1. Substance Abuse and Behavioral Health - Shared Risk Factors/Shared Prevention: Call for Collaboration Rob Lillis, Evalumetrics Research Lynne Gochenaur, LG Consulting & Training and Kim Strauser, Allegany Council on Alcoholism and Substance Abuse
Rob

2. Public Health Model Interactive Comprehensive
Cuts across issues/problems/disciplines
Epidemiology
Lynne
The PHM addresses health or social problems in a comprehensive way. It considers human factors, characteristics of the source of harm and the environment identifying causes & potential ways to intervene.

3. Public Health Approach
Surveillance
Risk Factors
(Root Causes)
Intervention
Program
Implementation & Evaluation
Lynne
PHM starts with surveillance through data collection…..from there
Identify causes of risk factors
Develop & test interventions
Implement interventions & measure prevention effectiveness

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

5. Logic Model Problem (What?) Root Cause (Why?) Local Cause (Why here?)
Action Plan
Rob

6. Logic Model Why? Root Causes What? (Prevalence) Why Here?
(Weighted factors)
What?
(Prevalence)
Why Here?
Local factors
Implementation
Evaluation
Bullying
Favorable Attitudes Toward Antisocial Behavior
Friends Use Drugs
Lack Belief in Moral Order
Workgroup
Input
Develop Action Plan
Evaluation
Rob

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

8. Bullied Other Student One or More Time Past 30 Days Proportion at risk
Proportion who bullied another student in past 30 days
Evalumetrics Youth Survey
2015
not at risk
at risk
Ratio
Favorable Attitudes Toward Antisocial Beh (R18-PI)
13.9%
27.4%
67.9%
2.48
Friend Use Drugs (R21-PI)
14.2%
28.2%
67.0%
2.37
Lack Belief in Moral Order (P11-PI)
7.5%
30.6%
72.1%
2.36
Interaction With Antisocial Peers (R20-PI)
12.4%
28.7%
65.8%
2.29
Favorable Attitudes Toward Drug Use (R19-PI)
13.4%
28.6%
65.5%
Sensation Seeking (R22-PI)
29.9%
24.0%
54.8%
2.28
Rebelliousness (R14-PI)
17.2%
27.0%
61.4%
2.27
Impulsiveness (R16-PI)
16.2%
27.2%
61.8%
Personal Transitions/Mobility (R3-C)
24.5%
53.6%
2.24
Parental Attitudes Favorable to Drug Use (R10-F)
14.7%
60.7%
2.11
Parental Attitudes Favorable to Antisocial Beh (R11-F)
10.9%
29.6%
2.09
Rewards for Antisocial Involvement (R23-PI)
12.2%
29.3%
60.5%
2.07

9. Predictors of Underage Drinking Proportion at risk
Proportion that drank alcohol in the past 30 days.
Evalumetrics Youth Survey
2015
Not at Risk
At Risk
Ratio
Friend Use Drugs (R21-PI)
14.2%
17.2%
46.0%
2.67
Lack of Supervision and Rules (R6-F)
7.5%
18.6%
2.49
Sensation Seeking (R22-PI)
29.9%
14.3%
34.8%
2.44
Favorable Attitudes Toward Drug Use (R19-PI)
13.4%
17.4%
42.0%
2.41
Perceived Risks of Drug Use (P8-PI)
19.6%
16.9%
38.4%
2.28
Parental Attitudes Favorable to Drug Use (R10-F)
14.7%
17.5%
35.1%
2.01
Laws and Norms Favorable to Drug Use (R4-C)
18.1%
24.7%
47.8%
1.94
Favorable Attitudes Toward Antisocial Beh (R18-PI)
13.9%
18.4%
35.2%
1.92
Rebelliousness (R14-PI)
32.6%
1.81
Antisocial Behavior (R17-PI)
8.9%
19.1%
34.5%
1.80

