Communities That Care in Europe
Prevention that starts with the data, not the programme
Communities That Care is a system for communities to identify what puts their young people at risk, choose interventions with proven effect, and measure whether they worked. It has run in Europe since 1998; this site brings the European adaptations together.
What CTC stands for.
Communities That Care stands for a scientifically grounded, community-owned way of helping every child and young person grow up safe and healthy.
A systematic approach
CTC relies on structured methods that enable communities to act for themselves. The five-phase CTC process joins research evidence to local expertise. A clear structure and a systematic sequence help communities develop and deliver prevention strategies that last.
A European network
CTC has run in Europe since 1998: first in the United Kingdom and the Netherlands, then in Croatia, Cyprus, Germany and Sweden, since 2025 in Estonia and Ireland, and as youth-survey pilots in Austria, Greece and Portugal. Not all of these processes are still running. This site records what is publicly documented for each country, with sources and review dates, and 11 countries are already on the map.
What really works
Effectiveness and evidence are at the centre of our work. With the Social Development Model, the validated CTC youth survey and the European evidence registers we rely on instruments that have been tested. Our aim is to help communities put their limited resources into measures that demonstrably work.
Prevention with a system.
Communities That Care is a method that communities use to plan and steer their prevention work. It shows where the needs and the strengths are, and it installs effective programmes made to measure.
- A local analysis built on data, not on gut feeling
- Programmes with proven effect, chosen from European and national evidence registers
- A cross-sector coalition of administration, social work, schools, police, health and civil society
- Repeatable measurement of results through the CTC youth survey
5 phases · one process
The five phases
From readiness to evaluation. Each phase has milestones; none is skipped.
Decide, on an honest look at the community, whether CTC is the right instrument, and secure the people and resources to begin.
- Is the community ready to take this on?
- Are the conditions in place for CTC to work in this community?
- Do key local decision-makers support a shared prevention strategy?
- Which existing structures can carry the implementation?
Build a board that can carry the assessment, the priorities, the plan and its implementation, and give it a vision the community shares.
- Who leads, and who does the work?
- Are the people who decide on funding and priorities on board?
- Who keeps the CTC process running locally, week to week?
- Are the practitioners who will deliver the work at the table?
Replace assumptions with data: which risk factors are elevated, which protective factors are weak, where in the community, and what already addresses them.
- What does the data say?
- Which risk factors are elevated, and which protective factors are weak?
- How do the results compare with regional or national benchmarks?
- Which two to five factors will the community prioritise?
Turn the priorities into a written, funded and approved plan of tested programmes, policies and practices, with measurable goals.
- Which interventions match the priorities?
- Which existing programmes and services should be strengthened?
- Which tested programmes from an evidence register fill the gaps?
- What measurable targets does the community set for itself?
- Where does the funding come from, and for how long?
Deliver the programmes as designed, measure what changes, and keep the board and the funding alive long enough for the effects to appear.
- Did it work, and what changes next?
- How are programmes delivered with fidelity and reach?
- How are they anchored in institutions so they outlast the project?
- How are interim results measured, and how does the plan adapt?
What the studies found
The effect of Communities That Care has been tested more thoroughly than that of almost any other community prevention system. The headline numbers come from the Community Youth Development Study (CYDS) in the United States, the strongest randomised long-term trial of community prevention to date. Australia and Germany add what happens when the model travels.
Main result- +49 %
- higher likelihood of sustained abstinence from gateway drugs to age 21Source: Oesterle et al. 2018
02- −11 %
- lower lifetime incidence of violence to age 21Source: Oesterle et al. 2018
03- +18 %
- higher likelihood of sustained abstinence from antisocial behaviourSource: Oesterle et al. 2018
04- +20 %
- more likely to hold a university degree by age 23Source: Kuklinski et al. 2021
05- AUD 2.60
- returned for every AUD 1 invested in the Australian alcohol-prevention studySource: Abimanyi-Ochom et al. 2024
What the evidence says, including where it is thin
The strongest evidence comes from a randomised trial across 24 towns in seven US states. Australian and European work adds to it. A 2025 UK review found the pooled effect on violence statistically uncertain and could draw on no UK study; CTC last ran in the UK in 2009. We present all of it.
