Susan David
Our panel members are Biddy Bostic and Lynn Evans from the National Prevention Network and the West Virginia Division on Alcoholism and Drug Abuse, and Phil Saltzman, who is from a community coalition in Boston. Dr. Mary Ann Pentz will respond to the panel and clarify some areas.
Biddy Bostic
I am the acting prevention coordinator for the West Virginia Division on Alcoholism and Drug Abuse, and for the past 10 years, I have been a volunteer coordinator for a grassroots, comprehensive community-based prevention program in South Charleston. I will talk about community issues, and Lynn will talk about the State aspects.
I concur with what has been said about the myth that you can "build it and they will come." They will not come. But if you let them build it themselves and help them build it, then it belongs to the community, and they will come. When members of the community have a vested interest in a program, it is theirs.
A program must be comprehensive in scope with a strong no-drug-use message. It must be both community-based and school-focused because that is where the kids are. A program must be multifaceted, and the methodologies have to link. A program must also support a social development strategy to give people opportunities, skills, and the recognition they need.
The one area I cannot emphasize enough is training, because with training, the community becomes its own expert. It is wonderful to hear about all of the research and all of the money that is being spent. But for a grassroots community that has little money, you train the folks to do the training, which makes it so much easier.
In Appalachia, sometimes it is not easy for outsiders to come in and do training. A strong community program must have one particular component - community mobilization. Community members need to know why they need to mobilize, and a needs assessment must be done so that they can figure out the problems.
I would also like to mention the importance of peer programs, parenting programs, and the DARE program, which is wonderful, especially when used in collaboration with other programs. I cannot speak highly enough for peer education. When you train a kid to go in and train, you are not only training that kid, you are training his or her children and their children's children. You begin to change norms, including individual, school, and community norms. Not only do you want input from youth, but also you want their empowerment.
A program should cover the lifespan, including preschools, primary schools, and secondary schools; the rest will follow. It also should be school-curriculum-based with outside resource programs - a collaborative effort. It has to be multicultural and multigenerational, with an evaluation that is easy to conduct. Volunteers want to work with the kids; they do not want to spend most of their time doing paperwork.
A program has to be interactive. Once community members are trained, let them adapt the program to their needs and let them be creative. It is their program, not yours. Researchers/trainers empower the community to empower itself because that is what changes the norms. Prevention is a forever-and-ever reality.
Lynn Evans
I am excited about Dr. Pentz's research, because her work bears out exactly what we have seen in West Virginia. Although there are many community programs throughout West Virginia, we have been working toward a comprehensive approach for about 12 years, long before "comprehensive program" was a buzzword. Our findings were exactly like those of Dr. Pentz, who did the research and put it down on paper for us. We have not had the money to do that up to this point.
We also found that although there are many programs out there, we have to work with communities to create a comprehensive prevention strategy; otherwise, it does not work. If we empower the communities, they are willing to do
it themselves. We do not need to do it for them. They will do the programs, and they will do the prevention as long as we give them the guidelines.
We can use the research we have been given today to go back to the communities that need some concrete evidence that what we have been telling is them is now based in fact. We have been telling them, because we knew it from our gut, but they needed something concrete.
From a State perspective, I am pleased that there are some long-term studies that are now coming to fruition and that we can use them to look at what are we going to do in the next 6 years and how we are going to make it comprehensive and longitudinal.
Phil Salzman
My experience at the community level - 20 years of public school work and 15 years of community-based prevention work - has taught me that we have to start with the data then translate the data into a framework that average people understand. When we talk about protective factors, we have to use the words that people who care about people use.
The data are the data, and they are framed in a methodology and in a language that is appropriate. It is critical that the program start from that base. Then we need to translate the data, so that as we invite people to participate in health and wellness promotion, they feel that we are meeting them on common ground and that they have the capacity to participate. They have a core set of assets and resources that we often call conventional wisdom - I like to call it the things my grandmother knew.
That does not mean they have to learn a new technology or that we are not reinventing the human dimension and inviting them to participate in a new human experience. Part of what we are doing is inviting them into something. We have to fund and pull together alienated institutions within our community.
We need to have those kinds of discussions with people whose frame of reference is a research base. When we talk about a need for community systems to interface and be multicomponent and collaborative, we have to acknowledge that we have abdicated a certain level of responsibility within our communities to people who get paid to provide that. We have professional people who are paid to care; we used to have neighbors who cared.
Part of what I am advocating is the funding of community-based research. We need to take a look at how multicomponent, intersecting experiences of participation for youth and adults and youth-adult partnerships can remind, redesign, and invent a sense of intentional social purposes. It is important that intentional social purposes get constructed into a belief/vision system that is community-based and that explains to a developing person what it means to be a normal member of that community.
That community may be defined as a neighborhood, public housing building, or other grouping. In my experience, the most powerful thing that people, particularly youth, respond to is that they want to be considered normal. If they are growing up in an environment where the conditions send a message to them that it is acceptable to take risks, to use and abuse substances, to become desensitized to violence within the home and the neighborhood, and if that is what normal is, there is a likelihood that they will participate in those activities.
