Building Community Collaboration to Promote Healthy Youth Development:

1
Building Community Collaboration to Promote
Healthy Youth Development
J. David Hawkins Ph.D.

• Social Development Research Group
• School of Social Work
• University of Washington
• www.sdrg.org

Melissa Institute May 1, 2008
2
The Challenge for Community Prevention

• To address those risk factors most prevalent in a
  community with tested, effective policies and
  programs.
• To address protective factors most depressed in a
  community with tested, effective policies and
  programs that strengthen those protective
  factors.

3
The Communities That Care Prevention System

• Helps communities apply the advances of
  prevention science to guide youth development and
  prevention work.
• Measures community levels of protection and risk
  by surveying young people.
• Matches the communitys profile of risk and
  protection with tested, effective programs and
  policies.

4
The Communities That Care Prevention System

• Local control builds ownership to create
  sustainable change.
• Focuses on outcomes to insure success Are fewer
  teens using drugs? Fewer smoking? Fewer
  committing violent acts?

5
The Communities That Care Operating System
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The Communities That Care Operating System

• Community readiness assessment.
• Identification of key individuals, stakeholders,
  and organizations.

7
The Communities That Care Operating System

• Training key leaders and board in CTC
• Building the community coalition.

8
The Communities That Care Operating System

• Collect risk/protective factor and outcome data.
• Collect information on community resources
• Construct a community profile from the data.

9
Peer-Individual
Estimated National Value
10
The Communities That Care Operating System

• Define outcomes.
• Prioritize factors to be targeted.
• Select tested, effective interventions.
• Create action plan.
• Develop evaluation plan.

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Addressing Barriers with Effective Action
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Effective Training for Middle School Parents

• Guiding Good Choices (Spoth et al., 1998)
• Adolescent Transitions Program (Dishion and
  Andrews, 1995)
• Parenting Adolescents Wisely (Gordon et al.,
  1998)
• Creating Lasting Connections (Johnson et al.,
  1996)
• Strengthening Families 10 to 14 Program (Spoth,
  1998)
• Focus on Families (Catalano et al., 1999 1997)

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The Communities That Care Operating System

• Form task forces.
• Identify and train implementers.
• Sustain collaborative relationships.
• Evaluate processes and outcomes.
• Adjust programming.

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What is required to install CTC?

• A coalition of community stakeholders.
• A coordinator for the CTC process.
• Manuals and curriculum materials.
• Training from certified trainers.
• Technical assistance when difficulties are
  encountered.
• A monitoring system to provide routine feedback
  on progress and outcomes.

15
CTC Trainings

1. Key Leader Orientation
2. Community Board Training
3. Community Assessment Training
4. Community Resource Assessment Training
5. Community Planning Training
6. Community Program Implementation Training

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Communities that CareProcess and Timeline
Measurable Outcomes

Process
Increase in priority protective factors Decrease
in priority risk factors
Increase in positive youth development Reduction
in problem behaviors
Assess risk, protection and resources
Implement and evaluate tested prevention
strategies
Vision for a healthy community
6-9 mos. 1 year 2-5 years
5-10 years
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The Community Youth Development Study (CYDS)

• A 24 community randomized controlled trial to
  test the Communities That Care system started in
  2003.

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The Community Youth Development Study Team
Abigail A. Fagan John Graham Kevin Haggerty Koren
Hanson J. David Hawkins David M. Murray Sabrina
Oesterle M. Lee Van Horn
Robert D. Abbott Michael W. Arthur Megan M.
Baldwin John S. Briney Blair Brooke-Weiss Eric
C. Brown Rick Cady Richard F. Catalano
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
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CYDS State Collaborators

• Colorado Alcohol Drug Abuse Division
• Illinois Division of Community Health
  Prevention
• Kansas Alcohol and Drug Abuse Services
• Maine Office of Substance Abuse
• Oregon Office of Alcohol Drug Abuse Programs
• Utah Division of Substance Use
• Washington Division of Alcohol Substance Abuse
  

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CYDS Primary Aim

• To test the efficacy of the Communities That Care
  system in
• reducing levels of risk
• increasing levels of protection
• reducing health and behavior problems among
  adolescents
• using a true experimental design.

