Preventing drug-related harm through community ...

Prevention Research Evaluation Report

Number 5 February 2003

Preventing drug-related harm through community mobilisation by Associate Professor John W. Toumbourou, Mr Bosco Rowland, Dr Joanne Williams and Dr Sheryl Hemphill, with editorial assistance from Ms Colleen Farrell Introduction The community mobilisation strategy emerges from the idea that young people’s behaviours are the outcome of influences from many levels, including the family, peer groups, school and the community. In order to improve outcomes for children and young people, advocates of community mobilisation argue the need to improve a range of conditions that have relevance for the social development of children and families within local communities. According to the definition provided in the second report in the Prevention Research Evaluation series, community mobilisation refers to “a defined community engaging in coordinated planning and social action to advance youth development and prevent harmful drug use”. Community mobilisation encompasses a broad range of practice. At one level, it is concerned with encouraging the involvement of local people in prevention initiatives. At another level it is focused on the co-ordination of a range of complementary prevention strategies within specific social settings, such as school drug education, parent education and enforcement of laws regarding the sale of alcohol and tobacco to minors. This fifth report in the Prevention Research Evaluation series reviews evidence for the effectiveness of community mobilisation as a strategy for preventing harmful drug use by young people. A survey of practitioners’ views on the implementation of community

mobilisation is used to establish the relevance of findings from the research literature to local community practices.

What is community mobilisation, and how is it different to any other community improvement initiative? Community mobilisation to prevent harmful drug use by young people involves many of the same principles and activities that underpin broader community development and community improvement initiatives. A distinguishing quality of community mobilisation is its advocacy for effective strategies which are aimed at the more specific objective of preventing harmful drug use. There are differences in the extent to which community mobilisation activities emphasise local control, empowerment of disadvantaged groups and the implementation of evidencebased prevention programs. In community mobilisation efforts, the community has tended to be geographically defined. In broader community improvement efforts, communities may be geographically dispersed but bonded by common interests; for example, disability or disadvantage due to having limited Englishlanguage skills. An example of a broad community improvement program is the Federal government’s Stronger Families and Communities strategy. Launched in April 2000,

Prevention Research Evaluation Report Number 5 February 2003 (Commonwealth Government Department of Family and Community Services, 2000) the three main priorities of the program are centred around supporting and strengthening the family, and early childhood development. Although none of these priorities directly address young people’s issues, the underlying principle is of early intervention and prevention. It is likely that its application in some communities will bring benefits that include the reduction of harmful drug use. Practitioners’ views: what is community mobilisation? In order to assess practitioners’ views on defining community mobilisation, interviewees were read a definition of community mobilisation and asked whether they thought it to be useful. The definition was similar to that provided in the second Prevention Research Evaluation Report (September, 2002); however, in case an interviewee was not familiar with the term, the definition also included an explanation of the underlying assumptions: Community mobilisation is generally understood to mean the delivery of campaigns which initiate or strengthen an explicit strategy of coordinated community action aiming to advance healthy youth development and prevent harmful drug use. It is premised on the notion that health behaviours are outcomes of influences from multiple levels of the social environment (e.g. individual, family, peer group, school and community). Only one of the 11 practitioners interviewed reported having heard of the term ‘community mobilisation’. However, each interviewee agreed that the definition generally described the work that he or she did. Terms used by practitioners in lieu of community mobilisation were ‘community development’, ‘community participation’, ‘community action’, ‘community strengthening’, ‘capacity building’ and ‘community partnership’. All practitioners agreed with the assumptions outlined in the second part of the Page 2 of 13

