International Standards for Drug Use Prevention International Standards for Drug Use Prevention Vienna, Austria Vienna, Austria January 24, 2012 January 24, 2012 Using Prevention Science for Using Prevention Science for Community Mobilization Community Mobilization Richard F. Catalano, Ph.D. Richard F. Catalano, Ph.D. Bartley Dobb Professor for the Study and Prevention of Violence Bartley Dobb Professor for the Study and Prevention of Violence Director, Social Development Research Group Director, Social Development Research Group School of Social Work School of Social Work University of Washington University of Washington www.sdrg.org www.sdrg.org
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International Standards for Drug Use PreventionInternational Standards for Drug Use Prevention
Vienna, AustriaVienna, Austria
January 24, 2012January 24, 2012
Using Prevention Science for Using Prevention Science for Community MobilizationCommunity Mobilization
Richard F. Catalano, Ph.D.Richard F. Catalano, Ph.D.
Bartley Dobb Professor for the Study and Prevention of ViolenceBartley Dobb Professor for the Study and Prevention of Violence
Director, Social Development Research GroupDirector, Social Development Research Group
School of Social WorkSchool of Social Work
University of WashingtonUniversity of Washington
www.sdrg.orgwww.sdrg.org
Universal
Selective
Indicated
Case
Identific
ation
Standard Treatment for
Known Disorders
Compliance with long-
term treatment (goal:
reduction in relapse and
recurrence)
After-car
e (including
rehabilita
tion)
Source: Institute of Medicine (2009). Preventing Mental, Emotional and
Behavioral Disorders Among Young People. O’Connell, Boat & Warner
(eds.) Washington DC: National Academy Press
Intervention Spectrum
Prevention
Prevention
Prevention
Prevention
TreatmentTreatmentTreatmentTreatmentMaintenance
Maintenance
Maintenance
Maintenance
Promotion
Define the Problem
Define the Problem
Identify Riskand Protective
Factors
Identify Riskand Protective
Factors
InterventionsInterventions
Program Implementation
and Evaluation
Program Implementation
and Evaluation
Public Health FrameworkPublic Health Framework
Problem Response
Risk Factors forRisk Factors for
Adolescent Problem BehaviorsAdolescent Problem Behaviors
����������Extreme Economic Deprivation
������Low Neighborhood Attachment and
Community Disorganization
��������Transitions and Mobility
��Media Portrayals
������Community Laws and Norms Favorable
Toward Drug Use, Firearms, and Crime
����Availability of Firearms
����Availability of Drugs
Community
Depression &
Anxiety
Violence
School Drop-Out
Teen Pregnancy
Delinquency
Substance Abuse
Risk Factors
��
Risk Factors for Risk Factors for
Adolescent Problem BehaviorsAdolescent Problem Behaviors
������Favorable Parental Attitudes and
Involvement in the Problem Behavior
������������Family Conflict
������������Family Management Problems
������������Family History of the Problem Behavior
FamilyFamily
Depression &
Anxiety
Violence
School Drop-Out
Teen Pregnancy
Delinquency
Substance Abuse
Risk Factors
Risk Factors for Risk Factors for
Adolescent Problem BehaviorsAdolescent Problem Behaviors
����������Lack of Commitment to School
������������Academic Failure Beginning in Late
Elementary School
SchoolSchool
Depression & Anxiety
Violence
School Drop-Out
Teen Pregnancy
Delinquency
Substance Abuse
Risk Factors
Risk Factors for Risk Factors for
Adolescent Problem BehaviorsAdolescent Problem Behaviors
��������Constitutional Factors
����������Early Initiation of the Problem Behavior
��������Favorable Attitudes Toward the Problem
Behavior
����������Friends Who Engage in the Problem
Behavior
������Rebelliousness
������������Early and Persistent Antisocial Behavior
Individual/Peer
Depression &
Anxiety
Violence
School Drop-Out
Teen Pregnancy
Delinquency
Substance Abuse
Risk Factors
Protective FactorsProtective 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
– Healthy Beliefs and Clear Standards
Communities Vary in Risk ExposureCommunities Vary in Risk Exposure
Risk and Protective FactorsRisk and Protective Factors
�� Both level of risk and level of protection Both level of risk and level of protection make a difference in predicting substance make a difference in predicting substance use and other problems use and other problems
�� Common risk and protective factors predict Common risk and protective factors predict substance use and other problemssubstance use and other problems
�� Risk and protective factors show much Risk and protective factors show much consistency in effects across diverse consistency in effects across diverse groups and cultures groups and cultures (Beyers et al., 2004; Glaser et al., (Beyers et al., 2004; Glaser et al., 2005; Hemphill et al., 2011; Solomon et al., 2011; Oesterle et a2005; Hemphill et al., 2011; Solomon et al., 2011; Oesterle et al., l., 2011) 2011)
�� Risk/protection vary by communityRisk/protection vary by community
5.5. Mentoring with Contingent Mentoring with Contingent ReinforcementReinforcement
6.6. Youth Employment with Youth Employment with EducationEducation
7.7. Organizational Change in Organizational Change in SchoolsSchools
8.8. Classroom Classroom Organization, Organization, Management, and Management, and Instructional StrategiesInstructional Strategies
9.9. School Behavior School Behavior Management StrategiesManagement Strategies
10.10. Classroom Curricula for Classroom Curricula for Social Competence Social Competence PromotionPromotion
