# Presentation: 047250

## THE BRIDGE BETWEEN RESEARCH AND PRACTICE

***THE BRIDGE BETWEEN RESEARCH AND PRACTICE***

- Karol L. Kumpfer, Ph.D.
- Director, CSAP

## Increases In Substance Abuse in Adolescents (30-Day Use of Illicit Drugs)

- Source:  1998 National Household Survey (DHHS)

***Increases In Substance Abuse in Adolescents (30-Day Use of Illicit Drugs)***

- 27% Increase in Illicit Drug Use in 12 to 17 Year Olds
- 73% Increase in Illicit Drug Use in 12 to 13 Year Olds
- 32% Increase in Marijuana Use in 12 to 17 Year Olds
- 33% Increase in Cigarette Use in 12 to 13 Year Olds
- Highest Rates in New Cocaine Users in Youth
- Highest Incidence Rate in Heroin Use in Youth

## CSAP’s Mission

***CSAP’s Mission***

- 	To Decrease Substance Use & Abuse and Related Problems Among the American Public Through:
- Bridging the gap between research and practice
- Field-testing scientifically defensible programs
- Disseminating comprehensive, culturally appropriate prevention strategies, policies, and systems
- Capacity-building for states and community-based providers

## CSAP’s Leadership Role

***CSAP’s Leadership Role***

- Increase Substance Abuse Prevention Knowledge Base
- Increase Public Awareness and Perceived Risk As Well As Disapproval of Substance Abuse
- Increase Access to Prevention Services
- Increase Quality and Effectiveness of Prevention Services
- Increase Assistance to States and Communities in Building Comprehensive Prevention Systems

## The Great Disconnect

***The Great Disconnect***

**Research**

**Practice**

## Building the Bridge

***Building the Bridge***

**Research**

**Practice**

## CSAP’s Vision for the Future

**Research**

**Practice**

***CSAP’s Vision for the Future***

## Continuum of Substance Abuse Prevention Research

- Basic Biomedical Research

- Nationwide Prevention and Health Services Program (Block Grants)

**II**
- Methods Develop-ment

**I**
- Hypothesis Develop-ment

**III**
- Controlled Intervention Trials

**IV**
- Defined Population Studies (KDs)

**V**
- Demonstra-tion and Imple-mentation (KAs)

**NIH:  NIDA/NIAAA/NIMH**

**CSAP/DoEd/OJJDP/CDC**

**STATES**

**Research on Applications**

**Applied Research**

**Applications of Research**

- Sources:  	Jansen, Glynn & Howard, 1996; Greenwald and Cullen, 1995

***Continuum of Substance Abuse Prevention Research***

## CSAP’s Activities

***CSAP’s Activities***

- 1.  Knowledge Development (KD):
- Developmental Predictor Variable Study
- Workplace Cross-Site Study
- Starting Early/Starting Smart
- New Cross-Site Knowledge Development Studies
- Children of Substance Abusing Parents
- Teen Parents and Welfare Reform
- Project Connect

## CSAP’s Activities (Continued)

***CSAP’s Activities ******(Continued)***

- 2.  Knowledge Application (KA):
-  State Incentive Grants (SIGs)
- 		    5 + 14 = 19 SIGs

- 3.  Knowledge Synthesis:
- National Center for the Advancement of Prevention (NCAP) I and NCAP II
- Prevention Enhancement Protocols System (PEPS)

## CSAP’s Activities (Continued)

***CSAP’s Activities ******(Continued)***

- National Clearinghouse for Alcohol and Drug Information (NCADI)
- Media Campaigns
- Publications
- Five Regional Centers for the Application of Prevention Technologies (CAPTs) and Border CAPT
- Faculty Development Program

- 4.  Knowledge Transfer and Dissemination:

