To celebrate recent advances in drug prevention science, the National Institute on Drug Abuse (NIDA) a part of the National Institutes of Health (NIH), sponsored its first virtual town hall meeting. This unique event on September 9, 2009 brought together representatives from key federal agencies involved in preventing and combating substance abuse in the United States.
They were linked via satellite from Washington, DC to Camden, Maine where members of five local communities as well as participants from Freeport, Illinois and Quincy, Washington talked about their success in implementing the Communities That Care (CTC) system aimed at keeping youth safe from drugs. The Washington, DC participants included NIDA Director Dr. Nora Volkow, Gil Kerlikowske, director of the Office of National Drug Control Policy, SAMHSA's Center for Substance Abuse Prevention Director Ms. Frances Harding, and Dr. David Hawkins. Dr. Hawkins heads the Community Youth Development Study at the University of Washington which researched the CTC approach.
The lively one hour discussion highlights how new scientific approaches combined with commitment at the community level can reduce the chances of children becoming involved with drugs.
For more information on drug prevention programs visit:
http://www.samhsa.gov/prevention/
Videos
NIDA Town Hall Meeting Summary
This is a a six-minute summary of the lively one hour discussion which highlights how new scientific approaches combined with commitment at the community level can reduce the chances of children becoming involved with drugs.
- Transcript
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Dr. Nora Volkow:
Hello, I'm Nora Volkow.
I Direct the National Institute on Drug Abuse.
And I want to welcome you all to this program where we will be discussing how to empower communities to implement effective preventions for substance abuse.
We now know through science what prevention measures work and we clearly know that prevention of substance abuse and addiction work and it improves the outcomes of an individual's life.
But at the end of the day of course, it is every person's life and you want to empower them with the knowledge that is evidence-based, it is scientific about why it is not a good idea to take drugs.
Mr. Gil Kerlikowske:
The president has made a strong commitment to evidence-based programs.
The science should drive what we are doing.
And so these programs have to have a defined population.
Preventing crime is a real hallmark of a good police department and preventing young people from going down the path of either drug abuse and abuse of alcohol, et cetera, is just critically important.
Local police officers are part of their communities.
Frances Harding:
When we talk about community prevention, we talk about the problems of substance abuse across the country, we're really talking about each community having individual problems, and we focus on the community, and the science supports this because we know that our communities, the people that reside in our communities, know the problems best.
And they also are the best people to be able to come up with the solution to approach some of the issues.
Dr. David Hawkins:
Communities That Care is an operating system for prevention.
It is not a program. It is a system that, like an operating system on your computer, Linux or Windows, gets you to the right application or program to meet your needs.
Communities That Care helps the community identify the risk factors that are elevated in that community.
Then a coalition of diverse stakeholders in that community use that information on risk and protective factors to choose from a menu of tested and effective preventative interventions that have been shown in controlled trials to prevent these problem behaviors in young people.
We are cutting the initiation of these behaviors by about a third in the CTC communities.
The benefits to individuals and to the communities that have done Communities That Care in this trial, is that for every dollar that has been invested in Communities That Care, $5.30 of benefit has been accrued because of less criminal behavior and less tobacco use.
Dalene Dutton:
What CTC has helped us to do is to identify our unique profile risk and protective factors.
Once we identified that, we were able to match our profile with some tested and effective programs.
And then, the CTC system helped us to monitor how well our programs were working and we're really pleased to report they are working very well.
One of the little pieces of data that we have had is that we had a 66 percent reduction in 8th grade marijuana use in our community in just four years, so we are really happy about that.
Phil Roberts:
This is the hub of this five-town area: Appleton, Hope, Lincolnville, Rockport and Camden.
We live in a very mobile society.
While we've got a charming scenery around us, it doesn't prevent drug trafficking from going on here.
[Background noise and music]
Carly Dorskey:
We are like in the middle of no where, so it is hard to like find something to do when we don't have any place to go.
Maria Libby:
Despite all of the programs we have done there are still kids who are using inhalants.
[Background noise and music]
Amelia Mank:
I'm not going to lie. I like cars and hanging out and stuff. But I also really like this.
[Background noise and music]
Heidi Baker:
I think just keeping children working and having an activity is a huge part and that's what Communities That Care really has done here.
Ted Tomita:
We found substance abuse, family management and low commitment to school are three prioritized areas.
Once we implemented these programs we saw that we had some great results after looking at the data again, so we continue our efforts in the coalition.
Esmeralda Blancas:
I got involved with Communities That Care while working as a community health worker for a local community health center.
One of the prevention programs that I taught was called Guiding Good Choices, where I facilitated in both English and Spanish.
My daughter, Christina, she was involved in a prevention program as well called Smart Moves where we taught kids how to deal with peer pressure.
Christina Blancas:
Well, Smart Moves taught me about the drugs and alcohol that are out there, and how they could affect me, and it also taught me how to deal with peer pressure and how to say no to drugs.
Phil Roberts:
That's the great thing about the Communities That Care.
The age bracket that they deal with.
Before that attitude, those behavioral patterns develop.
Dr. Nora Volkow:
We motivate the communities to take action to empower and try to address the issues in the community for substance abuse.
Finally, the big challenge is how do you sustain those prevention programs because what science has told us is that prevention programs to be effective have to be sustainable.
[Applause]
NIDA Town Hall Meeting Part 1 of 2
This lively one hour discussion highlights how new scientific approaches combined with commitment at the community level can reduce the chances of children becoming involved with drugs.
- Transcript
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Operator:
Please stand-by, video will begin momentarily.
Nora Volkow:
Hello, I'm Nora Volkow.
I Direct the National Institute on Drug Abuse.
And I want to welcome you all to this program where we will be discussing how to empower communities to implement effective preventions for substance abuse in the community.
I want to introduce now Carol Krause who will be the moderator for this program. Carol...
Carol Krause:
Thank you Dr. Volkow.
Well we know that no two communities in America are alike.
So, today we are going to talk about some exciting developments in substance abuse prevention science and how communities can develop prevention programs that will work for their own unique needs.
