Communities That Care

Program

Overview

Executive summary

Evidence Standard

Supported

Description

Communities That Care (CTC) is a process designed to enhance the healthy development of children and young people. CTC builds community capacity to plan and deliver effective developmental prevention services that are evidence-based and respond to local needs. CTC uses a public health approach to decrease the prevalence of youth-related problems such as substance abuse, violence, mental illness, school failure and antisocial behaviour. Through the training provided, communities develop the skills to identify and minimise the risk factors for these health and behaviour outcomes, whilst simultaneously promoting protective factors, to improve well-being for young people in the community. Communities undertaking the CTC process are provided with extensive training and technical assistance to guide them through five phases of planning and delivery.

Background

Website

http://www.communitiesthatcare.org.au

Development History

Originating in the United States, the CTC process has been adapted for use in Australia by Communities That Care Ltd. (CTC Ltd.), a not-for-profit company. The CTC process was initiated in Australia in the early 2000s as a long term community planning process aimed at preventing a range of health and social problems including alcohol and drug abuse, violence and crime, school failure and community disengagement. The School of Psychology at Deakin University and the Centre for Adolescent Health (part of the Murdoch Childrens Research Institute), located at Melbourne’s Royal Children’s Hospital have been collaborating to provide research and technical support for this best practice initiative, while significant fundraising and administrative support has been provided through the Rotary Club of Melbourne.

Model

How is the program structured and what are the core components?

The CTC process involves five phases of planning and delivery: - In Phase 1 "Get Started" the community works to achieve basic ‘readiness’ for prevention by mobilising the support of key community leaders and stakeholders. - Phase 2 "Get Organised" sees the establishment of a relevant prevention coalition or committee to oversee the CTC process. - Phase 3 "Develop a Profile" is centred around gathering data through the Communities That Care Youth Survey and other sources to provide the community with information about the key risk and protective factors influencing local children and adolescents within the domains of family, school, community, peer groups and at the individual level. A community profile is systematically developed from survey data and other sources to establish local prevention and intervention priorities and health promotion targets. - In Phase 4 "Create a Plan" the coalition selects, and then plans the implementation of evidence-based prevention programs that have been designed to address the selected priorities and targets. - Finally, in Phase 5 "Implement and Evaluate", monitoring and evaluation strategies are implemented to assess the effectiveness of selected programs, and the local community plan overall. A series of training programs, assessment resources and consultations are provided to support communities at each phase of this process.

Delivery Mode

Direct to Recipient

Trainer

Train the trainer

Other (please specify)

Delivery Mode - Other

Local coordinators are trained by CTC Ltd. staff. CTC Ltd. staff deliver training and consulting support to community members.

Are there other versions/variants of this program?

Yes

Please specify names if known

The CTC process is delivered in many countries. The Australian version of CTC aligns closely with international standards.

Operating locations

Where is this program currently running?

Location

In 2016, CTC worked with 12 communities in Victoria, three in Queensland and two in Western Australia.

Australia

Summary

CTC operates within a community e.g. small town, local government area.

Is it currently operating in Australia?

Yes

Has the program been evaluated in Australia? Or are there any plans to trial it in Australia?

Yes

Please provide details of the trial if known

See Rowland et al (2013) www.ncbi.nlm.nih.gov/pubmed/23355674

Aims & outcomes

Focus & Aims

Focus of program

Community connectedness

Educational attainment

Family support

Parental support

School engagement

Youth justice

Child health

Mental health

Other (please specify)

Program Focus - Other

Substance abuse prevention.

Aims / intended outcomes

The CTC process aims to promote the healthy development of children and young people through the prevention of health and social problems including substance abuse, violence, antisocial behaviour, school failure, and depression/anxiety.

The Nest goals

NEST priority directions

Improving Early Childhood Learning & Development

Improving Educational Performance

Improving Physical Health

Improving Social & Emotional Wellbeing

NEST Outcomes

Positive, supportive family environment

Positive parenting practices

Positive, trusted peer relationships and communication

Community safety

Youth not in detention

Youth in employment / training / education

Healthy physical development

Good mental health

Reduced injury deaths

Reductions in teenage pregnancies

Reduced substance use

Reduced youth violence

Parental engagement in child learning

School retention rates

Youth participation in education

Youth feeling able to have a say

Involvement in organised activities

Membership of social/community/ civic groups

Positive sense of culture and identity

Factors targeted

Risk Factors

Behaviour problems

Poor social skills

Poor attachment

Anxiety / depression

Poor early school achievement

Low commitment to school

School failure (low academic achievement)

