Sustaining Adoption of Science-Based Prevention through Communities That Care

Introduction:  Previous findings from a randomized trial have shown that the Communities that Care (CTC) prevention system significantly reduced youth problem behaviors including substance use and delinquency community wide. The study has also shown that CTC increased communities’ adoption of a science-based approach to prevention (as reported by community key leaders) during the active intervention period in the trial as well as 1.5 years after study funding for intervention activities ended.  Importantly, analyses showed that CTC’s impact on youth outcomes was reached through greater adoption of a science-based prevention approach, supporting the CTC logic model. Because adoption is a key mechanism in the success of the CTC process, the present study examined the extent to which communities were able to sustain high levels of adoption three years after study support to communities ended. The study also examined the role of training key leaders in CTC in sustaining adoption of a science-based prevention approach.

Methods:  This study used data from the Community Youth Development Study (CYDS), a community-randomized controlled trial of the CTC system in 24 communities across seven states. Data came from surveys of community key leaders (e.g., school superintendent, mayor, police chief) administered in 5 waves from 2001 to 2011 (N=1,041). Adoption was measured by 21 questions designed to categorize Adoption into 6 discrete stages (0 to 5) based on each respondent’s rating of his or her community’s level of implementation of science-based prevention activities. To compare the stage of adoption between CTC and control communities, three-level Hierarchical Generalized Linear Models were used, adjusted for key leader and community-level characteristics, including whether key leaders had attended any CTC training sessions.

Results:  Key leaders from CTC communities continued to report significantly higher stages of Adoption compared to control community leaders (p<0.05)  during the sustainability phase, approximately three years after study-provided funding, technical assistance, and training ended.  In addition, key leaders in CTC communities who received CTC training were more likely to report higher levels of Adoption over time (p<0.05) than those who were not trained in CTC.

Conclusions:  High levels of Adoption of a science based approach to prevention can be maintained several years after external support for CTC has ended.  However, since exposure to CTC training was related to sustained Adoption within CTC communities, training in CTC for new key leaders as well as booster sessions for all key leaders in CTC communities are likely to be beneficial.