Coalition Planning May 14, 2014 CADCA s National The Institute helps coalitions get smarter faster All trainings built around the Strategic Prevention Framework Public Health Approach to Prevention Coalitions Agent Host Agent Environment Environment 1
Individual-Focused Strategies Typically focus on changing behavior of the Host usually through affecting individual decisionmaking. Host Agent Environmental Approaches Address the context of host/agent interactions Context means places, settings, occasions and circumstances in which behaviors occur. Strategies Targeting Individualized Environments Socialize, Instruct, Guide, Counsel Strategies Targeting the Shared Community Environment Support, Thwart Family INDIVIDUAL YOUTH School Norms Regulations ALL YOUTH Faith Community Health Care Providers Availability 2
Community Problem Solving Using the Strategic Prevention Framework (SPF) Community Assessment Capacity Planning Implementation Evaluation Sustainability Cultural Competence Community Assessment Examples: Problem Statements The problem is underage drinking in ABC County. The problem is marijuana use by teens in ABC County. The problem is the abuse of Rx Drug by teens in ABC County. The problem is alcohol-related car crashes by 18 25 year olds in ABC County. 3
Problem Analysis But Why? Problem Problem Analysis Needs Assessment Data But Why? = Root Causes = Risk Factors Laws and Enforcement Community Norms Retail Access/Availability Promotion and Price Underage Marijuana Rx Drug Use Drinking Abuse by Teens Social Access/Availability Parental Attitudes Favorable Toward Use Favorable Youth Attitudes (Low perception of risk) 4
But Why Here? = Local Conditions 1. Specific 2. Identifiable 3. Actionable Local Conditions Local conditions must be specific, identifiable and actionable. Be sure to describe: What is happening? Who is doing what? What is the context in which the behavior occurs? When and where is the behavior is occurring? How often? On what occasions? Who is involved? Who knows? Criteria for Moving Problem Analysis to a Logic Model 1. Local Data 2. Prevention Science 3. Community Experience 4. Community Expectations 5
Logic Model Underage Drinking Favorable Parental Attitudes Parents allow children to drink in the home at age 15 Parents Hosting Parties Availability of Alcohol Liquor Stores Not Carding Minors Youth Attend College Parties Problem Statement But Why? (Root Cause) But Why Here? (Local Conditions) Adding Data to the Logic Model Underage Drinking 30 day use Age of Onset Problem Statement Favorable Parental Attitudes Perception of Risk Parental Disapproval Availability of Alcohol Perception of Availability But Why? (Root Cause) Parents allow children to drink in the home at age 15 Youth Focus Groups Parents Hosting Parties Police Reports Liquor Stores Not Carding Minors Compliance Check Violations Youth Attend College Parties MIP Arrests But Why Here? (Local Conditions) Data Collection Triangulation 6
Data Collection Activity 1. Parents host parties for youth with alcohol 2. Friends over 21 years old buy alcohol for youth 3. Youth share their legally prescribed Rx drugs at school 4. Rite of Passage drinking at prom and graduation parties 5. Youth smoke marijuana afterschool at friend s houses 6. Many community celebrations involve / promote alcohol 7. Doctors are over prescribing pain killing medication 8. Meth is being manufactured in the community Logic Model SMART Objectives What will be changed? By how much? How will it be measured? By when? Baseline? What will be changed? By how much? How will it be measured? By when? Baseline? What will be changed? By how much? How will it be measured? By when? Baseline? Data-based Objectives Based on the data collected during community assessment and problem analysis and included on the logic model. Set targets for changes in community conditions based on the logic model. Establish the data (baseline) used to evaluate community level changes identified on the logic model 7
Objectives should be SMART : 1. Specific S 2. Measurable M 3. Achievable A 4. Relevant R 5. Timed T Objectives What will be changed? By when? By how much? Baseline? How will it be measured? Example (Local Condition): Decrease the number of youth issued citations for smoking marijuana by local police in central city parks by 75% by 2015. Baseline 2013: 36 youth issued citations for smoking marijuana by local police. Target 2015: 9 youth issued citations for smoking marijuana by local police. Local condition: Retailers selling alcohol to minors Objective: Coalition Objectives Practice Measure: Failed compliance checks by retailers reported by Law Enforcement. Baseline 2013: 45% of retailers failed their compliance checks Target 2015: % of retailers failed their compliance checks 8
Writing SMART Objectives Considerations for determining how much? : Existing trends in the data Size of the community Number of targets of change Existing coalition capacity and resources Data used to measure the change Political, social and economic influences Writing Objectives Example 1: Decrease the retailers selling alcohol to minors by 35% by 2015. Baseline 2013: 45% of retailers failed compliance checks. Target 2015: 10% of retailers fail compliance checks. Example 2: Decrease the number of retailers selling alcohol to minors by 35% from 45% failed compliance checks in 2013 to 10% failed compliance checks in 2015. Logic Model SMART Objectives Comprehensive Strategies Information Build Skills Provide Support Reward / Consequence Access / Barriers Policy Change Physical Change Information Build Skills Provide Support Reward / Consequence Access / Barriers Policy Change Physical Change Information Build Skills Provide Support Reward / Consequence Access / Barriers Policy Change Physical Change 9
