Section 10. The Strategic Prevention Framework

Nearly every community – large or small, urban, suburban, or rural – must cope, to some extent, with substance use, substance misuse, and substance use disorders involving alcohol, tobacco and nicotine products, and other drugs. Most communities try to address these problems, and some are reasonably successful. Others find themselves doing everything they can think of and barely staying even, or – worse – losing ground.

The difference is sometimes in the way they approach the problem. Those that are most successful often try to prevent problems before they start or become more serious. They focus on the community as a whole and try to devise ways to help community members experiencing increased risk – often including young people – avoid behaviors, conditions, or situations that could put them in harm’s way. Although they don’t ignore treatment, law enforcement, policy decisions, public education, or other actions needed to address problems that already exist, these communities take a long-term perspective and work to prevent or reduce substance misuse over time.

Most of the models we’ve described in this chapter look to both the present – addressing a current issue – and the future. In this section, we examine another that does the same: the Strategic Prevention Framework developed by the Center for Substance Abuse Prevention (CSAP), part of the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services.

What is the Strategic Prevention Framework?

Note: The graphic above reflects an earlier version of SAMHSA’s SPF terminology. Current SAMHSA guidance retains the same five steps but identifies Community Relevance and Sustainability as the framework’s two guiding principles.

The Strategic Prevention Framework (SPF) outlines a process that an organization, initiative, community, tribe, territory, or state can follow to prevent substance use and misuse and reduce related problems.

SAMHSA’s SPF is designed specifically for substance use prevention and related behavioral health problems. Because its basic process – assessment, capacity building, planning, implementation, and evaluation – is broadly applicable, communities may also find elements of the framework useful when thinking about other prevention and community-change efforts.

The framework addresses both risk and protective factors. Risk factors are characteristics or conditions within individuals, relationships, communities, or broader environments that can increase the likelihood of harmful behaviors or outcomes. Protective factors are characteristics or conditions that can reduce risk or help support healthy development and well-being. Neither risk nor protective factors determine what will happen to any particular person.

Risk and protective factors vary depending on the issue. Some examples of risk factors related to harmful or underage alcohol use, for instance, include:

• The availability of alcohol in the community, including adults providing alcohol to young people.
• Community norms that tolerate or encourage underage drinking or harmful patterns of alcohol use.

Community acceptance of harmful alcohol use might include treating binge drinking as a normal way to relieve stress, expecting heavy drinking at parties or other events, or tolerating underage drinking. These norms can occur in communities across different income levels and social settings.

• Economic hardship and limited opportunities for young people.
• A family history of alcohol use disorder.
• Beginning alcohol use at an early age.

Some examples of protective factors related to the same behavior include:

• Close and supportive family relationships.
• Good communication between children or adolescents and parents or caregivers.
• Peer support for avoiding underage or harmful alcohol use.
• Clear and consistent family and community expectations that discourage underage and harmful alcohol use.

The Strategic Prevention Framework addresses risk and protective factors through a five-step process.

The Community Tool Box has hundreds of how-to resources that can help communities implement different parts of the Strategic Prevention Framework. Some links to related Toolkits are provided beneath each of the SPF steps below.

Assessment

The process begins by using data and community knowledge to understand local prevention needs, strengths, resources, and conditions. A community planning group should include people with relevant knowledge, experience, and perspectives, including people directly affected by the issue.

Assessment includes such tasks as:

• Identifying and understanding community prevention needs and strengths.
• Identifying existing resources and determining what additional resources may be needed.
• Assessing community readiness.

Related Toolkits:

2. Assessing Community Needs and Resources

3. Analyzing Problems and Goals

Capacity

Developing capacity means building the resources and readiness needed to carry out prevention work. This includes mobilizing people and organizations, strengthening partnerships, identifying financial and other resources, and providing training and technical assistance so that participants have the knowledge and skills to plan, implement, and sustain the effort.

Related Toolkits:

1. Creating and Maintaining Partnerships

6. Building Leadership

8. Increasing Participation and Membership

15. Improving Organizational Management and Development

Planning

In this step, community partners develop a plan with goals, objectives, and strategies aimed at the prevention needs identified during assessment. The group may use a logic model or other framework for action, identify evidence-based or evidence-informed programs, policies, and practices that fit local conditions, and determine the resources needed for successful implementation.

