1. Overview of Strategic Prevention Framework (SPF) for GRAA Grantees Presented by Penny Deavers, GRAA Lead and T/TA Specialist for CAPT, SE Resource Team April, 2011

2. Strategic Prevention Framework

3. Infusion of the Strategic Prevention Framework State Systems Prevention Infrastructure Community Coalitions Action Mechanism General Public Awareness and Outreach

4. SPF & Prevention History Changes in Prevention Planning Over Time 1990’s Funding was available for the creation of community-based coalitions 1999-2011 Evidence-based strategies. Emphasis on implementing effectively with fidelity

5. SPF & Prevention History 2004-2011 Strategic Prevention Framework planning process - assessing, capacity building, planning, implementation and evaluation Prevention planning today:

6. Strategic Prevention Framework Why the SPF? Strategic planning process Community development process The change process at the state & community level

7. Key Principles of the SPF Public health approaches, widened to population-based prevention. Outcomes-based prevention that starts with the end in mind. Prevention is targeted across the lifespan (not just youth). Data-driven planning process

8. Focus for States and Communities Consumption & consequences (prevent the problem associated with use) Across the lifespan (not just youth) Based on evidence-based research & empirical data Outcomes measured at the population level (not just program level)

9. “The height of insanity is doing the same thing over and over again and expecting different results.”

10. “We Don’t Do It That Way Around Here” Each individual community has its own way of doing things is unique, and that quality is valued knows the real “in and outs”

11. Change… It is important to recognize and preserve unique qualities while finding new ways for systems to work together.

12. The Plan Includes Systems at State & Community Levels public and private entities state agency directors community volunteers youth boards that make policy parents who make house rules

13. Strategic Prevention Framework Step #1: Assessment Assessment of substance use and related problems Prioritization of Problems by State and Community Documentation of the extent, scope and nature of substance abuse and related problems

14. Infusing Data Throughout SPF SPF strives to use data across all steps Deliberate process to collect, analyze, interpret, and apply lessons from substance use and consequence data to drive state efforts across the entire SPF

15. Infusing Data Throughout SPF (cont’d.) Ongoing and integrated data analyses are critical to: –identify problems and set priorities –assess and mobilize capacity for using data –inform prevention planning and funding decisions –guide selection of strategies to address problems and goals –monitor key milestones and outcomes and adjust plans as needed

16. What Are We Assessing? Assessment of substance use and related problems (i.e. needs) leading to recommendations for state and community priorities Assessment of capacities, resources and gaps Assessment of readiness 16

17. Why Should I Assess Resources? Identify gaps in services Identify duplication of services Build collaboration among service providers Modify existing services to meet needs

18. Words of Wisdom What you get out of a needs assessment is directly related to what you put into it…

19. Translating Data into Priorities Looking across the data you have collected, are there risk factors or protective factors for which you have no data? Which risks are most prevalent in your community? Which protective factors are most lacking? At what developmental periods are children most at risk in your community? Is there an identifiable “cluster” of risk factors that, addressed together, could provide a synergistic response? Which 2-5 risk factors should your community tackle first? Which protective factor should you tackle first?

20. Key Milestones in Step 1 Include: Development of problem statements Identification of potential geographic target areas and populations Assessment of readiness, external factors, and potential barriers to success Assessment of organizational, fiscal, and leadership capacity Assessment of cultural competence Analysis of service gaps

21. SPF Step #1 Requirements Profile Population Needs, Resources, and Readiness Community Requirements: Accurately assess substance-abuse related problems using epidemiological data Identify the magnitude of the (substance abuse) problem and where it is greatest Identify risk and protective factors Assess community assets and resources, gaps in services and capacity, and readiness to act.

22. Strategic Prevention Framework Step 2: Capacity Community Level Engage Key Stakeholders Key Tasks May Include: –Assessing community the prevention system –Convening community leaders & stakeholders –Building coalitions –Training and technical assistance –Leveraging resources

23. Examples of Capacities State level Knowledge of cultural protocols in sub-populations Workforce knowledge, skills and competencies Infrastructure, such as coalitions Sub-populations’ capacity in prevention (e.g., Boys and Girls clubs) Data systems

24. Examples of Capacities (cont’d.) Community level Number of community organizations collaborating on addressing ATOD-related problems Leadership within the coalition and the community to engage in solving ATOD and other related problems Prevention knowledge at the community level Resources that are allocated and available to address ATOD problems

25. Another Thought on Change It's not that some people have willpower and some don't. It's that some people are ready to change and others are not. –James Gordon, M.D.

