Transcript Slide 1

Building Community Collaboration to Promote
Healthy Youth Development:
J. David Hawkins Ph.D.
Social Development Research Group
School of Social Work
University of Washington
www.sdrg.org
Melissa Institute
May 1, 2008
1
The Challenge for
Community Prevention
• To address those risk factors most
prevalent in a community with tested,
effective policies and programs.
• To address protective factors most
depressed in a community with
tested, effective policies and programs
that strengthen those protective
factors.
2
The Communities That Care
Prevention System
• Helps communities apply the
advances of prevention science to
guide youth development and
prevention work.
• Measures community levels of
protection and risk by surveying
young people.
• Matches the community’s profile of
risk and protection with tested,
effective programs and policies.
3
The Communities That Care
Prevention System
• Local control builds ownership to create
sustainable change.
• Focuses on outcomes to insure success:
Are fewer teens using drugs? Fewer
smoking? Fewer committing violent acts?
4
The Communities That Care
Operating System
Get Started
Implement and
Evaluate
Creating
Communities
That Care
Create a Plan
Get Organized
Develop a Profile
5
The Communities That Care
Operating System
• Community readiness
assessment.
• Identification of key
individuals, stakeholders,
and organizations.
Get Started
Implement and
Evaluate
Creating
Communities
That Care
Create a Plan
Get Organized
Develop a Profile
6
The Communities That Care
Operating System
• Training key leaders
and board in CTC
Get Started
Implement and
Evaluate
• Building the
community coalition.
Creating
Communities
That Care
Create a Plan
Get Organized
Develop a Profile
7
The Communities That Care
Operating System
Get Started
Implement and
Evaluate
Creating
Communities
That Care
Create a Plan
• Collect
risk/protective factor
and outcome data.
•Collect information on
community resources
• Construct a
community profile from
the data.
Get Organized
Develop a Profile
8
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Lo
Percent At Risk
Madison Middle School Risk Profile 8th Grade
2002
100%
90%
Community
Diffusion Consortium Project
Social Development Research Group, University of Washington
Family
School
Peer-Individual
80%
Survey Participation Rate 2002: 87.4%
70%
60%
50%
40%
30%
20%
10%
0%
School 2002
District 2002
Estimated National Value
9
The Communities That Care
Operating System
Get Started
Implement
and
• Define outcomes.
•Prioritize factors to be
Evaluate
targeted.
• Select tested, effective
interventions.
• Create action plan.
• Develop evaluation plan.
Creating
Communities
That Care
Create a Plan
Get Organized
Develop a Profile
10
Addressing Barriers with
Effective Action
Factor Addressed
Family Management
Problems
Program Strategy
Developmental Period
Prenatal/Infancy Programs
prenatal-2
Early Childhood Education
3-5
Parent Training
prenatal-14
Family Therapy
6-14
11
Diffusion Consortium Project
Social Development Research Group, University of Washington
Effective Training for
Middle School Parents
• Guiding Good Choices (Spoth et al., 1998)
• Adolescent Transitions Program (Dishion and
Andrews, 1995)
• Parenting Adolescents Wisely (Gordon et al.,
1998)
• Creating Lasting Connections (Johnson et al.,
1996)
• Strengthening Families 10 to 14 Program (Spoth,
1998)
• Focus on Families (Catalano et al., 1999; 1997)
12
Diffusion Consortium Project
Social Development Research Group, University of Washington
The Communities That Care
Operating System
• Form task forces.
• Identify and train
implementers.
• Sustain collaborative
relationships.
• Evaluate processes and
outcomes.
• Adjust programming.
Implement and
Evaluate
Get Started
Creating
Communities
That Care
Create a Plan
Get Organized
Develop a Profile
13
What is required to install CTC?
•
•
•
•
•
A coalition of community stakeholders.
A coordinator for the CTC process.
Manuals and curriculum materials.
Training from certified trainers.
Technical assistance when difficulties
are encountered.
• A monitoring system to provide routine
feedback on progress and outcomes.
14
CTC Trainings
1.
Key Leader Orientation
2.
Community Board Training
3.
Community Assessment Training
4.
5.
6.
