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The Seven Steps To Building A Successful Prevention Program


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The Seven Steps To Building A Successful Prevention Program

  1. 1. Strategic Plan Consideration*The Seven Steps to Building a Successful Prevention Program*Adapted by the Southeast CAPT from the web site of the Western Center for theApplication of Prevention Technologies. MUST KNOW for Evidence-Based Prevention!!! Step 1: Community Readiness Is your community ready for prevention? (Assess community readiness) Step 2: Needs Assessment What are your community’s greatest needs for prevention? (Conduct a needs assessment) Step 3: Prioritizing Which risk and protective factors are your priorities? (Translate needs indicator data into risk and protective factors) Step 4: Resource Assessment What resources already exist in your community that address the risk and protective factors that you have prioritized? (Conduct a resource assessment) Step 5: Targeting Efforts Where will you target your prevention efforts? (Select universal, selective, or indicated populations) Step 6: Best Practices Which prevention strategies have been shown through research to be effective? (Select scientifically-defensible best practice to implement) Step 7: Evaluation How will you evaluate your prevention program? (Conduct evaluation planning, implementation, analysis, and use results for future program planning) 1
  2. 2. Strategic Plan Consideration Step 1: Community Readiness Is your community ready for prevention? (Assess community readiness)What is community readiness and why is it important?Community readiness is the extent to which a community is adequately prepared toimplement a drug abuse prevention program. A community must have the support andcommitment of its members and the needed resources to implement an effectiveprevention effort. Because community readiness is a process, factors associated with itcan be objectively assessed and systematically enhanced.Nine stages of community readinessExcerpt from Community Readiness for Drug Abuse Prevention: Issues, Tips and Tools,1997, National Institute of Drug Abuse, p. 13-15Through extensive research on community development and substance abuse preventionefforts, Oetting and colleagues (Oetting et al. 1995) have identified nine stages ofreadiness through which communities develop: the higher the stage of development, thegreater the degree of readiness. The following are descriptions of the nine stages and thecharacteristics of communities at each stage: Stage 1: Community Tolerance/No KnowledgeCommunity norms actively tolerate or encourage the behavior, although the behaviormay be expected of one group and not another (e.g., by gender, race, social class, or age).The behavior, when occurring in the appropriate social context, is viewed as acceptableor as part of community norm. Those who do not engage in the behavior may betolerated, but might be viewed as somewhat deviant. Stage 2: DenialThere is usually recognition that the behavior is or can be a problem. Community normsusually would not approve of the behavior, but there is little or no recognition that thismight be a local problem. If there is some idea that it is a problem, there is a feeling thatnothing needs to be done about this locally, or that nothing can be done about it. Stage 3: Vague AwarenessThere is a general belief that there is a local problem and that something ought to be doneabout it. Knowledge about local problems tends to be stereotypical and vague, or linkedonly to a specific incident or two. There is no immediate motivation to do anything. Noidentifiable leadership exists, or leadership lacks energy or motivation. Stage 4: PreplanningThere is clear recognition that there is a local problem and that something should be doneabout it. There is general information about local problems, but ideas about etiology orrisk factors tend to be stereotyped. There are identifiable leaders, and there may be acommittee, but no real planning. 2
  3. 3. Strategic Plan Consideration Stage 5: PreparationPlanning is going on and focuses on practical details. There is general information aboutlocal problems and about the pros and cons of prevention programs, but it may not bebased on formally collected data. Leadership is active and energetic. The program mayhave started on a trial basis. Funding is being actively sought or has been committed. Stage 6: InitiationEnough information is available to justify a prevention program, but knowledge of riskfactors is likely to be stereotyped. A program has been started and is running, but it is stillon trial. Staff are in training or just finished with training. There may be great enthusiasmbecause limitations and problems have not yet been experienced. Stage 7: Institutionalization/StabilizationOne or two programs are running, supported by administration, and accepted as a routineand valuable activity. Staff are trained and experienced. There is little perceived need forchange or expansion. Limitations may be known, but there is not much sense that thelimitations suggest a need for change. There may be some form of routine tracking ofprevalence. There is not necessarily permanent funding, but there is established fundingthat allows the program the opportunity to implement its action plan. Stage 8: Confirmation/ExpansionStandard programs are viewed as valuable and authorities support expanding orimproving programs. New programs are being planned or tried out in order to reach morepeople, those thought to be more at risk or different