A planning framework is an important tool when making changes in your community. The following framework shows the relationship of various planning, implementation and evaluation activities to one another and to impacts and outcomes. 

Problem Definition

The first step in planning is to analyse the situation and articulate a clear definition of the issue to be addressed (see Assessment Tool). As illustrated in the model below, the path from substance use to harm is complex. It is influenced by factors related to the substances being used, the people using them and the context in which they are used. Nonetheless, it is important to be clear about the harms experienced in your community and to identify the underlying determinants that most contribute to them. Also know which determinants are susceptible to being modified through strategic efforts you can implement.

Harms related to substance use come in a variety of forms. Some relate to immediate or acute health consequences (e.g., injury or death due to accidents or overdose). Others are associated with longer term chronic health effects (e.g., cancer, heart or liver disease, mood disorders, blood-borne pathogens). Many of the harms, however, impact social wellness (e.g., family conflict; impaired parenting; financial, work or relationship problems; crime and violence).

• What kinds of health and social harms related to substance use are experienced in your community?
• Who experiences those harms?
• Which harms are the most significant? How do you know?
• How does the social, physical or political environment of your community impact harm?

Risk is also complex. It is not merely a product of use; it is influenced by a variety of factors related to which substances are being used, by which people, in what contexts.

• What substances pose the greatest risk in your community (cause the most harm)?
• For each particular substance, who (what groups) are at increased risk of harm? Why?
• What common risk factors may be most influencing the harm?
• How do policies, norms and services in your community increase or decrease risk? What other protective factors are present?

Patterns of substance use – quantity, frequency and mode – have a major impact on risk and harm. Understanding these patterns of use is more important than simply knowing how many people in your community use particular substances.

• Why do people in your community use substances?
• How much do they typically use? How often?
• Through what mode do they use them?
• How does your community context influence patterns of substance use?

After you have completed this analysis, you can develop a clear statement that articulates the challenges related to substance use in your community. In order to apply a comprehensive community health approach, this statement should be broadly understood and embraced within the community. If it is not, the first desired outcome may be to achieve community buy-in.

A Simple Logic Model

Once you are clear on what your community's issues are, you can construct a simple logic model or visual map. This model or map should describe the relationship between a desired long-term outcome and to the defined problem. It should also characterize the short-term impacts that will contribute to the realization of the desired outcome,  as well as the strategic activities necessary to achieve those impacts. Logic models are often associated with evaluation. But they can also be effective planning and management tools to clarify goals, achieve consensus, identify gaps in logic and knowledge, and track progress. The logic model helps communicate the program both internally and externally and builds a credible case for the concept of the initiative. It can be used in many ways – for example, in accessing funding. The language and models should be kept simple and seek to convey the underlying rationale or logical relationships. Avoid making them too complex by trying to map all the elements of evaluation into a single model.  

The following is an example of a simple logic model applied to the population of BC as if it were a single community. It reflects the recommendations in one section of Following the Evidence (Stockwell et al., 2006).

Desired Outcome

The desired outcome can be expressed as a broad goal that relates to improving the health and wellbeing of people in the community. The outcome needs to be measurable based on health status indicators (e.g., wellbeing, human function, health conditions, deaths) and should be widely understood and embraced by the community.

Short-Term Impacts

The objectives relative to short-term impacts define what must occur so that the desired outcome can be achieved. These objectives address the factors that cause or contribute to the priority health issue identified. A careful analysis of the determinants of the priority health issue is critical to the selection of objectives relative to short-term impacts.

Strategic Activities

The next stage involves developing a range of interventions to achieve the objectives. Effective approaches include a combination of societal and individual-focussed interventions at multiple levels. Appropriate strategies should: be based on relevant theory, have evidence of effectiveness, and fit local context and resources. In a comprehensive community health approach different groups can be encouraged to develop specific strategic activities to address various objectives.

The following is an example of a comprehensive approach involving a combination of interventions for delaying and reducing substance use by teens in BC. The example is adapted from Following the Evidence (Stockwell et al., 2006). Note that in this example the mix of interventions is appropriately weighted to universal strategies. For other objectives, the weight balance would be different. You can access a tool to help you assess the comprehensiveness of existing supports and services in your community and to identify needed areas of attention.

 

A Comprehensive Approach to Delay and Reduce Substance Use by Teens
	Whole Community (universal)	Elevated Risk Groups (selected)	Those Displaying Risky Patterns (indicated)
	Increase enforcement to increase retailer compliance Programs that aim to reduce perceived favourable community norms, and restrict access	Encourage implementation of a range of alcohol and tobacco free recreational and social opportunities for higher risk youth  Utilize peer involvement to create healthy contexts and activities	Identify and address those environmental influences that undermine prevention efforts and reinforce problem behaviours
	Use media to increase public awareness of harms  Use media and parent education strategies to encourage responsible supervision  Develop learning resources for use in school curriculum  Provide teacher training to encourage interactive classroom teaching	Program to increase sense of belonging at school targeted to marginalized groups (e.g., poor academic performance)	Develop mentorship program that matches substance using youth with caring adults

 

 

References

Kaplan S.A., and Garrett K.E. (2005). The use of logic models by community-based initiatives. Evaluation and Program Planning. 28(2): 167–172.

Klerman, L.V., Santelli, J.S., Klein, J.D. (2005). "So What Have We Learned? The Editors' Comments on the Coalition Approach to Teen Pregnancy.." Journal of Adolescent Health 37: S115-S118.

Nutbeam, D. (2000). What makes an effective health promotion program? Oxford Handbook of Public Health. Sydney, Australia: Oxford University Press.

Renger, R. and Titcomb, A. (2002). A three-step approach to teaching logic models. American Journal of Evaluation 23: 493-503.

Stevenson, J.F. and Mitchell, R.E. (2003). Community-level collaboration for substance abuse prevention. Journal of Primary Prevention 23(3): 371-404.

Stockwell, T., Reist, D., Balfour, K., Poole, N., Tupper, K. (2006) Following the Evidence: Preventing Harms from Substance Use in BC. Victoria: BC Ministry of Health.