definition. However, most respondents found the first part of the definition too complex, some suggesting that certain terms (e.g. ‘campaigns’ and ‘youth’) were ‘loaded’, ambiguous or too general. Other respondents suggested that the first part of the definition was problematic because it was dependent on the terms ‘community’ and ‘mobilisation’, and that in the main these terms were not clearly understood by the general population, neither were they explained in the definition. The terms most interviewees had difficulty with were ‘campaigns’ and ‘youth’. Interviewees suggested that the term ‘campaigns’ is too vague; one interviewee proposed that it be replaced with ‘interventions’. The specific inclusion of the term ‘youth’ was seen to be problematic because it focused on a particular group or segment, whereas interviewees believed that community mobilisation was not limited to a specific group in the community. These comments suggest that the term ‘community mobilisation’ may not be widely used by practitioners in Victoria, although it is common in the evaluation literature. Later in this document we suggest that the ‘campaign’ aspects of community mobilisation might be applied to the early activities which focus on building community support. In the review that follows we examine published evaluations addressing young people and drug use, but it is relevant to recognise that such campaigns are run in the context of a whole-population strategy. Despite definitional difficulties, community mobilisation programs described by interviewees were consistent with research literature. That is, programs described were restricted to a specific geographical location, such as council municipalities or certain rural regions. Programs also consisted of a broad range of practices, and included a wide range of external professionals. Furthermore, all interviewees stated that programs involved local people; one interviewee stating that in smaller rural communities some individuals wore ‘multiple hats’, such as those of a paid professional involved in the program and an active member of the community. All practi-

Prevention Research Evaluation Report Number 5 February 2003 tioners agreed that community mobilisation was a worthwhile approach to preventing harmful drug use amongst young people.

How effective is community mobilisation? The evidence suggests that well-implemented community mobilisation can be an effective strategy for preventing harmful drug use by young people. While the costs and resources required to implement multi-level, community based intervention programs are considerable, evaluations have yet to make clear whether or not there are advantages in using this combination of strategies over the simpler strategies such as conducting school drug education or parent education on their own. In Research Evaluation Report No. 4 (November 2002) in this series, the community mobilisation activities within the United States Midwest Prevention Program and Project Northland were outlined. These programs are important because of their leadership and apparent success in developing and implementing community mobilisation interventions focused on preventing drug use by young people. The Midwest Prevention Program combined a drug-education curriculum for Grade 6 and 7 students, a parents program for reviewing school prevention policy, and training for parents in positive parent–child communication skills, as well as community mobilisation elements aimed at reducing the availability of alcohol and drugs. After three years the program appeared to be effective in preventing tobacco and marijuana use, but not alcohol use (Johnson et al., 1990). For students who were using tobacco, marijuana or alcohol at the start of the program, there was evidence that the intervention resulted in a greater decrease in their substance use relative to similar students in the control conditions (Chou et al., 1998). In addition to having an impact on drug use, the Midwest Prevention Program also showed positive influences on mediating risk and protective factors such as attitudes, knowledge and perceived peer involvement in drug use. Page 3 of 13

Project Northland focused on preventing the early initiation of alcohol use. The project began with a Grade 6 drug-education curriculum and a set of activity books completed at home with parents over the course of four weeks. This was followed by eight weeks of drug education repeated in school Years 7 and 8, led by peers and teachers and including information booklets for parents. From the second year of the project, parents, other community members and later the Year 8 students themselves were recruited to community taskforce activities. Activities included passing new laws to prevent illegal alcohol sales to under-age young people and intoxicated patrons, and the instigation of a program whereby local businesses provided discounts to students who pledged to be alcohol and drug free (Perry et al., 1996). Students exposed to the Project Northland intervention were less likely to state that they used or intended to use alcohol, and progression to regular (weekly) alcohol use was also reduced. By Year 8 the intervention students showed a small, significant reduction in rates of weekly alcohol use (10 per cent versus 15 per cent for the control students). There was some evidence of lower cigarette and marijuana use. Impacts were also demonstrated on a range of risk and protective factors such as estimates of peer drug use that had been targeted by the intervention (Perry et al., 1996). The Midwest and Northland projects emerged from earlier heart-health initiatives that had attempted to mobilise communities to implement a wide range of healthy lifestyle interventions (e.g. The Stanford Heart Health Project, The Mr FIT trial). Due to problems of design and implementation, these earlier programs tended to have very mixed results, but did suggest the feasibility of organising community wide interventions. Over the past decade a range of community mobilisation programs have been implemented and evaluated. In some cases, evaluation designs have enabled comparison of community mobilisation programs against simpler strategies involving one element such as

