Although the intention of universal services is that benefits are shared all round, research has shown that such programs are sometimes not as effective for children at higher risk. In other cases, some universal programs are less effective for low-risk children. Some programs have been found to be effective only for girls or boys, depending upon which risk and protective factors they target. In addition, there is a chance that universal programs may even increase the likelihood of problem behavior in particular groups of children. It is important to know, then, that if a program is delivered universally, it is universally effective.

In many studies of universal programs, it is clear that, on average, the whole community has improved on the targeted outcomes. Although it is important to show large-scale improvement, in order to test whether some groups are benefitting more than others, subgroups need to be compared.

Sabrina Oesterle and colleagues from the University of Washington Social Development Research Group compared the effects of the Communities that Care (CTC) program for boys versus girls, and for children at higher or lower risk for substance use and delinquency.

CTC is a universal program that helps communities to identify their particular areas of risk, find evidence-based programs to target those areas, and evaluate the implementation and effectiveness of the selected programs. The aim of CTC is to empower community leaders to work together to reduce the prevalence of problems for children, using evidence-based programs. This is achieved by targeting risk and protective factors that will affect young people’s potential substance use and anti-social behavior. The system that is developed is intended to address a range of problems across the community, affecting all members, not just a targeted group.

This study was part of a larger trial, in which CTC was implemented in 12 communities that were compared to 12 communities that continued to implement their usual prevention services. The CTC communities each selected different sets of interventions from a list of evidence-based programs, depending on what they identified as risks.

Previous reports from the trial indicated that the CTC system was implemented successfully, including higher levels of evidence-based prevention and community collaboration, than the comparison communities. The results also show that levels of youth offending and rates of initiation of substance abuse were significantly lower in the CTC communities overall.

To look more in depth at whether these effects applied to all children targeted by the CTC implementation, the authors looked for differences between specific sub-groups. In general, the results were encouraging. They indicated that the CTC program was equally effective for most sub-groups, particularly when taking into account previous substance use and targeted risk factors. The program was also equally effective for boys and girls in reducing anti-social behavior.

However, two differences did emerge. The analyses revealed that CTC was more effective for preventing anti-social behavior in children that had not previously offended.
However, the intervention did also reduce offending in the higher risk group but the effects of the program were just not as large.

In general, the effects of CTC were similar for both boys and girls. Nevertheless, the authors found that program was more effective in reducing boys’ use of marijuana that that of girls. The results also indicated that the program was more effective in preventing boys from using alcohol, binge drinking, and the use of smokeless tobacco than for girls.

This study does show that it is possible to design universal interventions that can be effective for a whole community of children and young people. CTC was able to prevent youth offending in boys and girls in equal measure. It was also able to reduce the prevalence of substance use in children who had already started using substances as well as those that had not.

This program also targeted a set of risk factors and was able to show equal effectiveness for those at risk and those not at risk in the community.

The research also demonstrated the importance of finding out whether universal interventions help all members of the community. Some particular groups did not benefit from the program as much as others with regard to particular outcomes. Assessing this can reveal differences in outcomes, which can be addressed by adapting interventions or adding interventions to target those who need additional services.

Communities that evaluate their particular risk factors and target them using evidence-based interventions are likely to be able to have an impact on the community as a whole, but this assumption needs to be continuously evaluated so that the provision of services can be adapted to improve outcomes for everyone equally.

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Reference:
Oesterle S., Hawkins J.D., Catalano R.F., Fagan A.A., & Abbott R.D. (2010). Testing the Universality of the Effects of the Communities That Care Prevention System for Preventing Adolescent Drug Use and Delinquency. Prevention Science, 11, 411-423.