30 SAMHSA has developed a Strategic Prevention Framework (SPF) as a planning process for preventing substance misuse. SPF’s five steps and two guiding principles offer prevention professionals a comprehensive process for addressing substance misuse and related behavioral health problems. SPF’s effectiveness begins with a clear understanding of community needs and involves community members in all stages of the planning proces The steps of SPF include: Step 1: Assess Needs: What is the problem, and how can I learn more? Step 2: Build Capacity: What do I have to work with? Step 3: Plan: What should I do and how should I do it? Step 4: Implement: How can I put my plan into action? Step 5: Evaluate: Is my plan succeeding? SPF also includes two guiding principles: 1. Cultural competence: The ability to interact effectively with members of diverse populations 2. Sustainability: The process of achieving and maintaining long-term results38 Ohio has developed its own version of the SPF to create the Ohio Strategic Planning Framework as it is applied to the opioid crisis. Goals and Objectives The development of one or more plays that address the impact of ACEs on the development of substance use disorders is a very important component of a community strategy for prevention. The goal is to halt or reduce the extent to which ACEs leads to substance use disorder or that influences the development of such disorders. It could be argued that policies and programs directly aimed at reducing the prevalence of ACEs is in itself an aspect of prevention strategies in as much as we have seen the high correlation with substance use disorder. Objectives for each such initiative under the play could be structured to reduce the propensity for substance use disorder by a specified percentage within a specified time period for a particular set (cohort) of people having a common ACEs scoring. Theory of Change A significant number of studies have strongly concluded that reducing exposure to adverse childhood experiences will reduce the likelihood of a person developing a substance use disorder. Well-documented programs that can have this effect include: home visiting, parenting assistance, parent/child interaction therapy and others that focus on the reduction of ACEs.39 The theory of change is that by offering evidentiary-based programs that reduce the number of ACEs, the likelihood of fostering the development of a substance use disorder is lessened. Another relevant theory applies to the design of treatment programs for current addicts. By improving the resilience of those having an experience leading to a substance use disorder, the perpetuation of this condition can be reduced or eliminated. Examples Seeking Safety,40 an approach developed by Dr. Lisa Najavits, addresses trauma-related problems and substance use at the same time. It is the most evidence-based model for people with both trauma and addiction. Seeking Safety can be delivered by peers, as well as by counselors or other professionals. Seeking Safety is also the lowest-cost evidence- based model available for trauma and addiction, and has shown especially strong results for heavy drug users. Dr. Stephanie Covington has developed several evidence-based, gender-responsive programs: Helping Women Recover,BeyondTraumaandBeyondViolence.ThetwonewestinterventionsareHealingTrauma:ABrief Intervention for Women and Exploring Trauma: A Brief Intervention for Men. All the programs incorporate knowledge about gender differences in risks of and responses to trauma. Treatment strategies include approaches for treating trauma