The International Journal ofInterdisciplinary Social and.docx

The International Journal of
Interdisciplinary Social
and Community Studies
TheSoCIalSCIenCeS.Com
VOLUME 7 ISSUE 4
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Exploring the Strategic Prevention
Framework (SPF) and Its Application to a
Comprehensive Substance Abuse and HIV/
AIDS Prevention Initiative
Evidence from Project C.O.P.E. (Communities Organizing
for Prevention and Empowerment)
ROBERT REID AND PAULINE GARCIA-REID
THE INTERNATIONAL JOURNAL OF INTERDISCIPLINARY
SOCIAL AND COMMUNITY STUDIES
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First published in 2013 in Champaign, Illinois, USA
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ISSN: 2324-7576

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ensuring that only intellectual work of the greatest substance
and highest significance is published.
Exploring the Strategic Prevention Framework
(SPF) and Its Application to a Comprehensive
Substance Abuse and HIV/AIDS Prevention
Initiative: Evidence from Project C.O.P.E.
(Communities Organizing for Prevention and
Empowerment)1,2
Robert J. Reid, Montclair State University, USA
Pauline Garcia-Reid, Montclair State University, USA
Abstract: The inextricable link between substance abuse and

HIV/AIDS poses a serious public health threat in the United
States. Of particular concern has been the detrimental impact
that this crisis has wrought on urban centers, where people
of color, particularly racial and ethnic minority youth, are
disproportionately impacted by this twin epidemic. The U.S.
federal government has made a concerted effort to fund
demonstration projects through its Minority AIDS Initiative
(MAI) in geographic areas with high rates of substance abuse
and HIV/AIDS prevalence, with the specific intent of
introducing culturally-resonant, model prevention protocols
with proven effectiveness. Responding to this public health
emergency, the U.S. Substance Abuse and Mental Health
Services Administration (SAMHSA), Center for Substance
Abuse Prevention (CSAP), introduced the Strategic Prevention
Framework (SPF) to guide prevention planning and
implementation efforts throughout the U.S. This paper
illustrates the five steps of the SPF (e.g., assessment, capacity,
planning, implementation, and evaluation) by describing its
application to Project C.O.P.E. (Communities Organizing
for Prevention and Empowerment), which is a comprehensive
substance abuse and HIV/AIDS prevention program
located in the northeastern United States.
Keywords: Substance Abuse and HIV/AIDS, Culturally-Tailored
Model Prevention Protocols, Racial and Ethnic Urban
Minority Youth, Strategic Prevention Framework (SPF)
The Twin Epidemic – Substance Abuse and HIV/AIDS
he twin epidemics of substance abuse and HIV/AIDS pose a
serious public health threat in
the United States. A significant body of research has shown that
risky behaviors
associated with drug use continue to fuel the spread of HIV

infection (National Institute
on Drug Abuse (NIDA) 2012). Of particular concern has been
the impact that this crisis has
wrought on urban minority communities, where African
Americans and Hispanics now constitute
57% of all HIV/AIDS cases (Centers for Disease Control and
Prevention (CDC) 2011a; CDC
2011b; NIDA 2012). Throughout these urban centers, racial and
ethnic minority youth have
suffered due to the health consequences of drug abuse and HIV.
Approximately 39% of the new
infections are occurring in young people between the ages of 13
to 29, and of those, 65% are
among African Americans (CDC 2011a; CDC 2011c; NIDA
2012). A similar trend emerges
for Hispanics in which the HIV infection rate in 2009 was
nearly three times higher than among
their non-minority counterparts (CDC 2011b). Based on these
sobering statistics, it becomes
1 This paper was prepared with the support of the U.S.
Department of Health and Human Services (HHS), Substance
Abuse and Mental Health Services Administration (SAMHSA),
Center for Substance Abuse Prevention (CSAP), Grant
No. SP-15104. The views expressed in this paper are those of
the authors and do not necessarily represent the position of
the sponsoring agency.
2 An earlier version of this paper was presented at the Seventh
International Conference on Interdisciplinary Social
Science, Barcelona, Spain, July 27, 2012.
T