Prevention Research Evaluation Report Number 5 February 2003 school drug education. This type of evaluation has demonstrated inconsistent findings, with the more complex community mobilisation programs not always superior to the simpler strategies. An example of this type of comparative evaluation was reported for an intervention conducted in rural New Hampshire in the United States from 1987. The intervention was based on the premise that preventing marijuana use required a community as well as a curriculum intervention in order to establish a threshold of societal disapproval. The evaluation had two intervention conditions in addition to a control condition. One intervention group received an anti-drug program as part of the school curriculum. The other intervention group received community intervention in addition to the school-based curriculum through parent courses and a community task force. A longitudinal study found that there were no differences between the three study groups in the proportion of children who tried marijuana. However, children in the community intervention were at reduced risk of regularly smoking marijuana when compared with the control group, while the control and curriculum-only groups did not differ. The community prevention approach did not deter children from trying marijuana, but appeared to be successful in preventing them from becoming regular users (Stevens et al., 1996). In a further example of this type of evaluation, a culturally sensitive skills and community based program was tailored to the everyday life of young Native American children living in reservation settings. Students from Grades 3, 4 and 5 in tribal and public schools were questioned on their use of tobacco, alcohol and marijuana. The students’ schools were then divided randomly into three groups. The first group undertook skills training, the second took some skills training with a component involving the community, and the remainder, as the control group, received no intervention.

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For 15 weeks, the skills training group took part in a weekly 50-minute session covering instruction and rehearsal in cognitivebehavioural skills associated with drug-abuse prevention. The intervention group with the community component involved families, teachers, school counsellors, police and local businesses. Information sessions outlining the program were held for parents, teachers and neighbours; posters and flyers were distributed to businesses, health and social services, schools and churches. The findings did not, however, indicate a significant advantage to supplementing school drug education curricula with community mobilisation activities. At the 42-month followup, the skills-only group consumed less alcohol and used less marijuana than the control group. The skills group with the community component had intermediary rates that did not differ significantly from the two other groups. Caution is required when attempting to tailor established intervention programs to nonEnglish-speaking cultural groups, and it may be necessary to develop new approaches to prevention for different cultural communities. Although the community mobilisation activities showed no superiority in this evaluation, it is possible that the failure to find effects may have been due to the young age of the participants (Schinke, Tepavac & Cole, 2000). Progress in evaluating community mobilisation programs has led to an interest in distinguishing the approaches that appear to be more effective. In their review of community based drug prevention programs, AguirreMolina and Gorman (1996) argued that the programs with the greatest promise relied heavily upon community action as the means for achieving change. In this context, community action referred to programs to empower the community through involvement in decision making. The more promising programs also used the public health model, identified problems beyond the individual and were guided by the best available research.

