Frankfort/Franklin County Just Say Yes: Stopping Youth Substance Use Before It Starts

Franklin County is home to the state Capitol; Franklin County Health Department (FCHD); and 207.84 square miles of mostly rural area and farmland.  A population of approximately 51,118, the majority of residents are white, non-Hispanic females, 81.2% and 51.8% respectively.  The other ethnic and racial breakdown of the population includes: African American (10.4%); Hispanic (3.9%); Two or More Races (2.7%); Asian (2.1%); and American Indian/Alaska Native (0.4%). 

Our community is home to two school districts, Franklin County Schools (FCS) and Frankfort Independent Schools (FIS), serving students from Pre-K through 12^th grade, 54.4% of whom qualify for free/ reduced lunch. 

In 2018, our community experienced the burden of 16 overdose deaths leading to an extremely poor ranking of 17 out of 118 across Kentucky. The have been some improvements, however the burden of both fatal and non-fatal overdoses remains high. The Kentucky Injury Prevention and Research Center (KIPRIC) also reported 184 non-fatal overdoses.    In addition, the 2019 Kids Count Report showed a rate of 48.1 per 1,000 of local youth are incarcerated in the juvenile justice system.

Franklin County experienced a fatal drug overdose rate of 65.4 per 100,000 in 2021, up sharply from 38.8 in 2020.  The burden of overdoses experienced in Franklin County and the need for prevention efforts was shown by Franklin County's selection to participate in the Kentucky CAN HEAL (KCH) project that was awarded by the University of Kentucky in 2019. 16 Kentucky Counties were identified as the hardest hit by overdoses in a three-year span. However, the KCH project is aimed at secondary and tertiary prevention.

Taking these alarming rates into consideration, FCHD and partners developed the Just Say Yes (JSY) program.  The purpose is to decrease substance use among youth in Franklin County by adapting the evidence-based Icelandic Prevention Model (IPM) to our community.  In addition, JSY is characterized by data-driven methods and trauma-informed perspectives to address the high burden on Adverse Childhood Experiences (ACESs) that our residents experience. 

The program goal was implementation of the JSY program targeting high risk school aged children at FIS. The primary prevention targeted middle school children receiving $400 YES Cards.  The first pilot year, YES Cards were used at venues giving youth opportunities to participate in activities during unsupervised hours. Venues were vetted for program quality, trauma informed care trained and required to submit background checks.

Activities:

·         FCHD launched the YES Card pilot program in September 2020 as a primary overdose prevention strategy. We began by selecting and on-boarding seven activity providers who met certain established criteria. 

·         FCHD contracted with the Icelandic Center for Social Research Analysis (Planet Youth”) through their Guidance Program designed to assist communities implementing the Icelandic Prevention Model (IPM) of youth substance use prevention. Planet Youth provided training on the IPM; technical assistance in implementing the model; assistance with development, administration, and analyzing the Franklin County Youth Survey (FCYS).

·         Data from the FCYS has been shared with thousands of stakeholders through presentations and school-specific and county-wide datasheets.

Results:

·         Initially, we issued 209 YES Cards, with 169 cards redeemed.  The number of students in the pilot group doubled between the first and second year of the program. Regular youth participation in sports and arts activities outside school hours increased from 2020 to 2021. Among students not eligible for the YES Card, once/week participation in arts increased 27% and 3x/week participation in sports increased 12%. At FIS, both increases were three times larger; once/week participation in arts increased 80% and 3x/week participation in sports increased 39%. While impact on substance use will take longer to determine, this early change in an important protective factor provides important evidence of the YES Cards' impact on the out-of-school time (OST) environment.

·         In fall 2020, 71% of 7^th-10^th grade students enrolled locally in public school completed the survey during virtual learning. A year later, 74% of 7^th-10^th grade students completed the survey, and among 7^th-8^th graders the response rate was 91%. 

·         The IPM process has resulted in a shift from an ad-hoc, disjointed approach toward a more cohesive, data-driven approach to prevention.

o   The data is credible, current, and actionable.

o   The data is shared widely across collaborative sectors

Success factors:

·         Strong multi-sector community partnerships

·         2019 Summit brought in American Psychologist Dr. Harvey Milkman, whose research informed the development of the IPM and who had a successful OST program with juvenile-justice-system-involved youth in Denver

·         Mini grant funded pilot project

·         Early community buy-in strengthened the project by starting from a well-rounded & less siloed” perspective on the community's needs, wants, challenges, strengths, opportunities and resources. 

