Community Engagement: An Essential Component of an Effective and Equitable Substance Use Prevention System

2022·11.6 MB·English

EVIDENCE-BASED RESOURCE GUIDE SERIES
Community Engagement:
An Essential Component
of an Effective and
Equitable Substance
Use Prevention System
Community Engagement: An Essential
Component of an Effective and Equitable
Substance Use Prevention System
Acknowledgments
This guide was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA)
under contract number HHSS283201700001 / 75S20319F42002 with SAMHSA, U.S. Department of Health
and Human Services (HHS). Donelle Johnson served as the contracting officer representative.
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Recommended Citation
Substance Abuse and Mental Health Services Administration (SAMHSA). Community Engagement:
An Essential Component of an Effective and Equitable Substance Use Prevention System. SAMHSA
Publication No. PEP22-06-01-005. Rockville, MD: National Mental Health and Substance Use Policy
Laboratory. Substance Abuse and Mental Health Services Administration, 2022.
Originating Office
National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services
Administration, 5600 Fishers Lane, Rockville, MD 20857, Publication No. PEP22-06-01-005. Released
2022.
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(including pregnancy, sexual orientation, and gender identity).
Publication No. PEP22-06-01-005
Released 2022
Community Engagement: An Essential Component of an Effective and Equitable
Substance Use Prevention System I
Acknowledgments
Abstract
By engaging community members, prevention systems learn firsthand from individuals and community
systems about substance use problems and social determinants that influence behavioral health. Community
engagement brings together the skills, knowledge, and experiences of diverse groups to create and/or
implement solutions that work for all members of the community. This guide focuses on how community
engagement can play a critical role in the equitable scale-up of evidence-based programs and policies within
the substance use prevention system. The guide presents what we know about community engagement from
research studies, reporting on common community engagement activities and outcomes. It also discusses
practical considerations drawn from on-the-ground experience regarding how to participate effectively in
community engagement.
Community Engagement: An Essential Component of an Effective and Equitable
Substance Use Prevention System II
Abstract
MESSAGE FROM THE ASSISTANT SECRETARY
FOR MENTAL HEALTH AND SUBSTANCE USE,
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
As the Assistant Secretary for Mental Health and Substance Use in the U.S. Department of Health
and Human Services and the head of the Substance Abuse and Mental Health Services Administration
(SAMHSA), I am pleased to present this new resource—Community Engagement: An Essential Component
of an Effective and Equitable Substance Use Prevention System.
SAMHSA is committed to improving prevention, treatment, and recovery support services for individuals
with mental illnesses and substance use disorders. SAMHSA’s National Mental Health and Substance
Use Policy Lab developed the Evidence-Based Resource Guide Series to provide communities, clinicians,
policymakers, and others with the information and tools to incorporate evidence-based practices into their
communities or clinical settings. As part of the series, this guide shares practical considerations for state,
community, and tribal leadership in using community engagement to create and/or implement solutions that
work for all members of the community.
This guide and others in the series address SAMHSA’s commitment to behavioral health equity, including
providing equal access for all people to evidence-based prevention, treatment, and recovery support
services regardless of race, ethnicity, religion, income, geography, gender identity, sexual orientation,
and disability. Each guide recognizes that substance use disorders and mental illnesses are often rooted in
structural inequities and influenced by the social determinants of health. Behavioral health practitioners and
community stakeholders must give attention to health equity to improve individual and population health.
Community engagement plays a pivotal role in the equitable scale-up of evidence-based practices,
programs, and policies within the substance use prevention system. I encourage you to use this guide, as
meaningful participation of community members ensures accountability to those most affected by problems
related to substance use.
Miriam E. Delphin-Rittmon, PhD
Assistant Secretary for Mental Health and Substance Use
U.S. Department of Health and Human Services
Community Engagement: An Essential Component of an Effective and Equitable
Substance Use Prevention System III
Message from the Assistant Secretary for Mental Health and Substance Use
Evidence-Based Resource Guide
FOREWORD
Series Overview
The Substance Abuse and Mental Health Services A priority for SAMHSA is ensuring that behavioral
Administration (SAMHSA), and specifically, its health services reach under-resourced populations
National Mental Health and Substance Use Policy for prevention, treatment, and recovery supports.
