Community partnerships are designed to change policies, activities, and norms in an entire community. This environmental approach to prevention is entirely consistent with public health practice and complements other prevention strategies that target specific at-risk individuals. The Community Partnership Program was therefore implemented in the following manner:
251 community partnerships, most receiving 5-year grants;
Grants averaging about $350,000 per year;
Goals promoting long-range and comprehensive initiatives, especially by coordinating and leveraging a community's existing prevention efforts; and
Broad representation of major sectors in the community, including large numbers of residents.
Using sophisticated statistical modeling, the Cross-Site Evaluation covering 48 communities found four conditions at the individual level that could be considered correlates, if not precursors, to reduced substance abuse:
Living in a partnership (but not a comparison) community;
Being involved in drug prevention activities;
Living in a neighborhood perceived to have minimal drug trading or other drug market conditions; and
Having a disapproving attitude toward the use of drugs.
All these relationships were statistically significant and are illustrated above. A similar sequence was found at the organizational level: Partnership activities, and not just prevention services, were statistically associated with the desired outcomes. Overall, both analyses suggest the importance of community partnerships in instigating community change and in turn affecting substance abuse.
Across all of the communities surveyed, partnership communities had lower substance use rates--relative to the matched comparison communities (pooled analysis). The reductions covered all three age groups surveyed, both illicit drug use and alcohol use, and use reported during the past month and during the past year. While the differences were small, one was statistically significant (adults' alcohol use for the past month).* Possibly, if the Community Partnership Program had operated for a longer period of time, the differences might have been larger.
Statistically significant differences were found with greater frequency when individual partnership communities were compared to their matches (paired analysis). Eight of the 24 intensively studied partnership communities showed some statistically significant reduction, for at least one age group and one type of substance use, relative to their matched comparison community.
* See Monograph for a fuller discussion and alternative interpretations of these results.
When the surveys were analyzed by gender, the pattern of reduced substance use among the partnership communities (relative to the comparison communities) was stronger for males than for females.
One reason for this gender difference could be that prevention is implicitly aimed more at males and the male culture. For instance, a common strategy is to support "alternative activities" as a way of diverting youths from substance use. These activities (e.g., camp outings, sports) may benefit males more than females. Such a scenario also suggests that prevention activities deliberately aimed at females may deserve more future attention.
No single characteristic guaranteed that a community partnership would successfully reduce substance use. However, certain features, confirming the literature, were found helpful in operating successful partnerships:
A Comprehensive Vision that covers all segments of the community and aspects of community life.
A Widely Shared Vision agreed upon by groups and citizens across the community. Partnerships can create this shared vision by developing a prevention plan to be embraced by nearly everyone in the community.
A Strong Core of Committed Partners at the outset of the partnership.
An Inclusive and Broad-Based Membership, with participation of groups from all parts of the community--welcoming members from all segments of the community and enlisting them in the work of the partnership.
Avoidance or Resolution of Severe Conflict that might reflect misunderstandings about a partnership's basic purpose.
Decentralized Units, encouraging action directed at the needs of small areas within a partnership, and empowering residents to take the necessary actions or make the necessary decisions.
Reasonable Staff Turnover that, when it happens, is not disruptive.
Extensive Prevention Activities and Support for Local Prevention Policies, reaching a large number of people for as many extended ("contact hours") as possible.
Future partnerships may want to emulate or adopt these features wherever possible.
Partnerships must be inclusive and have commitments from a large number of partners, and a solid volume of participation and help, as well as sufficient funding.
Partners:
Types of partnering organizations include local government; schools; faith organizations; neighborhood groups; businesses; service agencies; police departments; and local colleges and universities. Some of these organizations were cooperating for the first time in an unfamiliar setting, and that alone marked a milestone of success. Working together for five years can produce solid linkages among community efforts for substance use prevention.
Volunteers:
The SAMHSA/CSAP community partnerships attracted many people who gave a large number of volunteer hours to their partnership.
Funding:
Overall, SAMHSA/CSAP awarded the partnerships an average of $350,000/year for 5 years. However, many partnerships were able to leverage other funds from additional grants or state governments, which helped bolster their activities.
Community partnerships averaged prevention activities with a large number of contact hours and also were increasingly involved in prevention policymaking.
Prevention Activities
Awareness Activities
(usually single events aimed equally at partnership visibility and support, not just prevention)
Cultural and ethnic festivals
Press releases, posters, pamphlets
Fundraisers
Media announcements
Program Activities
(usually extended efforts reflecting a major prevention or community development strategy)
Alternative programs for youth
Media campaigns
Employment programs
Workplace programs
Neighborhood empowerment
Coordination of community organizations
Prevention Policies
Gun free/drug free school zones
Local control of liquor licensing
School substance abuse and weapons suspension policies
Drug conviction fines to support youth training activities
Pre-employment and random drug testing
The diversity of activities and policies supported by the partnerships reflects the assumption that substance abuse prevention is not merely a matter of targeting certain at-risk groups, but that programs and activities aimed at the community environment also are essential prevention initiatives.
The SAMHSA/CSAP community partnerships faced traditional problems common to virtually all organizations striving for sustained viability. The main barriers are charted below:
Partnerships also encountered problems more specific to their partnering functions:
Partnership as a "Project." Partnerships that were only projects within an existing agency or community organization tended to (a) limit activities into a time coinciding with the period of SAMHSA/CSAP funding; and (b) make less effort to reach out to grassroots constituents, faith communities, businesses, or others not associated with public agencies and large and diverse memberships. The "project" orientation also led to conflicts between partnership boards or executive committees and the partnership's supervising agency.
