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Substance Education and Awareness Fund Annual Report 2018-19 Annual Report 2018-19 Boulder Substance Education and Awareness (SEA) Fund 2 Annual Report 2018-19 Boulder Substance Education and Awareness (SEA) Fund Submitted to: City of Boulder Housing & Human Services Community Investments Program December 2019 For more information, please contact: Julia Simhai, MPH jsimhai@omni.org 303-839-9422 ext. 137 Project Team: Lynnette “T” Schweimler, Charlotte Gray Acknowledgements: OMNI expresses sincere appreciation to the Boulder County Community Services Department and the partners of the SEA Fund for their collaboration on this evaluation and contributions to both process and outcomes data collected for this report. 3 Table of Contents Executive Summary ..................................................................................................................................... 4 The SEA Fund .............................................................................................................................................. 6 History of the SEA Fund ............................................................................................................................. 6 Current SEA Partners .................................................................................................................................. 6 Evaluation Structure and Goals.................................................................................................................. 8 Progress Toward SEA Goals ................................................................................................................... 10 Goal 1: Widespread Distribution ............................................................................................................. 10 Goal 2: Increase Perceptions of Risk ....................................................................................................... 14 Goal 3: Reduce Youth Substance Use .................................................................................................... 19 Goal 4: Reduce Accidental Ingestion ...................................................................................................... 20 SEA Fund Impact and Challenges ........................................................................................................... 21 SEA Partner Impact .................................................................................................................................... 21 SEA Fund Challenges ................................................................................................................................. 22 What's Next for the SEA Fund? ............................................................................................................. 23 Appendix ................................................................................................................................................... 25 Common Measure Questions .................................................................................................................. 25 SEA Fund Logic Model .............................................................................................................................. 27 4 Executive Summary On November 5, 2013, City of Boulder voters approved Ordinance 7916, which authorized the city to impose an excise tax of up to ten percent and a sales and use tax of up to ten percent on recreational marijuana sales to offset some of the indirect costs of recreational marijuana. In June 2016, the City of Boulder launched the Substance Education and Awareness (SEA) Fund, which utilizes a portion of this tax revenue. The SEA Fund serves as a community-wide substance use prevention initiative. Funding is used by community agencies (partners) to provide direct programming and to disseminate media campaigns designed to prevent youth substance use. This report is a compilation of data from the third year of the SEA Fund evaluation and documents progress made toward achieving the four SEA Fund goals, which are outlined in the following sections. The partners below were active in Year 3 of the SEA Fund (July 2018 - June 2019). Boulder Substance Education and Awareness (SEA) Fund 2018-19 Annual Report Executive Summary 52%25%23% were parents were adults who work with youth were youth About the SEA Fund Goal 1: Widespread Distribution of Programs and Messaging Sources of Strength promotes connections between middle school peers and caring adults. EFFEKT trains parents on positively influencing their children’s attitudes and behaviors. Responsible Association of Retailers trains retailers to promote patron safety and limit youth access to substances. Youth Prosocial Activities provide substance- free Teen Nights Out and Days of Service. Influencer Trainings help YMCA staff be trusted adults and effective communicators with youth. Speak Now Campaign teaches parents strategies for talking to youth about substance use. Out of Reach Campaign encourages parents to keep substances out of reach of young children. The number of direct programming participants has increased more than 40% each year of the SEA Fund, with 733 individuals served this year. 350 517 733 Among the 733 participants in direct programming this year: Year 1 Year 2 Year 3 5.2 million impressions were garnered by SEA- funded community messaging campaigns (Speak Now and Out of Reach) in Year 3, including bus ads, billboards, online ads, and radio spots. 