Laboratory (Policy Lab), is pleased to fulfill the Implementation of evidence-based practices, policies,
charge of the 21st Century Cures Act. This charge is to and programs can reduce mental health and substance
disseminate information on evidence-based practices use problems for individuals and communities.
and service delivery models. However, implementation and uptake of EBPs can
be challenging, and only a small percentage of
The Evidence-Based Resource Guide Series is a
communities have implemented them. Even when
comprehensive set of modules with resources to
communities implement EBPs, not all populations
improve health outcomes for people at risk for,
experience their benefits equally, including those in
experiencing, or recovering from mental health and/or
greatest need. Health disparities may worsen as a result,
substance use disorders. It is designed for practitioners,
despite the goal of equity.
administrators, community leaders, health professions
educators, and others considering an intervention for Prevention researchers have identified community
their organization or community. engagement as a critical factor that influences
the equitable scale-up of EBPs and subsequently
Expert panels of federal, state, and non-governmental
contributes to improvements in population health.1 This
participants provided input for each guide in this
guide reviews research on community engagement in
series. The panels include accomplished researchers,
substance use prevention, outlining common community
educators, service providers, community members
engagement activities and outcomes. It is one piece of
with lived experience (including families), community
an overall approach to implement and sustain change.
administrators, and federal and state policymakers.
Readers are encouraged to review the SAMHSA
Members provide input based on their lived expertise
website for additional tools and technical assistance
and knowledge of healthcare systems, implementation
opportunities.
strategies, evidence-based practices (EBPs), provision
of services, and policies that foster change.
1 Cooper, B., Hill, L., Parker, L., Jenkins, G., Taylor, G., & Graham, P. (2019). Prevention works: A call to action for the behavioral
health system. Society for Prevention Research. https://www.preventionresearch.org/wp-content/uploads/2019/06/SPR-Behavioral-
Health-Brief_FINAL.pdf
Community Engagement: An Essential Component of an Effective and Equitable
Substance Use Prevention System IV
Evidence-Based Resource Guide Series Overview
Behavioral health equity is the right to access high-quality and affordable healthcare services and supports
for all populations, including Black, Latino, and Indigenous and Native American persons, Asian Americans
and Pacific Islanders, and other persons of color; members of religious minorities; lesbian, gay, bisexual,
transgender, queer/questioning and intersex (LGBTQI+) persons; persons with disabilities; persons who live
in rural areas; and persons otherwise adversely affected by persistent poverty or inequality. As population
demographics continue to evolve, behavioral healthcare systems will need to expand their ability to fluidly meet
the growing needs of a diverse population. By improving access to behavioral health care, promoting quality
behavioral health programs and practice, and reducing persistent disparities in mental health and substance
use services for under-resourced populations and communities, recipients can ensure that everyone has a fair
and just opportunity to be as healthy as possible. In conjunction with promoting access to high-quality services,
behavioral health disparities can be further mitigated by addressing social determinants of health, such as
social exclusion, unemployment, adverse childhood experiences, and food and housing insecurity. In all areas,
including community engagement, SAMHSA is committed to behavioral health equity.
Community Engagement: An Essential Component of an Effective and Equitable
Substance Use Prevention System V
Evidence-Based Resource Guide Series Overview
Content of the Guide FOCUS OF THE GUIDE
For years, practitioners and researchers
This guide contains a foreword (FW) and five chapters (1-5). Each
in the prevention field have widely
chapter is designed to be brief and accessible to practitioners,
recognized community engagement as
administrators, community leaders, health professions educators, important and necessary. By engaging
and others considering community engagement strategies and community members, prevention systems
activities to support the equitable scale-up of evidence-based learn firsthand from individuals and
practices, programs, and policies. community systems about substance use
problems and social determinants that
FW Evidence-Based Resource Guide Series influence behavioral health.
Overview
This guide highlights research on
Introduction to the series. community engagement in substance
use prevention and provides practical
1 Issue Brief guidance for implementing and evaluating
community engagement strategies and
This chapter provides definitions of community
activities.
engagement; describes how community engagement
can support the equitable scale-up of evidence- The guide does not focus on specific
based practices, programs, and policies; and reviews evidence-based practices, programs, or
community engagement principles and proposed policies, but instead provides an overview
benefits. of how community engagement can play a
pivotal role in the uptake of EBPs broadly
2 What Research Tells Us
across the substance use prevention
This chapter highlights research on community system.
engagement in substance use prevention, outlining
common community engagement activities and
outcomes.
