European CTC Implementation Guide

Introduction: European CTC Implementation Guide

The CTC-EU-Network aims to make the established CTC-method transferable to other European countries.

This European Implementation Guide will facilitate the use of the CTC-method in other European countries. Evaluations of CTC are showing positive impacts for children living in the CTC-area, compared with children who did not live in the area. The EU-funded CTC-EU project (2013-2015) contributes to enhanced implementations of community-based programmes based on a risk and protective factor model, and initiatives that focus on preventing the development of problem behaviour by early intervention with children and youth.  

The project results lead to a facilitated use of the "Communities That Care" approach by stakeholders in community-based prevention efforts (municipalities, youth-care agencies, schools and preschools, parents etc.). Thus, beneficiaries of the project will be after all families and youth in communities who use the CTC framework to increase the implementation of evidence-based prevention measures, taylored to their local specific needs and resources.   

Our project aims to facilitate the implementation of the CTC-system in every European country. We expect that adapting CTC from the U.S. is only in part adapting it to specific national conditions, but at the same time (even more) adapting it to European conditions. Based on the expected results of our project this work could be economized in future.

Implementing CTC measures at the European level will reduce implementation costs for communities and states. CTC itself has been found a cost-beneficial intervention in the U.S. (5,3 $ return on every 1 $ spend, Kuklinski et al. 2011).   

What is CTC?

Communities That Care (CTC), a coalition-based system for preventing a wide range of adolescent problem behaviours, was developed by J. David Hawkins and Richard Catalano of the Social Development Research Group to narrow the gap between science and community priorities and practices.

CTC core elements are:

• Social epidemiological analysis of problem behaviours in a community (social background, problems, risk factors and protective factors),
• Worked out implementation strategy (trainings, guidance, community actors, implementation over time),
• Use of effective and tested programs,
• Evaluation of results and ongoing strategy.

The CTC-approach involves assessing the prevalence of problem behaviours, but also of the risk and protective factors in a community (e.g. a neighbourhood, city borough or town) related to the problem behaviours. With the local profile based on epidemiological research on problem behaviours, risk factors and protective factors, communities can identify and choose tested and effective, preventive interventions to address these underlying factors. A strategic, community specific process has been designed and tailored to increase communication, collaboration and ownership among professionals, service providers and community members. During this process, communities get technical assistance and specific training courses by trained and licensed CTC-experts. Although it is a community intervention in which different parties bear responsibility, one person (the local project leader or coordinator) has specific responsibilities during the three year implementation period. After the implementation period, the community will be strong enough to work on its own, using the CTC-prevention framework.

The originality of CTC lies in its rationale and systematic approach of social and youth problems at the local level. Social change is a very complex process and it requires a well thought through and reasoned approach through knowledge of the problems at hand, reliable organisation and the availability of effective interventions.

CTC consists of 5 phases:

5 Phases of CTC

Communities That Care is an ongoing process. When communities follow the phases below, their young people get improved conditions to flourish.

1. Get Started
   Communities get ready to introduce CTC. They work behind the scenes to:
   • Activate a small group of catalysts.
   • Assess how ready the community is to begin the process.
   • Identify key community leaders to champion the process.
   • Invite diverse stakeholders to get involved.
      
2. Get Organized
   Communities form a board or work within an existing coalition. After recruiting community board members, they:
   • Learn about prevention science.
   • Write a vision statement.
   • Organize workgroups.
   • Develop a timeline for installing CTC.
      
3. Develop a Community Profile
   Communities assess community risks and strengths—and identify existing resources. The community board and workgroups:
   • Review data from the community’s youth survey.
   • Identify priority risk and protective factors that predict targeted health and behavior problems.
   • Assess community resources that address these factors.
   • Identify gaps in existing resources to be filled in.
      
4. Create a Community Action Plan
   The community board creates a plan for prevention work in their community, to:
   • Reduce widespread risks and strengthen protection.
   • Define clear, measurable outcomes using assessment data.
   • Select and expand tested and effective policies and programmes using the Blueprints for Healthy Youth Development website (in the U.S.).
      
5. Implement & Evaluate
   In this final phase, communities:
   • Implement selected programmes and policies.
   • Monitor and evaluate them.
   • Measure results and track progress to ensure improvements are achieved.

(see: http://www.communitiesthatcare.net/how-ctc-works/)

CTC in Europe

Guidelines for Implementing CTC in European Context.

Meso and macro level implementation actions need to be considered.
CTC related issues on this level are: youth surveys/ databank/menu of evidence-based programmes and training on acceptance are having local implications.
At a national level, countries starting with the implementation of CTC should take a close look at the country readiness. In this paragraph, we first consider local issues and from there we elaborate on the concept of country readiness.

