IOWA DEPARTMENT OF PUBLIC HEALTH BUREAU OF SUBSTANCE ABUSE Prevention Guide
IOW A DEP A RT M ENT O F PU B LI C H E ALT HBU R E AU O F SU B ST A NC E A B U S EPreventionGuideJ AN U AR Y 2 0 1 9
PREFACE .4INTRODUCTION.5Substance Abuse Prevention and Treatment Block Grant Overview Prevention Set-Aside .5FOREWORD .6Story of the River .6Definition of Primary Prevention/Continuum of Care .7Prevention Priorities FROM IDPH .8Prevention Specialist .8Foundational Skills Prevention Performance Domains .8Ethics . 10Certified Prevention Specialists in Iowa . 14INTRODUCTION TO THE STRATEGIC PREVENTION FRAMEWORK. 15Framework Overview . 15Outcomes-Based Prevention . 16THE STRATEGIC PREVENTION FRAMEWORK . 18Assessment . 18Overview . 18Collecting and Analyzing Community Data . 18Risk and Protective Factors . 19Identifying Disparate Populations . 19Assessing Community Readiness . 20Building Capacity . 21Community Engagement . 21Community Coalitions . 22Required Sectors . 23Planning . 24Public Health Model. 24Types of Prevention Strategies. 26SAMHSA’s Prevention Strategies. 27Intervening Variables & Underlying Conditions. 28Population of Focus . 29Dosage and Frequency . 29Strategic Planning . 29Selecting Programs, Practices, and Policies . 30Effective Strategies Evidence-based Programs, Practices, and Policies . 30Feasibility & Feasibility Checklist . 31Creating Short- and Long-Term Outcomes . 32Creating a Strategic Plan . 32Creating a Logic Model . 33Creating an Action Plan. 33Bureau Prevention Guide1
Communication Strategies . 34Plain Language . 34Media Advocacy through Strategy Implementation . 35IDPH Health Promotion Campaigns . 35Media Campaign Planning and Implementation . 36Reaching the Appropriate Population of Focus . 36Media Articles, Agency-created Materials, and Websites. 37Implementation . 37Balancing Fidelity and Adaptation . 38Feasibility Checklist . 39Establish Implementation Supports . 39Evaluation . 40A Framework for Program Evaluation. 41Sustainability. 43Crosswalk of SPF Steps with Sustainability Milestones and Skills . 43Building Capacity for Sustainability. 49Cultural Competence . 50Skills for Cultural Competency. 51The National CLAS Standards. 51IDPH PREVENTION GUIDANCE . 54Correspondence and IowaGrants.gov . 54Prevention Reporting Requirements . 54Data Collection, Surveying, and Qualtrics. 55Contract Monitoring . 55Distributors and Companies. 55Advocacy vs. Lobbying . 55Unallowable Costs and Services . 56Match . 57Site Visit Process . 58Subcontracts/Work Plans. 58Local Public Health & Board of Health Involvement. 59Iowa Department of Public Health General Conditions . 60Staffing and Personnel Hours of Operation & Service Location . 60PREVENTION ORGANIZATION EXPECTATIONS . 61Policies and Procedures Manual . 61Staff Development and Training . 61Data Reporting . 61Fiscal Management . 61Personnel. 61Job Descriptions . 62Bureau Prevention Guide2
Prevention Specialist Certification . 62Evaluation of Job Performance . 62Personnel Records . 62Child Abuse, Dependent Adult Abuse, and Criminal Background Checks . 63Service Records . 63Quality Improvement . 63Safety. 63CONCLUSION . 64APPENDICES . 65Bureau Prevention Guide3
PrefaceWelcome to the field of prevention. The Iowa Department of Public Health congratulates your agency forembarking on the journey toward creating a healthy Iowa by reducing substance misuse and issuesrelated to problem gambling. The 2019 Prevention Guide provides foundational instruction and bestpractices for implementing prevention services. This tool should be maintained at your agency to ensureadherence to each component provided within this document. Due to the evolving nature of theprevention field, the Prevention Guide will be reviewed and revised by a collective group of stakeholdersevery two years. This group will consist of, but will not be limited to, Iowa Department of Public Healthrepresentatives and contracted agencies.The 2019 Prevention Guide offers comprehensive instruction related to program performance standardsfor service availability and delivery, personnel onboarding and development trainings, fiscal practices,record keeping, and data reporting. Embedded throughout the guide are useful tips and tools to ensurecontract compliance throughout the project period. Each component of this guide has been carefullydrafted to assist your agency each step of the way.Note: Throughout the Prevention Guidance, the term “substance misuse” will refer to alcohol, other drugs (legal and illegal), andtobacco.Bureau Prevention GuidePreface4
