Sustaining Adoption of Science-Based Prevention: Long-Term Effects of Communities That Care
Previous studies have shown that the Communities that Care (CTC) prevention system has significant effects on reducing the risk of youth outcomes including alcohol and tobacco use and delinquency (Hawkins et al., 2009). An important theorized mechanism by which CTC leads to improved youth outcomes is by increasing communities’ adoption of a science-based approach to prevention (Adoption). Prior findings from a community-randomized trial have showed effects of CTC on increasing levels of Adoption during the active intervention period (Brown et al., 2011) as well as sustained effects 1.5 years after study funding for intervention activities ended (Rhew et al., 2012).This study addresses two questions: (1) Can high levels of Adoption continue to be sustained approximately four years after study intervention resources to communities ended, given that people in community leadership positions change?; and(2) To what extent is training in CTC related to the sustainability of Adoption in CTC communities over time?
This study reports findings from the Community Youth Development Study (CYDS), a community-randomized controlled trial of the CTC system in 24 communities across seven states. This study uses data from surveys of community key leaders (e.g., school superintendent) administered in 5 waves from 2001 to 2011 (N=1,041). Adoption was measured by 21 questions designed to categorize into 6 discrete stages (0 to 5) each respondent’s rating of his or her community’s level of implementation of science-based prevention activities. To compare the stage of adoption between CTC and control key leaders, three-level ordinal logistic Hierarchical Generalized Linear Models (HGLMs) were used with study wave nested within key leaders, who are nested within communities. The models adjusted for key leader characteristics (e.g., age, education level) as well as community-level factors (e.g., community population size, percentage of residents living in poverty). CTC training was measured as attended any CTC training or not, and was included as a covariate in the model.
While Adoption did decline between 2007 and 2011, key leaders from CTC communities continued to report significantly higher stages of Adoption compared to control community leaders (p<0.05) in 2011, approximately four years after study-provided funding, technical assistance, and training ended. In addition, key leaders in CTC communities who reported receiving CTC training were more likely to report higher levels of Adoption over time (p<0.05) than those who were not trained in CTC.
Conclusions and Implications:
Results of this study suggest that high levels of Adoption of a science based approach to prevention can be maintained several years after external support for CTC has ended. However, since exposure to CTC training is related to sustained Adoption within CTC communities, training in CTC for new key leaders as well as booster sessions for all key leaders in CTC communities are likely to be beneficial.