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Program Profile

Communities That Care

Evidence Rating: Promising - More than one study Promising - More than one study

Program Description

Program Goals

Communities that Care (CTC) is a system for planning and marshalling community resources to address problematic behavior, such as aggression or drug use, in adolescents. It has five phases to help communities work toward their goals. The CTC system includes training events and guides for community leaders and organizations. The main goal is to create a “community prevention board” comprising public officials and community leaders to identify and reduce risk factors while promoting protective factors by selecting and implementing tested interventions throughout the community. Repeated assessments are incorporated into the CTC system to serve as an ongoing evaluation of the program and as a guidepost for communities dealing with adolescent health and behavioral problems.

 

Program Activities

CTC requires six training events, delivered between six months and one year to properly install it in communities. Certified CTC trainers lead community leaders and other local figures through the five phases of the program. Phase One, or “Getting Started,” is where communities organize and identify community issues. Phase Two, “Getting Organized,” has these early organizations reach out to key leaders and involve more of the community. Phase Three, or “Developing a Community Profile,” is where research comes in: in this phase, communities should collect data, analyze risk and protective factors, and assess available resources that can be used to address the issues at hand. Phase Four, known as “Creating a Comprehensive Community Action Plan,” is where organized communities merge the data gathered with the stated problems and create clear measurable outcomes that the community can work to resolve.

 

By marshalling resources, focusing on specific problems, and selecting evidence-based interventions, the CTC is expected to reduce communitywide risk factors that lead to reductions in adolescent delinquent behaviors. It should take two to five years for communities to notice a marked reduction in risk factors, and five to 10 years to observe substantial decreases in adolescent substance use and delinquency.

 

Eligibility/Targeted Sites
CTC is a community-level intervention that focuses on risk factors leading to teenage substance use and problem behavior. As such, any community that is dealing with or has problems with adolescent drug use and delinquency is eligible to use the CTC system.

Evaluation Outcomes

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Study 1
Risk Factors

Hawkins and colleagues (2008) found that baseline measures of risk factors at grade Five between Communities that Care (CTC) communities and control communities were not significantly different. By grade Seven, those same risk factors were significantly higher for students in control communities. Grade Five levels of risk, students’ age, and parental education were all significantly associated with grade Seven levels of risk. No other demographic variables had such a relationship.

 

Drug Use
There was no significant intervention effect on substance use initiation. A student’s race, parental education, religious attendance, and rebelliousness were significantly associated with the onset of substance use. Community demographic variables were not significantly related to behavior outcomes. 
 

 

Delinquency

A significant intervention effect was found on the initiation of delinquent behavior. Adolescents from control communities were 27 percent more likely to initiate delinquent behavior during grades Six and Seven than youth from intervention communities. A student’s age, gender, race, parental education, and rebelliousness were significantly associated with onset of delinquent behavior. Community demographic variables were not significantly related to behavior outcomes.

 

Study 2
Drug Use

Hawkins and colleagues (2009) found a significant effect on the initiation of the use alcohol, cigarettes, and smokeless tobacco between seventh and eighth grades. Adolescents receiving the CTC system intervention were significantly less likely to start using any of the aforementioned substances. Students in control communities, on the other hand, were 60 percent more likely to use alcohol, 79 percent more likely to use cigarettes, and 134 percent more likely to use smokeless tobacco between seventh and eighth grade. Significant effects for the onset of marijuana and inhalant use were not observed by the spring of eighth grade, however.

 

Delinquency

A significant intervention effect was found on the incidence of delinquency that was proportional across time. Students in control communities were 41 percent more likely to initiate in delinquent behavior than those receiving the CTC intervention.

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Evaluation Methodology

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Study 1

Hawkins and colleagues (2008) started The Community Youth Development Study (CYDS) in 2003 as the first community-randomized trial of the Communities That Care (CTC) system. Twenty-four communities across seven states in the United States were selected for this five-year experimental study. The communities selected to be in the study were asked to target their interventions on children ages 10 to 14 and their families. Interventions available for selection and implementation could be found in the “Communities That Care Prevention Strategies Guide.” Each intervention within this guide has demonstrated positive effects in rigorous evaluations with middle school–aged children, and contains training, materials, and assistance.

