Substance Abuse Midland, Michigan

Substance Abuse Midland, Michigan

Midland County
Substance Abuse Prevention Strategy
Strategic Prevention Framework/State Incentive Grant
TABLE OF CONTENTS
DATA SOURCES
SUMMARY
Figure 1: Midland County Population by Age Group1
NEEDS ASSESSMENT
SECTION I – UNDERAGE DRINKING
Figure 2: Drinking Drivers Involved in Crashes by Age Group3
Figure 3: Alcohol Related Convictions6
Figure 4: DUI Arrests by Age Group5
Figure 5: Juvenile Charges9
Figure 6: Percent of Students who reported at least one drink of alcohol in past 30 days18
Figure 7: Percent of Students who reported driving under the influence (DUI) 18
SECTION II – ALCOHOL RELATED FATAL CRASHES
Figure 8: Percent of Crashes that were Alcohol Related3
Figure 9: Alcohol Related Fatal Crash Rates3
Table 1: Costs of Alcohol-Involved Traffic Crashes in Midland County (2004 Dollars)16
Table 2: Costs of Traffic Crashes versus Alcohol-Involved Traffic Crashes in Midland
County (2004 Dollars) 16
2
SECTION III – INCREASE IN ILLICIT DRUG USE
Table 3: Narcotic Crime Trends7
Figure 10: Drug Abuse and Dependence: MMMC Hospital Admissions12
Figure 11: Consumption Data: Drug Use - % Responding Drug Use in Past 30 Days20
Figure 12: Outpatient Drug Use – Ten Sixteen Treatment Center13
Figure 13: Inpatient Drug Use – Ten Sixteen Treatment Center13
SECTION IV – SMOKING
Figure 14: Midland County Teen Current Smokers18
Figure 15: Midland County Adult Current Smokers17
Figure 16: Current Smokers by Grades Earned18
SECTION V – INTERVENING VARIABLES
Chart 1: Top Intervening Variables
Figure 17: Peer Pressure: % Responding that they Feel Pressure to Use20
Figure 18: Illicit Drug Use by College Plans20
Figure 19: Risk Taking Behaviors by Asset Levels19
CAPACITY ASSESSMENT
STRATEGY PROPOSAL
APPENDIX
3
DATA SOURCES
Demographics
1
U.S. Census Bureau: Profile of General Demographic Characteristics
State & County Quick Facts
Police/Crime Data
2
Michigan Drunk Driving Audit, Michigan State Police, 2006, 2007
3
Michigan Traffic Crash Facts 2006, Office of Highway Safety
4
Crash Statistics, Traffic Crash Reporting System, MSP, 2005-2007
5
Uniform Crime Reports, Michigan State Police, 2006
6
Conviction Disposition Summary, 2006
7
Crime Analysis Report - Narcotic Crime Trends, MSP, June 2006
8
Midland County Sheriff’s Office Annual Report 2007
Juvenile Offenses
9
Midland County Prosecuting Attorney 2006 Annual Report
10
Midland County Prosecuting Attorney 2007 Annual Report
11
Midland County Probate Court 2007Annual Report
Hospital Data
12
MidMichigan Medical Center–Midland 2005-2007
Treatment Data
13
Ten Sixteen Treatment Center
14
NMSAS Treatment Data
Literature
15
Campaign for Tobacco-Free Kids, University of Michigan, 2005
16
Societal Costs of Traffic Crashes and Crime in Michigan, University of Michigan
Transportation Research Institute, 2004 update
21
Tapping the Power of Community: Building Assets to Strengthen Substance Abuse
Prevention, Search Institute, March 2004
Survey Data
17
Behavioral Risk Factor Surveillance Survey (BRFSS), Michigan Department of
Community Health, Bureau of Epidemiology, 2002, 2006
18
Michigan Youth Risk Behavior Survey (YRBS), Michigan Dept. of Education, 2005
19
Profiles of Student Life: Attitudes and Behaviors, Legacy Center for Student Success
and the Midland County Probate & Family Court, 2006
20
Alcohol and Other Drugs School Survey (AOD), Western Michigan University, 2007
4
SUMMARY
This report documents the Phase I findings and recommendations of the Strategic
Prevention Framework State Incentive Grant (SPF/SIG) within Midland County. The SPF
process focuses on creating a coordinated community effort to deliver prevention services
directed at target substance abuse problems. In order to facilitate a coordinated
collaborative effort, the Health and Human Services Council (HHSC) provided oversight
of the project. The HHSC appointed stakeholders to serve as representatives on the
Community Epidemiological Workgroup (CEW). Individual membership and community
agency representation in the HHSC and CEW are included in the Appendix. The CEW
consists of representatives from the following:
• Family and Children’s Services
• 1016 Recovery Network
• Circle of Health Partnership
• Midland Community Cancer Services
• Midland Police Department
• Midland Public Schools
• Midland County Health Department
• Community Mental Health
• Untied Way
• Faith based liaison
• MidMichigan Medical Center-Midland
• Senior Services
• Department of Human Services
• Juvenile Care Center
• The Legacy Center for Student Success
• Community Member at large
The CEW workgroup was organized to coordinate a county level review of the available
data relating to consequences and consumption patterns of substance abuse. CEW
members shared areas of local concern regarding substance abuse problems, and provided
insights and ideas into the development of the needs assessment plan. The group was
instrumental in identifying target areas of concern, defining causal factors, assessing
current capacity, and ultimately developing a prevention strategy for Midland County.
Analyzing Midland County demographic data was the first step in the process. Midland
County’s total population is reported at 82,874. Roughly 55% reside in urban areas and
45% rural. In Midland County, 36% of the population is less than 25 years of age
(Figure 1). Culturally, nearly 95% of the Midland County population is identified as
white. In analyzing data, attention was made to ensure that all populations and age groups
were investigated, when possible, to ensure cultural competence.
5
Figure 1: Midland County Population by Age Group
5-14 years
16%
25-34 years
12%
35-44 years
17%
45-54 years
14%
55+ years
21%
15-19 years
8%
20-24 years
6%
< 5 years
6%
14%
Substance Abuse consequence and consumption data was gathered and analyzed for
Midland County. In reviewing the data, areas that were targeted as priority problems were
those areas in which the magnitude, prevalence and/or severity of Midland’s experience
was found to be greater than that of the statewide level or the benchmark county levels.
The CEW group selected the following counties as counties that they would like to see
Midland data compared to: Lapeer, Livingston, Oakland and Shiawassee. After an
extensive review of the available consequence and consumption data for Midland County
and a review of the State level targeted priorities, the priority Substance Abuse problems
in Midland County were identified to be:
• Underage drinking
• Alcohol Related Crashes
• Increase in illicit drug use
• Smoking.
Next the CEW identified intervening variables which have scientific evidence of
contributing to the identified target substance related consequences and use patterns.
The intervening variables were seen as causal factors for the use. Available data was
gathered on the intervening variables. Using the data trends along with a weighted
response listing from the CEW group, the intervening variables were prioritized.
Peer pressure, resistance, restraint and positive view of personal future were the top
factors. Environmental factors were identified by the CEW group and seen to be
adequately addressed by several initiatives led by the Circle of Health Partnership and the
local law enforcement. The 2008 Midland County Sheriff’s Office Compliance Checks
Report is included in the Appendix. The report demonstrated an 87% compliance success
rate for local bars and businesses.
After reviewing the intervening variables identified for the target substance abuse
problems identified in Midland County, a capacity assessment was conducted. The
capacity assessment focused on the current community resources and assets of Midland
6
County related to the delivery of substance abuse prevention services. To ensure the
capability of bringing about desired changes, Midland County must have resources in
place to carry out the intended interventions. This assessment identified several issues and
barriers in regards to community resources.
The capacity assessment also looked at current substance abuse prevention efforts in the
community. Ongoing programs and initiatives were considered to be continued after they
were gauged as to their ability to demonstrate impact on the target substance abuse
problems identified in Midland County. Gaps in services were identified for underserved
populations and underrepresented target areas.
Assessing the community readiness and political will to address the identified substance
abuse targets was an additional piece of the capacity assessment. Community readiness
needed to be considered to ensure that effectiveness of interventions will not be
compromised due to unwillingness of the community to address the issue. Political will
was considered for sustainability purposes. Both areas will be discussed further in depth
in the Capacity Assessment section.
With direction attained and resources reviewed, an overall strategy for substance abuse
prevention was developed. As part of the strategy, a proposal of new programs and
interventions was created in order to fill the gaps identified in the capacity assessment.
The CEW group appointed a core group of agencies to identify programs that would fit
into the developed strategy. Four main agencies provide the majority of substance abuse
prevention services for Midland County. They will be referred to as the core agencies.
The core agencies include Circle of Health Partnership, Family and Children’s Services,
Ten Sixteen Recovery Network and Midland Cancer Services. The SPF process provided
a forum for these agencies to target substance abuse initiatives, coordinate efforts, share
information, and dialogue on barriers and assets that each has experienced in providing
prevention services in Midland County.
With the prevention program and intervention services determined, the CEW group,
because of the compelling data indicating the profound impact that assets have in
protecting youth from risk-taking behaviors, recommended incorporating asset building
into our prevention strategy. Accomplishing this requires training and consultation of
asset building for representatives of the core agencies. The CEW group believes that asset
building will enhance and increase the effectiveness of the program services and
initiatives in Midland County.
7
NEEDS ASSESSMENT
SECTION I – UNDERAGE DRINKING
According to the available data, Underage Drinking is a priority problem for Midland
County. In 2006, 21% of drinking drivers involved in crashes were underage drivers.
