Prevention System Mediation of Communities That Care Effects on Youth Outcomes

Abstract

This study examined whether the significant intervention effects of the Communities That Care (CTC) prevention system on youth problem behaviors observed in a panel of eighth-grade students (Hawkins et al. Archives of Pediatrics and Adolescent Medicine 163:789–798 2009) were mediated by community-level prevention system constructs posited in the CTC theory of change. Potential prevention system constructs included the community’s degree of (a) adoption of a science-based approach to prevention, (b) collaboration on prevention activities, (c) support for prevention, and (d) norms against adolescent drug use as reported by key community leaders in 24 communities. Higher levels of community adoption of a science-based approach to prevention and support for prevention in 2004 predicted significantly lower levels of youth problem behaviors in 2007, and higher levels of community norms against adolescent drug use predicted lower levels of youth drug use in 2007. Effects of the CTC intervention on youth problem behaviors by the end of eighth grade were mediated fully by community adoption of a science-based approach to prevention. No other significant mediated effects were found. Results support CTC’s theory of change that encourages communities to adopt a science- based approach to prevention as a primary mechanism for improving youth outcomes.

Benefit–cost analysis of a randomized evaluation of Communities That Care: monetizing intervention effects on the initiation of delinquency and substance use through grade 12

“…The study design does not allow attribution of the effects reported in this study to a single part of the CTC system or to a specific combination of evidence-based programs (Hawkins et al 2008b). This inference is supported by research by Brown and colleagues (2013a), which has indicated that CTC's impact on youth outcomes in this trial was mediated by community-level changes in the adoption of a science-based prevention approach. Adoption was a multifaceted construct taking into account awareness of prevention science constructs; the use of epidemiological data to understand community-specific risk, protection, behavioral health outcomes, and existing prevention resources; the selection and implementation of evidence-based prevention programs that fill gaps in existing services to address those concerns; and monitoring that ensures sustained, high-quality implementation of the CTC system and prevention programs.…”

“…Adoption was a multifaceted construct taking into account awareness of prevention science constructs; the use of epidemiological data to understand community-specific risk, protection, behavioral health outcomes, and existing prevention resources; the selection and implementation of evidence-based prevention programs that fill gaps in existing services to address those concerns; and monitoring that ensures sustained, high-quality implementation of the CTC system and prevention programs. Training and support to implement the CTC system increased adoption of a science-based approach to prevention in CTC communities, which mediated CTC's effects on youth outcomes (Brown et al 2013a; Rhew et al 2013). This research suggests that the CTC system, including local choice of tested and effective preventive interventions implemented, and not some specific combination of preventive interventions, produced the results and economic benefits reported here.…”

The full translational spectrum of prevention science: facilitating the transfer of knowledge to practices and policies that prevent behavioral health problems

“…PROSPER has a three-tiered structure that includes teams from the community, prevention coordinators, and a state management team that facilitates the receipt of ongoing proactive technical assistance based on need assessments of any given community [18][19][20]. And finally, the well-known Communities that Care (CTC) prevention service delivery system develops local infrastructures and coalitions of community stakeholders to improve the behavioral health of young people [21,22].…”

Relating Coalition Capacity to the Adoption of Science‐Based Prevention in Communities: Evidence from a Randomized Trial of Communities That Care

“…In turn, greater adoption of a science-based approach to prevention in CTC communities explained the significantly lower level of youth problem behaviors in CTC compared to control communities observed in a cohort of 8 th graders followed since 5th grade (Brown et al 2014). These findings provide empirical support for CTC’s hypothesized link between science-based community coalition efforts and improving population health (Hawkins et al 2008).…”