1. Impaired Driving Prevention: Focusing on Youth & Charting Progress in Reducing DUI
Rob Lillis
Evalumetrics Research
Lynne Gochenaur
LG Training and Consulting
Introductions.

2. Public Health Model Interactive Comprehensive
Cuts across issues/problems/disciplines
Epidemiology
Lynne

3. Public Health Approach
Surveillance
Risk Factors
(Root Causes)
Intervention &
Evaluation
Program
Implementation
Lynne

4. Haddon Matrix Environment Host Vector Physical Cultural Pre-event
Environment
Host
Vector
Physical
Cultural
Pre-event
Event
Post-event
Rob

5. Unified Framework Lett, Kobusingye and Sethi Injury Control and Safety Promotion. 2002, Vol. 9, No. 3, pp. 199–205
Rob

6. Fear Arousal Model
Based on the idea that showing the negative consequences of behavior will motivate and change behavior of the audience.
Even when you do motivate someone by fear or arousal you need to give them a solution.
Early cancer prevention programs showed diseased lungs but failed to give the ways prevent lung cancer
Deterrence has been the dominate model in impaired driving.
What solutions are offered?
Designated Driver/Safe Ride
Limited effectiveness and serious unintended consequences
Rob

7. RISK AND PROTECTIVE FRAMEWORK
Risk Factors – Predict greater prevalence of problems
Protective Factors – Predict lower prevalence of problems
Lynne - They are the aspects of a person (or group) and environment or personal experience that make it more likely (risk factors) or less likely (protective factors) that people will experience a given problem or achieve a desired outcome. For example, if a person smokes, that is a risk factor for having a heart attack. If he walks two miles a day, that's a protective factor against that same heart attack.
Risk and protective factors are key to figuring out how to address community health and development issues. It's a matter of taking a step back from the problem, looking at the behaviors and conditions that originally caused it, and then figuring out how to change those conditions.
Not all risk factors can be measured by a survey. E.g. Poverty

8. RISK AND PROTECTIVE FRAMEWORK
Domains :
Family
School
Community
Peer/Individual
Lynne - Family Domain:
Maltreatment and abuse
Exposure to repeated family violence
Participation in shared activities between youth and family
The presence of a positive adult (ally) in the family
School:
Poor academic performance
Low commitment to school
Schools that provide a safe environment
Commitment to school
Community:
Living in an impoverished neighborhood
High crime neighborhoods
A community/neighborhood that fosters healthy activities for youth
Peer/Individual:
Poor cognitive development
Early antisocial behavior
High IQ
Positive social skills

9. To practice effective prevention, practitioners need to:
Plan rather than chase the shiny object.
Apply SAMHSA’s Strategic Prevention Framework (SPF), a five step planning framework designed to help communities more effectively understand and deliver prevention practices.
Rob – Strategic Planning

10. Data - driven
Practicing effective prevention means gathering and using data to guide all prevention
Primary – e.g. surveys
Archival – e.g. arrests, injuries
Anecdotal – e.g. focus groups, key informants
Rob

11. Data - driven
It also means understanding and applying prevention research so that prevention efforts are informed by best practice –
Effective
Efficient
Efficacious
Rob

12. Comprehensive Community Approach
It means working with diverse community partners to plan and deliver culturally appropriate, effective, and sustainable prevention practices that are a good fit for the populations being served.

13. Logic Model Problem (What?) Root Cause (Why?) Local Cause (Why here?)
Action Plan
Lynne

14. Logic Model Why? Root Causes What? (Prevalence) Why Here?
(Weighted factors)
What? (Prevalence)
Why Here?
Local factors
Implementation
Evaluation
Underage Impaired Driving
Antisocial Behavior
Attitudes Favor Drug Use
Friends Use Drugs
Workgroup
Input
Develop Action Plan
Evaluation
Lynne – Introduce concept of root cause

15. Root Cause Evalumetrics Youth Survey - 2015 Proportion at risk
Proportion who drove after drinking in past 30 days
Ratio
Students with Driver License
2015
not at risk
at risk
Friend Use Drugs (R21-PI)
14.2%
13.8%
59.2%
4.28
Favorable Attitudes Toward Drug Use (R19-PI)
13.4%
57.4%
4.15
Antisocial Behavior (R17-PI)
8.9%
15.0%
61.7%
4.11
Interaction With Antisocial Peers (R20-PI)
12.4%
15.2%
56.9%
3.74
Rob will expound

16. Prevention Stratigies
Population-wide influence
System/culture change
Environmental
Host resiliency
Inoculation
Individual
Lynne -Environmental:
Grounded in he field of public health
Emphasizes the broader physical, social and cultural forces that contribute to substance abuse problems.
The goal is to change the context (environment) in which a problem occurs.
Individual:
Based on the premise that substance abuse develops because of deficits in knowledge, inadequate skill development and lack of positive attitudes toward self, family/peer and future.

