Sherry Young
We were asked to address what was said during this morning's presentations. I have to point to Dr. Leshner's talk when he defined prevention as a process of educational and behavioral change and the realization, as Dr. Pandina stated, that risk and protective factors are not fixed and are subject to change. Those two things are what we need to talk about when we talk to States, counties, and communities because that is the most simplistic way I have heard anyone explain this research, which actually becomes pretty complicated, or appears to be complicated.
I would like to have heard more from Dr. Pandina about the community, as well as the individual, in risk and protective factor research. I learned something new from his discussion of markers, modifiers, and mediators. In Utah, we are using the research findings to influence changes at the State, county, and community levels. We also are working with the Department of Human Services, under which our Division of Substance Abuse falls, the State Office of Education, Criminal and Juvenile Justice, and most recently, the Department of Corrections, in learning how this research can be applied to services. It is important to see what attitudes and behaviors will work across the board.
Barriers, as Dr. Leshner stated, are important. We do not always say the same things or sing the same song. I have noticed in Utah, but not solely in Utah, that some people in the field of substance abuse prevention contradict what this research says about risk and protective factors. They sometimes influence others to discount the research on risk and protective factors. I was happy to hear Dr. Botvin say that we must identify what puts the children and schools at risk. I have heard people interpret his research differently, so it is good to hear him explain that. People in the field who contradict research tend to be selective about what they present, and they most often leave out the risk part of risk and protective factors.
We still do not know enough. We always want to know more, and we are not doing as good a job as we could in disseminating the information that we have. I would encourage NIDA to continue to increase support to those who collect the data and who understand the benefits of this as a science and how important this research is in developing credible prevention systems.
Carol Stone
I am glad to see that there are people here who are with community coalitions. I will address the information that I received today from the community coalition perspective. First of all, I did not hear anything today that was not useful or will not be useful to me when I get back home to Portland. It certainly fits our perceptions in terms of the work we have done and our perceptions of the nature of the problems and their solutions. There are pieces coming from the community coalition perspective. There are pieces of this work that we and other community coalitions across the country are involved in and can support that we did not hear about today. But we certainly can support some of the things that we have heard discussed.
We have heard that the most effective prevention programs are school based. From a community coalition perspective, there is certainly no argument with that. But there is a lot that a community coalition can do to build resiliency factors, change policies, and change the social environment that will support those school-based prevention programs. I can give you examples of that.
A community coalition is one that pulls together the leadership from across all sectors in the community, including the health care community, faith community, government leaders, business community, prevention and treatment programs, and schools. They pull together everybody so that there is widespread community support for prevention and so that, as Dr. Leshner said this morning, there is truly an environment that is created so everyone can "sing the same song." That is absolutely crucial. One of the reasons the Regional Drug Initiative was formed in Portland 10 years ago was because the schools were saying, "Do not leave this all to us. We really need some more help on this issue."
In addition to a community coalition supporting what is already in existence, there is much more of an opportunity for making policy changes. In most community coalitions - and there are thousands of them in the United States - there is a real commitment on the part of coalition members to make changes within their spheres of influence. I have seen this in Portland with the 3,000 employers we have worked with on drug-free workplace programs. This is one of the components that can support what is going on in the schools.
Drug-free workplaces can be sites for parent training, parent gatherings, parent support, and getting parents more information about how to set limits in their own homes. In Oregon this year we have seen some tragic results of parents who have lost children - and it seems like this year has been a particularly bad year - because they thought it was okay to send their son or daughter to a keg party that was being sponsored by friends who they thought were responsible. Or they thought it was responsible to host a keg party for their high-school-age children, and it simply is not responsible, as we all know.
There are other kinds of things that community coalitions can do, for instance, including youth in presenting the messages and in becoming positive peer influences, as well as having them be part of changing that whole social environment and helping to build resiliency factors.
I think it is certainly feasibile to work with this information. I know that I personally am going to take some of the latest research information we have heard and start looking at ways to update coalition members. It seems that there is constantly more information to learn. There has been some validation of several programs I have seen that deal with family management problems. I know that there is an excellent one in Oregon that is based on family interventions, working with the schools, working with families, and working with employers. It is based on building family strengths.
In looking at barriers that we are facing, identifying high-risk kids is really touchy and can be damaging, even though there is a real need to make sure that we offer prevention programs in all areas where there is risk.
There certainly is always a need for continued funding. More than anything, and I hear this all over the country, there is a real need to fund the evaluation of program results. It is difficult to prove that what you are doing works without that evaluation. For some reason, evaluations are not something that people usually want to pay for.
The other idea that was touched on briefly was the political reality of going for the hard policy changes within a community that might decide that they cannot support you any more because you are too outspoken and you are trying to make changes that are too radical.
Robert Pandina
One of the biggest gaps that this conference is trying to address is the need for people like me and people like you who do prevention trials research to meet together in the same room to discuss what scientists have to offer. I mean this seriously - we work for you. The big problem is finding a forum or venue where we can meet together.
In New Jersey, we have a large community coalition program, and at our university we are trying to work with both our State and Governor's Council. The basic mechanism is to bring these groups together to have a real exchange of information. We have a certain kind of information to give you, but you also have a certain kind of information to give us that probably will enrich our ability to develop the models you need.
