Transcript (school-based) prevention programs

THEORIES AND WORKING MECHANISMS IN
PREVENTION
THE UNPLUGGED
The Standards and the Certification Process in
Prevention in the Czech Republic
Roman Gabrhelik
Serbia, May 2013
Prevention in Addictology
Focus of this talk: PP of risk behavior (substance use).
Prevention in addictology (drug ab/use field): complex of psychosocial, legal and health actions used in order to prevent health
damage, emergence of diseases, health problems, and constant
effects as results of various forms of risk behavior/substance use.
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Goals of PP of Drug Use
Three main goals of primary prevention of drug use:
1) Forestalling of drug use
2) Delay of drug use
3) HR in experimenting youth
Risk factors: may increase the probability of drug ab/use
Protective factors: may decrease the probability of drug ab/use
Goal of PP: To strenghten the protective factors over the risk ones.
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Overlaps b/n types of prevention
(EMCDDA, 2009)
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Úvod
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The overall framework of prevention
strategies (EMCDDA, 2008)
Environmental
strategies
Universal
prevention
Selective
prevention
Indicated
prevention
School
school policies,
health promotion
frameworks and
school climate
interventions for
first and early
second grader
interventions for
pupils with
academic or
social problems,
truants
interventions for
pupils with
ADHD, Conduct
Disorder
Community
tobacco & alcohol
policies &
regulations, norms
on legal drugs,
cannabis &
antisocial
behaviour
interventions for
youth in alternative
leisure time
programmes,
outside school, in
sports clubs, youth
clubs
interventions for
young offenders,
clubbers, ethnic
groups, problem
neighbourhoods,
experimenting
youth
follow-up
interventions for
paediatric patients
with ADHD,
depression, or CD
Family
education styles
(laissez-faire,
authoritative,
authoritarian)
interventions for
families at large
interventions for
families at risk
help for families
with children at
risk
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Theoretical concepts in prevention
From the perspective of prevention of risk behavior is crucial:
• knowledge of human personality
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theories and models in the psychology of personality
developmental stages
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theories and models in developmental psychology
social and cultural contexts
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theories and models in social psychology but also sociology
variability of the human psyche, normality, impaired mental
functions
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clinical psychology, abnormality psychology and psychopathology
Diagnostics
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including knowledge of relevant medical theories and models
many other factors that ‘shape’ a person
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Theoretical concepts in prevention
(2)
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Cognitive and information-based models
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Health belief (Rosenstock et al., 1994)
Reasoned action-attitude (Fishbein, Ajzen, 1975)
Sociologic and developmental models
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Evolution theory (Kandel, 1980)
Socio-economic model and ecological-environmental model (Kumpfer,
Turner, 1990-91)
Diffusion of innovation theory (Ferrence, 2001)
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Theoretical concepts in prevention
(3)
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Social influence models
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Social learning (Bandura, 1986, 1994)
Life skills (WHO, 1993)
Normative beliefs (McGuire, 1964, Tobler et al., 1986)
Comprehensive social influence models
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Problem behavior (Jessor, Jessor, 1977)
Social development (Catalano et al., 1992)
Comprehensive social influence models (Sussman et al., 2004)
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Types of (school-based) prevention
programs (EMCDDA)
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Programs aimed at developing life skills
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aimed at decision-making skills
• e.g., out-of-school, HR, Take Home Naloxone (THN) (+)
aimed at coping with anxiety and stress
• e.g., Pre-Venture (Conrod et al.) (+)
aimed at training (development) of social skills
• e.g., Unplugged (Gabrhelik et al., 2010) (+)
aimed at practicing skills to resist pressure
• e.g., SHAHRP (+)
Programs aimed at the development of intrapersonal skills
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aimed at realizing the values
• e.g., Maat in de shit’ (Friend in n(w)eed) (Be) (n.a.)
aimed at setting goals
• e.g., Positive Futures (UK) (n.a.)
aimed at building a positive self-esteem
• e.g., EmPeCemos (+)
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Types of (school-based) prevention
programs (EMCDDA)
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Programs with social component
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Programs based on the information
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aimed at setting standards
• e.g., GBG (+)
related to swear the oath
• e.g., sexual education (-)
peer
• e.g., Unplugged (Faggiano et al., 2010) (-)
Informative
• e.g., Prevention Smart Parents (Mentor F.) (n.a.)
Media campaign
• e.g., Just Say No (USA) (-), Frank (n.a.)
Programs for /with Parents
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e.g., Strengthening Families Program (Catalano et al., 2009) (+)
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Research:
PP interventions requirements
Prevention interventions in addictology should:
• be based on up-to-date scientific knowledge and on good
practice
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• be monitored and under constant evaluation
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• be delivered by true (i.e. educated) professionals
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• be disseminated and implemented only if proven effective
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PP interventions requirements (2)
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Drug prevention interventions are being extensively developed and
implemented in school settings for almost four decades (Cuijpers,
2003).
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Many of these interventions are still lacking appropriate and
scientifically sound evaluations of effectiveness (eg. Cujipers,
2002; Tobler et al., 2000).
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Only limited numbers are then designed as randomized controlled
trials (RCTs), even fewer meet fundamental methodology criteria.
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Majority of well designed RCTs are of the US provenience
(Faggiano et al., 2008a).
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The Unplugged
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History of EUDAP projects
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http://www.eudap.net/
The Unplugged
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Universal school-based
substance abuse prevention
program
Based on CSI model
Targed group aged 12 -14
Teacher`s Manual, Workbook
for childredn, Cards
12 lessons delivered
throughout one school-year
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Basic info
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Evaluation of effectivity
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Design: Cluster randomized control trial
Instruments:
• ESPAD questionnaire + drugs knowledge test
• Monitoring of other preventive activities than the Unplugged, etc.
