Program Evaluation for Prevention Contract (PEP-C): Findings From the Partnerships for Success (PFS) National Cross-Site Evaluation

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1 Program Evaluation for Prevention Contract (PEP-C): Findings From the Partnerships for Success (PFS) National Cross-Site Evaluation Elvira Elek, Antonio Morgan-Lopez, and Nichole Scaglione RTI International SPF PFS Grantee Briefing February 13, 2017

2 Who Is on the Team? Center for Substance Abuse Prevention (CSAP) Thomas Clarke, COR Anthony Johnson Stephanie Blake PEP-C/PFS Leadership Phillip Graham, PEP-C Project Director Sandhya Bikmal, Systems Team Lead Antonio Morgan-Lopez & Nichole Scaglione, Evaluation and Analysis Team Leads Elvira Elek & Cheryl Roberts, Cross-site Evaluation Co-Leads Chelsea Burfeind, Data Collection and Processing Team Lead Monique Clinton-Sherrod & Gillian Leichtling, Training & Technical Assistance (T/TA) Team Co-Leads 2

3 Who Is on the Team? 3 Analysis Team Members Sharnail Bazemore Laura Dunlap Jenna Gabrio Lissette Saavedra Michael Bradshaw Kyle Emery Carolina Holt BeLinda Weimer

4 AGENDA 4 Introduction to PFS Who are the PFS grantees? Evaluation questions and data collection Selected outcomes and process findings from fiscal year (FY) 2015 data Lessons learned Next steps

5 The Strategic Prevention Framework & PFS Strategic Prevention Framework (SPF): Assessment Capacity Planning Implementation Evaluation 5

6 PFS Priorities Prevent the onset and reduce the progression of substance abuse, prioritizing underage drinking among people age 12 20, prescription drug misuse and abuse among people age 12 25, or both Reduce substance abuse-related problems Strengthen prevention capacity and infrastructure at the state and community levels Leverage, redirect, and align statewide funding streams and resources for prevention 6

7 PFS Grantee Cohorts & Community Subrecipients Cohort Grantees Funded Community Subrecipients Length of Grant Start Date End Date PFS II years Oct Sept PFS years Oct Sept PFS years Oct Sept PFS ~246 5 years Oct Sept PFS ?? 5 years Oct Sept Total 70** ~641** ** All 14 PFS II grantees received funding as PFS 2015 grantees, so these 7 totals count those grantees and subrecipients only once.

8 Geographic Distribution of PFS Grantees and Subrecipients Nooksack ITC 1 Native American Health Center 5 Tanana Chiefs Conference 4 AK 10 8 CA 6 OR 14 Cook Inlet Tribal Council 1 WA 43 NV 13 UT 13 MT 23 Pacific Jurisdictions American Samoa 9 Guam 14 Palau 1 Federated States of Micronesia -- Republic of Marshall Islands 3 Northern Mariana Islands -- WY 23 MT WY Tribal Leaders Council 1 CO 6 NE 16 IA 12 AZ NM OK AR 33 First Nations 4 Hawaii -- ND 10 SD 15 Lower Brule STC TX 8 KS 10 MN 7 Winnebago Tribe MO 5 LA 10 Great Lakes Inter- Tribal Council 4 WI 12 IL 9 MS 9 IN 10 MI 9 TN 10 AL 8 OH -- KY 2 Cherokee Nation 11 Little Traverse Bay Band 1 GA 3 WV 6 Southern Plains Tribal HB -- Other Jurisdictions Puerto Rico 6 U.S. Virgin Islands 5 NH 18 VT 6 NY 10 PA 5 VA 9 NC 13 SC 9 FL -- ME 9 MA 16 RI 12 CT 11 NJ 17 DE 11 MD 10 DC 9 PFS 2013 PFS 2014 PFS 2015 PFS II/2015 PFS 2016 # next to grantee is # of subrecipients

9 Priorities Across PFS Grantees PFS Cohorts Underage Drinking Priority Prescription Drugs Marijuana Other PFS II PFS PFS PFS Total* * Excludes PFS II, as they are also included in PFS 2015 counts.

10 Priority Outcomes Across PFS Community Subrecipients PFS Cohorts Underage Drinking Priority Prescription Drugs Marijuana Other PFS II PFS PFS Total* * Excludes PFS 2015, as many grantees had not selected subrecipients, and selected subrecipients had not implemented interventions at the time of FY2015 data collection.

