Office of Substance Abuse Prevention

Updated Nov 11, 2014

NEW MEXICO

ASSESSMENT TRAINING

November 17, 2014

Albuquerque, New Mexico

PARTICIPANT MANUAL

Presented by: Natalie Skogerboe, MPA, CPS – Coop Consulting & Elizabeth Lilliott, PhD – Pacific Institute for Research and Evaluation

This training was adapted from an earlier training developed by Paula Feathers of Kamama Consulting for the NM Office of Substance Abuse Prevention. The assessment tools and assessment report were created by Natalie Skogerboe (Coop Consulting), Elizabeth Lilliott, and Martha Waller (both of PIRE). Funding for this training is from the NM Behavioral Health Services/Office of Substance Abuse Prevention.

For questions please contact: Karen Cheman, MPH (Staff Manager, NPN & SEOW Director), Office of Substance Abuse Prevention, BHSD/HSD, 37 Plaza La Prensa, Santa Fe, NM 87507, 505-476-9270. [email protected]

1 Updated Nov 11, 2014 www.nmprevention.org Assessment Training Agenda November 17, 2014

Topic Time Welcome & Introductions 9:00 Assessment Overview & Activity 9:15 Overview of Strategic Prevention Framework 9:30 Review of Assessment Report 10:00 Review of Logic Models 10:30 Review of New Mexico Community Survey Data 11:30 Lunch (on your own) 12:00 County Level Data Collection (Review of Tools) 1:00 Qualitative Data Collection Guidance 1:30 Focus Group Practice 2:00 Development of Data Collection Plan 3:00 Next Steps & Adjourn 3:30

Training Description This training will provide an overview of the Strategic Prevention Framework (SPF) to gain an understanding of the theory of change used by the Office of Substance Abuse Prevention (OSAP) to address problems related to alcohol abuse and prescription drug abuse. Participants will learn how to conduct an assessment around substance abuse priorities, use of a consequence logic model, implement effective focus groups, design a data collection plan for the county, identify how to gather representative data, use OSAP-developed data collection tools, and create an action plan for completing a countywide assessment.

GAUGE PARTICIPANT KNOWLEDGE Participants will leave the training with an understanding of the SPF and With an action plan for completing the OSAP Assessment Report Training Objectives  Define SPF Terminology  Use a logic model to guide data collection  Understand Eddy County Data related to Alcohol  Review data collection tools  Describe key factors in conducting focus groups and interviews  Design data collection action plan

2 Updated Nov 11, 2014

SPF Step Key Components Assessment Gather data on priority issues that can be used to assist in making informed strategic decisions - Identify data sources - Develop data collection plan - Develop / Identify data collection tools - Gather and compile data around priority areas and community factors - Analyze data and compile a report - Use data to identify needs, and risk and protective factors - Use data to begin prioritizing populations, risk factors, intervening variables, and contributing factors

Capacity Build or increase the ability of individuals and organizations to effectively address the priorities and needs identified in the assessment - Convene stakeholders and leaders - Build partnerships and obtain MOUs - Identify and participate in training and education - Organize provider networks - Mobilize resources (human, financial, organizational) - Leverage resources to help sustain efforts and outcomes - Identify coalition strengths and needs - Incorporate culturally appropriate means for recruiting community partners - Assess community readiness and develop plans to increase readiness

SFP Step Key Components Planning Use data from the assessment, capacity, and readiness to identify strategies that will have the greatest impact on priority areas - Articulates a vision for prevention initiatives - Identifies benchmarks and timeframes - Clearly states goals and measurable objectives for reaching outcomes - Identifies programs, policies, or practices - Uses logic models to guide work - Involves input from multiple stakeholders, coalition members and the community

Implementation Carry out every step of the SPF and turn the strategic plan into action - Monitor implementation and make quality improvements as necessary - Hold stakeholders accountable to work promised - Adapt process or plan as needed

Evaluation Monitor the process and measure effectiveness of programs, policies or practices - Develop an evaluation plan that connects to each goal and objective - Track indicators (process and outcome) - Complete evaluation reports - Present findings and progress

Cultural Competence Meaningfully include everyone who will be impacted by your prevention efforts (including data collection, tool development, reporting, prioritization, planning, implementation and evaluation) - Incorporate representation from every subgroup and cultural group in your community - Adapt processes according to cultures, languages, needs, and

values of community - Consider disparities and how to address them respectfully Sustainability Consider the multiple factors that contribute to project success—such as the existence of stable prevention infrastructure, available training systems, and community support— and work toward maintaining these - Supportive policies and procedures that build capacity - Securing resources to build capacity - Acquire expertise needed for SPF and strategic plan - Develop and nurture broad community support - Develop stakeholders into system leaders and champions - Develop sustainability plan Review Assessment Report Template

Assessment Report New Mexico Office of Substance Abuse Prevention Grantees COMPLETE REPORT DUE – December 7 2014 NOTE: WHILE THIS REPORT IS DUE ON THE DATE ABOVE, CONSIDER IT A LIVING DOCUMENT. ADD RELEVANT DATA ABOUT YOUR COMMUNITY AS YOU GATHER IT AND MAKE IT ACCESSIBLE TO YOUR COALITION FOR CONTINUOUS PREVENTION PLANNING. Please submit this report to the following people [email protected], Natalie Skogerboe [email protected] and Liz Lilliott [email protected]

Coalition Name:

Project Director: Program Coordinator: Other Staff:

Briefly describe your coalition Key Members: Core Team Members: Key accomplishments to date (highlights): Challenges or barriers experienced:

This Assessment form will help you and your coalition plan your prevention efforts in the future. Consider it to be a tool for your best use, so continuously update as you gather more data and be sure to make it understandable for others.

Section I Submit this section by November 7 for OSAP review

ALL PROGRAMS: complete the two substance tables below. You are only required to use archival data for these tables—that is, data that already exists. Refer to the NM Substance abuse Epi Profile (NMDOH-ERD-SubstanceAbuse-SEOW-2013 ), and your county’s YRRS results. Add additional data as you have available in your community (ie, from IBIS (https://ibis.health.state.nm.us), NMCS from 2012 or 2010 or that you gathered yourself; other prevention program evaluation results (such as DWI programming), other community surveys, etc. Fill in all data in the left column for each age group. Use the column on the right to show the source of data and results.

Priorities: Underage Alcohol-related Priorities (Binge Drinking / Drinking and Driving) Using the Underage Drinking Logic Model provided at the Assessment Training, please describe the data you gathered on the problem itself (in the table below). Binge Drinking and Drinking and Driving 12-17 yrs List data source, date and results here. This is an example of the kind of information we are looking for. Please delete the example information and enter your own: Drank Before age 13 Data Source 2013 YRRS Happy County is higher than the state for drinking before age 13  Happy HS 30.7% compared with NM HS 22.4% (US rate is 21.9) Current Drinking Data Source 2013 YRRS (past 30 days) Happy County is higher than the state for drinking in the past 30 days  Happy Middle School: 21.4% compared with NM 12.9%;  Happy High School: 41.1% compared with NM 36.9% Current Binge Drinking Data Source 2013 YRRS Our youth also report binge drinking more than the rest of NM  Happy MS: 10.5%, NM MS:6.3%  Happy HS: 30.7%, NM HS:22.4% Current DWI Data Source 2013 YRRS Happy County is higher than the state for DWI in the last 30 days  Self-reported DWI: Happy HS: 15.5%, NM HS 9.3%  Driving in a car with a drunk driver: Happy HS 18%, NMHS 13% Other data? (youth DWI (Optional – according to availability of data) arrests, youth alcohol hospitalizations, etc.) 18-20yrs (adults under legal Possible data sources: (note that you may not have good data on a age for drinking) county level for this challenging age group). 2011 NSDUH 2010, 2012, 2014 (if choose to) Community Survey – May have too limited numbers for this age group to report. Other? Current Drinking (past 30 days) Current Binge Drinking Current DWI Other data? (youth DWI (Optional – according to availability of data) arrests, youth alcohol hospitalizations, etc.) Adults over 18 Possible Data sources: NM Epi Profile Current Binge Drinking 2010, NM-Epi profile 9% in Happy County, and 11.1% in NM (US is 15.1) Current DWI .9% in New Mexico, as compared to .3% in Happy County. (US not available) Other data? (Adult DWI (Optional – according to availability of data) arrests, alcohol hospitalizations, etc.)

