implementing evidence-based substance abuse prevention strategies

November 8, 2007Maine Office of Substance Abuse (OSA)

Maine’s Environmental Substance Abuse Prevention Center (MESAP)

Welcome! OSA staff Technical Assistance Contacts

HMP grantees EPS grantees Other partners

Spirit of the DayRespect the expertise in the room, both from presenters and participants

Trusting environmentOpen dialogue

AgendaEnvironmental prevention & why it’s

importantLessons from CMCA & CTI models for

community organizing~ LUNCH! ~A flash overview of project examples from

the guidePutting it all together: a comprehensive

approachWhere to go for more information & tools

Warm-up/Intros… (10 min)

Reflect for a moment, write on post-its, and then share with your table-mates:

What is one thing I would like to leave here with today?

…When finished, assign a rep to collect & post on newsprint at front of the room.

Maine’s Environmental Substance Abuse Prevention Center (MESAP)

We also need to address conditions in their shared environment

We work to change conditions within each individual

INDIVIDUALSTRATEGIES ENVIRONMENTAL

STRATEGIES

A Comprehensive Approach

“…Why?”INDIVIDUAL-LEVEL POPULATION-LEVEL

Traffic fatalities in the 60’s“Unsafe drivers” “Unsafe cars!”

Smoking“Don’t know the risks” “It’s everywhere,

it’s cheap, and it’s cool.”Obesity

“Don’t know “Junk food is cheaper,what’s healthy” and there’s nowhere to walk.”

1990’s: Research FindingsCommunity Trials Intervention (CTI):Treno, A.J. and Holder, H.D. (1997). Community

mobilization: evaluation of an environmental approach to local action. Addiction. 92 (Supplement 2): S173-S187.

Communities Mobilizing for Change on Alcohol (CMCA):

Wagenaar, A.C., Gehan, J.P., Jones-Webb, R., Toomey, T.L., Forster, J.L. (1999). Communities Mobilizing for Change on Alcohol: Lessons and results from a 15-community randomized trial. Journal of Community Psychology. 27(3):315-326.

2004: IOM Report to Congress“Reducing Underage Drinking: A Collective Responsibility”

Reduce youth exposure to alcohol advertising

Reduce youth access to alcoholRaise alcohol excise taxes to deter

underage drinkingIncrease law enforcement to deter adults

from purchasing alcohol for minorsMobilize communities to change policies &

practices on local levelhttp://www.marininstitute.org/alcohol_policy/Underage_Drinking_Exec_Summary.pdf

2007: US Surgeon General Call to Action to Prevent & Reduce Underage DrinkingFoster changes in American societyEngage all stakeholders in a coordinated effortImprove public health surveillance on

underage drinking and on population-based risk factors

Ensure that policies at all levels are consistent with the goal of preventing & reducing underage drinking

http://www.surgeongeneral.gov/topics/underagedrinking/calltoaction.pdf

Individual Change

Environmental Change

TOOLS: Education, treatment, Media advocacy, small group activities policy change,

social pressure, law enforcement

FOCUS: Individual behavior Policy, laws, norms

WHO: Professional and client;Coalitions, stakeholders,

Educator and student community organizers

IndividualPersonal ChangePrivate

responsibilityEducation

& Programs

EnvironmentalSocietal ChangePublic

responsibilityPolicy &

Enforcement

Shifting the frame:

“…WHY?”

Individual responsibility

“Parents need to do a better job”

“Kids need to learn the consequences”

Community responsibility

“We need to change the way our society promotes and makes alcohol so accessible to kids”

According to MYDAUS…

Source: 2006 Maine Youth Drug and Alcohol Use Survey, grades 6-12

COMMUNITY NORMSYouth who believe adults in their community think it’s OK for kids to drink are 2 times more likely to drink.

(60% vs. 27%)

ALCOHOL ACCESSYouth who think it’s easy to get are 4 times more likely to drink than youth who think it’s hard to get.

( 45% vs. 12%)

Source: 2006 Maine Youth Drug and Alcohol Use Survey, grades 6-12

PARENTSYouth are almost 5 times more likely to drink if they believe they would NOT get caught by their parents.

Source: 2006 Maine Youth Drug and Alcohol Use Survey, grades 6-12

ENFORCEMENTYouth who think underage drinkers will NOT be caught by police are 4 times more likely to drink.

(36% vs. 8%)

Source: 2006 Maine Youth Drug and Alcohol Use Survey, grades 6-12

Activity: Elevator Speech Individually, spend 2 minutes writing

your own “elevator speech” (a brief paragraph) explaining environmental substance abuse prevention & why it’s important.

Share your speech with the person sitting next to you.

Report back: What worked? What was challenging?

Maine’s Environmental Substance Abuse Prevention Center (MESAP)

Raise your hand…• Who is implementing or planning to implement CMCA or CTI models as part of your workplan?• Who has prior experience with implementing the CMCA or CTI models?• Who has found the models to be kind of vague?

This presentation includes:• Summary of CMCA and CTI research & key findings.

• What was the process used?• What strategies did they implement?• What were the results?

• Lessons that can apply to all of us in our work.

• Multi-year research project (Wagenaar et al, 1994, 1999, 2000) by UMN.• 15 randomly selected midwestern towns

• 7 had CMCA, 8 were controls • avg population: 20,836 (range: 8,029-64,797)

• rural culture • Led by a community organizer & a Strategy Team of concerned citizens.