Local issues:
Make arrangements for reliable data collection on risk and protective factors and problem behaviours, which can be repeated over time.

Youth Survey:

A challenge with the CTC youth survey is to get and keep the involvement of local schools involving the age group 12-18 years old. They are in some cases not willing to cooperate. In case of inviting youth to fill in the survey online by sending an invitation at their homes the problem is a lack of response and non-response of groups at risk, impairing the validity of the youth survey results. If this happens acceptance of CTC is endangered. Building long-term trusting relationships with school administration and principals is key.

Know what programmes are involved in the community and develop knowledge and acceptance of better fitting evidence based programmes

Programme Databank:

Generally on a national level databanks/ menues of evidence based programmes are accepted and embraced as showing what should be done. But on a local level it means that professionals should be trained in new programmes, that type of costs of introducing new programmes should be taken in account for. Another form of resistance to implementing evidence based programs is the fear to stop with an already established programme/activity done for years, which is felt as a rejection of tacit professional knowledge and experience. This results often in claiming that the usual activities will show evidence if researched anyway, but for that local funds are too small or not available.

Make the CTC method and prevention principles largely and repeatedly known during years

Training:

One of the issues often mentioned in the different countries is staff turnover. The people working in the CTC area and involved in the introduction of CTC are very often not the same two or three years later. New people need to be trained in the CTC method and in the science-base of prevention. A change of project leader of CTC seems quite negative for the sustainability of the CTC process.

Keep multi stakeholder management clearly focused on the desired prevention outcomes

Staff:

Trained CTC project leaders should keep the multi stakeholders of the CTC effort informed, connected and involved. This is an arduous task because prevention outcomes appear not directly but after 2-5 years after introducing CTC (Fagan et al, 2008, Quinby et al, 2008)

Local implementation cannot succeed without country-readiness for the implementation of CTC

Country readiness

The CTC approach has extended attention for the community- and stakeholder readiness in the first phase of CTC. In the introduction phase efforts take place to involve the community in prevention science, the underlying theories of the social development model and joint thinking about the “why” of starting with CTC in that particular area.

There is yet no such way of thinking and introducing CTC when a country wants to implement CTC in different communities or cities.

Why country readiness for CTC is important and a condition for successfully local CTC implementation:

• CTC implementation is not possible only on a local level.
• Research, survey baseline, evidence based programmes and training/coaching are too complex and too costly for the local level to organise.
• “Higher” level involvement is necessary: Policy and Government at a national level: for setting the framework of science based prevention, for setting the legislation of local prevention and for funding.
• Knowledge: Universities to develop the science base of prevention on national and regional level.
• Quality of implementation support (training, coaching and technical assistance) is key.
• Larger scale implementation is more cost effective.

Aspects of country readiness:

Organise cooperation between national agencies and universities for development of national CTC instruments: youth survey, databank of evidence based programmes and support: coaching and training

An organisation starting with CTC in a country must make sure that the national (or regional, as in Germany) government supports CTC long enough to realize a system change. A system change is required in the sense of building science based prevention organised at a local level by local CTC implementations that are supported by national agencies for the youth survey (quality, baseline comparison) and a databank of evidence based programmes with tested and available programmes to bring into local settings to target selected risk- and protective factors.

Keep the focus on prevention, reduction of risk factors and promotion of protective factors

The situation of CTC in the Netherlands showed that CTC is vulnerable for policy change on a national level. In the nineties, the national government favoured CTC as a new and evidence based way of organizing prevention and solving the problem of fragmentation in the field of youth policy. In the 2005 the national policy forced local communities to form new organisations for families to receive prevention (Family Centres Centra voor Jeugd en Gezin) that made all the local efforts go to this new organisation and move away from the CTC implementation, even cities that had started implementing CTC stopped because of the need for organizing the family centres. From 2014 onwards with the decentralisation of youth care in the Netherlands, the family centres are now being dissolved in new organisations on a local level. This process costs so much energy and new ways of cooperation that no city is at the moment open to science based prevention as is conducted with CTC. 

Organise coalitions:

CTC implementation demands coalitions on local and national level.

• Between local and national prevention policy
• Between academic knowledge and local application of prevention science and implementation science
• Between different support organisations for families, youth, youth care, education and communities

 

How to start with CTC

European level

• Collect information and organise support from international agencies.
• Collect lessons from experienced CTC coaches and trainers from other countries.
• Support national governments with knowledge and training in the conditions of successful CTC implementation and the lessons learned in Europe.
   