This virtual town hall will look at evidence-based prevention principles and programs in general.
And we will take a special look at the Communities That Care prevention system.
A community-wide system designed to reduce risky behaviors among middle schoolers and increase protective factors within communities, schools, and families.
Communities That Care or CTC is sponsored by the U.S. Department of Health and Human Services, more specifically the Center for Substance Abuse Prevention, CSAP and SAMSHA, the Substance Abuse and Mental Health Services Administration.
But first let's see what they are saying about Substance Abuse Prevention in the five-town community of Appleton, Camden, Hope, Lincolnville and Rockport, Maine.
Adam Kohlstrom:
Well, I first came to hear about Communities That Care back in 2003 when Communities That Care was being the very inception of it here in our community.
I was at the original training events that happened at the YMCA.
Maria Libby:
Each year our school participates in a survey that provides CTC with data on a variety of different factors. I
t's through that survey and the work that CTC did in evaluating it that we realized that we had a higher than usual abuse of inhalants in our middle school community.
Adam Kohlstrom:
When I preach and prepare and if I'm speaking specifically to something that bears upon the teen culture and teen population, the fact is I'm able to speak with greater clarity with greater directness and with greater understanding of what they are facing.
Sarah Post:
I definitely believe that kids need some wonderful opportunities, Some structure too and mentoring from adults. People to really look up to beyond their parents.
Andrew Lesmerises:
And now, they'll more readily accept the messages of, you know, don't do drugs, don't smoke, stay in school. Learn. Get active.
Phil Roberts:
I hear comments back from the officers who are doing the foot patrol and having the contact with people out here on the street.
But the attitude is much better, much more receptive.
They don't get the hostility that we did a few years ago.
Adam Kohlstrom:
I think one of the biggest advantages of Communities That Care is that it has really brought together the entire community.
Carol Krause:
And there they are. The good citizens from the five-town community in Maine.
Our partners in this first ever night of Prevention Town Hall.
Camden, can you hear us? We can hear you.
The folks in Maine have a lot of questions for our experts today.
We have some questions for them. But, first let's meet our expert panel.
The people who are front and center in our nation's Drug Abuse Prevention efforts.
Mr. Gil Kerlikowske, Director, White House Office of National Drug Control Policy.
You've met Dr. Nora Volkow, Director of National Institute on Drug Abuse, National Institutes of Health.
Frances Harding, Director of SAMHSA's Center for Drug Abuse Prevention and Dr. David Hawkins, lead author of the Community Youth Development Study at the University of Washington in Seattle.
I would also like to point out that in the audience here at the National Press Club we are joined by scientists and other prevention experts in both the public and private sector who are instrumental in the nation's prevention efforts so thanks to everyone for joining us.
So, let's get started. First, let's hear from Director Gil Kerlikowske.
Newly selected by President Obama to head the White House Office on National Drug Control Policy.
Before being selected to head the nation's Drug Control efforts Director Kerlikowske was Chief of Police in Seattle and has a long history with community prevention.
Director Kerlikowske, could you begin by telling us a little bit about the President's commitment to prevention?
Director Gil Kerlikowske:
I could. Certainly this administration has a renewed re-energized focus on the importance of prevention.
We know that evidence-based prevention programs can be very effective.
We know that they can save money.
For instance, for a dollar invested in prevention programs you can have up to a ten dollar savings in substance abuse treatment.
And so those are the things that President Obama is very interested in.
The other thing that the President really wants to ensure is that as we think about his drug control strategy which by law has to come out at the end of or in the beginning of next year.
That he gets as much input from people across the United States.
That's why I'm particularly indebted to Dr. Volkow and to NIDA for letting me participate in this and have this opportunity to hear a lot of different people. Let me just mention a couple of other things about prevention in particular.
That is, that it can't be just any prevention programs.
The President has made a strong commitment to evidence-based programs.
The science should drive what we are doing. And so these programs have to have a defined population.
They have to be appropriate to the risk.
They have to look at the protective factors involving substance abuse.
They should intervene at the early stages and transitions because we know that addiction is a disease.
We know it is treatable, diagnosable.
That is has an age of onset and, therefore, prevention programs that are evidence-based can be very effective.
They have to have sound management.
They need to have people that are not only active and caring and involved in these programs.
But they have to be widely and soundly managed.
They should intervene in appropriate settings and domains.
Parents are a key focus in all of the prevention programs.
And that's critical. Not only in preventing drug abuse in the future, but it is also quite critical in building kids' social skills.
Lastly, the approach is about effectiveness having to have been demonstrated. And I could not be more pleased to be a participant in this today.
And thank you all and thank you to the people in Maine.
Carol Krause:
We could not be more pleased to have you here.
So thank you very much. Now, of course there is a lot of information on ONDCP's prevention efforts on its website whitehousedrugpolicy.gov.
Next we will hear again from NIDA Director Dr. Volkow.
Dr. Volkow tell us a little bit about prevention science.
Dr. Volkow:
Well, substance abuse and drug addiction can have very catastrophic consequences to the individual, and yet they can be fully prevented.
So we actually use science in order to help identify actually what are the principles that our community can use in order to prevent that use of substances.
And through science we have come to actually understand that prevention measures are effective and can decrease drug utilization in an individual and in its community.
So what are the principles?
One of the crucial principles is that drug prevention should be initiated early in life.
And this is because the highest risk for substance abuse is during adolescence and unfortunately sometimes during childhood.
So, an effective prevention can actually gear that individual to where positive attitudes and behaviors while decreasing the risk of taking substance abuse.
Ultimately affecting what the life of that person will be.
A second very important principle, which is basically the backbone of the prevention strategies, is the identification of both risk and resiliency factors that can actually enhance the ability of a young person to actually say no to drugs.
Both — we want the prevention measures to elevate preventive factors while decreasing those risk factors, and these are at the level of the individual, the family, the peers, the school and their community.
And the community has motivation to actually change them can have effective results in decreasing substance abuse of the individual at the community level.
