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The Untapped Power of Community- School Based Prevention Mark T. Greenberg Pennsylvania State University
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The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Dec 23, 2015

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Page 1: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

The Untapped Power of Community-School

Based Prevention

Mark T. Greenberg

Pennsylvania State University

Page 2: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

First we must seek out the causes of mental illness … and eradicate them. Here, more than in any other area, "an ounce of prevention is worth more than a pound of cure." For prevention is far more desirable for all concerned. It is far more economical and it is far more likely to be successful. Prevention will require both selected specific programs directed especially at known causes, and the general strengthening of our fundamental community, social welfare, and educational programs which can do much to eliminate or correct the harsh environmental conditions which are often associated with …mental illness.

(Pres. Kennedy, 1963)IEY1SUM

Page 3: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Poor School Achievement

Poor Mental HealthAggression/

ViolenceEarly Substance

Use

Impulsive Action

Emotion Dysregulation

Insecure Relations w/ Parent, Teachers, Peers

Undesired Related Outcomes

Underlying Shared Constraints

Improving Public Health Through Education

Page 4: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Self-Control/Emotion Regulation Cognitive Abilities – Problem Solving Skills Building Attention and Learning Capacity Healthy relations with

peers and adults Safe, Welcoming, Caring

Classrooms

Resilience Factors that create Well-Being for Children

Page 5: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.
Page 6: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Core Challenge Scope of the Problems in “Rural” Populations

30-Day Cigarette UseU.S. Monitoring the Future Study, 2008 U.S. Monitoring the Future Study, 2008—among 8th-12th graders, 30 day cigarette use

8th Grade 10th Grade 12th Grade0

5

10

15

20

25

30

35

Non-MSA Other MSA

Per

cent

age

Page 7: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

1. Implementing Programs with High Quality and Fidelity

2. Program Integration with Ongoing Programs & Activities

3. Building Sustainability of Programs, Policies, and Practices

Three Research and Practice Challenges that could be

impacted by Effective Community Coalitions

Page 8: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Effective Universal Programs

Social/Emotional Cognitive Violence Prevention Responding in Peaceful

and Positive Ways Interpersonal Cognitive

Problem Solving Promoting Alternative

Thinking Strategies (PATHS)

Increased Social Awareness/Social Problem Solving

Making Choices

Drug/Alcohol Prevention Life Skills Training Project Alert All Stars It Real

Family Focused Intervention Triple P Strengthening Families: 10-14

–Iowa

Ecological School Transition Project Child Development Project Good Behavior Game/Mastery

Learning

Multi-Domain Linking the Interests of

Families and Teachers Seattle Social Development

Project Incredible Years

Page 9: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

What has been Accomplished:

The number of empirically validated (EV) preventive interventions and policies has grown substantially

RCTs have been crucial in legitimizing prevention efforts – although many programs still require independent replication

Reviews of these programs are now widely available

The easy work is done!

Page 10: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Types of Research

Type 1 translational research applies basic science discoveries to

intervention development.

The typical endpoint for Type 1 research is testing of promising new models of prevention to reduce risk and improve health

and well-being.

Type 2 translational research investigates factors, models, and processes associated with the adoption,

implementation, and sustainability of tested and effective prevention programs, policies, and

practices in communities, services

settings, and populations.

Page 11: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

A Focus on Type 2 Translational Research is Key to Examining the Process and

Outcomes of CCs

Type Two Translation is research on factors associated with the adoption and utilization of scientifically validated interventions by service systems.

In the real world, translation of science-based practices often stumble, largely unguided, toward uneven, incomplete and socially disappointing outcomes.

Page 12: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Sustained, quality EBIs

Evaluated-not effective

EBIs

Public Health Impact on Substance Use Requires…

Not Evaluated

Rigorously demonstrated, long-term EBI impact is very rare (Foxcroft et al., 2003).

…greater use of evidence-based interventions (EBIs)

…sustained, quality implementation on a large scale

Page 13: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

What Do We Want?

