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SAMHSA’s Strategic Prevention Framework (SPF) is a 5-step planning process to guide the selection, implementation, and evaluation of effective, culturally appropriate, and sustainable prevention activities. The effectiveness of this process begins with a clear understanding of community needs and depends on the involvement of community members in all stages of the planning process.
These steps are guided by the principles of cultural competence and sustainability. The SPF is designed to help states, tribes, jurisdictions, and communities build the infrastructure necessary for effective and sustainable prevention. Each step contains key milestones and products that are essential to the validity of the process. Focused on systems development, the SPF reflects a public health, or community-based, approach to delivering effective prevention.
How the SPF Evolved
To understand the SPF, it’s helpful to place it in some historical context. In the early 1990s, Center for Substance Abuse Prevention (CSAP) funded community partnership grants to address local substance abuse problems. Although these were successful in helping communities build effective coalitions, these coalitions did not always select effective strategies and practices.
So, in the late 1990s, a push began toward using model programs and practices. These were programs or practices that met a certain threshold of evidence. But people then tended to latch on to their favorite programs, without linking them to the needs of their own communities. As a result, many of these programs failed to produce the outcomes they’d produced in their original research settings.
From this experience, CSAP determined there was a need to bring the two together: to emphasize best practices embedded in the context of the community. To meet that need, CSAP developed the SPF as a roadmap to help communities do just that.
Distinctive Features of the SPF
Though the steps of the SPF should look familiar to most prevention practitioners, the framework has four distinctive features:
- It is driven by the concept of outcome-based prevention. Increasingly, funders require evidence that communities have defined and achieved their prevention outcomes. For example, many funders have threatened to discontinue drug-free zone programs at schools because there is no tangible proof that they work. The SPF drives people toward defining the specific results they expect to accomplish with their prevention plan. Outcomes-based prevention starts with looking at consequences of use, then identifying the patterns of consumption that produce these consequences.
- It focuses on population-level change. Earlier prevention models usually measured success by looking at individual program outcomes or changes among small groups. For example, a prevention program aimed at middle-school students might look for individual increases in resiliency or changes across one grade level. Under the SPF, a community might instead decide to implement a range of programs and practices which could collectively produce more broad-scale change—in this case, among all participating 7th and 8th graders, instead of just one grade level. Population-level change also forces practitioners to look at the constellation of factors, across related systems, which influence substance use.
- It focuses on prevention across the lifespan. Traditionally, prevention has focused on adolescent consumption patterns. The SPF challenges prevention practitioners to look at substance abuse among other populations which are often overlooked, such as 18- to 25-year-olds and adults over 65.
- It emphasizes data-driven decision-making. States, tribes, jurisdictions, and communities are expected to collect data on consumption and consequence patterns. They are also expected to use data to describe their community, as well as their community’s capacity to address identified problems. Finally, communities are required to choose prevention programs and practices whose effectiveness is supported by data.
Step 1 Assessment:
Assessment involves the systematic gathering and examination of data related to substance abuse and associated problems, as well as related conditions and consequences in the community. Assessing the problems means pinpointing where the problems are in the community, as well as the populations that are affected. It also means examining the conditions that put a community at risk and identifying conditions that can protect against those problems.
Practitioners engaged in a comprehensive assessment need to collect information related to:
- Population needs, including levels of substance abuse and related problems
- Available resources to support prevention efforts
- Community readiness to address identified prevention problems or needs
Based on their assessment of need, resources, and readiness, practitioners at the State and community levels will identify one or more prevention priorities on which to focus their prevention efforts.
Step 2 Build Capacity:
States and communities must have the capacity—that is, the resources and readiness—to support the prevention programs, policies, and strategies they choose to address identified substance abuse problems. Why? Because programs, policies, and strategies that are well-supported are more likely to succeed. Building capacity means taking a close look at your assessment data, finding the gaps that lie therein, and developing an action plan to address those gaps.
Key components of capacity building include:
- Increasing the availability of fiscal, human, organizational, and other resources
- Raising awareness of substance abuse problems and readiness of stakeholders to address these problems
- Strengthen existing partnerships and/or identify new opportunities for collaboration
- Developing and preparing the prevention workforce
There is tremendous value in these capacity-building activities. Together they will not only improve the effectiveness of prevention activities in the short term, but also help to ensure the sustainability of these activities, over time.
Step 3 Planning:
Planning is pivotal to prevention success. Planning will increase the effectiveness of prevention efforts—by focusing energy, ensuring that staff and other stakeholders are working toward the same goals, and providing the means for assessing and adjusting programmatic direction, as needed. If done carefully, planning will also make future evaluation tasks much easier. Prevention practitioners at the state and jurisdiction levels engage in these planning activities:
- Establish criteria for prioritizing risk and protective factors associated with the identified priority problems, focusing on their importance and changeability.
- Develop a state-, tribe-, or jurisdiction-level logic model that links the consumption patterns and consequences of the priority problems, associated risk and protective factors, evidence-based strategies, and anticipated prevention outcomes.