Community Resource Assessment
Training
Community Planning Training
Community Program Implementation
Training
15
Communities that Care
Process and Timeline
Process
Assess risk, Implement and
protection and
evaluate
resources
tested
prevention
strategies
6-9 mos.
1 year
Measurable
Outcomes
Increase in
priority
protective
factors
Increase in
positive youth
development
Decrease in
priority risk
factors
2-5 years
Reduction in
problem
behaviors
Vision for a
healthy
community
5-10 years
16
The Community Youth
Development Study (CYDS)
• A 24 community randomized
controlled trial to test the
Communities That Care
system started in 2003.
17
The Community Youth
Development Study Team
Robert D. Abbott
Michael W. Arthur
Megan M. Baldwin
John S. Briney
Blair Brooke-Weiss
Eric C. Brown
Rick Cady
Richard F. Catalano
Abigail A. Fagan
John Graham
Kevin Haggerty
Koren Hanson
J. David Hawkins
David M. Murray
Sabrina Oesterle
M. Lee Van Horn
Funded by:
National Institute on Drug Abuse
Center for Substance Abuse Prevention
National Cancer Institute
National Institute on Child Health and Development
National Institute on Mental Health
CYDS State Collaborators
• Colorado Alcohol & Drug Abuse Division
• Illinois Division of Community Health &
Prevention
• Kansas Alcohol and Drug Abuse Services
• Maine Office of Substance Abuse
• Oregon Office of Alcohol & Drug Abuse
Programs
• Utah Division of Substance Use
• Washington Division of Alcohol & Substance
Abuse
19
CYDS Primary Aim
To test the efficacy of the Communities
That Care system in
• reducing levels of risk
• increasing levels of protection
• reducing health and behavior problems
among adolescents
using a true experimental design.
20
STUDY DESIGN
Randomized Controlled Trial
2003-2008
2003
2004
1997-2002
CTCYS
Randomize
CTCYS
CKI
CRD
CTCYS
CTCYS
CKI
CRD
CTCYS: Cross-sectional student survey of 6th-, 8th-, 10th-, and
12th-grade students using the CTC Youth Survey
CKI: Community Key Informant Interview
CRD: Community Resource Documentation measuring effective
prevention programs and policies in the community
CTC Board: CTC Board Member Interview
YDS: Longitudinal Youth Development Survey of students in the
class of 2011 starting in 5th grade in spring 2004
CTCYS
CTC
Board
YDS
Control
2007
2008
CTCYS
CKI
CRD
CKI
CRD
Intervention
98 99 ‘00 ‘01 ‘02
2006
Implement selected interventions
Planning
5-Year Baseline
2005
CTC
Board
YDS
CTCYS
CTC
Board
YDS
CTC
Board
YDS
YDS
CTCYS
CTCYS
CKI
CRD
YDS
YDS
CTC
Board
CKI
CRD
YDS
YDS
YDS
21
Demographics of 24 CYDS
Communities
Mean
Minimum
Maximum
14,616
1,578
40,787
89.4%
64.0%
98.2%
Percent Hispanic Origin
9.6%
0.5%
64.7%
Percent African-American
2.6%
0.0%
21.4%
36.5%
20.6%
65.9%
Total Population
Percent Caucasian
Percent Eligible for
Free/Reduced Lunch
22
PanelYouth Development Survey
(YDS)
• Annual survey of panel recruited from the
Class of 2011 (5th grade in 2004)
• Active, written parental consent
23
Youth Development Survey
• Participants recruited in grades 5 and 6.
