Education and Advocacy Track: Planning and Best Practices for Community Responses Presenters: • Veronica Nunley, MS, Director of Organizational Development, Pathways, Inc. • Mary Elizabeth “Mel” Elliott, Vice President of Communications, Membership and IT, Community Anti-Drug Coalitions of America (CADCA) • Amy RH Haskins, MA, SIT, Public Health Educator and Sanitarian, Jackson County (WV) Health Department, and Project Director, Jackson County Anti-Drug Coalition Moderator: Tom Handy, Chair, Operation UNITE Board of Directors
Transcript
Education and Advocacy Track: Planning and Best Practices for
Community Responses
Presenters:
• Veronica Nunley, MS, Director of Organizational Development, Pathways, Inc.
• Mary Elizabeth “Mel” Elliott, Vice President of Communications, Membership and IT, Community Anti-Drug Coalitions of America (CADCA)
• Amy RH Haskins, MA, SIT, Public Health Educator and Sanitarian, Jackson County (WV) Health Department, and Project Director, Jackson County Anti-Drug Coalition
Moderator: Tom Handy, Chair, Operation UNITE Board of Directors
Disclosures
Veronica Nunley, MS; Mary Elizabeth “Mel” Elliott; Amy RH Haskins, MA, SIT; and Tom Handy have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.
Disclosures
• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
• The following planners/managers have the following to disclose:– Kelly Clark – Employment: Publicis Touchpoint Solutions;
Consultant: Grunenthal US– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center– Carla Saunders – Speaker’s bureau: Abbott Nutrition
Learning Objectives
1. Demonstrate the Prevention on Purpose: Planning for Outcomes model for community engagement in Rx drug abuse prevention.
2. Evaluate environmental and individual prevention strategies for decreasing risk factors and increasing protective factors.
3. Explain CADCA’s Seven Strategies for Community Change for communities tackling OTC and Rx drug abuse.
4. Describe best practices proving successful for community coalitions across the U.S.
Planning and Best Practices for Community Responses
Veronica A. Nunley, MA, CPShas disclosed no relevant, real, or
apparent personal or professional
financial relationships with
proprietary entities that produce
health care goods and services.
Learning Objectives
1. Demonstrate the “Prevention on Purpose: Planning for
Outcomes” model for community engagement in Rx drug
abuse prevention.
2. Evaluate environmental and individual prevention strategies
for decreasing risk factors and increasing protective factors.
3. Explain CADCA’s “7 Strategies for Community Change” for
communities tackling OTC and Rx drug abuse.
4. Describe best practices proving successful for community
coalitions across the U.S.
HEALTH & SAFETY
ECONOMICWORKPLACE
EDUCATION
LEGAL/LAW ENFORCEMENT
OTHER MENTALHEALTH
COMMUNITYSYSTEMS
PREVALENCEWho (age, gender, etc.) is using/misusing
what (which substances), how frequently
(once a day, four times a day, only on
weekends), in what time fame (past 30 days,
past year, lifetime, etc.)
RISK FACTORcharacteristics or attributes that, if
present, make it more likely that
an individual will exhibit problem behaviors.
PROTECTIVE FACTORcharacteristics which mediate or
moderate the effect of exposure to
risk factors, resulting in a reduced incidence of problem behavior.
Research has shown…• The number of risk factors students are
exposed to increases with age (one
study showed a three-fold increase from
the 6th to the 11th grade)
• Findings from several studies show a
linear relationship between the level of
risk exposure and problem behavior
• An increase in risk exposure increases
the likelihood of subsequent problem
behavior
• Risk and protective factors are not
reciprocal
• Some risk and protective factors are
more salient than others
Domains
• Individual
• Peer
• Family
• School
• Community
Individual/Interpersonal – individual characteristics and
attributes that influence one’s own alcohol, tobacco,
and other drug choices.