11.11. Community & School Community & School PoliciesPolicies
12.12. Community Community MobilizationMobilization
Summary of Benefits and Costs (2003Summary of Benefits and Costs (2003 DollarsDollars))Dollars Per Youth (PV lifecycle)Dollars Per Youth (PV lifecycle) BenefitsBenefits CostsCosts B B -- CC
Early Childhood Education $17,202 $7,301 $9,901
Nurse Family Partnership $26,298 $9,118 $17,180
Seattle Soc. Development Project $14,246 $4,590 $9,837
Life Skills Training $746 $29 $717
Guiding Good Choices $7,605 $687 $6.918
Strengthening Families Program 10-14 $6,656 $851 $5,805
Teen Outreach Program $801 $620 $181
Some Prevention Programs Have Some Prevention Programs Have
Demonstrated Benefit over CostDemonstrated Benefit over Cost
Steve Aos, Associate DirectorSteve Aos, Associate Director
Washington State Institute for Public PolicyWashington State Institute for Public Policy
�� How can we increase use of tested How can we increase use of tested
and effective prevention policies and and effective prevention policies and
programsprograms……
while recognizing that communities while recognizing that communities
are different from one another and are different from one another and
need to decide locally what policies need to decide locally what policies
and programs they use? and programs they use?
Why Community Mobilization Why Community Mobilization
to Prevent Substance Use?to Prevent Substance Use?
�� Risk/protective factors located in community, Risk/protective factors located in community,
family, school, peer and individualfamily, school, peer and individual
�� Risk/protection vary by neighborhoodRisk/protection vary by neighborhood
�� Community coalitions representing multiple Community coalitions representing multiple
sectors of influence can coordinate multiple sectors of influence can coordinate multiple
resources and actionsresources and actions
�� Community coalitions may be more likely to Community coalitions may be more likely to
reach all children and youth and may have reach all children and youth and may have
population wide effectpopulation wide effect
Ineffective Preventive Community Ineffective Preventive Community
Mobilization ApproachesMobilization Approaches
Providing resources to support community Providing resources to support community coalitions without a structure or processcoalitions without a structure or process
Sources of failure Sources of failure (Hallfors et al. 2002; (Hallfors et al. 2002; Klerman et al. 2005; Klerman et al. 2005; Merzel & D'Afflitti, 2003):Merzel & D'Afflitti, 2003):
–– Lack of clearly defined goals based in data, with highLack of clearly defined goals based in data, with high--quality data sources to monitor progress; quality data sources to monitor progress;
–– Lack of use of tested and effective programs, Lack of use of tested and effective programs,
–– Inattention to monitoring of implementation quality Inattention to monitoring of implementation quality and fidelity;and fidelity;
Effective Preventive Community Effective Preventive Community
Mobilization ApproachesMobilization Approaches
�� CMCACMCA--Communities Mobilizing for Change on Alcohol Communities Mobilizing for Change on Alcohol
((no effect under age 18no effect under age 18) (Wagenaar et al., 2000)) (Wagenaar et al., 2000)
�� CTICTI--Community Trials Intervention to reduce high risk Community Trials Intervention to reduce high risk
drinking (drinking (no effect under age 18no effect under age 18) (Holder et al., 2000)) (Holder et al., 2000)
�� Project NorthlandProject Northland (Perry et al., 2002)(Perry et al., 2002)
�� MPPMPP--Midwest Prevention Project Midwest Prevention Project –– (Pentz et al., 2006)(Pentz et al., 2006)
�� KIKI--Kentucky Incentives for prevention (Collins et al., Kentucky Incentives for prevention (Collins et al.,
2007)2007)
� PROSPER-Promoting school–community -university partnerships to enhance resilience (Spoth et al., 2007)
� CTC-Communities that Care (Hawkins et al., 2009; 2011; Feinberg et al., 2007)
Elements of Effective Elements of Effective
Community Mobilizization to Community Mobilizization to
Prevent Substance UsePrevent Substance UseCross-sector Community Mobilizing Program
Assess and Prioritize Risk and Protective Factors
Efficacious school prevention curriculum
Other efficacious preventive programs
Change norms and laws
CMCA Norms, laws, availability
CTI Norms, laws, availability
Project Northland
Norms, peers, family norms
MPP Norms, peers, family norms
KI Comprehensive
PROSPER No
CTC Comprehensive
Characteristics of Effective Characteristics of Effective
Coalitions with Impact on YouthCoalitions with Impact on Youth
�� Goals clearly defined, and manageableGoals clearly defined, and manageable
�� Planning time adequatePlanning time adequate
�� Prioritization based on local data about Prioritization based on local data about
community levels of risk, protectioncommunity levels of risk, protection
�� Prevention actions employed have Prevention actions employed have
evidence of efficacy from controlled trialsevidence of efficacy from controlled trials
�� Prevention actions monitored to ensure Prevention actions monitored to ensure
implementation quality implementation quality
An Example: CAn Example: Communities That Care ommunities That Care
Creating
Communities
That Care
Get Started
Get Organized
Develop a ProfileCreate a Plan
Implement andEvaluate
• Community readiness assessment.
