Section 8. Communities That Care

Learn about Communities that Care as a structure for community efforts working to address risk and protective factors.

 

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 youth with the proper support and opportunities, development will proceed in the right direction.

But there are negative as well as positive influences at work in families, schools, and communities. If no one in an adolescent’s family has graduated from high school, that adolescent may see quitting school at 16 as normal and desirable. Young people may find it harder to avoid drug use if drugs are readily available in school and on the street. If the community fosters a culture of violence, youth are likely to be caught up in that culture.

In this section, we’ll look at a model that acknowledges both the positive (protective) and negative (risk) factors that work on 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 youth, 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. Similarly to PRECEDE/PROCEED, it identifies problems and resources, devises solutions aimed directly at the identified problem, and integrates evaluation into the implementation of the solution.

Communities That Care resembles the Search Institute’s asset development model in its emphasis on youth and the protective and risk factors affecting them. Where asset development looks at the overall development of children and adolescents, however, Communities That Care, as we shall see, focuses specifically on problem behaviors and their prevention or reversal.

What is Communities That Care?

Communities That Care (CTC) is based on the Social Development Strategy formulated by J. David Hawkins and Richard Catalano at the University of Washington. Rather than a program, CTC is an “operating system” that provides the structure, but not the content, of a community effort to address youth issues.  It focuses on risk and protective factors, which are approached through a community-wide process that involves training at each step.

CTC is a copyrighted, structured process. The Channing-Bete Corporation charges a fee for administering a comprehensive community effort that includes training, materials, and help with assessment, planning, and the choice, implementation, and evaluation of specific interventions designed to address risk and protective factors for youth.

CTC is specifically aimed at addressing five problem behaviors among youth:

• Substance use
• Delinquency
• Teen pregnancy
• School dropout
• Violence

Risk factors

Risk factors are those elements in the environment or the inner makeup of people that make them more susceptible to particular behaviors or conditions. Research has identified 19 risk factors associated with one or more of the problem  behaviors identified above.  An assumption behind the CTC model, which it shares with the other models described in this chapter, is that such elements as risk and protective factors span all areas of community life.  With that assumption in mind, the 19 risk factors are divided into four groups related, respectively, to community, family, school, and individual/peer contexts.

Community risk factors. These have to do with both conditions within the community and its attitudes and structure.

• Availability of drugs. The availability of drugs is, not surprisingly, a significant risk factor for both drug use and violence. Availability is such an important factor that the drug use rate was found to be higher even in communities where drugs were perceived to be readily available, but actually were not.
• Availability of firearms.Statistics show that the more available firearms are in a community, the higher the violent crime rates tend to be, and, conversely, fewer firearms in a community is correlated with lower violent crime rates.
• Community laws and norms favorable to drug use, firearms, and crime. High taxes on alcohol and cigarettes, as well as bans on their use in various circumstances, can control their use and send a message about the community’s attitude toward them.

Lack of clarity in laws and practices can also raise problems for youth. If alcohol is customarily served at community festivals, if the drinking age isn’t enforced, or if drinking to excess among both adults and adolescents isn’t seen as a problem, the chances are that young adolescents won’t see any reason for avoiding these behaviors.

• Media portrayals of violence. There is evidence that young people who watch large amounts of media violence become numb to its impact and are more likely to behave violently themselves.
• Transitions and mobility. Transitions (from one school to another, for example, or from middle to high school) are always difficult for adolescents. Unusual community transitions (integration of socioeconomic groups through school busing, for instance, or widespread job losses), may compound the problem for teens. Transitions and/or a high level of transience – families moving frequently – can put kids at risk for substance use, delinquency, and school drop-out.
• Low neighborhood attachment and community disorganization. When people feel that they have little control over their lives, the results are all too often low community participation and voting levels, lack of community surveillance of public areas, vandalism, and decay of the physical and social structure of the neighborhood. These conditions can lead adolescents into substance use, violence, and delinquency.
•  Extreme economic deprivation. Poverty puts youth at higher risk for all problem behaviors.

Family. As might be expected, a child’s family’s attitudes and conditions have a huge effect on his present and future behavior. All five problem behaviors are subject to family-related risk factors.

