The Community Youth Development Study: Testing Communities That Care Funded by: National Institute...

The Community Youth The Community Youth Development Study:Development Study:

Testing Communities That CareTesting Communities That Care

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

The Community Youth The Community Youth Development Study: Project StaffDevelopment Study: Project StaffJ. David Hawkins, Ph.D.J. David Hawkins, Ph.D.Principal Investigator

Richard F. Catalano, Ph.D. Richard F. Catalano, Ph.D. Co-Investigator

Michael W. Arthur, Ph.D. Michael W. Arthur, Ph.D. Co-Investigator

Kevin Haggerty, MSW Kevin Haggerty, MSW Co-Investigator

Rose Quinby, MSWRose Quinby, MSWProject Director

Barb McMorris, Ph.D.Barb McMorris, Ph.D.NL Project Director

Abby Fagan, Ph.D. Abby Fagan, Ph.D. Intervention Specialist

Blair Brooke-Weiss, MPH Blair Brooke-Weiss, MPH Intervention Specialist

Rick CadyRick CadyIntervention Specialist

Robert Abbott, Ph.D.Robert Abbott, Ph.D.Statistical Consultant

David Murray, Ph.D.David Murray, Ph.D.Statistical Consultant

Eric Brown, Ph.D.Eric Brown, Ph.D.Research Analyst

Beth Egan, Ph.D.Beth Egan, Ph.D. Research Analyst

John BrineyJohn Briney Data Manager

Koren Hanson, M.A. Koren Hanson, M.A. Data Manager

Renee PetrieRenee Petrie Data Operations Unit Director

Out of 12 community based Out of 12 community based coalitions, how many produced coalitions, how many produced

positive outcome ofpositive outcome of reduced reduced youth substance use?youth substance use?

0

Berkowitz, 2001; Halfors, 2002

What works?What works?Findings on Findings on

Coalition EffectivenessCoalition EffectivenessHallfors et al., made these recommendations : Hallfors et al., made these recommendations :

1. Clearly defined, focused and manageable 1. Clearly defined, focused and manageable goals & outcomes based on high quality goals & outcomes based on high quality data sources. data sources.

2. Evidence based programs should be 2. Evidence based programs should be encouraged with careful attention to dose encouraged with careful attention to dose and quality. and quality.

3. Evaluation of impact needed. Select 3. Evaluation of impact needed. Select outcomes & goals meaningful to communityoutcomes & goals meaningful to community. .

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



That Care

Get Started

Get Organized



• Community readiness assessment.

• Identification of key individuals, stakeholders,

and organizations.



That Care

Get Started

Get Organized



• Training key leaders and board in CTC

• Building the community coalition.



That Care

Get Started

Get Organized



• Collect risk/protective factor and outcome data.

• Construct a community profile

from the data.



That Care

Get Started

Get Organized



• Define outcomes.•Prioritize risk factors to be

targeted.• Select tested, effective

interventions.• Create action plan.

• Develop evaluation plan.



That Care

Get Started

Get Organized



• Form task forces.• Identify and train

implementers.• Sustain collaborative

relationships.• Evaluate processes and

outcomes.• Adjust programming.

The Community Youth The Community Youth Development Study Development Study

(CYDS)(CYDS)

A randomized controlled trial to test A randomized controlled trial to test the effects of the Communities that the effects of the Communities that Care system.Care system.

CYDS Primary AimCYDS Primary Aim

To test the effectiveness of the Communities To test the effectiveness of the Communities That Care (CTC) system in reducing levels That Care (CTC) system in reducing levels of risk, increasing levels of protection, and of risk, increasing levels of protection, and reducing health and behavior problems in reducing health and behavior problems in early adolescence.early adolescence.

