Communities That Care (CTC) is a program of the Center for Substance Abuse Prevention (CSAP) in the office of the United States Government's Substance Abuse and Mental Health Services Administration (SAMHSA). CTC is a coalition-based prevention operating system that uses a public health approach to prevent youth problem behaviors such as violence, delinquency, school drop out and substance abuse.Hawkins JD, Catalano RF, & Associates. 1992. Communities That Care: Action for drug abuse prevention. San Francisco: Jossey-Bass, Inc. Using strategic consultation, training, and research-based tools, CTC is designed to help community stakeholders and decision makers understand and apply information about risk and protective factors, and programs that are proven to make a difference in promoting healthy youth development, in order to most effectively address the specific issues facing their community's youth.Fagan, A.A., Hawkins, J.D., Catalano, R.F. (2008). Using community epidemiologic data to improve social settings: The Communities That Care prevention system. In M. Shin (Ed.) Toward positive youth development: Transforming schools and community programs (pp. 292–312). Oxford; New York: Oxford University Press.
Developed by Drs. J. David Hawkins and Richard Catalano at the University of Washington's Social Development Research Group (SDRG), CTC's principal strategy, the Social Development Strategy (right), focuses on strengthening protective factors that can buffer young people from problem behaviors and promote positive youth development.
CTC is grounded in rigorous research from social work, public health, psychology, education, medicine, criminology, and organizational development. It engages all community members who have a stake in healthy futures for young people and sets priorities for action based on community challenges and strengths. Clear, measurable outcomes are tracked over time to show progress and ensure accountability.
Research base
Public health understanding of risk and protective factors
The field of public health has developed a systematic methodology for understanding and effectively preventing health problems. Through rigorous research, the etiology of diseases has been documented, and the factors contributing to those diseases have been identified. Once these contributing factors are understood, careful study and application of approaches to amend those factors have demonstrated reductions in the disease burden. For example, heart disease has been one of the primary causes of death among American adults. Research shows, however, that adequate exercise, a healthy diet, and avoidance of smoking can help to prevent heart disease. These behaviors are considered protective factors, just as smoking, high blood pressure, and a family history of heart disease are considered risk factors for poor heart health.
Since the late 1970s, researchers in a variety of disciplines (for example, criminology, sociology, social work, psychology, community psychology, education) have been applying this public health approach to the study of the healthy development of young people. This work has created a field called prevention science, which identifies the factors that contribute to the healthy development of children and youth (protective factors) and the factors that impede that development (risk factors).
Cause: Longitudinal studies of youth development
Protective Factors and the Social Development Model. The prevention of health and behavior problems in young people requires, at its foundation, the promotion of the factors required for positive development. Research shows that five basic factors promote positive social development: opportunities for developmentally appropriate involvement, skills, recognition for effort, improvement and achievement, strong social bonds, and clear, consistent standards for behavior. All children need opportunities to be actively involved with positive adults and peers, the skills to participate and succeed in social, school, and civic settings, and recognition for their efforts, improvements, and accomplishments. When young people are provided with opportunities, skills, and recognition, they develop strong social bonds, that is connections with and commitment to the families, schools, and communities that provided them. When families, schools, and communities communicate to young people clear standards for behavior, those who feel bonded, emotionally connected, invested in the group, will follow those standards that promote health and success. These five factors are protective factors that promote positive development in young people (Hawkins & Weis, 1985), and form the basis for the Social Development Model.
Risk Factors. Research has also identified risk factors that can interrupt the process of positive social development. High quality longitudinal studies have identified risk factors in neighborhoods and communities, families, schools, and peer groups, as well as in individuals themselves.Biglan, A., Brennan, P. A., Foster, S. L., & Holder, H. D. (2004). Helping adolescents at risk: Prevention of multiple problem behaviors. New York: Guilford Press.Hawkins, J.D., Herrenkohl, T.I., Farrington, D.P., Brewer, D., Catalano, R.F., Harachi, T.W., Cothern, L. (2000). Predictors of youth violence. OJJDP Juvenile Justice Bulletin, April. These factors increase the probability of delinquency, violence, substance abuse, teen pregnancy, dropping out of school, and other behavior problems in young people. The risk factors shown in the risk factor chart (right) have been found in at least two high-quality studies to predict later health and behavior problems in young people. Many of these risk factors predict multiple problems. For example, the risk factor of "Poor Family Management" has been shown to predict five youth problem behaviors: substance abuse, delinquency, teen pregnancy, school drop-out, and violence. Providing effective parent training programs in a community, therefore, could potentially impact all five of these undesirable outcomes.
