Environmental Strategies for Youth Alcohol Abuse Prevention

Jeremy T. Goldbach, LMSW
June 8, 2011
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After participation in this workshop, participants will be able
to :
1.
Define environmental strategies
2.
Describe how to use the Strategic Prevention
Framework (SPF) to select appropriate environmental
strategies
3.
Identify environmental strategies that may be a good fit
in their own communities
 
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A significant portion of youth in the United States (age
12 to 17) have used alcohol and other drugs.
Rates of binge drinking (five or more drinks) in
underage youth is a concern, with large increases
between 7
th
 grade (1.6% of 12 and 13 year olds) and
high school graduation (34.7% of 18 to 20 year olds).
Economically, the costs of alcohol use and its related
consequences in U.S. communities add up to more
than $235 billion annually (Rehm, et al, 2009).
(NSDUH, 2009; Rehm et al. 2009) 
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Addressing alcohol abuse through only one strategy
(such as a single direct service prevention intervention
only) is less effective than taking a broader approach
that includes the larger community.
multi-component strategies promote a systemic
approach to solving issues recognizing that individuals
operate within, and are affected by, an “environment”.
(Hawley, 1950; Rousseau & House, 1994; Stokols, 1996). 
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What are Environmental Strategies?
  
Making flowers bloom?
  
Ending Wars?
  
Getting rid of pollution?
   
NO…well, not for us anyway!
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Technically speaking…
Strategies that address policies, norms, expectations,
regulations and enforcement within a shared
environment with others in a community. Such strategies
tend to: have greater reach (affecting more individuals)
and less strength (intensity per individual); (2) be longer
in duration; and (3) show more rapid results. – 
quoted from
the 2004 RAND Getting to Outcomes.
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Discuss successes you’ve
had in using environmental
strategies
Discuss barriers/struggles
in using environmental
strategies
Draft a “working definition”
of environmental strategies
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Less technically speaking:
 
Are policies and practices (customs, habits, etc) that
change the context & norms where we live and work,
and limits access to a substance, and can prevent
harmful behaviors.
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Environmental Strategies focus on the following 4 areas:
Access & Availability;
Policy & its Enforcement;
Community Norms; and
Media Messages.
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Policies/Regulations/Laws
Availability
Norms
 
Adapted from:
http://captus.samhsa.gov/southwest/resources/documents/envchangetheory.pdf
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They control availability, support norms, and specify
sanctions for violations
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Is the amount of time, energy, and money that must be
expended to obtain a substance (alcohol, tobacco,
drugs).  The more resources (harder) it takes to get the
substance the less availability (access).
  
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The rightness or wrongness,
the acceptability or
unacceptability, and/or
deviance of specific
behaviors for a specific
group of individuals
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The Strategic Prevention Framework (SPF)
SAMHSA/CSAP Supported
Based on a 
Public Health Approach
Cholera – John Snow
An 
iterative 
process designed to reduce of the negative
consequences of substance abuse problem
A 
framework 
that identifies the major needs and then
selects a strategy to target these needs
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Effective capacity building process
Required by SAMHSA and used by many others
Gives a roadmap based on research, data, and evidence
Decisions can be evaluated through data-driven
measurement
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Why do we assess?
To guide the prevention effort
To provide information about
the target population and their
corresponding substance abuse
 problem
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The “But Why Here?”
Retail Access?
Low Enforcement?
Social Access?
Perceived Risk?
Social Norms?
Alcohol Promotion?
Pricing?
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To find out what we already
have and what we need
Different types of capacity
(fiscal, physical, staff, etc)
-  So we don’t duplicate efforts
or pick much-needed but
unachievable strategies
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What kind of planning is done?
Identifying the most powerful factors (intervening
variables) contributing to the target behavior
Investigating appropriate evidence-based strategies to
match population’s needs
Planning expected outcomes (both short and long-term)
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What do we do?
Develop Action Plan for implementing the Strategic Plan
Take Fidelity of Implementation into account
Write detailed Evaluation Plan that includes process and
outcome measurements
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What do we evaluate?
The effectiveness of the selected evidence-based
program, policy, or practice (EBP)
How?
By collecting required outcome data
Recommendations made for quality improvement
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What are we sustaining, the prevention programs or the
prevention effort?
Why is cultural competence important?
How do we create prevention systems with culturally
responsive behaviors, attitudes, and practices?
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As a group, read the case study
Complete the Logic Model sections:
Problem
But Why? (Intervening variables)
But Why Here? (description)
Strategies
STOP at “Activities”
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What are the 5 types (broad categories) of Environmental
Strategies?
Policy
Enforcement
Education
Communication
Collaborations
Adapted from
http://captus.samhsa.gov/northeast/resources/prevention_materials/strengthening_families.cfm#c
ollaboration
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Examples
minimum age to buy
taxes
underage drinking laws
driving while intoxicated (DWI) laws
restrictions on advertising and billboard placement
restrictions on smoking in public places or private entities
open container laws
limits on the location, density, and hours of operation of
liquor stores
rules governing the use and placement of cigarette
vending machines
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Policies without enforcement = no change
Sobriety checkpoints
Compliance checks
Steps detailed in policy for non-compliance
Publicize laws and penalties
Increase building inspections
Post signs to notify about surveillance (in stores on
roadways, etc)
Citizen patrols
E
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Need to educate people on policies, penalties, proper
procedures
Retail seller trainings – owners, managers, cashiers. (off
premise)
Retail server trainings – bartenders, wait staff, owners.
(on premise)
Curriculum targeting entire populations.
Education also occurs under communications, see later slide.
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Social Marketing
Media Advocacy
Counter-marketing
Media Literacy
Social Norms Campaigns
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People working together professionally or casually with a
shared goal. Examples:
Businesses unite to prohibit smoking
Share resources and reduce duplication
Reclaim public spaces (parks, vacant lots, etc) by
picking up trash, planting gardens, and spending time in
the areas to discourage others
Work with schools to keep substances off school
grounds
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How do you know which type of environmental strategy is
best for your state or community?
What do you need to know to decide which is best?
Can you do just one or should you do more than just one?
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Responsible Beverage
Service
Compliance Checks
Happy Hour Restrictions
Reducing Outlet Density
Sobriety check points
Graduated drivers license
laws
Social Host Laws
Keg Registration
Restriction of alcohol
sales at public events
Increasing taxes on
Alcohol
Other Policy Changes?
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Discuss the best strategies and short, intermediate and
long-term goals related to those strategies
Report back to the group on what you’ve decided is best
for your community
D
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What is one thing your organization is doing well already,
and you’re proud to report?
What is one thing that you will take home to integrate
into your prevention planning?
Other Questions or Comments?
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   Jeremy Goldbach, LMSW
 