## SAMHSA-CSAPCommunity Partnership Program

**6**

**1**

**1**

**9**

**2**

**4**

**5**

**4**

**6**

**6**

**13**

**22**

**2**

**3**

**7**

**4**

**5**

**5**

**6**

**7**

**26**

**2**

**1**

**5**

**8**

**13**

**8**

**2**

**1**

**1**

**1**

**3**

**1**

**1**

**3**

**5**

**3**

**5**

**11**

**10**

**2**

**5**

**1**

**5**

**3**

**1**

**1**

***Location of the 251 Partnerships***

***SAMHSA-CSAP******Community Partnership Program***

**Notes:**
Slide 2

 From 1990 to 1996, SAMHSA-CSAP, provided grants to 251 		community partnerships.
 Most grants were for five years, averaging $350,000 per year.

The Partnership Goals were:
to develop comprehensive, long-term substance abuse 	prevention.
to build necessary prevention infrastructure in the 		community. 
to change community and environmental conditions, 		ultimately changing residents’ behavior. 
to define its own agenda and work, attending to local 		conditions and leading to local empowerment.  

The national cross-site evaluation focused on two 		main types of outcomes:
We will begin this presentation with a discussion of 	the first type:  community infrastructure building 	and change.
We will then move on to the second type, 		individual substance use behavior outcomes.
Finally, we will offer some comments and ideas about 	future actions that might be taken by both 		practitioners and researchers.

## A Rigorous National Evaluation

**                     ****	****	****1994-95****	****         1996****	****       Total**
**Adults****	****	****	****	**
**Tenth graders****	****	**
**Eighth graders****	****	**
**	****Total:****	****	****	**

***Annual Site Visits to 24 Partnerships***
**Annual Site Visit Reports (N=24)**
**Composite Reports (N=24)**

**	****	**** ****14,807****	**** 12,092****	****26,899**
**	****	**** ****12,842****	**** 13,042****	****25,884**
**	****	**** **_**14,151**__**	**__** 16,539**__**	**__**30,690**_
**	****	**** ****41,800****	**** 41,673****	****83,473**

***A Rigorous National Evaluation***

***Age Groups Surveyed in the 24 Partnerships and 24 Comparison Communities***

**Notes:**
	Slide 9

 Aside from this general profile of all the partnerships 	as just shown on the last few slides, the cross-site 	evaluation collected an intensive amount of data 	from 24 representative partnerships and 24 		matched comparison communities.
 The data were based on surveys of representative 	samples of adults, 10th graders, and 8th graders, at 	two points in time, in the 48 communities.
 All told, about 31,000 eighth graders, 26,000 tenth 	graders, and 27,000 adults were surveyed (different 	and adults were surveyed at two points in time). 
Due to administrative clearance delays, the first set of 	data was not collected until 1994-1995.  Therefore, 	we do not have the ideal “baseline” for this 		evaluation period.
The data also included four annual site visits to the 24 	partnerships.
I am now going to turn this over to Dr. Yin, who will tell 	you about the individual behavior outcomes that 	came out of the evaluation.

## Adults are Less Likely to Use Illicit Drugs When:

**•**

**SAMHSA-CSAP**

**COMMUNITY PARTNERSHIP**

***Adults are Less Likely to Use Illicit Drugs When:***

- Living in partnership communities,
- Participating in drug prevention activities,
- Living in neighborhoods safe from drugs, and
- Disapproving of drug use.

**Notes:**
Slide 12

 Statistical path analysis of the survey data showed 	that, by the second point in time, there were 		statistically significant relationships among the 	following five conditions:
being in a partnership community (not a comparison 	community) 
being involved in prevention activities
being in a neighborhood perceived to be safe from drugs
having a disapproving attitude toward drug use and
being less likely to use illicit drugs.
 In other words, adults who lived in a partnership 	community, participated in drug prevention 		activities, lived in neighborhoods they perceived to 	be safe from drugs, and disapproved of drug use, 	were found to be less likely to use illicit drugs.
 So these findings begin to provide support for the 	community partnership strategy in relation to 	behavioral outcomes, not just organizational 		outcomes.