Study Design

Randomize

5-Year Baseline

1997-2002

Randomized Controlled Trial

2003-2008

98 99 ‘00 ‘01 ‘02

SS SS SS

CKICRD

CKICRD

2003 2004 2005 2006 2007 2008

Control

Intervention

SSSS

SSSS

CKICRD

CKICRD

CKICRD

CKICRD

Panel Panel Panel Panel

Planning

Implement selected interventions

Evaluate

SS

SS

Panel

CTCBoar

d

CTCBoar

d

CTCBoar

d

CTCBoar

d

CTCBoar

d

Panel Panel Panel PanelPanel

Demographics of 24 Study Demographics of 24 Study Communities from 7 States Communities from 7 States

Mean Minimum Maximum

Total Population 14,616 1,578 40,787

Percent Caucasian 89.4% 64.0% 98.2%

Percent Hispanic Origin

Percent African-Amer.

Percent Eligible for Free/Reduced Lunch

9.6%

2.6%

36.5%

0.5%

0.0%

20.6%

64.7%

21.4%

65.9%

1010thth Grade Drug Use Prevalence in CYDS Grade Drug Use Prevalence in CYDS and Monitoring The Future and Monitoring The Future

20022002

CYDS MTF

30-Day Cigarette 20.0 17.7

30-Day Alcohol 38.4 35.4

Binge Drinking 23.5 22.4

30-Day Marijuana 21.5 17.8

CTC ImplementationCTC Implementation

1.1. Training:Training: Six events in each community with Six events in each community with refresher trainings as neededrefresher trainings as needed

2.2. Coordinators:Coordinators: One full time in each community One full time in each community3.3. CTC Manuals:CTC Manuals: For each phase training; For each phase training;

Milestones & Benchmarks are includedMilestones & Benchmarks are included..4.4. Technical Assistance – Technical Assistance – SDRG intervention SDRG intervention

specialist weekly calls to specialist weekly calls to 5.5. ResourcesResources - - To implement To implement selected tested, effective programs --$75,000 selected tested, effective programs --$75,000

per for each communityper for each community

CYDS Progress: What are CYDS Progress: What are interim signs of success?interim signs of success?

1.1. High fidelity implementation High fidelity implementation a. The CTC system a. The CTC system b. Prevention programs that are proven to workb. Prevention programs that are proven to work

2.2. Results from participant evaluations Results from participant evaluations moving in the expected directionmoving in the expected direction

3.3. Fair to good exposure to programs Fair to good exposure to programs (Goal: involve a substantial proportion of (Goal: involve a substantial proportion of target populations so we’ll see target populations so we’ll see community-wide effects)community-wide effects)


1.1. High fidelity implementation High fidelity implementation a. The CTC systema. The CTC system b. Prevention programs that are proven to workb. Prevention programs that are proven to work



Implementation FidelityImplementation Fidelity

What is ‘implementation fidelity’? What is ‘implementation fidelity’? Replicating programs with integrity to their Replicating programs with integrity to their

core components and theoretical framework.core components and theoretical framework. Why is it important?Why is it important?

Verifies that the selected program is, in fact, Verifies that the selected program is, in fact, being implementedbeing implemented

Increases the likelihood of achieving the Increases the likelihood of achieving the results found in the original evaluations.results found in the original evaluations.

Implementing CTC with FidelityImplementing CTC with Fidelity

Assessed as the proportion of achieved CTC Assessed as the proportion of achieved CTC Milestones and Benchmarks (goals, steps, Milestones and Benchmarks (goals, steps, actions, and conditions)actions, and conditions)

Phase 1: Getting StartedPhase 1: Getting Started Milestone: The community is ready to begin CTCMilestone: The community is ready to begin CTC

Benchmark: A Key Leader “Champion” has been identified Benchmark: A Key Leader “Champion” has been identified to guide the CTC processto guide the CTC process

Phase 2: Getting OrganizedPhase 2: Getting Organized Milestone: Key Leaders have been engagedMilestone: Key Leaders have been engaged

Benchmark: A Key Leader Orientation has been held Benchmark: A Key Leader Orientation has been held

