Maryland SPF SIG Needs Assessment Training Meeting ADAA MSPF Evaluation Team April 2012

Agenda Introductions and Expectations MSPF Evaluation Overview Needs Assessment Capacity Building Meeting with coalitions Wrap-up Evaluation

Training Objectives Understand MSPF evaluation at the state and community level Collect data on intervening variables and contributing factors Prioritize intervening variables Assess organization, resources, and community readiness

Introductions Where you are in the MSPF process? Expectations for today Barriers/challenges

MSPF Evaluation Overview

What Are We Evaluating? MSPF priority: reduce underage drinking and alcohol abuse – Reduce the number of youth, ages 12-20, reporting past month alcohol use – Reduce the number of young persons, ages 18-25, reporting past month binge drinking – Reduce the number of alcohol-related crashes involving youth ages 16-25

Process Evaluation State Level – Focus on the extent to which the state successfully adheres to the five steps of the SPF Community Level – Assess each community coalition’s adherence to and progress on implementation of the five steps of the SPF

Process Evaluation Community Level (cont.) – Work with local community evaluator to track and document all SPF related activities – Example: Providing Monthly Reports on Coalition and SPF activities – Examine whether selected strategies are being implemented as planned

Outcome Evaluation State Level – Will examine whether or not implemented strategies are effective in reducing underage drinking – Will work with the State Epidemiological Outcomes Workgroup (SEOW) to evaluate the outcomes of interest

Outcome Evaluation Community Level – Is critical since we may not be able to see an overall change in the state rates due to only 24 communities being funded – The outcome evaluation at the community level will focus on the primary indicators – Will work with the local evaluator – Community coalitions will select their strategies bases on their needs assessment

SEOW State Epidemiology and Outcomes Workgroup – To provide state substance abuse prevention providers and policy makers with information to determine prevention priorities – Identify, monitor, and interpret key indicators that provide information on consequences of alcohol and drug use and measures of use State level Jurisdictional level

MSPF Evaluation Team University of Maryland, School of Pharmacy o Françoise Pradel, PhD-Lead Evaluator o Nicole Sealfon, MPH-Program Coordinator o Michelle Campbell, MS-Research Assistant o Linda Simoni-Wastila, PhD-SEOW Lead Epidemiologist

Where We Are Currently At the State Level – Completed a state-wide needs assessment and developed a state-wide strategic plan At the Jurisdiction Level – Completed a jurisdictional assessment to determine needs and to select a community At the Community Level – Are working on their Needs Assessment, Capacity Building, and Strategic Plan

MSPF Process

Community Needs and Resources Assessment  Substance use rates of the potential target population  Substance use consequences in the potential target population  Factors that might cause, lead to, or promote substance abuse  Community readiness  Cultural Competence  Prevention resources  Partnerships within the community

Organizational Needs Assessment  Leadership  Human resources  Technical resources  Infrastructure  Finding sources  Mission/Vision  Organizational experience  Cultural Competence

How to Conduct a Needs Assessment in your Community?

The Community Needs Assessment is completed by the coalition with the local evaluator.

Community Needs Assessment A systematic gathering and analysis of data about the community your coalition serves for the purpose of identifying and addressing local Alcohol problems. The overall goal of the needs assessment is to answer the five “W” questions: What? Who? Where? When? Why?

Types of Data o Quantitative Data o Defined as variables that you can count o Data that help answer the question “how many?” o Can be collected from archival data or surveys o Qualitative Data o Defined as people’s attitudes, opinions, or beliefs o Non-numerical data rich in detail and description o Can be collected from interviews, town hall meetings, focus groups, open-ended survey questions, individual interviews

Data Collection Methods Primary Data Focus groups Surveys Interviews Environmental Scans Town Hall Meetings Secondary Data Existing Surveys Hospital Records Law Enforcement Records

Assessing the Indicators: the WHAT? Maryland Indicators – Reduce the number of youth, ages 12-20, reporting past month alcohol use – Reduce the number of young persons, ages 18-25, reporting past month binge drinking – Reduce the number of alcohol-related crashes involving youth ages Identify the problem in your community

Data Collection Sources Community level surveys FARS NSDUH Maryland Adolescent Survey YRBSS BRFSS

Identifying the Who?, Where?, and When? WHO? Should we target a demographic subgroup? WHERE? Should we target a geographic location? WHEN? Does the time of the year matter?

Data Collection Sources Law Enforcement Hospital Staff/EMS DOT/SHA website Existing Survey Data Focus Groups Interviews Court Records

Intervening Variables- “Why?”