17. Evidenced based/Individual: LifeSkills Training
Universal strategy utilized in schools and community-based settings
Research-validated substance abuse and violence prevention program
Promotes healthy alternatives to risky behavior
Provides enhancement of cognitive and behavioral skills
The LST program produced a $50 benefit for every $1 invested
Lynne - Universal strategy utilized in schools and community-based settings
Research-validated substance abuse prevention program proven to reduce the risks of alcohol, tobacco, drug abuse, and violence by targeting the major social and psychological factors that promote the initiation of substance use and other risky behaviors.
Promotes healthy alternatives to risky behavior
Provides enhancement of cognitive and behavioral competency to reduce and prevent a variety of health risk behaviors
According to economic studies conducted by the Washington State Institute for Public Policy (WSIPP) researchers found that the LST program produced a $50 benefit for every $1 invested--yielding the highest return on investment of any substance abuse prevention curriculum studied.

18. Delivering a program with fidelity means….
Faithful replication of proven prevention strategies to deliver a given program the way it was intended to be delivered - otherwise known as implementation fidelity.
When communities "tweak" a program to suit their own preferences or circumstances, they wind up with a different program whose effectiveness is unknown.
Evidence-based programs have produced better outcomes when implemented with fidelity.
Make sure arousal activities are consistent with the objectives of the lessons in the EB programs.
Lynne - minimize

19. To practice effective prevention, practitioners need to:
Understand substance misuse prevention within the larger context of behavioral health.
Prevention plays a crucial role in addressing mental and/or substance use disorders. These disorders can have an enormous impact on behavioral health, which includes a person’s state of mental or emotional being and the choices and actions he or she makes that affect his or her wellness.
Rob

20. Evalumetrics Youth Survey - 2015
Common Root Cause
Root Causes of Problem Behavior
Proportion at risk
Drove after drinking
Underage Drinking
Bully Others
Suicide Ideation
Self-Injury
Evalumetrics Youth Survey
Ratio
Friend Use Drugs (R21-PI)
14.2%
4.28
2.67
2.37
2.58
1.98
Favorable Attitudes Toward Drug Use (R19-PI)
13.4%
4.15
2.41
2.48
3.58
2.30
Antisocial Behavior (R17-PI)
8.9%
4.11
1.80
1.85
2.15
1.54
Rob -

21. Align Prevention Activities
Mock Crash – Arouse fear and sympathy
Strategy could be aligned with (scheduled) to interact with LST lesson to teach assertiveness
Rob

22. Align Prevention Activity: Mock Crash
Evidence-Based Prevention Programs
Skills
Risk & Protective Factor Focus
Lessons
LifeSkills Training
Decision Analysis & Coping Skills
Antisocial Behavior
Decision making
Coping with Anxiety
Positive Family Support
Positive Peer Development
Coping Skills
Healthy Decisions
Friends Use Drugs
Second Step
Assertiveness
Disagreeing Respectfully
Staying in Control
Lynne

23. Align Prevention Activities
Fatal Vision Goggle
Align with physiology/impairment
Rob

24. Align Prevention Activity: Fatal Vision Goggles
Evidence-Based Prevention Programs
Skills/Information
Risk & Protective Factor Focus
Lessons
LifeSkills Training
Analyzing data
Checking assumptions
Considering pros/cons.
Separating fact and fiction
Favorable Attitudes Toward Drug Use
Smoking Myths & Realities
Marijuana Myths & Realities
Alcohol Myths & Realities
Drug Abuse: Causes & Effects
Second Step
Facts About Brain & Body
Substance Abuse Impact on Lives
Myths & Facts

25. Align Prevention Activities
Outside Speakers: Drinking Driver or victim
Align with physiology/impairment
Rob

26. Align Prevention Activity: Outside Speakers: DD or Victim
Evidence-Based Prevention Programs
Skills/Information
Risk & Protective Factor Focus
Lessons
LifeSkills Training
Analyzing data
Checking assumptions
Considering pros/cons.
Separating fact and fiction
Favorable Attitudes Toward Drug Use
Smoking Myths & Realities
Marijuana Myths & Realities
Alcohol Myths & Realities
Drug Abuse: Causes & Effects
Second Step
Facts About Brain & Body
Substance Abuse Impact on Lives
Myths & Facts

27. Challenges
Bureaucratic structure at the state level is an impediment to this concept of weaving of these two strategies.
Old habits are hard to break - DARE
Rob

28. Move Toward Collaboration
Coexist – No interaction. Communicate – Talk about the process with PPAC Cooperate – Have worked together on events and shared data, worked in a group process. Coordinate – Used data or planning results for joint planning for all organizations. Collaborate – Integrated strategic planning into all organizations’ planning – they are one and the same.
Rob

29. What Have You Learned Dorothy?