Indiana Strategic Prevention Framework

February 24, 2009

Chuck KlevgaardSheila Nesbitt

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When thinking about SPF, do you ever feel like this….?

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Maybe you fear being put on the spot?Or this…..?

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My life broken down into segments

Or this…..?

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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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A “Good Conceptual Fit” intervention should: Fit into community logic model (alignment) Drive positive outcomes in identified substance

abuse problems (reach) Address the community’s intervening variables Be founded on evidence-based principles for

target population Target multiple opportunities for intervention

(sufficient mix)

Conceptual FitCommunity

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ConditionMediating / Moderating

Variable

Consequence Consumption

Patterns

StrategiesPrograms, Policies, and Practices

Conceptual FitScreening for Alignment

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

andliquor 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

Retail Availability of Alcohol to Youth

Implement a Friday Night Basketball Program

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ConditionMediating / Moderating

Variable

Consequence Consumption

Patterns

StrategiesPrograms, Policies, and Practices

Conceptual FitScreening for Reach

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

andliquor law violations.

Social Availability of Alcohol to Youth

Implement Shoulder

Taps With 6 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

Social Availability of Alcohol to Youth

Implement Shoulder

Taps With 40 of 47 Package Stores

Once a Year

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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 community’s 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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Existing Programs

Intervening Variable

Limitations

Practical FitSynergy and Layering

Low enforcement

of alcohol laws

College Campus Alcohol

Awareness Program

Environmental approach

doesn’t target 15-18 y/o

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

Expand current environmental

approach to high schools

Possible Additions

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Definitions of “Evidenced-Based”Revised

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 Effectiveness:Revised

1. Based in solid theory documented in a logic or conceptual model; and

2. Similar in content and structure to interventions that appear in registries or peer-reviewed literature; and

3. 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 Effectiveness:Revised

4. 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

Conditions: mediating, moderating,

intervening variables

Sheila Nesbitt

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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.

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 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

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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 community’s 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.

StrategyConditionsconsumption 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?

StrategyIntervening

Variable Policy, Program, Practice

Alcohol Compliance ChecksRationale: 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.

StrategyIntervening

Variable 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)

StrategyIntervening

Variable Compliance Checks: Conceptual fit?

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

StrategyIntervening

Variable Compliance Checks: Practical Fit ?

Feasible given a community’s 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?

StrategyIntervening

Variable Compliance Checks: Practical Fit?

SustainabilityDoes the community have resources to sustain

this initiative?

StrategyIntervening

Variable 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

High Low

Sufficient Highest Priority? Less Priority?

Limited High Priority?Lowest Priority?

Conceptual Fit(Logic model, conditions, alignment, and reach)

Pra

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Fit

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Decision Matrix

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.

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, commentsSheila Nesbitt

CSAP’s Central CAPT

1800-782-1878 x128

snesbitt@miph.org