Alcohol-related Consequences (from the 2014 NM Epi profile) Alcohol-related deaths 2013 NM Epi Profile: between 2007-2011, there were 39.2 per 100,000 deaths in Happy County, lower than the state rate of 52, but still higher than the national rate of 28 per 100,000. Alcohol-related chronic The 2013 NM Epi Profile reports that between 2007-2011, there were 14.5 disease death alcohol-related chronic disease deaths per 100,000, lower than the NM rate of 24.2 , but higher than the national rate of 11.2 Alcohol-related injury death Happy County: 24.6 versus NM 27.7 but still higher than US 16.8 (same Epi profile source) Alcohol-related crash deaths Happy County’s rate of 7.0 per 100K, considerably higher than the NM rate of 6.0 and the US rate of 3.9! Other? (DWI crash rates, (Optional – according to availability of local data sources) alcohol-related hospitalizations, etc.)

Complete the tables above before completing this final section

Your coalition is asked to work on at least two of the following priorities with OSAP funding: underage binge drinking, underage DWI, adult binge drinking, or adult DWI. You are not required to determine these today, but based upon the data entered above and your assessment process to date, please check off all the possible priorities you may be working on, and give a brief justification of those priorities (as well as the ruling out of others).

Check at Substance Abuse Priorities least two Adult DWI Adult Binge Drinking Underage DWI Underage Binge Drinking

Please explain your choices and exclusions:

EXAMPLES:  We will choose among the alcohol-related priorities (underage and adult binge drinking and DWI) because our YRRS data show us that underage drinking is much higher than in other NM counties and that adult alcohol-related deaths are also very high. Rx painkillers abuse, while of concern, is still lower than the rest of the state, as shown by overdose rates and YRRS results. Additionally, an existing coalition in our county works with Rx and illicit drug prevention, and in discussion with them, we have determined it to be the best approach to focus on alcohol alone in order to best supporting the coalition’s work. Or:  Our initial assessment shows that all areas are still of concern. We therefore collected qualitative data on all priorities. We will continue to consider all the above priorities as we move forward. Etc.

Send your completed Section I to Elizabeth Lilliott [email protected] & Natalie Skogerboe [email protected]

Keep Section I attached to the rest of this report

Section II The data gathered throughout your community assessment will help you make informed decisions about where the problems are in your community, and what contributes to those problems. 1. Complete the Focus Group Summaries as you conduct them. Once you complete all your data collection, please provide an overview of the data collected. You do not need to report everything, but the highlights of what you have learned.

2. Use the tables with BLUE headings for alcohol-related priorities

FOCUS GROUPS SUMMARIES Using the table below, please provide a brief description of each focus group and/or interview you conducted, or the survey you implemented to collect data. Add or delete tables as needed. 1 Focus Group / EXAMPLE (delete this example before submitting your report): Interview / Tool Name Focus Group with parents and community members who have middle/high school age children Special geographic This group was from a village closer to the Mexico border than the county area / population? seat and many participants were Spanish-speakers Date / Time / Number April 10, 2014 / 5:30-6:30pm / 9 parents (6 females, 3 males, Ages 30-56) of Participants / Place The focus group was held at the Boys & Girls Club community room. Main Feedback The parents gave us great information on where they think youth access alcohol, and shared stories about a local incident involving prescription drugs being sold at the high school by a student. Their perception of risk for providing alcohol to minors was very low. Hosting parties where alcohol is available for underage youth seems common. Other pertinent We provided dinner and $25 gift cards to all participants. information Our Prevention coordinator and partner from the SBHC facilitated the FG.

2 Focus Group / Interview / Tool Name Special geographic area / population? Date / Time / Number of Participants / Place Main Feedback Other pertinent information

INTERVENING VARIABLE/CONTRIBUTING FACTOR DATA Now, please describe the type of data gathered and the key findings for each intervening variable and contributing factor for the alcohol-related priorities (UDWI/UBD, ADWI/ABD). Use the UAD/DWI Logic Model Provided at the Assessment Training. Try to make note of unique differences among different populations (under 18, 18-20 year olds, parents, etc). Add relevant contributing factors as needed.

If you are using a data source that is not on the Assessment Guide or was not given to you by OSAP, please briefly describe the data source (what is the source, how many surveys were collected from whom, who collected it, and where it was collected, etc.) We would like to get an idea of the validity and reliability of the data and how representative the sample is for your community. Please tell us your ALCOHOL RELATED PRIORITIES: Intervening Variable Social Access Data Source (i.e. What do the data for your community reveal? YRRS, Focus Group Contributing Factors Does this seem to be a main contributor to alcohol with youth, survey misuse or is it not really important? name, etc) Minors access alcohol Focus Group data EXAMPLE (erase before submitting): from of-age friends / from Parents, This is a main contributor to UAD as it is the main way relatives Community Members minors obtain alcohol and Youth.  There a perception in many of our communities YRRS that people are “expected to do certain things at certain ages no matter what the law is…” and so older family member supply alcohol to youth • Law enforcement believes the same sentiments “A lot of parents within Happy County think that it’s okay to buy beer for their child… even though they are committing a felony.” • As noted above from the YRRS information, Happy County is higher than the state average for drinking before age 11, as well as middle school and high school binge drinking. The majority of our youth who drink give money to adults to purchase alcohol or it is given to them. • It seems the common theme is that youth are able to ask adults (from the focus groups youth indicate asking people who they know) who are willing to purchase them alcohol Minors consume alcohol at certain “hot spots” or unsupervised parties Other: fill in CFs as you identify them & add rows. Refer to logic models for help. Other:

Intervening Variable Retail Access Data Source (i.e. What do the data for your community reveal? Contributing Factors YRRS, Focus Group Does this seem to be a main contributor to alcohol with youth, etc) misuse or is it not really important? Merchants sell to minors Merchants sell to intoxicated patrons High alcohol outlets density makes access easy Other: fill in CFs as you identify them & add rows. Refer to logic models for help.

Intervening Variable Low Enforcement Data Source (i.e. What do the data for your community reveal? Contributing Factors YRRS, Focus Group Does this seem to be a main contributor to alcohol with youth, etc) misuse or is it not really important? Lack of resources for saturation or party patrols / checkpoints Lack of resources for prosecuting MIP Lack of enforcement for providing alcohol to minors* Low number of DWI checkpoints and saturation patrols* Few arrests for alcohol-related crimes* Low conviction rates* Other: fill in CFs as you identify them & add rows. Refer to logic models for help. * For these you will need to fill in current and possibly past # of annual enforcement events from your enforcement data gathering table. If you end up selecting an enforcement strategy to follow, you will need to have baseline data to show that there is a need to increase enforcement, so seek out this information as early as you can.

Intervening Variable Perception of Risk

Data Source (i.e. What do the data for your community reveal? Contributing Factors YRRS, Focus Group Does this seem to be a main contributor to alcohol with youth, etc) misuse or is it not really important? Youth do not perceive any enforcement for drinking Adults to not see or know of legal consequences for offering alcohol to minors Lack of evidence of DWI enforcement leads to low perception of risk of getting caught Other: fill in CFs as you identify them & add rows. Refer to logic models for help.

Intervening Variable Community Norms Data Source (i.e. What do the data for your community reveal? Contributing Factors YRRS, Focus Group Does this seem to be a main contributor to alcohol with youth, etc) misuse or is it not really important? Family Acceptance (inclusion of alcohol at events, parents permit UAD) Considered a rite of passage Excessive drunkenness is OK or even cool Community stakeholders support efforts to reduce UAD Other: fill in CFs as you identify them & add rows. Refer to logic models for help.

Intervening Variable Price & Promotion Data Source (i.e. What do the data for your community reveal? Contributing Factors YRRS, Focus Group Does this seem to be a main contributor to alcohol with youth, etc) misuse or is it not really important? Low prices make it easy for minors to get

13 Updated Nov 11, 2014 alcohol Bars near campus compete for student purchases Advertising / marketing toward youth Other: fill in CFs as you identify them & add rows. Refer to logic models for help.

Intervening Variable Individual Factors Data Source (i.e. What do the data for your community reveal? Contributing Factors YRRS, Focus Group Does this seem to be a main contributor to alcohol with youth, etc) misuse or is it not really important? Peer support for not drinking Peer pressure to drink Healthy family boundaries discourage drinking Other: fill in CFs as you identify them & add rows. Refer to logic models for help. Other:

What community strengths relative to alcohol abuse prevention did you find that you might be able to build upon and benefit the work of this grant?

What differences did you find between different age groups, geographic areas, focus groups, or populations for alcohol and/or DWI?

What challenges did you face, if any, in collecting data for underage or adult binge drinking and/or DWI?

What data have you not been able to find/use? Why?