Prevention Research Evaluation Report Number 5 February 2003 Practitioners’ views: perceived effectiveness In order to establish the relevance of findings from the research literature to local community practices, practitioners were asked questions about their perception of the effectiveness of community mobilisation projects and how this effectiveness was measured All practitioners, except one, said they believed that community mobilisation projects were an effective way to tackle the issue of preventing harmful drug use among young people. One practitioner argued that it was difficult to say whether community mobilisation was effective, because often “evaluation gets thrown into the ‘too hard basket’”. He suggested that this was partly due to a lack of clear understanding of the term ‘community’. It was also due to the fact that individuals delivering programs did not have adequate understanding of the society in which the interventions take place. For those interviewees who perceived community mobilisation to be effective, a variety of qualitative and quantitative techniques were reported to be used as measures of effectiveness. Quantitative measures included epidemiological, roadtrauma, criminal and hospital admission statistics, as well as psychological constructs such as attachment to neighbourhood, connectedness, sense of community, and risk and protective factors. Qualitative measures were perceived to increase in community participation, people’s opinions about community mobilisation, young people reporting that they felt engaged and supported, and general community feedback about project satisfaction. When measuring effectiveness, all interviewees indicated that both long- and short-term outcomes should be considered. Short-term outcomes were perceived to be important because they enabled “a steppingstone approach” to building on successes, and “kept people on track”. One practitioner stated that “it was important to show people that there is a potential for change and development, but not to be overly ambitious about what can be Page 5 of 13

achieved in the short-term”. Long-term measures of effectiveness were also deemed important because they provided evidence of sustainability. However, it was also noted that long-term effectiveness was difficult to assess, often because of “compounding factors such as concurrent campaigns”. Acknowledging that community projects often have budgetary and time constraints, interviewees were also asked about the feasibility of community mobilisation projects. All interviewees indicated that they believed community mobilisation was feasible. One interviewee stated that “if the project is well planned it should be feasible” given certain conditions; another indicated that if the project was designed with realistic aims there was no reason a community mobilisation project should not be viable. Some interviewees, however, were more cautious in their support, and argued that community mobilisation was only feasible in the long term. One interviewee claimed that community mobilisation projects were essentially about “generational change… so to do anything you are looking at 15–20 years”. Thus, community mobilisation projects, he stated, needed significant resources if they were to succeed. He said that “often funding was provided to get the structure in place, but there was no money to take the next step”. Consistent with research findings, practitioners judged programs to be beneficial to the community because they relied on community action as the means for achieving change, and were based on a model that identified problems beyond the individual. One interviewee described her community mobilisation project as “capacity building”, empowering individuals in a community to “self-determine”. Another indicated that she believed community mobilisation programs to be beneficial because they were based on a model which recognised that health behaviours extended beyond traditional communities such as family, peer group and school, but also recognised that environmental, structural and biological environmental issues, such as the difference between people living in an urban industrial environment and those living in a

Prevention Research Evaluation Report Number 5 February 2003 rural environment were influential in health behaviours. However, one practitioner argued that the drug and alcohol arena was dominated by “psychologists, medical people and social workers with a limited understanding of social structures, political science and social theory”. Consistent also with research findings, practitioners, in the main, recognised the benefits of being guided by the best available research. Evidence-based practice was seen by most practitioners as providing a benchmark that could be used to demonstrate change. It was also said to be important because it could be used to establish whether practices were effective in the Australian context, and could be used to effect policy change. Some practitioners argued that evidence-based practice was important but not essential, one practitioner stating that “it was difficult to find unequivocal evidence to support intervention efficacy”. These comments suggest that practitioners generally accept the requirement for evaluation. Their comments also suggest that they have a good understanding of some of the practical challenges that need to be confronted in order to carry out evaluations. In the sections that follow, evaluations of community mobilisation programs are examined for more specific impacts on alcohol, tobacco, cannabis and other illicit drug use.

Alcohol Project Northland revealed a small reduction in students’ tendency to start using alcohol, and the Midwest Prevention Program appeared to assist young people who were using alcohol to reduce their use. Both of these goals are relevant to a policy orientation which encourages young people to abstain from alcohol use. It is relevant to consider whether community mobilisation targets can be adapted to the Australian harm-minimisation context. Caswell (2000) has presented one of the most recent reviews of the research on community approaches to alcohol prevention. This review concluded that community mobilisation was able to create changes in the Page 6 of 13