• Identification of key
individuals, stakeholders,
and organizations.
The CThe Communities That Care ommunities That Care Operating SystemOperating System
Creating
Communities
That Care
Get Started
Get Organized
Develop a ProfileCreate a Plan
Implement andEvaluate
• Training key leaders
and board in CTC
• Building the
community coalition.
The CThe Communities That Care ommunities That Care Operating SystemOperating System
Creating
Communities
That Care
Get Started
Get Organized
Develop a ProfileCreate a Plan
Implement andEvaluate
• Collect risk/protective factor and outcome
data with CTC survey.
• Construct a
community profile from the data.
The CThe Communities That Care ommunities That Care Operating SystemOperating System
Creating
Communities
That Care
Get Started
Get Organized
Develop a ProfileCreate a Plan
Implement andEvaluate
• Define outcomes.
•Prioritize risk factors to be
targeted.
• Select tested, effective
interventions.• Create action plan.
• Develop evaluation plan.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Communityopportunities for
prosocialinvolvement
Communityrecognition for
prosocialinvolvement
FamilyAttachment
Familyopportunities for
prosocialinvolvement
Familyrecognition for
prosocialinvolvement
Schoolopportunities for
prosocialinvolvement
Schoolrecognition for
prosocialinvolvement
Social skills Belief in themoral order
OverallProtection
Pe
rce
nt P
rote
cte
dProtective Profile 10th Grade
School 2002 District 2002
Community Family School
Estimated National Value
Survey Participation Rate 2002: 79.7%
Peer-Individual Overall
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pe
rce
nt A
t R
isk
Risk Profile 10th Grade
School 2002 District 2002
Community Family School
Estimated National Value
Survey Participation Rate 2002: 79.7%
Peer-Individual
Protective Factors
Risk Factor Addressed Program Strategy
Healthy
Beliefs
& Clear
Standards
Bonding Opport. Skills Recog.Developmental
Period
Family Therapy � � � � � 6-14
Classroom Curricula for Social Competence
Promotion� � � � � 6-14
School Behavior Management Strategies � � � 6-14
Afterschool Recreation � � � � � 6-10
Mentoring with Contingent Reinforcement � � � 11-18
Rebelliousness
Youth Employment with Education � � � � � 15-18
Parent Training � � � � � 6-14
Classroom Curricula for Social Competence
Promotion� � � � � 6-14
Afterschool Recreation � � � � � 6-14
Friends Who Engage in the
Problem Behavior
Mentoring with Contingent Reinforcement � � � 11-18
Classroom Curricula for Social Competence
Promotion� � � � � 6-14Favorable Attitudes
Toward the Problem
Behavior Community/School Policies
Parent Training � � � � � 6-14
Classroom Organization Management and
Instructional Strategy� � � � � 6-10
Classroom Curricula for Social Competence � � � � � 6-14
Strengthening Families Program (SFP) 10-14 2 3 3 2
Guiding Good Choices (GGC) 6 7* 8* 7
Parents Who Care (PWC) 1 1 - -
Family Matters 1 1 2 2
Parenting Wisely - 1 1 2
TOTAL 27 38 37 37
*Program funded through local resources in one or two communities
Prevalence of 30 Day Alcohol Use Prevalence of 30 Day Alcohol Use
by Number of Risk and Protective Factorsby Number of Risk and Protective Factors
Six State Student Survey of 6th-12th Graders, Public School
Students
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 to 1 2 to 3 4 to 5 6 to 7 8 to 9 10+
Number of Risk Factors
Pre
va
len
ce
0 to 1
2 to 3
4 to 5
6 to 7
8 to 9
Number of
Protective Factors
Prevalence of Illicit Drug Use (Past 30 Days)Prevalence of Illicit Drug Use (Past 30 Days)
By Number of Risk and Protective FactorsBy Number of Risk and Protective Factors
Six State Student Survey of 6th - 12th Graders,Six State Student Survey of 6th - 12th Graders,Six State Student Survey of 6th - 12th Graders,Six State Student Survey of 6th - 12th Graders,