Lack of Understanding and Consensus Over the Basic Mission. Some partnerships experienced early confusion concerning membership size, composition, and use of funds. Some of this resulted from the complexity of the original grant applications, generally completed by a single entity and only later communicated fully to new partners. Even though SAMHSA/CSAP quickly clarified many misunderstandings, the nature of a community partnership involved diverse groups that may have had little previous interaction and therefore encountered difficulty in developing workable relationships.
Too Much Staff Control. Another barrier reflected the dichotomy between a partnership's staff and its members. Paid staff who were too directive limited the members' involvement in leadership roles needed to make the members feel ownership over partnership priorities.
Insufficient Identity. There also were cases where identities were obscured through association with the grantee agency. This could result from physical co-location or using names or logos closely matching those of the grantee organization--confusing outsiders regarding the purpose of the partnership.
SAMHSA/CSAP's community partnerships covered a diverse array of communities, from Alaska to Puerto Rico and from major metropolitan areas to small towns and rural areas. While every community is unique, from the standpoint of prevention strategies, a helpful fourfold typology emerged from communities that were studied intensely:
Type A:
Middle- or working-class communities ("resource-rich"), where drug problems were considered either to be newly rising or beginning to reach unacceptable levels (e.g., whole metropolitan areas or medium- to large-sized cities or bedroom suburbs).
Type B:
"Resource-poor" communities (a large portion of residents with incomes below poverty levels or low levels of public services), where drug problems were considered either to be newly rising or beginning to reach unacceptable levels (e.g., rural poverty areas or urban ethnic neighborhoods).
Type C:
Communities where drug use had been high and chronic for a long period of time (e.g., low-income communities with high unemployment).
Type D:
Communities where any of the other three types of communities are combined with a local economy in which drug production* is a significant component.
These four types potentially reflect differing prevention needs and therefore strategies, as "no one shoe fits all."
For instance, many communities were just detecting new waves of drug abuse during this era, especially illegal drug use by youths, new forms of drug trafficking, and crimes related to substance use. These new problems encouraged many communities--some resource-rich (Type A) but others resource-poor (Type B)--to take action.
Other communities had suffered from chronically high levels of drug use and accompanying social ills--for instance, poverty, abandoned housing, high crime, and high juvenile delinquency rates (Type C). These communities may have been seeking change for a long period of time, and the resources available through the Community Partnership Program represented one more opportunity to address pressing community problems.
Finally, some communities relied heavily on drug production, either licit or illicit, to support the local economy, with many residents deriving income from the drug-producing activities (Type D).
Different prevention strategies appear relevant in these four different scenarios. A challenge to all community partnerships is to define their community type and plan their strategies accordingly.
Future partnerships may want to consider different prevention strategies, depending on the type of community:
Since Type A communities already have viable prevention infrastructures, partnerships should develop high awareness activities, increase the coordination within the existing infrastructure, and promote the implementation of supportive local policies.
Type B communities lack the resources available to Type A communities, and thus, while supporting local policies that do not require a well-developed infrastructure, also need to focus on developing this prevention infrastructure.
Type C communities, where drug use has been high or chronic, should develop a strategy that centers around resident mobilization, combined in some cases with explicit efforts to both 1) restrict the supply of drugs and 2) reduce possible antagonisms between residents and service providers. These communities also need to work on relevant policies and infrastructure development.
Finally, Type D communities should address the need to reduce the mixed messages its residents often receive, in addition to possibly working on restricting the supply of drugs.
To capture the spirit of a community partnership in action, a general "open-systems" model (which reflects an organization continuously affecting and affected by its contextual environment) was developed.
The basic components of the framework, which collectively depict partnership prevention theory, fall into a presumed causal sequence:
Partnership Characteristics and
Partnership Capacity are presumed to work in interactive phases (P1, P2, P3, etc.) with
Community Actions and Prevention Activities, which in turn produce
Immediate Process and Activity Outcomes and then
Substance Abuse-Related Outcomes, together with
Community Outcomes and
Reduced Substance Abuse Behavior, all within a
Contextual Environment.
This framework was used by the Cross-Site Evaluation and many local evaluators associated with individual community partnerships. The framework was later tested with actual data collected from the partnerships. The results affirmed the major tenets of the framework, with statistically significant findings. Partnership activities--not just prevention activities--were most directly related to the partnerships' ability to attain desired goals. Prevention activities also were significantly related to the attainment of goals, but they were less important than partnership activities.
Model partnerships exhibited the desired partnership features and also achieved statistically significant reductions in drug use relative to their matched comparison communities. Five of the 24 partnerships met these criteria and were therefore considered models worth sharing and emulating.
The models came from three of the four community types--resource-rich communities with emerging drug problems (Type A), communities with chronic drug problems (Type C), and communities where drug production is a significant part of the economy (Type D).
Summary of Five Model Partnerships
Economics/ Substance Use Problem
Population and Ethnicity
Prevention Approach
SPRINGFIELD, MO
Midwestern metro area
Renewed growth, though poverty rates higher than statewide averages; youth alcohol problems
240,000; 95% white
Multiple activities and service coordination
LAKE COUNTY, IL
Large suburban county in the Midwest
Diversity in incomes; youth alcohol and rising problems with illicit drug use
500,000; 83% white
Large-scale support for "mini"-partnerships
EL PASO, TX
Southwestern city
25% below poverty level; drug trafficking
590,000; 70% Hispanic
Grassroots organizing of neighborhood task forces
SOUTH CENTRAL LOS ANGELES, CA
Area within large western city
High rate of juveniles living in poverty; high rates of drug use in the
city
600,000; largely African American with large proportion of Hispanics
Intense advocacy of policy changes
KNOX, LAUREL, AND WHITLEY COUNTIES, KY
Southern rural counties
High poverty rate; marijuana trade seen as a key part of the economy
110,000; almost 100% white
Coordination among social service agencies
The five model partnerships operated in different types of communities.
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