Background on the strategic prevention framework
In 2003, the United States Substance Abuse and Mental Health Services Administration (SAMHSA) unveiled its newly formulated approach to state and community substance abuse prevention. The Strategic Prevention Framework (SPF) described a specific process involving five major steps to be implemented at both the state and community level (SAMHSA, 2008a). These five steps are identified in the following graphic.
To help operationalize the SPF in states and communities, the Center for Substance Abuse (CSAP) has awarded SPF State Incentive Grants (SPF-SIGs) to 42 states, territories, and tribal governments (hereafter referred to as states) over the past 3 years. This grants program supports an array of activities by states to help communities plan, deliver, and sustain effective substance abuse prevention strategies. In almost all of the participating states, the agencies involved provide guidance and funding to a selected subset of communities throughout the state. Across the states, grantee "communities" are defined geographically in a variety of ways, including by county, city or town, and school district. It is primarily at the community level where the prevention strategy planning and implementation activities occur. The goals of the grants program are to: (1) prevent the onset and reduce the progression of substance abuse, including childhood and underage drinking; (2) reduce substance abuse-related problems in communities; and (3) build prevention capacity and infrastructure at the state and community levels.
Underlying these grants is a public health approach that first seeks to identify priority foci for substance abuse prevention efforts using population-level epidemiologic data. The strategies then selected and implemented are those that can be expected to reduce rates of substance use and related consequences at the state and/or community level, as opposed to achieving outcomes at the individual program level only (i.e., among program participants). Many prior initiatives that have focused on program-level outcomes have failed to examine whether program effects translate into improvements discernable at the population level. Given that many prevention programs are delivered to small groups of program participants only, it is unlikely that such programs could have significant impacts on population-level indicators of the problems they are designed to address. In keeping with the goal of achieving population-level reductions in substance abuse and related consequences, a key feature of the SPF-SIGs is the promotion of environmental change strategies within the mix of intervention activities implemented in the grantee communities.
Another distinguishing feature of the SPF-SIG initiative is the central role of epidemiological data in helping states identify and justify priority targets for prevention efforts. Step 1 of the SPF process at the state level calls for an assessment of substance abuse levels and patterns, including both consumption and negative consequences of consumption, based on a review and analysis of relevant epidemiological data. This assessment is intended to inform the prioritization of the state's substance abuse problems and facilitate a greater understanding of the patterns by which they are distributed. Where possible, data from specific sources are typically also disaggregated by substate areas and/or by demographic subgroups (e.g., age groups as categorized by youths, young adults, and older adults). Most states have used this process to determine a limited set of statewide priority foci, which communities funded through the SPF-SIG are then encouraged or required to address.
A variety of criteria that vary across participating states have been employed for the purpose of selecting grantee communities. A number of states have used data that are readily available at the sub-state level to help make these selections (e.g. …