norms about alcohol use and alcohol harms and, as a result, could facilitate structural change within the community to have a direct impact on alcohol harms. The largest and most methodologically rigorous community alcohol prevention program conducted to date has been the Community Trials Project (CTP), in California and South Carolina in the United States over a five-year period (Holder et al., 1997a). The project aimed to reduce harms associated with drinking alcohol, rather than the drinking itself, and comprised interrelated components. Community mobilisation was used to initiate the program, and in the early phases involved efforts to develop relationships with existing organisations, coalitions, media and other events in order to encourage local awareness of issues associated with alcohol-related harm. Local support and involvement was sought for the co-ordinated implementation of the other elements that included training in responsible drink service, efforts to reduce drink-driving, programs to reduce under-age drinking and the access of minors to alcohol. The CTP placed particular emphasis on the enforcement of liquor laws in regard to service to intoxicated and under-age drinkers, as well as using local controls on alcohol availability. On a number of levels, the CTP was successful, with perhaps the hardest evidence for improvements noted in a 10 per cent reduction in alcohol-related vehicle accidents. Other improvements that were noted included significant community support for the project, an increase in media coverage of alcoholrelated trauma, an increase in policy initiatives, a reduction in the sale of alcohol to under-age decoys and a reduction in alcohol-related violence. Economic evaluation suggested that just under $3 in health and social costs were saved through every $1 invested in the CTP (Holder et al., 1997). In New Zealand, the Community Action Project (CAP) comprised a multimedia campaign designed to encourage males to drink moderately, and the use of community organisers to stimulate local discussion of alcohol policy issues. The main impact was in

Prevention Research Evaluation Report Number 5 February 2003 curbing the trend of increasingly liberal attitudes towards alcohol (Casswell & Gilmore, 1989). Closer to home, the Partysafe Project was implemented by researchers from the National Drug Research Institute, in collaboration with interested organisations in the Western Australian town of Carnarvon. The project used a community mobilisation framework to reduce drug-related harm associated with drinking in private settings (homes and private parties). The campaign was initiated through a planning phase that included linking with local agencies involved in health promotion. Early activities attempted to assess alcohol-related harms (local data were compared to that for the town of Kunanurra) and to raise local awareness of the potential problems associated with alcohol consumption. Indicators used to assess the success of community mobilisation in this intervention included an increase in local media coverage, the formation of action groups and coalitions, and survey data indicating an increase in community recognition and concern regarding alcohol-related harm. A widely recognised element of the campaign (over 60 per cent recognition) was a cartoon character published in the local newspaper to convey messages relevant to the harms associated with alcohol use and methods of reducing consumption and alcohol harms. Other program elements included training to promote responsible drinking in licensed premises, and structural changes designed to lower risks. Analysis of trends in local data suggested a reduction in harms from the previous year, including a decrease in road crashes over the Christmas period (Cooper et al., 2001). A further initiative developed in collaboration with the National Drug Research Institute was the COMPARI (Community Mobilisation for the Prevention of AlcoholRelated Injury) program. This program operated over a three-year period in Geraldton, Western Australia. It was designed to show how environmental factors influenced alcohol-related harm, and how alcohol-related injury could be reduced by a community taking Page 7 of 13

an active role in changing drinking behaviour (Midford & Boots, 1999). The initiation of the program involved networking and involvement with existing committees, and the establishment of a new coalition. Although Midford and Boots (1999) experienced difficulties in initiating the COMPARI project due to their ‘community outsider’ status, the project eventually received community acceptance, and 22 major activities were initiated. Activities included policy changes, social marketing, health education, alcoholfree events and drink-driver programs. The intervention was evaluated by contrasting trends against the Western Australian regional city of Bunbury. Evidence of success through the community mobilisation phase included the intervention being successfully adopted for regional funding support. The evaluation was not run on a sufficient scale to measure an overall impact on levels of harm. The existing evidence suggests that community mobilisation programs can be successfully implemented to address alcoholrelated harms. Existing evaluation evidence suggests that a diverse range of targets are feasible, ranging from reducing risk factors for early alcohol use through to harm-reduction strategies aimed at reducing accidents and injuries when people are intoxicated.