In comparison to benchmark counties (Lapeer-16%, Livingstion-15%, Oakland-12%
and Shiawassee-11% as well as the State of Michigan-14%), Midland experienced a
greater prevalence of drinking drivers involved in crashes being underage (Figure 2).
Figure 2: Drinking Drivers Involved in Crashes by Age Group: Midland County 2006
16-20
21%
21-24
9%
25-34
29%
35-44
20%
45-54
18%
55+
3%
Underage
Drinking Driver %
Midland - 21
Lapeer - 16
Livingston - 15
Michigan - 14
Oakland - 12
Shiawassee - 11
In looking at the conviction data for the year 2006, 402 convictions in Midland County
were categorized as alcohol related. One third of the alcohol related convictions were
Minors in Possession (MIP) or Zero Tolerance convictions all issued to underage
drinkers (Figure 3). 12% of the DUI arrests were drivers 18-20 years of age
(Figure 4).
Figure 3: Alcohol Related Convictions 2006 Figure 4: DUI Arrests by Age Group
8
MIP
31%
INJ/ENDGR
1%
INTOX
41%
OWPD
0%
IMPAIR
25%
ZEROT
2%
<20
12%
21-29
34%
31-39
18%
41-49
24%
51-59
10%
60+
2%
Juvenile population substance abuse data was not easily quantifiable. In 2006 18% of the
359 charges filed against juveniles were alcohol/drug related. 2007 data shows that there
was a 17% increase in overall charges filed against juveniles from 2006 with a shift
towards alcohol and assault crimes (Figure 5).
Figure 5: 2006 Juvenile Charges
Theft
54%
Sex
4%
Driving
2%
Destruction
Crimes
5%
Alcohol
7%
Drug
11%
Assaultive/Weapons
17%
Actual alcohol and drug use is underrepresented in juvenile data. The policy with
juveniles is that in multiple offenses, the less serious offense is often dropped. The gaps
in information as well as a need for standardization of consequence policies among school
districts were identified as action items and were also addressed at a CAP21 (Community
Awareness Project 21)meeting.
Alcohol consumption data was obtained through several surveys. The consumption
patterns were reviewed and although the reported rates of drinking alcohol and driving
under the influence were similar or lower than the Michigan youth levels, stark differences
were noted within the Midland youth amongst grade levels and grades earned (Figures 6).
Figure 6: Percent of Students who reported at least one drink of alcohol in past 30 days
9
11th
12th
10th
A's/B's
C's
D's/F's
20%
30%
40%
50%
60%
10th 11th 12th
A's/B's C's D's/F's
Grade Level
Grades in School
An increase is found in reported use as grade levels increases as well as an increase in
reported use as grades earned decrease from A/B to C’s and finally to D/F.
The same pattern can be seen when we look at students reporting driving under the
influence. Over one fourth of Midland respondents report at least one drink of alcohol in
the past 30 days. Nine percent of Midland teens report driving under the influence.
Figure 7: Percent of Students who reported driving under the influence (DUI)
11th
12th
10th
C's
D's/F's
A's/B's
0%
5%
10%
15%
20%
10th 11th 12th
A's/B's C's D's/F's
Grade Level
Grades in School
SECTION II – ALCOHOL RELATED FATAL CRASHES
In examining the alcohol related traffic crashes from the years 2005 through 2007,
Midland is ranked 51st
of 83 counties in experiencing the highest percentage of crashes
involving alcohol (Figure 8). In this period, 3.3% of all crashes in Midland were alcohol
related.
Figure 8: Percent of Crashes that were Alcohol Related: 2005-2007
4.32%
3.90%
3.81%
3.70%
3.39%
3.30%
Livingston
Michigan
Shiawassee
Lapeer
Oakland
Midland
Midland County
2005-2007:
256 Alcohol Related Crashes
Average: 85 per year
10
In looking at alcohol related fatal crash deaths Midland has a fatal crash rate of 0.119,
which is much lower than the 0.34 statewide fatal crash rate (Figure 9).
Figure 9: Alcohol Related Fatal Crash Rates - 2006
0%
5%
10%
15%
20%
25%
30%
35%
40%
Shiawassee Michigan Livingston Oakland Lapeer Midland
0.0
0.1
0.2
0.3
0.4
0.5
0.6
% Fatal Crashes - Alcohol Related Fatal Crash Rate per 10,000 people
Due to the lower incident rates of alcohol related fatal crashes, and the compelling cost
data (Table 1) associated with alcohol related crashes, we will base our strategy on
reducing alcohol related crashes with the assumption that this will have an overriding
effect on the alcohol related fatal crashes.
Table 1: Costs of Alcohol-Involved Traffic Crashes in Midland County (2004 Dollars)
Fatal Serious
Injury
Moderate
Injury
Minor
Injury
Property
Damage Only
Total
Medical Care $86,777 $441,484 $296,049 $119,201 $12,049 $955,561
Future Earnings
(Lost Wages) $4,533,727 $1,178,369 $621,675 $241,649 $49,365 $6,624,785
Public Services $2,684 $2,929 $3,807 $2,257 $1,530 $13,207
Property Damage and
Loss $33,099 $82,509 $128,906 $93,480 $74,905 $412,899
Subtotal
(Monetary Costs) $4,656,285 $1,705,292 $1,050,437 $456,588 $137,849 $8,006,450
Quality of Life $8,480,111 $1,771,270 $1,293,577 $397,338 $41,515 $11,983,811
Total
(Comprehensive Costs) $13,136,397 $3,476,562 $2,344,014 $853,926 $179,364 $19,990,262
11
Each year from 1998 through 2004, the costs associated with traffic crashes range from
2.4 to 2.9 times that of the costs of index crimes. Index crimes include larceny, burglary,
rape, assault, robbery, motor vehicle theft, and murder. The average cost of alcohol
related traffic crashes in Midland County in 2004 was seven times more than the average
cost of non-alcohol related traffic crashes (Table 2).
Table 2: Cost of Traffic Crashes vs. Alcohol-Involved Traffic Crashes in Midland County (2004 Dollars)
Non-Alcohol Related Alcohol Related
Traffic Crash
Casualty Severity
Traffic
Crash
Casualties
Traffic
Crash Costs
Traffic
Crash
Casualties
Traffic
Crash Costs
Property Damage Only 3273 $9,569,973 47 $179,364
Minor Injury 461 $18,760,510 21 $853,926
Major Injury 180 $10,793,729 27 $2,344,014
Serious Injury 59 $12,499,289 11 $3,476,562
Fatal 11 $45,940,873 3 $13,136,397
Total 3984 $97,564,374 109 $19,990,262
Average cost of traffic crash $24,489 $183,397
SECTION III – INCREASE IN ILLICIT DRUG USE
There are several indicators that illicit drug use is increasing in Midland County.
Michigan State Police provided narcotic crime trends by district in their 2006 Crime
Analysis Report. Midland’s offense rate has increased 36% from 2000 to 2004. At the
same time the Third District realized an increase of only 20% (Table 3).
Table 3: Crime Analysis Report, June 2006
Narcotic Crime Trends
Midland Narcotic Offense Rate Third District* Narcotic Offense Rate
2004: 50.83 2004: 45.36
2000: 37.51 2000: 37.86
% change: 36% % change: 20%
Offense rate is per 10,000 Offense rate is per 10,000
*Third District: Arenac,Bay,Genessee,Gladwin,Huron,Iosco,Lapeer,Midland,Ogemaw,Saginaw,Sanilac,Tuscola
Another type of consequence data reviewed was hospital admission data. The data was
provided by the local hospital (MidMichigan Medical Center–Midland), which services
12
over 80% of Midland County. The analysis stratified the inpatient admissions by age and
date of admission. The data extraction filtered out all but those admissions with ICD-9
(International Statistical Classification of Diseases and Related Health Problems)
Diagnostic codes that were indicative of drug abuse or drug dependence. ICD-9 coding is
used world wide for morbidity and mortality statistics. The analysis findings show that
29% of the hospitalizations due to drug use are from the age group 15-24 years. This age
group represents 14% of the Midland county population, yet yields 29% of the
hospitalizations due to drug use (Figure 10). The data shows a marked difference in
gender as well as age group. Overall, males were admitted due to drug use 3:2 over
females.
Figure 10: Drug Abuse and Dependence: MMMC Hospital Admissions 2005-2007
25-34 years
16%
35-44 years
22%
45-54 years
19%
55+ years
14%
15-19 years
13%
20-24 years
16%
29%
The 2007 Alcohol and Other Drugs School Survey provided consumption data regarding
drug use. The data shows Midland County’s 12th
grade reporting illicit drug use above
that of the national 12th
grade levels (Figure 11). The Profiles of Student Life: Attitudes
and Behaviors Survey showed 26% of Midland County’s 12th
grade reporting illicit drug
use (3 times in last year).
Figure 11: Consumption Data: Drug Use - % Responding Drug Use in Past 30 Days
11.1%
17.6%
29.3%
23.4%
15.1%
10.8%
10.5%
7.2%
0%
5%
35
%
%
%
%
%
%
Midland
County 8th
Midland
County 10th
Midland
County12th
National 12th
30
25
Illicit Drug Use
Drug Use Other than
Marijuana
20
15
10
13
Looking at outpatient treatment data, obtained from Ten Sixteen Recovery Network, by
drug choice gives a picture of what Methadone and other opiates play in drug
misuse/dependence in Midland County (Figure 12).