5 Goal 2: Increase Perceptions of Risk Goal 3: Reduce Youth Substance Use Year 4 of the SEA Fund will include: •Expansion of the evaluation to include common outcome measures across all partners. These will allow for comparison of SEA outcomes to Healthy Kids Colorado Survey data. •Continuation of the SEA dashboard for program reporting. •Addition of two new partner programs that will expand the SEA portfolio to include prevention of vaping and opioid misuse. What’s Next for SEA For more information on the SEA Fund or to access the full 2018 -19 report, please contact Elizabeth Crowe, City of Boulder Housing and Human Services: CroweE@bouldercolorado.gov. SEA programs and messaging are designed to increase perceptions of risk of substance use as well as build protective factors that buffer against youth substance use and enable healthy development. Overall, SEA program participants report high perceptions of risk and protective factors. National research on adolescent perceived risk of substance use has shown that increases in perceived risk are associated with decreases in substance use rates. The measures below represent a portion of SEA data collected this year on risk and protective factors. The SEA evaluation is tracking substance use rates among Boulder youth. In 2017, one in three Boulder Valley School District high schoolers reported drinking alcohol and more than 20% reported using marijuana in the past 30 days. Among BVSD high schoolers, in the past 30 days: Goal 4: Reduce Accidental Ingestion 2.4 million impressions The Out of Reach campaign aims to decrease the number of children who accidentally ingest substances left within reach by encouraging parents to safely store substances. This year’s campaign featured bus ads, billboards, radio spots, information cards, and a website. The campaign achieved: 35% drank alcohol 22% used marijuana SEA Partner Impact SEA partners report that being a member of the SEA Fund has been beneficial to their work and organization in a variety of ways. Organizational benefits include increased evaluation skills and prevention knowledge. SEA facilitates more collaboration with other organizations and community members to address substance use. Over 2,000 website visitors of Speak Now-trained parents plan to change their approach to discussing substance use 77% 97% of SOS participants have an adult at school they trust 85% 97% of SOS participants think regular alcohol use is risky of SOS participants think it is wrong for someone their age to use marijuana YMCA Prosocial Teen Night Out 6 The SEA Fund History of the SEA Fund On November 5, 2013, City of Boulder voters approved Ordinance 7916, which authorized the city to impose an excise tax of up to ten percent and a sales and use tax of up to ten percent on recreational marijuana sales to offset some of the indirect costs of recreational marijuana. In June 2016, the City of Boulder launched the Substance Education and Awareness (SEA) Fund, leveraging the City's recreational marijuana tax revenue to fund community agencies (partners) to provide direct programming and to disseminate media campaigns designed to prevent youth substance use. Boulder County Public Health and Boulder County Community Services worked in partnership with the Healthy Futures Coalition (HFC) to identify the original set of SEA Fund programs, all of whom were coalition members. HFC is a coalition of community agencies, businesses, and individuals focused on developing protective factors and reducing risk factors for all youth as the means for effective community-based substance abuse prevention. Boulder County Community Services Department manages the distribution of funds to partners. In addition, the Community Services Department provides technical assistance to partners to support implementation of their activities. Full descriptions of each of the SEA partners currently funded are below. Current SEA Partners Boulder County Public Health: The safe storage campaign, branded Out of Reach is a media and education campaign for adults and retailers. It is designed to reduce accidental ingestion and unintended access to all substances (marijuana, alcohol, and prescription drugs) and provide information about the effects of substance use and addiction on individuals, families, and communities. Boulder County Community Services: Boulder County Community Services provides technical support for SEA partners, assists with project coordination, reinforces consistent messaging across community partners, and offers education and training opportunities for SEA partners. Boulder County Community Services also manages the Speak Now campaign in the City of Boulder. This campaign includes targeted community outreach to parents at events such as back to school nights, the Latino Festival, and parent conferences. In addition to the media campaign, SEA funds support community training events for parents to provide them with the skills to have effective prevention conversations with their children. 7 Boulder Valley School District: Boulder Valley School District manages two programs funded through SEA: Sources of Strength (SOS) and EFFEKT. The mission of SOS is to increase help-seeking behaviors and promote connections between peers and caring adults. SOS uses peer leaders to enhance protective factors and leverages the power of peer social networks to change unhealthy norms and culture, ultimately preventing suicide, bullying, and substance use. This upstream model strengthens multiples sources of support (protective factors) for young individuals so they have strengths and readily available resources to rely on during difficult times. The EFFEKT program provides parents with practical advice on how they can positively influence their children’s attitudes and behaviors. Information is disseminated to parents of middle school students at the beginning of each semester in large group meetings and by regular communications throughout the year. EFFEKT reinforces the message that parents have a strong influence on their children’s attitudes and behaviors and en courages them to prioritize prevention of substance use for their children. Responsible Association of Retailers: The Reponsible Association of Retailers (RAR) connects retailers from the alcohol and cannabis industries with prevention and treatment professionals to promote patron safety and limit youth access to substances. In exchange for an agreement to certain operational standards and attendance at monthly meetings, RAR provides its members with staff trainings, free resources such as ID checking guides, and member discounts for self-check programs and responsible vendor training. RAR joined the SEA Fund in the spring of 2019, and thus did not collect data in Year 3 of the evaluation to include in this report. YMCA