The document provides recommendations for improving the European Cities on Cities (CtC) project based on a meeting in Berlin. It summarizes that the number of participating cities is declining, possibly due to a lack of short-term successes, standardized top-down approach, and insufficient local adaptation. It recommends organizing more external input, further reflecting on the basics and theory of CtC, strengthening databases, expanding CtC to early childhood, developing new tools, and building expert capacity. The priorities are to make CtC more innovative, integrated with local initiatives, and responsive to current research and city needs.

1. My Reflections & Recommendations
on the European CTC project
based on Berlin meeting
23-24 November 2015
Clemens Hosman
Scientific advisor to the Europeam CtC project
Emeritus Professor of Mental Health Promotion & Prevention

2. Foreword
This note on the EU-CtC meeting in Berlin at 23 and 24 of November 2015 reflects my
personal perception of major messages that were presented by participants during their
presentations and the discussions, as well as my own reflections on the developments in
CtC and recommendations for next steps and the future of EU-CtC.
It is not meant as a formal summary or minutes of the meeting, more as my conclusions
and recommendations in my capacity as advisor of the project.
While the strengths of CtC are sufficiently known in our group, I have concentrated on more
critical issues and options for improvement and innovation.
Clemens Hosman
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3. Content
EU-decline decline in number of cities participating in CtC:
What could be the reasons?
Some critical reflections on current CtC
Some Priorities for the Future of CtC
‒ Organizing more external input in the reflection on CtC and its future
‒ Further reflection needed on basics of CtC
‒ Strengthen national and European databases for CtC
‒ Expanding and innovating CtC
‒ Development of new instruments and tools
‒ Expert capacity building
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4. EU-wide decline in number of cities participating in CtC
What could be the reasons?
CtC lacks opportunities for showing motivating short-time successes and
among policy-makers doubts exists about achieving a satisfying cost-benefit ratio
CtC is – despite its intentions – too much a standardized, top down approach in conflict
with trends in strengthening bottom-up local initiatives and social empowerment;
‒ no tools to integrate flexibly with local bottom-up initiatives and social movements
‒ poor attunement to how cities solve problems in step-by-step approach (Matej); city policy making
‒ formula of ‘pre-cooked food products’ versus ‘inspiring, supportive cook books’, ‘intermediate products’
Crisis in belief of wide usability of “standardized effective interventions + fidelity”
CtC is insufficiently responsive to need for local adaptation, ownership and resistance to adoption
Dependency of finding/using /supporting Champions at all levels underestimated
National governments withdraw from being national organizers/facilitators
Lack of local expertise (trained professionals, staff-turnover) and budgets (financing systems)
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5. Some critical reflections on current CtC
There is a need for a EU-based critical analysis of the fundamentals of CtC. Major reasons:
(1) no EU evidence on pretended effects; (2) The basics of CtC have not changed over more then
20 years, while innovation is a core driving force across many public /privated sectors;
(3) Relevant sciences have generated new basic knowledge that is not yet included in the CtC.
There exists a divergence in view on how to move forward with CtC. Many prefer fidelity to
the original CtC design and principles, and want to put main effort in further improving its full
implementation according to strict and original criteria. Others are in favour of a more creative
input and to discuss options for innovation of the basics of CtC, as is usual in many sectors
CtC pretends to be a generic, theory-based & preventive approach to problem behaviors and
positive development in children/youth, however:
CtC is mainly based in research on adolescents and aggressive/violent behavior & substance use
Strong interest of science and cities in early childhood, where many risk+protectve factors emerge
Insufficient focus on the social factors that cities hve to deal with, e.g. poverty, inequity, refugees
Presumption “all countries can build a large collection of evidence-based interventions”
from which neighborhoods & cities can choose is not valid: not affordable for many countries
CtC lacks attunement to actual city policies and insights from current policy science
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6. Some Priorities for the Future of CtC
ORGANIZE MORE EXTERNAL INPUT IN REFLECTING ON CTC AND ITS FUTURE
Invite ‘outsiders’: from science, policy and social innovation field to comment on CtC,
to evaluate its strength/weaknesses and suggest options for innovation
e.g. Breton & de Leeuw (2010) Review theories of policy process in HP research; Cairney (2011)
Understanding public policy; Publications in Stanford Social Innovation Review (e.g. collective impact)
Input of new theories and knowledge in (1) developmental factor model of CtC and
(2) the CtC dissemination-implementation approach. Current theory basis is too small.