·         Partnership with Planet Youth provided training to build strong local capacity for primary prevention

·         Connecting parents, youth, and community stakeholders

·         Flexibility with YES Card implementation

·         Universal eligibility to remove stigma of YES Cards use

Public Health Impact:

·         Significant shift in OST

·         Increase protective factors

·         Anticipated reduction in substance use

Partnerships

JSY is led by a Multidisciplinary Data Group (MDG) comprised of diverse partners including but not limited to: schools, city and county government, local 501 (c)(3) organizations, faith-based organizations, parents, and providers of OST activities. 

Reduce Health Inequities

·         High school students served on the MDG; racial and gender balance was prioritized.

·         Likewise, parent representatives comprised diverse representation.

·         The JSY MDG is responsible for the implementation of the program targeting high risk school-aged children at FIS. Located in the urban core of the county, FIS serves a racially diverse student population with approximately 70% of students qualifying for free and reduced lunch. 

·         YES Cards used at OST venues during high risk unsupervised hours.

·         Participating venues were vetted and trained in trauma informed care.

·         Transportation barriers reduced through FIS and partnering faith-based organizations.

·         Parent and community education with data-based information regarding risk and protective factors was distributed.

·         Assistance provided at all touch points reducing barriers to YES Card access and utilization.

www.fchd.org/just-say-yes-ky 

The Just Say Yes (JSY) Program is a creative use of an existing tool.  It adapts the evidence-based Icelandic Prevention Model (IPM) of youth substance use prevention to a Kentucky context.  The size and demographics of Frankfort and Franklin County, and Frankfort Independent Schools (FIS) in particular, make it an ideal Kentucky community to pilot this model.  Just Say Yes is inspired by the experience of the country of Iceland, which had its own problems with addiction and found a way to turn things around in a dramatic way.

The IPM emphasizes a primary prevention approach that includes the entire population (youth, parents, teachers, community members, etc.) in the implementation area. While locally this includes all of Franklin County, the YES Card intervention was piloted primarily with one cohort of middle school students from Second Street School (now including 9th and 10^th graders at Frankfort High School who were in 7^th and 8th grade when the YES Card launched). Due to a gap between the estimated student population of Second Street middle school and actual enrollment when the YES Card launched, the MDG opted to expand the pilot group to include all middle school students who receive services from the Wanda Joyce Robinson Foundation (students impacted by parental incarceration) as well as students identified by the Family Resource and Youth Service Centers at Bondurant and Elkhorn Middle Schools. In all aspects of the project, FCHD and the MDG have worked diligently to ensure that marginalized populations are intentionally reached in a variety of ways to maximize health equity.

In addition to the original pilot group of 230 middle school students at Second Street School (within FIS), each year we have been able to expand the YES Card pilot to include incoming 6th grade students while continuing to cover the original pilot group as they matriculated into 9th and then 10th grade. In Year 1, 54% of eligible students were issued a card through a parent and/or guardian sign-up process. During year 2, 47% were requested and issued, but when sign-up was incorporated into start-of-school paperwork, requests and issuing of cards increased to 83%. By the end of Year 3 we had reached over 95% of students through meeting with them about interests and issuing them a card (100% were issued a card but some never received due to attendance issues at the end of the school year). Of cards issued in Year 3,72% were redeemed in part or in whole, compared to 69% in year 1. This is a significant improvement given that the Year 1 cardholders were low-hanging fruit” of parental opt-in during virtual learning (54% of pilot population), whereas Year 3 included virtually the entire pilot population. Overall the original pilot group population of 230 middle schoolers represents 14% of the total public-school population of this age group in Franklin County (1660 students).