What are Intervening Variables and Contributing Factors? Intervening Variables are constructs that have been identified as being strongly related to, and influencing the occurrence and magnitude of substance abuse- in our case Alcohol. Contributing Factors are the specific issues in a community that contribute to the problem

Intervening Variables 1.Retail Availability 2.Social Availability 3.Enforcement and Adjudication 4.Social/Community Norms 5.Promotion 6.Pricing 7.Low Perceived Risk

Retail Availability Availability of alcohol in your community How easy it is to obtain alcohol

Contributing Factors- Retail Availability ID IssuesUse of fake IDs; failure to check IDs Compliance to Regulations and Ordinances Sales to minors; bootlegging, sales to intoxicated persons DensityHigh-density package sales and open- container sales locations EmployeesClerks have underage friends and sell to them Product PlacementEase of shoplifting; alcohol placement in store Product CharacteristicsForty-ounce containers; keg registration tags are easy to remove

Data Collection Tools and Methods Retail Availability Liquor Licenses Per Capita Where and How is Alcohol sold Bar Availability How is alcohol sold, priced, and promoted Law Enforcement Activities Alcohol Compliance Checks

Social Availability Obtaining alcohol from friends, associates, and family members

Contributing Factors- Social Availability Provision of alcohol to minorsParents provide alcohol to underage persons; older siblings or other relatives provide alcohol to underage persons; older friends supply alcohol; parents do not monitor the alcohol in the home and kids take it Availability of unsupervised and other drinking locations Numerous party settings; off-campus college parties Community celebrationsAcceptance of binge drinking in many social settings; Alcohol obtained at community celebrations by underage persons Lack of awareness among adults that there are consequences for providing alcohol to minors Adults do not know they can be arrested for providing alcohol to a minor Lack of parental monitoring of alcohol supply in the home Take/steal alcohol from parents’ home Workplace promotionWorkplaces promote drinking as part of the culture Parents providing a location/allowing underage persons to drink Parents think it is safer for youths to drink in their homes

Data Collection Tools and Methods Social Availability Town Hall Meeting Focus Groups Individual Interview Community Social Events Law Enforcement Activities Party Patrols

Enforcement and Adjudication The impact of law enforcement practices and judicial processes on underage drinking, binge drinking, and alcohol- related crashes.

Contributing Factors- Enforcement and Adjudication ResourcesShortage of officers; lack of knowledge/training for officers; few or no retail compliance checks Law enforcement practiceInconsistent application of laws with minors; low number of arrests/citations for alcohol use for minors; alcohol is not a big issue relative to drugs and other issues Judicial practiceHigh dismissal rated by courts for DUI’s/underage use; no/low prosecution by DA; inconsistent application of legal consequences by courts; few first offender consequences; short mandatory sentences Lack of parental enforcementParents have few rules, if any, around drinking; parents don’t enforce underage drinking laws

Data Collection Tools and Methods Enforcement and Adjudication DUI alcohol results Number of impaired driving cases Conviction rates for alcohol-related offenses Law Enforcement Interviews Parental Surveys

Social/Community Norms The acceptability or unacceptability of certain behaviors in a community

Contributing Factors- Social/Community Norms Family AcceptanceParents permit underage drinking; family inclusion of alcohol at events Multigenerational UseDrinking is a normal pattern of parents and other relatives Considered Rite of PassageUsing alcohol and binge drinking are what kids do Youth PerceptionDrinking is a bonding activity; binge drinking is normal and not harmful; drunkenness is OK and even cool Culturally AcceptableDrinking is part of everyday life of the community Available in homesAlcohol is available in the home

Data Collection Methods and Tools Social/Community Norms Focus Groups Interviews Surveys Town Hall Meetings

Pricing The cost of alcohol and the extent to which changes (i.e., discounting or price increase) affect consumption.

Contributing Factors- Pricing Drink pricingBars near campus compete for student purchasers with drink specials; happy hours; retail competition; holiday discounts Container PricingDiscount pricing in quantity purchases; retailer competition; convenience stores cheaper

Data Collection Tools and Methods Pricing Pricing Assessment Tool

Promotion Attempts by alcohol retailers and industry to increase demand through the marketing of their products.

