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					     Using a Strong Research Design and
 Statewide Data Systems to Make the Case
                               for Prevention:
   Washington’s Strategic Prevention Framework (SPF)
                         State Incentive Grant (SIG)

                                Roy M. Gabriel, Ph.D.
                                RMC Research Corporation
                                   Portland, Oregon

Linda G. Becker, Ph.D.                                           Kevin Cambell, Ph.D.
Scott B. Waller, M.A.                                            Michael Langer, M.A.
               Washington Division of Alcohol and Substance Abuse
                              Olympia, Washington

    Annual Meeting of the Society for Prevention Research; May 29-June 1, 2007; Washington D.C.
                    SPF SIG Project:
                    Size and Scope
 A 5-year SAMHSA/CSAP-funded project; $2.7 M per
  year beginning October 2004 (Cohort 1)
 35 states and territories funded through 3 cohorts
 Data-driven prevention planning, implementation and
 State and local community levels (85% of funds to
  selected communities)
 RMC responsible for both state-level and
  community-level evaluation

  RMC Research Corporation
            CSAP’s SPF SIG Goals

 Build prevention capacity and infrastructure at
  state and community levels
 Implement a process of infusing data across all
  SPF steps for improved decision-making
 Effect Community-level Change
  Prevent onset and reduce progression of substance
   abuse, including childhood and underage drinking
  Reduce substance abuse-related problems

  RMC Research Corporation
        CSAP Requirements of SPF SIG

 Establish State Epidemiological Workgroup (SEW)
  and Advisory Council
 Submit statewide comprehensive strategic plan for
  approval prior to SPF implementation, featuring
  statewide prevention priorities established via epi
 Include underage drinking as a statewide priority
 Report annually on SAMHSA National Outcome
  Measures (NOMs)

  RMC Research Corporation
        CSAP’s Strategic Prevention
        Framework (SPF): Five Steps
1. Profile needs, resources and readiness to address
   the problems and gaps.
2. Mobilize and/or build capacity to address needs.
3. Develop a comprehensive strategic plan.
4. Implement evidence-based prevention programs
   and infrastructure development activities.
5. Monitor process, evaluate effectiveness, sustain
   effective programs/activities, and improve or replace
   those that fail.

   RMC Research Corporation
    Washington’s Existing Data Sources

 Biennial Healthy Youth Survey (HYS)
      2004, 2006: 80% of Washington Schools, and 85% of
       students (Grades 6, 8, 10, 12)
 Community Outcome and Risk Evaluation Geographic
  Information System (CORE GIS)
 Performance Based Prevention System (PBPS) MIS
 School-based Prevention/Intervention Services
  Program (PISP) Reporting System
 Core Student Record System (CSRS)
 State Needs Assessment Household Survey (2002)
 Treatment and Report Generation Tool (TARGET)
  RMC Research Corporation
       First Step: Establish Statewide
             Prevention Priorities

 Statewide epidemiological analysis of HYS data
     (consumption, consequences, costs)
 Based on these analyses State SPF SIG Advisory
     Council selected Underage Drinking as single state
     prevention priority for SPF SIG
 Community eligibility criteria
 –      High Need: 23% or higher reported 8th grade use of
        alcohol within the last 30 days (State average: 18%)
 –      Precision: A minimum of 30 8th graders participating in the
 –      Representativeness: 65% participation of enrolled 8th
        graders in the HYS
RMC Research Corporation
                         SPF Prioritization
State Priority                          Consequences
                                             Drinking & Driving
                                    Riding with driver who had been drinking
                                              Driving after drinking
Underage Drinking                             School Problems
                                              Skipping school
                                      Showing up drunk or high to school

                                              Crime & Violence
                                           Physical fighting in school

                                                Mental Health
                                            Feelings of Depression
                                               Suicide Ideation
  RMC Research Corporation
             Community Selection Process

State SPF SIG Advisory Council insisted on a
    random selection process in order to :

           Make the Best Case for Prevention

  Advisory Council insisted on balance between Eastern and
       Western Washington communities in final selection
  Project management was committed to selecting two communities
       with high concentration of American Indian students

 RMC Research Corporation
        Stratified Random Selection of
        SPF SIG-funded Communities

• Strata based on cluster analysis of 43 applicant
   – Non-urban, low poverty, low minority
   – Non-urban, high poverty, high minority
   – Urban
• Random selection of 10 communities within these
  clusters (3, 3, 4)
• Remaining communities serve as comparison in
  outcome evaluation
• Two of 3 American Indian communities that applied were
  selected for SPF SIG funding
  RMC Research Corporation
        Washington’s 12 SPF SIG Communities

                       * Eckstein, Seattle

RMC Research Corporation
           Generic Logic Model for the Reduction of Underage
             Drinking (Washington State SPF SIG Priority)
Consequences               Consumption     Intervening             Strategies

                            Underage      Alcohol Availability:
                            Drinking:    Retail Access; Social
  Poor school
                            Beginning        Access; Price
                                             Alcohol Laws:
                                         Enforcement; Penalties;
  Mental health             Underage
                             Problem     Promotion of Alcohol

Violent Behavior
                                          Protective Factors
Impaired driving            Drinking:
                                          Psychosocial Risk
                             Heavy             Factors