Examples: Epigenetics; early development and trauma research; social factor research, empowerment,
dissemination and policy research; innnovation development; sociale movement;
Compare Strengths & Weaknesses of CtC, Healthy Cities, Prosper, SEL-ENSEC and
develop a new integrated approach with the best of each: the next generation of CtC
CtC and Healthy Cities have been developed from different traditions and science communities
European identity of CtC: Is there one? What differentiates us? What could EU-CtC add
to the CtC-concept? Does Euro-culture and health & social policies makes a difference?
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7. Some Priorities for the Future of CtC
FURTHER REFLECTION NEEDED ON BASICS OF CTC
Develop a more in-depth scientific analysis of how different health & social problems
are related over time (life-span) and across system levels; learn to understand what
the strategic implications are for effective health and social policy
Targeting earlier problems to prevent later problems; differentiating several ‘smart clusters of narrowly
related problems’ and designing models for integral preventive approaches;
Reflection on the pros and cons of standardization and options for more flexibility,
adaption, attunement to and integration with existing or bottom-up policies/practices
How could new ideas on “collective impact” be integrated in CtC? What conditions
are needed to create collective impact? Develop collective impact theory for CtC.
Better understanding of ‘how’ different interventions could strenghen or complement other
interventions to achieve larger effects, larger public reach, larger public impact / collective impact.
What are the conditions and drivers of public and collective impact?
Better understanding the conditions needed to enhance sustainability of CtC
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8. Some Priorities for the Future of CtC
STRENGTHEN NATIONAL AND EUROPEAN DATABASES FOR CtC
European epidemiological database with internationally comparable data on youth problem
behaviors, risk factors and protective factors from national/local surveys
National databases of evidence-based effective interventions, and a European database
with interventions, evidenced to be effective across multiple countries (e.g. incredible years)
Collect data about the implementation level of interventions and their public reach in
targeted local and national populations. Public reach x effectiveness = Public impact
Effective is essential in CtC. Develop a more advanced conceptual system of ‘effective’, that
differentiates between: efficacy, effectiveness, public impact and collective impact
Strengthen the set of valid evaluation instruments & indicators that offer data which are are
both locally relevant and internationally comparable
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9. Some Priorities for the Future of CtC
EXPANDING AND INNOVATING CtC
Develop a CtC version targeted at pregnancy & early childhood (Healthy Start)
More emphasis on identifying evidence-based ‘Working elements, principles & factors’,
(not exclusively on standardized effective interventions), organized in transparent model
Develop a theoretical model on conditions needed to implement CtC successfully;
measures to asssess local/national profiles of needed conditions,
and strategies for their improvement
Refugee problem: What could CtC contribute? Social development and bonding strategy;
enhancing socialization and social integration; programs for traumatized children/adults
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10. Some Priorities for the Future of CtC
DEVELOPMENT OF NEW INSTRUMENTS AND TOOLS
Elaborated and science-based decision tree for selecting interventions for local practice
from a national database of interventions
Legal document at EU level about authorship, copyright, opportunities to make national or
local adaptations, and how we can avoid claims and ‘bills’ of program owners.
International harmonisation of criteria for e.g. quality indicators, descriptive dimensions
Measures to assess community readiness and different implementation contexts
National CtC lobby groups and Advocacy tools & strategies
Developing a sustainable EU-CtC network (even without a EU grant? Within EU-SPR?),
identifying major agenda issues and dividing tasks across European partners
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11. Some Priorities for the Future of CtC
EXPERT CAPACITY BUILDING
How could we turn CtC into an effective learning system at local, national and
international level? What are the learning targets and tools?
European and national training programs to develop prevention expertise / experts
Explore needs and opportunities for professional training in CtC and prevention
Define types and standards of needed professional expertise at local and national level
European summer schools
Training modules and materials that could be adopted by national institutes, universities and NGOs
Training on priority issues: advocacy; local policies; outcome evaluation; public reach; cost-benefit;
working elements, principles & factors; collective impact; creating structural conditions
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12. Contact:
Hosman Prevention Consultancy &Hosman Prevention Consultancy &Hosman Prevention Consultancy &Hosman Prevention Consultancy & InnovationInnovationInnovationInnovation
hosman@psych.ru.nl