Related Toolkits:

4. Developing a Framework or Model of Change

5. Developing Strategic and Action Plans

Implementation

The prevention plan is put into action. Programs, policies, and practices should be implemented with attention to both the evidence supporting them and their fit with the community.

Related Toolkits:

7. Developing an Intervention

10. Advocating for Change

11. Influencing Policy Development

13. Implementing a Social Marketing Effort

Evaluation

Although listed as the fifth step, evaluation takes place throughout the process. Programs, policies, and practices are evaluated to understand how well they were implemented and whether they contributed to the intended outcomes. Evaluation findings are then used to strengthen the effort, reconsider strategies where necessary, and inform the next round of assessment and planning.

Related Toolkits:

12. Evaluating the Initiative

Community Relevance and Sustainability

These are the two guiding principles that should be considered throughout all five SPF steps. Community relevance means that prevention decisions reflect local conditions, priorities, cultures, experiences, and perspectives. Sustainability means building the relationships, capacity, resources, and systems needed to maintain effective prevention work over time.

Related Toolkits:

16. Sustaining the Work or Initiative

14. Writing a Grant Application for Funding

9. Enhancing Cultural Competence

Why use the Strategic Prevention Framework?

Given that there are a large number of models available, what are the advantages of using SPF?

• SPF is collaborative and participatory. The framework benefits from involving community partners from the beginning, including people directly affected by the issue. Meaningful participation can strengthen community ownership, support, and the quality of prevention decisions.
• SPF emphasizes the role of the community in prevention. Prevention efforts are stronger when they are based on local conditions and when the people and organizations that make up the community are involved. This agrees with the broader Healthy Communities view that health is a community issue, even when a particular condition affects some groups more than others.
• SPF is flexible and encourages communities to identify locally appropriate solutions. SPF does not prescribe a single prevention program. It provides a planning process that communities can use to select programs, policies, and practices that fit their needs, resources, and circumstances.
• SPF takes a long-term approach by focusing on risk and protective factors that prevention efforts can influence. Breaking a large problem into factors that can actually be addressed can make prevention more manageable and help communities identify practical places to act.
• SPF encourages the use of evidence-based and evidence-informed programs, policies, and practices. Communities can use research evidence along with local data and knowledge to select strategies that fit their prevention priorities.
• SPF is supported by training, technical assistance, and prevention resources. SAMHSA’s Strategic Prevention Technical Assistance Center provides training, technical assistance, and resources to help prevention practitioners understand and apply the SPF.
• SPF’s focus on risk and protective factors can contribute to broader community well-being. Protective factors such as strong family communication, supportive relationships, community connection, and clear expectations can contribute not only to substance use prevention but also to healthy development and stronger communities.

There is a fine line between preventing a harmful condition and promoting a positive one. An effective prevention effort that reduces risk and strengthens protective factors may also help create conditions in which community members are better able to lead healthy and fulfilling lives.

Potential challenges in using SPF

• Limited resources. Thorough assessment, partnership development, planning, implementation, and evaluation all require time and capacity. Communities with fewer financial, staffing, or organizational resources may need to begin on a smaller scale, build partnerships, seek technical assistance, or identify additional funding.
• Balancing fidelity with community fit. It makes sense to use programs and practices supported by evidence rather than reinventing the wheel. At the same time, even strong programs may not fit every community in exactly the same way. Communities should understand which elements of an intervention are essential to its effectiveness and make adaptations thoughtfully and consistently with available implementation guidance.
• Administrative demands. Prevention grants may include substantial requirements for planning, documentation, data collection, performance measurement, and reporting. Smaller organizations may need additional administrative capacity or partnerships to manage those responsibilities.

Some of these challenges are more significant for organizations receiving grant funding, because funders may establish specific program, reporting, and evaluation requirements. Communities that use SPF simply as a planning framework have greater flexibility, but they still need enough time, people, knowledge, and resources to carry out the process effectively.

When should you use the Strategic Prevention Framework?

Prevention, in the ideal, means just that. The best time to start prevention work is before a serious problem becomes deeply established. With its emphasis on risk and protective factors, the framework can help communities prevent substance misuse while also promoting healthy behaviors and environments. In that respect, it is similar to asset development.

The reality in many communities, however, is that issues may not receive sustained attention until they become highly visible or urgent. The best time to embark on a strategic prevention effort may therefore be when the community is ready to turn its attention in that direction.

