Building a Community-Based Implementation System for Prevention
In Parts 1 and 2 of this series we described having a culture of prevention in place to support evidence-based prevention programming and what it means to have a ‘ready’ community in which an implementation system can be created to support comprehensive prevention programs to address community needs. Part 3 will focus on the structure and function of this implementation system.
What are the components of a Community Implementation System?
When we talk about community implementation systems we are talking about:
Community mobilization, including team organization and capacity building
Evidence-Based Interventions/Policies selection/adoption, guided by needs and resource assessments of the community
Quality implementation of EBIs
Sustained implementation of EBIs.
In prior Nuggets, we discussed a multilevel developmental approach to the prevention of substance use. In this context we addressed two issues of importance:
The age of initiation of substance use, generally in early to mid-adolescence, and,
Factors that increase the likelihood of substance use or other problem behaviors and how they are related to the interface between individuals’ vulnerability and their micro- and macro-level environments
As indicated by this approach, when prevention professionals plan preventive interventions, they need to consider targeting children, adolescents, and adults through their micro- and macro-level environments. In most situations, only one or two prevention interventions or policies are implemented, at only the micro- or macro-level. This approach to prevention programming is quite limited and will not have a population or community-wide impact.
In an ideal situation, evidence-based prevention interventions and policies would be implemented with multiple interventions at both micro- and macro-levels, and basic phases of teams supporting those intervention. So, interventions would be delivered in both micro- and macro-level environments, depending on the extent of substance use within a community.
The power of these multiple interventions and policies, addressing family/schools/workplace/community-related influences, could greatly impact the numbers of community residents who would initiate substance use or engage in other behaviors that affect their social and physical health. However, such a ‘system’ of services requires coordination.
That is where a community-based prevention implementation system plays an important role. Prevention scientists have been thinking of how to best conceptualize this implementation system. They developed a framework called the Translation Science Impact Framework. As you will see, basically, this means describing what needs to be in place to develop a prevention plan that has the best potential to impact substance use within a community. The phased approach addresses a process for developing community teams to implement and monitor this plan but also addresses the need for a support structure to maintain the plan and to address the many barriers that can block the plan at any point in its progress.
The community team is the cornerstone of a community-based prevention-oriented system. It serves the purpose of focusing community-based efforts on prevention goals. The point of building an implementation system is to organize a comprehensive prevention interventions and policies in the community that considers all domains of influences on substance use or abuse (family, school, community, workplace and health) across all stages of human development, as guided by needs/resource assessments and related goal setting. Many different sectors of the community must align to build a comprehensive prevention system. And many of the sectors of the community that are represented in this prevention system are links to other community-based systems, such as social service systems.
The process of developing a community-based prevention system is complicated. In fact APSI in coordination with researchers who have developed and tested comprehensive community based implementation systems, has developed a training to help prevention professionals on how to develop community systems in a way that builds on existing efforts and uses them to create a comprehensive prevention approach. So, by building a community team that draws members from key organizations in the community, no one is re-inventing the wheel and collaboration is a key element of building sustainable structures.
And many of the sectors of the community that are represented in this prevention system are links to other community-based systems, such as social service systems.
The process of developing a community-based prevention system is complicated. In fact APSI in coordination with researchers who have developed and tested comprehensive community based implementation systems, has developed a training to help prevention professionals on how to develop community systems in a way that builds on existing efforts and uses them to create a comprehensive prevention approach. So, by building a community team that draws members from key organizations in the community, no one is re-inventing the wheel and collaboration is a key element of building sustainable structures.
For example, this graphic shows a community-based team that includes representation from other community-based, prevention-related systems such as health, social services, law enforcement, faith-based groups, and education. Community representatives’ participation on the team not only links the team to the community but also to the systems which they represent. The sector or group represented by each team member’s agency or organization supports the prevention-focused system in the community. When well connected to stakeholder sectors, the team can influence the work of these other systems and their support can benefit the work of the team. And, if these community-connected systems are tied to larger regional or national systems, the interactions of the team can affect these larger entities and can create the potential to influence or build an even larger system or network to support prevention.
How can Community Coalitions/Partnerships help build community implementation systems?
This graphic shows in general, what a community-based prevention implementation system would look like. The Team would consist of at least two major groups: a working central team with a permanent leader, staff to maintain and community representatives to monitor the work of the Coalition/Partnership and at least one advisory group that is composed of Key Stakeholders including representatives those we saw in the prior slides representing both the formal and informal community “power structures” and representatives of the community target populations.
There are two evidence-based approaches/models to forming community implementation systems to support prevention programming: Communities That Care (CTC) and PROmoting School-community-university Partnerships to Enhance Resilience (PROSPER). We select these models as they not only are considered Evidence-Based implementation systems, but although they share the same structures, they differ in many ways. We mentioned that communities are more different than they are alike. Here we have alternatives that could meet the needs of a variety of communities.
What are examples of effective coalition processes?
The PROSPER model works well in moderately ready communities and was designed primarily for rural areas. It is more dependent on using the U.S. Extension Service of the Department of Agriculture and of U.S. Department of Education. This model works well for areas with limited services. PROSPER builds on schools to reach children and families.
The Communities That Care model works well in a variety of communities that may have more extensive services. It is broader in scope, but again dependent on available services and resources.
It is also important to note that there are other systems that address similar behavioral health outcomes such as the Community Anti-Drug Coalitions of America (CADCA), Getting To Outcomes and Evidence2Success but to date none they have NOT been evaluated using a rigorous, multi-year longitudinal randomized control trial. There is some promising research that is accumulating for these other models but none that reaches ‘evidence-based’ criteria.
References
Information on these other community-based implementation systems can be found on these websites:
· Communities That Care: https://www.communitiesthatcare.net/
· PROmoting School-community-university Partnerships to Enhance Resilience (PROSPER): https://prosper.ppsi.iastate.edu/
· Getting To Outcomes: www.rand.org/health/projects/getting-to-outcomes.html
· Evidence2Success: www.aecf.org/work/evidence-based-practice/evidence2success
· Community Anti-Drug Coalitions of America (CADCA): www.cadca.org/resources
Readings:
Chilenski, S.M., Frank, J., Summers, N., & Lew, D. (2019). Public health benefits 16 years after a statewide policy change: Communities That Care in Pennsylvania. Prevention Science, 20(6), 947-958.
Hawkins, J. D., Oesterle, S., Brown, E. C., Monahan, K. C., Abbott, R. D., Arthur, M. W., & Catalano, R. F. (2012). Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial. Archives of Pediatrics & Adolescent Medicine, 166(2), 141-148.
Spoth, R., Redmond, C., Shin, C., Greenberg, M., Feinberg, M., & Schainker, L. (2013). PROSPER community-university partnerships delivery system effects on substance use through 6½ years past baseline from a cluster randomized controlled intervention trial. Preventive Medicine, 56, 190-196.
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