*PROSPER Partnerships:Toward Evidence-Based Intervention

for Youth, Family and Community IMPACT

Richard SpothPartnerships in Prevention Science Institute

Congressional Educational BriefingJune 12, 2006

*Funded by the National Institute on Drug Abuse

Map for Today’s Presentation

1. A Partnership Path to Positive Impact Challenges to Youth, Family, Community Impact Opportunities for Impact IMPACT Framework Illustrations of Long-term Impact

2. The PROSPER Partnership Model, Successes to Date

3. Proposed Multistate Network, Anticipated Benefits

1. A Partnership Path to Youth, Family & Community Impact:

Challenges, Opportunities, Illustrations

Sustained, quality EBIs

Evaluated-not effective

EBIs

The Challenge—Impact Requires a Larger “Piece” of Sustained, Quality, Evidence-Based Interventions (EBIs) with General Community Populations

Not Evaluated

… and rigorously demonstrated, long-term

EBI impact is very rare

Seizing an Opportunity for Impact— Linking Public Education Dissemination Systems Reaching Every U.S. Community

• Public School System Universal system reaching nearly all children Increasing emphasis on accountability/evidence orientation

Cooperative Extension System in Land Grant Universities Largest informal education system in the world Over 3,150 agents in nearly every county in the U.S. Science with practice orientation

IMPACT Framework—Basic Science with Practice Tasks

Implant intervention science in stable public education dissemination systems, linked with other resource systems

Maintain systems-level support for science with practice

Partner with communities strategically, offering proactive technical assistance

Advance intervention evidence-baseConduct high quality implementation/

participant engagement

Tailor toward sustainability of partnerships and EBIs, planned early

PublicSchoolSystem

Land GrantUniversityExtension

System School-Community-University

Partnerships

OtherService/

ResourceSystems

Source: Spoth et al. (2006). Society for Prevention Research 14 th Annual Meeting.

What is evidence-based—how do we know what works?• Society for Prevention Research Standards of Evidence

Design allows strongest possible statement about intervention “causing” outcome (e.g., randomized, controlled); also

Specific statement about what outcomes, with whom Specific description of intervention and outcome measures Quality, timing of measurement Sample clearly specified Sound statistical analyses, with attention to practical value and

duration of effects• Specific to phase of prevention research• Applies to partnership-based interventions• See www.preventionresearch.org

Illustration of Long-Term Impact—Reduced Meth Use 4-6 Years Past Baseline

Specific results to be announced when released by the journal publishing them.

Illustration of Long-Term Impact—Lifetime Marijuana Use Through 6 Years Past Baseline

See Spoth, Redmond, Shin, & Azevedo (2004). Brief family intervention effects on adolescent substance initiation: School-level curvilinear growth curve analyses six years following baseline. Journal of Consulting and Clinical Psychology, 72, 535-542.

0

0.1

0.2

0.3

0.4

0 mo.(Pretest)

6 mo.(Posttest)

18 mo.Grade 7

30 mo.Grade 8

48 mo.Grade 10

72 mo.Grade 12

Fir

st

Tim

e P

rop

ort

ion

Trajectory for ISFP Condition

Trajectory for Control Condition

Other Positive Long-Term Outcomes from Randomized, Controlled Studies

• ↑ Parent and Youth Skills• ↑ Academic Success• ↓ Tobacco/Cigarette Initiation• ↓ Alcohol Initiation• ↓ Drunkenness• ↓ Multi-substance Use• ↓ Inhalant Use• ↓ Aggression/Conduct Problems• ↓ Diagnosable Disorders

*Case Study of “Billy” or “Betty”: Costs of Life Trajectory of Early Substance Use and Problem Behaviors

*Illustrative case history and cost projections from Dennis Embry (PAXIS Institute).

Early Childhood Young Adulthood

Resident home expenses $50,000Medicaid $110,000Special education $28,000State hospital $128,000Legal (estimated) $20,000Total $336,000

Lev

el o

f Pr

oble

m B

ehav

iors

Trajec

tory of P

roblem

s/

Incr

easin

g Costs

Source: Spoth, Guyll, & Day (2002). Universal family-focused interventions in alcohol-use disorder prevention: Cost-effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol, 63, 219-228.

Illustration of Potential Economic Impact

$9.60

$11.34

$7.86

1

3

5

7

9

11

13

Do

lla

rs R

etu

rne

d

*Actual Studyconditions

1 more caseprevented/100

1 less caseprevented/100

Partnership-Based Strengthening Families Program:Benefit-Cost Ratios Under Different Assumptions

*Estimated $9.60 returned for each dollar invested under actual study conditions.