CTC Implementation FidelityCTC Implementation Fidelity

Conclusion: CTC implementation during the first 18 months of CYDS was very high

PhasePhase % of Milestones Completed % of Milestones Completed

Across Communities & RatersAcross Communities & Raters 1—Getting Started1—Getting Started 91.5%91.5%

2—Organizing, Introducing, 2—Organizing, Introducing,

Involving.Involving. 99%99%

3—Developing a community 3—Developing a community profileprofile

100%100%

4—Creating a community 4—Creating a community Action Plan Action Plan

98.5%98.5%

Community ratings on Community ratings on four most difficult (challenging) four most difficult (challenging)

milestonesmilestones

Milestone/ Benchmark

% Rating Milestone as

“Mostly” or “Very Challenging”*

Average Challenge Score

(1 = high challenge)

Average Implementation

Score (1 = high

implementation)

1.4 Community readiness issues have been analyzed and either addressed, or a plan for addressing them has been developed. 58.3% 1.86 2.07

1.43 An action plan for addressing outstanding readiness issues has been developed 83.3% 1.70 2.10

3.2 Community assessment information has been collected and prepared for prioritization. 2.00 1.00

3.23 CTC Youth Survey and archival data has been prepared for prioritization

50.0% 1.83 1.00

4.1 The Community Board has the capacity to create a focused community action plan. 1.60 1.73

4.12 All stakeholders whose support is required have been engaged

83.3% 1.60 2.30

4.4 Implementation plans for each program, policy or practice to be implemented have been developed. 50.0% 1.92 1.13

4.43 Resources required to implement each new program, policy or practice have been identified 66.6% 1.75 1.38

Community Board InterviewCommunity Board Interview

What is it? – A yearly interview with a What is it? – A yearly interview with a sample of 15-20 Board members.sample of 15-20 Board members.

Main goal of 2005 interview: Main goal of 2005 interview: to learn more to learn more about internal operation and efficiency of about internal operation and efficiency of the Board--the Board--

Your Board development plan is based in Your Board development plan is based in part on this data.part on this data.

CTC Community BoardsCTC Community BoardsA

vera

ge

Sc

ore

on

1-4

Sc

ale

CTC Board Functioning

3.2

3.5

3.2 3.2

3.4 3.4

3.1

3.8

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Board Directedness Board Cohesion Board Efficiency Board Conflict Resolution

Community Y 2004 Community Y 2005 All 12 Communities 2005

CTC Community BoardsCTC Community BoardsA

vera

ge

Sc

ore

on

1-4

Sc

ale

Level of Community Involvement in CTC

2.3

1.8

2.8

3.3

2.2

2.7

3.1

2.2

1.9

1.5

3.1

2.7

2.4

1.9

2.9

2.7 2.7

2.22.2

2.9

2.12.2

2.6

1.6

2.7

3.3

1.0

1.5

2.0

2.5

3.0

3.5

4.0

ElectedCommunity

Leaders

Parents Teachers andStaff

School DistrictAdmin

Social ServiceProviders

Students BusinessLeaders

FaithCommunity

Leaders

LawEnforcement

MediaRepresentatives

RecreationOfficials

CommunityVolunteers

OtherCommunityMembers

Port Angeles 2004 Port Angeles 2005 Combined Communities

Perceived Impact of CTC in the Perceived Impact of CTC in the CommunityCommunity

4.1

3.43.9 3.9 4.03.94.1 4.1

1

2

3

4

5

Quality of local programs Level of systematic andcomprehensive school-community planning

Extent to which the schooland community partners

work together oncollaborative projects

Well-being of people in ourcommunity

Aver

age o

n sc

ale o

f 1 (A

Lot

Wor

se) t

o 5

(A L

ot B

ette

r)

.

