Multi-component Strategies

Multi-component Strategies Peggy Kelley Thu, 10/25/2018 - 02:51 PM EDT

Multicomponent programs involve implementing more than one strategy simultaneously or in tandem. These varying components work together simultaneously to address various factors that prevent NMUPD. In general, in order to be successful, multicomponent programs:

  • Incorporate multiple levels of influence. A widespread approach targeting multiple risk and protective factors across multiple levels of influence may achieve the greatest impact. For example, the Harmful Legal Product Prevention Project incorporates intervention at the family level, the school setting, and the broader community; and when strategies are implemented together, research demonstrates increased community readiness1, increased parental locking up of prescription drugs2, and decreased harmful legal product use for youth.3 Similarly, Project Lazarus intervenes with the general community to change community norms, and with prescribers to change prescribing practices and when activities occur together, outcomes have been linked to decreases in overdose death rates.4
  • Require successful collaboration. They include engagement of stakeholders from different community sectors (e.g., public health, education, business, law enforcement) to design, raise awareness of, and/or implement program activities. All multi-component programs listed involve formal or informal collaborative arrangements among groups or organizations where everyone is working together toward a common goal. For example, Drug-Free Community Coalitions require formal collaboration and have demonstrated success in reducing substance use.5
  • Are strategic and data-driven. The programs are grounded in understanding local assessment data and community readiness for identifying priorities and selecting relevant strategies. They also utilize current prevention science to guide practice. For example, Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER) uses collaboration with the local land-grant universities to leverage expertise on prevention science and Project Lazarus utilizes assessment data to target areas of high risk.

Multi-Component strategies, summarized here, include the following:

1 Ogilvie, K. A., Moore, R. S., Ogilvie, D. C., Johnson, K. W., Collins, D. A., & Shamblen, S. R. (2008). Changing community readiness to prevent the abuse of inhalants and other harmful legal products in Alaska. Journal of Community Health, 33(4), 248–258.

2 Collins, D. A., Johnson, K. W., & Shamblen, S. R. (2012). Examining a home environmental strategy to reduce availability of legal products that can be misused by youth. Substance Use & Misuse, 47(12). doi:10.3109/10826084.2012.716481. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884673/

3 Johnson, K. W., Shamblen, S. R., Ogilvie, K. A., Collins, D., & Saylor, B. (2009). Preventing youths’ use of inhalants and other harmful legal products in frontier Alaskan communities: A randomized trial. Prevention Science, 10(4), 298–312. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735174/

4 Albert, S., Brason II, F. W., Sanford, C. K., Dasgupta, N., Graham, J., & Lovette, B. (2011). Project Lazarus: Community-based overdose prevention in rural North Carolina. Pain Medicine, 12, S77–S85. Retrieved from http://prescribetoprevent.org/wp-content/uploads/2012/11/pm2011albert.pdf

5 Office of National Drug Control Policy. (2014). Drug-Free Communities Support Program: 2013 National Evaluation Report.

Office of National Drug Control Policy. (2015). Drug-Free Communities Support Program: 2014 National Evaluation Report.

Drug-Free Community Coalitions

Drug-Free Community Coalitions Peggy Kelley Thu, 10/25/2018 - 02:52 PM EDT

Description

Drug-free community coalitions are formal collaborative arrangements among groups or organizations within a community that are formed or expanded to prevent and reduce youth substance use, including prescription drug abuse, within the community. In a community coalition, each member maintains its independent status while agreeing to work collaboratively to achieve a common goal (Community Anti-Drug Coalitions of America [CADCA], 2012).

