Prevention Center of Excellence

Annotated Bibliography:
Community Infrastructure Development

Community Infrastructure Development available in PDF.
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Compiled by: Anush Yousenfian, Prevention Center of Excellence, University of Southern Maine
October 12, 2006

Prevention infrastructure/capacity building

Campbell, P. & Conway, A. (2005). Developing a local public health infrastructure: The Maine Turning Point experience. Journal of Public Health Management Practice, 11(2), 158-164.

Summarizes the current state of the Maine Turning Point initiative, in regards to strengthening Maine’s local public health capacity on a state level. Maine Turning Point deliberations highlighted the following deficiencies related to public health infrastructure: 1.) There is very little strategic planning at the local level when it comes to health promotion and disease prevention. Existing organizations, such as non-profits groups, often respond to individual RFP’s, which identify a specific health issue that will be addressed, rather than supporting inter-connected, evolving public health issues that are problems in the community. 2.) Local public health efforts lack sufficient coordination and collaboration. Authors cite the Children’s Cabinet as the only real example of an organization which cuts across various state agencies. There is also very little coordination among the state’s public health organizations and their health care counterparts, hospitals, and medical practices. 3.) There is a relative lack of accountability at the local level – Maine lacks a network of local leaders who will hold public health providers accountable for results of public health efforts/interventions. Some successes that have grown out of the Turning Point Initiative include the Healthy Maine Partnerships, the One Maine Program, the Maine Center for Public Health, the Maine Network or Healthy Communities and the Maine-Harvard Prevention Research Center.

Chavis, D. (2002). Building community capacity: An initial inventory of local intermediary organizations. Retrieved October 20, 2005 from http://comm-org.wisc.edu/papers2005/chavis.htm

Examines intermediary organizations that provide support and resources to community development organizations. Intermediaries are seen as the link between two segments of society: organizations with resources (funders) and organizations seeking resources. The intermediary provides: funding, technical assistance, training, incentives, peer support and networks. Intermediaries are also sometimes viewed as a resource to empower low-income communities and community organization movements. They can empower by: building and enhancing viability, encouraging cohesiveness and effectiveness through participatory methods, improving access to financial resources, providing technical skills, and building coalitions between communities and the political system.

Ebbesen, L.S., Heath, S., & Naylor, P.J. (2004). Issues in measuring health promotion capacity in Canada: A multi province perspective. Health Promotion International., 19(1), 85-94.

Outlines critical issues in measuring health promotion capacity and building capacity in communities where health promotion interventions are needed. They identify several shared issues among the many sites of the Canadian Heart Health Initiative when assessing capacity: understanding of terms (health promotion and prevention terminology), evolving understanding of capacity, invisibility of capacity building (difficulty in recognizing, describing and measuring the process), detecting change within a dynamic system, staff turnover, time course required for change, attribution for change in capacity, lack of existing “gold standard” measurement tools, validity and credibility of instruments (establishing validity criteria is difficult when there is no “gold standard”), evolving nature of measurement tools, gathering perspectives from multiple levels within organizations, dealing with conflicting perspectives, and managing and disseminating sensitive data.

Goodman, R.M., Speers, M., & McLeroy, K. (1998). Identifying and defining the dimensions of community capacity to provide a basis for measurement. Health Education and Behavior, 25, 258-278.

Summarizes findings from a CDC symposium on community capacity. Two working definitions of community capacity were used: 1.) the characteristics of communities that affect their ability to identify, mobilize, and address social and public health problems and 2.) the cultivation and use of transferable knowledge, skills, systems, and resources that affect community – and individual-level changes consistent with public health-related goals and objectives. The dimensions of capacity that were suggested by participants at the symposium included participation and leadership (which is basic to capacity – leaders enhance capacity when they ensure active involvement of a diverse network of community members), skills (participants and leaders must have considerable skills to ensure capacity. Skills may include: coordination of meetings, planning activities, collecting, analyzing and reporting data, mobilizing resources, resolving conflicts and resisting opposing factions), resources (traditional and social capital), social and interorganizational networks (includes structural characteristics, relationships among network members, and benefits that members receive from network ties), sense of community (characterized by “caring and sharing” among people in a community, mutual respect, generosity, and service to others), understanding of community history, community power (including who holds the power, who wants power, how the power will be used, and who decides how it will be used), community values (a community’s ability to articulate a clear set of values is integral to capacity) and critical reflection (an activity of action and reflection within one’s community for the purpose of challenging assumptions and creating change toward the core public health values).