Figure 12: 2007 Outpatient Drug Use – Ten Sixteen Treatment Center
Alcohol
45%
Marijuanna
26%
Opiates
9%
Prescription
1%
Crack/Cocaine
8%
Methamphetamines
2%
Heroin/Other
Opiates
2%
Other
1%
No Current Use
6%
In examining the inpatient data, prescription drug abuse and dependence is clearly
magnified (Figure 13). The differences in referrals were noted in that 78% of inpatient
admissions are self or family referred. In outpatient admissions only 16% are referred in
this manner. The major referral source for outpatients is the courts.
Figure 13: 2007 Inpatient Drug Use – Ten Sixteen Treatment Center
Alcohol
47%
Prescription
34%
Other
1%
Marijuanna
6%
Crack/Cocaine
12%
14
The Treatment data illustrates similar gender findings as the hospital data. Outpatient
treatment admissions for 2007 were 66% male and 34% female patients. Inpatient data
was reported and analyzed as well.
SECTION IV – SMOKING
All of the data reviewed indicate that the trend in Midland County is a decrease in
smoking. The Midland County Behavioral Risk Factor Survey (BRFS) reported a
decrease from 26% of those surveyed in 1998, to 25% in 2002 and finally 21% in 2004. A
similar trend can be seen within the youth population from the 2005 Youth Risk Behavior
Survey. From 26% in 2001 reported as current smokers, to 23% in 2003, and finally 17%
in 2005. (Figures 14 & 15)
Figure 14: Midland County Adult Current Smokers
21%
27%
25%
0%
5%
10%
15%
20%
25%
30%
1998 2002 2006
Figure 15: Midland County Teen Current Smokers
17%
26%
23%
0%
5%
10%
15%
20%
25%
30%
2001 2003 2005
%CurrentSmokers
15
Additionally, the Youth Risk Behavior Survey contained data for Midland County that
highlighted a possible correlation between smoking and grades earned in school. 12% of
the A/B’s population responded as current smokers, while 42% of the D/F’s population
responded as current smokers (Figure16).
Figure 16: Current Smokers by Grades Earned
12%
23%
42%
0%
10%
20%
30%
40%
50%
A's/B's C's D's/F's
Grades in School
%CurrentSmokers
Although the trends indicate that the number of people who smoke is decreasing, the CEW
group deemed it important enough of an issue to want to continue the prevention efforts
directed at smoking. Some compelling facts regarding smoking from data issued by the
Campaign for Tobacco-Free Kids in 2005 entitled “The Toll of Tobacco in Michigan”
included the following:
Deaths in Michigan from Smoking:
• Adult who die each year from their own smoking: 14,500
• Adults who die each year due to Secondhand smoke: 930 - 2,610
Smoking Caused Monetary Costs in Michigan:
• Annual health care costs in Michigan directly caused by smoking: $3.4 Billion
• Smoking-caused productivity losses in Michigan: $3.8 Billion
• State and Federal Tax burden from smoking-caused government expenditures:
$637 per household
16
SECTION V – INTERVENING VARIABLES
The CEW group’s next task, after finalizing and agreeing upon a listing of priority
substance abuse problems for Midland County, was to follow the outcomes-based
prevention model and identify intervening variables. The group defined intervening
variables as those factors that “cause” substance-related consequences and consumption in
the community. Each member of the CEW group completed a brainstorm listing of those
variables that they saw as contributing to each target problem in Midland. Available data
was gathered and analyzed on these identified variables.
The variables were then prioritized based on an exercise that rated the variables in relation
to the following: link to consequence, changeability, community readiness, community
capacity, local data available, political will, and impact on consequence. The top
intervening variables are listed in the figure below (Chart 1).
Chart 1: Top Intervening Variables
Top Intervening Variables
Positive Peer Influence
Resistance (refusing to participate in risky behavior)
Restraint (avoiding risky situations)
Positive View of Personal Future
Lack of Social/Physical Activities
Ease of Access
Social Acceptance
Stress
Parent Education
Lack of Parent Involvement/Intervention
Poor modeling of risky behaviors
Enforcement and Adjudication
• Misperception of legal consequences
Non-Standardized School Policy
Peer pressure was defined as pressure applied from one’s peers to behave in a manner
similar or acceptable to them, in this case, pressure to use. This can be construed as a lack
of positive peer influence. In looking at the Midland County AOD survey data, as the
students get older the peer pressure to use gets greater. Feeling pressure to use alcohol is
near 50% by the time a student reaches 10th
grade. Alcohol is by far the substance that
most peer pressure to use is perceived (Figure 17).
17
Figure 17: Peer Pressure: % Responding that they feel pressure to use
The AOD Survey provided aggregate data stratified by the respondent’s future college
plans. There were startling differences noted in drug use between those who had indicated
that they had plans to attend college and those who indicated they did not. The data also
gave the ability to compare the Midland County 12th
grade respondents to the national 12th
grade norm. The Midland County 12th
grade non-college bound cohort responded that
over 50% had used illicit drugs within the past 30 days, while the national level for 12th
grade non-college bound was near 30%. The Midland college bound cohort responded
using illicit drugs at a higher rate than the national 12th
grade college bound as well.
Figure 18: Illicit Drug Use* by College Plans
0%
10%
20%
30%
40%
50%
60%
Alcohol Marijuana Cigarettes Illicit Drug
8th Grade
10th Grade
12th Grade
* Use within past 30 days
10%
16%
29%
21%
35%
44%
54%
29%
0%
10%
20%
30%
40%
50%
60%
8th Grade 10th Grade 12th Grade Ntl. 12th
College Bound NOT College Bound
18
The most compelling intervening variable data was found in the analysis of the Profiles of
Student Life: Attitudes and Behaviors Survey that was conducted in Midland County
(2006). This is survey, published by the Search Institute, assesses adolescent development
and provides a comprehensive overview of participating youth. The data can be compared
to normative data from other communities across the U.S. Specifically, the survey is
designed to measure a youth’s developmental assets, positive experiences, and qualities
identified as being essential to healthy psychological and social development in childhood
and adolescence. These assets have the power to influence young people’s developmental
trajectories, protect them from a range of negative outcomes, and help them become more
productive, caring and responsible adults. In Midland County, the survey was
administered to over 6,000 public school students and approximately 100 juvenile court
wards, which represented 85% of the adolescent population. The key finding was that the
more developmental assets a youth has, the fewer risk taking behaviors they exhibit
(Figure 19). Take note of the Midland Court Wards trend. The court ward population had
no statistical representation with more than 20 assets.
Figure 19: Risk Taking Behaviors by Asset Level
0
2
4
6
8
10
12
14
0-10 11-20 21-30 31-40
# of Assets
#ofRiskTakingBehaviors
Midland Court Wards
Midland Youth
National Youth
Currently a regression analysis of the Midland data is being conducted by The Legacy
Center for Student Success. The primary goal of this analysis is to identify which of the
developmental assets significantly predict alcohol, drug or tobacco use within the Midland
youth population. Preliminary results show that the developmental assets of positive peer
influences, restraint and resistance skills are the top three assets in their ability to predict
alcohol, drug and tobacco use scores. In addition to the local data, there is an impressive
body of research that points to the need for communities to embrace asset building as an
integral part of their substance abuse prevention efforts.
19
CAPACITY ASSESSMENT
Before the CEW group could effectively select substance abuse programs and initiatives
to include in the strategy, a capacity assessment was needed. The CEW group delegated
the capacity assessment to the core group of substance abuse prevention agencies. First,
the core group compiled and reviewed a comprehensive listing of current prevention
services provided in the community. After reviewing the targets identified by the Needs
Assessment for Midland County, gaps in services were identified for underserved
populations and underrepresented target areas. The gaps identified in services provided in
Midland County included the following:
• First Offense population is underserved. This population includes first time
offenders from athletics programs, schools (secondary schools and universities),
and courts
• Parent-Involvement programs, parent education, awareness and intervention
• Non-college bound, blue collar 18-25 year old population
• Community mobilization environmental effort targeting alcohol
Next the capacity assessment focused on the current community resources and assets of
Midland County related to the delivery of substance abuse prevention services. To ensure
the capability of bringing about desired changes, the community of Midland County must
have resources in place to carry out the intended interventions. The core agencies looked
at the human, technical, organizational and financial resources needed to implement the
proposed programs and interventions included in the strategy. From this analysis the
issues and barriers that were identified include:
• Family and Children’s Services does not have the ability to deliver prevention
services under the current reimbursement system. Currently agencies are funded
after delivery. Funding is needed upfront in order to have the ability to deliver
prevention services.
• In order to have the ability to implement and sustain tobacco prevention services,
Midland Community Cancer Services needs to obtain prevention licensing. The
other core agencies support this action and offered advisement and assistance in
obtaining licensing.
• Core agencies experience difficulty in penetrating Midland Public schools-- MPS
has no prevention services delivered to students other than the Michigan Model
and DARE. Recruitment of a representative from the MPS administration as a
member of the CEW group may assist in addressing this issue.
Assessing the community readiness and political will to address the identified substance
abuse targets was an additional piece of the capacity assessment. Community readiness
needs to be measured to ensure that effectiveness of interventions will not be
20
compromised due to unwillingness of the community to address the issue. Political will
needs to be examined for this as well as sustainability purposes.
There are community coalitions in place in Midland County that are currently working to
educate the community to the growing dangers stemming from substance abuse. An
example is the Community Awareness Project 21 (CAP 21) coalition. CAP 21 is a group
of Midland County residents who support youth in Midland County through advocacy and
action. Their focus is to curb underage drinking. Information regarding barriers in the
community was gathered from coalition representatives. Another data source used to
monitor community readiness was gathered through a survey distributed at various
community events. The survey, distributed and analyzed by Circle of Health Partnership,
questioned respondents regarding the issue of underage drinking. Their data collection to
date shows positive support by the community on addressing this issue. Some of the
information from the survey includes:
91% Respondents are familiar with the issue of underage drinking
0% 100%
94% Participants respond that it is very important to reduce underage drinking.
