Creating a Strategic Plan: How-to Guide for Virginia SPF SIG

Creating a Strategic Plan: How-to Guide for Virginia SPF SIG Adapted from: Creating a Strategic Plan Based on Your Needs Assessment Findings: A How-To Guide. Developed For the North Carolina Strategic Prevention Framework State Incentive Grant by the Pacific Institute for Research and Evaluation Elizabeth Eustis Turf, Ph.D., SPF-SIG Epidemiologist Virginia Commonwealth University Michelle Schmitt, Ph.D., SPF-SIG Evaluator Virginia Commonwealth University The Evidence-Based Practices Workgroup Hope Merrick, M.S.W., Virginia Department of Behavioral Health and Developmental Services Jeanne Martino-McAllister, Ph.D., Professor Emerita, Department of Health Sciences and University Studies, James Madison University David Anderson, Ph.D., Professor, School of Recreation, Health and Tourism in the College of Education and Human Development, George Mason University

Table of Contents Section Page # Table of Contents Acronyms and Abbreviations ii iv 1. Introduction 1 2. Clarifying Where You Are & Where You Are Headed 3 2.1 Where Are You? 3 2.2 What Is Next? Creating your logic model 4 3. Selecting Evidence-Based Interventions 9 3.1 Bringing The Right People To The Table 10 3.2 What To Consider: Determining Fit 12 3.3 What To Consider: SAMHSA Criteria For Evidence-Based 13 3.4 Reviewing Evidence-Based Strategies 14 3.5 Addressing Cultural Competence 17 3.6 Selecting Evidence-Based Strategies 19 3.7 Creating Capacity Development Plans 21 3.8 Strategy Selection Summary Considerations 22 3.9 Evaluation Considerations 23 3.10 Developing The Implementation Plan 24 4. Writing Your Strategic Plan 25 4.1 Outline For Jurisdiction-Level, Three-Year Strategic Plan 25 4.2 Submission Of Strategic Plans 28 Appendices Appendix A: Strategic Planning Worksheets Worksheet A-1. Logic Model First Three Columns Only 1 Worksheet A-2. Selecting Strategies 2 Worksheet A-3. Jurisdiction Logic Model Final 4 Worksheet A-4. Capacity Worksheet 5 Worksheet A-5. Objectives of Strategy Implementation 7 Worksheet A-6. Implementation Plan 10 Appendix B: Pre-Approved Strategies Introduction 12 Primary Targeted Intervening Variable: Retail Access 13 Primary Targeted Intervening Variable: Social Availability 17 ii

Primary Targeted Intervening Variable: Law Enforcement 18 Primary Targeted Intervening Variable: Community Norms 20 Primary Targeted Intervening Variable: Promotion 21 Primary Targeted Intervening Variable: Low Perceived Risk 21 Primary Targeted Behavior: Excessive Alcohol Use In College Students 24 Appendix C: Approval for Use of Non-Pre-Approved Strategy 25 Appendix D: Budget Forms 29 iii

Acronyms and Abbreviations AOD ATOD CDC CSAP CSAT DUI EBPW EPI Profile EBS FARS MVC NHTSA NIAAA NIDA PIRE PRT SAMHSA SIG SPF Alcohol and other drugs Alcohol, tobacco and other drugs Centers for Disease Control and Prevention Center for Substance Abuse Prevention within SAMHSA Center for Substance Abuse Treatment within SAMHSA Driving under the influence of alcohol Evidence-Based Practices Workgroup Epidemiological profile Evidence-based strategy Fatality Analysis Reporting Systems Motor vehicle crash National Highway Traffic Safety Administration National Institute on Alcohol Abuse and Alcoholism National Institute on Drug Abuse Pacific Institute for Research and Evaluation Prevention Resource Trainers Substance Abuse and Mental Health Services Administration State Incentive Grant Strategic Prevention Framework iv

1. INTRODUCTION All SPF SIG funded jurisdictions must target the same alcohol use related outcome -- the level of motor vehicle crashes (MVCs) with drinking drivers between the ages of 15 and 24. However, how each jurisdiction does so will vary depending upon the results of their needs assessments, identified community capacity, cultural needs and readiness to act. The strategic planning process will guide Coalitions in moving from the prioritization of the causative contributing factors / intervening variables through the selection of the most appropriate evidence-based strategies (EBS) to implement in their jurisdiction. The prioritization of contributing factors and selection of appropriate interventions are two of the most challenging steps in the SPF model. These require synthesizing everything that was learned from the needs assessment and connecting that knowledge with appropriate strategies to address the identified needs. In theory, it sounds simple. In practice, it requires a lot of work. This process requires you to go through all the information gained in the needs assessment step by step, talk to many people, read a lot, and critically review with all the invested partners the goals, needs, capacities, and resources of the community. The journey is a learning process that will ultimately lead to a strong plan for your jurisdiction and should develop your local capacity to do similar planning in the future. Substance abuse problems require comprehensive solutions a variety of intervention approaches directed to multiple opportunities In practice, [Coalitions] seeking to reduce substance abuse problems will need to put together their own mix of interventions. An optimal mix of interventions will fit the particular needs of the community its population, cultural context, and unique local circumstances, including community readiness. http://store.samhsa.gov/product/sma09-4205

