Communities That Care (CTC) is a program of the Center for Substance Abuse Prevention (CSAP) in the office of the United States Government’s Substance and Mental Health Services Administration (SAMHSA).
CTC is a coalition-based prevention operating system that uses a public health approach to prevent youth problem behaviors such as violence, delinquency, school drop out, and substance abuse. Using strategic consultation, training, and research-based tools, CTC is designed to help community stakeholders and decision makers understand and apply information about risk and protective factors, and programs that are proven to make a difference in promoting healthy youth development, in order to most effectively address the specific issues facing their community’s youth.
Training and technical assistance: Successful CTC efforts include high-quality training and technical assistance from experienced and certified facilitators. Regional Prevention Consultants (RPCs) within the Regional Prevention Services Project are certified trainers of the Communities That Care Model. RPCs then provide technical assistance as needed on an ongoing basis to communities implementing this prevention process.
Developed by Drs. J. David Hawkins and Richard Catalano at the University of Washington’s Social Development Research Group (SDRG), CTC’s principal strategy, the Social Development Strategy, focuses on strengthening protective factors that can buffer young people from problem behaviors and promote positive youth development.
CTC is grounded in rigorous research from social work, public health, psychology, education, medicine, criminology, and organizational development. It engages all community members who have a stake in healthy futures for young people and sets priorities for action based on community challenges and strengths. Clear, measurable outcomes are tracked over time to show progress and ensure accountability.
Protective Factors and the Social Development Model: The prevention of health and behavior problems in young people requires, at its foundation, the promotion of the factors required for positive development. Research shows that five basic factors promote positive social development: opportunities for developmentally appropriate involvement, skills, recognition for effort, improvement and achievement, strong social bonds, and clear, consistent standards for behavior. All children need opportunities to be actively involved with positive adults and peers, the skills to participate and succeed in social, school, and civic settings, and recognition for their efforts, improvements, and accomplishments. When young people are provided with opportunities, skills, and recognition, they develop strong social bonds, that is connections with and commitment to the families, schools, and communities that provided them. When families, schools, and communities communicate to young people clear standards for behavior, those who feel bonded, emotionally connected, invested in the group, will follow those standards that promote health and success. These five factors are protective factors that promote positive development in young people (Hawkins & Weis, 1985), and form the basis for the Social Development Mode.
Risk Factors: Research has also identified risk factors that can interrupt the process of positive social development. High quality longitudinal studies have identified risk factors in neighborhoods and communities, families, schools, and peer groups, as well as in individuals themselves. These factors increase the probability of delinquency, violence, substance abuse, teen pregnancy, dropping out of school, and other behavior problems in young people. The risk factors shown in the risk factor chart (right) have been found in at least two high-quality studies to predict later health and behavior problems in young people. Many of these risk factors predict multiple problems. For example, the risk factor of “Poor Family Management” has been shown to predict five youth problem behaviors: substance abuse, delinquency, teen pregnancy, school drop-out, and violence. Providing effective parent training programs in a community, therefore, could potentially impact all five of these undesirable outcomes.
Communities That Care guides the community’s prevention efforts through a five-phase process which includes:
- Get Started—assessing community readiness to undertake collaborative prevention efforts
- Get Organized—getting a commitment to the CTC process from community leaders and forming a diverse and representative prevention coalition
- Develop a Profile—using epidemiologic data to assess prevention needs
- Create a Plan—choosing tested and effective prevention policies, practices, and programs based on assessment data
- Implement and Evaluate—implementing the new strategies with fidelity, in a manner congruent with the programs’ theory, content, and methods of delivery, and evaluating progress over time.
CTC activities are planned and carried out by the CTC Community Board, a prevention coalition of community stakeholders who work together to promote positive youth outcomes. Board members participate in a series of six CTC training workshops in which they build their coalition and learn the skills needed to install the CTC system.
Working through the five phases of CTC provides the opportunity to increase communication, collaboration, and ownership among community members and service providers invested in healthy youth development.
Phase One: Getting Started. With technical assistance provided by a CTC trainer, a community catalyst and small group of advisors assess community readiness to undertake collaborative prevention efforts, and identify the stakeholders who need to be involved. Key activities in this phase include recruiting key leaders to serve as champions of the effort, obtaining school district support to conduct a youth survey to provide epidemiological data on risk, protection, and youth behaviors, and hiring a coordinator to manage CTC activities.
Phase Two: Organizing, Introducing, Involving. In Phase Two a diverse and representative prevention coalition is formed. Specific tasks for this phase include involving and educating stakeholders who were identified in Phase One; developing a vision for the future of the community’s children, and putting an organizational structure in place to help the community move toward the vision. The first two CTC trainings are implemented in this phase: the Key Leader Orientation (KLO) and the Community Board Orientation (CBO). These trainings introduce prevention science to community stakeholders, and help community members create an appropriate structure for the Community Board.
Phase Three: Developing a Community Profile. This is the data collection phase, including a comprehensive community assessment of adolescent behaviors and current prevention services. This phase usually requires administration of the CTC Youth Survey. Members of the Risk and Protective Factor Assessment Work Group participate in the Community Assessment Training, in which they learn about key data sources for risk and protective factors (such as the student survey) and how to analyze the data. In communities already using the CTC Youth Survey, this training is tailored to help the work group interpret survey results and identify elevated risk factors, depressed protective factors, and problem behaviors prevalent among youth in the community. From this analysis, the work group recommends priority risk and protective factors for focused attention by the CTC Board.