Tobacco A systematic review of community interventions for preventing smoking in young people was recently published by the Cochrane Collaboration (Sowden & Arblaster, 2001). This review examined the question of whether combining strategies within community mobilisation efforts achieves superior results to using separate strategies on their own. Three of five studies examining this question found an advantage for the more complex strategy. A reduction in smoking prevalence was reported in one of three studies that compared multi-component interventions with schoolbased programs only (Biglan et al., 2000; Baxter et al., 1997; Sussman et al., 1998; Gordon, Whitear & Guthrie, 1997). One study

Prevention Research Evaluation Report Number 5 February 2003 reported significantly lower prevalence of smoking in a group receiving a multicomponent approach consisting of a combination of media, school and homework interventions, compared with a group that had received the media intervention only (Kaufman et al., 1994). Another study comparing a multicomponent community intervention with a mass-media intervention found the former had a lower rate of increase in smoking (Pentz, Dwyer, MacKinnon et al., 1989). The findings were less favourable for studies that compared community intervention with no intervention communities, with only two of nine studies showing reductions in smoking rates (Perry, Kelder & Klepp, 1994; Baxter et al., 1997; Murray, Prokhorov & Harty, 1994; Piper, Moberg & King, 2000; St Piette et al., 1992; Sussman et al., 1998; Vartiainen et al., 1998; Winkleby, Fortmann & Rockhill, 1993). To the above findings we can add positive findings from the Midwest Prevention Program (Chou et al., 1998; Johnson et al., 1990) that successfully targeted youth tobacco use as part of a broader set of prevention targets.

Marijuana and illicit drug use Evidence from the Midwest, Northland and New Hampshire projects suggests that student involvement in marijuana use can be reduced through appropriately organised community mobilisation activities. There have been considerable efforts in Victoria to develop drug education programs and, in some cases, programs have included complementary community activities co-ordinated through the Individual School Drug Education Strategies (ISDES; see Research Evaluation Report No. 4, November 2002). Unfortunately, there has not been a well-controlled evaluation of these initiatives. Following the leadership of Victoria’s Turning the Tide initiative in the mid-1990s, many Australian states have introduced community wide programs aimed at better coordinating community responses to illicit drug use. Common activities include bringing together community members for

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consultations, and making efforts to establish agreed local strategies. These activities have resulted in positive service development in many cases, and in better co-ordination of resources as well. More systematic evaluation of these programs is important. Practitioners’ views: is community mobilisation worth the extra effort? Consistent with the general evidence, in the main practitioners suggested that community mobilisation projects have favourable outcomes, and thus are worth the commitment of extra effort and resources. Overall, practitioners perceived community mobilisation to be a more sustainable form of intervention because it was a “longer, more in-depth and structured approach”. In addition, it was reported to be an approach that allowed greater access to resources and professionals. A number of practitioners also encouraged the employment of community mobilisation strategies because it allowed for a variety of perspectives and for the input of local knowledge, thus giving the community ownership of the project and giving it an overall local flavour. Although practitioners reported having an overall commitment to the philosophy and practices of community mobilisation, they were also mindful that community mobilisation was heavily reliant on outside support, generally on funding or a paid professional to “assist and provide direction”. It was suggested by one practitioner that community mobilisation projects were dependent on outside support because local community members usually “did not have the skills to do some of the basic sort of things, like putting together various community groups, reference groups, and so on”. In a similar vein, the initiation of community mobilisation projects was also reported to be dependent upon outside support. Some practitioners indicated that community mobilisation projects may be initiated through a combination of community members and paid professionals; however, in the main most practitioners recognised that the