• Family history of problem behavior. If their father spent time in jail, if their mother was only 15 when her first child was born, if a parent dropped out of high school, if someone in the family regularly drinks large amounts of alcohol, if physical violence is a family norm, then adolescents in the family risk repeating the same behavior, and engaging in other problem behaviors as well.
• Family management problems. Family management comprises the methods and procedures parents use to regulate relationships and raise their children. Some family management problems are obvious: no controls on children’s activity and whereabouts, or child abuse used as discipline.  Other less visible, but equally harmful, problems include lack of clear expectations for behavior and character, inconsistent demands, and unclear definitions of the boundaries between parents and children. All of these act as risk factors for all five problem behaviors.
• Family conflict. Whether the conflict is between parents, between parents and children, among siblings or step-siblings, or among other members of the household, a high level of conflict figures into adolescent susceptibility to all problem behaviors.
• Parental attitudes toward, or involvement in, substance use, crime, and violence. If parents approve of or accept these behaviors, or engage in them themselves, their children are much more likely to be involved in them as well.  This is especially true when parents involve the children directly in their own problem behaviors – heroin addicts taking their children along on drug buys, for instance (a situation the author has encountered often), or parents sending their children to buy cigarettes for them.

School. School represents not just a place to learn reading or algebra. It is a social center, and a miniature of society as a whole.The identity an adolescent assumes or that influences her in school is the identity that she and others expect she will assume as an adult.  School-related risk factors affect all the problem behaviors.

•  Early and persistent antisocial behavior. A child who’s a terror in kindergarten, but learns to stay out of trouble in school most of the time, is probably doing fine. If the antisocial behavior is still present at 12, he’s at serious risk.
• Academic failure in elementary school. In addition to being a source of frustration for both child and teacher, academic failure is self-perpetuating – the child can’t understand the material, and as a result, she pays little attention, misses even more, and falls further and further behind. Academic failure also distances the child from education as a tool for life, making it seem irrelevant and “not for me.” Finally, it encourages a self-image fueled in equal parts by anger and despair: “slow,” not very competent at anything related to the intellect, an outsider, etc. All of this leads the child away from the mainstream and toward the subcultures of problem behaviors.

In some cases, the subculture of a whole group of children may see academic success as suspect or wrong. Among some Black urban teens, for instance, doing well in school is viewed as trying to be white. Some working class cultures have looked down on academic success as class betrayal. If a child heeds these voices of culture, he’s limiting his adolescent options, and laying himself open for problem behaviors.

• Lack of commitment to school. This may be a result of academic difficulty, or simply of a lack of interest in school, and a feeling that school, or education in general, are unimportant.

Individual/peer. This last set of risk factors concerns personal characteristics and attitudes that are either inherent in the individual, or are influenced by close peer relationships – or, in some cases, both.

•  Alienation and rebelliousness.The Regional Preventive Center of the Flint Hills (Kansas) describes alienated and rebellious youth as those who “feel they are not part of society, are not bound by rules, don’t believe in trying to be successful or responsible, or who take an active rebellious stance toward society.”
• Friends who engage in problem behaviors. Because of the importance of peer approval to adolescents, friends’ attitudes and actions can be a powerful factor in teens’ behavior.  This risk factor is one of the most consistent predictors of the presence of problem behaviors.  In other words, your mother was right – you shouldn’t be hanging around with those bums.
• Favorable attitudes toward the problem behavior. If a youth’s friends – or parents, for that matter – binge drink, commit crimes, or drop out of school, she’s more likely to be positive about those behaviors.  Developing favorable attitudes toward problem behaviors obviously puts kids at greater risk of engaging in them.
• Early initiation of the problem behavior. The earlier you start drinking, for instance, the more of a “normal” behavior it becomes.  If you’ve been getting drunk for nearly half your life by the time you’re 17, you aren’t apt to see anything wrong with it.
• Constitutional factors. These are internal factors that may be either in-born (genetic, neurological, or biological) or environmental, but that are, in any case, very much a part of who an individual is.  These can include lack of impulse control, sensation-seeking, and low risk avoidance.

