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What is the SPF?

The Strategic Prevention Framework (SPF) will serve as a planning model for communities to address identified substance abuse related consequences. The assessment phase of this framework is the foundation for all future work that will occur, and therefore must be approached with an appreciation of its importance.

The SPF requires a data-driven and systemic approach both at the state level and community level to address the most critical needs as identified by a State Epidemiological Workgroup (SEW). Once substance abuse related consequences are identified, a prioritization process determines which consequence(s) will be focused on. The SPF further requires a collaborative approach to address this selected consequence, encouraging every facet of a community to become involved in decreasing the identified consequence.

The Center for Substance Abuse Prevention (CSAP) has funded twenty-one states and territories to date to begin the implementation of this framework with Strategic Prevention Framework State Incentive Grants (SPF SIG). These funded states and territories are required to complete every identified step of the SPF, beginning with the assessment phase. Though assessment is the step the work begins with, it is important to keep in mind that the SPF is a circular process, in which every step occurs within every step. For example, you can not begin the assessment phase if you don’t have the capacity or a plan to look at data. Further, implementation occurs as data gathering, analysis, and prioritization take place.

• Preventing the onset and reducing the progression of substance abuse, including underage drinking.
• Reducing substance-related problems in communities.
• Building prevention capacities and infrastructure at state and community levels.
• Implementing a process of infusing data across all SPF steps for improved decision-making.

1. Profile population needs, resources, and readiness to address the problems and gaps
in service delivery

• Assess sub populations among 15 to 24 year olds involved in alcohol-related crashes in respective communities.
• Assess the usage patterns related to alcohol-related motor vehicle crashes among 15 to 24 year olds using epidemiological data provided by the State as well as other local data.
• Develop a set of intervening variables that link with substance use patterns.
• Cultural considerations are identified through every data collection process.
• Develop a logic model for creating evidence-based strategies that will address the intervening variables.
• Communities must also assess community assets and resources, gaps in services and capacity and readiness to act.
• Have evaluators design and lead the data-driven processes.

2. Mobilize and/or build capacity to address needs

• Participate in existing community planning efforts where they exist, and broaden these to include all related program initiatives and stakeholders.
• Engage key stakeholders at the State and community levels.
• Key tasks may include, convening leaders and stakeholders; building coalitions; training community stakeholders, coalitions, and service providers; organizing agency networks; leveraging resources; and engaging stakeholders to help sustain the activities.
• Encompasses all cultures represented in the community.

3. Develop a comprehensive implementation plan that:

• Articulates a vision for the prevention activities and strategies for organizing and implementing prevention efforts based on the community’s developed logic model.
• Focuses on addressing intervening variables identified by each community.
• Is based on documented needs, built on identified resources/strengths, sets measurable objectives, and includes the performance measures and baseline data against which progress will be monitored.
• Is flexible and can be adjusted as the result of ongoing needs assessment and monitoring activities.
• Addresses the issue of sustainability by creating a long-term strategy to sustain policies, programs and practices.
• Takes into account and respects the cultures in which is it will be implemented.

4. Implement evidence-based prevention programs and infrastructure development
activities

• Local stakeholders will use the findings of their needs assessments to guide selection and implementation of policies, programs and practices proven to be effective in research settings and communities.

• Ensure that culturally competent adaptations are made without sacrificing the core elements of the program.

5. Monitor process, evaluate effectiveness, sustain effective programs/activities, and improve or replace those that fail

• Provide performance data to the State on a regular basis, so that the State can monitor, evaluate, sustain and improve the Strategic Prevention Framework activities.

Cultural competence is a major component of the Strategic Prevention Framework. The CSAP Prevention Fellows Program Competencies which relate to the incorporation of cultural competency within the SPF are as follows:

Assessment:
Assemble culturally competent groups of experts and stakeholders to analyze and interpret data.

• Understand the role of culture, race, ethnicity, and gender as they relate to assessment strategies and needs of populations

Capacity Building:

• Understand community mobilization from a fiscal, human, and material resources perspective with culturally appropriate strategies.
• Create new fiscal, material, and human resources ensuring cultural representation (e.g., gender, age, language, disability).
• Implement a mechanism for providing continuing training and education to promote cultural competence, readiness, leadership and evaluation.

Planning:

• Identify necessary program adaptations for defined populations and community environment.

Implementation:

• Identify necessary program adaptations for defined populations and community environment

Evaluation:

• Use data collection methods that are culturally responsive and appropriate.

Planning for sustainability requires more than planning for funding. Planning for sustainability should be geared toward maintaining positive outcomes and should involve focusing on elements of the prevention system that need to be maintained/strengthened to meet the needs of a target population with effective prevention interventions. Sustainability is ultimately about outcomes, not programs.

Public Health Model & Substance Abuse Prevention
Until recently, substance abuse prevention measured success on an individual basis. Evidence-based programs were based on the change in use, perception of harm, and other individual based measurements. Success was seen as measurable change within participants of a strategy or activity.

With the transition to a public health approach, success will now be seen as a change in population level indicators opposed to only those who received a direct prevention service.

The public health approach considers an entire range of factors that can affect health. These factors go beyond the traditional Risk and Protective Factor Theory substance abuse preventionists have become accustomed to. They require the use of programs, practices, or policies that impact the population as a whole, not just those participating in a program. The measure of success now becomes the change of consequences or indicators at the community level.

Epidemiologic Triad: The traditional model of infectious disease causation, which has three components: an external agent, a susceptible host agent, and an environment that brings the host and agent together so that disease occurs.

Host: A person or other living organism that is susceptible to an infectious agent under natural conditions.

Agent: A factor that is essential for a disease. Examples of agents include microorganisms, chemical substances, forms of radiation, and, in the case of injury, physical force. Agents can cause a health problem by either by being introduced, being present in excess, or being present at deficient levels.

Environment: An extrinsic factor, such as geology, climate, insects, sanitation,
or health services, that affects an agent and the opportunity for exposure.

From: Feathers, Paula and Cox, Marie (2006) Assessment Training, Presented to CSAP Fellows at NASADAD/NPN/NTN Annual Meeting May 31 and June 1, 2006.