Substance Abuse & Mental Health Services Administration

The Substance Abuse and Mental Health Services Administration (SAMHSA)

Medical Care Development, Inc. Public Health: 21 Reasons

21 Reasons (a project of MCD Public Health), is a community-based, coalition-led, and professionally staffed initiative to reduce youth substance abuse in Portland, Maine. Its mission is to create an environment that includes policies, practices, and attitudes that support the drug-free development of students in grades 7 through 12. The program uses multiple approaches to influence the knowledge, attitudes, beliefs, and behaviors of the adults who control access to substances of abuse, with particular emphasis on alcohol and marijuana.

21 Reasons implements a wide variety of interventions in order to achieve community-wide environmental change. Program strategies include community organizing, media advocacy, policy development, training and technical assistance, informational resources, social norms marketing, social support, and parenting education. Because of its complexity, the project is in need of a more sophisticated and rigorous evaluation design to better measure its impact. With funding from SAMHSA’s Service to Science Subcontract to Build Evaluation Capacity of Evidence-Based Interventions, program staff will implement an evaluation plan that addresses challenges to evaluating environmental change strategies. Furthermore, 21 Reasons intends to continue to implement the evaluation enhancements moving forward, should the evaluation design prove effective.

The proposed evaluation enhancements will help determine whether anticipated outcomes are linked to program implementation and if the program has had a positive impact on participating youth over time. Specifically, MCD Public Health will implement an evaluation design that includes comparison communities—created using propensity score matching to differentiate between exposed and unexposed participants post-intervention—in order to determine whether outcomes differed between populations exposed and unexposed to the 21 Reasons program. Evaluation results will be used to make program improvements, deepen community engagement in and support of the program, and inform the growing body of research on environmental change strategies.


Jo Morrissey
Project Manager
Medical Care Development, Inc.
48 Free Street, Suite 208
Portland, Maine 04101
Phone: (207) 773-7737