Protective factors

Just as there are risk factors that put adolescents in harm’s way, there are protective factors that tend to shield them from engaging in problem behaviors. These fall into three categories:

Individual characteristics.

• Gender. Conventional wisdom is right on this one – girls get into less trouble than boys do. Whether it’s testosterone or social conditioning, boys are at greater risk for all of the problem behaviors except teen pregnancy.
• Resilient temperament. Some children and adolescents simply seem to be better able to weather difficulties than others. They can experience numerous risk factors without losing their ability to cope reasonably with whatever comes up.
• Positive orientation. Children who are optimistic and cheerful, enjoy other people, and are themselves well-liked are at reduced risk for all the problem behaviors.
• Intelligence.Intelligence is a defense against delinquency and school drop-out, but not against substance use.

Everyone can cite examples of brilliant scientists or poets who were substance users. The real question is why others – often with similar pain in their lives – were not. Perhaps the necessary type of intelligence here is not intellect, but emotional intelligence – the ability to understand yourself and others, to be honest with yourself about your motivations, and to consider what you’re doing before you act.

Bonding. Many birds and other animals are programmed to recognize and bond with the first large creature they encounter after birth as their mother. Children and adolescents also bond – they establish strong connections to parents and other individuals and groups. When kids are bonded in this way, they tend to act in the ways expected by the individual or group they feel connected to, so as not to threaten the relationship.

CTC presents bonding as an unalloyed protective factor, but it is worth noting that these bonds are not always to individuals or groups that will prevent problem behaviors. If teens bond to a violent gang, that connection isn’t likely to act as a protective factor. Protective bonds are those where the relationship is with an individual or group that holds pro-social values that oppose the problem behaviors.

These might include:

• Parents and families
• Other significant adults – relatives, neighbors, counselors and mentors, etc.
• Teachers
• Peer groups
• School
• Organizations – Scouts, church groups, social clubs, workplaces, etc.
• Sports teams
• Community – service groups, cultural organizations, etc.

Healthy beliefs and clear standards. Significant adults and groups create a community environment that communicates a positive value system, and lets teens know what’s expected of them

Families, other adults, schools, and the community at large should all clearly state and practice values that oppose problem behaviors.  In addition to holding positive beliefs, families, schools, and the community should all have plainly stated high expectations and standards for children’s and adolescents’ behavior and achievement.

In other words, adults in the community should both preach and practice an admirable value system, and expect youth to do the same.

The ideal here – the one that CTC hopes to create in communities if it doesn’t already exist – is one where the community speaks with one voice about values and standards. In practice, that’s a difficult goal to achieve. However, if significant adults – parents, teachers, and coaches particularly – clearly communicate reasonable value systems as well as the standards that adolescents are expected to meet, most adolescents will get the 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 operate.

Individual characteristics provide a foundation for healthy behavior. Gender, resilient temperament, positive orientation, and intelligence don’t, by themselves, necessarily lead kids in the right direction.  The possession of one or more of them does, however, give an adolescent a starting place from which she can move in that direction.  Having access to a piano doesn’t assure that you’ll learn to play, but it affords you the opportunity.  Without that access, you surely won’t learn.

While individual characteristics can act as protective factors, the lack of any of these individual protective traits doesn’t mean that a youth is doomed. Other protective factors can be reinforced to compensate, or, in some cases, the missing protective traits can be developed. Attitudes, and even personality, can change with positive changes in circumstances, or with appropriate counseling or psychotherapy. Even intelligence can be increased with the proper stimulation and circumstances.

• To develop or enhance individual characteristics, children and adolescents should be given a chance to contribute to their families, schools, and communities.  In order to contribute and reap the protective benefits, kids need three things:
  • Skills. These include both the social skills to work with others and the specific competencies (basic skills, reasoning, specialized knowledge, and/or physical abilities) that will make their contributions valuable.
  • The opportunity to contribute. Kids need to be given responsibilities that fit their age and abilities, and come with appropriately high expectations.  They should have the chance to make a significant contribution, not just a token.

Depending on the child’s age and ability, contributions can vary from simple household chores to running a youth organization or serving on a community board. The range can include such activities as in-school tutoring of younger children or school-based peer mediation; responsibilities in social clubs, Scouts, or faith-based groups; membership in a band or orchestra; or taking care of younger siblings.