• Favorable attitudes toward
drug use
• Misperception of social
disapproval and harmful
consequences of drug abuse
• Academic failure
• Perceived availability of
alcohol, tobacco, and other
drugs
• Genetic susceptibility
• Antisocial behavior in late
childhood and early
adolescence
• High sensation-seeking
behavior
• Low self-esteem
• Low commitment to school
• Low social bonding
• Conduct problems
• Aggressiveness
• Shyness, alienation, and rebelliousness
Peer Group Risk Factors - relationships with peers
and friends that positively or negatively impact
personal alcohol, tobacco, and other drug choices.
• Bonding to a peer group
that uses alcohol and drugs
• Bonding to a peer group
that engages in other
delinquent activities
• Deliberate selection of alcohol or other drug using peers
• Social clique influence
• Peer pressure
• Rejection in elementary school
• Friendship of other rejected children
Family Risk Factors - family characteristics/dynamics that
positively or negatively impact individual alcohol, tobacco, and other drugs choices.
• Family conflict
• Low levels of family bonding
• Poor family management or communication
• Parental or sibling
substance abuse
• Perceived parental
permissiveness toward
drug/alcohol use
• Coercive discipline style
• Inconsistent parental discipline
• Parental rejection
• Lack of family rituals
• Lack of extended family or support systems
• Stress and dysfunction caused
by death, divorce,
incarceration of parent, or low
income
• Sexual and physical
abuse
School Risk Factors - school characteristics and
formal/informal policies implemented in school systems.
• Academic failure
• Norms conducive to use of drugs
• Lack of appreciation for school
• Less school involvement
• Lack of opportunities for involvement and reward
• Lack of support from school environment/teachers
• Low student/teacher morale
Community Risk Factors - community
characteristics and formal/informal
policies implemented in community systems.
• Poverty and lack of employment
• Availability of drugs and alcohol
• Not feeling a part of the community
• Being in a community that condones substance abuse
• Disorganized neighborhoods lacking active community institutions/leadership
• Stress from social situations
• Lack of youth involvement in positive ways
• High rate of crime and substance abuse
• Lack of economic mobility
• Lack of social supports
• High-population density
• Transient populations
• Physical deterioration
Protective Factors (Resiliency) – the ability to bounce or spring back into shape or position; the ability to recover strength or spirits quickly; or the ability to recover in the face of hardship or trouble.
PERSONAL STRENGTHS
SOCIAL COMPETENCE• Responsiveness
• Communication
• Empathy
• Caring
• Compassion
• Altruism
• Forgiveness
PROBLEM SOLVING• Planning
• Flexibility
• Resourcefulness
• Critical Thinking
• Insight
AUTONOMY• Positive Identity
• Internal Locus of Control
• Initiative
• Self-efficacy
• Mastery
• Adaptive distancing
• Resistance
• Self-awareness
• Mindfulness
• Humor
SENSE OFPURPOSE• Goal Direction
• Achievement Motivation
• Educational Aspirations
• Special Interest
• Creativity
• Imagination
• Optimism
• Hope
• Faith/Spirituality
• Sense of Meaning
Resiliency – What We Have Learned, WestEd, Bonnie Bernard, 2003
Social domains – family, school, peer group and neighborhood/community
FAMILY
• Healthy parenting styles – foster feeling
“connected,” satisfied with family relationships,
and feeling loved and cared for
• Caring relationships
• High and youth-centered expectations
• Opportunities for participation and contribution
SCHOOL
• Well-functioning learning community, meeting
young people’s basic psychological needs –
belonging and affiliation, sense of competence
and meaning, feelings of autonomy and safety
• Caring relationships in school
• High expectations in schools
• Opportunities for participation and contribution in
school
Resiliency – What We Have Learned, WestEd, Bonnie Bernard, 2003
Social domains – family, school, peer group and neighborhood/community
COMMUNITY
• Caring and supportive community – especially
for youth with few family and school resources
• Quality neighborhood organizations – especially
for youth not receiving critical protective factors
in the families and schools
• Caring relationships in the community – formal
and informal mentoring
• High expectations in the community –
community in general, youth-serving