Rebelliousness

Interaction with antisocial peers

Use of drugs by friends

Sensation seeking

Social withdrawal

Emotional dysregulation

Perceived risks of substance abuse

Parental attitudes favourable to substance use

Harsh or inconsistent discipline

Lack of warmth and affection

Favourable attitudes toward antisocial behaviour

Rewards for antisocial involvement

Low commitment to school

Family conflict or violence

Past /current family antisocial behaviour

Poor family management

Poor family discipline

Low neighbourhood attachment

Personal transitions and mobility

Favourable attitudes toward substance use/abuse

Perceived availability of drugs

Community disorganisation

Community transitions and mobility

Protective Factors

Social skills

School attendance and engagement in learning

Attachment to family

Belief in moral order

Opportunities for prosocial involvement

Parental attachment

Expectations of pro-social behaviour

Appropriate monitoring /discipline / structure / routines

Opportunities for prosocial involvement

Rewards for prosocial involvement

Supportive relationship with other adults

Family harmony

Positive relationships with extended family and/or social networks

Access /availability of community services (e.g. playgroup, health services, childcare and education)

Positive social networks (e.g. peers, teachers, neighbours)

Cultural and faith-based networks

Participation in community activities (e.g. sport, recreation, church)

Rewards for prosocial involvement

Opportunities for prosocial involvement

Clients & delivery

Type

Intervention Type

Universal Prevention (entire population)

Selective Prevention

Client group

Target cohort

Families

Service providers

Teachers

Parents

Mothers

Fathers

Extended family members

Other adults

Carers

Infants and pre-school children

Primary school age children

Secondary school age children

Young adults (aged 18-24)

Allied health/health professionals

Other (please specify)

Target cohort - Other

Communities, local children and adolescents, stakeholders (i.e. service providers, local council, police, schools/school systems).

Special focus population cohort

Mental Health

Other culturally and linguistically diverse (CALD)

Rural and Remote

Socio economically disadvantaged

Age

Early Childhood (3-4) - Preschool

Late Childhood (5-11) - Primary

Early Adolescence (12-14) - Middle School

Late Adolescence (15-18) - High School

Gender of Concern

Male

Female

Delivery model

Please describe what is delivered to the target cohort?

In Phase 4 of the CTC process, the community board prioritises risk and protective factors, and health outcomes based on local data from the community profile. The community then identifies the appropriate evidence-based programs, policies and practices to address these priority areas. As each community's priorities differ, so too will the selected programs for implementation (and therefore training and accreditation requirements for each selected program).

What is the recommended intensity for each of the target cohorts?

A local CTC coordinator is responsible for coordinating CTC planning and implementation activities across a community (e.g. local government area). Each of the five phases involve support from CTC Ltd. for example: a one-day training event; three-days of consulting support; access to tools such as the CTC Youth Survey. Community members would typically attend monthly meetings and three to five training events per year. Services delivered through the resultant Phase 4 Community Action Plans will depend on the programs, policies and practices chosen by the community. Refer to 7.1.

Over what period does the target cohort participate?

To fully complete the five CTC Phases requires around two to three years. The prevention services delivered through the resultant Phase 4 Community Action Plans will depend on the programs, policies and practices chosen by the community. Refer to 7.1.

Program Setting

Home

Primary school

Middle school

Secondary/highschool

Community facility

Recreational facility

Conference/training facility

Other (please specify)

Program Setting - Other

CTC training events occur in a range of settings.

Medium of delivery to target cohort

Classroom

DVD

eLearning

Group

Webinar

Written materials

Other (please specify)

Medium of delivery to target cohort - Other

The CTC process assists communities to develop prevention strategies that result in diverse changes to service delivery

Facilities

Training events for each phase require meeting rooms with equipment necessary for training events e.g. projectors, speakers, whiteboards, internet access for online videos etc.

What languages can it be delivered in?

English

Client resources

What are the training materials for the participants?

The training materials are provided by CTC Ltd. at training events. Community coordinators from registered CTC communities can also access templates and resources through a restricted access portal at www.communitiesthatcare.org.au.

Evaluation & evidence

Evaluation

Evaluation methodology and design

The randomised community trial in the United States showed CTC was associated with reductions in youth substance use and delinquency (Hawkins et al 2009: www.ncbi.nlm.nih.gov/pubmed/19736331).

Number of participants in the evaluated program

The Australian pilot work with CTC began in 2002 in three communities. From 2002 until 2012 the process was implemented in communities where over 10,000 youth have now grown up. Evaluations suggest these youth have been positively influenced by the CTC process.

Are there measures in place to assess fidelity?