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STUDY DESIGN
Randomized Controlled Trial 2003-2008
2003 2004 2005 2006 2007
2008
Implement selected interventions
Planning
5-Year Baseline 1997-2002
CTCYS
CTCYS
CTCYS
CKI CRD
CKI CRD
Intervention
98 99 00 01 02
CTC Board
CTC Board
CTC Board
CTC Board
CTC Board
Randomize
CTCYS
CTCYS
CTCYS
YDS
YDS
YDS
YDS
YDS
CKI CRD
CTCYS
CTCYS
CTCYS
CKI CRD
Control
CKI CRD
CKI CRD
CTCYS Cross-sectional student survey of 6th-,
8th-, 10th-, and 12th-grade students using the
CTC Youth Survey CKI Community Key Informant
Interview CRD Community Resource Documentation
measuring effective prevention programs and
policies in the community  CTC Board CTC Board
Member Interview YDS Longitudinal Youth
Development Survey of students in the class of
2011 starting in 5th grade in spring 2004
YDS
YDS
YDS
YDS
YDS
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Demographics of 24 CYDS Communities
Mean Minimum Maximum
Total Population 14,616 1,578 40,787
Percent Caucasian 89.4 64.0 98.2
Percent Hispanic Origin Percent African-American Percent Eligible for Free/Reduced Lunch 9.6 2.6 36.5 0.5 0.0 20.6 64.7 21.4 65.9
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Panel-Youth Development Survey (YDS)

• Annual survey of panel recruited from the Class
  of 2011 (5th grade in 2004)
• Active, written parental consent

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Youth Development Survey

• Participants recruited in grades 5 and 6.
• Final consent rate 76.4

Sixth Grade Eligible Population Percent Consented Percent Surveyed Total Surveyed
Experimental 3170 76.2 75.4 2391
Control 2621 76.7 76.3 1999
Total 5791 76.4 75.8 4390
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2006 YDS

• 96.2 Overall Student Participation
• 10.3 (n454) had moved out of project schools

7th Grade Eligible Population Percent Surveyed Total Surveyed
Experimental 2406 95.5 2298
Control 2001 97.0 1941
Total 4407 96.2 4239
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2007 YDS

• 96.2 Overall Student Participation
• 11.9 (n525) have moved out of project schools

8th Grade Eligible Population Percent Surveyed Total Surveyed
Experimental 2406 95.6 2300
Control 2001 96.9 1940
Total 4407 96.2 4240
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Communities That CareLogic Model
CTC Training and Technical Assistance
Adoption of Science-based Prevention Framework
Collaboration Regarding Prevention Issues
Appropriate Choice and Implementation of Tested,
Effective Prevention Programs Adoption of
Social Development Strategy as Communitys Way of
Bringing Up Children
Decreased Risk and Enhanced Protection
Positive Youth Outcomes
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Adoption of Science-Based Prevention

• Stage 0 No Awareness
• Stage 1 Awareness of Prevention Science Terms
  and Concepts
• Stage 2 Using Risk and Protection Focused
  Prevention Approach as a Planning Strategy.
• Stage 3 Incorporation of Community
  Epidemiological Data on Risk and Protection in
  Prevention System.
• Stage 4 Selection and Use of Tested and
  Effective Preventive Interventions to Address
  Prioritized Risk and Protective Factors.
• Stage 5 Collection and Feedback of Process and
  Outcome Data and Adjustment of Preventive
  Interventions Based on Data.

Note. Community Key Informant Survey (CKI).
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Baseline Stages of Adoption by Intervention
Status
Control Communities
CTC Communities
Probability
Stage of Adoption in 2001
Note. Community Key Informant Survey (CKI) N
534 ?001 .037, SE .395, df 20, p gt .05 .
30
Post-Intervention Stages of Adoption by
Intervention Status
Control Communities
CTC Communities
Probability
Stage of Adoption in 2004
Note. Community Key Informant Survey (CKI) N
534 ?101 -1.311, SE .355, df 20, p lt .002
.
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Collaboration onPrevention

• Prevention Collaboration
• Assessed by 9 items measuring prevention-specific
  collaborative activities.
• There is a network of people concerned about
  prevention issues who stay in touch with each
  other.
• Organizations in community share money or
  personnel when addressing prevention issues.
• Organizations in community participate in joint
  planning and decision making about prevention
  issues.

