A Strategic Approach to Transforming Traffic Safety Culture to Reduce Deaths and Injuries (2018)

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48 Chapter 2: Guidance on a Process to Develop a Strategic Approach 2.1 Introduction This chapter provides the “who, what, and where” of a process to develop a strategic approach to transform traffic safety culture across the layers of the social environment. It addresses who should lead the process, at what level of society the process can take place, and what the process involves. This chapter provides guidance on a “high-level process.” Specifically, the guidance focuses on the purpose of the process phase and outlines generalized steps within each of these phases, but cannot account for every situation or circumstance. This process may be applied at different levels of society (e.g., national, state, regional, and local), and each level brings different contextual challenges. For example, even within a state, communities vary from one another. Therefore, the details of each step will need to be adapted by those applying this process to their own specific situations and circumstances. 2.1.1 Leading the Process Research addressing both community and organizational culture change encourages using a coalition to lead the process for several reasons:  Coalition members representing various layers of the social environment facilitate a deeper understanding of the complex issues involved in traffic safety;  Coalition members representing various layers of the social environment facilitate deployment of strategies at different layers;  Engaging diverse stakeholders brings a wider array of perspectives and helps strategies more effectively reach different sub-cultures; and,  Engaging a coalition of stakeholders fosters shared ownership and better sustainability. (Foster-Fishman & Behrens, 2007). However, a coalition is not the only entity that can engage in the process of transforming traffic safety culture or deploy a TSCB strategy. Table 4 summarizes a variety

49 of actions that various stakeholders can perform to support transforming traffic safety culture. Table 4. Summary of Stakeholders and Activities by Level Level Stakeholder Potential Activities Community (town, city, county)  Local Leader  Community-based Coalition  Sub-committee of existing health / safety coalition  Collection of local traffic safety culture data  Education occurring in local schools  Local ordinances / policies  Enhanced workplace initiatives  Local media campaigns  Interventions deployed at the local level  Enhanced cooperation among service providers, healthcare providers, and enforcement Regional (collection of towns, cities, counties)  Regional Coalition  Traffic safety sub- committee of a regional planning entity  Support local coalition formation and development  Collection and dissemination of regional traffic safety culture data  Development of strategies to be used at the local level  Initiation of local pilot strategies  Enhanced workplace initiatives  Regional media campaigns  Enhanced cooperation among regional service providers, healthcare providers, and enforcement State  Highway Safety Office  Traffic Safety Commission  Traffic safety sub- committee of a state planning entity  Safety coalition convened by state transportation entities  Support regional and local coalition formation and development by providing technical assistance to support capacity building  Collection and dissemination of state traffic safety culture data  Development of strategies to be used at the state, regional, and local level  Initiation of local pilot strategies  Educational policy for schools  State laws and policies  Enhanced workplace initiatives  State media campaigns  Interventions deployed at the state level  Foster cooperation among service providers, healthcare providers, and enforcement National  Federal agencies  National research entities  National interest / groups  Support state, regional, and local coalition formation and development  Collection and dissemination of national / state traffic safety culture data  Fund research on the development of strategies  Establish national policies and regulations  Provide funding to states  National media campaigns

50 2.1.2 Level of Society Efforts to transform traffic safety culture can occur at the local, regional, state, and national levels. Some research supports focusing efforts at the local level (e.g., neighborhood, town, or county) because of the increased effectiveness of campaigns (Helkstra & Wegman, 2011), the local nature of many problems, and the closer proximity to those being impacted (e.g., individual citizens). However, to truly span the social environment, coalitions at the state and national levels are important as well. While the process described below references “community,” the community can represent groups much broader than just a local community. The level of detail pursued in the process will vary based on the level of the coalition. For example, a national coalition would focus on national, regional, and perhaps state level data and strategies. A state level coalition would focus more narrowly on state, regional, and perhaps county-level data and strategies. 2.1.3 Process Overview – Phases and Steps The recommended process to transform traffic safety culture includes five basic phases: Figure 22. Process to Transform Traffic Safety Culture. The purpose and action steps of each of the phases are summarized in Table 5. While the phases and steps are described as discrete, they really overlap in practice. For example, steps occurring in the first phase (e.g., recruiting stakeholders) may also take place throughout the process. Furthermore, some steps may need to be repeated based on new 1. Formation 5. Implementation and Monitoring 2. Assessment  4. Strategy  Development and  Piloting  3. Prioritization and  Strategy Selection

51 information gathered during the process. For example, during the third phase of prioritization, it may be determined additional assessment data are required, thus requiring additional assessment actions (second phase). The process should also be considered as iterative and cyclic. That is, the process is repeated as new issues arise and continual improvements are made. Acknowledging that the process will be repeated allows initial efforts to start “small” to learn about the process. Transforming culture is a new endeavor for many stakeholders – especially at the community level – and therefore requires new knowledge and capacities among stakeholders and agencies to support the transformation process. Engagement and proficiency in the steps improve with experience. Table 5. Summary of Strategic Process Phase / Purpose Steps 1. Formation The purpose is to build the infrastructure to engage in the work. Transforming culture is a long-term effort and requires a sustainable infrastructure. Diversity of participants fosters transformation by bringing a wide variety of viewpoints and facilitates greater engagement with those being served. 1.1 Create concern 1.2 Recruit stakeholders 1.3 Form or join a coalition 2. Assessment The purpose is to develop a deeper and shared understanding of traffic safety issues in the community. Shared understanding means everyone is using similar language and has a similar understanding of the data. A shared understanding does not imply the group agrees. 2.1 Gather prevalence and consequence data (e.g., road user data, crash data etc.). 2.2 Assess traffic safety culture 2.3 Assess existing interventions and system interactions 3. Prioritization and Strategy Selection The purpose is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies 4. Strategy Development and Piloting The purpose is to test (or pilot) potential strategies in the community to better understand how to implement the strategy community-wide. Piloting first provides an opportunity to address problems on a smaller scale. Piloting may be preceded by developing a new strategy. 4.1 Plan for strategy development 4.2 Plan for piloting strategies including evaluation 4.3 Implement and evaluate pilot 4.4 Revise strategies based on evaluation 5. Implementation and Monitoring 5.1 Plan for implementation including evaluation

52 The purpose is to implement the strategies on a larger scale seeking sustainability. On-going evaluation informs whether the strategy is effective or not and whether modifications are required. 5.2 Implement strategies 5.3 Monitor evaluations and revise strategies as needed 2.2 Guidance for Strategic Approach This section provides guidance for each phase of the process by breaking each phase down into steps. Guidance is provided for each step using a standard set of information intended to support the process of developing a strategic approach to transform traffic safety culture:  Purpose - What is the purpose of the step?  Role in Transforming Culture – how does this step contribute to transforming culture?  Description - What is the action required in the step?  Guidance - What are the issues and recommendations to ensure the effective completion of the step?  Potential Areas for Skill Building – What resources and skill development are necessary to support this step? As described in Figure 22, the guidance is provided in a standard layout and information format consistent with best practices previously used by NCHRP for concisely reporting guidance information (NCHRP 600, 2012).