## Outcome Evaluation Results:Characteristics of Successful Partnerships

***Outcome Evaluation Results:******Characteristics of Successful Partnerships***

**Notes:**
Slide 13

 The paired analysis also was a way of beginning to identify 	“successful” partnerships.  Of the eight partnerships that 	exhibited statistically significant reductions, compared to 	their matched comparison communities, shown on the map 	on the previous slide, five also demonstrated those 		characteristics that previous literature claimed were 		important in being associated with successful partnerships.  	We therefore considered these five partnerships to be 	models of successful partnerships, because they had 		shown statistically significant outcomes and emulated the 	desirable processes.
Eight characteristics were important and may be considered as 	goals in operating your current coalitions:  
a widely shared vision embraced by nearly 		everyone in the community
a comprehensive vision covering all segments of the 	community
an inclusive and broad-based membership
a strong core of committed partners
extensive prevention activities and support for local 	prevention policies
decentralized units, with task forces or mini-		partnerships covering smaller areas within the 		partnership area
avoidance or resolution of severe internal 		conflict
reasonable staff turnover

## 30 Day Illicit Drug UseMALES

**Comparison Communities**

**Partnership Communities**

**Adults**

**10th Graders**

**8th Graders**

**p********005***

**p********036***

**p********025***

***one-tailed**

***30 Day Illicit Drug Use******MALES***

## 30 Day Alcohol UseMALES

**Adults**

**10th Graders**

**8th Graders**

**Partnership Communities**

**28**

** **

***one-tailed**

***30 Day Alcohol Use******MALES***

## 30 Day Illicit Drug UseFEMALES

**Adults**

**10th Graders**

**8th Graders**

**Comparison Communities**

**Partnership Communities**

** **

**4**

** **

**22**

**24**

** **

**1**

**0**

**5**

**6**

**0**

**18**

**20**

**0**

**p********026***

**18**

**20**

**22**

**24**

***one-tailed**

***30 Day Illicit Drug Use******FEMALES***

## 30 Day Alcohol UseFEMALES

**Adults**

**10th Graders**

**8th Graders**

**Comparison Communities**

**Partnership Communities**

**0**

**38**

**40**

**42**

** **

**0**

**26**

**28**

**30**

**32**

** **

***30 Day Alcohol Use******FEMALES***

## 1998 Drug-Free Communities Support Grant Program

***1998 Drug-Free Communities ******Support Grant Program***

- Partnership Between OJJDP, ONDCP and CSAP
- Supports 105 Existing Coalitions to Develop Prevention and Treatment Strategies

## 1998 Drug-Free Communities Support Grant Program

***1998 Drug-Free Communities ******Support Grant Program***

- Five One-hour Regional Telephone Conferences
- Training and Technical Assistance (T&TA) for:
- 1.		Application and Review Process
- 2.		Needs Assessment
- 3.		Community Mobilization
- 4.		Evaluation
- 5.		Best Prevention Practices
- Program Introduction and Q & A from Agency Directors (Kumpfer, McCaffrey & Bilchik)

## 1998 Drug-Free Communities Support Grant Program

***1998 Drug-Free Communities ******Support Grant Program***

- T&TA CSAP/ONDCP
- Objectives:
- Increase Grantee Knowledge and Skills
- Strengthen Grantees’ Networks and Linkages With CAPTs
- Increase Dissemination and Application of Relevant Science-based Knowledge

## 1998 Drug-Free Communities Support Grant Program

***1998 Drug-Free Communities ******Support Grant Program***

- Reduced the Number of Applications From Ineligible Organizations
- Listeners Liked Telephone Conference as a Convenient Way to Access Information
- Q & A Rated As Most Informative Aspect of the Telephone Conference
- Convenient to Participate From Work or Home