Creating a Strategic Plan This guide briefly takes you through the steps involved in developing your strategic plan, using worksheets that are located in the Appendix, as well as on the VA SPF SIG website (http://www.cscc.soe.vcu.edu/spfsig.html). All completed worksheets should be included in your final Strategic Plan. The Strategic Plan is the document that will guide you and your coalition as you implement your prevention strategies. It will serve as a path for you to follow, so it needs to be as clear and precise as possible but it is also important to remember that no one can predict what complications or obstacles might arise and what modifications might be necessary as a result. As you implement your plan, any modifications will be an important part of your evaluation process. In order to make your Strategic Plan as beneficial as possible, consider these questions: 1. What strategies are likely to have the most impact on the contributing factors identified in my jurisdiction? a. Do the strategies directly affect the contributing factors identified as leading to increased alcohol-related MVCs with young drivers? b. Is there strong research evidence to support their effectiveness? c. Do you have the capacity to implement a particular strategy? d. What capacity needs to be built and how can it be built? e. Who will implement the strategies and what steps need to be taken to implement them well? 2. Are the selected strategies culturally appropriate for the targeted groups? 3. Can the selected strategies be sustained over time even after the SPF SIG funding is no longer available? The worksheets in this manual are tools to help you answer these questions and record what you learn. It is important that the Coalition as a whole completes these worksheets and it is recommended that you collaborate with other stakeholders in your jurisdiction who are invested in the outcomes of this SPF SIG work; their input can be invaluable in your strategic planning discussions. As you progress through the strategic planning process, we strongly encourage you to remain in close contact with your Prevention Resource Trainer (PRT), share drafts of sections of your plan with them, and contact the PRTs with questions you have along the way. 2

Creating a Strategic Plan 2. CLARIFYING WHERE YOU ARE & WHERE YOU ARE HEADED 2.1. Where are you? By now, all Coalitions should be close to completing their data gathering for their needs assessment and be reviewing the findings and ranking intervening variables / contributing factors (Step 1). Needs assessments usually identify multiple factors that contribute to a high level of the outcome studied so it is expected that you found a number of contributing factors that led to a high number of MVCs with drinking drivers in the 15 to 24 year age range in your jurisdiction. It is usually not financially feasible to target all factors identified; however, research has shown that the greatest success is seen when several key related contributing factors are targeted simultaneously. Therefore, your prioritization process to identify the primary few to target is of great importance. By now, you should be considering the prioritization process using Chapter 6 and the accompanying worksheets in the Needs Assessment Training Workbook to identify the top three contributing factors that are deemed More Important/High Likelihood to Change -- making these the High Priority for Planning. 3

Creating a Strategic Plan Considering how the contributing factors you identified as high priority for planning relate to each other within your community is the final step in selection of your priority factors to target. This is completed using Worksheet 6.4 in the Needs Assessment Training Workbook. 2.2 What is next? Creating your logic model To help you visualize how your plan will reduce the level of alcohol-related MVCs you will first create a logic model. This logic model will connect (1) this outcome to (2) the target populations, including demographic groups and possibly geographic areas/times, (3) the intervening variables and contributing factors you identified as important in the causation pathway and (4) subsequently, the strategies you select for implementation. Developing a logic model is an important part of the strategic planning process and your final model will be included in your Strategic Plan. You were introduced to locality-specific Logic Models in Chapter 7 of the Needs Assessment Training Workbook. The logic model starts with the outcome to be targeted for change and works backwards through the causation pathway to the intervening variables and contributing factors that are your actual targets for prevention. In the next section, you will review how to select the best evidence-based strategies that target the listed contributing factors. This information will then be added as the final column of your logic model. The first column of your logic model will be the same consequence for all Coalitions it is the outcome being targeted by all VA SPF SIG funded jurisdictions. To help you fill in column 2 of the logic model, review the points below to decide what demographic groups, locations or behaviors to target for change with your prevention efforts. Defining Columns 1 and 2 of your Logic Model Column 1: Substance-Related Consequence o MVCs with alcohol-impaired drivers 4

Creating a Strategic Plan Column 2: Who, Where, When and Consumption Behaviors o Who was identified as most at risk for being in a MVC? (Age, gender possibly race/ethnic group -- Chapter 5 of Needs Assessment Training Workbook and Worksheet 5.4) o Considering your local data, Who shows a high level of inappropriate drinking: underage drinking or binge drinking among different age groups? (Age, gender, possibly race/ethnic group -- Chapter 5 of Needs Assessment Workbook and Worksheet 5.4) o Is there a high-risk geographic area(s) Where? (Chapter 5 of Needs Assessment Training Workbook and Worksheet 5.5) o Is there a time(s) of day / time(s) of year with many MVCs -- When? (Chapter 5 of Needs Assessment Training Workbook and Worksheet 5.5) Task 2.1: Using the 3-column Logic Model Worksheet A-1 (page 1 of Appendix A), start to create your logic model connecting the outcome of alcohol-related MVCs with your targeted populations and their consumption behaviors (Who), possible geographic areas (Where) and time of day / year (When). Figure 1: Example of a Logic Model first two columns only completed The example in Figure 1 shows the outcome being targeted and indicates that (1) college students 18 to 24 are targeted because they were found to have a high prevalence of binge drinking. The data also showed that (2) a number of MVCs occurred around campus so that geographic area is being targeted for prevention. Remember, this is only an example. You might have selected males between 18 and 20 or found that no specific geographic area seemed to have more than expected MVCs. Your logic model needs to reflect your data. 5

