Chapter 2., Section 8. Communities That Care — Main Section | Community Tool Box

In Chapter 2, we’ve looked at a variety of different models for building healthy communities, including one – asset development – that focused on building the advantages that young people need in order to develop into healthy, successful adults. That model approaches adolescent health and growth from a positive angle, assuming that if you can provide young people with the appropriate support and opportunities, healthy development is more likely.

But there are negative as well as positive influences at work in families, schools, and communities. If completing high school is uncommon or not strongly supported in an adolescent’s environment, that young person may be less likely to see graduation as important or attainable. Young people may find it harder to avoid substance use if substances are readily available at school or in the community. If violence is common or normalized in a community, young people may be more likely to experience or become involved in it.

In this section, we’ll look at a model that acknowledges both the positive (protective) and negative (risk) factors that affect adolescents, with the goal of enhancing the former and reducing the latter. The model has a narrower focus than some we’ve profiled, but its purpose is the same – to enhance the healthy development of young people, and thus to create a healthier community.

Like most other models, Communities That Care takes a community-wide perspective and calls for broad community participation. Similar to PRECEDE/PROCEED, it identifies problems and resources, develops solutions aimed directly at the identified issues, and integrates evaluation into implementation.

Communities That Care resembles the Search Institute’s asset development model in its emphasis on young people and the protective and risk factors affecting them. Where asset development looks at the overall development of children and adolescents, however, Communities That Care focuses more specifically on preventing health and behavior problems and promoting healthy youth development.

What is Communities That Care?

Communities That Care (CTC) is based on the Social Development Strategy developed through the work of J. David Hawkins, Richard Catalano, and colleagues at the University of Washington. Rather than being a single prevention program, CTC is a prevention-planning system that provides the structure, but not the specific content, of a community effort to address youth health and behavior issues. It focuses on risk and protective factors through a community-wide process that includes assessment, planning, training, implementation, and evaluation.

The current Communities That Care PLUS system is supported by the Center for Communities That Care at the University of Washington. The Center provides licensing, training, coaching, tools, and technical assistance to help communities carry out the process.

The version of CTC discussed in this section has historically focused on several major adolescent health and behavior outcomes:

• Substance use
• Delinquency
• Pregnancy among adolescents
• Leaving school before graduation
• Violence

Risk factors

Risk factors are conditions or characteristics that can increase the likelihood of particular behaviors or outcomes. An assumption behind the CTC model, which it shares with the other models described in this chapter, is that risk and protective factors span many areas of community life. With that assumption in mind, CTC organizes risk factors into four broad contexts: community, family, school, and individual/peer.

Community risk factors. These have to do with conditions within the community as well as community attitudes, policies, and structures.

• Availability of drugs. Easier access to alcohol and other drugs can increase opportunities for young people to use them and can contribute to community norms that make substance use appear more acceptable.
• Availability of firearms. Access to firearms can increase the potential for serious harm when violence occurs.
• Community laws and norms favorable to drug use, firearms, and crime. Laws, policies, enforcement practices, and community norms can influence how acceptable or common particular behaviors appear to young people.

Lack of clarity in laws and practices can also raise problems for young people. If alcohol is routinely available at community events, if minimum drinking-age laws are rarely enforced, or if excessive drinking by adults and adolescents is widely accepted, young people may receive inconsistent messages about what is expected of them.

• Media portrayals of problem behavior. Media can influence attitudes and beliefs about violence, substance use, and other behavior, particularly when those behaviors are repeatedly portrayed as normal, desirable, or without consequences.
• Transitions and mobility. Transitions – from one school to another, for example, or from middle to high school – can be difficult for adolescents. Frequent moves or major community disruptions can make it harder for young people and families to maintain stable relationships and support systems.
• Low neighborhood attachment and community disorganization. When residents feel little connection to their neighborhoods or limited ability to influence community conditions, community participation and informal support may weaken. Deteriorating physical conditions, instability, and a lack of shared responsibility for public spaces can increase risks for young people.
• Extreme economic deprivation. Severe economic hardship can expose young people and families to multiple stresses and barriers that increase the likelihood of a range of negative health, educational, and social outcomes.