F g igure 23: D uidance for escription strategic a of standard pproach. 53 format and content for reporting process

Phase 1. Formation Steps 1.1 Create concern 1.2 Identify, select and recruit stakeholders 1.3 Form or join a coalition The purpose of this phase is to build the infrastructure to engage in the work. Transforming culture is a long-term effort and requires a sustainable infrastructure. Diversity of participants fosters transformation by bringing a wide variety of viewpoints and facilitates greater engagement with those being served. Step 1.1 Create concern Purpose of this Step Raise awareness and concern about the issue(s) among stakeholders to facilitate engagement. Role in Transforming Traffic Safety Culture Raising concern increases motivation to change which is critical in transforming culture. Description Raising concern is typically done by gathering information about the problem (e.g., traffic safety consequences such as fatal crashes, serious injuries, pedestrian fatalities and injuries, etc.) and sharing this information with others. Guidance Without concern, people are less likely to join an effort or see a need to change their own behaviors (Prochaska & DiClemente, 1992; Witte & Allen, 2000). Local data are often more impactful than state or national data. Developing speaking points about the issue for others to use can facilitate those less familiar with the issue to speak more effectively. Often asking others what concerns them about the issue helps inform efforts to raise concern. For example, some may be concerned with the impact on the community’s youth while others may focus on long-term economic costs. This may require open conversations to debate conflicting interpretations about the significance of these data. Potential Areas for Skill Building  Sources of local, state and national traffic safety data 55

Phase 1. Formation Steps 1.1 Create concern 1.2 Identify, select and recruit stakeholders 1.3 Form or join a coalition The purpose of this phase is to build the infrastructure to engage in the work. Transforming culture is a long-term effort and requires a sustainable infrastructure. Diversity of participants fosters transformation by bringing a wide variety of viewpoints and facilitates greater engagement with those being served. Step 1.2 Identify, select and recruit stakeholders Purpose of this Step Identify, select, and recruit stakeholders to lead the effort. Role in Transforming Traffic Safety Culture Gathering the right stakeholders can result in greater effectiveness in the overall effort. Stakeholders provide access to the social environment and critical resources to complete the work. Description A small task force may be assembled to identify, select and recruit stakeholders. The task force can develop lists of potential individuals and organizations to approach (see Appendix G). The potential individuals can be prioritized based on interest in the issue, influence and resources. Members of the task force can approach the high priority individuals and seek their participation. Guidance In some cases, a coalition with many stakeholders may already exist (e.g., standing safety committee, traffic safety commission, safety coalition, etc.). If such a group already exists, it may be beneficial to review the current members and seek to identify additional members that could be added. Having a wide variety of viewpoints engaged in the effort fosters transformation. Stakeholders should be identified representing different layers of the social environment, different sectors of organizations (government, education, healthcare, etc.), and different demographic groups from within the population served. Having broad representation provides a wider variety of viewpoints on the issues, greater opportunities for implementation of strategies, and important resources to engage in the work. The following are basic steps that can be followed to identify and prioritize potential stakeholders: 1. Establish a task force to identify and prioritize stakeholders. A small group can lead the effort to identify stakeholders. The group should know the population well and have enough personal connections to facilitate recruiting 56

Phase 1. Formation Steps 1.1 Create concern 1.2 Identify, select and recruit stakeholders 1.3 Form or join a coalition The purpose of this phase is to build the infrastructure to engage in the work. Transforming culture is a long-term effort and requires a sustainable infrastructure. Diversity of participants fosters transformation by bringing a wide variety of viewpoints and facilitates greater engagement with those being served. stakeholders once they are identified. It may be necessary to add additional members to this task force. 2. Establish the population to be served. It is assumed that the focus of the effort will be to improve traffic safety. The specific population to be addressed should be clearly identified. Is it a geographic community (e.g., a town or county) or a population that shares a common activity (e.g., bicyclists)? 3. Identify critical sectors, demographic groups, and layers of the social environment to include. Stakeholders from different sectors can contribute in different ways (see Table 6). The task force should review the list of sectors and identify those most important for the population. Next, the task force should discuss what demographic groups are represented in the population. Census or other data about the demographics of the population may be helpful. Next, the social environment of the population should be discussed with a focus on what layers have more influence. For example, in a rural area with few local businesses, it may be more important to engage faith communities and elected officials. In urban areas, neighborhood associations may be more important. 4. Identify potential stakeholders by name. Specific potential stakeholders representing the various sectors, demographics, and layers of the social environment should now be identified. The task force may find it needs to recruit additional members to help identify people. 5. Prioritize potential stakeholders by interest, influence, and resources. Next, rate each potential stakeholder based on their interest, influence, and resources. A simple rating scheme of low (1), moderate (2), and high (3) may be used. Interest: Why does this stakeholder care about the initiative? Is the interest positive (i.e., they want it to succeed) or negative (i.e., they would be OK if it failed)? In what way will the stakeholder benefit or be harmed by success? What do they want from the effort? 57

Phase 1. Formation Steps 1.1 Create concern 1.2 Identify, select and recruit stakeholders 1.3 Form or join a coalition The purpose of this phase is to build the infrastructure to engage in the work. Transforming culture is a long-term effort and requires a sustainable infrastructure. Diversity of participants fosters transformation by bringing a wide variety of viewpoints and facilitates greater engagement with those being served. Rate this stakeholder’s level of interest in the project – high, medium, or low. If the project is brand new, the task force may need to speculate about what level of interest the stakeholder will have when she or he hears about the project. Influence: Each stakeholder has a base of power and capacity to influence others (i.e., take action or make policies). This power or influence can take many forms such as control over funds, creation of trust, mediation of lines of communication, or other forms of influence. Discuss how each stakeholder’s unique forms of influence may affect the project. Resources: Inventory what resources the stakeholder might bring to the project. Is it good will, knowledge, skill, access to an audience, access to data, funding, training, space, media? Is the stakeholder linked to a particularly important network or influential in establishing policy? The three ratings can be summed together to identify those with the most interest, influence and resources. 6. Recruit high priority stakeholders. The task force members use their personal connections or network to recruit each high priority stakeholder to join the effort. This may require building a relationship or working with others who know the stakeholder. Table 6. Potential Resource and Roles by Sector Sector Potential Resources / Roles Business and industry Opportunities for workplace interventions; support for media campaigns; partnerships; support for new statewide laws Economic and Basic Needs Access to low-income populations for (housing, food programs, implementing strategies employment, etc.) Education Access to youth and adults for implementing strategies; access to data collected among youth; best practices in training and teaching; resources for research (higher education) Government Access to related efforts (public health, etc.); opportunities to implement strategies; 58

Phase 1. Formation Steps 1.1 Create concern 1.2 Identify, select and recruit stakeholders 1.3 Form or join a coalition The purpose of this phase is to build the infrastructure to engage in the work. Transforming culture is a long-term effort and requires a sustainable infrastructure. Diversity of participants fosters transformation by bringing a wide variety of viewpoints and facilitates greater engagement with those being served. Potential Areas for Skill Building / Resources Needed  Listings of existing groups addressing traffic safety  Names of leaders representing different layers of the social environment 59 opportunities for new policies among public employees; access to data; access to political leadership; access to financial resources Health and Human Services Opportunities to implement strategies in healthcare settings; medical outcome data (injuries, healthcare costs, etc.); healthcare expertise Faith Communities Opportunities to implement strategies; leaders for community-level organizing; political influence Information and Media Opportunities to implement strategies (e.g., media campaigns); promote awareness of the effort Justice and Safety Opportunities to implement strategies – especially enforcement; access to arrest data; influence on enforcement policy and sentencing actions Philanthropy and Civil Society Financial resources; access to various groups for education / presentations; political influence Physical Environment Opportunities to implement strategies associated with public lands or resources (e.g., parks, etc.) Recreation, Leisure and Creative Culture Opportunities to implement strategies with special interest groups – bicyclists, runners, etc. – and ways to reach families and children Transportation Leadership role in the process; funding; crash data; knowledge on best practices

