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  1. Community Interventions The Public Policy Analysis & Education Center for Middle Childhood, Adolescent & Young Adult Health and National Adolescent Health Information Center, Department of Pediatrics and Institute for Health Policy Studies, University of California, San Francisco

  2. Presentation Overview • Communities & After-school time • Adolescent involvement and empowerment in community • Coalition building • Cultural sensitivity • Models for community health programs • Principles for building prevention programs • Examples in adolescent health (teen pregnancy prevention and youth tobacco prevention)

  3. Community Interventions: Importance of After-School Time • The community represents a key setting for public health efforts to improve adolescent health. • After-school programs fill gaps, by complementing the institutions of school and family by providing opportunities and resources that otherwise would be unavailable. Source: National Institute for Out-of-school Time

  4. Importance of After-School Time • Unstructured after-school time has been shown to be a common time for teenagers to engage in risky behaviors linked to critical adolescent health issues. • Relationships with positive adult mentors in after-school programs have been shown to be a protective factor in preventing risky behaviors. Source: Adapted from Kahne et al., 2001

  5. Developing Interventions • What aspects are important to consider in developing a community intervention? • Youth involvement • Coalitions • Cultural sensitivity

  6. IOM Report: Youth Development • The 2002 Institute of Medicine report examined programs that promote youth development. Recommendations for policy and practice include: • Programs should be based on a developmental framework that supports personal and social gains; • Funders should provide resources at the community level; and, • Program opportunities should meet the diverse needs of the community. Source: Eccles & Gootman, 2002

  7. Adolescent Involvement in Community • Participating in positive, meaningful activities, learning useful and relevant skills, and being recognized are all important to youth involvement in community activities. • Youth involvement has also been shown to have a protective role in reducing the incidence of risk taking behaviors. Source: Chinman & Linney, 1998; Teipel & Park, 2006

  8. Adolescent Involvement in Community • The developmental benefits (i.e.protective factors) of participation in activities include: • critical awareness of how to have a significant influence, • how to use new skills to make a contribution, • self-efficacy, • confidence, • self-esteem, and • a stable positive identity. Source: Chinman & Linney, 1998

  9. “Adolescent Empowerment Model” Focus on the Positive Need to experiment with different roles Nature of activities in which to participate Participate in activities Receive positive reinforcement Learn new skills Bond to positive institutions Source: Chinman & Linney, 1998

  10. Tips for Involving Youth In Community Work • Include partners who respect youth and are willing to work with teens. • Train adults in the skills needed for working with young people. • Let teens guide the coalition’s understanding of how young people think and feel. • Provide youth with the training and guidance necessary to promote meaningful participation in the group. • Consider what specific strategies young people can undertake that affect their peers, their families, and their schools. Source: CDC-HRSA-NAHIC, 2004

  11. Coalition Building What is a coalition? • A coalition is a temporary alliance or partnering of groups in order to achieve a common purpose or to engage in joint activity. Source: Spangler, 2003

  12. Coalition Building What is coalition building? • Coalition building is the process by which parties (individuals, organizations, or nations) come together to form a coalition. • Forming coalitions with other groups of similar values, interests, and goals allows members to combine their resources and become more powerful than when they each acted alone. Source: Spangler, 2003

  13. Why is Coalition Building Important? • Coalitions can bring together people from different facets of the community to achieve a common goal. • Coalitions may be built around any issue and at any scale of society, from neighborhood issues to international conflict. Source: Spangler, 2003

  14. How do you Build a Successful Coalition? • Building a successful coalition involves a series of steps. To do this one needs to demonstrate: • that your goals are similar and compatible, • that working together will enhance both groups' abilities to reach their goals, and • that the benefits of working together will be greater than the costs. Source: Spangler, 2003

  15. Benefits of Coalitions • A coalition can develop new leaders. As experienced group leaders step forward to lead the coalition, openings are created for new leaders in the individual groups. The new, emerging leadership strengthens the groups and the coalition. • A coalition can increase the impact of each organization's effort. Involvement in a coalition means there are more people who have a better understanding of your issues and more people advocating for your side. • A coalition can build a lasting base for change. Once groups unite, each group's vision of change broadens and it becomes more difficult for opposition groups to disregard the coalition's efforts as dismissible or as special interests. Source: Spangler, 2003

  16. Disadvantages of Coalitions • Groups can get distracted from other work. • Individual organizations may not get credit for their contributions to a coalition. Members that contribute a lot may think they did not receive enough credit. • Each member organization will have different levels of resources and experience as well as different internal problems. • To keep a coalition together, it is often necessary to cater to one side more than another, especially when negotiating tactics. Source: Spangler, 2003