organizations, and community initiatives
Resilience-based Approaches
Asset-Based Community Development
Healthy Communities/Healthy Youth
Community Health Realization
Resiliency – What We Have Learned, WestEd, Bonnie Bernard, 2003
INDIVIDUAL APPROACHES - the
environments in which individual
children grow, learn, and mature
ENVIRONMENTAL APPROACHES - the
environment in which all children
encounter threats to their health
Designed to change an individual’s
attitudes or behaviors relating to ATOD use
Designed to change the social, political, and
economic context where ATODs are used
Programs may be run in schools,
churches, or community-based
organizations
Strategies may be developed and implemented
through various sectors in the community
Educate youth about the harmful effects of
ATOD, teach life skills, and build resiliency
Involves changing availability of ATODs, laws
and policies, and community norms
Approaches generally use existing social
mechanisms to reach young people and
others at risk, such as youth leaders,
teachers, and counselors
Approaches focus on norms, regulations, and
the availability of drugs working with broader
community systems
Focus on helping people develop the
knowledge, attitudes, and skills needed to
change behavior
Focus on creating an environment that makes it
easier for people to act in healthy ways
Environmental strategies are not intended to replace prevention efforts targeted at individuals. They are most effective when used in conjunction with individual interventions. Combining environmental strategies with individual strategies is sometimes called a “social ecological” model of prevention.
Strategies Targeting Individualized Environments
Socialize, Instruct,
Guide, Counsel
Strategies Targeting the Shared Environment
Support, Hinder
Factors in the Shared Environment
• Norms – Basic orientations concerning the “rightness” or “wrongness,” acceptability or unacceptability, and/or deviance of specific behaviors for a specific group of individuals
• Availability – The inverse of the sum of resources that must be expended to obtain a commodity –alcohol, marijuana, tobacco, or other drugs
• Regulations – Formal or informal laws, rules, policies that serve to control availability and codify norms and that specify sanctions for violations
• There exist regulations and policies that discourage the behavior
• Community norms disapprove of the behavior
• The commodities needed to engage in the behavior are not easily available
THE PROBABILITY OF AN UNDESIRABLE BEHAVIOR IS DECREASED TO THE EXTENT THAT:
ASSESSMENT AND CAPACITY BUILDING
• Organized based on data
• Six organizational meetings to “select”
chair, officers, and Executive Committee
• Community readiness key leader survey completed
• Community norms survey completed
• Youth focus groups
• 42 Coalition members trained in the Strategic Prevention
Framework (6 hours)
• 15-minute mini-trainings at every meeting
• Support and inclusion of faith community coalition
• Community activities – Red Ribbon Week
NEGATIVE CONSEQUENCES• A community in distress, hopelessness
• Over 550 individuals in the Kentucky State
Police catchment area under investigation for
prescription medication diversion (Florida)
• 71 Drug trafficking cases opened in the previous
15 months – 93% related to pills
• 12 cases (140 charges) opened in the previous
six months for doctor shopping
SOURCE: Department of Community Based
Services
Drug/Alcohol Risks Present
Drug/Alcohol Risks NOT
Present
Average Cumulative Risk Rating for Family
28 = Highest Risk to Child Safety
0 = No Risk to Child Safety
13.9 7.47
Average # of Prior Referrals to CPS 6.5 3.05
Average # Risks out of the Following 5:
mental health; criminal history; domestic
violence; serial relationships; income
issues
3.21 0.79
NEGATIVE CONSEQUENCES• From Child Protective Services:
o 461 families investigated
o 43.8% of families with reported drug/alcohol risks
o 76.4% of families with substantiated abuse/neglect and reported
drug/alcohol risks
o 66.7% of children who entered out-of-home care were in
families with reported drug/alcohol risks (including 60% of
children 3 years and younger who entered out-of-home care)
NEGATIVE CONSEQUENCES2011-12 State Testing Scores from the
Carter County Board of Education2007 Community Readiness Score of
“3”Vague Awareness
“Most community leaders feel that
there is a local problem, but there
is no immediate motivation to do
anything about it.”
