Use of Evidence-Based Practices by Community Substance Abuse Coalitions: Reports from the Front-Line
Michelle Strout, MSW, Boston University.
Background/Significance: Federal funding agencies have been requiring community substance abuse coalitions to use Evidence-Based Practices (EBPs) or “Model Programs” available as evaluated and packaged prevention programs. This trend toward EBPs is affecting many disciplines, including social work. Historically, funding for community substance abuse prevention coalitions did not require such rigorous methods or evaluation. Instead, coalitions constructed strategies for education, public awareness, and information dissemination based on local interpretations of risk and protective factors. The new expectation that coalitions implement EBPs called for research at the community level, but a review of the literature and contacts with the Center for Substance Abuse Prevention, the funding source, revealed that this transition was not being studied. Researchers were not examining the experiences and perceptions of the street-level coordinators charged with facilitating and implementing this shift to EBPs. Purpose: This study, in a New England state, explored the experiences and perceptions of coordinators of 20 community prevention coalitions to understand (a) their use of EBPs, (b) the extent to which the models were delivered with fidelity, (c) perceived barriers and facilitating factors to use of EBPs and (d) if EBPs were not used, what were their alternative prevention methods? Methods: Constructivist grounded theory methods and semi-structured in-person interviews were used to elucidate the experiences and perceptions of the coalition coordinators. Data analysis used the grounded theory methods of coding and re-coding allowing themes to emerge across multiple participant interviews. This constant comparative method of analysis led to the discovery of substantive theory. Findings: Coordinators' reports show that many coalitions are not using EBPs or not using them with fidelity. Instead, the coalitions use “home grown” or locally constructed strategies based on common sense knowledge. Among barriers perceived: (a) the state's lack of guidance for navigating this change to EBPs, and (b) the coordinators' and coalition members' lack of prior training in delivering EBPs. Among perceived facilitating factors: (a) grass roots organizing with other coordinators/coalitions led to construction of common understandings about the process of shifting to EBPs, and (b) collaborations helped to obtain funding to implement EBPs which were complex, time consuming, and costly. Perhaps the most significant barrier was the coordinators' or coalitions' perceptions that the way they were already “doing prevention” was successful. Implications: Giving voice to street-level coalition coordinators is fundamental to understanding communities' perceptions of EBPs; such coordinators, charged with reducing the nation's substance abuse problem, are leading coalitions across the country. Findings may provide insight into common coordinator and coalition experiences, and inform those designing and disseminating EBPs so they can address barriers by increasing either the “user-friendliness” of the EBPs, or the community's skill in implementing them. Social workers who value EBPs, but also appreciate the realities street-level implementors face, are ideal agents to bridge the science to practice boundary at the local, state, and national level. Success demands that, as researchers, we find best practices for promoting and implementing EBPs by considering the experiences and perceptions of the implementors.