Phase 1. Formation Steps 1.1 Create concern 1.2 Identify, select and recruit stakeholders 1.3 Form or join a coalition The purpose of this phase is to build the infrastructure to engage in the work. Transforming culture is a long-term effort and requires a sustainable infrastructure. Diversity of participants fosters transformation by bringing a wide variety of viewpoints and facilitates greater engagement with those being served. Step 1.3 Form or join a coalition Purpose of this Step Establish “who” is going to lead the effort to transform traffic safety culture for a specific population Role in Transforming Traffic Safety Culture Transforming culture is a long-term process that requires sustained effort. A coalition is an effective mechanism to lead the effort because it can be self-sustaining, engage a variety of stakeholders spanning multiple sectors and layers of the social environment, and can adapt to the needs of the process. Description A coalition is a group of individuals coming together to address a common purpose. Coalitions can take many forms – from rather informal groups that regularly meet to full- fledged non-profit corporations. Coalitions may create a leadership structure (chair, vice- chair, secretary, treasurer), bylaws, and sub-committees. Some coalitions hire full or part-time staff. Guidance In many situations, a coalition may already exist that would be suitable to lead a process to transform traffic safety culture. In this case, the leadership of the coalition should be approached with the idea of expanding the existing coalition’s scope to include traffic safety. In other cases, a new coalition may need to be formed. While some people may find addressing the details of coalition infrastructure a distraction from the issue at hand, the investment proves valuable in sustaining the coalition over time. Critical activities in developing a coalition include establishing the coalition’s purpose, recruiting stakeholders (see previous step), and inventorying resources. Engaging in these activities early will be valuable later as the coalition engages in the process of transforming traffic safety culture. Investing in the facilitation skills of coalition members (at a minimum, coalition leaders) is critical. Many stakeholders may be high-level leaders and will not invest time in a poorly run meeting. Good group processes should be used to foster healthy exchanges of information. 60

Phase 1. Formation Steps 1.1 Create concern 1.2 Identify, select and recruit stakeholders 1.3 Form or join a coalition The purpose of this phase is to build the infrastructure to engage in the work. Transforming culture is a long-term effort and requires a sustainable infrastructure. Diversity of participants fosters transformation by bringing a wide variety of viewpoints and facilitates greater engagement with those being served. Some larger coalitions invest in hiring dedicated facilitators. Many resources are available to help build capacity on facilitation skills. Extensive resources are readily available for developing a coalition:  NHTSA’s Community Traffic Safety Resource Center http://www.nhtsa.gov/Driving+Safety/Community+Traffic+Safety/Community +Traffic+Safety+Building+Coalitions Resources on developing and leading a coalition.  National Safety Council’s Safe Communities America http://www.nsc.org/learn/NSC-Initiatives/Pages/safe-communities.aspx A certification process to establish a nationally recognized coalition.  Community Anti-Drug Coalitions of America (CADCA) http://www.cadca.org/resources (Start a Coalition) While these materials are designed for those working to reduce substance abuse, the resources about starting a coalition are applicable to traffic safety as well. Potential Areas for Skill Building  Coalition structures  Facilitation skills  Marketing skills to publicize coalition and efforts to garner public support and participation. 61

Phase 2. Assessment Steps 2.1 Gather prevalence and consequence data 2.2 Assess traffic safety culture 2.3 Assess existing interventions and system interactions The purpose of this phase is to develop a deeper and shared understanding of traffic safety issues in the community. Shared understanding means everyone is using similar language and has a similar understanding of the data. A shared understanding does not imply the group agrees. Step 2.1 Gather prevalence and consequence data Purpose of this Step Gather information about negative consequences associated with traffic safety as well as the prevalence of risky and protective behaviors that may result in negative consequences. Role in Transforming Traffic Safety Culture Developing an accurate understanding of the harm and related risky behaviors is important for focusing efforts and achieving meaningful improvements. Gathering this information grounds decision making in accurate data. Description The assessment process should begin by gathering prevalence and consequence data. Prevalence data indicate the level of engagement in risky (or protective) behaviors by individuals. The percentages of people who drive under the influence, use seat belts, and speed are all examples of prevalence data. These data may be available at the state or local level. Some involve self-reported data (e.g., driving within two hours of drinking alcohol) and others may be observed (e.g., seat belt studies). Some may be available for both adults and youth. The Youth Risk Behavior Survey is conducted in most states among middle and high school students and measures a variety of traffic safety measures including bike helmet use, seat belt use, texting while driving, and drinking and driving. In some cases, data may need to be collected. In addition to prevalence data, it is important to collect consequence data. Consequence data indicate the occurrence of events associated with a risky behavior such as alcohol-related crashes, serious injuries, and fatalities. Consequences associated with risky behaviors also include arrests, emergency calls, emergency room visits, healthcare costs, property damage costs, insurance claims, missed work or school, etc. Guidance Care should be taken in interpreting all data. Incomplete samples, reporting problems, and other issues can impact the quality of the measures. Arrest statistics are hard to interpret and are often more representative of the amount of law enforcement effort (resources) than the prevalence of underlying risky behaviors themselves. Assessing trends should be done with caution because assessing change in infrequent events can be difficult. For example, fatal car crashes can be rare (especially for small population sizes) and therefore seemingly large 62

Phase 2. Assessment Steps 2.1 Gather prevalence and consequence data 2.2 Assess traffic safety culture 2.3 Assess existing interventions and system interactions The purpose of this phase is to develop a deeper and shared understanding of traffic safety issues in the community. Shared understanding means everyone is using similar language and has a similar understanding of the data. A shared understanding does not imply the group agrees. changes from one year to another could be a result of random variations and not significant of underlying changes in risky behaviors or shifts in beliefs or attitudes. Potential Areas for Skill Building  Sources of national, state, and local prevalence and consequence data  Understanding various statistical measures used to report data (such as absolute and relative frequencies, risk ratios, risk rates, etc.) o Often each field has its own language (often using abbreviations) to describe behavior. It is important to invest time in building the knowledge of coalition members in what data are available and what each indicator represents. Data will be shared using a variety of statistical measures (absolute and relative frequencies, risk ratios, risk rates, etc.). Coalition members need to learn how to make meaning of basic statistical information. 63

Phase 2. Assessment Steps 2.1 Gather prevalence and consequence data 2.2 Assess traffic safety culture 2.3 Assess existing interventions and system interactions The purpose of this phase is to develop a deeper and shared understanding of traffic safety issues in the community. Shared understanding means everyone is using similar language and has a similar understanding of the data. A shared understanding does not imply the group agrees. Step 2.2 Assess traffic safety culture Purpose of this Step Develop a better understanding of not only what is happening regarding traffic safety consequences and behaviors, but why it is happening. Role in Transforming Traffic Safety Culture Fundamental to this entire approach is changing underlying values and beliefs as a way to change behavior. Therefore, it is critical to assess these values and beliefs before attempting to create change. Description Traffic safety culture is the values and beliefs shared among groups of road users and stakeholders that influence their decisions to behave or act in ways that affect traffic safety. Traffic safety culture influences the behaviors of individuals. Changing traffic safety culture is the mechanism by which to achieve change in traffic safety. Measurements of traffic safety culture should be based on a strong theoretical foundation. Assessing traffic safety culture may require additional data gathering such as surveys. Additional analyses should be performed to understand the relationship between traffic safety culture and behavior. Guidance Methods to measure traffic safety culture include surveys, focus groups, key informant interviews and use of existing data sources. Issues of representativeness, accuracy, sensitivity, and utility in predictive modeling should be considered when selecting methods (see 1.6 Measuring Traffic Safety Culture above). It should be noted that the use of multiple methods may reveal a more descriptive and informative view of the culture. Combining the various methods (i.e., representative survey with focus groups, intercept studies, and key informant interviews) gives a greater and more in-depth understanding of the existing culture, instead of relying only on a single method as providing the definitive answers about the status of the safety culture. Practitioners will obtain a more complete picture from using multiple methods and often discover new stakeholders and other exiting strategies that are being effectively implemented. Traffic safety culture should be assessed among various layers of the social environment; however, this may not occur at the same time. The assessment of one layer may inform the assessment of another. For example, understanding the role of family rules in teen driving 64

