Using Advances in Prevention Science to Guide Youth Development and Prevention of Problems in Commun

1
Using Advances in Prevention Science to Guide
Youth Development and Prevention of Problems in
Communities.

• J. David Hawkins Ph.D.
• Social Development Research Group
• University of Washington
• www.sdrg.org

2
Presentation Objectives

• A science-based public health approach to
  prevention of adolescent problem behaviours.
• How can local agencies collaborate to apply the
  advances of prevention science to promote
  positive youth development and prevent problem
  behaviours?

3
History of Delinquency Prevention in the U.S.

• Before 1980, nine experimental tests of
  delinquency prevention programs were conducted in
  the U.S.
• NONE found desired effects in preventing
  delinquency. (Berleman, 1980)

4
Early Drug Abuse Prevention Research Findings

• Tested approaches were largely ineffective
  (Elmquist, 1995 Hanson, 1992 Moskowitz, 1989).
  
• Drug information programs increased drug use in
  some studies (Tobler, 1986).

5
The Premise of Prevention Science

• To prevent a problem before it happens, the
  factors that predict the problem must be changed.

6
Advances in Prediction

• Longitudinal studies have identified predictors
  of substance abuse-
• Risk factors.
• AND predictors of positive outcomes including
  avoidance of health risk behaviors-
• Promotive and protective factors.

7
Risk Factors for Adolescent Problem Behaviors
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Risk Factors for Adolescent Problem Behaviors
9
Risk Factors for Adolescent Problem Behaviors
10
Risk Factors forAdolescent Problem Behaviors
Depression Anxiety
Violence
School Drop-Out
Teen Pregnancy
Delinquency
Substance Abuse
Risk Factors
 
 
 
 
 
 
Community
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Availability of Drugs
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Availability of Firearms
?
?
?
Community Laws and Norms Favorable Toward Drug
Use, Firearms, and Crime
?
Media Portrayals of Violence
?
?
?
?
Transitions and Mobility
?
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?
Low Neighborhood Attachment and Community
Disorganization
?
?
?
?
?
Extreme Economic Deprivation
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Promotive and Protective Factors

• Individual Characteristics
• High Intelligence
• Resilient Temperament
• Competencies and Skills
• In each social domain (family, school, peer group
  and neighborhood)
• Prosocial Opportunities
• Reinforcement for Prosocial Involvement
• Bonding or Connectedness
• Clear and Healthy Standards for Behavior

12
Prevalence of Illicit Drug Use(Past 30 Days)By
Exposure to Risk and Protective Factors
13
Prevalence of Attacked to HurtBy Risk and
Protection Levels
14
Prevalence of Academic SuccessBy Number of Risk
and Protective Factors
15
What Is Known AboutRisk and Protection

• Risk protective factors are found in
  communities, families, schools, peer groups and
  individuals.
• The same risk protective factors predict
  substance abuse, violence, and other health and
  behavior problems of youth.
• Risk protective factors show much consistency
  in effects across cultures, races and genders in
  samples from the US, Australia and the
  Netherlands.
• The more risk factors present, the greater
  likelihood of substance abuse, violence, and
  other behavior problems and the less likelihood
  of positive outcomes.
• Protective factors reduce effects of exposure to
  risk -- the greater the level of protection, the
  less likelihood of behavior problems.

16
Research Guiding Practice

• Malleable risk and protective factors
  identified through longitudinal studies should be
  targeted by preventive interventions.

17
Advances in Prevention

• Over the past 25 years, controlled trials have
  identified both ineffective and effective
  prevention policies and programs.

18
Ineffective StrategiesNational Institute of
Justice

• Didactic programs targeted on arousing fear (e.g.
  Scared Straight).
• D.A.R.E.
• Peer counseling programs.
• Segregating problem students into separate
  groups.
• After school activities with limited supervision
  and absence of more potent programming.
• Summer jobs programs for at-risk youth.

