Latest studies of the the effectiveness of the Communities that Care (CtC) operating system as a vehicle for programs to help young people sidestep the pitfalls of their adolescence are showing modestly successful results.

Mark Feinberg and his colleagues at Penn State and Kansas universities report in Prevention Science that among the 120 communities in Pennsylvania that have implemented CtC as part of a statewide roll-out which began in the mid 1990s, levels of risk factors have increased more slowly and levels of protective factors have declined more slowly.

Outcomes for adolescents who had contact with the community coalitions the CtC system brings into being improved in terms of their lower delinquency rates and better academic performance. Small gains in a territory of small gains, seems to be the overall verdict.

Communities that Care engages and emboldens community leaders in neighborhoods afflicted with economic deprivation, community disorganization and high crime rates.

The third-party prevention programs it makes available and helps to manage address needs or risk factors through the activity of a "key leaders group" made up of multi-agency professionals. The group devises an action plan which draws down appropriate model programs from the CtC menu.

Developed by David Hawkins and Richard Catalano inside the Social Development Research Group at the University of Washington, Seattle, CtC is in place in more than 400 US communities, as well as in the UK, where more over 30 initiatives have been launched, and in parts of continental Europe and Australia.

Feinberg and his team confirm the value of CtC particularly as a way to guarantee the sustainability (staying power), and faithful implementation (fidelity) of program implementation in real-world settings.

They also consider it to be a strategy whose time may have come. With the global economy in a parlous state, and drastic public spending cuts inevitable, being able to invest confidently in CtC in order to reduce the enormous costs associated with combating adolescent substance abuse, delinquency and other problem behaviors becomes an increasing attractive proposition.

In the Pennsylvania trial, effect sizes for risk and protective factors ranged from small to moderate. For instance, smaller effects were found for factors such as group differences in the "perceived availability of drugs and firearms" (d= .09), whereas, larger group differences were found in relation to academic grades (d= .32), antisocial peers (d=.27) and school prosocial support (d=.35).

The researchers attribute the smaller effect sizes to using a prevention program unsuitable to the particular risk factor identified. Relatively large effect sizes on the other hand, for example in relation to prosocial involvement, were observed, they say, probably because relevant universal programs were available in school.

The Pennsylvania study had some acknowledged limitations. Communities were not randomly assigned to receive CtC; rather they made a choice from the state's training and support program.

The researchers see some virtue in self-selection: "Unlike most randomized trial efficacy trials, the effectiveness study did not involve high levels of researcher involvement and oversight in program implementation. The positive findings reported indicate that CtC is not only efficacious, but is effective under 'real world' conditions."

Other hindrances included that fact that the study team were unable to identify new adolescent arrivals in CtC communities, also that the comparison was between communities that used alternative prevention services, rather than none at all.

Self-report was relied upon for the adolescents' judgment about whether CtC had worked for them, and there was a lack of evidence about the system's impact on substance abuse.

The cost benefit argument was more forthright. Analysis by the Washington State Institute for Public Policy found a return of $7.82 for every dollar spent and a cost benefit of $5,805 for each youth participating.

Another generally upbeat verdict on Communities that Care is reported in the current edition of the Journal of Community Psychology. Its focus was the Community Youth Development Study, a randomized controlled trial conducted in 12 pairs of communities across Colorado, Illinois, Kansas and Maine since the fall of 2002.

In that case, the originating Social Development Research Group investigated the effectiveness of CtC coalitions as a vehicle for prevention initiatives, in particular the objectives of the US Center for Substance Abuse Prevention's Strategic Prevention Framework.

David Hawkins and his team found that their own creation was generally more successful than any equivalent approach used by the control groups.

But they were disappointed to discover that there was little crossover between CtC and other preventive coalitions operating simultaneously among organizations represented in the intervention group.

Diffusion theory suggested that useful innovation was contagious, David Hawkins and his colleagues write. Perhaps they had underestimated how long it was likely to take.

See: Jones D, Greeberg M T, Osgood D W, Bontempo D, "Effects of the Communities That Care Model in Pennsylvania on Change in Adolescent Risk and Problem Behaviors" Prevention Science, DOI 10.1007/s11121-009-0161-x, published online 18 December 2009, and Arthur M W, Hawkins J D, Brown E C, Broney J S, Oesterle S and Abbott R D, "Implementation of the Communities That care Prevention System by Coalitions in the Community Youth Development Study" Journal of Community Psychology, Vol. 38 No. 2 pp 245-258. DOI: 10.1002/jcop.20362.