Substance use can be a rite of passage for youth in rural areas. In addition, the experience of childhood trauma and intergenerational poverty in these areas can lead to an increase in risky behaviors as young adults. In response to this, the Communities That Care Coalition of Franklin County and the North Quabbin region was founded in 2002 and brings together youth, parents, schools, community agencies, and local governments to promote the health and well-being of young people in the region.

The members of the coalition developed a community action plan and acquired funding from over twenty sources to support its response. To achieve collaboration equity, the coalition spread decision-making across collaborators by creating a Coordinating Council, which comprises representatives from all sectors of the community, as well as three work groups that make decisions and implement coalition strategies. The community action plan and strategies implemented are all informed by data from annual surveys as well as input from coalition members. 

The Communities that Care (CTC) model is a coalition-based youth prevention model that mobilizes community leaders and stakeholders to adopt an evidence-based approach to prevention that involves local collection of data to inform the selection and implementation of programs to reduce initiation and prevalence of youth problem behaviors. It has been implemented nationwide during middle school years and has been rigorously evaluated. CTC has been shown to be cost-effective, significantly reduce  substance use in high school, and reduce risky behaviors long-term into young adulthood. 

Although CTC models implemented in communities differ on their measured impacts, the model in Franklin County has been recognized nationally for its significant reduction in youth substance use over the last 15 years, as alcohol, marijuana, and cigarette use as well as and prescription drug misuse have all seen a decreasing trend. More information and results of the program can be found in the discussion paper here, the case study here, and the journal article here. Contact information for the program can be found here.