Chinman, M., Imm, P., & Wandersman, A. (2004). Getting to Outcomes. Chapter #5: What organizational capacities are needed to implement the program? Retrieved October 20, 2005 from http://www.rand.org/pubs/technical_reports/TR101/TR101.ch5.pdf#
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Guide/tools for defining organizational capacity and assessing a community’s capacity. They define human capacities, technical capacities, fiscal capacities, structural/formal linkage capacities. It is critical to assess these capacities before program implementation in order to achieve desired outcomes. In situations where an organization does not possess adequate capacities, clear plans should be developed to obtain or access them elsewhere. Staff/human capacities can be enhanced by “active” trainings, where staff can practice or role-play the program and receive feedback. It is also important to have the correct number of staff for successful programs. Skills such as commitment, ownership, leadership, communication, conflict resolution, decision making, and group facilitation are critical. Components of technical capacity include: Access to program materials and access to personnel with appropriate evaluation skills. Fiscal capacities can be strengthened through grants, gifts, sponsorships, fund raising, and the sale of program-related products. Provides lists of resources for addressing substance abuse prevention.

Spoth, R.L. & Greenberg, M.T. (2005). Toward a comprehensive strategy for effective practitioner-scientist partnerships and larger-scale community health and well-being. American Journal of Community Psychology, 35(3-4), 107-26.

Explores the relationship between science and community psychology and the tensions between scientists and community practitioners. Outlines recommendations/models for resolving some of this tension in order to achieve successful community-based interventions. The authors suggest that there are two challenging tasks to address concerning increased capacity for diffusion of effective partnership-based interventions. The first is to clarify a theoretical framework to guide diffusion and the second is to formulate a comprehensive strategy for promoting and facilitating it. Components of this include the expansion of networks of effective partnership innovations, the articulation of a partnership-based research agenda, and the clarification of policy-making necessary to support network and research development.

Prevention theory/models promoted by SAMHSA/OSA

Chinman, M., Hannah, G., Wandersman, A., Ebener, P., Hunter, S.B., Imm, P., et al. (2005). Developing a community science research agenda for building community capacity for effective preventive interventions. American Journal of Community Psychology, 35(3-4), 143-57.

Focuses on the role of community capacity and develops a model for studying community capacity and its relationship to prevention practice and outcomes. Develops methods and tools for improving community capacity and reviews community capacity building technologies that are currently being employed. The article stresses the importance of bridging the gap between “science” and “practice.” The first factor that contributes to this gap is the fact that implementing high-quality prevention programming is complex, and requires strong knowledge and skills – there must be needs assessments, goals and objectives must be set and must fit the local context, there must be planning, implementation, evaluation and sustainability. Each one of these factors represents a point in the process that can fail, leading to poor outcomes. Second, there are often key differences between researchers and practitioners in their training and philosophies when it comes to prevention as well as a lack of community readiness to adopt evidence-based strategies. Third, a lack of monetary and technical resources can provide many barriers to implementation. Also, practitioners must focus on adapting prevention programs to their own community. The authors proposed a capacity building model that hypothesizes connections between capacity building technologies such as technical assistance, community capacity, prevention practices and outcomes. It focuses on local capacity as the starting point. It stresses that all aspects of community capacity building interventions be closely monitored through process evaluation. It especially stresses the importance of examining relationships between components of technical assistance intervention and certain elements of community capacity. This should focus on the “dose” of the technical assistance required to yield significant improvements in community capacity, the most appropriate delivery channels, and timing.

Center for Substance Abuse Prevention, SAMHSA. (2000). Annual summary: Effective prevention principles and programs. Retrieved October 30, 2005 from http://www.samhsa.gov/csap/modelprograms

This summary reviews 7 areas: science-based knowledge, National Registry of Effective Prevention Programs, risk and protective factors conceptual model, current state of knowledge on risk and protective factors by domain, effective prevention principles arranged by domain, emerging issues in prevention research, and effective substance abuse prevention programs identified in 1999. The current state of knowledge for risk and protective factors for the individual domain has found that youth who believe cigarettes or drugs will cause them physical harm are less likely to use them; that “sensation seeking” has consistently been linked to drug and alcohol use among youth; that deviant behavior or peer associations are precursors of later drug use; that youth who have conventional values and who value academic achievement are less likely to use alcohol when compared to those that value independence; youth who possess various social competencies are more resistant to substance abuse. Within the family domain, poor parenting practices, low bonding between parent and child, and inconsistent parental discipline increase the risk for youth alcohol use. Positive family dynamics, close parent-child relationships, and parental monitoring and supervision of children’s activities protect against substance abuse. Studies of factors related to the school domain reveal that low school performances, absenteeism, drop-out, poor educational performance and an unsafe school climate are predictive of youth alcohol use. School bonding and clear rule enforcement are protective against alcohol use. When examining the family domain, research has indicated that peer substance use is among the strongest predictors of an individual’s substance use and associating with deviant peers strongly predicts use as well. There is a correlation between sustained involvement in structured peer activities and low levels of drug use. Generally, young people overestimate the actual prevalence of all forms of substance use. In the community, ready access to ATOD increases the chance that youth will use these substances. Communities lacking resources are particularly vulnerable to high rates of adolescent substance abuse. Neighborhood anti-drug strategies, such as citizen surveillance and civil remedies can be effective within small areas. Community awareness and media efforts can improve perceptions about the likelihood of apprehension and reduce noncompliance. In the workplace domain, it has been found that adolescents who work more than 15 hours a week are at increased risk for substance abuse. There is an association between stress in the workplace and elevated levels of alcohol consumption.

