Community Wise: Pilot Findings of a Substance Abuse and HIV Prevention Multilevel Intervention

Background and Purpose:  Substance abuse and HIV prevention and treatment interventions tend focus on changing individual behavior while ignoring mezzo and macro level variables known to impact substance use and HIV transmission. In 2010, the Newark Community Collaborative Board (NCCB) was created to apply Community Based Participatory Research (CBPR) principles in developing Community Wise, a manualized, multi-level intervention comprised of 12 weekly group sessions aimed at reducing substance use, HIV risk behaviors, and reoffending among individuals with histories of substance abuse and incarceration. Community Wise is grounded in critical consciousness and includes capacity building projects designed to mobilize participants’ to engage in community action.

Method: Community Wise was implemented at Rutgers University and at a community based organization. A pre-posttest evaluation was used to pilot-test Community Wise and findings were gathered to continue improving the intervention. Seventy-nine participants recruited by the NCCB completed a phone and clinical screening. Of those who met eligibility criteria, 40 were assigned to Community Wise and 36 completed a baseline, 6- and 12-week follow-ups, and a focus group at the end of the intervention. Outcome measures assessed participants’ substance use, criminal offending, and HIV risk behaviors. Process measures assessed community engagement, psychological distress, critical consciousness, group cohesion, client satisfaction, and acquired treatment skills. In order to be eligible to participate in Community Wise, participants had to have been incarcerated within the past four years, have a history of substance use, be 18 years of age or older, speak English and provide consent. Participants were screened by masters-level clinicians and deemed ineligible if they were found to have a high level of suicidality, an unstabilized psychotic disorder or gross cognitive impairment.

Results: Findings indicated high engagement, retention, and follow-up rates (participants completed an average of 7 (3.85) out of 12 sessions; 65% successfully completed the intervention, and 90% completed the 3 months post baseline follow-up). Eighty five percent found the intervention to be helpful. Preliminary outcome analysis indicated reductions in the expected direction among all variables. Some of the statistically significant differences from baseline to 3 months post baseline included a significant reduction in number of drinking days from 47.27 (37.7) to 18.91(17.86), p<.01, Cohen d= 1.02 and a significant increase in critical consciousness from 4.25 (.58) to 4.53 (.61), p<.05, Cohen d= .47. Further changes will be made to enhance the manual based on these findings. For instance, based on clinical supervision and participants’ feedback, the NCCB modified the format for community capacity projects by emphasizing the value of the learning and change process aiming to increase capacity as opposed to reaching the original project’s goal. The NCCB learned that the new capacity building project format must be implemented as a group project as opposed to individual projects. Thus each group must select a community problem and work together to resolve it.

Conclusions and Implications: Community Wise is a promising intervention in reducing substance use, HIV/HCV risk behaviors, and reoffending. Further research is needed to estimate effect sizes using a randomized clinical trial design.