Provide Information ato Build Skills Provide Social Support Comprehensive Strategies Seven Community Change Strategies Individually Focused Modify barriers/access Change consequences/incentives Alter the physical design of the environment Change policies and rules Source: KU Work Group for Community Health and Development, 2007 Environmentally Focused Comprehensive Strategies Example Local Condition: Retail stores are selling alcohol products sold to youth despite age restrictions. 1. Provide Information Publicize failed & passed compliance checks 2. Build Skills Train merchants to check ID s 3. Provide Support Technical assistance to merchants 4. Access / Barriers Translate merchant education materials 5. Incentives / Disincentives Increase taxes & fines 6. Physical Design Place alcohol products behind counter, ID mats 7. Policies or Regulations Require RBST training as part of licensing requirements Comprehensive Strategies 1. Provide Information: Presentations, workshops, brochures, billboards, social norms campaigns, town hall meetings, web- based communications, etc. 2. Enhance Skills: Workshops/seminars designed to teach skills needed to achieve population-level outcomes. 3. Providing Support: Assisting others to conduct training, obtaining funding for equipment, training, reach specific target audiences 10
Comprehensive Strategies 4. Changing Access/Barriers Access: - Provide instructions/training in multiple languages - Give scholarships to training programs - Provide training at vendor locations Barriers: - Enhance law enforcement operations for dealing with MIP - Remove tobacco machines from public venues - Place pseudoephedrine behind the counter Comprehensive Strategies 5. Change Consequences (Incentives/ Disincentives) Incentives: Provide awards to businesses/ organizations who pass Compliance Checks Public Recognition (as part of a overall effort) Discounts Disincentives: Increase Citations/Fines Increase Excise Taxes Use/Lose Laws Comprehensive Strategies 6. Change the Physical Design - Lighting in parks - Signage - Alcohol Outlet Density/Proximity - Advertising (Restrictions) - Product Placement - Packaging 11
Comprehensive Strategies 7. Change Laws, Policies, Procedures, By-Laws Laws: Social Host Liability, Keg Registration Policies: 24/7 Zero Tolerance policy in a school district, Drug Free Workplace Policies, Mandatory Merchant Education with License Re-Application Procedures: MIP Arrest Processing by Law Enforcement, By-Laws: Civic organization use of alcohol, collaboration & networking Comprehensive Strategies Example Local Condition: Open market drug sales occurring in City Park and local neighborhood. 1. Provide Information Flyers for residents identifying issue / steps 2. Build Skills Train residents to report activity anonymously 3. Provide Support Work with Neighborhood Association 4. Access/Barriers Extra staff for Law Enforcement at specific times 5. Incentives/Disincentives Increase penalties / fines 6. Physical Design Install cameras and signs throughout the area 7. Policies or Regulations Pass Drug Free Park Ordinance 35 Strategies Targeting Individualized Environments Socialize, Instruct, Guide, Counsel Strategies Targeting the Shared Community Environment Support, Thwart Family INDIVIDUAL YOUTH School Norms Regulations ALL YOUTH Faith Community Health Care Providers Availability 12
Environmental Strategies Prevention efforts aimed at changing or influencing community conditions, standards, institutions, structures, systems and policies that shape behaviors. - Hours/Days of Sale - Outlet Density Reduction - Naloxone Distribution - Open Container Ordinance - Happy hour Ordinance/Laws - Sobriety Checkpoints - Advertising Ordinance/Laws - Third Party Transaction shoulder tap - Social host ordinances - Responsible Beverage Server Training - Compliance Checks - Fake ID Enforcement - PDMP Strategies - Enhanced access to treatment Individual Strategies Developing Strategies Environmental Strategies Focus on behavior and behavior Focus on policy and policy change change Focus on relationship between Focus on social, political, economic individual and drug-related problems content of alcohol/drug problems Short-term focus on program Long-term focus on policy development development Individual does not generally People gain power by acting participate in decision making collectively Individual is an audience Individual as an advocate Environmental Strategies Underage Drinking Limitations on Access Compliance checks and appropriate sanctions Merchant education (TIPS) Dram Shop Liability Penalties for false IDs Cops in Shops Keg Registration Shoulder Tap Social Host Laws Increase price (e.g., taxes, limit drink specials) Conditional Use Permits Outlet Density Restrictions Community Norms Limitations on sales and promotion at community events Media campaigns, media advocacy, social norms campaigns, counteradvertising Outlet Density Sponsorship and promotion of Alcohol free events School Based Strategies School policies update and consistently enforce Prevention curricula and programs 13
