Chapter 19. Choosing and Adapting Community Interventions | Community Tool Box

• What is a promising practice or intervention?

• Where do you find out about existing promising practices or interventions?

• How do you identify a true promising practice or intervention?

• How do you choose the particular practice or intervention that's right for your community?

The West Perry Youth Initiative (WPYI) has completed a careful assessment of youth issues involving all sectors of the community. The findings were revealing: young people and other community members alike were concerned by the number of young people who brought weapons to school and by the number of violent incidents that many youth encountered. The initiative therefore identified youth violence prevention as the area it most needed to address.

So far, so good. But a problem identified is not the same as a problem solved. Everyone knows that you can't just wave a magic wand and make youth violence in the community disappear. It's a complex issue that involves young people, parents and caregivers, schools, law enforcement, community resources, community attitudes, access to weapons, and many other factors. The initiative and the community have to choose an intervention that will work.

One way to deal with this issue is to look at what other communities have done to try to prevent youth violence. But the question then becomes "How do we know that a particular model will have the effect we're looking for?" WPYI has some choices here:

• It could just do what most other communities are doing, without worrying about how well it works. (This may sound silly, but a surprising number of organizations in a variety of fields adopt this approach.)
• It could invent something from scratch. After all, there was a lot of community involvement in the assessment and planning process. Surely, if we put all those brains together, we can come up with some good ideas.
• It could look for some practices and interventions that are already being used elsewhere that seem to be successful in the ways that WPYI has in mind.

This chapter is about finding out what kinds of practices and interventions are possible, choosing what's appropriate for your purposes and your community, and adapting it to the particular needs, strengths, and character of your community and priority population. In this opening section of the chapter, we'll discuss how to tell whether a practice or intervention is one that has a chance of fulfilling your purposes.

What is a promising practice or intervention?

Promising practices and interventions are those that have the potential to effectively address the issues of concern in your community. They are usually (though not always, as we'll see) approaches that seem to have worked elsewhere, as judged by standards that make sense for your community and your issue.

What's the difference between a practice and an intervention?

A practice is a particular way of doing things. It may encompass a whole program or it may simply refer to a single method or approach. Vaccinating infants according to recommended schedules in order to provide appropriate protection against disease is an example of a practice. Another example might be using a low-barrier approach in an emergency shelter so that people experiencing homelessness can access safe shelter while staff maintain clear procedures for protecting the safety and well-being of everyone using the service.

An intervention is usually a whole program or initiative meant to achieve an overall result. In the first example above, for instance, the practice is vaccinating infants according to an appropriate schedule. The intervention used to support this practice might include outreach to parents and caregivers, convenient vaccination opportunities, reminder systems, transportation assistance, and coordination with other health care services.

In the shelter example, an intervention might include street outreach, access to safe overnight shelter, connections to permanent housing, behavioral health services, transportation, and other supports. Individual practices within that intervention would be chosen to promote both accessibility and safety.

Practices are the tools that interventions use to get the job done. Sometimes a whole intervention may also be considered a practice. An adult literacy or workforce development program, for instance, might be seen as one practice within a larger initiative addressing economic opportunity. A substance use treatment program with several components might be treated as a single practice if those components work together as an integrated model.

Untried practices and interventions

Promising practices and interventions may also be untried, but based on something solid. Sometimes, there is no model for what you want to do, or at least no satisfactory one. In that case, there are places to look for ideas.

• Theory. You may have read about a new idea, or may know an academic whose research is in the area you're concerned with. Trying out a practice or intervention grounded in theory is a way both to come up with a strategy that has a good chance of working and to test the theory as well.

• Past experience. You may have tried or seen something that worked well in a similar situation, or you may have evidence from what you've done before that certain methods are likely to work well under certain circumstances. That's a reasonable basis for action.
• Analysis of the problem, especially one that comes from a broad community discussion. If lots of people are involved in looking at the issue, including members of the priority population and the community at large, solutions are more likely to reflect real causes, community strengths, history, and cultural realities.

New practices and interventions have to start somewhere. Sometimes they start from entirely new ideas or new perceptions of an issue. You may be in a situation where that's appropriate. One caution, however: there are few ideas that are totally new. If you do have a new idea, check around and see if it or something similar has been tried before. If it has, you may be able to get some suggestions about how to make it work and how to avoid pitfalls.

Where do you find out about existing promising practices or interventions?

The discussion above, of course, brings up the question of where to look for promising practices and interventions. There are a number of possibilities, and the ideal is to use as many of them as you can. The best strategy for learning about promising practices and interventions is to find and contact directly the programs or initiatives using the practices or interventions you're interested in.

Some sources of information about promising practices and interventions:

Networking.

Talk to everyone you know. Directors and staff from other agencies, coalition members, community partners, and others may know about things happening locally, statewide, nationally, or internationally. They may be able to provide introductions, or at least information so that you can contact programs or initiatives and learn about what they're doing.

Online sources.

Online sources can provide access to research, program descriptions, evaluation reports, toolkits, databases, and examples of practices being used in other communities. Look for credible sources, consider the quality and date of the evidence, and, when possible, contact the organizations implementing practices you are interested in.

Libraries.

Public libraries are open to all. Colleges and universities may also provide community or alumni access to their collections. Much of the material referred to above may be available through libraries, and librarians can be extremely helpful in finding what you're looking for. They are skilled at identifying credible sources, locating research, and helping users navigate both print and digital information.

State and national advocacy and professional organizations.

These organizations often identify promising practices, publish journal articles, host conferences, and maintain online resource collections. You can contact the organization or explore its website to find out what's available.

International, state and federal agencies.

UNESCO, HUD, public health agencies, government departments, and other public institutions often publish promising practices, program evaluations, guidance, and examples from initiatives they fund. These resources may be available online or through agency publications.

Foundations and other private funders.

These funders may identify promising practices or describe projects they support. Many publish reports, evaluations, case studies, and project descriptions online.

Academia.

Local colleges and universities may have researchers studying the issue you're concerned with, or may know others who are. Graduate students and faculty may also be interested in working with community organizations through research projects, practicum experiences, evaluation work, or master's and doctoral projects. Start by contacting the university department most closely connected to the work you do - education, environmental science, psychology, public health, social work, urban planning, etc.

Word of mouth from the community.

Faith leaders, members of service organizations, business leaders, community organizers, and other community members may know through their networks about intervention models being used elsewhere. Members of the priority population may also know of programs or initiatives similar to the one you want to start and may be able to offer valuable perspectives on what has or has not worked.

How do you identify a true promising practice or intervention?

Once you've looked at a number of promising or "best" practices and talked to some people about their programs, how do you decide what really works, and what might work for you? First, you need to determine what the practices you've been looking at are effective for. Then, the question is what criteria do you use to identify promising practices and interventions. In other words, how do you know they actually work? Finally, what are some of the common elements of successful practices and interventions, elements that you can incorporate into whatever you decide to do?

Best practice for what?

Particular promising practices may or may not be relevant to your goals. Some organizations, agencies, or government departments identify practices according to how effectively they address a specific problem or condition. For example, a practice addressing child maltreatment might focus on identifying immediate safety concerns, protecting children from further harm, and responding appropriately when maltreatment occurs. These responses are essential, but by themselves they may not address all of the conditions that contribute to the problem.

Another type of promising practice focuses on prevention. In the case of child maltreatment, a preventive intervention might combine effective responses to current harm with family supports, accessible behavioral and mental health services, parenting resources, economic and social supports, community education, and other strategies that strengthen protective factors for children and families.

Finally, some promising practices focus on promoting positive behaviors, relationships, or community conditions. These approaches build strengths rather than focusing only on stopping harmful outcomes. For example, sexual health initiatives may promote consent, healthy relationships, condom use, STI prevention, and safer sexual practices. Similarly, many health initiatives emphasize creating conditions that support physical activity, nutritious food, stress management, social connection, and access to preventive care.

As you look for promising practices, be clear about what kind of approach you're interested in and have the resources to support. Are you addressing an immediate problem or condition? Are you focusing on prevention by addressing contributing factors before harm occurs? Or are you promoting strengths, protective factors, and conditions that support well-being? Many effective interventions combine elements of all three.

There's another element to the question of what a promising practice is meant to do: what is the real problem or issue that your community needs to address?

Criteria for identifying promising practices and interventions

There are essentially two ways you can look at a practice or intervention: quantitatively and qualitatively.

The quantitative view uses numbers to analyze and understand the impact of particular practices or interventions on participants and communities. These numbers may be used in simple or complex ways. They could state the number of people served, the number who accomplished something specific, or changes in community-level outcomes. They can also be used in statistical analysis to draw more complex conclusions about the effects of a program.

Even simple numbers can provide useful information about how well a practice or intervention is working, but numbers should be interpreted carefully. Growth in participation may indicate that a program is valued and accessible, but participation alone does not prove that the program is accomplishing its goals.

Quantitative analysis can provide an important indication of whether change has occurred as a result of a program. It is often what public funders and public officials request as evidence of effectiveness. At the same time, quantitative analysis by itself may not explain why an intervention succeeds, why people participate or leave, or how participants experience the program.

Qualitative analysis looks at what actually happens when a particular practice or intervention is used. It may include interviews, observations, stories, focus groups, participant feedback, case studies, photographs, or detailed analysis of trends and experiences over time.

The quantitative analysis of the program may show that there are fewer violent incidents and that more young people are participating in programs that build skills for preventing and resolving conflict. The qualitative analysis may show that broader changes are taking place in relationships, attitudes, trust, and the overall climate of the community. Using both quantitative and qualitative data can provide a more complete picture of whether and how the program is working.

The lesson here is that the combination of quantitative and qualitative analysis is what's likely to give you the best picture of reality and make it possible to identify a promising practice or intervention. That's not the end of the lesson, however. Let's go back to that program that seems to serve a small number of people extremely well. What can we learn from that example?

If we make the standards for a "best practice" too strict, we're apt to reject some possibilities that may have potential. Remember, things work differently in different places and in different circumstances. If your standards are "nothing but the Mercedes," you'll never buy that Subaru that can get you home in the snow while your Mercedes is spinning its wheels in the parking lot.

When you look for promising practices and interventions, start by casting a wide net. Something that works only adequately in another community may work extremely well in yours with thoughtful adaptation. By the same token, something that works well someplace else may not be appropriate for you.

Another element of your search should be finding out what didn't work. You may have a terrific idea with a hidden flaw that has already been discovered elsewhere. Or there may have been an attempt to do something similar in your community before, with poor results because the approach did not fit local circumstances, culture, or priorities. Knowing your history can save you vast amounts of time, energy, and frustration. It's one of the most important criteria for assessing promising practices and interventions.

General characteristics of a successful program

One way to approach the search for promising practices and interventions is to look at the general elements of programs that seem to work. Lisbeth Schorr, in her book Common Purpose: Strengthening Families and Neighborhoods to Rebuild America (New York: Anchor Books, Doubleday, 1997), discusses what works in improving outcomes specifically for children and families. She identifies "Seven Attributes of Highly Effective Programs":

• Successful programs are comprehensive, flexible, responsive, and persevering. They address many aspects of an issue rather than a single one; they can, and do, change according to the needs and strengths of participants and the community; and they remain committed for as long as it takes to accomplish their purpose.
• Successful programs see children in the context of families. Children don't exist in a vacuum, and understanding their families, caregivers, relationships, and environments can be important to understanding their experiences and supporting positive outcomes.
• Successful programs understand families as parts of neighborhoods and communities. Families don't exist in a vacuum, either. Effective interventions consider the community conditions that affect families, draw on local strengths and knowledge, include people with community connections among staff and leadership, and help strengthen local leadership and capacity.
• Successful programs have a long-term preventive orientation, a clear mission, and continue to evolve over time. Successful programs address underlying causes rather than only responding to immediate symptoms, and realize that meaningful change may take years. They know what they're trying to accomplish, while remaining flexible about how they pursue that mission as new information, community priorities, and participant experiences emerge.

As Thomas Peters and Robert Waterman pointed out in In Search of Excellence, the key here is to be tight about your mission, but loose about how to achieve it. The mission itself - what you aim to accomplish in the long run - is non-negotiable. How you go about accomplishing it, however, should be flexible and responsive to the realities of the situation. It may change continually in response to new information, changes in the community, and the experiences of participants.

• Successful programs are managed by effective and committed individuals with clearly identifiable skills. Schorr identifies some of those skills as willingness to experiment and take risks, tolerate ambiguity, seek evidence of results, collaborate, and allow staff appropriate discretion.

Other skills that must be added here are the practical managerial skills that assure that bills are paid, that there's a reasonable budget in place and that it isn't exceeded, that funders receive the reports and other information they require, and that staff issues are dealt with quickly, fairly, and well. No matter how collaborative and community-based an organization is, someone still has to keep the organization functioning.

• Staffs of successful programs are trained and supported to provide high quality, responsive service. Just as participants and communities have to be considered in context, so do staff members of organizations. They need an organizational climate that supports their work and values ongoing learning and professional development.
• Successful programs operate in settings that encourage practitioners to build strong relationships based on mutual trust and respect. Strong programs treat participants with dignity, recognize their knowledge and lived experience, and avoid relationships that position staff as inherently more important or knowledgeable. Current and potential participants should feel welcomed, respected, and included as partners in the work.

In addition to Schorr's seven attributes, there are two more that might be added:

• Successful programs are collaborative both internally and externally. Internal collaboration refers to the inclusion of both staff and participants in the planning, implementation, and decision-making of the program. External collaboration means involving a broad range of agencies, officials, schools, community organizations, and others connected to the issue. This can make it easier to coordinate services and address the issue from multiple angles.
• Successful programs and their staffs generally have, both institutionally and individually, a set of relationships and core values that strengthen their sense of shared purpose, and give them confidence that disappointments and setbacks can be overcome. These values often manifest themselves as a passion for the work and for social justice, and translate into relationships with participants that support personal development, agency, and leadership.

All of these nine attributes might apply to a program of any sort: how do they help you sort out promising practices for what you want to accomplish? In fact, these general characteristics are some of the promising practices you need to pay the most attention to. They provide an overall structure for a program that works. How you decide to approach your specific issue should depend on the priorities and strengths of your community, what the priority population identifies as useful and appropriate, a participatory planning process, the talents and skills of your staff, and the resources available.

The nine attributes here paint a picture of a program that is responsive, flexible, equitable, collaborative, well-managed, effective, aware of context, supportive of staff members and their development, and committed for the long term to a clear mission. If you can adopt these general characteristics, the chances are your intervention will do well. To make it the best it can be, it's necessary to find - or create or adapt - the specific practices and/or interventions that are right for your community.

How do you choose the particular practice or intervention that's right for your community?

All of these steps assume community involvement, ideally in both planning and implementing an intervention.

• Conduct a community-based assessment and planning process to be sure that you're addressing the issues that are most appropriate and pressing for the community. If your intervention is to work, it has to address the real issues and priorities identified by the community. An assets and needs assessment and planning process will help you identify those issues and think about how to approach them most effectively.
• Decide whether you'll address the issue directly, or whether you'll try to change the conditions that contribute to it. It may be that working on underlying causes will be more successful than addressing the issue only at the individual level; and that could mean a totally different kind of intervention.
• Find (or create, if that's necessary) practices or interventions that have successfully addressed the issue in the way you want to address it. It's important to realize that not every successful program is successful in the way that you're interested in. If your focus is community empowerment, for instance, a highly centralized program that provides few opportunities for community participation may not be what you're looking for. If you want to address root causes, a program that focuses only on immediate symptoms may not be a good fit. Make sure that a practice or intervention matches both your immediate goals and the principles behind them.
• Determine what elements of a promising intervention will work in your community, and which ones need to be changed. In other words, adapt the intervention, or parts of it, so that it fits your community's needs, strengths, culture, and circumstances. Not all the pieces of an urban program will work in a rural area, for instance, where transportation, childcare, access to services, geography, and everyday life may be very different. The community and the priority population should have meaningful opportunities to shape an adopted practice or intervention and make it work for them. If no two communities are exactly alike, interventions may also need to look different while preserving the core elements that make them effective.

