What the evidence says about Communities That Care: a review

At a glance

1. CTC is one of the best-evaluated community prevention systems anywhere. Its central evidence comes from a community-randomised trial, the Community Youth Development Study, which followed 4,407 pupils in 24 small towns from fifth grade into adulthood and kept 92.5 % of them in the study through the end of secondary school (Hawkins et al., 2009, 2014).
2. The effect is real, and it is specific. CTC durably delays or prevents the first use of substances and the first steps into delinquency. It does not consistently lower how much young people in late adolescence are currently using, and its effects on protective factors are confined to some domains of life (Hawkins et al., 2014; Kim et al., 2014).
3. The mechanism has been tested, not assumed. The behavioural effects run entirely through the adoption of a science-based approach to prevention by the community, and that change outlasted the study’s funding (Brown et al., 2013; Rhew et al., 2013).
4. Replication outside the United States is mixed. Australia found steeper declines in adolescent substance use and a positive economic return; the Dutch outcome study could not reproduce the behavioural effects; the German study has so far reported system-level results that depend heavily on how well a community implemented (Toumbourou et al., 2019; Jonkman et al., 2015; Röding et al., 2026).
5. The most recent independent review is cautious. In 2025 the Youth Endowment Fund pooled 41 effect sizes from 13 publications and found a pooled relative risk of 0.93 across violence and offending outcomes, with a confidence interval that crosses one, and rated the approach low impact and very low confidence. None of the studies it pooled came from the United Kingdom. We think the right answer to that verdict is more European evidence, not less.

Why prevention systems are hard to evaluate, and why CTC was evaluated anyway

Communities That Care is not a programme. It is a way for a community to decide what to do: collect data on the risk factors and protective factors that shape young people’s lives, prioritise the ones that are most elevated locally, choose tested programmes that address them, implement those programmes well, and measure again. A single parenting course can be evaluated by comparing families who took it with families who did not. A system of deciding can only be evaluated by comparing communities, over years, with all the noise that communities generate.

In European debates about community prevention strategies it is sometimes argued that interventions of this kind, multi-year, multi-sector and adapted to each locality, cannot be evaluated with controlled designs at all. The argument deserves a straight answer. First, exactly such an intervention has been evaluated with a community-randomised design, a longitudinal cohort and replicated mediation analyses: that is what the Community Youth Development Study is (Hawkins et al., 2009, 2014). Second, evaluation methodology has spent two decades building a toolkit for complex public-health interventions, from the Medical Research Council’s framework for complex interventions to realist evaluation and process evaluations that take a systems perspective (McGill et al., 2020). Complexity is not a methodological fate. It is a requirement on study design and on funding. Where the claim that something cannot be evaluated hardens into a principle, it protects the intervention from scrutiny rather than advancing knowledge about it.

The theory that was put to the test

CTC rests on two models that belong together. The Social Development Model, formulated by Richard F. Catalano and J. David Hawkins (1996), integrates control theory, social learning theory and differential association into a developmental account of behaviour. Its core claim is simple: young people bond to the people and institutions that give them opportunities for meaningful involvement, the skills to take those opportunities, and recognition for doing so. Bonding leads to the adoption of that group’s norms. The same mechanism produces prosocial bonding in a supportive setting and antisocial bonding in a troubled one.

The Social Development Strategy is the model’s practical form: create opportunities for prosocial involvement in every domain of a young person’s life, teach the skills needed to use them, give timely and fair recognition, and hold all of it together with clear, health-promoting expectations and reliable relationships (Hawkins et al., 2002; Fagan et al., 2019). It is the bridge between an abstract model and the concrete work of a local coalition.

The system built on that theory runs in five phases: getting started, organising a coalition, developing a community profile from the CTC youth survey, building an action plan around a small number of prioritised factors and tested programmes, and implementing and evaluating that plan on a two-to-five-year cycle. The system is described in detail elsewhere on this site; what matters here is that data collection, programme selection and evaluation are locked together in a single loop. That loop is what the trial tested.

The Community Youth Development Study: design

The trial began in 2003 in 24 small towns in seven US states: Colorado, Illinois, Kansas, Maine, Oregon, Utah and Washington. Within each state the towns were matched in pairs on size, poverty, ethnic composition and crime, and one town in each pair was assigned to CTC by coin toss (Hawkins et al., 2009, 2012). The twelve intervention communities received training, technical assistance, a funded coordinator and money for programmes for the five years of the intervention period. A longitudinal cohort of 4,407 fifth-graders was surveyed every year from 2004 to 2011, and 92.5 % of them were still in the study in twelfth grade (Hawkins et al., 2014). The towns were small, none larger than about 50,000 residents, and rural or suburban in character. That fact will matter later.

What the trial found, in sequence

Early years, to eighth grade. Effects on the targeted risk factors and on the initiation of delinquent behaviour were already visible between fifth and seventh grade (Hawkins et al., 2008). By eighth grade, the incidence of first use of alcohol, cigarettes and smokeless tobacco, and of first delinquent acts, was significantly lower in CTC communities than in control communities. Thirty-day prevalence of some substances and past-year delinquency were lower too (Hawkins et al., 2009).