ACTIVITY Terminology

ACTIVITY Matching SPF Activities with SPF Steps

Below are some of the terms that will be used throughout your funding with OSAP. Many of the terms derive from the Strategic Prevention Framework and should become familiar to you over time. Please draw a line from the term on the left to the corresponding definition/explanation on the right.

Logic Model Obtaining ATODs through social sources (friends, family, social events)

Intervening Variable Insufficient enforcement of existing ATOD regulations, policies, and laws

Contributing Factor ATODs are bought/sold through retail markets

Low Enforcement This is a simplified picture of a program, initiative, or a map for getting to the intended outcome

Retail Access Belief held (whether rational or irrational) by individuals, groups, or societies about the chance, or severity or risk

Specific issues in a community that explain the intervening Community Norms variable. These are identified through focus groups, surveys, observation and other data gathering processes aimed to inform you about what substance abuse looks like in your community. They are the key link to identifying appropriate programs, policies and practices.

Individual Factors Factors that influence ATOD use and associated problems including biological factors, genetic predisposition, psychological factors, maturation, emotional regulation, etc.

Social Access Factors that have been identified to strongly influence the occurrence and magnitude of substance abuse and its related problems

Perception of Risk The acceptability or unacceptability of certain behaviors – including beliefs about what constitutes appropriate substance use

Logic Models

Logic Models…  help create a picture or provide a road map for how your program is supposed to work (W.K. Kellogg Foundation, Logic Model Development Guide, 2004)  show logical relationships among the resources that are invested, the activities that take place and the benefits or changes that take place  display your theory of change  help us identify which activities need to come before others  are a visual way to link planned activities and the changes or results you hope to achieve  provide a road map, conceptual map, or pathways map  display a mental model or blueprint for change  provide a framework for action or program framework  display a program theory or program hypothesis  show theoretical underpinning or rationale  explain the causal chain or chain of causation (The Community Toolbox: http://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and- development/logic-model-development/main )

There are several types of/purposes for Logic Models  Program or Strategy - The program logic model is defined as a picture of how your organization does its work – the theory and assumptions underlying the program. A program logic model links outcomes (both short- and long-term) with program activities/processes and the theoretical assumptions/principles of the program (W. K. Kellogg Foundation, 2004).  Planning - For planning purposes, the logic model structure helps grantees articulate the parameters and expectations of their program, as well as, the changes among participants, systems, or organizations that are expected to result from program activities. http://www.cdc.gov/ncbddd/birthdefects/models/resource1-evaluationguide2009.pdf  Evaluation - As an evaluation tool, the logic model allows planners to make program design decisions that will influence the trajectory of the evaluation and map outcomes http://www.cdc.gov/ncbddd/birthdefects/models/resource1-evaluationguide2009.pdf .  Others?

(LATER ACTIVITY we will have them identify data sources / focus group questions for intervening variables/contributing factors)

Prescription Drug Logic Model + Data Sources Interve ning Problem Behavior Contributing Factors Possible Data Sources Variabl es

Social Family members / friends provide access unintentionally Community Survey (Q28, Q29, Q30) Access Focus Groups / Interviews Family members / friends provide access intentionally

Retail Health care providers over-prescribe pain medications Community Survey (Q27, Q28, , PDMP, Focus Groups Access (parents, youth, Drs, etc) Dr / Pharmacy shopping takes place

Access to International drug market Border Patrol, HIDTA, Comm Survey (Q28), Law Enf/Campus police, Focus groups Illegal sales in the community

Low Prescription monitoring systems are not used effectively PDMP Enforc to deter misuse Focus Group/Interviews with law enf, students, Drs, Prescription Drug ement pharmacists Misuse / Abuse Lack of strong laws/regulations around prescribing practices/sales

Percei Perception that if it is prescribed, law enforcement Community Survey ved cannot do anything Focus Groups / Interviews Risk Low perception of getting caught for over-prescribing or Dr / pharm shopping

Prescription drugs are seen as safe

High price leads to accessing Rx through other means and Focus groups (students, law enf, consumers) Price possible switch over to heroin

Comm Culture that encourages use of Rx for any ailment Community Survey (Q27) unity Focus Groups / Interviews Norms

Individ Chronic / acute pain requires use Community Survey (Q27), ual Focus Groups / Interviews

Past addiction makes individuals more susceptible to Factor abuse Rx pain meds

Underage Drinking Logic Model Problem Behavior Intervening Variables Contributing Factors Possible Data Sources

Minors access alcohol from friends/family YRRS (where got alcohol), Community Social Access Survey (Q21,Q23), Focus Groups

Adults host parties for minors Comm Survey (Q21, Q23), Focus Groups

Merchants sell to minors Special Investigations Division, Retail Access Focus Groups with Youth

High alcohol outlet density makes access easy

Lack of resources to do party patrols or refer youth who Interviews with Law Low Enforcement get caught drinking Enforcement

Underage Drinking Minimum legal drinking laws are not upheld Interviews with courts/law enf, YRRS, CS (Q1)

Youth do not see legal consequences of drinking CS (Q2), Focus Groups Perceived Risk with Youth

Adults do not see legal consequences of providing CS (Q2, Q3), Focus alcohol to minors Groups with Parent & Comm Members

Low prices make it easy for youth to purchase / pay for YRRS (where youth someone to buy alcohol got alcohol), Price & Promotion Focus Groups with Youth

Advertising/marketing directed toward youth Center for Alcohol

Marketing to Youth, Scan of local stores

Adults think it is OK for youth to drink Focus Groups w youth & adults, Community Norms YRRS (how wrong do adults think it is…)

Parents host parties where youth can consume alcohol Focus Groups with Youth

Peer and family influence to drink / not drink YRRS (how wrong would…, friends who Individual Factors drink…),Focus Groups with Youth

Boxes indicate stronger evidence of a relationship and strong evidence of population prevention effects

Drinking and Driving Possible Data Problem Behavior Intervening Variables Contributing Factors Sources

Community celebrations encourage binge drinking Community Survey, Social Access Focus Groups

Parties provide unsupervised access (more about Comm Survey, Focus minors accessing from friends/family) Groups

Merchants sell to intoxicated patrons Special Investigations Division, Retail Access Focus Groups with Youth

High alcohol outlet density makes access easy

Drinking & Driving Lack of resources to do checkpoints, saturation patrols, Interviews with Law Low Enforcement or party patrols Enforcement

Illegal sales to intoxicated patrons are not enforced Interviews with courts/law enf, CS?

Judicial practices are inconsistent – DWIs are not Interviews with prosecuted or upheld in court courts/law enf

People do not think they will get caught for drinking and CS (Q2, ), Focus Perceived Risk driving Groups

Little evidence of significant enforcement CS (Q2, Q3), Focus Groups Binge Drinking Previous drinking and driving did not have negative consequences

Price & Promotion Low prices make it easy to purchase large quantities Placement makes shoplifting easy Center for Alcohol Marketing to Youth, Scan of local stores

Excessive advertising promotes specials and excessive drinking, making it look sexy

Multigenerational use – Drinking is a normal part of get Focus Groups Community Norms togethers

Binge drinking is acceptable Focus Groups

Boxes indicate stronger evidence of a relationship and strong evidence of population prevention effects

Activity County Wide Data Collection

Complete a county-wide map that highlights the following items: - Population centers (with population estimates and a sentence about why that spot is unique i.e. college campus, mostly Spanish-speaking population lives here, etc) - Highlight Law Enforcement entities - Highlight clinics, hospitals and pharmacies - Highlight schools and college campuses - Highlight coalition existing partners - Make note of population centers in your county where no partners exist and brainstorm who you might be able to recruit from those areas/populations to help with the project. Updated Nov 11, 2014

Review Assessment Tools

Qualitative Tools

Preparation: These forms will need to be reviewed and the Consent forms will need to be distributed prior to data collection (with youth)  Introductory Script for Focus Groups  Consent Forms (Passive and Active) Tools:  Youth / Young Adult Focus Group Questions (general population)  Youth / Young Adult Focus Group Questions (at risk group)  Community Member / Parent Focus Group Questions  Law Enforcement Interview Questions  Medical Providers Focus Group Questions  Alcohol Retailer Assessment Form

Quantitative Tools

 Drs/Pharm Survey  Law Enforcement / CYFD Data Collection Tool  Community Survey Review (collecting in June 2014)  Strategies for Success Review (not mandatory to be collected at this time)

Presentation Conducting Focus Groups and Interviews

Presentation on Conducting Focus Groups – Dr. Liz Lilliott

What is a focus group?