PREVALENCE
Past 30 Day Use6th Grade 8th Grade 10th Grade 12th Grade
It Takes a Coalition: Best Practices from the Community Response to
Rx Drug Abuse
Mary E. Elliott
Vice President, Communications, Membership and IT
CADCA
Amy RH Haskins, MA, SIT
Project Director, Jackson County Anti Drug Coalition
Public Health Educator & Sanitarian, Jackson County Health Department
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Disclosure
• Mary Elliott, Vice President, Communications Membership and IT, CADCA, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.
• Amy RH Haskins, MA, SIT, Project Director, Jackson County Anti Drug Coalition, Public Health Educator & Sanitarian, Jackson County Health Department, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.
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Who Is CADCA?
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The Drug-Free Communities Program
• The U.S. has invested a total of $1.25 billion in the DFC program since it began in 1998.
• The DFC Program has funded more than 2,000 coalitionssince it began.
• Currently, the U.S. has 680 DFC Grantees.
• CADCA was the driving force behind the passage of this program and is the primary training and technical assistance provider for the program.
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Social Ecological Model
Coalitions engage at each step within this public health model.
Source: U.S. Centers for Disease Control and Prevention; http://www.cdc.gov/obesity/health_equity/culturalrelevance.html
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Community anti-drug coalitions recognize that substance use/abuse prevention is unique and involves:
• Reducing access and availability;
• Enforcing consequences;
• Changing attitudes and perceptions;
• Changing social norms;
• Raising awareness about costs and consequences; and
• Building skills in youth, parents and communities to deal with these issues effectively.
CADCA Member Coalitions Address the Prescription
Drug Epidemic at the Local Level
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CADCA Trains Coalitions on Seven Comprehensive Change Strategies
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Case Study:Jackson County Anti-Drug Coalition
Ripley, West Virginia
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29,000 residents 17.7% are over the age of 65 (state is 16%) 61% are between the ages of 19-64 22% are under 18 years of age 24.9% of children live in poverty Per capita income is $21,855
Quick Facts on Jackson County
Jackson County
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Coalition Formation
Formed in 2006 originally
2005 – “isolated incident” of one youth overdosing in a gas station bathroom
2006 – 2008 16 deaths DIRECTLY related to prescription drugs ages 15-26.
In cars and in yards of local residents
Jackson County Health Department Public health crisis Forged the way for grant applications, research
Data Revealed the Tragic Cause of our Local Prescription Drug Abuse Epidemic
Jackson County Anti-Drug Coalition
• 2009 - Awarded Drug Free Communities Grant• 2010 -2011 - Trained by CADCA - Graduated from CADCA
National Coalition Academy • Active members include:
o Law Enforcement (2 City offices and Sheriff’s Department)o 2 Youth Coalitions (roughly 50 youth) o Substance Abuse Treatment Providerso Community Members/Concerned Parentso Other organizations working to reduce substance abuseo Religious/Fraternal Organizationso Board of Educationo Medical Professionalso Civic Groupso Business communityo Youth Serving Organizationso Media
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Problem:Jackson County youth
are dying from Prescription Drug
Overdoses.