Tenth grade, one year after the intervention period ended. Targeted risk factors rose more slowly in CTC communities and remained significantly lower. Current cigarette smoking and past-year delinquency and violence were reduced (Hawkins et al., 2012).

Twelfth grade, three years after. Here the picture shifted. Pupils in CTC communities were significantly more likely never to have used any drug (relative risk 1.32, 95 % confidence interval 1.06–1.63), never to have drunk alcohol (1.31, 1.09–1.58), never to have smoked (1.13, 1.01–1.27) and never to have committed a delinquent act (1.18, 1.03–1.36), and they were less likely ever to have been violent (0.86, 0.76–0.98). On past-year and past-month prevalence of current use or behaviour, however, there were no longer meaningful differences (Hawkins et al., 2014). CTC durably shifts initiation. It does not necessarily equalise levels in late adolescence.

Into adulthood. At age 21, young adults from CTC towns were 49 % more likely to have remained abstinent from so-called gateway drugs, 18 % more likely to have avoided antisocial behaviour altogether, and had an 11 % lower lifetime incidence of violence; sustained tobacco abstinence was higher among young men (Oesterle et al., 2018). At age 23, twelve years after baseline, they were 20 % more likely to hold a university degree, and the benefit-cost analysis put the return at 12.88 dollars for every dollar invested, using conservative assumptions and primary outcomes only (Kuklinski et al., 2021). An earlier analysis had already found benefits exceeding costs by the end of secondary school (Kuklinski et al., 2015). A 2023 analysis of the same cohort documented lower handgun carrying in adolescence in the CTC communities (Rowhani-Rahbar et al., 2023).

Beyond behaviour: mechanism, system change, sustainability

• Mechanism. The community-level effects on youth outcomes were fully mediated by the adoption of a science-based approach to prevention, which is an empirical test of the model’s logic rather than a restatement of it (Brown et al., 2013).
• System transformation. Four and a half years after implementation began, key leaders in CTC communities reported significantly higher adoption of a science-based approach than their counterparts in control communities (Brown et al., 2011). Six years in, community norms against adolescent substance use were durably stronger (Rhew et al., 2013).
• Durability of the structures. Twenty months after study funding ended, eleven of the twelve CTC coalitions still existed and met far more of the system’s process requirements than the comparison bodies (Gloppen et al., 2012). A year and a half after funding ended, adoption of science-based prevention remained significantly higher in CTC communities (Rhew et al., 2013).
• Protective factors. Effects on protective factors were measurable in eighth grade in the community, school and peer-and-individual domains, but not in the family domain (Kim et al., 2014). By tenth grade, a year after the intervention period, effects across all domains were no longer consistently visible, although differential effects by gender and baseline risk remained (Kim et al., 2015).
• Gender. At age 19, the lifetime effects were clearer for young men than for young women (Oesterle et al., 2015).

Reading the trial honestly

The Community Youth Development Study meets the highest standards prevention science has: a community-randomised design, a long observation period, very high retention, validated scales and replicated mediation analyses. Its effect is nonetheless specific: strong on delaying or preventing the first use of substances and the first delinquent acts, less clear on current prevalence in late adolescence, and confined to particular domains where protective factors are concerned.

It is also context-bound. The trial ran in small US towns with rural and suburban structures. Nothing in it licenses a direct inference about large cities. The first evidence from a large urban, high-burden setting arrived only in 2024, from a non-randomised evaluation of CTC in Chicago’s Greater Bronzeville community, which found reductions in aggravated assaults and robberies relative to similar Chicago neighbourhoods (Gorman-Smith et al., 2024). That is encouraging, and it is one study with a weaker design than the trial.

One misreading should be named. Because most of the measured effects came from tested programmes delivered to ten- to fourteen-year-olds, CTC is sometimes reduced to a school-programme logic. That is too narrow. CTC understands itself as a community coordination and decision system (Hawkins et al., 2002; Fagan et al., 2019). Eisenberg and Raghavan (2024) put it in a gardener’s terms: individual programmes are the seed, CTC is the soil without which the seed does not take. The youth survey gives youth services, schools, public health, police, voluntary organisations and local politics one shared picture of the situation and one shared language to act on it across sector boundaries.

Replication outside the United States

Australia. CTC has been implemented in Victoria since 2001. A longitudinal analysis compared four communities that completed the CTC process with 104 other localities, drawing on 41,328 adolescent surveys collected between 1999 and 2015, and found significantly steeper annual reductions in lifetime alcohol, tobacco and cannabis use and in past-year antisocial behaviour in the CTC localities (Toumbourou et al., 2019). Later analyses documented effects on municipal youth crime rates between 2010 and 2019 (Rowland et al., 2022) and on hospital-admitted injuries among children and adolescents (Berecki-Gisolf et al., 2020). The benefit-cost analysis of this non-randomised coalition study put the return at 2.60 Australian dollars per dollar invested, with 93 % of the benefits coming from avoided crime and violence; the intervention cost about three dollars per young person per year and returned about eight (Abimanyi-Ochom et al., 2024). The Australian findings are trend-level, from a design weaker than the US trial, and they point the same way. They are examined in more detail in a separate article.