You can help this process along by assessing the community’s current level of readiness and using appropriate strategies to strengthen awareness, understanding, participation, and support. The first part of a prevention initiative may therefore involve increasing community readiness before a detailed prevention program is developed.

With that said, there are times when SPF might be particularly appropriate:

• When resources and partnerships are available. Resources can include funding, people with prevention experience, community organizations, local sponsors, foundations, public agencies, media and communication partners, volunteers, data, and technical assistance.
• When a community problem has become visible, but before it reaches crisis stage. This may provide an opportunity to focus attention on prevention before most available resources have to be devoted to responding to immediate consequences.
• When a community problem has reached crisis stage. Prevention may be harder to emphasize when immediate needs are urgent, but preventing future harm is still an important part of a long-term response.
• When there is public concern about a population experiencing increased risk, including young people. Prevention can address the factors influencing risk before harmful patterns become established or more serious.
• When community leaders are examining quality of life. Because substance use prevention can involve schools, families, health, public safety, economic conditions, neighborhood environments, and other sectors, it can fit naturally into broader community improvement efforts.
• When a grassroots movement for community improvement is looking for a way to address long-term community issues. A prevention effort can address present concerns while also attempting to improve conditions for future generations.

Who should use the Strategic Prevention Framework?

As with many of the “Who...?” questions in the Community Tool Box, this one not only has more than one answer, but is, in reality, more than one question.

• Who might implement SPF? SPF can be used by state, tribal, territorial, and local agencies; community coalitions; health and human service organizations; schools and universities; prevention providers; and other organizations or partnerships involved in substance use prevention.

SAMHSA continues to support substance use prevention through several funding mechanisms, including Strategic Prevention Framework-related grants and other prevention programs. Specific grant programs, eligibility requirements, and funding opportunities change over time, so organizations seeking funding should consult current SAMHSA funding announcements rather than rely on older grant lists.

Whether or not the effort is federally funded, prevention works best when relevant sectors of the community participate in assessment, planning, implementation, and evaluation. These may include:

• People from populations experiencing increased risk and people with lived experience related to the issue.
• Health and medical professionals.
• Health and human service workers.
• Substance use prevention, treatment, and recovery professionals, along with researchers in the field.
• Law enforcement and public safety representatives.
• Educators.
• Elected and appointed public officials and policymakers at the appropriate level.
• Parents and caregivers.
• Young people.
• Older adults.
• Business and employer representatives.
• Other interested community members.

As stated throughout the Community Tool Box, participatory planning and implementation can help efforts better reflect community needs and strengthen community support. Participation should include not only formal leaders and professionals, but people directly affected by the issue and people whose knowledge comes from lived experience.

Many organizations may use SPF without receiving a specific CSAP or SAMHSA grant. Community-based health and human service organizations, community coalitions, local health departments, schools, universities, tribal organizations, and other groups can use the framework simply to structure prevention work.

• Whom should SPF efforts serve? Prevention efforts can be organized according to three commonly used categories: universal, selective, and indicated. Universal prevention is directed toward a general population that has not been selected on the basis of individual risk. Selective prevention focuses on groups with an elevated level of risk. Indicated prevention focuses on individuals showing early signs or behaviors associated with increased risk but who do not necessarily meet criteria for a substance use disorder.

A typical universal prevention effort might involve community education through schools, media, organizations, workplaces, or other settings. It might provide information about alcohol and other substances, strengthen protective factors, address community norms, or let people know where they can get reliable information and assistance. It might be aimed at a neighborhood, a school system, the whole community, or even a larger geographic area.

Groups served by selective prevention efforts will vary from one community to another. Examples may include:

• Young people experiencing increased risk. Adolescence is a period of continued development, growing independence, social influence, and experimentation. Prevention can help young people develop skills, strengthen protective relationships, understand risks, and delay or avoid substance use.
• People who are pregnant. Prevention efforts can provide accurate, nonjudgmental information and support related to alcohol, tobacco and nicotine, medications, and other substance use during pregnancy. Alcohol use during pregnancy can cause fetal alcohol spectrum disorders, and tobacco, nicotine, and other substance use can also pose risks to pregnancy and fetal development.
• Older adults. Changes associated with aging, isolation, health conditions, medication use, and interactions between medications and alcohol or other substances can create prevention concerns for some older adults. Prevention efforts can increase awareness among older adults, families, caregivers, and professionals.
• People experiencing homelessness. Substance use disorders, mental and physical health concerns, trauma, and housing instability can intersect in complex ways. Prevention and support efforts should avoid assuming that substance use is the cause of homelessness and instead respond to the combination of needs and conditions affecting individuals and communities.