Phase 2. Assessment Steps 2.1 Gather prevalence and consequence data 2.2 Assess traffic safety culture 2.3 Assess existing interventions and system interactions The purpose of this phase is to develop a deeper and shared understanding of traffic safety issues in the community. Shared understanding means everyone is using similar language and has a similar understanding of the data. A shared understanding does not imply the group agrees. behavior (as reported by teens) may inform a future assessment of parents and their beliefs about establishing family rules. Predictive modeling should be used to provide an empirical relationship between the various components of traffic safety culture and behavior (see Figure 6). The predictive model provides guidance for selecting and implementing strategies (Phase 3). Potential Areas for Skill Building • Traffic safety culture model, its components, and how they impact behavior o Behavior models provide a theoretical basis for how values, beliefs and other conditions influence behavior. Coalition members need to learn about behavior models so they move beyond drawing conclusions about contributing factors based on anecdotal evidence. Sometimes stakeholders have personal experience of a tragic event, and conclusions about what leads to the risky behavior are drawn from this limited experience. • Role of social environment in impacting traffic safety culture o To foster transformation of the culture, the coalition needs to understand the role of the social environment. Also called social ecological theory, the social environment represents an interactive system that can promote or reduce risky behavior. Understanding the role of the social environment helps coalition members move from an individual focus (i.e., how to change road user behavior) to a systems approach (i.e., how do we transform our community’s traffic safety culture). Learning about social ecological theory fosters this shift in thinking. • Best practices for various methods for gathering data (See Appendix E). 65

Phase 2. Assessment Steps 2.1 Gather prevalence and consequence data 2.2 Assess traffic safety culture 2.3 Assess existing interventions and system interactions The purpose of this phase is to develop a deeper and shared understanding of traffic safety issues in the community. Shared understanding means everyone is using similar language and has a similar understanding of the data. A shared understanding does not imply the group agrees. Step 2.3 Assess existing strategies / system interactions Purpose of this Step Identify existing efforts and strategies addressing traffic safety for the population being served. Role in Transforming Traffic Safety Culture Understanding existing strategies provides important information about what is currently being attempted, what is working, and what may need to change. Existing strategies are also potential opportunities for new strategies – as new strategies can be added to existing ones. Interactions between agencies can impede or promote progress. Assessing system interactions reveals problems and opportunities for improvement. Description Before implementing or developing new strategies, it is important to understand the existing strategies and interactions. Even in small communities, there can be many existing efforts to address traffic safety. For example, potential local efforts to improve occupant protection may include: the local hospital providing car seats to new mothers; public health conducting car seat inspections; emergency services providing programs at the schools; driver education programs addressing seat belt use; law enforcement conducting special enforcement campaigns, etc. Strategies also include potential interventions used with those arrested for violating traffic safety laws. These strategies may include driver safety programs, DUI assessments or classes, etc. Transformation occurs as traffic safety culture and behaviors align across the social environment. Assessing system interactions facilitates this alignment. This is less about gathering information about existing strategies and more about convening key stakeholders and engaging in dialogue about how these strategies (and their underlying systems) interact. Guidance Assessing existing strategies may require contacting many different agencies spanning the social environment (e.g., driver education, schools, workplaces, social service providers, law enforcement, etc.). The use of key informant interviews can play an important role in the process of inventorying existing strategies. Effective key informant interviews always include a question about “who else should we talk with?”, revealing additional, potential stakeholders 66

Phase 2. Assessment Steps 2.1 Gather prevalence and consequence data 2.2 Assess traffic safety culture 2.3 Assess existing interventions and system interactions The purpose of this phase is to develop a deeper and shared understanding of traffic safety issues in the community. Shared understanding means everyone is using similar language and has a similar understanding of the data. A shared understanding does not imply the group agrees. already implementing strategies of which the interviewer is unaware. Often these newly- identified stakeholders may have access to other groups within the social environment that can play a key role in the process to change the traffic safety culture. Information about level of activity or service (e.g., how many people served), quality of service, and outcomes of service should be gathered for each strategy. Each of these local strategies provides a potential opportunity to contribute to future efforts. Although inventorying existing strategies takes time, the information has tremendous benefit in the future. When the coalition represents a large population (like a state), it may be impossible to inventory all strategies. In this case, the intention is to identify those strategies serving large populations – perhaps statewide or regional strategies. 67

Phase 2. Assessment Steps 2.1 Gather prevalence and consequence data 2.2 Assess traffic safety culture 2.3 Assess existing interventions and system interactions The purpose of this phase is to develop a deeper and shared understanding of traffic safety issues in the community. Shared understanding means everyone is using similar language and has a similar understanding of the data. A shared understanding does not imply the group agrees. The following questions can be used to assess system interactions:  What are the values guiding current strategies, policies, and practices?  Who are the leaders within the various systems? What are their values and beliefs about these issues? How do we know?  To what extent are relationships among stakeholders a contributing factor to these issues? In what ways?  What data do we need that is available but we do not have access to? Why? What can be done to help gain access?  What policies and procedures are in place to encourage collaboration and service coordination?  What policies, practices and procedures exacerbate risky behaviors? Reduce risky behaviors? Encourage protective behaviors?  Is there a discrepancy between stated policy and implemented practices? If so, why? (Adapted from Foster-Fishman et al., 2007) Potential Areas for Skill Building / Resources Needed  Strong facilitation skills to lead dialogue about system interactions  Listings of existing traffic safety efforts including campaigns, programs, strategies  Information about current traffic safety laws and associated programs for those arrested  Development of a comprehensive interview protocol to use in conducting key informant interviews; training for interviewers on developing follow-up questions to gather additional information when the person being interviewed mentions a point of interest/new strategy, etc., of which the interviewer is unaware, but may be useful for strategy development. 68

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. Step 3.1 Prioritize traffic safety behavioral hazards Purpose of this Step Focus efforts by prioritizing which behavioral hazard(s) should be addressed by transforming traffic safety culture. Role in Transforming Traffic Safety Culture By focusing on the highest priority behavioral hazards, traffic safety is more likely to be improved in the short-term. Description Not all behavioral hazards can be addressed at the same time. Prioritizing is a process of weighing many considerations to decide how to focus limited resources. Considerations may include prevalence, severity, and changeability of a risky behavior as well as readiness to address the behavior and resources available. Readiness may include knowledge, political will, and stakeholder engagement. For example, medically impaired driving among the elderly may have relatively low prevalence (it is a relatively rare event compared to other risky behaviors in the community), high severity (often resulting in fatality or serious injury), and modest changeability (addressing licensing laws, working with doctors to screen elderly patients, working with families to address the issue, providing alternative transportation, etc.). However, no funding is available to address the issue, and the local leadership is currently opposed to discussing it. For those reasons, its priority may be reduced relative to another behavior. Additional considerations in prioritization may be availability of traffic safety culture data and access to the population engaging in the risky behavior. Traffic safety culture data are needed to select or develop strategies. For example, texting while driving among high school students may be identified as a priority issue. However, no data about the values, beliefs and behaviors of the students are available, and relations with the schools are poor. An appropriate decision may be to delay immediate efforts on this issue and focus on building necessary relationships with the school leadership while addressing a different behavior. Guidance Several data-driven methods are available to reach consensus about priorities (see Appendix H for an example of a process used by a community where size, seriousness, and changeability of a variety of consequences were each individually rated by coalition members 69

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. and then ranked using the formula Priority= [Size + (2 x Seriousness)] x Changeability where Size ranged from 1 to 3, Seriousness ranged from 1 to 3, and Changeability ranged from 0 to 3). The intention of using a formal process is to ensure the final decision is well grounded in available data (as opposed to being driven by the agenda of a powerful individual or based on anecdotal evidence). Stakeholders may have very different opinions about these considerations. Some may consider an issue as high severity while others disagree. Some may view a behavior as able to be changed while others feel it cannot be changed. Engaging in constructive dialogue about these differences of opinion is important. These discussions will help build shared understanding about the issues and foster alignment across the social environment – thus fostering transformation. Potential Areas for Skill Building  Prioritization methods o Several processes can be used by coalitions to guide prioritization activities. The coalition should review different approaches and reach consensus about an approach. The intention is to leverage the collective wisdom of the group and avoid making decisions without a strong understanding of the data. The prioritization process is difficult – how individuals weigh the severity of different outcomes is highly subjective. A key byproduct of the process is to foster a deeper understanding of traffic safety in the community and how it impacts its members.  Strong facilitation skills to engage multiple stakeholders in the process and resolve differences in opinions 70

