PROSPER

Evidence Rating:

Near Top Tier

Highlights

Program:

A program-delivery system in which universities partner with community teams to implement evidence-based programs for preventing youth substance abuse and other problem behaviors.
Evaluation Methods:

A well-conducted randomized controlled trial (RCT).
Key Findings:

At the 6.5-year follow-up (end of 12th grade) –

(i) Community-wide reductions of 10-35% in illicit drug use initiation by youth who were non-users in 6th grade (prior to program delivery); and

(ii) Moderate reductions in substance use for the full sample – non-users and users (e.g., 14% lower likelihood of past-month cigarette use).
Other:

(i) These findings are based on the use of the PROSPER system to deliver a specific set of evidence-based programs, and may not generalize to the system’s delivery of a different program set.

(ii) A study limitation is its relatively small, homogeneous sample – 28 rural towns and small cities in two states. Thus, replication of these findings in a second trial, in another setting, would be desirable to confirm the initial results and establish that they generalize to other settings where PROSPER might be implemented.

Promoting School-community-university Partnerships to Enhance Resilience (PROSPER) is a program-delivery system in which universities partner with community teams to implement evidence-based programs for preventing youth substance abuse and other problem behaviors. Each participating community (i.e., town or small city) forms a community team of 8-12 people, which is led by a Cooperative Extension System representative [1] and a public school representative, and includes social service and health agency officials as well as community parents and youth. A state-level team of university researchers then provides the community teams with a menu of evidence-based programs, [2] from which the community teams select (i) one family-focused program to deliver in 6^th grade, and (ii) one school-based program to deliver in 7^th grade. A prevention coordinator team, based in the university Cooperative Extension System, serves as a liaison between the community and state-level teams, providing ongoing, proactive technical assistance to community teams to optimize program delivery and sustainability.

All PROSPER communities in the study described below selected the Strengthening Families Program: 10-14 for the family-focused program. This program, delivered to parents and youth in seven sessions, focuses on enhancing parenting skills as well as youth substance refusal and other pro-social skills. For the school-based program, six PROSPER communities selected All Stars, four communities selected LifeSkills Training, and four communities selected Project Alert. All three are substance-abuse prevention programs delivered to students in classrooms, generally by a regular classroom teacher trained in that program. [3]

The university research team updates PROSPER’s menu of evidence-based programs over time based on new research findings regarding both the listed programs and potential alternative programs. [4]

The cost of implementing PROSPER in a community of 25,000 people – roughly the average population in the study described below – ranges from $177,000 to $192,000 per year in 2017 dollars, and the cost per participating youth totals about $410-$440 over 6^th and 7^th grade (depending on which family and school-based programs the community selects). For a larger community of 50,000 people, the cost is $208,000 to $237,000 per year, and the cost per youth is about $240-$270. ^[5]

Link to PROSPER’s website.

To see our full evidence summary:

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Top Tier

Programs shown in well-conducted RCTs, carried out in typical community settings, to produce sizable, sustained effects on important outcomes. Top Tier evidence includes a requirement for replication – specifically, the demonstration of such effects in two or more RCTs conducted in different implementation sites, or, alternatively, in one large multi-site RCT. Such evidence provides confidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original studies.

Near Top Tier

Programs shown to meet almost all elements of the Top Tier standard, and which only need one additional step to qualify. This category primarily includes programs that meet all elements of the Top Tier standard in a single study site, but need a replication RCT to confirm the initial findings and establish that they generalize to other sites. This is best viewed as tentative evidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original study.

Suggestive Tier

Programs that have been evaluated in one or more well-conducted RCTs (or studies that closely approximate random assignment) and found to produce sizable positive effects, but whose evidence is limited by only short-term follow-up, effects that fall short of statistical significance, or other factors. Such evidence suggests the program may be an especially strong candidate for further research, but does not yet provide confidence that the program would produce important effects if implemented in new settings.

References

[1] The Cooperative Extension System serves an outreach function for land grant universities in every state, disseminating scientific information to the community.

[2] PROSPER’s website defines “evidence-based programs” as programs that have been rigorously evaluated and found to be effective.

[3] Trained observers found that both the family and school-based programs achieved close adherence (approximately 90%) to the program’s content. About 17% of families in the PROSPER group participated in the family-focused program offered in sixth grade.

[4] For example, after PROSPER’s delivery of programs to the students in this study, Project Alert was replaced on the menu by Lions Quest Skills for Adolescence.

[5] This includes both the cost of the university-community partnership (i.e., PROSPER’s “infrastructure” cost) and the cost of delivering the family and school-based programs, as described above. Further detail on PROSPER’s infrastructure cost is shown here.

Crowley, Daniel M., Damon E. Jones, Mark T. Greenberg, Mark E. Feinberg, and Richard L. Spoth. “Resource consumption of a dissemination model for prevention programs: The PROSPER delivery system.” (2012). Journal of Adolescent Health, vol. 50, no. 3, pp. 256-263.

Redmond, Cleve, Richard L. Spoth, Chungyeol Shin, Lisa M. Schainker, Mark T. Greenberg, and Mark E. Feinberg. “Long-term protective factor outcomes of evidence-based interventions implemented by community teams through a community-university partnership.” (2009). Journal of Primary Prevention, vol. 30, pp. 513-530.

Spoth, Richard L., Scott Clair, Mark T. Greenberg, Cleve Redmond, and Chungyeol Shin. “Toward dissemination of evidence-based family interventions: Maintenance of community-based partnership recruitment results and associated factors.” (2007). Journal of Family Psychology, vol. 21, no. 2, pp. 137-146.

Spoth, Richard L., Cleve Redmond, Scott Clair, Chungyeol Shin, Mark T. Greenberg, and Mark E. Feinberg. “Preventing substance misuse through community-university partnerships: Randomized controlled trial outcomes 4½ years past baseline.” (2011). American Journal of Preventive Medicine, vol. 40, no. 4, pp. 440-447.

Spoth, Richard, Cleve Redmond, Chungyeol Shin, Mark Greenberg, Scott Clair, and Mark Feinberg. “Substance-use outcomes at 18 months past baseline: The PROSPER community-university partnership trial.” (2007). American Journal of Preventive Medicine, vol. 35, no. 5, pp. 395-402.

Spoth, Richard, Cleve Redmond, Chungyeol Shin, Mark Greenberg, Mark Feinberg, and Lisa Schainker. “PROSPER community-university partnership delivery system substance misuse outcomes through 6½ years past baseline.” (2013). Prevention Science, vol. 56, pp. 190–196.

Spoth, Richard L., Linda S. Trudeau, Cleve R. Redmond, Chungyeol Shin, Mark T. Greenberg, Mark E. Feinberg, and Gee-Hong Hyun. “PROSPER partnership delivery system effects on conduct problem behavior outcomes through 6.5 years past baseline.” (2015). Journal of Adolescence, vol. 45, pp. 44-55.

Spoth, Richard L., Linda S. Trudeau, Chungyeol Shin, Ekaterina Ralston, and Cleve Redmond. “Longitudinal effects of universal preventive intervention of prescription drug misuse: Three RCTs with late adolescents and young adults.” (2013). American Journal of Public Health, vol. 103, no. 4, pp. 665-672.

Spoth, Richard L., Cleve R. Redmond, Chungyeol Shin, Mark T. Greenberg, Mark E. Feinberg, and Linda S. Trudeau. “PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors.” (2017). Psychological Medicine, vol. 43, no. 13, pp. 2246 – 2259.

Email correspondence with Richard Spoth.

Highlights

Program:

Evaluation Methods:

Key Findings:

Other:

References

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