June Newsletter
Strategic Prevention Framework
Step 4: Implementation
The key to positive outcomes in substance misuse prevention is using evidence-based programs and practices that produce the intended results. This is accomplished when prevention practitioners select, plan for, and carefully implement those interventions.
 
Sometimes a practice or program will need to be adapted. This adaptation may be identified early in the planning process or may be discovered later. Monitoring the i mplementation process is necessary to identify areas of concern. The sooner the need for adaptation is identified, the better your prevention outcomes will be. SAMHSA has identified 5 guidelines to consider when balancing fidelity and adaptation.
 
  • Retain core components. Evidence-based programs are more likely to be effective when their core components are maintained.
  • Build capacity before changing the program. Rather than change a program to fit local conditions, consider ways to develop resources or to build local readiness so that it can be delivered as it was originally designed.
  • Add rather than subtract. Doing so decreases the likelihood of important program elements (i. e.., those that are critical to program effectiveness) getting lost.
  • Adapt with care. Even when programs and practices are selected with great care, there may be ways to improve their appropriateness for a unique focus population.
  • If adapting, get help. Knowledge experts, such as program developers, can provide information on how a program has been adapted in the past, how well these adaptations have worked, and what core components should be retained to maintain effectiveness.1

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1 A Guide to SAMHSA’s Strategic Prevention Framework, pages 20-21, https://www.samhsa.gov/sites/default/files/20190620-samhsa-strategic-prevention-framework-guide.pdf
Additional Resources 
Partnerships for Success Academy 2020
Making the Steps of the Strategic Prevention
Framework Work for You
Mid America Prevention Technology Transfer Center
This site provides training, tools, and resources for each step of the Strategic Prevention Framework.
 
Publication: Substance Misuse Prevention for Young Adults
Substance Abuse and Mental Health Services Administration (SAMHSA)
This guide supports health care providers, systems, and communities seeking to prevent substance misuse among young adults.
 
Webinar Recording: Selecting and Implementing Evidence-Based Practices to Address Substance Misuse Among Young Adults: SAMHSA’s Resource Guide
Pacific Southwest Prevention Technology Transfer Center
In this webinar, participants will learn about the findings and resources available in the recently released SAMHSA resource guide, Substance Misuse Prevention for Young Adults
 
Active Implementation Hub
National Implementation Research Network
The Active Implementation Hub is a free, online learning environment for use by anyone involved in active implementation and scaling up of programs and innovations.

Implementation Primer: Putting Your Plan into Action
Community Anti-Drug Coalitions of America (CADCA)
This primer assists coalitions in the implementation of comprehensive strategies designed to achieve population-level reductions of substance misuse rates.

YouTube Recording: Language, Culture, and Intervention
SAMHSA’s Tribal Training and Technical Assistance Center
Language, Culture, and Intervention: A three-part series devoted to increasing the impact of programs through use of cultural components that are unique to tribes and tribal communities.

Best Practices for Comprehensive Tobacco Control Programs—2014
Centers for Disease Control (CDC)
This is an evidence-based guide to help states build and maintain effective tobacco control programs to prevent and reduce tobacco use.
What's Happening Around the Region?
Training and Events
Webinar Series: PFS Academy 2020: Making the Steps of the Strategic Prevention Framework Work for You

Each webinar will begin 8:00 PT / 9:00 MT / 10:00 CT / 11:00 ET

The Mid America PTTC, in collaboration with the South Southwest PTTC, is offering a seven-part webinar series on the Strategic Prevention Framework.

SAMHSA’s Strategic Prevention Framework (SPF) provides practitioners with comprehensive guidance to more effectively address substance misuse and related behavioral health problems in their communities. This seven-part webinar series will explore this five-step, data-driven process to identify genuine prevention needs, build capacity and plans to address those needs, implement effective programs and interventions, and evaluate and continually improve prevention efforts.

