Speakers
Description
Authors: Nicole Eisenberg (University of Washington), Steven Joyce (County Kildare SW Regional Drug and Alcohol Task Force), Darren Shanahan (County Lois SW Drugs Prevention & Education Initiative), Dalene Beaulieu (University of Washington), Mats Glans (Swedish Institute for Applied Prevention Science), Karin Streimann (National Institute for Health Development), Frederick Groeger-Roth (Ministry of Justice Lower Saxony), Margaret Kuklinski (University of Washington, Social Development Research Group), Birgitta Månsson (Swedish Institute for Applied Prevention Science), Katarina Bremer, Ricarda Brender, Ulla Walter
Chair: Nicole Eisenberg
Discussant: Margaret Kuklinski
Symposium Abstract
CTC is an evidence-based preventive framework that assists multisectoral community coalitions in selecting and implementing locally tailored prevention strategies known to improve youth behavioral health. In three large trials, CTC yielded 20-30% population-level improvement in youth substance use, violence, delinquency, arrests, handgun carrying, depression symptoms, and college completion; many effects lasted a decade or more. Training and technical assistance for implementing CTC are available to communities, regions, and countries around the globe. However, because CTC is complex and requires cross-systems collaboration and coordination, readiness and capacity for carrying out CTC’s key elements are crucial early considerations for those wanting to implement CTC.
This symposium includes five presentations focusing on factors to consider early in CTC implementation. We first introduce the CTC framework, highlighting its goals, theoretical basis, phases, and evidence. The second presentation draws on ongoing work in Ireland to showcase the importance of engaging key leaders and organizing coalition work from the beginning. The third presentation uses examples from Estonia and Sweden to illustrate the importance of gathering, analyzing, and reporting on CTC Youth Survey data to aid in prevention planning. The fourth focuses on the need for linguistically and culturally appropriate tested and effective prevention strategies, using Germany’s Green List as an example. The fifth describes the importance of securing ongoing training and technical assistance (TTA) to support sustained high-quality implementation. Presentations highlight CTC’s generalizability across multiple countries and contexts. They show that with strong local coordination, key leader support, efforts of a diverse coalition, local youth data, effective prevention strategies, and TTA throughout, diverse countries and communities can progress through the various aspects of CTC implementation.
After the presentations, the discussant will provide some overarching comments and facilitate a discussion with the audience focused on readiness and early considerations in CTC implementation.
Abstract 1
An introduction to Communities that Care, a community-based prevention framework
Nicole Eisenberg (University of Washington)
Background: CTC is an evidence-based approach in which communities select and implement prevention strategies known to foster youth behavioral health. To assist in this challenging multisectoral effort, CTC provides a step-by-step process facilitated by a paid coordinator, coaching tailored to context, and web-based tools. Decision-making and leadership are centered in a diverse, representative community coalition that uses local data to understand key underlying issues facing youth. It prioritizes the most pressing and puts into place a comprehensive set of prevention strategies that reduce the likelihood of youth developing behavioral health problems. The coalition monitors and adjusts implementation to ensure progress towards prevention goals. This presentation describes CTC’s theoretical foundation, community-based implementation in diverse context and cultures, and results from four high-quality trials and studies showing youth behavioral health impact.
Methods: CTC’s theory of change is that building capacity in community coalitions drives local systems transformation towards greater use of locally tailored effective prevention strategies that improve youth behavioral health by addressing underlying causes. A Milestones and Benchmarks tool structures the 5-phase implementation process (Get Started; Get Organized; Develop a Community Profile; Create a Plan; Implement and Evaluate) over approximately 18 months. Coalitions receive training and technical assistance throughout.
Results: Trials demonstrated CTC fostered the development of effective coalitions, increased science-based prevention, and reached more young people with effective prevention strategies. It also sustainably reduced population-level mental and behavioral health problem onset (e.g., alcohol use, cigarette use, delinquency, handgun carrying) in adolescence by 20-30% within five years of initial implementation. Youth impacts have been corroborated in the United States, the state of Pennsylvania, and Australia. CTC also reduced aggravated assaults and robberies over 10 years in an urban “high-burden” community.
Discussion: CTC is an evidence-based approach to developing prevention systems that improve youth behavioral health in diverse countries and contexts.
Abstract 2
Mobilizing communities and key leaders to implement CTC: an illustration from Ireland
Steven Joyce (County Kildare SW Regional Drug and Alcohol Task Force), Darren Shanahan (County Lois SW Drugs Prevention & Education Initiative), Dalene Beaulieu (University of Washington)
Background: Communities That Care (CTC) is a community-based approach to positive youth development in which coalitions of diverse community members transform the local prevention system towards a more science-based approach. Support and action from key leaders with influence in the community are essential to launching and sustaining CTC. Gaining their support requires intentional engagement strategies and awareness of local issues and priorities. It is a central focus of the first phase of CTC implementation. This presentation describes the process by which an Irish county built readiness for CTC, including engaging the support of the Substance Use Regional Forum (SURF), an influential body tasked with implementing national drug and alcohol policy at a regional level.
Method: CTC uses a Milestones and Benchmarks tool to guide communities through the five phases of CTC implementation. We will overview Milestones and Benchmarks for Phase 1: Getting Started, which include considerations for organization, scope of prevention efforts, and readiness issues—as well as engaging key leaders. We will then highlight steps the Ireland county took to complete these milestones in preparation for CTC.
Results: The county engaged the regional SURF and, with its support, established a CTC Core Group, which includes Irish leaders with national, regional, and community-level knowledge and perspectives. The Core Group selected a backbone agency to lead a pilot of CTC, secured funding for the work, and engaged CTC technical assistance providers to support implementation. The Core Group outlined the scope and geographical area and engaged multisectoral organizations and efforts aligned with CTC goals. Work has begun on ensuring access to student self-report surveys to assist in identifying prevention priorities and building support for broader data collection in Ireland.
