*PROSPER Partnerships: Toward Evidence-Based Intervention for Youth, Family and Community IMPACT

1. *PROSPER Partnerships:Toward Evidence-Based Intervention for Youth, Family and Community IMPACT Richard Spoth Partnerships in Prevention Science Institute Congressional Educational Briefing June 12, 2006 *Funded by the National Institute on Drug Abuse

2. Map for Today’s Presentation • A Partnership Path to Positive Impact • Challenges to Youth, Family, Community Impact • Opportunities for Impact • IMPACT Framework • Illustrations of Long-term Impact • The PROSPER Partnership Model, Successes to Date • Proposed Multistate Network, Anticipated Benefits

3. 1. A Partnership Path to Youth, Family & Community Impact:Challenges, Opportunities, Illustrations

5. Sustained, quality EBIs The Challenge—Impact Requires a Larger “Piece” of Sustained, Quality, Evidence-Based Interventions (EBIs) with General Community Populations EBIs Evaluated- not effective Not Evaluated … and rigorously demonstrated, long-term EBI impact is very rare

6. Seizing an Opportunity for Impact— Linking Public Education Dissemination Systems Reaching Every U.S. Community • Public School System • Universal system reaching nearly all children • Increasing emphasis on accountability/evidence orientation • Cooperative Extension System in Land Grant Universities • Largest informal education system in the world • Over 3,150 agents in nearly every county in the U.S. • Science with practice orientation

7. Public School System Land Grant University Extension System School- Community- University Partnerships Other Service/ Resource Systems IMPACT Framework—Basic Science with Practice Tasks Implantintervention sciencein stable public educationdisseminationsystems, linked with other resource systems Maintainsystems-level supportfor science with practice Partnerwith communities strategically, offering proactive technical assistance Advanceintervention evidence-base Conducthigh quality implementation/ participant engagement Tailor toward sustainability of partnerships and EBIs, planned early Source: Spoth et al. (2006). Society for Prevention Research 14th Annual Meeting.

8. What is evidence-based—how do we know what works? • Society for Prevention Research Standards of Evidence • Design allows strongest possible statement about intervention “causing” outcome (e.g., randomized, controlled); also • Specific statement about what outcomes, with whom • Specific description of intervention and outcome measures • Quality, timing of measurement • Sample clearly specified • Sound statistical analyses, with attention to practical value and duration of effects • Specific to phase of prevention research • Applies to partnership-based interventions • See www.preventionresearch.org

9. Illustration of Long-Term Impact—Reduced Meth Use 4-6 Years Past Baseline Specific results to be announced when released by the journal publishing them.

10. Illustration of Long-Term Impact—Lifetime Marijuana Use Through 6 Years Past Baseline See Spoth, Redmond, Shin, & Azevedo (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline. Journal of Consulting and Clinical Psychology, 72, 535-542.

11. Other Positive Long-Term Outcomes from Randomized, Controlled Studies • ↑ Parent and Youth Skills • ↑ Academic Success • ↓ Tobacco/Cigarette Initiation • ↓ Alcohol Initiation • ↓ Drunkenness • ↓ Multi-substance Use • ↓ Inhalant Use • ↓ Aggression/Conduct Problems • ↓ Diagnosable Disorders

13. *Case Study of “Billy” or “Betty”: Costs of Life Trajectory of Early Substance Use and Problem Behaviors Resident home expenses $50,000 Medicaid $110,000 Special education $28,000 State hospital $128,000 Legal (estimated) $20,000 Total $336,000 Increasing Costs Level of Problem Behaviors Trajectory of Problems/ Early Childhood Young Adulthood *Illustrative case history and cost projections from Dennis Embry (PAXIS Institute).

14. *Estimated $9.60 returned for each dollar invested under actual study conditions. Illustration of Potential Economic Impact Source: Spoth, Guyll, & Day (2002). Universal family-focused interventions in alcohol-use disorder prevention: Cost-effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63, 219-228.