Orleans, C.T., Gruman, J., Ulmer, C., Emont, S.L., & Hollendonner, J.K. (1999). Rating our progress in population health promotion: report card on six behaviors. American Journal of Health Promotion, 14(2), 75-82.

Assesses the current state of prevention models for six lifestyle behaviors: tobacco use, alcohol abuse, drug abuse, unhealthy diet, sedentary lifestyle and risky sexual practices related to HIV/AIDS. Summarizes “downstream,” “midstream” and “upstream” prevention programs. Downstream interventions are individual-level interventions that are geared towards people who possess a specific risk factor or suffer from risk-related diseases, with an emphasis on changing rather than preventing health-damaging behaviors. Interventions could include group/individual counseling, patient health education/behavioral interventions, self-help programs, and pharmacologic treatments. Midstream interventions are population-level that target defined populations for the purpose of changing and/or preventing health damaging behaviors. These may include: worksite and community-based health prevention/promotion programs, primary care screening, school-based youth prevention activities, and community-based interventions focused on a defined at-risk population. Upstream interventions are macro-level state and national public policy/environmental interventions to strengthen social norms for healthy behaviors and to redirect unhealthy societal and industry counter-forces. These can include: nationwide media campaigns, economic incentives, policies reducing access to unhealthy products and policies reducing the advertising of unhealthy products and behaviors. The authors suggest that more progress has been made in “downstream” individually oriented interventions that in broader, environmentally focused “upstream” approaches.

Center for Substance Abuse Prevention, SAMHSA. (2001). Science-based substance abuse prevention: Guide to science-based practices #1. Retrieved October 30, 2005 from www.samhsa.gov

This booklet highlights the risk and protective factors that have been established as a unifying descriptive and predictive framework in substance abuse prevention. Risk factors include biological, psychological/behavioral, and social/environmental characteristics. Researchers have identified 6 life or activity domains in which risk/protective factors exist. These are: Individual, peer, family school/work, community, and society/environmental. These domains interact with each other in different ways throughout one’s life. This interaction is known in the field was the “Web of Influence.” Another model, which illustrates objectives of substance abuse interventions is the IOM’s prevention program classification system –this model classifies interventions according to the population(s) that they target. There are universal (target the general population), selective (targets subgroup of population whose risk is higher than others) and also indicated interventions (aimed at individuals who already display signs of substance abuse). This booklet also offers detailed qualitative and quantitative strategies for evaluating existing substance abuse prevention programs.

Center for Substance Abuse Prevention, SAMHSA. (2001). Promising and proven substance abuse prevention programs: Guide to science-based practices #2. Retrieved October 30, 2005 from www.samhsa.gov

Based on the principles and domains described in the first booklet of this series (see above), this guide provides numerous examples of programs that have proven effective based on measurable outcomes. These programs are organized by domain and IOM intervention categories.

Center for Substance Abuse Prevention, SAMHSA. (2001). Principles of substance abuse prevention: Guide to science based practices #3. Retrieved October 30, 2005 from www.samhsa.gov.

This booklet goes into further detail about scientifically defensible principles that can help providers design and implement substance abuse prevention programs that work. These principles are organized by the 6 established domains: individual, family, peer, school, community and society/environmental. The use of these principles can help organizations build programs with measurable outcomes. Prevention interventions targeting individual domains should be designed to change knowledge about and attitudes toward substance abuse – it needs to focus upon social and personal skill-building and should focus on immediate consequences of alcohol use, rather than on long-term effects. These interventions must be culturally sensitive and should also recognize the relationship between substance use and other adolescent health problems. Interventions surrounding family domain should target the entire family, and should focus on family management practices and also substance use by family members who serve as examples to children. They should focus on developing parenting skills and emphasize family bonding. They should also help minority families respond to cultural and racial issues. Interventions targeting the peer domain should focus on peer alcohol use, peer norms favorable toward use, and peer activities conducive to use. Research has shown that structured alternative activities off peers a place to socialize without using alcohol – these activities can incorporate social and personal skills and should be intensive, requiring a substantial time commitment from youth. Peer-led activities can be more effective than adult-led. In the school domain, risk factors for alcohol use include lack of commitment to educations, poor grades, lack of attachment to school, negative school climate, and lenient school alcohol policies. Students with little satisfaction in their school achievements are more likely to develop student-based risk factors for use. Community domain risk factors include lack of bonding or attachment to social and community institutions, lack of community awareness or acknowledgment of substance use problems, community norms favorable to use and tolerant of abuse, insufficient community resources to support prevention efforts, and inability to address substance abuse problems. One-time prevention and education events in the community are unlikely to affect anyone’s behavior, but can be effective if part of a comprehensive prevention program. Risk factors in the society/environmental domain include norms tolerant of use, policies enabling use and abuse and lack of enforcement. Prevention specialists are trying to mesh individual change and changes in the environment to prevent alcohol use and abuse. Media campaigns aimed at certain communities can be effective if targeted to the proper audience/age range – these campaigns should focus on immediate consequences of use and should depict peers rather than authority figures. Stricter alcohol policies can also effect use/abuse.