Creating a Strategic Plan Coalitions collected data on seven intervening variables associated with the outcome of alcohol-related MVCs. Working through Chapter 6 and the associated worksheets in the Needs Assessment Training Workbook, you should now have prioritized which of the intervening variables and contributing factors appeared to be: (1) Most strongly linked to the outcome and (2) Changeable within your communities. These were the factors rated as More Important / High Likelihood to Change with a High Priority for Planning in Chapter 6 of the Needs Assessment Training Workbook and discussed in Section 2.1 on page 3 of this Workbook. In the Logic Model example (Figure 2) these factors are included in Column 3. Arrows link each one to the appropriate demographic group, geographic or temporal target or consumption behavior as seen in Figure 3. Defining Column 3 of a Logic Model Which contributing factors were identified as High Priority for Planning? These explain the Why MVCs are high in your jurisdiction. (Chapter 6 and Worksheets 6-2 and 6-3 of the Needs Assessment Training Workbook.) Which contributing factors were considered as high priority after discussing connections with your targeted groups and the community. (Chapter 6 of the Needs Assessment Training Workbook and Worksheet 6-4.) Task 2.2: Add the intervening variables and contributing factors you prioritized as High Priority for Planning in Column 3 of Worksheet A-1. 6

Creating a Strategic Plan Figure 2: Example of a Logic Model first three columns only Figure 2 adds the intervening variables/contributing factors to be targeted in this example. Three intervening variables / contributing factors were identified as high priority. These were (1) Low Perceived Risk of getting caught with a DUI, (2) Law Enforcement because officials in the local police and campus police are not coordinating efforts to monitor drivers and (3) Retail Availability due to several retail outlets near the college campus that were found to sell alcohol to minors. Key Point: These contributing factors will guide the selection of intervention strategies that aim to modify these situations. Task 2.3: Review the 3-column Logic Model you developed on Worksheet A-1 and be sure it reflects your data and your city / county. Then add the arrows to show the connections between the targeted groups and the intervening variables / contributing factors. 7

Creating a Strategic Plan It is important to understand which target groups identified in the second column are affected by the contributing factors you prioritized; this relationship is indicated by the addition of arrows to the Logic Model. For instance, in the example below the data indicated that it was easy for 18-20 year old college students to obtain alcohol thus increasing the prevalence of underage binge drinking. Similarly, the perception of risk of a DUI was found to be very low so the 18-24 year age group did not feel they were at risk for legal charges by driving after drinking, making driving after binge drinking more acceptable. Your prioritized contributing factors will each affect some of your demographic or geographic groups but usually not all. Figure 3: Example of a Logic Model first three columns only with arrows 8

Creating a Strategic Plan Another example shown in Figure 4 indicates that the data found the targeted outcome to be highest in (1) the county s urban centers among (2) young adult males and (3) minors of both sexes. The figure then shows that the top three contributing factors were within two intervening variables. Specifically, (1) Retail Availability where on-site retailers in the urban areas (e.g., restaurants) sold alcohol to intoxicated patrons and (2) some off-site retailers in the urban areas (e.g., convenience stores, supermarkets) sold alcohol to minors; and (3) Law Enforcement because it was found that law enforcement were not patrolling retailers or areas surrounding retailers, whether restaurants or convenience stores, but are interested in focusing efforts in this area. Figure 4: Another Example of a Logic Model first three columns only Key Point: Your logic model will look very different from the ones in Figures 3 and 4. For example, your data might lead you to focus on only two contributing factors; you might have different target populations. It is very important to carefully and accurately choose the contributing factors because you will only pick strategies that can impact the contributing factors you identified in your community. The selection of strategies must be targeted and precise, based on what you are trying to change. The important thing is that your logic model should reflect your data and your jurisdiction! 9

Creating a Strategic Plan 3. SELECTING EVIDENCE-BASED STRATEGIES Now that you have conducted your needs assessment and created your logic model based on your data, you should have a good understanding of the important intervening variables and contributing factors that are potentially causing the high rates of alcoholrelated MVCs in your jurisdiction. Now that you have answered the question of why these crashes are happening, you need to wrestle with the question of what to do about it. A key requirement that accompanies the CSAP SPF SIG funding is that all prevention strategies selected for implementation are supported by evidence of their effectiveness. A second requirement is that the selected interventions be the best ones to target the contributing factors identified in your jurisdiction. As you begin to focus on the evidencebased strategies (EBS) available to target the selected factors it is important for Coalitions to consider the relationship between the identified factors because this will also be useful when making your strategy selection. This chapter will review the VA SPF SIG requirements for evidence-based strategies and how to select the best strategies for your prioritized intervening variables and associated contributing factors. Few substance abuse problems change through direct influence or attack. Rather, it is indirect influence on the underlying factors that contribute to the problem and its initiation, escalation, and adverse consequences that succeed in modifying the targeted problem or outcome. http://store.samhsa.gov/product/sma09-4205 10