Root Cause“But why?”:
Ease of Availability
Local Condition #1:
Unable to monitor sales and/or prescriptions
across state line
Local Condition #2:
Kids obtaining and using in school
Local Condition #3: People provide
family/friends, etc. with left over medications
Local Condition #4:
People take medication from excess supply in
the home
Root Cause“But why here?”:Low Perception of Danger or Harm
Local Condition #1:
Prescription Drug supply is not
monitored in the home
Local Condition #2:
Kids are obtaining and using
prescription drugs in school
CADCA Training Helped our Coalition Identify the Root Causes and Local Conditions
Source: CADCA National Coalition Institute, National Coalition Academy
Strategies Implemented
1. Provide Informationa) Jackson Co. Anonymous Tip line b) Multifaceted media campaign aimed at
parents, youth, seniors, providers, businesses, and general public
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Strategies Implemented
2. Enhance Skillsa) Classroom Presentations b) Pill Identification and Diversion Training for LEc) State Prescription Drug Monitoring Databased) Community Presentationse) Businesses – Abuse Identification Presentationsf) Proper Disposal Presentations
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Strategies Implemented
3. Provide Supporta) Encouragement of access to WV Rx Quitlineb) Mobilization of Resources within community to
address local conditions ($50,000+)c) Development of disposal protocolsd) Advocacy and Encouragement of use of WV
Prescription Drug Monitoring Database
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4. Enhance Access/Reduce Barriersa) Advocacy at State level for local Law Enforcement access to
WV State Prescription Drug Monitoring Databaseb) Advocacy at State level for access to other state monitoring
systemsc) Training for School Employees on identification of substance
abused) Integration of disposal information into regular community
communicatione) Static Take Back Sitesf) Regular Disposal Days
Strategies Implemented
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Strategies Implemented
5. Change Physical Designa) Purchase of an incinerator
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6. Modify/Change Policiesa) Development and implementation of policy for static and
point in time take backsb) Advocacy work to mandate use of WV Prescription Drug
Monitoring Databasec) Expansion of random drug testing at middle and high
schools to include specific Rx drug classes
Strategies Implemented
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Reducing Barriers of Disposal vs. Overdose Rates as Reported by Jackson County EMS
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Prescription Drug Use
0
5
10
15
20
6th 7th 8th 9th 10th 11th 12th
Annual Prescription Drug UseJackson County vs. National Statistics
PRIDE Survey 2013
Annual use Rx Drugs Nationally
Annual use Rx Drugs Jackson County
Monitoring the Future
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Prescription Drug Use
0
2
4
6
8
10
12
6th 7th 8th 9th 10th 11th 12th
30 Day Rx DrugUse Nationally
30 Day Rx UseJackson County
Monitoring theFuture
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Jackson County vs. National RatesPrescription Drug Use Among 12th graders
6.5
9.2
7
14.8
0
2
4
6
8
10
12
14
16
30 Day Rx Use Annual Rx Use
Jackson Co
Nationally
Jackson County 2012-2013 PRIDE Survey and 2012 Monitoring the Future
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Lessons for Coalitions
Important to encompass all ages in prevention efforts
Statistics that are “out of the box” can provide great insight into the community
Local partnerships + Coalitions = BIG CHANGE
Disposal reducing access, increases perception of harm, reduces overdose deaths
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CADCA’s Resources and Action
Published first Rx abuse prevention toolkit in 2002
Dose of Prevention Toolkit on cough medicine abuse in 2006
Town hall meetings
Stopmedicineabuse.org with partner CHPA
Informational video developed for communities
5 CADCA TV shows
Began National Medicine Abuse Awareness Month in 2007
Strategizer publication with ONDCP in 2008
Rx Abuse Prevention Toolkit: From Awareness to Action in 2010
General Dean testifies before Congress
Hosts Rx specific tracks at Forum and Mid-Year
Online course launched October 2012 – learning.cadca.org
Online Rx Toolkit launched in 2014
Co-convener of Collaborative for Effective Prescription Opioid Policies
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PreventRxAbuse.org
October is National Medicine Abuse Awareness Month
• Take advantage of this national observance and plan a local or state event
• CADCA began NMAAM in 2007.
• CADCA 50 Challenge encouraging all coalitions to host educational events throughout NMAAM.
• Dose of Prevention Award recognizes best practices in OTC and Rx Medicine Abuse Prevention
• CADCA hosts town hall meetings, Twitter chats, and webinars to raise awareness.
Education and Advocacy Track: Planning and Best Practices for
Community Responses
Presenters:
• Veronica Nunley, MS, Director of Organizational Development, Pathways, Inc.
• Mary Elizabeth “Mel” Elliott, Vice President of Communications, Membership and IT, Community Anti-Drug Coalitions of America (CADCA)
• Amy RH Haskins, MA, SIT, Public Health Educator and Sanitarian, Jackson County (WV) Health Department, and Project Director, Jackson County Anti-Drug Coalition
Moderator: Tom Handy, Chair, Operation UNITE Board of Directors