Northeast Center for the Application of Prevention Technologies, SAMHSA. (2001). Prevention: What’s science got to do with it? Retrieved October 30, 2005 from www.samhsa.gov

Northeast CAPT has specified seven effective prevention approaches: Policy, Enforcement, Collaboration, Communications, Education, Early Intervention, and Alternatives – this guide provides a fact sheet for each of these principles and also an applied example of each. These principles are most effective when used in conjunction with each other – using multiple strategies in multiple settings and working toward a few common goals has proven the most effective when trying to prevent youth substance use and abuse. Science-based prevention, which is guided by individual, intra- and inter-organizational, and community change theories uses evidence from evaluation research for prevention practices. When using the collaboration approach, it is important that the collaboration addresses an important need and has broad support and involvement from the community, that membership is inclusive, that decision making is shared by a number of people, that members focus on how to work well together, and that participants are frequently required to change the way they do things.

Wandersman, A. & Florin, P. (2003). Community interventions and effective prevention. American Psychologist, 58, 441-448.

Defines and evaluates community-level prevention interventions, including substance abuse prevention interventions. The authors stress the need for involvement of prevention practitioners and community residents in community-level interventions and also the used of technical assistance systems for prevention. They compare research-driven prevention and community-driven prevention and offer examples of successful programs for each, but point out that reviews of multi-site programs and many community interventions have failed to demonstrate positive results. This could be due in-part to the difficulty of detecting outcomes from community-level interventions because of questionable appropriateness of random assignment, difficulty finding comparison sites, and problems making connections between immediate outcomes and specific programs. The authors address how funders can contribute to capacity of these prevention organizations through established technical assistance systems. TA should include training programs for skills development, telephone and on-site consultations, information and referral services, mechanisms for creating linkages among coalitions, methods of recognizing group achievement, and publications and other public education materials. These systems require careful design in order to be effective.

Other SPF-SIG States

Birkby, B. Community readiness for strategic planning in substance abuse prevention. Statewide Epidemiology Workgroup, Substance Abuse Prevention Program, Kentucky Department of Public Health.

Outlines Kentucky’s SPF SIG and community readiness plans. SPF activities include a statewide needs assessment, a community readiness assessment, development of a comprehensive community assets and resources map using GIS, use of GIS for spatial epidemiology, establishment of a functional data warehouse, expansion of Kentucky’s SEW, establishment of a statewide strategic planning group, development of a system to train preventionists to assure competency, engagement of targeted communities with in-depth planning, implementation of an integrated system of evidence-based prevention strategies. Provides a brief summary of various community readiness assessment tools, including the Tri-Ethnic Center’s Community Readiness Survey and the NIDA Community Readiness Inventory, and provides comprehensive definition of sustainability as it relates to community readiness. Sustainability is defined as the process of ensuring the continuance of a strategic planning prevention effort that achieves long-term substance abuse prevention results for a target community. The goals of sustainability are to build, support and strengthen prevention infrastructure and to provide effective prevention programs and strategies.

Community Anti-Drug Coalitions of America. Core competencies that facilitate implementation of the SAMHSA’s Strategic Prevention Framework. Retrieved November 10, 2005 from http://www.coalitioninstitute.org/SPF_Elements/SPFElem entsHome.asp

This document outlines details and steps that should be taken during each of the 5 steps of the SPF-SIG process: Assessment, Capacity building, Planning, Implementation, and Evaluation. During the initial assessment step, collaborators most importantly need to understand and recognize the critical role that local coalitions play in the work of community health and development. Local leaders can determine potential membership, facilitate a shared vision, define the agenda, anticipate needed resources and begin a formal structure for the effort. By tapping into the variety of perspectives from members of local coalitions, data and information collected will allow for a more complete understanding of community problems. Qualitative data about these local problems should be collected via community forums, focus groups, key informant interviews and surveys. Quantitative data from partners and outside sources and survey data should be used in conjunction with more detailed qualitative data. Once problems are identified, they should be framed in a matter respectful of the community. Root causes and local conditions are the causal factors (risk and protective factors) that exist in a particular community. Once these community problems are identified, a framework or model of change should be developed. Logic models that illustrate this framework will allow a collation to analyze its progress toward short term goals and adjust/improve as necessary. This language and elements of this logic model should reflect the culture and values of the community.

During the capacity building stage, a coalition must foster ongoing and active participation of existing members and seek feedback on how it can be improved. It needs to assess coalition members’ skills and what skills may be lacking. There needs to be leadership within the coalition to be successful. Cultural competence is also a prerequisite to coalition success – it is and essential aspect of every other competency and coalition process. Cultural audits can be used to assess the competence of a coalition. It is also important while building capacity to address the “business side” of coalition work. Financial management, meeting legal requirements and building and managing human resources are key to success.

