Strategic Prevention Framework State Incentive Grant Coordinator Training

History of the Strategic Prevention Framework Created by the Substance Abuse and Mental Health Services Administration (SAMHSA) Similar to other planning processes but somewhat different

Proven Effectiveness Cross-Site Evaluation at Results from SPF SIG Cohorts 1 and 2 SPF SIG Cohorts 3, 4, and 5 are currently providing data

SPF SIG Coordinator FAQ’s Contracts Subcontracts Military Involvement Iowa SPF SIG Website Due Dates One Step at a Time

Working With a Coalition or Collaboration Council Countywide Coalition Focuses on a variety of issues and projects Can utilize a subcommittee process Includes required sectors Includes military representative SPF SIG Coordinator does not lead

Working With a Coalition or Collaboration Council Collaboration Council Established due to no countywide coalition Not a coalition Provides direction to the county SPF SIG project Includes required sectors Includes military representative SPF SIG Coordinator does not lead

Budget Guidance Review Budget Guidance Document Funding environmental strategies No marketing/promotional materials No conferences/trainings outside what IDPH provides

Project Timeline Assessment and Capacity – June - August 2011 Planning – September – November 2011 Implementation and Evaluation – December 2011 – June 2014

Upcoming Dates Contractor Meetings: November 3, 2011 and April 2, 2012 Planning Regional Training: September 7 - Moravia September 8 – Sioux City September 27 - Dubuque September 29 – Cedar Rapids Register at

Implementation and Evaluation Regional Training: November 8 - Moravia November 10 – Sioux City November 14 - Dubuque November 17 – Cedar Rapids Upcoming Dates

Q & A Session

Assessment Profile population needs, resources, and readiness to address needs and gaps Evaluation Monitor, evaluate, sustain, and improve or replace those that fail Implementation Implement evidence-based prevention programs and activities Planning Develop a Comprehensive Strategic Plan Capacity Mobilize and/or build capacity to address needs The Process “Trust the Process”

Review – Assessment Key concepts How does it inform other steps – Capacity Key concepts How does it inform other steps

Step 1. Assessment

Module Overview Under the SPF, counties assess: Population needs Available resources Community readiness

Assessing Population Needs Looks at the patterns and effects of substance abuse in particular populations. Begins at the State level Based on State-level EPI data

Assessing Population Needs A State may identify one problem for all communities to address. Or, counties may choose from among several options. Either way, counties need to collect additional data.

Assessing Population Needs Why is local assessment critical? To change a problem locally, you must understand it. Only then can you identify the best way to solve it.

Assessing Population Needs Consequences Describe the effects of misuse Consumption Patterns Describe how people use or misuse substances

Assessing Population Needs ConsequencesConsumption Consequences and Consumption : Up Close and Personal Who uses alcohol? Where is it happening? What kinds of problems does underage drinking and binge drinking cause?

Assessing Population Needs X X X

Types of Data Quantitative Qualitative

Taking Stock See what the State has collected Look for existing survey data Collect new data

Setting Priorities

Magnitude Alcohol Oxycontin

Setting Priorities Changeability Alcohol Oxycontin

Setting Priorities Impact Oxycontin Alcohol

Setting Priorities Concentration Girls Boys

Setting Priorities Time Lapse Heroin Smoking

Assessing Risk & Protective Factors Each substance abuse problem has its own set of risk and protective factors. Factors driving a problem in one county may differ from factors driving it in another county.

Assessing Risk & Protective Factors Effective, prevention strategies must address the underlying factors driving a problem.

Assessing Resources What resources are available? Where are the gaps?

Assessing Resources Identified Needs Available Resources

Assessing Resources Resources include: Staff Financial support Sound organizational structure...

Assessing Resources Resources also include: County efforts to address prevention issues County awareness Practical experience Knowledge of local politics and policies

Assessing Community Readiness Community Readiness Willingness to engage in and support prevention efforts

Cultural Competence and Assessment Involving representatives across sectors Collecting information in appropriate ways Looking in your own backyard

Sustainability and Assessment Engage key stakeholders Track data sources Share assessment findings

Step 2. Building Capacity

What is Capacity? Capacity refers to: Types and levels of resources available to maintain a prevention system Readiness to commit resources to address prevention needs

What is Capacity? Capacity-building can include: Forming partnerships Strengthening county prevention systems Increasing county awareness

Cultural Competency and Capacity Broad cultural representation is key to sustaining prevention efforts in the long-term

Sustainability and Capacity Skills Required: Increase participation and membership Build leadership Enhance cultural competence Improve organizational management and development

Step 3. Planning

Planning Tasks Start with the problem and data Prioritize intervening variables Select evidence-based approaches

Planning Tasks Identify measurable outcomes Create an Action Plan and Logic Model Consider cultural competency and sustainability

Prioritizing Intervening Variables Change Intervening Variables Change Substance Abuse Problems

Prioritizing Intervening Variables Underage Drinking Retail Availability Social Availability Law Enforcement

Prioritizing Intervening Variables Changeability Do we have the capacity to change this intervening variable? Importance How important is this intervening variable in reducing the problem?