IntroductionThis handbook serves as a guide for Iowa Department of Public Health (IDPH)–funded preventioncontractors. The creation of this handbook was funded by the Substance Abuse Prevention andTreatment Block Grant and the Partnerships for Success Grant through the Substance Abuse and MentalHealth Services Administration (SAMHSA) within the U.S. Department of Health and Human Services.SUBSTANCE ABUSE PREVENTION AND TREATMENT BLOCK GRANTOVERVIEW PREVENTION SET-ASIDEThe Substance Abuse Prevention and Treatment (SAPT) Block Grant is distributed by formula to all U.S.states and territories. The grant is the cornerstone of states’ substance misuse prevention, treatment, andrecovery systems. The SAPT Block Grant is administered by SAMHSA, within the U.S. Department ofHealth and Human Services.Federal statute requires states to direct at least 20% of SAPT Block Grant funds toward the primaryprevention of substance misuse. This “prevention set-aside” is managed by the Center for SubstanceAbuse Prevention (CSAP) in SAMHSA and is a core component of each state’s prevention system. Onaverage, SAPT Block Grant funds make up 68% of primary prevention funding in states and territories. In21 states, the prevention set-aside represents 75% or more of the state agency’s substance misuseprevention budget. In six of those states, the prevention set-aside represents 100% of the state’s primaryprevention funding.In Iowa, the Block Grant is called the Integrated Provider Network (IPN), which includes funding fromSAMHSA and state appropriations for substance misuse prevention and treatment, as well as problemgambling prevention and treatment. This funding provides prevention and treatment services for all 99counties in Iowa through 19 service areas.Bureau Prevention GuideIntroduction5
ForewordSTORY OF THE RIVERThis story is often used to illustrate our role as prevention specialists:Two friends, Susan and Fernando, are fishing on a river when Fernando looks upriver and sees a man inthe water. He is struggling to stay afloat, so Fernando drops his fishing pole and pulls the man out of thewater. The man is sputtering and cold, and Susan calls an ambulance on her cell phone to take him to ahospital. Susan and Fernando go back to fishing. Pretty soon they look upriver again and see a woman inthe water. She is struggling, too, so Fernando drops his fishing pole again and pulls the woman out of thewater.She is not in very good shape, so Susancalls another ambulance to take her to ahospital. The friends return to fishingwhen they look upriver and see a wholegroup of people in the water. They arestruggling to stay afloat and look like theyare dragging each other down. Fernandodrops his fishing pole and starts haulingpeople out of the water. He looks up andsees Susan walking away, upriver. Hecalls to her to come help pull people outof the river, and Susan responds that sheis going upriver to find out why all thepeople are ending up in the water.What prevention is:We go upriver to find out what contributes to people misusing substances or experiencing issues relatedto problem gambling. We want to know exactly what is causing people to fall into the river, which may bedifferent from river to river. Perhaps we go upstream—like Susan—and find that a fence to keep peopleaway from the river has fallen and needs to be rebuilt. Maybe we find a slippery slope running into theriver and can plant vegetation to prevent people from falling down the banks. Perhaps we find a big signannouncing, “The water’s great; jump in!” and we can take the sign down and replace it with a warning.We in prevention work to discover what is causing people to misuse substances or engage in high-riskgambling activities in our community, and then we work to reduce those risks and to build protectionsagainst substance misuse and/or problem gambling.Source: Introduction to the field of prevention, The Athena Forum by the Washington State Health Care Authority/Division ofBehavioral Health and Recovery, 2018Bureau Prevention GuideForeword6
DEFINITION OF PRIMARY PREVENTION/CONTINUUM OF CAREThe term primary prevention refers to prevention services that are directed toward people who do notneed treatment. Primary prevention should include a variety of strategies that prioritize populations andtarget populations with different levels of risk. Practitioners need to provide services in each of theInstitute of Medicine (IOM) Model classifications (see below), which categorize preventive interventions bytargeted population. The definitions for these population classifications are: Universal: The general public or a whole population groupthat has not been identified based on individual risk.o Universal Direct: Interventions directly serve anidentifiable group of participants who have not beenidentified based on individual risk.o Universal Indirect: Interventions support populationbased programs and environmental strategies.Selective: Individuals or a subgroup of the population whose risk of developing a disorder is significantly higherthan average.Indicated: Individuals in high-risk environments who haveminimal but detectable signs or symptoms foreshadowingdisorder or have biological markers indicatingpredispositions for disorder but do not yetmeet diagnostic levels.