0% 100%
46% Respond underage drinking is one of the most important issues in our community
0% 100%
79% Judge that the community leaders deem this issue as important
0%
100%
To gauge political will, Circle of Health Partnership has facilitated youth policy group
meetings. The meeting’s participants include key community stakeholders and elected
officials. The purpose of these meetings is to provide dialogue and assessment of youth
policy in Midland County. As part of the overall strategy, this group will be reconvened
in late October in order to discern the Midland County Strategic Prevention Framework
outcome information and future planning strategy. Midland County also is in the process
of developing a Youth Master Plan (YMP). This plan represents a long-term blueprint
among youth-oriented organizations and stakeholders that supports positive opportunities
for youth to flourish and thrive. The YMP has four principal desired outcomes and
benefits for both youth in the County as well as for the community at large:
• Measurably improve the quality of life for youth in the community
• Support complementary and integrated initiatives to achieve shared
goals and attain greater community impact
21
• Leverage expertise and other forms of shared resources through inter-
agency collaboration to get more done with less
• Minimize duplication of programs and services, thereby maximizing
the use of increasingly scarce funding
• Reduce administrative costs and streamline processes by creating
common procedures
The YMP, once in place, aligns well with the SPF and should support sustainability
efforts. A more detailed summary is included in the Appendix.
22
STRATEGY PROPOSAL
This summary will focus on the Substance Abuse Prevention strategy proposed by the
CEW for Midland County.
The CEW group has convened since March 2008. There have been ongoing dialogue and
data searches conducted and reviewed. The meeting minutes and slides are included in the
Appendix. As a result of these efforts, Midland County has completed the following
activities:
• Identified priority substance abuse problems
• Identified and prioritized intervening variables that are believed to be the
underlying causes of substance abuse behavior
• Identified gaps in resources and services in Midland County
• Developed a strategy to impact the priority substance abuse problems
• Gathered baseline data to measure against for outcome evaluation purposes
After reviewing the information obtained for and documented in the Needs Assessment
and the Capacity Assessment, the CEW group next examined the program or initiative
selections that would best fill the gaps identified. Program/Intervention criteria were
formulated by a combination of two tools.
The first tool utilized was the guidance document for the Strategic Prevention Framework
State Incentive Grant Program entitled “Identifying and Selecting Evidence Based
Interventions”. Utility and feasibility checks were utilized to ensure that the proposed
programs considered each of the points in the checklists. The second tool used was a
resource which delved into the building of assets. The book, “Getting to Outcomes with
Developmental Assets”, provides a full range of tools needed to improve the quality of
community development work. A worksheet from the book, “Choosing Programs and
Projects through an Asset Building Lens”, was utilized to help with the prospective
programs review. The core agencies met and coordinated efforts in defining prospective
programs to fill gaps. This collaborative effort resulted in a forum for the core agencies to
share information, assist one another and to define an opportunity for partnering in the
future implementation of a prospective program.
To address the substance abuse problems of Underage Drinking, Alcohol related Crashes,
Illicit Drug Use and Smoking, Midland County proposes the following programs to be
included with the current prevention initiatives in an overall coordinated strategy:
• Protecting You/Protecting Me
o Elementary age children
o Delivered by Ten Sixteen Network
o A five year classroom-based alcohol use prevention and vehicle safety
program for elementary 1-5 and high school grades 11-12. The program
aims to reduce alcohol-related injuries and death due to underage alcohol
use and riding in vehicles with drivers who are not alcohol free. Resistance
23
strategies are taught and program has a parent take-home activities
component.
• NOT Not On Tobacco
o High School students
o Coordinated by Midland Community Cancer Services
o A school based training program designed to educate, engage and support
youth who have decided to stop smoking
• Pathways to Prevention
o Parent – involvement; 6 weeks long course, designed to spend 1 hour per
week with parents and 1 hour per week with youth. The topics include
morals, values, the stages of addiction, drugs and their effects, positive
communication, boundaries, problem solving and refusal skills.
o Delivered by FCS
• First Offense Program (TBD)
o FCS & COHP to determine best fit evidence based program
o Coordinated delivery by FCS
• Project Success
o Students 12-18 years of age
o Delivered by FCS
o Designed to prevent and reduce substance use among middle and high
school students. Contains four components: Prevention Education Series,
school-wide activities and promotional materials, parent program,
individual and group counseling leading to referral to appropriate
community services for those requiring more intensity.
• Project Northland
o Middle school age children
o Delivered by COHP
o Multi-level intervention program designed to delay the age at which
adolescents begin drinking, reduce alcohol problem use among those
already drinking, and limit the number of alcohol-related problems among
young drinkers. Focus on resistance skills and normative expectations
• Positive Action
o Alternative high school population
o Delivered by COHP
o An integrated and comprehensive program designed to improve academic
achievement; school attendance; and problem behaviors such as substance
abuse, violence, suspensions, dropping out and sexual behaviors. Designed
to improve parent-child bonding, family cohesion, and family conflict
24
• Life Skills
o Elementary age children; 4th
& 5th
grade students
o Delivered by COHP
o A program combining social competencies, violence prevention and
alcohol, tobacco, and other drug abuse prevention. Designed to address a
wide range of risk and protective factors.
• All Stars
o After school program; 7 sites, 6-10 year old students
o Delivered by COHP
o A multi-year school based program for middle school students designed to
prevent and delay the onset of high-risk behaviors such as drug use,
violence, and premature sexual activity. The program focuses on five
topics that are not only important to prevention, but are essentially asset
based. Parent component included.
• Community Mobilization on Change of Alcohol
o Community based awareness initiative
o Coordinated by COHP
o A community-organizing program designed to reduce teens’ access to
alcohol by changing community policies and practices. Seeks both to limit
youths’ access to alcohol and communicate a clear message to community
that underage drinking is inappropriate and unacceptable. The program
involves community members in seeking and achieving changes in local
public policies and the practices of community institutions that can affect
youths’ access to alcohol.
• Team Awareness
o Non-college bound, blue collar, 18-25 year age group
o Coordinated by COHP
o Worksite prevention training program that addresses behavioral risks
associated with substance abuse among employees, their coworkers and
families. Training seeks to promote social health and increased
communication between workers; improve knowledge about and attitudes
toward alcohol and drug related protective factors in the workplace-such as
company policy and Employee Assistance Program; and increase peer
referral behaviors.
Because of the compelling data indicating the profound impact of assets in protecting
youth from engaging in risk taking behaviors, the CEW group also recommends that the
strategy includes incorporating asset building into the existing and proposed substance
abuse prevention services. The Profiles of Student Life: Attitudes and Behaviors Survey
provided Midland County with information regarding assets for our student population.
Baseline levels were established regarding assets. Search Institute provides extensive
25
research that confirms the power of assets in preventing ATOD use. The data obtained by
the Profiles Survey regarding the Midland community youth’s assets as well as the
evidence and research documented by Search Institute in “Tapping the Power of
Community: Building Assets to Strengthen Substance Abuse Prevention”21
suggest that
incorporating asset building into our prevention strategy will be instrumental in reducing
substance abuse related consequences and consumption. Search Institute leads
workshops, provides consultation, and trains individuals and organizations to become
asset builders in work and daily life. Providing the core agencies with training services
offered by Search Institute would allow for the enhancement of the overall prevention
strategy. The core group discussed the opportunity to leverage asset building knowledge
and skills with other community agencies in an effort to spread asset building beyond
substance abuse prevention services. Efforts will be made to minimize the cost of training
by coordinating with other agencies in Midland County that are currently incorporating
asset building into their initiatives.
A vital piece of any strategy is the evaluation and measurement plan. The overarching
measurement for the effectiveness of the substance abuse prevention strategy will be in
realizing a decrease in consequences and consumption of:
• Underage Drinking
• Crashes related to Alcohol
• Illicit Drug Use
• Smoking
Components of the evaluation plan include process and outcome measures. The process
measures will be produced by the agencies that deliver the programs. These measures
would include; adherence to the program guidelines and delivery, attendance, and program
specific measures. The core agencies will provide the CEW group with an annual report
regarding implementation and process measures of programs and services made available
by the strategy. Outcome measures will be obtained by utilizing the needs assessment
data as baseline information and tracking progress toward changing the levels of
highlighted substance abuse consequence and consumption. Data will be evaluated
annually based on availability.
26
Appendix 1
GLOSSARY
Acronym Definition
ATOD Alcohol, Tobacco and Other Drugs
BRFSS Behavioral Risk Factor Surveillance Survey
CAP 21 Community Awareness Project 21
CEW Community Epidemiological Workgroup
COHP Circle of Health Partnership
FCS Family and Children's Services
HHSC Health and Human Services Council
ICD-9
International Statistical Classification of Diseases and
Related Health Problems
MIP Minors in Possession
MMMC MidMichigan Medical Center
MPS Midland Public Schools
MSP Michigan State Police
NMSAS Northern Michigan Substance Abuse Services
SAMHSA Substance Abuse and Mental Health Services Administration
SIG State Incentive Grant
SPF Strategic Prevention Framework
YMP Youth Master Plan
YRBS Youth Risk Behavior Survey
27
28
Filename: Midland County Substance Abuse Prevention Strategy
Directory: G:CommunicationsNeighbor to NeighborWebsite support
Template: C:Documents and SettingshollyApplication
DataMicrosoftTemplatesNormal.dot
Title: Strategic Prevention Framework/State Incentive Grant
Subject:
Author: Mike Somers
Keywords:
Comments:
Creation Date: 2/26/2009 4:14 PM
Change Number: 2
Last Saved On: 2/26/2009 4:14 PM
Last Saved By: holly
Total Editing Time: 1 Minute
Last Printed On: 2/26/2009 4:14 PM
As of Last Complete Printing
Number of Pages: 28
Number of Words: 6,080 (approx.)