The Netherlands. CTC was introduced in the late 1990s by Josine Junger-Tas and evaluated quasi-experimentally in five neighbourhoods (Steketee et al., 2013). The outcome study covering 2008 to 2011 could not reproduce the effects on adolescent problem behaviour measured in the United States. Its authors attribute this mainly to the limits of the design (Jonkman et al., 2015), while the much shorter list of tested programmes then available in the country is described as a further constraint on implementation (Steketee et al., 2013). At the level of risk and protective factors, by contrast, the same factors predicted adolescent problem behaviour in both countries (Oesterle et al., 2012). The diagnostic logic of CTC travels. The effectiveness of any particular programme selection has to be demonstrated in each country.

Germany. CTC-EFF, a non-randomised community trial led by the Hannover Medical School, compared CTC communities with matched comparison communities (Röding et al., 2021). Its observation window fell entirely into the pandemic years, and unlike the US trial it did not fund a coordinator in the participating communities. Under those conditions implementation made little progress and an average effect on the local prevention system could not yet be shown (Röding et al., 2026). A meta-analysis across twelve matched pairs of communities found a positive overall effect on the adoption of evidence-based prevention (g = 0.57) together with wide variation between sites, of which implementation quality alone explained 40.5 % (von Holt et al., 2025; so far a conference abstract). Behavioural outcomes have not yet been reported. What the German study has shown so far is how much depends on implementation, which is the subject of a separate article.

The United Kingdom. Communities that Care UK worked with more than sixty sites between 1998 and 2008; around thirty of them ran the CTC process, the rest commissioned the youth survey only. Operations ceased in 2009. The evaluation of three demonstration sites found that two of them did not implement the model as intended; the third, which did, showed promising results (Crow et al., 2004). The programme ended when its funding did. The UK has produced no CTC outcome study since.

The 2025 Youth Endowment Fund review

In November 2025 the Youth Endowment Fund, which advises on violence prevention in England and Wales, published a review of CTC in its Toolkit (Youth Endowment Fund, 2025). Its meta-analysis of 41 effect sizes from 13 publications found a pooled relative risk of 0.93 across violence and offending outcomes, with a 95 % confidence interval of 0.84 to 1.02, which is not statistically significant, and substantial heterogeneity between studies. The Fund rated the approach as low impact, very low confidence and high cost, and advised commissioners not to fund or scale new CTC programmes until further research shows that the approach can be delivered effectively in the UK context.

Two things are worth knowing about that verdict. First, none of the studies the review pooled came from the United Kingdom; the concern is about deliverability in a setting where CTC has not run since 2009 and was last evaluated in the mid-2000s, not about the model. Second, the violence-only estimate of roughly 10 % less violence (relative risk 0.87, 95 % CI 0.75–1.01) points the same way as every study on this page; what the review could not establish, on the studies available, was that the effect is reliably different from zero. That is a fair challenge. The evidence page and a separate article take it up in detail.

Limitations and open questions

With all due respect for the evidence that exists, its limits should be stated plainly:

• The trial is methodologically strong but bound to its context, small US towns and outcomes centred on substance use and delinquency, and it shows no consistent effects on current prevalence in late adolescence or on family protective factors (Hawkins et al., 2014; Kim et al., 2014).
• International replication is mixed: positive trend findings from Australia stand beside a null result in the Dutch outcome study, which underlines how much depends on suitable, locally available programmes (Toumbourou et al., 2019; Jonkman et al., 2015).
• The durability of CTC’s effects depends on continued training and funding (Rhew et al., 2013; Gloppen et al., 2012).
• The most recent independent review rates the effect on violence as uncertain, and the reason is a shortage of studies in the setting it cares about.

Research is needed above all on the effectiveness of CTC in large cities and in socially and linguistically diverse neighbourhoods, where the Chicago study is a first data point rather than an answer; on behavioural outcomes in European implementations, which Germany is generating and Sweden, Estonia and Ireland are preparing, while Croatia builds the survey infrastructure for it; and on the economic evaluation of prevention systems as opposed to single programmes. Complex community interventions can be evaluated when the investment in staged designs, from context analysis through implementation research and mediation analysis to outcome measurement, is actually made (McGill et al., 2020). The Community Youth Development Study shows what that investment buys.

Conclusion

Communities That Care has done something most community prevention strategies have not: it has tested its own assumptions in a randomised trial and followed the participants into adulthood. The result is a durable shift in when young people start using substances and breaking rules, a measurable change in how their communities make decisions, and an economic return that has held up under conservative assumptions. The result is also narrower than its reputation sometimes suggests, and it has not yet been reproduced in a European outcome study. A community considering CTC should take both halves of that sentence seriously. So should the researchers whose job it is to close the gap.

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