Everett Rogers, in his book Diffusion of Innovations (New York: Free Press, 1995), writes of the concept of "reinvention." Individuals and organizations, when adopting a new practice or idea, often make it their own by changing it - sometimes slightly, sometimes substantially - to meet their particular needs. These "reinvented" innovations may work better and be more likely to be sustained because they are better adapted to local circumstances and because the people using them have helped shape them.

• Implement the intervention, making adjustments as you go along. It's probably helpful to start out with the expectation that you'll have to make changes as you learn more about the fit between the practices you've adopted or created and the priority population. That attitude will make it easier to make those changes, and thus to become more effective over time.
• Evaluate your work and results regularly, understanding that no matter how well any intervention works, it can always be improved. It's important to examine your work and outcomes continually, whether formally or informally, so that you'll have more than intuition to tell you whether you're achieving your goals or not. It's perhaps even more important to keep the idea of a dynamic program always before you, so that no matter how well you're doing, you'll still be willing to try something new if it looks promising.

In the rest of this part of the section, we'll concentrate on finding and choosing the appropriate practice and intervention for your community.

Difficulties in finding practices or interventions you can use:

One possibility, of course, is finding the best program around and simply copying it exactly in your community. That should be fairly simple to do, shouldn't it? Actually, no... it's not. Copying - replication is the term that's most often used - doesn't always work well. Lisbeth Schorr, again, has some ideas on this subject:

• Excellent programs often don't travel well. You may know that some fine wines can't be sold far from where they're made, because the shaking they go through when they're being shipped changes their character. Community interventions can change character when they're transported, too.
  • You can't necessarily take something that works in one community and expect it to work the same way in another, entirely different, community. An intervention's success depends on the needs, strengths, culture, and circumstances of its community. A successful intervention from elsewhere may need to be adapted to fit a new setting.
  • Even where an intervention was tremendously effective, people may not be able to tell you exactly what they did. Some programs keep careful records of nearly everything; others keep almost none. Some programs are based on clear theoretical and philosophical foundations; others "just grew" out of their founders' experience and intuition. So you may not be able to replicate a program exactly simply because no one can tell you what "exactly" is.
  • A successful intervention - especially one which is hard to describe - may depend largely on the talents, relationships, or experience of a particular individual or small group. Sometimes, such a program can't be reproduced exactly because those relationships and local circumstances are unique.
• Even if you can replicate it exactly, you can't expect people to accept and embrace a program if it's imposed upon them from above. They should have meaningful opportunities to participate in its planning, adaptation, and, where possible, implementation in order to develop shared ownership.
• No intervention or practice that involves people - either staff or participants - is perfect. People, organizations, and communities change over time, so even a strong program will probably need to adapt as circumstances, priorities, and participants change.

A successful adult literacy program found itself adapting continually as the circumstances and goals of its learners changed. Changes in the local economy, housing and employment conditions, immigration policy, community resources, and other factors affected who participated in the program. At different times, participants included young people who had left school before graduating, adults seeking employment, people with substance use disorders, people learning English, and survivors of domestic violence. Different participants brought different strengths, goals, experiences, and support needs. Staff members continually adjusted their educational methods, services, and relationships with learners in response.

• The difference between a successful and an unsuccessful intervention can be subtle. It may be as simple as the way a participant is greeted the first time they walk through the door, whether the space is welcoming and accessible, or whether people feel respected and included. Often, the subtleties aren't even part of the formal intervention itself. Small shifts in the economic climate, transportation access, public assistance requirements, or other conditions can affect participation in ways that may not be immediately obvious. As a result, replicating a successful program may be more complicated than it looks, no matter how well documented the program and its practices are.
• If you can't replicate an intervention's resources as well as its practices, you're probably headed for trouble. Programs that are asked to reproduce successful models with substantially fewer staff, funding, facilities, or other resources may have difficulty achieving the same results. Successful adaptation requires realistic expectations about the resources needed to support quality implementation.

Keys to success in replication

Just as there are difficulties in replicating successful programs, there are also some factors that will help replication work. They depend largely on characteristics of the original intervention (the first six of these are also from the work of Lisbeth Schorr):

• Ideas that are sound and well-developed through experience. Interventions that are solid, evidence-informed, and based on well-tested concepts are more likely to transfer successfully to other settings.
• Ideas that can be taught and can inspire local leadership. The ideas behind the intervention need to be understandable and practical, while also giving community members and organizations meaningful opportunities to shape, lead, and sustain the work.
• A sense of mission, of belonging to something larger. The program has to carry a vision that transcends the immediate project and connects people with a greater purpose. This goes back to the sense of passion for the work and for social justice mentioned earlier. A program may be easier to sustain when people see how their work contributes to larger community goals.
• Access to people who have successfully implemented the program. As emphasized from the beginning of this section, the best way to find out about a program is to consult the people who are actually carrying it out. They can give you the details that no one else can and help you understand the relational and contextual elements that may affect success.
• Supportive and thoughtful consultation. This consultation might come from colleagues in other organizations; funding organizations; members of the community and priority population; people with lived experience; or a consultant with relevant expertise.
• Technical assistance that recognizes there are new things to be discovered.
• Local involvement in initial planning for, finding and choosing, adapting, and implementing the intervention. This will help to develop local ownership, leadership, and stewardship of the intervention.
• Awareness on the part of funders that trying to replicate a program that's been successful elsewhere doesn't guarantee immediate success. Even strong models need time to be adapted to local conditions, cultures, and community priorities. Funders can support success by allowing organizations time to build relationships, learn, adapt, and improve.
• Adequate resources - people, money, supplies, and time - to achieve your goals. Match the scope of your intervention to the resources you actually have.

Elements of successful replications of effective programs

Just as there are factors in the programs themselves, there are also elements in the replication process that lead to successful replication. Some elements of successful replications:

• They combine the replication of the essence of a successful intervention with the adaptation of many of its components to a new setting or population. Every program needs to be adapted to its community, its specific priority population, the skills and concerns of staff members, local culture, available resources, and other conditions.
• They have had the continuous backing of an intermediary organization. This might be a local coalition, a grassroots group, a particular agency - some entity that could offer expertise, mobilize support, lend legitimacy and influence, and connect the intervention with appropriate local networks.
• They recognize the importance of systems and institutional context. They seek settings where the intervention is welcomed and where there is real commitment to its success.
• They recognize the importance of people. They understand that participants, community members, staff, and partners need to see value in the intervention and have meaningful opportunities to contribute to its success.
• They judge success by the outcomes for individuals and communities. What actually happens - whether participants meet their goals, whether community conditions improve, and whether the changes people hoped for occur - is the standard for whether these interventions consider themselves effective.
• They tackle, directly and strategically, the obstacles to large-scale change. Successful interventions look beyond the immediate issue to underlying causes and community conditions. Part of a successful youth violence prevention program, for instance, might focus on strengthening supportive relationships, creating safe opportunities for young people, supporting family and caregiver involvement, addressing access to weapons, improving community conditions, and developing effective responses to violence.

In Summary

Choosing a promising practice or intervention for your purposes may not be a simple matter. What works in another community may not work in yours, and it may be difficult to determine exactly how a particular successful intervention operates or which parts of it are essential.

There are, however, some general elements that good programs seem to have in common:

• Responsiveness
• Flexibility
• An equitable philosophy
• Commitment to collaboration
• Good management
• Effectiveness
• Awareness of the context of the issue and the priority population
• Commitment for the long term to a clear mission

In addition to these general characteristics, there are some factors that identify successful replications. They include the adaptation of program features to local needs, strengths, and cultures; backing by an intermediary organization; an understanding of the importance of community and human context; judging success by individual and community outcomes; adequate resources; meaningful community participation; and a focus on root causes.

The process of choosing may be difficult, but it doesn't have to be a guessing game. If you follow the guidelines in this section, examine the available evidence, and listen to community members - especially people most directly affected by the issue - you can choose and adapt practices that support meaningful and lasting community change.

What is a promising practice or intervention?

___You know that a practice is a particular way of doing things.

___You know that an intervention is usually a whole program or initiative meant to achieve an overall result.

___You use theory, past experience, and/or analysis of the problem to help you create or judge untried practices and interventions.

Where do you find out about existing promising practices or interventions?

You use these sources to find out about existing promising practices or interventions:

___Networking.

___State and national advocacy and professional organizations.

___International, state and federal agencies.

___Foundations and other private funders.

___Academia.

___Libraries.

___The Internet.

___Word of mouth from the community.

How do you identify a true promising practice or intervention?

___You have decided whether you're searching for a best practice for treatment, prevention, or promotion.

___You know how to use both quantitative and qualitative data to judge promising practices and interventions.

You recognize the attributes of successful programs:

___Successful programs are comprehensive, flexible, responsive, and persevering.

___Successful programs see children in the context of families, and families as parts of neighborhoods and communities - in other words, they consider their work in context.

___Successful programs have a long-term preventive orientation, a clear mission, and continue to evolve over time.

___Successful programs are managed by competent and committed individuals with clearly identifiable skills.

___Staffs of successful programs are trained and supported to provide high quality, responsive service.

___Successful programs operate in settings that encourage practitioners to build strong relationships based on mutual trust and respect.

___Successful programs are collaborative both internally and externally.

___Successful programs and their staffs generally have, both institutionally and individually, a set of relationships and core values that strengthen their sense of shared purpose, and give them faith that disappointments and setbacks can be overcome.

How do you choose the practice or intervention that's right for your community?

You follow the basic steps to choosing a promising practice or intervention:

___You conduct a community-based assessment and planning process to be sure that you're addressing the issues that are most appropriate and pressing for the community.

___You decide whether you'll address the issue directly, or whether you'll try to change the conditions that make it possible.

___You find (or create, if that's necessary) practices or interventions that have successfully addressed the issue in the way you want to address it.

___You determine what elements of a promising intervention will work in your community, and which ones need to be changed.

___You implement the intervention, making adjustments as you go along.

___You evaluate your work and results regularly, understanding that no matter how well any intervention works, it can always be improved.

You pay attention to the difficulties in finding practices or interventions you can use:

___Excellent programs often don't travel well.

___You can't expect people to accept and embrace a program if it's imposed upon them from above.

___No intervention or practice that involves people - either staff or participants - is perfect.

___The difference between a successful and an unsuccessful intervention can be subtle.

___If you can't replicate an intervention's resources as well as its practices, you're probably headed for trouble.

You try to assure successful replication by:

___Choosing a program based on ideas that are sound and well-developed through experience.

___Choosing a program based on ideas that can be taught and can inspire local leadership.

___Choosing a program that conveys a sense of mission, of belonging to something larger.

___Making sure you have access to people who have successfully implemented the program.

___Making sure you have supportive and wise consultation.

___Making sure you have technical assistance that recognizes there are new things to be discovered.

___Including local involvement in initial planning for, finding and choosing, and implementing the intervention.

___Making sure funders know that trying to replicate a program that's been successful elsewhere doesn't guarantee success overnight, or even at all.

___Matching your goals to your available resources.

You structure the replication process for success by:

___Combining the replication of the essence of a successful intervention with the adaptation of many of its components to a new setting or population.

___Obtaining the continuous backing of an intermediary organization.

___Recognizing the importance of the systems and institutional context.

___Recognizing the importance of people.

___Judging success by the outcomes for individuals and communities.

___You tackle, directly and strategically, the obstacles to large-scale change.

Tool: A Self-Assessment to Help You Find and Choose Promising Practices

Starting the search

Answering these questions will help start your search for the best promising practice for your community.

• What is the broad area of interest (e.g., health promotion, independent living )?
• What specific problem are you working on (e.g., substance use, obesity)?
• What population will benefit from your effort (e.g., Hispanics, youth, rural groups)
• What type of intervention or community change (i.e., change in program, policy, or practice) are you seeking? Is it listed in your strategic plan?
• In what sector of the community will this take place (e.g., business, youth groups, churches)?
• Are you interested in a targeting an intervention at a high-risk group or a comprehensive approach, or both?

Choosing your approach

Answering these questions will help you choose the best promising practice for your community.

• Does the promising practice meet all of the criteria set by your search?
• Some programs can be complicated, which means an organization that can support the effort is needed. Are there organizations in your community that can support the effort? If not, can you create such an organization?
• What is the evidence that the promising practice will have some impact?
• Will you be able to replicate the practice? If not, how will you modify it for your community?
• What resources do you have or will you be able to generate to support the practice? Will a pared back version satisfy your needs?
• Is the practice compatible with your community's beliefs, attitudes and values (e.g., will your community support condom distribution)?
• Have you looked at different versions of the practice in the examples and stories provided in the Community Tool Box or in other resources? Have you contacted others who have implemented the practice?
• How will this promising practice work for you? What would make it a success for your community?

A PowerPoint presentation summarizing the major points in the section.

Have you ever wondered why some people in our communities have better outcomes than others? Why some children do well in school while other children - equally capable - face greater barriers? Why people in the same community may experience unequal health outcomes? Have you wanted to help change these outcomes?

There are many different and interrelated causes of problems and desired outcomes. If your organization can understand these causes, it can focus its intervention to better contribute to community improvement. This can help your organization and community work toward the conditions and outcomes you envision.

So, where do you begin in trying to make these changes? We believe one very good way to go about it is to consider the risk and protective factors that may contribute to a particular problem or desired outcome.

What are risk and protective factors? They are aspects of a person, group, environment, or life experience that make it more likely (risk factors) or less likely (protective factors) that people will experience a given problem or achieve a desired outcome. For example, smoking is a risk factor for cardiovascular disease. Regular physical activity can be a protective factor for cardiovascular health.

Risk and protective factors are key to figuring out how to address community health and development issues. It's a matter of taking a step back from the problem, looking at the behaviors, experiences, systems, and conditions that contribute to it, and then figuring out how those conditions can be changed or strengthened.

For example, in an effort to prevent harmful substance use, an approach that uses risk and protective factors to direct interventions might increase young people's access to positive activities, supportive adults and peers, accurate information, coping and decision-making skills, and environments that support healthy choices.

We suggest that you consider risk and protective factors as one of your early steps when you are writing or revising the strategic plan for your initiative.

In this section, you will learn more about risk and protective factors and their role in identifying the changes in your community that your organization wants to make. Specifically, we are going to look at:

• A more in-depth understanding of risk and protective factors
• When to look at the risk and protective factors for the issue that's important to you
• How to identify the specific risk and protective factors for your focus area
• How these factors can help your organization identify the people and communities who may benefit most and select strategies for making a difference

Ready? Then let's dive in!

What are risk and protective factors?

As we said above, risk and protective factors are aspects of a person or group, their environment, and their life experiences that make it more likely (risk factors) or less likely (protective factors) that people will develop a given problem or achieve a desired outcome. Risk factors increase likelihood; they do not determine what will happen to a particular person or community.

Often, risk and protective factors can be considered flip sides of the same coin. For example, a family history of alcohol use disorder may be a risk factor for developing problems related to alcohol. On the other hand, growing up in a family where parents and caregivers talk openly about alcohol, model healthy choices, and provide consistent support may be protective. Research suggests that the accumulation of risk factors can increase the likelihood of adverse outcomes in health, education, and development.

Another term used for protective factors is "assets." So-called "asset-based" approaches put the emphasis on strengths and resources that support positive outcomes. These assets may exist within individuals, families, organizations, neighborhoods, cultures, or broader community systems.

We generally group both risk and protective factors into two broad categories: those that occur in the environment, both socially and physically, and those that relate to individual characteristics and experiences. These categories interact with one another and should not be considered in isolation. Let's look at personal factors first.