- Study design
Community Youth Development Study (CYDS)
24 small towns in seven US states (Colorado, Illinois, Kansas, Maine, Oregon, Utah, Washington), matched in 12 pairs and randomised in 2003 to CTC or control. A cohort of 4,407 fifth-graders was followed from grade 5 into young adulthood (age 23), with 76.4 % taking part at baseline and 92.5 % of the sample retained at the last adolescent wave. The five waves of findings below rest on this data.
- Design
- cluster-randomised controlled trial, 12 pairs
- Sample
- n = 4,407
- Participation
- 76.4 % at baseline
- Retention
- 92.5 % through adolescence
- Observation
- grade 5 to age 23
- Grade 8 · economics
After five years every dollar invested had already paid back.
By grade 8, barely three years after implementation began, the first CTC benefit-cost analysis showed a net benefit of about USD 5,250 per child. The effect came above all from significantly less first tobacco use and less delinquency. Even under conservative assumptions each dollar spent saved USD 5.30 in later social costs; under more plausible assumptions USD 10.23.
- Source
- Kuklinski, Briney, Hawkins & Catalano 2012, Prevention Science
- Net benefit
- USD 5,250 per child
- Ratio (conservative)
- 1 : 5.30
- Ratio (plausible)
- 1 : 10.23
- Drivers
- less tobacco, less delinquency
- Grades 8 to 10 · mental health
Mental health follows the same risk and protective factors.
Depressive symptoms share most of their risk and protective factors with substance use, delinquency and antisocial behaviour. A longitudinal analysis of the CYDS cohort (n = 2,002, grades 8 and 10) showed that young people growing up in a strained family, school or community environment are more often depressed and, at the same time, more often violent or dependent. The authors speak of co-effects: a prevention system such as CTC that reduces these shared factors can plausibly improve mental health without targeting it as a primary outcome. The CTC youth survey observes this mechanism through the validated CTC brief depression scale, which makes CTC one of the few community prevention systems that measure internalising problems at all. It is not an established effect, though: the direct test for clinical depression and anxiety at age 23 found no difference between the study arms (Kuklinski et al. 2021). That is why this chapter speaks of shared factors and observation, not of proven impact.
- Source
- Monahan, Oesterle, Rhew, Hawkins 2014, J. Community Psychology
- Sample
- n = 2,002 (CYDS subsample)
- Finding
- shared risk and protective factors
- Confirmed
- cross-sectionally and longitudinally
- Instrument
- CTC brief depression scale (Rhew et al. 2016)
- Scale quality
- sensitivity/specificity > 0.8 · AUC 0.91 (N = 3,939)
- Grade 12 · behaviour
Fewer drugs, less delinquency, less violence up to the end of school.
By the spring of grade 12, young people from CTC communities were significantly more likely than those in control communities to have stayed completely abstinent from any drug use, alcohol, tobacco and delinquency. They were also less likely ever to have been violent. Notably, the effects held three years after the study funding had ended.
- Source
- Hawkins, Oesterle, Brown et al. 2014, JAMA Pediatrics
- RR drug abstinence
- 1.32 (CI 1.06–1.63)
- RR alcohol abstinence
- 1.31 (CI 1.09–1.58)
- RR tobacco abstinence
- 1.13 (CI 1.01–1.27)
- RR delinquency abstinence
- 1.18 (CI 1.03–1.36)
- RR ever violent
- 0.86 (CI 0.76–0.98)
- Age 21 · lifetime effects
The effects last into young adulthood.
At age 21, about eleven years after the intervention began, the CYDS follow-up confirmed that the lifetime incidence of substance use, antisocial behaviour and violence remains significantly lower in CTC communities. CTC does not only prevent first use in adolescence; it shifts the risk profile of whole birth cohorts, even after the young people have long left the study towns. The findings concern sustained abstinence and lifetime measures; on past-year prevalence the study found no effect.
- Source
- Oesterle, Kuklinski, Hawkins et al. 2018, AJPH
- Outcome
- lifetime incidence
- Follow-up age
- 21
- Domains
- substance use · antisocial behaviour · violence
- Meaning
- the effect survives growing up
- Age 23 · long-term economics
Twelve years after baseline CTC still pays.