Community X compared to all 12 communities (shown by the dot)

Perceived Barriers to CTC Perceived Barriers to CTC ImplementationImplementation

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0% XXX 2005

XXX 2004

All communities


1.1. High fidelity implementationHigh fidelity implementation a. The CTC system a. The CTC system b. b. Prevention programs that are proven to workPrevention programs that are proven to work



Programs Implemented Programs Implemented July 2004 – June 2005July 2004 – June 2005

PROGRAMPROGRAM COMMUNITYCOMMUNITY CYCLESCYCLES

All Stars Core All Stars Core 11 11

Life Skills TrainingLife Skills Training 22 55 Lion’s-Quest Skills for AdolescenceLion’s-Quest Skills for Adolescence 22 22 Program Development Evaluation TrainingProgram Development Evaluation Training 11 11

Participate and Learn Skills (PALS)Participate and Learn Skills (PALS) 11 33 Big Brothers/Big SistersBig Brothers/Big Sisters 22 22

Stay SMARTStay SMART 33 99

TutoringTutoring 33 1111 Valued Youth Tutoring ProgramValued Youth Tutoring Program 11 33

Strengthening Families 10-14Strengthening Families 10-14 22 1515

Guiding Good ChoicesGuiding Good Choices 66 3838 Parents Who CareParents Who Care 11 33 Family MattersFamily Matters 11 22

We Know Guiding Good We Know Guiding Good Choices® works!Choices® works!

Research trials have shown that Guiding Good Choices: Research trials have shown that Guiding Good Choices: reduces alcohol and marijuana use by 40.6% reduces alcohol and marijuana use by 40.6% reduces progression to more serious substance abuse reduces progression to more serious substance abuse

by 54% by 54% increases the likelihood that non-users will remain increases the likelihood that non-users will remain

drug-free by 26%drug-free by 26% reduces depression symptoms by 28%reduces depression symptoms by 28%

And it’s cost effective!And it’s cost effective! For every dollar spent on GGC, $11.07 is saved in preventable For every dollar spent on GGC, $11.07 is saved in preventable

costs associated with youth substance use and delinquency costs associated with youth substance use and delinquency (Washington State Institute for Public Policy, 2004, (Washington State Institute for Public Policy, 2004, www.wsipp.wa.govwww.wsipp.wa.gov) )

Implementation Fidelity ChecksImplementation Fidelity Checks Obtained/created Obtained/created

monitoring tools monitoring tools Trained all program Trained all program

implementers implementers Required program Required program

implementers to implementers to complete fidelity complete fidelity checklists checklists

Generated progress Generated progress reports for communitiesreports for communities

CYDS Program Fidelity ResultsCYDS Program Fidelity ResultsJuly 2004 – June 2005July 2004 – June 2005

ADHERENCE: extent to which the programs’ critical ADHERENCE: extent to which the programs’ critical elements and content are delivered elements and content are delivered

90% adherence rate across all programs and 90% adherence rate across all programs and

communities communities

Some modifications were reported, most often Some modifications were reported, most often deleting parts of sessions or program activitiesdeleting parts of sessions or program activities

Common challenges included lack of time and Common challenges included lack of time and participant misbehavior participant misbehavior

Adherence Rates Adherence Rates July 2004 – June 2005July 2004 – June 2005

0

10

20

30

40

50

60

70

80

90

100

LST AS SFA PDE SMART Tutor VY BBBS PALS SFP GGC PWC FM

Percentage of material taught and core components achieved

CYDS Program Fidelity ResultsCYDS Program Fidelity ResultsJuly 2004 – June 2005July 2004 – June 2005

DOSAGE: extent to which the required number, DOSAGE: extent to which the required number, length, and frequency of sessions were taughtlength, and frequency of sessions were taught

91% dosage rate across all programs and 91% dosage rate across all programs and communities communities

Full dosage was achieved in 78% of all Full dosage was achieved in 78% of all replications (74 of 95 cycles)replications (74 of 95 cycles)

Deviations in dosage were generally minorDeviations in dosage were generally minor~ e.g., 30 vs. 45-minute sessions e.g., 30 vs. 45-minute sessions ~ e.g., deleting 1 of 12 required sessionse.g., deleting 1 of 12 required sessions