When looking at the big picture of substance use, misuse and prevention, primary prevention has not been prioritized from a resource standpoint, in Franklin County as in most places. This is itself a root cause and structural driver of substance use. Other root causes include ACEs, poverty, housing insecurity and other social determinants of health, and the predatory behavior of pharmaceutical companies giving rise to the opioid epidemic, which in turn turbo-charged generational cycles of addiction and trauma. A lack of timely local data collection, analysis and dissemination also limited stakeholder understanding, engagement and knowledge about prevention needs.  Past primary prevention efforts have included DARE and other school-based programs focused on building decision-making skills of youth and educating them about the dangers of using alcohol, tobacco, and other drugs.   While ad hoc efforts at improving environmental factors have existed in Franklin County for years (parent education through schools and community-based organizations; after-school programs) these efforts were not cohesive, coordinated, data-driven, and often not evidence-based. 

Just Say Yes takes pride in addressing health inequities locally through the program.  For example, student representatives from each of the three public high schools in the county were invited to serve on the MDG, with a recommendation that at least one of the two students selected be a student of color and that gender balance be considered as well. Likewise, for parent representatives on the MDG, there was a diverse representation in terms of race, ethnicity, socioeconomic status, gender and sexuality, as well as intentional inclusion of parents raising children with special needs and grandparents raising grandchildren. This was important to ensure that all families felt a sense of inclusion and ownership of the project, and to help ensure the MDG and stakeholders understand the diverse needs of all families and in turn, plan programs to meet these needs. 

The decision to utilize Be Strong Families (BSF) Parent Cafes for family engagement exemplifies this approach in action. The 2020 Franklin County Youth Survey found that relatively weak compared to other familial protective factors was the number of students who reported that their parents knew the parents of their friends. When Just Say Yes shared this data with parent groups in spring 2021, many parents and caregivers expressed a desire to have more opportunities to connect with other parents and to discuss with other parents their roles as caregivers and how to navigate challenges relating to substance use and other mental and behavioral health issues. Parent Cafes were selected as a data-driven strategy to not only connect parents to one another but also to explicitly build protective factors in the family domain to prevent youth substance use in Franklin County. Parent Cafes are based on the five Strengthening Families protective factors: parental resilience; social connections; knowledge of parenting and child development; concrete support in times of need; and social & emotional competence of children. Parent Cafes were selected from the many available parent engagement strategies due to BSF Parent Cafes' integration of trauma-informed processes and content, diversity/equity/inclusion best practices, and a focus on community-building, all of which our JSY MDG have identified as critical to successful adaptation of the Icelandic Prevention Model to our local context given high levels of ACEs, inequity, and polarization. In December 2021, trainers from Be Strong Families, based in Illinois, trained 29 community partners and stakeholders at an in-person Parent Café Training Institute” in Franklin County.  Those trained included 8 parent-provider teams from a variety of partner organizations such as schools, homeless and recovery shelters, and faith-based organizations.  Each team committed to host four Parent Cafes in 2022 and to share our youth survey data & substance use prevention messaging at each Cafe. Because JSY worked with the partners to ensure a very diverse group of parents and caregivers participated in the training, we anticipate being able to reach a much more representative audience of parent participants.

In adapting the IPM to a Kentucky context, JSY is characterized by: the ongoing use of data to inform interventions and policies in real time; an all-hands-on-deck” approach – including high-level support from all major local institutions - that powerfully impacts local risk and protective factors through coherent, mutually-reinforcing strategies and messages across sectors and population groups; leveraging the untapped protective potential of out-of-school time; data-driven parent and community education and engagement; and a trauma-informed approach that recognizes the high burden of ACEs that Kentucky communities experience.   

This model was successful in Iceland as demonstrated by more than 100 peer reviewed articles.  However, FCHD became one of the first jurisdictions in the US to implement the model, and the very first entity outside of Iceland to implement a program to similar to Iceland's leisure card” (i.e. YES Card) to change community norms around how kids spend their OST time.  In addition, FCHD has innovated implementation of the IPM through encompassing trauma-informed practices and a health equity lens, as well as community-building approaches.  These community building approaches are designed to overcome the high levels of social and political division in our current climate in order to create a shared sense of purpose, ownership, and responsibility for our local youth.

Also, Be Strong Families Parent Cafes are based on the evidence based Strengthening Families Protective Factors.  Incorporating these cafes as well as partnering with eight other organizations to train parent and/or practitioner teams to host helped to further innovate the Just Say Yes Program.