Number of Characters: 34,477 (approx.)

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Substance Abuse Midland, Michigan

  • 1. Midland County Substance Abuse Prevention Strategy Strategic Prevention Framework/State Incentive Grant
  • 2. TABLE OF CONTENTS DATA SOURCES SUMMARY Figure 1: Midland County Population by Age Group1 NEEDS ASSESSMENT SECTION I – UNDERAGE DRINKING Figure 2: Drinking Drivers Involved in Crashes by Age Group3 Figure 3: Alcohol Related Convictions6 Figure 4: DUI Arrests by Age Group5 Figure 5: Juvenile Charges9 Figure 6: Percent of Students who reported at least one drink of alcohol in past 30 days18 Figure 7: Percent of Students who reported driving under the influence (DUI) 18 SECTION II – ALCOHOL RELATED FATAL CRASHES Figure 8: Percent of Crashes that were Alcohol Related3 Figure 9: Alcohol Related Fatal Crash Rates3 Table 1: Costs of Alcohol-Involved Traffic Crashes in Midland County (2004 Dollars)16 Table 2: Costs of Traffic Crashes versus Alcohol-Involved Traffic Crashes in Midland County (2004 Dollars) 16 2
  • 3. SECTION III – INCREASE IN ILLICIT DRUG USE Table 3: Narcotic Crime Trends7 Figure 10: Drug Abuse and Dependence: MMMC Hospital Admissions12 Figure 11: Consumption Data: Drug Use - % Responding Drug Use in Past 30 Days20 Figure 12: Outpatient Drug Use – Ten Sixteen Treatment Center13 Figure 13: Inpatient Drug Use – Ten Sixteen Treatment Center13 SECTION IV – SMOKING Figure 14: Midland County Teen Current Smokers18 Figure 15: Midland County Adult Current Smokers17 Figure 16: Current Smokers by Grades Earned18 SECTION V – INTERVENING VARIABLES Chart 1: Top Intervening Variables Figure 17: Peer Pressure: % Responding that they Feel Pressure to Use20 Figure 18: Illicit Drug Use by College Plans20 Figure 19: Risk Taking Behaviors by Asset Levels19 CAPACITY ASSESSMENT STRATEGY PROPOSAL APPENDIX 3
  • 4. DATA SOURCES Demographics 1 U.S. Census Bureau: Profile of General Demographic Characteristics State & County Quick Facts Police/Crime Data 2 Michigan Drunk Driving Audit, Michigan State Police, 2006, 2007 3 Michigan Traffic Crash Facts 2006, Office of Highway Safety 4 Crash Statistics, Traffic Crash Reporting System, MSP, 2005-2007 5 Uniform Crime Reports, Michigan State Police, 2006 6 Conviction Disposition Summary, 2006 7 Crime Analysis Report - Narcotic Crime Trends, MSP, June 2006 8 Midland County Sheriff’s Office Annual Report 2007 Juvenile Offenses 9 Midland County Prosecuting Attorney 2006 Annual Report 10 Midland County Prosecuting Attorney 2007 Annual Report 11 Midland County Probate Court 2007Annual Report Hospital Data 12 MidMichigan Medical Center–Midland 2005-2007 Treatment Data 13 Ten Sixteen Treatment Center 14 NMSAS Treatment Data Literature 15 Campaign for Tobacco-Free Kids, University of Michigan, 2005 16 Societal Costs of Traffic Crashes and Crime in Michigan, University of Michigan Transportation Research Institute, 2004 update 21 Tapping the Power of Community: Building Assets to Strengthen Substance Abuse Prevention, Search Institute, March 2004 Survey Data 17 Behavioral Risk Factor Surveillance Survey (BRFSS), Michigan Department of Community Health, Bureau of Epidemiology, 2002, 2006 18 Michigan Youth Risk Behavior Survey (YRBS), Michigan Dept. of Education, 2005 19 Profiles of Student Life: Attitudes and Behaviors, Legacy Center for Student Success and the Midland County Probate & Family Court, 2006 20 Alcohol and Other Drugs School Survey (AOD), Western Michigan University, 2007 4
  • 5. SUMMARY This report documents the Phase I findings and recommendations of the Strategic Prevention Framework State Incentive Grant (SPF/SIG) within Midland County. The SPF process focuses on creating a coordinated community effort to deliver prevention services directed at target substance abuse problems. In order to facilitate a coordinated collaborative effort, the Health and Human Services Council (HHSC) provided oversight of the project. The HHSC appointed stakeholders to serve as representatives on the Community Epidemiological Workgroup (CEW). Individual membership and community agency representation in the HHSC and CEW are included in the Appendix. The CEW consists of representatives from the following: • Family and Children’s Services • 1016 Recovery Network • Circle of Health Partnership • Midland Community Cancer Services • Midland Police Department • Midland Public Schools • Midland County Health Department • Community Mental Health • Untied Way • Faith based liaison • MidMichigan Medical Center-Midland • Senior Services • Department of Human Services • Juvenile Care Center • The Legacy Center for Student Success • Community Member at large The CEW workgroup was organized to coordinate a county level review of the available data relating to consequences and consumption patterns of substance abuse. CEW members shared areas of local concern regarding substance abuse problems, and provided insights and ideas into the development of the needs assessment plan. The group was instrumental in identifying target areas of concern, defining causal factors, assessing current capacity, and ultimately developing a prevention strategy for Midland County. Analyzing Midland County demographic data was the first step in the process. Midland County’s total population is reported at 82,874. Roughly 55% reside in urban areas and 45% rural. In Midland County, 36% of the population is less than 25 years of age (Figure 1). Culturally, nearly 95% of the Midland County population is identified as white. In analyzing data, attention was made to ensure that all populations and age groups were investigated, when possible, to ensure cultural competence. 5
  • 6. Figure 1: Midland County Population by Age Group 5-14 years 16% 25-34 years 12% 35-44 years 17% 45-54 years 14% 55+ years 21% 15-19 years 8% 20-24 years 6% < 5 years 6% 14% Substance Abuse consequence and consumption data was gathered and analyzed for Midland County. In reviewing the data, areas that were targeted as priority problems were those areas in which the magnitude, prevalence and/or severity of Midland’s experience was found to be greater than that of the statewide level or the benchmark county levels. The CEW group selected the following counties as counties that they would like to see Midland data compared to: Lapeer, Livingston, Oakland and Shiawassee. After an extensive review of the available consequence and consumption data for Midland County and a review of the State level targeted priorities, the priority Substance Abuse problems in Midland County were identified to be: • Underage drinking • Alcohol Related Crashes • Increase in illicit drug use • Smoking. Next the CEW identified intervening variables which have scientific evidence of contributing to the identified target substance related consequences and use patterns. The intervening variables were seen as causal factors for the use. Available data was gathered on the intervening variables. Using the data trends along with a weighted response listing from the CEW group, the intervening variables were prioritized. Peer pressure, resistance, restraint and positive view of personal future were the top factors. Environmental factors were identified by the CEW group and seen to be adequately addressed by several initiatives led by the Circle of Health Partnership and the local law enforcement. The 2008 Midland County Sheriff’s Office Compliance Checks Report is included in the Appendix. The report demonstrated an 87% compliance success rate for local bars and businesses. After reviewing the intervening variables identified for the target substance abuse problems identified in Midland County, a capacity assessment was conducted. The capacity assessment focused on the current community resources and assets of Midland 6
  • 7. County related to the delivery of substance abuse prevention services. To ensure the capability of bringing about desired changes, Midland County must have resources in place to carry out the intended interventions. This assessment identified several issues and barriers in regards to community resources. The capacity assessment also looked at current substance abuse prevention efforts in the community. Ongoing programs and initiatives were considered to be continued after they were gauged as to their ability to demonstrate impact on the target substance abuse problems identified in Midland County. Gaps in services were identified for underserved populations and underrepresented target areas. Assessing the community readiness and political will to address the identified substance abuse targets was an additional piece of the capacity assessment. Community readiness needed to be considered to ensure that effectiveness of interventions will not be compromised due to unwillingness of the community to address the issue. Political will was considered for sustainability purposes. Both areas will be discussed further in depth in the Capacity Assessment section. With direction attained and resources reviewed, an overall strategy for substance abuse prevention was developed. As part of the strategy, a proposal of new programs and interventions was created in order to fill the gaps identified in the capacity assessment. The CEW group appointed a core group of agencies to identify programs that would fit into the developed strategy. Four main agencies provide the majority of substance abuse prevention services for Midland County. They will be referred to as the core agencies. The core agencies include Circle of Health Partnership, Family and Children’s Services, Ten Sixteen Recovery Network and Midland Cancer Services. The SPF process provided a forum for these agencies to target substance abuse initiatives, coordinate efforts, share information, and dialogue on barriers and assets that each has experienced in providing prevention services in Midland County. With the prevention program and intervention services determined, the CEW group, because of the compelling data indicating the profound impact that assets have in protecting youth from risk-taking behaviors, recommended incorporating asset building into our prevention strategy. Accomplishing this requires training and consultation of asset building for representatives of the core agencies. The CEW group believes that asset building will enhance and increase the effectiveness of the program services and initiatives in Midland County. 7