2. PROSPER (Promoting School-community-university Partnerships to Enhance Resilience):

Model and Successes to Date

PROSPER Study Aims* • Evaluate the effectiveness of partnership

implementation of evidence-based interventions (EBIs) on youth and family outcomes

• Learn what factors are most important in partnership effectiveness, quality

implementation and sustainability*Funded by the National Institute on Drug Abuse—Collaboration with Pennsylvania State University (Mark Greenberg, PI and Karen Bierman, Co-PI)

PROSPER Organizational Structure

University/State-Level TeamUniversity Researchers, Extension Program Directors

Prevention Coordinator TeamExtension Prevention Coordinators

Local Community TeamsExtension Agent, Public School Staff,

Social Service Agency Representatives, Parent/Youth Representatives

Phases of PROSPER Implementation• Phase 1: Organization—team formation/planning• Phase 2: Initial operations—program

implementation– Teams selected one of three evidence-based, family-

focused programs for 6th graders– Teams selected one of three evidence-based school

programs for 7th graders• Phase 3: Early sustainability planning/ institutionalization within Extension• Phase 4: Ongoing Operations and Sustainability

PROSPER Success—Implementation Quality

• Literature: Typical implementation adherence ranges from 42%-86%

– In PROSPER, based on ratings by trained observers: Average 91% adherence for family-

focused EBI Average 90% adherence for school-based

EBIsSource: Spoth, Guyll, Lillehoj, Redmond, & Greenberg (In press). PROSPER study of evidence-based intervention implementation quality by community-university partnerships. Journal of Community Psychology .

PROSPER Success—Positive Outcomes for Families

At 1½ Years Past Baseline:• More consistent discipline• Less harsh discipline• Better family cohesion• Better mother-child

relations

PROSPER Success— Substance-related Outcomes for 7th Graders at 1½ Years Past Baseline

.00

.01

.02

.03

.04

.05

.06

Marijuana Use** Inhalant Use**

Past Year User Rates

Intervention

Control

**p <0.01

Source: Spoth, Redmond, Shin, Greenberg, Clair, & Feinberg (2006). Substance use outcomes at 1½ years past baseline from the PROSPER community-university partnership trail.

Another PROSPER Success—Initial Sustainability

• 100% of PROSPER teams obtained external funding, within a year of starting the early sustainability phase!

• Funds were obtained from a variety of sources – state, city, business, religious and service organizations, and private individuals.

3. Proposed Multistate Partnership IMPACT Network and Benefits

Multistate Partnership IMPACT Network

• Step-by-step expansion of partnership network

• Twofold purpose of multistate network

To replicate the PROSPER Model for “real world” dissemination of evidence-based interventions (EBIs) in early-adopter states

To conduct multisite process and outcome evaluations or prevention trials, to learn more about how to achieve large-scale community IMPACT

Potential Benefits of Network for Partnership-Based EBIs on a Larger Scale

• To Our Fund of Knowledge– Expanding knowledge of interventions producing long-term

positive outcomes and economic benefits– Potential for learning from multistate research network about

optimal dissemination of evidence-based interventions

– To Schools and Communities– Reduced substance use problems among youth– Reduced youth behavior problems in school and community

settings

• To Youth and Families– Enhanced parenting and youth life skills– Increased family cohesion and well-being

What Could Be…Scaling up Evidence-Based Interventions Through Partnership Networks

• Consider the empirically-demonstrated return from one set of NIDA-funded projects

• Imagine this on a larger scale Improved economic benefits from federally-funded projects

–Prevention “stock” is blue chip–Evidence-based prevention interventions fiscally wise

Improved health and well-being of youth, families and communities—making a “real world” difference

Imagine…

IMPACT!

Acknowledgement of Our Partners in Research

Investigators/Collaborators R. Spoth (Director), C. Redmond & C. Shin (Associate Directors),

T. Backer, K. Bierman, G. Botvin, G. Brody, S. Clair, T. Dishion, M. Greenberg, D. Hawkins,

K. Kavanagh, K. Kumpfer, C. Mincemoyer, V. Molgaard, V. Murry, D. Perkins, J. A. Stout

Associated Faculty/ScientistsK. Azevedo, J. Epstein, M. Feinberg, K. Griffin, M. Guyll, K. Haggerty, S. Huck, R. Kosterman,

C. Lillehoj, S. Madon, A. Mason, J. Melby, M. Michaels, T. Nichols, K. Randall, L. Schainker,

T. Tsushima, L. Trudeau, J. Welsh, S. YooPrevention Coordinators

E. Berrena, M. Bode, B. Bumbarger, E. Hanlon K. James, J. Meek, A. Santiago, C. Tomaschik

www.ppsi.iastate.edu or

www.prevention.psu.eduAlso see www.preventionresearch.org for the Society for Prevention Research Standards of Evidence Guidelines.

For more information please visit our websites at...

And, again, thank you for this opportunity…

Questions?