BRIDGING THE GAP BETWEENRESEARCH AND PRACTICE INCOMMUNITY-BASED SUBSTANCEABUSE PREVENTION

Shakeh Jackie KaftarianCenter for Substance Abuse Prevention

Abraham WandersmanUniversity of South Carolina

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Family and community factors contribute to substance abuse. Family and community so-lutions are necessary to prevent substance abuse. A special issue of the Journal of Prima-ry Prevention (Kaftarian & Kumpfer, in press) sponsored by the Center for SubstanceAbuse Prevention (CSAP) of the Substance Abuse and Mental Health Administration(SAMHSA) of the Department of Health and Human Services (DHHS) addresses effec-tive family interventions and some of the possible ways to bridge the gap between fami-ly-focused research and practice. The present special issue, again sponsored by CSAP/SAMHSA/DHHS, focuses on effective community interventions and some of the waysthat community-focused prevention research can be linked with community-focused pre-vention practice. The lessons learned and strategies proposed are relevant to all areas ofcommunity-based prevention and public health.

In the past decade, community-based prevention strategies and programs have beensupported by the CSAP, which is the lead Federal Government organization for sub-stance abuse prevention, and several other Federal and non-Federal agencies and orga-nizations. The Community Partnership and Community Coalition Prevention Grant pro-grams, as well as the current State Incentive Grant Program, funded by CSAP, are goodexamples of community-based prevention approaches. Robert Wood Johnson Founda-tion’s Fighting Back program, as well as the Safe and Drug-Free Communities grant pro-gram sponsored by the White House Office of National Drug Control Policy and the De-partment of Justice are other very good examples of community-based prevention. Infact, more than 4,300 community coalitions across the country have united to initiate theCommunity Anti-Drug Coalitions of America (CADCA), an organization which advocatescomprehensive and community-wide approaches to substance abuse and related problems.

However, despite this apparent widespread acceptance of community-focused sub-stance abuse prevention, there is still a large gap between the research-based knowledge

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and the actual practice of community-based prevention. At this point in time, the sub-stance abuse prevention field faces the challenge of transforming the knowledge derivedfrom research into widespread practice.

To foster and accelerate the adoption of new scientific knowledge into preventionpractice, we must work to overcome the gap between research and practice highlightedby both prevention researchers and practitioners. Bridging this gap requires our best in-novative thinking, a problem-solving orientation, and attention to the most effectivemodes of dissemination and diffusion.

In the fall of 1999, CSAP convened a symposium that brought together representa-tives from the academically-oriented research community and from the practitioner com-munity to help bridge the gap between the science and practice of community-based pre-vention. Participants addressed three central questions:

• What are the most important evidence-based findings and lessons on effectivecommunity-based substance abuse prevention that prevention organizations andpractitioners should now know?

• Why are these research findings and empirical lessons not applied consistently incommunity prevention practice? And,

• What can be done to address the problems and overcome the barriers to linkingempirical evidence on effective community prevention with widespread practice?

The overall objective of CSAP’s “Bridging the Gap” Symposium was to facilitate thetransformation of substance abuse prevention knowledge into usable forms, and to fosterthe adoption of proven or promising prevention strategies. The symposium format was atwo-day meeting with attendees from both research and practice arenas, who represent-ed various agencies and organizations that have significant interests in substance abuseprevention. Participants were leading researchers and practitioners who presented papersreflecting the current state-of-knowledge in community-based prevention domain; sug-gested why the findings and lessons from that domain are not consistently applied in pre-vention practice; recommended actions leading to better research, more widespread ac-ceptance and application of science-based results; and discussed approaches, tools andpolicies that facilitate the timely dissemination and application of prevention knowledge.The participants identified barriers and opportunities relevant to dissemination, adapta-tion and adoption of scientific knowledge into practice, and recommended solutions.

In this monograph, we present the articles that the participants of this symposiumdeveloped and used as the basis for their discussions. These papers have used differentpresentation styles, and have focused on different aspects of community-based preven-tion research and practice. Some of the articles are formal and technical in their ap-proach, while others are informal and conversational in tone. The common feature ofthese articles however is that they are all based on the state-of-the-art of community-basedprevention research and/or practice, and their discussions are based on documentedempirical or practical experience.

These articles are relevant to multiple audiences: 1) policy makers who allocate fund-ing for substance abuse prevention; 2) administrators that implement funded programsand feel accountable for the success of those programs; 3) researchers who seek to ad-vance the theoretical basis of community-based prevention; and 4) evaluators who mustassess the outcomes of community-based programs and capture all the lessons learnedfrom the implementation of those programs.