10. Suicide Ideation (Made Plan in Past Year)
Proportion at risk
Made plan for suicide
Evalumetrics Youth Survey
2015
not at risk
at risk
Ratio
Favorable Attitudes Toward Drug Use (R19-PI)
13.4%
10.9%
38.9%
3.58
Rewards for Prosocial Involvement (P5-F)
20.4%
11.8%
35.3%
3.00
Opportunities for Prosocial Involvement (P4-F)
17.3%
12.5%
36.4%
2.92
Attachment (P3-F)
18.1%
12.7%
34.7%
2.74
Interaction with Antisocial Peers (R20-PI)
12.4%
14.0%
37.9%
2.72
Parental Attitudes Favorable to Antisocial Beh (R11-F)
14.3%
36.3%
2.54
Friend Use Drugs (R21-PI)
14.2%
14.1%
35.5%
2.51
Rewards for Antisocial Involvement (R23-PI)
12.2%
35.6%
2.49
Favorable Attitudes Toward Antisocial Beh (R18-PI)
13.9%
34.6%
2.46
Lack of Supervision and Rules (R6-F)
17.2%
13.3%
32.6%
2.44
Rewards for Prosocial Involvement (P7-S)
14.5%
35.1%
2.42

11. Priority Factors Across Problem Areas
Evalumetrics Youth Survey
Summary Score
Sensation Seeking (R22-PI)
8.63
Favorable Attitudes Toward Drug Use (R19-PI)
5.95
Friend Use Drugs (R21-PI)
5.75
Perceived Risks of Drug Use (P8-PI)
5.50
Rewards for Prosocial Involvement in the Family (P5-F)
4.54
Personal Transitions/Mobility (R3-C)
4.46
Rebelliousness (R14-PI)
4.09
Low Neighborhood Attachment (R1-C)
4.07
Little Commitment to School (R13-S)
3.98
Favorable Attitudes Toward Antisocial Behavior (R18-PI)
3.87
Parental Attitudes Favorable to Drug Use (R10-F)
3.84
Lack of Supervision and Rules in the Family(R6-F)

12. How Do You Get More Bang for Your Buck?? Activity I
In small groups, discuss your assigned factor and document:
What available activities/programs address your assigned factor:
Directly?
Indirectly?
None/Little?
Lynne

13. How Do You Get More Bang for Your Buck
How Do You Get More Bang for Your Buck?? Activity I Example Risk Factor: Rebelliousness
Directly: -MST - Functional Family Therapy - Positive Action
Indirect:
- Family/Parent Training
- 21st Century
Little/None:
- Compliance checks
- Party Patrols
Lynne

14. Cost of Environmental Strategies$
Time
Training
Political chits
Materials
Maintenance
Rob

15. Cost of Individual Strategies$
Time
Training
Political chits
Materials
Maintenance
Lynne

16. Direct Impact of addressing a specific root cause: Environmental Strategies
1. Some direct impact
Difficult to measure
2. Not likely to impact the hard-core who are disproportionately involved
By missing the minority of the population you miss the majority of the problem
3. But…keeps the majority from entering the risk pool
Rob

17. Environmental Strategy Example: Deterrence
3 Components of Deterrence: - Certainty - Speed - Severity
Rob

18. Environmental Strategy Example: School Climate Change: Olweus Bullying Prevention Program
Introduction of schoolwide rules against bullying
Embed bullying prevention language in school district policies procedures for staff & students
Refinement of school’s supervisory & discipline system
Establishes core principles of bullying prevention through both environmental and individual strategies including:
Lynne
Develop partnerships with local community groups
Weekly class meetings with students to build resiliency through discussion on bullying behavior

19. Direct impact of addressing a specific root cause: Evidence-based/Individual
1. Most direct impact
Better able to measure impact
2. More likely to impact the hard-core who are disproportionately involved
3. Increase in dose increases impact
“one shot” programs have limited impact
Lynne
Measuring impact – help rob!
Evidenced-based interventions target biological, psychological and social factors that are more prominent in high-risk groups than among the wider population
One shot interventions have been shown to do little to affect long term change.

20. Evidenced based/Individual: Positive Action
Universal strategy utilized in schools and community-based settings
Research-validated prevention program
Social emotional learning program designed to increase positive behavior, reduce negative behavior & improve school & emotional learning.
A classroom curriculum for grades K-6
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.

