Indiana Strategic Prevention Framework March 20, 2008 Sheila Nesbitt Chuck Klevgaard Kathy Asper

22 When thinking about SPF, do you ever feel like this….?

3 Maybe you fear being put on the spot? Or this…..?

4

5 My life broken down into segments Or this…..?

6 Or maybe this…..?

77 Expectations What are three things you’re hoping will happen today (a topic/issue you want to learn more about, someone you want to network with, a question you absolutely have to have answered, etc.)?

8 Overview of Day Provide guidance on selecting strategies Walk through one example together Small groups walk through additional examples Discussion of next steps and additional needs

9 Determining Fit

10 A “Good Conceptual Fit” intervention should: Fit into community logic model (alignment) Drive positive outcomes in identified substance abuse problems (reach) Address the community’s intervening variables Be founded on evidence-based principles for target population Target multiple opportunities for intervention (sufficient mix) Conceptual Fit Community

11 Condition Mediating / Moderating Variable Consequence Consumption Patterns Strategies Programs, Policies, and Practices Conceptual Fit Screening for Alignment Underage Drinking In preventing and reducing underage drinking and binge drinking, there will be a reduction in arrest rates for driving under the influence, public intoxication and liquor law violations. Retail Availability of Alcohol to Youth Administer Alcohol Compliance Checks The community logic model can be used to check the alignment of interventions Retail Availability of Alcohol to Youth Implement a Friday Night Basketball Program

12 Condition Mediating / Moderating Variable Consequence Consumption Patterns Strategies Programs, Policies, and Practices Conceptual Fit Screening for Reach Underage Drinking In preventing and reducing underage drinking and binge drinking, there will be a reduction in arrest rates for driving under the influence, public intoxication and liquor law violations. Social Availability of Alcohol to Youth Implement Shoulder Taps With 6 of 47 Package Stores Once a Year The logic can also screen for strategies / interventions that may not have sufficient reach to create community level change Social Availability of Alcohol to Youth Implement Shoulder Taps With 40 of 47 Package Stores Once a Year

13 Developing a Comprehensive Approach Sufficient Mix Use multiple interconnected strategies in order to reach community level change Multiple strategies will complement and reinforce each other Consider number of people impacted in each strategy

14 Practical Fit Community Feasible given a community’s resources, capacities, and readiness to act Add to or reinforce prevention strategies in the community - synergism and layering Consider community climate Meet cultural needs of target population Sustainable in community Evaluability

15 Existing Programs Intervening Variable Limitations Practical Fit Synergy and Layering Low enforcement of alcohol laws College Campus Alcohol Awareness Program Environmental approach doesn’t target y/o Practical fit is assessed through a series of utility and feasibility checks that grow out of the needs/resource assessment and capacity-building activities conducted in SPF Steps 1 and 2 Expand current environmental approach to high schools Possible Additions

16 Resource Mechanism for Evidence-Based Intervention (cont’d.) Guidelines for Documenting Effectiveness: 1. Based in solid theory validated by research; 2. Supported by a documented body of knowledge generated from similar or related effective intervention; and 3. Judged by informed experts to be effective.

17 Resource Mechanism for Evidence-Based Intervention Included on federal lists or registries of evidence-based interventions; Reported (with positive effects) in peer-reviewed journals; and Documented evidence of effectiveness based on guidelines developed by SAMHSA/CSAP

18 Evidence-Based Interventions Strength of Evidence The strength of evidence of a tested intervention will fall somewhere along a continuum from weak to strong The strength of evidence is assessed using scientific standards and criteria for applying these standards

19 Strength of Evidence Components Rigor of the study Rigor and appropriateness of the methods used to collect and analyze the data The extent to which a finding can be generalized to similar populations and similar settings.