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. Step 3.2 Prioritize traffic safety culture beliefs Purpose of this Step Prioritize values and beliefs in transformation of traffic safety culture that will result in behavior change. Role in Transforming Traffic Safety Culture By focusing on the highest priority beliefs, strategies are more likely to result in behavior change and thus lead to improved safety. Description Once the specific risky behavior to address is identified, the traffic safety culture components associated with the selected risky behavior(s) should be prioritized. Behavior models and assessments of system interactions (conducted in the previous phase) should be reviewed and used to inform the process. Statistical predictive analyses (e.g., correlation, linear and logistic regressions, decision trees, risk ratios, etc.) using the behavior models can provide additional insights about the relationship between various beliefs and behaviors. This may require returning to the assessment step to gather additional information and engaging other experts to conduct the statistical analyses. Guidance In this step, the focus shifts from identifying the behavior to be changed, to how to change this behavior. The intention is to make decisions grounded in strong data as opposed to personal opinions or anecdotal evidence. People are often ready to suggest how to change behavior. However, fostering behavior change is very complex. Critical questions to ask include:  What are the theories and mental models that stakeholders use to explain why this risky behavior occurs? (Foster-Fishman et al., 2007); and,  Does the data collected and analyzed support or refute these explanations? For example, with an issue such as texting while driving among youth, coalition members may say they believe the cause is lack of discipline in the home because of disengaged parents or selfish youth. Analyses of the data may show the leading causes are a low sense of risk from texting while driving and a perception that everyone does it. Discussing and reconciling 71

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. the varied viewpoints leads everyone to a better understanding and results in selecting better strategies. The intentions of prioritizing traffic safety culture beliefs are to further the collective understanding of the coalition about the risky behavior and guide selection of strategies. Gathering the viewpoints of individuals not often involved in the process (such as those who engage in the risky behaviors) is also important. The tone of the activity should be one of exploration as opposed to argument. This is an area in which convening focus groups of those involved in the risky behaviors may prove beneficial, as well as conducting surveys of the groups to determine their specific viewpoints. As with the previous step, engaging key stakeholders in this process also builds shared understanding and leads to alignment of efforts across the social environment – thus fostering transformation. Potential Areas for Skill Building  Strong facilitation skills to navigate differences of opinion  Behavior models  Understanding statistical predictive modeling o Statistical predictive modeling uses various mathematical techniques to reveal relationships between various measures. For example, an analysis may show that protecting oneself from harm had a stronger relationship with wearing a seat belt than concerns about getting a ticket. Coalition members will need to learn how to make meaning of various predictive models so they can make informed decisions about which beliefs to address.  Prioritization methods.  Use of skilled, experience facilitators to convene and moderate focus groups representative of the subgroup exhibiting the risky behaviors. Facilitators and those convening focus groups should be skilled in interpreting the results of the discussions.  Strong skills in survey development, implementation, and interpretation to insure the accuracy and legitimacy of the survey findings. 72

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. Step 3.3 Prioritize strategies and opportunities for system change Purpose of this Step Identify potential strategies to change the prioritized beliefs as well as opportunities to change the interaction of systems to reduce risky behaviors. Role in Transforming Traffic Safety Culture By focusing on the highest priority strategies, change is more likely to occur. Additional improvements can be achieved by focusing on the highest priorities for system change. Description With a clearer understanding of what beliefs need to be changed to reduce the risky behavior, potential strategies can be identified. When possible, “evidence-based strategies” should be selected (that is, strategies that have a proven record of effectiveness). Specific examples of evidence-based strategies are provided below. Unfortunately, supporting evidence for TSCB- strategies may be lacking (see 1.7.4 Evaluation and 1.10 TSCB Strategies and Roadway Safety Campaigns). In addition, Appendix I provides an overview of a process to develop TSCB strategies. Efforts to transform traffic safety culture not only include changing beliefs of road users, but also aligning stakeholder actions across the social environment. The assessment of systems and system interactions performed in the previous phase should be reviewed and potential opportunities for changing systems and system interactions identified and prioritized. Guidance It is also possible to integrate TSCB strategies with traditional traffic safety methods. Here, the goal is to align these traditional methods with the goals of the TSCB strategy. For example, a TSCB strategy to transform teen culture regarding texting and driving could be aligned with traditional efforts to increase enforcement of existing texting laws, perhaps with additional efforts to have law-makers clarify or add laws that focus on texting among young drivers. They key for this integration strategy is to align traditional traffic safety methods with the road user behavior that is the focus of the TSCB strategy. Various resource guides or other articles can be used to help identify relevant traditional traffic methods. If possible, existing evidence-based strategies should be used over developing 73

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. new strategies, as strategy development takes time and expertise. The following are resources to help identify potential strategies:  Countermeasures That Work (CTW) – A Highway Safety Guide for State Highway Safety Offices CTW addresses safety countermeasures that address unsafe behaviors, such as impaired driving, failure to use safety belts, distracted driving, etc. It can be accessed from both the NHTSA and the GHSA websites (www.nhtsa.dot.gov and www.ghsa.org).  NCHRP Report 500 Series The 500 series is available on the AASHTO website (www.asshto.org). It is a series of guidebooks for addressing the 23 countermeasure areas in the AASHTO Strategic Highway Safety Plan.  FHWA Office of Safety Proven Countermeasures FHWA regularly updates and publishes a “hit list” of selected actions it believes will have the greatest impact on fatalities and serious injuries. Once a specific countermeasure, such as installation of roundabouts, achieves substantial national penetration, FHWA removes it from the list and moves on to those with lesser implementation (http://safety.fhwa.dot.gov).  NCHRP Report 622 – Effectiveness of Behavioral Safety Countermeasures (www.trb.org). Report 622 can be accessed from the TRB website and provides a starting point for measuring the effectiveness of behavioral countermeasures and programs.  Substance Abuse and Mental Health Administration’s (SAMHSA) National Registry of Evidence-Based Programs (www.samsa.gov). As the SAMSA title suggests this website catalogues proven effective programs for reducing alcohol and drug abuse, which are associated with a significant proportion of vehicle and pedestrian fatalities and serious injuries.  Governors Highway Safety Association (GHSA) GHSA represents the state and territorial highway safety offices that implement programs to address behavioral highway safety issues, including: occupant protection, impaired driving, and speeding. (http://ghsa.org). 74

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition.  Crash Modification Clearinghouse FHWA maintains a database at the FHWA Safety website containing proven effective infrastructure countermeasures. States can input data from their countermeasure evaluation studies; however, caution is advised because some of the countermeasures have been more frequently and effectively evaluated than others (http://safety.fhwa.dot.gov).  TRB maintains the Transportation Research Information Database (TRID) where information on research programs and papers can be accessed on a wide variety of safety topics. Since safety culture is a relatively new concept in the transportation lexicon, research information addressing the topic may be somewhat sparse. However, many evidence-based countermeasures contain elements intended to impact and change safety behaviors (www.trb.org).  Safer People, Safer Streets: Summary of Transportation Action Plan to Increase Walking and Biking and Reduce Pedestrian and Bicyclist Fatalities, September 2014 provides a comprehensive and coordinated approach that builds off of FHWA’s existing work to improve pedestrian and bicycle safety. This initiative will include new research and tools to improve safety, generate better data on pedestrian and bicycle activity, crashes, and infrastructure, and build stronger partnerships between DOT headquarters and field offices, local officials, safety organizations, State, regional, and local planners and engineers. o https://www.transportation.gov/office-policy/transportation- policy/secretary%E2%80%99s-action-plan-bike-and-pedestrian-safety  PEDSAFE (Pedestrian Safety Guide and Countermeasures Selection System) is intended to provide practitioners with the latest info available for improving the safety and mobility of those who walk. BIKESAFE (Bicycle Safety Guide and Countermeasures Selection System) is intended to provide practitioners with the latest info available for improving the safety and mobility of those who bicycle. o www.pedbikesafe.org  Both pedestrian and bicycle road safety audit guidelines and prompt lists are available from the following two (2) FHWA web links: o www.safety.fhwa.dot.gov/ped_bike/tools_solve/ped_rsa/ o www.safety.fhwa.dot.gov/ped_bike/tools_solve/fhwasa12018 75