Selecting Strategies Federal registries Research or experts in the field (NIAAA, NIDA) Evidence-Based Practice Workgroup, a subcommittee of the SPF SIG Advisory Council

What is a Logic Model? Ensures that no step along the way will be overlooked Explains the work you are doing It is the approach Lets others know: Where you are going How you are getting there How you are measuring progress How you will know when you arrived

Logic Model Underlying Conditions (Why Here?) Intervening Variables State Identified Priority Problem 30-day past binge drinking Under 21 Social access & availability (of alcohol) Older friends procure alcohol for 11 th & 12 th graders Youth parties in remote areas (no police patrols) Low enforcement of alcohol laws Lack of enforcement of sanctions for serving minors Low enforcement of DUI laws

Action Plan Describes how the strategies will meet its objectives along with the action steps Delineates responsibilities for achieving the outcomes in your strategic plan Gives organization to the process Promotes accountability

Cultural Competence and Planning Engage various populations in the planning process Consider cultural perspectives when selecting evidence-based strategies Look at cultural perspective on intervening variables—how they may be viewed in different cultures

Sustainability and Planning Provides a Comprehensive Plan Helps build a strong coalition Focuses on population level change Attracts funders for future work

Step 4. Implementation

Overview of Implementation Action Plan Review Fidelity and adaptation Factors that influence implementation Cultural competence and sustainability

Implementing Your Action Plan

What you expect to accomplish Your approach Action steps People responsible for completing action steps Timeline

Planting Seeds for EBP Implementation Increase county awareness of problem Expand internal and external partnerships needed for EBP Introduce strategies to partners and key stakeholders

Fidelity refers to the degree to which a strategy is implemented. Strategies that are implemented with fidelity are most likely to achieve their expected outcomes. In other words, they are most likely to be effective. Fidelity

Adaptation Adaptation - How much, and in what ways, a program is changed to meet local circumstances

Guidelines for Adaptation Consult the experts Retain core components Adhere to evidence-based principles Select strategies with the best initial fit

Change capacity before changing strategy Be consistent with evidence-based principles Add, rather than subtract Guidelines for Adaptation

Barriers to Implementation Ongoing needs for training and information Lack of feedback Miscommunication How can we break through?

Breaking Down the Barriers Offer training and support Give meaningful tasks Keep people informed Clear communication Recognize coalition/ Collaboration Council members

Cultural Competence and Implementation Effective cultural adaptation is important to implementation

Sustainability and Implementation Good implementation involves the community What about sustainability?

Environmental Strategy Overview

What Are Environmental Strategies? Environmental Strategies reduce problems associated with the use of alcohol through changes in the physical, social, legal, and economic environment

Why Are They Effective? Once in place, many environmental strategies can have immediate effects on availability Policy changes do not depend on a constant influx of dollars to keep them going

Why Are They Effective? Changes in the legal, economic and social structures that affect substance use foster shifts in both individual attitudes and community norms Local people solve local problems best People support what they help create

“Holding young people solely responsible for underage drinking is like holding fish responsible for dying in a polluted stream.”

Additional Information The Evidence-Based Practices Workgroup Identified environmental strategies IDPH will fund the implementation of these strategies by SPF SIG counties The list of approved strategies will be provided to counties during the regional training

Step 5. Evaluation

Evaluation Measures the impact of the SPF and the implementation of strategies, programs, policies and practices

Evaluation Helps Counties Describe what they plan to do Monitor what they are doing Improve services Determine which efforts to sustain

Five Functions of Evaluation Improvement Coordination Accountability Celebration Sustainability

Measuring Population-Level Change Individual-Level vs. Population

Process and Outcome Process Evaluation Documenting strategy implementation Outcome Evaluation Documenting effects that you expect to achieve after the strategy is implemented

83 Process Evaluation How are resources allocated to various activities? To what extent was the strategy implemented as planned? What obstacles were encountered during strategy implementation?

If-Then Relationships Underlying a logic model is a series of ‘if-then’ relationships that express the program’s theory of change IF then If we implement the Talk It Up, Lock it Up Campaign … Parents awareness about underage drinking will increase If awareness increases then, then… Parents will communicate talk more Talk It up If parents communicate more with children, then… Messages about family expectations become clear If family messages are reinforced and parents take steps to reduce home access then… Middle school youth will have fewer opportunities to obtain alcohol at home If it becomes more difficult for youth to obtain alcohol, then… Overall access for middle school youth will go down If access goes down then… Use will go down IF then Sample: Watertown Talk It Up, Lock It Up Media Campaign If awareness increases then, then… Parents will reduce home access Lock it up

85 Outcome Evaluation Over the duration of the strategy, to what extent has: School attendance improved? Community-wide prevention awareness activities changed adult norms about substance use? Youth substance use decreased?

Evaluation vs. Monitoring Evaluation Assesses the effectiveness of the intervention External or independent analysis Monitoring Emphasis on data collection Analyzes performance

Cultural Competency and Evaluation Involve cultural groups in choosing appropriate evaluation methods Keep the county engaged after data has been collected by involving them in interpretation and dissemination of results

Sustainability and Evaluation Monitors progress and provides regular feedback Helps provide a system for continuous improvement Tracks county trends Provides a way for counties to share their stories and results with stakeholders

How successful was the county in selecting and implementing appropriate strategies? Were these the “right” strategies? Were stakeholders involved? Were new partners identified? What was the quality of the data? Evaluate the Entire Planning Process

Features of a SPF Evaluation Measures population change Measures change across multiple strategies and settings Evaluates the entire planning process Is collaborative