Care Prevention System Research Articles

Installing the communities that care prevention system: implementation progress and fidelity in a randomized controlled trial

AbstractThis article describes the degree to which high fidelity implementation of the Communities That Care (CTC) prevention operating system was reached during the first 18 months of intervention in 12 communities in the Community Youth Development Study, a 5‐year group randomized controlled trial designed to test the efficacy of the CTC system. CTC installation in these communities included the delivery of six CTC trainings from certified CTC trainers at each site, the active involvement of locally selected and community‐based CTC community coordinators, ongoing monitoring of progress using the CTC milestones and benchmarks, and proactive technical assistance and coaching. CTC implementation fidelity ratings averaged across three groups of raters show that between 89% and 100% of the CTC milestones in the first four phases of CTC implementation were “completely met” or “majority met” in the 12 intervention communities, indicating that the first four phases of the CTC system have been well implemented in the communities in this trial. © 2008 Wiley Periodicals, Inc.

Multilevel Analysis of a Measure of Community Prevention Collaboration

This study assesses a measure of community-wide collaboration on prevention-specific activities (i.e., prevention collaboration) in context of the theory of community change used in the Communities That Care prevention system. Using data from a sample of 599 community leaders across 41 communities, we examined the measure with regard to its factor structure, associations with other concurrent community-level measures, and prediction by individual- and community-level characteristics. Results of multilevel confirmatory factor analysis provide evidence for the construct validity of the measure and indicate significant (p < .05) associations with concurrent validity criteria. Female community leaders reported significantly higher levels of prevention collaboration and community leaders sampled from religious organizations reported lower levels of prevention collaboration than did their respective counterparts. Although no community-level characteristics were associated significantly with prevention collaboration, community clustering accounted for 20-28% of the total variation in the measure. Findings support the use of this measure in assessing the importance of collaboration in community-based prevention initiatives.

Effects of Communities That Care on Prevention Services Systems: Findings From the Community Youth Development Study at 1.5 Years

The Community Youth Development Study (CYDS) is a community-randomized trial of the Communities That Care (CTC) prevention system. Using data from 2001 and 2004 administrations of the Community Key Informant Survey, this study reports changes in three community-level outcomes 1.5 years after implementing CTC in 12 communities. Respondents consisted of 534 community leaders in 24 communities representing multiple sectors within each community. Results of multilevel analyses controlling for respondent and community characteristics indicated that (a) CTC and control communities had comparable baseline levels of adopting a science-based approach to prevention, collaboration across community sectors, and collaboration regarding specific prevention activities; and (b) CTC communities exhibited significantly greater increases in these outcomes between 2001 and 2004 relative to control communities. These results suggest that CTC was successful in changing proximal system outcomes theorized to lead to more effective prevention services and, ultimately, reduced risk, enhanced protection, and improved adolescent health and behavior outcomes.