## Pathways to Substance Use for High Risk Youth

**Family **
**Supervision**

**Family **
**and Peer **
**Norms**

**No**
**Substance **
**Use**

**Family **
**Bonding**

***Pathways to Substance Use ******for High Risk Youth***

## Pathways to Substance Use for High Risk Youth

**Substance **
**Use**

**Family **
**Supervision**

**Family **
**and Peer **
**Norms**

**Family **
**Bonding**

***Pathways to Substance Use ******for High Risk Youth***

## Thirty-Day Use of Various Types of Drugs, 1995(Cases Where Female Use is Higher than Male Use)

**Prevalence Rate**

***Thirty-Day Use of Various Types of Drugs, 1995******(Cases Where Female Use is Higher than Male Use)***

## Thirty-Day Use of Various Types of Drugs, 1995(Cases Where Male Use is Higher than Female Use)

**Prevalence Rate**

***Thirty-Day Use of Various Types of Drugs, 1995******(Cases Where Male Use is Higher than Female Use)***

## CSAP Female Adolescent Program

- Lei `Ilima - Health Connections for Female Adolescents
- Decrease Use of Tobacco and Difficulty Refusing Drugs
- Decrease Family Conflict and Argument
- Decrease Depression
- Increase Satisfaction With Physical Appearance
- Young Women’s Health Initiative at Boston High School
- Decrease Use of Alcohol and Beer Relative to Comparison Group
- Nuevo Dia Female Adolescent Program
- Increase Positive Self-esteem for High Attenders
- Increase Decision-making Skills for High Attending Females

## Female Adolescent Programs

- 	NUEVO DIA (NEW DAY) FEMALE ADOLESCENT PROGRAM  (Centro De La Familia De Utah)
- Intervention:
- After-school Program
- Alternative Recreational Activities
- Advocacy services
- Outcomes:
- Increase Self-esteem
- Increase Decision-making Skills
- Increase Social Skills
- Increase Positive Mother/Daughter Bonding and Attachment
- Decrease Substance Use

## Female Adolescent Programs (continued)

- 	LEI `ILIMA -- HEALTHY CONNECTIONS FOR FEMALE ADOLESCENTS (Coalitions for a Drug-Free Hawaii)
- Intervention:
- Intermediate School
- Prevention Education Class
- Strengthening Hawaii Families Program (SHFP)
- Lei `Ilima Club
- Lei `Ilima Network
- Outcomes:
- Decrease Family Conflict and Argument
- Decrease Depression
- Increase Satisfaction With Physical Appearance
- Increase Refusal Skills

## Short-Term Outcomes:Developmental Predictor Variable (Cross-Site Study - 10 Sites)

- Decrease Family Conflict
- Decrease Harsh Parenting Strategies (Spanking, Yelling, and Threatening)
- Increase Parent Involvement in Classroom
- Decrease Aggression
- Decrease Conduct Disorders
- Increase Cooperation and Behavioral Control
- Increase Academic Performance
- Decrease Substance Use

## Predictor VariablesEarly Risers Program - Results of Phase II

**Severity of Problem**

***Predictor Variables******Early Risers Program - Results of Phase II***

## High Risk Youth Demonstration Programs

- CHILD DEVELOPMENT PROJECT
-  (Developmental Studies Center - California, Kentucky, Florida, & NY)
- Intervention:
- Elementary Schools
- Students, Families, and School Staff
- Promote Attachment to School Community
- Outcomes:
- Decease Delinquent Acts - Gang Involvement, Carrying a Weapon, Fighting
- Increase Social Competence
- Increase Conflict Resolution Skills
- Increase Acceptance of Differences
- Increase Motivation to be Kind and Helpful
- Decrease Loneliness in School
- Increase School Enjoyment
- Decrease Substance Use