 

The 12 communities selected 13 different prevention programs to implement during the 2004–05 school year, and 16 programs for the 2005–06 school year. The following programs were selected and implemented: All-Stars, Life Skills Training, Lion’s Quest Skills for Adolescence, Program Development Evaluation Training, Participate and Learn Skills, Big Brothers/Big Sisters, Stay Smart, Strengthening Families 10-14, Guiding Good Choices, Parents Who Care, and Family Matters. Close to half of these programs were selected by multiple communities and offered multiple times a year. For example, Guiding Good Choices was administered 38 times across six communities.

 

Communities were drawn from a larger pool, and within the seven states, matched pairs were created. Matching was done on key characteristics, such as total population, poverty, racial composition, unemployment, and crime. Twelve matched pairs of communities were then randomly assigned to receive the CTC system or the control condition, where one community was the treatment and its counterpart, the control. From these communities, a panel of students was selected to be followed from fifth grade to eighth grade.

 

After obtaining consent, the resulting sample of adolescents was 4,404. This sample was evenly split between male and female students. The majority of participants were white (70 percent), followed by Hispanic (20 percent), Native American (nine percent), and African American (four percent). Just more than half of the sample (55 percent) came from treatment communities; the remainder comprised the control communities.

 

The Youth Development Survey was used to gather data on risk factors, substance use, delinquency, and basic demographics. This is a self-report survey students fill out to disclose their own behavior. The three outcomes examined in this study were risk factors, substance use, and delinquency. Risk factors were measured by a scale of composite items. Delinquent behavior was measured as the first occurrence, in the past year, of any of nine behaviors. Questions included “How many times in the past year did you attack someone with the idea of seriously hurting them? Bring a handgun to school? Sold illegal drugs?” Onset of substance abuse was measured as the first reported lifetime use of alcohol, marijuana, cigarettes, or other illegal drugs.

 

Analysis of covariance (or ANCOVA) was used to determine differences in average levels of risk factors between CTC and control communities. The general linear mixed model accounted for the hierarchical data structure of students within communities, communities within matched pairs of communities, and the variability of interventions across communities. A multilevel discrete-time survival analysis was used to assess the effects of the CTC system on preventing the initiation of substance use and delinquent behavior between grades Five and Seven. Students who had not used alcohol, cigarettes, marijuana, or inhalants, or engaged in delinquent behavior were examined to determine when, if ever, they would engage in these behaviors. Each wave of data was analyzed, and students that initiated in any of the measured behaviors were excluded.

 

Study 2

Hawkins and colleagues (2009) used a subset of the CYDS to examine the effects of the Communities That Care system on alcohol, tobacco, and other drug use for a panel of students followed from grade Five through grade Eight. This study period was four years after the implementation of CTC and almost three years after CTC communities started implementing proven prevention programs.

 

Recruitment of the student panel started in the fall of 2003. From the 24 communities in CYDS, 88 schools agreed to participate. All fifth-grade classrooms in these schools were eligible for participation. After obtaining consent from parents, the resulting longitudinal panel was 4,407 students (2,194 girls and 2,213 boys). A little more than half of the panel (55 percent) came from intervention communities. Just as with the CYDS communities, treatment and control students did not differ significantly in demographics or socioeconomic indicators.

 

Data on drug use and delinquent behavior was collected with annual surveys of students. The first wave of data collection in spring of 2004 was a preintervention baseline measure. Scientific-based prevention programs started in schools and communities the following fall of 2004. The last data collection was in the spring of 2007, when students should have advanced to the eighth grade. Accounting for attrition and additional recruitment procedures, 96.7 percent of the sample completed at least three out of the four waves of data collection.

 

A multilevel discrete-time survival analysis was used to determine the effect of the CTC intervention in preventing the incidence of drug use and delinquency between grades Five and Eight. Students who had not used alcohol, cigarettes, marijuana, or inhalants, or engaged in delinquent behavior were examined to determine when, if ever, they would engage in these behaviors. Each wave of data was analyzed, and students that initiated any of the measured behaviors were excluded. A mixed-model analysis of covariance was used to determine the effect of the CTC intervention on reducing the prevalence in the eighth grade of heavy drinking within the past two weeks, drug use in the last month, and delinquency in the last year.

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Cost

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There is no cost information available for this program.
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Implementation Information

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Required materials: All Communities That Care (CTC) training materials, survey instruments, prevention strategies guides, and other materials necessary to install CTC have been placed in the public domain by the Center for Substance Abuse Prevention and are available at the CTC Web site.  