We want programs that are:

Cost Efficient (affordable)

Teachable (broad scale use)

Sustainable (over time, changing

events)

Page 14: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Effective Programs

Evidence-based programs are most effective when they are implemented with fidelity

Fidelity = the practitioners use all the core intervention components skillfully

Page 15: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Midwestern Prevention Project (MPP)Effects of Fidelity of Implementation

Cigarettes Used in the Last Month (N= 42 Schools*)

13.4% 13.4%

24.3%

15.3%12.2%

22.0%

0%

5%

10%

15%

20%

25%

30%

Perc

ent U

se o

f Cig

aret

tes

Baseline

Year One

Data from Pentz, Trebow, Hansen, MacKinnon, Dwyer, Johnson, Flay, Daniels, & Cormack

*Approximately 5,000 6th and 7th grade students @ baseline and follow-up

Page 16: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Questions About Sustainability and CCs

How can communities institutionalize prevention programming as they do treatment?

What factors can improve the sustainability or “staying power of prevention programming”?

What types of technical assistance do schools, agencies and community leaders need to create systemic change?

Page 17: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.
Page 18: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Creating CC Models to Insure Quality Implementation and Sustainability

1. Communities That Care

2. PROSPER

Page 19: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Sustainability: Definitions

Continuation of a program or policy following adoption; the last stage of implementation.

The incorporation of a change into everyday behaviors and beliefs.

“Making the change stick.” “Doing business in a new way”

Page 20: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Sustainability is a Process

Sustainability is a process. It requires buy-in from end users and leaders who have had sufficient experience to see the program work effectively in their context.

This requires 4-5 years of implementation. Thus, a long-term plan for training and support is essential to more toward sustainability.

Page 21: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Large Scale Diffusion of Research-Based Prevention: The Pennsylvania Experience

Investigators: Collaborative Policy Innovators:Mark Feinberg Clay YaegerMark Greenberg Mike Pennington

Page 22: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Building Community Coalitions

In 1992, PA Commission on Crime and Delinquency (PCCD) chose to use the Communities That Care (CTC) model

Developed by David Hawkins and Richard Catalano Mobilizes local communities by involving “key leaders” Establishes a prevention board to oversee local

prevention assessment, planning and implementation process.

Board develops a long-term prevention plan based on an assessment of risks in the community.

Page 23: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Communities That Care

Prevention Board members undergo a “six-phase training” on the CTC model:

Key Leader Orientation Community Board Orientation

Community Assessment Training Community Resource Assessment

Training

Community Planning Training Community Plan Implementation Training

Page 24: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Why CTC?

Why PCCD chose the CTC model: Community readiness – prepares “fertile

ground” to support a comprehensive community prevention effort before selecting specific programs.

Programming often selected based on the availability of grant funds – we have money so let’s do a program!

CTC turns this approach on its head – identify a need before choosing a program designed to meet that need.

Make sure that chosen program(s) fits with the risks and strengths of each individual community.

Provides a roadmap to ensure that programming leads to specific, measurable positive outcomes in the community.

Page 25: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

PA Communities That Care

First CTC Funding Announcement Released in 1994

Eight CTC Sites were Funded! Some Rural, Some Urban

Created State-Wide Technical Assistance Structure

Divided state into five regions, each with a dedicated Regional Strategic Consultant (RSC) to work proactively with sites

From 1995 - 2002 PCCD funded the start-up of 127 CTC Sites throughout Pennsylvania.

Page 26: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Longitudinal Study

• Used Pennsylvania Youth Survey data from 2001, 2003 and 2005

• Over 231,000 student self-reports

• Stronger design because the earlier waves of data act as a control, allowing examination of within-unit change over time

• Because surveys were anonymous, examined change in school/grade cohorts across time

Page 27: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Longitudinal Sample

Grade 6th 8th 10th 12th Total

Non-CTC 18,116 25,766 25,094 13,726 82,702

CTC 39,988 43,230 38,466 26,996 148,680

Expected Impact (subsample of CTC)

15,917 18,158 15,525 9,721 59,321

TOTAL 58,104 68,996 63,560 40,722 231,382

Year (# schools) 2001 (91)

2003 (154) 2005 (174)

6th 4 5 6

8th 3 4 5

10th 2 3 4

12th 1 2 3

Page 28: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

CTC vs. non-CTCRisk and Protective Factors

Coefficient P-value

Community Cohesion .0037* .008

Community Drugs/Firearms .0029* .031

School Prosocial -.0107* .000

Family Cohesion .021* .02

Family Risk -.085* .001

Antisocial Attitudes -.021* .009

Antisocial Peers -.0128* .023

Page 29: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

CTC vs. non-CTCATOD Use

Coefficient P-value

Alcohol - Frequency of Use -.020 NS

Cigarette - Frequency of Use -.004 NS

Marijuana (past 30 day use) -.017 NS

Grades in Last Year .058* .001

Delinquency -.061* .007

a Frequency of Use statistics are based on a 2-level hierarchical model

Page 30: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Communities that Care

Over 2/3 of CTC sites that received PCCD start-up funding remain active and functioning.

