1. Aligning Outcomes with Population Needs
Slides based on Carol Hays’ Identifying and Selecting Evidence Based Strategies presentations approved by CSAP For FL March 2007, where were based on Carol McHale’s CADCA 2007 NREPP presentation.
Kathy Atwood and Deirdre Danahar
SAMHSA/CSAP’s Southeast CAPT
July 10, 2007

2. Key Principles of SPF Based on a public health approach
Focused on outcomes based prevention
Widens the scope to population-based prevention
Provides a systematic strategic planning process using epidemiologic data to drive decision making
Provides a framework for building systems capacity
Refresher- make link between SPF Overview and this session
Note this small group session focuses on making the link between using the information gained and decisions made in Assessment, Capacities, Strategic Planning steps informs the successful implementation of strategies and evaluation of these. 2 2

3. Integration of Substance Abuse and HIV Prevention Efforts
Complex social problem
Best addressed by targeting the local circumstances, conditions and individual-level behaviors.
Requires comprehensive solutions at both the individual and community level
Variety of intervention approaches directed to multiple aspects of the problem
Determining optimal mix of strategies is complicated by limited information on evidence of effectiveness of hybrid (Substance and HIV prevention) interventions
Note NREPP FY 08 Priority area of HIV/Substance abuse problems (June 4th Fed. Reg.)
Small group discussion: What have been the greatest challenges they have encountered in developing their strategic plan to address integration of substance abuse and HIV prevention strategies?

4. SAMHSA/CSAP Expert Workgroup on Evidence-Based Programming
Convened nationally recognized prevention experts to develop recommendations and guidelines for State and community prevention planners
Prevention research indicates that few problems are amenable to change through direct influence
Most problems must be influenced indirectly by addressing underlying factors that contribute to the problem
Need broad array of evidence-based interventions
Flexibility to choose options that fit community circumstances

5. Underlying Factors
Conditions that lead to the development of problems and consequences
May include specific local policies and practices, community realities and population shifts
Risk and protective factors
Present across the course of human development
Make individuals and groups either more or less prone to substance abuse and HIV risk behaviors in certain social contexts
Note that the phrases “ Causal Factors”, “Underlying factors”, “Risk & Protective Factors” and “Underlying conditions” are often used interchangeably.

6. Your Program Logic model is a…
Picture of your program or intervention
Graphic representation of the “theory of action” – what is invested, what is done, and resulting changes in participants and/or community conditions
Core of planning and evaluation
Provides a common framework for your work
Offers a simple description of how the activities carried out within the program are related to expected outcomes

7. Program Logic Model Design
INPUTS
OUTPUTS
OUTCOMES
Program investments
Activities
Participation
Short
Medium
Long-term
Example of Program Logic Model Design
Inputs - what is invested by the organization(s)
Outputs - program activities and numbers served
Outcomes – immediate results of program activities
Impacts – cumulative changes to community conditions
This example looks at single program logic model. If you are implementing one or more programs simultaneously, you need to examine each- looking at its internal dynamics as well as across the (multiple) program efforts addressed by your grant. 
What we invest
What we do
Who we reach
Resulting changes

8. My Program’s Logic Model
What outcome(s) is my program aiming to achieve?
What activities are we implementing to accomplish this outcome(s)?
What changes in causal factors (e.g. risk and protective factors) does the outcome of your program contribute to?
What program/policy/practice is being implemented?
Small Group Exercise: Program Teams participants to create simple logic model for the MAI work. Can use what ever graphic format works for them, but must minimally address these three question on slide
Report out to larger group & large group discussion of common themes, challenges and successes related to program logic models

9. Benefits of Program Logic Models
Enhances team work and provides focus
Guides prioritization and allocation of resources
Motivates staff
Helps to identify important variables to measure; use evaluation resources wisely
Increases resources, opportunities, recognition
Supports replication
Often is required!
Ask participants: to name some benefits they have found in using logic models

10. Benefits of Program Logic Models
Provides a common language
Helps differentiate between program activities and results --- outcomes
Increases understanding of program
Guides and helps focus work
Increases intentionality and purpose
Provides coherence across complex tasks, diverse environments
Ask participants: what other benefits have they found in their own use of logic models?

11. What’s In It For You…
Helps you explain your program to others—especially funders
Provides a picture of your program on one page
Helps you set boundaries: if it doesn’t fit within your logic model, you can say no.
Increases your confidence in your program
Helps you think as a team

12. Logic Models are… …Used at different conceptual and practical levels
Program level
Community level
Transitioning here to the larger picture in which the program level logic model must operate.
Logic models are used at different conceptual and practical levels: 
Program level: bounded by a particular program, or practice, or strategy. 
Community level: bounded by the particular issue (ATOD consequence) where we have a desired outcome, the behaviors contributing to the issue, the causal factors (e.g.: risk/protective factors…) contributing to the ATOD issue and the particular strategies which are likely to influence those factors.
Now we are going to look at the community level- make reference to CSAP Evidence-Based Guidance Document here

13. Outcome-Based Prevention Community Logic Model
Programs/
Policies/
Practices
Substance-Related Consequences and Use
Causal (e.g. Risk/Protective) Factors
Note that CSAP uses the phrases “ Causal Factors”, “Risk & Protective Factors” and “Underlying conditions” interchangeably.
Transitioning here to the larger picture in which the program level logic model must operate.
Implementing the Strategic Prevention Framework
Planning, Monitoring, Evaluation and Replanning

14. The Community Logic Model: Key Tool for Community Planning
Community logic model serves as a map of the problem (e.g., substance use and HIV risk behaviors) and the factors leading to that problem
Community logic model represents systematic plan for attacking local problem within a specific context
Community logic model starts by defining problem not choosing the solutions (program, practices, or policies)
Small group discussion: How have the participants developed and used logic models in their own MAI work?