Objective(s)

To harness and maximize multi-sector resources for the purposes of designing or selecting and implementing activities that are likely to prevent or reduce youth substance use, including prescription drug abuse

Typical Elements

Since 1997, SAMHSA and the Office of National Drug Control Policy (ONDCP) have offered Drug-Free Communities (DFC) grants to support community coalitions established to prevent youth substance abuse (ONDCP, 2015). In addition, CADCA offers technical assistance to community coalitions (CADCA, 2012), which typically includes the following:

  • Assistance in determining the coalition type (CADCA, 2010):
    • Activity/Event Coalitions focus on providing information and service referrals to the general public
    • Service/Program Delivery Coalitions focus on developing and providing individual or indicated-level prevention programs and services
    • Community Mobilization Coalitions focus on mobilizing the community to support specific prevention actions (for example, implementing drug-free zones)
    • Comprehensive Community Coalitions focus on implementing universal and/or selective prevention programs and services
      • Note: Coalitions can change their focus over time or choose to focus on multiple facets of prevention simultaneously, as the community situation and resources warrant (CADCA, 2010).
  • Assistance in selecting coalition activities (CADCA, 2012), for example:
    • Assessment: Collecting and assessing data to define the scope of the problem (for example, the rates of prescription drug abuse), currently available resources to address the problem, areas in need of improvement, etc.
    • Capacity: Developing the community’s ability to address the problem
    • Planning: Creating a plan to address the problem, selecting activities and other strategies for implementation
    • Implementation: Implementing the chosen prevention strategies and activities
    • Evaluation: Evaluating the impact of the implemented strategies
      • Note: Community coalitions generally center their activities on one of these five elements, the names of which are taken from SAMHSA’s Strategic Prevention Framework (CADCA, 2012).
  • Assistance in selecting coalition members who represent 12 key sectors (SAMHSA, 2014): youth; parents; business; media; education; youth-serving organizations; law enforcement; religious organizations; civic or volunteer organizations; healthcare organizations; state, local, or tribal agencies involved in the substance abuse field; and other organizations involved in the substance abuse field
  • Assistance with implementing promising or effective prevention programs, for example:

Populations

Communities

Outcomes

  • In communities where a coalition received a DFC grant, middle and high school students have shown reductions in their use of tobacco, alcohol, and marijuana (ONDCP, 2014, 2015).
  • Prescription drug abuse was added as one of the four DFC core substance abuse outcomes in 2012, and only baseline data have been collected thus far (ONDCP, 2014).

Guidelines

Drug-Free Communities Support Program, Request for Applications No. SP-14-002: 2nd Modified Announcement. 

Capacity Primer: Building Membership, Structure and Leadership. 

Handbook for Community Anti-Drug Coalitions. 

Acknowledged by

Office of National Drug Control Policy. Drug-Free Communities Support Program. 

Community Anti-Drug Coalitions of America. Drug-Free Communities Program. 

References

Community Anti-Drug Coalitions of America. (2010). Capacity primer: Building membership, structure and leadership. Retrieved from https://www.cadca.org/sites/default/files/resource/files/capacityprimer.pdf

Community Anti-Drug Coalitions of America. (2012). Handbook for community anti-drug coalitions. Retrieved from https://www.cadca.org/sites/default/files/resource/files/coalitionhandbook.pdf

Dublin A.C.T. Coalition. (2011). Who we areOverview. Retrieved from http://dublinact.org/

Good Drugs Gone Bad (GDGB). (n.d.). About Us. Retrieved from http://www.gooddrugsgonebad.com/find_us/

Office of National Drug Control Policy. (2015). Drug-Free Communities Support Program: 2014 National Evaluation Report. Retrieved from https://obamawhitehouse.archives.gov/sites/default/files/DFC2014Interim%20ReportExecutiveSummaryFinal.pdf

Substance Abuse and Mental Health Services Administration. (2014). Drug-Free Communities Support Program, Request for Applications No. SP-14-002: 2nd Modified Announcement. Retrieved from https://www.samhsa.gov/sites/default/files/grants/pdf/sp-14-002-modified2.pdf

Harmful Legal Product Prevention Project

Harmful Legal Product Prevention Project Peggy Kelley Thu, 10/25/2018 - 02:53 PM EDT

Description

The Harmful Legal Product Prevention Project was part of a National Institute on Drug Abuse pilot project. From 2004 to 2008, researchers, community coalitions, and schools collaborated to implement three primary prevention strategies—the Community Readiness Model, the Home Environmental Strategy, and Think Smart—in rural/frontier Alaskan communities. The strategies were implemented in tandem, though each could be implemented on its own (Gruenewald, Johnson, Shamblen, Ogilvie, & Collins, 2009).

