Session: Sustaining a Comprehensive and Coordinated Community Prevention System for Improving Adolescent Health and Behavior: Communities That Care (Society for Prevention Research 22nd Annual Meeting)

Coordinated and sustainable community-based prevention systems that use evidence-based programs to address multiple risk and protective factors have great potential to improve youth health and behavior outcomes and achieve objectives set forth in the National Prevention Strategy. Communities That Care (CTC) is a tested and effective community-based prevention system that helps communities understand which risk factors are elevated and which protective factors are depressed among community youth; establish coordinated prevention priorities; and then install, implement, and monitor the results of evidence-based prevention programs that improve risk and protection, reduce problem behavior, and foster healthy youth development. In each CTC community, a coalition representing multiple community sectors is trained to carry out CTC with fidelity. Support from key community leaders like the mayor and police chief is also crucial to long-term success.

CTC’s efficacy has been demonstrated in the Community Youth Development Study, a randomized controlled trial begun in 2003 involving 24 communities from 7 states, matched in pairs within state. Major findings include faithful implementation of the CTC system and prevention programs, significant reductions in targeted risk factors in youth exposed to CTC compared to youth in control communities, and lower incidence of delinquency, alcohol use, and cigarette smoking through grade 12. CTC effects were sustained at least three years after financial and technical support to communities ended.

This panel’s papers highlight several features critical to the long-term sustainability of comprehensive and effective community prevention systems. “Benefit-Cost Analysis of Communities That Care Outcomes Through Grade 12” shows how economic analysis can help make the business case for investing in evidence-based prevention systems. “Sustaining Adoption of Science-based Prevention through Communities That Care” documents the effectiveness of CTC in sustaining science-based prevention and the role of CTC training in sustaining adoption.  “The Role of Leader Support, Technical Assistance, and New Member Integration in Sustaining Coalition Functioning Over Time” describes predictors of coalition directedness, an indicator of coalition use of science-based prevention. Significant predictors included key leader support for CTC and orientation of new coalition members. The discussant will comment on the papers and show how they helped motivate the redesign of CTC training to achieve scale and support sustainability through the use of internet-based training, which increases flexibility and reduces cost. The panel’s work helps advance understanding of how to build and sustain effective community-based prevention systems with proven capacity to foster healthy youth development.