Yes

Fidelity Measures - Please specify

The CTC process uses specific milestones and benchmarks to ensure that communities are meeting the required standards. CTC Ltd. Community Relations Officers meet regularly with local coordinators to ensure that all relevant milestones and benchmarks are met throughout each phase of the CTC process.

Evaluation Outcomes

The Australian CTC process has been adapted from the original United States version. CTC has also been implemented in the United Kingdom, Canada, Germany, and the Netherlands. The randomised community trial in the United States showed CTC was associated with reductions in youth substance use and delinquency (Hawkins et al 2009: www.ncbi.nlm.nih.gov/pubmed/19736331). Pre-post surveys in Australia have shown that in the majority of CTC communities, risk factors were reduced, protection factors enhanced and health and social problems reduced with effect sizes similar to the United States trial (Williams J, Canterford L, Cini K, Rajan V, Williams A. (2012) Results from the Healthy Neighbourhoods School Survey: Mornington Peninsula Shire. Melbourne: Centre for Adolescent Health).

Evaluation effect size

0.3

Evidence

Peer reviewed research evidence papers

Greenberg, M.T., Feinberg, M.E., Brendan J., Gomez, B.J., & Osgood, D.W. (2005) Testing a community prevention focused model of coalition functioning and sustainability: A comprehensive study of communities that care in Pennsylvania. In Stockwell, T., Gruenewald, P., Toumbourou, J.W., Loxley, W. (Editors) Preventing harmful substance use: The evidence base for policy and practice. Wiley: London, pp 129 – 142. http://books.google.com.au/books?id=z8vUX2VvPhwC&pg=PA129&lpg=PA129&dq=Testing+a+community+prevention+focused+model+of+coalition+functioning+and+sustainability&source=bl&ots=0Fep0w_IRf&sig=LVynYLurKzt4_ORP1l3cLMIwCw4&hl=en&sa=X&ei=UYzfUd_FFMbGkQW0goGAAQ&ved=0CE4Q6AEwBQ#v=onepage&q=Testing%20a%20community%20prevention%20focused%20model%20of%20coalition%20functioning%20and%20sustainability&f=false Hawkins, J.D., Brown, E.C., Oesterle, S., Arthur, M.W., Abbott, R.D., and Catalano, R.F. (2008) Early effects of Communities That Care on targeted risks and initiation of delinquent behavior and substance use. Journal of Adolescent Health. 43(1), pp 15-22. www.ncbi.nlm.nih.gov/pubmed/18565433 Hawkins, J.D., Oesterle, S., Brown, E.C., Arthur, M.W., Abbott, R.D., Fagan, A.A., Catalano, R.F. (2009) Results of a Type 2 Translational Research Trial to Prevent Adolescent Drug Use and Delinquency: A Test of Communities That Care. Archives of Pediatric and Adolescent Medicine. 163(9), pp.789-798. www.ncbi.nlm.nih.gov/pubmed/19736331

External reference website

Communities That Care Ltd.

Blueprints

Communities That Care (US)

Descriptive papers

Introducing Communities That Care: Helping communities build better futures for children and young people http://www.communitiesthatcare.org.au/sites/default/files/files/images/introducing_communities_that_care.pdf

Are you ready? Community planning to prevent health and social problems for children and young people http://www.communitiesthatcare.org.au/sites/default/files/files/images/ctc_are_you_ready.pdf

Communities That Care: Guide to Australian Prevention Strategies http://www.communitiesthatcare.org.au/sites/default/files/files/images/communities_that_care_-_guide_to_australian_prevention_strategies.pdf

Source

Loxley et al 2004

Has a cost benefit study been undertaken and published?

Yes

Cost benefit study - Please provide references

A cost benefit study is currently underway in Australia. Cost benefit analysis is available for CTC in the United States. For further information please refer to the following: Kuklinski, M. R., Briney, J. S., Hawkins, J. D., & Catalano, R. F. (2012) Cost-benefit analysis of Communities That Care outcomes at eighth grade. Prevention Science, online first Nov 23, 2011; doi:10.1007/s11121-011-0269-9

Implementation

Training

Training Description

The CTC process brings together a diverse range of stakeholders within a local community, with an overarching goal of increasing the community's capacity for prevention. Whilst not all these stakeholders will be actively involved in the implementation of selected evidence-based strategies that address the developmental outcomes of children and adolescents (Phase 4 and beyond), they are integral to the overall success of CTC in the local setting in that they need to understand and support prevention work. There are no minimum qualifications to participate in the CTC process locally.