Community Studies
Volume 7, 2013, www.thesocialsciences.com, ISSN 2324-7576
© Common Ground, Robert J. Reid, Pauline Garcia-Reid, All
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paramount to structure preventive interventions and health
education messages that address the
constellation of factors that disproportionately place minority
adolescents at heightened risk for
acquiring HIV infection – that is the intersection between
substance abuse and sexual risk-taking
behaviors.
Responding to this public health emergency, the federal
government has made a concerted
effort to fund demonstration projects through its Minority AIDS
Initiative (MAI) in geographic
areas with high rates of substance abuse and HIV/AIDS
prevalence, with the specific intent of
introducing prevention models with proven effectiveness
(Substance Abuse and Mental Health
Services Administration (SAMHSA) 2008). Project C.O.P.E.
(Communities Organizing for
Prevention and Empowerment) emerges as one such initiative
that has received federal funding
from the U.S. Department of Health and Human Services
(HHS), SAMHSA , CSAP to develop
and coordinate comprehensive substance abuse and HIV/AIDS
prevention services for racially

and ethnically diverse youth in a northeastern urban community.
The target community
identified for this project has among the highest rates in the
state for both substance abuse and
HIV/AIDS infection among African American and
Hispanic/Latino residents. Prevention
programs, however, are scarce. As a collaborative venture
between a public university and
numerous community-based organizations, this initiative has
embraced the five stages of the
Strategic Prevention Framework (SPF) – e.g., assessment,
capacity building/mobilization,
strategic planning, model program implementation, and
evaluation (SAMHSA 2008) – with the
purpose of empowering a community to take action in
promoting positive youth development.
This paper will illustrate the five steps of the SPF by describing
its application to our project.
Strategic Prevention Framework (SPF)
Nearly a decade ago, SAMHSA introduced the newly formulated
SPF to address the substance
abuse prevention needs for state and local communities (Arthur,
Hawkins, Brown, Briney,
Oestrerle, and Abbott 2010, 246; Flewelling, Birckmayer, and
Boothroyd 2009, 388; Piper,
Stein-Seroussi, Flewelling, Orwin, and Buchanan 2012, 68).
The SPF is grounded in a public
health approach to prevention that examines a constellation of
risk and protective factors across
multiple systems such as individual/peer, family, school/work,
and community (NIDA 2003, 6),
which may either impede or promote population-level change
(Community Anit-Drug Coalitions
of America (CADCA) 2009a, 5). This public health model

involves the integration of five major
steps: 1) organize the community to profile needs and resources;
2) mobilize and/or build
capacity to address needs; 3) develop a comprehensive strategic
plan; 4) implement evidence-
based prevention strategies and activities; and 5) monitor,
evaluate, and sustain (Imm et al., 2007,
3; SAMHSA n.d.). By incorporating the common components
of effective prevention
programming through a risk and protective factor lens, the SPF
has a wide range of applicability
in preventing a host of public health concerns that may include
the prevention of underage
drinking and smoking, cancer, or diabetes (CADCA 2009a ;
Flewelling et al. 2009, 388).
The SPF is driven on the concept of outcome-based prevention
(SAMHSA n.d.). Funders
have become increasingly concerned about the lack of
quantifiable evidence in demonstrating
program effectiveness. By adhering to a data-driven approach,
community-level prevention
programs are being held more accountable for producing
measurable results pertaining to their
defined goals and objectives (Reid 1999, 43). The SPF also
allows for a more expansive
approach to prevention, as compared to prior prevention
initiatives that have often operated in
silos by focusing on a singular social problem with limited and
non-evidence based interventions
(Flewelling 2009, 390). This was demonstrated in the latter
part of the 1980s and the early 1990s
when the response to HIV prevention focused on theory-based,
cognitive behavioral models of
behavior change (Beeker et al., 1998, 832). Since the
introduction of the SPF, initiatives have

begun to emerge that move beyond individual-level
interventions and are now more
14
REID & GARCIA-REID: SPF AND ITS APPLICATION TO
SUBSTANCE ABUSE PREVENTION INITIATIVE
comprehensive, coordinated, and far more capable of reaching a
broader audience (SAMHSA
n.d.).
Figure 1: SAMHA’s Five Steps of the Strategic Prevention
Framework (Inn et al. 2007, 3;
SAMHSA n.d.)
The Importance of Cultural Competence
SAMSHA has identified cultural competence as an integral
component to the SPF. Cultural
competence refers to the beliefs, knowledge, and skills
necessary to work effectively with
individuals different from one's self and further recognizes that
issues of social justice are critical
to the process (CADCA 2009c,11; Resnicow, Soler, Braitwaite,
Ahluwala, and Butler 2000,
272). According to Imm and others (2007), “a commitment to
cultural competence ensures that
there is respect for the complexities of multiple cultures in
communities” (3). Attending to the