Planning should include strategic and action plans which align coalition work with larger, long-term priorities and ensure that members are carrying out the work of the coalition appropriately. It is during this stage that coalition assets and resources are linked to identify community need. Action steps are identified, after which the actors, timelines, required support and communication through group process should be outlined and eventually implemented.

During implementation, interventions are developed as a response to identified community problems. Interventions should use multiple strategies in multiple sectors to change substance abuse. Coalition members need to adapt these interventions to fit the local context using best programs and practices. It is also during the implementation stage that coalitions should advocate for change, asking both their own members and general community to make needed changes to reduce the risk for substance abuse. These changes can include improved working relationships among members of the community, new or improved programs to reduce risk, new practices, environmental changes and new policies. Throughout this process, coalitions should continue to write grants and see out financial resources to sustain the coalition and the work that it does.

A final evaluation step is needed to measure the quality and outcomes of coalition work – it should help the team improve its work, coordinate more effectively, be accountable for the effects of their work, celebrate progress along the way, and sustain the effort long enough to make a difference in the community. Evaluation of coalitions is fundamentally different from program evaluation since the target of coalition work is the health and behavior of the entire community. Sustainability plans also should be developed as part of the evaluation of a coalition.

Center for Substance Abuse Prevention, SAMHSA. (2003). Pathways to effective programs and positive outcomes. Chapter #2: Build capacity. Retrieved October 30, 2005 from http://captus.samhsa.gov/southwest/resources/documents

Outlines steps for evaluation an organization’s capacity: 1) Determine internal capacity and readiness, 2) Determine readiness of community to support efforts and collaboration, 2) Assess external capacity. Emphasizes importance of human and financial resources. Includes logic model for needs assessment, capacity building, program selection and implementation, and outcomes evaluation. In the capacity-building actions steps for the logic model, it stresses the assessment of internal capacity, including cultural competency, skills for administrative tasks, long and short term planning, communication, decision making, problem solving, conflict resolution and creative thinking. When assessing community readiness (external capacity), it is key to examine awareness of the substance abuse problem in the community and to determine community norms relevant to substance abuse. It is also important to identify key stakeholders and assess their available skills. During the assessment of cultural competence, organizations should acknowledge that cultural differences exist and have impact on the delivery of substance abuse prevention programs, should respect the culturally defined needs of the population, and should recognize that the number of people who describe themselves as bi-or multi-racial is increasing.

Vermont Department of Health. SAMHSA Strategic Prevention Framework brief. Retrieved November 10, 2005 from http://www.healthyvermonters.info/adap/grants/SAMHS A_Framework.pdf

A brief 1-page matrix outlining the Vermont Department of Health’s SPF approach. Steps include: Assessment, Capacity, Planning, Implementation, and Evaluation.

Community capacity-building technologies (technology transfer and training, technical assistance)

Chinman M., Early, D., & Ebener, P. (2004). Getting to Outcomes: A community-based participatory approach to preventive interventions. Journal of Interprofessional Care, 18, 441-443.

A brief summary of a developed prevention process and corresponding technical assistance package called “Getting To Outcomes.” The approach draws from the community-based participatory research framework by Wandersman, et al.

University of Kansas, Dole Human Development Center, Workgroup on Health Promotion and Community Development. Community Tool Box. Retrieved January 10, 2006 from http://ctb.ku.edu/about/en/

The Tool Box provides over 6,000 pages of practical information to support work in promoting community health and development. This web site is created and maintained by the Work Group on Health Promotion and Community Development at the University of Kansas in Lawrence, Kansas. Developed in collaboration with AHEC/Community Partners in Amherst, Massachusetts, the site has been on line since 1995, and it continues to grow on a weekly basis. The core of the Tool Box is the "topic sections" that include practical guidance for the different tasks necessary to promote community health and development. For instance, there are sections on leadership, strategic planning, community assessment, grant writing, and evaluation. Each section includes a description of the task, advantages of doing it, step-by-step guidelines, examples, checklists of points to review, and training materials.

The resources of the CTB are organized by what you may want to do. These include:

Learn a Skill , Plan the Work (includes 16 Core Competencies in doing the work), Solve a Problem (common dilemmas, questions for analysis and links to topic sections), and Connect with Others. It focuses on developing practical information for community building that both professionals and ordinary citizens could use in everyday practice - for example, leadership skills, program evaluation, and writing a grant application. The emphasis was on these core competencies of community building, transcending more categorical issues and concerns, such as promoting child health, reducing violence, or creating job opportunities. By using this website, you can access the following core competencies:

1. Creating and maintaining coalitions and partnerships
2. Assessing community needs and resources
3. Analyzing problems and goals
4. Developing a framework or model of change
5. Developing strategic and action plans
6. Building Leadership
7. Developing and intervention
8. Increasing participation and membership
9. Enhancing cultural competence
10. Advocating for change
11. Influencing policy development
12. Evaluating the initiative
13. Implementing a social marketing effort
14. Writing a grant application for funding
15. Improving organizational management and development
16. Sustaining the work or initiative

Florin, P., Mitchell, R., & Stevenson, J. (1993). Identifying training and technical assistance needs in community coalitions: a developmental approach. Health Education Res., 8(3), 417-32.