We also have to acknowledge as communities that addiction and substance abuse exist, and their total elimination may not be a realistic goal. Many community coalitions think they have failed if they have not eliminated substance abuse or chemical dependency, despite making progress against these problems.
On a public awareness level, we have to acknowledge what addiction is, what substance abuse intervention is, what substance abuse prevention is, and how we can craft a community with multiple opportunities to promote health and wellness at different stages of development. Sometimes, relapse prevention is primary prevention for the child of an addict.
Policy is important. I remember clearly a time when we used to throw all of our garbage out the car window because that was normal, it was not against the law, and it was public policy. We did not have an environmental movement when I was growing up. The combination of public policy, public information, social change, and awareness changed that behavior and created a new set of attitudes about the environment and the community we live in.
Much attention should be placed on where the change agent and the change dynamic begin. The approach must be multifaceted from the behavioral, public policy, and community development points of view. We need research into how those intersecting, layering initiatives intersect into the daily life and perception of ordinary people and how that creates a sense of change.
Mary Ann Pentz
I will start with the policy issue. I cannot say for sure, but in light of the results we have seen so far - some new papers are coming out in January 1997 - communities can get faster, better, more supportive policy change if they implement other pieces of programs first, with those programs in a community focused on building up an antiuse norm. That is, if you do it programmatically first, and you get children and their parents to be aware of that antiuse norm in a supportive way, they are much more likely to support policies and policy changes in schools and communities. This is in preference to the other way, which is more punitive, in which a policy is enacted because we have such a bad drug use problem, which causes problems and requires enforcement.
I want to deal with barriers first. One barrier is present when a coalition starts out as a separate entity in a community. One of the best ways to get everybody involved in singing the same message is to get the schools to support your effort.
I will give you a "bad case" example of a small city in southern California when I first moved there. I was asked by a prominent parents' group to monitor what they were doing. They were aggressive, and they did not like the school principal. They started their own Parents Who Care group and were not going to work with the school. It fell flat on its face, and when it got bad press, they could not get the support of the school.
When community leaders are involved in any kind of community organization or coalition, they are usually people who volunteer for a variety of things. They are good people, and we have to make sure that we do not burn them out. One of the ways we have found to prevent burnout is to ask people to make a commitment for no longer than 21/2 years and to build into the last half-year another person they nominate to take their place. If they choose or really push to stay on, that is fine, but they need to see a limit to their commitment in a positive way and build in somebody else to take their place. Also, you have to expect that coalitions evolve over time.
In Kansas City the coalition effort was the Kansas City Drug Abuse Task Force, a political entity that involved the district attorney for the whole midwestern part of the United States, the mayor of Kansas City, and several other people. They had a definite timeline - for political reasons - to finish their objectives at the community level by 1991, which was also the end of our grant period. When they determined they had completed their objectives, they disbanded the group.
It is okay for that to happen, but another possible model is for people to meet after 21/2 years and acknowledge their efforts to design objectives that were achievable within 6 months to 3 years and that would produce demonstrable effects. Now that the end of this period has arrived, what do we want to do with this? More likely, the healthier coalitions will start to change.
In Indianapolis the Community Action Council decided to merge with another group, the Hoosier Alliance, which was sponsored by the Governor's office and other drug prevention entities. They have now taken on the mantle of not only drug abuse prevention but also some violence prevention initiatives. Evolving over time is not a bad thing.
I would also like to talk about the role of the researcher. I do not think communities use good researchers in the best way they could. A National Institute on Alcohol Abuse and Alcoholism monograph addresses this topic if you are interested. I was trained as a clinical and school psychologist, but I was lucky enough in graduate school to have one professor who taught an invaluable yearlong sequence in organizational consultation. It was a University of Texas model, and I learned that a good consultant is one who listens to the audience. When they tell you what they need, you reframe that. Even if you knew what you wanted to offer them, you must have a meeting point with what they tell you they need. Then you say, this is what I hear you saying, and this is the way I think I can help you meet your needs. Part of the role of a researcher should be that of a community consultant, not a paid consultant, but a consultant in terms of reinterpreting what a community says it needs in terms of what a researcher says.
The second role of a researcher should be that of an information broker, which is particularly important if you want to change community policy. It takes a long time, up to 3 years we found, to change policy, and often what will sway the powers that be is how much good information you can bring to the table from research about etiology and prevention and costs. A researcher can help a community coalition do that.
The third researcher role is that of an adviser when needed. For example, if you have five possible school prevention programs and they all look fairly similar to your community coalition, you can consult a researcher to determine the best content to govern decisions about which one to use or which pieces of several to use.
The fourth role, the one typically associated with research, is that of evaluator. But a researcher does not have to be only an evaluator; there are multiple other roles a researcher can play if that person has been trained in drug prevention.
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