After aspect of the principles is targeting the prevention of multiple substances, such that one can observe how these universal preventions strategies that go after different risky behaviors will result in a decrease of behaviors not just related to substance abuse, but also to the delinquency and criminal acts.
Finally, what are the challenges that we have ahead of us.
Well, one of them is how we must educate our communities to take action to empower and try to address the issues in the community for substance abuse.
The other one is how that community identifies a unique characteristics that they have, while at the same time being able to implement evidence-based prevention.
And finally, the big challenge is how to sustain those prevention programs because what science has told us is that prevention programs to be effective have to be sustainable.
Thanks very much.
Carol Krause:
Thank you, Dr.Volkow.
You can find more on NIDA's website on drugabuse.gov.
Before we hear more about the recent results from the Communities That Care research.
Fran Harding I'm going to hand you the remote for the Power Point.
With more than twenty-five years in state substance abuse leadership Ms. Harding was appointed to head CSAP last year.
Fran, what are the general kinds of community prevention programs that are offered through SAMSHA?
Frances Harding:
When we talk about community prevention, we talk about the problem of substance abuse across the country, we're really talking about each community having individual problems and we focus on the community.
And the science supports this because we know that our communities, the people that reside in our communities, know the problems best, and they are also the best people to be able to come up with the solution to approach some of the issues.
Some of the — we create our goals at SAMHSA is to create a healthy and safe communities across our country.
What that basically means is that we are looking at programs that approach the workplace, schools, and also families.
We want to have supportive communities in both all communities and in neighborhoods if we are looking at the urban settings across our country.
We are looking to help our communities become safer, healthier and free of crime, and of course substance abuse.
And we do this, of course, by also having working with our partners across what we call continuum of services, which includes prevention through treatment.
So we want to have access to those services.
As Carol said when she began our talk today, we know that one size doesn't fit all.
The science has helped us to be able to focus in on the individual issues that each community presents.
SAMHSA has an enormous amount of programming that we focus on and what you are looking at now is a slide that shows you the different types of programs that we have that is focusing on our substance abuse block grant dollars and also our communities, our drug-free communities programs, and a thousand different discretionary programs across our country.
We're specifically talking about our Strategic Prevention Framework.
Our Strategic Prevention Framework Grant is a process where there are five steps that a community engages.
Starting with an assessment of the problem right straight through of how to utilize data, how to approach the data to prioritize our local problems, and then help with science to identify the appropriate program to help with that.
Something to note in Maine, the Strategic Prevention Framework is very similar to the process that you have gone through with the Communities That Care process.
One of our biggest programs. We also go through a life span.
We can look at just one age group so we also have programs in SAMHSA that covers the kids as young as three years old to six.
We also have programs that focus on underage drinking with fifth and sixth grade students.
Too Smart to Start is another science-based program that we also look at for underage drinking.
Underage drinking is a priority for SAMHSA.
Around some of you hopefully have known and been participating in some of our community programs or some of the teachers out there may actually have been involved with our Reach Out Now teach-ins.
All of our underage drinking programs are primarily focused on the Surgeon General's Call to Action paper which actually motivated the country to focus in on underage drinking and some of the programs and the tasks to follow.
Lastly, we have targeted initiatives.
The reason why we go beyond just focusing on adolescence is because substance abuse problem is a community problem so we want to offer programs for all community — all members of the community.
For instance, we have a program for Fetal Alcohol Spectrum Disorder and I mentioned that specifically today because today, September 9th, is the awareness day across our country for FASD.
We have tried to focus on different groups. We have programs for Native Americans.
We have programs along the border of our country that have issues.
We have programs that focus on the workplace and of course I would be remiss if I didn't focus on our older adults in the audience and across the country as well.
So to be — prevention is — if I was to leave you with one message I'd say that prevention is a good investment.
The more we can work with prevention within health care and within crime and local problems, and to be engaged.
We want to be able to get all of the members of the community, you all have a part so parents, teachers, law enforcement officers, health care workers, faith-based organizations, we want all of you — as you're doing in Maine, and to show that you are the model for the rest of the country to bring all of the partners that have a say in community health and safety.
Carol Krause:
Thank you, Director Harding.
Well, we will guide you to SAMHSA's prevention website in a minute.
But first let's get to the Communities That Care system. One of these systems, one of these prevention programs.
In particular, we're here to discuss newly released results of the Community Youth Development Study. Research conducted by the University of Washington Scientists to examine the effectiveness of the Communities That Care prevention system.
The study was funded by NIDA, your host for today's event.
SAMHSA's center for substance abuse prevention along with several other NIH institutes, The National Cancer Institute, The National Institute of Mental Health, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
And we do have some very good news.
To tell us about it I'd like to introduce Dr. David Hawkins.
Lead author of the Community Youth Development Study. His results were just published in the Journal Archives of Pediatrics and Adolescent Medicine. Dr. Hawkin's what's the news?
Dr. David Hawkins:
The good news is that communities armed with the advances of prevention science and using the Communities That Care system can prevent adolescent tobacco use, alcohol use, and crime — all at the same time by really using these advances of prevention science that Dr. Volkow was talking about earlier.
Communities That Care is an operating system for prevention.
It is not a program. It is a system that, like an operating system on your computer, Linux or Windows, gets you to the right application or program to meet your needs.
Communities That Care helps the community identify the risk factors that are elevated in that community.
The protective factors that are lower depressed in that community and then a coalition of diverse stakeholders in that community use that information on risk and protective factors to choose from a menu of tested and effective preventative interventions that have been shown in controlled trials to prevent these problem behaviors in young people.
Those programs that address the risk factors that are elevated in the community and strengthen the protective factors that are needed in that community.
We were able to to test the Communities That Care system in a randomized controlled trial involving twenty-four communities, matched initially within states and then randomly assigned to either get Communities That Care or to serve as a control community across seven states in this country.