  17. Cultural Sensitivity in Community Interventions • Prevention programs must develop culturally informed and responsive programs that deliver the best science while also addressing the practical concerns of the local community. • Effective community-based programs involve both “top-down” (social planning) and “bottom-up” (locality development) approaches. • The top-down approach incorporates scientific experts in the design phase and the bottom up approach mobilizes community members to address a common public health concern. Source: Castro et al., 2004

  18. Cultural Sensitivity in Community Interventions • Community buy-in will help sustain any program implemented. • Cultural adaptation refers to modifications that are culturally sensitive and tailored to a cultural group’s traditional world views. • The primary aim of cultural adaptation includes a culturally equivalent model of a prevention program. Source: Castro et al., 2004

  19. A First Step to Developing a Community Intervention is Clarifying the Goal through Developing Models

  20. Developing a Shared Vision: Logic Models • Logic Model: • A logic model presents a picture of how your effort or initiative is supposed to work. • Effective logic models make an explicit, often visual, statement of the activities that will bring about change and the results you expect to see for the community and its people. • A logic model keeps participants in the effort moving in the same direction by providing a common language and point of reference. Source: Community Toolbox

  21. Developing a Shared Vision: Logic Models • There are many approaches to developing logic models, the following slides show three models: • 1 template, • 1 example of youth development, and • 1 example on substance use.

  22. Template: Logic Model Source: Community Toolbox

  23. Collaborating and Planning: Community Action Framework for Youth Development Build Community capacity and conditions for change Building stakeholders’ awareness, knowledge, and commitment Conveying urgency, possibility, equity and inevitability of change Increase Supports and opportunities for youth Adequate nutrition, health, and shelter Multiple supportive relationships with adults and peers Meaningful opportunities for involvement and membership Challenging and engaging activities and learning experiences Improve long-term outcomes in adulthood Economic self-sufficiency Healthy family and social relationships Community involvement Implement Community Strategies to enhance supports and opportunities for youth Strengthen community adults and families capacity to support youth Reform and coordinate public institutions and services to support youth development Increase number and quantity of developmental activities for youth Improve youth development Learning to be productive Learning to connect Learning to navigate Source: Connell et al., 2000

  24. Example Logic Model: Reduction in Youth Substance Use Theory of Change When community coalition implements a strategic substance abuse prevention plan, it is more likely to decrease rates of substance abuse over time Aim Strategies Strategy Indicators Activities Increase % of effective coalitions Improve coalitions’ use of data for needs assessment & strategic planning -Showcase effective coalitions -Provide needs assessment & strategic planning tools -Deliver training & TA % of coalitions that use data for needs assessment and strategic planning (Annual survey) Improve structure, operations, leadership & sustainability of coalitions -Implement training & TA delivery system -Develop methods to improve financial sustainability -Implement a mentor coalition network Outcome Measures % of coalitions that receive funding from the DFCSP and/or other sources (Annual Survey) • % of coalitions who track and show positive results in: • Social capital, • Community capacity, • Intermediate outcomes • Substance abuse rates Support the coalitions in their implementation of the principles of effective coalitions and the development of evidence-based strategies % of coalitions that implement evidence-based strategies (Annual surveys) -Develop inventory of evidence-based strategies -Provide training & TA -Facilitate NREPP applications Improve coalitions’ ability to track results that measure process and outcomes % of coalitions that track results (Annual survey) -Showcase effective coalitions -Provide evaluation & tracking tools -Deliver training & TA Source: Fighting Back Partnership

  25. Principles for Building Prevention Programs • Identify the real issues facing local youth. • Establish well-defined goals. • Be comprehensive in addressing both risk and protective processes. • Collaborate with stakeholders in the community or neighborhood. • Educate coalition members on current research and theory on adolescent development and prevention programming. Source: Bogenschneider, 1996

  26. Principles for Building Prevention Programs • Tailor the plan to the specific community needs. • Involve the target audience in the program design, planning, and implementation. • Be sensitive to cultural and other forms of diversity in the community. • Select developmentally appropriate strategies. • Evaluate effectiveness by monitoring changes in risk and protective processes. Source: Bogenschneider, 1996

  27. Applying Community Intervention Principles to two Areas of Prevention: Teen Pregnancy and Youth Tobacco

  28. Principles for Successful Pregnancy Prevention Program • Assess the effectiveness and quality of programs and build on existing foundations. • Ensure that programs are comprehensive, integrated, and multi-faceted. • Involve community members and teens in program planning, service delivery, and evaluation. • Collaborate with other community sectors, including business, religious organizations, and the media. Source: Brindis and Davis, 1998