15. Community Logic Model
Essential tool for comprehensive, effective community prevention effort
Links the risk behavior to underlying factors based on research and local data
Provides explicit rationale for selecting programs, policies and practices to address the risk behavior

16. Community Logic Model Example
Reducing alcohol
related youth traffic fatalities -
Each causal factor provides an opportunity or potential point of entry for types of interventions or strategies (policies, practices, programs) that may change the targeted problem
Substance -
Substance
Related
Causal
Strategies
Use
Factors
(Examples)
Consequences
Underage
Easy RETAIL ACCESS to
Alcohol for youth
BINGE
Enforce underage
DRINKING
retail sales laws
Low ENFORCEMENT of
alcohol laws
Social Event
High rate of
Underage
Easy SOCIAL ACCESS to
Monitoring and
alcohol -
DRINKING
Alcohol
Enforcement
related crash
AND DRIVING
mortality
Low PERCEIVED RISK of
alcohol use
Media Advocacy to
Among 15 to
Young Adult
Increase Community
24 year olds
BINGE
Concern about
SOCIAL NORMS accepting
DRINKING
Underage Drinking
and/or encouraging
youth drinking
Restrictions on
Prevention Strategy: Any effort to reduce the incidence or prevalence of substance use and HIV risk behavior
Path to Outcomes: Influence intervening variables that in turn influence substance use and subsequent HIV risk behaviors
Young Adult
PROMOTION of alcohol
use (advertising, movies,
alcohol advertising in
DRINKING
music, etc)
youth markets
AND DRIVING
Bans on alcohol price
Low or discount PRICING
promotions and
of alcohol
happy hours 16

17. Community Logic Models Fit Unique Community Needs
Communities must tailor the logic model to fit their particular context, needs, capacities, and readiness
Small Group Discussion: In what ways does their own experience reflect this Statement? What lessons have they learned?

18. Analytic Process to Select Best Fit Prevention Interventions

19. Conceptual Fit of Strategies
Identify strategies that are relevant to the variables in the community’s logic model
Strategies that don’t fit the community logic model are unlikely to effectively address the identified problem
Select strategies to effect the community’s most significant risk/protective factors and conditions
Target multiple points of entry to impact the target population across social environments and sectors

20. Comprehensive Community Plans
Person
Primary Environments
Near Environments
Broader Environment
Time
School
Peers
Family
Work
Neighborhood
Religious
Groups
Laws and Policies
Social Services
Media
Judicial System
Political Influences
Cultural Influences
Economic Influences

21. Practical Fit and Utility of Strategies
Is the strategy a practical fit with the resources, capacity, and readiness of the community organizations responsible for implementing interventions
Developed/adaptable for the target population
Age, gender, culture, language
Implemented successfully with a similar population
Delivered in a similar setting
Implementation materials, Training/TA, evaluation tools available to ensure implementation quality

22. Assess Feasibility of Strategies
Cultural fit with community values
Political fit with local power structure
Organizational fit with mission, vision, culture
Administrative fit with policies and procedures
Technical fit with staff capability and time
Financial fit with existing resources
Make links here with Day 1 Cultural Competency sessions, and Day 2 morning sessions

23. Benefits of logic modeling to community partnerships
Provides framework to discuss and articulate joint work
Helps facilitate conversation with focus on agreed upon goals
Shows contribution of each partner and how result depends upon all
Keeps end outcome upfront and center
Provides way to communicate about the partnership to others

24. Prevention System Pre-Alignment
Stakeholders i.e. Providers, Police,
Preventions professionals,
community leaders
Stakeholders efforts & resources target different outcomes
Community ATOD Coalition
Efforts are diluted and not coordinated to effect change
Programs/ Policies/ Practices
Why develop a common Community Logic Model… helps to foster and sustain alignment of system and efforts.
HIV/AIDS and substance use and related consequences too complex issues to be addressed by only one organization
Example here uses a coalition, could be some other type of “community task force” or collective working together in an intentional way to plan to address common issues and is working towards a common outcome.
community wide reductions in identified ATOD use and related consequences

25. Prevention System Alignment
Stakeholders i.e. Providers, Police,
Preventions professionals,
community leaders
Stakeholders efforts & resources target same outcomes
Community ATOD Coalition
Efforts are targeted and coordinated to effect change
Programs/ Policies/ Practices
community wide reductions in identified ATOD use and related consequences

26. My Community Logic Model
What is the outcome my community is aiming to achieve?
What behaviors (e.g.: specific substance use) are present in my community?
What causal factors (e.g.: risk and protective factors) are supporting the behaviors?
What local contributing factors are present?
What is the overlap between my community logic model and my program level logic model?
Audience breaks in to small groups to develop community model
Groups will report out on their findings
What is the overlap between community logic model and the program level logic models?
Groups to use easel and poster paper provided

27. Benefits of Community Logic Models
Provides common language and understanding among partners
Guides and focuses work
Provides coherence across work done by partners
Guides prioritization and allocation of resources
Enhances collaboration and provides focus
Ask participants: Name some benefits they have found in using community logic models

28. Logic Model and Evaluation Questions
Needs assessment:
What are the characteristics, needs, priorities of target population?
What are potential barriers/facilitators?
Process evaluation:
How is program implemented?
Are activities delivered as intended?
Are participants being reached as intended?
What are participant reactions?
Logic model link to evaluation planning, design and questions
Outcome evaluation:
To what extent are desired changes occurring? For whom?
Is the program making a difference?
What seems to work? Not work?
What are unintended outcomes?