PCCD has created an infrastructure to build and support local coalitions and to ensure they continue to be effective.

Created structure and uniformity in function for all sites assuring that all sites follow the same logic model.

Page 31: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

PA Communities That Care

Four factors predicted sustainability

Quality of Board Functioning (Culture and Leadership)

Fidelity of CTC Implementation

Management of Changing Board Membership

Effective Sustainability Planning

Rural Areas More Likely to Succeed

Page 32: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Program Selection by Type

3327 28

61

0

10

20

30

40

50

60

70

Classroom-based

Community/Mentoring

FamilyPrevention

Family Treatment

Co

un

t

Page 33: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Classroom-based

Community/ Mentoring

Family Prevention

Family Treatment

Across Ages BBBS

Book Lending Library

BSFT

Incredible Years Buddy SystemBrookline Early Int.

Ed.FFT

Know Your Body CASASTART CLFC

MST

Lions Quest CMCA FAST

MTFC

LST Community Policing FDRP TB-CBT

MPP Core Youth After-

school GGC

OBPP Mentoring Parents As Teachers

PATHS PALS Parenting Wisely

Positive ActionParenting Wisely

PDFY

Project Alert QO PFSS

Project Northland Safe Dates PWC

RHC TND SFP

RY

Second Step

STARS

Program Classification

Page 34: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

n=41 grantees off of funding 2 or more years

Program Sustainability

37

24

39

0

10

20

30

40

50

Not Operating Operating atReduced Level

Operating at theSame or Higher

Level

Per

cent

76%

Page 35: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Coalition Connection And Sustainability

67

3643

33

6457

0

10

20

30

40

50

60

70

80

None CTC Other

Per

cen

t

Not Operating

Operating at the Sameor Higher Level

Grantees off of funding 2 or more years

Page 36: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Summary:Sustainability 2-years Post-

funding

School-based prevention programs can be sustained!

Connection to a local prevention coalition, community and school leader support were associated with sustainability

Page 37: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Can we Use Existing Community Systems?

CTC Creates a New System

Can we work with Existing Community Systems to Create a “Home” for

Prevention and its Coordination in Communities?

The Cooperative Extension System!!!!Eureka!

Page 38: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

The PROSPER Project: Promoting School-Community Partnerships

to Enhance Reslience

Richard Spoth, Cleve Redmond, Mark Greenberg, Mark Feinberg

And Many Others!!!!

Page 39: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

PROSPER: a model for the diffusion and support of evidence-based prevention

(Promoting School-community-university Partnerships to Enhance Resilience)

Page 40: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

PROSPER RCT

28 communities, randomly assigned to intervention or delayed wait-list control (14 each – 7 per state)

All Rural School Districts Approximately 11,000 youth across two cohorts Each community selected 1 family-focused and

1 school-based EBI from a menu Provided two years of funding for each program,

match for year three, then only team support

Page 41: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

The Three -Tiered Partnership Model

University/State-Level TeamUniversity Researchers, Extension Program Directors

Prevention Coordinator Team–Extension Prevention Coordinators

Local Community TeamsExtension Agent, Public School Staff,

Social Service Agency Representatives, Parent/Youth Representatives

Page 42: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Making Use of Existing Infrastructures Extension Linked with the Public School Systems

Cooperative Extension System– Largest informal education system in the world– Over 3,150 agents in nearly every county– Science with practice orientation– Horizontal/vertical linkages for effective implementation

Public School System– Universal system reaching nearly all children– States have networks for programming support– Increasing emphasis on accountability/empirical

orientation

Page 43: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

The Core Components: Fundamentals of PROSPER

I. A community-level PROSPER teamII. A three-tiered partnership structure

with proactive technical assistance and ties to a land-grant university

III. Utilization of evidence based programs for middle school youth and families chosen from a menu

IV. High quality program implementationV. Evaluation of program impact & process

Page 44: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

PROSPER Partnership Goals

Positive Youth Development & Strong FamiliesPrevention of Risky Youth BehaviorsQuality administration of programsBuilding Sustainability

PreventionResearchers

ExtensionPersonnel

Public SchoolPersonnel

CommunityCitizens

Page 45: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Findings

Families can be effectively recruited to join these programs

PROSPER sites can implement programs with effectiveness

Significant outcomes are shown for both families and teens

Page 46: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Behavior How Assessed? Mean SD

Lifetime Alcohol Use

Drunk more than a few sips of alcohol? 45.1% 7%

Lifetime Cigarette Use

Smoked a cigarette? 31.9% 9%

12 Month Aggressive Behavior

Beat up someone or physically fought with someone, or thrown objects…to hurt or scare them?