Indicated prevention focuses on people who show early signs, behaviors, or conditions associated with increased risk but who have not necessarily developed a diagnosable disorder. Depending on the setting and program, participants may be identified through schools, health care, families, social services, community programs, or other appropriate referral pathways.

How do you use the Strategic Prevention Framework?

As described above, SPF has five steps. We’ll examine those in more detail here to see how they guide prevention work.

SAMHSA’s Strategic Prevention Technical Assistance Center provides current training, technical assistance, and resources related to the Strategic Prevention Framework, prevention science, evidence-informed programs and policies, and community-based prevention.

Phase 1: Assessment. In the assessment phase, you use data and community knowledge to determine prevention needs, strengths, resources, and relevant risk and protective factors.

• Form a prevention assessment or planning group. Because prevention takes a community perspective, the group should include people and organizations with relevant knowledge, experience, and perspectives. Depending on the issue and community, these might include:
  • Law enforcement and public safety
  • Education
  • Young people
  • Courts and justice-system partners
  • Civic and community organizations
  • Parents and caregivers
  • Faith communities
  • Older adults
  • Businesses and employers
  • Human service providers
  • Health care
  • Military and veteran-serving organizations where relevant
  • Colleges and universities
  • Racial, ethnic, cultural, and language communities
  • Government agencies
  • Elected and appointed officials
  • Childcare and youth-serving providers
  • People with lived experience of substance use, recovery, prevention services, or related community conditions

People directly affected by substance use should not be treated merely as the subjects of prevention efforts. People in recovery and others with lived experience can contribute important knowledge about community conditions, barriers, services, and what prevention messages or strategies may actually be useful.

• Assess community needs and assets. Ideally, the community will conduct an assessment broad enough to understand both its prevention needs and the resources already available. The scale of the assessment should fit the organization’s or coalition’s resources. A smaller community group may need to rely more heavily on partnerships, existing data, volunteers, and focused assessment methods.

Some questions you might try to answer through a community assessment include:

• What patterns of substance use, substance misuse, and related harms are present in the community?
• Which substances are most available and most commonly used?
• What trends are occurring in substance use, availability, and related harms?
• Which populations or groups are experiencing greater risk or harm?
• Are some geographic areas experiencing different conditions or levels of harm?
• Do patterns of substance use differ among populations, age groups, or geographic areas?
• At what ages are particular forms of substance use commonly beginning?
• What prevention efforts, treatment services, recovery supports, policies, and community resources already exist? What is known about their reach and effectiveness?
• Which aspects of substance use and related harm are most important for the community to address?

A community assessment can use several methods. In general, using multiple sources helps produce a more complete picture of community conditions.

• Surveys. Surveys may be conducted in person, by phone, by mail, online, or through other appropriate formats. They can be designed for groups or individuals and can gather information about a wide range of topics.
• Interviews. Interviews may be individual or group, structured, semi-structured, or unstructured, and can be conducted in person, by phone, or through other accessible communication methods.
• Focus groups. A focus group is a guided discussion designed to gather information on a particular topic from a group of participants. Skilled facilitation can help ensure that different participants have opportunities to contribute.

In surveys, interviews, focus groups, and other community engagement, there may be some people you particularly want to hear from. These might include:

• Community leaders – people from different parts of community life whom others look to for leadership, guidance, or trusted information. Some may hold formal leadership positions; others may be respected because of their experience, relationships, or community involvement.
• The population or populations most directly affected by the issue or by the proposed prevention effort.
• People who work with those populations – health and human service professionals, educators, outreach workers, prevention specialists, and others.
• Family members, caregivers, peer-support groups, recovery groups, and other people or organizations connected with those directly affected.
• Policymakers and other people who influence laws, regulations, funding, policies, and community attitudes.
• Researchers and others who have studied substance use or related conditions in the community.

• Observation. Observation can be used in different ways in a community assessment. It might include observing neighborhood conditions and public spaces, documenting the location and concentration of alcohol or tobacco retailers, examining community events and advertising, or participating in authorized ride-alongs or other structured observation with community partners. Observation should be planned in ways that are safe, ethical, and appropriate for the people conducting the assessment.
• Public and administrative records. Federal, state, tribal, territorial, and local agencies may already collect useful demographic, health, behavioral, service-use, school, public safety, and other data. The U.S. Census, SAMHSA, CDC, state and local health agencies, schools, hospitals, and other organizations may all have information relevant to your assessment.
• Assess community readiness. Community readiness is the degree to which a community is prepared to take action on an issue. Once you understand the current level of readiness, you can select strategies that begin there and help the community move forward.