Associate
CSAP’s CAPT Southwest Resource Team
 
swpc@ou.edu
405-325-1454
Please complete the CAPT Evaluation Forms and
Attendance Sheets
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This workshop overview by Jeremy T. Goldbach, LMSW, on environmental strategies for preventing youth alcohol abuse delves into defining such strategies, utilizing the Strategic Prevention Framework (SPF) for selection, and identifying suitable strategies for communities. The content emphasizes the significant levels of alcohol and drug use among American youth, highlighting the alarming rates of binge drinking and the substantial economic costs associated with alcohol-related consequences. Through this workshop, participants aim to build awareness and capabilities in implementing effective environmental strategies to combat youth alcohol abuse.


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  1. Environmental Strategies Overview Jeremy T. Goldbach, LMSW June 8, 2011

  2. Learning Objectives After participation in this workshop, participants will be able to : 1. Define environmental strategies 2. Describe how to use the Strategic Prevention Framework (SPF) to select appropriate environmental strategies 3. Identify environmental strategies that may be a good fit in their own communities

  3. Whats the point?!

  4. So Why Environmental Strategies? A significant portion of youth in the United States (age 12 to 17) have used alcohol and other drugs. Rates of binge drinking (five or more drinks) in underage youth is a concern, with large increases between 7thgrade (1.6% of 12 and 13 year olds) and high school graduation (34.7% of 18 to 20 year olds). Economically, the costs of alcohol use and its related consequences in U.S. communities add up to more than $235 billion annually (Rehm, et al, 2009). (NSDUH, 2009; Rehm et al. 2009)

  5. Continued Addressing alcohol abuse through only one strategy (such as a single direct service prevention intervention only) is less effective than taking a broader approach that includes the larger community. multi-component strategies promote a systemic approach to solving issues recognizing that individuals operate within, and are affected by, an environment . (Hawley, 1950; Rousseau & House, 1994; Stokols, 1996).

  6. Breaking it Down What are Environmental Strategies? Making flowers bloom? Ending Wars? Getting rid of pollution? NO well, not for us anyway!

  7. Environmental Strategies Technically speaking Strategies that address policies, norms, expectations, regulations and enforcement within a shared environment with others in a community. Such strategies tend to: have greater reach (affecting more individuals) and less strength (intensity per individual); (2) be longer in duration; and (3) show more rapid results. quoted from the 2004 RAND Getting to Outcomes.

  8. Team Work! Discuss successes you ve had in using environmental strategies Discuss barriers/struggles in using environmental strategies Draft a working definition of environmental strategies

  9. Environmental Strategies Less technically speaking: Are policies and practices (customs, habits, etc) that change the context & norms where we live and work, and limits access to a substance, and can prevent harmful behaviors.

  10. Environmental Strategies Environmental Strategies focus on the following 4 areas: Access & Availability; Policy & its Enforcement; Community Norms; and Media Messages.

  11. Environmental Factors Policies/Regulations/Laws Availability Norms Adapted from: http://captus.samhsa.gov/southwest/resources/documents/envchangetheory.pdf

  12. Policies/Regulations/Laws They control availability, support norms, and specify sanctions for violations

  13. Availability Is the amount of time, energy, and money that must be expended to obtain a substance (alcohol, tobacco, drugs). The more resources (harder) it takes to get the substance the less availability (access).