32.7% 5%

12 Month Property

Destruction

Purposely damaged or destroyed property that did not belong to you?

21.3% 5%

Community 8th Grade Data

Page 47: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

PROSPER Substance Initiation Results ─

Diverging Trajectories of Marijuana Use Through 4½ Years Past Baseline

Source: Spoth, Redmond, Greenberg, Shin, et al. (2009). Addressing addiction with community health partnerships and evidence-based intervention: Substance use outcomes 4½ years past baseline. Manuscript in preparation. 

0%

5%

10%

15%

20%

25%

30%

35%

40%

Perc

ent L

ifetim

e U

se

Control

Intervention

Page 48: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Purpose: Improved Child and Family Outcomes

Goal 2: Sustaining Well-

Functioning Teams

Goal 1:Sustaining Growth &

Quality of Programming

Objectives

Effective External Relationships

· Strong ties with schools/aligned community organizations

· Effective communications

Effective Internal Relationships

·Strategic teams with strong participation

·Productive meetings

Evidence-based Family Program

· Delivery to increasing percentage of families

· Quality implementation

Evidence-based School Program

•Delivery to all 7th graders

•Quality implementation

StrategiesConductingEffective, Regular Meetings

Planning forRecognitions

and Rewards

Monitoring Team

Structure &Roles &

Participation

StrengtheningPartnerships with Schools/

Other Organizations

StrategicCommunication

Planning

Community/ School

Positioning

ProgramQuality

Management/Planning

Resource Generation

for Programs

PROSPER Sustainability Model

Page 49: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Sustainability Status

All teams and family programs sustained; 12 of 14 school programs sustained

Combination of short-term and stable funding sources

Teams have institutionalized monitoring of implementation quality/fidelity

Teams continue to use Sustainability Planning Model to guide action plans

Several teams have expanded into neighboring communities

Page 50: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

At Year 5, Teams Sustainability Planning related to

Quality of Board Functioning (Culture and Leadership)

Orientation of New Team Members

Members see more Benefits than Costs in Participation

Page 51: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Illustrative Findings ─Annual Sustainability Funding

2004-5 2005-6 2006-7 2007-8$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$16,457

$7,494

Dollars Raised

In-Kind Contributions

Average per Community = $23,951

Page 52: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Organization

Communities

TA Systems

Program

State Plans

Programs are embedded in systems:

These systems heavily influence implementation and sustainability

Page 53: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Features Specific to Rural Schools and Communities — The Double-

Edge Sword

Schools are the Center of the Community Rural Schools and Communities have had growing problems but

have received much less help on how to use evidence-based models As a result there is an openness to data, ideas, and interventions

Key Leaders are known to each other There are dense social networks that can be strength or challenge!

They are substantially more stable in their roles Fewer people are necessary to co-ordinate and make decisions There is less competition among stakeholders – fewer non-

profits Cooperative Extension –in most communities is trusted and

respected.

Page 54: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Bottom Line: The Challenge

We will continue to see broad dissemination of a growing number of EV prevention programs thru discretionary grant programs

The programs face the challenge of maintaining implementation quality and sustainability

There is a great need to put in place school-community level systems such as CTC and PROSPER to ensure quality implementation and effective and sustainable programming

Page 55: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

Building Systems Integration Across

Institutional StructuresDevelop Community Level Leadership across Schools and Agencies

Educate Leadership regarding Impact of Prevention and need for Cross-Institution Cooperation

Provide Training to Agency Staff, Teachers, and School Support Staff on Prevention Programming

Develop and Showcase Model Communities

Page 56: The Untapped Power of Community-School Based Prevention Mark T. Greenberg Pennsylvania State University.

“If you don’t know where you are going, you will end up

somewhere else”

Lewis Carroll

“Alice in Wonderland”

Clear Goals