Each October, we celebrate Substance Use Prevention Month — an opportunity to highlight the importance of prevention and the positive impact prevention is having on individuals, families, and communities across the country. Preventing substance use is a major priority for the Biden-Harris Administration, as evidenced by the U.S. Department of Health and Human Services’ Overdose Prevention Strategy.
This year, we also celebrate the 20th anniversary of the Strategic Prevention Framework (SPF), an evidence-based strategic planning and implementation process that provides states and communities with a roadmap for prevention action.
In 2004, the Center for Substance Abuse Prevention at the Substance Abuse and Mental Health Services Administration (SAMHSA) first launched the SPF, which offers a five-step model to plan effective initiatives to prevent substance use and related harms. The model is used by states, tribes, territories, jurisdictions, local governments, communities, coalitions, community-based organizations, colleges, and universities.
Twenty years later, the SPF continues to be highly effective, offering prevention practitioners and public health leaders a clear framework for crafting strategic prevention activities, efficiently allocating resources, and ensuring that interventions are evidence-informed and well-evaluated.
What made the SPF unique when it first launched — and what keeps it relevant today — is its premise. That is, effective prevention begins with a clear understanding of local community needs, and planning must involve community members (in all five steps) as well as make use of data to drive planning and implementation.
At a time when people were sometimes eager to jump to solutions, the SPF required communities to take a step back; to plan effectively before acting. It challenged them to connect with key partners, reflect on the myriad factors that might be influencing the problems they hoped to address, consider intended outcomes, and think strategically about the best way to achieve those outcomes — centering the voices of the community in these efforts.
The SPF emphasizes the use of data to guide all prevention decisions — from identifying which problems to focus on, to choosing the best ways to address them, to figuring out what progress is being made. It also highlights the role of community capacity (resources and readiness). Without capacity, the best-designed programs are likely to fail.
The SPF offers a flexible template that can mature over time.
- Since 2004, our understanding of the complexity of substance use has evolved. We now recognize how adverse childhood experiences, intergenerational trauma, and social determinants of health (SDOH) can contribute to substance use patterns and harms.
- We’ve also expanded our understanding of prevention science, including community-based experience as well as scientific research.
- And we continue to see that the substance use landscape, illicit drug markets, and the availability of (and access to) substances is dynamic and evolving.
- As a circular (rather than linear) process, the SPF provides space to incorporate advancements and emerging threats, as often as needed.
The SPF also was unique in its requirement to approach prevention in a cross-sector, collaborative way. Partnerships were originally focused on 12 community sectors. Today, this has expanded to include partners addressing SDOH, mental health, injury and violence prevention, suicide prevention, and more. These associations generate insights needed to address complex problems, reveal community strengths, prevent duplication of effort, encourage synergy, and accomplish more with limited resources.
The SPF has two guiding principles, with tips on integrating each into the five planning steps:
- Cultural Competence: to overcome systemic barriers that contribute to disparities, and to achieve health equity (by nurturing cultural humility, ensuring cultural appropriateness, and including the population of focus in all aspects of planning and evaluating).
- Sustainability: capacity to maintain outcomes over time.
Since 2004, 76 states, tribes, territories, and jurisdictions (and thousands of communities) have received funding to implement the SPF, and numerous studies have demonstrated its utility.
For example, a 2014 evaluation of SAMHSA’s SPF State Incentive Grant (which focused on SPF implementation) highlighted the role of the SPF’s structured approach in reducing substance use and improving prevention capacity in funded communities. Evaluations of various prevention programs have also found that the SPF’s comprehensive approach (to needs assessment, capacity-building, planning, implementation, and evaluation) led to better outcomes when compared to less structured approaches.
The prevention landscape is continually evolving. Today’s communities grapple with challenges such as underage alcohol use, fake pills (containing lethal amounts of fentanyl), opioids, stimulants, vaping, and (especially in states where laws have changed) marijuana use. The SPF offers a clear, systematic method to respond to these problems in thoughtful ways, tailored to the individual contexts of communities.
With the support of technical assistance and training, the SPF will remain an effective, central part of our nation’s prevention frameworks — for states, tribes, territories, jurisdictions, and communities.
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