• Final consent rate = 76.4%
Sixth Grade
Eligible
Population
Percent
Consented
Percent
Surveyed
Total
Surveyed
Control
3170
2621
76.2%
76.7%
75.4%
76.3%
2391
1999
Total
5791
76.4%
75.8%
4390
Experimental
24
2006 YDS
• 96.2% Overall Student Participation
• 10.3% (n=454) had moved out of project
schools
7th Grade
Eligible
Population
Percent
Surveyed
Total
Surveyed
Experimental
2406
95.5%
2298
Control
2001
97.0%
1941
Total
4407
96.2%
4239
25
2007 YDS
• 96.2% Overall Student Participation
• 11.9% (n=525) have moved out of project
schools
8th Grade
Eligible
Population
Percent
Surveyed
Total
Surveyed
Experimental
2406
95.6%
2300
Control
2001
96.9%
1940
Total
4407
96.2%
4240
26
Communities That Care
Logic Model
CTC Training and
Technical Assistance
Adoption of Science-based
Prevention Framework
Collaboration
Regarding Prevention Issues
Appropriate Choice
and Implementation
of Tested, Effective
Prevention Programs &
Adoption of Social Development
Strategy as Community’s Way of
Bringing Up Children
Decreased Risk and
Enhanced Protection
Positive Youth
Outcomes
27
Adoption of
Science-Based Prevention

Stage 0:
No Awareness

Stage 1:
Awareness of Prevention Science Terms and Concepts

Stage 2:
Using Risk and Protection Focused Prevention Approach as a
Planning Strategy.

Stage 3:
Incorporation of Community Epidemiological Data on Risk and
Protection in Prevention System.

Stage 4:
Selection and Use of Tested and Effective Preventive
Interventions to Address Prioritized Risk and Protective
Factors.

Stage 5:
Collection and Feedback of Process and Outcome
Data and Adjustment of Preventive Interventions Based on Data.
28
Note. Community Key Informant Survey (CKI).
Baseline Stages of Adoption
by Intervention Status
0.6
Probability
0.5
Control Communities
CTC Communities
0.4
0.3
0.2
0.1
0.0
0
1
2
3
4
5
Stage of Adoption in 2001
Note. Community Key Informant Survey (CKI); N = 534; γ001 = .037, SE = .395, df = 20, p > .05 .
29
Post-Intervention Stages of Adoption
by Intervention Status
0.6
Probability
0.5
Control Communities
CTC Communities
0.4
0.3
0.2
0.1
0.0
0
1
2
3
4
5
Stage of Adoption in 2004
Note. Community Key Informant Survey (CKI); N = 534; γ101 = -1.311, SE = .355, df = 20, p < .002
30
Collaboration on
Prevention
• Prevention Collaboration
 Assessed by 9 items measuring prevention-specific
collaborative activities.
There is a network of people concerned about prevention issues who
stay in touch with each other.
Organizations in [community] share money or personnel when
addressing prevention issues.
Organizations in [community] participate in joint planning and decision
making about prevention issues.
1=strongly agree, 2=somewhat agree, 3=somewhat disagree, 4=strongly disagree
31
Note. Community Key Informant Survey (CKI).
Change in Prevention Collaboration
by Intervention Status
0.30
0.20
Factor Score
Control Communities
CTC Communities
0.10
0.00
-0.10
-0.20
-0.30
Post-Int (2004)
Pre-Int (2001)
Year
Note. Community Key Informant Survey (CKI); N = 530; γ001 = -0.123, SE = .118, df = 20, p > .05;
γ101 = 0.237, SE = .094, df = 20, p < .022.
32
Communities That Care
Theory of Change
CTC Training and
Technical Assistance
Adoption of Science-based
Prevention Framework
Collaboration
Regarding Prevention Issues
Appropriate Choice
and Implementation
of Tested, Effective
Prevention Programs &
Adoption of Social Development
Strategy as Community’s Way of
Bringing Up Children
Decreased Risk and
Enhanced Protection
Positive Youth
Outcomes
33
Program Selection
CTC Community Board members
selected prevention programs from
a menu* of programs that:
~ Showed significant effects on risk/protective
factors, and drug use, delinquency, or violence
~ Involved at least one high-quality research study
~ Targeted children or families in grades 5-9
~ Provided materials and training
* Communities That Care Prevention Strategies Guide
34
Programs Selected in 2004-2007
PROGRAM
2004-05
2005-06
2006-07
All Stars Core
1
1
1
Life Skills Training
Lion’s-Quest Skills for Adolescence
Project Alert
Olweus Bullying Prevention Program
Program Development Evaluation Training
2
2
1
4*
3
1
2*
5*
3
1
2*
1
-
Participate and Learn Skills (PALS)
Big Brothers/Big Sisters
Stay SMART
Tutoring
Valued Youth Tutoring Program
1
2
3
4
1
1
2
3
6
1
Strengthening Families 10-14
Guiding Good Choices
Parents Who Care
Family Matters
2
6
1
1
3
7*
1
1
1
2
1
6
1
3
8*
2
Parenting Wisely
-
1
1
27
38
37
TOTAL
*Program funded through local resources in one or two communities
35
Exposure in the Community
Program Type
2004-05
2005-06
2006-07
School
Curricula
1432
3886
5165
After-school*
546
612
589
Parent
Training
517
665
476
Note: Total eligible population of 6th, 7th, and 8th-grade students in
2005-06 was 10,031.