Creating a Strategic Plan The Evidence-Based Practices Workgroup (EBPW) has put together a list of Preapproved Strategies (Appendix B). This list is organized by the contributing factor to be targeted and contains primarily Environmental Strategies that have solid evidence of effectiveness and have been used effectively in other SPF SIG states. We strongly recommend that all jurisdictions select the known effective strategies included on this list in order to facilitate approval of your Strategic Plans. Remember -- the EBPW and the Advisory Council (AC) will review your Strategic Plans focusing on your data findings and strategy selection. Both need to approve your Plan before Phase II funding and implementation can begin. 3.1 Bringing The Right People To The Table Before selecting your strategies and planning for implementation, you must make sure you have the best group of people to advise the process. In the Needs Assessment Training Workbook, the first worksheet you considered who needed to be involved in the needs assessment process. Now that you have decided what intervening variables / contributing factors in your jurisdiction to target for prevention, you need to revisit that issue. You might find that for strategy selection you need a slightly different workgroup than the one that completed the needs assessment. For instance, if you have selected a specific demographic or geographic group to target, you need people who represent these subpopulations and geographic areas. In general, you should include persons who are knowledgeable about the identified intervening variables and contributing factors, are experienced in implementing strategies, are good critical thinkers, and are well respected in the community. Workgroup members must be able to think through all the potential pros and cons of various strategies, including cultural appropriateness, as you work through the strategy selection process. Task 3.1: Discuss the questions below about Bringing the Right People to the Table. As you think about who should be at the table as you select and plan your prevention strategies, consider the following questions: 1. Does your coalition or workgroup include people who represent the subpopulations and geographic areas you plan to target? Or persons who advocate for the subpopulations or geographic areas? 2. Who is knowledgeable about your targeted groups, i.e., demographic groups (age, racial/ethnic) or geographic areas? 3. Does your coalition or workgroup include people who represent all segments of your community, such as, leaders, power brokers, deal makers, peacemakers, gatekeepers, parents, teachers, students, clergy, administrators, health care professionals, law makers, police, reporters, media specialists, etc.? 4. Do you have people equipped with the technical skills and other talents needed to accomplish the tasks (e.g., facilitation, evaluation, effective communication, writing)? 5. Do you have people who are respected by the segment of the community they represent? 11

Creating a Strategic Plan 6. Who is important, given the culture, history, and traditions of the community? 7. Who can garner support for the group and the plan? After you have discussed the questions above, review these for further consideration: 8. Who do you currently have on your team who can assist you with planning, writing, and providing guidance for implementing your Strategic Plan? 9. What skills do they have? 10. What skills and talents do you still need? 11. Who or where might you look to for these skills and talents? 12. Who should be added to the workgroup when implementation begins? Some people or agencies to consider in your discussion: 1. Any other alcohol, tobacco and other drugs (ATOD) community coalitions 2. Local education administrators 3. High school personnel, staff, faculty 4. College and university or community college personnel 5. Parents 6. Students (high school or college) 7. Local law enforcement: Police/Sheriff/Campus/DEA/ATF 8. DMV staff 9. Alcohol retailers 10. Local restaurant owners 11. Judges and lawyers (retired possibly) 12. Social workers, prevention and treatment advocates, mental health 13. Youth centers & recreation programs 14. Religious and spiritual leaders 15. SADD and MADD chapters 16. Athletic coaches 17. Local businesses, particularly those who employ or target young adults 18. Media (TV, radio, print news) 19. Health care providers 20. Military personnel 21. Ethnically-based organizations, Tribal leaders, culturally-focused groups 12

Creating a Strategic Plan 3.2 What To Consider: Determining Fit Evidence of positive effect is critical to selecting approaches that are likely to work. But not all EBS are right for all communities. Best fit interventions are those interventions that: 1. Most clearly impact the substance abuse-related health outcome in your community, i.e., motor vehicle crashes with drinking drivers within the 15 to 24 age range; and 2. Are most appropriate given the community s identified contributing factors, resources, and readiness to act. To select an EBS, whether program, practice or policy, that is a good fit for your community: Consider conceptual fit. Does the strategy clearly address the contributing factor(s) that lead to substance use in your community? Consider practical fit. Is the strategy a good match for the community, given available resources, cultural context, and community readiness to take action? Will it garner the support of community leaders? Is it culturally appropriate for the target population? Consider effectiveness. Do the selected strategies fit the criteria for what is evidence-based? How strong is the evidence? http://captus.samhsa.gov/prevention-practice/defining-evidence-based/determining-fit If communities follow this process, using these criteria, they are likely to arrive at a combination of strategies and programs that best fit their community. 13