Objective(s)

To assess and improve community readiness to address prescription drug abuse, youth prescription drug, and youth harmful legal product (HLP) abuse; to strengthen parent-child communication, parents’ efficacy to modify home environments in order to limit access to HLPs, and youth skills to resist drug offers; and to decrease youth’s motivation to use drugs and their vulnerability to social influences to use drugs

Typical Elements

  • The Community Readiness Model (CRM) determines community readiness across six dimensions and provides guidance on using survey results to create an action plan to improve community readiness (Colorado State University, 2011). The CRM is based on the Stages of Change Model (Prochaska & Di Clemente, 1982) of how individuals process and experience change, both on their own and in formal settings (Oetting et al., 2014). The steps of CRM implementation are as follows:
    • Step 1: Identify and clearly define the issue
      • Note: In addition to addressing prescription drug abuse, the CRM can be adapted to address underage drinking, binge drinking, illicit drug use, or non-substance-related issues, such as breast cancer prevention (Oetting et al., 2014).
    • Step 2: Identify and clearly define the community you wish to assess and improve (for example, by geographic areas, population subgroups, occupation subgroups, public systems, organizations, or departments within organizations)
    • Step 3: Determine the key dimensions you wish to assess
      • Note: The six dimensions assessed by the CRM are Community Efforts, Community Knowledge of the Efforts, Leadership, Community Climate, Community Knowledge About the Issue, and Resources Related to the Issue (Colorado State University, 2011).
    • Step 4: Prepare survey questions
      • Note: Survey questions should be succinct. They should define the issue of concern and any technical terms used (Oetting et al., 2014). The CRM guidelines contain a standardized format for survey questions (Colorado State University, n.d.).
    • Step 5: Determine how you will score interview responses, in terms of community readiness
      • Note: The CRM identifies nine stages of community readiness:
        • Stage 1: Community tolerance / no knowledge
        • Stage 2: Denial
        • Stage 3: Vague awareness
        • Stage 4: Pre-planning
        • Stage 5: Preparation
        • Stage 6: Initiation
        • Stage 7: Institutionalization/stabilization
        • Stage 8: Confirmation/expansion
        • Stage 9: Professionalization (Colorado State University, 2011)
    • Step 6: Select key respondents for the survey from pools of individuals who are involved in the community and are aware of any efforts to address the selected issue
      • Note: For example, school personnel, law enforcement personnel, court system personnel, city/county/tribal government employees and officials, health system personnel, social service providers, behavioral health treatment providers, spiritual/religious leaders, and community members at large.
    • Step 7: Conduct the interviews
      • Note: The CRM suggests conducting 6 to 12 interviews, although smaller or homogenous communities may only need as few as 4 interviews (Oetting et al., 2014).
    • Step 8: Score interview responses across the key dimensions, using the predetermined scale (Oetting et al., 2014)
    • Step 9: Average scores from each interview to develop overall community scores for each dimension
    • Step 10: Develop and implement an action plan to improve community readiness
    • Step 11: Set goals for improvement based on the dimensional scores
    • Step 12: Create working groups to identify and implement the action plan and activities for improvement
      • Note: In the Alaskan communities, the initial interview responses showed that most students (48% to 91%, depending on the community) thought that it would be “sort of easy” or “very easy” to obtain four types of HLPs. However, the communities received a score of “2” (denial/resistance) or “3” (vague awareness) on their level of knowledge about the issue. The HLP Prevention Project stakeholders identified and developed improvement activities to increase community readiness while also implementing the Home Environmental Strategy and Think Smart (Johnson et al. 2007, p. 9).
  • The Home Environmental Strategy is intended to reduce children’s misuse of HLPs, such as prescription drugs, by removing unnecessary HLPs from the home and locking up and monitoring any HLPs that must remain (Collins, Johnson, & Shamblen, 2012).
    • Note: This model calls for parents to consider substituting HLPs with other products when possible, particularly for HLPs such as markers or glues (Johnson et al., 2007).