“The term primaryprevention refers toprevention servicesthat are directed topeople who do notneed treatment.”According to the Substance Abuse MentalHealth Services Administration (SAMHSA),a comprehensive approach to behavioralhealth also means seeing preventionas part of an overall continuum ofcare. The Behavioral HealthContinuum of Care Modelrecognizes multiple opportunitiesfor addressing behavioral healthproblems and disorders. Based onthe Mental Health InterventionSpectrum, first introduced in a 1994Institute of Medicine report, the model includes the following components: Promotion: These strategies are designed to create environments and conditions that supportbehavioral health and the ability of individuals to withstand challenges. Promotion strategies alsoreinforce the entire continuum of behavioral health services.Prevention: Delivered prior to the possible onset of a disorder, these interventions are intendedto prevent or reduce the risk of developing a behavioral health problem, such as underagealcohol use, prescription drug misuse, illicit drug misuse, and/or problem gambling.Treatment: These services are for people diagnosed with a substance misuse, problemgambling, or other behavioral health disorders.Recovery: These services support individuals’ abilities to live productive lives in the communityand can often help with abstinence.Source: Substance Abuse and Mental Illness Prevention, Substance Abuse and Mental Health Services Administration, 2018Bureau Prevention GuideForeword7
PREVENTION PRIORITIES FROM IDPHIDPH prevention services typically focus on alcohol, tobacco, and illicit drug misuse, as well as problemgambling behaviors. All prevention strategies must endeavor to impact the established short- and longterm outcomes identified in the agency work plan. All services provided must also align with theinformation listed in the plan. If a community need that was not previously identified arises, contact IDPHto discuss potential next steps for revision of the plan. Priority areas may change based on the fundingavailable.Through the Iowa Integrated Provider Network Grant, IDPH has determined the following priorities forprevention services. Funded grantees are required to provide services across the lifespan of the grant foreach of the following: AlcoholMarijuanaPrescription medicationsProblem gamblingTobaccoOther additional prevention priority areas that will receive specific attention with direction from IDPH havebeen identified, including: MethamphetamineOpioidsSuicidePREVENTION SPECIALISTA prevention specialist is a “professional who uses a specialized set of knowledge, experience, training,and skills to encourage healthy attitudes and behaviors that prevent substance misuse and/or problemgambling. The role of the prevention specialist, as defined by the six Prevention Performance Domains(see below), is to empower individuals and communities to assess needs and to develop and implementstrategies that effectively meet those needs.”Source: Application Handbook for Certified & Advanced Certified Prevention Specialists, Iowa Board of Certification, 2017For more information, please see Appendix A: Application Handbook for Certified & Advanced CertifiedPrevention Specialists.FOUNDATIONAL SKILLS PREVENTION PERFORMANCE DOMAINSThe International Certification and Reciprocity Consortium (IC&RC) has worked with subject matterexperts in the field to identify the critical tasks, knowledge, and skills needed for working as a communityprevention specialist. These essential functions are broken down into six domains:Domain 1: Planning and EvaluationDomain 2: Prevention Education and Service DeliveryDomain 3: CommunicationDomain 4: Community OrganizationBureau Prevention GuideForeword8
Domain 5: Public Policy and Environmental ChangeDomain 6: Professional Growth and ResponsibilitySource: Application Handbook for Certified & Advanced Certified Prevention Specialists, Iowa Board of Certification, 2017The following, shared from the Maine Prevention Certification Board, are key tasks for each domain:Domain 1: Planning and Evaluation Determine the level of community readiness for change.Identify appropriate methods of gathering relevant data for prevention planning.Identify existing resources available to address the community needs.Identify gaps in resources based on the assessment of community conditions.Identify the target audience.Identify factors that place people in the target audience at greater risk for the identified problem.Identify factors that provide protection or resilience for the target audience.Determine priorities based on a comprehensive community assessment.Develop a prevention plan based on research and theory that addresses community needs anddesired outcomes.Select prevention strategies, programs, and best practices to meet the identified needs of thecommunity.Implement a strategic planning process that results in the development and implementation of aquality strategic plan.Identify appropriate prevention program evaluation strategies.Administer surveys or pre- or post-tests at activities.Conduct evaluation activities to document program fidelity.Using evaluation data, identify opportunities to improve outcomes.Utilize evaluation to enhance the sustainability of prevention activities.Provide applicable work groups with prevention information and other support to meet preventionoutcomes.Incorporate cultural responsiveness into all planning and evaluation activities.Prepare and maintain reports, records, and