The authors collected data from 35 community coalitions in Rhode Island, which aimed to address alcohol and other drug abuse prevention. Using this data, they focused on identifying common technical assistance needs that were encountered by those seeking to implement community coalitions. It is critical to develop a clear framework for judging progress and identifying these TA needs, in order for funds for coalitions to be properly spent. The authors used two approaches to specify TA needs: 1.) the first four steps of progress of coalition development were assessed diagnostically, step by step – these steps were: Initial mobilization, Establishing organizational structure, Building capacity for action, Planning for action, Implementation, Refinement, and Institutionalization. 2.) Community task-force members and leaders were surveyed about what they thought of the services and resources supplied to them, and also what other TA they needed. The study found that during initial mobilization, task forces were able to mobilize significant participation, but that some segments of the population were under-represented. TA must therefore aid coalitions in recruiting specific groups of people, such as youth and the elderly. During the establishment of organizational structure, TA should provide options for organizational structuring and guidelines for operating procedures as well as leadership training. During the capacity building stage, TA needs to address building member capacity through trainings and written resources and also establishing inter-organizational linkages. When planning for action, there must be clarity and specificity of a coalition’s goals, objectives, problem conditions and evaluations. TA should focus on the articulation of local problem conditions believed for AOD problems before solutions are sought.

Mitchell, R.E., Florin, P. & Stevenson, J.F. (2002). Supporting community-based prevention and health promotion initiatives: Developing effective technical assistance systems. Health Education and Behavior, 29(5), 620-639.

While broad-based community partnerships have the potential to reach hard-to-reach populations when it comes to health promotion and prevention initiatives, they may fail to implement evidence-based programs for a number of reasons: confusion about what is scientifically grounded, limited resources, lack of community readiness, difficulty adapting existing programs to the local problem and insufficient attention to the process of technology transfer. This article describes the challenges that arise when establishing TA systems that can aid community organizations in delivering effective evidence-based interventions. These challenges that the authors address include: 1) setting prevention priorities and allocating limited TA resources, 2.) balancing capacity-building versus program dissemination efforts, 3.) collaborating across categorical problem areas (i.e. health issues that have similar risk factors), 4.) designing TA initiatives with enough “dose-strength” to have an effect (logic models should help with this), 5.) balancing fidelity vs. adaptation in implementation (the need to include respect for scientific evidence and also community experiences), 6.) building organizational cultures that support innovation, and 7.) building local evaluative capacity versus generalizable evaluation findings. The authors warn of a few negative consequences to avoid when providing TA; 1.) The merging of regulatory and technical assistance functions make cause community organizations to avoid asking for assistance if they suspect that showing their weaknesses may jeopardize future funding, 2.) The understaffing or overextension of TA staff – providing poor TA may be worse than not providing any at all, and 3.) Becoming overly prescriptive in program selection – insisting that proven evidence-based models be used that may not fit with the problem or environment.

Community needs, resources, and readiness assessment

Beebe, T.J., Harrison, P.A., & Sharma, A. (2001). The Community Readiness Survey: Development and initial validation. Evaluation Review, 24(1), 55-71.

Stresses the importance of facilitating the participation of communities in the identification of prevention strategies tailored to their own situation. The authors criticize the Tri-Ethnic Center’s readiness survey since it relied solely on qualitative review and since it has not been tested externally for validity. They offer their own Community Readiness Survey, which entails a short and inexpensively administered mail survey measuring population attitudes toward substance use and the potential receptivity of communities to various prevention efforts. The authors summarize the development and evaluation of a mail survey measuring attitudes about substance use and potential acceptance of communities to different prevention efforts. Psychometric evaluation revealed 5 distinct domains: perception of alcohol, tobacco or other drug problems, support for prevention, attitudes toward teen substance use, perception of adolescent access, and perception of community commitment.

Beebe, T.J. & Sharma, A.R. (1998). Presentation from proceedings of Program Sharing Conference. The Community Readiness Survey: How to tell if your community is ready for prevention services. Search Institute. Minneapolis, MN.

This brief presentation outlines the purpose of MN’s Community Readiness Survey. This survey was developed to learn about population attitudes toward substance abuse and the receptivity of communities to various prevention initiatives. Researchers aimed to develop a psychometrically-sound instrument for measuring relevant community readiness domains and to develop an instrument that communities can easily administer and use to identify the best prevention strategies for their own population. The survey was sent by mail to 15,000 adult Minnesotans and focused on 5 regions within the state. Within each region, two communities were selected to represent each level of readiness (low, med, high). The analytic goals of the survey were to assess internal and external validity and also to reduce the number of items on the survey. Findings suggested support for some of the theoretical domains hypothesized while developing the instrument.