11 11

12 EVALUATION QUESTIONS AND DATA COLLECTION 12

13 PFS Cross-Site Evaluation Questions 13 EQ1 EQ2 EQ3 Was the implementation of PFS programs associated with a reduction in underage drinking and/or prescription drug misuse and abuse? Did variability in the total level of funding from all sources relate to outcomes? Did variability in the total level of PFS funding relate to outcomes, above and beyond other funding available to communities? What intervention type, combinations of interventions, and dosages of interventions were related to outcomes at the grantee level? What intervention type, combinations of interventions, and dosages of interventions were related to outcomes at the community level?

14 PFS Cross-Site Evaluation Questions 14 EQ4 Were some types and combinations of interventions within communities more costeffective than others? EQ5 How does variability in factors (strategy selection and implementation, infrastructure, geography, demography, subrecipient selection, training and technical assistance, barriers to implementation) relate to outcomes across funded communities?

15 Grantee-Level Data Grantee-Level Process Data 1. Revised Grantee-Level Instrument (GLI-R) 2. Project Director (PD) Interview 3. Quarterly Progress Reports 15 Grantee-Level Outcome Data From National Survey of Drug Use and Health (NSDUH) estimates

16 Community-Level Data 16 Community-Level Process Data Revised Community-Level Instrument (CLI-R) o Submitted by subrecipients Community-Level Outcome Data PFS Community-Level Outcomes o o Submitted by grantee for each community National Poisoning Data System (NPDS)

17 FINDINGS 17

18 Outcomes Definition of baseline for FY2015 data report Year before grantees received funding Preliminary findings Only 3 years (maximum) of follow-up data for PFS II, only 2 years for PFS 2013, and only 1 year for PFS 2014 Subrecipient funding and implementation lags resulted in intervention implementations not beginning, on average, until 15 months after grantee funding 18

19 Mean Number of Days From Grantee Funding to Community Intervention Implementation 19

20 Grantee Outcomes NSDUH combined 2-year estimates , , , and Different baseline for each cohort ( for PFS II; for PFS 2013, etc.) No follow-up yet for PFS 2014 Included only states Analysis compares trends from through baseline (normative change) to changes after baseline 20

21 EQ1 Was PFS associated with a reduction in underage drinking at the grantee (state) level)? PFS was associated with reductions in past-30-day underage alcohol use and binge drinking, over and above normative change through baseline. Age Group Past-30-Day Alcohol Use Past-30-Day Binge Drinking Normative Change Annual Change Baseline 1st 1st 2nd 21

22 EQ1 Was PFS associated with a reduction in prescription drug misuse at the state level? Reductions in past-year prescription drug misuse for 18- to 25-year-olds in the 1st year of the grant Increases in past-30-day prescription psychotherapeutic misuse in the 2nd year of the grant Past-30-Day Psychotherapeutics Misuse Past-12-Month Psychotherapeutics Misuse Past-30-Day Pain Medication Misuse Past-12-Month Pain Medication Misuse 22 Age Group Normative Change Annual Change Baseline 1st 1st 2nd

23 Grantee Outcomes During the first year of funding, PFS also was associated with increases in the harm that underage youth perceived in binge drinking ages and Summary: Some meaningful effect sizes suggest that PFS helped reduce underage drinking and pain medication misuse among young adults 23

24 Community Outcomes Provided by grantees 24 Outcomes vary but focus on use, risk and protective factors, and consequences Survey data: Youth Risk Behavioral Surveillance System (YRBSS), other state surveys Archival data: arrests, crashes, emergency room (ER) visits 2,325 data points (data point = a single variable for a single community at a single time point) 398 data points (17%) post-baseline

25 EQ1 Was PFS associated with a reduction in underage drinking or prescription drug misuse at the community level? PFS was associated with significant reductions in past- 30-day alcohol use (1.6% per year) and past-30-day prescription drug misuse (2.3% per year). Past-30-Day Alcohol Use Past-30-Day Binge Drinking Past-30-Day Prescription Drug Misuse Pre-baselines Through Baseline Baseline Through Follow-Ups 25

26 Poisoning Call Data National Poisoning Data System (NPDS) Poisoning call cases by drug classes (ethanol, antidepressants, sedatives, stimulants, and opioids) Ages 12 25, except for ethanol (ages 12 20) Data from FY2012, FY2013, FY2014, and FY2015 Aggregated up to community (county) level Converted counts to poisoning rates per 10,000 Used propensity score modeling to select matched (non-pfs) communities for each PFS community 26

