The Development and Functioning of “Communities That Care” Prevention Coalitions in Chile

Introduction: Creating strong cross-sector community coalitions is a key element of the Communities that Care (CTC) prevention system, an evidence-based intervention for preventing adolescent problem behaviors such as drug use and delinquency. CTC empowers coalitions to assess youth risk and protective and problem behaviors, prioritize the community’s prevention needs, select evidence-based prevention programs matched to priorities, and deliver selected programs with fidelity and reach. In this study, we explore the development and functioning of community prevention coalitions implementing an adapted version of CTC in three low income communities in Chile.

Methods: We translated and adapted a version of the CTC Community Board Interview (CBI), which measures constructs such as coalition involvement, cohesion, support for prevention, and barriers to implementation. The CBI was administered to the majority (90%) of coalition members in 2016 (N=61) and to a sample of about half (56%) of coalition members in 2018 (N=59). We examined results from the interview (e.g., percentage distributions, mean scale scores) and compared results between the two time points.

Results: CBI scales showed adequate reliability (most coefficient alphas above 0.8). Coalitions engaged community representatives from varied sectors (e.g., parents, municipal employees, school and health services staff), developed functioning workgroups, recruited new members and sustained them over time. While some indicators remained similar across the two waves (e.g., cohesion scores were 0.82 and 0.89), others showed more change (e.g., coalitions tended to be more formalized in 2018 when compared to 2016, with mean scores of 0.69 versus 0.86). Among the most frequently reported barriers to CTC implementation in 2016 were obtaining cooperation from coalition members (36%) and support from key leaders (36%); in 2018, these were not perceived as so problematic (18% and 13% respectively); the main barriers reported in 2018 were difficulties getting resources for programs in their action plan (30%) and low participation from schools (24%). There were also differences between communities; for example, some communities reported higher levels of support for prevention than others (2.8 versus 3.2 in a 1-4 scale).

Conclusions: Using the CTC model, these three communities were able to build multi-sector coalitions to drive local decision making, generating local prevention infrastructure in a country that had not previously engaged in this type of work. Coalitions grew, were sustained, and became more organized and formalized over time. Lessons learned from this experience can help communities in other countries around the world trying to adapt and implement coalition-driven prevention approaches.