of Northern Colorado: The YMCA of Northern Colorado manages two SEA- funded programs: Adult Influencer Training and Youth Prosocial Activities. Adult Influencer trainings educate adults who work and interact with youth at the YMCA on how to become an “askable adult” or trusted person to talk with. The goal of the program is to train adults on how to effectively communicate and interact with youth to have a positive impact on their lives. The training focuses on topics including substance use, bullying, and parental disputes, and teaches adults to comfortably manage conversations with youth. Youth Prosocial activities are substance-free events (monthly Teen Nights Out and quarterly Days of Service) which create an environment for young people where caring, dedicated staff are there to listen and help them navigate the stresses, changes, and choices that come with adolescence. Building relationships with responsible adults and other young people from different backgrounds helps give youth the inner strength to avoid risky behaviors. 8 Evaluation Structure and Goals At the outset of the SEA Fund, the City of Boulder specified four goals for the program. Since 2016, the primary aim of the evaluation has been to assess the effectiveness of funded programs in addressing the four SEA goals. The goals of the SEA Fund are as follows: SEA Fund Goals Evaluation Questions that Measure Progress toward Goals Goal 1: Widespread Distribution Widespread community distribution and awareness of information and programs developed. • How many youth and adults received direct services funded by the SEA Fund? • How many youth and adults were exposed to the SEA-funded community-wide messaging? Goal 2: Increase Perceptions of Risk Shift in community perceptions of risk associated with substance use, including the impact of drugs, alcohol, and recreational marijuana, and use of prescription medications on children and youth. • What evidence is there that SEA strategies resulted in increases in adult risk perceptions of youth substance use? • What evidence is there that SEA strategies resulted in increases in youth risk perceptions of substance use? • What evidence is there that SEA strategies bolstered youth protective factors against substance use? Goal 3: Reduce Youth Substance Use Prevent/reduce youth use of alcohol and recreational drugs including marijuana. • What evidence is there that SEA strategies resulted in lower rates of youth substance use or related consequences? Goal 4: Reduce Accidental Ingestion Among Youth Reduce accidental ingestion of marijuana and other drugs. • What evidence is there that SEA strategies resulted in lower rates of accidental ingestion of marijuana and other drugs among youth aged 0-9? 9 OMNI has worked with the City of Boulder and SEA partners since 2016 to design data collection strategies that build the evidence surrounding the four SEA Fund goals (see the appendix for a copy of the evaluation logic model). The first year of the evaluation focused on creating evaluation infrastructure and establishing process measures to track progress toward SEA Goal 1. In Year 2, the evaluation added outcome measures to track progress toward SEA Goal 2. SEA partners set a target to achieve through their programming for each outcome. The evaluation tracks individual program outcome results as well as collective progress toward outcome targets for the full portfolio of partner programs. This report includes data and activities from Year 3 of the SEA evaluation (July 2018 – June 2019). Process and outcome measures in Year 3 were the same as in Year 2 of the evaluation. In addition to the process and outcome measures that address the four SEA goals, the evaluation includes internal assesments of the SEA Fund's effectiveness and impact on partner organizations. These assessments include: • A bi-annual survey of SEA partner staff; • Quarterly program reporting on progress, challenges, and supports needed; and • Documentation of technical assistance requests, conversations, and feedback provided to partner staff by OMNI and Boulder County Community Services. 10 Progress Toward SEA Goals The following sections of the report describe progress made toward achieving the four SEA Fund goals. This report includes aggregated data and selected program-level measures to summarize progress. Detailed process and outcome data for each program, including participant demographics, are available on the SEA Fund dashboard hosted by the City of Boulder. Goal 1: Widespread Distribution The first goal of the SEA Fund is widespread community distribution and awareness of information and programs developed. The SEA Fund has taken a comprehensive approach to distribution and program awareness by funding a mix of direct programming, community messaging, and long-term capacity-building activities. Direct Programming This year, SEA partners implemented five direct programs serving a mix of youth, parents, and adults who work with youth: Sources of Strength, EFFEKT, Adult Influencer Training, Youth Prosocial Activities, and Speak Now training. The number of participants who received direct programming has increased more than 40% each year of the SEA Fund, with 733 individuals served this year. 350 517 733 Year 1 Year 2 Year 3 52% Among the 733 participants in direct programming this year: 25%23% were parents were adults who work with youth were youth 11 Direct programming participants by target audience 382 Parents 186 Adults Who Work with Youth 165 Youth • 66 parents attended an EFFEKT training. • 316 parents attended a Speak Now training. • 7 school staff members served as adult leaders for Sources of Strength programming at their school. • 179 YMCA staff members completed Adult Influencer training. • 91 students were peer leaders for Sources of Strength programming. • 74 teens attended youth prosocial activities (Teen Nights Out, Days of Service). Creating a trusting community among Boulder's adolescents "The most impactful thing for me was when we split into groups and talked a lot about what we struggle with… It was really powerful to see people that I don't know very well talk about a very personal matter in their lives