Family. Family relationships, expectations, and circumstances can have an important effect on a young person’s present and future behavior.

• Family history of problem behavior. Young people may be influenced by behaviors, experiences, and expectations within their families. A family history of substance use, involvement with the justice system, leaving school before graduation, violence, or other challenges can increase risk, although it does not determine what any individual young person will do.
• Family management problems. Young people benefit from clear expectations, appropriate supervision, consistent boundaries, and supportive relationships. A lack of these structures, or the use of abuse or violence as discipline, can increase risk.
• Family conflict. High levels of ongoing conflict among members of a household can contribute to stress and increase the likelihood of difficulties for children and adolescents.
• Parental attitudes toward, or involvement in, substance use, crime, and violence. When parents or caregivers approve of, normalize, or engage in these behaviors, young people may be more likely to view them as acceptable. Risk can be especially high when adults directly involve children or adolescents in harmful or illegal activity.

School. School represents more than a place to learn reading or algebra. It is also an important social environment in which young people develop relationships, skills, expectations, and a sense of belonging.

• Academic failure beginning in late elementary school. Persistent academic difficulty can be frustrating and discouraging. A student who doesn’t understand the material may disengage, miss additional learning, and fall further behind. Over time, repeated difficulty can weaken the student’s connection to school and confidence as a learner.

Peer and group norms can sometimes make academic achievement seem inconsistent with belonging or with the identity a young person values. When young people feel pressure to choose between academic success and acceptance by people important to them, school engagement can suffer. Supportive peers, families, teachers, and communities can help make achievement compatible with a young person’s identity and sense of belonging.

• Lack of commitment to school. This may result from academic difficulty, negative experiences at school, a lack of belonging, or a belief that school and education are not relevant or worthwhile.

Individual/peer. This set of risk factors concerns personal characteristics, attitudes, experiences, and close peer relationships.

• Early and persistent antisocial behavior. Persistent patterns of aggressive or seriously disruptive behavior beginning early in life can signal increased risk, particularly when they continue without effective support or intervention.
• Rebelliousness. Persistent rejection of rules, social expectations, or conventional goals may increase risk when it becomes connected with harmful or illegal behavior.
• Friends who engage in problem behaviors. Because peer relationships are especially important during adolescence, friends’ attitudes and actions can strongly influence behavior. Put more simply: the people adolescents spend time with matter.
• Favorable attitudes toward the problem behavior. Young people are more likely to engage in a behavior when they view it as acceptable, desirable, harmless, or normal.
• Early initiation of the problem behavior. The earlier a behavior begins, the more opportunity there may be for it to become established as a regular part of a young person’s life.
• Constitutional factors. CTC uses this term for individual characteristics that may have biological, neurological, developmental, or environmental influences and that can affect behavior, such as impulse control and sensation-seeking. These characteristics do not determine a young person’s future, but can interact with other risk and protective factors.

Protective factors

Just as some factors increase risk, protective factors can support healthy development and buffer young people from risk. The Social Development Strategy organizes protection around several closely connected elements.

Individual characteristics.

Young people differ in temperament, abilities, interests, experiences, and ways of responding to stress. Some individual characteristics and skills can make it easier to cope with challenges, but no single characteristic guarantees healthy development, and the absence of a particular characteristic does not determine a young person’s future.

• Resilience-related characteristics. Some children and adolescents appear better able to adapt to difficulties than others. Their ability to cope can also be strengthened by relationships, experiences, skills, and supportive environments.
• Positive orientation. Hopefulness, positive relationships, and a sense that challenges can be managed can support healthy development.
• Cognitive, social, and problem-solving skills. Skills that help young people understand situations, consider consequences, manage emotions, solve problems, and interact effectively with others can help protect against a variety of risks.

