This unit is intended to provide the partnership teams with a common framework for thinking about community prevention planning and evaluation. The proposed planning process merges several elements important to the work of partnerships that are well known but not usually merged: community prevention of ATOD abuse; phases of program planning and evaluation; active and wide community participation in planning, implementation, and evaluation; and strategic-planning processes. Such a planning process can serve as a kind of map or guide for both the work of the partnerships and this Institute. It is intended that partnerships will examine their ATOD abuse prevention efforts from time to time in terms of how they blend these important elements together.
Describe a prevention planning and evaluation process that shows community participation in each phase of planning and implementing ATOD abuse prevention strategies.
Describe the major phases of planning and how they are related to evaluation.
Use the same planning process as a kind of road map through the many activities of the Institute.
This unit shifts gears from the preceding units, moving away from each team's individual vision of its partnership's future to a common frame of reference for planning among all the teams at the Institute. The present unit provides a central orientation point for the rest of the units in the Institute.
Because this unit is very content dependent, it is structured as a straightforward presentation, to be delivered briskly, with only enough additional material to clarify or enliven the session. If the trainer wishes to use a more interactive presentation, he or she will need to prepare carefully, time the presentation, and decide how and when to use interaction with the participants at places not indicated by the text.
For trainers who are familiar with the material, the objectives can be achieved in the time allotted with an interactive process that relies primarily on sheets of newsprint that correspond to each part of the planning process. In this scenario, the trainer would ask the participants a series of questions about planning and evaluation and note the answers on the appropriate newsprint sheet until there were items on each part of the planning process. The presentation would then largely fill in the blanks and use the transparencies. This approach means that the trainer would need to be able to sort each response from participants immediately into the correct part of the process, with the likelihood that disagreements would arise about where some responses from the participants "really belong."
In addition to the articles in the Trainer Resource Manual, the following articles may prove useful to trainers in delivering this unit:
Kreuter, Marshall, L.W. Green, and Matthew Kreuter. (1991). Case studies in health promotion: Practical application of PRECEDE/PROCEED, Case 1. Injury Prevention in Wood County. The World Health Organization Collaborating Center for Research, Training, and Eradication. (1991). "Guidelines for Health Education and Community Mobilization in Dracunculiasis Eradication Programs." Centers for Disease Control, Atlanta, GA.
Price, R.H., and S.S., Smith. (1988). Guide to Evaluating Prevention Programs in Mental Health. DHHS Pub. #(ADM) 85-1365.
Bryson, J. M. (1988). An effective strategic planning approach for public and nonprofit organizations. In Strategic planning for public and nonprofit organizations. San Francisco: Jossey-Bass, 46-70.
Gibbs, J., and S. Bennett. (1990). Together we can reduce the risks: A conceptual framework for planning comprehensive prevention programs. Seattle: Comprehensive Health Education Foundation.
Green, L.W., and M.W. Kreuter. (1991). Health promotion today and a framework for community planning. In Health promotion planning: An educational and environmental approach. 2nd ed. Mountain View, CA: Mayfield Publishing, 1-33.
Manger, T. H., J. D. Hawkins, K. P. Haggerty, and R. F. Catalano (in press). Mobilizing communities to reduce risks for drug abuse: Lessons on using research to guide prevention practice. Journal of Primary Prevention.
McLeroy, K. R., D. Bibeau, A. Steckler, and K. Glanz. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15:351-377.
A. Begin with a light touch by asking the participant group:
"How many of you in the room consider yourselves planners?" (Ask for a show of hands.)
"How many are evaluators?"
"How many have a best friend who is a planner or an evaluator?"
"How many of you would like to be planners or evaluators?"
Content Points
B. This session is not designed to turn participants into either planners or evaluators. It is an overview of ATOD abuse planning and evaluation. The process to be described underpins:
CSAP's view of the partnership grants; and
The content and structure of this Institute.
C. The planning process emphasizes health promotion and education and systems approaches.
It is based on, and adapted from, the work of Larry Green and Marshall Kreuter.
It does not represent any "official" CSAP policy, nor is it "the" approach.
It does embody sound principles of prevention planning and differs in some important ways from traditional program planning.
D. This session will outline the planning process in 5 phases. Details will be held to a minimum during the next half hour or so, but there will be several sessions of training devoted to these details and time for discussion later in the week.
E. At community meetings, the question of how each day's training is linked to this planning and evaluation process will be addressed.
