program Level Logic Model

- Represents the theory behind specific intervention components and activities designed to change individuals or populations

## New Mexico Program Level Logic ModelLow Enforcement

- Sheriff’s
- Office

- Coalition

- Coalition

- Sobriety Check Points

- ID Compliance Checks

- Merchant Education

- Server Training

- Shoulder Taps

-          Inputs		          Outputs	       Short term
- 					       Outcomes      Long term
- 							 Outcomes

- Community Change

- 15-24 year olds Alcohol related crashes

## Prevention is Prevention!

*Sharing the Vision*
- Historical Overview/Timeline
- View Points of Prevention

## Research, Science, Evidence-Based?

- A process in which experts:
- use commonly agreed upon criteria for rating research interventions
- come to a consensus that evaluation research findings are credible and can be sustained
- (Adapted from Brounstein, Zweig, and Gardner, 1998)

## Evidence Based Prevention 

- Should utilize strategies that are **well thought out and feasible,  **meeting any of the following criteria:
- The program, policy, strategy or practice is based on prevention theory.
- The program, policy, strategy or practice is supported by a body of evidence including data with a positive track record.
- The program, policy, strategy or practice appears on at least one federal government approved list of programs. *Carol McHale NPN Conference 2006*

##  Why all the concern over Evidenced Based prevention?

- Federal and state agencies, as well as private funders are asking for it
- Public accountability
- The desire to improve programs
- Use what is effective
- Use limited resources wisely

## Evidenced Based Practices and Programming at the local level are...

- Theory-based
- Targeted
- Audience specific
- Goal-oriented
- Measurable
- Carefully implemented
- Evaluated

## Additionally, model programs have credible, substantiated findings that have been subjected to critical review and have been replicated in a variety of settings.

## Three Major Theoretical Models 

- Risk Factors/Protective Factors
- Developmental Assets
- Resiliency

- 3

## Risk Factors/Protective Factors Approach

- Risk Factors*Five problem behaviors:*
- 1. Substance abuse2. Violence3. Delinquency4. Teen pregnancy5. School dropout

*Four categories of risk:*
- 1. Community2. Family3. School4. Individual/peer

- Protective Factors*Three basic factors:*
- 1. Individual characteristics2. Bonding3. Healthy beliefs and
-  clear standards

## Developmental Assets Framework

- Emphasizes strengths in people
- Focuses on youth as resources, not problems
- Focuses on increasing the number of assets present in youth’s lives
- Is a “promising framework”

## Resiliency Approach

- Focuses on how children “bounce back” in the face of adversity
- Based largely on the work of Emmy Werner
- Includes several factors which foster resilience in kids
- Is a “promising” approach

## Six Prevention StrategiesCenter for Substance Abuse Prevention (CSAP)

**Six Prevention Strategies****Center for Substance Abuse Prevention (CSAP)**

- Information Dissemination
- Prevention Education
- Alternative Activities
- Community-Based Processes
- Environmental Approaches
- Problem Identification and Referral

## Information Dissemination

- Complementary to more intensive / interactive approaches
- Appeal to youth motives
- Choice air times
- Target audience
- Avoid authority figures & exhortations

## Prevention Education

- Combine information, skills, protective factors
- Interactive, intense, with booster sessions
- Peer-led components
- Provide social skills training & practice
- Involve parents individually & with students

## Alternatives

- May be more effective with high-risk youth
- Intense programs with variety
- Component of integrated comprehensive strategy
- Community service, mentoring, recreation, cultural activities

## Community-Based Processes

- Utilize multi-agency activities & interagency coordination (Coalition Building)
- Clear purpose, appropriate planning, commitment to results
- Active participation by meeting members’ needs
- Leadership essential
- Appropriate roles for paid staff
- Implement proven effective strategies to achieve outcome-based goals
- Effectiveness based on strategies not structure

## Environmental Approaches

- Individualized environment
- Seek to socialize, instruct, guide, & counsel children to increase their resistance to health risks
- Shared environment
- Support healthy behavior, prevent risky behavior for all children
- Environmental strategies
- Price interventions, minimum -purchase-age, deterrence, location & density, counter-ads

## Problem Identification and Referral

- Estimate accurately youth who justify intervention
- Ensures appropriate referral to meet needs
- Realize relationship between substance use & other health problems.
- Risk of exposure to other deviant behaviors
- Brief interventions appear promising

## Sample Criteria for Selecting Strategies

- Effectiveness
- Matching strategy/program requirements with agency capacities
- Resources
- Cultural Assumptions
- Target population
- Organizational climate
- Community climate
- Evaluability
- Future Sustainability
- Source: CSAP’s Northeast CAPT. (2004). Enriching Prevention Using Evidence Based Practices
- Retrieved July , 2003.

## Multiple Efforts

- Prevention strategies showing greatest promise of effectiveness focus on change at multiple levels:
- Individuals
- Family
- School
- Communities

## Common Attributes of Effective Approaches

- Interactivity
- Cultural relevance
- Intensity and duration
- Presenter– peers– cross age mentors
- Message– accuracy– relevance

- Credibility of:

## A Summary of SDFSCA Principles of Effectiveness

- 1.  Base program on an assessment of data about local drug and violence problems.
- 2.  Design program to meet measurable goals and objectives.
- 3.  Implement programs based on research or evaluation that provide evidence that these programs prevent or reduce drug use, violence or disruptive behavior.
- 4.  Evaluate programs to assess progress toward achieving goals and objectives and improve program efforts.