to almost strangers. Everyone was supportive of all the others, it was awesome." -SOS Youth Participant Equipping parents to have effective prevention conversations "Groups of parents have been seen giving feedback to each other on how they handle certain situations. I have had several individuals approach me after presentations asking advice on how to talk about EFFEKT skills with their partners who were not in attendance." -EFFEKT Program Staff Member Sources of Strength display at a City of Boulder middle school 12 Community Messaging To complement direct programming that focuses on a small group of participants, community messaging campaigns reach a larger audience. SEA funding supported two community messaging campaigns this year: Speak Now and Out of Reach. The Speak Now campaign is part of a statewide effort combining direct parent education and mixed media messaging to encourage parents to talk to their children about substance use. Out of Reach encourages parents to keep marijuana, prescriptions, and alcohol out of reach of young children to prevent accidental ingestion and overdose. Together, the Speak Now and Out of Reach campaigns had more than 5.2 million impressions across bus ads, billboards, online ads, and radio spots. • 2,448,707 Out of Reach impressions • 2,314,139 Speak Now online ad impressions • 440,796 Speak Now bus ad impressions In addition, six of the seven SEA partners distributed Speak Now informational materials to their program's audience, amplifying the reach of the campaign. Speak Now campaign image and bus ad 13 Community Capacity for Long-Term Substance Use Prevention In addition to the direct programming and community messaging for the public, the SEA Fund is also focused on sustainability by building capacity for substance use prevention work among the participating partners and their staff. A number of activities support capacity building, including connecting SEA partners to existing community resources (such as the Healthy Futures Coalition and the Speak Now prevention campaign) and enrolling SEA partner staff in Substance Abuse Prevention Skills Training. The Boulder County Community Services Department also regularly updates SEA partner staff on training resources in Colorado that will help partners meet the qualifications for becoming a Certified Prevention Specialist, such as prevention ethics course s. The table below describes the activities SEA partner staff completed this year to bolster their prevention skills and engage with other prevention initiatives in Boulder. Prevention Skills Development Engagement with Complementary Prevention Initiatives • 4 of 7 SEA partners are run by staff who have completed Substance Abuse Prevention Skills Training (SAPST). SAPST is a federally recognized curriculum designed for substance use prevention practitioners. • 1 SEA partner staff member has completed certification to become a SAPST trainer, which will allow for additional SAPST training opportunities in future years. • 3 SEA partners have staff trained to deliver the Speak Now parent program. • All SEA partner staff attended at least one Healthy Futures Coalition meeting this year, and five staff attended five or more meetings. The Healthy Futures Coalition is a group of individuals and organizations dedicated to reducing substance use in Boulder County and provides several partnership opportunities for SEA partners to build their connections and impact. 14 Goal 2: Increase Perceptions of Risk The second SEA Fund goal is to shift community perceptions of risk associated with substance use, including the impact of drugs, alcohol, and recreational marijuana, and use of prescription medications on children and youth. SEA programs and messaging are designed to increase perceptions of risk of substance use as well as build protective factors that buffer against youth substance use and enable healthy development. Data for Goal 2 are tracked across three domains: youth perceptions of risk, youth protective factors, and youth-adult interactions. Within each domain, the programs addressing that domain collect outcome data from program participants and set targets for their outcome results. Across all domains, 8 of the 13 direct programming targets were met this year. The following sections provide detailed data on each outcome and target. Youth Perceptions of Risk Sources of Strength's direct work with youth is intended to change unhealthy norms. Part of this work involves changing youth's perceptions of risk regarding substance use behavior. National research on adolescent perceived risk of substance use has shown that increases in perceived risk are associated with decreases in substance use rates.1 The data below were collected to understand SOS participants' perceptions of risk of alcohol and marijuana use. Youth participating in the Sources of Strength program were more likely to perceive high levels of risk associated with alcohol and marijuana use than their Boulder Valley School District (BVSD) peers.2 The percentage of SOS participants who think regular alcohol use is risky increased 14 percentage points between 2017-18 and 2018-19. Although the Sources of Strength program did not meet its target for perceived risk of marijuana use, there was a small increase in perceived risk (1.3 percentage points) between 2017-18 and 2018-19. 