Individual characteristics should never be treated as destiny. Young people develop over time, and skills, coping strategies, relationships, and confidence can grow through supportive experiences, learning, and appropriate services.

Bonding. Children and adolescents form strong connections to parents and caregivers, other adults, peers, schools, organizations, and communities. When young people feel connected to people or groups that model and support healthy behavior, those relationships can serve as important protective factors.

CTC emphasizes positive bonding. Not every strong bond is necessarily protective. A young person who feels deeply connected to a group that encourages violence or other harmful behavior may be influenced in that direction. Protective bonds are connections with people and groups that support healthy development and positive social values.

These might include:

• Parents, caregivers, and families
• Other significant adults – relatives, neighbors, counselors, mentors, etc.
• Teachers
• Peer groups
• Schools
• Organizations – Scouts, faith-based groups, social clubs, workplaces, etc.
• Sports teams
• Community groups, service organizations, cultural organizations, and others

Healthy beliefs and clear standards. Significant adults and groups help create environments that communicate positive values and make expectations clear to young people.

Families, other adults, schools, and communities can communicate and model values that support healthy behavior. They can also establish reasonable, clearly stated expectations and standards for children’s and adolescents’ behavior and achievement.

In other words, adults in the community should practice the values they communicate and make clear what they expect of young people.

The ideal here – the one that CTC hopes to strengthen in communities – is not that every person has exactly the same values or opinions, but that the important adults and institutions in young people’s lives communicate consistent expectations around safety, responsibility, respect, and healthy behavior. If parents and caregivers, teachers, coaches, mentors, and other adults communicate reasonable standards and model them themselves, young people receive a clearer message.

How protective factors work to counter high-risk environments: the Social Development Strategy

Hawkins and Catalano’s Social Development Strategy explains how protective factors can be strengthened.

The Social Development Strategy emphasizes a sequence of opportunities, skills, recognition, bonding, and healthy beliefs and clear standards.

Provide meaningful opportunities. Children and adolescents need developmentally appropriate opportunities to participate actively in their families, schools, peer groups, organizations, and communities.

Build skills. Opportunities are most useful when young people have the skills they need to succeed. These may include social and emotional skills, problem-solving, communication, academic or vocational skills, specialized knowledge, and physical or creative abilities.

Provide recognition. Like anyone else, young people need to know that their effort, improvement, and contributions are valued. Specific and consistent recognition can strengthen their sense of connection to the people and groups around them.

Depending on a child’s age, interests, and abilities, meaningful contributions can range from household responsibilities to participating in a youth organization or serving on a community advisory group. Other examples include tutoring younger students, peer mediation, responsibilities in clubs or faith-based groups, participation in a band or orchestra, helping care for younger family members, volunteering, or working on a community project.

Opportunities, skills, and recognition can strengthen bonding. Making a meaningful contribution to a family, school, organization, or community can help young people develop a stronger sense of attachment and commitment to it.

Bonding increases the influence of healthy beliefs and clear standards. Young people are more likely to take seriously the expectations of people and groups they trust, respect, and feel connected to.

Ultimately, this progression supports healthy behavior. The work of protective factors is demonstrated in the following diagram illustrating the Social Development Strategy:

Why would you want (or not want) to adopt the Communities That Care approach?

As with all the models discussed in this chapter, there are both advantages and potential limitations to using CTC. Some characteristics can be viewed either way, depending on the community and how the process is carried out.

Advantages

• CTC is grounded in prevention science and practice. The ideas underlying CTC – including risk and protective factors – come from prevention research. Communities use local data to select tested and effective programs, policies, and practices that address their priorities.
• CTC can be inclusive and participatory. The planning process is designed to involve people from different sectors of the community in discussion and decision-making, with a community board helping guide implementation and evaluation.