National Institute of Justice, 1998
19
Effective Programs and Policies Have Been
Identified in a Wide Range of Areas

• Prenatal Infancy Programs
• Early Childhood Education
• Parent Training
• After-school Recreation
• Mentoring with Contingent Reinforcement
• Youth Employment with Education
• Organizational Change in Schools

• Classroom Organization, Management, and
  Instructional Strategies
• School Behavior Management Strategies
• Classroom Curricula for Social Competence
  Promotion
• Community School Policies
• Community Mobilization

(Hawkins Catalano, 2004)
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Life Skills Training
Description Curriculum for social competence
promotion and drug abuse prevention Target
Students ages 11 to 14. Contact Gilbert
Botvin, Ph.D., Director Institute for
Prevention Research Cornell University Medical
College 411 East 69th Street, KB-201 New
York, NY, 10021 212-746-1270
21
Life Skills TrainingMajor Components

• Drug Resistance Skills and Norms
• Self-Management Skills
• General Social Skills

22
Middle School Program

• 15 Class Periods (6th or 7th Grade)
• 10 Class Periods (7th or 8th Grade)
• 5 Class Periods (8th or 9th Grade)

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Life Skills Training Evidence of Effect

• Reduces tobacco, alcohol, and marijuana use
  50-75.
• Effects maintained through grade 12.
• Cuts polydrug use up to 66.
• Reduces pack-a-day smoking by 25.
• Decreases use of inhalants, narcotics, and
  hallucinogens 25 to 55.

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Toward No Drug Abuse (TND)

• Description Self-control/Social Competency
  Instruction, Drug Abuse Prevention
• Target All High School Youth (age 14-18) in
  Regular and Alternative High Schools
• Contact Steve Sussman, Ph.D.
• IPR-USC
• 1540 Alexander Street, CHP 209
• Los Angeles, CA 90033

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Program Delivery

• 12 classroom-based lessons
• Approximately 40-50 minutes each
• Implemented over a 4-week period (3-4 days per
  week)
• Option twice a week for 6 weeks, if all lessons
  are taught.

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Drug Use and Violence-Related Effects across the
first 3 TND Evaluation Studies Compares
Reduction of Program Group(s) Relative to Control
Group(s)
Notes AHSalternative high schools
RHSregular high schools NSnot statistically
significant drug use refers to last 30 days
violence indicators refer to last 12 months
among males only
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Toward No Drug AbuseEvidence of Effect

• Consistent and significant reductions in alcohol
  use and in hard drug use across studies through 1
  year follow up.
• Consistent significant reductions in
  victimization and weapons carrying across
  studies.

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Guiding Good Choices(Preparing for the Drug Free
Years)
Description Series of Five Two Hour Workshops
for Parents Target Parents of children ages 9
to 14 Contact J. David Hawkins Richard
Catalano University of Washington Available
from Channing Bete Company
www.channing-bete.com
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Guiding Good Choices

• Strengthens parents skills to
• build family bonding,
• establish and reinforce clear and consistent
  guidelines for childrens behavior,
• teach children skills to resist peer influence,
• improve family management practices, and
• reduce family conflict.

30
Guiding Good ChoicesEvidence of Effects

• Significantly reduced drug use through age 18.
• Significantly reduced growth in delinquency
  through age 16.
• Significantly reduced growth in depression
  through age 18.
• Significantly reduced alcohol abuse among young
  women at age 22.

31
Benefits and Costs of Prevention and Early
Intervention Programs for Youth
Steve Aos, Associate Director Washington State
Institute for Public Policy Phone (360)
586-2768 E-mail saos_at_wsipp.wa.gov Institute
Publications www.wa.gov/wsipp
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A program for parents of children entering
adolescence Evidence of reduced drug use,
reduced delinquency, reduced
depressive symptoms
Examples
Guiding Good Choices 7,605 687 6,918
Life Skills Training 746 29 717
Intensive Juv. Supervision 0
1,482 -1,482
A middle/junior high school social competence
promotion program Evidence of reduced
alcohol, tobacco marijuana use, decreased
use of inhalants, narcotics and hallucinogens
Aos meta-analyzed 19 studies of intensive
supervision programs for juvenile offenders. No
statistically significant effect on recidivism
rates.
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Benefit-to-Cost RatiosSelected Programs

• Program Return on 1.00
  investment
• Life Skills Training 25.61
• Guiding Good Choices 11.07
• Washington Institute for Public Policy (2004)

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Lists of Rigorously Tested and Effective Youth
Violence and Substance Abuse Prevention Approaches

• Blueprints for Violence Prevention
• www.colorado.edu/cspv/blueprints/
• Communities That Care Prevention Strategies
  Guide
• http//preventionplatform.samhsa.gov

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But

• Prevention approaches that do not work or have
  not been evaluated have been more widely used
  than those shown to be effective.
• (Gottfredson Gottfredson, 2002, Hallfors et al
  2001, Ringwalt et al., 2002.)