FOCUS GROUPS List at least 3 “Dos” and 3 “Don’ts” that you remember from the presentation

DOs DON’Ts Updated Nov 11, 2014 Updated Nov 11, 2014

Review Assessment Tools IMPORTANT TO KEEP IN MIND FOR THIS PREVENTION ASSESSMENT: DO NOT PUBLICALLY DISSEMINATE DATA COLLECTED UNTIL YOUR PLANS ARE COMPLETE

FOR QUALITATIVE DATA COLLECTION

Use the form below for your focus group or interview script so you can easily track the data you need to report in summary of your focus groups. An example is provided below:

 Tools can be modified, but try to ask all the questions currently included in the script. If you wish to add questions, check with PIRE and your evaluator to review.

 Never video interviews or focus groups and do not publically disseminate quotes, photos or other identifying information collected.

 Always provide informed consent (see template below)- verbal is ok for those 18 or older

 Always get passive or active parental consent for youth under 18

 Do not count responses from a focus group or set of interviews. Your sample is not representative and the point is to generate conversation.

 Avoid encouraging people to talk about their personal use/abuse or those of anyone identifiable to others (unless a public figure).

 You are not the expert: your participants are.

 Carefully review each script before conducting a focus group or interview so you can make sure to frame the questions best for your population

 Document the process of conducting the focus group using a similar structure as the following example.

Qualitative data collection log - Focus Group or Interview Protocol: Youth At Risk 14-17 Date: 10-19-2014 Location: Lucha Libre coffee shop, Contentotown Population: Youth involved in the JPPO Name/affiliation of interviewer: Liz Lucha, programming prevention coalition evaluator Number of people attending: 6 boys and 1 girl Name/affiliation of scribe: Natalie Libre, prevention coalition coordinator How participants recruited & incentives: “snowball sampling” starting with two volunteers recruited through JPPO who invited others to participate. Participants given a $20 gift card and a meal at the café. Issues, concerns, insights: We initially only had 3 participants show, but they texted some other friends who were able to come over so we made quorum. After the focus group was over we spent about another hour chatting and they had a lot of questions about the prevention program and what it entailed. Updated Nov 11, 2014

FOR QUANTITATIVE DATA COLLECTION:  Ensure that only de-identified data are requested/used.

 Data collection tools can be edited or amended according to need. Check with PIRE and your evaluator for ideas.

 Not all topics lend themselves to quantitative data collection methodologies.

Focus Group Introductory Script TEMPLATE

Thanks again for being here today. The purpose of this focus group is to understand important issues around the prevention of drugs and alcohol in our communities. The goal is to provide input for our agency and to the state of New Mexico about how to enhance this program. We want to ask you about [fill in here according to your focus group topic].

Here are a couple of things to remember about how a focus group works.

• First, please remember, there are no right or wrong answers to any of the questions that we ask. If you don’t feel comfortable answering any question you don’t have to.

• Second, we’ll ask everyone to please not interrupt so that we make sure everyone gets a chance to talk.

• Third, because we really want to hear what everyone thinks, if it seems like someone is not speaking up, we may ask him/her what he/she thinks.

• Next, we’d like to encourage you all to speak to one another as much as possible. We are here to focus the discussion amongst you.

• Finally, we ask that everyone please agree to keep whatever is said in here private. While it’s okay to talk about the focus group generally, we ask that each of you not talk to anyone about what specific people say today.

Because we want to be able to remember everything that people tell us today, [scribe’s name] is going to write notes about what people say. Sometimes, [scribe’s name] can’t write fast enough to keep up, so we’re also going to digitally record what is being said. This way, we can check later to make sure we get everything right.

I just want to stress once again that everything you say will be confidential. If your name gets recorded, we’ll make sure it gets erased from the transcript. Updated Nov 11, 2014

 Our discussion will take about 2 hours. Please feel free to get refreshments or use the bathroom at any time during our discussion.

 Does anyone have any questions about anything I have said?

 Okay, we’d like to start now. Is it okay with everyone if I start the audio recorders? Updated Nov 11, 2014

Active Parental Consent Form Name of your coalition – Office of Substance Abuse Prevention

Your child has been asked to participate in a focus group sponsored by ______on behalf of a grant through the New Mexico Office of Substance Abuse Prevention. In this focus group, we will ask questions about alcohol and prescription drug use. Nobody participating in the focus group will be identifiable, and the information that the participants provide will serve to help our coalition design our prevention strategies so they have the most impact.

Doing this focus group will cause little or no risk to your child. The only potential risk is that some students might find certain questions to be sensitive. The focus group asks no questions about personal or individual substance use and behaviors, but asks participants to reflect upon what they see in their community. No one will ever be mentioned by name in a report of the results. This focus group is voluntary. Anyone may decline to participate, cannot respond to questions that they do not wish to answer, or can stop/withdraw at any time from the group without penalty. No action will be taken against you or your child, if your child does not take part.

Please read the section below and check one box. Return the form to ______by the date below. If you have questions about the focus group, please call ______. If you cannot reach this person, please call Dr. Liz Lilliott at 575-313-7029 or 505 765-2330; [email protected]

Thank you.

------NAME OF COALITION Date of Focus Group: Location:

I have read this form and know what the survey is about.

□ Yes, my child may participate in the OSAP youth focus group □ No, my child may not participate in the OSAP youth focus group Parent or Guardian’s signature: ______Date: ______Updated Nov 11, 2014

Passive Parental Consent Form

Name of your coalition – Office of Substance Abuse Prevention

Your child has been asked to participate in a focus group sponsored by ______on behalf of a grant through the New Mexico Office of Substance Abuse Prevention. In this focus group, we will ask questions about alcohol and prescription drug use in our community. Nobody participating in the focus group will be identifiable, and the information that the participants provide will serve to help our coalition design our prevention strategies so they have the most impact.

Doing this focus group will cause little or no risk to your child. The only potential risk is that some students might find certain questions to be sensitive. The focus group asks no questions about personal or individual substance use and behaviors, but asks participants to reflect upon what they see in their community. No one will ever be mentioned by name in a report of the results. This focus group is voluntary. Anyone may decline to participate, cannot respond to questions that they do not wish to answer, or can stop/withdraw at any time from the group without penalty. No action will be taken against you or your child, if your child does not take part.

Please read the section below and check one box. Return the form to ______by the date below. If you have questions about the focus group, please call ______. If you cannot reach this person, please call Dr. Liz Lilliott at 575-313-7029 or 505 765-2330; [email protected]

Thank you.

------NAME OF COALITION Date of Focus Group: Location:

Child’s name: ______

I have read this form and know what the survey is about.

□ No, my child may not participate in the OSAP youth focus group

Updated Nov 11, 2014

Parent or Guardian’s signature: ______Date: ______

Data Collection Sheet - Assessment Youth and Young Adults (general population)  Since you should gain information about your county as a whole, consider conducting more than one focus group with youth that represent the diversity of your county, in terms of communities and ethnic or other subgroups.

Qualitative data collection log - Focus Group or Interview Protocol Date: Location: Population: Name & Affiliation of interviewer: Number of people attending: Name & Affiliation of scribe: How participants recruited & incentive provided: Issues, concerns, insights:

Introductory script (EXAMPLE): You have been asked to participate in this focus group because you are a young person in this community so you could comment on what youth in this community do and think as a whole. We are not interested in learning information about specific individuals or infractions of the law, but are most interested in learning what attitudes and beliefs young people have in this community around drinking and prescription drug misuse. Please think about your community when responding. We thank you again for your participation.

First, we will talk some about how youth drink alcohol in this community.

1. Can you tell us about how common do you think it is for youth under the legal age to drink in your community? (Probe for all sub-questions as much as possible – is this similar to or different than other communities in our county?)

a. How old do people typically start drinking around here?

b. Describe the young people who drink. What about youth who don’t drink? What are they like? (Probe for different communities, age groups, social groups like ‘jocks’ or whatever the language is used locally, high school, middle school, college, boys vs. girls, etc.)

c. How is this different for young adults? Once people reach 21 do these groups change in terms of their consumption of alcohol?

d. Are some types easier or cheaper to get than others? Can you talk a little more about that?

2. How hard do you think it is for underage youth to get alcohol in this community? Updated Nov 11, 2014

a. How do youth typically get alcohol? (Probe for adult and of-age family members, friends, strangers, directly in stores, bars or restaurants, stealing from home, getting at parties, fake ids.)

3. Where do youth usually drink here? (Probe for known hotspots, at homes, at teen drinking parties, at family events, friends’ homes, bars/restaurants, school, out of town limits (in desert, woods, local parks, out of town) while driving, on campus ….) Why do they prefer to drink there? Does location differ by whether the youth is underage or not?