Training in the CTC process is delivered to communities by CTC Ltd. staff. Communities involved in the CTC process are required to participate in the following training events:

- Community Coordinator Training (Prior to Phase 3): Coordinator and line-manager only - coordinator should have minimum qualifications outlined above.
- Key Leader Orientation (Phase 2).
- Community Board Orientation (Phase 2).
- Community Assessment Training (Phase 3).
- Community Resources Assessment Training (Phase 3).
- Community Planning Training (Phase 4).
- Community Planning Implementation Training (Phase 5).
- Implementation Monitoring Training for program implementers (Phase 5).
- Community Implementation Review (Phase 5).

Can training be accessed in Australia?

Yes

Who delivers the program?

Social Worker

Welfare Worker

Aboriginal Community Liaison Officer

Community Development Officer

Community Worker

Youth Worker

Family Support Worker

Student Counsellor

Counsellor

School Principal

Faculty Head

Primary School Teachers

Secondary School Teachers

Paediatrician

Psychologist

Registered Nurse

Educational Psychologist

Public health/Health promotion worker

Parent

Volunteer

Qualifications and/or licenses

Minimum delivery agent qualifications

Bachelor (Undergraduate) Degree

Are there any licensing or accreditation requirements?

Yes

Licensing or accreditation requirement - Please specify

Communities register as a CTC site (payment of registration fee required) in order to proceed with Phase 3 onward.

Training resources

Is there a manual that describes how to implement the program?

Yes

What are the required materials for the trainer?

At each of the five CTC phases, CTC trainers (i.e. CTC Ltd. staff) deliver training sessions accompanied by specific resources and materials for participants.

Implementation

Are specific assessments required prior to implementation?

Yes

Pre-Implementation Assessments - Please specify

Communities are required to attend all relevant training sessions throughout the five phases of CTC, and meet the relevant milestones and benchmarks.

Are particular tools required for implementation?

Yes

Implementation Tools - Please specify

The Communities That Care Youth Survey.

Overall implementation / resourcing Issues

To start the CTC process, assistance is available to run the Phase 1 events. Phase 1 helps communities to build readiness for prevention which is essential for success in developing a local prevention strategy plan. Once they have completed Phase 2 (developed and trained a local coalition) communities must raise funds adequate to hire a Community Coordinator at a minimum of 0.5 EFT. Communities should identify a local agency to host the Community Coordinator, provide meeting rooms etc.

Scalability

Is the program scalable?

Yes

Scalability comments

The CTC process is designed to be used in a wide variety of communities.

Costs

Setup costs

The CTC process begins with Phase 1 where community champions receive support to develop local community understanding (readiness) of the feasibility and benefits of encouraging a local community prevention approach. The cost of Phase 1 in 2016 is $6,612 (inc. GST) and includes: - a community training event - 10 hours of consulting assistance; support to assess local readiness. All training, consulting and technical support is provided by CTC Ltd. In Phase 2, assistance is provided to community to establish a local Communities That Care Board (coalition). The cost of Phase 2 in 2016 is $9,200 (inc. GST) and includes: - 10 hours of consulting assistance - Key Leader Orientation Meeting; and Community Board Orientation Meeting. All training, consulting and technical support is provided by CTC Ltd. To progress through Phases 3 to 5, communities are required to be registered and to have funds available for at least a 0.5 EFT Coordinator. CTC Ltd. costs associated with progressing through the phases are: - Community Coordinator Training, $5,000 - Phase 3 (including registration), $23,500 - Phase 4, $5,832 - Phase 5, $24,800. In addition, communities should have funds available for implementing selected evidence-based programs. CTC Ltd. recommends a minimum of $22,000.

Ongoing costs

Communities must maintain funds for at least a 0.5 EFT Coordinator. Fidelity monitoring and evaluation can be obtained from program providers at variable costs. Fidelity monitoring of the CTC system is embedded within Phase 5. There is also a five-yearly site registration fee.

Contact

Organisation Contact Details

Name

Ms. Amber Osborn

amber.osborn@mcri.edu.au

Phone Number

+61 (03) 9345 4147

Organisation

Communities That Care Ltd., Australia

Postal Address

Flemington Road Royal Children's Hospital

3052 Parkville, Melbourne , VIC

Leader Contact Details

Name

Prof. John Toumbourou

john.toumbourou@deakin.edu.au

Phone Number

0400 502 938

Organisation

Chief Executive Officer for Communities That Care Ltd., Australia

Postal Address

Flemington Road Royal Children's Hospital

3052 Parkville, Melbourne , VIC

Australian Contact Details

Name

Ms. Amber Osborn

amber.osborn@mcri.edu.au

Phone Number

+61 (03) 9345 4147

Organisation

Communities That Care Ltd., Australia

Postal Address

Flemington Road Royal Children's Hospital

3052 Parkville, Melbourne , VIC

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