36
Empowering Communities to Prevent Youth Substance
Misuse

• Youths in different neighborhoods and communities
  are exposed to different levels of risk and
  protection.

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Distribution of Risk in a City
38
Madison Middle School Risk Profile 8th Grade 2002
Peer-Individual
Estimated National Value
39
Nova High School Risk Profile 10th Grade 2002
Peer-Individual
Peer-Individual
Estimated National Value
40
The Goal for Community Prevention
To identify and address those risk factors
that are most prevalent and those protective
factors that are most suppressed with tested and
effective policies and programs.
41
The Communities That Care Prevention System

• A coalition/board of diverse community
  stakeholders applies the advances of prevention
  science to guide youth development and prevention
  work.
• Measures community levels of protection and risk
  by surveying young people themselves.
• Matches the communitys profile of risk and
  protection with tested, effective programs and
  policies.

42
The Communities That Care Prevention System

• Ensures that new programs and policies are
  implemented with fidelity
• Local control builds ownership to create
  sustainable change.
• Focuses on measured outcomes Are fewer teens
  using drugs? Fewer smoking? Fewer committing
  violent acts?

43
The Communities That Care Operating System
44
The Communities That Care Operating System

• Community readiness assessment.
• Identification of key individuals, stakeholders,
  and organizations.

45
The Communities That Care Operating System

• Training key leaders and board in CTC
• Building the community coalition.

46
The Communities That Care Operating System

• Collect risk/protective factor and outcome data.
• Collect information on community resources
• Construct a community profile from the data.

47
Peer-Individual
Estimated National Value
48
The Communities That Care Operating System

• Define outcomes.
• Prioritize factors to be targeted.
• Select tested, effective interventions.
• Create action plan.
• Develop evaluation plan.

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Addressing Barriers with Effective Action
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Effective Prevention for Parents of Young
Adolescents

• Creating Lasting Connections
• Family Matters
• Guiding Good Choices
• Parents Who Care
• Parenting Wisely
• Strengthening Families 10-14

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The Communities That Care Operating System

• Form task forces.
• Identify and train implementers.
• Sustain collaborative relationships.
• Evaluate processes and outcomes.
• Adjust programming.

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CTC Trainings

• Key Leader Orientation
• Community Board Training
• Community Assessment Training
• Community Resource Assessment Training
• Community Planning Training
• Community Program Implementation Training

53
Communities that CareProcess and Timeline
Measurable Outcomes

Process
Increase in priority protective factors Decrease
in priority risk factors
Increase in positive youth development Reduction
in problem behaviors
Assess risk, protection and resources
Implement and evaluate tested prevention
strategies
Vision for a healthy community
6-9 mos. 1 year 2-5 years
5-10 years
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The Community Youth Development Study (CYDS)

• A 24 community randomized controlled trial to
  test the Communities That Care system started in
  2003.

56
The Community Youth Development Study
Funded by National Institute on Drug Abuse
Center for Substance Abuse Prevention National
Cancer Institute National Institute on Child
Health and Development National Institute on
Mental Health
57
CYDS State Collaborators

• Colorado Alcohol Drug Abuse Division
• Illinois Division of Community Health
  Prevention
• Kansas Alcohol and Drug Abuse Services
• Maine Office of Substance Abuse
• Oregon Office of Alcohol Drug Abuse Programs
• Utah Division of Substance Use
• Washington Division of Alcohol Substance Abuse
  

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CYDS Primary Aim

• To test the effects of the Communities That Care
  system in
• reducing levels of risk
• increasing levels of protection
• reducing health and behavior problems among
  adolescents
• using a true experimental design.

