Needs Assessment Training

1. Needs Assessment Training Elizabeth Eustis Turf, Ph.D. Adapted from Assessment Training for New Mexico, prepared by: Paula Feathers, Southwest Center for Applied Prevention Technology and The North Carolina SPF-SIG Community Needs Assessment Workbook 2007, prepared by: Dr. Phillip W. Graham, Carol L. Council, Michael Bradshaw & Claudia Squire, RTI International

2. Acknowledgements • Other key people: • Michelle Schmitt, Ph.D., SPF-SIG Management Team • Hope Merrick, M.S.W., SPF-SIG Management Team • The Evidence-Based Practices Workgroup: • Jeanne Martino-McAllister, Ph.D., Professor Emerita, James Madison University • David Anderson, Ph.D., Professor, George Mason University • Joseph L. Cannon, Special Agent in Charge, Education and Training Division, Virginia ABC

3. Virginia SPF-SIG Project • SAMHSA-funded • Use Strategic Prevention Framework - SPF • Outcomes-based prevention process

4. Two-Day Workshop • 1st half day • SPF-SIG overview • Why Do a Needs Assessment • Logic Models • 2nd full day • Needs assessment steps • Prioritization of findings • Capacity and Planning

5. Outcomes-Based Prevention • Use of data to identify high levels of a substance-related consequence • Consequence - AKA ‘outcome of interest’ -- targeted for reduction • Change in level of outcome over time determines success of prevention activities • Based on belief that: • Successful prevention targets causes of outcome • Use of data only way to identify causes

6. Statewide Key Data Findings & Conclusions

7. Other Considerations • Feasible to change in 5 years? • Evidence-based prevention interventions available? • Capacity at state and local level to address these issues? • Ex. Cirrhosis -- not feasible to change in 5 years • All other issues related to inappropriate behaviors of drinking and subsequent driving • With consequence of MVCs

8. Virginia SPF-SIG GOAL: Prevent motor vehicle crashes with drinking drivers aged 15 to 24 statewide Show decrease in outcome statewide within 5 years of funding -- ~2-3 years left

9. Updates - 2009 • Patterns of use of alcohol or other drugs remained the same into 2009 • Total number of MVCs downward trend 2008+ • Number of alcohol-related did not drop much • Overall, rate of alcohol-related MVCs down • Still - 35% of fatalities involved alcohol-related crashes in Virginia in 2009

10. Prevention Aimed at Causation • SA consequences are the result of a causation pathway • Pathway includes: • Individual behaviors surrounding consumption • Community-level characteristics • Community level characteristics: • Categories of Intervening Variables • Retail availability, community norms, etc • Made up of various Contributing Factors

11. Causation Pathway

12. Causation Pathway • To prevent a consequence - need to work backward to find its causes • Consequence: MVCs w/ drinking drivers 15 to 24 • Identify consumption patterns • Binge drinking • Underaged drinking • Then -- driving after drinking • Identify intervening variables and contributing factors that lead to (cause) the increased level of MVCs • This is the WHY the patterns and outcomes occur

13. Workshop & Workbook • Guide Coalitions through Phase I of SPF-SIG funding • Describe overall SPF process • Describe needs assessment process • Review data collection methods • Introduce Strategic Plan

14. Workshop Objectives • By the end of this workshop, participants will: (1) Develop strategies to identify: • Who is drinking & involved in crashes • When these crashes occur • Where these crashes occur • Why these crashes occur (2) Critically review and assess relevance of multiple data sources (3) Understand intervening variables and their contributing factors and why these are the target of prevention

15. Objectives, continued (4) Determine how to assess intervening variables - to describe the causative pathway leading to the MVCs with drinking drivers aged 15-24 (5) Consider cultural and demographic issues important when gathering data (6) Prioritize identified causes and assess capacity to address them (7) Consider evidence-based strategies to address identified causes (8) Learn about Logic Models

16. Strategic Prevention Framework • Step 1: Assessment • Step 2: Capacity • Step 3: Planning • Step 4: Implementation • Step 5: Evaluation • Sustainability and inclusion of cultural competency important throughout

17. Strategic Prevention Framework • Used by both state and local jurisdictions 1st At the state level to identify AOD issue with greatest consequences • Consequence (What): Motor vehicle crashes (MVCs) with alcohol-impaired drivers • Who: 15-24 year olds • Where: Funded localities 2ndAt the jurisdiction level to identify risk factors and causes to address • Who, When, Where andWhy