 

Training requirements/provider certification: CTC training, training of trainers, and trainer certification are available from the Social Development Research Group, University of Washington.

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Hawkins, David J., Eric C. Brown, Sabrina Oesterle, Michael W. Arthur, Robert D. Abbott, and Richard F. Catalano. 2008. “Early Effects of Communities That Care on Targeted Risks and Initiation of Delinquent Behavior and Substance Use.” Journal of Adolescent Health 43:15–22.

Study 2
Hawkins. David J., Sabrin Oesterle, Eric C. Brown, Michael W. Arthur, Robert D. Abbot, Abigail A. Fagan, Richard F. Catalano. 2009. “Results of a Type 2 Translational Research Trial to Prevent Adolescent Drug Use and Delinquency.” Archive of Pediatric and Adolescent Medicine 163:789–98.
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Additional References

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These sources were used in the development of the program profile:

Arthur, Michael W., J. David Hawkins, Eric C. Brown, John S. Briney, Sabrina Oesterle, and Robert D Abbott. 2010. “Implementation of the Communities That Care Prevention System by Coalitions in the Community Youth Development Study.” Journal of Community Psychology 38:245–58.

Communities That Care. N/d. “Home.” Accessed May 24, 2011.
http://www.sdrg.org/ctcresource/

Fagan, Abigail A., Michael W. Arthur, Koren Hanson, John S. Briney, and J. David Hawkins. In press. “Effects of Communities That Care on the Adoption and Implementation Fidelity of Evidence-Based Prevention Programs in Communities: Results From a Randomized Controlled Trial.” Prevention Science 12:223-34.

Fagan, Abigail A., Koren Hanson, J. David Hawkins, and Michael W. Arthur. 2008a. “Bridging Science to Practice: Achieving Prevention Program Implementation Fidelity in the Community Youth Development Study.” American Journal of Community Psychology 41:235–49.

Fagan, Abigail A., Koren Hanson, J. David Hawkins, and Michael W. Arthur. 2008b. “Implementing Effective Community-Based Prevention Programs in the Community Youth Development Study.” Youth Violence and Juvenile Justice 6:256–78.

Fagan, Abigail A., Koren Hanson, J. David Hawkins, and Michael W. Arthur. 2009. “Translational Research in Action: Implementation of the Communities That Care Prevention System in 12 Communities.” Journal of Community Psychology 37:809–29.

Kuklinski, Margaret R., John S. Briney, J. David Hawkins, and Richard F. Catalano. 2011. “Cost–Benefit Analysis of Communities That Care Outcomes at Eighth Grade.” Manuscript under review.

Myers, David L., and Michael Arter. 2005. “Evaluating the Implementation of Indiana Area ‘Communities That Care’”. Crime Prevention and Community Safety: An International Journal 7(1): 43–52.

Oesterle, Sabrina, J. David Hawkins, Abigail A. Fagan, Robert D. Abbott, and Richard F. Catalano. 2010. “Testing the Universality of the Effects of the Communities That Care Prevention System for Preventing Adolescent Drug Use and Delinquency.” Prevention Science 11:411–24.

Quinby, Rose K, Abigail A. Fagan, Koren Hanson, Blair Brooke–Weiss, Michael W. Arthur, and J. David Hawkins. 2008. “Installing the Communities That Care Prevention System: Implementation Progress and Fidelity in a Randomized Controlled Trial.” Journal of Community Psychology 36:313–32.
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Program Snapshot

Age: 10 - 17

Gender: Both

Race/Ethnicity: Black, American Indians/Alaska Native, Hispanic, White

Geography: Suburban, Urban

Setting (Delivery): School, Other Community Setting

Program Type: Classroom Curricula, School/Classroom Environment, Community Crime Prevention , Alcohol and Drug Prevention

Current Program Status: Active

Listed by Other Directories: Model Programs Guide, National Registry of Evidence-based Programs and Practices, Blueprints for Healthy Youth Development (formerly Blueprints for Violence Prevention)

Program Developer:
J. David Hawkins
Principal Investigator
Social Development Research Group
9725 Third Avenue NE, Suite 401
Seattle WA 98115
Phone: 206.685.1997
Website
Email