*Includes
PALS, BBBS, Stay SMART, and Tutoring programs
36
Participant Attendance
Percentage attending >60% of the total number of sessions
Program Type
2004-05
2005-06
2006-07
School
Curricula
96%
91%
95%
After-school*
77%
81%
65%
Parent
Training
79%
78%
79%
*Includes
PALS, BBBS, Stay SMART, and Tutoring programs
Fidelity Assessment Checklists
• Obtained from developers (9) or created by
research staff (7)
• Provided similar information across all
programs to measure 4 elements of fidelity
• Over 6,000 checklists were completed by
program implementers and coordinators
~ Minimal missing data (8.2% in 2004-05 and 2.1% in
2005-06)
• Checklists were collected and reviewed by
communities, then sent to SDRG
Adherence Rates
2004-05 and 2005-06 school years
Percentage of material taught or core components achieved
100
90
80
70
60
50
40
30
20
10
0
LST
AS
SFA
Alert
BPP
PDE
SS
Tutor
VY
BBBS
PALS
SFP
GGC
PWC
FM
Adherence
• Average adherence rate were high:
in 2004-05 and 94% in 2005-06
91%
• “Problematic” modifications were
infrequent (1.2 reported per cycle)
~ Deletions reported twice as often as additions
• Implementer reports of challenges:
~ Lack of time (14-20% of checklists)
~ Participant misbehavior (9-11%)
~ Trouble engaging participants (4-9%)
Delivery of Lessons
2004-05 and 2005-06 school years
(number, length, and frequency of required sessions)
Percentage of delivery requirements met
100
90
80
70
60
50
40
30
20
10
0
LST
AS
SFA
Alert
BPP
SMART Tutor
VY
BBBS
PALS
SFP
GGC
PWC
FM
Delivery of Lessons
• Delivery scores were high: 91% and 92%
in 2004-05 and 2005-06
• “Problematic” deviations in delivery
requirements were infrequent
• Deviations most likely to occur in
school-based programs
~ e.g., 30 vs. 45-minute sessions
~ e.g., deleting 1 of 12 required sessions
Program Observations
• Observed 10-15% of sessions in 10 of 16
programs
• Completed fidelity checklists to verify
adherence information
~ Rate of agreement between observers and
implementers was 93% (range: 77%-100%)
• Observers also rated the quality of
delivery and participant responsiveness
Quality of Delivery
• Observers rated the quality of delivery on
10 items (alpha = .83-.88) using a 5-point scale
(higher scores indicate better quality)
• Example Items:
~ In general, how clear were the program implementer’s
explanations of activities?
~ To what extent did the implementer keep on time during the
session and activities?
~ Rate the implementer on the following qualities:
• Level of enthusiasm
• Rapport and communication with participants
• Effectively addressed questions/concerns
Quality of Delivery
2004-05 and 2005-06 school years
Average score on 10 items reported by program observers
5
4.5
4
3.5
3
2.5
2
1.5
1
LST
AS
SFA
BPP
SMART
PALS
SFP
GGC
PWC
Quality of Delivery
Diversity of Teaching Techniques
• Observers rated the percentage of the session
in which each teaching technique was used
Lecture
Practice
Discussion
Video
2004-05
29%
34%
31%
6%
2005-06
30%
28%
36%
4%
Participant Responsiveness
• Observers rated participant responsiveness
on two items, using a 1-5 scale (higher scores
indicate better responsiveness):
~ To what extent did the participants appear to
understand the material?
~ How actively did group members participate in
discussions and activities?