Personal Factors

Personal factors are characteristics, knowledge, experiences, skills, and circumstances that differ among individuals. They include an individual's knowledge, skills, experience, history, health, and genetic makeup. Here is more specific information on the types of personal factors that may contribute to risk and protection:

Knowledge and Skill:

• Knowledge, including knowledge about available choices, possible consequences, and available resources
• Beliefs, such as ideas about the causes of problems or the consequences of choices
• Skills, including being able to navigate one's environment, communicate, make decisions, and set and accomplish goals
• Education and training, such as formal education, community-based learning, or specialized training

Experience and History

• Experience, such as experiences of care and support, maltreatment or neglect, overcoming barriers, or successfully attaining goals
• Cultural norms and practices, including values, traditions, and expectations that may influence behavior and well-being
• Social and structural position, including experiences of discrimination, exclusion, privilege, or access to opportunity

Biology/genetics

• Existing health, including current health status and health conditions
• Cognitive, mental health, and physical functioning, including disability-related factors and access needs
• Chronic health conditions, including needs for ongoing care, accommodations, or other supports
• Age and sex or gender, when these are relevant to the particular health or development issue
• Genetic predisposition or family history, such as a family history of diabetes, cardiovascular disease, or alcohol use disorder

Environmental Factors

Environmental factors are conditions that affect people within a community rather than being unique to one individual. The environment includes the conditions in which people live, learn, work, play, and interact - their households, neighborhoods, schools, workplaces, and larger communities. These may include aspects of the social environment, including relationships, social support, norms, policies, and community connections. They also include aspects of the physical environment, including access to resources, exposure to hazards, transportation, housing, and other living conditions. Environmental factors fall into the following categories:

Support and services

• Availability and continuity of social support and relationships, such as with family, friends, neighbors, mentors, and others
• Availability of appropriate services, including services that are accessible, responsive, and appropriate to community needs
• Availability of resources, including human, organizational, financial, and material resources

Access, barriers, and opportunities

• Physical access and barriers, including distance, transportation, accessibility, and physical access to services
• Communication access and barriers, including language access, interpreters, translation, accessible communication formats, and technology
• Competing requirements for participation, including work, caregiving, school, transportation, or other responsibilities that can make participation difficult

Consequences of efforts

• Social encouragement and discouragement, such as whether family, peers, institutions, or community norms support particular behaviors
• Incentives and disincentives, including monetary and material gain or loss and access to desired benefits
• Time costs and delays, including the time and effort required to take action, meet needs, and access services

Policies and living conditions

• Policies, such as those affecting access to benefits, enforcement of laws, workplace conditions, and eligibility for services
• Financial barriers and resources, including whether people have sufficient resources for needed goods and services and how resources are distributed
• Exposure to hazards, including toxic chemicals, air pollution, unsafe environments, or other environmental risks
• Living conditions, such as the availability and quality of housing, food, clothing, heating and cooling, transportation, and clean drinking water
• Economic hardship and inequities in resources and opportunity, including difficulty meeting basic needs and unequal access to income, services, and other resources

General principles about risk and protective factors

Before going further, let's look briefly at some general principles about risk and protective factors. These apply across risk and protective factors and across personal, social, physical, and environmental conditions. Research has consistently shown us that:

• Many risk and protective factors are related to multiple community outcomes. That is, they may influence more than one community health and development concern. As such, they can give you a useful place to start in developing your own lists of risk and protective factors. For example, economic hardship and limited access to resources can affect health care access, educational opportunities, nutrition, housing, and other outcomes. On the other hand, a young person having a strong relationship with a caring adult can be an important protective factor across a number of health and development outcomes.

• Not all risk and protective factors are equally influential. Some factors may have a stronger relationship with a particular outcome than others. For example, peer substance use may be an important factor to consider in adolescent substance use prevention. It's important to consider the relative importance of each risk and protective factor because this will help you prioritize your actions later on.
• Risk and protective factors can accumulate and interact. Greater exposure to multiple risk factors may increase the likelihood of an adverse outcome, while multiple protective factors and assets may help support positive outcomes. For example, cardiovascular risk may be influenced by the combination of tobacco use, physical inactivity, blood pressure, cholesterol, nutrition, health care access, and other factors rather than by any single factor alone.

When do you want to learn about the risk and protective factors for your issue?

So, you believe risk and protective factors are important, but are unsure when your initiative should address them. The answer depends in great part on the stage of development of your group - how long you've been around, what you are doing now, your resources, and so on.

Generally speaking, the rule is the earlier, the better. If your organization is already up and running, you might want to look at risk and protective factors before you revise the strategic plan for your initiative. That's something you will probably want to review regularly as conditions, priorities, and available information change.

If you are planning a new initiative or if your organization is starting a new program - perhaps your Youth Coalition recently received a grant to reduce adolescent pregnancy - then the time to start is after you have developed your long-term goals, but before you've developed the road map, or "model of change," that will get you to them.

If your organization is using the "VMOSA" (Vision, Mission, Objectives, Strategies, and Action Plan) approach to planning, you will want to look at risk and protective factors after you've developed your vision and mission, but before you get to the more specific goals outlined in the objectives, and definitely before you develop your strategies. This is because risk and protective factors will sometimes influence your objectives, but they generally fit hand in glove with your strategies, as well as the desired community and system changes that implement those strategies. Let's look at a specific example.

This is the point at which the coalition may want to study risk and protective factors. The LVHCC found that strong relationships with parents, caregivers, and other supportive adults were protective factors for child health and development, while school disengagement was associated with poorer outcomes. Further study suggested that some students faced barriers such as limited academic support, language-access needs, and insufficient culturally and linguistically responsive resources. Altogether, the coalition identified a range of risk and protective factors for child health and well-being. These findings led the coalition to develop a number of objectives and strategies, including the examples below.

• Two of our several objectives are: 1) Within two years, increase meaningful parent, caregiver, and adult interaction with children under 2 years of age by 40%; and 2) Within four years, increase the percentage of young people graduating from high school by 25%.

Remember: Your objectives are specific, measurable results of the work done by your organization. They include the practical details, including how much of what will be accomplished by when.

• Two of our strategies for supporting children and young people in school include: 1) Involving caring adults in talking with or reading to young children; and 2) Increasing the number of bilingual or multilingual teachers and other language-access supports in area schools.

Remember: Your strategies explain how you are going to achieve your goals; they are broad ways to address the mission. Most organizations use multiple and complementary strategies, for example providing information and enhancing skills, improving access and reducing barriers, strengthening services and supports, and changing policies or environmental conditions.

How do you identify risk and protective factors and use them to select people, communities, and strategies for your intervention?

Once you have an understanding of risk and protective factors, as well as when you should include them in your planning, the time is right to identify the particular risk and protective factors that your organization will address. The following few pages offer one possible way to go about doing this.

Review data and information about candidate risk and protective factors for the issue your community is facing.

You can do this by either gathering data that is already available or compiling your own if what you need doesn't seem to have been collected. And of course, you can also combine these two options by using the general data that already exist and supplementing them with information gathered by your organization and community partners.

Let's look briefly at both of these options - gathering and compiling data - and how you might go about each of them.

Gathering available data.

If information is already available, use it. Data on risk and protective factors may already be available for many of the issues of importance to your community. This includes topics such as substance use, cardiovascular diseases, adolescent pregnancy, child maltreatment, access to health care, school success, and a host of other community problems or goals.

To find this information, you can start with ideas given in this section for both general and issue-specific risk and protective factors. From there, you can search credible online sources, check your local library, or contact state agencies, local health or education departments, community organizations, or universities.

If you already know the risk and protective factors for the problem or goal you are working on, you're halfway home. The next step is to find current, reliable data to understand which risk and protective factors are most important in your community and how local conditions compare with appropriate benchmarks.

Historical example: Percentage of Kansans with selected risk factors for cardiovascular diseases

The table below is retained as a historical example of how state and national data can be compared. For current planning, use the most recent reliable data available.

	Kansas	National
Physical Inactivity	50%	56%
Obesity	26%	24%
Smoking	22%	23%
Hypertension	21%	21%
High Cholesterol	18%	18%

Source: 1992 Behavior Risk Factor Surveillance System, Kansas Department of Health and Environment

Developing your own information.

Sometimes, however, there just isn't information available on the topic that you are researching. Or, you might have general information on risk and protective factors, but also want to know which specific factors are important in your community, how people experience them, or the extent to which they exist locally. Then, you'll need to use other methods to develop the information you need. Although they are discussed more fully in other sections of the Community Tool Box, let's touch here briefly on several possibilities.

• The "But why?" technique. This is a method often used to identify underlying factors that contribute to a community issue. The "But why?" technique examines a problem by asking what caused it. Each time an answer is given, a follow-up "But why?" is asked. For example:

From the brainstorming done here, you might identify factors such as competing work and caregiving responsibilities, limited access to affordable childcare, and the need for more flexible educational or family supports. This technique is especially useful early on for developing possibilities that can then be explored through conversations with people affected, focus groups, surveys, or existing data.

Focus groups

Focus groups can also give you a better understanding of the issue. They are small-group discussions designed to gather participants' experiences, perspectives, and ideas. Depending on the purpose, a focus group may bring together people who share certain experiences or characteristics when doing so helps participants feel comfortable speaking openly. The composition of the group should be based on the questions you are asking rather than assumptions about who will or will not feel comfortable together.

One advantage of focus groups is that they can provide context, lived experience, and a deeper understanding of how people feel about an issue. Although a survey can provide systematic information about patterns across a larger group, focus groups can help explain what those patterns mean to community members and why they may exist.

Surveys

If you have the resources and would like to make your results more systematic, you can conduct a survey to find out which risk and protective factors are important in your community. It's possible that you will want to test some of the information you found using the "But why?" technique, compare local information with broader data, or develop or adapt a survey to address these topics.

Select risk and protective factors to be addressed by your comprehensive intervention.

Now that you have determined what the likely risk and protective factors for your issue are, the next step is to decide to what extent each of these factors should influence your strategic plan. There may be some factors on which you want to spend a great deal of time and resources, and others that you may not want to address directly, at least at the beginning. Two key questions can help you sort out how much weight you want to give to each risk and protective factor:

• Does it strongly influence the issue? Is a given risk or protective factor strongly associated with the outcome you hope to change, or is the relationship weaker? For example, peer substance use may be an important factor to consider in adolescent substance use prevention. The relative importance of a risk or protective factor can often be explored through existing research, local data, community experience, surveys, and other forms of evidence.
• How changeable is it? Most factors fall into one of three broad categories, or "degrees of changeability":
  • Some risk and protective factors can be changed substantially. For example, high cholesterol may often be improved through changes in nutrition and physical activity and, when appropriate, medication and clinical care.
  • Some risk and protective factors may be modified but not completely eliminated. An example might be access to alcohol or other substances among young people. Communities may be able to reduce access through policy, enforcement, retailer practices, education, family engagement, and other strategies, even if complete elimination is unrealistic.
  • Finally, some factors cannot be changed directly. Family history and genetic predisposition, for example, may influence the likelihood of developing some health conditions, including alcohol use disorder. These factors should not be used to label people or assume an outcome is inevitable. Instead, they can help identify opportunities to strengthen protective factors, supportive relationships, prevention resources, and early access to appropriate services.

One way to decide which factors to prioritize is to consider those that appear to have a strong relationship with the outcome and that your organization or partnership has a realistic and equitable opportunity to influence.

By answering the two questions above, you can start to decide the appropriate mix of risk and protective factors that you want to address. The next step is to decide how many of these factors your initiative has the resources and partnerships to pursue effectively.

It is quite common for an organization to address a mixture of risk and protective factors. How extensive your list is may be determined in large part by the people, partnerships, time, funding, and other resources available. Most organizations will not be able to address every factor at once, and some factors will have a higher priority than others. You will therefore have to make thoughtful choices about priorities.

But remember: positive outcomes can be supported by strengthening multiple protective factors and community assets. If your organization cannot address all of the factors needed to make a meaningful difference, consider forming a partnership with other groups that can contribute complementary strengths and resources.

Once you have considered all of this, make a list of the risk and protective factors your initiative will try to change or strengthen. You will want to have this list handy as you move to the next step.

Use information about risk and protective factors to identify people and communities who may benefit most.

Once you have decided which risk and protective factors are important and potentially changeable, your next step is to identify the people and communities who may benefit most from your intervention. This may include people who experience greater exposure to particular risk factors, have less access to protective resources, or are affected by systems and conditions connected to the issue.

Be careful not to use risk information in ways that stigmatize people or imply that an outcome is inevitable. Risk and protective factors can help identify where resources, opportunities, policy changes, or additional support may be useful, but they should be considered alongside community strengths, lived experience, and the priorities identified by people most affected.

Other considerations include cost, reach, feasibility, equity, and the likely benefit of different approaches. These choices have ethical implications. People or communities with the greatest barriers should not automatically receive less attention simply because reaching or serving them may require additional resources.

If the intervention you are planning is fairly new and there isn't yet much evidence about how it will work in your community, you might begin with a well-defined pilot group while involving community members in planning and evaluation. A pilot can help you learn and improve before expanding the effort, but participants should not be selected simply because they make success easier to demonstrate.

The table below shows how candidate personal and environmental factors can be used to help identify people and communities who may benefit from the intervention.

Use the information about the types of risk and protective factors to select promising strategies or components for the comprehensive intervention.

At this point, you have decided what you want to change or strengthen - the specific risk and protective factors your organization has chosen. You have also identified who may benefit most and who should be involved. The next step is to organize all of this information to help you develop your initiative's strategies - how you are going to get things done.

The table below shows how risk and protective factors, the people and communities involved, and strategies are all interrelated.

Using risk and protective factors to select people, communities, and strategies (components) for a comprehensive intervention

	What Candidate Risk and Protective Factors	Who People or Communities Who May Benefit	How Strategies for the Comprehensive Intervention
Personal	Knowledge and skills Knowledge Beliefs Skills Education and training	People who would benefit from additional information, education, training, or skill-building opportunities	Provide accessible information and opportunities to build knowledge and skills; engage participants and community partners in designing relevant approaches
Personal	Experience and history Experience Cultural norms and practices	People who have experienced maltreatment, discrimination, exclusion, or other barriers to achieving their goals People whose social or cultural environments may include factors that increase or reduce risk	Strengthen services, relationships, and support Expand opportunities and address barriers
Personal	Biology and genetics Existing health Cognitive, mental health, and physical functioning Chronic health conditions Age and sex or gender Genetic predisposition or family history	People living with health conditions or disabilities who may benefit from accessible services, accommodations, prevention, or other supports	Strengthen accessible services, supports, accommodations, and preventive resources
Environmental	Support and services Availability and continuity of social support and relationships Availability of appropriate services Availability of resources	People experiencing social isolation, unmet support needs, or limited access to appropriate services and resources	Strengthen services, relationships, resources, and support
Environmental	Access, barriers, and opportunities Physical access and barriers Communication access and barriers Competing requirements for participation	People facing barriers to services, participation, communication, transportation, accessibility, or opportunity	Improve access, reduce barriers, and expand opportunities
Environmental	Consequences of efforts Social encouragement and discouragement Incentives and disincentives Time costs and delays	People whose participation or choices are affected by social expectations, limited incentives or resources, work or caregiving responsibilities, time, or other competing demands	Adjust incentives, supports, expectations, and conditions to make desired actions more feasible
Environmental	Policies and living conditions Policies Financial barriers and resources Exposure to hazards Living conditions Economic hardship and inequities in resources and opportunity	People and communities experiencing economic hardship, inequitable access to resources, unsafe or unhealthy conditions, or disparities in outcomes	Modify policies, systems, resource allocation, and environmental conditions

For a concrete example of the above, consider the following example from an organization working to improve quality of life in an urban neighborhood. It lays out just a few of the group's identified risk and protective factors, the people and partners connected to them, and possible strategies. After each risk or protective factor, its category from the table above is listed in parentheses.