4. What kinds of problems do you see in youth who use alcohol in your community? (Probe: Problems with school? With family? With the law? With friendships? No problems at all?

5. What generally happens when a student uses alcohol at school or school-related events?

a. Do people get caught? What kinds of people get caught? Why or why not?

b. What are the consequences? Are consequences given in the same way for everyone? Why or why not?

c. Have you noticed any changes this year in what happens? What kinds of changes?

6. What generally happens here when underage youth are caught drinking by other authorities (like the police, not school staff?)

a. Do youth get arrested? Why or why not?

b. Do the people who provided them alcohol get caught too? Why or why not?

c. Have you noticed any changes in the last year in what happens? What kinds?

d. What about drinking and driving? What happens when youth are caught drinking and driving? How do school officials respond compared to law enforcement?

e. Does this differ if the youth is under 18 or older than 18 but still underage?

Now we’re going to shift gears to talk about prescription drug abuse. Our questions here will be very similar. We are interested in understanding what’s going on here specifically. It’s ok if you don’t know the answer to a question, we would like to inspire conversation. So we’re going to talk about lots of different ways that people can use or misuse prescription drugs. Updated Nov 11, 2014

7. How do young people learn about using prescription drugs for recreational use (especially painkillers/opioids)?

a. Do youth typically know the difference between specific prescription drugs (pain-killers, sedatives, etc.)? OR do they use them all regardless of what kind they are?

b. How do young people think that prescription painkiller use can affect them? (How harmful or dangerous do they think it is? Why?)

8. How common is it for young people to use prescription painkillers (recreationally or as prescribed)? (Probe for different age groups and communities)

a. How do people tend to talk about them? Do they name the medication or use other terms? What other terms are used?

b. Where do people usually get prescription drugs that are used recreationally/for fun/to get high? (From their doctor or dentist? From family members? From friends? From dealers? At parties? Where else? Travel to Mexico/Texas/AZ/ tribal lands?)

c. How hard is it for people to get painkillers for recreational use? Do young people just take them from people they know, or are they shared intentionally?

d. Where do young people usually use Rx drugs recreationally? (at parties, at school, at home, where else?)

e. Why do young people use painkillers? Do people use them for legitimate pain? Do they use them to relax, get high, when they party?

f. How do young people use them, when it’s recreational? (Do they combine medications? Do they use them with alcohol or with illicit drugs like meth, cocaine or marijuana?)

g. Do high school students use prescription drugs differently from college students or from those no longer in school? How?

9. What other kinds of prescription medications do young people use a lot or misuse here? (Valium? Ritalin? Other uppers? Benzos? Other downers? What else? – Probe for lingo and for different age groups and communities) How does this differ from prescription pain-killer misuse? Updated Nov 11, 2014

10. What kinds of problems do you see in youth who misuse prescription drugs in your community? (Probe: addiction? Problems with school? With family? With the law? With friendships?) (probe for different communities and age groups).

11. What generally happens when a young person gets caught for misusing prescription drugs? (probe for different communities and age groups)

a. What are the consequences? Are consequences given in the same way for everyone? Why or why not?

b. Do they get referred somewhere for help (counseling, etc.)? Why or why not?

c. Do youth get arrested? Why or why not?

d. Do the people who provided them Rx drugs get caught and get in trouble? Why or why not?

e. Do you see any difference between what happens at school versus what happens with law enforcement?

f. Do you know if local high schools have in place a system for addressing Rx drug abuse? What about local colleges and universities? What do these systems look like?

12. And finally, tell us about some resources that exist in this community to help protect people from having problems with drugs and alcohol. Are there certain places, people, organizations, groups that will be important for us to consider? Are there resources for teens and young adults?

Thank you so much for your participation in our assessment process. Your contribution will be essential as we move forward with prevention planning. Do you have any final thoughts you wish to share? Updated Nov 11, 2014

Qualitative Data Collection Protocol - Assessment Youth and Young Adults – “at risk”  These questions are intended to gain perspective from youth or young adults that may already be experiencing problems with drugs & alcohol, or who are at risk of having those problems because they are not in school.  Do not place those under 18 and legal adults into the same group and adapt your probes to match your group. Qualitative data collection log - Focus Group or Interview Protocol Date: Location: Population: Name & Affiliation of interviewer: Number of people attending: Name & Affiliation of scribe: How participants recruited & incentive provided: Issues, concerns, insights:

Introductory script (EXAMPLE): You have been asked to participate in this focus group because you are a young person in this community so you could comment on things in this community that can help or hurt those at risk for drug and alcohol problems. We are not interested in learning information about specific individuals or infractions of the law, but are most interested in learning what attitudes and beliefs young people have in this community around drinking and prescription drug misuse. Please think about your community when responding. We thank you again for your participation.

1. Describe the young people who drink alcohol here. (Probe for different communities, age groups, social groups like ‘jocks’ or whatever the language is used locally, high school, middle school, college, boys vs. girls, etc.) a. How is this different for young adults? Once people reach 21 do these groups change in terms of their consumption of alcohol? b. Are some types easier or cheaper to get than others? Can you talk a little more about that? c. Are there other drugs that are preferred here?

2. How hard do you think it is for underage youth to get alcohol in this community? a. How do youth typically get alcohol? (Probe for adult and same-age family members, friends, strangers, directly in stores, bars or restaurants, stealing from home, getting at parties.) b. How is it for young people who are not in school? Is it easier or harder for them to drink and why?

3. Where do youth usually drink here? (Probe for known hotspots, at homes, at teen drinking parties, at family events, friends’ homes, bars/restaurants, school, out of town limits (in desert, woods, local parks, out of town) while driving, on campus ….) Why can they prefer to drink there? Updated Nov 11, 2014

4. What kinds of problems do you see in youth who drink? (Probe: Problems with school? With family? With the law? With friendships? No problems at all?)

5. What generally happens here when underage youth are caught drinking by other authorities (like the police, not school staff?)

a. Do youth get arrested? Why or why not?

b. Do the people who provided them alcohol get caught too? Are there consequences for providers? Why or why not?

c. Have you noticed any changes in the last year in what happens? What kinds?

d. What about drinking and driving? What happens when youth are caught drinking and driving? How do school officials respond compared to law enforcement?

Now we’re going to shift gears to talk about prescription drug abuse. Our questions here will be very similar. We are interested in understanding what’s going on here specifically. It’s ok if you don’t know the answer to a question, we would like to inspire conversation. So we’re going to talk about lots of different ways that people can use or misuse prescription drugs.

6. How do young people learn about using prescription drugs for recreational use (especially painkillers/opioids)?

a. Do youth typically know the difference between specific prescription drugs (pain-killers, sedatives, etc.)? OR do they use them all regardless of what kind they are?

b. How do young people think that prescription painkiller use can affect them? (How harmful or dangerous do they think it is? Why or why not?)

7. How common is it for young people to use prescription painkillers (recreationally or as prescribed)? (Probe for different age groups and communities)

a. How do people tend to talk about them? Do they name the medication or use other terms?

b. Where do people usually get prescription drugs that are used recreationally/for fun/to get high? From their doctor or dentist? From family members? From friends? From dealers? At parties? Where else? Travel to Mexico/Texas/AZ/ tribal lands?)

c. How hard is it for people to get painkillers for recreational use? Do young people just take them from people they know, or are they shared intentionally? Updated Nov 11, 2014

d. Where do young people usually use Rx drugs recreationally? (at parties, at school, at home, where else?)

e. Why do young people use painkillers? Do people use them for legitimate pain? Do they use them to relax, get high, when they party?

f. How do young people use them, when it’s recreational? (Do they combine medications? Do they use them with alcohol or with illicit drugs like meth, cocaine or marijuana?)

8. What other kinds of prescription medications do young people use a lot or misuse here? (Valium? Ritalin? Other uppers? Benzos? Other downers? What else? – Probe for lingo and for different age groups and communities) How does this differ from prescription pain-killer misuse?

9. What kinds of problems do you see in youth who misuse prescription drugs in your community? (Probe: addiction? Problems with school? With family? With the law? With friendships?) (probe for different communities and age groups).

10. What generally happens when a young person gets caught for misusing prescription drugs? (probe for different communities and age groups)

b. Do they get referred somewhere for help (counseling, etc.)? Why or why not?

d. Do the people who provided them Rx drugs get caught? Why or why not?

e. Have you noticed any changes in the last year in what happens? What kind of changes?

f. Is this any different at school versus by law enforcement?