demographic groups. Funds for newprograms are being sought or committed. Data are obtained regularly on extent of localproblems and efforts are made to assess risk factors and causes of the problem. Stage 9: ProfessionalizationDetailed and sophisticated knowledge of prevalence, risk factors and etiology exists.Some programs may be aimed at general populations, while others are targeted at specificrisk factors and/or at-risk groups. Highly trained staff are running programs, authoritiesare supportive, and community involvement is high. Effective evaluation is used to testand modify programs.Oetting and colleagues (Oetting et al. 1995) have found that as communities achievesuccessively higher stages, they realize greater improvement in their degree of readiness.Therefore, to increase a communitys readiness for prevention programming and therebyimprove the likelihood that a prevention effort will succeed, it is important to give carefulconsideration to these nine stages of community readiness development during theprocess of conducting an objective assessment of community readiness.Oetting, E.R.; Donnermeyer, J.J.; Plested, B.A.; Edwards, R.W.; Kelly, K.; and Beauvais,F. Assessing community readiness for prevention. International Journal of Addictions,30(6):659-683, 1995. 3
  4. 4. Strategic Plan ConsiderationFor more information and tools on community readiness, the National Institute on DrugAbuse has available, "Community Readiness for Drug Abuse Prevention: Issues, Tipsand Tools. To obtain a copy, contact National Technical Information Services at (800)553-6847 (publication number PB# 97-209605). This book is part of a 5 book packetwhich costs $83 plus $5 handling.The links below will help you assess your communitys readiness for prevention as wellas provide you with strategies to improve community readiness. (From NIDAs"Community Readiness for Drug Abuse Prevention: Issues, Tips and Tools (1997).) Community readiness assessment survey This survey will assist you in determining where your community is in terms ofreadiness for prevention. This survey, developed by Goodman and Wandersman at theUniversity of South Carolina, uses key leaders to look at three areas: awareness, concern,and action across community levels. Key leaders respond to questions in these three areasboth on a personal level and a perceptual level of their organizations responses. Community readiness strategies Once you have assessed your communitys readiness for prevention, you can usesome of these strategies to improve your communitys readiness. These strategies areincluded in NIDAs "Community Readiness for Drug Abuse Prevention: Issues, Tips andTools." Next step: Needs Assessment 4
  5. 5. Strategic Plan ConsiderationStep 2: Needs AssessmentWhat are your community’s greatest needs for prevention?(Conduct a needs assessment)What is a community assessment (needs assessment)?A community assessment is a systematic process for examining the current conditions ofa situation (such as substance abuse) and to identify the level of risk and protection inyour community.Why do we need to complete a community assessment?• A community assessment will assist you in:• Creating an objective profile of your community• Determining the geographic and demographic areas that are at greatest risk• Ensuring you are putting your time and money where it will have the greatest impact• Showing policy makers the need for funding your prevention programs• Identifying research-based strategies to implement in your communityHow do we complete a community assessment?How do we complete a community assessment?1. Collect data.2. Analyze the data.3. Select the priority risk factors (step 3 of the web-site). 1. Collect data.Data collection is the first phase of conducting a community assessment. At this point,data needs to be identified and assembled in order to determine how prevalent each riskfactor and protective factor is in your community. It is important that you examine riskfactors because this will tell you which factors are prevalent in your community that areincreasing the risk that your youth will be involved in substance abuse, teenagepregnancy, youth violence, school drop-out, and delinquency. If you only examine theprevalence of a particular problem (e.g. the number of kids abusing drugs), you wontknow what you can do to impact and/or prevent the problem. However, if you can figureout which risk factors (that increase the likelihood of a problem occurring) are prevalentin your community, then you can identify and implement strategies to reduce those risksand thus reduce the problem behavior. Similarly, by examining the level of protectivefactors that exist in your community, this will tell you how prevalent factors are whichbuffer the effects of risk factors.Two kinds of data can be collected: Archival data, or data that already exists Survey data, or data that you createArchival indicators, data that already exists, have been identified through research toenable you to determine how prevalent risk factors are in your community. Click here for 5