The second component of the community profile is an assessment of current community programs, policies, and resources that address the prioritized risk and protective factors. The Resource Assessment workgroup is trained in assessment procedures during the Community Resource Assessment Training. The goals of the resource assessment are to identify existing evidence-based programs that address the priority factors, discern the gaps in existing program delivery, and recommend where new programs or policies are needed.
Phase Four: Creating a Community Action Plan. During the fourth phase of CTC, the results of the assessment process are reviewed by the full Community Board, and a community action plan is developed. The Community Plan Training (CPT) is provided to Community Boards during this phase. During this training, Board members select prevention policies and programs that target their prioritized risk factors to fill gaps in current prevention services. The CTC Prevention Strategies Guide is a tool used during this process. It describes prevention programs that have been demonstrated in at least one high quality research trial to be effective in changing risk, protection, and problem behaviors. Once program choices are made, CPT participants are trained to write an action plan that sets clear, measurable goals regarding anticipated outcomes, and also develop an evaluation plan.
Phase Five: Implementing and Evaluating the Community Action Plan. In this phase, the CTC Board implements selected strategies, and evaluates progress over time. Board members and staff for the selected preventive programs attend the final CTC training workshop, the Community Plan Implementation Training (CPIT), which emphasizes the importance of implementing prevention programs with fidelity; that is, ensuring that the programs’ content, dosage, and manner of delivery adhere to the protocols identified by program developers. Participants also learn methods for tracking implementation progress, assessing desired changes in participants, and using this information to adjust implementation as needed to fulfill program objectives.
CTC is intended as an ongoing process. The process of monitoring implementation progress and community level changes in risk, protection and youth outcomes is repeated every two years. Based on a review of these data, CTC boards revise their action plans as needed.
*For more information: Introduction to the Communities That Care System, Investing in Your Community's Youth.
The CTC system is collaborative, proactive, science-based, and data driven, and provides structure, tools, training and technical assistance for coalitions.
Collaborative. CTC uses a coalition approach to address issues at the community level. The coalition will include a diverse group of stakeholders concerned with youth development(youth-serving agency staff, school representatives, health professionals, city leaders, law enforcement, United Way, other funding entities, neighborhood groups, business people, parents, media representatives, faith community members, youth, etc.) in applying prevention science principles to decisions affecting the community’s youth. By providing a setting and common language for all stakeholders to discuss prevention, the model ensures that all voices in the community are heard and respected.
Proactive. Rather than reacting to problems once they have already occurred, CTC focuses on strengthening protections and decreasing risks in order to promote healthy youth development and decrease the likelihood of problem behaviors.
Science based. CTC is grounded in rigorous research from a variety of disciplines, including public health, sociology, psychology, criminology, and community psychology. This research has identified the predictors of youth problem behaviors, developed epidemiologic assessment tools for measuring those predictors in a community, and tested programs that work in addressing those predictors.
Data driven. The CTC system ensures local control of decisions based on local data and needs assessments, and flexibility to implement actions specific to the priorities identified by community members. The CTC system provides tools for measuring levels of risk and protective factors, selecting priority factors on which to focus a strategic plan, selecting appropriate prevention responses, and tracking progress toward desired changes in priority risk factors.
- The CTC Youth Survey is the primary tool for needs assessment and monitoring. This is a confidential, schoolwide survey for students appropriate for Grades 6-12, that measures a majority of the risk and protective factors identified to predict youth problem behaviors. Coalition members use survey results from students in their community as well as community archival data to prioritize risk and protective factors for attention. The survey is re-administered every 2 years in order to monitor progress over time.
- Effective program selection is another element of the data-driven process. Coalition members review policies and programs that have been tested and proven effective in addressing their priority factors. They consider the suitability of each program to the community's circumstances, and select prevention responses most likely to be successful in that environment. Information on program effectiveness is summarized in menus of effective programs, for example CTC’s Prevention Strategies Guide (www.preventionplatform.samhsa.gov/) and the Blueprints for Violence Prevention list of effective programs (http://www.colorado.edu/cspv/blueprints/model/overview.html).
- Monitoring of program implementation is the third element of the data-driven process. Throughout the implementation cycle of each prevention program or strategy, coalitions collect data to ensure that the program is delivered with fidelity to the original program design. This monitoring information is important, because without close replication, the effectiveness of these programs can be compromised (see, for example, Elliot & Mihalic, 2004). Monitoring implementation is also a mangement tool for identifying challenges that can be addressed before they lead to program failure.
Structure and tools. The CTC structure includes six training workshops and additional tools that help walk community members through each stage of the process. Training manuals are comprised of modules that provide comprehensive information, exercises, and guidelines for each stage of the process. The Milestones and Benchmarks checklist functions as a roadmap for the entire effort. Milestones are major tasks that must be accomplished in each phase of CTC, and benchmarks provide essential steps toward achieving each of these major tasks. Booklets are available to help local leaders evaluate and address community readiness issues before initiating the process, and to explain the system to key leaders and potential board members.