The Community Youth Development Study: Testing Communities That Care 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

The Community Youth Development Study: Project Staff J. David Hawkins, Ph.D. Principal Investigator Richard F. Catalano, Ph.D. Co-Investigator Michael W. Arthur, Ph.D. Co-Investigator Kevin Haggerty, MSW Co-Investigator Rose Quinby, MSW Project Director Barb McMorris, Ph.D. NL Project Director Abby Fagan, Ph.D. Intervention Specialist Blair Brooke-Weiss, MPH Intervention Specialist Rick Cady Intervention Specialist Robert Abbott, Ph.D. Statistical Consultant David Murray, Ph.D. Statistical Consultant Eric Brown, Ph.D. Research Analyst Beth Egan, Ph.D. Research Analyst John Briney Data Manager Koren Hanson, M.A. Data Manager Renee Petrie Data Operations Unit Director

Out of 12 community based coalitions, how many produced positive outcome of reduced youth substance use? 0 Berkowitz, 2001; Halfors, 2002

What works? Findings on Coalition Effectiveness Hallfors et al., made these recommendations : 1. Clearly defined, focused and manageable goals & outcomes based on high quality data sources. 2. Evidence based programs should be encouraged with careful attention to dose and quality. 3. Evaluation of impact needed. Select outcomes & goals meaningful to community.

The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate

The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Community readiness assessment. Identification of key individuals, stakeholders, and organizations.

The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Training key leaders and board in CTC Building the community coalition.

The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Collect risk/protective factor and outcome data. Construct a community profile from the data.

The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Define outcomes. Prioritize risk factors to be targeted. Select tested, effective interventions. Create action plan. Develop evaluation plan.

The Communities That Care Operating System Creating Communities That Care Get Started Get Organized Develop a Profile Create a Plan Implement and Evaluate Form task forces. Identify and train implementers. Sustain collaborative relationships. Evaluate processes and outcomes. Adjust programming.

The Community Youth Development Study (CYDS)  A randomized controlled trial to test the effects of the Communities that Care system.

CYDS Primary Aim  To test the effectiveness of the Communities That Care (CTC) system in reducing levels of risk, increasing levels of protection, and reducing health and behavior problems in early adolescence.

Study Design Randomize 5-Year Baseline Randomized Controlled Trial ‘00 ‘01 ‘02 SS CKI CRD CKI CRD Control Intervention SS CKI CRD CKI CRD CKI CRD CKI CRD Panel PlanningImplement selected interventionsEvaluate SS Panel CTC Board CTC Board CTC Board CTC Board CTC Board Panel

Demographics of 24 Study Communities from 7 States MeanMinimumMaximum Total Population14,6161,57840,787 Percent Caucasian89.4%64.0%98.2% Percent Hispanic Origin Percent African-Amer. Percent Eligible for Free/Reduced Lunch 9.6% 2.6% 36.5% 0.5% 0.0% 20.6% 64.7% 21.4% 65.9%

10 th Grade Drug Use Prevalence in CYDS and Monitoring The Future 2002 CYDSMTF 30-Day Cigarette Day Alcohol Binge Drinking Day Marijuana

CTC Implementation 1. Training: Six events in each community with refresher trainings as needed 2. Coordinators: One full time in each community 3. CTC Manuals: For each phase training; Milestones & Benchmarks are included. 4. Technical Assistance – SDRG intervention specialist weekly calls to 5. Resources - To implement selected tested, effective programs --$75,000 per for each community selected tested, effective programs --$75,000 per for each community

CYDS Progress: What are interim signs of success? 1. High fidelity implementation a. The CTC system b. Prevention programs that are proven to work 2. Results from participant evaluations moving in the expected direction 3. Fair to good exposure to programs (Goal: involve a substantial proportion of target populations so we’ll see community-wide effects)

CYDS Progress: What are interim signs of success? 1. High fidelity implementation a. The CTC system b. Prevention programs that are proven to work 2. Results from participant evaluations moving in the expected direction 3. Fair to good exposure to programs (Goal: involve a substantial proportion of target populations so we’ll see community-wide effects)

Implementation Fidelity  What is ‘implementation fidelity’? Replicating programs with integrity to their core components and theoretical framework. Replicating programs with integrity to their core components and theoretical framework.  Why is it important? Verifies that the selected program is, in fact, being implemented Verifies that the selected program is, in fact, being implemented Increases the likelihood of achieving the results found in the original evaluations. Increases the likelihood of achieving the results found in the original evaluations.