Intervention: Testing effectiveness of interventions
The identification of risk and protective factors provides the foundation for advances in preventing adolescent health and behavior problems. Prevention scientists have rigorously tested programs and policies that address these risk and protective factors in studies funded largely by the National Institutes of Health, and an increasing number and range of effective prevention approaches have now been identified. By 2004, 56 tested and effective programs were available in the United States that have been demonstrated to reduce involvement in problem behaviors and/or increase positive outcomes for youth. These 56 effective programs and policies are summarized in CTC's Prevention Strategies Guide at https://www.communitiesthatcare.net/Prevention%20Strategies%20Guide/introduction.pdf . Sixteen of these programs have been tested at least twice with replicated findings and have been designated as Blueprint model programs,Elliott, D. S. (1997). Blueprints for Violence Prevention. Boulder, CO: University of Colorado, Institute of Behavioral Science, Center for the Study and Prevention of Violence. which, if rigorously followed, will significantly reduce youth violence and substance abuse. Programs range from prenatal (for example, Olds, 1997Olds, D.L. (1997). The Prenatal/Early Infancy Project: Fifteen years later. In G.W. Albee & T. Bullotta (Eds.), Primary prevention works (pp.41–67). Thousand Oaks, CA: Sage Publications.) and early childhood interventions (for example, Reid et al., 2001), to community policies related to alcohol (e.g. Holder et al., 2000), to school-based curricula that teach youth social and emotional skills that will help them navigate life (e.g. Botvin at al, 2003, Eisen at al., 2002, and Grossman et al., 1997).
Systems: Researching systems change in states and communities
Prevention scientists understand that the final task arising from these research findings is the application of proven prevention programs, policies and strategies in the real world in order to enhance youth development on the ground in communities. In collaboration with communities and state and federal governments, researchers are studying the impact that prevention science can have on the effectiveness of prevention efforts within those systems. [link to History section of this article, to be added]
Description
Five Phases
Communities That Care guides the community's prevention efforts through a five-phase process which includes: 1) Get Started—assessing community readiness to undertake collaborative prevention efforts; 2) Get Organized—getting a commitment to the CTC process from community leaders and forming a diverse and representative prevention coalition; 3) Develop a Profile—using epidemiologic data to assess prevention needs; 4) Create a Plan—choosing tested and effective prevention policies, practices, and programs based on assessment data; and 5) Implement and Evaluate—implementing the new strategies with fidelity, in a manner congruent with the programs' theory, content, and methods of delivery, and evaluating progress over time.
CTC activities are planned and carried out by the CTC Community Board, a prevention coalition of community stakeholders who work together to promote positive youth outcomes. Board members participate in a series of six CTC training workshops in which they build their coalition and learn the skills needed to install the CTC system.
Working through the five phases of CTC provides the opportunity to increase communication, collaboration, and ownership among community members and service providers invested in healthy youth development.
Phase One: Getting Started. With technical assistance provided by a CTC trainer, a community catalyst and small group of advisors assess community readiness to undertake collaborative prevention efforts, and identify the stakeholders who need to be involved. Key activities in this phase include recruiting key leaders to serve as champions of the effort, obtaining school district support to conduct a youth survey to provide epidemiological data on risk, protection, and youth behaviors, and hiring a coordinator to manage CTC activities.
Phase Two: Organizing, Introducing, Involving. In Phase Two a diverse and representative prevention coalition is formed. Specific tasks for this phase include involving and educating stakeholders who were identified in Phase One; developing a vision for the future of the community's children, and putting an organizational structure in place to help the community move toward the vision. The first two CTC trainings are implemented in this phase: the Key Leader Orientation (KLO) and the Community Board Orientation (CBO). These trainings introduce prevention science to community stakeholders, and help community members create an appropriate structure for the Community Board.
Phase Three: Developing a Community Profile. This is the data collection phase, including a comprehensive community assessment of adolescent behaviors and current prevention services. This phase usually requires administration of the CTC Youth Survey . Members of the Risk and Protective Factor Assessment Work Group participate in the Community Assessment Training, in which they learn about key data sources for risk and protective factors (such as the student survey) and how to analyze the data. In communities already using the CTC Youth Survey, this training is tailored to help the work group interpret survey results and identify elevated risk factors, depressed protective factors, and problem behaviors prevalent among youth in the community. From this analysis, the work group recommends priority risk and protective factors for focused attention by the CTC Board.