  • 8. NEEDS ASSESSMENT SECTION I – UNDERAGE DRINKING According to the available data, Underage Drinking is a priority problem for Midland County. In 2006, 21% of drinking drivers involved in crashes were underage drivers. In comparison to benchmark counties (Lapeer-16%, Livingstion-15%, Oakland-12% and Shiawassee-11% as well as the State of Michigan-14%), Midland experienced a greater prevalence of drinking drivers involved in crashes being underage (Figure 2). Figure 2: Drinking Drivers Involved in Crashes by Age Group: Midland County 2006 16-20 21% 21-24 9% 25-34 29% 35-44 20% 45-54 18% 55+ 3% Underage Drinking Driver % Midland - 21 Lapeer - 16 Livingston - 15 Michigan - 14 Oakland - 12 Shiawassee - 11 In looking at the conviction data for the year 2006, 402 convictions in Midland County were categorized as alcohol related. One third of the alcohol related convictions were Minors in Possession (MIP) or Zero Tolerance convictions all issued to underage drinkers (Figure 3). 12% of the DUI arrests were drivers 18-20 years of age (Figure 4). Figure 3: Alcohol Related Convictions 2006 Figure 4: DUI Arrests by Age Group 8 MIP 31% INJ/ENDGR 1% INTOX 41% OWPD 0% IMPAIR 25% ZEROT 2% <20 12% 21-29 34% 31-39 18% 41-49 24% 51-59 10% 60+ 2%
  • 9. Juvenile population substance abuse data was not easily quantifiable. In 2006 18% of the 359 charges filed against juveniles were alcohol/drug related. 2007 data shows that there was a 17% increase in overall charges filed against juveniles from 2006 with a shift towards alcohol and assault crimes (Figure 5). Figure 5: 2006 Juvenile Charges Theft 54% Sex 4% Driving 2% Destruction Crimes 5% Alcohol 7% Drug 11% Assaultive/Weapons 17% Actual alcohol and drug use is underrepresented in juvenile data. The policy with juveniles is that in multiple offenses, the less serious offense is often dropped. The gaps in information as well as a need for standardization of consequence policies among school districts were identified as action items and were also addressed at a CAP21 (Community Awareness Project 21)meeting. Alcohol consumption data was obtained through several surveys. The consumption patterns were reviewed and although the reported rates of drinking alcohol and driving under the influence were similar or lower than the Michigan youth levels, stark differences were noted within the Midland youth amongst grade levels and grades earned (Figures 6). Figure 6: Percent of Students who reported at least one drink of alcohol in past 30 days 9 11th 12th 10th A's/B's C's D's/F's 20% 30% 40% 50% 60% 10th 11th 12th A's/B's C's D's/F's Grade Level Grades in School
  • 10. An increase is found in reported use as grade levels increases as well as an increase in reported use as grades earned decrease from A/B to C’s and finally to D/F. The same pattern can be seen when we look at students reporting driving under the influence. Over one fourth of Midland respondents report at least one drink of alcohol in the past 30 days. Nine percent of Midland teens report driving under the influence. Figure 7: Percent of Students who reported driving under the influence (DUI) 11th 12th 10th C's D's/F's A's/B's 0% 5% 10% 15% 20% 10th 11th 12th A's/B's C's D's/F's Grade Level Grades in School SECTION II – ALCOHOL RELATED FATAL CRASHES In examining the alcohol related traffic crashes from the years 2005 through 2007, Midland is ranked 51st of 83 counties in experiencing the highest percentage of crashes involving alcohol (Figure 8). In this period, 3.3% of all crashes in Midland were alcohol related. Figure 8: Percent of Crashes that were Alcohol Related: 2005-2007 4.32% 3.90% 3.81% 3.70% 3.39% 3.30% Livingston Michigan Shiawassee Lapeer Oakland Midland Midland County 2005-2007: 256 Alcohol Related Crashes Average: 85 per year 10
  • 11. In looking at alcohol related fatal crash deaths Midland has a fatal crash rate of 0.119, which is much lower than the 0.34 statewide fatal crash rate (Figure 9). Figure 9: Alcohol Related Fatal Crash Rates - 2006 0% 5% 10% 15% 20% 25% 30% 35% 40% Shiawassee Michigan Livingston Oakland Lapeer Midland 0.0 0.1 0.2 0.3 0.4 0.5 0.6 % Fatal Crashes - Alcohol Related Fatal Crash Rate per 10,000 people Due to the lower incident rates of alcohol related fatal crashes, and the compelling cost data (Table 1) associated with alcohol related crashes, we will base our strategy on reducing alcohol related crashes with the assumption that this will have an overriding effect on the alcohol related fatal crashes. Table 1: Costs of Alcohol-Involved Traffic Crashes in Midland County (2004 Dollars) Fatal Serious Injury Moderate Injury Minor Injury Property Damage Only Total Medical Care $86,777 $441,484 $296,049 $119,201 $12,049 $955,561 Future Earnings (Lost Wages) $4,533,727 $1,178,369 $621,675 $241,649 $49,365 $6,624,785 Public Services $2,684 $2,929 $3,807 $2,257 $1,530 $13,207 Property Damage and Loss $33,099 $82,509 $128,906 $93,480 $74,905 $412,899 Subtotal (Monetary Costs) $4,656,285 $1,705,292 $1,050,437 $456,588 $137,849 $8,006,450 Quality of Life $8,480,111 $1,771,270 $1,293,577 $397,338 $41,515 $11,983,811 Total (Comprehensive Costs) $13,136,397 $3,476,562 $2,344,014 $853,926 $179,364 $19,990,262 11
  • 12. Each year from 1998 through 2004, the costs associated with traffic crashes range from 2.4 to 2.9 times that of the costs of index crimes. Index crimes include larceny, burglary, rape, assault, robbery, motor vehicle theft, and murder. The average cost of alcohol related traffic crashes in Midland County in 2004 was seven times more than the average cost of non-alcohol related traffic crashes (Table 2). Table 2: Cost of Traffic Crashes vs. Alcohol-Involved Traffic Crashes in Midland County (2004 Dollars) Non-Alcohol Related Alcohol Related Traffic Crash Casualty Severity Traffic Crash Casualties Traffic Crash Costs Traffic Crash Casualties Traffic Crash Costs Property Damage Only 3273 $9,569,973 47 $179,364 Minor Injury 461 $18,760,510 21 $853,926 Major Injury 180 $10,793,729 27 $2,344,014 Serious Injury 59 $12,499,289 11 $3,476,562 Fatal 11 $45,940,873 3 $13,136,397 Total 3984 $97,564,374 109 $19,990,262 Average cost of traffic crash $24,489 $183,397 SECTION III – INCREASE IN ILLICIT DRUG USE There are several indicators that illicit drug use is increasing in Midland County. Michigan State Police provided narcotic crime trends by district in their 2006 Crime Analysis Report. Midland’s offense rate has increased 36% from 2000 to 2004. At the same time the Third District realized an increase of only 20% (Table 3). Table 3: Crime Analysis Report, June 2006 Narcotic Crime Trends Midland Narcotic Offense Rate Third District* Narcotic Offense Rate 2004: 50.83 2004: 45.36 2000: 37.51 2000: 37.86 % change: 36% % change: 20% Offense rate is per 10,000 Offense rate is per 10,000 *Third District: Arenac,Bay,Genessee,Gladwin,Huron,Iosco,Lapeer,Midland,Ogemaw,Saginaw,Sanilac,Tuscola Another type of consequence data reviewed was hospital admission data. The data was provided by the local hospital (MidMichigan Medical Center–Midland), which services 12
  • 13. over 80% of Midland County. The analysis stratified the inpatient admissions by age and date of admission. The data extraction filtered out all but those admissions with ICD-9 (International Statistical Classification of Diseases and Related Health Problems) Diagnostic codes that were indicative of drug abuse or drug dependence. ICD-9 coding is used world wide for morbidity and mortality statistics. The analysis findings show that 29% of the hospitalizations due to drug use are from the age group 15-24 years. This age group represents 14% of the Midland county population, yet yields 29% of the hospitalizations due to drug use (Figure 10). The data shows a marked difference in gender as well as age group. Overall, males were admitted due to drug use 3:2 over females. Figure 10: Drug Abuse and Dependence: MMMC Hospital Admissions 2005-2007 25-34 years 16% 35-44 years 22% 45-54 years 19% 55+ years 14% 15-19 years 13% 20-24 years 16% 29% The 2007 Alcohol and Other Drugs School Survey provided consumption data regarding drug use. The data shows Midland County’s 12th grade reporting illicit drug use above that of the national 12th grade levels (Figure 11). The Profiles of Student Life: Attitudes and Behaviors Survey showed 26% of Midland County’s 12th grade reporting illicit drug use (3 times in last year). Figure 11: Consumption Data: Drug Use - % Responding Drug Use in Past 30 Days 11.1% 17.6% 29.3% 23.4% 15.1% 10.8% 10.5% 7.2% 0% 5% 35 % % % % % % Midland County 8th Midland County 10th Midland County12th National 12th 30 25 Illicit Drug Use Drug Use Other than Marijuana 20 15 10 13
  • 14. Looking at outpatient treatment data, obtained from Ten Sixteen Recovery Network, by drug choice gives a picture of what Methadone and other opiates play in drug misuse/dependence in Midland County (Figure 12). Figure 12: 2007 Outpatient Drug Use – Ten Sixteen Treatment Center Alcohol 45% Marijuanna 26% Opiates 9% Prescription 1% Crack/Cocaine 8% Methamphetamines 2% Heroin/Other Opiates 2% Other 1% No Current Use 6% In examining the inpatient data, prescription drug abuse and dependence is clearly magnified (Figure 13). The differences in referrals were noted in that 78% of inpatient admissions are self or family referred. In outpatient admissions only 16% are referred in this manner. The major referral source for outpatients is the courts. Figure 13: 2007 Inpatient Drug Use – Ten Sixteen Treatment Center Alcohol 47% Prescription 34% Other 1% Marijuanna 6% Crack/Cocaine 12% 14
  • 15. The Treatment data illustrates similar gender findings as the hospital data. Outpatient treatment admissions for 2007 were 66% male and 34% female patients. Inpatient data was reported and analyzed as well. SECTION IV – SMOKING All of the data reviewed indicate that the trend in Midland County is a decrease in smoking. The Midland County Behavioral Risk Factor Survey (BRFS) reported a decrease from 26% of those surveyed in 1998, to 25% in 2002 and finally 21% in 2004. A similar trend can be seen within the youth population from the 2005 Youth Risk Behavior Survey. From 26% in 2001 reported as current smokers, to 23% in 2003, and finally 17% in 2005. (Figures 14 & 15) Figure 14: Midland County Adult Current Smokers 21% 27% 25% 0% 5% 10% 15% 20% 25% 30% 1998 2002 2006 Figure 15: Midland County Teen Current Smokers 17% 26% 23% 0% 5% 10% 15% 20% 25% 30% 2001 2003 2005 %CurrentSmokers 15
  • 16. Additionally, the Youth Risk Behavior Survey contained data for Midland County that highlighted a possible correlation between smoking and grades earned in school. 12% of the A/B’s population responded as current smokers, while 42% of the D/F’s population responded as current smokers (Figure16). Figure 16: Current Smokers by Grades Earned 12% 23% 42% 0% 10% 20% 30% 40% 50% A's/B's C's D's/F's Grades in School %CurrentSmokers Although the trends indicate that the number of people who smoke is decreasing, the CEW group deemed it important enough of an issue to want to continue the prevention efforts directed at smoking. Some compelling facts regarding smoking from data issued by the Campaign for Tobacco-Free Kids in 2005 entitled “The Toll of Tobacco in Michigan” included the following: Deaths in Michigan from Smoking: • Adult who die each year from their own smoking: 14,500 • Adults who die each year due to Secondhand smoke: 930 - 2,610 Smoking Caused Monetary Costs in Michigan: • Annual health care costs in Michigan directly caused by smoking: $3.4 Billion • Smoking-caused productivity losses in Michigan: $3.8 Billion • State and Federal Tax burden from smoking-caused government expenditures: $637 per household 16
