Reducing Substance Abuse in America: Building the Nation's Demand Reduction Infrastructure A Framework for Discussion

SAMHSA's Strategic Prevention Framework: An Evidence-Based Prevention Planning and Implementation Process

SAMHSA's Strategic Prevention Framework (SPF) is the cornerstone of all of SAMHSA's prevention efforts. The SPF is also a key part of SAMHSA's public health approach to enable states and communities to build prevention infrastructures and sustainable prevention programs, policies and practices. The SPF is built on the principle that communities must understand the nature, extent and scope of their local substance abuse problem, identify the causes and solutions, and take action. Indeed, the best solutions to substance abuse problems often come from local communities because local people solve local problems best. The SPF is based on five essential components that guide the planning and implementation of prevention services. In addition to the five steps of the SPF, sustainability and cultural competence permeate the process and ensure that all prevention efforts will be relevant and have an ongoing impact.

Components of Assessment—Collecting data to define community problems and underlying risk and protective factors; mobilizing key stakeholders to collect needed data; creating epidemiology workgroups to build state and local data infrastructures and spearhead data collection efforts.

Components of Capacity—Identifying and mobilizing financial and organizational resources to address the identified problems within the State or community; convening key stakeholders, coalitions, and service providers to plan and implement sustainable prevention efforts; creating partnerships; addressing leadership, determining community readiness, and building capacity to implement strategies that include programs, policies, and practices, evaluation, cultural competence and sustainability.

Components of Planning—Developing a strategic plan that includes policies, programs, and practices that create a logical, data-driven plan to address the problems identified throughout the assessment process; identifying performance targets; developing ongoing action plans; selecting evidence based policies, programs, and practices that address the identified problems; developing a sustainability plan.

Components of Implementation—Taking action guided by the Strategic Plan; implementing culturally competent programs, practices, and policies; creating an evaluation plan; collecting process measure data; monitoring implementation; and implementing the sustainability plan.

Components of Evaluation—Measuring the impact of the SPF process, as well as the implemented programs, policies, and practices; identifying areas for improvement; reviewing the effectiveness, efficiency, and fidelity of implementation in relation to the strategic plan, implementing corrections to the plan if necessary; and evaluating sustainability of current efforts.

Sustainability and Cultural Competence

• Assessment
  
  
• Capacity
  
  
• Planning
  
  
• Implementation
  
  
• Evaluation

Strategic PreventionFrameworkState Incentive Grants (SPF SIG)

SAMHSA/CSAP helps States to develop a prevention strategy that is tailored to local needs, implements new policies, programs and practices, and leverages the resources of the community programs that are already in place. The SPF SIG uses the Strategic Prevention Framework as a comprehensive state and community planning framework to:

• Build prevention capacity at the state and community levels
  
  
• Reduce substance abuse-related problems in communities
  
  
• Prevent the onset and reduce the progression of substance abuse.

Central to this grant program's success in building multi-level capacity are four reinforcing components:

• Working through the leadership of the Governor's Office in each state
  
  
• Creating the State Incentive Grant Advisory Committee that has representative members of State Agencies, nonprofit organizations and other stakeholders who provide prevention resources, data, programs and funding within the state Incorporating Epidemiology Work Groups into assessment activity to emphasize data-driven decision-making at state and local data levels to ensure the closest possible relationship between assessment, planning and goal achievement
  
  
• Uniting multiple funding streams that cut across existing programs and systems to forge a common pathway from the State to the community
  
  
• Reinforcing a community-based approach to substance abuse prevention and mental health promotion by requiring that 85 percent of the SPF SIG funding go to communities to strengthen local prevention capacity and infrastructure.

Success Story

With the support of SAMHSA's Strategic Prevention Framework State Incentive Grant (SPF SIG) program, New Mexico has used their SPF SIG funding to expand their focus to evidence-based programs, policies, and practices for all age groups. When asked about the primary advantages of the Strategic Prevention Framework State Incentive Grant, Donald Maestas, Chief of the New Mexico Prevention Services Bureau, says, "The SPF SIG has provided New Mexico with the ability to focus on community level indicators which is critical to changing systems, community norms, and individual behavior. It is the first SAMHSA grant that truly supports the State in its efforts to put funding where the data shows it is needed and involve people from the community every step of the way." New Mexico already has outcomes to report for 2005. The percentage of 30-day use of alcohol among 12-17 year olds dropped from 24.6-24 percent, while 30-day use of the comparison group increased from 23.3-25.3 percent. The percentage of 30-day use of marijuana among 12-17 year olds dropped from 16.5-14.8 percent, while the 30-day use of the comparison group increased from 13.3-15.8 percent. The percentage of 30-day use of tobacco among 12-17 year olds dropped from 23.2-21.2 percent, while 30-day use of the comparison group increased from 19.2-19.4 percent.

Stopping Drug Use Before It Starts

Fostering Drug-Free Communities

Community anti-drug coalitions harness the power of multiple sectors of the community to work together, using evidence-based strategies and practices to achieve community-level change goals. In 1997, the Community Anti-Drug Coalitions of America was successful in getting Congress to create the Drug-Free Communities Support Program (DFCSP). The DFCSP has grown to over 700 grantee anti-drug coalitions in communities across the United States and its territories. The goals of the Drug-Free Communities Support Program are to:

• Reduce substance abuse, including alcohol, tobacco, and drugs among youth
  
  
• Strengthen collaboration among various sectors in the community.

