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Abstract:
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Tested and effective approaches are available to prevent mental, emotional, and behavioral problems in youth, but they are underutilized. Communities That Care (CTC) is a coalition-based strategy that creates a local infrastructure for prevention service delivery that facilitates the community-wide adoption of a scientific approach to preventing these problems. A community-randomized trial of CTC in 24 communities, matched in pairs and randomly assigned to a control or an intervention condition, has demonstrated that CTC significantly increases the community-wide adoption of a science-based approach to prevention, as reported by community leaders. For this dissertation, I first examined the extent to which the effect of CTC on the adoption of a community-wide scientific approach to prevention varied significantly across matched community pairs. Results indicated significant and substantial variation in the effect of CTC on the adoption of a scientific approach to prevention across the 12 community pairs. Next I explored potential sources of the variation across community pairs in community transformation toward a scientific approach to prevention. These sources included five coalition capacities: member knowledge, member acquisition of new skills, member attitudes, organizational linkages, and influence on organizations. Findings indicated that CTC coalitions successfully built capacities. Results also showed that new skill acquisition by coalition members and the engagement of diverse sectors in coalition work, as reported by coalition members, moderated the relationship between CTC and the community-wide adoption of a science-based approach to prevention. Finally, I explored whether the internal functioning of CTC coalitions predicted community-wide adoption of a science-based approach to prevention directly or through a coalition culture that builds capacities necessary for coalitions to achieve system transformation. No significant direct effects of four dimensions of coalition functioning, (goal-directedness, efficiency, opportunities for participation, or cohesion,) on community-wide adoption of a science-based approach to prevention were found. However, results suggest that coalition functioning may affect community adoption of a science-based approach to prevention through an indirect pathway of building specific capacities: new member skills and organizational linkages to diverse sectors. Identification of these malleable coalition processes and capacities, which facilitate the community-wide adoption of a scientific approach to prevention, should be useful for improving the effectiveness of community coalitions focused on preventing adolescent mental, emotional, and behavioral problems. |