indiana strategic prevention framework february 24, 2009 chuck klevgaard sheila nesbitt
TRANSCRIPT
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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
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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.
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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?
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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.
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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)
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StrategyIntervening
Variable Compliance Checks: Conceptual fit?
Comprehensive Approaches (mix)Add to or reinforce a strategy in the community?Target multiple opportunities for intervention?
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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?
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StrategyIntervening
Variable Compliance Checks: Practical Fit?
SustainabilityDoes the community have resources to sustain
this initiative?
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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
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High Low
Sufficient Highest Priority? Less Priority?
Limited High Priority?Lowest Priority?
Conceptual Fit(Logic model, conditions, alignment, and reach)
Pra
cti
cal
Fit
(com
munit
y r
eso
urc
es
readin
ess
)
Decision Matrix
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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.
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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