  • 17. SECTION V – INTERVENING VARIABLES The CEW group’s next task, after finalizing and agreeing upon a listing of priority substance abuse problems for Midland County, was to follow the outcomes-based prevention model and identify intervening variables. The group defined intervening variables as those factors that “cause” substance-related consequences and consumption in the community. Each member of the CEW group completed a brainstorm listing of those variables that they saw as contributing to each target problem in Midland. Available data was gathered and analyzed on these identified variables. The variables were then prioritized based on an exercise that rated the variables in relation to the following: link to consequence, changeability, community readiness, community capacity, local data available, political will, and impact on consequence. The top intervening variables are listed in the figure below (Chart 1). Chart 1: Top Intervening Variables Top Intervening Variables Positive Peer Influence Resistance (refusing to participate in risky behavior) Restraint (avoiding risky situations) Positive View of Personal Future Lack of Social/Physical Activities Ease of Access Social Acceptance Stress Parent Education Lack of Parent Involvement/Intervention Poor modeling of risky behaviors Enforcement and Adjudication • Misperception of legal consequences Non-Standardized School Policy Peer pressure was defined as pressure applied from one’s peers to behave in a manner similar or acceptable to them, in this case, pressure to use. This can be construed as a lack of positive peer influence. In looking at the Midland County AOD survey data, as the students get older the peer pressure to use gets greater. Feeling pressure to use alcohol is near 50% by the time a student reaches 10th grade. Alcohol is by far the substance that most peer pressure to use is perceived (Figure 17). 17
  • 18. Figure 17: Peer Pressure: % Responding that they feel pressure to use The AOD Survey provided aggregate data stratified by the respondent’s future college plans. There were startling differences noted in drug use between those who had indicated that they had plans to attend college and those who indicated they did not. The data also gave the ability to compare the Midland County 12th grade respondents to the national 12th grade norm. The Midland County 12th grade non-college bound cohort responded that over 50% had used illicit drugs within the past 30 days, while the national level for 12th grade non-college bound was near 30%. The Midland college bound cohort responded using illicit drugs at a higher rate than the national 12th grade college bound as well. Figure 18: Illicit Drug Use* by College Plans 0% 10% 20% 30% 40% 50% 60% Alcohol Marijuana Cigarettes Illicit Drug 8th Grade 10th Grade 12th Grade * Use within past 30 days 10% 16% 29% 21% 35% 44% 54% 29% 0% 10% 20% 30% 40% 50% 60% 8th Grade 10th Grade 12th Grade Ntl. 12th College Bound NOT College Bound 18
  • 19. The most compelling intervening variable data was found in the analysis of the Profiles of Student Life: Attitudes and Behaviors Survey that was conducted in Midland County (2006). This is survey, published by the Search Institute, assesses adolescent development and provides a comprehensive overview of participating youth. The data can be compared to normative data from other communities across the U.S. Specifically, the survey is designed to measure a youth’s developmental assets, positive experiences, and qualities identified as being essential to healthy psychological and social development in childhood and adolescence. These assets have the power to influence young people’s developmental trajectories, protect them from a range of negative outcomes, and help them become more productive, caring and responsible adults. In Midland County, the survey was administered to over 6,000 public school students and approximately 100 juvenile court wards, which represented 85% of the adolescent population. The key finding was that the more developmental assets a youth has, the fewer risk taking behaviors they exhibit (Figure 19). Take note of the Midland Court Wards trend. The court ward population had no statistical representation with more than 20 assets. Figure 19: Risk Taking Behaviors by Asset Level 0 2 4 6 8 10 12 14 0-10 11-20 21-30 31-40 # of Assets #ofRiskTakingBehaviors Midland Court Wards Midland Youth National Youth Currently a regression analysis of the Midland data is being conducted by The Legacy Center for Student Success. The primary goal of this analysis is to identify which of the developmental assets significantly predict alcohol, drug or tobacco use within the Midland youth population. Preliminary results show that the developmental assets of positive peer influences, restraint and resistance skills are the top three assets in their ability to predict alcohol, drug and tobacco use scores. In addition to the local data, there is an impressive body of research that points to the need for communities to embrace asset building as an integral part of their substance abuse prevention efforts. 19
  • 20. CAPACITY ASSESSMENT Before the CEW group could effectively select substance abuse programs and initiatives to include in the strategy, a capacity assessment was needed. The CEW group delegated the capacity assessment to the core group of substance abuse prevention agencies. First, the core group compiled and reviewed a comprehensive listing of current prevention services provided in the community. After reviewing the targets identified by the Needs Assessment for Midland County, gaps in services were identified for underserved populations and underrepresented target areas. The gaps identified in services provided in Midland County included the following: • First Offense population is underserved. This population includes first time offenders from athletics programs, schools (secondary schools and universities), and courts • Parent-Involvement programs, parent education, awareness and intervention • Non-college bound, blue collar 18-25 year old population • Community mobilization environmental effort targeting alcohol Next the capacity assessment focused on the current community resources and assets of Midland County related to the delivery of substance abuse prevention services. To ensure the capability of bringing about desired changes, the community of Midland County must have resources in place to carry out the intended interventions. The core agencies looked at the human, technical, organizational and financial resources needed to implement the proposed programs and interventions included in the strategy. From this analysis the issues and barriers that were identified include: • Family and Children’s Services does not have the ability to deliver prevention services under the current reimbursement system. Currently agencies are funded after delivery. Funding is needed upfront in order to have the ability to deliver prevention services. • In order to have the ability to implement and sustain tobacco prevention services, Midland Community Cancer Services needs to obtain prevention licensing. The other core agencies support this action and offered advisement and assistance in obtaining licensing. • Core agencies experience difficulty in penetrating Midland Public schools-- MPS has no prevention services delivered to students other than the Michigan Model and DARE. Recruitment of a representative from the MPS administration as a member of the CEW group may assist in addressing this issue. Assessing the community readiness and political will to address the identified substance abuse targets was an additional piece of the capacity assessment. Community readiness needs to be measured to ensure that effectiveness of interventions will not be 20
  • 21. compromised due to unwillingness of the community to address the issue. Political will needs to be examined for this as well as sustainability purposes. There are community coalitions in place in Midland County that are currently working to educate the community to the growing dangers stemming from substance abuse. An example is the Community Awareness Project 21 (CAP 21) coalition. CAP 21 is a group of Midland County residents who support youth in Midland County through advocacy and action. Their focus is to curb underage drinking. Information regarding barriers in the community was gathered from coalition representatives. Another data source used to monitor community readiness was gathered through a survey distributed at various community events. The survey, distributed and analyzed by Circle of Health Partnership, questioned respondents regarding the issue of underage drinking. Their data collection to date shows positive support by the community on addressing this issue. Some of the information from the survey includes: 91% Respondents are familiar with the issue of underage drinking 0% 100% 94% Participants respond that it is very important to reduce underage drinking. 0% 100% 46% Respond underage drinking is one of the most important issues in our community 0% 100% 79% Judge that the community leaders deem this issue as important 0% 100% To gauge political will, Circle of Health Partnership has facilitated youth policy group meetings. The meeting’s participants include key community stakeholders and elected officials. The purpose of these meetings is to provide dialogue and assessment of youth policy in Midland County. As part of the overall strategy, this group will be reconvened in late October in order to discern the Midland County Strategic Prevention Framework outcome information and future planning strategy. Midland County also is in the process of developing a Youth Master Plan (YMP). This plan represents a long-term blueprint among youth-oriented organizations and stakeholders that supports positive opportunities for youth to flourish and thrive. The YMP has four principal desired outcomes and benefits for both youth in the County as well as for the community at large: • Measurably improve the quality of life for youth in the community • Support complementary and integrated initiatives to achieve shared goals and attain greater community impact 21
