A guiding principle of SAMHSA’s Strategic Prevention Framework is sustainability. Not just of particular programs—which may or may not prove effective—but sustainability of the prevention workforce, community support, strategic planning, and desired outcomes.
How can States, Territories, and Tribal entities bolster the sustainability of their prevention efforts? How can they ensure continued best practice among community task forces, school programs, and town or city services?
One way States are increasing sustainability is through the development of State-based training and technical assistance (T/TA) systems that provide ongoing prevention support to local communities. Models for these State-based T/TA systems vary, and include both centralized and decentralized approaches. In some states, regional T/TA centers serve specific counties. In others, centralized resource centers provide a single repository of information and TA on evidence-based prevention. And in still others, decentralized networks of highly skilled consultants or coaches work as needed with local-level organizations and coalitions.
“In developing a T/TA system, States have lots of decisions to make,” says Carol Oliver, Director of Training and Technical Assistance for SAMHSA’s Collaborative for the Application of Prevention Technologies (CAPT), which consults with States, as requested, in developing their internal T/TA services. “Some of the issues we encourage States to consider are their size and geography, funding sources, the competencies of their existing prevention workforce, organizational structures, and local needs.”
For example, when New Hampshire received its five-year Strategic Prevention Framework State Infrastructure Grant (SPF-SIG) from SAMHSA in 2005, it did not have a strong existing State prevention infrastructure, says Valerie Morgan, Prevention Administrator for the New Hampshire Bureau of Drug and Alcohol Services. To address this deficit, New Hampshire used some of its funding to develop and fund a network of 10 geographically based Community Prevention Coalitions (CPC). Each CPC has a full-time coordinator tasked with building community- and regional-level capacity to address alcohol and drug prevention through assessment, planning, implementation, and evaluation of best practices and evidence-based prevention strategies. The State also contracted for a centralized Center for Excellence—located just outside the State capital of Concord—to provide professional development, systems change TA, web-based tools, and data that supports CPC coordinators, community-level practitioners, and service providers working in the field. This T/TA model works well for a small state like New Hampshire, where the CPC coordinators regularly meet at the Center for Excellence and TA specialists travel to CPCs for ongoing TA support.
“We’ve created a regional system that serves every community in the State of New Hampshire,” Morgan says. “Our goal is to build prevention capacity in the whole state, not just in programs funded by the state.”
New York Funds Regional Centers; Other States Choose Coaching Model
In New York, the State Office of Alcoholism and Substance Abuse Services (OASAS) supports six Regional Prevention Resource Centers. OASAS leaders determined that region-based T/TA centers could better serve local needs in such a large, diverse state. Trainers with SAMHSA's CAPT, including Associate Coordinator Linda Barovier, have worked with Resource Center staff to grow their knowledge of environmental prevention strategies and the five steps of the Strategic Prevention Framework (SPF)—assessment, capacity, planning, implementation, and evaluation. The Resource Center staff, in turn, provide prevention training and TA to local schools, coalitions, police departments, youth programs, and other groups involved in community-based efforts.
“We built their capacity to support effective prevention in local communities,” Barovier says.
Several states in the Southeast and Midwest have settled on a different approach. Mississippi, South Carolina, Kentucky, and Oklahoma are among those that have adopted a coaching model for their ongoing T/TA systems. “Coaching is a process that helps people marry their existing knowledge and expertise with new information,” explains Deirdre Danahar, a T/TA specialist for SAMHSA's CAPT who has trained coaches in several states. Danahar says that community-level prevention workers are “doers” who want to help make people’s lives better. But the SPF requires them to approach their work in new ways—using data and evaluation in a deliberate planning process—and this can prove challenging. State coaches—sometimes called “capacity coaches” or “master trainers”—offer individualized support and facilitation to community groups as they internalize the SPF into their daily work.
“Coaching is an ongoing professional relationship that is intended to be generative, so that the client is creating sustaining, lasting change,” Danahar says.
In addition to helping States develop their own T/TA systems and capacity, CAPT consultants can assist States in evaluating their T/TA approaches. SAMSHA promotes outcomes-based T/TA, which measures success by achieving specific prevention goals—for example, reductions in binge drinking or teenage marijuana use—rather than by delivering particular services, such as trainings or conferences.
“Quality training and technical assistance looks at final outcomes—whether a community or coalition reached their specific goals,” Oliver says. “State-based T/TA systems can help increase sustainability but they need to be continually assessed. If local communities aren’t seeing the results they seek, States must adapt the assistance they provide.”