• Recognition for their contribution. Like anyone else, kids need to know that their work is valued, and that someone noticed that they did a good job.  Recognition also helps cement their feeling as though they are part of the group, whether it’s a family, a school, an organization, or a group whose only other member is a caring adult.

Contribution leads to bonding. Providing real help to an individual, group, organization, or the community helps youth to identify with that entity and its ideals and values.  That identification makes adolescents less likely to engage in problem behaviors, both for fear of alienating the individual or group they’re attached to and because their image of themselves includes acting in ways consistent with the values of the bonded individual or group.

For a bonded child or adolescent, the provision of healthy beliefs and clear standards furnish the structure and corrective feedback needed for positive development.Adolescents get clear messages about the goals they should be striving for, and are held accountable for reaching those goals by adults and groups significant in their lives.

Ultimately, this progression leads to 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 disadvantages to using CTC. Many of the advantages can also be viewed as disadvantages, depending upon your point of view.  The advantages listed below largely mirror CTC’s own claims for effectiveness, while the disadvantages present, in many cases, an alternative way of looking at those claims.

Advantages

• CTC is grounded in theory and practice.The ideas underlying CTC – the concepts of risk and protective factors, for instance, and the studies that indicate their influence –come from prevention theory.  CTC’s list of “best practices” includes methods and programs that have been cited as effective, and can be reproduced in other settings.
• CTC is inclusive and participatory.The conceptualization and planning process involves people from all sectors of the community in discussion and decision-making.  A community board oversees the implementation and evaluation of the program.

There are real advantages to being inclusive – involving people from all sectors of the community, including youth and others directly affected by any intervention – and participatory – engaging everyone, not just leaders, in decision-making. First, it taps a broad range of ideas and knowledge, particularly about the history and character of the community and its youth. Second, it assures that all decisions are carefully discussed, and that nothing is hastily adopted. Perhaps most important, it means that, because everyone in the community has been represented, the final plan and implementation will be “owned” by the community. Since the plan came from the people, rather than being imposed on them by someone else, they’re 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 looks at the prevention of problem behaviors and the healthy development of youth as a community-wide responsibility that demands a community-wide effort.  Whether the community in question is a rural village or a city as large as Seattle,Washington (which, led by the school system, has adopted the model), CTC assumes that only by engaging the whole community can a prevention program be truly effective.
• CTC involves training at every step. Rather than simply presenting a model or helping with assessment, CTC provides training and assistance at each point in the process.  Such crucial phases as community assessment and strategic planning are thus undertaken by groups that have the background to proceed competently.
• CTC provides a menu of best practices to choose from. Instead of having to engage in lengthy research or plan their own interventions from scratch, CTC participants choose the interventions most appropriate to their community from a list of “best practice” methods and programs that have been proven effective. Furthermore, CTC encourages communities to choose multiple approaches, aimed at a range of the risk factor areas.

“Best practices” are those whose effectiveness is documented in studies by funders (often government agencies) or academics (who publish the results in journals and other publications).

• CTC is adapted to its own needs by each community. Rather than employing a “cookie-cutter” approach, CTC encourages communities to mix and match best practices to build a prevention program that speaks specifically to local needs and character.  Because training and a community assessment are part of the system, each community builds the knowledge and skills to analyze its needs and make wise choices.
• CTC includes evaluation and adjustment as an integral part of any effort. No program or method, best practice or not, is perfect for every community, and no implementation of a program or method is perfect, either. Regular evaluation and readjustment of programs goes a long way toward assuring effectiveness.
• CTC seems to work for most problem behaviors. Communities, by their own reports, seem to have good results in reducing the incidence of problem behaviors, with the exception of substance use.

Disadvantages

• The CTC approach is only inclusive and participatory for certain people. While it claims to involve the whole community, the formal CTC approach is actually top-down, starting with a small number of “key community leaders.”  These leaders who may or may not be representative of the whole community in terms of race, socioeconomic class, or interests – then “invite” other participants “from all sectors” to make up a community board of 30.  The reality is that they’ll usually invite people they know, who are apt to be much like them and may not represent the true diversity of the community..