Creating a Strategic Plan 3.3 What To Consider: SAMHSA Criteria for Evidence-Based SAMHSA has developed criteria for determining whether or not a prevention intervention should be considered evidence-based. The strategies included on the Pre-Approved List all fit these criteria and also show evidence of repeatability. If you are unable to find an appropriate strategy on the Pre-Approved List, you will need to follow these criteria at a minimum when identifying and requesting approval of something different. The following are SAMHSA s criteria for defining an intervention as evidence-based (http://captus.samhsa.gov/prevention-practice/defining-evidence-based): 1. It is included in Federal registries of evidence-based interventions. 2. It is reported (with positive effects on the primary targeted outcome) in peer-reviewed journals. 3. It has documented evidence of effectiveness, based on guidelines developed by SAMHSA/CSAP and/or the State. These guidelines include the following: Guideline 1: The intervention is based on a theory of change that is documented in a clear logic or conceptual mode; AND Guideline 2: The intervention is similar in content and structure to interventions that appear in registries and / or the peer-reviewed literature: AND Guideline 3: The intervention is supported by documentation that it has been effectively implemented in the past, and multiple times, in a manner attentive to scientific standards of evidence and with results that show a consistent pattern of credible and positive effects; AND Guideline 4: The intervention is reviewed and deemed appropriate by a panel of informed prevention experts that includes: well-qualified prevention researchers who are experienced in evaluating prevention interventions similar to those under review; local prevention practitioners; and key community leaders as appropriate, e.g., officials from law enforcement and education sectors or elders within indigenous cultures. It is important to note that the nature of evidence is continuous. The strength of evidence of tested approaches will fall along a continuum from weak to strong. Strong evidence means that the approach works that it generates a pattern of positive outcomes attributed to the approach itself, and that it reliably produces the same pattern of positive outcomes for certain populations under certain conditions. When deciding between two approaches, experts suggest choosing the one for which there is stronger evidence of effectiveness if the approach is similar, equivalent, and equally well matched to the community s unique circumstances. 14

Creating a Strategic Plan 3.4 Reviewing Evidence-Based Strategies Reviewing strategies is the next very important step in your SPF SIG project. You need to know what your options are to make the best decisions. All jurisdictions are required to implement environmental strategies. If your data suggest that individual-based curricula, such as school-based, is a wise choice for you, then you will need to review those options and discuss this with your PRT. There is one prevention education strategy aimed at college students included on the Pre-Approved List. As mentioned previously, the EBPW developed a list of EBS that are pre-approved for use by coalitions. To be included on the list, the strategy fit the SAMHSA criteria for effectiveness with demonstrated evidence of effectiveness as required for determining fit. The strategies are grouped by which intervening variable and contributing factor they target. The Pre-Approved List of Evidence-Based Strategies is included in Appendix B. In order to select the EBS that best fit your targeted priorities, you must learn about the different strategies listed in Appendix B. Consider their strengths and weaknesses and how those relate to the specific needs assessment findings in your jurisdiction. It is also important to learn what is involved in implementing the strategies with fidelity a very important part of achieving effectiveness. As you learn more about the different options you have, keep in mind things you considered when you prioritized the contributing factors: The culture of your jurisdiction and whether or not a strategy would be accepted and supported. Whether or not you have the capacity to implement a specific strategy. You might need to include law enforcement at the state or local level, advertising and media experts, local newspaper reporters, lawyers, judges, prevention specialists, and /or health care providers in this decision. What else is being done currently in your jurisdiction? Would you be duplicating other efforts? Would your strategies enhance current efforts? In addition to the pre-approved list in Appendix B, there are several resource documents and websites listed below that may be used to inform your coalition / workgroup about the different strategies available to target different contributing factors. The documents listed below can be found on the Virginia SPF SIG website. Other listed items are website links to information that might be helpful in guiding you through the selection of the best strategies for implementation in your jurisdiction. Remember, the Management Team and EBPW reviewed numerous EBS and selected the ones with the best evidence of effectiveness for the list in Appendix B, so you might find strategies discussed in the resources below that are not included on the pre-approved list. The listed resources are for reference use and learning only. 15

Creating a Strategic Plan Task 3.2 Review the Pre-Approved Strategies list in Appendix B to familiarize yourself with possible strategies. Additional reference material can be obtained from the documents listed below (posted on the VA SPF SIG website http://www.cscc.soe.vcu.edu/spfsig.html) and the listed websites. If you do not find strategies on the pre-approved list that fit your situation, you need to discuss this with your PRT as soon as possible. There is a specific document to complete to request approval for a strategy not included on the Pre-Approved Strategy List. This document can be found in Appendix C. Documents available on the Virginia SPF SIG Website The following documents list and discuss examples of strategies and the factors targeted and give an indication of the strength of the evidence supporting a strategy. For the most part, there will be a lot of overlap between these documents and the Virginia SPF SIG Pre-Approved Strategies list. However, some strategies might be listed in the documents/websites below that you will not find on the Virginia Pre-Approved List. 1. Environmental Strategies Companion This companion guide was developed by PIRE for the SPF SIG team in Nevada and then subsequently adapted for North Carolina. It includes strategies that are directed toward alcohol-related traffic crashes and deaths. The information is conveniently organized by intervening variables. 2. Environmental Strategies, Strength of the Research Evidence This document was developed by Al Stein-Seroussi at PIRE for the New York State Office of Alcoholism & Substance Abuse Services for their SPF SIG project. This booklet is organized by type of strategy, including policy change, enforcement strategies and media strategies. 3. Regulating Alcohol Outlet Density: An Action Guide (Strategizer 55) The publication was developed by Community Anti-Drug Coalitions of America (CADCA) in partnership with the Center on Alcohol Marketing and Youth (CAMY) at Johns Hopkins School of Public Health. 4. Prevalence and Implementation Fidelity of Research-Based Prevention Programs in Public Schools, Final Report This report was prepared for the U.S. Department of Education by researchers at Westat. It is a thorough review of school-based intervention programs and the evidence support their effectiveness. Websites 1. National Registry of Evidence-Based Programs and Practices This website supported by SAMHSA provides an easily searchable resource for EBS. Some of the listed strategies have more evidence to support effectiveness than others and many are individually-based so most are not eligible for use with SPF SIG funding. http://www.nrepp.samhsa.gov/ 16