We have been following a panel of students who were fifth graders at the beginning of the study, and we've been following them through the eighth grade, and we are now reporting on the effects of Communities That Care on that panel of all of the fifth graders whose parents allowed them to be engaged in this longitudinal study followed through the eight grade.
You can see from the slides that the communities in the Communities That Care trial, that we are talking about our small towns and middle-sized towns from Washington to Maine.
Matched communities randomly assigned within each state to either get Communities That Care or not Communities That Care.
Communities That Care has five phases.
The first phase is to get organized and that means to get all of the stakeholders concerned about the successful development of young people involved.
It is important to have everyone involved in the community because depending on which risk factors are elevated in that community, different organizations may need to implement the prevention policies and programs that are needed in the community.
And you can see from this slide the variety of organizations and groups that are involved in Communities That Care and the communities participates in the Community Youth Development Study.
Those coalitions in the twelve experimental or CTC communities got training in the first year in Communities That Care — six training events during that year and then they conducted a survey of all of the sixth, eighth, tenth, and twelfth graders in their community that allowed young people to tell what their experiences were with regard to the levels of risk and and levels of protection.
Based on that data, the communities were able to choose elevated risk factors.
So for example, if sixty-five percent of the young people in a community said my parents don't know where I am and who I am with when I'm not at home, then that's a family management risk factor and that risk factor could be a priority for attention in that particular community.
So communities chose two to five priority risk factors, and then they chose prevention programs targeted to those risk factors.
So if family management was a risk factor or family conflict was a risk factor, they might choose the Guiding Good Choices program or Strengthening Families 10 to 14.
If academic failure or low commitment to school is a risk factor, they might choose individual tutoring for young people falling behind in school.
If they found rebelliousness or children needing more skills to resist drug offers was a problem, they might implement life skills training, or the Olweus Bullying Prevention program in the schools.
The risk factors.
There are twenty major risk factors that are identified through longitudinal studies of young people.
The communities in this study chose these nine risk factors.
Different combination's of risk factors in different communities were chosen because as you said at the beginning, different communities have different profiles.
Different communities and Communities That Care choose different risk factors to focus their attention on.
These nine risk factors were the ones that were prioritized in at least one of the communities in the trial that we are conducting of Communities That Care called The Community Youth Development Study.
Based on the assessment from the menu of Communities That Care, the Prevention Strategies Guide to Prevention that is on the CSAP web page, the SAMHSA web page, the communities chose tested and effective preventive interventions.
Things that have been tested just like we test drugs before we make them available to the public.
These programs have been tested and well controlled trials and that was the menu from which communities chose their prevention programs.
What we can see is that when you use this Communities That Care system, you can significantly reduce health and behavior problems among young people.
What you are looking at in this slide is the profile of risk exposure from grade five through grade eight in the panel of young people who are following.
We know that as young people enter adolescence, their risk exposure increases. Children develop more favorable attitudes towards drugs sometimes.
They begin to run into peers who started smoking or drinking or stealing.
Their parents may become more lax in their monitoring because they have a teenager now instead of a little child.
But what we see from this slide is that the risk exposure in the controlled communities in red went up significantly faster than risk exposure in the blue Communities That Care communities.
And what that led to was a significant decrease in both the incidence that is new, young people starting to smoke,or starting to drink, or starting to become involved in delinquent behavior.
As well as in the prevalence of alcohol use, and delinquent behavior in the CTC communities when compared to those same young people in the eighth grade young people in the controlled communities.
And just to illustrate this what you are looking at here is the onset of delinquent behavior among young people who hadn't started the delinquent behavior by the fifth grade.
And what you can see is that by the eighth grade, that slide should say 0.18 in the seventh grade compared to 0.13.
Eighteen percent of the kids who hadn't yet started delinquent behavior in the controlled communities began a delinquent act in the seventh grade compared to thirteen percent in the CTC communities.
By the eighth grade Twenty-one percent of those kids who hadn't yet been delinquent started the delinquent behavior in the controlled communities as compared to about fifteen percent in the Communities That Care community.
When you look at alcohol use, this slide should actually say at the eighth grade twenty-five percent of the kids who hadn't yet started drinking in the — by the seventh grade actually started drinking in the eighth grade.
One out of every four kids who hadn't been drinking in the seventh grade, started drinking in the eighth grade in the control communities.
But only seventeen percent of those young people who hadn't been drinking before eighth grade, started drinking in the eighth grade in the CTC communities.
And with regard to cigarette use, twelve percent of those kids who hadn't yet started smoking before the eighth grade, started smoking in the controlled communities, compared to eight percent in the CTC communities.
What we are seeing is that we are cutting the initiation of these behaviors by about a third in the CTC communities.
There is also an effect on actual prevalence of these behaviors. Just to illustrate, about 21.4 percent of the eighth graders in the controlled communities were current users of alcohol.
That is they had had alcohol in the last thirty days. In the CTC communities, that was only about 16.4 percent.
And if you think about binge drinking, that is children who have had five or more drinks in a row in the last two weeks, nine percent, almost one out of every ten kids in the controlled communities, were in the eighth grade say, Yes I have had five or more drinks in a row in the last two weeks, compared to 5.7 percent in the CTC communities.
Also significant reductions in the prevalence of delinquent behavior.
What we are seeing is that by addressing these shared risk factors for a variety of health and behavior problems among young people we can actually reduce not only tobacco use, and alcohol use; but crime as well among young people in these communities.
CTC works because it provides a complete set of manualized trainings.
All of the manuals for CTC are available on the SAMHSA website.
It provides a process whereby communities can decide whether this is the right set of tools for them.
Whether they're ready for CTC or whether CTC is ready for them.
It provides a set of milestones and benchmarks step-by-step guides all the way through the five phrases of the CTC process.
It provides a survey that allows you to assess risk and protection among sixth, eighth, tenth, and twelfth graders across the community.
A menu of test and effective preventions and importantly training and tools that are used to implement those programs with fidelity and sustain those programs over time.
The other key to the successful Communities that Care, is a community coordinator who facilitates the implementation of this process in the local community of Communities That Care.