Risk and Protective Factors for a High Quality of Life in the Neighborhood	People, Communities, or Partners Involved	Strategies (Components of the Intervention)
Limited incentives for businesses to invest in the neighborhood (Consequences - incentives/disincentives)	Local residents, small and large business owners, economic development organizations, and public officials	Change incentives and conditions - consider targeted incentives, technical assistance, or other strategies that support businesses that meet community priorities and contribute to local economic opportunity
Lead paint and other housing hazards (Policies and living conditions - exposure to environmental hazards)	Residents of affected housing, property owners and managers, housing organizations, building inspectors, and public health agencies	Modify policies and practices - enact and enforce appropriate housing safety requirements Work with residents, property owners, building inspectors, and health departments to identify and address housing hazards
Community experience, leadership, and knowledge of overcoming barriers (Experience - protective factor/asset)	Local residents, neighborhood leaders, and community organizations	Strengthen community leadership - support resident-led advocacy, leadership development, shared decision-making, and opportunities for community members to shape policies and neighborhood improvements

In Summary

Having a solid understanding of risk and protective factors, along with the people and communities most affected by them, gives you an excellent base from which to develop strategies for your initiative. By reducing or changing important risk factors, strengthening protective factors and community assets, and addressing the systems and conditions that shape people's opportunities, your organization and its partners can work more effectively toward the outcomes the community has identified.

 

___You have a good understanding of risk and protective factors, including the different categories of factors, what affects these factors, and when they should be addressed by your organization.

___You have gathered available data on risk and protective factors for the issue your community is facing.

You have decided what technique(s) will best help your information on local risk and protective factors:

___The "but why" technique

___Focus groups

___Surveys

___You have developed your own information on risk and protective factors, using the mean(s) you decided were most appropriate ("but why," focus groups, and/or surveys ).

___You have selected the risk and protective factors your intervention will address.

___You have used information about who is affected by multiple risk factors to select your "targets of change."

___You have used the information about risk and protective factors and targets of change to select promising strategies for the comprehensive intervention.

Example 1: Risk and protective factors that may be related to disparities in health outcomes associated with race and ethnicity

Here, risk and protective factors are separated into three broad categories by who is affected by, or can affect, that factor.

This example is adapted from Promoting Health for All: An Action Planning Guide for Improving Access and Eliminating Disparities in Community Health. See Resources for a full citation.

Knowledge and skill (personal)
Consumers/Local Residents	Health Care Providers	Broader Agents/Allies
Knowledge (e.g., of preventative health practices, self-care, resources for health care) Beliefs (ie, about causes and consequences of health behaviors and outcomes, e.g., effects of diet, physical activity) Skill (e.g., in accessing available services, advocating for needed services, language spoken) Education and training (e.g., years of formal education)	Knowledge (e.g., of local culture, client health needs) Belief (e.g., about what consumers value) Skill (e.g., cultural competence, languages spoken) Education and training (e.g., extent and adequacy of training)	Knowledge (e.g., of the problem of access/disparities) Beliefs (e.g., about how our health is bound up in that of others)
Experience and history (personal)
Consumers/Local Residents	Health Care Providers	Broader Agents/Allies
Experience with health systems (e.g., discrimination in seeking services) Experiences of prior health care (e.g., pain, no improvement) Cultural norms and religious practices (e.g., diet, healing practices)	Experience with service provision (e.g., respect shown to consumers) History of working with consumers (e.g., hostility, no improvement)	Community norms for racial and ethnic harmony (e.g., history of race/ethnic relations ) History of collaboration in public problem solving (e.g., involving those most affected and those most responsible)
Biology/Genetics
Consumers/Local Residents
Type and degree of existing health (e.g., pre-existing conditions, risk markers ) Cognitive, mental or physical ability (e.g., mobility impairment, psychiatric disability, cognitive ability) Chronic illness (and requirements for care) Gender (e.g., women or men may be more at risk for particular health outcomes) Age (e.g., infants, adolescents, or older adults may be more at risk for particular health outcomes) Genetic predisposition (e.g., diabetes)
Support and services (environmental)
Consumer/Local Residents	Health Care Providers	Broader Agents/Allies
	Availability and continuity of services and support (e.g., continuity of care from providers; peer support)	Social support and ties (e.g., through neighbors, faith communities)
Access, barriers, and opportunities (environmental)
Consumer/Local Residents	Health Care Providers	Broader Agents/Allies
Communication access/barriers (e.g., languages spoken) Physical access/barriers (e.g., transportation)	Communication access/barriers (e.g., available interpreters) Physical access/barriers (e.g., distance and physical access to facilities) Human resources (e.g., too few providers for need; availability of providers from ethnic community)
Consequences of efforts (environmental)
Consumer/Local Residents	Health Care Providers	Broader Agents/Allies
Competing requirements to participation (e.g., child care, work)	Time costs (e.g., waiting time for service, convenient hours of service)
Policies and living conditions (environmental)
Consumer/Local Residents	Health Care Providers	Broader Agents/Allies
Living conditions (e.g., homelessness, adequate housing, heat/cooling, clean drinking water) Poverty/financial resources (e.g., not enough money for basic needs, for needed health services)	Financial barriers and resources (e.g., not enough money for needed health care, for prevention) Policies (e.g., requirements for insurance coverage, co-payments, refusal of service)	Public accommodations for participation (e.g., available child care, transportation ) Employer accommodations and policies (e.g., workplace health services, flextime policies to permit participation, health insurance policies) Government policies (e.g., distributive policies that assure access to care) Poverty and deprivation (e.g., policies supporting economic development, education, and housing in neighborhoods of concentrated poverty)

 

Example 2: Substance use among young people

Information in this example comes from Drs. David Hawkins' and Richard Catalano's book Communities that Care. See Resources for a full citation.

Researchers David Hawkins and Richard Catalano have done extensive research on the risk and protective factors associated with substance use, particularly among young people in the United States. They determined that the risk and protective factors in the environment include all of the following. (Note that the heading itself gives the risk factor with the corresponding protective factor following in parentheses.)

• Economic deprivation (affluence)
  Those who live in deteriorating neighborhoods with little or no hope of a better future are much more likely to abuse alcohol and other drugs than those who live in more affluent communities.
• Community disorganization (organization)
  There are more problems related to substance use in areas where there is little sense of community; where people don't feel as if they are part of a greater whole.
• Transitions and mobility (stability)
  The more young people move to new environments, the more likely they are to use drugs. These transitions can be as typical as changing from middle school to high school, but changes are more likely to increase risks when they are more significant, such as frequent moves to new cities or towns.
• Availability of substances (lack of availability)
  The easier it is for people to get a hold of illegal substances such as drugs, the more likely they are to use them.
• Community norms saying it's "okay" to use drugs and alcohol (community views that say it's not okay)
  An example of this might be students in a college town, where excessive drinking among younger students is seen as a type of rite of passage to adulthood and not as a public health problem.

Hawkins and Catalano also determined that some of the individual or personal risk and protective factors for substance use include the following things. Again, protective factors are in parentheses.

• Family history of drug abuse (family history of appropriate use or nonuse)
  Children who have parents who are alcoholic or who abuse drugs are much more likely to have drug problems themselves. This is true for both girls and boys, but is a higher risk for boys, for whom a genetic link for alcoholism has been established.
• Family management problems (family strengths)
  These include a lack of clear expectations of what a child is supposed to do, a lack of someone to pay attention to what a child is doing, and inconsistent or overly harsh discipline.
• Academic failure (academic success)
  Children may fail in school for a variety of reasons, but it appears that just not succeeding increases the likelihood of substance use problems.
• Antisocial behavior (strong, positive social skills)
  This may include aggressive behavior among small children, misbehaving in school, skipping school, or getting into fights with other children.
• Friends who use drugs (friends who don't approve of drugs)
  This is one of the risk factors that has consistently predicted the use of drugs. Children whose friends use drugs are much more likely to do so than those whose peers don't use drugs, even if they don't generally experience other risk factors.

Some of the protective factors (this time, with the associated risk factors in parentheses) Hawkins and Catalano have found for substance use include:

• Bonding (lack of caring adults)
  Research has consistently shown that close relationships with non-drug users are one of the cornerstones of keeping adolescents from experimenting with drugs. Young people who have adults who care about them, and who help strengthen their values or beliefs of what is strong, ethical behavior are likely to have a clear idea about what is right, and the strength to behave in an appropriate manner.
• Skills (lack of competence)
  Children need to have skills to feel like they are contributing members of their family. If children are given the chance to help out with responsibilities, and are also given adequate training for those responsibilities (for example, they are taught to cook dinner, or to help tend the family garden), they will feel useful and successful. They will be less likely to start abusing alcohol or other drugs in search of the positive recognition they aren't getting at home.
• Healthy beliefs and clear standards (mixed messages)
  Living in a community, attending a school, and being part of a family where beliefs and standards are clearly against the use of drugs is a strong protective factor against experimentation. On the other hand, if children receive mixed messages, this could become a risk factor. For example, the message to a child is clear when the family goes out to eat, and the waitress asks if the family would prefer the smoking or nonsmoking section. If mom says, "Non smoking, please, we worry about our children inhaling second hand smoke," the message against cigarettes is clear to the children, even if the reply wasn't directed to them. On the other hand, a father who instructs his children not to use alcohol over his fourth beer sends a message that is much less clear.

Example 3: Determination of which risk and protective factors to focus on for teen substance use

Members of a small anti-drug coalition in rural Mississippi wanted to decide which risk and protective factors they should address. Using the table below, several people sat down and discussed which risk and protective factors were both important and changeable. Then, they ranked what they had said. The smaller the number they used, the more important the risk or protective factor (or, the easier it was to change.)

This is what they found:

Risk or protective factor	Importance		Changeability		Final value
Family history of drug abuse	1	+	3	=	4
Community norms saying it's "okay" to use drugs and alcohol	1	+	1	=	2
Transitions and mobility	2	+	3	=	5
Availability of substances	1	+	2	=	3

When all of the information was in front of them, they realized that their choices were easier to make. Although they all agreed that a family history of drug abuse was a very important risk factor, they realized that, given their limited budget, there wasn't a whole lot they could do about that risk factor right now. Similarly, with the category "transitions and mobility," they all agreed it was at least somewhat important, but again, there wasn't a whole lot they could do. Besides, the community was relatively stable; there weren't a lot of people moving in and out, and so this factor seemed a little less important.

However, all of the members felt that changing community norms and lessening the availability of substances were important risk factors that they could do quite a bit about. They could talk to people, start media campaigns, and conduct "stings " on stores that were selling alcohol to people under 21. The members decided to concentrate on these two risk factors as part of their current strategic plan. They also decided to come together again and reevaluate their work in six months.

Example 4: Risk and Protective Factors for Sexual Violence Prevention

This infographic highlights the connections between risk and protective factors and social determinants of health at the various levels of the social ecology, and can be used to link sexual violence prevention with anti-oppression and related public health issues in order to create more effective change.

 

Download a PDF of this chart.

 

 

Tool 1: Determining which risk or protective factors to focus on

In the table below, list all of the risk and protective factors that you have determined in the first column. In the next column, rate the importance of the factor, with one "1" being very important, two "2" being moderately important, and three "3" being slightly important. Note that more than one factor can have the same number. Do the same in the column labeled "Changeability," with one "1" being completely changeable, two "2" being partially changeable, and three "3" for factors you are unable to change. Finally, in the last column, add up the numbers you have gotten in each row. The factor(s) which has/have the lowest final value is/are the risk and protective factors you should start with, those with the second lowest value should come second, and so on.

Risk or protective factor	Importance		Changeability		Final value
		+		=
		+		=
		+		=
		+		=
		+		=
		+		=
		+		=
		+		=

 

 

Tool 2: Understanding the factors that contribute to the problem

Download this editable worksheet here.

A PowerPoint presentation summarizing the major points in the section.

What is risk reduction? What are protective factors?

You know your group wants to work on preventing a particular health problem in your community. Many effective prevention efforts work both to reduce risk factors and strengthen protective factors. But what's risk reduction? And what are protective factors?

Risk reduction means identifying the factors and conditions that increase the likelihood of the problem you're trying to prevent and then working to reduce or change those factors. For example, if you're working to prevent lung cancer, reducing tobacco use and exposure to tobacco smoke may be important parts of your strategy.

Protective factors are strengths, resources, relationships, conditions, and experiences that can reduce risk or support positive outcomes. For instance, if you work with a coalition to reduce cardiovascular disease, protective factors might include access to nutritious food, opportunities for physical activity, supportive social relationships, and high-quality preventive health care. Protective factors can help reduce the effects of risk factors and create conditions that support health and well-being. To demonstrate this, let's look at an example adapted from the work of researchers Hawkins and Catalano on risk and protective factors.

Example: Risk and protective factors for substance use among young people

 Risk factors:

• Economic hardship and limited access to resources
• Community instability or limited social connection
• Frequent transitions and mobility
• Availability of alcohol and other substances
• Community norms that normalize or encourage substance use
• Family history of substance use disorders or problematic substance use
• Limited family support, communication, or consistent expectations
• Academic difficulties or school disengagement
• Persistent behavioral challenges or involvement in harmful behavior
• Peers who use substances

Protective factors:

• Strong family, peer, school, and community connections
• Social, emotional, decision-making, and coping skills
• Clear and supportive expectations around substance use
• Stable employment and economic opportunity
• Availability of substance-free activities and opportunities for young people
• Supportive role models and mentors

By looking at the above lists, you should be able to identify several risk and protective factors that relate to one another. Clear and supportive expectations around substance use may help counter community norms that normalize substance use, for example. Strong relationships and community connections may also provide stability and support during periods of transition.

As you might have guessed by now, once you've figured out what the risk and protective factors are for the issue you're dealing with, the next step is to develop ways to reduce risk and strengthen protective factors. It's not enough simply to say, "Okay, we need to reduce sexual activity without adequate protection against STIs and unintended pregnancy among 18-to-24-year-olds." You'll need to develop strategies that address the factors contributing to that risk and specific tactics for carrying out those strategies.

Who should be involved in selection of risk reduction strategies?

Deciding on risk reduction strategies is something you shouldn't do completely on your own. While your organization may come up with some strong ideas, it's important to bring community members into the process, including people most affected by the issue and people who can contribute knowledge, relationships, resources, services, or decision-making authority. A community-wide approach works best in many cases.

Including members of the community in this process is advised because:

• It can help shape community norms and conditions that are connected to risk and protective factors. For example, HIV and STI prevention efforts may involve community members in promoting safer sexual practices, consent, access to condoms and testing, accurate health information, and supportive norms around sexual health.
• It creates a wider base of support for positive change. Involving people from a variety of groups, organizations, programs, and community networks can broaden participation and strengthen the effort.
• It can give you a better understanding of the strengths and resources available in the community. No single organization knows everything about community resources. Involving people from community organizations, government, social services, businesses, schools, health systems, neighborhood groups, and other sectors can help identify existing assets, relationships, and opportunities.
• It can help build broader community support for your initiative. When community members participate meaningfully in planning and decision-making, they are more likely to see the effort as something they helped shape and may share information and support through their own networks.
• It is more likely to support long-term change. Strategies developed through strong community partnerships can become integrated into organizations, relationships, policies, and community systems in ways that support sustainability.

Who are good people and groups to think about including?

• Local law enforcement and other public safety partners, when relevant
• Faith and spiritual leaders
• Local government officials and public agencies
• School administrators, teachers, students, parents and caregivers, school board members, and other education partners, especially when the effort involves young people
• Health and human service organizations
• Local media and communications organizations
• Young people, parents, caregivers, and families
• Local business owners, employers, and workers
• Community members representing a range of neighborhoods, backgrounds, experiences, and perspectives

You should also include people who are most directly affected by the issue in the process. Why is their participation important?

Including people most directly affected is important because:

• Meaningful participation can help establish and strengthen trust. Some communities have understandable reasons for mistrusting public health organizations or other institutions because of past or ongoing discrimination, exclusion, or mistreatment. Historical abuses such as the U.S. Public Health Service Syphilis Study at Tuskegee illustrate why transparency, accountability, respect, and meaningful community involvement are essential.
• People most affected by an issue bring essential strengths, knowledge, relationships, and lived experience. Community members often understand local conditions, barriers, assets, and possible solutions in ways that outside organizations may not. Their leadership can make an initiative more relevant and effective.
• It can give your group a better understanding of community priorities and what is likely to work. People with lived experience can identify barriers, strengths, unintended consequences, and opportunities that may not be apparent to planners or service providers.
• It can also increase community awareness of your organization and effort. Ongoing communication and participation can help community members understand what the initiative is doing and provide feedback as the work develops.