Trainer Note: Present this lecture briskly. The intent is not for participants to learn details but rather for them to understand what the phases are; how they relate to each other; how evaluation is integral to planning; and how and why communities should be involved in both planning and evaluation.
Content Points
A. ATOD abuse prevention has twin aims (T-1: Aims of ATOD abuse Prevention):
Voluntary actions that people can take on their own-individually or collectively,
As citizens looking after their own health, and
As decision makers looking after the health of others and the common good of the community.
Complementary social and political actions that will facilitate the necessary organizational, economic, and other environmental supports for the conversion of individual actions into healthy lives.
B. For each ATOD abuse issue targeted, partnerships must determine that issue's
Urgency,
Causes,
Variability, and
The degree to which individuals want to and can control the determinants of that ATOD abuse issue.
C. The CSAP partnership grants are community grants because there is much research to show that long-term impact, depth of effect, and solidness of changes are closely tied to the extent of active participation of those communities and cultural groups directly affected by the problem.
D. The grants are planning grants because experience and initial research findings provide a thoughtful foundation for a systematic, forward-looking, coordinated approach to ATOD abuse prevention.
E. Thus, the general purpose of the partnerships is participatory community prevention planning.
F. This training will use a planning and evaluation process that will (T-2: Purposes of the Planning Process):
Serve as a framework for thinking about ATOD abuse problems and strategies for preventing ATOD abuse;
Show how the different phases of planning fit together;
Show how evaluation is tied to planning; and
Illustrate community involvement in partnership planning and evaluation.
G. This process will be called the Green/Kreuter planning process, framework, or model, after the authors whose work forms the basis of the process described here.
H. A chart of this planning and evaluation process will be posted in each of the training rooms to be used as a reference point or road map to show where training is headed throughout the week.
The first phase of this planning and evaluation process calls for discovering the nature and extent of the ATOD abuse problems to be prevented. It is a critical phase because it gives form and substance to the prevention goals and objectives and to the strategies selected. Thus, this phase shapes the entire partnership planning effort (T-3: Planning Process (1)).
This phase is similar to the early steps in other planning processes: determining broad problems and needs. However, this phase includes some activities not found in some other approaches.
B. Community Involvement
This phase involves the community in defining and determining the nature and extent of ATOD problems in the community.
This provides an important "subjective" view of problems and needs and allows for the expression of the goals and aspirations of the community.
Problems are defined typically in terms of family disruption, lack of jobs and unemployment, drug-related crime, lack of housing opportunities, days lost from school or work, and other "quality of life" issues.
Directions
Ask participants to list some reasons why community involvement in planning is important. Write these on newsprint. If the following points have not been mentioned, add them:
Ensure that processes of community development occur, especially ownership and a sense of responsibility for taking action.
The process can begin at the earliest stages, while the definition of ATOD abuse prevention problems is still fluid enough to be influenced by such participation.
Content Points
Community assessment can be done in a variety of ways through participatory community processes. This topic is covered in its own workshop and is addressed at several times during the week.
C. Professional Assessment
The other activity in Phase 1 is the determination of the prevalence of ATOD abuse and associated problems in the community, both in the total population and among specific groups.
This a "professional assessment" because specialized training is required to locate and assess the pertinent data and documentation.
Because this activity relies on systematically obtained data, it may be called an "objective" assessment.
Directions
Cite 2 or 3 examples of how problems are typically defined:
Rates of death or disability due to drugs and alcohol;
Patterns of ATOD abuse-related hospital admissions or arrests and injuries;
Numbers of children diagnosed with fetal alcohol syndrome;
Indicators of economic and social deprivation, and neighborhood and community disorganization; and
Norms and laws that facilitate use and availability of alcohol, tobacco, and other drugs.
So, Phase 1 of the planning process recognizes the importance of both community and professional perspectives about what the problems are.
D. Synthesizing community and professional assessment
Occasionally, a partnership may face the task of involving a community reanalyzing problems after these have been defined and strategies started. In such cases, to ensure a sense of community ownership and responsibility for action, the partnership may use participatory processes to involve the community in:
Ranking problems;
Examining the criteria already used to determine what ATOD problems were important;
Looking at the assumptions made about the ATOD abuse cause-effect relationships; and
Validating these criteria and assumptions.
Phase 1 should not only define the problems the partnership is working to affect, but should also develop a positive vision of the future related to the needs, problems, and aspirations of the community (T-4: Planning Process (2)).