1 Trends in Adolescent Substance Use and Perception of Risk from Substance Use, SAMHSA, 2013: https://www.samhsa.gov/data/sites/default/files/NSDUH099a/NSDUH099a/sr099a-risk-perception-trends.pdf 2 Comparisons in risk factor rates are observational and conclusions about statistical significance cannot be made. Boulder Valley School District data is from the middle school 2017 Healthy Kids Colorado Survey: https://assets.bouldercounty.org/wp-content/uploads/2018/05/hkcs-results-bvsd-middle-school-2017.pdf 97% Target: 90% Think regular alcohol use is risky 85% Target: 90% Think it is wrong for someone their age to use marijuana BVSD: 79% BVSD: 76% 15 Youth Protective Factors Protective factors increase youth's likelihood of avoiding risky behaviors. They provide youth with alternatives to risky behaviors and enhance social and emotional competence.3 Sources of Strength and YMCA's Youth Prosocial activities work directly with youth to enhance protective factors. The Sources of Strength protective factors measure school connectedness, which can affect both health and learning. Students who feel connected to their school are less likely to engage in alcohol, tobacco, and other drug use.4 Sources of Strength participants met all three targets for youth protective factors for the second year in a row. S Participants in YMCA Prosocial events also met the program's target for youth resiliency for the second year in a row.5 3 Adapted from the Centers for Disease Control and Prevention's Adolescent and School Health definition of protective factors: https://www.cdc.gov/healthyyouth/protective/index.htm 4 Centers for Disease Control and Prevention, Adolescent and School Health: Fostering School Connectedness: https://www.cdc.gov/healthyyouth/protective/school_connectedness.htm 5 The YMCA Youth Prosocial Resiliency scale measures participants' outlooks and perceptions to assess individual capacity to handle and overcome adverse events. "This program has shown that teens are looking for an outlet and can still participate in innocent fun." - Partner Staff Member YMCA Prosocial Teen Night Out 77% 82% 89% Feel welcome at school Have an adult at school they trust Have an adult at school who listens to them 77% Target: 75% Target: 75% Target: 60% Report high levels of resilience Target: 70% a 22% increase from last year 16 Youth-Adult Interactions Youth connectedness and engagement with adults is an important protective factor. In 2017, BVSD high schoolers who reported they could talk to a parent were less likely to have used substances than their peers who couldn't talk to a parent.6 The EFFEKT, Speak Now, and Adult Influencer programs aim to support parents and adults in building these important connections. As a result of the Speak Now training, attendees know where to get resources on talking to their children about substance use and they plan to change their approach to discussing substance use based on information they learned. 6 Analysis of 2017 Healthy Kids Colorado Survey data by Boulder County Public Health: https://assets.bouldercounty.org/wp-content/uploads/2018/07/healthy-futures-coalition-presentation-june-13-2018.pdf Fostering supportive communities in Boulder middle schools "While it may not be obvious on the surface, there are people at our own school who always feel left out, and [I learned] how to make sure that these people feel more connected." "A lot of people feel isolated at school, and no one should have to deal with that." -SOS Youth Participants Sources of Strength messaging on display at a City of Boulder middle school. Know where to go for more resources on discussing substance use with their child Plan to change their approach to discussing substance use with their child Target: 75% Target: 75% 92% 97% 17 The majority of EFFEKT participants have established expectations with their children around substance use. However, only a quarter of participants believe they can influence their children’s substance use decisions. These data demonstrate the need for EFFEKT and the opportunities the program has in future years to increase parents' efficacy around influencing youth substance use. This was the first year that EFFEKT was implemented and thus the targets were set without context from previous program data on parents' beliefs and behavior. Boulder Valley School District is the first community in the United States to implement EFFEKT (a Swedish program) and has identified ways to adapt the program to best fit the local context. Adjustments to program content and targets will be made in future years to optimize the impact of this program. Believe underage alcohol use is wrong Perceive they have influence on underage marijuana use Perceive they have influence on underage alcohol use Establish marijuana use expectations for children at least once a year Establish alcohol use expectations for children at least once a year Target: 90% Target: 75% Target: 75% Target: 80% Target: 80% 71% 26% 26% 82% 74% EFFEKT training participants 18 Adult Influencer training participants report improvements in understanding youth substance use behavior and the influence YMCA staff have as role models and mentors. Qualitative data provide a snapshot of how the Adult Influencer program is impacting interactions between YMCA staff and the youth they serve. I think it can be incredibly difficult to talk to kids about substance use, but I also don’t think it needs to be the entire topic of conversation. In my experience, kids seek substances to fit in and feel less alone. When we build connections with these teens and we set the example of how to be a role model, we are showing them fulfillment is possible without substances. The influencer training was a good reminder about the impact we have on youth. It has helped me be a little more conscious of the way I and our staff present ourselves in front of the kids. It's not that my demeanor or attitude around the kids was inappropriate before, but it's helpful to be conscious of the little things and how kids observe them/how it can rub off on them. “ ” “ ” Building adult-youth relationships "I always have someone to turn to when I need it." -SOS Youth Participant 19 Goal 3: Reduce Youth Substance Use The third goal of the SEA Fund is to prevent/reduce youth use of alcohol and recreational drugs, including marijuana. The evaluation draws on substance use data that is monitored at the national, state, and local levels to track and compare rates of youth substance use. Although the SEA Fund evaluation design does not allow for an assessment of the direct impact of SEA partner programs on substance use outcomes, tracking substance use data across Boulder Valley School District contextualizes the SEA Fund within the broader landscape of the county. These data demonstrate both the need for prevention programs as well as potential changes in youth substance use that may be the result of SEA and other programs designed to address this issue. Healthy Kids Colorado Survey (HKCS) data and its national