Especially in a large community, it takes research to know whom to include, and 30 may be too small a number to be truly representative of all sectors. Furthermore, some sectors – youth themselves, for instance, or single parents on welfare – are unlikely to be included unless specifically targeted by the process.  And if the “key community leaders” see themselves as leading the process, its participatory nature can go out the window.

• CTC allows the choice of only a finite number of approaches. CTC’s claim of allowing communities the freedom to devise their own solutions is only partially accurate. Communities can create combinations of interventions that speak to their needs, but only from a limited pool of choices.

The fact that CTC offers a menu of best practices is a double-edged sword. On the one hand, it presents a community with a number of programs and interventions that have worked in other places, and the security of set curricula for implementing them. On the other, it can limit the possibilities for creativity and the use of local wisdom that might arise if there were more freedom of choice and the chance for the community to craft its own program.

• Choosing from among best practices may encourage communities merely to follow directions, rather than throwing heart and soul into the effort. Though it simplifies the process, an intervention that’s laid out for the community, rather than built from the ground up, may lead people to believe that if they implement it “right,” they’ll automatically get results.  If the results aren’t forthcoming, the community may be tempted to try harder to hone its implementation, rather than carefully analyzing the situation.
• CTC is narrowly focused. CTC focuses specifically on youth, and more specifically on the five problem behaviors – substance use, delinquency, teen pregnancy, school dropout, and violence.  This emphasis has both positive and negative aspects. On the one hand, it means not trying to do too many things at once, and setting manageable goals.  On the other, it implies taking a small-picture view of community health and development, and not necessarily planning for the long term or for the whole community.

If the ultimate goals are as narrow as reducing one or more of the problem behaviors, they can give the impression that reaching those goals “fixes” the problem and the community. If the goal is the end of the process, there’s no community commitment to long-term social change. And long-term social change is usually needed to fully solve community problems.

• CTC is, to a certain extent, based on assumptions. While the theory behind it and the best practices have been subject to a fair amount of research, the program has only been shown to be effective in the short- to mid-term range. Long-term data have not yet been collected.
• CTC has a service to sell.  In most cases, CTC is sold as a package that includes literature, training, and support. While there are some obvious advantages to this, it also means that there can be less flexibility in the model than might be desirable, and that the provider benefits from selling all parts of the package, whether they’re the most appropriate or effective possibilities for the community or not.  The fact that this is a commercial venture doesn’t make conflict of interest inevitable, but it raises the possibility of it.

Some of these disadvantages are serious, but none are insurmountable if you adapt the program to your community’s own needs. You may define “key community leaders” a bit more broadly, for instance, although you might want to include at least some of those that meet CTC’s criteria in an initial group. You can include teens, parents, and a cross section of people from the community as well, so that the initiative for the effort is community-wide, rather than top-down. You may be creative with programming ideas, or use some of the best practice programs and devise others of your own. No model is sacrosanct, and no model works equally well in all communities.

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, respected business figures, etc. – are important, but you need all the stakeholders if you expect the whole community to buy into the effort.

Stakeholders include all who have a vested interest in an initiative: supporters, beneficiaries, planners, implementers, etc. Some possibilities include:

• People directly affected by the problem behaviors.They can bring to the discussion experience and a deep understanding of the behaviors and their effects.
  • Youth themselves, especially those who’ve been there – former gang members, recovering substance users, teen parents, dropouts. They can offer not only the insight of personal knowledge, but also credibility with other youth.They speak from experience, not from an adult position of moral rectitude.
  • Families, significant others, and friends of those involved in the problem behaviors. Their experience is often just as intense as, and more painful than, that of the adolescents themselves.
  • Victims of delinquency or youth violence.
• People affected indirectly by the problem behaviors. This group might comprise people with a number of different interests.
  • Teachers, counselors, coaches, and other school staff.
  • Those who work in non-school organizations that serve youth – caseworkers, street workers, gang liaisons, mentors, coaches, youth group leaders, etc.
  • Those who deal with the consequences of youths’ actions – police, medical professionals and other health workers, judges, probation officers.
  • Merchants and others who believe that their businesses or property values are reduced by teens loitering and/or getting drunk or high outside, or by streets made unsafe by youth violence.
• Community leaders and decision-makers.There are really two kinds of community leaders here: official and unofficial.
  • Official leaders. These are largely present and former elected and appointed officials.
  • Unofficial leaders. This is a larger group, made up of opinion leaders, well-known business, institutional, and civic figures, community activists, spokespersons for particular groups (language minorities, labor unions or tradespeople, neighborhoods), clergy, and ordinary citizens whom others respect and listen to.
• Those with a community interest. These are people who may not be directly involved or affected, but care about kids and the community.
  • Parents and others who want the best possible environment and support for youth.
  • Business people, community developers, etc., who want to be able to present the community as a desirable place to settle, raise children, or start a business.
  •  Community volunteers and other concerned citizens.
• The media. Involving representatives of the media from the beginning – as individuals and parents, rather than just in their professional capacities – is the best way to assure that the community gets the information it needs about CTC and its activities in your community.