39 active / 35 control schools (N=1,801)
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Time span
9/2007
Test
6/2008
9/20075/2008
intervention
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6/2009
9/2008
6/2010
9/2009
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Effectiveness of the intervention
Baseline Prevalence
Experimental1
Control1
% Experimental % Control
n/N
n/N
Odds Ratio
95% CI
Odds Ratio
95% CI
256/911
289/841
1.96
(1.0937-1.6407)
0.7291
(0.5812-0.9146)
82/911
112/841
1.32
19/911
44/841
2.18
291/906
58/906
287/834
88/834
1.1089
1.47
56/903
71/828
1.86
21/903
39/828
2.0760
205/907
249/837
1.01
During the past 30
days
Any Smoking
9.66
Frequent Smoking
1.28
Daily Smoking
0
Any Drunkenness
Frequent Drunkenness
16.77
2.37
Any Cannabis
1.33
Frequent Cannabis
0.10
7.52
0.59
0.24
12.84
1.18
0.48
0.12
Unadjusted2
(1.1486-2.1003)
(1.5007-4.4764)
(0.9082-1.3539)
(1.2205-2.4372)
(0.9860-2.0409)
(1.2109-3.5594)
Multilevel Model3
0.6174
0.4315
0.8365
0.5695
0.6672
0.4592
(0.4113-0.9268)
(0.1861-1.0002)
(0.6385-1.0959)
(0.3759-0.8628)
(0.4350-1.0235)
(0.2425-0.8696)
Lifetime
Any Drug Use
6.31
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4.62
(1.1697-1.7977)
0.6219
(0.4715-0.8204)
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What do we learn from this?
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A statistically significant effect of the Unplugged intervention
(experimental group) at wave six/final wave was observed for all
outcomes, with the exception of:
• Any smoking, frequent smoking
• any drunkenness
• any cannabis use for the unadjusted model
• marginal significance for daily smoking (OR=0.4315 95% CI 0.18611.0002 p=0.0501)
Booster sessions proved to be an option to maintain or even enhance
the effect of the basic intervention (Cujipers, 2002; Tobler et al., 2000;
Botvin et al., 1983).
To further improve the outcomes of the intervention, we propose to
study the improvement of the intervention (Unplugged) while using the
booster sessions focused on alcohol, tobacco and marijuana use.
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Gender Specific Trajectories in Cigarette Smoking
Behaviors: growth mixture modeling data (Muthén &
Shedden, 1999)
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Using data from the Czech
Unplugged school-based
prevention trial, we investigated
the relationships of cigarette
smoking class trajectories on
cigarette smoking behaviors
and gender in elementary school
students in Czech.
The results indicate additional
efforts are needed to prevent the
onset and escalation of smoking
among adolescent females.
Gender specific messages may
be needed.
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UNIVERSALITY OF PREVENTION
INTERVENTION
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Aims: To examine the effect of school-based preventive intervention on
cannabis use in Czech adolescents with different levels of risk factors and
provide evidence of its universality.
We used own developed two-level logistic random-intercept model for
panel data.
Findings:
• All the selected characteristics of the children to be relevant in relation
to cannabis use, except their relationships with their friends.
• the intervention is universal in two dimensions for the selected
characteristics of the children:
• all adolescents undergoing the intervention are expected to benefit
• the total level of individual risk of cannabis use is superior to the
composition of the risk factors in the individual risk profile
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UNIVERSALITY OF PREVENTION
INTERVENTION (2)
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Czech Standards: Introduction
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Full title
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The Standards of Professional Competency of Providers of the
Programmes of School-based Primary Prevention of Risk
Behaviour
hereinafter referred to as ‘Standards’
The objective of the Standards is to assess the programmes aimed at
any type of risk behaviour, differentiating only between three types of
direct preventive efforts, i.e. three types of programmes: universal
programmes, selective programmes, and those indicated by the schoolbased primary prevention of risk behaviour.
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EU Standars vs. Czech Standards
Table 1: Proposed use of version 1 of the European drug prevention quality standards
(adapted Brotherhood, Sumnall,2011)
Recommended (EU
Purpose
Czech Standards
Standards)
Information, education and
✔
✔
guidance
Developing or updating quality
✔
✔
criteria
Self-reflection
✔
✔
Discussion in group settings
✔
✔
Performance appraisals
✔
✔
Not yet (Further work is
planned to make the
standards suitable for these
purposes)
✔
Formal self-assessment the
standards suitable for these
purposes
Funding decisions
External accreditation
Substitute for outcome evaluation
how to conduct evaluation
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No, although the standards
provide guidance on
✔
✔
=
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Aims of the Standards
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To establish the criteria for enhancement of quality of school-based
prevention programs focusing on risk behaviors, which are…
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…mandatory for all providers of school-based prevention programs
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Certification is a brand - mark of quality for those interested in the
programs, clients, the public and the authorities.
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Standards shall provide the institutions (state, local administration etc.)
providing funding instrument also applicable for the supervision of level
of professionalism.
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Should make the complex and continuous prevention activities in the
educational institutions availabilable.
Setting quality standards that enable providers with comparable and
repeatable independent quality assessments in prevention.
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Practical Use of the Standards
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The purpose of Certification of competence of the providers of schoolbased prevention is to assess and formally recognize program that
meets the criteria of quality and complexity.
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Standards provide a framework in the process of assessment of
prevention services.
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Certification Rules and Methodology on Local Investigation of the
Certification Process
Certifier’s Manual - On-Site Inspection Guidelines
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These two documents serve the practical purposes in implementation of
the Standards.
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Thank you for your attention

E-mail:
[email protected]
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Serbiastruktury
2013