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STUDY DESIGN
Randomized Controlled Trial 2003-2008
2003 2004 2005 2006 2007
2008
Implement selected interventions
Planning
5-Year Baseline 1997-2002
CTCYS
CTCYS
CTCYS
CKI CRD
CKI CRD
Intervention
98 99 00 01 02
CTC Board
CTC Board
CTC Board
CTC Board
CTC Board
Randomize
CTCYS
CTCYS
CTCYS
YDS
YDS
YDS
YDS
YDS
CKI CRD
CTCYS
CTCYS
CTCYS
CKI CRD
Control
CKI CRD
CKI CRD
CTCYS Cross-sectional student survey of 6th-,
8th-, 10th-, and 12th-grade students using the
CTC Youth Survey CKI Community Key Informant
Interview CRD Community Resource Documentation
measuring effective prevention programs and
policies in the community  CTC Board CTC Board
Member Interview YDS Longitudinal Youth
Development Survey of students in the class of
2011 starting in 5th grade in spring 2004
YDS
YDS
YDS
YDS
YDS
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Demographics of 24 CYDS Communities
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Panel-Youth Development Survey (YDS)

• Annual survey of panel recruited from the Class
  of 2011 (5th grade in 2004)
• Active, written parental consent

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Youth Development Survey

• Participants recruited in grades 5 and 6.
• Final consent rate 76.4

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2007 YDS

• 96.2 Overall Student Participation
• 11.9 (n525) have moved out of project schools

64
Communities That CareLogic Model
CTC Training and Technical Assistance
Adoption of Science-based Prevention Framework
Collaboration Regarding Prevention Issues
Appropriate Choice and Implementation of Tested,
Effective Prevention Programs Adoption of
Social Development Strategy as Communitys Way of
Bringing Up Children
Decreased Risk and Enhanced Protection
Positive Youth Outcomes
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Adoption of Science-Based Prevention

• Stage 0 No Awareness
• Stage 1 Awareness of Prevention Science Terms
  and Concepts
• Stage 2 Using Risk and Protection Focused
  Prevention Approach as a Planning Strategy.
• Stage 3 Incorporation of Community
  Epidemiological Data on Risk and Protection in
  Prevention System.
• Stage 4 Selection and Use of Tested and
  Effective Preventive Interventions to Address
  Prioritized Risk and Protective Factors.
• Stage 5 Collection and Feedback of Process and
  Outcome Data and Adjustment of Preventive
  Interventions Based on Data.

Note. Community Key Informant Survey (CKI).
66
Stages of Adoption by Intervention Status (2001)
Control Communities
CTC Communities
Probability
Stage of Adoption
67
Stages of Adoption by Intervention Status (2004)
Control Communities
CTC Communities
Probability
Stage of Adoption
Note. Change from 2001 to 2004, p lt .05.
68
Stages of Adoption by Intervention Status (2007)
Control Communities
CTC Communities
Probability
Stage of Adoption
Note. Change from 2004 to 2007, nonsignificant
(i.e., p gt .10).
69
Communities That CareTheory of Change
CTC Training and Technical Assistance
Adoption of Science-based Prevention Framework
Collaboration Regarding Prevention Issues
Appropriate Choice and Implementation of Tested,
Effective Prevention Programs Adoption of
Social Development Strategy as Communitys Way of
Bringing Up Children
Decreased Risk and Enhanced Protection
Positive Youth Outcomes
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Program Selection

• CTC Community Board members selected prevention
  programs from a menu of programs that
• Showed significant effects on risk/protective
  factors, and drug use, delinquency, or violence
• In at least one high-quality research study
• Targeted children or families in grades 5-9
• Provided materials and training
• Communities That Care Prevention Strategies
  Guide

71
Programs Selected in 2004-2007
Program funded through local resources in one or
two communities
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Exposure in the Community
Note Total eligible population of 6th, 7th, and
8th-grade students in 2005-06 was 10,031.
Includes PALS, BBBS, Stay SMART, and Tutoring
programs
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Fidelity Assessment Checklists

• Obtained from developers (9) or created by
  research staff (7)
• Provided similar information across all programs
  to measure 4 elements of fidelity
• Over 6,000 checklists were completed by program
  implementers and coordinators
• Minimal missing data (8.2 in 2004-05 and 2.1 in
  2005-06)
• Checklists were collected and reviewed by
  communities, then sent to SDRG

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Adherence Rates 2004-05 and 2005-06 school years
Percentage of material taught or core components
achieved
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Communities That CareTheory of Change
CTC Training and Technical Assistance
Adoption of Science-based Prevention Framework
Collaboration Regarding Prevention Issues
Appropriate Choice and Implementation of Tested,
Effective Prevention Programs Adoption of
Social Development Strategy as Communitys Way of
Bringing Up Children
Decreased Risk and Enhanced Protection
Positive Youth Outcomes
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Prioritized Risk Factors in CTC Communities