At each step of the SPF, and in separate sessions, practitioners will learn to incorporate the guiding principles of cultural competence and sustainability to help support the implementation of SAMHSA’s Strategic Prevention Framework. 

Prevention contact hours available to those who register and complete this webinar.
 
  • June 23, Part 5: Evaluation, will offer helpful guides for the collection and analysis of prevention strategies and teach participants how to modify programming for future enhanced results.
 
  • July 21, Part 6: Sustainability, will provide participants with the elements of a sustainable prevention program and how to integrate sustainability into each step of the SPF.


Recordings of previous events in the series can be found here .
Drug Endangered Children: June Peer Sharing Call

Date: June 11

Please join us for our quarterly drug endangered children's peer sharing call. We will be joined by Eric Nation and Stacee Read from the   National Alliance for Drug Endangered Children.
Drug Endangered Children: September Peer Sharing Call

Date: September 3

Please join us for our quarterly drug endangered children's peer sharing call. We will be joined by Eric Nation and Stacee Read from the   National Alliance for Drug Endangered Children.
Featured Podcasts!

Podcast Episode 30:
Drug Free Communities (DFC)
Steps for Success

This episode discusses a proven process for building coalition buy-in and sustainability.
PreventionTalks

Win the Morning, Win the Day
Organizing for Change

41 - Quarantine and Innovation with Mid-America PTTC Director, David Closson
Self-guided Learning Courses
 
Informing Prevention: Adolescent 6-part Webinar series
  • Informing Prevention: Understanding Adolescent Development (1 of 6)
  • Informing Prevention: Effectively Engaging Adolescents in Interventions (Part 2 of 6)
  • Informing Prevention: Effective Use of Epidemiological Data (Part 3 of 6)
  • Informing Prevention: Effectively Using Technology for School-Based Prevention (Part 4 of 6)
  • Informing Prevention: The Effects of Drug Use on Adolescent Brain Development (Part 5 of 6)
  • Informing Prevention: Vaping Among Adolescents (Part 6 of 6)

Today’s Marijuana: Stronger, More Edibles, Confusing Information about Driving

Early Childhood Development: Toxic Stress and Adverse Childhood Experience s

Online Courses
All online courses can be accessed at: healtheknowledge.org/courses
 
If you are new to HealtheKnowledge, please log in or set up an account here: healtheknowledge.org/new-user
Check out the Mid America Prevention Technology Transfer Center website for additional resources and training!
Mid-America PTTC
The Mid-America Prevention Technology Transfer Center (Mid-America PTTC) is designed to serve as a prevention catalyst, empowering individuals and fostering partnerships to promote safe, healthy, and drug-free communities across Missouri, Iowa, Nebraska and Kansas. Our services are evidence-based, culturally competent, and locally focused. We provide intensive technical assistance to support organizations' and systems' efforts to implement evidence-based prevention strategies. The Mid-America PTTC also forms partnerships with local and regional stakeholders to ensure that the training needs of the region are identified and met.

The Mid-America PTTC goals are to:
  • Accelerate the adoption and implementation of evidence-based and promising substance misuse prevention strategies.
  • Heighten the awareness, knowledge, and skills of the workforce that addresses substance misuse prevention.
  • Foster regional and national alliances among culturally diverse practitioners, researchers, policymakers, funders, and the local communities.

To learn more about our services:  Mid-America PTTC
Epi Corner
Iris E. Smith, Ph.D., M.P.H.

Implementation: Measuring Benchmarks and Monitoring Progress


The fourth step in SAMHSA’s Strategic Prevention Framework (SPF) is implementation. This is the stage where the “rubber meets the road”, so to speak. By the time you reach this step, the initial needs and capacity assessments have been completed, you have prioritized the risk and protective factors that will become the focus of the selected strategy, and you have selected a prevention strategy with supporting evidence that it can influence the risk and protective factors that are the focus of your prevention effort (Figure 1).
 
