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Promising Program Seal

Communities That Care

Blueprints Program Rating: Promising

A prevention system designed to reduce levels of adolescent delinquency and substance use through the selection and use of effective preventive interventions tailored to a community's specific profile of risk and protection.

Program Outcomes

  • Alcohol
  • Antisocial-aggressive Behavior
  • Delinquency and Criminal Behavior
  • Illicit Drug Use
  • Tobacco
  • Violence

Program Type

  • Community, Other Approaches

Program Setting

  • Community (e.g., religious, recreation)

Continuum of Intervention

  • Universal Prevention (Entire Population)


  • Infant (0-2)
  • Early Childhood (3-4) - Preschool
  • Late Childhood (5-11) - K/Elementary
  • Early Adolescence (12-14) - Middle School
  • Late Adolescence (15-18) - High School
  • Early Adulthood (19-22)


  • Male and Female


  • All Race/Ethnicity


  • Blueprints: Promising
  • SAMHSA: 3.2 - 3.6

Program Information Contact

Blair Brooke-Weiss
Social Development Research Group
University of Washington School of Social Work
9725 3rd Ave. NE, Suite 401
Seattle, WA 98115-2024
(206) 543-5709

Program Developer/Owner

  • J. David Hawkins, Ph.D.
  • University of Washington School of Social Work

Brief Description of the Program

Communities That Care (CTC) is a prevention system, grounded in science that gives communities the tools to address their adolescent health and behavior problems through a focus on empirically identified risk and protective factors. CTC provides a structure for engaging community stakeholders, a process for establishing a shared community vision, tools for assessing levels of risk and protection in communities, and processes for prioritizing risk and protective factors and setting specific, measurable, community goals. CTC guides the coalition to create a strategic community prevention plan designed to address the community's profile of risk and protection with tested, effective programs and to implement the chosen programs with fidelity. CTC instructs the coalition to monitor program implementation and to periodically reevaluate community levels of risk and protection and outcomes, and to make adjustments in prevention programming if indicated by the data. Implementation of CTC is organized into five stages, each with its own series of "benchmarks" and "milestones" to help guide and monitor implementation progress. CTC is installed in communities through a series of six training events delivered over the course of 6 to 12 months by certified CTC trainers.

See: Full Description


Randomized Control Study in 24 communities:

Through Grade 7 (Hawkins, Brown et al., 2008):

  • Students in control communities were significantly more likely to initiate delinquent behavior between fifth and seventh grades than were students in CTC communities.
  • No significant intervention condition effects were found on substance use initiation between grades 5 and 7.

Through Grade 8 (Hawkins et al., 2009):

  • The incidence of delinquent behavior, alcohol, cigarette, and smokeless tobacco initiation were significantly lower in CTC than in control communities between grades 5 and 8.
  • In grade 8, the prevalence of alcohol and smokeless tobacco use in the last 30 days, binge drinking in the past 2 weeks, and the number of different delinquent behaviors committed in the past year in grade 8 were significantly lower in CTC communities compared to control communities.

Through Grade 10, one year after the end of technical assistance (Hawkins et al., 2011):

  • The incidence of alcohol use, cigarette use, and delinquency was lower by grade 10 among students in CTC communities than in control communities.
  • The prevalence of current cigarette use and past-year delinquent and violent behavior were significantly lower in CTC than in control communities in grade 10.

Through Grade 12, eight years post baseline (Hawkins et al., 2014)

  • Abstinence from drug use, drinking alcohol, smoking cigarettes, and engaging in delinquency lower in the CTC communities than control communities.
  • Less likely to ever have committed a violent act in CTC communities, relative to control communities.

Through age 19, nine years after baseline (Oesterle et al., 2015):

  • The incidence of cigarette use and delinquency was lower for males in CTC communities than in control communities.

Through age 21, ten years after baseline and compared to control participants (Oesterle et al., 2018), treatment participants had:

  • Higher likelihood of sustained abstinence from gateway drugs (alcohol, tobacco, and marijuana) and marijuana
  • Higher likelihood of abstaining from antisocial behavior
  • Reduced risk of lifetime engagement in violence

Community-Level Prevention Service System Outcomes (Brown et al., 2007; Rhew et al., 2011 draft):

  • CTC communities exhibited significantly greater increases in adopting a science-based approach to prevention, collaboration across community sectors, and collaboration regarding specific prevention activities between 2001 and 2004, relative to control communities.
  • CTC communities reported higher levels of adoption of a science-based approach to prevention in 2009, 1.5 years after study-funded resources for CTC ended.
  • All but one of the 12 CTC coalitions was still in existence in 2009 and sustaining the coalition's structure and prevention activities.

Pennsylvania Quasi-experimental Study (Feinberg et al., 2007)

  • In general, the pattern of findings shows that communities employing the CTC model had lower levels of risk factors and problem behaviors (delinquency and alcohol/drug use) than communities not employing CTC.
  • When contrasting grade cohorts that were actually exposed to evidence-based programs ("expected impact" cohorts), compared to grade cohorts in the same schools that were not exposed to EBPs combined with students from non-CTC schools, youth in "expected impact" CTC grade cohorts demonstrated significant and beneficial effects for risk/protective factors, academic grades, and delinquency.