3 Guidance for Community Engagement
This chapter presents key considerations and
strategies for incorporating community engagement
in substance use prevention.
4 Examples of Community Engagement for
Substance Use Prevention
This chapter highlights three organizations using
community engagement in their substance use
prevention interventions.
5 Resources for Evaluation
This chapter provides guidance and resources for
evaluating community engagement strategies and
activities.
Community Engagement: An Essential Component of an Effective and Equitable
Substance Use Prevention System VI
Content of the Guide
CHAPTER
1
Issue Brief
The World Health Organization (WHO) defines connect with community, and carry out activities of
community engagement as “a process of developing daily life. Substance use affects all Americans and all
relationships that enable stakeholders to work together communities—the young and old, all racial and ethnic
to address health-related issues and promote well-being groups, people of all abilities, and people of all sexual
to achieve positive health impact and outcomes.”1 orientations, gender identities, or sex characteristics.3-7
Community engagement brings together the skills, Substance use affects both under-resourced and affluent
knowledge, and experiences of diverse groups to create neighborhoods. It impacts all community sectors:
and/or implement solutions that work for all members business, education, health care, law enforcement, social
of the community. Practitioners and researchers in the services, and more.8
prevention field have recognized community engagement
Prevention systems aim to:
as important and necessary for years. However, researchers
have not systematically studied community engagement
• Protect community members across lifespans
in ways that have yielded the practical guidance necessary from substance use and SUDs
to promote more widespread use. This guide presents
• Minimize the negative consequences of
what we know about community engagement from
substance use on individuals and society
research studies. It also discusses practical considerations
• Advance equity and population health
drawn from on-the-ground experience regarding how to
effectively participate in community engagement.
Achievement of these goals depends on scaling up
evidence-based practices (EBPs). Dozens of prevention-
Preventing Substance Use
focused EBPs have been developed for community
Disorders Depends on settings with various populations and conditions.9
The Substance Abuse and Mental Health Services
Expansion of Evidence-
Administration (SAMHSA) provides guidance in
Based Programs and determining what EBPs could be applied or adapted
to a community.10 However, only a small percentage
Policies
of communities have implemented EBPs.9 Even when
Substance use disorders (SUDs) are among the most communities implement EBPs, the benefits are often not
common disabling conditions in the United States.2 experienced by all populations equally, especially those
They have the potential to impair a person’s ability to in greatest need.11 Health disparities may worsen as a
work, engage in relationships, maintain mental health, result, despite the goal of equity.
Community Engagement: An Essential Component of an Effective and Equitable
Substance Use Prevention System 1
Issue Brief
Community engagement is a critical factor that • Implementation and evaluation of EBPs to
influences the equitable scale-up of EBPs and measure improvements in community conditions
contributes to improvements in population health.12 and behavioral health
As stated in the White House Office of National Drug • Assessment of the community engagement
Control Policy’s (ONDCP’s) 2022 National Drug process to ensure it is equitable, meaningful, and
Control Strategy, “implementing evidence-based continual
policies, environmental strategies, and programs
• Obtaining feedback from community members
requires an understanding of a community’s challenges
to ensure outcomes from EBPs are consistent
and knowing which strategies will effectively address with community priorities, expectations, and
a community’s specific challenge.”13 By engaging lived experiences
community members, prevention systems learn firsthand
from affected individuals and community systems about Community Engagement
substance use problems and the social determinants that
Requires Trust
affect behavioral health. Within prevention systems,
community engagement often consists of:
Community engagement begins by “gathering the
community,” or assembling a group of community
• Engaging community members with needs
members. Relationships and the trust upon which they
assessments and prevention planning
are built need to be in place. Authentic community
• Building community capacity
engagement efforts recognize that there may be distrust in
• Selecting and implementing EBPs the community.