At age 23, twelve years after baseline, the benefit-cost ratio rose to about 1 : 12.88. That makes CTC one of the few prevention strategies with a documented long-term return across several stages of life, from school age through graduation into young adulthood. The positive effects on substance use and delinquency persist.
- Source
- Kuklinski, Oesterle, Briney, Hawkins 2021, Prevention Science
- Ratio
- 1 : 12.88
- Follow-up age
- 23
- Observation
- 12 years since baseline
- Across the waves
- 1 : 5.30 (grade 8) → 1 : 8.22 (grade 12) → 1 : 12.88 (age 23)
- Australia · benefit-cost analysis
Australia shows that CTC pays outside the United States as well.
A benefit-cost analysis of the first four Australian CTC communities (2001–2015) asked, from a limited societal perspective, whether the reduction in alcohol use among 10- to 14-year-olds outweighs the cost of running CTC. The answer: AUD 2.60 returned for every AUD invested, at an average cost of AUD 48 per young person over 15 years against AUD 123 in avoided later costs. The Australian approach is far more conservative than the US analyses: it counts a single outcome (alcohol use) and only the intervention period, with no lifetime modelling. Above all, the running cost per head was radically lower, AUD 3 per young person and year against AUD 199 in the US trial. CTC infrastructure can evidently be run much more cheaply inside other health and welfare systems, which matters for every European adaptation.
- Source
- Abimanyi-Ochom, Wanni Arachchige Dona, Bohingamu Mudiyanselage, Toumbourou, Rowland et al. 2024, PLOS ONE
- Context
- 4 CTC communities, 2001–2015, ages 10–14
- Benefit-cost ratio
- 1 : 2.6
- Avoided costs
- AUD 123 per young person / 15 years
- Running cost AU
- AUD 3 per head / year
- Compared with US CYDS
- AUD 199 per head / year
- Main driver
- 93 % of the benefit from less crime and violence
- Germany · CTC-EFF
The German replication: CTC-EFF at Hannover Medical School.
CTC has been implemented in German communities since 2009. The CTC-EFF study at Hannover Medical School, funded by the Federal Ministry of Education and Research, carried the CYDS question into a non-randomised design: 22 matched pairs of communities from four federal states, surveyed through 318 local key persons at two points in time (2021/22 and 2023/24). It is the first controlled effectiveness study of CTC in Germany, under two conditions the US trial did not have: the whole survey period fell into the pandemic years, and the communities received no money from the study, whereas every CYDS community had a paid coordinator. Implementation accordingly made little progress, and at the system level none of the three outcomes changed significantly. At the programme level the number of evidence-based programmes delivered in CTC communities more than doubled (3.57 to 8.57 per 10,000 inhabitants) while the rise in comparison communities stayed below significance, although a difference between the two groups could not be secured in the end (Decker et al. 2025). The authors stress that this is no evidence that CTC is ineffective or untransferable, and recommend a third survey wave.
- Source
- Röding, von Holt, Decker & Walter 2026 and Decker et al. 2025, Prevention Science; design: Röding et al. 2022, Prävention und Gesundheitsförderung
- Funding
- BMBF, 2021–2023
- Design
- non-randomised community comparison, 22 matched pairs
- Sample (communities)
- 18 intervention + 11 comparison communities in the analysis
- Sample (key persons)
- n = 318
- Uptake of science-based prevention
- no significant change (b = 0.272; SE = 2.306; p = 0.906)
- Programmes per 10,000 inhabitants
- 3.57 → 8.57 (p = 0.004)
- Trial registration
- DRKS00022819
Europe
Where CTC runs, and has run, in Europe
What is publicly documented about Communities That Care in each country: current processes, past projects and survey adaptations, and the organisations behind them. This site compiles public information and does not speak for the organisations or initiatives named. Every entry is sourced and dated; organisations are named when they have agreed to it or when their role is documented in public sources.
Legend
- Established
- CTC processes have run here for years, with a partner organisation that trains and supports communities.
- Piloting
- First communities are going through the five phases; results are not in yet.
- Adapting
- The method and the survey are being adapted to the country; no community process yet.
- Survey adapted
- The CTC youth survey has been translated and tested here, mostly through EU projects; no community process is known.
- Past projects
- CTC ran here in the past, as a programme or an EU project; no current activity is known.
