Session: Evidence From a Community-Based Initiative: Effects of the Communities That Care Prevention System (Society for Social Work and Research 15th Annual Conference: Emerging Horizons for Social Work Research)

Advances in prevention science over the past 3 decades have led to the identification of effective practices for preventing adolescent health-risking behaviors. Yet, the widespread use and high-quality implementation of these effective practices is not commonplace in communities. A community-centered effort to reduce adolescent health-risking behaviors, coordinated across health, education, and human service sectors, should significantly reduce health risking behaviors community wide. However, studies of coalition-based approaches have found that these efforts often do not achieve the desired outcomes. Communities That Care (CTC) is an operating system that mobilizes and empowers community stakeholders to collaborate on the development and implementation of a science-based community prevention plan aimed at reducing risk factors, enhancing protective factors, and reducing the prevalence of adolescent health and behavior problems. The CTC system is expected to produce community-wide changes in prevention service system characteristics, including increases in the adoption of a science-based approach to prevention, increases in collaboration among service providers, and increases in the use of effective preventive interventions that address risk and protective factors prioritized by the community. These changes in prevention services are expected to change youth exposure to the risk and protective factors targeted by the preventive interventions. These changes, in turn, are expected to produce reductions in adolescent mental, emotional, and behavioral problems community-wide. CTC has been tested in a group randomized trial in 24 communities across 7 states, matched within state, and randomly assigned to control or CTC conditions. Results from this trial of CTC have shown that 1.5 years after initial implementation, the CTC system was successfully implemented with fidelity in intervention communities, levels of adoption of science-based prevention were significantly higher in CTC than control communities, and effective preventive programs were selected and well implemented in the CTC communities. Three years after initiation of CTC, hypothesized effects of CTC on risk factors targeted in the intervention communities were observed. Four years after the initial implementation of CTC, the rates of initiation of delinquent behavior, alcohol, cigarette, and smokeless tobacco use in a panel followed from Grades 5 through 8 were found to be significantly lower in CTC than in control communities. In addition, in the longitudinal panel Grade 8 prevalence rates of alcohol and smokeless tobacco use in the last 30 days, binge drinking in the past 2 weeks, and the number of different delinquent behaviors committed in the past year were significantly lower in CTC than in control communities. This symposium presents three papers investigating different aspects of CTC using data from the randomized trial: Paper 1 examines whether CTC, designed to prevent adolescent drug use and delinquency universally, had equal effects for boys and girls and high versus lower risk subgroups. Paper 2 examines the relationships between four characteristics of community prevention service systems and adolescent problem behaviors. The third paper examines the relationship between characteristics of CTC coalition functioning and community change.