needs of diverse communities, the SPF requires that cultural
competencies be infused and
integrated across all five steps. Many prevention programs
have begun to identify ways to
increase ethnic/cultural awareness and pride, develop conflict
resolution skills, and promote pro-
social competencies that focus predominantly on the external
characteristics (i.e., surface
structure of culture). These prevention initiatives tend to rely
on people, language, food, and
music that are known to and preferred by the intended
population to increase the receptivity,
comprehension, and acceptance of messages (273). Yet, the
deeper structure level of culture is
also needed to determine how social, psychological, and
environmental factors can shape
behavior within and across ethnic groups. It is recommended
that strategies targeting substance
abuse and HIV/AIDS prevention among racial and ethnic
minority youth embrace various
dimensions of cultural sensitivity that will not only increase the
receptivity of the interventions
(i.e., surface structure activities), but will also combine culture,
history, social forces, and core
values as an avenue to stimulate change (i.e., deep structure)
(273). Programs should consider
tailoring their prevention messages to attend to the specific
strengths and needs of their
respective communities (Reid, Garcia-Reid, Klein, and
McDougall 2008, 419). For instance,
15

understanding the importance of immediate and extended family
ties in the Hispanic community
(known as familismo) can help shape preventive interventions
that resonate with its intended
audience.
The Importance of Sustainability
Sustainability refers to the “ability of a program to maintain the
human, social and material
resources needed to achieve long-term goals for community
change” (CADCA 2009e, 10). As a
“cross cutting” element of the SPF, it should also be considered
throughout the assessment,
capacity, planning, implementation, and evaluation phases.
Sustainability activities need to be
introduced during the early stages of an initiative being mindful
of long-term goals for
community change. However, achieving these goals will not
only require maintaining existing
resources (e.g., human, social, and material), but also
identifying and leveraging additional
opportunities for growth and development (10). For example, a
sustainability working group
may be formed at the onset of the project with the purpose of
exploring and identifying various
funding streams at the federal, state, and local levels, as well as
private foundations. The success
of sustaining a viable prevention program depends on a
multitude of factors, such as creating a
stable infrastructure, providing quality training systems, and
securing community support.

Additional elements to consider throughout this process include
building ownership among
stakeholders, disseminating program successes, investing in
capacity, and developing the systems
necessary to support these activities over time (SAMHSA n.d.).
Step 1: Assessment
Because the nature and extent of drug abuse and the HIV/AIDS
epidemic vary widely,
prevention strategies must be adapted to local community needs
and resources. Local drug use
and HIV/AIDS risk-behavior patterns must be tracked to refine
program approaches over time
and to evaluate program outcomes. Conducting a community-
wide needs assessment to identify
the magnitude of particular social problem emerges as the first
step in the SPF (CADCA 2009a,
10; Imm et al. 2007, 13). This process includes an assessment
of the risk and protective factors
associated with the problem. To address the intractable nature
of substance abuse and the spread
of HIV infection among urban minority youth, a coordinated
and sustained prevention initiative
that adheres to the SPF will focus on identifying common risk
factors while promoting protective
factors (SAMHSA n.d.). According to a cost-effectiveness
study of school-based drug
prevention programs conducted by Caulkins and colleagues
(1999, xxxii), the implementation of
nationwide model prevention programs seems to be justifiable
in that the resulting benefits would
likely outweigh the costs of the resources used to implement
such interventions. In addition, it
provides an opportunity to identify community assets and
resources, while simultaneously

exploring gaps in services and capacity.
In developing a comprehensive needs assessment to profile
population needs, we utilized a
multi-level approach that included a variety of data collection
methods and resources. During
both our first and second waves of funding (e.g., 2003-08 and
2008-13), the systematic gathering
and analysis of data regarding our target population involved
the following: 1) conducting focus
groups and semi-structured qualitative interviews with at-risk
African American and
Hispanic/Latino adolescents; and 2) administering a school-
wide youth survey to assess the
degree of substance abuse involvement and the level of HIV-
risk-taking behaviors among a
random sample of urban minority youth. This survey contained
CSAP-Core Measures
(SAMHSA 2008) and sexual behavior questions from the CDC
Youth Risk Behavior Survey
(CDC 2012). The interview guides and questionnaires identified
for these data-collection
processes were developed using a risk and protective factor
framework (i.e., examining issues
16
across the following life domains: individual/peer, family,
school, and community) and included

outcome measures pertaining to sexual health and drug use.
Focus group interviews revealed significant concerns among
youth in the identified service
area. For example, adolescents who participated in the
interview process poignantly described an
insidious presence of drugs, crime, and violence that is ravaging
their community. These
findings were further substantiated by a comprehensive, school-
wide, needs assessment survey
that was administered to 991 high school students in our target
community (see Table 1.). Risk
factors contributing to the needs of our study population are
highlighted below:
Table 1. Needs Assessment Findings
Individual Risk Factors
Sexual Risk
intercourse.
first time before the
age of 16.
4 sexual partners.
physically forced to have
sexual intercourse against their will.
Alcohol and Drug Use
nts reported using alcohol, with more
than 20% claiming
that they were younger than 13 years of age when they had their