Goodman, R.M., Wandersman, A., Chinman, M., Imm, P., & Morrissey, E. (1996). An Ecological Assessment of Community-Based Interventions for Prevention and Health Promotion: Approaches to Measuring Community Coalitions. American Journal of Community Psychology, 24(1), 33-61.

While traditional approaches to community health promotion and development have largely focused on social psychology where individual changes in health behavior are targeted, Goodman et al. focus on the importance of community interventions with an ecological perspective, where social and cultural norms are considered when aiming to change the health behaviors of citizens within a particular community. This model also considerers the structure of community services including their comprehensiveness, coordination, and linkages, as well as individual motivations and attitudes. Community readiness and change must be implemented before behavioral and health status outcomes can be realized. It is important to consider that an effective strategy that is implemented at an inappropriate time and cause more harm than good – communities must be ready for these campaigns for them to achieve success. Also, while many health promotion campaigns appear successful during the initial mobilization stages of the program, implementing and securing effective, sustainable community changes is often difficult. These social systems are complex, and in turn require sophisticated assessments that can be used to identify strengths, weaknesses, and gaps in community health promotion infrastructure and initiatives.

The Midlands Prevention Alliance in South Carolina proposed a change in the overall norms or the entire Midlands community regarding alcohol, drug, and tobacco use; increased involvement in remediating these problems in local work-places, reduction of substance use and violence amount 12 to 17 year olds; and reduction in the annual incidence of HIV/AIDs and sexually transmitted diseases throughout the SC Midlands. The proposed intervention occurred in three phases: 1) the forming of a coalition by hiring staff, recruiting members from multiple sectors of the community, and involving the membership in a needs assessment that informed the planning of community strategies; 2) the implementation of these strategies with awareness campaigns, service programs, and policy initiatives; and 3) the institutionalization of these programs and policies, the production of salutary community impacts, and the maintenance of the coalition once original grant funding terminates.

The ecological assessment conducted for this project focused upon social levels and stages of community readiness. Triangulation of method, time, and space were considered important aspects of the assessment. Triangulation refers to the use of multiple methods/strategies when assessing a program – this is done to overcome the bias inherent in any one specific method and also to increase validity and agreement. During the assessment, triangulation allowed for pulling together numerous pieces of data at different times in order to draw up an accurate and rich picture of the community in question, their level of readiness, and the development of their coalition. The most important aspects of evaluating the Midlands program was recognizing the interventions as occurring across multiple social levels and as occurring across stages of development. The evaluation was fluid and “hands on”, in that while it aimed to ensure fidelity to the original aims and purposes of the grant, open and honest information-sharing and feedback helped the Alliance develop effective strategies to improve the intervention as it moved forward. Evaluators used Forecast Evaluation, which consists of: models, markers, measures, and meaning – to assess the formation of the coalition (i.e., organizational, inter- and intrapersonal levels) – this system is quite similar to a logic model, in that it maps out the purpose/mission of the intervention in a visual way and it is used to keep the project on track. They also used a Meeting Effectiveness Inventory and Project Insight Form to measure organizational-level measures and stages of readiness – this includes the evaluation of the quality of interaction among coalition partners, staff, consultants, and evaluators. The Needs Assessment Checklist and Plan Quality Index were used to help the coalition gauge whether it is approaching the stages of readiness for building capacity for action and implementation. To reduce implementation failure, the evaluators uses Prevention Plus III, a workbook for program assessment published by CSAP (1991) – it contains a four-step model composed of identifying goals., processes, outcomes and impacts and includes worksheets for community groups to fill out for planning and implementing individual programs.

Beebe, T.J., Minnesota Department of Human Services & Search Institute. (1996). Community Readiness Survey.

Six-page survey aimed at assessing a community’s readiness for prevention initiatives for substance abuse.

Plested, B.A., Edwards, R.W., & Jumper-Thurman, P. (2005). Tri-ethnic Center for Prevention Research Community Readiness: A handbook for successful change.

Defines the community readiness model and outlines the process of conducting a community readiness assessment. The community readiness model integrates a community’s culture, resources and level of readiness to address a specific issue. Readiness is very issue-specific, it is measurable across multiple dimensions and may vary across different segments of a community. It can be increased successfully and is essential knowledge for the development of strategies and interventions. The community readiness model conserves valuable resources by guiding the selection of strategies that are most likely to be successful. It promotes community recognition and ownership of the issue and helps to ensure that strategies are culturally congruent and sustainable. It encourages the use of local experts and resources and should create a community vision for healthy change. When using this model, communities need to first identify the issue, then define community, conduct key respondent interview, score the responses to determine readiness level, and develop strategies/conduct workshops to move toward community change. Includes a survey and scoring criteria that can be used to assess community readiness in a given population.