1strongly agree, 2somewhat agree, 3somewhat
disagree, 4strongly disagree
Note. Community Key Informant Survey (CKI).
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Change in Prevention Collaboration by
Intervention Status
Factor Score
Post-Int (2004)
Pre-Int (2001)
Year
Note. Community Key Informant Survey (CKI) N
530 ?001 -0.123, SE .118, df 20, p gt .05
?101 0.237, SE .094, df 20, p lt .022.
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Communities That CareTheory of Change
CTC Training and Technical Assistance
Adoption of Science-based Prevention Framework
Collaboration Regarding Prevention Issues
Appropriate Choice and Implementation of Tested,
Effective Prevention Programs Adoption of
Social Development Strategy as Communitys Way of
Bringing Up Children
Decreased Risk and Enhanced Protection
Positive Youth Outcomes
34
Program Selection

• CTC Community Board members selected prevention
  programs from a menu of programs that
• Showed significant effects on risk/protective
  factors, and drug use, delinquency, or violence
• Involved at least one high-quality research study
  
• Targeted children or families in grades 5-9
• Provided materials and training
• Communities That Care Prevention Strategies
  Guide

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Programs Selected in 2004-2007
PROGRAM 2004-05 2005-06 2006-07
All Stars Core 1 1 1
Life Skills Training 2 4 5
Lions-Quest Skills for Adolescence 2 3 3
Project Alert - 1 1
Olweus Bullying Prevention Program - 2 2
Program Development Evaluation Training 1 1 -
Participate and Learn Skills (PALS) 1 1 1
Big Brothers/Big Sisters 2 2 2
Stay SMART 3 3 1
Tutoring 4 6 6
Valued Youth Tutoring Program 1 1 1
Strengthening Families 10-14 2 3 3
Guiding Good Choices 6 7 8
Parents Who Care 1 1 -
Family Matters 1 1 2
Parenting Wisely - 1 1
TOTAL 27 38 37
Program funded through local resources in one or
two communities
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Exposure in the Community
Program Type 2004-05 2005-06 2006-07
School Curricula 1432 3886 5165
After-school 546 612 589
Parent Training 517 665 476
Note Total eligible population of 6th, 7th, and
8th-grade students in 2005-06 was 10,031.
Includes PALS, BBBS, Stay SMART, and Tutoring
programs
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Participant Attendance
Percentage attending gt60 of the total number of
sessions
Program Type 2004-05 2005-06 2006-07
School Curricula 96 91 95
After-school 77 81 65
Parent Training 79 78 79
Includes PALS, BBBS, Stay SMART, and Tutoring
programs
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Fidelity Assessment Checklists

• Obtained from developers (9) or created by
  research staff (7)
• Provided similar information across all programs
  to measure 4 elements of fidelity
• Over 6,000 checklists were completed by program
  implementers and coordinators
• Minimal missing data (8.2 in 2004-05 and 2.1 in
  2005-06)
• Checklists were collected and reviewed by
  communities, then sent to SDRG

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Adherence Rates 2004-05 and 2005-06 school years
Percentage of material taught or core components
achieved
40
Adherence

• Average adherence rate were high 91 in
  2004-05 and 94 in 2005-06
• Problematic modifications were infrequent (1.2
  reported per cycle)
• Deletions reported twice as often as additions
• Implementer reports of challenges
• Lack of time (14-20 of checklists)
• Participant misbehavior (9-11)
• Trouble engaging participants (4-9)

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Delivery of Lessons2004-05 and 2005-06 school
years(number, length, and frequency of required
sessions)
Percentage of delivery requirements met
42
Delivery of Lessons

• Delivery scores were high 91 and 92 in 2004-05
  and 2005-06
• Problematic deviations in delivery requirements
  were infrequent
• Deviations most likely to occur in school-based
  programs
• e.g., 30 vs. 45-minute sessions
• e.g., deleting 1 of 12 required sessions

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Program Observations

• Observed 10-15 of sessions in 10 of 16 programs
• Completed fidelity checklists to verify adherence
  information
• Rate of agreement between observers and
  implementers was 93 (range 77-100)
• Observers also rated the quality of delivery and
  participant responsiveness

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Quality of Delivery

• Observers rated the quality of delivery on
  10 items (alpha .83-.88) using a 5-point scale
  (higher scores indicate better quality)
• Example Items
• In general, how clear were the program
  implementers explanations of activities?
• To what extent did the implementer keep on time
  during the session and activities?
• Rate the implementer on the following qualities
  
• Level of enthusiasm
  
• Rapport and communication with participants
  
• Effectively addressed questions/concerns

45
Quality of Delivery 2004-05 and 2005-06 school
years
Average score on 10 items reported by program
observers
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Quality of Delivery Diversity of Teaching
Techniques