16. 2. PROSPER(Promoting School-community-university Partnerships to Enhance Resilience):Model and Successes to Date

17. PROSPER Study Aims* • Evaluate the effectiveness of partnership implementation of evidence-based interventions (EBIs) on youth and family outcomes • Learn what factors are most important in partnership effectiveness, quality • implementation and • sustainability *Funded by the National Institute on Drug Abuse—Collaboration with Pennsylvania State University (Mark Greenberg, PI and Karen Bierman, Co-PI)

18. PROSPER Organizational Structure Local Community Teams Extension Agent, Public School Staff, Social Service Agency Representatives, Parent/Youth Representatives Prevention Coordinator Team Extension Prevention Coordinators University/State-Level Team University Researchers, Extension Program Directors

19. Phases of PROSPER Implementation • Phase 1: Organization—team formation/planning • Phase 2: Initial operations—program implementation • Teams selected one of three evidence-based, family-focused programs for 6th graders • Teams selected one of three evidence-based school programs for 7th graders • Phase 3: Early sustainabilityplanning/ institutionalization within Extension • Phase 4: Ongoing Operations and Sustainability

20. PROSPER Success—Implementation Quality • Literature: Typical implementation adherence ranges from 42%-86% • In PROSPER, based on ratings by trained observers: • Average 91% adherence for family-focused EBI • Average 90% adherence for school-based EBIs Source: Spoth, Guyll, Lillehoj, Redmond, & Greenberg (In press). PROSPER study of evidence-based intervention implementation quality by community-university partnerships. Journal of Community Psychology.

21. PROSPER Success—Positive Outcomes for Families At 1½ Years Past Baseline: • More consistent discipline • Less harsh discipline • Better family cohesion • Better mother-child relations

23. **p <0.01 PROSPER Success— Substance-related Outcomes for 7th Graders at 1½ Years Past Baseline Source: Spoth, Redmond, Shin, Greenberg, Clair, & Feinberg (2006). Substance use outcomes at 1½ years past baseline from the PROSPER community-university partnership trail.

25. Another PROSPER Success—Initial Sustainability • 100% of PROSPER teams obtained external funding, within a year of starting the early sustainability phase! • Funds were obtained from a variety of sources – state, city, business, religious and service organizations, and private individuals.

26. 3. Proposed Multistate Partnership IMPACT Network and Benefits

27. Multistate Partnership IMPACT Network • Step-by-step expansion of partnership network • Twofold purpose of multistate network • To replicate the PROSPER Model for “real world” dissemination of evidence-based interventions (EBIs) in early-adopter states • To conduct multisite process and outcome evaluations or prevention trials, to learn more about how to achieve large-scale community IMPACT

28. Potential Benefits of Network for Partnership-Based EBIs on a Larger Scale • To Our Fund of Knowledge • Expanding knowledge of interventions producing long-term positive outcomes and economic benefits • Potential for learning from multistate research network about optimal dissemination of evidence-based interventions • To Schools and Communities • Reduced substance use problems among youth • Reduced youth behavior problems in school and community settings • To Youth and Families • Enhanced parenting and youth life skills • Increased family cohesion and well-being

30. What Could Be…Scaling up Evidence-Based Interventions Through Partnership Networks • Consider the empirically-demonstrated return from one set of NIDA-funded projects • Imagine this on a larger scale • Improved economic benefits from federally-funded projects • Prevention “stock” is blue chip • Evidence-based prevention interventions fiscally wise • Improved health and well-being of youth, families and communities—making a “real world” difference

31. Imagine… IMPACT!

32. Acknowledgement of Our Partners in Research Investigators/Collaborators R. Spoth (Director), C. Redmond & C. Shin (Associate Directors), T. Backer, K. Bierman, G. Botvin, G. Brody, S. Clair, T. Dishion, M. Greenberg, D. Hawkins, K. Kavanagh, K. Kumpfer, C. Mincemoyer, V. Molgaard, V. Murry, D. Perkins, J. A. Stout Associated Faculty/Scientists K. Azevedo, J. Epstein, M. Feinberg, K. Griffin, M. Guyll, K. Haggerty, S. Huck, R. Kosterman, C. Lillehoj, S. Madon, A. Mason, J. Melby, M. Michaels, T. Nichols, K. Randall, L. Schainker, T. Tsushima, L. Trudeau, J. Welsh, S. Yoo Prevention Coordinators E. Berrena, M. Bode, B. Bumbarger, E. Hanlon K. James, J. Meek, A. Santiago, C. Tomaschik

33. And, again, thank you for this opportunity…Questions? For more information please visit our websites at... www.ppsi.iastate.edu or www.prevention.psu.edu Also see www.preventionresearch.org for the Society for Prevention Research Standards of Evidence Guidelines.