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. Critical questions to ask when selecting a strategy include:  How will this strategy change the beliefs identified in previous steps?  How well can this strategy be implemented for this population?  What are the initial and on-going costs of this strategy? Who will pay for these costs?  How difficult is it to sustain this strategy?  Do we have the expertise to implement this strategy? Answering these questions can help prioritize which strategies to select. In addition to identifying potential strategies to use, the coalition should review the assessment of system interactions to identify opportunities for improvement. The following questions can guide that dialogue:  What new resources or opportunities are needed to support the desired change?  How can the systems use resources differently to support the change?  What policies are not in place but are needed to address contributing factors?  What current policies are incompatible with addressing the contributing factors (Foster-Fishman et al., 2007)? Potential Areas for Skill Building  Sources and reviews of various evidence-based strategies 76

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. Step 3.4 Develop logic models for change Purpose of this Step Validate the strategy selection process by developing a logic model describing how the strategy will result in improved traffic safety. Role in Transforming Traffic Safety Culture Effective strategies lead to behavior change. The most effective strategies are those where a compelling logic can be established between implementing the strategy and improved safety. Description A logic model is a written and visual description of how implementing the strategy would result in improved traffic safety. Using a series of “if, then” statements, the model describes a logical sequence for reducing a negative consequence. Addressing some behaviors can become complex, and leaders can get “lost” between identification of the consequence to be reduced and the selected strategy. Capturing the logic behind the selected strategy increases the likelihood of achieving change. The logic model also aids in developing the implementation and evaluation plans. Guidance For example, suppose a community identifies that children injured by motor vehicles while walking to school is a high priority consequence. A review of the data identified distraction among high school youth (driving to a nearby high school) accounting for a significant portion of the incidents. Prevalence data from high school students revealed a high rate of texting while driving, and traffic safety culture data showed a strong relationship between low perception of risk of texting while driving and engagement in the risky behavior. An evidence-based curriculum addressing texting while driving was identified that could augment the local driver education program. Figure 24 shows a logic model documenting how implementing this new curriculum will result in a reduction of children injured by motor vehicles while walking to school. While logic models validate the strategy selection process, they also provide important information to guide implementation and evaluation. The logic model can inform a strategy implementation plan identifying who needs to do what for the strategy to work. The logic model also identifies potential process measures (following the same example, how many 77

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. students have participated in the new curriculum) as well as intermediate variables (perception of risk from texting while driving, engaging in texting while driving). Problem / Issue Strategy Activity Outcomes Consequence Risky Behavior TSC Belief Short- term Intermediate Long- term Too many children seriously injured by vehicles when walking to school (8 in past 4 years) 40% of incidents involved a distracted, high school driver. 30% of high school youth report texting while driving in past 30 days 60% of high school youth report low perception of risk from texting while driving Increase perception of risk of texting while driving by using Distraction while Driving Curriculum. Distraction while Driving Curriculum deployed in HS driver’s education classes Increase perception of risk from texting while driving among HS students. Decrease prevalence of texting while driving among HS students Decrease children injured walking to school Figure 24. Example Logic Model Potential Areas for Skill Building  Logic model creation o Logic models are a valuable tool to help coalition members see the connection, based on good science, between strategy and improved traffic safety. They also aid planning and evaluation. Teaching coalitions about logic models is relatively straight-forward and many resources are available. Here are a few:  CDC’s Logic Models  http://www.cdc.gov/oralhealth/state_programs/pdf/logic_models. pdf  W.K. Kellogg Foundation’s Logic Model Development Guide  https://www.wkkf.org/resource-directory/resource/2006/02/wk- kellogg-foundation-logic-model-development-guide  CADCA’s Planning Primer: Developing a Theory of Change, Logic Models and Strategic and Action Plans  http://www.cadca.org/resources/planning-primer-developing- theory-change-logic-models-and-strategic-and-action-plans 78

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. Step 3.5 Develop a program of strategies spanning the social environment Purpose of this Step Transform the culture by changing beliefs and behaviors across the social environment. Role in Transforming Traffic Safety Culture Cultural transformation requires changing behaviors across the social environment. When the behaviors align toward safety across the social environment, each layer reinforces the other layers. For example, as families align around safe practices, they expect schools to do likewise. Description Transforming culture requires more than changing the behavior of one group; it requires addressing how the social environment addresses the issue (Nation et al., 2003). For each risky behavior addressed, strategies across the social environment should be identified. In this way, multiple layers of the community reinforce the shift in beliefs, and the outcomes are more likely sustained. Guidance In the previous example of reducing texting while driving among high school students (in an effort to reduce injuries of children walking to school caused by vehicle incidents), the proposed strategy and activity focused only on the drivers themselves. In addition, reaching parents, other community adults, law enforcement, and teachers would bolster efforts. A “program” (or collection) of strategies could be implemented to address this risky behavior. For example, law enforcement could engage in high visibility enforcement; parents could be encouraged to establish rules about never texting while driving; teachers could discuss the value of protecting the community’s children. In this way, multiple strategies across the social environment would seek to address this behavior. For any given risky behavior, protective behaviors across the social environment can be identified. These are behaviors engaged in by others. In the previous example, texting while driving was the risky behavior. Parent, teacher, and law enforcement behaviors are the protective behaviors. Shifting from only focusing on risky behaviors to thinking across the social environment is transformational. Traditionally, we might ask “How do we get people to wear their seat 79

Phase 3. Prioritization and Strategy Selection Steps 3.1 Prioritize traffic safety behavioral hazards 3.2 Prioritize traffic safety culture beliefs 3.3 Prioritize strategies and opportunities for change 3.4 Develop logic models for change 3.5 Develop a program of strategies The purpose of this phase is to focus efforts by prioritizing and selecting strategies to create change. An important byproduct of the prioritization process is a deeper understanding of the issue and how to address it by the coalition. belts?” Thinking from a cultural lens, the question becomes “What actions do we want to grow across the social environment that will result in more people wearing seat belts? And what are the beliefs that influence engaging in these various behaviors?” The same theoretical approach to reducing risky behaviors can be applied to growing protective behaviors. For example, traffic safety culture among parents about their protective behaviors within their families can be assessed. These assessments identify the values and beliefs among parents that can be bolstered to grow their protective behaviors. Strategies to grow these beliefs (and thus grow their protective behaviors) can be identified and implemented. A similar process as outlined in the previous steps can be applied to each layer of the social environment. Potential Areas for Skill Building  Evidence-based strategies  Social ecological theory 80