As previously mentioned, the main goal of the program was implementation of the Just Say Yes program targeting high risk school aged children at Frankfort Independent Schools (FIS).  Located in the urban core of a rural county, the demographics of this small district mirror those of large urban systems, with a racially diverse student population and approximately 70% of students qualify for free and reduced lunch. The primary prevention intervention targeted middle school aged children in sixth, seventh and eighth grades, which is approximately 305 students. Just Say Yes provided $400 Yes Cards to all sixth through eighth grade students at FIS. For the first pilot year of the project, the Yes Cards were used as an electronic card/spend down/gift card at a small number of five to ten after school activity venues throughout the community giving youth opportunities to participate in extracurricular activities during high risk unsupervised out of school hours. All participating after school activity venues were carefully vetted for program quality, trained in trauma informed care and required to submit background checks. Simultaneously, parent and community education were provided to the community with data-based information about risk and protective factors.  

In order to implement these goals and objectives, Just Say Yes partnered with schools to implement the Franklin County Youth Survey, share survey data and prevention messaging, and promote the YES Card to students and families. This has included everything from having the YES Card Newsletter linked from each week's school newsletter, to utilizing the schools' One-call” systems to invite parents to attend a workshop to hear and discuss the school's results from the Youth Survey, to sending flyers and datasheets home with students, to having teachers talk with students about the YES Card and ways to connect to activities that interest them. Partnerships with the Wanda Joyce Robinson Foundation and the Family Resource and Youth Service Centers at Bondurant and Elkhorn Middle Schools have been important in reaching those YES Card students and families that do not attend the main pilot school.

The Just Say Yes program would not be possible without a diverse range of community partners and stakeholders, including YES Card providers and Parent Café partners.  Essential Just Say Yes partners include the following:

·         Franklin County Health Department (Fiscal and Administrative Agency)

·         City of Frankfort (including Frankfort Police Department)

·         Franklin County Fiscal Court (including Franklin County Sherriff's Office)

·         Franklin County Schools

·         Frankfort Independent Schools

·         Frankfort Area Chamber of Commerce

·         United Way

·         Franklin County Agency for Substance Abuse Policy

·         Yes Arts  - A community arts center in the heart of Frankfort fostering a safe, inclusive space where all people can create and heal

·         Wanda Joyce Robinson Foundation - an independent, non-partisan 501(c)(3) non-profit organization that fosters partnerships aimed at healing and unifying our community. We welcome a diversity of ideas and experiences in our search for equitable and inclusive solutions to address the impact of parental incarceration on children and youth.

·         Franklin County Ministerial Association

·         First Corinthian Missionary Baptist Church

·         South Frankfort Presbyterian Church

·         Franklin County Department of Community Based Services

·         Kentucky State University

·         Norton's Children's Medical Group-Frankfort

·         The State Journal

·         Youth and Parent Leaders

In addition to community stakeholders and partners, the YES Card Providers and Parent Café partners are vital to the success of this program. YES Card Providers include:

·         Yes Arts

·         Broadway Clay

·         Kentucky Dance Academy

·         Josephine Sculpture Park

·         My Old Kentucky OM Yoga Center

·         Kentucky Gem Cats

·         Frankfort Martial Arts

·         Canoe KY

·         New Day Ministries

·         Kentucky Historical Society

·         C-Squared Creations 502

·         CrossFit Infinity

·         Frankfort Tennis Association

·         Family Circle Inc.

·         Frankfort Youth Bengals

·         Capital City Dance Studio

·         Golden Mantis LLC/ TA Strength

·         Grand Theatre

·         Frankfort School of Ballet

·         Franklin County Extension Office

·         Hurst Music

·         P Athletics LLC

·         Wesley Academy of Music, LLC

·         B's Bakery

·         City of Frankfort Parks and Recreation

·         Franklin County 4-H Partners

·         Explore Kentucky

·         Frankfort Independent Schools

Parent Café partners include:

·         Franklin County Health Department

·         Franklin County Schools

·         Frankfort Independent Schools

·         Wanda Joyce Robinson Foundation

·         Second Street School Parent Teacher Student Association

·         Franklin County Women's and Family Shelter

·         Simon House - Emergency Shelter

·         First Corinthian Missionary Baptist Church

·         South Frankfort Presbyterian Church

·         Sunshine Center - Domestic violence/family abuse shelter and support

As the fiscal and administrative agent of Just Say Yes, FCHD is an integral part to both the planning and implementation processes.  FCHD convened the coalition, secured funding for YES Cards and staff, contracted with Planet Youth for guidance program including data collection and analysis of the Franklin County Youth Survey and training of coalition partners and staff on the Icelandic Prevention Model (IPM) as well as leading the collaborative implementation of the IPM in Franklin County.  In addition, FCHD identified and onboarded YES Card providers including background checks, providers agreements, orientations, and co-promotion of activities and programs.  FCHD also researched platforms for the YES Card and helped select the Yiftee platform (including training).