There are real advantages to being inclusive – involving people from different sectors of the community, including young people and others directly affected by the issues – and participatory – engaging people beyond formal leaders in decision-making. First, it taps a broad range of ideas, knowledge, and lived experience, particularly about the history and character of the community and its young people. Second, it helps ensure that decisions are carefully discussed. Perhaps most important, meaningful participation can create community ownership of the final plan. When people have helped shape an effort rather than having it imposed on them, they are more likely to support it and work to make it successful.

• CTC takes a community perspective. Adopting an outlook similar to that of the other models reviewed in this chapter, CTC treats the prevention of health and behavior problems and the healthy development of young people as a community-wide responsibility that calls for a community-wide effort.
• CTC provides training and implementation support. Rather than simply presenting a model or providing an assessment tool, the current CTC PLUS system provides training, coaching, and technical assistance to help communities carry out assessment, planning, implementation, and evaluation.
• CTC emphasizes tested and effective prevention strategies. Instead of requiring communities to design every intervention from scratch, CTC helps them identify programs, policies, and practices with evidence of effectiveness and match them to locally identified needs.

“Tested and effective” does not simply mean that a program is popular or widely used. It means that it has been evaluated rigorously enough to provide evidence that it can improve relevant outcomes.

• CTC is adapted to the needs of each community. Rather than using a completely cookie-cutter approach, CTC uses local risk and protective factor data, existing resources, and community priorities to guide planning and the selection of prevention strategies.
• CTC includes evaluation and adjustment as an integral part of the effort. No program or method is perfect for every community, and no implementation is perfect either. Regular evaluation and adjustment allow communities to learn from results and improve what they are doing.
• CTC has evidence of effectiveness. A community-randomized trial found reductions in several youth health and behavior problems in communities implementing CTC, and follow-up research has found that some benefits continued into adulthood.

Potential limitations

• Participation depends on who is actually included and how power is shared. CTC places substantial responsibility on community leaders and a community board. If those groups do not reflect the people, neighborhoods, and experiences within the larger community – or if a small group controls the decisions – the process may be less inclusive than intended.

Especially in a large or diverse community, identifying appropriate participants takes deliberate outreach. Young people themselves, parents and caregivers, people with lived experience of the issues, residents of different neighborhoods, and groups that have traditionally had less influence in community decision-making may need to be intentionally included. Representation alone is not enough: participants also need a meaningful role in decisions.

• Its emphasis on tested and effective interventions can constrain some choices. Evidence-based programs and policies provide communities with useful options and reduce the need to start entirely from scratch. At the same time, an emphasis on established interventions can make it harder to use a locally developed approach that has not yet been formally evaluated.

This can be a double-edged sword. On one hand, communities benefit from programs and strategies that have worked elsewhere and from clear guidance for implementing them. On the other, communities still need room to use local knowledge, adapt thoughtfully to local circumstances, and recognize approaches that are already working.

• Following an established model can sometimes encourage people merely to follow directions rather than throwing heart and soul into the effort. Even a tested and effective intervention does not automatically produce results simply because all the instructions were followed. Communities still have to examine implementation, local conditions, participation, and whether the selected strategies actually fit the issues they are trying to address.
• CTC has a specific focus. CTC centers on healthy youth development and the prevention of particular adolescent health and behavior problems. This focus can be an advantage because it keeps the effort manageable and measurable. On the other hand, a community seeking a broader framework for all aspects of community health and development may need to use CTC alongside other approaches.

If the ultimate goal is defined only as reducing one particular behavior, there is a danger of assuming that reaching that goal “fixes” the broader problem. Long-term community change may require attention to underlying social, economic, institutional, and environmental conditions as well.