first alcoholic
beverage.
be very easy to obtain
alcohol.
one third of the students drank alcohol within the past
30 days, and more
than 20% admitted to drinking 5 or more drinks in a row within
a couple of hours.
very easy for them to
obtain drugs like
cocaine, LSD, or methamphetamines.
Other Individual Risks
sad, or depressed
within the 6 months prior to the survey.
Peer Risk Factors
half of the respondents have friends who are gang
members.
Family Risk Factors
lack of communication
among their family members.
in
their families.
School Risk Factors

their school staff.
presence in their
schools.
Community Risk Factors
e respondents acknowledged drug selling
and crime in their
neighborhoods.
In our effort to assess the target community’s readiness for
change, we also embarked upon
the following activities: 1) focus-group interviews with key
community stakeholders (e.g., local
politicians, clergy, law enforcement, school officials, and
business leaders) to determine what
17
factors place youth at risk for substance abuse and HIV
infection, and explore the ways in which
adolescents are protected from engaging in risk-taking
behaviors; 2) a community-network
analysis to identify community assets and resources, as well as
gaps in services and capacity; and
3) a random digit dialing (RDD) survey to evaluate the impact

of substance abuse and escalating
HIV infection rates among a randomly selected sample of
community residents. These collective
needs assessment activities helped our initiative meet a variety
of objectives – e.g., enabled
consensus about the scope and detrimental impact of substance
use and HIV/AIDS problems in
the community; provided collateral support in identifying the
underlying factors that contribute
to those problems; aided in the identification and analysis of
environmental, social, and
individual factors associated with the primary areas of concern;
and guided the selection of
policies and programs aimed at reducing substance use and
HIV/AIDS problems in the
community and establishing a baseline to track progress
(CADCA 2009a, 11; SAMHSA n.d.).
Step 2: Capacity
Once communities have completed their needs assessment
activities and have identified their
prevention priorities, they can begin to enhance capacity and
harness local resources as a means
to implement effective programs, practices, and strategies.
Success during this “capacity-
building” phase of the SPF framework will require that
programs and practices are accepted and
well-supported by the community. Building trust among
community stakeholders is not an easy
undertaking as it requires time to cultivate relationships and
partnerships. Program developers
are encouraged to engage community members in the
development, implementation, and
evaluation phases of the proposed intervention. In addition to
adopting this collaborative

approach, it is important to introduce prevention protocols that
show sustainable, outcome-driven
results. These combined efforts could increase the likelihood of
obtaining demonstrable program
outcomes.
Research has demonstrated the importance of community
support and involvement at the
local level to help initiate such policy changes and to sustain
durable shifts in the social
environment (CADCA 2009b, 9; NIDA 2003, 13; SAMHSA
n.d.). SAMHSA’s Collaborative
for the Application of Prevention Technologies has identified
four key components of the
capacity-building phase and is illustrated with specific
examples from our initiative (SAMHSA
n.d.):
Improving Awareness of Substance Abuse and HIV/AIDS
Problems and
Readiness of Stakeholders to Address These Problems
During the initial stages of our funding cycle, several focus
group interviews were conducted
with key stakeholders in the community to explore the service
needs of its adolescent population.
One of the more salient themes that emerged from the findings
was that the social problems
plaguing youth were exacerbated by unmet treatment needs and
gaps in social-service delivery
among the city’s community-based organizations. Group
members represented all segments of
the community, such as municipal government, law
enforcement, health and human services,
faith-based institutions, community-based organizations,
parents, youths, and the public school

district. Participants indicated that the service delivery system
for at-risk youth was hampered by
the following factors: 1) lack of integration and coordination
among service providers; 2)
evidence of a gang problem plaguing youth in the identified
community; and 3) lack of resources
for adolescents who are at risk for substance abuse and HIV
infection. For example, throughout
the entire community that is comprised of approximately 30,000
youth under the age of 18, there
was only one substance abuse prevention program and two HIV
prevention programs serving the
entire city. The focus groups further revealed a strong
commitment among community members
18
and stakeholders in attending to the myriad of public health
problems adversely impacting the
city’s racial and ethnic minority youth.
Strengthening Existing Partnerships and/or Identifying New
Opportunities
for Collaboration
Engaging and involving a range of partners committed to a
similar vision is an essential aspect of
community mobilizing. By developing an expansive network of
community providers, there are