    • An important first step in implementing this strategy is to develop and offer Family Night events for parents of school-age children. The goal of Family Night is to increase parental norms related to HLP misuse (such as parental disapproval of children’s HLP misuse, and family rules that reduce the availability of HLPs).
      • These events should last approximately two hours, be held at the school, and occur multiple times over a series of months
      • At the events, provide information to parents on the potential dangers of HLPs and guidance on how to prevent children’s misuse
      • Encourage parents to clearly communicate the dangers of HLP misuse to their children
        • Note: For example, parents might link their HLP message to their own values and beliefs, establish rules and consequences related to HLP misuse, and provide positive reinforcement to children who adhere to family rules regarding HLPs (Johnson, Shamblen, Ogilvie, Collins, & Saylor, 2007).
      • Ask parents to identify and inventory all HLPs in the home
      • Persuade parents to control the availability of HLPs in the home (for example, by locking up and monitoring them)
      • Support other parent-focused prevention efforts, including informal parent-to-parent support
      • Identify parents who may be interested in participating in or supporting community-wide prevention strategies
        • Note: In the Alaskan communities, the Home Environmental Strategy focused on parents of fifth-, sixth-, and seventh-graders. The strategy consisted of a series of Family Night events held over the course of 10 months. Parents were invited to participate through letters and telephone calls, and additional events were held in areas where the first events had low turnout.
  • Think Smart is a weekly interactive school-based program developed for the HLP Prevention Project and derived from the Life Skills Training program for Native American communities; it has been modified to focus on HLPs and for frontier Alaskan communities. However, the strategy is not designed solely for Alaska Natives; it is intended for all frontier Alaskan communities (Johnson et al., 2010). Community coalitions interested in Think Smart may need to modify the program to suit their communities.
    • The Think Smart program (Johnson et al., 2010):
      • Includes 12 weekly core lessons of 45–60 minutes (three booster lessons are implemented two to three months after the core lessons are complete)
      • Is provided by teachers in a classroom setting
      • Draws from behavioral models that “emphasize teaching drug refusal skills, anti-drug norms, personal self-management skills, and general social skills in an effort to resist drug offers, decrease the motivations to use drugs, and decrease vulnerability to drug use social influences” (Johnson et al., 2009, p. 3)
      • Presents stereotypes about drugs (including peer norms and cultural identity), teaches facts about drugs, and then introduce and practice a problem-solving model known as S.O.D.A.S. (Stop, Options, Decide, Act, Self-Talk), which emphasizes refusal and self-assertiveness skills.
    • Before implementing Think Smart, the group or organization should determine the need for additional school-based prescription drug prevention programming and whether the Think Smart program is applicable. Next steps:
      • Obtain program materials, including curricula and “a complete teaching kit with all the items necessary to implement the interactive curriculum (e.g., laminated role play cards, timers)” (Johnson et al., 2010, p. 6)
      • Partner with an intervention agency to provide a two-day onsite training for teachers
      • Offer schools technical assistance throughout the program
      • Schedule weekly sessions for teachers to implement the curriculum
      • Obtain parental consent, if necessary

Populations

Local community members, parents of school-age children, school-age children

Outcomes

  • As part of the HLP Prevention Project, CRM was linked to an average increase in community readiness, as measured by the combined score of all six dimensions (a combined score of 32 pre-action plan implementation, and 34 post-action plan implementation). The largest average increases were in the dimensions of “community knowledge about the issue” and “community resources available to address the issue” (Ogilvie et al., 2008).
  • The Home Environmental Strategy has been linked to parents statistically significantly becoming more likely to lock up prescription drugs (Collins, Johnson, & Shamblen, 2012).
  • The rates of past-30-day HLP use of Alaska students who participated in Think Smart were eight times lower than the rates of students who did not participate, according to a two-group, randomized, matched-control trial (Johnson et al., 2009).