How to select risk reduction strategies

Now you have identified the risk and protective factors for your coalition, you have people together, and you're ready to start coming up with strategies and tactics. Where do you begin?

Take advantage of existing information.

First of all, you don't want to reinvent the wheel. There's a great deal of existing information that community health coalitions can use. Know your community's history. Has this initiative or something similar been tried here before? Even an effort that didn't achieve its goals may offer valuable lessons. Take advantage of existing knowledge on risk reduction and protective factors before developing strategies and tactics from scratch. Here are some ways you can do this:

Research to find out what other groups with missions similar to your own have done. A library search, credible online sources, research databases, program evaluations, and conversations with other organizations can yield a wealth of information. For example, a successful healthy food access program in another community might provide useful ideas for your own effort. Exchanging information with people doing similar work can benefit everyone involved.

Network, network, network. Get to know people who work with groups like yours. Conferences, workshops, professional networks, and community learning opportunities can connect you with people who have useful experience. Establish relationships with your peers so that you can exchange information, stories, lessons, and suggestions. Here are a few ways you can connect with people doing similar work:

• Attend conferences, workshops, webinars, and community learning events
• Get involved in regional and national coalitions or professional networks
• Join relevant email groups, online communities, professional associations, or other networks for people working on similar issues

A word of caution, however - don't assume that what has worked in other communities will necessarily work in your own. When you examine a possible strategy that has been used elsewhere, consider how well it fits your community's culture, laws, resources, priorities, history, and existing services. A syringe services program, for example, may require different outreach, partnerships, and implementation strategies in different communities.

Finally, conduct your own research and see what original strategies you can develop with community members and partners. A little ingenuity goes a long way. While many strong strategies can be adapted from other sources, don't be afraid to modify them when needed or develop new approaches based on local knowledge and experience.

Characteristics of effective risk reduction strategies

Here are some things that are usually present in an effective risk reduction strategy:

• First and foremost, an effective risk reduction strategy also works to strengthen protective factors. Focusing on strengths, resources, relationships, and supportive conditions can help avoid stigmatizing people based on risk factors or behaviors.
• The goals, methods to be used for data collection, evaluation, and feedback, and specific roles and duties of staff, volunteers, community partners, and other participants should be clearly defined. Outlining these things ahead of time can reduce confusion later in the process.
• The strategy approaches risk reduction in a way that's appropriate and responsive to the people and communities involved. Consider age, developmental stage, culture, language, accessibility, lived experience, community priorities, and the level and type of risk involved. For example, peer education can be effective with young people because peers may bring credibility, shared experience, and ways of communicating that complement information provided by adults and professionals.
• Many effective risk reduction strategies include early prevention and support. For example, providing people with access to nutritious food, health care, and other supports before and during pregnancy can promote healthy outcomes. Likewise, age-appropriate education about healthy relationships, consent, contraception, and STI prevention can help young people make informed decisions before problems arise.
• The strategy makes thoughtful and realistic use of available resources, including funding, staff time, partnerships, materials, facilities, and community capacity. If an approach cannot be sustained with available resources, consider adapting it or working with partners who can contribute additional support.
• If addressing more than one risk factor, it's usually helpful to use more than one strategy. Complex issues rarely have a single cause or solution. Domestic violence, for example, may be addressed through a combination of survivor-centered services, prevention education, economic and housing supports, programs that promote healthy relationships, accountability for people who cause harm, and policies and community norms that support safety and respect.

Questions to ask when evaluating prevention strategies you're considering:

• Does the strategy address important and well-supported risk factors?
• How will the strategy reduce risk and/or strengthen protective factors and community assets?
• Is the strategy likely to reach and meaningfully engage the people and communities it is intended to benefit?
• Is the strategy designed in a way that allows its implementation and effectiveness to be evaluated?

Common types of risk reduction strategies

Risk reduction strategies are often grouped into approaches that support individual behavior and approaches that change organizational, community, environmental, or policy conditions. Effective efforts often use both.

Strategies related to supporting individual behavior include:

• Incentives or disincentives - changing the costs, benefits, or supports associated with particular behaviors (for example, tobacco taxes that discourage tobacco use or free and low-cost cessation supports that make quitting more accessible)
• Increasing or reducing the time, effort, or other barriers associated with desired actions
• Providing support, such as peer education, coaching, counseling, navigation, or other forms of assistance
• Developing mentoring and supportive relationship programs
• Enhancing resources - raising funds, improving materials, strengthening connections with other programs and services, and increasing awareness of resources that are available
• Changing programs or services to reduce barriers and make them more accessible and responsive to the people using them
• Changing policies by creating, modifying, or ending policies as appropriate
• Providing information through approaches such as communication campaigns, community outreach, peer education, and counseling
• Modeling positive behaviors, relationships, or practices, including through peer education and mentoring
• Building skills through education, peer learning, coaching, counseling, practice, and other approaches
• Providing feedback on progress and opportunities for participants to reflect on and adjust their goals

Strategies related to organizational and community development include:

• Public awareness and communication campaigns, using tactics such as information campaigns, community outreach, peer education, and other appropriate communication methods
• Community assessment, learning, and monitoring
• Building coalitions and partnerships with other community groups
• Changing access to products and services, such as reducing youth access to tobacco products or expanding access to preventive health services
• Developing resources that strengthen family, peer, and community support
• Implementing and enforcing existing policies and laws fairly and consistently
• Advocacy and nonviolent civic action, including public education, community organizing, and other forms of collective participation
• Changing policies and laws through appropriate advocacy, outreach, public participation, and decision-making processes

Common tactics used in risk reduction

There are many tactics that can be used in risk reduction. Here are a few of the most common - but remember that the tactics you use should fit your goals, community, resources, and the people you hope to engage.

• Information and communication campaigns - This is one of the most commonly used tactics in risk reduction. Campaigns can help people understand health risks, protective factors, available resources, and actions they can take. Communication methods might include social media, websites, advertisements, posters, brochures, community newsletters, radio or television messages, speakers, text messaging, and informational hotlines.
• Street and place-based outreach - Outreach workers or peer outreach specialists connect directly with people in neighborhoods and other places where community members spend time. Activities might include conversations, canvassing, information tables, distributing supplies, harm-reduction resources, referrals, and connections to services. Consistent outreach can help build trust and make information and resources more accessible.
• Community outreach - Community outreach often takes place through workshops, presentations, listening sessions, community events, or other group settings. These activities can share information, build relationships, gather community input, and connect people with resources. They are often most effective when combined with other ongoing strategies.
• Peer education - Peer education involves people with shared experiences, identities, or community connections providing information, support, and opportunities for learning. Peer educators may bring credibility and lived experience that help make communication more relevant and accessible. They can participate in one-on-one conversations, group education, outreach, mentoring, navigation, or other activities.
• Risk reduction counseling - Risk reduction counseling is collaborative, nonjudgmental support for people who may experience increased risk. A counselor, peer specialist, health worker, or other trained person works with participants to understand their goals, identify risks and protective factors, explore realistic options, and develop skills and strategies that support safer and healthier choices. Counseling may take place one-on-one or in small groups.
• Direct action - Direct action refers to organized public actions intended to draw attention to an issue or advocate for change. Examples may include demonstrations, symbolic actions, public events, sit-ins, boycotts, or other forms of nonviolent civic participation. Because these tactics may attract significant public attention or involve legal, safety, and accessibility considerations, organizations should plan carefully and consider how the action fits within their broader goals and strategy. If using direct action tactics, think through the purpose, participants, safety, communication, and possible consequences in advance.

In Summary

This section provides an understanding of how you can design strategies and tactics to reduce risk and strengthen protective factors and community assets. Pay close attention to evidence and lessons from other communities, particularly those that share relevant characteristics with your own, while recognizing that strategies may need to be adapted to local strengths, priorities, resources, and circumstances. Community members - especially people most directly affected by the issue - should help shape those adaptations. You may find that a combination of locally developed ideas and approaches adapted from other sources works best for your community.

You understand that:

___Risk reduction involves finding out what in your community leads to the problem you're trying to prevent and then working to cut down on those factors.

___Protective factors are those things that keep whatever it is you're trying to prevent from occurring.

___A strategy is a broad step in a plan to accomplish a specific goal.

___A tactic is a specific step you take to complete a strategy.

You understand the following reasons for including members of the community in the process of selecting risk reduction strategies:

___It can help change community norms and values, which are often tied to risk and protective factors.

___It creates a wider base of support for changing behavior.

___It can give you a better sense of what resources are available to you in the community.

___It can help galvanize public support for your initiative.

___It is more likely to lead to long-term changes.

You have considered including people from the following groups in the process of selecting risk reduction strategies:

___Local law enforcement

___Religious leaders

___Local government officials

___School administrators, teachers, PTA members, school board members

___Health and human services agencies

___Local media representatives

___Youth and parents

___Local businesspeople

___Members of the target population you serve

You understand the following reasons for including members of the target population in the process of selecting risk reduction strategies:

___Giving the target population a say helps establish trust

___Affected communities are often stronger and more resourceful than we give them credit for

___It can give your group a better understanding of what the community needs

___It can also increase community awareness of who you are and what you do

Selecting risk reduction strategies:

___Research to find out what other groups with missions similar to your own have done

___Attend conferences and workshops

___Get involved in regional and national coalitions

___Sign on to an email list for people who do the same type of work you do

___When you examine a possible strategy that has been used in another community, think about how it would work with your own community

___Conduct your own research and see what original strategies you can come up with on your own

You understand the following characteristics of an effective risk reduction strategy:

___The strategy works to increase protective factors

___The goals, methods to be used for data collection, evaluation, and feedback, and specific roles and duties of all staff, volunteers, and any other personnel are clearly defined

___The strategy approaches risk reduction in a manner appropriate to your target population

___The strategy employs early intervention

___The strategy makes the best possible use of available resources

___If addressing multiple risk factors, it's probably best to use multiple strategies

You've asked the following questions when evaluating prevention strategies you're considering:

___Does the strategy address known risk factors?

___How will the strategy reduce risk and/or increase protective factors?

___Is the strategy likely to reach your target population?

___Is the strategy set up in a way in which it can be evaluated?

You're familiar with risk reduction strategies related to changing individual behavior:

___incentives or disincentives

___increasing (or reducing) time and effort for target behaviors

___providing support

___arranging mentors

___enhancing resources

___changing environmental design to remove barriers or enhance accessibility

___changing policy (creating, modifying, or terminating)

___providing information

___modeling

___skills training

___providing feedback on progress

You're familiar with risk reduction strategies related to organizational and community development include:

___public awareness and media campaigns

___community assessment and monitoring

___coalition building

___modifying access to products and services

___integrating and coordinating local agencies and resources

___developing resources to enhance family and peer support

___enforcement of existing policies and laws

___advocacy and nonviolent protest

___changing policies and laws

You understand some of the common tactics used in risk reduction:

___Information campaigns

___Street outreach

___Community outreach

___Peer education

___Risk reduction counseling

___Direct action

Tool #1: Supporting Youth at Risk: A Policy Toolkit for Middle-Income Countries

From the introduction of the Policy Toolkit, published in 2008:

Today, there are 1.5 billion people between the ages of 12 and 24 worldwide, with 1.3 billion of them living in developing countries—making the young the largest segment of developing country population in recorded history. More important, young people constitute a disproportionately large part of the world’s poor. While they represent 50 percent of the developing country population, they represent nearly 60 percent of the poor in those countries.1 Young people can be a source of growth and development for their countries, but a subset of young people—those known as youth at risk—are a source of the inequality, poverty, exclusion, and much of the crime and violence that plagues every region in the world, thereby imposing enormous costs on themselves, their families, and society at large.

The World Bank has produced this Policy Toolkit in response to a growing demand from our government clients and partners for advice on how to create and implement effective policies for at-risk youth. We have highlighted 22 policies (six core policies, nine promising policies, and seven general policies) that have been effective in addressing the following five key risk areas for young people around the world:

• Youth unemployment, underemployment, and lack of formal sector employment
• Early school leaving
• Risky sexual behavior leading to early childbearing and HIV/AIDS
• Crime and violence
• Substance use

The objective of this Toolkit is to serve as a practical guide for policy makers in middle-income countries—as well as professionals working within the area of youth development—on how to develop and implement an effective policy portfolio to foster healthy and positive youth development.

Supporting Youth at Risk: A Policy Toolkit for Middle-Income Countries

A PowerPoint presentation summarizing the major points in the section.

• What do we mean by "adaptation?"

• What do we mean by "different cultures and communities?"

• Why should you adapt interventions?

• When should you adapt interventions?

• An important question: Does an intervention always need to be adapted?

• How should you adapt interventions?

• Some special situations: "What should I do if...?"

What do we mean by "adaptation"?

Suppose you have conducted a community intervention and it is successful. Naturally, you might think about building upon your success and using the intervention elsewhere -- in a community or setting that may differ in culture, history, language, resources, geography, or other important ways.

For example, suppose you have organized a successful park clean-up, voter registration drive, or home-visiting program for older adults. The park becomes clean; voters are registered; and visits are being made. Now there's a chance to use a similar approach in another setting, with a different community. Will your success be repeated?

The key questions here are (1) whether that intervention will be successful elsewhere, and especially (2) how it can be made most relevant and effective in the new setting. The best answers are (1) "maybe," and (2) "with careful thinking, community involvement, and planning."

The basic idea is that interventions are not always one-size-fits-all. When the setting is different, they may need to be adapted. Adaptation means modifying an intervention so that it fits the strengths, priorities, culture, circumstances, and resources of the community while preserving the elements that make the intervention effective. That is the main focus of this Tool Box section.

What do we mean by "different cultures and communities?"

"Culture" is a broad term that can include shared values, beliefs, practices, traditions, languages, histories, relationships, identities, and ways of understanding and interacting with the world. Culture is not fixed, and people who share one identity or background may still differ greatly from one another.

Race and ethnicity can be important parts of cultural identity, but they should not be treated as if every racial or ethnic group has a single culture. People who identify as Black, Latino or Hispanic, Asian, Indigenous, White, or with another racial or ethnic identity may have many different cultural traditions, languages, histories, experiences, and perspectives within those broad categories.

Cultural differences can also be connected to age, gender, socioeconomic circumstances, religion or spirituality, region, sexual orientation, disability, immigration experience, profession, family background, neighborhood, or combinations of these and other factors. A potluck supper, blood-pressure screening, or immunization drive might be a terrific success in one setting while the same event could receive little participation in another. Differences in relationships, communication preferences, accessibility, history, trust, timing, location, and community priorities may all affect how well an intervention fits.

Why should you adapt interventions to fit different cultures and communities?

Possibly the most important reason you might want to adapt your intervention is because your intervention has worked already and you would like it to work well in another setting. A well-adapted intervention can:

• Show respect for a community's values, identities, strengths, and experiences
• Improve your ability to connect and build relationships with the community you hope to engage
• Increase the relevance and accessibility of your actions
• Reduce the possibility of unintended or unexpected consequences
• Increase meaningful involvement and participation from community members
• Increase community understanding and support for your program, even among people who do not participate directly
• Increase the chances that your intervention will achieve its intended outcomes
• Build trust, relationships, and collaboration that can support future community efforts

These are all excellent reasons to proceed, if the conditions are right.

When should you adapt interventions to fit different cultures and communities?

Here are six useful criteria:

1. When you think you have a promising idea or intervention
2. When the intervention has been tested or otherwise has evidence suggesting that it can be effective
3. When you are interested in using the intervention in a different community or cultural setting
4. When you have the needed time, funding, people, partnerships, and other resources to move forward
5. When community members have expressed interest in the intervention or in addressing the issue it is designed to address
6. When community members are willing to collaborate in determining whether and how the intervention should be adapted

An Important Question: Does An Intervention Always Need to Be Adapted?