documents pertaining to funding sources.Domain 2: Prevention Education and Service Delivery Coordinate prevention activities.Implement prevention education and skill development activities appropriate for the targetaudience.Provide prevention education and skill development programs that contain accurate, relevant,and timely content.Maintain program fidelity when implementing evidence‐based practices.Serve as a resource to community members and organizations regarding prevention strategiesand best practices.Domain 3: Communication Promote programs, services, and activities, and maintain good public relations.Participate in public awareness campaigns and projects relating to health promotion across thecontinuum of care.Identify marketing techniques for prevention programs.Apply principles of effective listening.Apply principles of public speaking.Employ effective facilitation skills.Communicate effectively with various audiences.Bureau Prevention GuideForeword9
Demonstrate interpersonal communication competency.Domain 4: Community Organization Identify the community demographics and norms.Identify a diverse group of stakeholders to include in prevention programming activities.Build community ownership of prevention programs by collaborating with stakeholders whenplanning, implementing, and evaluating prevention activities.Offer guidance to stakeholders and community members in mobilizing for community change.Participate in creating and sustaining community‐based coalitions.Develop or assist in developing content and materials for meetings and other related activities.Develop strategic alliances with other service providers within the community.Develop collaborative agreements with other service providers within the community.Participate in behavioral health planning and activities.Domain 5: Public Policy and Environmental Change Provide resources, trainings, and consultations that promote environmental change.Participate in enforcement initiatives to affect environmental change.Participate in public policy development to affect environmental change.Use media strategies to support policy change efforts in the community.Collaborate with various community groups to develop and strengthen effective policy.Advocate to bring about policy and/or environmental change.Domain 6: Professional Growth and Responsibility Demonstrate knowledge of current prevention theory and practice.Adhere to all legal, professional, and ethical principles.Demonstrate cultural responsiveness as a prevention professional.Demonstrate self‐care consistent with prevention messages.Recognize the importance of participation in professional associations locally, statewide, andnationally.Demonstrate the responsible and ethical use of public and private funds.Advocate for health promotion across the lifespan.Advocate for healthy and safe communities.Demonstrate knowledge of current issues of addiction.Demonstrate knowledge of current issues of mental, emotional, and behavioral health.Source: IC&RC Prevention Domains, Maine Prevention Certification Board, 2018ETHICSAccording to the Iowa Board of Certification, “All prevention specialists must subscribe to the IBC Code ofEthics upon application for certification. The principles of ethics are models of exemplary professionalbehavior. These principles of the Prevention Think Tank Code express prevention professionals’recognition of responsibilities to the public, to service recipients, and to colleagues within and outside ofthe prevention field. They guide prevention professionals in the performance of their professionalresponsibilities and express the basic tenets of ethical and professional conduct. The principles call forhonorable behavior, even at the sacrifice of personal advantage. These principles should not be regardedas limitations or restrictions, but as goals toward which prevention professionals should constantly strive.They are guided by core values and competencies that have emerged with the development of theprevention field.”Bureau Prevention GuideForeword10
Iowa’s Code of Ethics for Prevention Specialists is guided by six principles: Non-DiscriminationCompetencyIntegrityNature of ServicesConfidentialityEthical Obligations for Community and SocietyIowa’s Prevention Specialists follow the Prevention Think Tank Code of Ethics, as recommended by theIC&RC.Prevention Think Tank Code of Ethical Conduct PreambleThe principles of ethics are models of exemplary professional behavior. These principles of thePrevention Think Tank Code express prevention professionals’ recognition of responsibilities tothe public, to service recipients, and to colleagues within and outside of the prevention field. Theyguide preventio
prevention of substance misuse. This "prevention set-aside" is managed by the Center for Substance Abuse Prevention (CSAP) in SAMHSA and is a core component of each state's prevention system. On average, SAPT Block Grant funds make up 68% of primary prevention funding in states and territories. In 21 states, the prevention set-aside .
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