With respect to general comments for success, the first point from our work group was the idea of the comprehensive, community, multicomponent approaches that we talked about yesterday. Surprising to me, there was consensus also about the utility of research. I can remember in the not-so-recent past when community coalitions said, "It is just a pain in the neck. Can't we just go on with our work and not evaluate our efforts?" I don't hear that anymore. There is an understanding of the need to use research as a tool, primarily for accountability for what you are doing and as a stepping stone for future funds.
What was interesting about this acknowledgment of the need for comprehensive community intervention were the group's ideas about how to extrapolate it to other things besides mul-ticomponents. One of these was adding age groups, using a multigenerational program, not all at the same time. One example came from Gloucester. There is a lot of attention paid to Little League players, but when those Little League players get older, there is nothing for them. A lot of them are latchkey children, and they have a lot of time on their hands. The point was to look at different stages or age groups and develop prevention programs for them.
Another recommendation was to interpret comprehensive community intervention as contextual programming. It was the idea of taking the systems that are already in place and for which a community already has a budget - recreation, waste removal, transportation, local ordinances, schools - and fashioning prevention programs for each of those existing systems. This involves talking to each of those systems to get at least part of their budgets invested in prevention
programming. I don't think we have done this before.
The group also discussed adding worksites, both as a future research area and as a means to get at adult behaviors. This includes worksite prevention programs aimed at those who have just passed through adolescence, young adults, and adults who have young adolescent children.
Another point was the need for a multicultural focus, and there was some discussion about how to do this with limited funds. There were several communities represented in our group that already have several coalitions that can deal with prevention issues. It was suggested that each could target a different cultural issue. The coalition should have collaborative efforts with ongoing agencies rather than turf battles, and the coalition in a community in which a program is run should recognize it as their own program. Failures and successes were mentioned with respect to outsiders coming in and not becoming part of the program in the community. Therefore, the program should be based on the community's acknowledging that it was their decision to adopt a program and to tailor it to the community if need be.
The work group offered general comments pertaining to the role of the researcher. In the community-based work, when researchers are used, they are used as evaluators. However, there are other roles for a researcher, the first being an organizational consultant to communities, especially during the needs assessment process. Another role is that of an information broker about drug use, etiology, epidemiology, and principles that work in prevention, and providing that information to communities. Still another role is that of evaluator.
The work group explored the question of how to sustain an effort by community coalitions over the long term. A first suggestion was moving the interventions from context to context. A second is building in a plan to rotate community coalition personnel at the 21/2-year point to prevent burnout. The third suggestion was having the coalition and community representatives vote on whether the community should move after about a 3-year period from a specific drug use focus to other problem behaviors that are related to drug use, so that problem behaviors, like violence, become more or less salient without loss of the drug use focus. The fourth suggestion was the notion of reinvention, which basically means tailoring a program over time by restructuring it slightly, making corrections, and fine-tuning it like you would a car. It also involves acknowledging the people who are involved in the fine-tuning to provide reinforcement and encouragement to continue their efforts.
We also dealt with the problem of adults and changing their behavior, since they are models for children. The first suggestion was that, because it is difficult to change adult behavior in Western society, we send children's messages home through prevention programs and exert positive pressure on parents through the child, particularly through homework activities.
A second suggestion was a model used in inner-city Detroit, where using positive child pressure is a rather threatening occurrence. The model involved getting adults, especially those in housing projects, to make a public commitment at the same time that children make a public commitment as part of a school program. The designated adult who makes the commitment may or may not be a parent. A third example was, again, using worksite prevention programs to address adult behaviors.
The work group also discussed how to regenerate community interest in drug abuse prevention. This involved the issue of readiness and an acknowledgment that we may no longer have many communities at the point of readiness for drug use prevention. We have had several years of that. The question is whether we can regenerate or regear to make drug use prevention a focus. The discussion revolved around conducting a needs assessment now and strategically using mass media.
Another issue the group discussed was how to enact policy changes at the community level. We did not have an answer for how to deal with big legislative hammers like the tobacco industry, and it is probably beyond the scope of the discussion here. But there was an acknowledgment that the way to change local policy is to use prevention programs in the mass media to start changing perceived social norms. In this way, you build up a norm for the unacceptability of drug use, and it becomes easier to change local policy at some point.
The work group also discussed turf battles among coalitions and agencies. Group members recommended the use of prominent, credible business leaders who can help remove the issue from a health agency domain. They also suggested minimizing the use of politicians unless there is a cohesive community council that will be behind prevention for a long time.
We discussed how to generate long-term funding, and this included charging schools a minimum of $2 to $3 per student, which is paid into a fund for delivery of prevention programs each year. This would also involve bringing businesses into coalitions but not systematically approaching them for donations each year.
Finally, in regard to directions for research, there was a recommendation for more research on predictors of effective coalitions and on the effects of coalitions on drug use changes. The research would involve building more in the way of doctoral and postdoctoral training programs for researchers in prevention.
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