Sustained effects of the Communities That Care system on prevention service system transformation.
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ABSTRACT:
SUBMITTER: Rhew IC
PROVIDER: S-EPMC3673484 | biostudies-literature | 2013 Mar
REPOSITORIES: biostudies-literature
Publications
Sustained effects of the Communities That Care system on prevention service system transformation.
Rhew Isaac C IC Brown Eric C EC Hawkins J David JD Briney John S JS
American journal of public health 20120621 3
<h4>Objectives</h4>We examined whether the Communities That Care (CTC) system sustained effects 1.5 years after study funding ended on prevention system constructs expected to be important for community-level reductions in drug use and antisocial behaviors among youths.<h4>Methods</h4>Data were from a community trial of 24 towns in the United States randomized to either the CTC intervention or control conditions. Participants were 928 community key leaders interviewed at 1 to 4 waves from 2001 t ...[more]
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Project description:OBJECTIVE:The Communities That Care (CTC) prevention system seeks to build community capacity for a science-based approach to the promotion of healthy youth development. Prior research shows the positive effects of CTC on youth protective factors during CTC implementation. This research tests sustained effects of CTC on youth protective factors 1 year after external support to communities for CTC implementation ended. METHOD:Data come from a community-randomized trial of CTC in 24 communities across 7 states. A panel of 4,407 youth in CTC and control communities was surveyed annually from Grade 5 through Grade 10. Youth reported their exposure to protective factors identified in the social development model. Global test statistics are calculated to examine effects of CTC across 15 protective factors in 5 domains (community, school, family, peer, and individual) assessed in Grade 10, 1 year after study support for CTC implementation ended. Analyses also examine variation in sustained effects by gender and baseline risk levels. RESULTS:Global effects of CTC on protective factors across all domains are not sustained in Grade 10. However, sustained domain-specific effects are observed in the individual domain for males, in the peer domain for females, and in the individual domain for youth with low-to-medium risk at baseline. CONCLUSIONS:Greater emphasis on strengthening protective factors during high school might be needed to sustain broad effects of CTC on protective factors observed during middle school.
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Project description:ObjectiveTo test whether the Communities That Care (CTC) prevention system reduced levels of risk and adolescent problem behaviors community-wide 6 years after installation of CTC and 1 year after study-provided resources ended.DesignA community randomized trial.SettingTwenty-four small towns in 7 states, matched within state, randomly assigned to control or intervention condition in 2003.ParticipantsA panel of 4407 fifth-grade students was surveyed annually through 10th grade from 2004 to 2009.InterventionA coalition of community stakeholders received training and technical assistance to install CTC, used epidemiologic data to identify elevated risk factors and depressed protective factors in the community, and implemented programs to address their community's elevated risks from a menu of tested and effective programs for youths aged 10 to 14 years, their families, and schools.Outcome measuresLevels of risk and incidence and prevalence of tobacco, alcohol, and other drug use; delinquency; and violent behavior by grade 10.ResultsMean levels of targeted risks increased less rapidly between grades 5 and 10 in CTC than in control communities and were significantly lower in CTC than control communities in grade 10. The incidence of delinquent behavior, alcohol use, and cigarette use and the prevalence of current cigarette use and past-year delinquent and violent behavior were significantly lower in CTC than in control communities in grade 10.ConclusionsUsing the CTC system can produce enduring reductions in community-wide levels of risk factors and problem behaviors among adolescents beyond the years of supported implementation, potentially contributing to long-term public health benefits.Trial registrationclinicaltrials.gov Identifier: NCT01088542.
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| S-EPMC3946405 | biostudies-literature
Project description:ImportanceThere is little information on upstream community-based interventions that reduce the prevalence of handgun carrying among adolescents, especially those growing up in rural areas.ObjectiveTo test whether Communities That Care (CTC), a community-based prevention system focusing on risk and protective factors for behavioral problems early in life, reduces handgun carrying prevalence among adolescents growing up in rural areas.Design, setting, and participantsCommunity-randomized trial of 24 small towns in 7 states assigned randomly to the CTC or control group with outcomes assessed from 2003 to 2011. Participants were youths attending public schools in grade 5 who received consent from their parents to participate (77% of the eligible population) and were repeatedly surveyed through grade 12 with 92% retention. Analyses were conducted from June to November 2022.InterventionsA coalition of community stakeholders received training and technical assistance to install CTC, used local epidemiologic data to identify elevated risk factors and low protective factors for adolescent behavioral problems, and implemented tested preventive interventions for youth, their families, and schools.Main outcomes and measuresHandgun carrying (never vs at least once) operationalized in 2 ways: (1) prevalence of past-year handgun carrying, and (2) cumulative prevalence of handgun carrying from grade 6 through grade 12.ResultsOverall, the 4407 study participants' mean (SD) age was 12 (.4) years in both CTC (2405 participants) and control (2002 participants) communities in grade 6; about one-half of participants in each group were female (1220 [50.7 %] in the CTC group and 962 [48.1%] in the control group). From grade 6 through grade 12, 15.5% of participants in CTC communities and 20.7% of those in control communities reported carrying a handgun at least once. Youths in CTC communities were significantly less likely to report handgun carrying at a given grade than those in control communities (odds ratio [OR], 0.73; 95% CI, 0.65-0.82). The most pronounced effects were observed in grade 7 (OR, 0.70; 95% CI, 0.42-0.99), grade 8 (OR, 0.58; 95% CI, 0.41-0.74), and grade 9 (OR, 0.65; 95% CI, 0.39-0.91). Cumulatively from grade 6 through grade 12, youths in CTC communities were significantly less likely to report handgun carrying at least once than those in control communities (OR, 0.76; 95% CI, 0.70-0.84). Overall, CTC reduced the prevalence of past-year handgun carrying by 27% at a given grade and by 24% cumulatively through grade 12.Conclusions and relevanceIn this study, CTC reduced the prevalence of adolescent handgun carrying in participating communities.Trial registrationClinicalTrials.gov Identifier: NCT01088542.
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Project description:BackgroundEffective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process.MethodsThe study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester-a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010-2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team.FindingsThe study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong organisational identification. Manipulated emergence of multi-organisational CoPs in the context of primary care may thus be problematic.ConclusionsIn cases when manipulated emergence of new CoPs is problematic, boundary issues could be addressed by adopting a developmental perspective on CoPs, which provides an alternative to the analytical and instrumental perspectives previously described in the CoP literature. This perspective implies a pragmatic, situational approach to mapping existing CoPs and their characteristics and potentially modifying them in the process of service improvement through the combination of internal and external facilitation.
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