  6. 6. Strategic Plan Considerationa list of validated archival indicators. These are the indicators which have been shownthrough research to be good proxy measures for risk factors. We need archival indicatorsbecause we cant go to our local health department and look up the statistics on "familymanagement problems" because a family management problems statistic does not exist.Consequently, we must use "proxy" measures to determine how prevalent familymanagement problems and other risk factors are. Here are some sources of archival data:National Data: CSAPs PREVLINE -- Contains links to 20 data sources Office of National Drug Control Policy -- Lists 25 links to data sets, along with thesponsoring agency, description of information available, population, geographic areas,and frequency/year started National Criminal Justice Reference Service -- Contains links to many sources ofcrime statistics, both National and State data Centers for Disease Control and Prevention -- Contains links to many sources,including the Youth Risk Behavior Surveillance System survey State of the Nations Cities Report (HUD) -- A database on American cities andsuburbs (includes data on items such as employment, income, land development)You can also identify the prevalence of risk and protective factors in your communitythrough surveys. This may be a preferred alternative if little archival indicator data isavailable to you. However, surveys can also function as a good supplement to thearchival indicator data you collect. By having both archival and survey data, you cancompare the two to see where differences and similarities lie.Steps for Collecting Data: Identify what data is currently available for each risk and protective factor, beginningwith the list of archival indicators. Determine which factors need additional data. Click here for a worksheet to assist youin completing this step. Develop a plan to collect the additional data that is needed. Click here for a worksheetto assist you. Collect that additional data. 2. Analyze the Data.How do we analyze all of the data we have collected?Once you have collected indicator data, it is time to analyze the data. Your data analysiswill assist you in identifying which risk and protective factors need to be prioritized inyour community action plan, as well as provide justification for grant applications,support existing policies and programs, and assist you in selecting new preventionprograms to implement.The following are questions that need to be asked of the data 6
  7. 7. Strategic Plan Consideration What does the raw data tell you? At first glance, what do the data tell you? Do the rawnumbers impress you as being low? Average? High? Any red flags? How do the data compare to previous years? Is there a trend? By comparing numbersfor previous years, you can begin to get a picture of how the data has been changing overtime. Is it increasing? Decreasing? Staying the same? How have trends changed inrelation to population changes? How do our data compare with other similar data (national, state, county, etc.)? Arethe trends similar? Are the rates about the same? Are they going up or down? What can be interpreted from the data? After reviewing the raw data, the data trends,and the data comparisons (if available), what can you interpret from your analysis? Whatis happening? Do you know why it is occurring? What could have caused the trend?What does the observed level or trend tell you about this risk or protective factor? Whatother factors or events could account for the data? Are there relationships among risk factors that you can identify based on the data youhave? Examine your data across risk factors and across protective factors. Should you prioritize this risk factor? The more information obtained about theindicator data, the easier this question will be to answer. See next step. Next step: Translating Data into Priorities 7
  8. 8. Strategic Plan ConsiderationStep 3: Translating Data into PrioritiesWhich risk and protective factors are your priorities?(Translate needs indicator data into risk and protective factors)(Adapted with permission from Developmental Research and Programs "CommunitiesThat Care©" Risk Assessment. All rights reserved.)Once you have completed the collection and analysis of the data collected for yourcommunity assessment, it is time to prioritize which risk and protective factors need to beaddressed in your community. The following questions will assist you in identifying yourpriorities: Looking across the data you have collected, are there risk factors or protective factors for which you have no data? If so, identify these factors, determine if andwhere the appropriate data can be collected, and add this information to your dataanalysis to strengthen your overall assessment. Remember, the assessment is thefoundation for your prevention action plan. The more thorough you are in completing thisstep, the more effective and accurate you will be in designing solutions. Which risks are most prevalent in your community? Which protective factors are most lacking? Based on: trends, comparisons with other similar data (national,state or other communities); comparisons across factors; and your interpretation of thedata and possible explanations. At what developmental periods are children most at risk in your community? Is there an identifiable "cluster" of risk factors that, addressed together, could provide a synergistic response? Which two to five risk factors, identified as most prevalent in your community, do you think your community should tackle first? Which protective factorshould you tackle first? Next step: Resource Assessment 8