Phase 4. Strategy Development and Piloting Steps 4.1 Plan for strategy development 4.2 Plan for piloting strategies including evaluation 4.3 Implement and evaluate pilot 4.4 Revise strategies based on evaluation The purpose of this phase is to test (or pilot) potential strategies in the community to better understand how to implement the strategy community-wide. Piloting first provides an opportunity to address problems on a smaller scale. Piloting may be preceded by developing a new strategy. Step 4.1 Plan for strategy development Purpose of this Step Careful planning increases the likelihood that newly developed strategies are effective. Role in Transforming Traffic Safety Culture Implementing effective strategies results in behavior change. Description In some cases, evidence-based strategies to address a certain behavior may not exist or may need to be significantly adapted for implementation in a new setting. In most cases, new strategies need to be developed (or existing ones modified). The development of a new strategy requires a systematic plan that include team member with a diverse range of necessary skills. The plan should include conducting formative research about the behavior, developing behavior models, identifying mechanisms to reach the intended group, developing materials and resources to train those delivering the strategies, pilot testing the materials developed, and subsequently piloting the overall strategy. Careful attention should be paid to evaluation. This may take considerable time (months to years) and involve outside expertise. Guidance Important considerations for developing effective strategies include using multiple settings (e.g., in the family, schools, workplaces, etc.); engaging varied communication / teaching methods; assuring sufficient dosage (that is exposure of the intervention with the population); using a strong theoretical basis; timing delivery appropriately for the developmental stage of the intended audience (i.e., middle school children comprehend information differently than adults); and making the information socio-culturally relevant (i.e., the issue needs to be relevant to the intended audience). An overview of developing strategies is provided in Appendix I –Overview of Strategy Development Process. Strategy development is complex. If the coalition lacks necessary expertise, stakeholders may include consultants or research universities. Potential Areas for Skill Building  Behavior change models  Strategy development  Evaluation resources and methods 81

Phase 4. Strategy Development and Piloting Steps 4.1 Plan for strategy development 4.2 Plan for piloting strategies including evaluation 4.3 Implement and evaluate pilot 4.4 Revise strategies based on evaluation The purpose of this phase is to test (or pilot) potential strategies in the community to better understand how to implement the strategy community-wide. Piloting first provides an opportunity to address problems on a smaller scale. Piloting may be preceded by developing a new strategy. o Resources for evaluation include private consultants as well as local intuitions of higher learning (e.g., colleges and universities). Graduate students may be willing to take on the evaluation of a project as a thesis project. Many resources for evaluation are available including:  Web Center for Social Research Method’s Introduction to Evaluation  http://www.socialresearchmethods.net/kb/intreval.php  The CDC’s Program Performance and Evaluation Office  http://www.cdc.gov/eval/  The Art of Appropriate Evaluation for Highway Safety Program Managers  http://www.nhtsa.gov/About+NHTSA/Traffic+Techs/current/The +Art+of+Appropriate+Evaluation+for+Highway+Safety+Progra m+Managers  The Robert Wood Johnson Foundation’s A Guide to Evaluation Primers  http://www.rwjf.org/content/dam/web-assets/2004/04/a-guide-to- evaluation-primers 82

Phase 4. Strategy Development and Piloting Steps 4.1 Plan for strategy development 4.2 Plan for piloting strategies including evaluation 4.3 Implement and evaluate pilot 4.4 Revise strategies based on evaluation The purpose of this phase is to test (or pilot) potential strategies in the community to better understand how to implement the strategy community-wide. Piloting first provides an opportunity to address problems on a smaller scale. Piloting may be preceded by developing a new strategy. Step 4.2 Plan for piloting strategies including evaluation Purpose of this Step Careful planning of a pilot results in better outcomes and the gathering of important lessons learned which will inform future deployment of strategies on a larger scale. Role in Transforming Traffic Safety Culture Strategies need to be implemented across the community and reach the overwhelming majority of the target population to be effective. Starting with a pilot leads to better long-term success. Description Piloting (or testing) strategies before full deployment allows for important learning and revisions. Often strategies will need to be adapted to local environments and the pilot process allows for these issues to be surfaced and corrected on a small scale. The appropriate settings for the pilot need to be selected. To maximize learning from the pilot, evaluation is critical. An evaluation plan should be developed as a part of the pilot implementation plan. Evaluation should include capturing process measures (measures of how many are served or impacted by the strategy, when, and how often), intermediate variables (such as predictive beliefs or supportive behaviors like parents or workplaces establishing rules or policies), and outcome measures (engagement in risky behaviors and/or consequences from engaging in risky behaviors). A detailed plan for implementing the pilot should be created. The plan should include who is leading the effort, who needs to be trained, timing, and evaluation requirements. All those involved in the pilot should agree to the plan before starting. Guidance Selecting sites for pilots involves balancing several factors including readiness, local capacity, political pressures, and fairness (e.g., do just the “good schools” get to test the new strategy?). Some strategies will require recruiting and engaging new partners (law enforcement leaders, school teachers, elected officials, etc.). Specific training may be required. The logic models for each strategy developed in the previous step provide guidance for planning the implementation of pilots of strategies as well as evaluation designs. 83

Phase 4. Strategy Development and Piloting Steps 4.1 Plan for strategy development 4.2 Plan for piloting strategies including evaluation 4.3 Implement and evaluate pilot 4.4 Revise strategies based on evaluation The purpose of this phase is to test (or pilot) potential strategies in the community to better understand how to implement the strategy community-wide. Piloting first provides an opportunity to address problems on a smaller scale. Piloting may be preceded by developing a new strategy. Decisions need to be made about the level of rigor for the evaluation addressing such issues as whether comparison sites should be used. A more rigorous evaluation would compare changes in the pilot site with similar measures collected in a comparison site where no strategy took place. This comparison provides a higher level of assurance that the changes measured were a result of the pilot strategy. However, the use of comparison sites also increases costs (evaluation measures need to be collected in two sites instead of one) and can be challenging to implement because the comparison site has to engage in significant work to collect measures without receiving the benefit of the new strategy. The results of the pilot should be analyzed by an experienced evaluator for evidence of change and lessons learned. Trained evaluators can assist in this effort. Engaging everyone in the planning process helps build ownership and commitment. There are many stories of pilot projects that have stopped early or where final evaluation data were not collected. Clearly, this greatly decreases the value of the pilot process. It is critical that all the involved parties have a clear understanding of the entire pilot process. Because of the added burden of implementing a pilot, individuals implementing the pilot may need to be provided additional pay or a stipend. Sometimes, a memorandum of understanding (MOU) is used to clarify roles and expectations. Potential Areas for Skill Building 84 • Detailed knowledge of how to implement the strategy (including training requirements) • Evaluation methods • Facilitation skills in participatory planning • Training in “getting to outcomes” – how do we reach the outcomes desired? What are the steps in the process? As further explanation: on-going evaluation measures need to be identified and defined/established. Evaluation measure data should be collected at specific milestone points or time periods (monthly/quarterly, etc.) and shared with project leadership/coalition members on an on-going basis so “course corrections” in strategy deployment can be made. If possible, up to 3 – 5 years of baseline data from years prior to strategy deployment should be collected, reflecting the level of the specific risky behavior prior to the intervention. .

Phase 4. Strategy Development and Piloting Steps 4.1 Plan for strategy development 4.2 Plan for piloting strategies including evaluation 4.3 Implement and evaluate pilot 4.4 Revise strategies based on evaluation The purpose of this phase is to test (or pilot) potential strategies in the community to better understand how to implement the strategy community-wide. Piloting first provides an opportunity to address problems on a smaller scale. Piloting may be preceded by developing a new strategy. Step 4.3 Implement and evaluate pilot Purpose of this Step Learn how effective the strategy is by deploying it with evaluation systems in place. Role in Transforming Traffic Safety Culture Not all strategies are effective, and not all strategies work in different contexts. Pilot implementations allow for critical learning and adaptations which will lead to better long-term outcomes. Description After careful planning, the pilot should be implemented by following the plan developed. Assessing the fidelity of the implementation is important. Fidelity of implementation describes the rigor with which a strategy adheres to the developer’s model (CSAP, 2002). Often those engaged in implementing the pilot have multiple responsibilities (e.g., teachers, law enforcement officers, etc.) and the pilot is viewed as “additional work.” When problems arise, they may skip steps, become disengaged or simply stop. Also, gathering evaluation data can be viewed as an additional burden or interpreted as a mechanism to evaluate the implementer’s performance. Guidance Progress should be monitored on a regular basis and unforeseen issues addressed quickly. It is critical to verify that the strategy is being implemented as designed and that evaluation measures are being captured. Carefully explaining the purpose and value of the evaluation is critical. Those implementing the pilot need to know that the evaluation is to assess the effectiveness of the strategy, not their job performance. Gathering qualitative feedback from those implementing and participating in the pilot is also valuable. Additional questions include:  What makes this easy or hard to implement?  What components have gone very well? How so?  What components have been difficult? How so?  Would you be willing to do this again? Why or why not?  Do you think others in a similar role as you could do this strategy? Why or why not?  Do the participants value the strategy? Why or why not? 85