Implementing CTC with Fidelity Assessed as the proportion of achieved CTC Milestones and Benchmarks (goals, steps, actions, and conditions) Phase 1: Getting Started  Milestone: The community is ready to begin CTC Benchmark: A Key Leader “Champion” has been identified to guide the CTC process Benchmark: A Key Leader “Champion” has been identified to guide the CTC process Phase 2: Getting Organized  Milestone: Key Leaders have been engaged Benchmark: A Key Leader Orientation has been held Benchmark: A Key Leader Orientation has been held

CTC Implementation Fidelity Conclusion: CTC implementation during the first 18 months of CYDS was very high Phase % of Milestones Completed Across Communities & Raters 1—Getting Started 91.5% 2—Organizing, Introducing, Involving. 99% 3—Developing a community profile 100% 4—Creating a community Action Plan 98.5%

Community ratings on four most difficult (challenging) milestones

Community Board Interview  What is it? – A yearly interview with a sample of Board members.  Main goal of 2005 interview: to learn more about internal operation and efficiency of the Board--  Your Board development plan is based in part on this data.

CTC Community Boards Average Score on 1-4 Scale CTC Board Functioning Board DirectednessBoard CohesionBoard EfficiencyBoard Conflict Resolution Community Y 2004Community Y 2005All 12 Communities 2005

CTC Community Boards Average Score on 1-4 Scale Level of Community Involvement in CTC

Perceived Impact of CTC in the Community Community X compared to all 12 communities (shown by the dot)

Perceived Barriers to CTC Implementation

CYDS Progress: What are interim signs of success? 1. High fidelity implementation a. The CTC system b. Prevention programs that are proven to work 2. Results from participant evaluations moving in the expected direction 3. Fair to good exposure to programs (Goal: involve a substantial proportion of target populations so we’ll see community-wide effects)

Programs Implemented July 2004 – June 2005 PROGRAM PROGRAMCOMMUNITYCYCLES All Stars Core All Stars Core11 Life Skills Training Life Skills Training25 Lion’s-Quest Skills for Adolescence Lion’s-Quest Skills for Adolescence22 Program Development Evaluation Training Program Development Evaluation Training11 Participate and Learn Skills (PALS) Participate and Learn Skills (PALS)13 Big Brothers/Big Sisters Big Brothers/Big Sisters22 Stay SMART Stay SMART39 Tutoring Tutoring311 Valued Youth Tutoring Program Valued Youth Tutoring Program13 Strengthening Families Strengthening Families Guiding Good Choices Guiding Good Choices638 Parents Who Care Parents Who Care13 Family Matters Family Matters12

We Know Guiding Good Choices® works! Research trials have shown that Guiding Good Choices:  reduces alcohol and marijuana use by 40.6%  reduces progression to more serious substance abuse by 54%  increases the likelihood that non-users will remain drug-free by 26%  reduces depression symptoms by 28% And it’s cost effective!  For every dollar spent on GGC, $11.07 is saved in preventable costs associated with youth substance use and delinquency (Washington State Institute for Public Policy, 2004,

Implementation Fidelity Checks  Obtained/created monitoring tools  Trained all program implementers  Required program implementers to complete fidelity checklists  Generated progress reports for communities

CYDS Program Fidelity Results July 2004 – June 2005 ADHERENCE: extent to which the programs’ critical elements and content are delivered  90% adherence rate across all programs and communities  Some modifications were reported, most often deleting parts of sessions or program activities  Common challenges included lack of time and participant misbehavior

Adherence Rates July 2004 – June 2005

CYDS Program Fidelity Results July 2004 – June 2005 DOSAGE: extent to which the required number, length, and frequency of sessions were taught  91% dosage rate across all programs and communities  Full dosage was achieved in 78% of all replications (74 of 95 cycles)  Deviations in dosage were generally minor ~ e.g., 30 vs. 45-minute sessions ~ e.g., deleting 1 of 12 required sessions

Dosage Rates July 2004 – June 2005 Percentage of program cycles achieving dosage requirements