• Family management problems
• Parental attitudes favorable to problem behavior
• Family conflict
• Low commitment to school
• Favorable attitudes toward problem behavior
• Friends who engage in problem behavior
• Academic failure
• Rebelliousness
• Laws and norms favorable toward drug and alcohol
  use

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Pre-post Change inTargeted Risk Factors
Average Level of Risk
Grade 5
Grade 7
Note. Values are model-fitted levels of
standardized average risk for students in the
Youth Developmental Study panel sample, N 4404.
For Grade 7 ?010 .111, SE .043, df 11, p lt
.026.
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Communities That CareTheory of Change
CTC Training and Technical Assistance
Adoption of Science-based Prevention Framework
Collaboration Regarding Prevention Issues
Appropriate Choice and Implementation of Tested,
Effective Prevention Programs Adoption of
Social Development Strategy as Communitys Way of
Bringing Up Children
Decreased Risk and Enhanced Protection
Positive Youth Outcomes
79
Communities That Care Evidence of Effects

• Adoption of science-based prevention is higher in
  CTC communities than in control communities.
• CTC communities and schools are adopting tested
  effective programs.
• The new programs are being implemented with
  fidelity.
• Exposure to targeted risk factors is increasing
  less rapidly in the panel in CTC than in control
  communities.
• By the spring of grade 8,
• significantly fewer panel students in CTC
  communities than controls have initiated smoking,
  smokeless tobacco use, alcohol use, and
  delinquent behavior.
• Significantly fewer report drug use, specifically
  current alcohol use, binge drinking, and
  smokeless tobacco use.
• Significantly lower rates of delinquent behavior.

80

• The Communities That Care Prevention Operating
  System is available at
• http//preventionplatform.samhsa.gov/

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The Future of Prevention in CTC
CommunitiesCommunity Leader Support for
Prevention

• If you were deciding how to spend money for
  reducing substance abuse, what percentage would
  you allocate to each of the following approaches?
• Law Enforcement
• Treatment
• Prevention

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Funding Allocation by Intervention Status (2001)
31.9
30.6
27.4
28.0
Law Enforcement
Law Enforcement
Treatment
Treatment
Prevention
Prevention
40.9
41.5
CTC Communities
Control Communities
84
Percentage Funding for Prevention by
Intervention Status
Percentage
2007
2001
2004
85
Percentage Funding for Prevention by
Intervention Status
Percentage
2007
2001
2004
Note. Change from 2001 to 2004 nonsignificant, p
gt .10.
86
Percentage Funding for Prevention by
Intervention Status
Percentage
2007
2001
2004
Note. Change from 2001 to 2007, p lt .05.
87
Summary and Implications

• Tested and effective policies and programs for
  preventing adolescent substance misuse are
  available.
• They can be implemented and sustained widely in
  communities with strong prevention coalitions.
• We should promote the use of tested and effective
  prevention approaches where appropriate.
• We should support rigorous evaluation of untested
  prevention approaches.

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Summary and Implications

• We can advance public health in our communities
• Sponsor, endorse and use tested and effective
  prevention programs.
• Promote the collection of data on levels of risk
  and protection to focus community action on
  elevated risks.
• Engage in community efforts to strengthen
  protection and reduce risks.
• For measurable results and sustainability
• USE COMMUNITIES THAT CARE.

89
What is required to install CTC?

• A coalition of community stakeholders.
• A coordinator for the CTC process.
• Manuals and curriculum materials.
• Training from certified trainers.
• Technical assistance when difficulties are
  encountered.
• A monitoring system to provide routine feedback
  on progress and outcomes.

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Communities That Care in the UK and Ireland

• CTC training, technical assistance, youth survey
  and materials are available from the Rainer
  Foundation in London.
• CTC UK Contact
• Fran Pollard
• Rainer Foundation
• 44 207 336 4806
• fran.pollard_at_raineronline.org

91
My Vision

• Training and technical assistance are readily
  available to communities seeking to use the CTC
  system.
• Systems for monitoring risk, protection and youth
  health are in place in communities.
• Systems for monitoring fidelity of prevention
  policies and programs are functioning in
  communities.
• Significant reductions in substance abuse and
  delinquency are achieved in communities.
• Significant increases in positive youth
  development are achieved across communities.

