Step 1: Assessment  

Based on its assessment of local survey and archival data about substance use consumption and consequences among youth in Anytown, Nebraska, the local substance abuse coalition is seeking to reduce underage drinking in their community. As part of its assessment process, the coalition has also identified risk and protective factors associated with underage drinking in the community, such as easy retail access and low enforcement of existing laws.

While collecting these data, the community experiences two tragic cases of youth suicide. Recognizing the link between alcohol use and suicide, the substance abuse coalition searches the SHARP Tool to see if it contains any risk or protective factors for underage drinking that also impact suicide outcomes. They discover the following:

• Poor academic performance is a shared risk factor for alcohol use and suicidal ideation among high school students.
• Truancy is a shared risk factor for alcohol use and past 12-month suicide plans and attempts among high school students.

To gauge the extent to which these shared factors contribute to Anytown's underage drinking problems, the coalition reviews some existing data.

• First, they look at math and English standardized test scores from their local high school and compare them to state averages. They learn that average student scores are strong in both math and English; Anytown's high school ranks among the top 20 high schools in the state.
• They also examine student Grade Point Average scores and discover that 90% of students have a GPA of 2.5 or higher. Based on these findings, the coalition decides that poor academic performance is not a salient risk factor for high school students in their community.

Next, to find out if truancy is a relevant problem, the coalition contacts the local high school to request school attendance data. It is disturbed to learn that during the past school year 25% of students were chronically absent (i.e., absent more than 20 days). It also reviews data from a local school survey based on the Youth Risk Behavior Survey, which reveal that high school students in Anytown have higher than average alcohol use and more suicide plans and attempts than other Nebraska communities. Given this information, the coalition decides to consider truancy as an additional factor to target.

Step 2: Capacity Building  

With an understanding of the scope of underage drinking in their community, as well as the factors contributing to the problem, the substance abuse prevention coalition needs to develop a clear picture of Anytown's capacity - both resources and readiness - to address underage drinking. It begins by looking at its coalition membership to make sure it includes key community stakeholders, such as representatives from the local high school and mental health agencies.

Since the coalition is thinking about targeting the shared factor truancy (in addition to other factors that are substance abuse-specific), it also assesses its capacity to address this factor, specifically:

• Since truancy is linked with suicide, as well as alcohol outcomes, the coalition reaches out to the local suicide prevention task force to find out if they would like to partner. The suicide task force expresses a strong interest in working together and a member of the suicide task force begins attending the prevention coalition's meetings.
• The school health coordinator, who sits on both the substance abuse prevention coalition and suicide prevention task force, contacts the local high school to find out what, if any, steps have been taken to improve the school's rate of chronic absenteeism. He learns that the school's current procedure is limited to sending an automated call to students' homes when they are absent. The principal has a strong interest in doing more to address attendance issues among students.
• The school health coordinator also meets with the school superintendent to assess her readiness to address the high school's truancy issues. He learns that the superintendent's sole priority at the high school is to continue to raise student test scores; truancy is not an issue of concern. The coordinator is concerned that without the superintendent's buy-in, the high school will not receive the support necessary approval to implement a truancy prevention intervention.

The coalition continues to consider truancy as one of several factors to address, but recognizes that it will need to mobilize more support for their efforts.

Step 3: Planning  

The substance abuse prevention coalition is ready to prioritize its list of identified risk and protective factors. In addition to truancy, they are considering three other risk factors - retail access, low enforcement by police of existing underage drinking laws, and lack of parental monitoring. To choose among the three factors, the coalition assesses their importance (i.e., the extent to which interviews with key informants and other qualitative data indicate which factor is most strongly linked to underage drinking) and changeability (i.e., the resources, time, and evidence-based interventions available to address the factor).

According to these criteria, retail access emerges as the most significant risk factor for underage drinking in the community. The coalition moves forward with addressing this factor. Of the remaining factors, both score high on importance, but because truancy is a shared factor, associated with both substance abuse and suicide outcomes, the coalition assigns it more weight. The coalition also has the support of the suicide prevention task force, which is interested in working together to target this factor. Given this information, the coalition decides to address truancy, as well. The school health coordinator agrees to lead this effort, and the suicide task force agrees to support the coalition's efforts to obtain the endorsement of the superintendent to improve truancy.

Step 4: Implementation  

The school health coordinator convenes a strategy meeting with the school principal and representatives from the coalition and task force to discuss next steps for mobilizing support for their plans.

First, the principal and school health coordinator meet with the school superintendent to enlist her support. They discuss the need to address this issue and highlight the connections between attendance and increased academic achievement - in addition to the links to underage drinking and suicide prevention. Convinced by the coordinator's arguments, and by the evidence of community support from the prevention coalition and suicide task force, the superintendent buys into their plans.

The coalition hires a consultant specializing in truancy. She proposes a multi-pronged plan that involves putting in place an early warning system - a data tool that alerts the school when a student shows a critical number of negative indicators (e.g., absenteeism, academic failure, multiple office referrals) - so the school can take swift action to help the student who is at risk. Identified students will meet with school staff to develop an individualized plan for helping the student get back on track. The coalition will support the school's efforts by coordinating the evaluation of the truancy prevention efforts. The coalition and suicide task force will also help the school identify relevant community supports for at-risk students (e.g., transportation, family support services, and substance and mental health counseling).

Next, the principal invites the coordinator and members of the coalition and task force to attend a staff meeting. During the meeting, they review with faculty and staff the school's attendance data and present the expected benefits of reducing truancy - increased academic achievement, improved student mental health, and lower rates of substance abuse.

Once the superintendent and the high school staff are on board, the coalition begins to implement its plan.

Step 5: Evaluate  

The coalition enlists the help of an evaluator from the local university to evaluate its prevention efforts. First, they develop a plan for assessing how the different components of their program are being implemented; this will allow them to make any necessary adjustments along the way.

They also develop a plan for evaluating the impact of their efforts. Since truancy influences both substance abuse and suicide, they are careful to measure the impact of their programs on multiple outcomes. They do not expect to see a significant change in truancy for some time, so plan to review truancy rates at the close of each semester for two years after the school implements the new reduction plan, and compare them to rates for the prior two years.

They will also compare results from the next two YRBS surveys to their baseline data, looking for decreases in suicidal plans and attempts and decreases in alcohol use.

In the meantime, the coalition is encouraged by the feedback it is beginning to receive from the high school. According to staff, the early warning system, combined with the individualized student plans, has already helped many chronically absent students improve their attendance. As one teacher reports, "When a student skips school, school staff now feel empowered to talk with students and support them with whatever challenges they face. It feels like we are taking a more holistic approach to educating our students. I am so proud of the progress we've made."