Indiana Strategic Prevention Framework

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Indiana Strategic Prevention Framework

• February 24, 2009
• Chuck Klevgaard
• Sheila Nesbitt

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When thinking about SPF, do you
ever feel like this.?
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Or this..?
Maybe you fear being put on the spot?
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Or this..?
My life broken down into segments



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Or maybe this..?
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Expectations

• What are you hoping will happen today (a
  topic/issue you want to learn more about, someone
  you want to network with, a question you
  absolutely have to have answered)?

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Overview of Day

• Provide guidance on selecting strategies
• Walk through one example together
• Small groups walk through additional examples
• Discussion of next steps and additional needs

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Determining Fit
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Conceptual FitCommunity

• A Good Conceptual Fit intervention should
• Fit into community logic model (alignment)
• Drive positive outcomes in identified substance
  abuse problems (reach)
• Address the communitys intervening variables
• Be founded on evidence-based principles for
  target population
• Target multiple opportunities for intervention
  (sufficient mix)

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Conceptual FitScreening for Alignment
Condition Mediating / Moderating Variable
Consequence Consumption Patterns
Strategies Programs, Policies, and Practices
Retail Availability of Alcohol to Youth
Implement a Friday Night Basketball Program
Underage Drinking In preventing and reducing
underage drinking and binge drinking, there will
be a reduction in arrest rates for driving under
the influence, public intoxication and liquor law
violations.
Retail Availability of Alcohol to Youth
Administer Alcohol Compliance Checks
The community logic model can be used to check
the alignment of interventions
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Conceptual FitScreening for Reach
Condition Mediating / Moderating Variable
Consequence Consumption Patterns
Strategies Programs, Policies, and Practices
Social Availability of Alcohol to Youth
Underage Drinking In preventing and reducing
underage drinking and binge drinking, there will
be a reduction in arrest rates for driving under
the influence, public intoxication and liquor law
violations.
Implement Shoulder Taps With 6 of 47 Package
Stores Once a Year
Social Availability of Alcohol to
Youth
Implement Shoulder Taps With 40 of 47 Package
Stores Once a Year
The logic can also screen for strategies /
interventions that may not have sufficient reach
to create community level change
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Developing a Comprehensive ApproachSufficient Mix

• Use multiple interconnected strategies in order
  to reach community level change
• Multiple strategies will complement and reinforce
  each other
• Consider number of people impacted in each
  strategy

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Practical Fit Community

• Feasible given a communitys resources,
  capacities, and readiness to act
• Add to or reinforce prevention strategies in the
  community - synergism and layering
• Consider community climate
• Meet cultural needs of target population
• Sustainable in community
• Evaluability

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Practical FitSynergy and Layering
Existing Programs
Intervening Variable
Limitations
Possible Additions
Environmental approach doesnt target 15-18 y/o
Low enforcement of alcohol laws
College Campus Alcohol Awareness Program
Expand current environmental approach to high
schools
Practical fit is assessed through a series of
utility and feasibility checks that grow out of
the needs/resource assessment and
capacity-building activities conducted in SPF
Steps 1 and 2
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Definitions of Evidenced-BasedRevised

• Included on federal lists or registries of
  evidence-based interventions
• Reported (with positive effects) in peer-reviewed
  journals and
• Documented effectiveness supported by other
  sources of information and the consensus judgment
  of informed experts, as described in the
  following set of four guidelines. all must be
  met

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Four Guidelines for Documenting
EffectivenessRevised

• Based in solid theory documented in a logic or
  conceptual model and
• Similar in content and structure to interventions
  that appear in registries or peer-reviewed
  literature and
• The Intervention is supported by documentation
  that it has been effectively implemented in the
  past, and multiple times, in a manner attentive
  to scientific standards of evidence and with
  results that show a consistent pattern of
  credible and positive effects and

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Four Guidelines for Documenting
EffectivenessRevised

• The intervention is reviewed and deemed
  appropriate by a panel of informed prevention
  experts that includes well-qualified prevention
  researchers who are experienced in evaluating
  prevention interventions similar to those under
  review local prevention practitioners and key
  community leaders as appropriate ,e.g., officials
  from law enforcement and education sectors or
  elders with indigenous cultures.

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Evidence-Based InterventionsStrength of Evidence

• The strength of evidence of a tested intervention
  will fall somewhere along a continuum from weak
  to strong
• The strength of evidence is assessed using
  scientific standards and criteria for applying
  these standards

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Strength of Evidence Components

• Rigor of the study
• Rigor and appropriateness of the methods used to
  collect and analyze the data
• The extent to which a finding can be generalized
  to similar populations and similar settings.