National level

Create a coalition of government departments, universities and national agencies that:

• Translate the CTC methodology fitting in the national culture and adoptable by local institutions and communities.
• Translate and adopt the CTC Youth Survey.
• Start by collecting information on available evidence based programmes, and make these accessible in online databanks.
• Start by selecting and supporting one to four pilot communities willing to implement CTC as forerunners, evaluate their attainments and challenges for further learning.
• Train CTC coaches and trainers.
   

Local level

• Start a local CTC pilot community within in bigger area.
• Position the local CTC project leader high.
• Organise the data collection by implementing the youth survey.
• Follow the CTC methodology.
• And adopt the local lessons learned in the CTC pilots for making a better fit of the CTC methodology to the regional and national developments.
• Make use of national agencies and universities, build long-lasting collaborative relationships.

 

Further Reading

Arthur, M.W., Hawkins, J.D., Brown, E.C., Briney, J.S., Oesterle, S. and Abbott, R.D. (2010), ‘Implementation of the Communities That Care prevention system by coalitions in the community youth development study’, Journal of Community Psychology, 38(2), pp. 245-258.

Axford, N., Sonthalia, S., Wrigley, Z., Webb, L., Mokhtar, N., Brook, L., Wilkinson, T. et al. (2016), What works in Europe? Developing a European Communities that Care database of effective prevention programmes, Dartington Social Research Unit, Dartington, UK.

Bannister, J. and Dillane, J. (2005), Communities That Care: An Evaluation of the Scottish Pilot Programme,  Social research Crime and Criminal Justice Research Findings No.79/2005.

Basic, J. (2015), ‘Community mobilization and readiness: planning flaws which challenge effective implementation of “Communities that care” prevention system’, Substance Use & Misuse 50(8-9), pp. 1083-1088.

Briney, J.S., Brown, E.C., Hawkins, J.D. and Arthur, M.W. (2012), ‘Predictive validity of established cut points for risk and protective factor scales from the Communities That Care youth survey’, Journal of Primary Prevention 33(5-6), pp. 249-258.

Brown, E.C., Hawkins, J.D., Arthur, M.W., Briney, J.S. and Abbott, R.D. (2007), ‘Effects of Communities That Care on prevention services systems: findings from the community youth development study at 1.5 years’, Prevention Science 8(3), pp. 180-191.

Brown, E.C., Graham, J.W., Hawkins, J.D., Arthur, M.W., Baldwin, M.M., Oesterle, S., Briney, J.S. et al. (2009), ‘Design and analysis of the Community Youth Development Study longitudinal cohort sample’, Evaluation Review 33(4), pp. 311-334.

Brown, L.D., Feinberg, M.E. and Greenberg, M.T. (2010), ‘Determinants of community coalition ability to support evidence‑based programs’, Prevention Science 11(3), pp. 287-297.

Brown, E.C., Hawkins, J.D., Arthur, M.W., Briney, J.S. and Fagan, A.A. (2011), ‘Prevention service system transformation using Communities That Care’, Journal of Community Psychology 39(2), pp. 183-201.

Brown, E.C., Hawkins, J.D., Rhew, I.C., Shapiro, V.B., Abbott, R.D., Oesterle, S., Arthur, M.W. et al. (2014), ‘Prevention system mediation of Communities That Care effects on youth outcomes’, Prevention Science 15(5), pp. 623-632.

Brown, L.D., Feinberg, M.E., Shapiro, V.B. and Greenberg, M.T. (2015), ‘Reciprocal relations between coalition functioning and the provision of implementation support’, Prevention Science 16(1), pp. 101-109.

Burkhart, G. (2013), North American drug prevention programs: are they feasible in European cultures and contexts?, European Monitoring Centre for Drugs and Drug Addiction, Publications Office of the European Union, Luxembourg. Crow, I. & France, A. (2001) CTC—The Story So Far, an Interim Evaluation of Communities thatCare (York, Joseph Rowntree Foundation)

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Fagan, A.A., Hawkins, J.D., and Catalano, R.F. (2008), ‘Using community epidemiologic data to improve social settings: the Communities That Care prevention system’, in Shinn, M. and Yoshikawa, H. (eds), Changing schools and community organizations to foster positive youth development, Oxford University Press, New York (available at

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Fagan, A.A., Arthur, M.W., Hanson, K., Briney, J.S. and Hawkins, J.D. (2011), ‘Effects of Communities That Care on the adoption and implementation fidelity of evidence‑based prevention programs in communities: results from a randomized controlled trial’, Prevention Science 12(3), pp. 223-234.

Fagan, A.A., Hanson, K., Briney, J.S. and Hawkins J.D. (2012), ‘Sustaining the utilization and high quality implementation of tested and effective prevention programs using the Communities That Care prevention system’, American Journal of Community Psychology, 49(3-4), pp. 365-377.

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