  • 22. • Leverage expertise and other forms of shared resources through inter- agency collaboration to get more done with less • Minimize duplication of programs and services, thereby maximizing the use of increasingly scarce funding • Reduce administrative costs and streamline processes by creating common procedures The YMP, once in place, aligns well with the SPF and should support sustainability efforts. A more detailed summary is included in the Appendix. 22
  • 23. STRATEGY PROPOSAL This summary will focus on the Substance Abuse Prevention strategy proposed by the CEW for Midland County. The CEW group has convened since March 2008. There have been ongoing dialogue and data searches conducted and reviewed. The meeting minutes and slides are included in the Appendix. As a result of these efforts, Midland County has completed the following activities: • Identified priority substance abuse problems • Identified and prioritized intervening variables that are believed to be the underlying causes of substance abuse behavior • Identified gaps in resources and services in Midland County • Developed a strategy to impact the priority substance abuse problems • Gathered baseline data to measure against for outcome evaluation purposes After reviewing the information obtained for and documented in the Needs Assessment and the Capacity Assessment, the CEW group next examined the program or initiative selections that would best fill the gaps identified. Program/Intervention criteria were formulated by a combination of two tools. The first tool utilized was the guidance document for the Strategic Prevention Framework State Incentive Grant Program entitled “Identifying and Selecting Evidence Based Interventions”. Utility and feasibility checks were utilized to ensure that the proposed programs considered each of the points in the checklists. The second tool used was a resource which delved into the building of assets. The book, “Getting to Outcomes with Developmental Assets”, provides a full range of tools needed to improve the quality of community development work. A worksheet from the book, “Choosing Programs and Projects through an Asset Building Lens”, was utilized to help with the prospective programs review. The core agencies met and coordinated efforts in defining prospective programs to fill gaps. This collaborative effort resulted in a forum for the core agencies to share information, assist one another and to define an opportunity for partnering in the future implementation of a prospective program. To address the substance abuse problems of Underage Drinking, Alcohol related Crashes, Illicit Drug Use and Smoking, Midland County proposes the following programs to be included with the current prevention initiatives in an overall coordinated strategy: • Protecting You/Protecting Me o Elementary age children o Delivered by Ten Sixteen Network o A five year classroom-based alcohol use prevention and vehicle safety program for elementary 1-5 and high school grades 11-12. The program aims to reduce alcohol-related injuries and death due to underage alcohol use and riding in vehicles with drivers who are not alcohol free. Resistance 23
  • 24. strategies are taught and program has a parent take-home activities component. • NOT Not On Tobacco o High School students o Coordinated by Midland Community Cancer Services o A school based training program designed to educate, engage and support youth who have decided to stop smoking • Pathways to Prevention o Parent – involvement; 6 weeks long course, designed to spend 1 hour per week with parents and 1 hour per week with youth. The topics include morals, values, the stages of addiction, drugs and their effects, positive communication, boundaries, problem solving and refusal skills. o Delivered by FCS • First Offense Program (TBD) o FCS & COHP to determine best fit evidence based program o Coordinated delivery by FCS • Project Success o Students 12-18 years of age o Delivered by FCS o Designed to prevent and reduce substance use among middle and high school students. Contains four components: Prevention Education Series, school-wide activities and promotional materials, parent program, individual and group counseling leading to referral to appropriate community services for those requiring more intensity. • Project Northland o Middle school age children o Delivered by COHP o Multi-level intervention program designed to delay the age at which adolescents begin drinking, reduce alcohol problem use among those already drinking, and limit the number of alcohol-related problems among young drinkers. Focus on resistance skills and normative expectations • Positive Action o Alternative high school population o Delivered by COHP o An integrated and comprehensive program designed to improve academic achievement; school attendance; and problem behaviors such as substance abuse, violence, suspensions, dropping out and sexual behaviors. Designed to improve parent-child bonding, family cohesion, and family conflict 24
  • 25. • Life Skills o Elementary age children; 4th & 5th grade students o Delivered by COHP o A program combining social competencies, violence prevention and alcohol, tobacco, and other drug abuse prevention. Designed to address a wide range of risk and protective factors. • All Stars o After school program; 7 sites, 6-10 year old students o Delivered by COHP o A multi-year school based program for middle school students designed to prevent and delay the onset of high-risk behaviors such as drug use, violence, and premature sexual activity. The program focuses on five topics that are not only important to prevention, but are essentially asset based. Parent component included. • Community Mobilization on Change of Alcohol o Community based awareness initiative o Coordinated by COHP o A community-organizing program designed to reduce teens’ access to alcohol by changing community policies and practices. Seeks both to limit youths’ access to alcohol and communicate a clear message to community that underage drinking is inappropriate and unacceptable. The program involves community members in seeking and achieving changes in local public policies and the practices of community institutions that can affect youths’ access to alcohol. • Team Awareness o Non-college bound, blue collar, 18-25 year age group o Coordinated by COHP o Worksite prevention training program that addresses behavioral risks associated with substance abuse among employees, their coworkers and families. Training seeks to promote social health and increased communication between workers; improve knowledge about and attitudes toward alcohol and drug related protective factors in the workplace-such as company policy and Employee Assistance Program; and increase peer referral behaviors. Because of the compelling data indicating the profound impact of assets in protecting youth from engaging in risk taking behaviors, the CEW group also recommends that the strategy includes incorporating asset building into the existing and proposed substance abuse prevention services. The Profiles of Student Life: Attitudes and Behaviors Survey provided Midland County with information regarding assets for our student population. Baseline levels were established regarding assets. Search Institute provides extensive 25
  • 26. research that confirms the power of assets in preventing ATOD use. The data obtained by the Profiles Survey regarding the Midland community youth’s assets as well as the evidence and research documented by Search Institute in “Tapping the Power of Community: Building Assets to Strengthen Substance Abuse Prevention”21 suggest that incorporating asset building into our prevention strategy will be instrumental in reducing substance abuse related consequences and consumption. Search Institute leads workshops, provides consultation, and trains individuals and organizations to become asset builders in work and daily life. Providing the core agencies with training services offered by Search Institute would allow for the enhancement of the overall prevention strategy. The core group discussed the opportunity to leverage asset building knowledge and skills with other community agencies in an effort to spread asset building beyond substance abuse prevention services. Efforts will be made to minimize the cost of training by coordinating with other agencies in Midland County that are currently incorporating asset building into their initiatives. A vital piece of any strategy is the evaluation and measurement plan. The overarching measurement for the effectiveness of the substance abuse prevention strategy will be in realizing a decrease in consequences and consumption of: • Underage Drinking • Crashes related to Alcohol • Illicit Drug Use • Smoking Components of the evaluation plan include process and outcome measures. The process measures will be produced by the agencies that deliver the programs. These measures would include; adherence to the program guidelines and delivery, attendance, and program specific measures. The core agencies will provide the CEW group with an annual report regarding implementation and process measures of programs and services made available by the strategy. Outcome measures will be obtained by utilizing the needs assessment data as baseline information and tracking progress toward changing the levels of highlighted substance abuse consequence and consumption. Data will be evaluated annually based on availability. 26
  • 27. Appendix 1 GLOSSARY Acronym Definition ATOD Alcohol, Tobacco and Other Drugs BRFSS Behavioral Risk Factor Surveillance Survey CAP 21 Community Awareness Project 21 CEW Community Epidemiological Workgroup COHP Circle of Health Partnership FCS Family and Children's Services HHSC Health and Human Services Council ICD-9 International Statistical Classification of Diseases and Related Health Problems MIP Minors in Possession MMMC MidMichigan Medical Center MPS Midland Public Schools MSP Michigan State Police NMSAS Northern Michigan Substance Abuse Services SAMHSA Substance Abuse and Mental Health Services Administration SIG State Incentive Grant SPF Strategic Prevention Framework YMP Youth Master Plan YRBS Youth Risk Behavior Survey 27
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  • 29. Filename: Midland County Substance Abuse Prevention Strategy Directory: G:CommunicationsNeighbor to NeighborWebsite support Template: C:Documents and SettingshollyApplication DataMicrosoftTemplatesNormal.dot Title: Strategic Prevention Framework/State Incentive Grant Subject: Author: Mike Somers Keywords: Comments: Creation Date: 2/26/2009 4:14 PM Change Number: 2 Last Saved On: 2/26/2009 4:14 PM Last Saved By: holly Total Editing Time: 1 Minute Last Printed On: 2/26/2009 4:14 PM As of Last Complete Printing Number of Pages: 28 Number of Words: 6,080 (approx.) Number of Characters: 34,477 (approx.)