• Evaluating EBPs’ effectiveness over time
Community engagement within prevention systems Structural racism is a system in which
integrates meaningful participation of community public policies, institutional practices, cultural
representations, and other norms work in various,
members who have diverse experiences, values, cultures,
often reinforcing ways to perpetuate racial group
and perspectives. Community engagement also ensures
inequity.14 It remains a root cause of persistent
accountability to those most affected by problems related
health disparities in the United States.
to substance use.
Historical trauma is collective, multigenerational
Effective Scale-Up Efforts Are Informed and trauma experienced over time by a group of
people who share an identity, affiliation, or
Executed at the Community Level
circumstance; it is frequently linked to health
Developing an effective community-based prevention
disparities.
strategy to address substance use depends on assessment
and engagement at the community level. It requires:
The process of establishing trust starts with dispelling
• Community voice concerning how substance use myths and honestly acknowledging community
affects individuals, families, neighborhoods, and members’ shared traumatic history, structural racism that
community sectors (e.g., child welfare, health
perpetuates inequities, and other trauma experienced
care, law enforcement)
by communities, including the LGBTQI+ community.
• Assessment of historical trauma and When distrust exists, communities need to promote
neighborhood-level risk and protective factors healing and reconciliation, so that meaningful, trusting
for substance use, as well as other social relationships can develop. This process involves actively
determinants of health
seeking information, visualizing what needs to change,
• Capacity building to enable SUD prevention and engaging in shared learning.
systems, partner organizations, prevention
Formally acknowledging a community’s shared
professionals, and others to deliver EBPs
successfully traumatic history is a fundamental step in preparing for
and planning community engagement efforts that address
• Collaboration among community partners
health inequities.
to identify EBPs that can effectively address
problems the community experiences
Community Engagement: An Essential Component of an Effective and Equitable
Substance Use Prevention System 2
Issue Brief
Community Engagement
Sustained engagement and participatory
Is Based on Core culture. Community engagement is
ongoing. All participants are valued for their
Principles but May Differ
contributions. Information and resources are shared
in Implementation among community members and stakeholders to advance
outcomes and build community capacity.
Community engagement can take many forms, and has
several core principles.15, 16
Community Stakeholder Examples
Transparency and trust. Community
engagement creates an environment in • Youth
which all ideas are respected and considered;
• Parents and family members
discussions and input of participants are documented and
• People in recovery
shared; and there is mutual understanding of stakeholders’
• Businesses (e.g., barbershops, salons, gyms)
and community members’ needs, capacities, and goals.
• Media
Careful planning and preparation.
• Schools and other educational institutions
Community engagement is a strategic process
of planning around an issue of interest. Those • Youth-serving organizations
involved continually reflect on the best ways to engage • Public safety and law enforcement
community members, stakeholders, and the needs of
• Faith-based organizations
participants.
• Fraternal organizations
Inclusion and demographic diversity.
• Civic and volunteer organizations
Community engagement involves leaders
• Health care (e.g., pharmacists, veterinarians,
from different sectors of the community, as
dentists, physicians, nurses, other prescribers)
well as community members at large. Individuals and
• State, local, and tribal governments
sectors participating in community engagement represent
the community’s diversity and bring various perspectives • Other organizations involved in reducing
and expertise. substance use (e.g., philanthropic organizations,
community gatekeepers or champions)
Collaboration and shared purpose.
Community engagement brings organizations
and individuals together around a shared
Multiple community engagement frameworks are
purpose, such as prevention of substance use.
available, using various terminologies and outlining
Community engagement involves shared decision-
areas of emphasis, such as level of engagement.
making and equity among participants.
• The Active Community Engagement (ACE)
Openness and learning. Participants in the Continuum17 identifies three levels of
community engagement process are open to engagement—consultative, cooperative, and
data, information, and ideas from all relevant collaborative—and five types of engagement:
sources. They listen to others’ views and experiences, community involvement in assessment; access
to develop an informed, data-driven plan for addressing to information; inclusion in decision-making;
community issues. local capacity to advocate to institutions and
governing structures; and accountability of
Impact and action. Community engagement institutions to the public.
focuses on making a difference in the
• The WHO proposes four engagement approaches:
community and having an impact on the
community-oriented, community-based,
identified problem. Community engagement is intended
community-managed, and community-owned.1
to move communities toward desired outcomes.
Community Engagement: An Essential Component of an Effective and Equitable
Substance Use Prevention System 3
Issue Brief