Discussion: CTC is complex, but aided by Milestones and Benchmarks and key leader support, communities can build readiness and support for CTC implementation.
Abstract 3
Developing readiness to collect youth data on risk and protective factors using the Communities that Care Youth Survey
Mats Glans (Swedish Institute for Applied Prevention Science), Karin Streimann (National Institute for Health Development), Birgitta Månsson (Swedish Institute for Applied Prevention Science), Nicole Eisenberg (University of Washington)
Background: Collecting epidemiological data on malleable risk and protective factors that predict youth wellbeing and problem behaviors is critical for prevention planning. For communities implementing the Communities that Care (CTC) framework, such data guides priority setting and informs the selection of preventive interventions. This presentation aims to help communities understand steps needed to prepare and adequately collect this type of prevention data, using examples from two European countries: Estonia and Sweden.
Method: The CTC Youth Survey (CTCYS) enables communities to assess the local prevalence of a broad range of youth behavioral problems and underlying risk and protective factors, and report them in a user-friendly format that can aid decision-making. Developed in the U.S., it was adapted for use in Estonia and Sweden, including translation and cultural adaptation of survey measures; school engagement; ethics committee review; pre-testing and piloting with local students; and assessing psychometric properties. In Sweden, adopting the CTCYS as part of city-wide prevention efforts required ensuring adequate representation of survey responses and building local capacity for data collection, analysis and reporting.
Results: The CTCYS was piloted in Sweden in 2014 and then administered biannually since 2017, to over 60,000 students in 17 communities. Data are used as part of community-wide prevention efforts, inform the selection of preventive strategies based on local need, and track change over time. In Estonia, the CTCYS was adapted and piloted with 265 students in 2022 and will be administered to larger samples in 3 communities in Fall 2025.
Discussion: Communities, agencies or countries planning for CTC implementation must ensure that they have the resources, logistics and capacity to collect, analyze and report data on youth risk and protective factors. Efforts must include appropriate adaptation of measures while preserving crucial aspects of the survey, sharing results with communities, and psychometric validation in different countries.
Abstract 4
Increasing the availability of culturally and linguistically appropriate, evidence-based interventions across the prevention continuum
Frederick Groeger-Roth (Ministry of Justice Lower Saxony), Katharina Bremer, Ricarda Brender and Ulla Walter
Background: Research has shown that implementing tested and effective interventions that reduce risk factors for problem behaviors, and increase protective factors, can improve health outcomes. Communities that Care (CTC) is a framework that helps communities align effective preventive programs, policies and practices with local need, and implement them with fidelity and reach. When effective preventive interventions are unavailable, communities face more difficulties reaching their prevention goals. This presentation will share how Germany expanded the supply of evidence-based preventive interventions in their country.
Methods: In 2009, the Crime Prevention Council of Lower Saxony began compiling a list of preventive interventions available in Germany and developing standards of evidence to assess the effectiveness of such interventions. Interventions that met certain standards of evidence were included in a registry. An extended literature review systematically collected published and unpublished (gray literature) evaluation studies on available interventions.
Results: In 2011 the first version of the “Green List Prevention” registry was published online, including 25 interventions, 6 of which were in the highest rating level “proven effective.” The registry included interventions in different settings (e.g. family, school, after school) and addressing a range of risk/protective factors. The development of the registry—which indicated the availability of a small but promising number of evidence-based interventions available at that time in Germany—informed the ongoing CTC pilot from 2009 to 2012. The Green List has since expanded, and currently includes 111 interventions, 30 of which are in the highest rating level.
Discussion: Communities preparing to implement CTC must consider the availability of programs, practices and policies that are linguistically and culturally relevant to their populations, and that span the prevention continuum, including universal, selective and indicated strategies.
Abstract 5
Building local capacity for prevention: training and technical assistance for Communities that Care
Dalene Beaulieu (University of Washington), Nicole Eisenberg (University of Washington)
Background: Implementation science has shown that complex interventions may benefit from technical assistance throughout the implementation process to ensure benefits shown in scientific trials translate to real-world impact. To support successful implementation of the Communities that Care (CTC) system, communities can access coaching, tools, training, and technical assistance (collectively “TTA”) as they progress through five implementation phases. Notably, TTA is available regardless of community readiness, as it assists locales in proactively thinking through what is needed to implement CTC and to build up core elements step by step (e.g., funding, youth data, evidence-based strategies, training infrastructure). This presentation will describe CTC training and technical assistance (TTA) in diverse communities around the globe.
Method: Since 2014, the Center for Communities That Care (Center) has supported high-fidelity CTC implementation through the CTC PLUS platform, which includes a vast library of tools, training materials, and demonstrational videos that help local coalitions implement CTC with fidelity—including templates, examples from actual communities, and curriculum modules with general prevention science and CTC-specific content. CTC specialists train regional CTC coaches, directly coach individual CTC sites, and provide TTA to regions, states, and countries seeking to implement CTC and build local prevention capacity. They also support communities of practice for CTC coalitions, coalition coordinators, and CTC coaches. TTA is offered primarily digitally/online, saving time and cost.
Results: The Center has served over 200 communities in 17 U.S. states and multiple countries, and has strong affiliations with CTC colleagues across 5 continents. TTA has evolved over the past decade as more communities, regions, states, and countries have adopted the framework and provided input.
Discussion: CTC is a flexible, tailored framework that has been implemented across multiple countries, regions, and cultural contexts. TTA is available to assist communities across the spectrum from building readiness to full implementation of CTC.
| Conflict of interest | no conflicts of interest |
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