Contributing Factors- Promotion National PromotionPro-alcohol message from alcohol industry, movies; large number of pro- alcohol messages; alcohol ads promote use as sexy and fun-filled Local PromotionLarge number of alcohol ads in stores and on college campuses; drinking is often promoted at community festivals and other activities; placement of cold beer near entrance of convenience stores; advertising and promotional practices encourage excessive alcohol consumption

Data Collection Tools and Methods Promotion Sponsorships Community Events and Festivals and their alcohol-related sponsors Advertising Local alcohol advertisements and promotional events

Low Perceived Risk Beliefs about the likelihood of receiving an alcohol-related violation or penalty or being harmed as a result of drinking alcohol.

Contributing Factors-Low Perceived Risk Low perception of getting arrestedLow evidence of getting caught drinking; belief that penalties are not serious; low number of arrests Low perception of consequencesDrinking and driving not perceived to be dangerous; minors don’t believe courts will punish them/won’t implement severe penalties Lack of parental enforcement of consequences Parents have few rules and consequences regarding alcohol use Low perceived risk of alcohol useAlcohol is not as dangerous as other drugs; belief that alcohol is safe as long as you are not driving; belief that hard liquor is dangerous but beer not

Data Collection Tools and Methods Low Perceived Risk Focus Groups Interviews Surveys

Prioritization Process Based on data obtained: 1.Rank each intervening variable on a scale from 0-10 using the following question: To what degree do you believe the intervening variable is affecting underage drinking, binge drinking, or alcohol related crashes in your community? 2.Select up to 3 contributing factors for the top ranked intervening variables 3.Assess your community’s readiness and capacity to address each contributing factor selected

Scoring and Ranking Intervening Variables Intervening VariablesScoreRank Retail Availability Social Availability Law Enforcement and Adjudication Social/Community Norms Pricing Promotion Low Perceived Risk No Impact Major Impact

Changeability Assessment What community resources are available to address the intervening variable? What are the gaps in the community resources? How ready is the community to address this intervening variable?

Changeability Assessment More ImportantLess Important High Likelihood to Change High Priority for Planning Low Priority Difficult to change Low Priority No Priority

Community Logic Model Problems (Indicators) Intervening Variables Contributing Factors Strategies Underage DRINKING Young Adult BINGE DRINKING Young Adult BINGE DRINKING DRINKING and DRIVING Retail Availability Low Perceived Risk Social Availability Enforcement & Adjudication Community/ Social Norms Pricing Promotion

Community Logic Model Problems (Indicators) Intervening Variables Contributing Factors Strategies Underage DRINKING Young Adult BINGE DRINKING Young Adult BINGE DRINKING DRINKING and DRIVING Retail Availability Low Perceived Risk Social Availability Enforcement & Adjudication Community/ Social Norms Pricing Promotion Retail sales to Underage Customers Alcohol Promotion Youth access to home alcohol supply Parental Provision of alcohol to other children Police enforcement of social availability Awareness of legal risk in providing alcohol to youth

Overview of Needs Assessment Results

Capacity Building

What is Capacity? Various types and levels of resources within the community and within an organization such as a coalition The community’s level of readiness to engage in and support prevention efforts Capacity= Resource + Readiness

How to Build Capacity in your Community? Identifying and recruiting coalition members Coalition Infrastructure Sustainability Community Readiness Community Awareness

Assessing the Situation Workforce Leadership Resources Culture

Assessing Capacity Community Readiness Community Resources Organizational Resources

Capacity Action Plans Capacity Plan for Coalition Membership Capacity Plan for Data Collection/Analysis Capacity Plan for Community Readiness

Community Readiness Conduct interviews to assess the problem Matching an intervention to a community’s level of readiness is absolutely essential for success. The Community Readiness Model offers tools to measure readiness and to develop stage- appropriate strategies

The Community Readiness Model Is a model for community change that integrates a community’s culture, resources, and level of readiness to more effectively address an issue. Increases community capacity for prevention and intervention Encourages and enhances community investment in an issue Readiness is the degree to which a community is prepared to take action on an issue.

Dimensions of Readiness Community Efforts Community Knowledge of the Efforts Leadership Community Climate Community Knowledge of the Issue Resources Related to the Issue

Stages of Readiness 1.No Awareness 2.Denial 3.Vague Awareness 4.Preplanning 5.Preparation 6.Initiation 7.Institutionalization/stabilization 8.Confirmation/expansion 9.Professionalization

Community Capacity Discussion Have you assessed the capacity of your community and coalition? What stage do you believe your community falls? Has anyone conducted a community readiness assessment? Community strengths, concerns, and resources Barriers?

Next Steps Developing Logic Model based on assessment results Determining Strategies Strategic Plan Implementation Plan

Wrap-up/ Questions