18. SPF

19. SPF Timetable - Page 6

20. Step 1: Assessment • Assess population of 15 to 24 year olds in MVCs • Assess alcohol usage patterns for 15 to 24 • Identify intervening variables linked w/ or causing substance use • Consider cultural issues • Assess jurisdiction assets, resources, and • Incorporate data-driven evaluation into the prevention design

21. Step 2: Capacity • Assess jurisdiction capacity & readiness to act • Participate in existing jurisdiction planning efforts • Engage key stakeholders in jurisdiction • Conduct tasks to encourage engagement of stakeholders to help sustain the activities • Encompass all cultures represented in every community within a jurisdiction

22. Step 3: Planning • Use assessment findings to guide selection of evidence-based policies, programs and practices • Focus on causes within each jurisdiction • Build on identified resources/strengths • Set measurable objectives to evaluate changes in outcome • Develop a logic model • Address sustainability - creating a long-term strategy • Understand and respect the cultures in which plan will be implemented

23. Step 4: Implementation • Implement evidence-based prevention programs and infrastructure development activities • Implement policies, programs and practices proven to be effective in research settings and communities and matched to the identified causes of high MVCs • Ensure culturally competent adaptations made without sacrificing core elements of program

24. Step 5: Evaluation • Monitor process, evaluate effectiveness, sustain effective programs/activities, and • Improve or replace those that were less than successful • Provide performance data to the State / SAMHSA regularly so State can monitor, evaluate, sustain and improve the SPF activities

25. State-Level Needs Assessment • Identified excess alcohol use (consumption) • Identified MVCs with drinking drivers (consequence) • Identified 15 to 24 year olds (targeted group) • Identified jurisdictions with biggest burden of MVCs • Identified and assessed resources and readiness

26. Jurisdiction Needs Assessment • Need to determine WHY so many alcohol-related MVCs where drivers 15 and 24 years were drinking • Collect and review data to • Refine the demographic target • 15-18 or 18-20 or 21+ • Identify time of year or place with high risk • Graduation, dangerous intersection • Identify which intervening variables (IVs) and contributing factors (CFs) (the causes) lead to increased drinking, driving and crashes

27. Jurisdiction Needs Assessment • Assessmentwillidentify the unique CFs that contribute to thealcohol-related crash problem locally • Jurisdictions will vary • These CFs are the specific target for prevention strategies

28. Cultural Competency • Jurisdictions must identify the cultural issues important to the behaviors and causes identified • Common -- ethnicity or race, language, income or class issues, historical community versus newcomer issues, college student versus local • Other issues specific to individual community behaviors, norms, and practices

29. Sustainability • Must be considered in planning • Resources and practices aimed at maintaining and enhancing prevention • Based on success in using data and evidence-based interventions • Resulting in significant reductions in targeted outcomes and • Improvement in prevention systems

30. Why Needs Assessment? • Research indicates: • Effective prevention targets and modifies specific IVs and CFs • Identified along the causation pathway, • i.e. the variables that cause the problem

31. Needs Assessment • Number of interventions effective in decreasing the rate of motor vehicle crashes (MVCs) where the driver is 15 to 24 and has been drinking • Evidence-based • Target different intervening variables • But -- Which one to use? • Do not know till causes are known • NEVER ASSUME YOU KNOW THE CAUSES

32. Needs Assessment • Some interventions target college students -- is that a problem in your area? • Some target beverage servers -- is that being done already in your area? • Some target high school students -- but evidence indicates they are not drinking as much these days -- those 18-24 are the biggest drinkers and drivers • So -- decisions cannot be made without looking at the data

33. Needs Assessment • Identify Who to target • Look at Where and When the MVCs occur • Look at Who is driving • Then look at Why there are so many

34. Why Needs and Resource Assessment Important? • Data gathered are necessary for Coalition to accurately develop a strategic plan – linking interventions to identified causes. • Needs and resources data allow jurisdictions to identify: • What groups of youth / young adults are most likely to drive after drinking and be in a crash • Why drinking drivers believe driving after drinking is okay • If most drinking drivers are underage or not and if so, are they less than 18 or 18 to 20 years • How underage youth / young adults (15 to 20) obtain alcohol (e.g., stores, restaurants, parents, older siblings) • Where underage youth (15 to 20) most frequently drink (e.g., school events, parties, motels, dorms, apartments)

