This brings me to the last part of this series and one of the most important. One of greatest challenges that I have faced over the last 4 ½ years as the Executive Director of a substance use disorder prevention organization is changing the community paradigm of what prevention programming looks like. The challenge is that most funders and donors are focused on our individual programming or what we call individual-level strategies.
These individual-level prevention approaches focus on helping people, mostly youth, to develop knowledge, attitudes and skills that they need to change their behavior. Most often this level of programming include classes or presentations on healthy behaviors and lifestyles. In 2009, the National Academy of Sciences issued a report on preventable mental, emotional and behavioral problems in young people and found that effective classroom-based programs:
· Focus on life and social skills
· Focus on direct and indirect (social) influences on substance use
· Involve interactions among participants
· Emphasize norms for, and a social commitment to, not using drugs
· Include community components
· Are delivered primarily by peer leaders
· Emphasize the benefit of building life skills and social resistance
While TEAM does do quite a bit of this type of work, the impact of that is relatively low. The volume of young people that we can impact is limited by our staff resources and access to youth in need of services.
Therefore, TEAM also incorporates broader environmental strategies in an effort to prevent substance use disorder in our community. Prevention professionals use environmental strategies to change the conditions within a community, including physical, social, or cultural factors that may lead to substance use. For example, prevention planners may decide to target laws or norms that are favorable towards alcohol misuse or illegal substance use. Environmental strategies are most effective when implemented as part of a comprehensive approach.
Environmental strategies include communication and education strategies, which seek to influence community norms by raising awareness and creating community support for prevention. Environmental strategies may also use enforcement and policy methods to deter people and organizations from illegal substance use.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), communication and education strategies are messages communicated through media to influence how the public thinks and behaves. Communications strategies—public education, social marketing, media advocacy, and media literacy—can be used to influence community norms, increase public awareness, and attract community support for a variety of prevention issues.
Enforcement and policy methods are closely connected. Policy implementation without enforcement can often be unsuccessful. Effective enforcement requires visibility. People need to see that substance use prevention is a community priority and that violating related laws and regulations will result in consequences.
SAMHSA’s examples of enforcement strategies include but are not limited to:
Enforcement strategies may include:
· Surveillance. May include the use of compliance checks and other efforts to determine if people are complying with existing laws. Examples of surveillance environmental strategies to address underage drinking include prohibiting sales to minors (link is external) and compliance checks (covert underage buyer programs) (link is external).
· Penalties, fines, and detention. These strategies create consequences for people or institutions that don’t comply with an existing policy.
· Community policing. Encourages citizens and community members to participate in prevention efforts. This could include neighborhood watches, efforts to remove sources of alcohol or drugs, or partnering with law enforcement to discourage underage drinking and substance use.
· Incentives. Incentives offer rewards that reinforce healthy behaviors, such as drug education programs for children that include stickers and other small prizes.
Using this multi-level approach allows TEAM to have a much greater impact on substance use disorder in our community and thus help more youth to navigate the pitfalls that come with the misuse and abuse of substances. The best way to understand the broader impact that environmental strategies have versus individual strategies is to simply look at the numbers of youth served by TEAM, directly versus indirectly. Last year TEAM directly served, using individual-level strategies, over 740 youth with 5 staff members. This is truly impressive and we are very proud of our individual programs as we know they are effective and make lasting impacts on the youth who we served. However, last year, using environmental strategies, TEAM indirectly served over 41,000 youth with essentially two staff members and community collaborators.
As I said before, funders and donors like to fund individual strategies however, I have come to understand that environmental strategies have the greatest impact for the dollar. The challenge is getting many funders and donors to shift their paradigm with us in the prevention world.