Communities that Care under US spotlight

Evidence about the longer-term performance of the latest generation of community-driven public health interventions is beginning to filter into the research literature and to fill the gaps left by earlier, inconclusive evaluations of pilots and demonstration projects.

On such example is Communities that Care (CtC). It looks like many other large-scale efforts devised during the last two decades to improve the lot of children, but it is set apart by being at once more structured and more flexible than many of the rest.

CtC does not deliver services itself, but aims to activate change. It takes a collaborative approach, involving community leaders from government, social services, and education and tries to prevent health and behavior problems among teens before they start by offering an array of programs for children and families.

A University of Washington research team is following the progress of 12 US CtC efforts that date back to 2003. They recently compared their progress to that of 12 similar non-CtC communities by collecting data from 534 community leaders.

Although CtC and the comparison communities were similar in their use of prevention and collaborative strategies in 2001, the CtCs increased their use of these strategies between 2001 and 2004 and did so to a greater extent than the comparison communities.

So far, so good, according to the assessment team, who will continue to monitor the communities to learn whether the CtC activity leads to significant improvements in the lives of young people.

Developed by J. David Hawkins and Richard F. Catalano of the University of Washington, CtC is being implemented in communities across the US and the UK. The process begins with a survey of local young people to identify common problems and common strengths (“risk and protective factors”) among adolescents.

Based on this information, community leaders select tested, effective preventive interventions that address the specific concerns of local youth. Over time, repeated assessments of risk and protective factors are used to evaluate the effects of the prevention service system and to guide future planning. So while the design process is quite rigid, the service system it creates differs from community to community.

The University of Washington research approach may sound cautious, but it could resolve some of the uncertainties that remained after researchers at Sheffield University monitored the progress of the first three CtC programmes in England and Wales. There the program's potential to make a difference to how local preventive services are planned and delivered was readily acknowledged, but too much variation in the pattern of implementation meant that their effectiveness could not be conclusively established.

Since December 2006 CtC work in the UK [1] has been an activity of the Rainer charity [2]. It has been implemented in more than 50 locations.

• Click the link for more on the Communities That Care system in the US [3]

Summary of “Effects of Communities That Care on Prevention Services Systems: Findings From the Community Youth Development Study at 1.5 Years” by Eric C. Brown, J. David Hawkins, Michael W. Arthur, John S. Briney and Robert D. Abbott in Prevention Science, Volume 8, Number 3, September, 2007, p. 180-191.