To facilitate the ongoing development of self-supporting community anti-drug coalitions, the Drug-Free Communities Support Mentoring Program was added. These grants are awarded to existing Drug-Free Communities grantees who agree to serve as guides for new coalitions in navigating start-up challenges and achieving sustainability. The Drug-Free Communities Program represents a collaborative effort between the White House Office of National Drug Control Policy (ONDCP) and SAMHSA/CSAP. Guidance is provided by an eleven-member expert Drug-Free Communities Advisory Commission appointed by the President.

Success Story

There was a time when deputies like Corporal Barry Sowards, with the Lexington County, South Carolina, Sheriff’s Department, would never have thought of writing citations for young people attending an underage drinking party. "I finally realized that by preventing underage drinking and enforcing laws we can prevent a lot of other types of crime—vandalism, robbery, rape, and even death." LRADAC (the Behavioral Health Center of the Midlands) and local law enforcement made a commitment to form a drug-free community coalition with goal of creating a safer and healthier community. The tremendous success of this collaborative effort is demonstrated through its outcomes.

• Among 6-8th graders, binge drinking is down by 42 percent, 30 day alcohol use is down 21 percent, and 30 day marijuana use is down 47 percent. Among 9-12th graders, binge drinking is down by 18 percent, 30 day alcohol use is down 35 percent, and 30 day marijuana use is down 17 percent.
  
  
• Attitudes and perceptions among 6-8th graders that the community's perception about the use of alcohol is not a good thing are up 24 percent among 6-8 th graders and up 12.2 percent among 9-12th graders. Attitudes and perceptions among 6-8th graders that alcohol is never a good thing are up 10 percent and up by 16% among 9-12th graders. Thirty-six percent fewer youth in the 6-8th grades report that parents allow drinking at parties and 15 percent fewer youth in the 9-12th grades report that parents allow drinking at parties.
  
  
• The alcohol compliance check buy rate dropped from a baseline of 28 percent to 9.1 percent in 2005.

Families, youth, schools, faith-based organizations, government agencies, businesses, and other community groups must all be involved and work together to help youth grow and develop in healthy ways, to support their making good decisions, and to provide the safe and supportive environments that help youth thrive.

National Community Anti-Drug Coalition Institute

The National Community Anti-Drug Coalition Institute aims to increase the knowledge, capacity and accountability of community anti-drug coalitions throughout the nation. The Institute serves as both a vehicle for coalition-specific substance abuse prevention policy development and a center for coalition training, technical assistance, evidence-based programming and implementation, evaluation, research and capacity building.

Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence

Launched in 2001, SAMHSA's FASD Center for Excellence focuses national attention on the problem of FASD by providing leadership in the fight against FASD and fostering collaboration among service providers in the field. The Center also works to improve quality of life for individuals and families affected by FASD.

The FASD Center's work also includes coordinating, planning, training, and program development by states, Tribes, community-based organizations, and criminal justice organizations. Information is also disseminated through the FASD Web site which serves as an online information resource, offers science-based information on FASD through fact sheets, posters, brochures, videos and curricula, as well as links to local and national resources.

Substance Abuse & HIV Prevention Initiative

The purpose of this grant is to expand substance abuse and HIV prevention services through rapid HIV testing. The focus of this program is on the prison population returning to racial or ethnic communities highly affected by the twin epidemics of substance abuse and HIV/AIDS.

PreventionLeadershipAcademy

To develop the prevention workforce, SAMHSA will continue the Prevention Leadership Academy as an on-going series of events designed for State and Territory Prevention Directors who make up the National Prevention Network (NPN). The first event in January 2005—the largest gathering of NPN members ever—identified significant prevention leadership challenges and strategies for addressing them. The Executive Committee of the NPN, its Workforce Development Committee, and the majority of individual NPN members designed an Academy to meet the current challenges of change in the prevention field.

Prevention Fellowship Program

SAMHSA/CSAP has launched the Prevention Fellowship Program that will help all States cultivate and nurture an ongoing work force for prevention throughout the United States. The purpose of this program is to provide professional development opportunities for the prevention field. Through the fellowship program, participants will enhance their knowledge, skills, and competencies in all components of the SPF to include:

• Substance abuse prevention across the life span;
  
  
• Community prevention planning and service delivery at the State and community level, including coalition building;
  
  
• Data, evaluation, and alcohol and drug epidemiology;
  
  
• Environmental prevention strategies, systems change and service delivery; and
  
  
• Social marketing as it relates to prevention.

Centers for the Application of Prevention Technologies (CAPTs) (Northeast, Southeast, Central, Southwest, and Western)

The CAPTs are regional technical assistance providers for the Center for Substance Abuse Prevention (CSAP) and serve as integral support for SAMHSA's mission to create a life in the community for everyone. The CAPT system is a practical tool to increase the impact of the knowledge and experience that defines what works best in prevention programming. The primary mission of SAMHSA/CSAP's National Centers for the Application of Prevention Technologies is to bring research to practice by assisting States, Tribes, and Jurisdictions in the application of the latest evidence-based knowledge to their substance abuse prevention programs, practices, and policies. The CAPTs also work to:

• Expand the capacity, increase effectiveness and strengthen the performance and accountability of substance abuse prevention services at the State and community level.
  
  
• Provide training and technical assistance to support effective, evidence-based substance abuse prevention programs, practices, and policies.
  
  
• Monitor the delivery and quality of services so that the impact of these services can be assessed in relation to States and community-based prevention programs reaching their goals.