92
Communities That CareCYDS Publications
Arthur, M.W., Briney, J.S., Hawkins, J.D.,
Abbott, R.D., Brooke-Weiss, B. . Catalano, R.F.
(2007). Measuring community risk and protection
using the Communities That Care Youth Survey.
Evaluation and Program Planning, 30,
197-211. Brooke-Weiss, B., Haggerty, K. P.,
Fagan, A. A., Hawkins, J. D., Cady, R. (2008).
Creating community change to improve youth
development The Communities That Care (CTC)
system. The Prevention Researcher 15(2),
21-24. Brown, E.C., Hawkins, J.D., Arthur, M.W.,
Briney, J.S., Abbott, R.D. (2007). Effects of
Communities That Care on prevention services
systems Findings from the Community Youth
Development Study at 1.5 years. Prevention
Science. 8, 180-191. Fagan, A. A., Hawkins, J.
D., Catalano, R. F. (2008). Using community
epidemiologic data to improve social settings
The Communities That Care prevention system. In
M. Shinn H. Yoshikawa (Eds.), Toward positive
youth development Transforming schools and
community programs. New York Oxford University
Press. Fagan, A.A., Van Horn, M.L., Hawkins,
J.D., Arthur, M.W. (2007). Using community
and family risk and protective factors for
community-based prevention planning. Journal of
Community Psychology, 35(4), 535-555. Hawkins,
J.D. (2006). Science, social work, prevention
Finding the intersections.  Social Work Research,
30(3), 137-152. Hawkins, J.D., Brown, E.C.,
Oesterle, S., Arthur, M.W., Abbott, R.D.,
Catalano, R.F. (2008). Early effects of
Communities That Care on targeted risks and
initiation of delinquent behavior and substance
use. Journal of Adolescent Health. Murray, D.M.,
Van Horn, M.L., Hawkins, J.D., Arthur, M.W.
(2006). Analysis strategies for a community
trial to reduce adolescent ATOD use A comparison
of random coefficient and ANOVA/ANCOVA models.
Contemporary Clinical Trials. 27, 188-206.
93
Communities That Care CYDS In Press
Brown, E.C., Hawkins, J.D., Arthur, M.W., Van
Horn, M.L., Abbott, R.D. (in press).
Multilevel analysis of a measure of prevention
collaboration. American Journal of Community
Psychology. Fagan, A.A., Hanson, K., Hawkins,
J.D., Arthur, M.W. (in press). Bridging
science to practice Achieving prevention program
implementation fidelity in the Community Youth
Development Study. American Journal of Community
Psychology. Fagan, A.A., Hanson, K., Hawkins,
J.D., Arthur, M.W. (in press). Implementing
effective community-based prevention programs in
the Community Youth Development Study. Youth
Violence and Juvenile Justice. Hawkins, J. D.,
Catalano, R. F., Arthur, M. W., Egan, E., Brown,
E. C., Abbott, R. D., et al. (in press). Testing
Communities That Care The rationale, design and
behavioral baseline equivalence of the Community
Youth Development Study. Prevention
Science. Jonkman, H. B., Haggerty, K. P.,
Steketee, M., Fagan, A. A., Hanson, K.,
Hawkins, J. D. (in press). Communities That Care,
core elements and context Research of
implementation in two countries. Social
Development Issues. Quinby, R.K., Fagan, A.A.,
Hanson, K., Brooke-Weiss, B., Arthur, M.W.,
Hawkins, J.D. (in press). Installing the
Communities That Care prevention system
Implementation progress and fidelity in a
randomized controlled trial. Journal of Community
Psychology. Van Horn, M.L., Fagan, A.A., Jaki,
T., Brown, E.C., Hawkins, J.D., Arthur, M.W.,
Abbott, R.D., Catalano, R.F. (in press). The
use of mixture models to evaluate differential
intervention effects in group randomized trials.
Multivariate Behavioral Research.
94
Using Advances in Prevention Science to Guide
Youth Development and Prevention of Adolescent
Problem Behaviours in Communities.
J. David Hawkins Ph.D. jdh_at_u.washington.edu

• Social Development Research Group
• University of Washington
• www.sdrg.org

Office of the Minister for Children and Youth
Affairs 30 June 2008