How do you employ the Communities That Care approach?

In 2000, Hawkins and Catalano went into partnership with Channing-Bete Company of South Deerfield, MA, to market a trademarked “Communities That Careâ” package to communities. The package includes an overall strategy, training of community participants at several junctures, help with choosing and implementing effective interventions, evaluation tools, and technical assistance throughout the process.

To implement a formal CTC program, you have to make arrangements with Channing-Bete. Visit the CTC section of their website.

The description of the phases of prevention below outlines the CTC process (i.e., describes what would happen if you hired Channing-Bete to help your community run a CTC program. There is, understandably, a lack of detail here, since the CTC folks couldn’t sell their program if they gave all the details away for free.

According to CTC, an effective community prevention process has seven phases, the first two of which are preliminary, and may or may not be necessary in a given community:

Awareness.

The first step in the process is to assess community readiness to address adolescent problem behaviors. Citizens from all sectors have to be aware that adolescents are engaging in problem behaviors in the community, and to see it as an important issue. Only when the community reaches that point is it ready for the next phase.

Education.

 Once people understand that there are problem behaviors to be addressed, they need information about them, to better understand them and to see why addressing them is important.  Community education presents citizens with what they need to know to begin to approach the issue – what the problem behaviors are, their nature and effects, evidence that some or all of them are a problem in the community, etc.

These two phases reflect the first two stages of readiness for change recognized by social marketers. Community Tool Box Understanding Social Marketing: Encouraging Adoption and Use of Valued Products and Practices, describes the “continuum of understanding” that accompanies behavior change:

• Knowledge about the problem.
• Belief that the problem is important.
• Desire to change.
• Belief that change is possible.
• Action.
• Maintenance of action.

The awareness and education phases of the CTC process address the first two stages on this continuum, and, ideally, lead to the third. The latter three stages are dealt with as part of the presentation, adoption, and implementation of CTC as a community effort.

An important aspect of the theory behind the continuum is that a person’s level of understanding of a problem is crucial in persuading her to change. You have to approach her at her current stage and try, with arguments or information that address that current stage of understanding, to move her to the next. Thus, it’s important, before starting an initiative like CTC or any of the others modeled in this chapter, to take the pulse of community understanding of the issues you want to address. No matter how good your process or your proposed intervention, if the community hasn’t gotten to the point where it’s ready to support the effort, it will probably fail. You have to do the groundwork of bringing the community to that point (ideally, through the community’s own participation) before you can start to take action.

Community mobilization.

Once the community sees and understands the problem and the need for correction and prevention, community mobilization begins with the recruitment of a small number of  “key community leaders.”  These are the decision makers and opinion leaders whose support is needed for things to happen in the community – top elected officials, business and labor leaders, heads of institutions and agencies, the Superintendent of Schools, etc.

This core group receives an orientation to CTC and commits to the process.  They then invite 30 people from all sectors of the community to form a community board to oversee the CTC process. The community board, in turn, receives a two-day orientation and training about the theory behind CTC and how the process should work.

