John F. Stevenson

Supporting Community-Based Prevention and Health Promotion Initiatives: Developing Effective Technical Assistance Systems

As research evidence for the effectiveness of community-based prevention has mounted, so has recognition of the gap between research and community practice. As a result, state and local governments are taking a more active role in building the capacity of community-based organizations to deliver evidence-based prevention interventions. Innovations are taking place in the establishment of technical assistance or support systems to influence the prevention and health education activities of community-based organizations. Several challenges for technical assistance systems are described: (1) setting prevention priorities and allocating limited technical assistance resources, (2) balancing capacity-building versus program dissemination efforts, (3) collaborating across categorical problem areas, (4) designing technical assistance initiatives with enough “dose strength” to have an effect, (5) balancing fidelity versus adaptation in program implementation, (6) building organizational cultures that support innovation, and (7) building local evaluative capacity versus generalizable evaluation findings.

Sense of community in neighborhoods as a multi‐level construct

Sense of community is a compelling construct that allows psychologists to examine fundamental questions about how individuals are connected to and influenced by their most important social settings. This investigation uses an existing database of 2,409 residents of 21 neighborhoods in a Northeastern city to examine sense of community at the neighborhood level. The investigation used a cross-levels program to examine whether sense of community can be detected at the neighborhood level. The investigation also tested the strength of the relationship of both neighborhood-level variables (i.e., physical attributes and presence of a grassroots neighborhood association) and individual-level variables (i.e., income and education) on neighborhood-level sense of community. Residents of the same neighborhood were more similar to one another than to residents of a different neighborhood on both the neighborhood-related variables and income and education. When variance attributable to the personal resources of income and education were removed, intraclass correlations for neighborhood-related attitudes (i.e., perceptions of neighborhood climate and perceptions of the ability of neighborhood residents to influence neighborhood conditions) remained significant at an alpha level of .05. However, neighborhood-related behavior (i.e., neighboring behavior and participation in a community organization) was no more similar to residents of the same neighborhood than to residents of a different neighborhood. Neither the presence of a grassroots neighborhood association nor the physical characteristics of neighborhoods examined in the investigation were significantly correlated with a sense of community.

Predicting intermediate outcomes for prevention coalitions: a developmental perspective

Abstract Longitudinal data from 35 substance abuse prevention coalitions were used to examine whether success in addressing initial coalition developmental tasks predicted intermediate outcomes one year later. Organizational climate, member skill development and coalition linkages predicted key informants’ ratings of coalition effects on community norms, policies, and prevention resources.

Building evaluation capacity in human service organizations: a case study

Abstract In response to a number of pressures, local human service organizations have been forced to develop greater capacity to evaluate their own programs. This case study reports the efforts of a state-funded evaluation support unit in Rhode Island to increase evaluation capacity in 13 community-based organizations by means of a needs assessment, on-site technical assistance, a workshop series, and selected model projects. Measures of organizational needs, staff confidence, and agency progress in completing evaluation steps are used to document both the successful increase in capacity and the areas of most resistance.

Decisional Balance for Immoderate Drinking in College Students

Immoderate drinking in college is common and is associated with significant negative sequelae. In this study, measures of Decisional Balance for Immoderate Drinking were developed. This construct is proposed to represent the basic decision-making process that is used by students when deciding whether to drink at immoderate levels or not. Furthermore this construct is embedded in a larger model of behavior change, the Transtheoretical Model of Change, which has been shown to be effective in understanding many health-related behaviors across a wide variety of populations. A total of 629 college students were administered a 25-item decisional balance questionnaire in 1993-1994. Exploratory and confirmatory analyses suggested two different solutions, a two-factor solution and a three-factor solution, but did not provide clear evidence for the psychometric superiority of one over the other. The three-factor solution was chosen as it was seen as an elaboration of the two-factor solution, and validity evidence for this solution is presented. The three factors were labeled the Pros, the Cons-Actual, and the Cons-Potential of Immoderate Drinking. The Cons-Actual scale is a measure of negative affective states associated with current drinking whereas the Cons Potential measures the risk of more concrete negative effects of drinking. External validity was established by the significant and meaningful differences on a number of alcohol-related variables including consumption variables, three measures of negative sequelae of immoderate drinking, and Stage of Change, the organizing construct of the Transtheoretical Model of Change.

The Psychosocial Functioning Inventory

The derivation and psychometric analyses of a general purpose outcome/survey instrument—the Psychosocial Functioning Inventory (PFI—are described. The instrument contains scales designed to measure a wide array of constructs, including subjective well-being, social functioning, stressful events, treatment dependency/aftercare, and consumer satisfaction. Extensive reliability and validity analyses are reported, indicating reasonable reliability and validity for the PFI scales.

Community-Level Collaboration for Substance Abuse Prevention.

This paper reviews the literature on the roles of community-wide collaboration in substance abuse prevention. Three broad strategies through which collaboration may have its effects are identified (i.e., building community capacity, increasing service integration, and influencing policy change). Alternative theories of effects, means of measurement, and results and conclusions from studies of collaborative interventions for prevention are discussed. The strength of empirical evidence for the impact of collaboration on substance abuse outcomes varies by strategy, with more support for the logic of policy change. Additional conclusions are offered regarding when and how this approach can work, and what might be useful next steps.

Cultivating Capacity: Outcomes of a Statewide Support System for Prevention Coalitions

Abstract Although community coalitions are an increasingly popular mechanism for attempting to change community-wide health, the empirical evidence has been mixed at best. Technical Assistance (TA) efforts have emerged in greater scale in hopes of improving both programming quality as well as the coalition structures supporting such programs. However, this commitment to TA interventions has outstripped our knowledge of optimal ways to deliver such assistance, and its limitations. This study takes advantage of results from a state-wide technical assistance project that generated longitudinal data on 41 health-oriented coalitions. The following questions were addressed: What are the circumstances under which coalitions will utilize available assistance? What are the effects of technical assistance on intermediate community outcomes? The results suggested that coalitions with greater initial “capacity” used more TA. Coalitions with low utilization mentioned difficulty in identifying their TA needs as the salient reason for not pursuing these resources. Over time, there were significant positive changes in coalition effectiveness as perceived by key informants, but these were not influenced by amount of TA.

Bridging the Gap Between Alcoholism Treatment Research and Practice: Identifying What Works and Why

Despite the proliferation of alcoholism treatment research over the past 2 decades, there is a continued gap between what has been shown to be promising in the extant literature and what is commonly practiced by clinicians in the alcohol treatment field. The present article is an effort to bridge this gap by examining findings from the broad body of alcoholism treatment outcome research to determine how these findings may optimally be used by treatment providers. To this end, the authors provide clinicians with a succinct review of the current alcoholism treatment outcome literature and identify hallmarks of the most empirically supported treatments. Clinical implications of this literature for practitioners working with client with alcohol use disorders are discussed, with a focus on factors underlying effective treatments and on how these factors can be transferred from research to practice.

Through the bullet-proof glass: conducting research in prison settings.

SUMMARY A team of academic researchers, clinicians, prison administrators and undergraduate and graduate students came together to conduct an evaluation of a pre-release discharge planning program in a womens prison facility. This paper describes differences between academic and corrections systems, adaptations needed in order to work within the correctional system, pragmatic and ethical issues addressed by our team, and the joys and benefits we experienced doing the project. Team members who had not previously worked in a prison setting found it an extraordinary, transformative learning experience in spite of the challenges.