21. Indirect Impact of Environmental Strategy: School Climate Change Olweus Bullying Prevention Program
Greater commitment to school
Decreased absenteeism
Academic performance
Emotional Competency
Lynne

22. Indirect Impact of Evidence- based/Individual
Mental Health
Depression
Suicide
Bullying
Self-injury
Crime
Antisocial
Academics
Drop out
Academic failure
Lynne
Ultimately gets the best results by targeting risk factors

23. Collaboration Mapping
ATOD
Treatment
Health
Care
Law
Enforcement
Antisocial Behavior
<21 impaired driving
Depression
Alcohol Abuse
Other Drugs
Self Injury
Bullying
Collaboration Mapping
ATOD
Prevention
Criminal
Justice
Lynne
Let’s look at one specific risk factor: Antisocial behavior
Antisocial behavior is a risk factor for not only for bullying but also
Depression
Bullying
Self injury
Alcohol abuse
Other drug abuse
When we look for collaborative partners, look for those whose primary problem area is also impacted by the same risk factor.
Mental
Health
Schools
Schools

24. Collaboration Level of Collaboration Coexistence Communication
Cooperation
Coordination
Collaboration
Functional Area:
Strategic Planning
Resource Acquisition
Policy & Program Direction
Staff Training
Program Operations
Disseminate Information
Community Representation
Community Leadership
Program Evaluation
Rob

25. Prevention Plan Strategy: Activity II
Based on the work you completed in the first activity:
Step 1. With the prediction chart for your root cause identify the problems that are predicted by this root cause
Step 2. Based on the problems related to your root cause, who are potential collaborators/partners?
Step 3. How do you build this collaborative with the identified partners? Where are you now, where would you like to be?
Step 4. Groups report out
Rob

26. Prevention Plan Strategy: Example
Ratio (Over-involved)
Drinking and Driving
Depression
Suicide Ideation
Self Injury
Bullying
Sensation Seeking
3.97
1.33
7.53
1.31
2.15
Root Cause: Sensation Seeking
Step 1: Identify the problems that are predicted by this root cause: Suicide Ideation (7.53) and Bullying (2.15)
Step 2: Who are potential collaborators/partners:
Mental Health and Schools
Step 3: How do you build this collaborative with the identified partners? Where are you now, where would you like to be?
Rob

27. Collaboration: Sensation Seeking Example
Level of Collaboration
Coexistence
Communication
Cooperation
Coordination
Collaboration
Functional Area:
**************
Strategic Planning
MH Now
MH Goal
School Now
School Goal
Resource Acquisition
Policy & Program Direction
Staff Training
Program Operations
Disseminate Information
Community Representation
Community Leadership
Program Evaluation
Rob

28. Key Points
By missing the minority of the population you miss the majority of the problem
The root causes of your target problem are probably the root causes of other peoples target problem.
Collaboration can take place on many functional levels.
Vision
Rob

29. What Have You Learned Dorothy?
Spend your prevention resources where they do the most good.
Be truly data driven.
Evaluate from a cost-benefit model.
Think outside the box…silo…funding tube.
Public Health model!
Rob

30. Contact Information
Rob Lillis:
Lynne Gochenaur:
Rob

31. Prevention Plan Strategy: Activity II-A
Root Causes of Problem Behavior
Proportion at risk
Drove after drinking
Underage Drinking
Bully Others
Suicide Ideation
Self-Injury
Evalumetrics Youth Survey
2015
Ratio
Favorable Attitudes Toward Drug Use (R19-PI)
13.4%
4.15
2.41
2.48
3.58
2.30
Root Cause: Favorable Attitudes Toward Drug Use
Step 1: Identify the problems that are predicted by this root cause.
Step 2: Who are potential collaborators/partners:
Step 3: How do you build this collaborative with the identified partners? Where are you now, where would you like to be?

32. Prevention Plan Strategy: Activity II - B
Root Causes of Problem Behavior
Proportion at risk
Drove after drinking
Underage Drinking
Bully Others
Suicide Ideation
Self-Injury
Evalumetrics Youth Survey
2015
Ratio
Antisocial Behavior (R17-PI)
8.9%
4.11
1.80
1.85
2.15
1.54
Root Cause: Antisocial Behavior
Step 1: Identify the problems that are predicted by this root cause.
Step 2: Who are potential collaborators/partners:
Step 3: How do you build this collaborative with the identified partners? Where are you now, where would you like to be?

33. Prevention Plan Strategy: Activity II-C
Root Causes of Problem Behavior
Proportion at risk
Drove after drinking
Underage Drinking
Bully Others
Suicide Ideation
Self-Injury
Evalumetrics Youth Survey
2015
Ratio
Lack Rewards for Prosocial Involvement in Family
20.4%
1.65
2.06
3.00
2.54
Root Cause: Lack of Reward
Step 1: Identify the problems that are predicted by this root cause.
Step 2: Who are potential collaborators/partners:
Step 3: How do you build this collaborative with the identified partners? Where are you now, where would you like to be?