  29. Principles for Successful Pregnancy Prevention Program • Acknowledge that teen sexual behavior is a complex issue that is often uncomfortable and difficult for adults to deal with. • Create strategies based on the latest research in teen pregnancy. • Start programs at early ages and provide interventions that reach young people through childhood, adolescence, and young adulthood. • Emphasize primary pregnancy prevention for both males and females. Source: Brindis and Davis, 1998

  30. Youth Tobacco Prevention: Community Intervention • Community interventions have multiple components and involve the use of community resources to influence both individual behavior and community norms or practices related to adolescent tobacco use. • This includes the involvement of families, schools, community organizations, churches, businesses, the media, social service and health agencies, government, and law enforcement, with intervention strategies generally focused on making changes in both the environment and individual behavior. Source: Lantz et al., 2000

  31. Youth Tobacco Prevention: Community Intervention Research suggests: • Programs should address the social influences of and peer norms regarding tobacco use. • Information should be provided on the long and short term physiologic consequences of smoking. • Program administrators need program specific training. • Schools need to adopt tobacco-free policies to ensure that prevention programs are implemented in a setting with broad support. Source: Lantz et al., 2000

  32. What We Have Learned • Community interventions are an important approach to address issues; school and health services are not enough. • In designing community prevention programs, a clear sense of the real issues facing local youth must be identified. • Community interventions can involve many factors: • Coalitions have many benefits, and many challenges. • Youth involvement can promote protective factors and reduce risk factors. • Programs that reflect diverse needs of the community have great chances of positive outcomes. • Logic models can help clarify goals and illustrate the shared vision.

  33. References • Bogenschneider, K. (1996). An ecological risk/protective theory for building prevention programs, policies, and community capacity to support youth. Family Relations; 45(2): 127-138. • Brindis C. and Davis L. (1998). Communities Responding to the Challenge of Adolescent Pregnancy Prevention: Linking Pregnancy Prevention to Youth Development; Volume V. Washington DC: Advocates for Youth. http://www.advocatesforyouth.org/publications/communitiesresponding5.pdf • Castro FG, Barrera M, & Martinez CR. (2004). The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit. Prevention science; 5(1): 41-45. • Centers for Disease Control & Prevention,National Center for Chronic Disease Prevention & Health Promotion, Division of Adolescent & School Health; Health Resources & Services Administration, Maternal and Child Health Bureau, Office of Adolescent Health; National Adolescent Health Information Center, University of California, San Francisco. Improving the Health of Adolescents and Young Adults: A Guide for States and Communities. Atlanta, GA: 2004 • Community Toolbox, http://ctb.ku.edu/ • Connell JP, Gambone MA, & Smith TJ. (2000). Youth development in community settings. In Public/Private Ventures (Ed.), Youth development: Issues, challenges and directions (pp.281-324). Philadelphia: Public/Private Ventures. • Chinman MJ. & Linney JA. (1998). Toward a model of adolescent empowerment: Theoretical and empirical evidence. The Journal of Primary Prevention; 18(4): 393-413.

  34. References • Eccles J & Gootman, JA (Eds.). Community programs to promote youth development. Washington, DC: National Academy Press, 2002 • Fighting Back Partnership, http://www.fight-back.org/ • Kahne J, Nagaoka J, Brown A, O’Brien J, Quinn T, & Thiede K. ( 2001). Assessing after-school programs as contexts for youth development. Youth & society; 32(4): 421-446. • Lantz PM, Jacobson PD, Warner KE, Wasserman J, Pollack HA, Berson J, & Ahlstrom A. (2000). Investing in youth tobacco control: A review of smoking prevention and control strategies. Tobacco Control; 9:47-63. • National Initiative to Improve Adolescent Health http://www.cdc.gov/HealthyYouth/AdolescentHealth/NationalInitiative/index.htm • Spangler, B. "Coalition Building." Beyond Intractability. Eds. Guy Burgess and Heidi Burgess. Conflict Research Consortium, University of Colorado, Boulder. Posted: June 2003 http://www.beyondintractability.org/essay/coalition_building/ • Teipel K. and Park J. (2006). Invest in Adolescents for a Promising Future. In Making the Case for State Investments in Adolescent and School Health. http://www.astho.org/pubs/MakingtheCase.pdf

  35. National Adolescent Health Information Center and Public Policy Analysis & Education Center for Middle Childhood, Adolescent & Young Adult Health WEB SITES: http://nahic.ucsf.edu/ http://policy.ucsf.edu/ EMAIL: nahic@ucsf.edu policycenter@ucsf.edu PHONE: (415) 502-4856