Significant Program Effects on Risk and Protective Factors:

  • The levels of risk factors targeted by CTC communities were significantly lower among panel students in grade 7 in intervention communities than in control communities after 1.67 years of implementing preventive interventions selected through the CTC process (Hawkins, Brown, et al., 2008).
  • Mean levels of targeted risks increased less rapidly between grades 5 and 10, and were significantly lower in grade 10, in CTC than in control communities (Hawkins et al., 2011).

Repeated cross-sectional study using CYDS data:

Among 6th graders, there was a possible harmful effect as control participants had significantly better outcomes than treatment participants in:

  • Antisocial behavior

In comparing change between 6th and 10th grade, the study found significant improvement in treatment communities than control communities for:

  • Lifetime use of smokeless tobacco

Race/Ethnicity/Gender Details

Communities That Care was implemented in communities with a diverse population. At nine years post baseline, only males showed significant sustained effects, however there were no significant differences in main effects between men and women 10 years after implementation (Oesterle et al., 2018).

Risk and Protective Factors

Risk Factors
  • Individual: Antisocial/aggressive behavior, Early initiation of antisocial behavior*, Early initiation of drug use*, Favorable attitudes towards antisocial behavior*, Favorable attitudes towards drug use*, Gang involvement, Physical violence, Rebelliousness, Stress, Substance use*
  • Peer: Interaction with antisocial peers, Peer rewards for antisocial behavior, Peer substance use
  • Family: Family conflict/violence, Family history of problem behavior, Parental attitudes favorable to antisocial behavior, Parental attitudes favorable to drug use, Poor family management*
  • School: Low school commitment and attachment, Poor academic performance
  • Neighborhood/Community: Community disorganization, Laws and norms favorable to drug use/crime, Low neighborhood attachment, Perceived availability of drugs, Perceived availability of handguns, Transitions and mobility
Protective Factors
  • Individual: Clear standards for behavior, Coping Skills, Perceived risk of drug use, Prosocial involvement, Refusal skills, Religious service attendance, Rewards for prosocial involvement, Skills for social interaction
  • Peer: Interaction with prosocial peers
  • Family: Attachment to parents, Opportunities for prosocial involvement with parents, Rewards for prosocial involvement with parents
  • School: Opportunities for prosocial involvement in education, Rewards for prosocial involvement in school
  • Neighborhood/Community: Opportunities for prosocial involvement, Rewards for prosocial involvement

*Risk/Protective Factor was significantly impacted by the program.

See also: Communities That Care Logic Model (PDF)

Training and Technical Assistance

For information on CTC training description, see: CTC_Training.pdf

Training Certification Process

For information about the CTC Training of Trainers model, see: CTC_TOT.pdf

Brief Evaluation Methodology

The Community Youth Development Study (CYDS) is the first community-randomized trial of CTC. The initial 5-year experimental study was conducted in 24 communities across seven states nationally. Sites were matched within state, and then randomly assigned to 12 intervention and 12 control communities in 2003. To test the effects of CTC in achieving observable reductions in targeted risk factors, delinquent behavior, and substance use within the 5 years of the study as hypothesized by CTC's theory of change, the intervention communities were asked to focus their prevention plans on interventions for youths aged 10 to 14 years and their families. Data from a panel of 4,407 fifth grade students was surveyed nine times through age 21 from 2004 to 2014. Levels and trends in adolescent and adult drug use and delinquency were assessed. A quasi-experimental study of CTC was conducted in Pennsylvania sites using a state-funded survey of adolescents in grades 6, 8, 10, and 12 in public and private schools. The full data sets available contained data on 92 school districts and 43,842 students in 2001 and 159 school districts and 101,988 students in 2003.

A second evaluation (Rhew et al., 2016) also used data from the CYDS but examined a series of cross-sectional surveys between 2000 and 2008. The study pooled the 2000 and 2002 assessments for baseline measures and the 2006 and 2008 assessments for follow-up measures and included 6th, 8th, and 10th graders. Sample sizes over survey years ranged from 4,647 to 5,077 for 6th graders, 4,491 to 4,984 for 8th graders, and 3,854 to 4,726 for 10th graders.

Peer Implementation Sites

Heidi Peterson
Certified Prevention Specialist
Director, Communities That Care
Tooele City, Utah
Phone: (435) 843-2188
Fax: (435) 843-2189

Gery Shelafoe, CPC-R
NorthCare Network
200 West Spring Street
Marquette, MI 59855

Vaughnetta J. Barton, MSW
Communities in Action
Communities That Care
School of Social Work
University of Washington
Mail: Box 354900, Seattle, WA 98195-4900
4101 15th Avenue NE, Seattle, WA


Arthur, M. W., Ayers, C. D., Graham, K. A., & Hawkins, J. D. (2003). Mobilizing communities to reduce risk for drug abuse: A comparison of two strategies. Pp. 129-144 in The Handbook of Drug Abuse Prevention: Theory, Science, and Practice, edited by Z. Sloboda and W. J. Bukoski. Kluwer Academic/Plenum Publishers: New York, NY.