- Develop a comprehensive and data-driven plan that includes a logic model, strategies for addressing resource and readiness gaps, anticipated evaluation activities, and how cultural competence will be addressed.
- Establish an Evidence-Based Workgroup responsible for determining what is evidence-based, soliciting proposals for community-level strategies, and reviewing and selecting those strategies.
Planning at the community and tribal levels addresses similar priority problems and associated risk and protective factors, but prevention practitioner’s focus on specific interventions and their intended consequences.
Good planning is also crucial to sustainability. It ensures the involvement and commitment of stakeholders beyond the initial funding period, establishes the organization structure necessary to maintain program activities over time, and greatly increases the likelihood that expected outcomes will be achieved. Whether planning happens within a formal coalition or among a more informal group of partners, decisions must reflect the ideas and input of diverse groups and individuals.
Step 4 Implementation:
Implementation is where the rubber hits the road—where States, Tribes, Jurisdictions, and communities do what they’ve said they’re going to do. When implementing prevention programs, practices, or strategies, it is important to consider the following:
Action plan development. An action plan is a written document that lays out exactly how you will implement the selected program, policy, or strategy. It describes what you expect to accomplish, the specific steps you will take to get there, and who will be responsible for doing what.
Fidelity and adaptation. Fidelity refers to the degree to which a program is implemented as its original developer intended. Adaptation refers to how much, and in what ways, a program, practice, or strategies is changed to fit local circumstances.
Factors that may influence implementation. These include staff or practitioner selection, pre- and in-service training, ongoing consultation and coaching, staff and program evaluation, facilitative administrative support, and a favorable history implementing prevention programs.
Step 5 Evaluation:
Evaluation is the systematic collection and analysis of information about program activities, characteristics, and outcomes to reduce uncertainty, improve effectiveness, and make decisions.
A good evaluation can help States and communities become more skillful and exact in describing what they plan to do, monitor what they are doing, and improve. Evaluation results can and should be used to determine what efforts should be sustained and to assist in sustainability planning efforts. Ultimately, good evaluation will help improve not only our own programs but those implemented by others.
Practitioners at the State, Jurisdiction, Tribe, and community levels engage in a variety of evaluation-related activities, including identifying evaluation expertise, designing evaluation plans, and collecting, analyzing, and reporting data.
CULTURAL COMPETENCE AND SUSTAINABILITY SHOULD BE CONSIDERED IN EVERY STEP OF THE SPF PROCESS
Cultural competence describes the ability of an individual or organization to interact effectively with people of different cultures. To produce positive change, prevention practitioners must understand the cultural context of their target community, and have the willingness and skills to work within this context. This means drawing on community-based values, traditions, and customs, and working with knowledgeable persons of and from the community to plan, implement, and evaluate prevention activities. More…
Culture must be considered at every step of the Strategic Prevention Framework in order for diverse populations to benefit from selected interventions.
While people often think of culture in terms of race or ethnicity, there are many other elements—some that are easy to see and others that are hidden. Cultural competence means being respectful and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse population groups. Lastly, developing cultural competence is an evolving, dynamic process that takes time and occurs along a continuum.
When thinking about sustainability, prevention practitioners typically think of sustaining prevention programs. But best practice challenges us to think about sustainability more contextually; to consider the multiple factors that contribute to program success—such as the existence of stable prevention infrastructure, available training systems, and community support—and work toward sustaining these contributors.
Best practice also encourages us to think critically about which activities we should, or should not, sustain. Our ultimate goal is to sustain prevention outcomes, not programs. Programs that produce positive outcomes should be continued. Programs that are ineffective should not be sustained.
In addition, SAMHSA’s Strategic Prevention Framework emphasizes sustaining the prevention process, itself, recognizing that practitioners will return to each step of the process, again and again, as the problems communities face continue to evolve.
Tips for increasing sustainability include the following:
- Think about sustainability from the beginning. Too often, practitioners wait until the 11th hour to begin thinking about sustainability. But building support, showing results, and ultimately, obtaining continued funding all takes time. So it’s critical to think about who needs to be at the table, from the beginning.
- Build ownership among stakeholders. The more invested stakeholders become, the more likely they will be to support prevention activities for the long term. Involve them early on and find meaningful ways to keep them involved. Stakeholders who are involved in assessment activities are more likely to support prevention activities that stem from the assessment. They are also more likely to sustain these activities, over time.
- Track and tout outcomes. A well designed and executed evaluation helps you determine which activities to keep and which to get rid of. It can also help demonstrate effectiveness. Then share outcomes with community members so that they can become champions of your efforts.
- Identify program champions willing to speak about and promote prevention efforts.
- Invest in capacity—at both the individual and systems levels. Teach people how to assess needs, build resources, and effectively plan and implement prevention programs and create the systems necessary to support these activities, over time.
- Identify diverse resources, including human, financial, material, and technological. Be sure to identify and tap as many of these as possible.