increased opportunities to share resources and information, and
to reach greater numbers of at-
risk youth with a host of strategies, in a variety of settings
(SAMHSA n.d.). For example, during
the early stages of this process, we cultivated numerous
relationships with key stakeholders
throughout the community, which included Memoranda of
Understanding with more than thirty
community-based organizations such as clergy, law
enforcement, municipal government, and the
local school district. Building a prevention team that represents
the various sectors of the
population and have a range of expertise in or represent the
target population will improve
outcomes leading to sustained results.
Improving Organizational Resources
At the local level, this often refers to the establishment of
planning groups that reflect the
demographics of the community, with a particular emphasis on
improving workflow efficiency
and effectiveness (e.g., identifying members, delegation of
responsibilities, and decision-making)
(SAMHSA n.d.). Community-level planning groups that are on
the frontlines may further
expand their reach by eliciting the support of other state-level
systems such as juvenile justice
and public safety. These entities can provide skills, training,
and technical assistance regarding
the implementation of policy initiatives that will augment the
planning and development of
coordinated prevention activities. Regarding our present work
in the community, we have served
on various coalitions, task forces, and substance abuse and
HIV/AIDS planning workgroups at

both the municipal and state levels, all with the shared purpose
of improving the quality of life
for at-risk youth.
Developing and Preparing the Prevention Workforce
The effectiveness of any prevention initiative depends on the
training, knowledge, and
experience of the staff delivering the intervention. Through a
solid workforce development plan,
programs are encouraged to provide ample opportunities for
practitioners to become well-versed
in a variety of intervention approaches that will enable them to
effectively intervene on behalf of
their service population (SAMHSA n.d.). For instance, our
prevention team is predominately
comprised of a blend of undergraduate majors from the fields of
family and child studies, public
health, psychology, and sociology and graduate level social
workers, counselors, and public
health educators with extensive experience working with high-
risk populations. Prevention
intervention specialists are provided with ongoing intensive
trainings facilitated by the program
coordinator and enhanced by experts in their respective fields of
practice on topics ranging from
sexual health, gangs, youth violence conflict negotiation,
decision-making, cultural competence,
and diversity. To further develop their understanding of the
community, prevention team
members volunteer at community-based organizations
throughout the service area prior to
initiating the health education workshops. Additionally, as a
means of strengthening our
community ties and increasing receptivity, we introduced
culturally-tailored prevention

intervention approaches that were shown to be effective in
preventing and reducing the onset of
substance abuse and HIV transmission among at-risk minority
subpopulations. Finally, to create
awareness and to mobilize the community toward action, our
prevention team provided
19
workshops and training for community stakeholders, service
providers, and families on strategies
to address a variety of social problems impacting at-risk
adolescents in the target community.
These collective activities enabled our team to galvanize the
community around these pressing
issues, thereby leading to the development of a strategic plan to
help guide our work in the
community.
Step 3: Planning
A comprehensive strategic plan is an integral component of the
SPF framework as it not only
provides a vision for prevention programming, but more
important, it articulates a clear direction
for organizing and implementing prevention activities.
According to SAMHSA (2008), “the
strategic plan must be based on documented needs, build on
identified resources/strengths, set
measurable objectives and include the performance measures

and baseline data against which
progress will be monitored ” (8). It is also important to note
that this is not a static process, and
as a prevention program evolves, its plan must be continuously
assessed and adjusted in response
to ongoing needs assessment and monitoring activities
(Flewelling et al. 2009, 389). Further,
intensive efforts should be undertaken at the inception of the
planning process to integrate
sustainability activities that will contribute to the permanent
expansion of coordinated prevention
programs throughout the community.
The strategic planning process requires that a diverse group of
stakeholders create a plan
with goals, objectives, and action steps aimed at addressing the
social problems impacting their
community. Table 2. illustrates the goals and measurable
objectives that emanated from our
project’s strategic planning process:
Table 2. Strategic Planning – Project Goals and Objectives
Project Goals Objectives
1. Decrease the incidence of substance
abuse and HIV infection among African
American and Hispanic/Latino youth in an
urban community located in the
northeasternUnited States
1a) Program participants will report a
reduction in neighborhood, family, peer
group, and individual risk factors.
1b) Program participants will report an
increase in attachment to community and
family, increased pro-social norms,

improved school performance, and greater
involvement with pro-social activities and
peers.
2. Increase the capacity for integrated
prevention activities in the community.
2a) Increase social network and support
systems that can promote and sustain social
cohesion in the community;
2b) Increase opportunities for youth to
function as active and contributing members
of the community and participate in
cooperative learning and shared decision
making; and
2c) Establish cultural norms that set high
standards of behavior for young people,
including clear norms regarding drug use
and sexual behavior, and that value youth as
community members. *It is important to
note that changing “cultural norms” is
considered a distal outcome, which will
require time, resources, and community
20
investment to realize.
3. Increase service utilization and
participation in substance abuse and HIV