Creating a Strategic Plan 2. The Community Guide: Motor Vehicle-Related Injury Prevention: Reducing Alcohol- Impaired Driving This website within the CDC Community Guide lists a number of reviewed interventions that aim to reduce alcohol-impaired driving and the associated deaths and injuries. http://www.thecommunityguide.org/mvoi/aid/index.html 3. The Community Guide: Preventing Excessive Alcohol Consumption This website within the Community Guide lists reviewed interventions that are effective against excessive alcohol use. http://www.thecommunityguide.org/alcohol/index.html 4. National Highway Traffic Safety Administration The NHTSA website offers several resources to prevent impaired driving. http://www.nhtsa.gov/impaired College Drinking Prevention Websites 1. College Drinking Changing the Culture The website, entitled College Drinking: Changing the Culture, was created by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to provide comprehensive researchbased information on issues related to excessive alcohol use among college students. http://www.collegedrinkingprevention.gov/ 2. Nebraska Collegiate Consortium website This website was developed by the Nebraska Collegiate Consortium and includes a comprehensive listing of environmental strategies designed to reduce high risk drinking among college students. http://www.nebraskaconsortium.org/ 3. The Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention The Higher Education Center helps campuses and communities address problems of alcohol, other drugs, and violence by identifying effective strategies and programs based upon the best prevention science. http://www.higheredcenter.org/ Additional Resources 1. CAPT Webinars Help Practitioners Implement Environmental Prevention Strategies The West Resource Team (RT) of SAMSHA s Center for the Application of Prevention Technologies hosted a series of five webinars on effective environmental prevention strategies. Environmental strategies are a key part of the ongoing [prevention] picture, so it s important that people understand what they are and how they work. (Michelle Frye- Spray, associate coordinator of the West RT, January 10, 2012) http://captus.samhsa.gov/access-resources/capt-webinars-help-practitioners-implementenvironmental-prevention-strategies 17

Creating a Strategic Plan 3.5 Addressing Cultural Competence Before you make your final strategy selection, you must ensure that you completely consider cultural competency and whether or not the strategies you are considering that target your prioritized contributing factors are appropriate for the culture within which they will be implemented. Cultural competence describes the ability of an individual or organization to interact effectively with people of different cultures. To produce positive change, prevention practitioners must understand the cultural context of their target community, and have the willingness and skills to work within this context. This means drawing on community-based values, traditions, and customs, and working with knowledgeable persons of and from the community to plan, implement, and evaluate prevention activities. http://captus.samhsa.gov/prevention-practice/strategic-preventionframework/cultural-competence Cultural competency is a broad topic that incorporates such things as language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups (http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=11). We might not always recognize important cultural issues but we usually recognize a situation where cultural competence is missing. It can be obvious and it can be subtle and most people are only aware of the obvious aspects of cultural competency. For example, if you target a Spanish speaking population and your materials are in English, we can all agree that this is not culturally competent. However, it may be harder to determine whether the same prevention message works as well with culturally different demographic subgroups such as Latino males age 21 to 24 versus White males 21 to 24. It is important to know how the cultures of these two subgroups differ so that you know how a message will be perceived. It is extremely important that as you plan to target different groups you make sure that your strategies will ring true with your target populations. To ensure this is true, be sure that the people on your coalition who represent any targeted cultural group preview all strategies, considering wording, targeting plans and implementation. As you consider different strategies, use the discussion questions below to consider cultural competency issues. It is recommended that you develop some broad goals and objectives related to addressing cultural competency in your jurisdiction. Task 3.3: With the entire Coalition, use the discussion questions below to consider cultural competency in your jurisdiction. Then document your short- and longterm goals and plans to reach those goals. 18