20 Indiana Gap Analysis Tool

21 Summary of Things to Consider Conceptual fit Practical fit Evidence of Effectiveness Comprehensive approach Reach

Conditions: mediating, moderating, intervening variables Chuck Klevgaard Kathy Asper

24 Strong evidence of relationship and strong evidence of population level prevention effects and or strong effect on other intermediate variables which have population level prevention effects. Figure 1-- Legend: Strength of (a) Evidence of relationship to underage drinking and (b) Evidence of Population-Level Effect on Underage Drinking, Alcohol-related Problems or Other Key Intermediate Variables Resulting from Prevention Interventions Strong evidence of relationship and moderate evidence of population level prevention effects or moderate evidence of effect on key intermediate variables which have population level effects Strong evidence of relationship but only limited or no evidence of population level prevention effects but evidence of target group effects. Theoretical but no empirical evidence of relationship and therefore no evidence of population level or target group prevention effects

25 Strategy Selection Out of two interventions, the one for which there is stronger evidence of effectiveness should be chosen, if the intervention is similar, equivalent, and equally well-matched to the community’s unique circumstances. Reserve selecting an intervention with little or weak evidence of effectiveness for situations in which other interventions with stronger evidence do not fit local circumstances.

26 Underage Drinking Outcome In preventing and reducing underage drinking and binge drinking, there will be a reduction in arrest rates for driving under the influence, public intoxication and liquor law violations.

StrategyConditionsconsumption Condition: Retail availability Definition: Ease of accessing alcohol through on- premise (bars, restaurants) and off-premise (liquor, convenience, grocery stores). Can refer to the presence and density of alcohol outlets and the frequency of use of specific commercial sources of alcohol by youth. Retailer compliance with laws: ability of underage persons to purchase or consume, service to obviously intoxicated. Sources of alcohol: actual sources of alcohol as reported by young persons. Hours and days of sale Outlet density How have you assessed retail availability in your community?

Strategy Intervening Variable Policy, Program, Practice Alcohol Compliance Checks Rationale: Law enforcement confirmation of whether outlets sell to underage person and sanctions for illegal sales reduce likelihood of sales Objective: Reduce illegal sales of alcohol to person under 21 years of age. Allow local control and sanctions against retailers that sell to underage persons. Increase retailer expectation that illegal sales will result in consequences.

Strategy Intervening Variable Compliance Checks: Conceptual fit? Fit into community logic model? Do compliance checks address the conditions: mediating and moderating variables? Drive positive outcomes in identified problems? Does this strategy impact the identified consequence: reduction in arrest rates for driving under the influence, public intoxication and liquor law violations Will this strategy have sufficient reach to move the needle in the community? # licensees x 2 checks (minimum), plus rechecks on failures within 90 days (Wagenaar, 2000)

Strategy Intervening Variable Compliance Checks: Conceptual fit? Comprehensive Approaches (mix) Add to or reinforce a strategy in the community? Target multiple opportunities for intervention?

Strategy Intervening Variable Compliance Checks: Practical Fit ? Feasible given a community’s resources, capacities, and readiness to act? -What would the process be for establishing this approach? -What tasks would need to be accomplished leading to implementation? Fidelity Can you implement in the manner it was designed? Is there support (Training, TA, materials) for implementation? (PIRE and U of Minnesota implementation guides) Consider community climate Does the approach account for readiness? Does the approach meet cultural needs?

Strategy Intervening Variable Compliance Checks: Practical Fit? Sustainability Does the community have resources to sustain this initiative?

Strategy Intervening Variable Compliance Checks: Effectiveness? Evidence-based principles for target population Is the approach research-based on a well defined theory or model? Is there documented evidence of effectiveness (such as formal evaluation results)? Have the results been replicated successfully by different researchers over time? Has the approach been shown to be effective for areas similar to those you will address?

34 Small Group Discussions After lunch, reconvene in small groups.

35 Large Group Discussion

Balancing Art and Science Research, tools, and checklists will only get you so far. At some (hopefully many!) points, you need to see how the big picture is coming together.

HighLow Sufficient Highest Priority? Less Priority? Limited High Priority? Lowest Priority? Conceptual Fit (Logic model, conditions, alignment, and reach ) Practical and Fit (community resources readiness) Decision Matrix - Art and Science

Strategy Intervening Variable We hope that now you feel less like this... Yikes!

39 And more like this…. Ahhhhh!

Strategy Intervening Variable 40 Thank YOU for your kind attention. We hope to see you again sometime! Please complete the evaluation.

41 Thank You!! For questions, comments Sheila Nesbitt CSAP’s Central CAPT x128