E. Evaluation
In most planning models, how evaluation fits with planning is the last topic addressed. But this planning process gives evaluation equal standing. Evaluation is seen as integral and parallel to the planning process. The two activities go on side-by-side, one looking forward, the other looking back.
The questions to be answered by evaluation are distilled from, and related to, each phase of planning.
Both evaluation and planning begin with asking the right questions. In this phase:
Planning asks the question: "What will be the effects of our prevention work on the community's perceived problems and on the prevalence or incidence of ATOD abuse?"
The evaluation asks two questions:
"What were the effects of our work?" This is impact evaluation. (T-5: Planning Process
(3))
"How did the partnership achieve those effects?" This is part of process evaluation. (T-6: Planning Process (4))
The principles of participation that pertain to evaluation are also involved in planning. As one researcher said, "successful evaluation hinges . . . on building ownership among all those who are involved in the process."
Participatory evaluation is covered in a concurrent workshop.
A. In the next phase of planning, the partnership builds on the results of Phase 1 (T-7: Planning Process (5)).
B. The first task in Phase 2 is to analyze the problems identified in Phase 1 to define, analyze, and select the targets to be used for prevention strategies and programs. This involves analyzing the causes of the problems or the relationship among factors implicated in them. The analysis attempts to pinpoint 2 things:
Individual behaviors related to ATOD abuse; and
Environmental factors that affect individual behaviors.
C. The ATOD abuse behaviors of individuals in the community that, taken together, constitute the problems identified in Phase 1 are the first focus of analysis:
This analysis aims to break each set of ATOD abuse behaviors into smaller elements.
This step is needed in order to make more precise the strategies and programs likely to prevent those behaviors.
Trainer Note: As an example, ask the participants to name some of the individual behaviors involved in high rates of alcohol use among junior high school youth.
D. The environmental causes are those factors that, though thought to contribute to individual behaviors, are difficult or impossible for individuals to control.
Trainer Note: Ask participants to name some of the environmental factors involved in high rates of alcohol use among junior high school youth.
E. Definitions of these factors are in the Participant Manual in HO-1 (HO-1: Behavioral and Environmental Factors).
Trainer Note: In this unit, it is better not to direct participants to look at handouts in Participant Manuals because of the natural tendency to search for and read them. Doing so would deflect participants' attention from the main parts of the planning process. The handouts here are to be read and digested outside of the training.
F. Awareness by the community and the partnership of the behavioral and environmental factors involved in ATOD abuse does 2 things for the community and the partnership. Such awareness:
Encourages realism about the limitations of ATOD abuse prevention directed toward personal behaviors; and
Enables the community and partnership to recognize that powerful social, cultural, organizational, and policy forces predispose, support, and reinforce those individual behaviors.
Opens many more lines of strategy development aimed at affecting these influences as part of a comprehensive prevention planning approach.
Multiple, concurrent strategies directed not only at changing individual behaviors but also the environmental factors make it much more likely that the prevention effort will have a successful impact on ATOD abuse problems identified in Phase 1.
G. As the planning process unfolds in this stage, people may lose sight of the forest for the trees. It is the whole vision-hopes, problems, etc.-that the partnership is trying to address, not just specific factors.
H. The factors selected to be addressed by the partnership should be chosen with a view toward their cumulative effect. The question is: Are the factors, tackled all together over time, likely to produce the changes embodied in the vision?
I. Phase 2 results in the formulation of a set of overall goals for the partnership in terms of intended reductions in the:
Rates of abuse of alcohol, tobacco, and other drugs;
Indicators of ATOD abuse-related crime, safety, and health problems; and
Number and extent of risk factors within the community.
J. The questions to be answered in this phase are:
For planning: "To what extent will our partnership's work affect the behavioral or environmental factors implicated in the ATOD abuse problems in the community?"
For evaluation:
"To what extent has our work affected these things?" This is called outcome evaluation (T-8: Planning Process (6)).
"How did the partnership achieve that effect?" This is part of process evaluation (T-9: Planning Process (7)).
K. Process evaluation is called for in both Phases 1 and 2. The basic questions are the same: What were the processes involved? Who did what, when, how?
A. Phase 3 of the Green/Kreuter planning process calls for the partnership to carry its analysis of the behaviors and environments of Phase 2 to a deeper level. Based on this deeper analysis, the partnership will set its specific objectives (T-10: Planning Process (8)).
B. Research and experience have suggested or identified hundreds of factors that could influence ATOD abuse-related behaviors.
C. In a traditional planning process, the complex task of deciding which factors to focus on is often done by staff. The Green/Kreuter planning process calls for the involvement of the community.