Understanding where the community is and starting from there is extremely important. If community members don’t yet recognize the problem, understand why it matters, or believe that action is possible, you may have difficulty gaining the participation and support needed for a successful prevention effort. Early work may therefore focus on awareness, relationships, community engagement, and readiness.

Tools for examining dimensions and levels of community readiness can be found in Community Readiness and related Community Tool Box sections.

• Determine the prevention need that your effort can realistically influence. There may be several important issues and populations to consider. The questions are where your effort can make a meaningful contribution and what your resources allow you to address. Starting with a focused and manageable priority may help the community build experience and capacity for broader work later.

Phase 2: Capacity.

The community needs both readiness and capacity to carry out prevention successfully. Capacity includes knowledge about local substance use and prevention; people and organizations able to do the work; leadership and partnerships; financial and other resources; community support; and the ability to sustain prevention efforts over time.

This doesn’t mean that everyone in the community has to understand, support, and participate in a prevention effort. Rather, there needs to be enough knowledge, participation, leadership, and support to make meaningful action possible.

To build community capacity:

• Start with your core group. The people involved in assessment and others who have supported prevention from the beginning may provide a foundation for continued planning and implementation. They can remain involved themselves and help bring in others whose knowledge, experience, or relationships are needed.
• Choose or develop a logic model or theory of change to guide your effort. A logic model can expand on the SPF by showing how specific activities are expected to influence risk and protective factors and ultimately contribute to desired outcomes.
• Use what you know about community readiness to communicate about the issue and encourage participation. Depending on what community members already know, communication may focus on the nature of the issue, its local effects, available strengths and resources, or ways people can participate. People with lived experience who choose to share their own stories can be powerful contributors, provided their participation is voluntary and respectful.

If the community is already well aware of the issue, you may be able to concentrate more heavily on building participation and support for planning and implementation. A community advisory board, prevention coalition, or similar group may help coordinate the effort.

• Expand the network of people interested in prevention. As community knowledge and support grow, recruit people whose skills, relationships, experience, or enthusiasm can strengthen the effort.

People can contribute in many different ways – facilitation, outreach, data analysis, youth engagement, communications, curriculum development, logistics, meeting coordination, evaluation, community organizing, or simply a willingness to help. Participation itself can also help people develop new skills and leadership capacity.

Phase 3: Planning.

The planning phase is at least as important as any other. First, it puts the participatory nature of the effort into practice, bringing different kinds of knowledge and experience into decision-making. Second, it creates the structure, organization, and content of the prevention effort itself. Careful planning can prevent a great deal of trouble later.

• Assemble a planning team. This may be the assessment group, include some of its members, or be a somewhat different group. Whatever the arrangement, the team should include the sectors, communities, and experiences relevant to the effort. Representation should be broad enough that people directly affected by the issue have meaningful opportunities to influence decisions.
• Prepare the planning team. Participants may bring very different levels of experience with meetings, group decision-making, planning, prevention science, and the issue itself. Useful preparation may include:
  • Ground rules for meetings – respecting participants, creating opportunities for different voices to be heard, listening carefully, focusing on ideas rather than personalities, sharing decision-making, and preventing a few people from dominating.
  • Problem-solving and group decision-making methods, including brainstorming, small-group discussion, and other participatory approaches.
  • Substance use and related conditions in the community, drawing on assessment findings and other reliable data.
  • Risk and protective factors – what they are, how they interact, and how prevention can address them.
  • Resources – not only funding, but also volunteer time, community knowledge, relationships, organizational support, communication channels, facilities, data, local expertise, and supportive policies.
  • Evidence-based and evidence-informed programs and practices – what the evidence tells you, how to judge fit, what elements need to be implemented faithfully, and when adaptation may be appropriate.
• Analyze local risk and protective factors. A college or university, prevention specialist, public health agency, community organization, technical assistance provider, or other knowledgeable partner may be able to help. Communities with limited resources can still use local data, community knowledge, and available expertise to identify factors that matter most.

