Building Prevention Infrastructure Around the World: An International Comparison of “Communities That Care” Coalitions in Germany and Chile

Introduction: Community coalitions have been widely used as a strategy to build prevention infrastructure to promote healthy youth development and prevent problem behaviors. Creating strong cross-sector community coalitions is a key element of the Communities that Care (CTC) prevention system. CTC empowers coalitions to assess and prioritize the community’s prevention needs, select evidence-based prevention programs matched to priorities, and deliver selected programs with fidelity and reach. CTC has been tested in the United States and found to be efficacious. Scaling the prevention infrastructure system around the world is a goal of the international CTC collaborative. In this study, we compared the development of prevention coalitions in two countries that have implemented local adaptations to the CTC model: Germany and Chile. These experiences provide an illustration of how the CTC process can be used in different contexts and cultures, arriving at similar goals.

Methods: We used a case study methodology to describe, compare and contrast the approaches to coalition building used in the two countries. Focusing on the early phases of CTC implementation, we examined (1) ratings on the CTC Milestones and Benchmarks tool, which tracks completion of critical system implementation steps; (2) results of the Community Board Interview (CBI), a survey of community coalition members (N=50 Germany, 60 Chile); and (3) qualitative data from semi-structured, open-ended interviews with key project staff (e.g., project leaders, local technical assistance providers) in the two countries.

Results: Coalition building during CTC implementation shared many similarities across the two countries. Sites in both countries met key implementation milestones and benchmarks, engaged key leaders and community representatives, developed functioning coalitions, and sustained them over time. For example, CBI scores showed similar levels of board cohesion (Germany=3.0, Chile=3.1) and involvement (G=2.6, C=2.9). The coalitions also shared common functions, such as fostering a common understanding among stakeholders and building capacity for community wide prevention. However, there were important differences regarding who initiated, led and funded CTC, which sectors of the community were represented in the coalitions, and how the coalitions operated. For example, Germany’s CTC efforts were government-led, with coalitions mostly comprised of public employees and NGO representatives, while Chile’s were led by a private foundation and coalitions had more community-resident involvement.

Conclusions: Prevention coalitions in the two countries differed in ways that respond to cultural and political contexts, but shared the common goal of building local capacity for prevention of youth health and behavior problems. The case study provides a real-world example of how local implementation can help optimize prevention through partnerships than can enhance local wellbeing goals. Using the CTC model, both countries built multi-sector coalitions to drive local decision making, generating prevention infrastructure. Lessons learned can help others striving to adapt and implement prevention strategies around the world with fidelity and reach.