equivalent (the Youth Risk Behavioral Surveillance System) are compared at the national, state, and school district level here. In subsequent years of the report, data from more recent administrations of HKCS and the Youth Risk Behavioral Surveillance System will be available, and change can be monitored over time. In 2017, one in three Boulder Valley School District high schoolers reported drinking alcohol and more than 20% reported using marijuana in the past 30 days.7 In 2017, Colorado Health Statistics Region 16, which includes Boulder and Broomfield Counties, had the third-highest rate of high schooler alcohol use among all 21 Colorado regions. The rate of current high schooler marijuana use in Region 16 was fourth highest among all regions the same year. 7 Differences in substance use rates are observational and statistically significant conclusions cannot be made. BVSD data: https://assets.bouldercounty.org/wp-content/uploads/2018/04/2017-hkcs.pdf Colorado data: https://www.colorado.gov/pacific/cdphe/healthy-kids-colorado-survey-data. National data: https://nccd.cdc.gov/Youthonline/App/Default.aspx 30% 29% 35% 20% 19% 22%Boulder Valley SD Colorado Percentage Who Drank Alcohol in the Past 30 Days Percentage Who Used Marijuana in the Past 30 Days United States 20 Goal 4: Reduce Accidental Ingestion The fourth goal of the SEA Fund is to reduce accidental ingestion of marijuana and other drugs. One SEA program, the Out of Reach campaign, addressed risk of accidental ingestion for children in the county. The other SEA Fund programs are focused on addressing intentional use of substances among youth and adolescents. Accidental ingestion of medications, alcohol, and marijuana is dangerous, especially for young children. In the United States: In Colorado: 95% of medication-related emergency room visits among children under age 5 are due to a child ingesting medication while unsupervised.8 56 children ages 14 and under die each year from unintentional medication overdoses.8 More than 1,200 young children are brought to the emergency room each year because they ingested marijuana, medicines, and alcohol that were left within reach.9 Over 70% of emergency room visits for young children are due to ingesting pharmaceutical drugs (including over-the-counter drugs).9 The Out of Reach Campaign was aimed at preventing young children from accidentally ingesting substances. The Out of Reach campaign, funded by SEA and Boulder County Public Health, encouraged parents of children ages 0 to 6 years to keep marijuana, prescription drugs, and alcohol out of reach of young children to prevent accidental ingestion and overdose. This year’s campaign featured bus ads, billboards, radio spots, information cards, and a website in English and Spanish. The campaign achieved 2,448,707 impressions across Boulder County and generated 2,001 visitors to the campaign website. This was the last year of the Out of Reach campaign. Since its inception, awareness of the dangers of accidental ingestion has grown and there have been changes in legislation to prevent accidental ingestion, including a universal labeling system that identifies marijuana products and child- resistant packaging requirements for some edible marijuana products. Data on emergency room visits among children 0-6 years old in Boulder County support the decision to refocus substance prevention resources to other areas. From 2014 to 2018, there were no cases of children 0-6 visiting the emergency room in Boulder County due to cannabis poisoning except in 2016. That year, at least one but fewer than ten ER visits were recorded.10 8 Safe Kids Worldwide: https://www.safekids.org/sites/default/files/medicine-safety-study-2012.pdf 9 ED visits for accidental poisoning among Colorado residents younger than 6 years, treated and released from January 2014 – September 2015: https://www.bouldercounty.org/families/addiction/out-of-reach 10 Colorado Health Observation Regional Data Service (CHORDS), 2014-2018. In 2016, at least one visit was reported. The number of visits that year was less than ten and the exact number is suppressed due to privacy concerns. 21 SEA Fund Impact and Challenges In Years 1 and 3 of the SEA Fund, OMNI administered a survey to assess SEA partners' impressions of the effects of SEA funding. The following sections highlight the survey findings on the impact of SEA funding on staff and programs and their challenges with program implementation. SEA Partner Impact SEA partners reported two primary impacts of engaging in this initiative: organizational improvements and community connections. Organizational Improvements Within organizational improvements, SEA partner staff noted two areas of improvement. The first area of improvement reported was technical skills and evaluation capacity. Five of seven partners reported an improvement in their program evaluation skills as a result of involvement in the SEA Fund. The second area of improvement was capacity around substance use prevention programming. Six of seven parnters reported that the SEA Fund has increased their substance use prevention knowledge and that SEA engagement has informed how their program delivers substance use prevention programming. As a result, partners report high efficacy in the SEA Fund and its potential impact on the community. The majority of partners believe that their staff feel a sense of responsibility towards prevention of youth substance use and that the collective efforts of SEA can reduce youth use of alcohol and other drugs. Partner Impact Community Connections Organizational Improvements Prevention Programming Technical Skills & Evaluation Collaboration Engagement SEA partner staff report that being a member of the SEA Program has increased their substance use prevention knowledge. 