Guidelines

Community Readiness for Community Change.

Acknowledged by

No acknowledgements have been found regarding the role of any HLP prevention project in preventing the nonmedical use of prescription drugs and/or its consequences.

References

Collins, D. A., Johnson, K. W., & Shamblen, S. R. (2012). Examining a home environmental strategy to reduce availability of legal products that can be misused by youth. Substance Use & Misuse, 47(12). doi:10.3109/10826084.2012.716481. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884673/

Colorado State University. (2011). Community Readiness. Tri-Ethnic Center for Prevention Research. Retrieved from http://www.triethniccenter.colostate.edu/community-readiness-2/

Gruenewald, P. J., Johnson, K., Shamblen, S. R., Ogilvie, K. A., & Collins, D. (2009). Reducing adolescent use of harmful legal products: Intermediate effects of a community prevention intervention. Substance Use & Misuse, 44(14), 2090–2098.

Johnson, K., Courser, M., Holder, H., Miller, B., Ogilvie, K., Moore, R., . . . Saltz, B. (2007). A community prevention intervention to reduce youth from inhaling and ingesting harmful legal products. Journal of Drug Education, 37(3), 227–247. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443954/

Johnson, K. W., Ogilvie, K. A., Collins, D. A., Shamblen, S. R., Dirks, L. G., Ringwalt, C. L., & Norland, J. J. (2010). Studying implementation quality of a school-based prevention curriculum in frontier Alaska: Application of video-recorded observations and expert panel judgment. Prevention Science, 11(3), 275–286. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569516/

Johnson, K. W., Shamblen, S. R., Ogilvie, K. A., Collins, D., & Saylor, B. (2009). Preventing youths’ use of inhalants and other harmful legal products in frontier Alaskan communities: A randomized trial. Prevention Science, 10(4), 298–312. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735174/

Oetting, E. R., Plested, B. A., Edwards, R. W., Thurman, P. J., Kelly, K. J., Beauvais, F., & Stanley, L. (2014). Community readiness for community change. Fort Collins, CO: Tri-Ethnic Center for Prevention Research, University of Colorado. Retrieved from https://www.coursehero.com/file/15527087/Community-Readiness-Handbook-2014/

Ogilvie, K. A., Moore, R. S., Ogilvie, D. C., Johnson, K. W., Collins, D. A., & Shamblen, S. R. (2008). Changing community readiness to prevent the abuse of inhalants and other harmful legal products in Alaska. Journal of Community Health, 33(4), 248–258.

Prochaska, J. O., & Di Clemente, C. (1982). Trans-theoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice, 19(3), 276–288. Retrieved from https://www.researchgate.net/publication/232461028_Trans-Theoretical_Therapy_-_Toward_A_More_Integrative_Model_of_Change

Project Lazarus

Project Lazarus Peggy Kelley Thu, 10/25/2018 - 02:54 PM EDT

Description

Project Lazarus addresses drug overdose deaths, with a focus on prescription drug overdoses. Its four-component overdose prevention program was initiated in Wilkes County, North Carolina, but has since been expanded statewide.

Objective(s)

To raise awareness of prescription drug abuse, address dangerous prescribing practices, and increase community efficacy to address prescription drug abuse and reduce overdose deaths

Typical Elements

Project Lazarus is a prevention model comprising four components, each of which is intended to work in conjunction with the others (Project Lazarus, n.d.a):

  • The first component is community activation and coalition building (Albert et al., 2011, p. 77). Coalitions can include representatives from organizations identified as important to health promotion—including health departments, schools, governmental agencies, hospitals, primary care clinical practices, churches, and newspapers—who together engage in prevention activities, for example:

    • Holding a town hall meeting focusing on overdose deaths
    • Creating special task forces to examine topics relevant to overdose deaths (such as prescribing rates)
    • Developing community leadership
    • Gathering input for an educational toolkit
    • Holding community training events that raise awareness of overdose deaths (Community Care of North Carolina [CCNC], n.d.)
    • Developing social marketing media campaigns
    • Creating school education events, such as classroom-based education, or pledge cards
  • The second component, monitoring and epidemiological surveillance (Albert et al., 2011), involves gathering and analyzing various types of data to describe and characterize overdose deaths occurring in the community, for example:
    • The number of emergency department (ED) visits for substance abuse and accidental poisonings
    • The amount of controlled substances dispensed to outpatients
    • The number of “fatal accidental poisonings” (Albert et al., 2011, p. S80)
    • Vital statistics from the state health agency
      • Note: For example, Project Lazarus determined that overdose deaths in Wilkes County were due “almost exclusively to prescription opioid pain relievers” (Albert et al., 2011, p. S77).
  • The third component, prescriber, patient, and law enforcement training and education (Albert et al., 2011), includes activities such as the following:
    • Developing an educational tool kit for prescribers and patients, including, for example, pain management guidelines, opioid risk assessment tools, universal precautions for opioid prescribing, a sample patient-prescriber agreement, defensive prescription writing materials, patient education materials, and information on screening, brief intervention, and referral to treatment (Albert et al., 2011, p. S81)
    • Providing individual education and training to prescribers on pain management and overdose prevention
    • Supporting continuing medical education on pain management and overdose prevention
    • Informing prescribers about actions the state medical board can take against prescribers who violate state regulations
    • Inspecting local pain clinics
    • Promoting use of Prescription Drug Monitoring Programs (PDMPs)
      • Note: PDMPs can have different names by state—for example, North Carolina’s is called the Controlled Substance Reporting System.
    • Modifying hospital ED policy on dispensing opioids (such as mandating PDMP use and limiting the amount of opioids that can be dispensed at one time)
    • Holding medication takeback events and establishing permanent medication disposal sites
    • Training specialized drug diversion law enforcement officers
    • Mandating the use of patient-prescriber agreements when pain medications are prescribed
    • Creating support groups for patients with chronic pain
    • Assigning ED case managers to patients with chronic pain
  • The fourth component, overdose reversal medication (Albert et al., 2011), encourages the establishment of procedures that enhance naloxone access to populations at risk of overdose (Harm Reduction Coalition, n.d.), for example:
    • Training prescribers to identify patients at risk of an overdose
    • Asking at-risk patients to participate in the initiative
    • Showing participating patients a 20-minute video that “covers patient responsibilities in pain management, storage, and disposal of opioid medications, recognizing and responding to an opioid overdose, and options for substance abuse treatment” (Harm Reduction Coalition, n.d., p. 1)
    • Giving participating patients a prescription for a free naloxone kit
    • Supporting efforts to expand the capacity of inpatient detox programs, for example, securing funding for additional beds at existing programs, increasing awareness of existing programs, and establishing new programs

Populations

Prescribers, patients at risk of overdose, community members

Outcomes

In Wilkes County, North Carolina, Project Lazarus has been linked to the following outcomes (Albert et al., 2011; Project Lazarus, n.d.b):

  • A 69% reduction in the overdose mortality rate from 2009 to 2011
  • A reduction (from 82% in 2009 to 0% in 2011) in the percentage of overdose patients whose death was caused by a prescription issued by a prescriber operating in the county
  • A 15% reduction in the number of ED visits for overdoses or substance abuse from 2009 to 2010
    • Note: Statewide, North Carolina saw a 6.9% increase in the number of ED visits for overdoses or substance abuse.
  • A percentage of prescribers who registered with the state PDMP, as of 2010, that is almost three times higher than the statewide average (70% and 26%, respectively) (CCNC, n.d.)