Creating a Strategic Plan Questions for guiding the discussion about cultural competency and strategies: When thinking about cultural competency consider the following questions: Who is your targeted population(s)? What do you believe are the key cultural issues in that population(s)? What are some of the cultural issues specifically to the subpopulation of those who drink and drive? For example, are 18 to 24 year old males who drink and drive different from those who do not? (In what way? How might that influence what you do and how you do it?) Do you need to consider conducting a cultural analysis of how the different values and traditions in sub-populations within your jurisdiction affect beliefs about health promotion and the most appropriate ways to communicate and provide services? Are there organizations already working with the targeted subpopulation(s) or geographic area that can offer assistance and guidance? Are the strategies selected appropriate for the targeted subpopulations or can they be modified to be more culturally sensitive? If you plan to modify an evidence-based strategy in any way, you must discuss this with the PRTs for input and approval from the EBPW. Are there local media sources or means for getting the word out to targeted subgroups/cultures? Do you need to develop new outlets to reach subpopulations? Is language a barrier? And, if so, how will you address it? Are there plans to pilot a strategy with the target population any bilingual tools or resources created for them? How can your Coalition build bridges between various cultures in your jurisdiction to further your prevention efforts? 19

Creating a Strategic Plan 3.6 Selecting Evidence-Based Strategies Once you have carefully reviewed the pre-approved strategies that target your prioritized intervening variables and contributing factors and you feel knowledgeable about what would be involved in implementing the strategies, you have to make some decisions about which ones are the best for you. There is not enough time, money or people to do everything you might want so it becomes necessary to weed out those strategies that are less likely to work and focus on what is most likely to work. Consider the following things when choosing each of your strategies: 1. Are the strategies you are considering targeted toward one or more of your contributing factors? Remember, the path to changing the number of MVCs must go through the contributing factors; each strategy must be likely to impact at least one of the prioritized contributing factors. 2. Are the strategies likely to change the number of MVCs (or at least impact the contributing factors) during the grant period? Remember, CSAP, the State, and your jurisdiction are expecting measurable decreases. 3. Do you have the capacity and resources, and is your community ready (culturally, socially, and politically), to implement the strategies? Remember, any strategy is only as good as the ability of the community to implement it well. If you answered no to any of these questions, you should consider a different strategy. Task 3.4: Complete Worksheet A-2. Selecting Strategies (page 2 of Appendix A). The selection of strategies should be done in collaboration with the entire coalition and other stakeholders who are knowledgeable or willing to be involved in implementation. For example, if you decide to implement sobriety checks, be sure law enforcement officials are included in your discussion so you are clear on what is involved and the approximate cost. As you learn about the strategies you will find that some are quite involved and others less so. Once you have completed Worksheet A-2, you should have a better idea of which strategies are best for implementation in your jurisdiction. Keep in mind that your task is to select the best mix of approaches to have a positive influence on MVCs with drinking drivers within the 15- and 24-year age range in your jurisdiction. The most important aspects of your plan are that it fits your data and can be implemented quickly and effectively. Once you have made your final selection regarding strategies, add those to your final logic model on Worksheet A-3 in Appendix A. An important aspect of selecting the most appropriate strategy is to clearly understand how the strategy will impact the 20

Creating a Strategic Plan contributing factors and how that will affect the demographic groups, time of day/year or geographic regions you listed in Column 2. Therefore, be sure and include arrows in your model. The arrows are a good way to understand the relationships between the components of your logic model. Task 3.5: Complete Worksheet A-3. Final Jurisdiction Logic Model connecting outcome, demographic / geographic groups (Who, When, Where), intervening variables / contributing factors (Why), and strategies. (Page 4 of Appendix A) In the example shown below (Figure 5), prevention will focus on three things: law enforcement both in the town and on campus and retail availability to increase sobriety checks, increase alcohol compliance checks and decrease the number of outlets for alcohol purchases in the area of campus. Increasing the perception of risk for a DUI should reduce the number of persons who are willing to risk driving after drinking and subsequently reduce the number of MVCs in the area around campus. Increased coordination of law enforcement in the area surrounding campus should also help to reduce the number of impaired drivers and subsequent MVCs. Reducing the outlets for alcohol sales around campus should reduce the opportunities for alcohol purchase in the area and the number of drinking drivers and subsequent MVCs. Your data might have many more relationships try to determine all of them and include them on your model. Figure 3.5: Example of a Final Logic Model Remember -- your logic model will be unique! Just ensure that it reflects your data. 21

Creating a Strategic Plan 3.7 Creating Capacity Development Plans At this point, you should have some idea of what will be required to implement the strategies you have selected. The next exercise will help you specifically identify the resources that are necessary and compare that to the resources that are available. You might find that some strategies are just too expensive for your Coalition to implement because of a lack of resources. Document these resources in the Capacity Worksheet (found in Appendix A-4). Be as precise as possible. For example: Do you know someone with media experience who is willing to help you? Do you have a relationship with a local news reporter? Do you have a good working relationship with the local police department or know a local judge or district attorney? It is expected that you will need to build some capacity. It may require developing some relationships, getting some training, or hiring some people. At this stage you want to consider all the steps that are involved in implementing a strategy and then think about what is needed to implement those steps. Ask yourselves: Who do you need to meet with to secure their cooperation? Who will do each task? Who will need training for a particular task? What can be done in-house and what needs to be out-sourced to experts? Do not expect that one person can do it all. Think about building capacity for both the short term and the long term. Build relationships that will last and that will allow you to continue to do this prevention work even after the grant is over (sustainability). Task 3.6: Complete Worksheet A-4: Capacity for each strategy (examples page 5 of Appendix A, blank Worksheet A-4 on page 6 of Appendix A). Make copies as needed. 22