22 Community Connections SEA partner staff discussed the impact of the SEA Fund on their communities, noting an increase in collaboration across SEA partners as well as the curation of greater community engagement. Increased collaboration is possible due to the connections to other organizations and community members the SEA Fund has facilitated. Partners also noted the ease of bridging these connections as a result of SEA and the benefits of cross-organization collaborations. Multiple partners noted an increase in community engagement within their programs. Most commonly noted was the increased engagement of parents in the programs as well as parents’ satisfaction with the programs. One partner wrote that "[parents] are grateful that this program is available to the teens and [they] have nothing but great things to say about it." SEA Fund Challenges While the majority of feedback from the SEA partner survey was positive, partners also reported some challenges in engaging with and implementing SEA Fund activities. These challenges reflect prior years’ feedback and predominantly relate to program funding and logistics. Funding and Sustainability The City of Boulder has provided funding for the SEA Fund on a year-to-year basis. Because of uncertainty around long-term sustainability, partners have found it difficult to maintain consistency in programming and engage in long-term strategy development. In addition, partners have not been able to respond to changing needs in their community because they are only getting funding for the originally planned programs to continue each year. As the SEA Fund continues to stabilize and mature, the City of Boulder may be able to consider adjustments to the funding model and timelines to address these challenges. SEA Fund Connections While SEA Fund connections were noted as a strength of the program, they also came up as a challenge. Partners are implementing diverse programs, which can strain connections and collaboration. One result of this is connection and engagement among the group are not always seamless. Although the quarterly SEA partner meetings provide an opportunity for collaboration, partners infrequently collaborate with each other or share information outside of the meetings. Additionally, because partners work in different sectors (education, youth recreation, public health, etc.), there is sometimes a language barrier among partner staff and the SEA Fund management team, especially around evaluation terms which are rooted in public health terminology and metrics (for example, "perceptions of risk" of substance use). "I have really benefited from the easy access to support from OMNI, Boulder County Public Health and other like- minded entities. Being constantly connected, we are able to share items, events, ideas, suggestions, etc. to better serve our community." "More groups have come together to collaborate and coordinate on improving and increasing substance [use] education programming across many disciplines." - SEA Partner Staff Members 23 What's Next for the SEA Fund? As the SEA Fund enters the fourth year of the evaluation, the City of Boulder and OMNI have planned several changes to the program and evaluation. Expansion of the Evaluation OMNI has worked to expand and revise the evaluation for Year 4 to more directly examine SEA Fund impact. Specifically, OMNI and Boulder County Community Services worked closely with each SEA partner to enhance evaluation capacity and create detailed logic models and evaluation plans for their programs that connect their programming and data to the SEA Fund goals. This included a review and adjustment of existing partner program metrics in summer 2019. In addition, OMNI established common evaluation measures that all partners will implement, allowing for standardized data across all programs in the 2019-20 program year. The common measures are aligned with the SEA Fund goals and the Healthy Kids Colorado Survey, which will serve as a benchmark for the SEA Fund data. These measures are designed to collect comprehensive data from each of the audiences engaged in SEA programming (youth, parents, and adults who work with youth) on the following topics: • Whether parents and trusted adults set clear expectations with youth about alcohol and marijuana use; • Whether parents and trusted adults have an influence on youth decisions to use alcohol and marijuana; • Adult and youth perceived risk of youth alcohol and marijuana use; and • Whether youth have trusted adults available in their lives. For each topic, there is a common measure question for each of the target audiences. These three sets of questions mirror each other with slight adjustments to the language or phrasing depending on the audience. For example, when asking about influence on youth alcohol use, parents are asked how much influence they think they have on their child's decision to use alcohol, while youth are asked how much influence the adults in their life have on their decision to use alcohol. Full versions of each question set are available in the appendix. The City of Boulder also intends to work with Boulder County Community Services, OMNI, and SEA Fund partners to incorporate an equity lens into program evaluations and technical assistance, to help all partners understand systemic inequities and help meet the needs of all Boulder community members. Continuation of the SEA Dashboard The City of Boulder maintains a public dashboard with all data from the SEA Fund. SEA partners submit data quarterly and the City updates the data in real time. The expanded evaluation metrics that were added for Year 4 will be included in the dashboard. The dashboard allows for ongoing monitoring of SEA Fund progress throughout the program year, as well as visibility of program impact. 24 Addition of New Partner Programs The Responsible Association of Retailers (RAR) joined the SEA Fund as a partner midway through the 2018-19 program year. RAR's first full year of SEA programming and evaluation is the 2019- 20 program year. In addition, the City of Boulder is funding two new SEA partners in the 2019-20 year: 1. Boulder County Public Health to implement a peer support program and peer -led media campaign to reduce youth vaping; and 2. Boulder Community Health to provide education for community members as well as medical and dental providers about opioid and poly-substance abuse. These additions to the SEA Fund expand the portfolio of substance prevention programs to include prevention of vaping and opioid misuse. 