Dosage RatesDosage RatesJuly 2004 – June 2005July 2004 – June 2005

Percentage of program cycles achieving dosage requirements

0

10

20

30

40

50

60

70

80

90

100

LST AS SFA PDE SMART Tutor VY BBBS PALS SFP GGC PWC FM

Participant Survey ResultsParticipant Survey ResultsSelected Parent Survey Results (n=47) from GGC in

Community C All questions on scale of 1 (strongly disagree) to 7 (strongly agree)

ItemItemPre-survey Pre-survey Mean ScoreMean Score

Post-Post-survey survey

Mean ScoreMean ScoreChangeChange

Children who are bonded to Children who are bonded to their families are less likely to their families are less likely to use drugsuse drugs

5.85.8 6.36.3 +0.5*+0.5*

Children should be involved in Children should be involved in deciding what the family rules deciding what the family rules will bewill be

5.05.0 5.85.8 +0.8*+0.8*

Part of learning to say “no” to Part of learning to say “no” to drugs is to suggest something drugs is to suggest something different to do with friendsdifferent to do with friends

5.75.7 6.46.4 +0.7*+0.7*

It’s important for family It’s important for family members to practice new skills members to practice new skills together even if it makes them together even if it makes them uncomfortable at firstuncomfortable at first

5.95.9 6.36.3 +0.4*+0.4*

* Indicates statistically significant change (p<.05) from pre-survey to post-survey

Participant Attendance Participant Attendance and Retention in the CYDSand Retention in the CYDS

July 2004 – June 2005July 2004 – June 2005

Program TypeProgram Type Total N Served Total N Served

% of Target % of Target PopulationPopulation

% Attending % Attending Majority of Majority of SessionsSessions++

School Curricula School Curricula 14321432 97 (75-100)%97 (75-100)% 96%96%

After-schoolAfter-school** 546546 17 (7-98)%17 (7-98)% 77%77%

Parent TrainingParent Training 517517 8 (3-28)%8 (3-28)% 79%79%

+Attending at least 60% of the total number of sessions*Includes PALS, BBBS, Stay SMART, and Tutoring programs

Parent Training ProgramsParent Training ProgramsPercent of Recruitment Goal ReachedPercent of Recruitment Goal Reached

0

10

20

30

40

50

60

70

80

90

100

H Q T G O C X W W A

GoalAttended

% of target pop

Strengthening Families

Guiding Good Choices PWC Family Matters

Summary of ResultsSummary of Results

13 different prevention programs 13 different prevention programs implemented in 12 communities implemented in 12 communities

Strong implementation fidelityStrong implementation fidelity Preliminary evidence of desired effects on Preliminary evidence of desired effects on

participantsparticipants Stronger growth in collaboration in CTC Stronger growth in collaboration in CTC

communitiescommunities Modest and growing exposure to the Modest and growing exposure to the

programsprograms

Where are we now?—Where are we now?—Update Update

All twelve CTC communities have completed All twelve CTC communities have completed the CTC planning process and developed the CTC planning process and developed community action plans.community action plans.

All twelve CTC communities will are in the All twelve CTC communities will are in the second year of implementing tested, effective second year of implementing tested, effective programs (2005-06). programs (2005-06).

2006 2006 studentstudent surveys will be conducted. surveys will be conducted. 2006 2006 CTC BoardCTC Board surveys will be conducted. surveys will be conducted. 2007 interviews with 2007 interviews with community memberscommunity members are are

complete.complete.