11. We’re especially interested in accessing young people who are not in school or college right now because they are often hard to reach and have concerns that are unique.

a. What do young people like you do socially? What are their interests? What kinds of groups do they spend time in? (with close family, workmates, based on race, gender, etc…..)

b. What makes it hard for these folks who may not have graduated? Are they treated differently? How? By whom? Updated Nov 11, 2014

c. Who can young people like these count on when they are in trouble or have problems? (friends, family, community leaders? mental health providers, other social services?) Why or why not?

d. How do these young people talk about this community?

e. How would be good ways to reach them? (Facebook, Twitter, other social media, at work sites, at cafes/bars/community center?)

12. And finally, tell us about some resources that exist in this community to help protect people from having problems with drugs and alcohol. Are there certain places, people, organizations, groups that will be important for us to know about?

Data Collection Sheet - Assessment Parents and Community Members For wider coverage consider doing multiple focus groups to cover different communities in county

Consider using this basic focus group script for specific communities and subpopulations, especially consumers/clients of substance abuse services, smaller communities in your county, parents of a particular school or of teens, or ethnically or linguistically defined groups. Use probes to specifically highlight this group (e.g., “as parents of teens… “)

Introductory script (EXAMPLE): You have been asked to participate in this focus group in order to comment on what youth and parents in this community do and think as a whole. We are not interested in learning specific information about individuals or infractions of the law, but are most interested in hearing what you have to say about what the attitudes and beliefs are in this community around drinking and prescription drug abuse. Please think about (name of community) when responding. We thank you again for your participation.

First we will discuss Underage Drinking and other alcohol-related issues:

1. What kinds of problems do you see in youth who use alcohol in your community? (Probe: Problems with school? With family? With the law? With friendships?)

2. How common do you think it is for youth to drink in your community?

a. How would you describe the kids who drink? What about the kids who don’t? What are they like? (Probe for age groups, social groups like ‘jocks’ or whatever the language is locally, high school versus middle school, boys vs. girls, etc.)

b. How is this different for young adults, say 18 to 20 year olds? What changes do you see once a person reaches 21, if any? Do these social groups change or drinking habits change?

c. How old do youth typically start drinking around here? Updated Nov 11, 2014

3. Where do youth usually drink here? (Probe for known hotspots, at homes, at teen drinking parties, at family events, friends’ homes, bars/restaurants, school, out of town limits (in desert, woods, local parks, out of town) while driving, on campus ….) Why do they prefer to drink there?

4. Sometimes, parents or other adults will allow underage family members to drink alcohol, but under certain conditions. What does that look like here? (Probe: Describe the typical circumstances or events where parents let children drink. What do you think about that? Would you say that is fairly common here?)

5. What do parents/other adults in this community do to keep alcohol away from their children?

a. Do those techniques work? Why or why not?

b. What kinds of strategies might work but aren’t being used?

c. What can be done to help more parents use strategies that work? (What can be done to get the word out to parents about the risks of underage drinking and ways to help keep alcohol away from children?)

6. What generally happens here when youth are caught drinking by the authorities?

a. What happens at school when youth are caught drunk or with alcohol?

b. Do youth who get caught drinking by authorities get arrested? Why or why not?

c. Do the people who provided them alcohol get arrested? Why or why not?

7. Binge drinking is consuming 5 or more drinks (for men) or 4 or more drinks (for women) in one sitting. This is a high risk behavior that has been linked to negative consequences including motor vehicle crashes, injury, assault, and other problems. What does this look like in our community?

a. Who (age, gender, geographic location, etc.) in our community is most likely to binge drink?

b. Why? What in our community makes this behavior acceptable?

Now we are going to discuss prescription drug abuse in our community. Again, there’s no right or wrong answers and we are not interested in learning about individuals, but just general trends here in (our community) . It’s ok if you don’t know the answer to a question, we would like to inspire Updated Nov 11, 2014 conversation. So we’re going to talk about lots of different ways that people can use or misuse prescription drugs.

8. First of all, how common is it for young people to use prescription painkillers? (Probe for different age groups and communities)

a. How do people tend to talk about them? Do they name the medication or use other terms?

b. Where do people usually get prescription drugs that are used recreationally/for fun/to get high? From their doctor or dentist? From family members? From friends? From dealers? Where else? Travel to Mexico/Texas/AZ/ tribal lands?)

c. Why do young people use painkillers? Do people use them for legitimate pain? Do they use them to relax, get high, when they party?

d. In some places, people think Rx drugs are safer than other (illicit) drugs. Do you think this is the case in your community? Why or why not?

e. How do young people use them, when it’s recreational? (Do they combine medications? Do they use them with alcohol or with illicit drugs like meth or marijuana?)

9. What other kinds of prescription medications do young people use a lot or misuse here? (Valium? Ritalin? Other uppers? Benzos? Other downers? What else? – Probe for lingo and for different age groups and communities)

a. How is this different than prescription pain killer use?

10. Who else is prone to abuse or misuse prescription drugs (particularly pain killers) in our community?

a. Where do they usually get prescription drugs that are used recreationally/for fun/to get high? From their doctor or dentist? From family members? From friends? From dealers? Where else? Travel to Mexico/Texas/AZ/ Tribal lands?)

11. What kinds of problems do you see in youth who misuse prescription drugs in your county? (Probe: addiction? Problems with school? With family? With the law? With friendships?) (probe for different communities and age groups). Updated Nov 11, 2014

12. What generally happens when someone gets caught for misusing prescription drugs? (probe for different communities and age groups)

b. Do they get referred somewhere for help (counseling, etc.)?

d. Do the people who provided them Rx drugs get arrested? Why or why not?

e. Have you noticed any changes in the last year in what happens? What kind of changes?

f. Is this any different at school versus by law enforcement?

13. How do people keep prescription medication away from youth and other vulnerable populations? What works?

14. What do you know about the price of prescription drugs?

a. Are certain types (opioids, Ritalin, etc.) more or less expensive than others?

b. How does the price play into the drug’s use/misuse?

15. And finally, tell us about some resources that exist in this community to help protect people from having problems with drugs and alcohol. Are there certain places, people, organizations, groups that will be important for us to consider?

Data Collection Sheet – Assessment Law Enforcement

Who provided this Information: Who collected this information:

To the degree possible, ask each law enforcement agency (sheriff, city, state, Tribal, campus…) to help you complete the following table. If data are not available, say “n/a” and provide a brief explanation. # of Arrests # of Arrests # and Type of Enforcement Alcohol-Related Arrests FY12 (July 2012- FY13 to Date Activities since July 2013 June 2013) (July 2013–today) Adults providing/serving alcohol to minors Minors in Possession Drinking and Driving Other: Other:

Amount of pills Amount of pills # of Arrests # of Arrests Prescription Drug-Related seized FY14 to Date seized FY13 (July 2012- Arrests (in pounds if (July 2013 – (in pounds if June 2013) possible) today) possible) Illegal Sales Diversion Other: Other:

Briefly describe the type of incidents/cases you saw over the last year related to prescription drugs (specifically pain killers/opioids):

**Coalition coordinators**Please complete this chart before going to your law enforcement agencies. Children Youth and Families Department maintains county-level data for all referrals they make/receive. # of Referrals # of Referrals CYFD - Type of Referral FY12 (July 2012- FY13 to Date Description of Case June 2013) (July 2013 – today) Alcohol Consumption Minors in Possession Drinking and Driving Possessing/distributing a controlled substance (Rx?) Updated Nov 11, 2014

Other: Other:

Qualitative Data Collection Protocol – Assessment Law Enforcement

Focus group or interview questions – Note that it may be difficult for you to conduct a focus group with law enforcement officers, so you may opt to interview more than one as you can. Ask the questions below directly to the law enforcement representatives – do NOT ask them to ‘fill in the blank” and return this form to you.

Focus group/Interview script: (use introductory template and also include sample consent form)

I represent “Name of your Coalition”, a coalition in “YOUR County” that has been organized in order to prevent the abuse of prescription medications/pain killers, binge drinking, DWI and underage drinking.

We are currently conducting an assessment about problems related to those problems and we would like to ask you some questions so we can learn more about the scope of these problems in our county. We already know that our rates are high1, which was why our county was selected to implement prevention. We are not interested in specific information about perpetrators, just general patterns. The responses you provide will help us understand the problem.

First we’ll talk about prescription drugs:

1. What are the most common problems that you see in relation to prescription drug abuse and misuse in our County? (Overdoses? Drug-related violence? Robberies of pharmacies? Youth involvement? Addiction to heroin? IV drug use?)

2. Who in the community are most likely to misuse prescription drugs (especially pain killers)? Why? In what contexts does abuse most often occur?