## ONDCP Principles

- Address risk and protective factors
- Use approaches proven to be effective
- Intervene early
- Intervene in appropriate settings and domains
- Manage programs effectively

## 7 Steps to Building a Successful Prevention Program

- 1.	Increase the readiness of the community
- 2.	Assess the levels of risk factors and protective factors in the community
- 3.	Translate data into priorities
- 4.	Examine the resources in the community that are reducing risk factors and increasing protective factors

## 7 Steps (continued)

- 5. Target efforts
- 6. Use “best practices” and “guiding principles”
- 7. Evaluate

## Sustainability

- The ability of **states** and **communities** to continually apply the SPF process over time
- 	to reduce alcohol and other drug-related problems and their associated consumption patterns.

## Create mechanism for planning to occur on an ongoing and or annual basis.
Document planning process and content.
Communicate results of planning process to community and coalition members.
Create planning that is clear and open (avoid hidden agendas and the appearance of favoritism).
Build community members capacity to participate in planning and understand the SPF model and data gathering and assessment.

- Document planning process and content.
- Communicate results of planning process to community and coalition members.
- Create planning that is clear and open (avoid hidden agendas and the appearance of favoritism).
- Build community members capacity to participate in planning and understand the SPF model and data gathering and assessment.

- Sustainability Considerations for SPF Step 3: Planning - States

## Defining Sustainability

- The two most frequently used were:
**Sustainability**: Continued ability of an innovation (e.g. program) to meet the needs of its stakeholders
**Institutionalization:** Long-term viability and integration of a new program within an organization.

**Notes:**
Systematic review of 105 articles, book chapters, and books.
Sustainability literature was intentionally excluded if it did not address how to ensure continuation of innovations after a confined trial period.
Also excluded was literature on environmental sustainability and the continuation of institutions like marriage, sexism, etc.
Our literature review revealed eleven terms for maintenance or continuation of an innovation – (e.g. confirmation, continuation, durability, incorporation, institutionalization, level of use, maintenance, routinization, stabilization, sustainability, and sustained use)

## Of these terms:

*Sustainability was the most comprehensive in that it addresses:** *
***Maintaining ******benefits****** achieved through an initial program***
***Continuing the program ******within an organization.***
***Building the capacity****** of the recipient community to continue a program***

**Notes:**
Systematic review of 105 articles, book chapters, and books.
Sustainability literature was intentionally excluded if it did not address how to ensure continuation of innovations after a confined trial period.
Also excluded was literature on environmental sustainability and the continuation of institutions like marriage, sexism, etc.
Our literature review revealed eleven terms for maintenance or continuation of an innovation – (e.g. confirmation, continuation, durability, incorporation, institutionalization, level of use, maintenance, routinization, stabilization, sustainability, and sustained use)

## Sustainability... 3 Critical Questions

**The Clarifying Question:**
***What are you trying to sustain?***

## Sustainability... 3 Critical Questions

**The Evidence Question:**
***What evidence do you have that what  you are doing is worth sustaining?***

## Sustainability... 3 Critical Questions 

**The Capacity and Power Question:**
***Where will the capacity and power***
***come from to sustain this effort?***

## Community Level Issues

- 	**INNOVATION: A new element in a prevention system that contributes toward a desired **_***outcome***_**. **
**Innovations may include:**
**A new prevention program, policy or practice (e.g. school-based prevention program or policy change that targets substance abuse or violence)**
**A new infrastructure element that provides support for a prevention program or strategy (e.g., an evaluation system, training curriculum, administrative policy, or formal linkage such as an MOU)**

## Examples of Prevention Innovations to be sustained

- A data collection system for local needs assessment
- An objective decision making process that is outcomes focused
- Effective prevention strategy/program(s)
- Organizational/coalition infrastructure such as process and/or outcome evaluation

## Sustaining Outcomes – Community level

## Slide 76

## Sustainability as it relates to Cultural Competency

- Innovations
- Outcomes

## LUNCH & NETWORKING

## Pre-Planning Efforts

- Facilitation & Logistics
- Key Stakeholder Selection
- Guidance & Consideration at National, State, and Local Levels
- Data Impressions & Readiness

## Identification of Data Sources

- National
- State
- Local
- What experience have you had with finding data?

## BREAK & Networking

## Budget Planning 

- Existing Fiscal/Physical Capital
- Asset Assessment
- New Expenditures
- Cost Related to Action Steps
- What are your experiences in fund availability for planning?

## Wrap Up

- Questions?
- Comments...
- Clarifications

## DAY 2-Welcome

- Fun & Games
- What did we learn?

## Differences in Planning Approaches

- What’s the Difference?
- CTC
- PfS
- Coalition Training
- SPF
- Does your state use any of these planning processes?

## Planning Simulation Activity

- Character Based Stakeholders
- Scope, Charge, Vision
- Shared Definitions
- Guidance & Consideration
- Key Stake Holder Engagement
- Data Impressions
- Data Review: Incidence, Prevalence, Attitudes, Beliefs, Perception

## Lunch & Networking

## Work Plan Development

- Direct Reflection & Relation to Need
- Feasibility/Guidance
- Target Population (IOM Activity)
- Cultural Competence
- Sustainable Effort

## BREAK & Networking

- Prevention Plan Presentations

## Wrap Up

- Questions?
- Concerns...
- Evaluations
- Logistics