Transcript Document

Evidence-based practices –
Universal school based prevention
Jennifer Hillebrand
Difference between good/best practices and
evidence –based practices
Good practice(s) or best practice(s) refer(s) to
interventions that are supposed to lead to
preferred client outcomes.
These may or may not have a scientific evidence-base.
Evidence-based practices are interventions that show
consistent scientific evidence of being related to
preferred client outcomes.
Evidence pyramid
Primary level research
Randomised controlled trial (RCT)
Prospective
Cohort Studies
Case controlled studies
Randomised controlled trials
Controlled trials
Primary level research
Meta-analyses
Systematic reviews
Secondary level research
Case reports
Expert opinion
Retrospective
Client opinion - preferences
Review of reviews
Tertiary level research
Evidence base based on tertiary research:
univeral based prevention
•
Buehler, A. & Kroeger C. (2006) Report on the prevention of substance
abuse. Federal Centre for Health Education BZgA
•
McGrath,Y. et al. (2006) Drug use prevention among young people: a
review of reviews. National Institute for Health and Clinical Excellence.
•
Canning, U. et al. (2004) Drug use prevention among young people: a
review of reviews. Health Development Agency.
•
Hawks, D. et al. (2002) A selected review of what works in the area of
prevention. World Health Organisation.
Faggiano, F. et al. (2005) School based prevention for illicit drugs. The
Cochrane Collaboration.
Primary and secondary level research -basis
• 59 systematic reviews, meta-analyses and
other reviews
• Individual studies
• 5 primary studies.
• 29 Randomised controlled trials, 3 controlled
prospective studies
Conclusions: Life skills-based interventions
Some evidence of effectiveness
Life Skills focused programmes have beneficial effects.
They have a positive effect on both mediating variables,
e.g. self-esteem, peer pressure resistance and substance use
compared to usual curricula (Faggiano et al. 2005).
However several concerns (i.e. the number of positive findings are
probably similar to the number of negative or null findings) have
been raised in regard to life skill programme evaluations (Stothard
and Ashton , 2000) and that their degree of effectiveness is
overstated (Coggans et al. 2003). Tobler et al. 2000; Coggans et al.
2003; Stothard and Ashton; 2000; Faggiano et al. 2005
Conclusions: Social influence based interventions
Some evidence of effectiveness
School-based programmes that implement the concepts
of social influence are effective. However, data from
several longer-term follow-up studies indicate that these
effects gradually decay over time. The effectiveness of
social influence approaches, particularly the resistance
skills training component has been questioned by several
reviewers.
Conclusions: Knowledge focused programs/ Knowledge
focused components
As component: Some evidence of effectiveness
As programme: Weak or no evidence of effectiveness
The effects of knowledge focused programmes on behaviour change are
limited. Compared to usual curricula knowledge focused programs improve
mediating variables (especially drug knowledge) but are not more effective
then skills based programs. When final outcomes are considered (drug use),
their effects are comparable to those of the usual curricula . Some reviewers
and recent primary studies have identified that the delivery of knowledge as
part of a skills training approach is an important aspect of a programme.
The type of knowledge provided, however, needs to be relevant to the
students, needs to be applicable to their life experiences and needs to be of
immediate practical use to them
Conclusions: Peer-led approaches
Inconclusive evidence of effectiveness
•The research evidence on effectiveness of
school-based programmes through the
involvement of peers is inconclusive. Thorough
research in the processes and outcomes that can
be expected from peer leaders, in comparison to
other alternatives, is required before they can be
accepted as part of regular substance use
education in schools
Conclusions: Interactive versus non-interactive
programmes
Strong evidence of effectiveness
Interactive school-based programmes have preventive effects on
consumption behaviour (for tobacco, alcohol, cannabis and other illegal
drugs).
Interactive educative programmes were ‘statistically superior’ (Black et al.,
1998) to non-interactive interventions in preventing drug misuse.
Two studies examined by Faggiano et al (2005) show no significant effect of
interactive programmes on drug knowledge, decision-making skills, selfesteem and marijuana use.
However, interactive techniques were more effective in reducing hard drug
use in the study by Sussman, 2002.
Thank you for your attention.
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