35. Why Needs and Resource Assessment Important? • Needs and resources data allow jurisdictions to identify: • Factors in the community associated with excess drinking • Factors in the community that contribute to driving after drinking • Existing jurisdiction and community resources to combat excessive drinking and driving after drinking • Baseline data that can be monitored for changes over time • Also helps to gather support from stakeholders • Adapted from: Pamela Imm, et al. 2007. Preventing Underage Drinking Using Getting To OutcomesTM with the SAMHSA Strategic Prevention Framework to Achieve Results. Rand Health; http://www.rand.org/pubs/technical_reports/TR403.html

36. Prevention Strategies Few substance abuse problems change through direct influence or attack. Rather, it is indirect influence on the underlying factors that contribute to the problem and its initiation, escalation, and adverse consequences that succeed in modifying the targeted problem or outcome. http://store.samhsa.gov/product/SMA09-4205

37. Underlying Factors • Intervening Variables (IVs) • Category of factors that influence the level of a behavior or outcome in populations • SPF-SIG -- used to describe community /population characteristics that influence the level of alcohol-related consequences • Each is made up of ‘contributing factors’ (CFs) • Risk and Protective Factors • Intervening variables that influence the chance of a behavior or outcome within individuals • Peers who use, poor academic record, stress

38. Intervening variables / contributing factors - the targets for prevention

39. Prevention Strategies • Community-level AKA Environmental: address community norms, institutions, structures or attitudes that encourage inappropriate behaviors and consequences • Individual-level: address individual-level risk and protective factors • Evidence very mixed regarding the success of individually-focused strategies • Work when implemented in conjunction with other efforts to address factors within the community

40. Prevention Strategies • Prevention should be multi-pronged • Multiple environmental strategies or • Environmental and individual “Practitioners (Coalitions) seeking to reduce substance abuse problems will need to put together their own mix of interventions. An optimal mix of interventions will fit the particular needs of the community, its population, cultural context, and unique local circumstances, including community readiness.” http://store.samhsa.gov/product/SMA09-4205

41. SPF-SIG Prevention • All prevention activities must be evidence-based and approved by SPF-SIG Evidence-Based Workgroup (EBW) • All jurisdictions required to implement environmental strategies • Individual (school-based) interventions depend on the data • Expect several strategies to be selected for 3 or so prioritized CFs

42. SPF-SIG Project • All funded coalitions will gather information to: • Describe individual level alcohol behaviors • Describe which IVs and CFs influence outcome • Prioritize IVs & CFs to result in MVCs • Prevention specific for prioritized variables • Evidence-based strategies must be appropriate for the CFs selected -- EBW will approve • Different for each jurisdiction

43. Alcohol-Specific IVs Seven (7) key community IVs • Retail Availability • Social Availability • Enforcement • Community Norms • Promotion • Price • Perceived Risk Why these? Harold Holder model - based on research (Environmental Prevention: Achieving High Quality Implementation to Best Outcomes, November 2011)

45. Key Intervening Variables-Table 3.2 Page 16

46. Logic Models • Used as a visual representation or road map • Shows the sequence of related events • Connects outcome or need with planned programs • Goal = Programs' desired results/outcomes • Decrease in outcome • sanctuaries.noaa.gov/education/evaluation/glossary.html

47. Logic Model Components (1) Start with prioritized outcome (consequence) - MVCs with drinking drivers 15-24 years old (2) Alcohol consumption or usage patterns • Community-level behaviors, circumstances, norms, policiescausing the consequence • Intervening variables and • Contributing factors -- ultimate targets of prevention (4) Evidence-based strategies matched to prioritized contributing factors

48. Causation Model to Logic Model

49. 1st Column: Consequence • Describes the substance-related consequence selected as target for prevention • Referred to as the outcome of interest • Prevention activities will try to decrease level • Why pick MVCs with drinking drivers? • Data showed higher than expected numbers • Can be changed within 3 years • Evidence-based interventions exist to target this • Goal: decrease number of MVCs with drinking drivers 15 through 24

50. Consequence • Need to clearly describe the outcome in your jurisdiction • Who was driving • Where did crashes occur • When did crashes occur • Help to identify demographic group, geographic area, time periods for high risk