What we know now is that when you use these tools from prevention science you can actually prevent substance abuse and crime community-wide, population level effects.
Carol Krause:
Dr. Hawkins, thank you so much.
All of the information you heard him talking about on the CTC program or any of the other prevention options, can be found on SAMHSA's website, prevention.samhsa.gov.
Now it's time to meet the folks in Maine.
Where a lot of folks have turned out to talk about substance abuse prevention.
Let's meet out moderator in the five-town area, Marie Roda.
Marie owns her own communications firm in Pennsylvania and has been in the trenches for many years promoting health programs.
She has been an active champion of Communities That Care in both Pennsylvania and Maine.
Marie, Hello.
Marie Roda:
Hello! Hello Carol, and welcome to Maine. We're very excited to be here and welcome to everyone in Washington.
Carol Krause:
So, what do you have for us?
Marie Roda:
Would you like to meet — we would like to introduce the CTC coordinator here in the five-town communities which is Dalene Dutton.
Dalene is the Executive Director at the five-town Communities That Care initiative and she would like to introduce a few special people seated behind her.
Dalene Dutton:
Thank you Marie. I have here with me my Board of Directors and folks from the Community Coalition. We're happy to be here. Thank you.
Marie Roda:
It's a great group I'd also like to introduce a few special guests that have joined us from CTC communities across the country.
We're are going to go over here and meet Mr. Ted Tomita He is from Freeport Illinois, and we also have with us Esmeralda Blancas and her daughter, Christina, who have come all of the way from the state of Washington, from Quincy Washington.
So thank you very much for joining us.
Now, what we would like to do is explain a little bit more about what CTC has done here in the five-town communities in Maine.
So Dalene, if you would join me and could you briefly explain what CTC has done in this community and in this region?
Dalene Dutton:
Sure. What CTC has helped us do is to identify our unique profile risk and protective factors.
Once we identified that, we were able to match our profile with some tested and effective programs, and then the CTC system helped us to monitor how well our programs were working.
And we're really pleased to report they are working very well.
One of the little pieces of data we have had is that we had a sixty-six percent reduction in eighth grade marijuana use in our community in just four years.
So we are really happy about that. The other thing that's allowed us to do it to increase the amount of collaboration in our communities.
The tools are really wonderful for helping us do that.
Marie Roda:
That's phenomenal.
Well thank you, and I think this is a perfect time to show a small video clip of one of the evidence-based prevention programs that they implemented here in the five-town area which is called The Star Program.
Now, The Star Program is an evidence-based prevention program that has multiple components that includes family and classes.
And it is meant to focus specifically on specific protection factors that they focused on here in the community.
So, what you are about to see are some kids who are involved in The Star Program, and for these kids, evidence-based prevention means that they get to be involved in and experience rather some interesting and challenging after-school activities.
NIDA Town Hall Meeting Part 2 of 2
This lively one hour discussion highlights how new scientific approaches combined with commitment at the community level can reduce the chances of children becoming involved with drugs.
- Transcript - Town Hall Part 2
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[Music and background noise]
Phil Roberts: This is the hub of this five-town area, Appleton, Hope, Lincolnville, Rockport, and Camden.
We live in a very mobile society.
While we've got a charming scenery around us, it doesn't prevent drug trafficking from going on here.
[Background noise]
[Music]
Carly Dorskey: We are like in the middle of no where, so it is hard to like, find something to do when we don't have any place to go.
Marie Libby: Despite all of the programs we have done there are still kids who are using inhalants.
[Music and background noise]
Amelia Mank: I'm not going to lie. I like cars and hanging out and stuff. But I also really like this.
[Music]
Heidi Baker: I think just keeping children working and having an activity is a huge part and that's what Communities That Care really has done here. It is a lot of work.
It is a lot of preparation to get an animal ready.
They go from a calf that can't be handled at all, to a you know, a twelve hundred pound animal that they are able to lead around.
Alice Flint: You just show them who is boss and make sure they listen to you, and then they eventually will just follow you around.
[Music and background noise]
Jen Curtis: We can't be with them every minute, but if we empower them here, then we know they have greater opportunity to feel confident in that situation and make their own choice.
Skye Bedell: When you are climbing up the rock wall it feels just like a, sort of like a weightlessness sometimes, and sometimes you feel the challenging part of it.
Phil Roberts: That's the great thing about the Communities That Care.
The age bracket that they deal with.
Before that attitude, those behavioral patterns develop.
[Music and background noise]
Adam Kohlstrom: The fact is the data backs up what it is that CTC has chosen to do and to be a part of.
So when I interact with teenagers, or when we are a part of anything that we are doing with teenagers, we are not just making our best guess.
Amelia Hank: It's just like taught me in school, to like step up and be a part of my group and take charge and taught me a lot of like, life skills.
Gino Ames: Shows them that there are different options from just hanging out on the street corner, watching tv. They learn that they can be productive in different activities.
Skye Bedell: It's very much like a confidence builder because after you are done you can feel like you can do anything.
Female speaker and music: Keep your body nice and close to the wall. Challenge yourself.
Carol Krause: That was a great video.
Thank you, Maine for sharing that. That was terrific.
I know that our folks, our expert panel here have some questions for the folks in Maine and I know that Dr. Volkow wants to start one right away.
Dr. Volkow...
Dr. Volkow: I enjoyed seeing that program in Maine, but tell them Christina how do the CTC programs look in your community?
Ted Tomita: Well, thank you first of all for inviting me all of the way from Freeport, Illinois.
Freeport is a community of about twelve thousand families in Northwest Illinois.
And as a business leader, I volunteer to head our work group called the Risk and Protective Factors Work Group.
And I am currently the chair of our entire coalition.
So as a work group we analyze the student survey data, and the CTC data, and other community information.
And we prioritize our problem areas. We found substance abuse, family management, and low commitment to school are three prioritized areas.
So what we did was we implemented two programs to address these issues.
The Guiding Good Choices Parenting Workshop and Lions-Skills Adolescent Skills Workshop for sixth graders.