Communities Mobilizing for Change on Alcohol (CMCA)

http://www.epi.umn.edu/alcohol/cmca/index.shtm

• Used community organizing & media advocacy to create changes in local policies & practices to reduce youth access to alcohol.

• Communities used a multi-strategy approach. Strategies included Responsible Beverage Service training, retail compliance checks, merchant/police partnerships, policies restricting alcohol at community events, and warning fliers stating penalties for furnishing to minors.

Communities Mobilizing for Change on Alcohol (CMCA)

RESULTS:• retail sales to minors• furnishing to minors by 18-20 yr olds • drinking by 18-20 year olds• alcohol-related auto crashes

Communities Mobilizing for Change on Alcohol (CMCA)

• Step 1: Assess the community.

• Step 2: Create a core leadership group.

• Step 3: Develop a plan of action.

• Step 4: Build a mass base of support.

• Step 5: Implement the action plan.

• Step 5: Evaluate efforts.

• Step 6: Maintain and institutionalize efforts.

From Wagenaar, A.C., Gehan, J.P., Jones-Webb, R., Toomey, T.L., Forster, J.L. (1999). Communities Mobilizing for Change on Alcohol: Lessons and results from a 15-community randomized trial. Journal of Community Psychology. 27(3):315-326.

CMCA Process…Look familiar?

• Multi-year research project (Treno & Holder, 1997) by UC Berkeley/PRC.• 3 ethnically diverse communities in California (N & S) & South Carolina.• Used coalition model, but work was carried out by specific task forces. • Used community organizing & media advocacy to create changes in local policies & practices.

Community Trials Intervention (CTI)

http://www.pire.org/CommunityTrials/

• Task forces formed around increasing Responsible Beverage Service, reducing alcohol access (general), reducing youth access to alcohol, and reducing drunken driving.

• Communities used a multi-strategy approach. Strategies included sobriety checkpoints, RBS training, compliance checks, policies restricting alcohol at community events, and policies to limit alcohol outlet density.

Community Trials Intervention (CTI)

RESULTS: (not age-group specific) • drinking • drinking and driving • alcohol-related crashes • assault injuries

Community Trials Intervention (CTI)

Lessons from CMCA & CTI…Community organizing & policy change

work!It’s effective to use a combination of

top-down & bottom-up approaches:Top-down: Focus specifically on

environmental change--changing policies & practices. Use specific recommendations from best available research (i.e. evidence-based strategies!).

Bottom-up: Build local leadership & ownership to select from those strategies, and develop an action plan tailored to your own community needs.

Lessons from CMCA & CTI…Recruit supporters one by one.

“The heart of organizing is careful building of interpersonal relationships, one-by-one. …[P]ay careful attention, particularly in the beginning stages…, to making contact with as many individuals as possible. These initial contacts, usually called ‘one-on-one interviews,’ help ensure a diversity of representation and a more accurate understanding of the issues that need to be addressed” (Wagenaar et al, 1999).

One-on-Ones• The foundation of CMCA• Serve 3 purposes at once:• Assessment of community concerns, priorities, & readiness• Education of key leaders• Recruitment (Strategy Team or general support)

• CMCA trainers recommend doing at least 100 in the first year—regardless of the size of your community.

Key stakeholders and leadersLaw enforcement (police, sheriff,

corrections, district attorney’s office…) Public officials Businesses—including alcohol retailers Youth and parents Civic & religious organizations Schools Service providers (prevention,

treatment, social services…)

Lessons from CMCA & CTI…A community coalition is not a CMCA/CTI task force.This work requires leadership from a

multi-sector team that is exclusively focused on the aims of environmental prevention & policy change.

A typical community coalition, regardless of its size, should not double as your CMCA/CTI task force unless it is solely focused on that purpose.

However, the task force or strategy team can be a subcommittee of your coalition.

Lessons from CMCA & CTI…Allow enough time at the beginning.

Make sure you provide enough time for recruiting and training your task force, as well as building relationships and support from a broad base of allies before pushing forward with action.

Lessons from CMCA & CTI…Use the media—a lot!

Media advocacy is an effective way to increase public & key leader support for your strategies.

“Earned” media (i.e. free!) from press releases, press conferences, letters to the editor, and Opinion Editorials can be much more effective than paid media in achieving your policy change objectives.

“Raising awareness is not enough. …What do you want them to DO about it?” (News for A Change: An Advocate's Guide to Working With the Media by Lawrence Marshall Wallack, 1999)

Lessons from CMCA & CTI…Know your stuff. Be an expert.

Make sure that project staff and task force members are trained and up to date on the latest research.

Tailor your message to different audiences.

Recognize that different sectors have different priorities, concerns, and motivations to come on board.

Activity: In pairs…Select a key stakeholder group from the cards on

your table, and discuss the following questions:At what level is this group already involved in

your organization’s work? Who is involved, and what is their current role?

Ideally, at what level do you need the group or individuals involved in order to achieve lasting changes in policies & practices?

Imagine that you are preparing for a one-on-one meeting with a key individual from this group. Keeping their concerns and motivations in mind: What are some key questions and speaking points you would want to include in your meeting?

ConclusionCMCA & CTI successfully used community

organizing and media advocacy to achieve environmental change in policies and practices. The models worked in rural, homogeneous communities AND in more diverse, urban communities.

Even though the focus is changing the community environment, success boils down to one-on-one relationships.

Key elements include a clear focus on evidence-based strategies and environmental change, a multi-strategy approach, and leadership from a community organizer and a task force or strategy team made of dedicated community stakeholders and leaders.