No, not every single time. There are certainly cases where little or no adaptation is necessary. For example:

• A grant-writing specialist was asked to give a grant-writing workshop to a Spanish-speaking community group. The basic principles of grant writing were largely the same, although language access and locally relevant examples still needed to be considered.
• Another specialist gave a digital skills demonstration to a group of recently arrived immigrants from several countries. Participants wanted to learn specific skills. The basic technical content did not need major cultural adaptation, although the instructor still needed to consider language access, participants' previous experience with technology, accessibility, and the examples used during the training.

At other times, cultural and community differences do indeed matter:

• An HIV prevention organization wanted to provide prevention education in a local Spanish-speaking community. Large public meetings did not work well for many community members, but smaller gatherings in trusted neighborhood settings did. The organization worked with community members to hold charlas, or informal community conversations, in homes and other familiar settings. Adapting the setting and format made the information more accessible and the conversations more comfortable.
• In another community, organizers learned that participants valued relationship-building and informal conversation before beginning a formal meeting agenda. Rather than assuming that one meeting style would work everywhere, facilitators allowed time for participants to connect with one another before moving into structured discussion. The adaptation reflected what community members themselves said helped them participate effectively.

These examples involve cultural differences, but the same principle applies to differences in language, age, disability, geography, organizational culture, socioeconomic circumstances, and many other factors. Our general point is that it's difficult to know in advance how much adaptation will be necessary. Rather than making assumptions, learn from the people involved and be prepared to adapt when doing so improves relevance, access, participation, or effectiveness.

Just how should you proceed? The "how-to" heading which follows may be helpful.

How should you adapt interventions to fit different cultures and communities?

Here is one step-by-step approach you can use as a guide. If you are working within an organization, the same steps will apply to your organization as well.

• Ask yourself, honestly: "Is the intervention worth adapting?" It may be good; but is it good enough? Is there evidence that it is effective or promising? Is its potential value high enough to justify the effort and resources needed to adapt it? A sincere and thoughtful answer to this question before you start can save a lot of time and trouble later on.
• Suppose you decide the intervention is worth adapting. Does your organization have the commitment and capacity to do the adaptation well? Successful adaptation takes time, relationships, flexibility, resources, and a willingness to learn. Consider whether you and your organization are prepared to make that commitment.
• You may decide that adaptation should move forward. But here's another question: What should your role be? Your organization may have useful resources or expertise, but community members may be better positioned to lead or co-lead the adaptation. Sharing leadership can strengthen the intervention and help ensure that decisions reflect community knowledge, priorities, and experience. In some cases, your most useful role may be to provide support, technical assistance, funding, or other resources while community partners take the lead.
• Check your readiness. If you do have a role, are you ready to approach the work with cultural humility, openness, and a willingness to learn? You might want to ask yourself these questions:
  • What are your own cultural values, assumptions, and experiences? How might they shape the way you understand the community or intervention?
  • What experience do you have working with this community or with communities facing similar circumstances?
  • What lessons can you draw from those experiences, and what assumptions should you avoid carrying into this work?
  • Are you and your organization prepared to listen, share decision-making, respond to feedback, and change your approach when appropriate?
• Learn about community interest, strengths, resources, and conditions. Readiness is not simply something a community either has or lacks. Instead, consider:
  • Are community members interested in the issue or intervention? What priorities have they identified?
  • What strengths, leadership, relationships, knowledge, organizations, and other resources already exist in the community? What additional resources or supports may be needed?
  • How might your organization's history, identity, reputation, or way of working affect the relationship? What can you do to build trust and accountability?
• Depending on your answers to these questions, you may be ready to go ahead. If so, make the commitment to approach the adaptation collaboratively and provide the time, relationships, and resources needed to do it well.
• Set specific objectives for the adapted intervention. What, specifically, do community members and partners want it to accomplish?

And now you are ready to move into the community-engagement and planning work. The next steps follow:

Learn about the community and context, especially if you don't already have strong relationships or knowledge of the community. Learn about relevant history, cultural practices, community strengths, institutions, languages, priorities, previous efforts, and current concerns. Avoid assuming that written research can tell you everything about a community; combine it with direct engagement and lived experience.

What kinds of questions should you ask?

Where can you begin finding information? Your local library and other reliable sources may provide:

• Census and demographic data
• Maps
• Government documents
• Local reports, assessments, and statistics
• Local news sources and archives
• Research, evaluations, and reports about similar interventions with communities that share relevant characteristics

Talk with people in the community. Talk with a variety of people if you can. These people can include:

• People with relevant lived experience, cultural knowledge, professional expertise, or research experience
• Trusted community members who understand local relationships, history, strengths, priorities, and concerns. These community connectors can help you understand whom else to involve and how to approach the work respectfully.

Who are these people, specifically? They could be:

• Local government officials and public agency staff
• Business owners, workers, and other business-sector partners
• Teachers, educators, or college and university faculty
• Researchers or evaluators
• People who have worked on similar issues or with similar communities
• Community members with lived experience, local knowledge, or trusted relationships, whether or not they hold a formal title
• Community-based organization staff and service providers
• Faith and spiritual leaders
• Local media and communications leaders

Note that each of these people can themselves be asked who else should be involved.

Talking with others may mean spending time one-on-one. Alternatively, you can also talk with others in a group. Listening sessions, focus groups, advisory groups, and community conversations can allow people to build on one another's perspectives, although some participants may prefer individual conversations.

Spend time building relationships in the community, especially if you haven't done so already. Attend public events, visit community organizations and gathering places when invited or appropriate, and take time to learn how people connect with one another. The goal is not simply to observe the community from the outside, but to build respectful relationships and better understand the setting through conversation and participation.

When you have learned more about the community and developed relationships, begin discussing the intervention idea with community members and potential partners. The people involved should include those who will be affected by the intervention as well as people with relevant knowledge, relationships, or responsibilities.

Rather than presenting a finished plan, invite discussion. You might say, "We've been considering this approach because it has worked in another setting. We'd like to understand whether it could be useful here, what would need to change, and whether there are better approaches we should consider." Be transparent about what is already decided, what is open to change, and what role community members can have in shaping the effort.

After you introduce the idea, ask for feedback and listen carefully. Do community members think the intervention addresses an important priority? What parts fit well? What parts don't? What changes should be made? What strengths or resources could the intervention build upon? What should happen next? Feedback should influence actual decisions rather than being requested simply as a formality.

If many community members and partners tell you that the intervention has little relevance, does not address their priorities, or is unlikely to work in the proposed form, pay attention. This may not be the right time, place, or approach. A different intervention -- possibly one developed or led by community members themselves -- may be more appropriate.

If there is sufficient community interest, then you may be ready to move ahead. The next step is to bring together community members and partners who will help shape and carry out the intervention. Some may be people you have spoken with before, and some should be people who will be directly affected by the intervention. If it's an adolescent pregnancy prevention program, for example, adolescents and young parents should be meaningfully involved alongside health professionals, families, educators, and other relevant partners.

In other words, at this stage, you want collaborators. You may want to bring these collaborators together into a working group, advisory group, steering committee, or another structure that fits the community. Whenever possible, people most affected by the issue should have meaningful influence over decisions rather than serving only in an advisory role.

At this point, you should begin planning and implementation, just as you would with any other intervention; those same basic procedures apply now as well. Your working group can decide what needs to be changed from the original intervention and what should remain. Together, members can agree upon a course of action, establish timelines, conduct pilot tests when appropriate, identify resources, and divide responsibilities. These steps are common to all interventions, whether or not they are adapted.

Some special situations: "What should I do if...?"

If conflicts arise?

If they do, don't be surprised. Conflict and disagreement are natural, especially when people or organizations do not have a history of working together. Relationships need to be formed, expectations clarified, and trust developed over time.

A useful guideline is not to suppress disagreement, but to create conditions in which it can be expressed openly and respectfully. Setting this tone at the beginning may help. Regular check-ins about both progress and the collaboration itself may help as well. Develop shared expectations for dealing with conflict so that disagreement can be addressed constructively rather than allowed to undermine the effort.

If people from different cultural backgrounds have difficulty understanding one another?

When people or organizations from different cultural backgrounds are working together for the first time, they may have different communication styles, expectations, experiences with institutions, or ways of approaching decisions. Structured opportunities for dialogue, cultural learning, and relationship building may help. Cultural humility is an ongoing process, so the goal should not be to teach participants a fixed set of assumptions about another group, but to strengthen their ability to listen, ask questions, recognize their own assumptions, and work respectfully across differences.

If materials need translation?

You may have materials in one language that you want to make available in another. Before translating, consider whether relevant materials already exist and have been developed or tested for the language community you hope to reach. Sometimes adapting existing materials will save time; in other situations, creating new materials with community members may produce something more relevant and useful.

If you do decide to translate, use qualified translators who understand the subject matter and, when possible, the language varieties and cultural context of the intended audience. Have translated materials reviewed by additional speakers from the community for clarity, meaning, accessibility, and tone. Back-translation or other quality-review methods may also be useful when accuracy is especially important.

If the adaptation involves several different cultural groups

Suppose you are adapting an intervention not just with one community, but with several different cultural or identity groups at the same time. This may occur in culturally diverse communities or in efforts that cross generations, languages, faith traditions, neighborhoods, or other groups.

Look for shared priorities while also recognizing meaningful differences. Communities may share goals such as safe and affordable housing, neighborhood safety, access to health care, or strong educational opportunities for children while having different experiences, barriers, strengths, or preferred strategies. Make sure the groups involved have meaningful opportunities to shape the intervention, ask for feedback throughout the process, and listen to what people say.

Many culturally diverse organizations and coalitions have successfully worked in this way. Community efforts that build relationships, trust, shared leadership, and progress across different cultures and identities can strengthen both the intervention itself and the community's capacity to work together in the future.

In Summary

These two closing statements sum up the key points of this section:

• First, work from an understanding of the experiences, priorities, strengths, and perspectives of the community involved. Don't assume that an intervention that worked elsewhere will automatically fit. Learn from community members, examine your own assumptions, build relationships, and adapt the intervention collaboratively. This takes cultural humility, flexibility, openness, and patience.
• Second, even with thoughtful planning and strong collaboration, success is not guaranteed. Resources may be limited, priorities may change, or the intervention may turn out not to be the right fit. But when adaptation is done collaboratively and respectfully, the result can be an intervention that is more relevant, accessible, and responsive to the community. The relationships, trust, and shared learning developed through that process can also strengthen future community efforts.

___You understand what it means to adapt interventions for different cultural traditions.

___You understand why you should adapt interventions.

___You understand when you should adapt interventions.

___You understand when you don't need to adapt an intervention.

___You understand how to adapt interventions to different cultural traditions:

___You have determined that the intervention is worth adapting.

___You have decided that you want to do the adaptation.

___You have decided that it is your role to direct the adaptation.

___You are culturally ready to take on the role.

___You have checked the readiness of your target group.

___You have made the commitment to do the adaptation.

___You have set specific objectives.

___You have done some research.

___You have talked to people in that cultural setting.

___You have spent some time in that cultural setting.

___You have proposed your intervention.

___You have asked for feedback.

___You have incorporated that feedback (or have a good reason why you didn't).

___You have found some people in that cultural community who will work together with you.

___You have planned and executed your intervention.

___You know what to do in the following situations:

       ___If conflicts arise

       ___If cultural groups really don't understand each other

       ___If materials need translation

       ___If the adaptation involves several different cultural groups

Questions to Consider in your Search for Information about the Community

Historical Issues

• What is the history of the community?
• What name or names do the cultural groups use to refer to themselves?
• What is the significance of the different names?
• What are the major differences between cultural groups in your target community, particularly across generational, educational, socio-economic and geographic lines?
• What have been the major historical events which describe the target group's experiences in the United States?
• What were and are the major conflicts between or among the cultural groups in the target community? What were the outcomes?
• What were and are the major conflicts within each group? What were the outcomes?

Economic and Political Issues

• What are the different socio-economic levels of groups within the community?
• What is the political status of each group in the community (e.g. undocumented, refugee, legal immigrant, citizen)?
• What are the different literacy levels within groups? Are they literate/illiterate in English and/or their own language?
• What are the different education levels within groups?
• How is their health status affected by their economic and political status? What are the predominant health problems?
• How often is medical care used by these different groups? What types of care?
• What are the organizations that successfully serve the different groups within the target community? Are they governmental, religious, community, social service, political or ethnic in nature?

Culture and Tradition-Specific Issues

• What are the values of the different groups in the community?
• How do various members of each cultural group define health and illness?
• What are some of the more common health beliefs and practices of community groups, both in general and with respect to specific problems?
• What are the predominant family structures within the community's cultural groups? Patriarchal, matriarchal, single parent household, extended families, etc.?
• What are some of the traditional roles of different family members in these cultural groups, particularly where health care is concerned?
• Who are the formal and informal leaders in the community, and what role do they have in the area of health promotion?
• How many languages and dialects are spoken?
• What are the formal and informal channels of communication within and between different groups?

Medical Orientation

• What are the group's general beliefs about the cause, prevention, diagnosis and treatment of disease?
• What are the group's attitudes towards "Western" medicine?
• In general, what has been the experience of different groups when trying to access the health care system?
• To what extent is there use of traditional medicine or healers?
• Where do people go for health information?

Diet

• What are traditional foods, and what role do they play in health, religion, and social activities?
• How has diet here in the U.S. changed over time as compared to in their country of origin?
• Is there access to foods that constitute traditional diet? Are there acceptable substitutes?

Religion

• What are the different religions practiced within the cultural groups in the community?
• How is practice of their religion influenced by their culture?
• What is the size of membership, and who are the members?
• Who are the religious leaders, and what is their role in the larger community?
• Are there conflicts among or within the various religious groups?
• What involvement do various religious groups have in the area of health education and promotion?
• Do religious beliefs conflict with the philosophy of health promotion? Can the beliefs be incorporated into your program?

A PowerPoint presentation summarizing the major points in the section.

You run a community violence prevention program, working with young people who have experience with gangs or the justice system. The young people trust you, and sometimes share sensitive information with you. Law enforcement also knows about your work and may ask you for information about particular participants. What information are you obligated to share, and what are you obligated to keep confidential?

The right of a person to understand what happens to information they share in the course of a community intervention falls under the heading of ethics. A participant in a community program -- a health clinic, an adult literacy class, a youth leadership initiative -- has a right to certain expectations about how they and the information they share are treated. The community also has expectations about the reliability, competence, honesty, and accountability of programs that serve community members. In this section, we'll discuss some of those expectations and the ethical and legal responsibilities that may apply to your organization or initiative.

What do we mean by ethics?

Ethics refers to principles and standards that guide decisions about what is right, fair, responsible, and respectful. Although ethical decisions can vary depending on circumstances, cultures, professions, and laws, community interventions generally share several guiding principles:

Do no harm. Hippocrates put this principle into words more than 2,000 years ago, and it remains a fundamental ethical consideration.

• Respect people as ends, not means: Treat each person as an individual with dignity, rights, strengths, and goals -- not simply as a number in a political, social, organizational, or clinical calculation.
• Respect participants' ability to help determine what they need. Don't assume that professional staff or program planners necessarily know what's best for an individual or community. People with lived experience should have meaningful opportunities to shape decisions that affect them.
• Respect everyone's human, civil, and legal rights. This includes non-discrimination, accessibility, cultural responsiveness, privacy, autonomy, and equitable treatment.
• Seek outcomes that are fair and beneficial under the circumstances. You may not be able to meet every person's needs in every situation, but decisions should consider the well-being, rights, and perspectives of everyone affected.