• Research evidence does not guarantee identical results in every community. CTC has substantial research support, including long-term evidence, but outcomes still depend on local conditions, the quality of implementation, sustained community participation, and how well selected strategies match the community’s priorities.
• Formal CTC implementation requires resources. The current CTC PLUS system includes licensing, training, coaching, assessment, and implementation support. These services can strengthen implementation, but communities still need to consider the money, staff time, organizational capacity, and long-term commitment required.

None of these limitations necessarily rules out CTC. They do mean that communities should use the model thoughtfully. You can broaden participation, make sure young people and people with lived experience have real decision-making roles, use local knowledge alongside research evidence, and continually assess whether the process fits your community. No model is sacrosanct, and no model works equally well in every community.

Who should be involved in Communities That Care?

As we’ve just discussed, CTC should be as broad-based as possible. Community leaders – elected officials, business and institutional leaders, and others with influence – are important, but an effort that expects community-wide support should also include the people most affected by the issues and by the decisions being made.

Stakeholders include all who have a meaningful interest in the initiative: people directly affected, supporters, participants, planners, implementers, community partners, and others. Some possibilities include:

• People directly affected by the health and behavior issues. They can bring experience and a deep understanding of the issues and their effects.
  • Young people themselves, especially those with lived experience – young people formerly involved in gangs or the justice system, people in recovery from substance use disorders, young people who became parents during adolescence, and those who left school before graduation. They can offer not only personal knowledge but also credibility with other young people. They speak from experience, not simply from an adult position of moral rectitude.
  • Families, caregivers, significant others, and friends of people affected by these issues. Their experiences may provide important insight into both challenges and possible solutions.
  • People who have been harmed by delinquency or violence involving young people.
• People affected indirectly by the issues. This group may include people with a number of different perspectives.
  • Teachers, counselors, coaches, and other school staff.
  • People who work in community organizations serving young people – outreach workers, caseworkers, mentors, coaches, youth-group leaders, and others.
  • People who respond when serious problems occur – law enforcement officers, health professionals, judges, probation officers, social service staff, and others.
  • Business owners, neighborhood organizations, and others concerned about the effects that public substance use, violence, unsafe conditions, or other community problems can have on businesses, public spaces, and neighborhood life.
• Community leaders and decisionmakers. There are both official and unofficial community leaders.
  • Official leaders. These include current and former elected and appointed officials.
  • Unofficial leaders. This larger group can include opinion leaders, business, institutional, and civic figures, community activists, people who speak for particular neighborhoods or cultural and language communities, labor and workforce representatives, faith leaders, and other community members whom people respect and listen to.
• People with a community interest. These are people who may not be directly affected by a specific problem but care about young people and the community.
  • Parents, caregivers, and others who want a supportive environment for young people.
  • Business people, community developers, and others concerned about the community as a place to live, work, raise children, or operate a business.
  • Community volunteers and other concerned community members.
• The media. Involving media representatives from the beginning – as community members as well as in their professional roles – can help ensure that accurate information about CTC and its activities reaches the larger community.

How do you employ the Communities That Care approach?

Communities That Care has evolved since its early implementation. The current CTC PLUS system is supported by the Center for Communities That Care at the University of Washington and combines prevention science, community assessment, training and coaching, planning tools, selection of tested and effective interventions, and ongoing evaluation.

Communities interested in formal CTC PLUS implementation can work with the Center for Communities That Care for training, coaching, tools, and technical assistance.

The current CTC process is organized into five phases:

Phase 1: Get Started

The first phase involves determining whether the community is ready and able to undertake the process, identifying people and organizations that can help lead and support the effort, and developing an initial understanding of how CTC can address local priorities.

Community readiness still matters. People need to recognize that youth health and behavior issues deserve attention and that prevention is both important and possible. If that understanding is not yet widespread, additional communication and community engagement may be needed before the effort can move forward successfully.

This reflects a broader principle of community change: people are more likely to support action when they understand the issue, believe it matters, believe change is possible, and see a meaningful role for themselves in creating that change. No matter how good your process or proposed intervention, an effort is unlikely to succeed if the larger community has no understanding of or support for it. Sometimes groundwork has to come first.