Guidelines

Project Lazarus [Website]

Acknowledged by

Office of National Drug Control Policy. A Public Health Approach to Overdose Prevention: Director’s Remarks at Project Lazarus, Wilkes County, North Carolina. 

References

Albert, S., Brason II, F. W., Sanford, C. K., Dasgupta, N., Graham, J., & Lovette, B. (2011). Project Lazarus: Community-based overdose prevention in rural North Carolina. Pain Medicine, 12, S77–S85. Retrieved from http://prescribetoprevent.org/wp-content/uploads/2012/11/pm2011albert.pdf

Community Care of North Carolina. (n.d.). Project Lazarus: A community-wide response to managing pain. Retrieved from https://www.slideserve.com/rivka/project-lazarus-a-community-wide-response-to-managing-pain

Harm Reduction Coalition. (n.d.). Project Lazarus: Case study. Retrieved from http://harmreduction.org/issues/overdose-prevention/tools-best-practices/naloxone-program-case-studies/project-lazarus/

Project Lazarus. (n.d.a). The Project Lazarus model. Retrieved from https://www.projectlazarus.org/the-model

Project Lazarus. (n.d.b). Project Lazarus results for Wilkes County. Retrieved from http://projectlazarus.com/project-lazarus-results-wilkes-county

Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER)

Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER) Peggy Kelley Thu, 10/25/2018 - 02:55 PM EDT

Description

Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER) is a prevention services delivery system that links land-grant university researchers and experts with community organizations to develop and support youth substance abuse prevention programming, including prescription drug misuse and abuse programs. PROSPER is not a specific prevention strategy; rather, it is a process designed to improve the quality of community-implemented strategies.

Objective(s)

To improve the quality and fidelity of community-implemented evidence-based prevention programs

Typical Elements

The PROSPER system is implemented in four stages: initial organization, initial operations, ongoing operations, and long-term stability.

  • Eight to 10 community members form a community team, which is co-led by a county-based member from a land-grant university system’s cooperative extension program and a representative from the local school district (PROSPER Partnerships, n.d.).

    • The team leaders are expected to spend 25–30% of their full-time work responsibilities on community team activities.
    • The community team should include members who represent a diverse cross-section of the community, including healthcare providers, social service providers, and representatives from law enforcement, parent and youth groups, businesses, and faith-based organizations.
      • Note: Factors influencing the success of community teams include the rates of community poverty, and perceptions of community readiness; therefore, in low resource and ready communities, greater focus may need to be given to building capacity by increasing team building and cross-agency understanding prior to moving into implementation (Greenberg, Feinberg, Meyer-Chilenski, Spoth, & Redmond, 2007).
  • The State Management Team, comprising of Extension administrators and university faculty, is led by a State Partnership Director, who is supported by land-grant university prevention researchers and experts who coordinate PROSPER implementation across the state (PROSPER Partnerships, n.d.). This team does the following:
    • Communicates the most recent prevention research findings and other information to prevention coordinators
    • Develops community team action plans, based on information provided by prevention coordinators
    • Engages with state-level agencies to further support prevention programming
    • Oversees evaluations at all levels of the system
    • Receives technical assistance and expert support from the National Network Team (see below)
  • The land-grant university system hires an expert prevention coordinator, who receives oversight and coordination support from the State Management Team. The coordinator’s responsibilities include the following (PROSPER Partnerships, n.d.):
    • Attending community team meetings, and providing support as necessary
    • Holding bi-weekly meetings with the community team co-leaders
    • Maintaining regular contact with other prevention coordinators to share information and best practices
    • Organizing training and professional development activities for community team members
    • Providing specific technical assistance to community teams on planning, recruiting for, and implementing the family-focused and school-based programs (see below), maintaining productivity, and securing sustained funding for the programs
    • Facilitating the flow of information between the community team and the State Management Team by attending regular meetings with the State Management Team to report on community team activities and progress
  • A National Network Team consists of trainers, technical assistance providers, prevention scientists, and evaluation specialists who coach and support the State Management Team. The National Network Team is established to address four key goals, set in conjunction with federal funding partners (PROSPER Partnerships, n.d.):
    • Learn how to identify state land-grant university systems that have the capacity and ability to adopt PROSPER
    • Learn how to work with adoption-ready state systems to build the infrastructure necessary for successful implementation
    • Learn the most effective ways to implement PROSPER at the community level
    • Develop a team capable of providing ongoing training and technical assistance to State Management Teams
  • From a “menu” of pre-approved evidence-based programs (EBPs), one family-focused EBP, targeting sixth-graders, and one school-based EBP, targeting seventh-graders, is selected and implemented by the community (Spoth, Guyll, Redmond, Greenberg, & Feinberg, 2011).
    • Note: Family-focused programs implemented in PROSPER evaluation studies include the Strengthening Families Program: For Parents and Youth 10–14, and Guiding Good Choices. School-based programs include All Stars, LifeSkills Training, and Lions Quest.
    • Families are recruited to participate in the family-focused program
    • The implementation of both programs is monitored with support from land-grant university researchers
    • Funds are raised to support the programs’ implementation by the Community Team
    • The prevention coordinator offers technical support
      • Note: The National Network Team works with states to build their infrastructure as needed to support implementation of the EBP that is most appropriate for their community.
  • Community team’s work with the State Management Team, through the prevention coordinators, to ensure that two primary sustainability goals are met annually: (1) sustaining the growth and quality of the EBPs, and (2) sustaining each well-functioning community team.
    • Note: As of March 2015, PROSPER had not developed an open system to initiate implementation of its model in all states. Its initial land-grant university systems were specifically selected to participate in the pilot program, while additional land-grant university systems applied to participate through a one-time National Institutes of Health funding opportunity (PROSPER Partnerships, n.d.).