CYDS Progress: What are interim signs of success? 1. High fidelity implementation a. The CTC system b. Prevention programs that are proven to work 2. Results from participant evaluations moving in the expected direction 3. Fair to good exposure to programs (Goal: involve a substantial proportion of target populations so we’ll see community-wide effects)

Participant Survey Results Selected Parent Survey Results (n=47) from GGC in Community C All questions on scale of 1 (strongly disagree) to 7 (strongly agree) ItemPre-survey Mean Score Post-survey Change Children who are bonded to their families are less likely to use drugs * Children should be involved in deciding what the family rules will be * Part of learning to say “no” to drugs is to suggest something different to do with friends * It’s important for family members to practice new skills together even if it makes them uncomfortable at first * * Indicates statistically significant change (p<.05) from pre-survey to post-survey

CYDS Progress: What are interim signs of success? 1. High fidelity implementation a. The CTC system b. Prevention programs that are proven to work 2. Results from participant evaluations moving in the expected direction 3. Fair to good exposure to programs (Goal: involve a substantial proportion of target populations so we’ll see community-wide effects)

Participant Attendance and Retention in the CYDS July 2004 – June 2005 Program Type Total N Served % of Target Population % Attending Majority of Sessions + School Curricula (75-100)% 96% After-school * (7-98)% 77% Parent Training (3-28)% 79% + Attending at least 60% of the total number of sessions * Includes PALS, BBBS, Stay SMART, and Tutoring programs

Parent Training Programs Percent of Recruitment Goal Reached % of target pop Strengthening Families Guiding Good ChoicesPWC Family Matters

Summary of Results  13 different prevention programs implemented in 12 communities  Strong implementation fidelity  Preliminary evidence of desired effects on participants  Stronger growth in collaboration in CTC communities  Modest and growing exposure to the programs

Where are we now?— Update  All twelve CTC communities have completed the CTC planning process and developed community action plans.  All twelve CTC communities will are in the second year of implementing tested, effective programs ( ).  2006 student surveys will be conducted.  2006 CTC Board surveys will be conducted.  2007 interviews with community members are complete.

Preventing Adolescent Cannabis Use in the Netherlands and the U.S.: A Binational Investigation of the Communities That Care Prevention System J. David Hawkins, Ph.D.J.C.J. Boutellier, Ph.D. University of WashingtonVerwey-Jonker Institute Funded by ZonMw and NIDA

Drug Policy Orientation U.S. goal: Use reduction Abstinence messages, any use is abuse Abstinence messages, any use is abuse Zero-tolerance Zero-tolerance The Netherlands goal: Harm reduction - Combination of abstinence and harm reduction messages - Accepts normative experimentation as a reality - Distinguishes between soft and hard drugs, and possession/use vs. dealing/production

Aims of the Binational Collaboration 1. To compare the prevalence and predictors of cannabis use and illicit drug use across samples of young people from the U.S. and the Netherlands: a. Are there differences in prevalence rates from self reports on equivalent instruments? b. Are relationships between risk/protective factors and cannabis the same?

Aims of the Binational Collaboration 2. To examine the implementation and effectiveness of the CTC approach across two nations with different policies and cultures: a. What are unique and common barriers to the use of the CTC strategy? What is sensitive to context?

United States Drug Use Rates age (n = 4,997) (n = 4,585) Alcohol -Ever use 64.3%64.6% -Past month use -Past month use38.0%39.2% Cigarettes -Ever smoke 48.5%43.2% -Past month smoke 20.7%17.6% Ecstasy -Ever use 9.2%5.5% -Past month use -Past month use5.4%2.2% “Hard drugs” -Ever use 10.9%9.3% -Past month use -Past month use6.3%4.1% Comparing Student Drug Use The Netherlands age (n = 4,768) 86.8% 70.9% 54.1% 27.8% 3.3% 1.7% 3.0% 1.6%

United States Cannabis Use Rates age (n = 4,997) (n = 4,585) Marijuana -Ever use 39.6%36.7% -Past month use -Past month use21.5%19.3% Frequency of marijuana use in the past month 0 times 78.5%80.7% 1-2 times 6.6%7.5% 3-5 times 3.1%3.3% 6-9 times 2.6%2.3% 10 or more times 9.2%6.2% Comparing Student Drug Use The Netherlands age (n = 4,768) 28.4% 15.4% 84.6% 7.6% 2.7% 1.0% 4.1%