  9. 9. Strategic Plan Consideration Step 4: Resource Assessment What resources already exist in your community that address the risk and protective factorsthat you have prioritized? (Conduct a resource assessment)What is a resource assessment?A resource assessment is a systematic process for examining the current resources in yourcommunity which are reducing risk factor and increasing protective factors. It answersthe question: "Whats going on in my community?"What are "resources"? They are anything that can be activated to reduce the likelihoodthat individuals or communities will begin or continue to abuse alcohol, tobacco, andother drugs.Why do we need to complete a resource assessment?A resource assessment will assist you in: Identifying gaps where new services should be implemented Avoiding duplication in services Building collaboration among service providers Modifying existing programs to meet prevention needs Identifying existing resources to sponsor new programs Ensuring you are putting your time and money where it will have the greatest impact Ensuring you are creating a comprehensive prevention strategy for your community Ensuring you are effectively impacting the priority risk and protective factors that youidentified when completing your community assessment (Steps 2 and 3).How do we complete a resource assessment? Before conducting a resource assessment, you must complete a communityassessment and identify priority risk and protective factors (Step 2 and Step 3). Collect information on existing resources in your community which may beaddressing the priority risk and protective factors that you identified through yourcommunity assessment. Analyze the resources to determine how effectively they are impacting your priorityrisk and protective factors. Determine where the gaps in services are in your community. Next step: Targeting Efforts 9
  10. 10. Strategic Plan Consideration Step 5: Targeting Efforts Where will you target your prevention efforts? (Select universal, selective, or indicated populations)What is a resource assessment?Now that you have completed your community assessment, identified priority risk andprotective factors, assessed your communitys existing resources, and identified the gaps,it is time to take one more look at your target population.Since you know in which area you want to place your time and funding (your priority riskand protective factors) and you know which gaps you need to fill (from your resourceassessment), you can now identify what type of target population you need to address:universal, selective, or indicated (click on these words for definitions).To determine what type of population your program/strategies should reach, answer thefollowing questions: Can your priority risk/protective factors and resource gaps be addressed at the universal level? Or would those risk/protective factors and gaps be better addressedwith selective or indicated populations? For example, if your priority risk factor is familymanagement problems but you know through your resource assessment that several localprograms already offer parenting classes aimed at the general population, then you maywant to look at implementing a parenting program for selective or indicated populations. Do you need a program/strategy that impacts the broader community (e.g., a city, a school), not a particular segment of that community? If so, you may want toimplement a universal program/strategy. Do you need to implement a program/strategy with greater intensity and duration for a specific population with identified risks? If so, you may want to choose a selective orindicated program/strategy to implement. If you are looking at implementing a selective or indicated program/strategy, do you have adequate funding? (Many selective and indicated programs/strategies requiremore funds than do universal programs/strategies.) Once you have answered the above questions and have determined what type of population you will target, make sure you are clear as to: what age group(s) you wantto address; whether you are targeting both genders or just one; in which developmentalstage your target group is; and from which culture your target group is. Next step: Best Practices 10
  11. 11. Strategic Plan Consideration Step 6: Best Practices Which prevention strategies have been shown through research to be effective? (Select scientifically-defensible best practice to implement)What are guiding principles and best practices?Best practices are those strategies, activities, or approaches which have been shownthrough research and evaluation to be effective at preventing and/or delaying substanceabuse.Guiding principles are recommendations on how to create effective prevention programs.When a community already has a prevention program or strategy in place, the guidingprinciples can be used to gauge the programs potential effectiveness. They can also beused to design an innovative program/strategy when none of the best practices areappropriate to the communitys needs.Before you select a best practice or apply the guiding principles, your community mustconduct an assessment (risk assessment) to identify the risk and protective factors thatneed to be addressed in your community. Once you have identified which risk andprotective factor(s) to address through your assessment, you can use the links below toselect the best practice(s) and/or guiding principles to address your communitys needs.Definition of "best practice": In this web-site "best practices" are those strategies andprograms which are deemed research-based by scientists and researchers at the NationalInstitute for Drug Abuse (NIDA), the national Center for Substance Abuse Prevention(CSAP), National Center for the Advancement of Prevention (NCAP), National Office ofJuvenile Justice and Delinquency Prevention (OJJDP) and/or the national Department ofEducation (DOE). These are strategies and programs which have been shown throughsubstantial research and evaluation to be effective at preventing and/or delayingsubstance abuse. If you are familiar with the rating scale presented in the document,"Science-Based Practices in Substance Abuse Prevention: A Guide" prepared by P.J.Brounstein, J.M. Zweig, and S.E. Gardner, the best practices in this web-site would fallinto the categories of types 3, 4, and 5. Click here for more information on this rate scale.