prevention activities by at-risk youth, which
will include referrals to HIV counseling and
testing sites.
3a) Engage children in educational
enrichment and skill-building activities;
build morale and foster attachment to the
goals of the program; and
3b) Maximize the number of youth who
complete the program and are referred to pre
and posttest HIV counseling and testing
sites.
4. Increase cultural identity and pride
among at-risk youth.
4a) Provide programs and messages that use
culture, ethnicity, history, and core values as
a medium to motivate behavior change; and
4b) Ensure that staff are sensitive to the
cultural needs of the target population.
Once the goals and objectives have been identified, the planning
group adopts a logic model,
or framework for action, which essentially serves as a graphical
representation of the project. As
an illustrative planning tool, the logic model links inputs
(resources) and program components
(activities) that have been identified to bring about the desired
outputs (objectives) and outcomes
(goals) (CADCA 2009d, 13;,SAMHSA 2008, 42). Logic models
further serve to inform the fifth
and final phase of the SPF framework – i.e., evaluation – by
allowing prevention programs to
critically analyze the progress that they are making toward their

goals.
Figure 2. provides a sample logic model that was developed for
the purpose of our project.
21
Figure 2: Logic Model
Step 4: Implementation
U.S. federal initiatives, sponsored by both CSAP and the CDC, ,
have been launched to promote
widespread dissemination of science-based prevention strategies
in disproportionately at-risk
minority communities. The evidence-based programs identified
through these U.S. federal
registries and listings are based on research that indicates a
comprehensive approach to
prevention should reduce risk factors (i.e., sexual risk-taking
behaviors) while enhancing
protective factors (i.e., personal negotiation and resistance
skills). According to Arthur et al.
(2010), “these initiatives are intended to disseminate prevention
research, encourage data-driven
planning, and mobilize community stakeholders to utilize
tested, effective strategies to prevent
adolescent drug use and related problems” (246).
To meet this objective, in 2003, SAMHSA initiated the National

Registry of Evidence-based
Programs and Practices (NREPP) project as a systematic way to
identify, promote, and
implement science-based prevention strategies (SAMHSA 2012;
Sherman 2010, 2; Springer and
Philips 2007, 2). Model program status requires that protocols
are carefully implemented,
thoroughly evaluated, and produce consistent, positive, and
replicable results that are readily
disseminated to the broader prevention community. In addition
to NREPP, the CDChas
22
developed a compendium of HIV risk reduction (RR) evidence-
based behavioral interventions
(EBIs) that are classified as either best-evidence or good-
evidence (CDC n.d.b). These
interventions represent the strongest HIV behavioral
interventions in the scientific literature to
date that have been rigorously evaluated and have demonstrated
evidence of efficacy. The
compendium includes individual, group, and community-level
behavioral interventions for high-
risk populations that focus on sex or drug-related risk behaviors
and have proven to either reduce
HIV or STD incidence or HIV-related risk behaviors, or
increase HIV risk-reduction behaviors
(CDC n.d.b). Key to successfully addressing the concomitant

problems of substance abuse and
HIV/AIDS will be the integration of evidence-based programs at
the local level. For example,
community-based organizations are on the front lines of
mitigating the multitude of health
disparities experienced by vulnerable members of the
population and are well positioned to
address their service needs.
According to the prevention principles proposed by NIDA
(2003) , “Community prevention
programs that combine two or more effective programs can be
more effective than a single
program alone” (13). Building upon these guiding principles, we
have adopted an eclectic
substance abuse and HIV prevention approach that includes
community mobilizing, intensive
case management, and interactive education-based
interventions. The intensive case
management model (i.e., CASASTART) and HIV/AIDS
prevention curricula (e.g., Be Proud! Be
Responsible, Focus on Youth, and Street Smart) have been
rigorously field-tested and evaluated
by CSAP and the CDC.. Based on prior research, this multi-
tiered strategy has proven to be an
effective method for reducing substance abuse and HIV risk
among African American and
Hispanic/Latino adolescents (13). The following section
provides a description of the model
programs included in our initiative:
Model Programs
CASASTART
This CSAP-endorsed prevention protocol (Striving Together to

Achieve Rewarding Tomorrows)
has been identified by SAMHSA as a model substance abuse
prevention program. CASASTART
was originally developed as a substance abuse and violence
prevention program serving high-risk
adolescents and their families living in socially distressed
neighborhoods (Murray 1999, 8;
Murray and Belenko 2005, 919). The program is a
comprehensive, neighborhood-based, school-
centered model that aims to provide coordination among police,
schools, and community-based
organizations to achieve two goals: 1) to redirect and build
resiliency in the lives of youth who
are at risk of using drugs, becoming delinquent, or dropping out
of school; and 2) to reduce and
control illegal drug use and related crime in the neighborhoods
where the adolescents live to
make the areas safer and more nurturing environments (9).
CASASTART has served as our
program’s organizing framework and we have incorporated core
elements of this model (e.g.,
community mobilizing and intensive case management) into our
comprehensive prevention plan
as a means of addressing the unique demands of at-risk youth in
our service area.
To further contextualize our prevention plan, we have identified
three CDC-endorsed HIV
prevention curricula (e.g., Be Proud! Be Responsible!, Focus on
Youth, and Street Smart) that are
culturally responsive and attend to the service needs of our
target population (CDC n.d.a,c,d).
Salient aspects from each of these behavioral interventions
(e.g., small group discussions,
interactive group activities, video presentations, and condom
demonstrations) have been