Figure 1
The success of the selected prevention strategy is dependent upon the quality of the implementation process. Quality implementation includes fidelity to the core components of the program model and it’s accessibility and acceptability by the community. There is a delicate balance between fidelity to the program and the need to address the unique needs, culture, and perceptions of the communities you are working with. Ongoing data collection during the implementation process can help identify program components that are not performing as expected and, when feasible, allow for adjustments. Even when it is not feasible to modify strategies, implementation data will help to identify factors that may have mediated the observed outcomes achieved.
 
The Consolidated Framework for Implementation Research (CFIR) developed by Damschroder et al. (2009) is based on a review and synthesis of theoretical constructs believed to influence the implementation of evidence based programs. 1 This framework has been used across a wide variety of evidence based programs. The CFIR comprises five major domains: the intervention, internal and external setting (context), the individuals involved, and the implementation process itself. 
 
The first domain covers the planning process: selection of the intervention, assessment of the supporting evidence, cost, and complexity. Internal/external settings refer to contextual influences both within the implementing organization (e.g. organizational culture, staffing) and external influences in the larger social environment (such as cultural values, political will, policies or government priorities). Individual influences in the CFIR model refers to the capacity of the individuals and community to implement the program (data collected during Step 2 of the SPF, Capacity).  Activities completed during planning and implementation comprise the fifth domain quality of the planning process: the extent to which community stakeholders and opinion leaders are engaged in the planning and implementation process, the execution of the program plan, and the extent to which there is ongoing reflection, communication, and feedback during the process. Damschroder et al (2009) emphasize the importance of dedicating time for reflecting and debriefing before, during, and after implementation to promote shared learning and improvement along the way. A systematic review by Bach-Mortensen, Lange & Montgomery (2018) found that the most consistent facilitators of implementation were available resources, organizational culture, and support of the implementation process. 2

Resources
 
Bach-Mortensen AM, Lange BC, and Montgomery P. (2018). Barriers and Facilitators to Implementing Evidence-based Interventions Among Third Sector Organisations: A Systematic Review.  Implementation Science 13 ; pg. 103 . https://doi.org/10.1186/s13012-018-0789-7
 
Palinkas LA, Spear SE, Mendon SJ, Villamar J, Valente T, Chi-Ping C, Landsverk J, Kellam SG and Brown CH (2016). Measuring Sustainment of Prevention Programs and Initiatives: A Study Protocol.  Implementation Science 11 ; pg. 95. https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0467-6

Saldana L (2014). The Stages of Implementation Completion for Evidence-Based Practice: Protocol for a Mixed Method Study. Implementation Science 9; pg. 43.  http://www.implementationscience.com/content/9/1/43

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1 Damschroder LF, Aron DC, Keith RE, Dirsh SR, Alexander JA & Lowery JC (2009) Fostering Implementation of Health Services Research Findings into Practice: A Consolidated Framework for Advancing Implementation Science. Implementation Science 4, 50.[1] https://doi.org/10.1186/1748-5908-4-50
2 Bach-Mortensen AM, Lange BC, & Montgomery (2018). Barriers and Facilitators to Implementing Evidence-Based Interventions among Third Sector Organizations: A Systematic Review . Implementation Science 13 ; pg. 103.   https://doi.org/10.1186/s13012-018-0789-7
Iris E. Smith, Ph.D., M.P.H.
Iris Smith is Associate Professor Emeritus of Emory University’s Rollins School of Public Health where she has taught graduate courses in Program Evaluation, Substance Misuse, Social Determinants of Health, and the Mental Health Capstone course. In addition to teaching Iris also served as principal or co-investigator for numerous studies on the prenatal effects of alcohol and other drugs and treatment and interventions with substance abusing women, including a treatment demonstration grant for pregnant and parenting addicted women and their children (1979-1999). From 2004-2011 she was Co-investigator for the Emory Prevention Research Center and from 2007 to 2010 she served as the lead evaluator for the Atlanta Clinical Translational Science Institute.