As discussed briefly above, this part of the process leaves something to be desired if you want a diverse group that sees itself as owning the process from the beginning. The Orlando Healthy Community initiative started with a self-selected group of key community leaders – the mayor, the heads of two hospitals, bankers, several present and former Junior League officers, etc. Their attempt at assembling a community board to oversee their effort was mediated by a facilitator. When the group drafted an “inclusive” list of people to invite as participants, the facilitator pointed out to them that virtually everyone on it was white, aged 35-65, and middle class.

To the group’s credit, they went back to square one, researched the community, made contact with many people they’d never met, and ultimately came up with a truly inclusive list...of 160, almost all of whom signed on. The number of community board participants again raises the other issue addressed in the previous discussion of inclusiveness and participation: whether 30 is a large enough number for a truly representative board.

In a small, relatively homogeneous community or a neighborhood, 30 might be fine. But in even a moderate-sized city, there might be more than 30 ethnic groups, each of which might need to be represented. In addition, there might be powerful reasons to include representation by geography, age, and class, as well as by people from specific organizations and professions. And all of these are over and above the original key community leaders, others who need to be included for political reasons, and people from the other various community subgroups (business, large institutions, public employees, the schools, academia, community volunteers, etc.).

The community board, once trained by a CTC facilitator, holds public meetings to introduce CTC to the community, and to involve the community in developing a shared vision to guide the planning and implementation process.

Community assessment.

The community assessment phase of CTC revolves not only around pinpointing weaknesses and needs, but also around identifying strengths and resources already present in the community. The community board employs a number of strategies to examine the nature of community needs:

• Youth survey. A survey given to youth in the schools is part of the CTC package. It is meant to identify risk and protective factors, and to help the community board understand where and what the prevention needs are.
• Census and accompanying GIS (Geographic Information Systems) data. Examining these and comparing them with those from the previous census can highlight trends, changes, and possible problems or new assets in the community. GIS maps can also show concentrations of particular racial or ethnic groups, language minorities, socioeconomic groups, employment patterns, and other information that might be useful.
• Archival records. The records of the school system, the police, the newspapers, and various government agencies can yield valuable information about what’s been done in the past, what the problems have been over time, whether there have been previous efforts and whether they have been successful, and much more.
• Direct contact with youth and other citizens. Through focus groups, community forums, individual interviews and conversations, and informal meetings with groups, the community board can obtain direct information from those who experience the problem behaviors and risk and protective factors and their effects every day.

Using these avenues, the board determines the nature of risk and protective factors in the community, and chooses two to five risk factors to focus on. Any action on these risk factors will be specific to the need in the particular community – that is, geared to areas and populations where the survey and other data show that the need for reducing risk and enhancing protection is greatest.

The board then receives a one-day training in identifying community strengths and resources, which it uses to find resources to support the CTC effort:

• Money, in the form of local funders or other sources.
• Expertise, from academics versed in theory, or from community groups or individuals experienced in working with youth.
• People – often both paid and volunteer – to provide the front-line and support tasks to make the effort work.
• Avenues to reach youth – schools, libraries, media outlets, sports facilities, street outreach, direct contact with parents, etc.

Prevention plan development.

Here, the community decides where to put its efforts, develops goals and ways of measuring them, and chooses from among a number of proven programs that address its issues.  This phase begins with community planning training, then launches into a strategic planning process.

The community board looks carefully at the risk and protective factors it has chosen to address in the last phase, and at the geographic, social, or demographic groups that show the greatest need.  Using this information, the board determines clear outcomes for protection enhancement, risk reduction, and behavior change.  It sets timelines and assigns accountability for carrying out a plan.

The next step is a two-day “effective prevention strategies” workshop that introduces the board to proven practices, and helps it select one or more appropriate to the community and its planning goals.  Rather than concentrating in one area, the board is urged to select strategies that address family, school, and community factors.

Program implementation.

The board creates an implementation task force, composed of members of the board itself, those who will actually run or work in the program, beneficiaries of the program, and other community members. CTC provides guidance and help in setting up the implementation, replicating the chosen programs, etc.

With CTC, as with any model, the keys to good implementation are thorough and inclusive planning, a carefully structured implementation process (i.e., everyone knows what comes when and who is responsible for doing what), and good communication among all parties to make sure that the process works the way it’s designed to. If these elements are present, the chances are that implementation of the plan will go smoothly.