Phase 2: Get Organized

In this phase, community leaders, organizations, young people, families, and other stakeholders establish or strengthen the community coalition or board that will guide the process. Participants learn about prevention science, the CTC framework, risk and protective factors, and their roles in the effort.

Who participates matters. A board that represents only people who already know and agree with one another may miss important community knowledge and perspectives. Creating a truly inclusive group may require deliberate outreach beyond the networks of the people who first organized the effort.

The Orlando Healthy Community initiative offers a useful example of this issue. An initial group of community leaders developed what it believed was an inclusive list of people to invite. A facilitator pointed out that the list did not come close to representing the full community. To the group’s credit, members went back to square one, researched the community, contacted people they had never worked with before, and eventually created a much broader group.

The lesson applies to CTC as well. A board doesn’t become representative simply because its members come from several organizations. Geography, age, race and ethnicity, socioeconomic circumstances, language, lived experience, and other dimensions of community life may all be relevant. Young people themselves should have meaningful opportunities to participate.

The community board or coalition also works to develop a shared vision for healthy youth development and the community conditions it wants to create.

Phase 3: Develop a Community Profile

Community assessment in CTC involves identifying both risks and strengths. The goal is not simply to catalog problems, but to develop a clear picture of the risk and protective factors affecting young people, the outcomes the community wants to improve, and the programs, policies, organizations, and other resources already available.

Strategies for gathering information may include:

• Youth survey. CTC uses survey data from young people to help identify local patterns of risk and protection and guide prevention priorities.
• Census, demographic, and GIS (Geographic Information Systems) data. These sources can help identify population patterns, changes over time, geographic differences, economic conditions, and other characteristics relevant to community planning.
• Archival and administrative records. Records from schools, public agencies, health organizations, law enforcement, media archives, and other sources can provide information about past and current conditions and previous community efforts.
• Direct engagement with young people and other community members. Focus groups, community forums, interviews, conversations, and other forms of engagement can provide information from people who experience local risks, protective factors, programs, and community conditions firsthand.

Using these sources, the community identifies priority risk and protective factors to address. The point is to focus attention where local data and community knowledge indicate that stronger prevention and protection are most needed.

The community also assesses the resources already available to support the effort:

• Money, including local funders and other funding sources.
• Expertise, including researchers, prevention professionals, community organizations, and people with lived experience working with young people and families.
• People – both paid staff and volunteers – who can provide direct services, outreach, coordination, and other support.
• Ways to reach young people – schools, libraries, community organizations, social and traditional media, sports and recreation programs, outreach programs, families, and other community settings.
• Existing programs, policies, and community strengths that can be strengthened rather than replaced.

Phase 4: Create a Community Action Plan

Planning is where the community decides where to put its efforts, identifies measurable goals and outcomes, and selects strategies to address its priority risk and protective factors.

The community board looks carefully at the factors identified during assessment and at the populations, neighborhoods, schools, or other settings where attention may be most needed. It then establishes clear outcomes for reducing risk, strengthening protection, and improving youth well-being.

CTC emphasizes the use of tested and effective programs, policies, and practices. The community chooses strategies that fit its priorities and existing resources and can work across several areas of young people’s lives – such as family, school, peer, and community settings.

The plan should also establish timelines, responsibilities, ways of measuring progress, and a strategy for sustaining successful efforts over time.

Phase 5: Implement and Evaluate

In this phase, the community puts its action plan into practice. People who will actually implement the selected programs, policies, or practices should be actively involved in planning the details of implementation along with community board members, young people, participants, and other relevant partners.

With CTC, as with any model, the keys to good implementation are thorough and inclusive planning, a carefully structured implementation process – everyone knows what comes when and who is responsible for doing what – and good communication among all parties. If these elements are present, the chances are better that implementation will go smoothly.