25 Appendix Common Measure Questions Questions for Parents 1. I set clear expectations for my student about not using alcohol: o Never o Less than once a year o Once a year o More than once a year 2. I set clear expectations for my student about not using marijuana: o Never o Less than once a year o Once a year o More than once a year 3. How much influence, if at all, do you think you have over your children’s decision whether or not to use alcohol? o No influence o Very little influence o Some influence o Great influence 4. How much influence, if at all, do you think you have over your children’s decision whether or not to use marijuana? o No influence o Very little influence o Some influence o Great influence 5. How much do you think youth risk harming themselves (physically or in other ways) if they have one or two drinks of alcohol nearly every day)? o No Risk o Slight Risk o Moderate Risk o Great Risk 6. How much do you think youth risk harming themselves (physically or in other ways) if they use marijuana regularly? o No Risk o Slight Risk o Moderate Risk o Great Risk Questions for Adults Working with Youth 1. I set clear expectations for the youth I work with about not using alcohol: o Never o Less than once a year o Once a year o More than once a year 2. I set clear expectations for the youth I work with about not using marijuana: o Never o Less than once a year o Once a year o More than once a year 3. How much influence, if at all, do you think you have over the decisions of the youth you work with around whether or not to use alcohol? o No influence o Very little influence o Some influence o Great influence 26 4. How much influence, if at all, do you think you have over the decisions of the youth you work with around whether or not to use marijuana? o No influence o Very little influence o Some influence o Great influence 5. How much do you think youth risk harming themselves (physically or in other ways) if they have one or two drinks of alcohol nearly every day)? o No Risk o Slight Risk o Moderate Risk o Great Risk 6. How much do you think youth risk harming themselves (physically or in other ways) if they use marijuana regularly? o No Risk o Slight Risk o Moderate Risk o Great Risk 7. I have the skills and resources necessary to establish myself as an adult that youth can trust and talk to if they have a serious problem. o Strongly disagree o Disagree o Agree o Strongly agree Questions for Youth 1. My family and/or the adults in my life have set clear rules about alcohol use: o Strongly disagree o Disagree o Agree o Strongly agree 2. My family and/or the adults in my life have set clear rules about marijuana use: o Strongly disagree o Disagree o Agree o Strongly agree 3. How much influence do your family or the adults in your life have on your decision whether or not to use alcohol? o No influence o Very little influence o Some influence o Great influence 4. How much influence do your family or the adults in your life have on your decision whether or not to use marijuana? o No influence o Very little influence o Some influence o Great influence 5. How much do you think people risk harming themselves (physically or in other ways) if they have one or two drinks of alcohol nearly every day)? o No Risk o Slight Risk o Moderate Risk o Great Risk 6. How much do you think people risk harming themselves (physically or in other ways) if they use marijuana regularly? o No Risk o Slight Risk o Moderate Risk o Great Risk 7. If you had a serious problem, do you know an adult in or out of school whom you could talk to or go to for help? o Yes o No o Not sure 27 TARGET AUDIENCE: PARENTS Safe Storage Campaign (BCPH CMU) Media campaign for adults to reduce accidental ingestion and unintended access to substances among children 0-6. EFFEKT (BVSD) Parent training on how they can positively influence their children’s attitudes and behaviors. Speak Now Campaign (BCCS) Campaign and trainings for parents on talking to youth about substance use and healthy behaviors. CONTEXT The City of Boulder launched the SEA Fund in 2016 The SEA Fund is a community-wide substance use prevention initiative for children, youth and families. Funding is used by community agencies (partners) to implement the strategies shown here. STRATEGIES Technical assistance and substance prevention training for SEA partner staff. SHORT-TERM Goal 1: Widespread community distribution and awareness of information and programs developed. INTERMEDIATE Goal 2: Shift community perceptions of risk associated with substance use, including the impact of drugs, alcohol, recreational marijuana, and abuse of prescription medications on children and youth. LONG-TERM Goal 3: Prevent/reduce youth use of alcohol and recreational drugs including marijuana. SEA FUND OVERARCHING GOALS STRATEGY-LEVEL OUTCOMES Increased knowledge of substance use prevention strategies. Expansion of substance prevention work. Goal 4: Reduce accidental ingestion of marijuana and other drugs. BCCS – Boulder County Community Services BCPH – Boulder County Public Health BVSD – Boulder Valley School District CMU – Communications and Marketing Unit YMCA - YMCA of Northern Colorado TARGET AUDIENCE: YOUTH Sources of Strength (BVSD) A peer leader program to increase help seeking behaviors and promote connections between peers and caring adults. Youth Prosocial Activities (YMCA) Substance-free Teen Nights Out and Days of Service to build youth relationships and resiliency. TARGET AUDIENCE: TRUSTED ADULTS Sources of Strength (BVSD) Adult leaders supporting students in promoting connections between peers and caring adults. Responsible Association of Retailers Association and trainings for alcohol and cannabis retailers to promote patron safety and limit youth access to substances. Influencer Training (YMCA) YMCA staff training on effective communication and interaction with youth for positive impact on their lives. Parents and trusted adults set clear expectations about alcohol and marijuana use with youth Parents and trusted adults have an influence on youth decisions to use alcohol and marijuana Adults and youth perceive risk in youth using alcohol and marijuana. Youth have trusted adults available in their lives. SEA Fund Logic Model