That doesn’t guarantee that it will be effective, however. Effectiveness depends on whether you’ve chosen an intervention that properly addresses the issues at hand, and on how well the people doing the direct work of implementation do their jobs, relate to the population being served, and work together.

Outcomes evaluation.

The program is evaluated against the outcome and accountability criteria developed earlier. CTC provides evaluation instruments and assists with the process.  The evaluation is meant to show the board where the intervention has been successful and where it hasn’t, and thus to provide them with the information they need to adjust the program where necessary.

Evaluation and adjustment is an integral part of the process, and should continue throughout the life of the effort. An initiative doesn’t end when the community sees positive results. If the results are indeed positive, then the program should continue in order to maintain them.  If results are less positive than you hoped, then you have to keep adjusting the process and the content of the intervention until you get the results you’re aiming for.

Even if results are overwhelmingly positive, it’s not time to rest on your laurels.  As soon as you turn your back, your positive changes can disappear.  You have to maintain your effort indefinitely – by continuing to evaluate, adapt, and implement interventions, and to identify and address needs – to create a better, healthier future for youth and your community.

In Summary

Communities That Careâ (CTC) is a trademarked process that grew out of the work of J. David Hawkins and Richard Catalano at the University of Washington.  Based on prevention science, their Social Development Strategy looks at the ways in which risk and protective factors push adolescents away from and toward healthy development.

CTC focuses on five problem behaviors: substance use, delinquency, teen pregnancy, school drop-out, and violence.  It aims to reduce the 19 research-identified risk factors – divided into individual/peer, family, school, and community categories – that may encourage these behaviors, and to strengthen the three protective factors – individual characteristics, bonding, and healthy beliefs and clear standards – that deflect adolescents from them.

Advantages of the process include:

• CTC is grounded in theory and practice.
• CTC is inclusive and participatory.
• CTC takes a community perspective.
• CTC involves training at every step.
• CTC provides a menu of best practices to choose from.
• CTC is adapted to the needs of each community.
• CTC includes evaluation and adjustment as an integral part of any effort.
• CTC seems to work for most problem behaviors.

Along with these advantages, CTC also has a number of potential drawbacks:

• The CTC approach is only inclusive and participatory for certain people.
• CTC allows the choice of only a finite number of approaches.
• Choosing from among best practices may encourage communities merely to follow directions, rather than throwing heart and soul into the effort.
• CTC is narrowly focused on youth and specific behaviors.
• CTC is, to a certain extent, based on assumptions.
• CTC has a service to sell.

Because broad-based participation is necessary for a successful effort, CTC should involve all stakeholders and all sectors of the community. This includes those directly affected by the problem behaviors and the proposed intervention, those indirectly affected; those who deal with the consequences of the behavior; concerned citizens; and members of the media.

CTC is presented to a community as a package that includes an overall structure, several trainings, literature, survey and evaluation instruments, guidance throughout, and technical assistance. The process starts with analysis of whether the community is aware of the issues, and ready to support action on them. If not, it needs to be brought to that point.  Next, the community needs to be educated about the problem behaviors – their characteristics, their severity, their frequency in the community, who is at risk, etc. Then the process starts in earnest.

First, a small number of key community leaders is recruited, receives an orientation, and agrees to sponsor the effort. They in turn recruit 30 people from a variety of community sectors to constitute a community board. The board, after training, presents CTC to the community, and generates, with community input, a shared vision.

After more training, the board engages in community assessment to identify the important risk factors and the populations most in need, as well as the resources available to fund and support the program. A planning process, also accompanied by training, arrives at a strategy, and interventions are chosen – ideally in all the crucial areas of family, school, and community factors – from among a number of best practices that have been shown to be effective and replicable.

An implementation task force, which includes those who’ll do the work of the intervention, then takes over to oversee the implementation of the effort. They set timelines, determine accountability and outcomes, and design the actual work.  Regular evaluation is an integral part of the process, and is meant to point out successes, which need to be continued, and problems, which need to be corrected.  The intervention should be constantly adjusted and improved based on this evaluation.

Finally, the process and the interventions need to be maintained in order for gains to continue, and not to fade away from neglect.