• Don't misuse your position or exploit a participant for personal advantage or power. This includes taking advantage of participants or others for political, social, sexual, professional, or financial gain.
• Don't attempt an intervention in areas in which you're not appropriately trained or competent. This principle goes along with "do no harm." Community organizations sometimes operate in settings with limited resources, but staff should recognize the limits of their expertise, seek appropriate supervision or consultation, make referrals when necessary, and avoid taking on responsibilities that create unreasonable risks for participants.
• Actively strive to improve, to the extent possible, the circumstances of participants and the community. This means providing effective and responsive services, listening to participants, strengthening community assets, and addressing underlying conditions that contribute to the issues the intervention is intended to address.

Why is ethical behavior important in community interventions?

In addition to being the right thing to do, consistent ethical behavior can strengthen your program. It can improve effectiveness, build trust and credibility in the community, support responsible leadership, and help your organization remain in good professional and legal standing.

• Program effectiveness. Consistent ethical behavior can contribute to a more effective program. Considering ethical principles in all aspects of a community intervention can lead to more respectful, responsive, and community-centered methods and can strengthen participation, relationships, and community support.
• Standing in the community. An organization with a reputation for ethical behavior is more likely to earn trust from participants, partners, and the broader community. That trust can make it easier to recruit staff, volunteers, Board members, partners, and participants and to build public and financial support.
• Ethical credibility and leadership. If your work is intended to promote social change, social justice, reduce suffering, foster human dignity, or provide needed services, your organization's actions should reflect those values. Ethical conduct helps ensure that your practices are consistent with your mission and strengthens your credibility when advocating for change.

• Professional and legal issues. Many health, legal, education, mental health, social service, and other professionals involved in community interventions are governed by professional codes of ethics, certification requirements, licensing rules, and laws. Professional associations and licensing bodies may establish standards related to confidentiality, informed consent, professional boundaries, competence, recordkeeping, conflicts of interest, and other areas.

  Serious violations of professional responsibilities can result in disciplinary action, suspension or loss of a professional license, employment consequences, civil liability, or, in some circumstances, criminal penalties.

  People working in regulated professions are responsible for understanding the ethical standards, laws, organizational policies, and professional requirements that apply to their work.

  Legal and ethical responsibilities frequently overlap, but they are not always identical. Organizations should have clear policies and access to appropriate professional or legal consultation when difficult questions arise.

Who is subject to a code of ethics in community interventions?

The short answer is that everyone who works in a community program or interacts with people in a professional or service role has ethical responsibilities. Some people are also subject to formal professional codes, licensing requirements, organizational policies, or legal obligations.

Here are some examples of people who may be expected to follow formal ethical or professional standards:

• Medical and health care professionals, such as physicians, nurses, emergency medical personnel, and other licensed or regulated health practitioners
• Mental health professionals, such as psychiatrists, psychologists, therapists, and counselors
• Social workers
• Clergy and other faith leaders
• Public officials
• Educators
• Youth workers
• People who work with children and young people, including child welfare professionals
• Lawyers and paralegals
• Mediators
• Administrators of community programs and sponsoring organizations
• Direct-service and support staff, such as home health aides and staff at residential programs or shelters

What are the ethical issues that need to be considered, and how do they play out in community interventions?

Ethical behavior in community interventions relates to the treatment of people, information, resources, and money, as well as to the actions of staff and organizations even when they are not dealing directly with participants. Not every issue below is governed by the same laws or professional codes in every setting, but all are important considerations for community programs.

Confidentiality

One of the most familiar ethical issues is the expectation that personal information shared by participants in the course of a community intervention or program -- including conversations, records, notes, assessments, test results, and other information -- will be handled responsibly and protected from inappropriate disclosure. Legal responsibilities vary by program, profession, type of information, and jurisdiction, so organizations should have clear confidentiality policies that reflect applicable law and professional standards.

Confidentiality protects participants' privacy and can help establish trust between participants and the program. Depending upon the program, the staff member's role, and applicable requirements, confidentiality may take several forms:

• Only staff members who need particular information for an appropriate program purpose have access to it, unless the participant has authorized broader disclosure. Paper and electronic records should be stored securely and protected from unauthorized access.

• Information may be confidential within a program but shared among appropriate staff members when necessary for consultation, supervision, coordination, or service delivery. Staff should share only the information needed for the purpose and follow applicable privacy requirements.

• Information may sometimes be shared with another program or organization when coordination is appropriate and the participant has given valid authorization, or when another lawful basis for sharing exists. Programs should clearly explain what information will be shared, with whom, for what purpose, and for how long the authorization applies.
• Funders may request information documenting services, participation, or outcomes. Programs should anticipate these requirements before making promises of confidentiality and should provide only the information that is necessary and permitted. Whenever possible, reports should use aggregate or appropriately de-identified information rather than personally identifiable participant records.

• Some programs cannot offer complete confidentiality. Participation may be court-ordered, required by another agency, or subject to reporting requirements. In these circumstances, participants should still receive clear information about what will remain private and what may be disclosed.

In all circumstances, ethical treatment of participants requires transparency about confidentiality. People should receive understandable information about the program's privacy practices and any limits on confidentiality so they can make informed decisions whenever they have a choice about participation.

Consent

There are several forms of consent relevant to community interventions: consent to share records or information; informed consent for services, treatment, research, or program conditions; and questions about community participation and acceptance when an intervention is introduced into a neighborhood or community.

• Consent to sharing of information. When participant information is protected, sharing it with another organization or person generally requires an appropriate legal or ethical basis. When participant authorization is required, the person should understand what information will be shared, with whom, for what purpose, and for how long.
• Informed consent for services, treatment, research, or program conditions. Ethical practice requires that people receive understandable information about what they are being asked to participate in, what the potential benefits and risks are, what alternatives may exist, what is expected of them, and what rights they have. Participants should have meaningful opportunities to ask questions before making a decision.

• Community involvement and acceptance. Ethical questions can arise when an organization wants to locate or operate a program in a neighborhood. For example, how should a community be involved when an organization plans to open supportive housing, a residential reentry program, a shelter serving people experiencing homelessness, or another service? Whose perspectives should be considered, and how should concerns be balanced against the rights and needs of people who will use the service?

Both confidentiality and consent bring up the broader issue of privacy. Digital technology, electronic records, online communication, data sharing, and increasingly interconnected information systems have created new opportunities and new risks. Organizations should think carefully about what information they collect, how long they retain it, who can access it, and how it is protected.

Disclosure

Like consent, disclosure in this context has more than one meaning.

• Disclosure to participants of the conditions of the program they're in -- including confidentiality policies and their limits, available services, program requirements, costs, time limits, grievance procedures, research activities, and other important conditions. Information should be provided in clear and accessible language so participants can understand what they are agreeing to and make informed choices whenever possible.

• Disclosure of participant information to other individuals or organizations. Programs should follow applicable confidentiality laws, professional standards, participant authorizations, and organizational policies. Any exceptions or limits to confidentiality should be communicated clearly when participants enter the program.
• Disclosure of conflicts of interest. Staff members, Board members, contractors, researchers, and organizations should disclose financial, professional, family, political, or other interests that could reasonably affect -- or appear to affect -- their judgment or decisions.

Competence

By offering services of any kind, an organization is making a commitment to participants that it will make a responsible effort to provide the services it says it will provide. That includes ensuring that the people doing the work have appropriate knowledge, skills, training, supervision, and support.

No program or individual will succeed 100% of the time. Outcomes may be affected by many factors, including the fit of the intervention, accessibility, available resources, participants' goals and circumstances, broader social conditions, and the quality of implementation. A program should not automatically interpret limited participation or unsuccessful outcomes as evidence that participants are "resistant" or unwilling to change.

Competence means more than simply having appropriate credentials or prior experience. A competent organization recruits qualified staff, provides supervision and professional development, seeks participant feedback, evaluates its work, and responds when services appear ineffective or harmful. If staff members need additional training or support, the organization should provide it when possible. If someone cannot perform essential responsibilities safely and effectively even with appropriate support, the organization may need to change their responsibilities or employment.

There may also be professional and legal consequences when licensed or regulated service providers practice outside the limits of their competence or fail to meet required standards. Organizations should make sure staff understand the responsibilities and limits associated with their roles.

Conflict of interest.

A conflict of interest is a situation in which someone's personal, financial, professional, political, social, family, or other interests could improperly influence -- or appear to influence -- their judgment or actions. In community interventions, conflicts of interest can affect decisions about services, hiring, purchasing, funding, research, referrals, or relationships with participants.

A conflict of interest does not always mean that someone has acted unethically, but undisclosed or unmanaged conflicts can undermine trust and lead to unfair or biased decisions. Organizations should identify potential conflicts, disclose them appropriately, and manage or eliminate them when necessary.

If you find yourself in such a situation, the ethical response generally has two parts:

• Disclose the conflict to the appropriate person or body -- such as your employer, supervisor, Board, funder, participant, or other relevant party -- and discuss how it should be handled.
• Manage or eliminate the conflict. Depending on the situation, this might mean removing yourself from a decision, using an independent review process, transferring responsibilities, declining funding, ending a financial arrangement, or making another change that protects participants and the integrity of the organization.

Some examples of conflicts of interest and possible responses include:

• A program director considering the purchase of equipment from a company owned by a close family member. The director has both a personal and financial connection to the decision. The relationship should be disclosed, and the director should generally step away from the purchasing decision.
• A staff member considering a romantic or sexual relationship with an intern or person they supervise. The power difference creates significant ethical concerns and may violate organizational policy or professional standards. The appropriate response is to follow applicable policies and ethical rules, protect the person with less institutional power, and remove the conflict rather than relying on informal arrangements.
• A researcher accepting funding from a company that could benefit financially from a particular study outcome. The financial relationship should be disclosed and managed through appropriate safeguards, independent oversight, or another funding arrangement when necessary.
• A counselor or therapist providing professional services to a close family member, current partner, former partner, or other person with whom they have a significant personal relationship. Professional boundaries and objectivity may be compromised, so referral to another qualified provider is usually more appropriate.
• A youth program staff member assigned to work closely with a young person whose family has an ongoing personal conflict with that staff member. The program should consider whether another staff member can provide services more fairly and effectively.
• A health care professional referring patients to a practice in which they have a financial interest. The relationship should be disclosed and managed according to applicable professional standards, organizational policies, and laws.

Grossly unethical behavior.

Some behaviors go far beyond ordinary ethical disagreements and involve serious violations of professional responsibilities, participant rights, organizational standards, or the law. Community programs should establish clear standards, reporting procedures, safeguards, and consequences for serious misconduct. Depending on the behavior, responses may include investigation, disciplinary action, termination, reporting to licensing or regulatory bodies, or referral to law enforcement.

Examples of serious ethical violations may include:

• Sexual or romantic relationships in professional situations where there is a significant power imbalance and where such relationships violate professional standards, organizational policy, or law.
• Exploiting participants financially, accepting bribes, or giving preferential access to services in exchange for money, gifts, favors, or personal benefits.
• Defrauding funders, such as billing for services that were never provided or falsifying records.
• Improperly denying necessary services because a person cannot pay when doing so violates professional, organizational, or legal obligations.
• Discriminating in service delivery on the basis of protected characteristics or otherwise treating people inequitably without a legitimate and lawful program reason.

• Criminal or abusive conduct connected to the program, such as theft or misuse of program funds, abuse or exploitation of participants, falsification of records, or other serious misconduct.

General ethical responsibilities.

Ethical behavior for a community intervention is more than simply following professional codes and avoiding misconduct. It means actively trying to do what is fair, responsible, respectful, and beneficial for participants, staff members, funders, community partners, and the broader community. By working in the community, you take on a number of responsibilities:

Responsibility to funders. You are responsible for being financially accountable, using funds appropriately, meeting legitimate reporting requirements, and making a good-faith effort to carry out the work you agreed to do.

Responsibility to staff members. You are responsible for treating staff fairly; compensating them appropriately for their work; providing reasonable autonomy, supervision, and opportunities for professional development; and taking reasonable steps to protect their health and safety.

A community violence prevention outreach worker, for example, may need training related to neighborhood dynamics, conflict de-escalation, trauma-informed practice, confidentiality, personal safety, professional boundaries, and local resources. Staff should also receive clear information about job risks and the support available to them from the organization.

Responsibility to participants. You are responsible for making a continuing effort to provide effective, respectful, and responsive services. This means looking for better methods and ideas; listening to participant feedback; building on program strengths; identifying and correcting weaknesses; respecting participants' rights; and recognizing participants as people with knowledge, agency, strengths, and goals.

Responsibility to the community. You are responsible for trying to understand community priorities, strengths, needs, and concerns; being responsive to community knowledge and perspectives; and using your intervention to contribute positively to community well-being without compromising essential ethical principles or participant rights.

The participatory nature of community interventions can itself raise ethical questions. Involving people most directly affected by an issue and the broader community in planning is generally both ethically and practically valuable. Community members bring lived experience, history, relationships, knowledge, and ideas that professional staff may not have.

Meaningful participation does not mean that everyone will always agree. Community members, service providers, researchers, funders, and other partners may have different interpretations of the issue or different ideas about what should be done. Ethical collaboration requires taking those perspectives seriously, explaining relevant evidence and constraints, being transparent about who has decision-making authority, and seeking shared solutions when possible.

The reality is that there aren't simple answers to many ethical questions. Clear principles and policies help, but organizations will still encounter situations in which legitimate values or responsibilities conflict. Ethical practice involves recognizing those tensions, consulting appropriate people, listening to those affected, documenting important decisions, and continually asking whether the organization's actions are consistent with its mission and responsibilities.

In Summary

Ethical considerations are extremely important in community interventions. A program that behaves unethically or allows serious ethical problems to go unaddressed risks harming participants, undermining its mission, damaging community trust, and reducing its effectiveness.

Because ethical issues are not always clear-cut, community programs should establish ethical guidelines, policies, and decision-making procedures before difficult situations arise. Clear expectations related to confidentiality, consent, disclosure, competence, professional boundaries, conflicts of interest, participant rights, staff responsibilities, and organizational accountability can help staff respond consistently and responsibly. Just as important, organizations should remain willing to learn from participants and community members and revise their practices when those practices do not live up to their ethical commitments.

___You know what ethics means

___You understand that ethical behavior is important in community interventions for:

• Program effectiveness
• Standing in the community
• Moral credibility and leadership
• Professional and legal issues

Ethical issues that need to be considered

___You have decided on the confidentiality level of your program participant's information

___You have informed your participants of this

___You asked for consent to share information if necessary

___You have used disclosure in situations where deemed necessary.

___Your organization is competent to accomplish its goals under reasonable circumstances.

___You have taken steps to eliminate conflict situations when they arise.

___You know how to prevent and deal with grossly unethical behavior from individuals and organizations.

___You know what your ethical responsibilities to your funders, staff members, participants and the community are.

A PowerPoint presentation summarizing the major points in the section.

• What is a best practice?

• Why promote the adoption and use of best practices?

• When should you promote the adoption and use of best practices?

• Who should be involved in promoting the adoption and use of best practices?

• Where do you find best practices?

• How do you promote the adoption and use of best practices?

The Parkville Heart Health Coalition was concerned. A community assessment showed that many elementary school children had limited opportunities for regular physical activity outside of school. Families and young people pointed to barriers that included limited access to safe recreation spaces, cost, transportation, and the amount of time spent on sedentary activities.

Research and community experience suggested that helping children find enjoyable forms of physical activity they can continue throughout life could support long-term health. Coalition members recognized this as a promising approach, but they also knew that success would require the participation of schools, families, young people, local officials, recreation organizations, and other community partners. How could they work together to determine whether the approach fit their community and, if so, put it into practice?

Best or promising practices can help you address community problems without having to start from scratch. If another community or organization has developed an approach with evidence of effectiveness, it makes sense to learn from it while also considering how well it fits your own community.

The first section of this chapter discussed how to recognize and choose promising practices for health and community development. Sometimes, however, those are only the preliminary steps. Once they're completed, there may remain the task of helping organizations and communities consider, adapt, adopt, and effectively use those practices. In this section, we explore how to do that, as well as what a "best practice" is and how to find one appropriate for your goals and circumstances.

What is a best practice?

