I want to acknowledge three organizations before I begin. One of them is the Center for Substance Abuse Prevention, which took the challenge and the risk of directly funding communities to create and build comprehensive
community-based systems of prevention. Join Together and the Community Anti-Drug Coalitions of America provided communities with realistic and practical technical assistance to get the job done. So on behalf of many, many communities, thank you.
I like the saying that unless we utilize the lessons learned from the past we are destined to keep repeating them. Thirty years into the challenge of addressing substance abuse problems, it sometimes becomes frustrating that we keep doing the "same old, same old."
I represent Franklin County, which includes Columbus, OH, and we are fortunate to have received a CSAP Community Partnership Grant. I want to talk about the process we went through in integrating prevention research into a strategic planning process.
Columbus already had a system of prevention. The public entity that funds substance abuse and mental health programs funded 30 prevention programs. When we did our needs assessment, we found 40 additional ones. Therefore, we found that a lot of activities were going on, but people were going off in very different directions.
Our goal as a community partnership was to help all the arrows point in the same direction to achieve a larger goal. First, we conducted a needs assessment to get a snapshot of what the landscape looked like regarding alcohol and other drug problems. We also wanted to measure the community's readiness to coalesce around the issue of substance abuse prevention. We also wanted look at things like funding streams, how dollars are allocated, and who is funding prevention services, and to review the current providing systems.
We then began a process of researching effective alcohol, tobacco, and other drug prevention model activities and came up with the ones that you are all familiar with, most of which came out of some of the CSAP literature and other popular literature: skills-building, community mobilization, alternative activities, advocacy, mentoring, and role-modeling. What we learned, not surprisingly, is that the community did not have a real understanding of prevention and how prevention works.
So the first order of business was to begin a comprehensive community awareness campaign to give a clear, concise prevention message to the community. That consisted of billboards and PSAs on television and radio, a poster campaign, and various appearances on TV shows and press releases through the media. We wanted to at least begin at a level where the community could begin to conceptualize what prevention was. In our community partnership, we initiated the "learning laboratory," where partners committed to meet on a regular basis for a year to begin the transition from activities to thinking more strategically about prevention and designing a comprehensive prevention system.
We wanted to avoid getting involved in the activities trap, that is, doing, doing, doing, and not thinking of how multiple activities fit into the bigger picture.
It was a wonderful experience, and some of the data that we received from those who went through that learning laboratory were beneficial because they indicated how the participants saw the community partnership and the organizations that they represented. Their bottom-line recommendation was that we needed to develop a strategy that would be more comprehensive than a series of individual programs, but these programs would still be part of the overall strategy.
So we went through a process of getting input from the entire community on what kinds of things should be included in a comprehensive substance abuse strategy. Within the county, we conducted over 30 focus groups with all sorts of different configurations. The result was the draft version of our strategic plan, which we called "Promises of a New Day." Our next challenge was to begin to develop a framework for directing and evaluating the progress of that strategy. Our coalition, like many of yours, is made up of over 60 organizations, so the challenge was to make the tent broad enough so that everyone's agenda and mission could fit under it. Our broad-based mission was to prevent the harm from substance abuse.
We decided to look at three goals according to populations of infants and preschoolers, children, adolescents, and adults, because in our county we tend to keep data on those groups. Much of the data came from Healthy People 2000. We wanted to look at health status objectives or those desired changes in individual health and well-being that could be stated in measurable terms; to look at risk-reduction objectives or those desired changes in individual behavior, perceptions, and beliefs stated in measurable terms; and finally, the strategy objectives, those programs or policies and funding streams, which are also stated in measurable terms. This paradigm was created by the health department, police department, our local board that funds alcohol and other drug and mental health services, drug-free schools, and the health coalition in central Ohio.
We thought that drug education had to be an important and viable part of the strategy - by that we meant multisession, culturally meaningful, and age-appropriate drug education from preschool through college. This included neighborhood-based support, specifically neighborhood-based community programs that meet the needs of kids between 2:30 and 6:30 p.m., a period that our data tell us is when kids are most vulnerable.
We are in the process of doing a policy panel on youth violence, and we are holding town meetings throughout the county. It is amazing to me that parents keep coming up and testifying that the times that they are most concerned about are those hours when they are at work and kids are out of school, between 2:30 and 6:30 p.m. We are happy to see that we are in sync with the community on that.
Community policing was an important part of that strategy; enforcement and the community should come together as problemsolvers to address community challenges.
We talked about workplace strategies and community involvement, with both adults and youth joining together to address neighborhood-
specific substance abuse prevention efforts and ongoing public awareness campaigns. We also included two more issues that are not usually mentioned in discussions of comprehensive prevention systems: One is access to treatment, and the second is jail-based treatment. As you all know, we are not going to build our way out of this problem with jails and prisons. We have been advocating for local jail-based substance abuse prevention treatment and general health education for all those who are incarcerated.
The challenge is integrating these strategies into our framework, and none of this is going to make any difference at all unless we believe that those policymakers who have the power buy into this and sign at the bottom line. So far we have a commitment from all of those agency heads who agreed to review their funding streams and their community plans so that they fit into this paradigm. We also established some level of responsibility and accountability by having the partnership sign a memorandum of understanding that goes beyond 3 years (the political life of a policymaker); we are trying to get people to sign off on this for the long term.