1 Consider bringing with you the most recent YRRS results or community survey results in order to demonstrate this. Updated Nov 11, 2014

3. We need to know about how people access prescription drugs for non-medical use. What have you seen here in terms of trafficking, illicit sales, sharing these drugs, stealing them?

a. Have you seen any changes lately in patterns? (more youth involved, preference for certain kinds of drugs, what kinds of people do you most commonly seen involved – are they ‘typical’ criminals or everyday folks? )

b. As far as you know, how is this information tracked? Would you be able to track it?

4. To the best of your knowledge, what are the local laws and regulations about prescription drugs? How easy or hard is it for you all to defend those laws?

5. How do you identify if someone is misusing prescription drugs?

6. Overall, what are the largest barriers to protecting your community against prescription drug abuse and misuse? (difficult to detect? Laws are unclear? Community norms? Perceived as safe? Pricing? Easy access?)

7. What would you recommend to those trying to prevent prescription drug use and abuse in your community? In what ways can the coalition help you? (This is more about showing Law Enforcement that we value their input than it is about informing our strategy selection).

Risky Alcohol Use questions: (Underage Drinking, Binge Drinking, Drinking and Driving)

Now I want to ask you some similar questions about underage drinking/binge drinking/drinking and driving.

8. Binge drinking is consuming 5 or more drinks (for men) or 4 or more drinks (for women) in one sitting. This is a high risk behavior that has been linked to negative consequences including motor vehicle crashes, assaults, and other problems.

a. Who (age, gender, geographic location, etc.) in your community are most likely to binge drink?

b. Why? What in your community makes this behavior acceptable?

9. What problems do you see associated with Underage Drinking (UAD) in our county? (Crashes? Deaths? Other crime? School performance? Family or emotional troubles? No problems at all?) Are there other things that you see as a greater problem for youth in our county? Updated Nov 11, 2014

10. Describe, to the best of your knowledge, what underage drinking is like in your community.

a. Where does it usually happen? (parties, out of town? Abandoned homes? Private homes when parents are gone? )

b. How do youth typically get alcohol? (parents, friends, siblings, at bars….)

c. What do youth here prefer to drink? (what’s the drink of choice these days? )

d. What makes it easy for youth to drink here?

e. What makes it harder for them to drink?

11. Describe, to the best of your knowledge, the current ways that Underage Drinking laws are enforced in your county. (Are there party patrols? Time of extra enforcement? Part of routine patrolling?)

a. Are there places in the county where enforcement is different or harder?

b. Are there places in the county where the problem is worse than others?

c. Have there been any changes in these efforts in recent years? Why? What’s been the impact?

d. Have you seen any changes in enforcement around UAD?

12. What are the challenges? What makes it hard for you to enforce underage drinking laws in our county? (Loopholes in the laws? Community norms? Geography? Lack of community support? Intergenerational drinking issues?)

a. Have you seen any recent changes in this? To what do you attribute these changes? (What do you think caused these changes?)

13. Research on alcohol prevention shows that increasing people’s perception of risk of getting caught for underage drinking, and increasing highly visible enforcement motivates people to avoid driving after drinking. What are ways that we can increase the perception of risk and increase highly visible law enforcement efforts in our community? What are the barriers to increasing enforcement and people’s perception of risk? How can these be addressed?

14. And finally, tell us about some resources that exist in this community to help protect people from having problems with drugs and alcohol. Are there certain places, people, organizations, groups that will be important for us to consider in our prevention planning?

Thank you so much for your participation in our assessment process. Your contribution will be essential as we move forward with prevention planning. Do you have any final thoughts you wish to share? Updated Nov 11, 2014 Updated Nov 11, 2014

Data Collection Sheet - Assessment: Health Care Providers, Doctors and Pharmacists

Introductory script: You have been asked to participate in this focus group/interview in order to comment on general attitudes and actions of prescribers (doctors and pharmacists) in your community. We are not interested in learning specific information about individuals or infractions of the law, but are most interested in hearing what you have to say about the attitudes and beliefs among your colleagues around prescription drug abuse and underage drinking. Please think about (NAME OF COMMUNITY) when responding. We thank you again for your participation.

First we are going to discuss prescription drug abuse, especially by young people in your community. Again, there’s no right or wrong answers and we are not interested in learning about individuals, but just general trends here in (your community) . It’s ok if you don’t know the answer to a question we would like to inspire conversation.

1. How big of a problem do you think prescription drug abuse / misuse is (especially pain killers and especially among young people)?

2. We have been told that people “Doctor Shop” or “Pharmacy Shop” to obtain more medication than is recommended/needed. How do people usually do this in your community?

a. How do you recognize it?

b. How often does this occur (one a week/month/year)?

c. What helps minimize this tactic? Updated Nov 11, 2014

d. How well does the Prescription Drug Monitoring Program/System work to deter this behavior? Why?

e. What other methods do you/your colleagues use to detect and/or deter this behavior? (Are doctors checking the PDPM regularly? Do doctors typically check medical records for other current/previous opioid prescriptions? Etc.)

f. How do health care providers track or record suspicious purchases like this? Are incident logs kept for incidents that occur?

3. Data from our state Department of Health shows dramatic increases in the sale of prescription pain killers over the last few years. What do you think the main contributors to this increase are?

a. How much do doctors (in general) contribute to this phenomenon? Insurance companies? Who else?

b. What current policies or protocols are in place to protect doctors from over-prescribing? How effective are they? How might they be improved?

c. Are prescribers more likely to suggest over the counter pain medication (like ibuprofen) or prescription pain meds? Why?

d. What current policies/protocols are in place to prevent patients from abusing prescription drugs? How effective are they? How might they be improved?

4. The CDC has identified seven types of laws that may help minimize prescription drug fraud/misuse, several of these are in place in New Mexico:

 Laws Requiring a Physical Examination before Prescribing (NM)  Laws Requiring Tamper-Resistant Prescription Forms (NM)  Laws Regulating Pain Clinics  Laws Setting Prescription Drug Limits  Laws Prohibiting “Doctor Shopping”/Fraud (NM – general law only)  Laws Requiring Patient Identification before Dispensing (NM)  Laws Providing Immunity from Prosecution/Mitigation at Sentencing for Individuals Seeking Assistance During an Overdose (NM) How effective are these? What else could be done? Why do you think we still have such high overdose death rates? 5. Do Doctors typically think they will not get caught for over-prescribing? Or are they pretty certain that they will get cited if they consistently prescribe large amount (particularly opioids)? Updated Nov 11, 2014

a. What are the penalties/consequences if a Doctor is cited/caught over prescribing?

b. How likely are those consequences to be enforced?

6. How might the medical community contribute to reducing the high rate of prescription drug overdose deaths in New Mexico?

7. Can you think of anything else that contributes to prescription drug misuse / abuse, especially among young people (ages 12-25)?

Next we have a few questions related to underage drinking. The American Academy of Pediatrics recommended that Doctors regularly screen adolescents for alcohol and other substance use (PEDIATRICS Vol. 125, Number 5, May 2010) and a study just released in the Journal of Studies on Alcohol and Drugs (Jan 2014, Vol. 75) shows a single screening question can detect alcohol or drug abuse.

8. When Doctors in your community see a patient that is 12-20 years old, how common is it to ask them about substance use and/or screen them for excessive use? 9. What is typically done with a patient who exhibits risk of substance abuse? (Are the consequences or dangers of this behavior discussed? Are they referred to a behavioral health specialist for help? Etc.) 10. What do you think the medical community could do to help reduce/minimize underage drinking? 11. And finally, tell us about some resources that exist in this community to help protect people from having problems with drugs and alcohol. Are there certain places, people, organizations, groups that will be important for us to consider?

Thank you so much for your participation in our assessment process. Your contribution will be essential as we move forward with prevention planning. Do you have any final thoughts you wish to share? Feel free to email (INSERT) or call (###-###-####) Updated Nov 11, 2014

July 1, 2014

YOUR NAME YOUR ADDRESS

PHYSICIAN NAME PRACTICE NAME ADDRESS

Dear Dr. NAME,

New Mexico has the highest drug-induced death rate in the nation and the most common drugs causing unintentional drug overdose in NM are prescription opioids. The Coalition NAME of BLANK County recently received an award from the New Mexico Office of Substance Abuse Prevention (NM OSAP) to address prescription opioid misuse and abuse. The funding originates from the federal Center for Substance Abuse Prevention (CSAP) at the Substance Abuse and Mental Health Services Administration (SAMHSA) and requires us to first conduct a thorough needs assessment of the problem in our community. Since physicians and other health care providers are an integral component of any prevention efforts, we feel it is important to understand what physicians in our community think about prescription pain killer misuse and abuse. We hope to better understand what challenges primary care physicians, physicians assistants, pharmacists and other providers face in their practices when addressing pain management in their patients.