Prevention Research Evaluation Report Number 5 February 2003 initiation of community mobilisation projects was often made by “someone on the outside looking in”. Practitioners also recognised some limitations of community mobilisation. Some practitioners reported community mobilisation as being difficult to “kick start”, one practitioner stating that in many cases “communities needed to be mobilised to get them started” on a community mobilisation project. Other practitioners suggested that sometimes individuals who became involved with the project were not the ones being targeted. Another practitioner stated that it often took time for people to develop relationships, and thus community mobilisation projects were slow to develop. She also indicated that resources could “disappear over time, depending on the political framework”. For example, at the start of a project the government might support community mobilisation, but if a new government was elected, funding and resources could be withdrawn or reduced. These comments indicate that similar to conclusions made by overseas and interstate researchers, Victorian practitioners consider community mobilisation to be a practical and viable approach to reducing drug-related harm. Overall, practitioners report that, despite community mobilisation being heavily dependent on additional external resources, it is worth committing the “extra effort” into securing funds and maintaining resources. Comments also suggest that practitioners are mindful of the limitations associated with community mobilisation.

What are the processes underlying effective community mobilisation? From the above discussion, the idea of different stages in the community mobilisation process begins to emerge. At an early phase, activities tend to be focused on attracting public attention and increasing involvement in prevention. Perhaps the term ‘campaign’ is best limited to this phase, given that it has a

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similar emphasis to a political campaign. Once individuals and organisations are engaged, mobilisation activities often progress to building prevention capacity and service delivery. This notion of a staging process underlying community mobilisation has been prominent in theoretical frameworks that have attempted to explain and assess community wide prevention activities. The extent to which professionals and other members of a community have the knowledge, motivation and organisational capacity to engage in well co-ordinated prevention programs has been referred to as ‘community readiness’ (Edwards et al., 2000). According to Edwards and colleagues, there are stages in community readiness that can be defined with reference to prevention-focused coalitions and activities within a community. At the lowest level of readiness are communities in which there are no individuals advocating for prevention and no history of delivering prevention programs. Community readiness increases as individuals advocate for prevention activities, leading to their adoption in policy and subsequently to prevention-service delivery. At the highest level of readiness, communities have a diverse range of prevention programs monitored through evaluation systems. A measurement system has been developed to assess community readiness (Oetting et al., 1995). This system is based on a series of interviews with key informants familiar with the organisation and operation of local prevention programs. The measurement of readiness is linked to activities recommended for increasing community readiness (Edwards et al., 2000). Although the system appears to be a reasonable means of assessing prevention activity, there is no attempt to assess the quality of prevention activities. A further attempt to develop a process model for encouraging community mobilisation was the Communities That Care (CTC) program, developed by researchers at the University of Washington (Fiske, 2000; Hawkins, Catalano & Associates, 1992). CTC emerged from research on the developmental

Prevention Research Evaluation Report Number 5 February 2003 risk and protective factors that lead to health and behavioural problems in young people. The approach begins by identifying ‘key leaders’ who have influence over organisational collaborations and/or resources in a specific community. Key leaders participate in a training program explaining the CTC approach and its implications for directing resources into evidence-based prevention programs. The community mobilisation aspects of CTC are further developed through the establishment of a Community Prevention Board, bringing together formal and informal community leaders and intervention personnel. The Community Board is provided with training and assistance in using the developmental risk and protection approach to prevention, in order to develop a local prevention strategy. A school survey assessing a comprehensive range of community risk and protective factors is an important information source, but other information is also used. Local assessment information is used to diagnose community needs and to prioritise intervention targets. A listing of evaluated interventions that effectively target risk and protective factors is made available to inform the development of local intervention strategies. Through the above steps, CTC aims to assist local Community Boards to select evidence-based interventions tailored to fit local conditions. Once a local prevention plan has been approved, CTC encourages intensive training and support to ensure rigorous implementation of the selected community interventions. The CTC program has been operating in Australia since 1999, and efforts are being made to establish a well-controlled evaluation (Toumbourou, 1999). Practitioners’ views: what is the process? In order to assess the level of awareness of the processes underlying effective community mobilisation, practitioners were asked about what they perceived to be important local factors for community mobilisation and co-ordination. Only one practitioner used the term ‘readiness’ to describe a community’s Page 10 of 13