  14. Norms The rightness or wrongness, the acceptability or unacceptability, and/or deviance of specific behaviors for a specific group of individuals

  15. But how do we know what to do? The Strategic Prevention Framework (SPF) SAMHSA/CSAP Supported Based on a Public Health Approach Cholera John Snow An iterative process designed to reduce of the negative consequences of substance abuse problem A framework that identifies the major needs and then selects a strategy to target these needs

  16. The SPF Framework Assessment Profile population needs, resources, and readiness to address needs and gaps Evaluation Capacity Monitor, evaluate, sustain, and improve or replace those that fail Mobilize and/or build capacity to address needs Sustainability & Cultural Competence Implement evidence-based prevention programs and activities Develop a Comprehensive Strategic Plan Implementation Planning

  17. Why Use the SPF? Effective capacity building process Required by SAMHSA and used by many others Gives a roadmap based on research, data, and evidence Decisions can be evaluated through data-driven measurement

  18. Step 1: Needs Assessments Why do we assess? To guide the prevention effort To provide information about the target population and their corresponding substance abuse problem

  19. Intervening Variables The But Why Here? Retail Access? Low Enforcement? Social Access? Perceived Risk? Social Norms? Alcohol Promotion? Pricing?

  20. Step 1: Outputs Milestones Products Epidemiological Workgroup forms, and begins to collect and analyze data Data Report with clear, concise data-driven problem statement Identification of target area and population Assessment of readiness and barriers to success Data sources for ongoing assessment Gap analysis

  21. Step 2: Capacity Building To find out what we already have and what we need Different types of capacity (fiscal, physical, staff, etc) - So we don t duplicate efforts or pick much-needed but unachievable strategies

  22. Step 2: Outputs Milestones Products Creation of partnerships Capacity Report with quarterly updates Directory of key stakeholders, leaders, and service providers Training and Technical Assistance (T/A) provided in targeted areas Meetings w/ key stakeholders Memorandums of Understanding (MOU) w/ stakeholders

  23. Step 3: Planning What kind of planning is done? Identifying the most powerful factors (intervening variables) contributing to the target behavior Investigating appropriate evidence-based strategies to match population s needs Planning expected outcomes (both short and long-term)

  24. Step 3: Outputs Milestones Products Writing goals, objectives, and performance targets Drafting Strategic Plan Logic Model Preliminary Action Plan Creation of Evaluation Plan Evaluation Plan

  25. Step 4: Implementation What do we do? Develop Action Plan for implementing the Strategic Plan Take Fidelity of Implementation into account Write detailed Evaluation Plan that includes process and outcome measurements

  26. Step 4: Outputs Milestones Products Developing and implementing Action Plan Action Plan Gathering information about EBIs (evidence-based interventions) Identification and selection of EBIs Creating Evaluation Plan and measures Evaluation Plan and Performance Measures

  27. Step 5: Evaluate What do we evaluate? The effectiveness of the selected evidence-based program, policy, or practice (EBP) How? By collecting required outcome data Recommendations made for quality improvement

  28. Step 5: Outputs Milestones Collaboration with Evaluation team Products Data collection and review of EBP effectiveness Recommendations for Quality Improvement Evaluation Report Quality Improvement recommendations

  29. Sustainability and Cultural Competence What are we sustaining, the prevention programs or the prevention effort? Why is cultural competence important? How do we create prevention systems with culturally responsive behaviors, attitudes, and practices?

  30. And..BREAK!

  31. Break Out! As a group, read the case study Complete the Logic Model sections: Problem But Why? (Intervening variables) But Why Here? (description) Strategies STOP at Activities

  32. Types of Environmental Strategies What are the 5 types (broad categories) of Environmental Strategies? Policy Enforcement Education Communication Collaborations Adapted from http://captus.samhsa.gov/northeast/resources/prevention_materials/strengthening_families.cfm#c ollaboration

  33. Policy Examples minimum age to buy taxes underage drinking laws driving while intoxicated (DWI) laws restrictions on advertising and billboard placement restrictions on smoking in public places or private entities open container laws limits on the location, density, and hours of operation of liquor stores rules governing the use and placement of cigarette vending machines

  34. Enforcement Policies without enforcement = no change Sobriety checkpoints Compliance checks Steps detailed in policy for non-compliance Publicize laws and penalties Increase building inspections Post signs to notify about surveillance (in stores on roadways, etc) Citizen patrols

  35. Education Need to educate people on policies, penalties, proper procedures Retail seller trainings owners, managers, cashiers. (off premise) Retail server trainings bartenders, wait staff, owners. (on premise) Curriculum targeting entire populations. Education also occurs under communications, see later slide.

  36. Communication Social Marketing Media Advocacy Counter-marketing Media Literacy Social Norms Campaigns

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