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Indiana Gap Analysis Tool

• Look at The Existing Approaches Tool
• Write Afternoons ROCK on line one
• Identify 2-3 additional programs
• Fill in the boxes as in the sample
• Pull Out Your Logic Model
• Fill in Consequence, Focus Pop, and Conditions
• Look at The Gaps Analyses Logic Model
• Fill in Approaches, Limitations and Enhancements

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Summary of Things to Consider

• Conceptual fit
• Practical fit
• Evidence of Effectiveness
• Comprehensive approach
• Reach

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Conditions mediating, moderating, intervening
variables

• Sheila Nesbitt

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(No Transcript)
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Figure 1-- Legend Strength of (a) Evidence of
relationship to underage drinking and (b)
Evidence of Population-Level Effect on Underage
Drinking, Alcohol-related Problems or Other Key
Intermediate Variables Resulting from Prevention
Interventions
Strong evidence of relationship and strong
evidence of population level prevention effects
and or strong effect on other intermediate
variables which have population level prevention
effects.
Strong evidence of relationship and moderate
evidence of population level prevention effects
or moderate evidence of effect on key
intermediate variables which have population
level effects
Strong evidence of relationship but only limited
or no evidence of population level prevention
effects but evidence of target group effects.
Theoretical but no empirical evidence of
relationship and therefore no evidence of
population level or target group prevention
effects
Draft
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Strategy Selection

• Out of two interventions, the one for which there
  is stronger evidence of effectiveness should be
  chosen, if the intervention is similar,
  equivalent, and equally well-matched to the
  communitys unique circumstances.
• Reserve selecting an intervention with little or
  weak evidence of effectiveness for situations in
  which other interventions with stronger evidence
  do not fit local circumstances.

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Underage Drinking Outcome

• In preventing and reducing underage drinking and
  binge drinking,
• there will be a reduction in arrest rates for
  driving under the influence,
• public intoxication and
• liquor law violations.

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Condition Retail availability

• Definition Ease of accessing alcohol through
  on-premise (bars, restaurants) and off-premise
  (liquor, convenience, grocery stores). Can refer
  to the presence and density of alcohol outlets
  and the frequency of use of specific commercial
  sources of alcohol by youth.
• Retailer compliance with laws ability of
  underage persons to purchase or consume, service
  to obviously intoxicated.
• Sources of alcohol actual sources of alcohol as
  reported by young persons.
• Hours and days of sale
• Outlet density
• How have you assessed retail availability in your
  community?

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Policy, Program, Practice

• Alcohol Compliance Checks
• Rationale Law enforcement confirmation of
  whether outlets sell to underage person and
  sanctions for illegal sales reduce likelihood of
  sales
• Objective Reduce illegal sales of alcohol to
  person under 21 years of age.
• Allow local control and sanctions against
  retailers that sell to underage persons.
• Increase retailer expectation that illegal sales
  will result in consequences.

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Compliance Checks Conceptual fit?

• Fit into community logic model?
• Do compliance checks address the conditions
  mediating and moderating variables?
• Drive positive outcomes in identified problems?
• Does this strategy impact the identified
  consequence reduction in arrest rates for
  driving under the influence, public intoxication
  and liquor law violations
• Will this strategy have sufficient reach to move
  the needle in the community? licensees x 2
  checks (minimum), plus rechecks on failures
  within 90 days (Wagenaar, 2000)

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Compliance Checks Conceptual fit?

• Comprehensive Approaches (mix)
• Add to or reinforce a strategy in the community?
• Target multiple opportunities for intervention?

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Compliance Checks Practical Fit ?

• Feasible given a communitys resources,
  capacities, and readiness to act?
• - What would the process be for establishing this
  approach?
• - What tasks would need to be accomplished
  leading to implementation?
• Fidelity
• Can you implement in the manner it was designed?
• Is there support (Training, TA, materials) for
  implementation? (PIRE and U of Minnesota
  implementation guides)
• Consider community climate
• Does the approach account for readiness?
• Does the approach meet cultural needs?

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Compliance Checks Practical Fit?

• Sustainability
• Does the community have resources to sustain this
  initiative?

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Compliance Checks Effectiveness?

• Evidence-based principles for target population
• Is the approach research-based on a well defined
  theory or model?
• Is there documented evidence of effectiveness
  (such as formal evaluation results)?
• Have the results been replicated successfully by
  different researchers over time?
• Has the approach been shown to be effective for
  areas similar to those you will address?

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Small Group Discussions

• Discuss examples specific to your priority
  substance (cocaine or alcohol).

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Large Group Discussion
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Decision Matrix
Conceptual Fit (Logic model, conditions,
alignment, and reach)
Practical Fit (community resources readiness)
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Balancing Art and Science

• Research, tools, and checklists will only get you
  so far.

• At some (hopefully many!) points, you need to see
  how the big picture is coming together.

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• We hope that now you feel less like
  this...
• Yikes!

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And more like this. Ahhhhh!
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Thank YOU for your
kind attention. We hope to see you
again sometime! Please complete the evaluation.
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Thank You!!

• For questions, comments
• Sheila Nesbitt
• CSAPs Central CAPT
• 1800-782-1878 x128
• snesbitt_at_miph.org