In all honesty, and I have said this at other forums, the real challenge is not to take $1 million and deliver an intervention service to 100 kids. The real challenge is to take $100 and find a way to provide an intervention model for 1 million kids, because that is more realistic at the community level. The other thing that I hope will come out of this conference is a recognition that we who do this research, which sometimes is thought of as rather esoteric, do have an appreciation for your efforts and are working hard to bring you useful information. Also, by communicating together, you can tell us from your perspective what you need so that we can help you adapt what we find at the research bench and implement it at the community level.
With regard to evaluation within the community perspective, we have fought hard to develop evaluation strategies within the basic science and applied science milieu. We are now at another stage in evaluation development. That is, trying to develop evaluation designs that can be applied to programs at the community level that do not traditionally fit the clinical trials mode. It is a real challenge. More than once we have been called in by people who want to know whether they are being effective in a program that is already operating. They ask us to evaluate it, and we have $100 with which to do that. You can appreciate the complexity of the research that you saw today and the resources that are necessary to do these kinds of evaluations. We need to develop an evaluation model that can be extended to the communities, but that is going to take a lot of thinking on our part and a lot of adaptation. I think that is a tool that we need to develop, and we are going to need your help to develop it. We need to find common ground or common ways of communicating with one another, and I think we are much closer to it than we have ever been before.
In a way, I believe that the building blocks are in place now. Conferences like this are an attempt to get us together to find a way to forge ahead on several levels: first, to exchange information so you can take what we now know and apply it in a practical sense, and second, to figure out how we can develop evaluation models and learn more about what your needs are.
I do not do prevention trials research as such. So when I hear what you are saying and I look at the community-level risk factors, I am concerned about how to take what we know about risk factors and give them to your community alliances so that you can use that information to change your communities.
There is no question that risk factors can be identified in the communities. Risk factors come in all sizes and shapes, and identifying them requires everything from understanding the nature of the community to understanding where the real community leadership is and how one can affect the leadership.
I will give you one example. My colleagues Nancy Boyd Franklin, who is an African-American woman doing work on family interventions, and Brenda Bry have been able to contact a group in a New Jersey township that is heavily African-American in terms of its culture and its investment in the faith community. They have had tremendous success in developing a drug prevention intervention involving the faith community and working from that group back to the schools to which they could not gain access. Because the faith community was strong in that community and because they could mobilize the community leadership, they were able to identify a resilience factor, a way of gaining access to the schools and developing a school-based, faith-based, and general community program. This would not have been possible if they had not recognized the strengths and weaknesses in the community and if they had not used the strengths within the faith community to reach the schools.
So when I talk about things like the availability of prosocial activities in schools and communities and the social norms, attitudes, and availability of support for prosocial values, I do not mean just in the school or the family but wherever you can find them in the community. The generic principles that I talk about can be applied at any level of analysis, including the community level, when looking at factors like prosocial values or the availability of constructive after-school activities.
More should be done to identify those kinds of factors, and a different kind of paradigm should be developed for learning how to intervene at the community level, because it can have an incredibly powerful influence. However, researchers, and especially prevention scientists, typically have a difficult time getting into the communities where the real leadership exists. It is hard to identify and meet community leaders, but we need to talk to these leaders so that we can tailor prevention programs to fit the needs of specific communities.
Risk and protective factors may be the same, but how one implements prevention programs may be quite different in different communities. One must be very creative about that. This is one of the next areas where prevention programs must go. After all, schools do not necessarily define the community. Communities are defined by many more factors, including the generic factors that I listed in my presentation.
For example, in New Jersey we have two places where kids meet - cemeteries and malls. Whenever I think we are doing very well in some prevention arena, I go to the different malls in New Jersey and sit in the parking lots, typically near the entrance to the movie theaters. In this way I can get some estimate of what is going on in that community. We need to do something in this venue because this is where the kids are. Someone said today that one of the reasons to use school-based programs is because that is where the kids are. But the kids are also in other places, and that is where they do the kinds of things that are considered to be high-risk behaviors.
You will notice that I never talked about "high-risk kids" today. I cannot think in those terms because it does not make sense to chop up the world that way. It is more a question of the factors to which some kids may be exposed. Generic risk and protective factors and those models go well beyond individual and biological issues and can be specified and identified at the community and State levels.
Our coalition has been very effective in convincing our Governor that resources ought to be set aside and distributed at the community level. One of the problems I see in that approach is that they need the technology to know what community programs to choose so that those dollars go as far as possible.
These are different kinds of approaches, but they fit well within the risk-and-protective-factor model. You have to be a little bit more generalized in thinking about that, and a little bit creative about extending yourself in that model, but it works very well.
A community, in a way, is an organism. It is made up of parts. Those parts fit together, and there is an outcome based on those parts. There is a dynamic in the community.
I think this kind of science can go a long way to helping with that kind of analysis. I would still offer that the risk factor approach starts with an analysis of those factors and how they operate. From that will flow the ability to pick out the menu of what we have from either family-based programs or school-based programs and adapt them to the communities. The principles are the same. They sound different, but they can be generalized to extend very nicely to the community, the State, or for that matter, the regional level.
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