So, once we implemented those programs we saw that we had some great results after looking at the data again.
So we continue our efforts in the coalition and it looks very promising for us and we continue our efforts.
Marie Roda: Okay. And Esmeralda, if you could tell us a little bit more about what you have done in your community in Quincy, Washington, that would be wonderful.
Esmeralda Blancas: Quincy is a small community.
Population of about five thousand and located North Central in the state of Washington.
And our area of concern in our community was gangs and substance abuse.
I got involved with Communities That Care while working as a community health worker for a local community health center.
One of — the prevention program that I taught was called Guiding Good Choices where I facilitated in both English and Spanish.
My daughter, Christina, she was involved in a prevention program as well called Smart Moves, where we taught kids how to deal with peer pressure.
Marie Roda: Christina, you joined in this program.
You were involved in this program, correct?
Christina Blancas: Yes.
Marie Roda: Now, what did you learn?
What was some of the things that you took away from that program.
Christina Blancas: Well, Smart Moves taught me about the drugs and alcohol that are out there and how they could affect me, and it also taught me how to deal with peer pressure and how to say no to drugs.
Marie Roda: So it's working?
Christina Blancas: Yes.
Marie Roda: That's great. That's great.
Carol Krause: Do you have a follow-up?
Dr. Volkow: Yes. What kind of changes — A question from Washington?
Carol Krause: Yes, Dr. Volkow asked what kinds of changes they have seen in their communities in Washington and Illinois.
Marie Roda: Would you two like to answer that? What kinds of changes have you seen in your communities? You could just stand up right where you are. That would be great.
Ted Tomita: Well, we've seen the community come together as a coalition.
We have the school district, the health network, the church community.
People volunteering all kind of pulling together in the same direction and really latching on to something we can hold on to in terms of a data-driven, we see the results kind of process.
So, we see it as a great addition to our community.
Marie Roda: Esmeralda, how about you?
Esmeralda Blancas: I would just like to add to what he said that in our community we also see a lot of family bonding and more communication within the families, which is really important, too.
Carol Krause: I know that Director Kerlikowske has a question for the folks in Maine.
Director Kerlikowske: Can you tell me how you engage the key stakeholders and then do they really make a long-term commitment through CTC?
Marie Roda: I think we have Jen to answer that question.
Jen Curtis: My name is Jen Curtis and I'm from the — YMCA, and from the very first meeting it was clear that CTC was going to allow our community to be successful in reaching out to the youth and the adults in our community, and I can vividly remember walking into the YMCA.
We had a community meeting, and this is over six years ago, and I walked into the meeting, and I looked around and there were businessmen, and there were law enforcement officers, and superintendent of schools, school counselors, and it was clear that this was going to be a new approach to meeting the needs of our community, and it wasn't going to be an approach that just haphazard.
It wasn't a flash in the pan, it was something that was going to be systematically implemented and one of the key pieces is that the needs were identified.
There was an educational component that was clear.
We as a community needed to know these were the needs. However, in that same meeting, the resources at our fingertips were also addressed.
And how could we clearly match the needs and our community's resources was the most empowering.
And the powerful part of that is that as a collective body, we knew that we could tackle the needs of our community.
The longevity piece, that can't be answered in one moment. It's trust.
And I think trust comes through time and showing that... it works.
And that the children in our community really are being empowered and they are able to — that you can see the protective factors being boosted in our youth and also the adults understand their role in reducing the risk factors in our communities, so longevity I think is knowing that CTC will be there and help our community address the needs of our community whether they are needs of today or they are changing.
Carol Krause: I know Dr. Hawkins has a question.
Dr. Hawkins: Communities That Care has a big emphasis on data collection, on collecting information.
Is that realistic, that emphasis on data collection, and is it helpful, or is it difficult?
Hank Lunn: Thank you. I'm Hank Lunn.
I'm a member of the Data Work Force for the CTC, and over the past several years we have been looking at all of the data that has been accrued from the local schools, the state and the national statistics.
And by looking at that information we have been able to say where are the problems, and where are the risk factors in our community, and to deal with them in a more pragmatic way.
In order for us to be able to understand the data we have been collecting, many of us have gone through extensive training, and to understand what the data does say, and therefore we were able to go out into the community and help the community to understand that these statistics that we have are just not numbers.
These are real people that are involved in our problems in our area.
Therefore, the community becomes much more behind the program and we are understanding better within our organization and in the community how to deal with the problems we are facing.
And, therefore, we can use programs that are data-driven, scientifically based, and therefore we hopefully can address the issues in a very pragmatic way and not this idea that, you know, we look at sometimes statistics and so forth or programs and we say, well, that feels good.
But, that isn't what we need. It is not subjective.
We need to have data-driven, scientific-based, information.
Thank you.
Carol Krause: Thank you, and we have just time for one more question from Director Harding.
Frances Harding: One of the most difficult pieces of the plan is sustainability.
So, I was wondering if you have a plan for sustainability for — to keep the success that you have seen for the last six years.
Ken Gardener: Ms. Harding, this is Ken Gardener.
I'm a business leader in the area and also a member of the five-town Communities That Care board.
Very good question. Sustainability I think is an issue that every community has to address regardless of what the programming is.
I will say that I think it requires two parts here.
One is obviously you've got to have a community involvement.
You know, I don't care whether you are a business leader or civic leader or politician.
You know, you are in government.
It doesn't matter if you are a mama or daddy or you are young or old.
Young being me.
Thank you very much. [laughter] I don't think it really matters.
As a community you've got to come together.
You've got to get involved.
I mean, that's first and foremost.
The other piece obviously is the financial piece. You know, it takes money to run programs.
Collectively as a community coming together as a coalition, nonprofits, joining together, like-minded, you know, trying to accomplish the same thing.
That's what it requires.
So it requires work in the community. It also requires financial support.
Carol Krause: Thank you so much and by the way, I know you are on the stage of the Camden Opera House.
Is anybody there going to sing for us?
No? All right.
We need to shift gears here.