Ensuring equitable, meaningful, and representative collaboration with target populations has been a central consideration in our parent and youth engagement activities due to the reality that traditional structures for institutional partnerships (i.e., a multisector coalition wherein major community institutions send a representative), while essential, do not yield a body that is representative of the target populations.  By being very intentional in how parent and youth representatives are identified, invited and engaged, we have sought to provide some correction to the inequities inherent in the multisector coalition structure. Also, the data dissemination with community members is a two-way street; we are not only talking to stakeholders about what the data says, but we are also asking, listening, and recording what they think about the data and what they see as needs, opportunities and priorities, and using that in our action planning and implementation.

We have also started sharing opportunities for public input such as the comprehensive planning survey as links within the YES Card newsletter that is distributed to both parents and students. We ask them to tell community leaders what they think is needed to create a more youth- and family-friendly community.

To help get the program started, there were funding costs associated.  These include the following:

      - Each YES Card costs $412.50, including fees

      - Total budget for 300 cards $123,750

      - Planet Youth guidance program contract - $21,000/year

      - One part-time coordinator (0.5FTE salary + benefits) is needed to run the YES Card program, especially in the start-up  phase which for us has been almost 3 years

      - At least one additional part-time staff (0.5FTE salary + benefits) to coordinate coalition partnerships, oversee contract with Planet Youth, lead data collection and dissemination efforts, lead action planning and communication efforts and all other aspects of IPM implementation, including parent/youth/community engagement and education efforts. 

     - Parent Cafes:

          -$20,000 for Parent Cafe Training Institute, including training and materials fee to Be Strong Families, trainer travel expenses, food/incentives/supplies for 30 trainees

          -Parent Engagement Specialist contracted for 200 hours/year at an hourly rate (no benefits), approximately $5,500

          -Parent Cafes require at least one lead host and several table hosts (one table host for every 4 participants, max participant number is 26). We have used YES Cards as incentives for parent hosts/table hosts, while practitioners hosting cafes as part of their job are not given an incentive.

         -Parent Cafe cost has been mostly born by partner organizations except for cafes offered by JSY/FCHD staff but includes:

              -$75 for childcare (2 providers at $15/hour for 2.5 hours)

              -$2-$10/person for food/drinks depending on whether it's snacks or a meal

              -$20 for supplies/decorations

FCHD and partners use a variety of data sources to evaluate the JSY program. The primary data source is the Franklin County Youth Survey, administered annually to 7^th-10^th grade public school students in Franklin County. The Youth Survey is adapted from the Youth in Iceland survey instrument that is currently being used by hundreds of communities on five continents to monitor youth substance use and other behavioral and mental health outcomes as well as a wide range of risk and protective factors in four domains: family, school, peer group and out-of-school time. Survey results are analyzed by researchers at Planet Youth, who provide in-depth reports within eight weeks of survey administration, including a county-wide report as well as school-level reports for each of the county's three public middle schools and three public high schools. The primary purpose of the report is to inform local policy and practice in order to alter risk and protective factors in the four environmental domains for youth in Franklin County, so data findings are explicitly expected to modify practice. In addition to the above-mentioned example of developing the Parent Cafes intervention based on Youth Survey findings and qualitative data from caregivers, we have responded to the 2021 data showing the YES Card's success at increasing participation in OST activities to accelerate our expansion of the program (see below).

While the Youth Survey data reports provided by Planet Youth are enormously beneficial, their analysis does not include disaggregation by demographic sub-group. This is an important gap from a health equity standpoint, particularly given the known contextual inequities in Franklin County. In 2022, JSY utilized the raw Youth Survey data to create a dashboard that disaggregates data by socioeconomic status, race, ethnicity, gender and history of parental incarceration (identified as a priority data point as over 15% of survey respondents reported such a history in 2021). These data will be used and shared with partners as appropriate to guide decisions about programming, resource allocation, etc. The dashboard also allows us to cross-tabulate risk and protective factors with not only substance use outcomes but also other behavioral and mental health factors and outcomes to strengthen understanding and messaging about opportunities to prevent multiple types of adverse outcomes in youth.