preparedness to begin a community mobilisation project. However, all practitioners recognised that a degree of readiness was required within the community if a community mobilisation project was to succeed. Terms used by some practitioners to describe readiness included community “enthusiasm, interest and concern”, “willingness to work in partnership” and “an openness to change”. Notwithstanding the importance of readiness, interviewees also reported that other local factors such as support from local council, the private sector and “local power brokers”, and a sense of common understanding and purpose within the community, were also important for the success of a community mobilisation project. According to practitioners, an essential feature of successful community mobilisation projects is a project co-ordinator. Practitioners described co-ordinators as individuals who essentially maintained communication between sectors, developed and maintained relationships, and “harnessed energy and resources”. One practitioner described a coordinator as a person who has access to power and resources. Besides having particular skills, a number of practitioners indicated that it was just as important that a co-ordinator had sufficient time to dedicate to the project. Similar to the CTC project, practitioners reported that community mobilisation projects targeted a variety of risk and protective factors. Most practitioners stated that risk and protective factors were population- and context-specific, and thus were dependent on the issue being addressed. For example, community mobilisation projects focusing on young people at school tended to target factors outlined by Hawkins and Catalano (1992) within the areas of relationships with peers, school, family and community. Broader focused programs tended to concentrate on factors such as sexual activity, underlying emotional anxiety, fragmentation, isolation and engagement in meaningful activity. Practitioners, in the main, reported protective factors as being the “flipside” of risk

Prevention Research Evaluation Report Number 5 February 2003 factors, and thus they were also described as being context- and population-specific. Protective factors focused on the individual and also the individual’s relationship with the broader community. Individual risk factors included “individual self worth”, “resilience” and “long-term education”. Risk factors focusing on the individual’s relationship with the community included “attachment to neighbourhood”, “having a place in the community”, “connectedness” and a “feeling of belonging”. Consistent with recommendations from the research literature, a number of practitioners reported having consulted young people to diagnose community needs and to prioritise intervention targets for community mobilisation projects. Input from young people was usually achieved by tapping into existing structures, administering surveys, having a young person’s reference group, or by conducting focus groups. A focus group was described by one practitioner as being a particularly effective way of gaining input from young people, because it could be used to draw from the different strata of the community. That is, focus groups enabled her to draw young people “from different schools, different year levels and different socio-economic groups”. Some practitioners indicated that sometimes it was difficult to get specific input from young people, because often funding did not allow for it, or that frequently the young people who became involved were “not the youth being targeted”. These comments suggest that practitioners are mindful of developmental stages associated with the implementation of

community mobilisation projects, particularly the early stage of “readiness”, as described in the evaluation literature. Comments also indicate that practitioners recognise that having a dynamic project co-ordinator is essential if a project is to move beyond the early phase of raising public awareness to a stage at which long-term outcomes can be measured. Targeting specific risk and protective factors was seen to be intrinsically important to community mobilisation projects, and similarly the consultation of young people.

Conclusion Community mobilisation requires considerable reliance on networking and co-ordination. Our small survey of Victorian practitioners suggests that the term ‘community mobilisation’ may not be widely used, but activities aligning with this strategy are commonly practised. Available evidence suggests that the strategy can be conducted successfully, and Victorian practitioners appeared to have a good understanding of the requirements for evaluation. Although the balance of recently published evidence appears favourable, further research is required to better establish the conditions whereby community mobilisation is able to translate into reductions in harmful drug use by young people. Further work is required to establish that community mobilisation programs can be effectively disseminated outside of the context of research demonstration programs.

This report was prepared for the DrugInfo Clearinghouse by the Centre for Adolescent Health and the Centre for Youth Drug Studies, Melbourne

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