Risk and protective factors can operate across multiple levels, including the individual, peer and relationship, family, school or organizational, community, and broader societal environment. Media, policy, economic conditions, culture, and other social conditions can influence local attitudes and behavior as well.

Protective factors may include supportive relationships, bonding and connection, meaningful opportunities, skills, healthy beliefs and expectations, and other conditions that help people and communities thrive.

Developmental assets, which are closely related to protective factors for children and adolescents, can also be considered in terms of external and internal assets.

External assets include:

• Support. Important people in a young person’s life encourage, help, listen to, and respect them.
• Empowerment. Young people have meaningful opportunities to contribute, take responsibility, and influence parts of their own lives and communities.
• Boundaries and expectations. Young people receive clear, reasonable expectations and consistent support.
• Constructive use of time. Young people have opportunities to engage in meaningful, enriching, and productive activities.

Internal assets include:

• Commitment to learning. The young person values learning and has opportunities and support to engage in education and skill development.
• Positive values. The young person develops values that support responsible and caring behavior.
• Social competencies. The young person develops interpersonal, communication, decision-making, and other skills needed to build healthy relationships and navigate daily life.
• Positive identity. The young person develops confidence, a sense of purpose, and a healthy view of themselves and their future.

The goal is to understand how risk and protective factors operate in your community – which factors appear especially important, which can realistically be influenced, and which are most closely connected to the prevention priorities identified through assessment.

• Choose the factors you’ll concentrate on. Select a manageable number. You can’t address everything at once without overextending your resources and diluting your efforts. Concentrate on factors that matter to the problem and that your community can realistically influence.

Trying to reduce the availability of drugs, for instance, may involve more than changing enforcement or attitudes within one neighborhood. Availability may be influenced by neighboring communities, online or informal markets, broader policies, and other conditions. A local strategy should therefore consider both what the community can influence directly and what may require collaboration beyond its boundaries.

• Research and choose evidence-based or evidence-informed approaches that address the risk and protective factors you’ve identified. Research evidence can tell you whether a program, policy, or practice has worked elsewhere and under what circumstances. Community data and experience can then help you judge whether it is a good fit locally.

Prevention approaches can also be thought of as universal, selective, or indicated. Another useful distinction is between strategies that work primarily with individuals and strategies that change the surrounding environment.

Individual-level approaches may help people develop knowledge, attitudes, relationships, coping skills, decision-making skills, or other capacities that support healthy behavior.

Environmental approaches seek to change conditions surrounding people. These may include policy change, enforcement of laws and regulations, changes in organizational practice, communication efforts, changes in the physical or social environment, or strategies aimed at community norms.

Effective community prevention often includes both individual and environmental strategies.

Evidence matters, but so does fit. If an intervention has been shown to work, there is a good reason to understand and preserve the elements responsible for its effectiveness. At the same time, communities differ in language, history, culture, institutions, resources, geography, and other conditions.

The aim is not to change a proven approach simply because you prefer something different, nor to follow a program so rigidly that obvious local realities are ignored. Instead, understand the intervention’s essential components, follow available implementation guidance, and make thoughtful adaptations when necessary to improve community relevance without undermining the elements that make the approach effective.

Reinventing the wheel is unnecessary if you already know the wheel works quite well. But you still need to make sure it fits the road you’re traveling on.

• Create an overall plan for the effort. Strategy includes not just what the program itself will look like, but a number of other elements:
  • Vision and mission statements for the effort.
  • How you’ll gather the resources you need. How much funding will be needed and where might it come from? How will you recruit staff, volunteers, partners, or other participants?
  • The timeline and implementation process. What will happen, by when, and who will take responsibility for what?
  • The results you hope to see in both the short and long term.
  • How you’ll monitor and evaluate the effort.

Your plan should be detailed enough that it could still be followed even if everyone involved in the planning suddenly decided to retire to a tropical island and left no forwarding address.

• Present the plan to the community and continue building support. Prevention is more likely to be sustained when community members understand the plan, see how it responds to local needs, and have meaningful opportunities to participate.

Phase 4: Implementation.

Now it’s time to put the prevention plan into practice. Implementation will be much easier if planning has been thorough and community partners understand and support the work.

• Hire staff and/or recruit volunteers. Whether an effort uses paid staff, volunteers, community partners, or a combination, it’s important to involve people with the appropriate skills, relationships, experience, and support.
• Follow the implementation plan while remaining responsive to real conditions. Timelines can be affected by staffing, contracting, community events, funding, or other circumstances. A clear plan helps keep the work organized, but implementation should also respond thoughtfully when conditions change.