• Across all programs, rates were high: 4.38 and
4.52 in 2004-05 and 2005-06
Communities That Care
Theory of Change
CTC Training and
Technical Assistance
Adoption of Science-based
Prevention Framework
Collaboration
Regarding Prevention Issues
Appropriate Choice
and Implementation
of Tested, Effective
Prevention Programs &
Adoption of Social Development
Strategy as Community’s Way of
Bringing Up Children
Decreased Risk and
Enhanced Protection
Positive Youth
Outcomes
Prioritized Risk Factors in CTC
Communities
•
•
•
•
•
•
•
•
•
Family management problems
Parental attitudes favorable to problem behavior
Family conflict
Low commitment to school
Favorable attitudes toward problem behavior
Friends who engage in problem behavior
Academic failure
Rebelliousness
Laws and norms favorable toward drug and alcohol
use
Average Level of Risk
Pre-post Change in
Targeted Risk Factors
0.25
0.20
0.15
0.10
0.05
0.00
-0.05
-0.10
-0.15
-0.20
Grade 5
Control Communities
Grade 7
CTC Communities
Note. Values are model-fitted levels of standardized average risk for students in the Youth Developmental
Study panel sample, N = 4404. For Grade 7: γ010 = .111, SE = .043, df = 11, p < .026.
50
Communities That Care
Theory of Change
CTC Training and
Technical Assistance
Adoption of Science-based
Prevention Framework
Collaboration
Regarding Prevention Issues
Appropriate Choice
and Implementation
of Tested, Effective
Prevention Programs &
Adoption of Social Development
Strategy as Community’s Way of
Bringing Up Children
Decreased Risk and
Enhanced Protection
Positive Youth
Outcomes
51
Youth Outcomes
• Initiation of Delinquent Behaviors
 Nine items measuring delinquent behaviors.
• Initiation of Substance Use
 Alcohol, marijuana, cigarettes, smokeless tobacco,
inhalants, non-prescribed use of prescription drugs, other
illicit drugs.
52
Delinquency Items
How many times in the past year (12 months)
have you...
5th Grade
6th Grade
7th Grade
stolen something worth more than $5?
√
√
√
purposely damaged or destroyed property that
did not belong to you (not counting family
property)?
√
√
√
taken something from a store without paying for
it?
√
√
√
attacked someone with the idea of seriously
hurting them?
√
√
√
been arrested?
×
√
√
beat up someone so badly that they probably
needed to see a doctor or a nurse?
×
√
√
sold illegal drugs?
×
×
√
stolen or tried to steal a motor vehicle such as a
car or motorcycle?
×
×
√
taken a handgun to school?
×
×
√
53
Delinquency Initiation
Between Grades 5 and 7
Control Communities
CTC Communities
Initiation Rate
0.50
0.36
0.40
0.30
0.21
0.20
0.10
0.00
0.31
0.17
0.00
Grade 5
Grade 6
Grade 7
Note. Youth Developmental Study panel sample. Excludes students who
initiated delinquent behavior by Grade 5. ω0001 = .237, SE = .103, df = 11, p < .05.
54
Substance Use Initiation
Between Grades 5 and 7
Initiation Rate
Control Communities
CTC Communities
0.50
0.39
0.40
0.24
0.30
0.20
0.10
0.36
0.22
0.00
0.00
Grade 5
Grade 6
Note. Youth Developmental Study panel sample. Excludes students who
initiated substance use by Grade 5. ω0001 = .142, SE = .122, df = 11, p > .05.
Grade 7
55
Summary
• Adoption of science-based prevention and collaboration are higher in CTC
communities than in control communities.
• CTC communities and schools are adopting tested & effective programs.
• The new programs are being implemented with fidelity.
• Targeted risk factors are increasing less rapidly in CTC than in control
communities.
• The rate of initiation of delinquent behaviors is significantly lower in CTC
than in control communities.
56
The Communities That Care
Prevention Operating System is
available at:
http://preventionplatform.samhsa.gov/
57
Published Papers
Arthur, M.W., Briney, J.S., Hawkins, J.D., Abbott, R.D., Brooke-Weiss, B. &. Catalano, R.F. (2007).