I know they have more questions, but I also know that we are running out of time and the folks in Maine have some questions for our experts.
So, Marie, who's next?
Marie Roda: Yes, we do. We have -- who would like to ask a question of our experts in Washington?
Phil Roberts: Mr. Kerlikowske, I'm Phil Roberts and I'm the Police Chief here in Camden.
We talked about some of the activities that can be done by the public to help in prevention but I'm wondering if you have some ideas about what law enforcement can do?
Director Kerlikowske: You know I think that's a great question, and after a long time in this business I know that my former colleagues now like you, understand that preventing crime is a real hallmark of a good police department, and preventing young people from going down the path of either drug abuse and abuse of alcohol, et cetera, is just critically important.
Local police officers are part of their communities.
They live in the neighborhoods, they coach, they volunteer, they do an awful lot. But, I also think besides all of the work that you do being a partner in the prevention programs and the Communities That Care.
The quick story I will tell you is that last week we announced our Methamphetamine Media Campaign in St. Louis.
We had a young man with us that's been in recovery for over five years, and he lost everything. He lost his children, when his mother was dying of cancer he wasn't able to see her.
All because he was addicted to Methamphetamine.
He made one telling statement at the press conference and he said when I was on my way to being -- to going to see his mother he said he was stopped by the police and arrested and he said that officer changed my life.
He said that the way he treated me with compassion and dignity helped me after a long downward plane for me to get the help that I needed.
Well, now he is a drug abuse counselor and he has been clean and sober for five years. It was most impressive and I hope everybody recognizes the law enforcement component and prevention. Thanks.
Carol Krause: That's a great story.
Any more questions for our experts?
Marie Roda: I think we have a young person here who would like to ask a question.
Isaiah: Hi. I'm Isaiah from Hope Elementary School, and I was wondering can science really be used to help prevent kids from using drugs and alcohol?
Carol Krause: That's for you, Dr. Volkow.
Dr. Volkow: Yes, indeed, science provides us with the facts and the knowledge about what drugs are doing to the brain and for example, through science we now know that the greatest vulnerability for substance abuse and addiction is during adolescence.
We also know that they are the effects of the drugs themselves that actually change the way that the brain develops.
And we also know that when individuals are intoxicated with alcohol, the function of the brain changes in such a way that they are much more likely to engage in risky behaviors that can increase the risks not just for addiction per se, but for criminal behavior or for other medical diseases like HIV Aids.
We also know another fact is that our kids at schools are really have a misperception of how many other kids are taking drugs and usually think there are many more that are actually doing it and that increases the risk for taking them.
And the other aspect about it is that we now know through science what prevention measures work and we clearly know that prevention of substance abuse and addiction work and it improves the outcomes of an individual's life.
But, at the end of the day, of course, it is every person's life and you want to empower them with the knowledge that is evidence-based and it is scientific about why it is not a good idea to take drugs.
Carol Krause: That was a great question.
Any more from Maine?
Marie Roda: Yes, we do.
Adam Kohlstrom: Ms. Harding, my name is Adam Kohlstrom and I'm the pastor at Chestnut Street Baptist Church right across the street from us here at the Opera House in Camden, Maine.
My question is I know how we got started here, but how can other communities get started with Prevention Programs?
What's the best strategy?
Frances Harding: The best strategy is exactly the strategy that you are using.
And using the framework of assessing a community for their needs and bringing in all of the members of the community to discuss that assessment, and helping the community to see how they can align their resources in the community to address the particular problem that you want, that you agree to address is really the best way to get people engaged.
We ask community members to come to the table wearing the hat they normally wear or hats that they wear in normal life. So we are not asking anybody to come in as experts.
We want them to come to the table as a parent, as a teacher, law enforcement, health official, member of the clergy, whichever job you are currently holding or the job of being a parent and also going to work.
To bring the talents and the expertise that you have naturally because what we are talking about is doing three things. We want to be able to look at the policies and the regulations that we have that will affect the problem that we have all decided around the table to approach.
We then want to bring in our law enforcement, our teachers, our parents that are going to enforce that new policy, that regulation or the law, and finally our ultimate goal is to create that normative change, the change to the behavior in your communities so that you not only reduce the problem that you are focusing on, but you are also, again, going to the direction of healthier and safer communities.
Carol Krause: Before we continue with the questions, thank you.
Before we continue with the questions, and we can have a few more, I wanted to say that Director Kerlikowske has been called back to the White House. This happens.
So I'm going to give him a chance to say a couple more words before we continue with the questions.
Director Kerlikowske: Good, thanks.
I can't tell you how much I appreciate NIDA and the people of Maine and everyone for this.
Seeing the success of Communities That Care and seeing the work that is being done, and the collaboration in that community and in particular, I think should give a lot of heart to a lot of people across the country.
And when the President looks at a National Drug Strategy this year or next year, you can certainly count on the fact that prevention and treatment will play a very significant role, and it has to be one that involves everyone.
So thank you so much for the opportunity.
Carol Krause: Thanks for participating.
While you are unhooking, is his mic unhooked?
We will continue with some more questions and you can go ahead and unhook him, and by the way, the White House is only a couple of blocks from here so we know he is going to make it back on time.
Any more questions now?
We can continue from Maine.
Female speaker: I am one of the local school superintendents and a five-town Communities That Care board member.
We all know that economically it is a very difficult time and finding necessary revenue sources to implement prevention programs and other community programs is a challenge.
Dr. Hawkins, can you share with us potential financial resources, communities who are interested in implementing prevention programs could access?
Dr. Hawkins: That's a very good question.
It costs about, in this trial we provided about seventy-five thousand dollars a year for communities to implement tested and effective preventative interventions, and we also provided resources for our community coordinator during the time of the trial, and that is another fifty to seventy thousand, so we are talking about one hundred twenty-five to one hundred and fifty thousand dollars a year.
Now, there are sources as Fran Harding said earlier, like the Drug-Free Communities Program, like the Strategic Prevention Framework, the CSAP and SAMHSA have made available.