In addition to the Youth Survey, we also rely on qualitative data from structured interviews with MDG members, parent feedback from yearly YES Card sign-up forms, Parent Cafe participant evaluation forms, and qualitative feedback from a variety of stakeholder sources, including in-depth discussions with key stakeholder groups during yearly Youth Survey data dissemination process.

Evaluation of short term and medium-term outcomes and indicators of the Just Say Yes program has focused on three key evaluation questions.

·         Develop Yes Card” system to increase youth participation in OST activities (Program objective - Outcome)

          1. To what extent do the Yes Cards increase OST program participation among middle schoolers?

                  -The 2021-2022 Franklin County Youth Survey data indicate a significant impact on OST program participation at Second Street School (pilot school).  There was 80% increase in weekly arts participation versus a 27% increase and non-pilot schools (control schools”).  In addition, there was a 39% increase in sports participation at least three times a week at the pilot school versus a 12% increase at the control schools.

                  -Additional analysis of the youth survey data conducted by Planet Youth researchers in 2022 and currently under peer review for possible publication in the journal Health Research Education found that the odds of participation in organized OST arts activities were more than twice as high in 2021 when receiving the YES Card intervention (OR: 2.43 [95%CI: 1.07-5.52]) compared to the group not receiving the YES Card and that the odds of participation in organized sports were almost twice as high in the YES Card intervention group (OR: 1.91 [95%CI: 1.08-3.38]) compared to the group not receiving the YES Card (control group”).

           -Furthermore, the Planet Youth analysis found that the YES Cards' impact on OST activity participation was amplified for students from historically marginalized subgroups. In the intervention group, girls and students who identified as neither girls or boys were almost three times more likely to participate in OST arts activities compared to the control group (girls: OR: 2.91 [95%CI: 2.24-3.78]; other: OR: 2.80 [95%CI: 1.68-4.66]) and students who perceived their family financial status as being worse-off than others were more likely to participate in these activities (OR: 1.50 [95%CI: 1.17-1.92]). As for sports, students who self-identified as Black/African American were more likely to participate in organized sports (OR: 1.44 [95%CI: 1.09-1.89]) and students who perceived their financial status as worse-off than others were more likely to participate in organized sports (OR: 1.60 [95%CI: 1.34-1.91]).

·         Collect, analyze, share, and utilize Franklin County Youth Survey data to guide prevention efforts (Program objective - Process)

               2. Does the use of the Icelandic Prevention Model (IPM) lead to increased collaboration and data used by MDG partners?

                     -Structured interviews with MDG members, conducted in early 2022 using a protocol adapted from an open source evaluation instrument developed by University of Ottawa researchers, gathered feedback about whether and how the Just Say Yes coalition had changed the way MDG members, their organizations and the community as a whole approached their work, specifically with respect to youth substance use & overdose prevention efforts. Overwhelmingly, MDG members reported that the project has dramatically increased the use of data to guide decisions about policy, practice and resource allocation, and has strengthened collaboration between sectors.

                   -Sample Interview Quotes:

                            ·  "There's usually a promise of fact-based decision-making in prevention activities, but this is real.  Being able to not just get data but to then turn it around so quickly has been the key, and then to use it.  It's a standard that will be hard for others to meet in terms of data-supported, evidence-based prevention." Charlie Kendell, JSY MDG Member and Franklin County Agency for Substance Abuse Policy Coordinator

                          · "This project is hands-on.  Not just meeting and talking but actually doing something." Amy Snow, JSY MDG Member and Board Chair, Wanda Joyce Robinson Foundation; Dropout Prevention Coordinator & Director of Student Services, Franklin County Schools

·         Expansion and continuation of YES Card to low-income middle school students county-wide (Program objective - Outcome)

                 3.To what extent is the JSY MDG able to obtain resources for continuation and expansion of the YES Card program?