27 Poisoning Call Data Outcomes favored PFS communities for Combined rate of poisoning calls for alcohol and several different types of prescription drugs Separate rate of just opiate poisoning calls 27

28 28 Any Poisonings

29 29 Opiate Poisonings

30 30

31 EQ2 Did variability in the total level of funding (or PFS funding) relate to outcomes? Median annual subrecipient prevention funding: Cohort Overall Prevention Funding PFS Prevention Funding PFS II $188, 852 $107, 255 PFS 2013 $261,340 $86,426 PFS 2014 $271,536 $142,282 PFS funding accounted for 47% of subrecipient communities prevention funding and 77% of funding used for PFS activities 31

32 EQ3 What intervention type and combinations of interventions were related to outcomes? 313 community subrecipients reported on 1,222 of their PFS intervention-service type activities in FY2015 Subrecipients reported an average of about 3.9 intervention-service type activities The number of intervention-service type activities ranged from 1 to 24 32

33 Intervention-Service Types Most activities fell under Information Dissemination (37%), Environmental Strategies (26%), or Prevention Education (21%) CSAP strategy types 31% of subrecipient communities implemented only one CSAP strategy type in FY2015; 35% combined 2, 21% combined 3, and 19% combined 4 or more. Subrecipients implemented more than twice as many media campaigns as any other service type 33

34 Evidence-Based Programs, Policies, & Practices (EBPPPs) Of those communities implementing interventions, 65% of PFS 2014, 73% of PFS 2013, and 88% of PFS II communities implemented at least one EBPPP in FY2015. Criteria used for determining if EBPPP (% subrecipients): On list recommended by grantee Included in a federal registry of EBPs Documentation of effective implementation Theory of change in clear logic/conceptual model 34 53% 38% 25% 20% Reviewed by a panel of 18% informed experts Found to be effective in a 18% published scientific journal Similar to interventions in 15% registries or literature Other 6%

35 Cultural Competence 65% of grantees enforced requirements to ensure culturally and linguistically competent programs, policies, and practices 47% of grantees used systematic processes to assess cultural appropriateness and inclusiveness of prevention materials 35

36 FY2015: Subrecipient T/TA Strategic plan development Needs and resource assessment Evaluation Cultural competence Staff or coalition member training Sustainability Received 21% 21% 20% 15% 19% 18% Needed 55% 55% 51% 51% 46% 46% 36

37 FY2015: Subrecipient T/TA Intervention selection Intervention implementation Health disparities Building relationships Participant recruitment Intervention adaptation Received 18% 15% 19% 12% 25% 14% 14% 9% Needed 35% 35% 32% 33% 37

38 38

39 LESSONS LEARNED 39

40 Training and TA (T/TA) Needs Grantees 40 Staff turnover, workforce assessment, and performance evaluation Data limitations Difficulties with getting partner buy-in Culturally targeted interventions and staff training Communities Leveraging funding and resources to ensure the sustainability of their activities

41 Implementation Lag May address this by: CSAP s more intensively monitoring grantees that take more than 6 months to fund communities Exploring whether the SPF process requires the observed funding and implementation lag times Examining potentially associated factors, such as grantee and community infrastructure and capacity 41

42 EBPPPs and Health Disparities Encourage greater use of evidence-based practices workgroups (EBPWs) to help increase the number of communities implementing EBPPPs Assess whether targets identified in grantee Disparities Impact Statements match community targets 42

43 43

44 NEXT STEPS for the Evaluation 44

45 Outcomes Focus on outcomes targeted by grantees and subrecipient communities Grantee NSDUH redesign (only 30-day alcohol use and 30- day marijuana use questions remained the same) Focus on poisoning call data at the state level and state reports of crashes, arrests, and mortality 45

46 Community Outcomes Check lags in the data Examine data for targeted age groups Consider intervention start dates in defining baseline Get additional comparison community data (from grantees for non-pfs communities) 46

47 Process Categorize media campaigns separately for CSAP strategy type (EQ3) Report on intervention dosage and reach (EQ3) Explore intervention cost data (EQ4) 47 Start-up costs compared with ongoing implementation costs Costs of different types of interventions Cost effectiveness analyses Define infrastructure constructs (EQ5)

48 48

49 For More Information Thank you for participating! Future questions? Contact: Special thanks to all of the PFS grantee and subrecipient staff who provided the data to make this evaluation possible. 49

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