Please be aware, none of this information will be connected to you in any way, it will not be shared with the DEA or other authorities. We are not advocating for new rules and regulations, we are simply trying to assess the problems and issues related to prescription drug misuse.

Enclosed is a brief survey intended to get a cursory understanding of how concerned providers are about opioid misuse and abuse and whether prescribing protocols or policies assist providers in navigating whether to prescribe or not prescribe opioids to patients. This is only a brief survey and should take you less than 10 minutes to complete. It is not intended to get at specific details that may well be important in understanding the problem from the medical professional point of view. The information gathered from this survey is intended to inform our interviews and focus groups with local physicians, which will gather additional details and context around prescription pain killer prescribing practices.

This survey is completely anonymous. Please do not include your name anywhere on the survey itself. We have provided you with a self-addressed stamped envelope to return the survey to our coalition. If you have any concerns or thoughts about the survey that you would like to share, you may include them on the survey itself or you may call BLANK BLANK at (999)-999-999.

If you would be interested in participating in an interview or focus group with other physicians and providers, please contact BLANK BLANK at (999) 999-999.

We appreciate your assistance with this endeavor we have undertaken and welcome your thoughts and expertise. Thank you in advance for your time.

Sincerely, Updated Nov 11, 2014

Health Care Provider Survey

Please indicate which title best describes you by circling the most appropriate title:

Primary Care Physici Pharmacist Nur S Other (please specify): Physician an’s se p Assista e nt c i a l t y

( p l e a s e

s p e c i f y Updated Nov 11, 2014

DIRECTIONS: Please circle the best response for each question. Please select only 1 response. About how frequently are providers in your community asked to Nearly Q1 address a patient's pain management concerns during an average Several times a month Almost Never Everyday work week? If a patient presents with pain concerns, how likely are providers to Q2 suggest an over-the-counter pain medication such as ibuprofen or Very likely Neither likely nor unlikely Very unlikely acetaminophen? (as the first option) If a patient presents with pain concerns, how likely are providers to Q3 Very likely Neither likely nor unlikely Very unlikely prescribe an opioid pain killer? (as the first option) Q4 When prescribing opioid pain killers to a patient… Neith er … how likely are providers to inquire about the likely Q4a Somewhat likely Somewhat unlikely Very unlikely patient’s past opioid use? nor unlike ly Neith er … how likely are providers to inquire about any past likely Q4b problems the patient may have with substance use or Somewhat likely Somewhat unlikely Very unlikely nor addiction? unlike ly Neith er … how likely are providers to review the patient's chart likely Q4c Somewhat likely Somewhat unlikely Very unlikely for previous opioid prescriptions? nor unlike ly Q4d ... how likely are Doctors to check the Prescription Drug Somewhat likely Neith Somewhat unlikely Very unlikely Monitoring data base for previous opioid prescriptions er given to the patient? likely Updated Nov 11, 2014

nor unlike ly Neith er ... how likely are other providers to check the likely Q4d Prescription Drug Monitoring data base for previous Somewhat likely Somewhat unlikely Very unlikely nor opioid prescriptions given to the patient? unlike ly Neith er ... how likely are providers to ask another staff person likely Q4e to check the Prescription Drug Monitoring data base for Somewhat likely Somewhat unlikely Very unlikely nor previous opioid prescriptions given to the patient? unlike ly In general, to what extent are you concerned about the abuse of Very Q5 Neither concerned nor Very unconcerned opioids in your patients? concerned unconcerned If yes, please explain: Does your practice have a current policy or protocol for prescribing Q6 Yes prescription pain killers to patients?

In your opinion, how well do providers adhere to the policy or Strictly Q7 Sometimes adhere Do not adhere at all protocol? adhere In your opinion, how effective is the current policy or protocol at Very Q8 your practice in protecting doctors from over prescribing Rx pain Sometimes effective Very ineffective effective killers? In your opinion, how effective is the current policy or protocol at Very Q9 Sometimes effective Very ineffective your practice in preventing patients from abusing Rx pain killers? effective

How likely are providers in your community to talk to their patients Q10 about the following: Q10a Proper disposal of unused/expired prescription Somewhat likely Neith Somewhat unlikely Very unlikely medication er Updated Nov 11, 2014

likely nor unlike ly

Neith er likely Somewhat likely Somewhat unlikely Very unlikely Q10b Safe storage of prescription drugs (especially opioids) nor unlike ly

Neith er likely Dangers of mixing prescription drugs with alcohol and Q10c Somewhat likely Somewhat unlikely Very unlikely other drugs nor unlike ly

Neith er likely Dangers of sharing prescriptions with other people to Q10d Somewhat likely Somewhat unlikely Very unlikely whom they are not prescribed nor unlike ly

Q10e Recognizing the signs of addiction (especially with Somewhat likely Neith Somewhat unlikely Very unlikely opioids) er likely nor unlike Updated Nov 11, 2014

Please share any thoughts or concerns you may have about the abuse of prescription drugs among youth and young adults in NM or in your practice that you think would be helpful in preventing prescription drug misuse in our community.

Data Collection Sheet - Assessment Questions for retailers in your community: (for alcohol)

Introductory script: You have been asked to participate in this focus group because you sell alcohol in this community and we’d like to get your feedback on how we can shape efforts to better help you prevent underage drinking problems in your community.

1. What things make it hard for you to uphold alcohol-related laws? Why is it hard?

(Probe for underage drinking laws; serving to intoxicated; keeping your outlet in compliance with certification land licensing laws; DWI)

2. What makes it easy for you to uphold alcohol-related laws? (Probe for underage drinking laws; serving to intoxicated; keeping your outlet in compliance with certification land licensing laws; DWI…)

3. What have you noticed about enforcement of alcohol-related laws in your community this year?

4. How have you learned about enforcement efforts? (Probe: local news, radio, word of mouth, etc.)

a. Of underage drinking laws Updated Nov 11, 2014

b. Serving to intoxicated patrons

c. Keeping your outlet in compliance with certification and licensing laws

d. DWI

5. Have you noticed any increases in enforcement over the past year or decreases?

a. Why do you think these changes have happened?

6. What would help businesses that sell alcohol to be better informed of the law and able to enforce it at your establishment(s)? (Probe: How can we help you avoid getting fined or cited?)

7. We will be working to prevent underage drinking in the entire county, is there any other information that would help us with those efforts? Do you notice any particular parts of the community that has problems? Are there other retailers that do not comply with the law? Are there issues with law enforcement you haven’t talked about?

a. What else do we need to know that we haven’t talked about already? How can we best support you in keeping young people from accessing alcohol? Updated Nov 11, 2014

ACTIVITY Conducting Focus Groups and Interviews

PRACTICE: Conduct a focus group! Hand out cards with the names of the different tools. Have each group select a card and they will work on that focus group tool.

- Each group needs to assign a facilitator and a scribe - Debrief

Developing your Data Collection Plan

Use the “Assessment Guide” on the following page to begin planning who/where/how/when data collection will take place. Updated Nov 11, 2014

Eddy County Grantee Timeline SPF Step/Training Report Due Date Aug/Sept SPF Overview Grant Expectations N/A Aug/Sept Coalition Training Coalition Checklists Due Nov 7 Sept Assessment Training Report Due December 7 Nov/Dec Capacity & Readiness Training Report Due February 13 Jan Intro to EBP’s (webinar?) N/A Jan Strategic Planning Training Strategic Plans Due April 1 May/June Evaluation Training (1 day) Evaluation Plans DUE Sept 2015 Updated Nov 11, 2014

New Mexico – Office of Substance Abuse Prevention – Assessment Guide Focus Items to be assessed Who will collect this? Where? From Whom? What is the timeframe? Population Youth (12-20) UAD (retail availability, social access, Conduct at least perceived risk, norms / beliefs) 1 FG

Rx Misuse

Youth (21-25) Binge/Excessive Drinking, Drinking & Conduct at least Driving 1 FG Rx Misuse

Parents / UAD, Binge Drinking, DWI Community Members at Rx Misuse large Conduct at least 1 FG Physicians & UAD & Binge Drinking Pharmacists Rx Misuse (ID Dr/Pharm shopping, Conduct at least contributors to over-prescribing, PDMP 3 Interviews (or 1 FG) Law UAD, Binge Drinking, DWI Enforcement Rx Misuse Conduct at least 3 Interviews (or 1 FG) CS = Community Survey, NSDUH = National Household Survey on Drug Use and Health, YRRS = Youth Risk & Resiliency Survey