RMC Research Corporation                                                        9
           Defining Underage Drinking:
        A composite of 30-day alcohol use
                and binge drinking
                 No. of times
                                               No. of times binge drinking
                 alcohol in the
                 past 30 days
                 None                      None              1              2+

                 1 to 2 days

                 3 to 5 days

                 6 + days

                            1 to 2 days in the past 30 days, but no binge drinking—
                            ―experimental drinking‖
                            3 to 5 days in the past 30 days OR 1 binge—―problem

                            6 + in the past 30 days OR 2 + binges—―heavy drinking‖

RMC Research Corporation
               Variations among communities in
          prevalence of underage drinking levels
• SPF SIG-funded communities range from 24% to 36%
  prevalence of 30-day alcohol use among 8th graders
• Among those youth who drink, there is wide variation in
  the amount and frequency in which they drink
   – In some communities, the majority of 8th graders who
     drink are in the ―beginning‖ or ―experimental‖ category
   – In others, over half of the 8th graders who drink do so
     6 or more times per month or binge drink 2 or more
     times in the past two weeks
• Variations in these prevalence rates suggest variations
  in prevention/intervention strategies selected in these
  RMC Research Corporation
                            Community-Level “Theory of Change” Model

                         Strategy 1                                Strategy 2                                  Strategy 3

Lack of           Resource         Lack Of           Lack of        Lack of Parental          Deficits in       Peer Substance        Lack of Sense    Beliefs
Sufficient or     Deficits:        Justice           Parental       Skills and Practices      Social/Emotion    Use Norms             of Achievement   Supporting
Meaningful        Facilities to    System’s          Support for     Failure of parents to   al Skills         Involvement with      and Strong       the
Consequences      hold juveniles   Vigorous          Enforcement     supervise and                              and attachment to     Bonds to         Acceptability
                  under the        Prosecution                       monitor their                              substance using       School           and Utility of
                  influence;       (of underage                      children                                   peers                                  Violent
                  Police           drinking laws)                    Excessively severe,                        Perception that                      Behavior
                  resources to                                       harsh, or                                   majority of peers
                  break up large                                     inconsistent                                are engaging in
                  parties                                            punishment                                  substance use and
                                                                     Lack of clear                              other problem
                                                                     expectations for                            behavior
                                                                     behavior and                                Expectations of
                                                                     instillation of a                           positive social
                                                                     moral code                                  effects of alcohol

                  ENFORCEMENT                       HEALTHY                          EARLY                                            EARLY
                  OF UNDERAGE                       BELIEFS AND                      INITIATION OF                                    INITIATION OF
                  DRINKING                          CLEAR                            ATOD USE                                         ANTISOCIAL
                  LAWS                              STANDARDS                                                                         BEHAVIOR


                RMC Research Corporation
                            State-Level Outcome
                            Evaluation Questions
 Are communities that implement the SPF
  more successful at reducing underage
  drinking and related problems than those
  that do not?
 What characteristics of SPF SIG
  communities and their prevention efforts
  are associated with greater success in
  reducing underage drinking and related
 RMC Research Corporation
          Where We’re Headed: Outcome
               Evaluation Design

                                                          2004   2006   2008   2010
                                 Nonurban, low
                                 poverty, low minority
SPF SIG Communities
                                 Nonurban, high
(n = 10)
                                 poverty, high minority
                                 Nonurban, low
                                 poverty, low minority
Comparison Communities
                                 Nonurban, high
(n = 33)
                                 poverty, high minority

      RMC Research Corporation
            Other Major Prevention
            Initiatives in Washington
   Previous CSAP State Incentive Grant
   Enforcing Underage Drinking Laws (EUDL)
   Drug-Free Communities grants
   Project SUCCESS
   Prevention/Intervention Services Program (PISP)
   Communities That Care (CTC)
   Community Health and Safety Networks
   Tobacco Prevention
   Communities mobilizing against substance abuse (CMASA)
   Readiness to Learn, 21st Century Community Learning
      Centers, Even Start. . .


RMC Research Corporation
         SPF SIG Research Design and Project Policy:
               Married or Just Living Together?

                  Challenge                                Resolution/Implication for
Use of standardized ATOD use survey other than     Less comparability in survey data across
HYS for SPF SIG eligibility and evaluation         communities (grade levels, time of year
eventually permitted                               administered)
                                                   ―Patchwork‖ needed in outcome evaluation data
Random selection process for                       Selection bias in pool of eligible communities
SPF SIG funding unacceptable to some               Modified initial set of eligibility criteria to ensure
communities                                        sufficient number of communities to select from

Project priority to fund 2 communities with high   Only 3 such communities that were eligible
proportion of American Indian students             applied for funding, precluding their inclusion in
                                                   outcome evaluation design.
                                                   Need to disaggregate school-level HYS data by
                                                   racial/ethnic group to determine prevalence rates.
                                                   Are AI students the prevention/intervention target
                                                   population in these communities?
    RMC Council Corporation
Advisory Research insistence on geographic         Strata derived from cluster analysis accomplished
balance in SPF SIG-funded communities              same thing due to inherent correlation between
                                                   cluster variables and geography


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