(PLEASE NOTE: Each best practice has not been labeled either 3, 4, or 5. The authors ofthe document did not specificy specific types to specific programs. Therefore, thisinformation does not exist.)We have also included a category called "Promising Practices" in areas of the web-sitewhere there are few programs that have enough outcome data (or that have beensufficiently evaluated) to be deemed best practices.Definition of "promising practices": Promising practices are programs and strategiesthat have some quantitative data showing positive outcomes in delaying substance abuseover a period of time, but do not have enough research or replication to supportgeneralizable outcomes. These practices would fall into the rating scale (mentionedabove) of types 1 and 2. 11
  12. 12. Strategic Plan ConsiderationNOTE: No single best practice will be successful at preventing substance abuse in yourcommunity. To be as comprehensive as possible, best practices addressing preventionstrategies (CSAP strategies) in all areas of your community (family, school, individual,peer, society/community) should be implemented. Remember: there is no "magic bullet"in prevention!Get more information on: Guiding Principles (Part of Step 4) Department of Educations Principles of EffectivenessBest PracticesAfter you have completed a needs (risk) assessment and have identified the area you needto address, you can access a list of best practices through the Needs Resources ofEffective Programs:http://modelprograms.samhsa.govAdditional Resource MaterialsAlso try visiting the other CAPT sites for more information. We recommend CentralCAPTs search page on best practices. Next step: Evaluation 12
  13. 13. Strategic Plan Consideration Step 7: Evaluation How will you evaluate your prevention program? (Conduct evaluation planning, implementation, analysis, and use results forfuture program planning) site is designed to be a "how-to" guide to planning and implementing an evaluationof your prevention program. If you start by clicking on Section I of the outline below,you will be led through the step-by-step process of developing an evaluation. You canalso use the outline to navigate the site and locate specific kinds of evaluationinformation. There are 7 major sections.Within each section you will find worksheets, tools, and examples of how to conductuser-friendly evaluations of substance abuse prevention programs using the risk andprotective factors model. These worksheets and tools can also be accessed in the lastsection of this site: Section X: Evaluation Tools & Measures.I. What is Evaluation & Why Do It?II. Using a Logic Model for Evaluation Planning A. Who should develop the logic model? B. Benefits of a Logic Model Logic Model WorksheetIII. How to Build Your Program Logic Model A. What You Need to Know to Build your Logic Model 1. What risk and protective factors does your program address? 2. What services and activities will your program provide? 3. Who will participate in your program? 4. How will these activities lead to outcomes? 5. What are your programs long and short term goals? a. What immediate changes are expected? b. What changes would your program ultimately like to create? B. Reviewing your Logic modelIV. How to Plan Your Evaluation A. General Considerations B. Developing the Plan 1. What are you going to evaluate? 2. What do you want to know about the program? a. Defining the purpose of the evaluation b. Defining the users of the evaluation c. Defining the evaluation questions 3. Focusing the Evaluation a. Timing and program development 13
  14. 14. Strategic Plan Consideration b. Scope of the program c. Pragmatic considerationsV. Evaluating Your Program Using the Logic Model A. General Issues in Evaluation Methods 1. Types of information 2. Quantitative and Qualitative information 3. Identifiying measureable indicators 4. Making decisions about methods B. Evaluating Issue Focus C. Evaluating Program Activities and Outputs D. Evaluating Coverage E. Evaluating Program Assumptions F. Evaluating Outcomes 1. Some common methods a. Post-test only b. Post-test with a comparison group c. Pre-Post d. Pre-Post with comparison group 2. Distinctions between long and short term outcomes 3. Measuring Client SatisfactionVI. Analyzing, Using & Interpreting Evaluation Information A. Basic Aggregation and Analysis Strategies B. Descriptive Information C. Testing for Changes Pre-Post D. Using and Interpreting Information 1. How will the information be interpreted-by whom? 2. How will the evaluation be communicated and shared?VII. Implementing the Evaluation A. Whos responsible for the evaluation B. How to know if you need an Evaluation Consultant or Contractor C. Finding and selecting a good consultantVIII. Glossary Links to evaluation resources Evaluation Tools & Measures 14
  15. 15. Strategic Plan ConsiderationA. Logic Model WorksheetB. Hypothetical Logic Models from CSAP Best PracticesC. Developing QuestionnairesD. Developing Behavioral SurveysE. InterviewingF. Using Tests and AssessmentsG. Using Observational DataH. Conducting Focus GroupsI. Using Case StudiesJ. Using Program RecordsK. Using Community Archival and Indicator DataL. Measuring Goal ImportanceM. Measuring Client SatisfactionN. Instruments for Risk and Protective Factors 15
  16. 16. Strategic Plan Consideration 16