• Observers rated the percentage of the session in
  which each teaching technique was used

2004-05 2005-06
Lecture 29 30
Practice 34 28
Discussion 31 36
Video 6 4
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Participant Responsiveness

• Observers rated participant responsiveness on two
  items, using a 1-5 scale (higher scores indicate
  better responsiveness)
• To what extent did the participants appear to
  understand the material?
• How actively did group members participate in
  discussions and activities?
• Across all programs, rates were high 4.38 and
  4.52 in 2004-05 and 2005-06

48
Communities That CareTheory of Change
CTC Training and Technical Assistance
Adoption of Science-based Prevention Framework
Collaboration Regarding Prevention Issues
Appropriate Choice and Implementation of Tested,
Effective Prevention Programs Adoption of
Social Development Strategy as Communitys Way of
Bringing Up Children
Decreased Risk and Enhanced Protection
Positive Youth Outcomes
49
Prioritized Risk Factors in CTC Communities

• Family management problems
• Parental attitudes favorable to problem behavior
• Family conflict
• Low commitment to school
• Favorable attitudes toward problem behavior
• Friends who engage in problem behavior
• Academic failure
• Rebelliousness
• Laws and norms favorable toward drug and alcohol
  use

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Pre-post Change inTargeted Risk Factors
Average Level of Risk
Grade 5
Grade 7
Note. Values are model-fitted levels of
standardized average risk for students in the
Youth Developmental Study panel sample, N 4404.
For Grade 7 ?010 .111, SE .043, df 11, p lt
.026.
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Communities That CareTheory of Change
CTC Training and Technical Assistance
Adoption of Science-based Prevention Framework
Collaboration Regarding Prevention Issues
Appropriate Choice and Implementation of Tested,
Effective Prevention Programs Adoption of
Social Development Strategy as Communitys Way of
Bringing Up Children
Decreased Risk and Enhanced Protection
Positive Youth Outcomes
52
Youth Outcomes

• Initiation of Delinquent Behaviors
• Nine items measuring delinquent behaviors.
• Initiation of Substance Use
• Alcohol, marijuana, cigarettes, smokeless
  tobacco, inhalants, non-prescribed use of
  prescription drugs, other illicit drugs.

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Delinquency Items
How many times in the past year (12 months) have you... 5th Grade 6th Grade 7th Grade
stolen something worth more than 5? v v v
purposely damaged or destroyed property that did not belong to you (not counting family property)? v v v
taken something from a store without paying for it? v v v
attacked someone with the idea of seriously hurting them? v v v
been arrested? v v
beat up someone so badly that they probably needed to see a doctor or a nurse? v v
sold illegal drugs? v
stolen or tried to steal a motor vehicle such as a car or motorcycle? v
taken a handgun to school? v
54
Delinquency InitiationBetween Grades 5 and 7
Initiation Rate
Note. Youth Developmental Study panel sample.
Excludes students who initiated delinquent
behavior by Grade 5. ?0001 .237, SE .103, df
11, p lt .05.
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Substance Use InitiationBetween Grades 5 and 7
Initiation Rate
Note. Youth Developmental Study panel sample.
Excludes students who initiated substance use by
Grade 5. ?0001 .142, SE .122, df 11, p gt
.05.
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Summary

• Adoption of science-based prevention and
  collaboration are higher in CTC communities than
  in control communities.
• CTC communities and schools are adopting tested
  effective programs.
• The new programs are being implemented with
  fidelity.
• Targeted risk factors are increasing less rapidly
  in CTC than in control communities.
• The rate of initiation of delinquent behaviors is
  significantly lower in CTC than in control
  communities.

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• The Communities That Care Prevention Operating
  System is available at
• http//preventionplatform.samhsa.gov/