The same principle applies to the methods, content, and structure of evidence-based programs and practices. Follow the elements that are important to the intervention’s effectiveness, monitor how implementation is going, and make adaptations thoughtfully rather than casually.

• Continue to pay attention to resources. Prevention takes time. Funding may be time-limited, staff and volunteer availability may change, and new needs may arise. Continue building relationships with funders and community partners, documenting results, and looking for ways to sustain effective work.
• Keep the community informed. Use community meetings, local media, websites, social media, newsletters, presentations, events, and other appropriate communication channels to share progress, lessons learned, opportunities to participate, and results.

Phase 5: Evaluation.

Only by monitoring and evaluating your effort can you understand how well it is working and what may need to change or improve. Evaluation should take place throughout the life of the prevention effort.

• Evaluate implementation and process. Did you do what you planned to do? Did activities occur when and how you expected? Did you reach the people or settings you intended to reach? What barriers or unexpected conditions affected implementation?
• Evaluate changes in the factors your strategies are intended to influence. Are the risk or protective factors you targeted changing in the direction you hoped? Are there unexpected effects?
• Evaluate outcomes. Is the community seeing the results it hoped for – such as reduced substance misuse or related harms, increased protective factors, or stronger prevention systems? If not, determine whether the strategy, implementation, selected risk and protective factors, or assumptions behind the plan need to be reconsidered.

Evaluation findings should be reviewed regularly and used to improve the effort. That is the point of evaluation – not simply to prove that something worked or failed, but to learn. Finding a way to make an effort stronger is not an admission of failure. Community conditions change, implementation can improve, and even successful programs can usually learn something from experience.

When you make major changes, communicate them to community partners and participants. Adjustments may require additional funding, volunteers, staff, expertise, communication, or other resources. Involving the community in those decisions can strengthen both the changes themselves and community ownership of the effort.

The Community Tool Box considers evaluation such an important part of any intervention or initiative that it devotes four chapters – 36 through 39 – to it. Those chapters include resources on planning evaluations, gathering information, interpreting findings, and using evaluation to improve community efforts.

SPF does not add a sixth step after evaluation, but regular users of the Tool Box will recognize an important lesson here: keep at it. Sustainability is built into the framework precisely because prevention and community change take time. A positive result does not automatically become permanent. Effective strategies, partnerships, knowledge, and community capacity have to be sustained and adapted as conditions change.

In Summary

SAMHSA’s Strategic Prevention Framework is a structure for planning and carrying out substance use prevention efforts and addressing related behavioral health problems. Its five steps – Assessment, Capacity, Planning, Implementation, and Evaluation – form a dynamic and recurring process rather than a one-time sequence.

Two guiding principles – Community Relevance and Sustainability – should inform all five steps. Community relevance means that prevention decisions are grounded in local data, conditions, priorities, cultures, experiences, and community knowledge. Sustainability means developing the relationships, resources, capacity, and systems needed to continue effective prevention work over time.

The Strategic Prevention Framework also focuses on risk and protective factors. Risk factors are conditions or characteristics that increase the likelihood of harmful outcomes, while protective factors can reduce risk or support healthier development. Neither determines an individual’s future. By identifying locally important risk and protective factors and selecting strategies that address them, communities can focus their resources where they are most likely to make a difference.

The five steps are:

1. Assessment – use data and community knowledge to understand prevention needs, strengths, resources, risk and protective factors, and community readiness.
2. Capacity – build the partnerships, participation, knowledge, leadership, resources, and readiness needed to act.
3. Planning – establish priorities and outcomes and select evidence-based or evidence-informed strategies that fit local needs and conditions.
4. Implementation – put the plan into practice with attention to both effective implementation and community relevance.
5. Evaluation – examine implementation and outcomes, learn from the results, and use what you learn to improve the effort.

SAMHSA and its Center for Substance Abuse Prevention continue to provide prevention resources, funding opportunities, and technical assistance. Current training and technical assistance for applying the Strategic Prevention Framework are available through SAMHSA’s Strategic Prevention Technical Assistance Center.

Most important, SPF is not simply a way to choose a prevention program. It is a way to understand a community, make decisions based on data and local knowledge, involve the people who have a stake in the work, act deliberately, evaluate what happens, and keep improving over time.