D. Phase 3 of the planning process focuses on the influences on targeted behavior and environments.
E. Several kinds of analytic frameworks could be used for this purpose. The Participant Manuals have some further information on these influences (HO-2: Definition of Types of Factors).
F. Analyzing and categorizing these factors leads the partnership and the community to decide which influences deserve the highest priority as objectives for the ATOD abuse prevention effort.
G. These objectives give direction to the development of comprehensive, coordinated, multilevel, extended strategies.
H. The questions to be answered in this phase are similar to those in Phase 2:
For planning:
"To what extent will our partnership's work affect the factors underpinning the behavioral or environmental targets selected?"
"How will we meet the targets we selected?"
"What are the strategies and activities we will use and how can we ensure that they will affect the targeted behaviors and environments the way we want them to?"
For evaluation:
"To what extent has our work achieved the objectives we set, and the goals we defined, so that our work had the impact that we wanted it to have?" Outcome evaluation (T-11: Planning Process (9)).
"How did the partnership achieve that effect?" "Did we do what we planned to do in the ways we planned to do it?" Why? Why not? Process evaluation (T-12: Planning Process (10)).
I. Once again, process evaluation is called for in this phase, as in every phase of this planning process.
J. Definitions of the levels of evaluation are in the Participant Manuals for this unit (HO-3: Definition of Evaluation).
A. After setting objectives, the next phase in most planning models is developing and implementing strategies to reach those objectives.
B. However, this planning process includes another phase that affects what and how strategies are developed.
C. This fourth phase calls for the partnership to study the internal and external environments within which it does its planning (T-13: Planning Process (11)).
D. An assessment of the internal environment of the partnership is a study of its own inner workings. It might cover such things as the partnership's strengths and weaknesses, its capabilities and resources, and the policies and circumstances prevailing in the partnership that could facilitate or hinder the development of effective ATOD abuse prevention strategies. Some aspects of this internal environment are:
The representativeness of the partnership (i.e., how faithfully and credibly it reflects the various cultures and groups composing its community);
The mechanisms used for ensuring the active involvement of all representatives in the partnership's decisions and actions;
The organizational policies and procedures needed to support the effort or the policies that need to be changed to enable the initiative to proceed and to succeed; and
The budgetary, staff, and organizational resources needed and available to implement strategies.
E. A partnership also benefits from scanning and analyzing its externalenvironment. This environment includes:
The organizations and groups that have an interest, or stake, in the community's prevention work (i.e., its stakeholders); and
The threats to, and opportunities for, the partnership's prevention planning posed by these stakeholders.
F. The assessment of internal and external environments often generates organizational development targets, objectives, and strategies by which the partnership will address barriers, strengths, threats, and opportunities.
G. The assessment of the environments of the partnership often leads to a reconsideration of goals and objectives. It often also results in developing new objectives focused on the partnership itself and on long-term issues.
H. Because there are no direct and substantive ATOD abuse impacts or outcomes flowing from this phase, there is no impact or outcome evaluation. But since this phase is part of what the partnership does, it is subject to process evaluation (T-14: Planning Process (12)).
I. The partnership would benefit from a process and a timetable for periodically revisiting each phase of the planning and evaluation process.
Trainer Note: Assure participants that there will be ample opportunity for teams to address details of this subject throughout the week. Many of the team sessions are devoted to this phase.
A. After setting the objectives for the partnership and assessing the environments, the partnerships develop and implement strategies to reach those objectives (T-15: Planning Process (13).
B. Strategies rest on the systematic processes and tasks in the first 4 phases of the planning and evaluation process.
C. It is in this phase that programs and activities thought to achieve the behavioral objectives and the strategies to tackle the environmental objectives are selected and given shape.
D. This topic will be covered in more detail tomorrow morning in session, and at other times during the week.
E. As is true of all the phases of planning, it is necessary to evaluate the processes involved in devising and implementing strategies (T-16: Planning Process (14)).
A. By reference to the transparency of the entire planning process, the trainer should briefly:
Recap each phase;
Point out that the process evaluation covers every aspect of the planning process; and
Mention that planning moves from problem definition to strategy development, while evaluation moves from implementation back to the problems in the community.
B. A chart of all of these phases (T-17) will be posted in each training room to use as a point of reference for the rest of the Institute.
C. In the community meetings on each day of the Institute, trainers will show where each aspect of training fits in this planning process.
D. The next unit will give you a chance to apply the planning process to your partnership.
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