Statewide substance abuse prevention planning

Data-Driven Decision Making in the Prevention of Substance-Related Harm: Results from the Strategic Prevention Framework State Incentive Grant Program

The Strategic Prevention Framework State Incentive Grant Program (SPF SIG) is a national public-health initiative in the United States to prevent and reduce substance-related harm. The model promotes data-driven decision making (DDDM), with an emphasis on using epidemiological data to help select prevention priorities and to allocate prevention resources. This article examines how well the first two cohorts of SPF SIG states (N = 26) implemented DDDM, and also explores what factors facilitated and hindered the process. Data were collected by reviewing and coding states' strategic plans, supplemented by interviews with state project directors, evaluators, and epidemiological workgroup chairs. Fidelity to the process was scored as high, medium, or low, based on transparency and support from relevant evidence. On selecting prevention priorities, 81% of states received high or medium scores on all priorities selected. On allocating prevention resources, 85% received a high or medium score. Facilitators included collaboration among stakeholders, training and technical assistance, and efforts of epidemiological workgroups and evaluators. However, states that lacked established data infrastructures for prevention were at a decided disadvantage in implementing the model. Future implications for SPF SIG states and ongoing challenges to DDDM in general are discussed.

Promotion of Service Integration Among Home Visiting Programs and Community Coalitions Working With Low-Income, Pregnant, and Parenting Women

This study assessed service integration promoted by home visitors and community coalitions in Baltimore's Comprehensive Family Support Strategy. The study first assessed home visitors' coordination of services for their clients. Two yearly home visitors surveys (n = 32) assessed changes in their perceptions of 11 community resources' availability, service quality, and referrals made to those resources. There were statistically significant increases in the percentage of home visitors who (a) reported availability of seven resources, (b) gave high service quality ratings for six resources, and (c) referred clients to all 11 resources. The study also assessed six community coalitions' actions to promote service integration during 1 year through observation of coalition meetings. Coalitions discussing more service integration exhibited greater increases in home visitors' perceptions of high service quality and referrals. Home visiting practitioners should consider including coalitions as part of their program models in order to better link clients to appropriate community resources.

Promoting science-based prevention in communities

In the past decade, prevention science has emerged as a discipline built on the integration of life course development research, community epidemiology, and preventive intervention trials [Am. Psychol. 48 (1993) 1013; Am. J. Community Psychol. 27 (1999) 463; Kellam, S. G., & Rebok, G. W. (1992). Building developmental and etiological theory through epidemiologically based preventive intervention trials. In J. McCord & R. E. Tremblay (Eds.), Preventing antisocial behavior: interventions from birth through adolescence (pp. 162-195). New York: Guilford Press.]. Prevention science is based on the premise that empirically verifiable precursors (risk and protective factors) predict the likelihood of undesired health outcomes including substance abuse and dependence. Prevention science postulates that negative health outcomes like alcohol abuse and dependence can be prevented by reducing or eliminating risk factors and enhancing protective factors in individuals and their environments during the course of development. A growing number of interventions have been found to be effective in preventing adolescent tobacco, alcohol, and other drug abuse, delinquency, violence, and related health risk behaviors by reducing risk and enhancing protection. During the same decade, comprehensive community-based interventions to prevent adolescent health and behavior problems have been widely implemented in the U.S. with federal and foundation support. Despite the advances in the science base for effective preventive interventions and the investments in community-wide preventive interventions, many communities continue to invest in prevention strategies with limited evidence of effectiveness [Am. J. Public Health 84 (1994) 1394; J. Res. Crime Delinq. 39 (2002) 3; J. Community Psychol. 28 (2000) 237; J. Community Psychol. 28 (2000) 237; J. Consult. Clin. Psychol. 67 (1999) 590; Eval. Program Plann. 20 (1997) 367.]. Translating prevention science into community prevention systems has emerged as a priority for prevention research [J. Community Psychol. 28 (2000) 363; J. Appl. Behav. Anal. 28 (1995) 479.]. The Communities That Care (CTC) prevention operating system is a field-tested strategy for activating communities to use prevention science to plan and implement community prevention systems. CTC provides tools that assist communities to use local data on risk and protective factors to identify elevated risks and depressed protective factors in geographic areas where levels of risk are high and levels of protection are low and then to implement tested, effective preventive interventions that reduce the identified risks and enhance protection in these [Developmental Research and Programs. (1997). Communities That Care: a comprehensive prevention program. Seattle, WA: Author; Developmental Research and Programs. (2000a). Communities That Care: a comprehensive prevention program. Seattle: Author; Hawkins, J. D., Catalano, R. F., et al. (1992). Communities That Care: action for drug abuse prevention (1st ed.). A joint publication of the Jossey-Bass social and behavioral science series and the Jossey-Bass education series. San Francisco: Jossey-Bass]. The CTC system is widely implemented, and process evaluations of CTC suggest that it can assist communities to develop more effective prevention systems. This paper describes the background and use of the CTC operating system and results of evaluations of implementation of the system.

Supporting community-based prevention and health promotion initiatives: developing effective technical assistance systems

As research evidence for the effectiveness of community-based prevention has mounted, so has recognition of the gap between research and community practice. As a result, state and local governments are taking a more active role in building the capacity of community-based organizations to deliver evidence-based prevention interventions. Innovations are taking place in the establishment of technical assistance or support systems to influence the prevention and health education activities of community-based organizations. Several challenges for technical assistance systems are described: (1) setting prevention priorities and allocating limited technical assistance resources, (2) balancing capacity-building versus program dissemination efforts, (3) collaborating across categorical problem areas, (4) designing technical assistance initiatives with enough "dose strength" to have an effect, (5) balancing fidelity versus adaptation in program implementation, (6) building organizational cultures that support innovation, and (7) building local evaluative capacity versus generalizable evaluation findings.

Identifying substance abuse treatment gaps in substate areas

Investigating concerns about uneven utilization of health services, especially affecting disadvantaged high-risk populations, the authors constructed composite indexes for identifying substance abuse treatment gaps in Rhode Island towns and multi-town planning areas. The Drug, Alcohol, and Substance Abuse Need Indexes combined multiple-year rates of substance-related deaths, hospital discharges, and arrests. These indicators were reliable and possessed convergent validity; the composite indexes were also reliable and had construct validity. Regression of treatment admissions rates on town Substance Abuse Need Index scores revealed that some areas had relative gaps in treatment services. Having an objective and validated method for identifying treatment gaps could help treatment planners ensure equal access to services throughout the state. Reducing travel to treatment facilities can increase treatment utilization and treatment retention.