Environmental Strategies Rx Drug Abuse Prescription drug monitoring (PMP) programs Drug take-back and disposal legislation. Prohibit e-scribing of narcotics and other Rx drugs Support increased penalties for unscrupulous prescribers & doctor shopping Rewards for healthcare/insurance providers Create a campaign to get people to lock their meds Collaborate with builders and realtors to ensure Rx Safe Boxes are installed or available in homes for sale Decrease the number of pain clinics in the community Promote signage at key locations (e.g. pharmacies, doctors, dentists or therapists) Parental monitoring and blocking of youth computer access to on-line pharmacies Source: CADCA Rx Abuse Prevention Toolkit http://www.cadca.org/resources/detail/rx-abuse-prevention-toolkit Comprehensive Strategies Example Local Condition: Youth Steal Rx Drug From Medicine Cabinets 1. Provide Information Inform parents, MDs about the issue 2. Build Skills Train staff on proper Rx disposal techniques 3. Provide Support Engage MDs, DDS, Pharmacies to inform public 4. Access/Barriers No questions asked drop off policy 5. Incentives/Disincentives Offer coupons at take back sites 6. Physical Design Permanent Rx Take back boxes 7. Policies Policy requiring year round take back boxes at all police stations and other locations Comprehensive Strategies (Intervention Map) Problem: Root Cause (But Why?): Local Condition (But Why Here?): Objective: Behavior Change Strategy Comprehensive Strategies Providing Information Building Skills Providing Support Changing Barriers/ Access Changing Consequences/ Incentives Changing the Physical Design of the Environment Changing Policy Environmental Strategies 14
Summary Planning involves: - Problem Analysis - Logic Models with data - Writing Objectives - Comprehensive Strategies Resources Dave Shavel dshave@earthlink.netnet 307-399-1259 CADCA Community Anti-Drug Coalitions of America www.cadca.org Help & Technical Assistance Contact: 1-800-54CADCA x240 training@cadca.org 15
Marijuana Use by Teens Underage Drinking Rx Abuse by Youth 16
But Why Here? Problem Analysis 17
Logic Model Coalition: Problem Root Causes Local Conditions & Data (Specific, identifiable, actionable) Data: Data: Data: Data: Data: Data: 18 Data:
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Coalition: Drug-Free Coalition of ABC County Problem But Why? But Why Here? Statement Root Causes Local Conditions & Data (Specific, identifiable, actionable) Retail Outlets Sell to Minors Underage Drinking Data: 50.1% of the people over age 12 reported current use of alcohol (ABC Survey) 125 youth referred for alcohol assessment by school district (ABC School District) Availability Data:87% of 9 12 th grade students report it is easy to get alcohol in our community ABC Survey). Data: In 2013 31% of retailers checked were non-compliant with alcohol checks. There are 352 alcohol outlets in ABC County which is 1.69 outlets per 1000 residents. Alcohol Tobacco Commission Alcohol is available in the home and not monitored by parents Data: 63.6% of students said it is not difficult to get alcohol from home without parents knowing. ABC Survey. One on One Interviews with youth:39% reported getting alcohol from their parents or friends parents (2012). Underage youth frequently attend college parties to experience the college atmosphere (high-risk drinking) and abundance of free alcohol) Community Norms Data: 32.1% (freshman), 34.5% (sophomores), and 30 % (juniors) said someone gave it to me when asked where they got their alcohol. ABC College Student Wellness Survey, Law enforcement received 267 calls for service for excessive noise involving college students (ABC Police Report) Data: 49.6 of students felt that most adults in the community think that it is okay for people underage to drink alcohol Alcohol use is acceptable at community events (Big-10 Football Games, Grand Prix, Graduation Parties, etc.) Data: 34.7% of 12 th graders drink to have a good time. There are 15 parties and festivals in town that allow and promote the consumption of alcohol by adults in open areas. 20
Evidence-Based Strategies Resources CADCA Environmental Strategies http://www.cadca.org/category/coalition-resourcestools/environmental-strategies CADCA Policy Change Toolbox http://www.cadca.org/policyadvocacy/prevention_works/policy-change-toolbox CADCA Rx Abuse Prevention Toolkit http://www.cadca.org/resources/detail/rx-abuse-prevention-toolkit National Registry of Evidence Based Programs and Practices (NREPP) SAMHSA http://nrepp.samhsa.gov/ The Community Guide CDC Alcohol Prevention http://www.thecommunityguide.org/alcohol/index.html Environmental Strategies: Selection Guide, Reference List, and Examples of Implementation Guidelines http://www.dsamh.utah.gov/spf/pdf/environmental_strategies.pdf SAMHSA Evidence Based Prevention Resources http://captus.samhsa.gov/accessresources?prevention=103&tid_2=all&term_node_tid_depth=all&term_node_tid_depth_1=all&type=all &title= Evidence-Based Program Registries http://whatworks.uwex.edu/pages/2evidenceregistries.html ONDCP- Marijuana Resource Center http://www.whitehouse.gov/ondcp/marijuanainfo Alcohol: No Ordinary Commodity - Research and Public Policy http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199551149.001.0 001/acprof-9780199551149 Helping America s Youth - Find Youth Info Program Directory http://www.findyouthinfo.gov/program-directory Strategies/Interventions for Reducing Marijuana Use http://www.nhcenterforexcellence.org/pdfs/marijuana_strategies_interventions.pdf 21
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Problem: Comprehensive Strategies / Intervention Map Risk Factor (But Why?): Local Condition (But Why Here?): Objective: Strategy Intervention Provide Information Build Skill Provide Support Access / Barriers Incentives / Disincentives Physical Design Policies or Regulations 24