That doesn’t guarantee effectiveness, however. Results still depend on whether you’ve chosen strategies that actually address the issues at hand, whether they are implemented well, whether they fit the local context, and whether the people doing the work establish strong relationships with the young people, families, and communities involved.

Evaluation compares what happens with the outcomes and accountability measures established during planning. It should help the community understand where implementation is going well, where results are appearing, where challenges remain, and what adjustments may be necessary.

Evaluation and adjustment are integral parts of the process and should continue throughout the life of the effort. An initiative doesn’t end simply because the community begins to see positive results. If an approach is working, the community has to consider how to sustain it. If results are less positive than hoped, the community needs to examine why and adjust the strategy, implementation, or both.

Even if results are overwhelmingly positive, it’s not time to rest on your laurels. Community conditions change, young people grow up, new groups of children enter adolescence, resources shift, and new challenges emerge. Maintaining progress requires continuing to evaluate, adapt, and strengthen prevention efforts over time.

In Summary

Communities That Care (CTC) is a prevention-planning system that grew out of the work of J. David Hawkins, Richard Catalano, and colleagues at the University of Washington. Based on prevention science, the Social Development Strategy looks at the ways risk and protective factors influence young people’s health and development.

The version of CTC discussed in this section has historically focused on substance use, delinquency, pregnancy among adolescents, leaving school before graduation, and violence. Rather than assuming that these outcomes result simply from individual choices, CTC examines risk and protective factors across community, family, school, and individual/peer contexts.

The Social Development Strategy emphasizes protective processes that can support healthy development. Providing meaningful opportunities, building skills, and recognizing young people’s efforts can strengthen bonding to families, schools, adults, organizations, and communities. Strong positive bonds can, in turn, make healthy beliefs and clear standards more influential.

Advantages of the process include:

• CTC is grounded in prevention science and practice.
• CTC can support inclusive and participatory community planning.
• CTC takes a community perspective.
• CTC provides training, coaching, and implementation support.
• CTC emphasizes tested and effective programs, policies, and practices.
• CTC uses local information to adapt prevention planning to the needs of each community.
• CTC includes evaluation and adjustment as integral parts of the effort.
• CTC has research evidence supporting its effectiveness, including long-term follow-up.

Potential limitations include:

• Participation may not be truly inclusive unless communities deliberately involve a broad range of people and share decision-making power.
• An emphasis on tested and effective interventions can limit the use of locally developed approaches that have not yet been formally evaluated.
• Following an established process can encourage communities merely to follow directions rather than continuously analyze whether the effort fits local conditions.
• CTC is focused specifically on young people and prevention, rather than on every aspect of community health and development.
• Evidence of effectiveness does not guarantee the same results in every community.
• Formal implementation requires resources for training, coaching, assessment, coordination, and sustained community work.

Because broad-based participation is important to a successful effort, CTC should involve stakeholders from throughout the community. This includes young people and families directly affected by the issues and proposed interventions; people who work with young people; people who respond to the consequences of health and behavior problems; community leaders and decisionmakers; other concerned community members; and media and communication partners.

The current CTC PLUS process has five phases:

1. Get Started – assess readiness, build initial support, and establish the foundation for the effort.
2. Get Organized – develop a representative community coalition or board, build knowledge and skills, and establish a shared vision.
3. Develop a Community Profile – use youth survey data, community information, and an assessment of existing programs and resources to identify priority risk and protective factors.
4. Create a Community Action Plan – establish measurable outcomes and select tested and effective programs, policies, and practices that fit community priorities.
5. Implement and Evaluate – carry out the plan, monitor implementation and outcomes, use data to make adjustments, and sustain effective strategies.

Finally, the process and successful prevention efforts have to be maintained if gains are to continue. Communities change, and prevention is not a one-time undertaking. The long-term goal is to strengthen the conditions that help young people thrive and to keep learning, adapting, and improving as the community changes.