## High Risk Youth Demonstration Programs

- 	INVOLVING PARENTS OF HIGH RISK YOUTH IN PREVENTION - THE FAMILY ADVOCACY NETWORK/	FAN CLUB   (The Pennsylvania State University)
- Intervention:
- 4 Boys & Girls Clubs in Large and Intermediate-sized Cities
- High Risk Boys & Girls Clubs Members Ages 11 to 13 and Their Parents
- Multi-cultural
- 27-month Offering of 3-year Start SMART, Stay SMART, and SMART Leaders
- FAN Club Program
- Outcomes:
- Increase Knowledge of the Health Consequences of Drug Use
- Increase Negative Attitude About Drug Use
- Increase Refusal Skills
- Decrease Substance Use

## Findings from the Replication Programs

- Growing Up Well:
- Decrease Rate for 7th Grade Participants in Alcohol, Marijuana, and Tobacco
- Decrease Fighting and Threatening Behaviors
- Across Ages:
- Increase Negative Attitudes Toward Substance Use
- Increase School Attendance
- Asian Youth Substance Abuse Prevention Program:
- Decrease Social Anxiety Skills
- DARE To Be You:
- Increase Parents’ Use of Appropriate Disciplinary Techniques and Parent-Child Communication

## CSAP’s Future Plans

- Secretary’s Youth Substance Abuse Prevention Initiative (YSAPI)
- National Families Strengthening Initiative
- State Incentive Grants
- Core Measures:  SIG Pilot Study
- Positive Activities Campaign
- More Field-Initiated Cross-Site Studies That Meet Local Needs
- Data Coordinating Center
- Science Symposia
- Colorado CD-ROM Project

## National Families Strengthening Initiative

- Increase the Family’s Role in the Secretary’s Youth Substance Abuse Prevention Initiative (YSAPI)
- Emphasize the Role of Family in Deterring Negative and Unhealthy Behaviors in Youth
- Five Levels of Family Involvement:
- 	1)  Receive Media Messages
- 	2)  Participate in National Family Strengthening Day
- 	3)  Participate in National Child Health Day
- 	4)  Join Parent and Peer Support Groups
- 	5)  Join Family Skills Training Groups

## CSAP Core Measures Initiative

**GOALS**
- Increase Knowledge of Effective Prevention Strategies
- Increase Ability to Analyze Results Across Cross-site Studies
- Increase Quality of Evaluation Data for Researchers and Practitioners
**OBJECTIVES**
- Identify and Foster the Use of the Best Instruments for Identified Core Variables
- Increase collaboration Across Federal Agencies In Use of Core Measures

## Phases of the Core Measures Initiative

- 1.	Develop Core Measures Catalogue
- 2.	Develop Draft List of Recommended Core Constructs, May 28-29
- 3.	Convene Five Measurement Task Forces, September 2
- 4.	Field Test of Core Measures in SIG States
- 5.	Develop Culturally Valid Measures
- 6.	Develop and Disseminate a CD ROM Expert System
- 7.	Use CSAP Data Coordinating Center for Analysis and Reporting

## Outcomes of the Core Measures Initiative

- Examine data on existing/past funded activities
- Promote the use of common data definitions across funding activities whenever possible
- Promote the ability to coordinate and/or compare data wherever possible within and across activities through linked databases
- Promote the collection of data needed for GPRA, ONDCP, HP2010
- Use data to guide future CSAP-wide program and policy development
- Use data to inform programmatic technical assistance and training
- Disseminate relevant cross-cutting information to interested constituents

## Milestones of the Core Measures Initiative

- Internal and external input on prevention data needs for CSAP, States, prevention constituencies
- January-May, 1998: Production of inventory of CSAP inventories for program variables for intermediate and long-term outcome measurement, and for process measurement (working documents)

## Milestones of the Core Measures Initiative (continued)

- May 28-29, 1998: Exploratory Core Data Initiative Meeting
- Identified Important Substance Abuse Prevention Evaluation Questions
- Presented Conceptual and Categorical Frameworks to Prioritize Data Needs
- Developed Preliminary List of CSAP Core Intermediate and Outcome Constructs