26. Capacity Building Action Steps 1.Determine internal capacity and readiness: human, technical and financial 2.Determine community readiness 3. Assess external capacity: human, technical and financial

27. Capacity Building Action Steps 1. Determine internal capacity and Readiness including cultural competency: human, technical and financial –Breadth and depth of cultural competency –Administrative skills: long- and short-term planning skills, communication skills, problem solving, etc. –Abilities for: networking, reaching out to community, community mobilization –Technological resources for information management and evaluation –Financial resources for implementation and operational expenses

28. Capacity Building Action Steps 2. Determine community readiness –Identify potential partners for team building –Determine availability of local support (foundations, United Way…) –Establish visibility in the community with media and key stakeholders –Mobilize potential partners and stakeholders –Ensure maximum collaboration within coalition to conserve resources and maximize results

29. Capacity Building Action Steps 3. Assess external capacity: human, technical and financial –Examine awareness of substance abuse problem –Determine relevant community norms –Identify key stakeholders, their skills, commitment, and access to resources –Develop approaches to address gaps in community readiness

30. Key Milestones of Step 2 Include: Creation of sustainable partnerships Introduction of training and education to promote readiness, cultural competence, leadership, and data collection, monitoring, and evaluation capacity Meetings and workshops with key stakeholders, coalitions, and service providers

31. SPF Step #2 Requirements Capacity: mobilize and/or build capacity to address needs Community requirements Engage key stakeholders at the State and community level to plan and implement successful prevention activities that will be sustained over time Key tasks may include: –Convening community leaders and stakeholders –Building coalitions –Training stakeholders, coalitions, and service providers –Organizing agency networks –Leveraging resources

32. Design comprehensive interventions to impact causal factors Substance- related problems Intervening Factors Evidence- Based Strategies Strategic Prevention Framework Step 3: Planning

33. Strategic Plan ReadinessData Resources & Gaps

34. Step #3: Developing a Comprehensive Strategic Plan Develop strategic goals, objectives, and performance targets The strategic plan lays the groundwork for: –The identification of strategies –The selection of evidence-based programs, policies, and practices

35. Strategic Prevention Framework Comprehensive strategies include: Programs Policies Practices

36. Select Evidence-Based Program Evidence-based programs are theory-driven, have activities related to theory, and have been well-implemented and well-evaluated. Prevent or reduce substance abuse or violence and disruptive behavior Change knowledge, attitudes, and beliefs that lead to substance abuse and violent behavior Promote or strengthen behaviors and skills

37. Program/Strategy Chosen Should: Be consistent with identified needs Directly address goals Be evidence-based Be assessed periodically Be consistent with local policies Demonstrate effectiveness Be implemented with fidelity

38. What DOES NOT Work? Scare tactics Segregating aggressive or anti-social students Programs that focus on self-esteem alone One-time “presentations” with no follow-up

39. Identification of Strategies Examine existing programs that address the underlying conditions Determine how the underlying logic fits the underlying conditions Reflect characteristics of target populations Ask others about the programs Assess resources needed to implement Involve evaluator

40. Examples of ATOD Environmental Strategies Restrictions on happy hours Taxes Minimum purchase age Licensing requirements Home delivery bans Keg registrations Social norms campaigns Smoke-free policies Compliance checks Restrictions on advertising Warning labels Bans on use in certain places Legal selling age BAC limits

41. Choosing Strategies Don’t forget…….Strategies MUST: Address the problem identified Address the causal factor(s) believed to be involved

42. Motor Vehicle Related Crashes Alcohol easily available in bars Little enforcement of drinking driving laws Middle school curriculum Mentoring Program Strategy Does Not Match Cause or Problem

43. Motor Vehicle Related Crashes Alcohol easily available in bars Little enforcement of drinking driving laws No service to intoxicated patrons Sobriety checkpoints Strategy Does Matches Problem and Cause

44. SPF Plan Requirements Develop a Comprehensive Strategic Plan, informed by needs assessment data, that: Articulates a vision Involve key stakeholders in the planning process Describes how resources will be allocates Identifies and addresses chosen priorities Articulates goals and objectives for obtaining expected outcomes Identifies appropriate strategies/interventions for achieving expected outcomes

45. SPF Plan Requirements (cont’d) The plan should also: Identify and address needed capacity development Include a plan for evaluating the project Include a plan for sustaining outcomes after the grant ends The Strategic Plan must be data-driven and focused on addressing the most critical substance prevention needs of the Tribe.