Preventing Adolescent Preventing Adolescent Cannabis Use in the Cannabis Use in the

Netherlands and the U.S.:Netherlands and the U.S.:A Binational Investigation of the A Binational Investigation of the

Communities That Care Communities That Care Prevention SystemPrevention System

J. David Hawkins, Ph.D. J.C.J. Boutellier, Ph.D.

University of Washington Verwey-Jonker Institute

Funded by ZonMw and NIDA

Drug Policy OrientationDrug Policy Orientation

U.S. goal: Use reductionU.S. goal: Use reduction Abstinence messages, any use is abuseAbstinence messages, any use is abuse Zero-toleranceZero-tolerance

The Netherlands goal: Harm reductionThe Netherlands goal: Harm reduction- Combination of abstinence and harm - Combination of abstinence and harm

reduction messagesreduction messages- Accepts normative experimentation as a Accepts normative experimentation as a

realityreality- Distinguishes between soft and hard drugs, Distinguishes between soft and hard drugs,

and possession/use vs. dealing/production and possession/use vs. dealing/production

Aims of the Binational CollaborationAims of the Binational Collaboration

1.1. To compare the prevalence and To compare the prevalence and predictors of cannabis use and illicit drug predictors of cannabis use and illicit drug use across samples of young people use across samples of young people from the U.S. and the Netherlands:from the U.S. and the Netherlands:

a. Are there differences in prevalence rates a. Are there differences in prevalence rates from self reports on equivalent instruments?from self reports on equivalent instruments?

b. Are relationships between risk/protective b. Are relationships between risk/protective factors and cannabis the same?factors and cannabis the same?

Aims of the Binational CollaborationAims of the Binational Collaboration

2. To examine the implementation and 2. To examine the implementation and effectiveness of the CTC approach effectiveness of the CTC approach across two nations with different policies across two nations with different policies and cultures:and cultures:

a. What are unique and common barriers to a. What are unique and common barriers to the use of the CTC strategy? What is the use of the CTC strategy? What is sensitive to context? sensitive to context?

United StatesUnited States

20022002 20042004

Drug Use RatesDrug Use Rates age 15-16age 15-16 age 15-16age 15-16

(n = 4,997)(n = 4,997) (n = 4,585)(n = 4,585)

Alcohol -Ever use Alcohol -Ever use 64.3%64.3% 64.6%64.6% -Past month use-Past month use 38.0%38.0% 39.2%39.2%

Cigarettes -Ever smoke Cigarettes -Ever smoke 48.5%48.5% 43.2%43.2%-Past month smoke-Past month smoke 20.7%20.7% 17.6%17.6%

Ecstasy -Ever use Ecstasy -Ever use 9.2%9.2% 5.5%5.5% -Past month use-Past month use 5.4%5.4% 2.2%2.2%

““Hard drugs” -Ever useHard drugs” -Ever use 10.9%10.9% 9.3%9.3% -Past month use-Past month use 6.3%6.3% 4.1%4.1%

Comparing Student Drug UseComparing Student Drug Use

The The NetherlandsNetherlands

2003-052003-05

age 15-16age 15-16

(n = 4,768)(n = 4,768)

86.8%86.8%

70.9%70.9%

54.1%54.1%

27.8%27.8%

3.3%3.3%

1.7%1.7%

3.0%3.0%

1.6%1.6%

United StatesUnited States

20022002 20042004

Cannabis Use Cannabis Use RatesRates

age 15-16age 15-16 age 15-16age 15-16

(n = 4,997)(n = 4,997) (n = 4,585)(n = 4,585)

Marijuana -Ever use Marijuana -Ever use 39.6%39.6% 36.7%36.7% -Past month use-Past month use 21.5%21.5% 19.3%19.3%

Frequency of marijuana Frequency of marijuana use in the past monthuse in the past month

0 times0 times 78.5%78.5% 80.7%80.7%1-2 times1-2 times 6.6%6.6% 7.5%7.5%3-5 times3-5 times 3.1%3.1% 3.3%3.3%6-9 times6-9 times 2.6%2.6% 2.3%2.3%

10 or more times10 or more times 9.2%9.2% 6.2%6.2%

Comparing Student Drug UseComparing Student Drug UseThe The

NetherlandsNetherlands

2003-052003-05

age 15-16age 15-16

(n = 4,768)(n = 4,768)

28.4%28.4%

15.4%15.4%

84.6%84.6%

7.6%7.6%

2.7%2.7%

1.0%1.0%

4.1%4.1%

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