The first part is to begin another communitywide campaign to educate the community about the strategic plan. In this first year, we will speak to every city council and other units of government throughout the county about the strategy. We will also talk to school boards - we have 17 districts in Franklin County - and then community groups, community organizations, and area commissions. We have partners who have signed on to become part of a speaker's bureau to help educate the community about this strategy.
Next is the implementation stage. There will be an ongoing evaluation after the CSAP grant ends that will be revised as necessary as we go along. We also think that it is important that there be a commitment from the key prevention system heads to work within the framework, especially in developing new kinds of funding streams. Categorical funding is not the way communities experience community problems, so we are trying to get systems to think more like the way communities experience problems, which is more conjointly with commingling of funds.
What did we learn in 5 years of becoming a CSAP partnership? Just because the funding was for 5 years, does not mean that in 5 years there will be a substantial reduction in substance abuse. We found that it took 2 years just to get people on board and to understand what we were trying to do. Something magical did happen in the third year - and I know "magical" is not one of those words that evaluators use. But the "lights came on" at different times. Suddenly, people were "getting" what it means to coalesce around the issue, and that was exciting. It is a challenge to get people and systems to think strategically because our human service, knee-jerk reaction is to think, "How?" It is ingrained in us that if there is a problem, we are going to have a program instead of thinking more in terms of the larger picture.
We also learned something that was reiterated at this conference - that you need to say the same thing in different ways over and over again. It is what I call the "Coca-Cola Syndrome," that is, marketing the same product in many different forms and ways.
We also learned that politics can inhibit the process. And I do not mean just capital "P" politics, but I mean some of that small "p" politics, too, where agency heads and institutional egos get in the way of trying to achieve a goal.
Sometimes systems have a difficult time seeing the bigger picture and seeing the interconnect-edness of their efforts. Early in the process, we thought we needed to help the community make sense of this issue so we wanted to address an issue that was winnable. We thought that underage access to alcohol was one of those issues that could be winnable for our community. We started off talking about underage access to alcohol. From there, we held our first policy panel. Some legislation is pending, and we are excited about many things that have happened as a result of the policy panel.
But in the beginning it was frustrating for people to see how their organizations or agencies interconnected around the issue of underage access to alcohol. Initially, the partnership said, "We need more people at the table to do that." Although that is true, it can also be a stonewalling strategy. At some point, we need to believe that the right people are at the table.
Community partnerships and coalitions sometimes have difficulty understanding the role they can play in creating a power base. But I believe there is only one reason to form a coalition, and that is to form a power base. If you are not looking at yourself as a power base, then you become program "doers," not overall planners. So getting our coalition members to see themselves as a power base that can effect social change was a challenge and is an ongoing process.
What has happened as a result of all this? We have looked at three things in the past 5 years. We have about 10 outcomes at this point, but I will discuss only 3: underage access to alcohol, underage access to tobacco, and the commingling of funding streams around prevention.
The first result was a significant decrease in outlets that sell tobacco to minors. In Ohio, as in other States, it is illegal for stores to sell tobacco and alcohol to minors, but it is not illegal for kids to buy them. In conjunction with the Columbus Health Department and the Franklin County Board of Health, we did a compliance survey and found a significant increase in the number of alcohol outlets that check identification to control underage access to alcohol. This is a 3-year study. In the first year, only 34 percent of the stores that we surveyed checked identification. The year after this coalition mobilized and jumped on the issue, the percentage nearly doubled to 61 percent. More and more stores in Franklin County are getting the message that they have to check the identification of young people. We thought this was a significant outcome.
In terms of tobacco access, because it is not illegal for kids to attempt to buy cigarettes, we sent kids into stores to purchase a pack of cigarettes. These kids looked like kids - [obviously] they were not 18. We found that 78 percent of the stores sold them cigarettes without asking anything. Then we did an intervention immediately afterward, and in 90 days went back. After the intervention, the percentage of stores that sold cigarettes to the teenagers went down to about 24 percent. We were really happy with that.
The other significant thing that happened - and this did take 5 years - was the creation of a new funding stream among the United Way, a local Columbus foundation, and our local Alcohol and Drug Addiction Mental Health Board, which put together some money to look at substance abuse prevention and violence prevention as a combined issue. This was the first time in our county's history that those three agencies came together to collaborate around a demonstration project. An exciting evaluation component will be part of all of this. We are going to do a trilevel evaluation:
- The first level will look at the collaboration among the collaborating agencies and ask questions such as, "Are there any policy outcomes that will result from this collaboration?"
- The second level will look at the grantees. We want to break away from a tradition that says you give grantees money and then you see them at the final report. There are 10 community-based grantees that meet together every month in a learning laboratory session for 21/2 hours. The first hour is devoted to helping them design their own evaluations, and the second hour consists of networking and peer-to-peer technical assistance. Our premise is that by giving more technical assistance, we will see a better outcome at the program level. This has been an exciting process, especially because the grantees were resistant to it in the beginning. On their weekly evaluation sheets, now they are saying things like, "We need to do this more often," and "We need to be able to get away for 2 days and do a big retreat."
- Finally, the third level of the evaluation will look at the impact on the communities from those 10 projects.
We believe that all of these strategies and communities working together help to operationalize what our logo represents, which is that we become a community that truly addresses substance abuse together.
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