                       -Program began with:

                               · 230 FIS middle schoolers

                               · 35 Wanda Joyce Robinson Foundation middle schoolers

                               · 40 Franklin County Schools (FCS) middle schoolers

                     -Current program statistics:

                              · 415 FIS students, expanded from 6^th 8^th to include 9^th and 10^th grades

                              ·128 Wanda Joyce Robinson Foundation in expanded 6^th 10^th grades

                              · 12 FCS middle school students

                  -New recurring funding of $10,000/year secured through Agency for Substance Abuse Policy

                  -Drug Free Communities Grant 5-year funding at $125,00/year for coalition activities.  Opportunity to renew for 5 additional years.

Long-term outcomes and indicators.

o   Due to the infancy of the JSY Program, all long-term outcomes are defined as anticipated at this time and include the following:

          o Decreased rates of alcohol, tobacco and other drug use among adolescents (4-6 years data assessment point) leading to decreased fatal and non-fatal overdoses in Franklin County (10 years data assessment point)

         o Integration of data-driven primary prevention into policy and practice of municipal, educational, health, first responder, business, human services, and faith sectors sustains impact over time

        o Collaboratively funded YES card available to ALL K-12 students in Franklin County.

Lessons learned in relation to:

Practice, partner collaboration, and community engagement

       -It is important to understand that this program is about supporting youth in the community and NOT about furthering any one organization's and/or sector's agenda. It is important for partners and the community to have active input into programming and also to see and understand the impact of the program, particularly the YES Cards, since they are the most expensive part of the JSY program. Using the data to guide action, seeking broad input from stakeholders, and sharing successes have helped us create a shared sense of ownership that we believe will be important to sustaining the program long-term. 

Available funding or funding mechanisms

       -Grants to start

              -The project was initially funded by a $10,000 grant from the Foundation for a Healthy Kentucky. 

              -A 4-year, $680,000 grant from KIPRC through the Overdose Data to Action (OD2A) grant program supported the YES Card pilot project, Planet Youth contract and part-time staffing. 

              -In 2022, the Just Say Yes coalition was awarded a Drug-Free Communities Grant, with FCHD as fiscal agent, totaling $625,000 over five years. 

              -The Franklin County Agency for Substance Abuse Policy has allocated $10,000 per year the last two fiscal years to support community engagement efforts, specifically Just Say Yes Parent Cafes and accompanying prevention outreach to families.

       -We are working on sustainability plan that will include:

              -Opioid Settlement and pandemic relief funding as a foundation and springboard to expand the YES Cards to cover more students

              -Shared/matched support from city, county, school district budgets (recurring annual funding)

              -Private sector support from local industry/businesses

              -Health sector actors such as insurers, hospitals and others who will see the return on investment (ROI) in saved costs down the road

              -Possible partnership with Managed Care Organizations to cover cost of YES Cards for Medicaid recipients

              -Federal, state, local grants (specifically to cover certain sub-groups depending on the focus of the grant).

Did you do a cost/benefit analysis? If so, please describe

       -We have not but this is something we are in discussions to do in the future in partnership with the University of Kentucky and/or Planet Youth.

Is there sufficient stakeholder commitment to sustain the practice?

       -We are confident that there is sufficient commitment to sustain JSY as a whole, including the contract with Planet Youth, the Youth Survey, the coalition's implementation of the IPM, and Parent Cafes. Stakeholders have seen the benefit of these programs and their relative cost is low.

       -The YES Card, on the other hand, is expensive. While stakeholder enthusiasm about the YES Card, resources marshalled to date, and the sustainability plans described above all give us reason for optimism, time will tell whether we are able to piece together the funding needed to sustain this portion of the program over time. We believe the ROI analysis will be critical to convincing stakeholders of the importance of continuing and expanding this program as a long-term investment in the health of our community.

Describe the sustainability plans

       -Again, due to the infancy of JSY and 2023 serving as the end of the program pilot, a full sustainability plan will be developed in 2023.

       -As the pilot project ends, we are exploring the possibility of lowering the per-card amount to $200 to make the costs more manageable while offering the card to more students. While we hope to eventually mimic Iceland's approach of providing a card to all K-12 students in Franklin County, our first priority is middle schoolers, with a near-term goal of being able to offer YES Cards for all middle schoolers (even if not the full $400) by the time the OD2A grant concludes in fall of 2023.