## Milestones of the Core Measures Initiative (continued)

- September 2, 1998: Initial Core Measures Meeting
- Critical Variables as Focus of Best Measures
- Formation of Task Forces and Recommended Participants
- Criteria for Identifying Best Measures for Variables
- Format for Reporting Recommendations
- Potential of Developing and Disseminating an Expert System

## Milestones of the Core Measures Initiative (Continued)

- CSAP DATA COORDINATING CENTER (DCC)
- THE CORE MEASURES INITIATIVE SOFTWARE PROGRAM
- COMPREHENSIVE CORE MEASURES STRATEGY

## Department of Health and Human Services

**CENTER FOR SUBSTANCE ABUSE PREVENTION**

- TEAM A LEADER  - Clarise Holden
- TEAM B LEADER - Will Hardy
- TEAM C LEADER - Deborah Castell

- Note: Shadowed components represent major components as published in the organizational statement of the _Federal Register_ or approved by the Center Director as branches.

**OFFICE OF THE DIRECTOR**
*DIRECTOR*
- Karol L. Kumpfer, Ph.D.
*DEPUTY DIRECTOR*
- James Sayers, Ph.D.

**OFFICE OF MANAGED CARE**
- Nancy Kennedy, Dr.P.H.

**OFFICE OF POLICY & PLANNING**
*Director*
- Elaine Parry

**DIVISION OF STATE AND COMMUNITY SYSTEMS DEVELOPMENT**
*Director*
- Ruth Sanchez-Way, Ph.D.

**DIVISION OF PREVENTION APPLICATION AND EDUCATION**
*Director (Acting)*
- Judith Galloway

**DIVISION OF WORKPLACE PROGRAMS**
*Director*
- Joseph Autry III, M.D.

**DIVISION OF KNOWLEDGE  DEVELOPMENT AND EVALUATION**
*Director (Acting)*
- Stephen Gardner, D.S.W.

**YOUTH SUBSTANCE ABUSE PREVENTION INITIATIVE**
- Robert Denniston

**OFFICE ON EARLY CHILDHOOD**
- Pat Salomon, M.D.

- BUDGET/ADMINISTRATION TEAM LEADER - Carolyn Nelson
- PLANNING & POLICY TEAM LEADER - Melvin Segal
- NATIONAL ADVISORY COUNCIL TEAM LEADER - Yuth Nimit, Ph.D.
- CONTROLLED CORRESPONDENCE TEAM LEADER - Estelle Feil
- INTERGOVERNMENTAL & EXTERNAL AFFAIRS TEAM LEADER

**Systems Application Branch**
- Chief, David Robbins

**Systems Development Branch**
- Chief, Theodore Weiss

- HIGH RISK YOUTH/REPLICATION TEAM LEADER (Acting)- Rose Kittrell
- WOMEN’S INITIATIVE TEAM LEADER(Acting) - Francis Johnson
- INDIVIDUAL FAMILY STUDIES TEAM LEADER - Soledad Sambrano, Ph.D.
- SYSTEMS/COMMUNITY/MANAGED CARE TEAM LEADER - Shakeh Kaftarian, Ph.D.

**Prevention Application Branch**
- Chief, Luisa Del Pollard

**Prevention Education Branch**
- Chief, Joan Quinlan

**OFFICE OF MEDICAL & CLINICAL AFFAIRS**
- Lucille Perez, M.D.

***Department of Health and Human Services***

## Promoting Leadership, Vision and Excellence Through Learning

- I.		Promote a Learning Community in CSAP
-   Karol’s Korner
- II.		Improve Senior Staff Management
-   Management Training
- III.	Improve Staff Morale
-   Fallfest:  New Beginnings
- IV.	Continue Strategic Planning
-   Vision Day - Mission Day
- V.		Staff Development
-  Staff College
-   Support Staff Network
-   360 Assessment