integrated into our prevention intervention service plan.
Be Proud! Be Responsible!
23
Be Proud! Be Responsible! encourages participants to build a
sense of pride and self-worth,
develop a futuristic orientation, and behave in a responsible
manner. The curriculum consists of
six, 50-minute modules and employs educational videos, films,
role-plays, games, exercises, and
condom demonstrations to increase knowledge of HIV
transmission and prevention, risk
reduction, condom use, safe-sex behaviors, confidence, personal
negotiation and resistance skills
(CDC n.d.a).
Focus on Youth (FOY)
Focus on Youth (FOY) is an eight-session intervention that
utilizes discussions, games, and
multimedia formats to actively engage youth in HIV/AIDS
education/prevention activities. The
program is comprised of seven, 90-minute sessions that focuses
on decision-making, negotiation
skills, communication, values clarification and goal setting, as
well as educational information
pertaining to condom use. Health education topics also include

facts regarding AIDS, STIs,
contraception, and human development. The curriculum is
further enhanced by booster sessions
in which program participants are given specific challenges to
work through to reinforce the
skills (e.g., decision making, communication, and condom use)
that were developed throughout
the primary phase of the protocol (CDC n.d.c ).
Street Smart
Street Smart is a multisession, skills-building program that was
originally developed to help
groups of runaway youth reduce unprotected sex, number of sex
partners, and substance use.
Delivered in a small, group session format, the intervention
consists of eight, 1.5 to 2 hour
sessions delivered over a two to six week period. During the
initial stage of the intervention,
HIV/AIDS prevention information is shared through multi-
media approaches, such as video and
art workgroups. This provides a comfortable and safe forum in
which youth review and discuss
commercial HIV/AIDS prevention videos and then develop their
dramatizations, public service
announcements, commercials, and rap songs. The primary focus
of these sessions is a social
skills building approach, with a particular emphasis on
assertiveness and coping. Exercises are
then introduced to help adolescents identify their emotional and
behavioral reactions and
unrealistic expectations in potentially high-risk situations (CDC
n.d.d).
Step 5: Assess Performance

Ongoing monitoring and performance assessment activities are
integral components to ensuring a
program’s success. Through a carefully orchestrated evaluation
plan, programs are able to gauge
their effectiveness, ensure the quality of the proposed
interventions (i.e., fidelity), identify best
practices, and encourage continuous quality improvement
(SAMHSA 2008, 13). A variety of
evaluation designs and data collection methods may be utilized
to conduct the process and
outcome evaluations. The process, or formative, evaluation
phase of the project may include
focus group and semi-structured interviews with program staff
and key informants (e.g., referral
sources, advisory board members, and program participants),
participant observation, and
archival program records such as staffing patterns, attendance
sheets, meeting minutes, and other
records required of the initiative (CADCA 2008, 16). The
purpose of the formative evaluation is
to assess the degree to which the services provided accurately
replicate the selected prevention
models and preserve its fidelity. For example, we recently
conducted qualitative interviews with
at-risk youth who have not participated in our program as a
means of understanding
environmental influences that may impede their receptiveness to
HIV/AIDS prevention messages
in their community. A recurring theme that emerged among the
adolescents was the lack of
support that they received from adults in their neighborhoods,
including parents and teachers.
24

In addition to collecting and analyzing process information, it is
important to identify the
program/contextual factors (i.e., dosage data), and consider
individual/peer, family, school, and
community-level variables, which may be associated with the
desired program outcomes (i.e., a
reduction in substance abuse and HIV/AIDS risk taking
behaviors). An outcome evaluation
provides data to help ascertain whether the prevention strategies
delineated in the strategic plan
meet the intended goals and objectives of the initiative
(CADCA 2008, 18). There are many
issues to consider when embarking upon an outcome evaluation
– e.g., survey development, data
collection, evaluation design, data analysis, and reporting – that
require careful planning and
implementation (18). For our purposes, we used performance
measures identified by SAMHSA
that defined key priority areas related to substance abuse and
HIV/AIDS knowledge, perceptions,
and behaviors (SAMHSA 2008, 12). By incorporating a quasi-
experimental pretest-posttest
nonequivalent comparison group design, we were able to show
that our interventions were on
track to achieving many of its critical programmatic objectives.
For instance, preliminary
analyses have revealed that program participants with higher
levels of program involvement (i.e.,
dosage) tended to report lower levels of tobacco use, alcohol,
and illicit drug use.