Measuring community risk and protection using the Communities That Care Youth Survey. Evaluation and
Program Planning, 30, 197-211.
Brown, E.C., Hawkins, J.D., Arthur, M.W., Briney, J.S., & Abbott, R.D. (2007). Effects of Communities That
Care on prevention services systems: Findings from the Community Youth Development Study at 1.5 years.
Prevention Science. 8, 180-191.
Fagan, A. A., Hawkins, J. D., & Catalano, R. F. (in press). Using community epidemiologic data to improve
social settings: The Communities That Care prevention system. In M. Shinn & H. Yoshikawa (Eds.), Toward
positive youth development: Transforming schools and community programs. New York: Oxford University
Press.
Fagan, A.A., Van Horn, M.L., Hawkins, J.D., & Arthur, M.W. (2007). Using community and family risk and
protective factors for community-based prevention planning. Journal of Community Psychology, 35(4), 535555.
Hawkins, J.D. (2006). Science, social work, prevention: Finding the intersections. Social Work Research,
30(3), 137-152.
Murray, D.M., Van Horn, M.L., Hawkins, J.D., & Arthur, M.W. (2006). Analysis strategies for a community
trial to reduce adolescent ATOD use: A comparison of random coefficient and ANOVA/ANCOVA models.
Contemporary Clinical Trials. 27, 188-206.
58
Papers In Press
Brooke-Weiss, B., Haggerty, K. P., Fagan, A. A., Hawkins, J. D., & Cady, R. (in press). Creating community change to
improve youth development: The Communities That Care (CTC) system. The Prevention Researcher.
Brown, E.C., Hawkins, J.D., Arthur, M.W., Van Horn, M.L., & Abbott, R.D. (in press). Multilevel analysis of a measure
of prevention collaboration. American Journal of Community Psychology.
Fagan, A.A., Hanson, K., Hawkins, J.D., & Arthur, M.W. (in press). Bridging science to practice: Achieving prevention
program implementation fidelity in the Community Youth Development Study. American Journal of Community
Psychology.
Fagan, A.A., Hawkins, J.D. and Catalano, R.F. (in press). Using community epidemiologic data to improve social
settings: The Communities That Care Prevention System. In M. Shinn, and H. Yoshikawa, (eds). Improving Social
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prevention programs in the Community Youth Development Study. Youth Violence and Juvenile Justice.
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Communities That Care on targeted risks and initiation of delinquent behavior and substance use. Journal of
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Van Horn, M.L., Fagan, A.A., Jaki, T., Brown, E.C., Hawkins, J.D., Arthur, M.W., Abbott, R.D., & Catalano, R.F. (in
press). The use of mixture models to evaluate differential intervention effects in group randomized trials. Multivariate
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Behavioral Research.
Building Community Collaboration to Promote
Healthy Youth Development:
J. David Hawkins Ph.D.
Social Development Research Group
School of Social Work
University of Washington
www.sdrg.org
Melissa Institute:
Reducing Violence
May 1, 2008
60
Risk Factors Addressed in CTC Communities
Community
Targeted Risk Factors
A
Parental attitudes favorable to problem behavior
Low commitment to school
Favorable attitudes toward problem behavior
C
Family management problems
Low commitment to school
Friends who engage in problem behavior
Favorable attitudes towards problem behavior
G
Poor family management
Low commitment to school
H
Poor family management
Academic failure
Low commitment to school
I
Low commitment to school
Friends who engage in problem behavior
J
Academic failure
Low commitment to school
Friends who engage in problem behavior
Favorable attitudes toward problem behavior
Rebelliousness
61
Risk Factors Addressed in CTC Communities
Community
Targeted Risk Factors
N
Academic failure
Friends who engage in problem behavior
O
Laws and norms favorable toward drug and alcohol use
Low commitment to school
Friends who engage in problem behavior
Rebelliousness
Q
Family conflict
Friends who engage in problem behavior
Favorable attitudes towards problem behavior
Rebelliousness
T
Family conflict
Low commitment to school
Friends who engage in problem behavior
W
Poor family management
Academic failure
Friends who engage in problem behavior
Favorable attitudes towards problem behavior
X
Academic failure
Low commitment to school
Friends who engage in problem behavior
62