Populations

Youth, families, schools, the community at large

Outcomes

  • Using a randomized controlled trial study, follow-up data six years after program exposure showed that participating youth had a lifetime prescription drug misuse rate of 27.3%, compared to 32.2% among non-participating youth (Coalition for Evidence-Based Policy, 2014).
  • Using a randomized controlled trial study, follow-up data 18 months after program exposure showed that participating youth were significantly less likely to initiate any form of substance abuse, compared to non-participating youth (Spoth et al., 2007).
  • PROSPER has been linked to communities maintaining an ongoing adherence rate to EBP models that is near 90% (Spoth et al., 2011).

Guidelines

All Stars. 

Guiding Good Choices

LifeSkills Training. 

Lions Quest

PROSPER Partnerships: We’ve got prevention down to a science

Strengthening Families Program

Acknowledged by

U.S. Centers for Disease Control and Prevention, Grant DP 002279.

National Institutes of Health, National Institute on Drug Abuse, Grant DA 028879.

References

Coalition for Evidence-Based Policy. (2014). Top tier evidence initiative: Evidence summary for Promoting School-Community-University Partnerships to Enhance Resilience (PROSPER). Retrieved from https://evidencebasedprograms.org/document/prosper-evidence-summary/

Greenberg, M. T., Feinberg, M. E., Meyer-Chilenski, S., Spoth, R. L., & Redmond, C. (2007). Community and team member factors that influence the early phase functioning of community prevention teams. Journal of Primary Prevention, 28(6), 485–504. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848438/

PROSPER Partnerships. (n.d.). How it works. Retrieved from http://helpingkidsprosper.org/how-it-works

Spoth, R., Guyll, M., Redmond, C., Greenberg, M., & Feinberg, M. (2011). Six-year sustainability of evidence-based intervention implementation quality by community-university partnerships: The PROSPER study. American Journal of Community Psychology, 48(0), 412–425. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727665/

Spoth, R., Redmond, C., Shin, C., Greenberg, M., Clair, S., & Feinberg, M. (2007). Substance-use outcomes at 18 months past baseline: The PROSPER community-university partnership trial. American Journal of Prevention Medicine, 32(5), 395–402. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869212/