Phase 4. Strategy Development and Piloting Steps 4.1 Plan for strategy development 4.2 Plan for piloting strategies including evaluation 4.3 Implement and evaluate pilot 4.4 Revise strategies based on evaluation The purpose of this phase is to test (or pilot) potential strategies in the community to better understand how to implement the strategy community-wide. Piloting first provides an opportunity to address problems on a smaller scale. Piloting may be preceded by developing a new strategy. Potential Areas for Skill Building  Methods for assessing fidelity o Addressing fidelity is an important issue when implementing evidence-based strategies. There are several resources available online including:  The Education Development Center’s Assessing Program Fidelity and Adaptations  http://www.promoteprevent.org/sites/www.promoteprevent.org/fil es/resources/FidelityAdaptationToolkit.pdf  Implementation Fidelity in Community-Based Interventions  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409469/  Methods in qualitative evaluation o Qualitative evaluation is distinct from quantitative evaluation (see Table 7) and can provide valuable insights to increase effectiveness. Program evaluators and project/coalition leadership can help augment quantitative evaluations of programs with qualitative components. Table 7. Comparison of Qualitative and Quantitative Evaluation Approaches Adapted from (McDavid & Hawthorn, 2006) 86 Qualitative Evaluation Quantitative Evaluation  Inductive approach to data gathering, interpretation, and reporting More holistic approach: finding the big “Aha” for the results Understanding the experiences of stakeholders Using natural language throughout the evaluation process  In-depth, detailed data collection  The evaluator is the primary measuring instrument Research hypotheses and questions that are tested in the evaluation  Finding patterns that either corroborate or disconfirm particular hypotheses and answer the evaluation question Understanding how social reality, as observed by the evaluator, corroborates or disconfirms hypotheses and evaluation questions  Emphasis on measurement procedures that lend themselves to numerical representation of variables Representative samples of populations using samples sizes large enough to provide statistical significance to detected expected outcomes  Focus on reliability and validity of measuring instruments

Phase 4. Strategy Development and Piloting Steps 4.1 Plan for strategy development 4.2 Plan for piloting strategies including evaluation 4.3 Implement and evaluate pilot 4.4 Revise strategies based on evaluation The purpose of this phase is to test (or pilot) potential strategies in the community to better understand how to implement the strategy community-wide. Piloting first provides an opportunity to address problems on a smaller scale. Piloting may be preceded by developing a new strategy. Step 4.4 Revise strategies based on evaluation Purpose of this Step Improve the effectiveness of the strategy by revising it based on lessons learned from the piloting process. Role in Transforming Traffic Safety Culture Changing behavior is difficult. Revising strategies to make them more effective will lead to better long-term outcomes. Description The results of the evaluation should be reviewed though the lens of “what did we learn?” not just “did it work?” Issues such as readiness and training are important factors that can greatly impact the success of a strategy (Nation et al., 2003). If the strategy was developed by others, it may be valuable to engage the developers to share the results and identify potential revisions. Revising strategies should be done with great care to avoid removing or changing components resulting in a reduction in effectiveness. Guidance The entire pilot process should be reviewed for opportunities to improve. This is a good time to revisit the logic models and compare the actual outcomes and process with the proposed logic for change. Partners should be warned that the planning process is often lengthy; however, it is essential for effective implementation and well-worth the investment in time and resources. Leaders should discuss the difference between “meaningful change” and “statistically significant change.” While a strategy may result in statistically significant change, the outcomes may not be significant enough to warrant full deployment. The qualitative information should also be reviewed. Issues that may have to be addressed include items like the implementers (or participants) not liking the strategy or the strategy requiring too much time. Potential Areas for Skill Building  Understanding evaluation results 87

Phase 5. Implementation and Monitoring Steps 5.1 Plan for implementation including evaluation 5.2 Implement strategies 5.3 Monitor evaluations and revise strategies as needed The purpose of this phase is to implement the strategies on a larger, sustainable scale. On-going monitoring and evaluation informs whether the strategy is effective or not and whether modifications are required. Step 5.1 Plan for implementation and monitoring Purpose of this Step Careful planning for large-scale implementation and monitoring results in better deployment and effectiveness of the strategies. Role in Transforming Traffic Safety Culture Successfully implementing strategies on a large scale leads to transformation. Description Based on the lessons learned from the pilot testing, plans for implementing strategies at a larger scale can be developed. In addition, systems to support on-going monitoring and evaluation should be put in place. Guidance Commitment from additional partners (such as additional schools or law enforcement agencies) may be required as may additional training. Engaging partners in the planning process will facilitate ownership and commitment. Wide-scale deployment may occur in stages and over time to overcome potential resistance from partnering agencies. Mechanisms to sustain implementation (like codifying the new strategies in operating policies or practices) should be pursued. For example, school boards can adopt policies that certain strategies will be used. This fosters sustainability when leadership (e.g., the principal) changes. On-going monitoring may require the gathering of new data. This may require developing or revising data collection systems by changing or adding new components to existing reporting systems or databases. For example, traffic citation forms used by law enforcement may be changed to include new items or court records updated to track participants in new strategies. Potential Areas for Skill Building  Facilitation skills in participatory planning  Training for new partners about the strategy  Existing monitoring system and how these can be modified to include the new strategy 88

89 Phase 5. Implementation and Monitoring Steps 5.1 Plan for implementation including evaluation 5.2 Implement strategies 5.3 Monitor evaluations and revise strategies as needed The purpose of this phase is to implement the strategies on a larger, sustainable scale. On-going monitoring and evaluation informs whether the strategy is effective or not and whether modifications are required. Step 5.2 Implement strategies Purpose of this Step Deploy the strategies on a large scale to create change in beliefs and thus changes in behaviors. Role in Transforming Traffic Safety Culture Successfully implementing strategies on a large scale leads to transformation. Description The implementation of the new strategies should be actively supported by the coalition. For example, those leading the effort may need to host the required training and pay for (or contribute to) costs associated with required changes. The implementation should be monitored to make sure the strategy is being implemented as it was designed (e.g., with fidelity). Agencies may decide to make modifications on their own; these should be carefully reviewed and assessed for potential impact to outcomes. Guidance The coalition needs to actively engage in the implementation process. Their active engagement shows the importance of the strategy to the community and those responsible for implementing the strategy. Potential Areas for Skill Building  Communication strategies to promote the new strategy in the population

90 Phase 5. Implementation and Monitoring Steps 5.1 Plan for implementation including evaluation 5.2 Implement strategies 5.3 Monitor evaluations and revise strategies as needed The purpose of this phase is to implement the strategies on a larger, sustainable scale. On-going monitoring and evaluation informs whether the strategy is effective or not and whether modifications are required. Step 5.3 Monitor evaluations and revise strategies as needed Purpose of this Step To improve the effectiveness of strategies by regularly monitoring and reviewing evaluation results and making revisions as necessary. Role in Transforming Traffic Safety Culture Communities are always changing. Strategies will need to be revised and updated to remain effective as the community changes. Description The evaluation data should be continually gathered and reviewed. Sustaining outcomes may require further refinements. Furthermore, other systems may change (e.g., new laws or practices are enacted) that may impact the strategy and require changes. Guidance Outcome evaluations should be fed-back to those implementing the strategies so they see the value of their efforts and can improve their quality as well. Nothing fosters sustained engagement like showing those doing the work that they are making a difference. Potential Areas for Skill Building  Understanding strategies for developing an evaluation process and evaluation data