Public School StudentsPublic School StudentsPublic School StudentsPublic School Students
0%0%0%0%
10%10%10%10%
20%20%20%20%
30%30%30%30%
40%40%40%40%
50%50%50%50%
60%60%60%60%
70%70%70%70%
80%80%80%80%
90%90%90%90%
100%100%100%100%
0 to 10 to 10 to 10 to 1 2 to 32 to 32 to 32 to 3 4 to 54 to 54 to 54 to 5 6 to 86 to 86 to 86 to 8 9 or More9 or More9 or More9 or More
Number of Risk FactorsNumber of Risk FactorsNumber of Risk FactorsNumber of Risk Factors
Prevalence
Prevalence
Prevalence
Prevalence
0 to 10 to 10 to 10 to 1
2 to 32 to 32 to 32 to 3
4 to 54 to 54 to 54 to 5
6 to 86 to 86 to 86 to 8
Number of Number of Number of Number of
ProtectiveProtectiveProtectiveProtective
Factors Factors Factors Factors
Prevalence of Other ProblemsPrevalence of Other Problems
by Number of Risk Factorsby Number of Risk Factors
0
10
20
30
40
50
0-1 2-3 4-6 7-9 >=10
Risk factors
%
depressive
symptomatology
deliberate self harm
homelessness
early sexual activity
Bond, Thomas, Toumbourou, Patton, and Catalano, 2000
Number of School Building Risk Number of School Building Risk
Factors and Probability of Meeting Factors and Probability of Meeting
WASL Standard (10WASL Standard (10thth Grade Students)Grade Students)
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Number of Risk Factors
Probability of Meeting Standard
Math Reading WritingArthur et al., 2006
Number of School Building Protective Number of School Building Protective
Factors and Probability of Meeting Factors and Probability of Meeting
WASL Standard (10WASL Standard (10thth grade students) grade students)
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0 1 2 3 4 5 6 7
Number of Protective Factors
Probability of Meeting Standard
Math Reading WritingArthur et al., 2006
CTC Youth SurveyCTC Youth Survey
�� Identifies levels of 21 risk and 9 Identifies levels of 21 risk and 9
protective factors and academic and protective factors and academic and
behavioral outcomesbehavioral outcomes
�� Guides planners to select tested, effective Guides planners to select tested, effective
actions actions
�� Monitors the effects of chosen actions Monitors the effects of chosen actions
Effects of CTC on Cigarette Use Effects of CTC on Cigarette Use
Initiation Maintained Through Initiation Maintained Through
Grade 10Grade 10
4646
AOR = .55 , p=.003(in 8th grade)
AOR = .54 , p=.006(in 10th grade)
Note: AOR = adjusted odds ratio from multilevel discrete time survival analysis controlling for student and community characteristics. (Hawkins et al., 2011)
Effects of CTC on Alcohol Use Effects of CTC on Alcohol Use
Initiation Maintained Through Initiation Maintained Through
Grade 10Grade 10
4747
AOR = .62 , p=.028(in 10th grade)
Note: AOR = adjusted odds ratio from multilevel discrete time survival analysis controlling for student and
community characteristics. (Hawkins et al., 2011)
Effects of CTC on Delinquent Behavior Effects of CTC on Delinquent Behavior
Initiation Maintained Through Grade Initiation Maintained Through Grade
1010
4848
AOR = .79 , p=.033(across grades 5-10)
Note: AOR = adjusted odds ratio from multilevel discrete time survival analysis controlling for student and community
characteristics. (Hawkins et al., 2011)
Effects of CTC on Current Drug Effects of CTC on Current Drug
Use and Delinquency in the Panel Use and Delinquency in the Panel
at Grade 8at Grade 8
–– 23% less likely to drink alcohol currently 23% less likely to drink alcohol currently
than controls. than controls.
–– 37% less likely to 37% less likely to ““bingebinge”” (5 or more drinks (5 or more drinks
in a row) than controls.in a row) than controls.
–– Committed 31% fewer different delinquent Committed 31% fewer different delinquent
acts in past year than controls acts in past year than controls