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These articles highlight different community-focused prevention questions, and ad-dress many of the concepts, issues, and questions which have been discussed in a volumedeveloped through the CSAP-sponsored National Center for the Advancement of Pre-vention (NCAP) called Getting to Outcomes: Methods and Tools for Planning, Evaluation andAccountability (NCAP/CSAP, 1999). This issue was designed to guide the user throughthe following ten accountability factors that are very important in the design, imple-mentation, evaluation, and maintenance of substance abuse prevention, as well as othercommunity-relevant programs:

• needs and resource assessment;

• establishment of appropriate prevention goals and target groups;

• selection of research-based prevention programs;

• assessment of the fit of the selected prevention program in the context of the com-munity;

• assessment of organizational/community capacities that are needed to implementthe plan of the prevention program;

• plan of activities that facilitates the systematic implementation of the program;

• process evaluation;

• outcome and impact evaluation;

• incorporation of systematic strategies to continuously improve the quality of on-going and future programs; and

• Strategies to sustain the program over time.

In their article, Arthur and Blitz provide a review of the scientific findings in the ar-eas of prevention needs assessment and comprehensive community prevention planning.In their article, they identify gaps between science and practice of needs assessment andprogram planning, and offer suggestions regarding how to promote the use of science-based prevention strategies.

Pentz presents the significant role and value of environmental and programmaticpolicy practice in community-based substance abuse prevention. She introduces criticalquestions about the relationship between policy development, community organization,programmatic practices, and alcohol, tobacco, and other substance abuse outcomes. Shenotes that policies contribute to increasing levels of community organization and mobi-lization, and community mobilization in turn facilitates additional new policy formula-tion and/or existing policy change.

Resnicow et al. point out that cultural sensitivity is one of the most important is-sues in the context of the community-based prevention, yet it is one of the most poor-ly researched concepts in public health. They define cultural sensitivity on the basis ofwhat they call “surface structure” and “deep structure”, and offer techniques borrowedfrom social marketing and health communication theory that should be used in de-veloping culturally sensitive community-based programs. This article highlights the importance of the “fit” of the program with the cultural characteristics of the com-munity.

Edwards et al. discuss an extremely important issue in the field of community-basedprevention which is the relationship of community readiness to effective implementationof prevention programs. This article is based on substantial theoretical and empirical in-

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formation and describes the methodology underlying the development of communityreadiness and capacity.

Goodman points out that communities are complex and open systems that evolvesocially, culturally, economically, psychologically, and environmentally over time. He em-phasizes the need for designing, implementing, and evaluating community-based sub-stance abuse prevention programs that present the potential for continuous evolutionand change, to be able to respond to different community conditions. He points out thedifficulties that are inherent in the implementation of community-based programs andoffers guidance for dealing with these challenges.

Yin and Ware address outcome evaluation issues and point out the importance ofthe availability of substance abuse prevention outcome data over time and across com-munities. They emphasize the value of well-planned outcome evaluation, and highlightthe importance of building capacity at the community level for good outcome evalua-tion. They discuss possible sources of community outcome data and how prevention canbe improved if a systematic collection of outcome data across communities is routinized.

Gabriel highlights the importance of a good plan of activities at the beginning of theprogram and talks about unique lessons learned by evaluators who work directly withcommunity-based prevention programs. He points out a number of the practical chal-lenges that one has to face in the design, implementation, measurement, and reportingof community-based prevention evaluation.

Akerlund addresses program sustainability and highlights the fact that programproviders and practitioners often find themselves in the presumed dual role of “provider/fund raiser” for which they may not be ready. She makes excellent recommendationsfrom her own experience on how to plan ahead of time to assure the sustainability ofthe program over time and across funding cycles.

Backer goes beyond the ten factors that are highlighted in the Getting to Outcomes vol-ume and provides a good overview of the reasons why dissemination of prevention pro-gram information and “lessons learned” has been so limited. He states that inappropri-ate methods of dissemination have contributed to the “gap between science and practiceof prevention” and offers a number of guidelines and practical suggestions to improvedissemination of community-based prevention models.

This issue should contribute to the achievement of results using community-basedprevention interventions. As we can see from the articles in this issue and from the Get-ting to Outcomes guidebook, developing effective community interventions is complex andchallenging. It takes a systematic approach to planning, implementation, evaluation, andsustainability, as well as to the use of empirically validated programs and policies, to makea difference. This issue provides a wealth of theory, research, and strategies to accom-plish results in public health via community interventions. Researchers and practition-ers must work more closely together to provide the ingredients of high standards to ef-fective community prevention efforts.

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