The Role of Leader Support, Technical Assistance, and New Member Integration in Sustaining Coalition Functioning over Time

Background: Communities that Care (CTC) is a comprehensive and coordinated prevention system that uses a coalition-based approach to develop community capacity for using science-based prevention. CTC has been shown to increase the adoption of a science-based prevention approach in communities, in turn, improving youth health and behavior community-wide. Coalition functioning (goal-directedness, efficiency, participation opportunities, and cohesion) predicts the development of community capacities for the adoption of science-based prevention. Because goal-directedness seems especially important for a science-based approach to prevention and the sustainability of CTC, this paper examines how levels of directedness changed over time (i.e., 5 years into study-supported implementation and 2 and 4 years after study-provided assistance and funding ended). This study also examines the extent to which coalition characteristics predict variation in coalitions’ ability to maintain directedness.

Methods/Results:  The analysis uses data from the Community Youth Development Study (CYDS), a community-randomized controlled trial of the CTC system in 24 communities across seven states. A total of 832 phone interviews (conducted biannually from 2004-2012) with 498 unique.  CTC coalition member respondents provide data to measure goal directedness (e.g., “the coalition has developed clear goals and objectives,” “the coalition leadership has a clear vision for the coalition”) in experimental communities.  CTC coalitions varied in their directedness over time (intraclass correlations ranged from .05 (early intervention) to .19 (post intervention). On average, directedness was high and stable through early and mid-intervention periods, but dropped significantly in late intervention and sustainability periods (n=12; p<.05). Regression analyses reveal that coalitions whose members reported greater community leader support for CTC (in early intervention and sustainability), perceived fewer barriers and needs for technical assistance (in early and mid-intervention), and managed member turnover well (at all times) were more likely to maintain high levels of directedness during late intervention and sustainability. These predictors uniquely explained 35%-81% of the variation between coalitions in directedness during late intervention and sustainability periods.

Implications: Knowing coalition characteristics that predict declines in functioning over time could inform the development and delivery of supports to coalitions in the form of timely training and technical assistance. These results suggest the need to support coalitions by building key leader support, enhancing training and technical assistance, and improving new member orientation and integration to the coalition.