Vermont Department of Health. (1999). Success and sustainability of effective coalitions. Retrieved November 10, 2005 from http://healthvermont.gov/

This collection of guidelines and tools provides information about forming and sustaining a successful community coalition dedicated to the prevention of substance abuse. It outlines 6 developmental tasks of coalitions building: Initial mobilization, Establishing organizational structure, Building capacity for action, Planning for action, Implementation, and Institutionalization. During the first state, Initial Mobilization, it is critical to recruit a mass of participants that are representative of the population and who hold a significant leadership position in a community sector. It is useful to include people who already are active in the ATOD problem in the community. During the second task, Establishing organizational structure, the group should determine officer roles, subcommittees, should formalize operating procedures, should keep written minutes of meetings, should used written agendas and establish regular meeting times. Task forces should also be created. During the capacity building task, it is important to orient all members to the concepts of prevention, risk and protective factors for ATOD and also to help the group develop skills in presenting, conducting community planning, designing and implementing programs and grant writing. It is also key to establish linkages with other community organizations. During Task #4, Planning for Action, the groups should identify community needs, specify and prioritize goals/objectives, choose strategies to reach those goals and create timelines and delegate responsibilities. Logic models can also be created at this time. During the Implementation phase, the coalition should develop a work plan that sets timelines, allocates resources and assigns responsibilities and should implement places that involve key organizational players, networks and broad citizen participation. As part of the Institutionalization process, established coalitions should identify and address process issues, identify organizations to continue programs as part of their mission and identify strategies to institutionalize the coalition itself. This document includes checklists and matrices for each developmental task.

Substance abuse

National Community Anti-Drug Coalition Institute. Community How-to Guides on Underage Drinking Prevention. Retrieved November 10, 2005 from http://www.nhtsa.dot.gov/people/injury/alcohol/Community%20Guides%20HTML/Guides_index.html

Includes tools for coalition building, needs assessments and strategic planning, evaluation, prevention and education, enforcement, public policy, media relations, self sufficiency, and resources. These “Community How To Guides” address fundamental components of planning and implementing a comprehensive underage drinking prevention program. Each guide contains a resource section to assist readers in obtaining additional and detailed information about the topics covered in that guide. The appendices include useful tools for each topic area that provide coalitions and organizations a jump-start in their planning and implementation activities.

Stevenson, J.F. & Mitchell, R.E. (2003). Community-level collaboration for substance abuse prevention. Journal of Primary Prevention, 23(3), 371-404.

Reviews literature on the roles of community-wide collaboration in substance abuse prevention. Suggests that prevention collaboratives should be organized in terms of how they deal with the broad dimensions of: origination and control, focus for change, composition, and comprehensiveness of intervention tactics. Highlights community capacity, service integration, and policy change as key components of successful substance abuse prevention interventions.

Vermont Department of Health Alcohol and Drug Abuse Program. (2000). Preventing alcohol and drug abuse in Vermont. Retrieved November 10, 2005 from www.state.vt.us/adap.

Summarizes ATOD use statistics in Vermont, and offers strategies for preventing and reducing this use among youth and adults. Strategies used include: family, school, community, media and marketing, cultural communities, college and university, and public policy strategies. The “New Directions” program (its SPF-SIG) is Vermont’s effort to enlist whole communities in preventing youth substance use – it includes 23 community coalitions aimed at preventing the use of alcohol, tobacco, marijuana and other drugs among youth ages 12-17.

Weitzman, E.R., Nelson, T.F., & Wechsler, H. (2003). Assessing success in a coalition-based environmental prevention programme targeting alcohol abuse and harms –process measures from the Harvard School of Public Health’s “A Matter of Degree” programme evaluation. Nordisk Alkohol & Narkotikatidskrift (English Supplement), 20, 1-9.

Evaluates whether community-based coalitions aiming to reduce college binge-drinking were effective. It is recognized that community based prevention programs can experience tensions among participants, which may be especially problematic when there are a variety of agendas and voices throughout these coalitions. The authors argue for including several measures of community based and environmental program development to assess the success of the coalition. The “A Matter of Degree” (AMOD) projects implemented by the community coalitions focus on: the diversity of coalition membership, partnered decision making across campus and community domains, perceptions about the environmental origins of binge drinking/harms, attribution of responsibility for addressing them to agents other than drinkers, development of environmental programs that reflect community as well as campus investments, and levels of substantive conflict. The authors found that the majority of coalition members reported that they were involved in coalition discussions and that almost half were involved in decision-making. Key findings of this study included: that orienting program participants to a model of environmental change is critical for a program’s earliest development and that being able to identify gaps in understanding about the program model, its rationale and component strategies may be instrumental in assessing readiness, identifying needs for technical assistance, and providing support for participants and staffing projects.

Wu, W. & Khan, A.J. (2005). Adolescent illicit drug use – understanding and addressing the problem. Medscape Public Health & Prevention, 3(2).

Summarizes the scope of adolescent drug and alcohol use. Addresses psychosocial factors influencing adolescent’s decisions and also intervention strategies, including policy and environmental changes.

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