46. Strategic Prevention Framework Step 4: Implementation Logical connection between the problem, the Intervening Factors and Strategies Implemented Related Problems Substance Use Intervening Factors Strategies High Rate of Youth Alcohol- Related Crashes High Rates of Binge Drinking High Rates of Drinking and Driving Low Perceived Risk of Alcohol Use Social Norms Encouraging Binge Drinking Little Enforcement of Drinking and Driving Curriculum to Increase Knowledge about Risk Media campaign to correct perceptions of ‘normal’ consumption Enforcement Checkpoints

47. SPF Step #4 Requirements …Implement evidence-based prevention programs and infrastructure development activities Community Requirements: Use the findings of needs assessments to guide selection and implementation of evidence-based policies, programs, and practices Strategies must be evidence based –Federal Model Program List –Peer reviewed journal with proven effectiveness –Documented effectiveness

48. Successful Implementation Elements The intervention be delivered by skilled personnel (staff or volunteers) The intervention be received by the proper audience The intervention be delivered to a sufficient number of people over a sufficient period of time The intervention be delivered as designed

49. Substance- related problems Intervening Variables Strategies/ Programs Planning, Monitoring, Evaluation and Re-planning Outcomes-Based Prevention

50. Community is unit of analysis – not the individual Trends over time Monitor progress and impact on selected change indicators… Strategic Prevention Framework Step 5: Evaluation

51. SPF Step #5 Requirements … monitor process, evaluate effectiveness, sustain effective programs/activities, and improve or replace those that fail Community Requirements: Monitor and evaluate activities Provide performance data to the State

52. Measurement Domains Systemic change at state and community levels SPF implementation and program fidelity at community level Changes in substance use and related outcomes at state and community levels

53. 53 Why Evaluate?  To gather information for funder  To determine the effectiveness of programs  To document that program objectives have been met; what works and what doesn’t  To provide information about service delivery

54. 54 Why Evaluate? (cont’d.)  To enable program staff to make changes that improve program effectiveness  To justify program continuation or expansion  To add knowledge to the field  To guide program and policy development

55. 55 Why Outcome Evaluation ?  Determines what outcomes were achieved  Determines whether intended outcomes were achieved  Determines cost effectiveness  Determines the effectiveness of the implementation of the program

56. Key milestones of Step 5 include: Consultation and collaboration with evaluation team Process evaluation Collection of required outcome data Outcome evaluation Review of policy, program, and practice effectiveness Development of recommendations for quality improvement

57. Cultural Competency Eliminates service & participation disparities Improves effectiveness & quality of programs, policies and practices …meets the needs of the people you are working with

58. The Need for Cultural Competence in the SPF Why is there a compelling need for cultural competence? To respond to current and projected demographic changes in the US. To eliminate long standing disparities in the quality of prevention services to people of diverse racial, ethnic, and linguistic populations; and consideration of gender, disabilities, and sexual orientation in delivery of prevention services. To improve the effectiveness, quality of services, and positive prevention outcomes to targeted populations.

59. Think sustainability from the beginning Look to the system to sustain outcomes Sustain prevention by making it everyone’s job Sustainability … Sustain outcomes, not just programs Strategic Prevention Framework

60. Sustainability  Sustainability is “the process of ensuring an adaptive and effective substance abuse prevention system that achieves long term results that benefit a target population” (Johnson, Hays, Center, and Daley, 2004).  Involves focusing on characteristics of the infrastructure that need to be sustained in order to continue to meet the needs of a target population with effective prevention interventions.

61. 5 Capacities Critical to Sustaining an Innovation Administrative structures and formal linkages Effective leaders and strong champions Financial, human, and technological resources Administrative policies and procedures Expertise and skills

62. 5 Innovation Characteristics Critical to Sustaining an Innovation Alignment with needs of innovation stakeholders Positive relationships among key implementers Successful implementation of the innovation Demonstrated effectiveness of the innovation Ownership of the innovation by key stakeholders

63. “To change, and to change for the better, are two different things.” old German proverb

64. However, there must be a change in the way existing systems operate for this approach to work.

65. QUESTIONS 65

66. Each of You Make the Difference…