58
Published Papers
Arthur, M.W., Briney, J.S., Hawkins, J.D.,
Abbott, R.D., Brooke-Weiss, B. . Catalano, R.F.
(2007). Measuring community risk and protection
using the Communities That Care Youth Survey.
Evaluation and Program Planning, 30,
197-211. Brown, E.C., Hawkins, J.D., Arthur,
M.W., Briney, J.S., Abbott, R.D. (2007).
Effects of Communities That Care on prevention
services systems Findings from the Community
Youth Development Study at 1.5 years. Prevention
Science. 8, 180-191. Fagan, A. A., Hawkins, J.
D., Catalano, R. F. (in press). Using community
epidemiologic data to improve social settings
The Communities That Care prevention system. In
M. Shinn H. Yoshikawa (Eds.), Toward positive
youth development Transforming schools and
community programs. New York Oxford University
Press. Fagan, A.A., Van Horn, M.L., Hawkins,
J.D., Arthur, M.W. (2007). Using community
and family risk and protective factors for
community-based prevention planning. Journal of
Community Psychology, 35(4), 535-555. Hawkins,
J.D. (2006). Science, social work, prevention
Finding the intersections.  Social Work Research,
30(3), 137-152. Murray, D.M., Van Horn, M.L.,
Hawkins, J.D., Arthur, M.W. (2006). Analysis
strategies for a community trial to reduce
adolescent ATOD use A comparison of random
coefficient and ANOVA/ANCOVA models. Contemporary
Clinical Trials. 27, 188-206.
59
Papers In Press
Brooke-Weiss, B., Haggerty, K. P., Fagan, A. A.,
Hawkins, J. D., Cady, R. (in press). Creating
community change to improve youth development
The Communities That Care (CTC) system. The
Prevention Researcher. Brown, E.C., Hawkins,
J.D., Arthur, M.W., Van Horn, M.L., Abbott,
R.D. (in press). Multilevel analysis of a
measure of prevention collaboration. American
Journal of Community Psychology. Fagan, A.A.,
Hanson, K., Hawkins, J.D., Arthur, M.W. (in
press). Bridging science to practice Achieving
prevention program implementation fidelity in the
Community Youth Development Study. American
Journal of Community Psychology. Fagan, A.A.,
Hawkins, J.D. and Catalano, R.F. (in press). 
Using community epidemiologic data to improve
social settings The Communities That Care
Prevention System.  In M. Shinn, and H.
Yoshikawa, (eds).  Improving Social Settings to
Facilitate Positive Development among
Adolescents.  New York W.T. Grant
Foundation. Fagan, A.A., Hanson, K., Hawkins,
J.D., Arthur, M.W. (in press). Implementing
effective community-based prevention programs in
the Community Youth Development Study. Youth
Violence and Juvenile Justice. Hawkins, J.D.,
Brown, E.C., Oesterle, S., Arthur, M.W., Abbott,
R.D., Catalano, R.F. (in press). Early effects
of Communities That Care on targeted risks and
initiation of delinquent behavior and substance
use. Journal of Adolescent Health. Quinby, R.K.,
Fagan, A.A., Hanson, K., Brooke-Weiss, B.,
Arthur, M.W., Hawkins, J.D. (in press).
Installing the Communities That Care prevention
system Implementation progress and fidelity in a
randomized controlled trial. Journal of Community
Psychology. Van Horn, M.L., Fagan, A.A., Jaki,
T., Brown, E.C., Hawkins, J.D., Arthur, M.W.,
Abbott, R.D., Catalano, R.F. (in press). The
use of mixture models to evaluate differential
intervention effects in group randomized trials.
Multivariate Behavioral Research.
60
Building Community Collaboration to Promote
Healthy Youth Development
J. David Hawkins Ph.D.

• Social Development Research Group
• School of Social Work
• University of Washington
• www.sdrg.org

Melissa Institute Reducing Violence May 1, 2008
61
Risk Factors Addressed in CTC Communities
Community Targeted Risk Factors
A Parental attitudes favorable to problem behavior Low commitment to school Favorable attitudes toward problem behavior
C Family management problems Low commitment to school Friends who engage in problem behavior Favorable attitudes towards problem behavior
G Poor family management Low commitment to school
H Poor family management Academic failure Low commitment to school
I Low commitment to school Friends who engage in problem behavior
J Academic failure Low commitment to school Friends who engage in problem behavior Favorable attitudes toward problem behavior Rebelliousness
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Risk Factors Addressed in CTC Communities
Community Targeted Risk Factors
N Academic failure Friends who engage in problem behavior
O Laws and norms favorable toward drug and alcohol use Low commitment to school Friends who engage in problem behavior Rebelliousness
Q Family conflict Friends who engage in problem behavior Favorable attitudes towards problem behavior Rebelliousness
T Family conflict Low commitment to school Friends who engage in problem behavior
W Poor family management Academic failure Friends who engage in problem behavior Favorable attitudes towards problem behavior
X Academic failure Low commitment to school Friends who engage in problem behavior