However, there are inherent limitations when embarking upon
this type of outcome-based
evaluation research with an adolescent population. More
specifically, obtaining parental consent
among targeted youth has been at times challenging due to a
lack of cooperation in returning the
necessary forms and paperwork. While addressing this issue
has not been an insurmountable
obstacle to overcome, it has required a significant re-allocation
of resources, manpower, and
time. Consistent with the SPF guidelines, we have begun to
disseminate our evaluation findings
with the broader prevention community to share both lessons
learned and program successes.
Concluding Comments
The strategic prevention framework (SPF) served as an
invaluable tool in guiding our prevention
work in a disenfranchised, urban community. From the initial
steps of the process, we identified
a paucity of prevention programs serving a large city that has
been inundated by a multitude of
public health concerns. Unfortunately, a lack of resources, poor
coordination among service
providers, and major gaps in service delivery have compounded
the myriad of social problems
experienced by adolescents residing in this high-risk
community. As a collaborative effort
between a public university and numerous social service
agencies, our project has helped
transform the way the community is served by increasing the
capacity of local, community-based
organizations. With the support of our partners, our prevention
team has developed a

comprehensive strategic plan that has led to the coordination
and implementation of culturally
appropriate, evidence-based substance abuse and HIV/AIDS
prevention protocols with proven
effectiveness throughout the target community. Through a
rigorous evaluation process, we were
able to demonstrate that youth participating in our program
exhibited significant reductions in
alcohol and drug use behaviors and marked increases in social
support, family cohesion, and
community involvement. We will continue to work toward
sustaining and expanding the scope
of services in our ongoing effort to mitigate the adverse health
consequences associated with
illicit drug use and risky sexual behaviors among vulnerable and
at-risk urban minority
adolescents.
25
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—. Sustainability primer: Fostering long-term change to create
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2012.http://www.cdc.gov/hiv/topics/research/prs/resources/fact
sheets/Be_Proud.htm.
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Subpopulations Cooperative Agreements. Request for
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93:243. 2008.
ABOUT THE AUTHORS
Dr. Robert Reid: Robert J. Reid, PhD, is an Associate Professor
in the Department of Family and
Child Studies, College of Education and Human Services, at
Montclair State University. His
research has focused on the development, coordination, and
testing of community-wide
prevention initiatives to reduce risk factors and to promote
protective factors associated with
various health behaviors, such as adolescent substance abuse,
sexual risk, and youth violence.
Dr. Reid’s research has continually examined the factors that
may either enhance or constrain the
quality of life for children, families, and communities. Since
2003, he has served as Principal
Investigator on a Minority AIDS Initiative (MAI) grant, which
is funded by the U.S. Department
of Health and Human Services, Substance Abuse and Mental
Health Services Administration
(SAMHSA), Center for Substance Abuse Prevention (CSAP).
Through this decade-long
initiative, Dr. Reid has developed and coordinated
comprehensive substance abuse and
HIV/AIDS prevention services targeting underserved racial and
ethnic minority youth in the city
27

of Paterson, New Jersey. More recently, Dr. Reid has been
funded by the White House Office of
National Drug Control Policy and SAMHSA to continue his
prevention work in the Paterson
community by developing the infrastructure of an anti-drug
coalition targeting at-risk
urban minority adolescents.
Dr. Pauline Garcia-Reid: Pauline Garcia-Reid, PhD, is an
Associate Professor in the
Department of Family and Child Studies, College of Education
and Human Services, with an
affiliate appointment in the Center for Child Advocacy and
Policy, College Humanities and
Social Sciences, at Montclair State University. Her research
interests include youth substance
use and violence prevention, social justice and advocacy within
a culturally-grounded social
work lens, and practice and research with racial and ethnic
minority children and families. She
has also served as a technical advisor to the SAMHSA National
Registry of Effective Prevention
Programs Project (NREPP).
28

The International Journal of Interdisciplinary Social
and Community Studies is one of eight thematically
focused journals in the collection of journals that
support the Interdisciplinary Social Sciences
knowledge community—its journals, book series,
conference and online community.
The journal presents studies of the social that exemplify
the disciplinary and interdisciplinary practices of the
social sciences.
As well as papers of a traditional scholarly type, this
journal invites case studies that take the form of
presentations of practice—including documentation of
socially-engaged practices and exegeses analyzing the
effects of those practices.
Community Studies is a peer-reviewed scholarly journal.
ISSN 2324-7576
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