Brown, E. C., Hawkins, J. D., Arthur, M. W., Briney, J. S., & Abbot, R. D. (2007). Effects of Communities That Care on prevention services systems: Findings from the community youth development study at 1.5 years. Prevention Science, 8, 180-191.

Brown, E. C., Hawkins, J. D., Rhew, I. C., Shapiro, V. B., Abbott, R. D., Oesterle, S., ... Catalano, R. F. (2013). Prevention system mediation of Communities That Care effects on youth outcomes. Prevention Science, DOI 10.1007/s11121-013-0413-7.

Fagan, A. A., Hanson, K., Hawkins, J. D., & Arthur, M. W. (2008a). Bridging science to practice: Achieving prevention program implementation fidelity in the Community Youth Development Study. American Journal of Community Psychology, 41, 235-249.

Fagan, A. A., Hanson, K., Hawkins, J. D., & Arthur, M. W. (2008b). Implementing effective community-based prevention programs in the Community Youth Development Study. Youth Violence and Juvenile Justice, 6, 256-278.

Fagan, A. A., Hanson, K., Briney, J. S., & Hawkins, J. D. (2012). Sustaining the utilization and high quality implementation of tested and effective prevention programs using the Communities That Care prevention system. American Journal of Community Psychology, 49,365-377.

Feinberg, M. W., Greenberg, M. T., Osgood, D. W., Sartorius, J., & Bontempo, D. (2007). Effects of the Communities That Care model in Pennsylvania on youth risk and problem behaviors. Prevention Science, 8, 261-270.

Feinberg, M. W., Jones, D., Greenberg, M. T., Osgood, D. W., & Bontempo, D. (2010). Effects of the Communities That Care model in Pennsylvania on change in adolescent risk and problem behaviors. Prevention Science, 11, 163-171.

Gloppen, K. M., Arthur, M. W., Hawkins, J. D., & Shapiro, V. B. (2012). Sustainability of the Communities That Care prevention system by coalitions participating in the Community Youth Development Study. Journal of Adolescent Health, 51, 259-264.

Harachi, T. W., Ayers, C. D., Hawkins, J. D., Catalano, R. F., & Cushing, J. (1996). Empowering communities to prevent adolescent substance abuse: Process evaluation results from a risk- and protection-focused community mobilization effort. The Journal of Primary Prevention, 16, 233-254.

Hawkins, J. D., Brown, E. C., Oesterle, S., Arthur, M. W., Abbot, R. D., & Catalano, R. F. (2008). Early effects of Communities That Care on targeted risks and initiation of delinquent behavior and substance use. Journal of Adolescent Health, 43, 15-22.

Hawkins, J. D., Catalano, R. F., Arthur, M. W., Egan, E., Brown, E. C., Abbot, R. D., & Murray, D. M. (2008). Testing Communities That Care: The rationale, design and behavioral baseline equivalence of the Community Youth Development Study. Prevention Science, 9, 178-190.

Hawkins, J. D., Oesterle, S., Brown, E. C., Arthur, M. W., Abbot, R. D., Fagan, A. A., & Catalano, R. F. (2009). Results of a type 2 translational research trial to prevent adolescent drug use and delinquency: A test of Communities That Care. Archives of Pediatric Adolescent Medicine, 163(9), 789-798.

Hawkins, J. D., Oesterle, S., Brown, E. C., Monahan, K. C., Abbott, R. D., Arthur, M. W., & Catalano, R. F. (2011). Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial.Archives of Pediatric Adolescent Medicine, published online October 3, 2011, doi: 10.1001/archpediatrics.2011.183.

Kuklinski, M. R., Hawkins, J. D., Plotnick, R. D., Abbott, R. D., & Reid, C. K. (2013). How has the econonmic downturn affected communities and implementation of science-based prevention in the randomized trial of Communities That Care? American Journal of Community Psychology, 51, 370-384.

Oesterle, S., Hawkins, J. D., Kuklinski, M. R., Fagan, A. A., Fleming, C., Rhew, I. C., ... Catalano, R. F. (2015) Effects of Communities that Care on males’ and females’ drug use and delinquency 9 years after baseline in a community-randomized trial. American Journal of Community Psychology, 56, 217-228.

Quinby, R. K., Hanson, K., Brooke-Weiss, B., Arthur, M. W., Hawkins, J. D., & Fagan, A. A. (2008). Installing the Communities That Care prevention system: Implementation progress and fidelity in a randomized controlled trial. Journal of Community Psychology, 36, 313-332.

Rhew, I. C., Brown, E. C., Hawkins, J. D., & Briney, J. S. (2011 Draft). Sustained effects of Communities That Care on prevention service system transformation. Seattle, WA: Social Development Research Group, University of Washington School of Social Work.

Rhew, I. C., Hawkins, J. D., Murray, D. M., Fagan, A. A., Oesterle, S., Abbott, R. D., & Catalano, R. F. (2016). Evaluation of community-level effects of Communities That Care on adolescent drug use and delinquency using a repeated cross-sectional design. Prevention Science, 17, 177-187.