- CTC municipalities (61)
- Communities running a CTC process: in Germany as on the German site, elsewhere as listed in the directory; dots without names.
- Schools in Germany (143)
- Schools That Care and Weitblick: the process adapted to a single school; dots without names.
Last reviewed 16 September 2026
Three EU-funded projects since 2008, one running now, and a network meeting of the European CTC groups at the EUSPR conference each year.Backed by Europe
Frequently asked questions
For communities considering CTC, and for parents and schools asked to take part in a survey.
What exactly is Communities That Care, and what does it aim to achieve?
Communities That Care is a system that helps a community plan prevention on the basis of its own data. It brings together the people who shape young people’s lives locally, from schools and youth services to police, health and local government. It takes them through five phases: assessing readiness, getting organised, building a profile of local risk and protective factors from a youth survey, choosing programmes with proven effect that match the priorities, and implementing them with an eye on results.
Its aim is to reduce problem behaviour among young people, above all substance use, violence and offending, and to promote healthy development. It does this by changing the conditions young people grow up in rather than by treating problems after they appear.
Is there scientific evidence that CTC works?
Yes, with honest caveats. The central evidence is the Community Youth Development Study, a randomised controlled trial in 24 US towns that followed more than 4,400 young people from age ten into adulthood. Young people in CTC towns started using alcohol and tobacco later, showed less delinquency and violence, and the differences persisted to age 21. Over twelve years the trial returned nearly thirteen dollars in avoided harm for every dollar invested.
A quasi-experimental comparison in Australia found a positive but smaller effect. European evidence so far shows CTC communities adopting more evidence-based programmes, has not yet shown the wider system change the US trial found, and is thinner still on behavioural outcomes. A 2025 review by the UK Youth Endowment Fund rated the effect on violence as statistically uncertain and advised against commissioning new CTC sites in the UK until the approach has been tested there again. None of the studies it pooled came from the UK, where Communities that Care UK ceased operations in 2009. The evidence page sets all of this out.
How does CTC connect the risks and the strengths of young people?
Through the concept of risk and protective factors. Research over several decades has identified conditions in family, school, peer group and neighbourhood that make problem behaviour more likely, and others that make it less likely. Many of them work across several outcomes at once: a weak bond to school raises the risk of both drug use and offending, and a strong family bond guards against both.
CTC measures these factors locally through the youth survey and asks the community to work on the two to five that matter most in its own data. Strengthening protection counts as much as reducing risk. The approach page explains the Social Development Model behind this.
How does a CTC process run in a community, and how much work is it?
In five phases, usually over twelve to eighteen months before the first programmes start. Phase one clarifies whether the community is ready: is there political backing, and is someone prepared to lead? Phase two builds the coalition and the working structure. Phase three runs the youth survey and turns the results into a community profile. Phase four selects programmes that match the prioritised factors and secures their funding. Phase five implements them and measures what changed.
The workload falls mainly on a local coordinator, typically a half to a full post, and on the coalition members, who meet regularly through phases two to four. Training for both is part of the process and is provided by the organisation that supports CTC in the country, a prevention council, a research institute or a non-profit, where one exists.
Who sits on a CTC steering group, and what does it decide?
Two bodies, in most implementations. A small group of key leaders, the heads of the organisations whose money and staff the process depends on: the mayor or council leader, the directors of youth, education, health and social services, the senior police officer. They give the mandate and keep the doors open. And a community board of practitioners, the people who run schools, youth centres, family services and clubs, together with residents and, ideally, young people themselves. The board does the work: it reads the profile, sets the priorities and chooses the programmes.
The distinction matters. When the leaders try to do the board’s job, or the board lacks a mandate from the leaders, the process stalls.
Should we introduce CTC across the whole city, or start with a pilot area?
Start where the coalition can actually work. In a town of thirty thousand that may be the whole town. In a city it is usually one or two districts with their own schools and services, where the people around the table know each other. A pilot area gives the coalition a real profile to act on and lets the city learn the process before scaling it.
What matters is that the survey area and the action area coincide. Surveying a whole city and then acting in one district produces a profile the district does not recognise.
From a research model to a European practice.
Read how CTC came out of the University of Washington, what the Social Development Model says, and how communities from Malmö to Newbridge have adapted the approach since the late 1990s.