Creating a Strategic Plan 3.8 Strategy Selection Summary Considerations Once you have selected your strategies for implementation from the pre-approved list, consider the following questions once more just to confirm that each of the strategies you plan to use is a good fit: Does this strategy fit your community s mission? Does the strategy fit the values of your community? Is the strategy compatible with your community s current focus? Implementation Capacity Does your community have the human resources to implement the strategy? Does your community have the material resources to implement the strategy? Does the strategy fit with your budget? Does the strategy take into account the stage of readiness of the community and target population? Cultural Relevance / Appropriateness Is the strategy appropriate for the community s existing practices? Is the strategy appropriate for the culture and characteristics of the community being served? Does the strategy take into account the community s values and traditions that affect how its citizens and the targeted group(s) regard health promotion issues, specifically the issue of impaired driving? Has the strategy shown positive results in communities with similar cultural attributes? Evidence-based Effectiveness Is the selected strategy the best fit, both conceptually and practically? Can you implement the strategy in the manner it was designed? If you answered no to any of the questions, think about how to overcome these barriers or whether you should consider a different strategy. 23

Creating a Strategic Plan 3.9 Evaluation Considerations The fifth step in the SPF process is evaluation. As mentioned in the Needs Assessment training workshop, the SPF process is an Outcome-based Prevention method so the primary change we want to see following strategy implementation is a decrease in the rate of our outcome: MVCs with drinking drivers within the 15 to 24 year age range. The level of MVCs with drinking drivers will be analyzed on an annual basis, both statewide and within each funded jurisdiction, and the outcome evaluation will be based on those changes and overall trends. In addition to monitoring the outcome, it is important to scrutinize the implementation of your strategies as well as the immediate impact they have on the targeted contributing factors with both process and intermediate impact measures. As you consider evaluation, review the Community Level Instrument (CLI) that is part of the SAMHSA evaluation component. Many process measures must be collected for entry into the CLI and these will be useful for your evaluation assessment as well. Your final logic model (Worksheet A-3) represents the causation pathway you identified as leading to increased alcohol-related MVCs and ends with the strategies that target the contributing factors /intervening variables, i.e., the identified causes. Worksheet A-5. Objectives of Strategy Implementation will help you outline the specific changes you are looking for and the objectives you will measure to document those changes. This information should be considered as you plan for implementation in the next section. The columns to be completed include: 1. Strategy to be implemented 2. Strategy-specific Behaviors / Groups to be Targeted: If your strategy is targeted toward a specific demographic group or area within the jurisdiction list it here. Similarly, if you hope to change a consumption-related behavior, it should be indicated here. 3. Targeted Intervening Variables / Contributing Factors: Indicate the contributing factors you hope to impact. 4. Process Measures: What steps can be monitored to demonstrate timely and effective implementation of the strategy. Describe what will be measured, how it will be measured and a reasonable target for each. 5. Intermediate Impact Objectives and Documentation of Effectiveness: These are the changes to the contributing factors or consumption behaviors that you hope to see that will then lead to a decrease in MVCs. Some impact should be evident within one year but it might take longer to reach your target. Include in this column what you will measure to document anticipated changes, how you will measure it and a targeted degree of change. Task 3.7: Complete Worksheet A-5. Objectives of Strategy Implementation on page 9 of Appendix A (The example on pages 7 & 8 of Appendix A is based on Figure 3.5: Example of a Final Logic Model.). 24

Creating a Strategic Plan 3.10 Developing The Implementation Plan Now that you have selected your strategies and have a better understanding of what will be involved to implement and evaluate them, it is necessary to consider how each of the strategies will be put into place. Complete Worksheet A-6. Implementation Plan in Appendix A for each of the strategies you select. The Worksheet specifies the selected strategy, contributing factors and targeted groups with a table listing each activity that must be completed as part of that strategy. In the table, list each activity outlining everything from who will be involved to the estimated costs. The columns to be completed include: 1. Strategy-related activity 2. Who is ultimately responsible for making sure the activity is completed as planned? 3. What is the timeline? Remember, this plan details only the first year of implementation. 4. What resources and training are needed to ensure successful implementation of the activity with fidelity? 5. How much will it cost? Consider all expenses that might arise in association with this activity. 6. Evaluation: What and How. Include process measures to monitor implementation and impact objectives to evaluate success. The key here is to be as specific as possible since this will be your blueprint for implementation. Your blueprints may change as you get into the implementation process, but hopefully the changes will not be so radical that you have to go back to the drawing board and start over. Your implementation plans should reflect activities for the first year only. Task 3.8: Complete Worksheet A-6. Implementation Plan for each selected strategy (example on page 10 of Appendix A, blank Worksheet A-6 on page 11 of Appendix A). Make copies as needed. Remember As you work through all of these steps, be sure to check with your PRT if you have questions there is a lot to consider and selection of the appropriate strategies is the most important step. 25