A best practice may be a particular method, or it may be a whole program or intervention. "Best practice" status is sometimes conferred by a government body, professional association, research organization, funder, or other entity. In other cases, a practice gains recognition through research, evaluation, or consistent positive results in multiple settings. In general, a method or program considered a best practice is:

• Measurable. Its goals are clear enough that progress and outcomes can be assessed. A smoking cessation program, for instance, might examine how many participants reduce or stop tobacco use and how those outcomes change over time.
• Demonstrably effective. Evidence suggests that the method or program contributes meaningfully to the outcomes it is intended to achieve.
• Replicable or adaptable. The method or program is documented clearly enough that others can understand its essential components and use or adapt them in another setting.

Best practices, in short, are methods or programs that have evidence of success in accomplishing particular goals and that may be usable or adaptable in other settings. The standards for choosing a best practice vary greatly depending upon who is doing the choosing. Some organizations use broad criteria, while others require extensive research and evaluation evidence.

Where the standards are relatively loose, programs designated as best practices may have limited evidence. Where the standards are extremely strict, valuable community programs may be overlooked because they lack the funding or evaluation capacity to produce extensive research. When considering a best practice, pay attention to who designated it as such, what evidence was used, which communities were included in that evidence, and how recently the practice was evaluated.

Some other things to keep in mind when considering best practices:

• Fit with your community and the people involved. Does the method or program make sense given the realities, strengths, needs, languages, culture, and resources of your community? Can it be adapted appropriately?

• Appropriateness to your goals. Does the practice actually address the outcomes you want to achieve? A practice that works well for one part of an issue may not address the underlying conditions you are most concerned about.
• Fit with the structure and philosophy of the organization or initiative that will use it. A highly centralized program, for example, may not fit well with an organization committed to shared decision-making and community leadership unless it can be meaningfully adapted.
• Availability of resources. Make certain you understand what a practice requires in funding, staffing, training, partnerships, facilities, technology, time, and other resources before committing to it.
• Cost-effectiveness and sustainability. A highly effective program may still be difficult to sustain if it requires resources far beyond what most communities can provide. A somewhat less intensive approach that produces strong outcomes with available resources may ultimately have greater reach and sustainability.

Why promote the adoption and use of best practices?

One answer to this question is straightforward: using a method or program supported by credible evidence can increase the likelihood that an effort will achieve its goals and benefit participants and the community. There are, however, additional reasons why using a best or promising practice can be advantageous.

• Using a recognized practice can help explain and justify the approach. Participants, community members, partners, and funders may reasonably want to know why a particular intervention was chosen. Evidence that the approach has worked elsewhere can provide useful support while still leaving room for local adaptation.
• Using recognized best practices can strengthen an organization's credibility. It shows that the organization has examined evidence and learned from the experience of others rather than relying only on assumptions or habit.
• Using best practices can strengthen funding proposals. Many funders want applicants to demonstrate that proposed approaches are informed by evidence or prior successful experience.

• Using a documented practice can reduce some of the uncertainty involved in planning. Having a clearly described structure, theory, and implementation process gives organizations a useful starting point.
• People with experience implementing the practice may be available to provide guidance. They may be able to explain what worked, what challenges arose, which components were essential, and how the practice has been adapted in other settings.
• Best practices provide evidence that an approach can work under particular conditions. That does not guarantee success in every community, but it provides a stronger starting point than using an approach with no supporting evidence or experience.

When should you promote the adoption and use of best practices?

Promoting the consideration and use of best practices can be an ongoing activity, but some times are especially appropriate.

• Before a new intervention or program begins. It is often easier to incorporate an evidence-supported practice while a program is being designed than to add it after structures and routines are already established.
• When a serious community issue requires a stronger response. Rising rates of domestic violence, child maltreatment, infectious disease, housing instability, or other concerns may prompt organizations and community members to examine approaches that have shown results elsewhere.
• When what's being done isn't working well. If a current intervention is not producing desired outcomes, it may be time to examine alternative or additional approaches.
• When community members or participants request change. People most directly affected may identify gaps in current services or call attention to approaches that appear to work elsewhere.
• When funders or officials encourage or require evidence-supported practices. Make sure, however, that requirements still allow appropriate adaptation to local circumstances and meaningful community input.

Who should be involved in promoting the adoption and use of best practices?

When considering whether to adopt a best practice, it's valuable to involve people who will be affected by, participate in, implement, or support the intervention. If they help identify, examine, and adapt possible practices, they are more likely to understand the evidence, identify potential problems, and help shape an approach that fits the community.

• Practitioners -- health and human service professionals, community development workers, educators, outreach staff, and others who may implement the practice.
• People who will participate in, be affected by, or benefit from the practice, including people with relevant lived experience.
• People and organizations that may be indirectly affected. These might include public agencies, social workers, businesses, property owners, schools, health systems, neighborhood organizations, or others whose work or responsibilities could change as a result of the intervention.
• Interested community members. Broader community participation can contribute local knowledge, strengthen transparency, and build support.
• Local and, when appropriate, regional, state, tribal, or other public officials. Their involvement may be important when policies, public funding, or government systems are connected to implementation.

Where do you find best practices?

To find best and promising practices, try:

• Online research. Search engines, research databases, government websites, university repositories, evidence clearinghouses, professional organizations, and program databases can provide research findings, evaluation reports, implementation guides, and descriptions of practices.
• Networking. Talk to colleagues, community partners, practitioners, researchers, and people with lived experience. They may know about practices that have worked elsewhere or connect you directly with organizations implementing them.
• Libraries. Public, academic, and specialized libraries can provide access to books, research databases, reports, journals, and professional guidance. Librarians can also help identify credible and relevant sources.
• State and national advocacy and professional organizations. These organizations may publish research, evidence reviews, implementation guidance, conference materials, or examples of successful programs.

• International, state, federal, tribal, and local agencies. Public agencies often publish evidence reviews, guidance, program evaluations, implementation resources, and descriptions of funded initiatives.
• Foundations and other private funders. Funders may publish evaluations, case studies, learning reports, and descriptions of projects they support.
• Colleges and universities. Researchers, faculty, students, extension programs, and research centers may be studying the issue you're concerned with or may know of relevant evidence and programs.
• Community knowledge and lived experience. Faith leaders, community organizations, service groups, businesses, advocates, participants, neighborhood leaders, and other community members may know about successful approaches that are not widely documented in academic or professional sources.

Using online sources to find best or promising practices

Online searching can provide access to an enormous amount of information, but finding reliable and relevant evidence requires more than simply entering a few words into a search engine. The goal is not only to find examples, but also to determine whether the source is credible, whether the evidence is current, and whether the practice has been used with communities or circumstances similar to yours.

General search engines can be useful starting points. Research databases, government websites, university repositories, professional associations, and evidence clearinghouses may be especially helpful when you need stronger evidence.

A few basic search strategies can make your search more useful:

• Be specific. Search for the issue, population or community, type of intervention, and outcome you're interested in. Instead of searching only for "child health best practices," for example, you might search for "school-based physical activity interventions elementary students" or another phrase that closely matches your question.
• Use several related terms. Different researchers and organizations may describe the same idea differently. Try terms such as "best practice," "promising practice," "evidence-based practice," "evidence-informed practice," "intervention," "program evaluation," or other issue-specific terms.

• Try different words and phrases if you don't immediately find what you're looking for. The terminology used in research, government, and community practice may differ, so testing several search terms can help uncover useful information.
• Search in relevant languages. When researching programs used in multilingual communities or in other countries, valuable information may be available in languages other than English. Translation tools may help with initial review, but important materials should be interpreted carefully.
• Use organizations' internal search tools and resource collections. Once you find a credible agency, university, professional association, foundation, or evidence clearinghouse, explore its reports, databases, toolkits, and related resources.

You can find an up-to-date list of Databases of Best Practices on the Community Tool Box. It contains web-based resources for exploring promising approaches to community health and development, as well as resources organized by issue.

Online sources are extremely useful, but they are not the only source of knowledge. Some strong community programs may have limited online visibility or may not yet have been formally evaluated. Talking with practitioners, researchers, participants, and community members can help you identify approaches that would otherwise be missed.

How do you promote the adoption and use of best practices?

Once you've brought together community members, practitioners, and other partners to consider best practices, the next steps are to define what you're trying to accomplish, identify approaches that fit your goals and circumstances, compare the available evidence, and decide together what should be adopted or adapted. Even then, you're not finished: successful implementation requires training, resources, ongoing learning, and evaluation.

Define your issue, priorities, and goals clearly, so that you can determine exactly what kind of best practice you're seeking.

As mentioned above, not every best practice related to your issue is necessarily aimed at the same outcomes you're working toward. To make sure that you're choosing a practice that fits your goals, begin by defining what you want to address and what success would look like.

• Define your issue. What exactly is it you want to address? If it's a broad issue, are you addressing the whole thing or one part of it? If the issue is community violence, for instance, are you focusing broadly on community safety, youth violence, intimate partner violence, firearm injury, or another specific concern? The answer will affect which practices are most relevant.
• Define the outcomes you intend to achieve. The practice you choose should aim at the outcomes you're interested in. If you're working to prevent intimate partner violence, for example, you may want an approach that combines survivor support and safety, healthy relationship education, prevention with young people, community norms change, economic and housing supports, accountability for people who cause harm, and appropriate policy or system changes. A program focused only on responding after violence occurs might be effective at that task but may not accomplish your broader prevention goals.

• Understand the people and communities involved. Who will participate in or be affected by the practice? What strengths, priorities, languages, cultures, experiences, access needs, and barriers should be considered? Involving people most affected can help determine whether a practice is likely to fit and what adaptations may be needed.
• Explore the context. Community history, geography, resources, systems, policies, relationships, transportation, housing, economic conditions, and other factors can influence whether a method or program will be effective.

This kind of analysis should help you identify practices that have produced outcomes similar to the ones you want and that appear compatible with your community's strengths, priorities, circumstances, and values.

Search for appropriate best practices.

Once you've defined what you're looking for, find several possible practices and compare them. Consider the quality of the evidence, who participated in the original programs, the settings in which they were tested, resources required, possible unintended effects, accessibility, cultural fit, and how much adaptation might be needed. Community members and people who would implement the practice should be involved in this review whenever possible.

Promote thoughtful consideration and adoption of best practices.

Sometimes organizations or communities are already using an approach they value. Even when evidence suggests that another method may produce stronger outcomes, simply telling people that their current work should be replaced is unlikely to build trust or collaboration.

A participatory process can help people examine current results, review alternatives, understand the evidence, identify strengths worth preserving, and decide whether a new or adapted approach would improve the work.

• Share evidence and community findings openly. Explain why particular practices appear promising and how they relate to local priorities, while also inviting questions and concerns.
• Engage funders as partners in implementation. Funders may be able to support training, evaluation, adaptation, staffing, or other resources needed to implement a practice effectively.
• Connect local participants and practitioners with people who have experience using the practice. Practical conversations about implementation, challenges, adaptations, and results can help everyone evaluate whether the approach is a good fit.

• Consider piloting or testing an approach before making a full transition. A limited pilot may allow the organization and community to compare approaches, identify needed adaptations, and learn whether the new practice actually improves outcomes in the local setting.

Ensure that anyone involved in implementing a best practice receives the training needed to carry it out effectively.

People should understand the assumptions, principles, and theory behind the program or method, as well as the specific skills needed to implement it. Even a strong practice can fail if staff members are asked to carry it out without adequate training, supervision, materials, or opportunities to practice.

Those implementing a practice should also understand why it was chosen and have opportunities to raise concerns, suggest adaptations, and learn from implementation. Commitment is more likely when people understand the evidence, see how the practice supports community priorities, and have a meaningful role in making it work.

Provide those who'll implement best practices with the necessary support.

You can't expect to reproduce the results of a successful practice without considering the resources and conditions that helped make the original successful. Those resources can include:

• Funding. Trying to implement a program with substantially fewer resources than it requires may undermine quality and outcomes. Understand the essential costs before beginning, and consider whether the model can be sustained over time.
• People and staffing. Some programs depend heavily on volunteers, peer leaders, community health workers, mentors, or other participants. Consider whether people have the time and resources to take on these roles and whether compensation may be appropriate. Volunteers and staff also need training, support, and supervision.
• Space and accessibility. Consider whether program locations are physically accessible, reachable by transportation, welcoming, appropriately sized, and suitable for the people using them. Virtual or hybrid participation may also be appropriate in some settings.
• Time. New programs need time to establish relationships, train staff, learn from implementation, make adjustments, and evaluate results. Accountability is important, but so is allowing enough time for responsible learning and improvement.
• Community and institutional support. Staff, participants, and partners are more likely to succeed when community leaders, public officials, funders, organizations, and other partners understand the work and support the conditions needed for it to succeed.

Keep making the best better, and maintain the community's commitment to effective practice.

Finally, remember that adopting a best practice is not the end of the work. Even a well-supported practice can be improved, and changing community conditions may require new adaptations over time.

Best practices are only as good as their implementation. Continue examining whether the practice is reaching the people it is intended to reach, whether participants experience it as respectful and useful, whether intended outcomes are being achieved, and whether changes are needed.

Community priorities, evidence, and available approaches will continue to change. Keep learning about promising practices, evaluating what you're already doing, listening to participants and community members, and strengthening approaches that support meaningful and lasting improvements.

In Summary

One way to strengthen community health and development efforts is to identify and thoughtfully use best or promising practices -- methods or programs that have evidence of effectiveness and that can be implemented or adapted in other settings. This doesn't guarantee success. No intervention works equally well everywhere, and communities may already have locally developed approaches that are effective. Evidence is most useful when it is combined with community knowledge, lived experience, thoughtful adaptation, and ongoing evaluation.

Considering a best practice should be a collaborative process. People most affected by the issue, practitioners, community organizations, public officials, funders, researchers, and other relevant partners can help examine the evidence, decide whether an approach fits, identify adaptations, and determine what resources are necessary for implementation.

Once a practice is adopted, continue learning. Provide the training and resources necessary to implement it well, evaluate both outcomes and participant experiences, and make improvements as evidence and community circumstances change. Even a practice labeled "best" should remain open to learning and improvement.

What is a best practice?

A best practice is:

___Measurable

___Notably successful

___Replicable

___A good fit for your circumstances

Why promote the adoption and use of best practices?

___Using a recognized best practice makes it easier to justify the work.

___Using recognized best practices can bolster the credibility of an organization.

___Using best practices can make it easier to get funding.

___Using a best practice removes a lot of the guesswork from planning.

___The originators of the practice are known, and might be available to consult on how to best implement it.

___We know that best practices work.

When should you promote the adoption and use of best practices?

___When a new intervention or program is starting up.

___When what’s being done isn’t working.

___When there’s a serious community problem that has to be tackled.

___When the community demands it.

___When funders or officials demand it.

Who should be involved in promoting the adoption and use of best practices?

___Practitioners – health and human service workers, community developers, etc.

___Members of the population that will participate in or benefit from the best practices in question.

___Those who’ll be indirectly affected by the program.

___Interested community members.

___Local and, if appropriate, state officials.

Where do you find best practices?

___On the Internet.

___By networking.

___In libraries.

___Through national advocacy and professional organizations and their journals.

___Through international, state, and federal agencies.

___Through foundations and other funders.

___In academia.

___Through community word of mouth.

How do you promote the adoption and use of best practices?

___Define your issue, needs, and goals clearly, so that you can determine exactly what kind of best practice you’re seeking.

___Search for appropriate best practices.

You promote the use and implementation of best practices by:

___Mobilizing community opinion.

___Alerting funders to best practice possibilities.

___Bringing some of the people who originated or who use appropriate practices together with people in your community.

___Suggesting that, rather than substituting a best practice for what it is already doing, an organization or group simply add it, or try it out.

___Ensuring that anyone involved in trying to replicate a best practice is provided with the training to make it successful.

___Providing those who’ll implement best practices with the necessary support and resources.

___Continuing to make the best better, and maintaining the community’s commitment to best practices.

A PowerPoint presentation summarizing the major points in the section.