There are also funds within education of various titles that can support prevention activities because as we know, those children who are falling behind academically in school are loosing their their commitment to school are at greater risk for substance abuse, and so those resources can be used to support tutoring and other academic focused programs.
One of the questions I think we need to begin to ask is can we really afford not to do prevention. We have done some preliminary estimates with regard to the findings that we have just reported today, and archives of Pediatrics and Adolescent Medicine recently.
And a very conservative estimate of the benefits to individuals and to the communities that have done Communities That Care in this trial, is that for every dollar that has been invested in Communities That Care, five dollars and thirty cents of benefit has been accrued because of less criminal behavior and less tobacco use.
This doesn't even count the alcohol use findings which haven't yet been added into this equation.
We are going to save money in terms of juvenile justice costs, criminal justice costs, incarceration costs, costs due to morbidity and mortality associated with tobacco use and the use of other drugs, if we invest in prevention in this way.
And it also means that we in our communities have to begin to think about using local resources.
Not relying exclusively on grant funded programs from the federal government or from the state, but really think about how can we reorient some of our dollars in our own community to support the Communities That Care or the Prevention Strategies in our communities that build stronger communities and that will ultimately save money through our communities in the long run.
Carol Krause: Thank you, Dr. Hawkins.
I'm told we have time for one more question from Maine for any of our three experts here.
Dalene Dutton: Well, I am very enthused about what I have been hearing in Washington and I was just wondering if there are any other plans to promote the Communities That Care system from SAMHSA or maybe CSAP or are there any plans for providing technical assistance or any funds to help other communities get started?
Carol Krause: Yes. I guess you are the one that gets to answer that, right?
Frances Harding: They are all looking at me.
Of course there are.
We truly believe and are following the research and the science that tells us that our communities are the focal point of our success of changing our country to become healthier and safe and alcohol and substance abuse-free for our youth.
And in saying that, we are continuing to offer grant opportunities for our Strategic Prevention Framework. Within that framework, it is a flexible enough funding opportunity that Communities That Care fit within.
All of our other community programs that focus on particular populations, like our HIV Aids population, for example, or older adult population.
All have this nucleus of a program of following a planning process that Communities That Care also fit in.
As far as specifically the training, we offer training through our center for the application of prevention research and technology, fondly known as our CAPRTS that do offer training regionally across the country.
On our website is the — all of the contact information you would need to find out where the CAPRTS trainings are and how you would call and apply for a particular training for your area.
Carol Krause: Thank you so much.
We have got to start wrapping things up here right now.
Dr. Hawkins, do you have any final words?
Dr. Hawkins: I just want to say two things.
One is I want to thank Dalene Dutton for the work she has done in coordinating the work of the five-town Communities That Care effort in the five towns that we've just been hearing from.
It has been exciting to see that effort and to watch that community thrive and grow well beyond the funding of the study of that coalition continues today and it is really exciting to see everyone there and it is much due to much of the work that Dalene has done.
The other thing I would like to say is that I am so happy and optimistic to see that we can now prevent problems like substance abuse and crime community-wide.
We can have population effects in prevention when we use the advances of prevention science, the knowledge about risk and protective factors and when we use tested effective programs and choose those at the community level that best meet the needs of our community, address the risk factors that need to be addressed, strengthen the protective factors that need strengthening and I'm glad that we've have had the opportunity to work with Communities That Care to develop it and I'm very happy that CSAP has made that part of what CSAP is making available to this nation.
Carol Krause: Thank you.
How about you, Frances Harding?
Frances Harding: I will jump on that and say that I, too, am pleased that we have finally gotten to the position in the field of prevention that we have the science to help guide us in making wise choices especially during this time of our watching every dollar and where it goes.
It doesn't much matter if you choose to use the Strategic Prevention Framework as your planning document, whether you use Communities That Care as your planning tool, whether you are a home grown coalition that is receiving funding from our friends at the CADCA Institute.
The issue that we are looking at and we are supporting is helping the country understand working within your community structure, working with evidence-based practices, bringing in your schools and your parents that are so very critical as well as the other partners, and doing that planning process from assessing your needs to actually evaluating your success is the message that I would leave you which I truly believe and SAMHSA is working towards really making a difference and in the normative effects of substance abuse and alcohol use across the country.
Carol Krause: Thank you.
Before we have final words from Dr. Volkow, I'd like to thank the awesome communities of Appleton, Camden, Hope, Lincolnville and Rockport, Maine.
Our guests from Washington State and Illinois, our crew at the Camden Opera House, Marie Roda and Dalene Dutton for helping to pull all of this together.
Dalene you are a real hero, thank you.
Thanks also to the crew here at the National Press Club and to the many people from NIDA's equally awesome Office of Science Policy and Communication who made this event happen.
Do we have any final words from Maine?
Marie Roda: Dalene?
Dalene Dutton: I just want to say it's been really wonderful to hear support for prevention at this level.
We know it works here and we're really glad to hear that you folks there also are supporting it.
So thank you very much.
Carol Krause: Dr. Volkow, do you have some final words?
Dr. Volkow: Yes, indeed.
I think that today we have seen, thanks to the science and the work of Dr. David Hawkins and his colleagues, that community treatment programs for prevention work.
We have objective data.
They work actually not just only reducing substance abuse, but they also work on reducing criminal behavior and delinquent behavior.
You also actually pointed out they are cost effective for every dollar that you spend you are going to save five to ten dollars in consequences.
But, actually more importantly you are going to gear the life of the a person to be successful.
I also want to thank him and also thank SAMHSA for being able to develop the tools and make them available so that communities can be empowered to actually take action into their hands and reduce substance abuse in their communities.
I, of course, also want to thank Gil Kerlikowske who has left from ONDCP and my very thanks to both of you for not just your participation in this program but for your commitment to the prevention of substance abuse in our country.
Thanks very much.
Carol Krause: Thank you, Dr. Volkow. Thanks to all for joining us today.
Todays' entire program will be available on SAMHSA's website at prevention.samhsa.gov.
Thank you.